[A Case of Meningitis Caused by Globicatella sanguinis in a Patient with a Lumbo-peritoneal Shunt]. / Lumbo-peritoneal Santli Hastada Globicatella sanguinis'e Bagli Menenjit Olgusu.

Globicatella sanguinis is catalase-negative, alpha-hemolytic, nonmotile, facultative anaerobic grampositive cocci, identified as a new species in 1992. Since the colony morphology in blood agar and microscopic appearance resembles streptococci, it is thought that some of the isolates previously identified in the Streptococcus viridans group were G.sanguinis species. G.sanguinis has been isolated from various clinical specimens, its species identification and antibiotic susceptibility have been tested since the year it was identified. Clinical specimens in which it is isolated include various mucosal surfaces, blood, urine, wound and cerebrospinal fluid. In this report, considering also the literature information, a case of G.sanguinis which is thought to cause meningitis was presented. Our case is a 39-year-old female patient with a lumboperitoneal shunt. The patient was admitted to the neurosurgery clinic with a headache and vision loss and was hospitalized in the service with a pre-diagnosis of pseudotumor cerebri. Neurological examination revealed no pathological findings. Eye examination revealed mild papillary edema, local retinal hemorrhage, and bilateral expansion in retinal vascularization. There was no pathologic findings in the brain magnetic resonance imaging. The colonies resembling alpha hemolytic streptococci were isolated from the cerebrospinal fluid taken upon the development of neck stiffness, fever, and tachycardia on the 10th day of hospitalization of the lumbo-peritoneal shunt administered patient. The identification of the isolate was determined in Bruker IVD MALDI Biotyper 2.3 (Bruker Daltonik GmbH, Bremen, Germany), available in our laboratory and it was identified as G.sanguinis (KJ680157.1) with a score of > 2. The definite identification of the isolate at the species level was made by 16S rDNA sequence analysis and it was determined that the bacterium was G.sanguinis with 100% similarity and coverage. The minimum inhibitory concentration (MIC) for some of the antibiotics was determined by the agar gradient method. The MIC values were found as; linezolid 0.50 µg/ml, vancomycin 0.75 µg/ ml, imipenem 0.75 µg/ml, meropenem 3 µg/ml, penicillin G 6 µg/ml and cefotaxime > 32 µg/ml. It is known that these rare isolates can be isolated in greater numbers along with the introduction of MALDITOF MS-based devices in many laboratories. Following greater numbers of isolation of this rare species of bacteria, our knowledge about its clinical significance, placement in the flora and antibiotic susceptibility will also be expanded.

[Femoral hemodialysis catheter-related bacteremia due to Globicatella sanguinis: challenges in species identification]. / Femoral hemodiyaliz kateteri ile iliskili Globicatella sanguinis bakteremisi: tür düzeyinde tanimlamada karsilasilan sorunlar.

In this case, catheter-related bacteremia due to Globicatella sanguinis in a 43 years old female patient undergoing hemodialysis with the diagnosis of diabetic nephropathy was presented and the methods in the laboratory diagnosis of the rare opportunistic pathogen, Globicatella cins, were nvestigated. A set of peripheral blood cultures and simultaneous catheter culture was obtained from the patient in third of May 2016. Biochemical tests, Phoenix (Becton Dickinson, USA) and MicroScan (Beckman Coulter, USA) automated systems and matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF MS) based Microflex MS (Bruker, Daltonics, Germany) and VITEK MS (database v2.0) (bioMérieux, France) systems were used for the identification of the cultured bacteria. Partial 16S rDNA sequencing was done by using specific p8FPL 5'-AGT TTG ATC ATG GCT CAG-3' and p806R 5'-GGA CTA CCA GGG TAT CTA AT-3' primers. Minimal inhibitory concentrations (MICs) for vancomycin, erythromycin, imipenem, cefotaxime and benzypenicillin were determined by agar gradient method. The blood and catheter cultures yielded the same type of bacterial colonies. Alfa-hemolytic, catalase negative colonies observed on blood agar plates after an over night incubation yielded gram-positive cocci on Gram staining. In Sisli Hamidiye Etfal Hospital, the isolate was identifed as G.sulfidifaciens (score value > 2) by Bruker MS system and as G.sanguinis by Phoenix automated system. In Inönü University, the isolate could not be identified by Microscan automated system while VITEK MS named the isolate as 99.9% G.sanguinis and 98.3% G.sulfidifaciens. The 16S rDNA sequencing identifed the isolate as 100% G.sanguinis (GenBank accessionno. KJ680157.1). The MIC values were 0.38 µg/ml, 1.5 µg/ml, 0.38 µg/ml, > 32 µg/ml and 64 µg/ml for vancomycin, eryrthromycin, imipenem, cefotaxime and benzylpenicillin, respectively. The patient was diagnosed as catheter-related bacteremia and vancomycin (1 x 1 g IV/72 h) was used for up to 10 days. No fever and bacterial growth in cultures were present in her control visits. As G.sanguinis is not among the commonly encountered pathogens and due to difficulties in laboratory diagnosis, it may be missedor mis-identified in clinical laboratories. BD Phoenix and Bruker MS data bases lack G.sulfidifaciens and G.sanguinis, respectively, while the Globicatella genus is not present in MicroScan database. The increased number of medical implementations and the increasing number of immunosuppressed patient populations in recenty ears will lead to the emergence of rare bacteria. Increasing the diagnostic power of clinical microbiology laboratories by conventional and molecular methods and renewal of the databases of commercial identification systems by expanding the pathogen spectrum are significantly important for the prevention and control of infections caused by these agents.

Molecular and antimicrobial susceptibility characterization of Globicatella sulfidifaciens isolated from sow's urinary tract infection.

BACKGROUND: The Globicatella genus comprises Gram-positive, facultative anaerobic, α-hemolytic and catalase negative cocci morphologically and phenotypically very similar to Streptococcus and Aerococcus genus which can lead to misidentification and underestimation of this pathogen. Globicatella species have already been isolated from human and animals with heart and brain disorders. Their clinical relevance in animals, and its zoonotic potential, remains unknown due to the difficulty in their identification. OBJECTIVE: To present the isolation, phenotypic and molecular characterization of G. sulfidifaciens from urinary tract infection in sows. MATERIALS AND METHODS: Urine samples from 140 sows of two swine herds located in São Paulo State (Brazil) yielded the isolation of three presumptive G. sulfidifaciens strains. Identification and species confirmation were done by MALDI-TOF MS and 16S rRNA sequencing. Strains were further characterized by single enzyme amplified fragments length polymorphism (SE-AFLP) and broth microdilution techniques. RESULTS: All three isolates were confirmed as G. sulfidifaciens. The SE-AFLP genotyping resulted in distinct fingerprint patterns for each strain. All isolates presented high MIC values to tetracycline, sulphonamides, aminoglycosides and tylosin tartrate, which present high usage in human and animal medicine. CONCLUSIONS: Globicatella sulfidifaciens could be related to sporadic urinary tract infections in swine and appear to present alarming antimicrobial susceptibility profile. It is necessary to differentiate Streptococcus-like microorganisms in routine laboratory diagnostics for the correct identification of underestimated species potentially pathogenic to animals.

Urosepsis caused by Globicatella sanguinis and Corynebacterium riegelii in an adult: case report and literature review.

We report an extremely rare case of urosepsis caused by Globicatella sanguinis and Corynebacterium riegelii coinfection in a 94-year-old Japanese man with nephrolithiasis. Prompt identification of this coinfection is important so that effective antimicrobial coverage can be initiated.