International Journal of Infectious Diseases (2010) 14, e75—e76 http://intl.elsevierhealth.com/journals/ijid CASE REPORT A rubber-degrading organism growing from a human body Mohit Gupta *, Deepali Prasad, Harshit S. Khara, David Alcid Department of Internal Medicine, Drexel University College of Medicine — Saint Peter’s University Hospital, 254 Easton Avenue, New Brunswick, NJ 08901, USA Received 24 October 2008; received in revised form 27 February 2009; accepted 3 March 2009 Corresponding Editor: Timothy Barkham, Tan Tock Seng, Singapore KEYWORDS Summary Patients with hematological malignancies are susceptible to unusual infections, Gordonia because of the use of broad-spectrum anti-infective agents, invasive procedures, and other polyisoprenivorans; immunocompromising procedures and medications. Gordonia polyisoprenivorans, a ubiquitous Pneumonia; environmental aerobic actinomycete belonging to the family of Gordoniaceae in the order Rubber-degrading Actinomycetales, is a very rare cause of bacteremia in these patients. We report the first case organism; of pneumonia with associated bacteremia due to this organism, which was initially described in Bacteremia; 1999 as a rubber-degrading bacterium following isolation from stagnant water inside a deterio- Leukemia rated automobile tire. We believe that hematologically immunocompromised patients on broad- spectrum antibiotics and with long-term central catheters select the possibility of infection with G. polyisoprenivorans. These infections can be prevented by handling catheters under aseptic conditions. We propose that blood cultures of persistently febrile neutropenic patients should be incubated for at least 4 weeks. Being a rare infection, there are no data available on treatment other than early removal of the foreign bodies. # 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. Introduction Case Patients with hematological malignancies are susceptible to A 17-year-old woman with undifferentiated myeloblastic unusual infections, because of the use of broad-spectrum leukemia (AML M1 type) was 5 weeks post-cytarabine and anti-infective agents, invasive procedures, and other immu- mitoxantrone intensification therapy. She presented to the nocompromising procedures and medications. Gordonia hospital with 4 days of fever, rhinorrhea, and productive polyisoprenivorans is a very rare cause of bacteremia in cough. She was already under treatment with azithromycin these patients. We report the first case of pneumonia with and ciprofloxacin for a presumed Rhodococcus equi bacter- associated bacteremia due to G. polyisoprenivorans. emia diagnosed 3 weeks earlier. At this time, her Broviac catheter was replaced and a new Broviac was inserted. On * Corresponding author. Tel.: +1 732 668 3793. examination, no source of infection was found. Laboratory 9 E-mail address: [email protected] (M. Gupta). work-up was significant for a white cell count of 0.3 Â 10 /l. 1201-9712/$36.00 # 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ijid.2009.03.006 e76 M. Gupta et al. Her chest X-ray showed right lower lobe consolidation in the tion of rubber, a component of intravascular devices, also lung; this was radiologically confirmed on computed tomo- contributes to its pathogenesis.1 graphy (CT) scan, which also revealed multiple scattered An extensive literature review only identified two case subsegmental nodules. This confirmed a lobar pneumonia reports of bacteremia and no cases of pneumonia due to this probably due to bacteria or atypical organisms. She was unusual organism. This organism was first described in a 24- started on vancomycin and ceftazidime in addition to her year-old bone marrow recipient who became febrile after ciprofloxacin and azithromycin. Ambisome was also added manipulation of her Hickman catheter, with G. polyisopre- for Aspergillus coverage. In hospital, the patient continued nivorans grown in a single blood culture.3 In 2006, Verma to be symptomatic and thus a bronchoscopy was done and et al. described a 78-year-old male with a past medical caspofungin was started for additional fungal coverage. history of Osler—Weber— Rendu and myelodysplastic syn- However, the bronchial washings remained negative for drome with pancytopenia, who developed endocarditis due bacteria, fungus, acid-fast bacilli, Legionella, virus, and to this organism secondary to long-term catheter use.1 This is malignant cells. An echocardiogram was done, which ruled similar to our patient, who, although she did not have a out any intracardiac vegetations. Since the patient contin- relapse of leukemia, was neutropenic and had a central ued to be symptomatic, a bone marrow aspirate and biopsy venous catheter. We believe that hematologically immuno- was done to rule out recurrence of leukemia and showed only compromised patients on broad-spectrum antibiotics and hypocellular marrow. The cultures belonging to this immu- with long-term central catheters select the possibility of nocompromised host were preserved for 4 weeks as per our infection with G. polyisoprenivorans. institution’s policy. They continued to be negative until 4 To the best of our knowledge and from our literature weeks after admission when 2/2 blood cultures grew a Gram- search, this is the first case of pneumonia with associated positive non-acid-fast organism identified by the Centers for bacteremia due to this organism. These infections can be Disease Control and Prevention (CDC) to be G. polyisopre- prevented by handling catheters under aseptic conditions. nivorans. The CDC identified it to be a Gram-positive pleo- We propose that blood cultures of persistently febrile morphic actinomycete, which was non-acid-fast, oxidase- neutropenic patients should be incubated for at least 4 negative, catalase-positive, and turned greenish brown on weeks. Being a rare infection, there are no data available rabbit blood agar. This was confirmed to be G. polyisopre- on treatment other than early removal of the foreign nivorans on the basis of sequencing of the 16S rRNA gene. bodies. However, the CDC could not provide any susceptibility Conflict of interest: No conflict of interest to declare. results. References Discussion 1. Verma P, Brown JM, Nunez VH, Morey RE, Steigerwalt AG, Pelle- Gordonia polyisoprenivorans is a ubiquitous environmental grini GJ, et al. Native valve endocarditis due to Gordonia poly- aerobic actinomycete belonging to the family of Gordonia- isoprenivorans: case report and review of literature of blood ceae in the order Actinomycetales. All of the 21 identified stream infections caused by Gordonia species. J Clin Microbiol 2006;44:1905—8. species are Gram-positive, catalase-positive, weakly acid- 1 2. Linos A, Steinbuchel A, Sproer C, Kroppenstedt RM. Gordonia fast, thin beaded coccobacilli. G. polyisoprenivorans was polyisoprenivorans sp. nov., a rubber-degrading actinomycete first described in 1999 as a rubber-degrading bacterium isolated from an automobile tyre.. Int J Syst Bacteriol following isolation from stagnant water inside a deteriorated 1999;49:1785—91. 2 automobile tire. It is able to form biofilms due to the 3. Kempf VA, Schmalzing M, Yassin AF, Schaal KP, Baumeister D, presence of mycolic acids and biosurfactants. Biofilms enable Arensko¨tter M, et al. Gordonia polyisoprenivorans septicemia this organism to evade host defenses and cause persistent in a bone marrow transplant patient. Eur J Clin Microbiol Infect infections despite the use of prolonged antibiotics. Degrada- Dis 2004;23:226—8..