Tuberculosis y una Gemella spp: Una combinación indeseable / Tuberculosis and a Gemella spp: An undesirable combination

El género Gemella spp corresponde a cocos gram positivos, anaerobios facultativos, catalasa negativos, no móviles y no formadores de esporas, usualmente comensales de la cavidad oral, que no suelen ser patógenos en pacientes inmunocompetentes. Sin embargo, puede comportarse como germen oportunista en pacientes inmunosuprimidos o con otros factores de riesgo como mala higiene dental, cirugía gastrointestinal, enfermedades metabólicas entre otras, y se asocia con endocarditis, meningitis y en menor medida compromiso pulmonar. La información respecto a la susceptibilidad antimicrobiana es limitada y se asemeja a la de S viridans, por lo que la penicilina y ampicilina son los medicamentos de elección, sin tener claridad en cuanto a duración del tratamiento, usualmente considerando llevar a 4 semanas o hasta el drenaje de la colección. Éste reporte de caso describe una paciente con tuberculosis en tratamiento, que desarrolla una infección invasiva con documentación de empiema y bacteriemia secundaria por Gemella morbillorum, representando la asociación poco común de ésta infección bacteriana con tuberculosis.

Gemella spp. corresponds to gram positive cocci, facultative anaerobes, negative catalase, non mobile and non spore producers, part of colonizing flora of the oral cavity that are not common pathogens in immunocompetent patients. Nevertheless it may behave as an opportunistic germ in immunosuppressed patients or with other risk factors that include bad dental hygiene, bowel surgery, and metabolic diseases among others. It's associated with infections such as endocarditis, meningitis and less frecuently can implicate the lung. The information regarding antimicrobial susceptibility is limited and resembles S viridans, so penicillin and ampicillin are the medications of choice, without being clear about the duration of treatment, usually giving 4 weeks or until collection drain. This case report describes a patient with known tuberculosis diagnosis and under treatment, that develops an invasive infection with empyema and secondary bloodstream infection by Gemella morbillorum, depicting a previously uncommon but described association of this bacterial infection with tuberculosis.

Pyogenic liver abscess caused by Gemella morbillorum / Absceso hepático piógeno causado por Gemella morbillorum

Even though Gemella morbillorum infection (GMI) is rare in humans, it may, nevertheless, cause endocarditis, meningitis, brain abscess, pleural empyema, nephritis, mediastinitis, and - occasionally - liver abscess. We are describing the case of a 64-year-old Caucasian male admitted with fever and abdominal pain. Laboratory parameters revealed inflammation signs, and instrumental examinations showed the presence of diverticula in the ascending colon. Abdominal ultrasound (US) and computer tomography (CT) showed two focal lesions in the right liver lobe. One had the characteristics of a simple cyst; the second was hypoechoic with a low density area, possibly containing necrotic material. US-guided needle biopsy was found negative for neoplastic cells, showing purulent infiltrate. Pus culture was found positive for GMI. Systemic antibiotic therapy, coupled with repeated US-guided needle aspiration, induced the resolution of the hepatic abscess. Few cases have been reported of hepatic abscess caused by GMI in immunocompetent non-cirrhotic subjects.

A pesar de que la infección por Gemella morbillorum (GMI, por el término en inglés) es poco común en seres humanos, puede causar endocarditis, meningitis, absceso cerebral, empiema pleural, nefritis, mediastinitis y en ocasiones, absceso hepático. Describimos el caso de un hombre caucásico de 64 años que ingresó con fiebre y dolor abdominal. Los parámetros de laboratorio revelaron signos de inflamación y los exámenes mostraron la presencia de divertículos en el colon ascendente. La ecografía abdominal (US) y la tomografía computarizada (CT) mostró dos lesiones focales en el lóbulo hepático derecho. Una presentó las características de un quiste simple; la segunda fue hipoecóica con una zona de baja densidad, que posiblemente contenía material necrótico. Biopsia con aguja guiada por US dio un resultado negativo para células neoplásicas, mostrando infiltrado purulento. Cultivo de pus fue encontrado positivo para GMI. Una terapia con antibióticos sistémicos, junto con aspiración repetida con aguja guiada por US indujo a la resolución del absceso hepático. Pocos casos se han reportado de absceso hepático causado por GMI en sujetos inmunocompetentes no cirróticos.

Empiemas pleurales por Gemella spp: una etiología no tan infrecuente / Pleural empyema due to Gemella spp: Report of 12 cases

Background: Gemella genus bacteria can produce localized or generalized severe infections, but very rarely they have been described as causingpulmonary infections or pleural empyemas. Aim: To characterize patients with empyema caused by Gemella genus bacteria. Material and Methods: The database of a Microbiology laboratory of a Spanish hospital was reviewed, searchingfor Gemella positive cultures ofpleural effusions in a period offive years. Results: We identified 12 patients (11 males) with Gemella spp pleural empyema. Eight were infected with G. haemolysans and four with G. morbillorum. All patients had predisposingfactors such as poor oral hygiene, smoking, chronic cardiovascular or respiratory disease, alcoholism or malignancies. In ten cases, a thoracic drainage tube was placed with fibrinolysis in seven. One patient needed surgery because of a relapse of the empyema. Two patients died because of an advanced neoplasm, and the empyema was resolved in the rest. Conclusions: Gemella pleural empyema can occur and its isolation must not be seen as a contamination.

Liver Abscess due to Gemella morbillorum in a Healthy Woman / 감염과화학요법

Gemella morbillorum is a normal flora of the oral cavity, upper respiratory tract, gastrointestinal tract, or genitourinary system. Human infection cause by G. morbillorum is very rare. Known predisposing conditions are intravenous drug abuse, alcoholism, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, renal disease and poor oral hygiene. Most reported cases are infective endocarditis and vasculitis. We experienced a case of liver abscess by G. morbillorum in a healthy young woman, who was treated successfully with antibiotics and drainage. We report this case along with a literature review.

Acute postoperative endophthalmitis by Gemella haemolysans.

Endophthalmitis is a rare and serious post-surgical complication. We report a case of acute postoperative endophthalmitis after an uneventful cataract surgery caused by a commensal organism, Gemella haemolysans. The patient was successfully treated with vitrectomy and intravitreal antibiotics like vancomycin, along with topical cefazolin.

An Unusual Case of Tubo-ovarian Abscess by Gemella morbillorum / 감염과화학요법

Gemellae is a gram positive cocci that forms part of the oropharyngeal microflora in humans and is anaerobic to aerotolerant. Unlike the other members of the same genus, G. morbillorum rarely causes human infections. Recently, we experienced a case of tubo-ovarian abscess caused by G. morbillorum which was initially suspected to be actinomycosis associated with intrauterine device. This is the first case in the world on tubo-ovarian abscess with G. morbillorum as the culprit.

An Unusual Case of Tubo-ovarian Abscess by Gemella morbillorum / 감염과화학요법

Gemellae is a gram positive cocci that forms part of the oropharyngeal microflora in humans and is anaerobic to aerotolerant. Unlike the other members of the same genus, G. morbillorum rarely causes human infections. Recently, we experienced a case of tubo-ovarian abscess caused by G. morbillorum which was initially suspected to be actinomycosis associated with intrauterine device. This is the first case in the world on tubo-ovarian abscess with G. morbillorum as the culprit.

Cerebellar abscess by Gemella morbillorum in a patient with inter-atrial communication

Gemella morbillorum, a commensal of the oropharynx, upper respiratory, urogenital and gastrointestinal tract is rarely associated with infections in humans. However, an increasing number of infectious processes in different locations have been reported. Cerebral abscesses caused by these bacteria are extremely uncommon with only four cases previously described in the literature. We present the case of a cerebellar abscess by Gemella morbillorum in a 50 years-old man with inter-atrial communication dealt by surgical excision and antimicrobial therapy.

Gemella morbillorum, uma bactéria comensal da orofaringe, vias aéreas superiores e aparelhos urogenital e gastrointestinal, raramente causa infecções em humanos. No entanto, um crescente número de processos infeciosos em diferentes localizações tem sido referido. Abcessos cerebrais provocados por esta bactéria são extremamente raros, encontrando-se apenas quatro casos previamente descritos na literatura. Apresentamos o caso de um abscesso cerebelar por Gemella morbillorum em um homem de 50 anos com comunicação inter-atrial, tratado por excisão cirúrgica e terapêutica antimicrobiana.

Identification of Gemella species by 16S ribosomal RNA gene sequencing from two patients with infective endocarditis / 대한내과학회지

Gemella species are opportunistic pathogens, which cause endocarditis, meningitis, musculoskeletal infections, or pulmonary infections. It is difficult to identify all strains of these species by a conventional culture system. Because 16S rRNA gene has the interspecific polymorphisms to differentiate the bacterial species, 16S rRNA gene sequence analysis could be used to identify these pathogens. To determine the molecular types of two unidentified Gram-positive cocci from two patients with infective endocarditis, PCR amplification and DNA sequencing of the 16S rRNA gene were performed. These sequences of the PCR product were compared with known 16S rRNA gene sequences using GenBank BLAST search. The 16S rRNA gene sequences of two isolates showed > 99% nucleotide similarities with those of Gemella morbillorum (GenBank accession number L14327). Phylogenetic analysis also indicated the close relatedness between these isolates and G. morbillorum.

A case of primary pulmonary botryomycosis by Gemella morbilium / 대한내과학회지

Botryomycosis is a chronic supprative disease with characteristic granules formation in the pus caused by bacteria and frequently is mistaken for a fungal infection. Pulmonary botryomycosis can resemble actinomycosis, tuberculosis, or invasive carcinoma by causing a mass lesion with constitutional symptoms. We report a case of pulmonary botryomycosis in a 43 years old man. He had a cavitary lesion of the right upper lobe and diagnosis was confirmed by percutaneous needle aspiration. The specimen demonstrated multiple clusters of bacteria within abscess that best were visualized by gram staining. Cultures of the biopsy materials yielded pure growth of Gemella morbilium. The patient recovered quickly after antibiotics treatment for 3 weeks.

Liver Abscess Caused by Gemella morbillorum / 대한소화기학회지

Gemella morbillorum, an anaerobic-to-aerotolerant Gram-positive coccus, is a normal flora of the oral cavity, respiratory tract, urogenital organ and gastrointestinal tract, and infections caused by this organism are unusual. It has been associated mainly with endocarditis and bacteremia, and rarely with arthritis, spondylodiscitis, meningitis, brain abscess and septic shock. Liver abscess caused by G. morbillorum is very rare, and only a few cases were reported. We experienced a case of liver abscess by G. morbillorum in a 56-year-old woman presented with fever. We report this case with a review of literatures.

A Case of Bacteremia due to Gemella morbillorum / 감염과화학요법

Gemella morbillorum is catalase-negative, facultative, anaerobic, gram-positive cocci which is generally thought to be normal inhabitants of mucous membrane in oral cavity, upper respiratory tract, and genitourinary tract of human. It rarely causes infective endocaditis, bacteremia, pneumonia, and localized infection such as lung empyema, brain abscess, and liver abscess. We report a case of bacteremia caused by G. morbillorum in a 44-year-old man who had been an alcoholic and suffered from dental caries. He was successfully treated with antimicrobial therapy

A Case of Bacteremia due to Gemella morbillorum / 감염과화학요법

Gemella morbillorum is catalase-negative, facultative, anaerobic, gram-positive cocci which is generally thought to be normal inhabitants of mucous membrane in oral cavity, upper respiratory tract, and genitourinary tract of human. It rarely causes infective endocaditis, bacteremia, pneumonia, and localized infection such as lung empyema, brain abscess, and liver abscess. We report a case of bacteremia caused by G. morbillorum in a 44-year-old man who had been an alcoholic and suffered from dental caries. He was successfully treated with antimicrobial therapy

A Case Report of Infective Endocarditis that Caused by Gemella Haemolysans in a Patient with Ventricular Septal Defect

Infective endocarditis is the infectious disease that produces vegetation on endocardium. Acute bacterial endocarditis is most frequently caused by Staphylococcus aureus, occurs on a normal heart valve, and subacute endocarditis usually caused by Streptococcus viridans occurs on damaged valves. Gemella haemolysans are gram-positive cocci that is placed in the family Streptococcaceae. As opportunistic pathogen, Gemella haemolysans are able to cause severe localized and generalized infections and it is known that this organism very rarely causes infective endocarditis. The paucity of reports concerning Gemella haemolysans is probably related to the difficulties associated with their identification. Several laboratory tests to prevent misinterpretation of this organism are now suggested. We have experienced a case of infective endocarditis that is caused by Gemella haemolysans in 37 year old male patient with ventricular septal defect. Gemella haemolysans were detected by blood culture and he was treated with intravenous vancomycin with gentamicin and ceftriaxone, and also underwent cardiac surgery. This is the first case of Gemella haemolysans endocarditis of ventricular septal defect in Korea.