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Importance of Coryneform Bacteria in Infective Endocarditis Infectious Disease Reports 2015; volume 7:6103 Importance of coryneform Toxigenic strains of different clonal groups have exhibited an aggregative-adhering pat- Correspondence: Alexander von Graevenitz, bacteria in infective endocarditis tern in HEp-2 cells.11 While strains of C. pseu- University of Zürich, Nidelbadstrasse 10, CH dodiphtheriticum affected males and those 8802 Kilchberg, Switzerland. Alexander von Graevenitz with prosthetic valves more frequently and Tel.: +41.44.715.3274. University of Zürich, Switzerland showed higher mortality than non-toxigenic E-mail: [email protected] strains of C. diphtheriae,12 strains of C. stria- tum causing endocarditis were frequently Key words: Infective endocarditis; coryneforms; Coryneform bacteria have been defined as corynebacterium; propionibacterium. non-sporing Gram-positive rods with an irregu- nosocomial and multiply antibiotic-resistant lar outline.1 Almost all can be grown aerobical- but the majority of patients survived under Conflict of interest: the author reports no conflict 8,13 ly and assigned to the class Actinobacteria appropriate treatment. of interest. which are characterized by a high guanine- P. acnes is probably underestimated as an cytosine content (>50%) and specific 16S agent of infective endocarditis. While the per- Received for publication: 7 July 2015. rDNA signature nucleotides.2 Some of the gen- centage of isolates from blood cultures that Accepted for publication: 21 July 2015. era in this class are environmental bacteria can be attributed to endocarditis is very small – most isolates are skin contaminants – This work is licensed under a Creative Commons but some (e.g., Actinomyces, Brevibacterium, Attribution NonCommercial 3.0 License (CC BY- Corynebacterium, Dermabacter, Propion - approximately 50 cases have been reported in 14 NC 3.0). ibacterium, and Rothia) belong to the human the literature. Males and patients with pros- microbiome and have also been reported as thetic valves were affected predominantly; and ©Copyright A. von Graevenitz., 2015 agents of human and animal disease. complications such as myocardial abscesses Licensee PAGEPress, Italy Coryneform genera and species have been and valvular insufficiency were frequent.15 In Infectious Disease Reports 2015; 7:6103 either confirmed or newly outlined since the spite of treatment with antibiotics that were doi:10.4081/idr.2015.6103 1990s when biochemical and molecular tests effective in vitro (penicillin alone or with an (PCR, 16S rDNA sequencing) were undertaken aminoglycoside) ci. 75% of the patients had to on a large scale.3 undergo surgery. Interestingly, only 62% 6. Shakoor S, Fasih N, Jabeen K, Jamil B. 15 Coryneform endocarditis is rare. In an inter- showed positive blood cultures; in the rest, Rothia dentocariosa endocarditis with national study on infective endocarditis the diagnosis was made by histopathology of mitral valve prolapse: case report and brief 16 coryneforms,4 although not specifically men- the excised valves. review. Infection 2011;39:177-9. tioned, probably figured among the 4 to 5% of It is to be hoped that species identification 7. van Scoy RE, Cohen SN, Geraci JE, causative microorganisms other than staphylo- and susceptibility testing of microorganisms Washington JA. Coryneform bacterial cocci, streptococci, enterococci, HACEK, fungi, in cases of coryneform endocarditis will lead to endocarditis. Mayo Clin Proc 1977;52:216- and those causing polymicrobial or culture- characterization of more species-specific fea- 9. negative infections. By now, species of tures. 8. Belmares J, Detterline S, Pak JB, Parada Actinomyces, Arcanobacterium, Arthrobacter, JP. Corynebacterium endocarditis species- Brevibacterium, Cellulosimicrobium, specific risk factors and outcomes. BMC Cellulomonas, Corynebacterium, Gardnerella, Infect Dis 2007;7:4. Propionibacterium, and Rothia have been References 9. Gubler J, Huber-Schneider C, Gruner E, reported as agents of infective endocarditis, Altwegg M. An outbreak of nontoxigenic albeit for most of them the number of cases 1. Rogosa M, Cummins CS, Lelliott RA, Corynebacterium diphtheriae infection: has been so small as to exclude an evaluation Keddie RM. Coryneform group of bacteria. single bacterial clone causing invasive of pertinent features of the disease and its In: Buchanan RE, Gibbons NE, eds. infection among Swiss drug users. Clin treatment. This is even true for the genera Bergey’s manual of determinative bacteri- Infect Dis 1998;27:1295-8. Actinomyces and Rothia,5,6 since reported ology. 8th ed. Baltimore: Williams & 10. Muttaiyah S, Best EB, Freeman JT, et al. cases of individual species are not numerous Wilkins; 1974. pp. 599-602. Corynebacterium diphtheriae endocardi- enough yet for a satisfactory analysis. At this 2. Stackebrandt E, Rainey FA, Ward-Rainey tis: a case series and review of the treat- time, the only exceptions are cases due to NL. Proposal for a new hierarchic classifi- ment approach. Int J Infect Dis Corynebacterium diphtheriae, C. pseudodiph- cation system, Actinobacteria classis nov. 2011;15:e584-8. theriticum, C. striatum, and Propionibacterium Int J System Bacteriol 1997;47:479-91. 11. Hirata Jr R, Pereira GA, Filarey AA, et al. acnes. Cases reported earlier as coryneform or 3. Funke G, Bernard KA. Coryneform Gram- Potential pathogenic role of aggregative- diphtheroid endocarditis cannot be included in positive rods. In: Versalovic J, ed. Manual adhering Corynebacterium diphtheriae of evaluations since they lack species diagnoses.7 of clinical microbiology. 10th ed. different clonal groups in endocarditis. A 2007 review article has listed risk factors Washington D.C.: American Society for Braz J Med Biol Res 2008;41:986-91. and outcomes of infective endocarditis due to Microbiology; 2011. pp. 413-442. 12. Morris A, Guild I. Endocarditis due to various species of the genus 4. Murdoch DR, Corey GR, Hoen B, et al. Corynebacterium Pseudodiphtheriticum: Corynebacterium.8 Aortic and mitral valves Clinical presentation, etiology and out- five case reports, review, and antibiotic were affected in most instances. Non-toxi- come of infective endocarditis in the 21st susceptibilities of nine strains. Rev Infect genic strains of C. diphtheriae have caused century: the international collaboration on Dis 1991;13:887-92. endocarditis in homeless and HIV-positive endocarditis-prospective cohort study. 13. Lee PP, Ferguson Jr DA, Sarubbi FA. individuals as well as in drug addicts who Arch Intern Med 2009;169:463-73. Corynebacterium striatum: an underap- transmitted the organisms through needle 5. Kottam A, Kaur R, Bhandare D, et al. preciated community and nosocomial sharing as proven by ribotyping.9 Treatment Actinomycotic endocarditis of the pathogen. J Infection 2005;50:338-43. with penicillin alone or in combination with an Eustachian valve: a rare case and review of 14. Park HJ, Na S, Park SY, et al. Clinical sig- aminoglycoside was mostly successful, in con- the literature. Tex Heart Inst J 2015;42:44- nificance of Propionibacterium acnes trast to cases due to toxigenic strains.8,10 9. recovered from blood cultures: analysis of [page 44] [Infectious Disease Reports 2015; 7:6103] Editorial 524 episodes. J Clin Microbiol Propionibacterium species. Clin Microbiol aggressive aortic valve endocarditis and 2011;49:1598-601. Infect 2009;15:386-94. importance of tissue grinding: case report 15. Sohail MR, Gray AL, Baddour LM, et al. 16. Günthard H, Hany A, Turina M, Wüst J. and revie w. J Clin Microbiol 1994;32:3043- Infective endocarditis due to Propionibacterium acnes as a cause of 5. [Infectious Disease Reports 2015; 7:6103] [page 45].
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