LETTERS

Acetobacter grew from both aerobic culture vials pha lineage (Figure). and yielded very small polymorphic Only the main genera (, cibinongensis colonies on Columbia sheep blood , ) Bacteremia and blood-chocolate agar plates (Bio- are discriminated by analytic meth- in Human Rad, Marnes-la-Coquette, France). ods, such as high-performance liquid Enhanced growth was observed on chromatography, which are not used To the Editor: The Aceto- Legionella agar (AES Chemunex, in routine microbiology (4). The tree bacter belongs to the group of acetic Bruz, France) and on R2A agar plates showed that 16S rDNA sequencing acid that oxidize alcohols or (BD-BBL, Le Pont de Claix, France). was effective for genus and species sugars incompletely, leading to the ac- Biotyping of this catalase-positive, identifi cation of bacteria cumulation of acetic acid. Acetic acid oxidase-negative rod with API 20NE (Figure). This method is also rapid and bacteria are of great industrial interest and API 20E strips (bioMérieux, convenient for use in a medical micro- because of their use to produce vin- Marcy l’Etiole, France) and with the biology laboratory. egar from spirits, wine, beer, and cider ID-GNB card system on a VITEK 2 Bacteria have been used in food in temperate regions of Europe, the apparatus (bioMérieux) did not iden- processing and have thus been ingest- Americas, and Japan. Several species tify the bacterium. Positive reactions ed, live or dead, throughout human seem to be associated with tropical cli- were obtained for acetoin production history. The safety of lactic and ace- mates. In Southeast Asia, Acetobacter and citrate assimilation. Antimicro- tic acid bacteria has been confi rmed spp. have been found in fermented bial drug–susceptibility pattern could over the years (5). However, in recent foods such as tea fungus beverage, not be validated owing to the lack of years, bacteria belonging to palm , palm wine, nata de interassay reproducibility. Pristina- the genera Lactobacillus, Leuconos- coco, and pickles (1). A. cibinongensis mycin was replaced by broad-spec- toc, Pediococcus, or Bifi dobacterium is mainly found in tropical fruits and trum antimicrobial therapy consisting have been isolated from a variety of fl owers (2). We describe a case of hu- of cefazolin (1 g every 48 hours) and clinical samples, generally from pa- man infection with a member of the tobramycin (225 mg after each hemo- tients with diabetes, cancer, or im- genus Acetobacter. dialysis session). After 3 courses of munosuppression (6). As lactic acid The patient was an HIV-serone- this regimen, treatment was changed bacteria are part of the normal human gative, 40-year-old man who for 1 to amoxicillin (2 g/day, plus 1 g after fl ora, their clinical relevance is often year had been receiving chronic he- each dialysis session) for 4 weeks. The diffi cult to establish. In contrast, acetic modialysis for end-stage renal failure. local infl ammation and fever subsided, acid bacteria have never been isolated He had a history of intravenous drug the C-reactive protein level returned to from human fl ora; recently, the patho- use, and continued use was suspected. normal, and the patient’s clinical sta- genicity of an unknown bacterium In February 2005, when admitted for a tus improved with no recurrence of that probably belonged to acetic acid routine dialysis session, he had fever infection. bacteria, Granulobacter bethesdensis, (38°C) and bronchitis and was receiv- A 1389-bp 16S rDNA sequence was found in a patient with lymphad- ing empiric treatment with amoxicil- was obtained for strain nîmes373, as enitis (7). lin (2 g/day). His respiratory status described (3). The sequence matched Our patient denied travel outside improved slightly, but fever persisted those of A. cibinongensis deposited in France and had no exotic dietary hab- after 48 hours. On his right forearm, the GenBank database (>99.6% iden- its. He was probably infected by direct he had a large infl ammatory skin le- tity). The 16S rDNA-based phylog- inoculation, possible during intrave- sion that followed the course of an eny confi rmed the affi liation of strain nous drug injection or after unnoticed arteriovenous fi stula, suggestive of nîmes373 to the species A. cibinon- injury when he worked in vineyards. staphylococcal infection. Treatment gensis in the family For hemodialysis patients, vascular was switched to pristinamycin (2 g/ (Figure). The growth of nîmes373 on access infections are a major cause of day for 4 days). The patient’s leuko- 0.7% calcium carbonate agar plates illness and death (8). Also for these cyte count was within normal limits, with 7% (pH 3.5) cleared calci- patients, unusual bacteria with low in- but his C-reactive protein level was um carbonate. This indicated tolerance herent pathogenicity are increasingly elevated (50 mg/L). Two blood sam- of the isolate to acidic conditions and reported as potential causes of bacte- ples were drawn, 1 through a subcla- ability to produce organic acids from remia (9). The decreased phagocytic vian catheter implanted in 2004 and alcohol, thereby proving its affi liation activity of neutrophils and monocytes the other through the arteriovenous to the group. associated with chronic renal failure fi stula. After 4 days, a gram-variable Currently, 6 genera of acetic acid may increase susceptibility to bacteria polymorphic rod, named nîmes373, bacteria are recognized in the Al- that would otherwise have low patho-

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4. Swings J. The genera Acetobacter and Gluconobacter. In: Balows A, Trüper HG, Dworkin M, Harder W, Schleifer KH, edi- tors. The prokaryotes, 2nd ed. New York: Springer-Verlag; 1992. p. 2268–86. 5. Pasteur L. Mémoire sur la fermentation acétique. Annales Scientifi ques de l’Ecole Normale Superieure Paris. 1864;1:113– 58. 6. Ishibashi N. Yamazaki S. Probiotics and safety. Am J Clin Nutr. 2001;73:465S– 70S. 7. Greenberg DE, Ding L, Zelazny AM, Stock F, Wong A, Anderson VL, et al. A novel bacterium associated with lymphad- enitis in a patient with chronic granuloma- tous disease. PloS Pathog. 2006;2:260–7. 8. Blankestijn PJ. Treatment and preven- tion of catheter-related infections in hae- modialysis. Nephrol Dial Transplant. 2001;16:1975–8. 9. Daxboeck F, Zitta S, Assadian O, Krause R, Wenisch C, Kovarik J. Ochrobactrum anthropi bloodstream infection compli- cating hemodialysis. Am J Kidney Dis. 2002;40:E17. 10. Muniz-Junqueira MI, Braga Lopes C, Magalhaes CA, Schleicher CC, Veiga JP. Acute and chronic infl uence of hemodi- alysis according to the membrane used on phagocytic function of neutrophils and monocytes and pro-infl ammatory cyto- Figure. 16S rDNA maximum-likelihood phylogenetic tree showing the relationships of the kines production in chronic renal failure isolate nîmes373 with 15 species of the genus Acetobacter and 6 strains representative patients. Life Sci. 2005;77:3141–55. of the 6 other genera of acetic acid bacteria in the Alpha Proteobacteria. Sequences of Alpha, Beta, and Gamma Proteobacteria of clinical relevance were also included in the Address for correspondence: Estelle Jumas- tree. Staphylococcus aureus (Firmicutes) 16S rDNA was used as an outgroup. The 16S Bilak, Université Montpellier 1, Laboratoire de rDNA sequences used to reconstruct this tree were obtained from the GenBank database, and their accession numbers are indicated in brackets. The tree was reconstructed using Bactériologie, EA 3755, Faculté de Pharmacie, DNAML from the PHYLIP package v. 3.6.6, on the basis of the F84 (+ gamma distribution + 15 avenue Charles Flahault, BP 14491, 34093 invariant sites) substitution model. The scale bar indicates 0.02 substitutions per nucleotide Montpellier CEDEX 5, France; email: ebilak@ position. Numbers given at the nodes represent bootstrap percentages calculated on 100 univ-montp1.fr replicates. genicity (10). This second known re- References port of human infection with acetic 1. Yamada Y, Hosono R, Lisdyanti P, Widyas- acid bacteria should alert clinicians tuti Y, Saono S, Uchimura T, et al. Identifi - to the risk for opportunistic infections cation of acetic acid bacteria isolated from with these bacteria, which are broadly Indonesian sources, especially of isolates classifi ed in the genus Gluconobacter. J used in food processing. Gen Appl Microbiol. 1999;45:23–8. Risk for Epidemics 2. Lisdiyanti P, Kawasaki H, Seki T, Yamada after Natural Anne Gouby,* Corinne Y, Uchimura T, Komagata K. Identifi ca- Teyssier,† Frédérique tion of Acetobacter strains isolated from Disasters Vecina,* Hélène Marchandin,‡ Indonesian sources, and proposals of Acetobacter syzygii sp. nov., Acetobacter Céline Granolleras,* Isabelle To the Editor: Myths that disas- cibinongensis sp. nov., and Acetobacter ter-affected populations are at high Zorgniotti,† and Estelle Jumas- orientalis sp. nov. J Gen Appl Microbiol. Bilak† 2001;47:119–31. risk for outbreaks and that dead bodies contribute to this risk are common (1). *Hôpital Carémeau, Nîmes, France; †Uni- 3. Teyssier C, Marchandin H, Jean-Pierre H, Diego I, Darbas H, Jeannot JL, et al. Conversely, some experts deny high, versité Montpellier 1, Montpellier, France; Molecular and phenotypic features for short-term risk after disasters (2). and ‡Hôpital Arnaud de Villeneuve, Mont- identifi cation of the opportunistic patho- We agree with Watson et al. (3) pellier, France gens Ochrobactrum spp. J Med Microbiol. 2005;54:945–53. that the risk for communicable diseases

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