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Inquilinus Limosus and Cystic Fibrosis

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Inquilinus Limosus and Cystic Fibrosis LETTERS rural South African district hospitals: an (3,4), 1 case in the United States (1), 5 stage, which indicates an infection epidemiological modelling study. Lancet. cases in France (5), and 1 case in the by this bacterium. Thus, in our study, 2007;370:1500–7. 2. Brewer T. Extensively drug-resistant United Kingdom (6) (Table). Only 1 the incidence of I. limosus was 2.8% tuberculosis and public health. JAMA. isolate of Inquilinus sp. has been re- (4.9% for adults with CF and 1.2% 2007;298:1861. covered from blood samples of a pa- for children with CF). The incidence 3. Kim HR, Hwang SS, Kim HJ, Lee SM, tient without CF who had prosthetic of Burkholderia cepacia complex dur- Yoo CG, Kim YW, et al. Impact of ex- tensive drug resistance on treatment out- valve endocarditis (7). ing the same period and in the same comes in non-HIV-infected patients with Because this bacterium is not re- patients was 2.1% (3 adults with CF multidrug-resistant tuberculosis. Clin In- corded in all commercial identifi cation were positive, data not shown). fect Dis. 2007;45:1290–5. system databases currently available, The genus Inquilinus belongs 4. Demographic and Health Survey, Lesotho 2004. a longitudinal study for I. limosus to the α-Proteobacteria; the genus 5. World Health Organization. Tuberculosis detection with a new real-time PCR Azospirillum is the most closely re- profi le, 2007 [cited 2007 Feb 21]. Avail- assay with a Taqman probe (Applied lated bacteria (2). This cluster of bac- able from http://www.who.int/tb/en Biosystems, Foster City, CA, USA), teria contains several strains that are 6. National Tuberculosis and Leprosy Pro- gram. Kingdom of Lesotho annual report, that targets the 16S rRNA gene, has able to grow under saline conditions 2007. Maseru (Lesotho): The Program; been developed and compared with and in biofi lms (8,9). The mucoid phe- 2007 the culture isolation. Primers il1d (5′- notype of I. limosus may contribute to 7. Shah NS, Wright A, Bai GH, Barrera L, TAATACGAAGGGGGCAAGCGT- its colonization and resistance to many Boulahbal F, Martin-Casabona N, et al. Worldwide emergence of extensively 3′) and il1r (5′-CACCCTCTCTTGGA antimicrobial drugs. Recently, the ex- drug-resistant tuberculosis. Emerg Infect TT CAAGC-3′) and probe ilProbe opolysaccharides (EPS) produced by I. Dis. 2007;13:380–7. (6FAM-GGTTCGTTGCGTCAGAT limosus were studied. The authors in- 8. Gandhi NR, Moll A, Sturm AW, Pawinski GTGAAAG-TAMRA), which were dicated that I. limosus produces main- R, Govender T, Lalloo U, et al. Extensive- ly drug-resistant tuberculosis as a cause of used in this study, were designed on ly 2 EPSs that exhibit the same charge death in patients co-infected with tuber- the basis of multisequence alignment per sugar residue present in alginate, culosis and HIV in a rural area of South of all I. limosus 16S rDNA sequences the EPS produced by Pseudomonas Africa. Lancet. 2006;368:1575–80. available in the GenBank database. aeruginosa in patients with CF. This To confi rm specifi city, the prim- similarity may be related to common Address for correspondence: Jennifer Furin, ers and probe were checked by using features of the EPS produced by these Brigham and Women’s Hospital, Division of the BLAST program (www.ncbi.nlm. 2 opportunistic pathogens that are re- Social Medicine and Health Inequalities, 651 nih.gov/blast/Blast.cgi) and also by lated to lung infections (10). Trans- Huntington Ave, 7th Floor, Boston, MA 02115, using suspension of several bacteria mission of I. limosus between patients USA; email: [email protected] recovered habitually in patients with with CF is not known, but in the report CF. For sensitivity of the Taqman PCR from Chiron et al., 1 of the 5 patients assay (Applied Biosystems), the mini- with I. limosus had a brother who had mal CFU detectable was 2 CFU/PCR. never been colonized with this bacte- From January 2006 through June rium despite living in the same home 2007, 365 sputum samples recovered (5). Schmoldt et al. reported that 3 Inquilinus limosus from 84 children and 61 adults with patients were treated in the same out- and Cystic Fibrosis CF and 71 sputum samples recovered patient CF clinic during overlapping from 54 patients without CF were time periods and each patient was in- To the Editor: Inquilinus limo- screened blindly for I. limosus. By us- fected/colonized by an individual I. li- sus, a new multidrug-resistant species, ing our real-time PCR, we detected 9 mosus clone, which suggests that there was reported in 1999 as an unidenti- I. limosus-positive samples from 4 pa- was no transmission among these pa- fi ed gram-negative bacterium in a lung tients with CF (Table); 8 of these sam- tients (4). This bacterium has been re- transplant patient with cystic fi brosis ples were also culture positive. How- covered mainly from sputum of ado- (CF) (1). This species was later char- ever, all sputum samples from patients lescents (mean age 17 ± 6.47 years, acterized by the description of 7 new without CF were negative. In 1 patient range 8–35), except in our study with isolates of I. limosus and 1 isolate of (Table, case 17), I. limosus was detect- a 2-year-old boy, which suggests that Inquilinus sp. (2). Infections and colo- ed by using real-time PCR 3 months this emerging bacterium may be hos- nizations by I. limosus have been doc- before the culture was positive. Ret- pital acquired, as recently suggested umented mainly in adolescent or adult rospectively, the patient’s medical fi le (7). Because this bacterium is multire- patients with CF. To date, 8 clinical was rechecked and his clinical respira- sistant to several antimicrobial drugs, cases have been described in Germany tory condition worsened briefl y at that particularly colistin, which is widely Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 6, June 2008 993 LETTERS Table. Clinical and epidemiologic features of cystic fibrosis (CF) patients with Inquilinus limosus* Clinical Growth on Growth on Other Case Age, Lung Positive manifestation, MacConkey selective Phenotypic associated no. y/sex transplant samples first isolation agar agar (d) identification† pathogens Reference 1 22/F Yes Lung explant, Pneumonia Poor ND AR PA, PM (1) BAL, sputum 2 17/M No Sputum Stable No Yes (6 d) SP SA, PA, CA (3) 3 14/F No Sputum Stable No Yes (5 d) SP PA, AF, CA (3) 4 12/M No Sputum Stable ND Yes (ND) SP PA, SM, (5) SA, AX 5 13/F No Sputum Exacerbation ND Yes (ND) SP PA, SA, AF (5) 6 8/M No Sputum Stable ND Yes (ND) SP PA (5) 7 10/M No Sputum Stable ND Yes (ND) SP None (5) 8 18/M No Sputum Exacerbation ND Yes (ND) AR PA, SA, AF (5) 9 16/F No Sputum Severe ND ND PA PA (4) exacerbation 10 19/M No Sputum Stable ND ND ND PA (4) 11 17/F No Sputum Exacerbation ND ND ND PA, CA, AF (4) 12 20/F No Sputum Exacerbation ND ND ND PA, SA, CA, (4) AF 13 17/F No Sputum Stable ND ND ND PA, SA, (4) SM, CA, AF 14 35/M No Sputum Respiratory ND ND PA PA, SM, (4) decline SMA 15 17/F No Sputum Stable No Yes (4 d) SP CA This study 16 2/M No Sputum Productive No Yes (3 d) SP SA, HI This study cough 17 21/M No Sputum Exacerbation No Yes (3 d) AR PA, AF This study 18 15/M No Sputum Fever and No Yes (3 d) AR SA This study thoracic pain *BAL, bronchoalveolar lavage; ND, not determined; AR, Agrobacterium radiobacter; PA, Pseudomonas aeruginosa; PM, Proteus mirabilis; SP, Sphingomonas paucimobilis; SA, Staphylococcus aureus; CA, Candida albicans; AF, Aspergillus fumigatus; SM, Stenotrophomonas maltophilia; AX, Achromobacter xylosoxidans; SMA, Serratia marcescens; HI, Haemophilus influenzae. †Phenotypic identification was obtained by using the BIOLOG GN MicroPlate assay (BIOLOG Inc., Hayward, CA, USA) for case 1 and the API 20NE kit system (bioMérieux, Marcy l’Etoile, France) for cases 2–8 and 15–18. used for treatment for P. aeruginosa This work was partly funded by the References colonization (as was the case for our French Association Vaincre La Mucovis- cidose. 1. Pitulle C, Citron DM, Bochner B, Bar- 4 patients), we hypothesize that this bers R, Appleman MD. Novel bacterium bacterium is selected during the evo- Mr Bittar is a PhD student at isolated from a lung transplant patient lution of the disease. with cystic fi brosis. J Clin Microbiol. URMITE UMR, Faculty of Medicine, We have developed a real-time 1999;37:3851–5. Marseille. His research interest is detec- PCR molecular method that is faster 2. Coenye T, Goris J, Spilker T, Vandamme tion and description of new or emerging P, Lipuma JJ. Characterization of unusual and easier than amplifi cation-sequenc- pathogens in cystic fi brosis patients. bacteria isolated from respiratory secre- ing for prompt detection and accurate tions of cystic fi brosis patients and descrip- identifi cation of I. limosus with good tion of Inquilinus limosus gen. nov., sp. specifi city and sensitivity. By using this Fadi Bittar,* Anne Leydier,† nov. J Clin Microbiol. 2002;40:2062–9. Emmanuelle Bosdure,† 3. Wellinghausen N, Essig A, Sommerburg screening assay, we identifi ed 4 ad- O. Inquilinus limosus in patients with cys- ditional cases of patients with CF who Alexandre Toro,* tic fi brosis, Germany. Emerg Infect Dis. were also infected with this bacterium, Martine Reynaud-Gaubert,‡ 2005;11:457–9.
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