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Possible Exiguobacterium Sibiricum Skin Infection in Human

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Possible Exiguobacterium Sibiricum Skin Infection in Human LETTERS characterization of peste des petits ru- Possible without organisms. Culture was per- minants virus, Sierra Leone. Emerg In- formed according to standard practice. fect Dis. 2012;18:193–5. http://dx.doi. Exiguobacterium org/10.3201/eid1801.111304 Colonies observed after 24 hours 4. Libeau G, Diallo A, Parida S. Evolution- sibiricum Skin of incubation on blood agar in pure ary genetics underlying the spread of peste Infection in Human culture were gray but turned orange des petits ruminants virus. Anim Front. after 48 hours. The colonies appeared 2014;4:14–20. http://dx.doi.org/10.2527/ af.2014-0003 To the Editor: The genus Exigu- mucoid and were nonhemolytic. Gram 5. Baron MD, Parida S, Oura CA. Peste des obacterium was first described in 1983 staining revealed wide, short, non– petits ruminants: a suitable candidate for by Collins et al., who characterized the spore-forming, gram-positive rods. eradication? Vet Rec. 2011;169:16–21. species E. aurantiacum (1). Since then, The isolate was motile, catalase posi- http://dx.doi.org/10.1136/vr.d3947 6. Banyard AC, Parida S, Batten C, Oura C, 9 new species have been added: E. tive, oxidase negative, and it fermented Kwiatek O, Libeau G. Global distribu- acetylicum, E. antarcticum, E. undae, glucose and lactose. Reactions for in- tion of peste des petits ruminants virus E. oxidotolerans, E. aestuarii, E. mari- dole, urea, and bile esculin were nega- and prospects for improved diagnosis and num, E. mexicanum, E. artemiae, and tive. The strain did not grow on Mc- control. J Gen Virol. 2010;91:2885–97. http://dx.doi.org/10.1099/vir.0.025841-0 E. sibiricum (2,3). The genus Exigu- Conkey agar and was facultatively 7. De Nardi M, Lamin Saleh SM, Batten C, obacterium belongs to the group of co- anaerobic. The strain was initially Oura C, Di Nardo A, Rossi D. First evi- ryneform bacteria, which encompasses identified asBacillus spp. and was sent dence of peste des petits ruminants (PPR) aerobically growing, non–spore-form- to the National Reference Laboratory virus circulation in Algeria (Sahrawi ter- ritories): outbreak investigation and virus ing, irregularly shaped, gram-positive of Majadahonda (Madrid, Spain) for lineage identification. Transbound Emerg rods (2). Exiguobacterium spp. have species identification. There, the iso- Dis. 2012;59:214–22. http://dx.doi. been isolated from a wide range of late was identified as E. sibiricum by org/10.1111/j.1865-1682.2011.01260.x habitats, including cold and hot envi- means of 16S rRNA sequence analy- 8. Kwiatek O, Ali YH, Saeed IK, Khala- falla AI, Mohamed OI, Obeida AA, ronments (3). Although strains of Ex- sis according to a previously reported et al. Asian lineage of peste des petits iguobacterium spp. have been isolated method (5). The fragment of 16S RNA ruminants virus, Africa. Emerg Infect from human clinical specimens (e.g., gene obtained from this isolate was Dis. 2011;17:1223–31. http://dx.doi. skin, wounds, and cerebrospinal fluid), 1,413 bp, and similarity with GenBank org/10.3201/eid1707.101216 9. Wang Z, Bao J, Wu X, Liu Y, Li L, the clinical significance of these bacte- sequences was 99.6% (GenBank ac- Liu C, et al. Peste des petits ruminants ria is poorly understood (4). We present cession nos. CP00122, GQ869573, virus in Tibet, China. Emerg Infect Dis. a case of cutaneous infection possibly and others). 2009;15:299–301. http://dx.doi.org/10.3201/ caused by E. sibiricum. After the organism was identi- eid1502.080817 10. ProMedMail. Peste des petits ruminants— In January 2014, a previously fied, we found that it was able to grow China (11): Sheep, goat, spread, OIE, healthy 66-year-old farmer was admit- on blood agar at 4°C after 6 days of request for information. ProMed 2014 ted to the Health Center of Molina de incubation. Antimicrobial drug sus- May 5. http://www.promedmail.org, ar- Aragón (Guadalajara, Spain) with a ceptibility testing was performed by chive no. 20140511.2465094. 7-day history of an ulcer on the dorsal using the Etest method (AB Biodisk, Address for correspondence: Ashley C. surface of the second finger on his right Solna, Sweden) on Mueller-Hinton Banyard, Wildlife Zoonoses and Vector Borne hand with a painful black eschar sur- agar plates incubated at 37°C for 24 Disease Research Group, APHA, Weybridge, rounded by edema, greenish exudate, hours. The isolate was susceptible to New Haw, Surrey KT15 3NB, UK; email: erythema, and a broken blister. The penicillin (MIC 0.023 mg/L), cefo- [email protected] lesion had progressively increased in taxime (0.5 mg/L), imipenem (0.047 size. The patient was a hunter who had mg/L), levofloxacin (0.19 mg/L), handled the skin of a deer and a wild vancomycin (0.5 mg/L), clindamycin boar 4 days before. He had no history of (0.125 mg/L), erythromycin (0.047 trauma or receipt of antimicrobial drugs. mg/L), gentamicin (0.094 mg/L), At admission, he was afebrile with no doxycycline (0.032 mg/L), linezolid systemic symptoms. Cutaneous anthrax (0.5 mg/L), and daptomycin (0.5 was suspected on the basis of the clini- mg/L). The patient’s clinical outcome cal appearance of the lesion and the pa- was good, and the lesion resolved af- tient’s contact with animals. An exudate ter 10 days of continuous ciprofloxa- sample was obtained for culture, and cin therapy. treatment with oral ciprofloxacin (500 This patient’s cutaneous infection mg/12 hour) was initiated. The Gram- and the morphologic appearance of the stained sample showed leukocytes lesion resembled cutaneous anthrax. 2178 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 20, No. 12, December 2014 LETTERS Initially, the Gram-stained appearance Table. Microbiological and clinical characteristics of Exiguobacterium sibiricum and and culture were compatible with those Bacillus anthracis* of Bacillus species other than B. an- Characteristic E. sibiricum B. anthracis thracis. In this sense, cutaneous infec- Colony on blood agar Mucoid and orange Gray-white to white tions caused by Bacillus species other Spore production – + (central) than B. anthracis have been reported Motility + – Hemolysis on blood agar – – and are clinically similar to cutaneous Penicillin susceptibility + + anthrax (6). Isolation of coryneform Catalase production + + bacteria from the ulcer may represent Indole production – – colonization rather than true infec- Growth at 4°C + – tion, and the absence of the organism Anaerobic growth + + on the initial Gram-stained slides may Cutaneous infection Ulcer, black eschar, blister Eschar, malignant pustule support contamination. However, the Other infections None reported Intestinal anthrax, pulmonary anthrax, meningitis evidence points to E. sibiricum as *+, present; –, absent. a pathogen and not a contaminant because it was the only organism Daniel Tena, ribosomal DNA sequence analysis of a isolated, and Gram staining of the Nora Mariela Martínez, large collection of environmental and exudate revealed leukocytes. In ad- clinical identified bacterial isolates. J Josefa Casanova, dition, the patient had not previous- Clin Microbiol. 2000;38:3623–30. Juan Luis García, Elena Román, 6. Tena D, Martínez-Torres JA, Pérez- ly received any antimicrobial drug María José Medina, Pomata MT, Sáez-Nieto JA, Rubio V, that could change the result of the cul- and Juan Antonio Sáez-Nieto Bisquert J. Cutaneous infection due ture. Moreover, the isolate was sus- to Bacillus pumilus: report of 3 cases. Author affiliations: Hospital Universitario ceptible to ciprofloxacin, and clinical Clin Infect Dis. 2007;44:e40–2. http:// de Guadalajara, Guadalajara, Spain (D. dx.doi.org/10.1086/511077 response to this drug was good. How- Tena, N.M. Martínez); Centro de Salud de 7. Kenny F, Xu J, Millar BC, McClurg RB, ever, we cannot absolutely rule out Moore JE. Potential misidentification of Molina de Aragón, Guadalajara (J. Casa- another organism as the cause of the a new Exiguobacterium sp. as Oerskovia nova, J.L. García); Servicios Periféricos de infection or co-infection with some xanthineolytica isolated from blood cul- Salud y Bienestar Social, Guadalajara (E. ture. Br J Biomed Sci. 2006;63:86. uncultured bacterium. Román); and Centro Nacional de Microbi- 8. Murayama M, Kakinuma Y, Maeda Y, Identification of Exiguobac- Rao JR, Matsuda M, Xu J, et al. Mo- ología, Madrid, Spain (M.J. Medina, J.A. terium spp. based on conventional lecular identification of airborne bac- Sáez-Nieto) methods is difficult and should be teria associated with aerial spraying of bovine slurry waste employing 16S DOI: http://dx.doi.org/10.3201/eid2012.140493 confirmed with molecular assays. rRNA gene PCR and gene sequenc- Bacteria in this genus can be mis- ing techniques. Ecotoxicol Environ identified as Oerskovia xanthineo- References Saf. 2010;73:443–7. http://dx.doi. lytica when the API Coryne kit (bio- org/10.1016/j.ecoenv.2009.10.003 9. Rodrigues DF, Ivanova N, He Z, Mérieux, Marcy l’Étoile, France) is 1. Collins MD, Lund BM, Farrow JAE, Schleifer KH. Chemotaxonomic study of Huebner M, Zhou J, Tiedje JM. Archi- used (7); 16S rRNA gene sequencing an alkalophilic bacterium, Exiguobacte- tecture of thermal adaptation in an Ex- seems to be useful for identification rium aurantiacum gen. nov. J Gen Micro- iguobacterium sibiricum strain isolated of E. sibiricum (8). Consequently, the biol. 1983;129:2037–42. from 3 million year old permafrost: a ge- nome and transcriptome approach. BMC frequency of this infection can be un- 2. Farrow JAE, Wallbanks S, Collins MD. Phylogenetic interrelationships of round– Genomics. 2008;9:547–64. http://dx.doi. derdiagnosed. In patients with lesions spore-forming bacilli containing cell walls org/10.1186/1471-2164-9-547 suspected of being cutaneous anthrax, based on lysine and the non–spore-forming 10.
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