Granulicatella adiacens and Abiotrophia defectiva bacteraemia characterized by 16S rRNA gene sequencing.

Traditionally, the identification, epidemiology and spectrum of clinical diseases caused by Granulicatella adiacens and Abiotrophia defectiva are dependent upon their phenotypic characterization. During a 6-year period (July 1995-June 2001), seven and two alpha-haemolytic streptococci were identified as G. adiacens and A. defectiva, respectively, by 16S rRNA gene sequencing. Three patients with haematological malignancies and neutropenic fever had primary bacteraemia. Three patients with valvular problems or congenital heart disease had infective endocarditis. A patient with ischemic heart disease and cerebrovascular accident had infected aortic atheroma with dissection. A patient with recurrent pyogenic cholangitis had acute cholangitis and a patient with polypoid cystitis and benign prostatic hypertrophy had acute prostatitis. Four of the nine patients died, including all three with G. adiacens infective endocarditis or infected atheroma. For the seven G. adiacens isolates, the API 20 STREP system successfully identified one and five isolates as G. adiacens with >95 % and 80-90 % confidence, respectively, whereas the Vitek System (GPI) and ATB Expression system (ID32 STREP) successfully identified none and one isolate as G. adiacens. Of the two A. defectiva isolates, none of the three systems successfully identified either of them as A. defectiva. 16S rRNA gene sequencing is the technique of choice for identifying G. adiacens and A. defectiva, and early surgical intervention should be considered when G. adiacens endocarditis is diagnosed.

Haemophilus segnis polymicrobial and monomicrobial bacteraemia identified by 16S ribosomal RNA gene sequencing.

This paper reports a case of Haemophilus segnis polymicrobial bacteraemia and a case of H. segnis monomicrobial bacteraemia identified by 16S ribosomal RNA gene sequencing. In the first case, a gram-negative aerobic coccobacillus was isolated with Streptococcus intermedius and S. sanguis from the blood culture of a 32-year-old intravenous drug addict with left thoracic empyema. In the second case, a gram-negative aerobic coccobacillus was isolated from the blood culture of an 82-year-old woman with Clostridium difficile colitis and septicaemic shock. Both gram-negative coccobacilli grew on chocolate agar as colonies of 1 mm in diameter after incubation for 24 h at 37 degress C in air with CO2 5%, but only to pinpoint sizes on blood agar under the same incubation conditions. Both strains were factor V-dependent, but not factor X-dependent. For the first isolate, the Vitek system (NHI) showed that it was 56% likely to be Actinobacillus actinomycetemcomitans and 40% Neisseria subflava; whereas the API system (NH) showed that it was 58% likely to be H. aphrophilus/paraphrophilus and 42% H. parainfluenzae. For the second isolate, the Vitek system (NHI) showed that it was 95% likely to be H. influenzae VIII; whereas the API system (NH) showed that it was 58% likely to be H. aphrophilus/paraphrophilus and 42% H. parainfluenzae. 16S rRNA gene sequencing showed that there were four base differences between isolate 1 and H. segnis and two base differences between isolate 2 and H. segnis, indicating that both isolates most closely resembled a strain of H. segnis. Only two cases of H. segnis bacteraemia were found in the English scientific literature, one in a case of infective endocarditis and the other in a case of pancreatic abscess. Including the present two cases, the overall mortality of H. segnis bacteraemia was 50%.