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Sphingomonas Mucosissima Bacteremia in Patient with Sickle

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Sphingomonas Mucosissima Bacteremia in Patient with Sickle LETTERS Sphingomonas old woman with homozygous sickle 98% similarity with the 16S rDNA se- cell anemia was hospitalized when quence of S. mucosissima (GenBank mucosissima her condition suddenly became worse. accession no. AM229669). A phylo- Bacteremia in The patient had undergone a splenec- genetic neighbor-joining tree resulting Patient with Sickle tomy in 1992 and a cholecystectomy in from comparison of sequences of the February 2007. Four days after admis- 16S rDNA genes of Sphingomonas Cell Disease sion, she had a fever of 38.7°C. Two spp. was made with the MEGA 3.1 To the Editor: The genus Sphin- aerobic blood specimens, drawn on the software (www.megasoftware.net). gomonas was proposed by Yabuuchi fi fth day of her hospitalization, yielded This analysis confi rmed that the iso- et al. in 1990 (1) and amended by gram-negative bacilli after a 24-hour late belonged to S. mucosissima. Takeuchi et al. in 1993 (2). It now incubation. The gram-negative ba- Initial treatment of intravenous has been subdivided into 4 sepa- cilli were positive for catalase and administration of ceftriaxone was rate genera: Sphingomonas sensu oxidase but remained unidentifi ed by begun. The fever resolved after 1 stricto, Sphingobium, Novosphingo- API 20NE strip (bioMérieux, Marcy day and the patient’s condition im- bium, and Sphingopyxis. The bacteria l’Etoile, France). MICs of antimicro- proved. Treatment was stopped af- of the genus Sphingomonas are yel- bial drugs were determined for the ter 5 days, and the patient remained low-pigmented, nonfermenting, gram- gram-negative bacilli by using an Etest apyretic. Two S. mucosissima iso- negative bacilli with a single polar assay (AB BIODISK, Solna, Sweden) lates were recovered from 2 differ- fl agellum; they are widely distributed on Mueller-Hinton medium. MICs ent blood-culture samples drawn 24 in the natural environment, especially were 1 μg/mL for cefotaxime, 1 μg/mL hours apart, which suggests that S. in water and soil (3). These bacteria for amoxicillin–clavulanic acid, 2–3 mucosissima was not just a transient are characterized by the presence of μg/mL for vancomycin, 0.064 μg/mL organism but indeed was responsible a unique sphingoglycolipid with the for imipenem, 4–5 μg/mL for ceftazi- for the patient’s septicemia. Pheno- long-chain base—dihydrosphingosin, dime, 1 μg/mL for amikacin, 3 μg/mL typic identifi cation of the gram-neg- ubiquinone 10 (Q-10), and 2-hydrox- for ciprofl oxacin, and 0.047 μg/mL for ative bacilli failed because the defi - ymyristic acid (2-OH C14:0)—and trimethoprim-sulfamethoxazole. nite bacterial species S. mucosissima the absence of 3-hydroxy fatty ac- DNA was extracted from 1 was not included in the API database ids (4). S. mucosissima was isolated colony by using a QIAamp Tissue (http://industry.biomerieux-usa.com/ and identifi ed in 2007 by Reddy and kit (QIAGEN, Hilden, Germany) industry/food/api/apiweb.htm) used Garcia-Pichel from biologic soil crust as described by the manufacturer. A for the phenotypic identifi cation. samples collected from sandy arid 16S rDNA sequence was obtained However, the isolates’ biochemical soil in the US Colorado Plateau (5). (1,410 bp) by using the fD1 (5′- characteristics were consistent with Sphingomonas spp. are opportunis- AGAGTTTGATCCTGGCTCAG-3′) those previously reported for S. mu- tic pathogens and have recently been and rP2 (5′-ACGGCTACCTTGTTAC cosissima (5) (Table). Final identi- implicated in a variety of community- GACTT-3′) primer pair (7,8). Using fi cation was achieved by comparing acquired and nosocomial infections, BLAST version 2.2.9 software (www. the almost complete 16S rDNA se- considered to originate from contami- ncbi.nlm.nig.gov/BLAST), we de- quence with homologous sequences nated hospital equipment or manipu- termined that this sequence showed deposited in GenBank. lation of some medical devices (3). Table. Biochemical characteristics of the previously reported Sphingomonas The survival of Sphingomonas spp. in mucosissima isolate (AM229669) and the isolate from this study indoor dust particles as aerosols and Characteristic S. mucosissima Isolate from this study their resistance to many disinfecting Biochemical characteristics and toxic chemicals may explain their Oxidase + + ability to colonize medical devices Catalase + + such as mechanical ventilators, cath- Phosphatase + + ȕ-galactosidase –– eters, and bronchofi beroscopes (6). In Gelatinase – – the past few years, these organisms, in Nitrate reduction – – particular S. paucimobilis, have been Assimilation of carbon compounds implicated in a variety of community- Alanine + + acquired and nosocomial infections. Glucose + + We report a case of S. mucosissima Glutamic acid – – bacteremia in a patient with sickle cell Mannitol – – disease. In February 2008, a 17-year- Sucrose + + Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 15, No. 1, January 2009 133 LETTERS We believe that the patient’s in- 5. Reddy GS, Garcia-Pichel F. Sphingomo- found in specimens from the respira- travenous catheter was the source of nas mucosissima sp. nov. and Sphingomo- tory tract only (1). nas desiccabilis sp. nov., from biological the infection because she did not have soil crusts in the Colorado Plateau, USA. Previous studies of other PyVs, wound infections, and cultures of her Int J Syst Evol Microbiol. 2007;57:1028– including BK virus, JC virus, and the urine were negative for infectious 34. DOI: 10.1099/ijs.0.64331-0 newly identifi ed KIPyV, demonstrat- agents. Antimicrobial drug treatment, 6. Lemaitre D, Elaichouni A, Hundhaus- ed their presence in fecal specimens en M, Claeys G, Vanhaesebrouck P, selected on the basis of an in vitro S. Vaneechoutte M, et al. Tracheal coloni- (2,3), which suggests their potential mucosissima susceptibility profi le, fa- zation with Sphingomonas paucimobilis for transmission through the gas- cilitated the patient’s recovery. This in mechanically ventilated neonates due trointestinal (GI) tract (2). Because case report illustrates that the patho- to contaminated ventilator temperature some children (6.8%–27.7%) who probes. J Hosp Infect. 1996;32:199–206. genic potential of S. mucosissima DOI: 10.1016/S0195-6701(96)90146-2 had WUPyV results in previous stud- should be considered in diagnosis in 7. Woo PC, Ng KH, Lau SK, Yip KT, Fung ies (1,4,5) displayed respiratory and such cases because the organism can AM, Leung KW, et al. Usefulness of the GI clinical signs, we speculated that cause bacteremia in patients, primarily MicroSeq 500 16S ribosomal DNA-based WUPyV might also be transmitted bacterial identifi cation system for iden- in those with underlying debilitating tifi cation of clinically signifi cant bacte- through the GI tract. conditions and those who have under- rial isolates with ambiguous biochemical In this study, we tested for the pres- gone medical interventions. profi les. J Clin Microbiol. 2003;41:1996– ence of WUPyV in children with acute 2001. DOI: 10.1128/JCM.41.5.1996- gastroenteritis. A total of 377 fecal Emmanouil Angelakis, 2001.2003 8. Kumar PS, Griffen AL, Moeschberger specimens were collected from children Véronique Roux, ML, Leys EJ. Identifi cation of candidate with acute nonbacterial gastroenteritis and Didier Raoult periodontal pathogens and benefi cial spe- at the Outpatient Clinic Department of Author affi liation: Faculté de Médecine et cies by quantitative 16S clonal analysis. J the Beijing Children’s Hospital from Clin Microbiol. 2005;43:3944–55. DOI: de Pharmacie–Université de la Méditer- 10.1128/JCM.43.8.3944-3955.2005 March 2006 through November 2007. ranée, Marseille, France Patients with nonbacterial gastroen- DOI: 10.3201/eid1501.080465 Address for correspondence: Didier Raoult, teritis were defi ned as 1) those who Unité des Rickettsies, CNRS UMR 6020, had acute, watery, but not bloody, di- arrhea, accompanied by other clinical References IFR 48, Faculté de Médecine, Université de la Méditerranée, 27 Blvd Jean Moulin, 13385 signs and symptoms such as fever, ab- 1. Yabuuchi E, Yano I, Oyaizu H, Hashimoto Marseille CEDEX 05, France; email: didier. dominal cramps, nausea, vomiting, and Y, Ezaki T, Yamamoto H. Proposals of [email protected] headache; and 2) those who had nega- Sphingomonas paucimobilis gen. nov. and tive test results for any known bacteria comb. nov., Sphingomonas parapauci- that might cause gastroenteritis, such as mobilis sp. nov., Sphingomonas yanoi- kuyae sp. nov., Sphingomonas adhaesiva Salmonella spp., Shigella spp., Staphy- sp. nov., Sphingomonas capsulata comb. lococcus spp., Campylobacter jejuni, nov., and two genospecies of the genus Clostridium spp., Escherichia coli, and Sphingomonas. Microbiol Immunol. Yersinia spp. 1990;34:99–119. 2. Takeuchi M, Kawai F, Shimada Y, Yokota WU Polyomavirus in All patients, whose ages ranged A. Taxonomic study of polyethylene Fecal Specimens of from 1 month to 13 years (mean age glycol–utilizing bacteria: emended de- 11.7 months, median age 9 months), did scription of the genus Sphingomonas Children with Acute not exhibit apparent clinical respirato- and new descriptions of Sphingomonas macrogoltabidus sp. nov., Sphingomonas Gastroenteritis, ry signs. Fecal specimens from patients sanguis sp. nov. and Sphingomonas terrae China were diluted in phosphate-buffered sa- sp. nov. Syst Appl Microbiol. 1993;16: line (pH 7.2) by using a 10% wt/vol 227–38. To the Editor: WU polyomavi- ratio and were cleared of cell debris by 3. Ammendolia MG, Bertuccini L, Minelli F, Meschini S, Baldassarri L. A Sphingomo- rus (WUPyV) is a recently described centrifugation (2,500 × g, 5 min). Virus nas bacterium interacting with epithelial PyV found in patients with acute re- nucleic acids were extracted by using cells. Res Microbiol. 2004;155:636–46. spiratory tract infections (1). The role the NucliSens miniMAG and isolation DOI: 10.1016/j.resmic.2004.05.009 of the virus in disease pathogenesis reagents according to the manufactur- 4. Kawahara K, Matsuura M, Danbara H. Chemical structure and biological activ- remains unclear. The ability to detect er’s instructions (bioMérieux, Marcy ity of lipooligosaccharide isolated from it in clinical specimens would help l’Etoile, France).
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