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Takai S, Mizuno Y, Suzuki Y, Sasaki Y, Kakuda T, Kirikae T. [Rhodococcus equi infections in humans: an emerging zoonotic pathogen]. Nihon Saikingaku Zasshi 2024; 79:15-24. [PMID: 38382971 DOI: 10.3412/jsb.79.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Rhodococcus equi is a facultative intracellular gram-positive coccobacillus which is a well-known cause of foal pneumonia and/or enteritis in equine veterinary medicine. More than 300 cases of R. equi infection have been reported since the first description of human disease in 1968. Most patients who become infected with R equi are immunocompromised, such as those infected with human immunodeficiency virus (HIV), recipients of organ transplantation, and patients receiving cancer treatment. However, there are increasing reports of the immunocompetent hosts. The pathogenicity of R. equi has been attributed to the presence of plasmid-encoded virulence-associated proteins (Vap). To date, three host-associated virulence plasmid types of R. equi have been identified as follows: the circular pVAPA and pVAPB, related, respectively, to equine and porcine isolates in 1991 and 1995, and a recently described linear pVAPN plasmid associated with bovine and caprine strains in 2015. More recently, these three plasmid types have been re-found in the human isolates which were isolated during 1980s to 1990s. Not only horses, but also pigs, goats, cattle and their environment should be considered as a potential source of R. equi for humans. In this review, we shed light on the current understanding of R. equi as an emerging zoonotic pathogen.
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Affiliation(s)
- Shinji Takai
- Laboratory of Veterinary Hygiene, School of Veterinary Medicine, Kitasato University
| | | | - Yasunori Suzuki
- Laboratory of Veterinary Hygiene, School of Veterinary Medicine, Kitasato University
| | - Yukako Sasaki
- Laboratory of Veterinary Hygiene, School of Veterinary Medicine, Kitasato University
| | - Tsutomu Kakuda
- Laboratory of Veterinary Hygiene, School of Veterinary Medicine, Kitasato University
| | - Teruo Kirikae
- Department of Microbiome Research, Department of Microbiology, Juntendo University School of Medicine
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Antimicrobial resistance spectrum conferred by pRErm46 of emerging macrolide (multidrug)-resistant Rhodococcus equi. J Clin Microbiol 2021; 59:e0114921. [PMID: 34319806 DOI: 10.1128/jcm.01149-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clonal multidrug resistance recently emerged in Rhodococcus equi, complicating the therapeutic management of this difficult-to-treat animal and human pathogenic actinomycete. The currently spreading multidrug-resistant (MDR) "2287" clone arose in equine farms upon acquisition, and co-selection by mass macrolide-rifampin therapy, of the pRErm46 plasmid carrying the erm(46) macrolides-lincosamides-streptogramins resistance determinant, and an rpoBS531F mutation. Here, we screened a collection of susceptible and macrolide-rifampin-resistant R. equi from equine clinical cases using a panel of 15 antimicrobials against rapidly growing mycobacteria (RGM), nocardiae and other aerobic actinomycetes (NAA). R. equi -including MDR isolates- was generally susceptible to linezolid, minocycline, tigecycline, amikacin and tobramycin according to Staphylococcus aureus interpretive criteria, plus imipenem, cefoxitin and ceftriaxone based on Clinical & Laboratory Standards Institute (CLSI) guidelines for RGM/NAA. Ciprofloxacin and moxifloxacin were in the borderline category according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Molecular analyses linked pRErm46 to significantly increased MICs for trimethoprim-sulfamethoxazole and doxycycline in addition to clarithromycin within the RGM/NAA panel, and to streptomycin, spectinomycin and tetracycline resistance. pRErm46 variants with spontaneous deletions in the class 1 integron (C1I) region, observed in ≈30% of erm(46)-positive isolates, indicated that the newly identified resistances were attributable to C1I's sulfonamide (sul1) and aminoglycoside (aaA9) resistance cassettes and adjacent tetRA(33) determinant. Most MDR isolates carried the rpoBS531F mutation of the 2287 clone, while different rpoB mutations (S531L, S531Y) detected in two cases suggest the emergence of novel MDR R. equi strains.
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Assessment of Antimicrobial Susceptibility of Virulent Strains of Rhodococcus equi Isolated From Foals and Soil of Horse Breeding Farms With and Without Endemic Infections. J Equine Vet Sci 2020; 91:103114. [PMID: 32684259 DOI: 10.1016/j.jevs.2020.103114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/27/2020] [Accepted: 04/27/2020] [Indexed: 12/21/2022]
Abstract
Rhodococcus equi is an opportunistic, intracellular saprophyte that causes severe pyogranulomatous pneumonia in foals. The bacterium displays in vitro susceptibility to many antibiotics. The highest efficacy against R. equi in vitro and in vivo is achieved by using a combination of rifampicin and macrolide antibiotics. Recent years have seen an upward trend in the minimum inhibitory concentration (MIC) of rifampicin and erythromycin, suggesting increasing resistance of R. equi to these antibiotics. The aim of the study was to determine the antimicrobial activity of 24 selected antibiotics against R. equi strains isolated from dead foals and from the environment of horse breeding farms with and without endemic R. equi infections. Minimum inhibitory concentration gradient strips were used to determine the lowest concentration of the antibiotic that inhibited the growth of R. equi. Based on normal MIC distribution, an epidemiologic cutoff values (ECOFF) were assessed for particular antibiotics and R. equi strains. The results were compared with ECOFFs for S. aureus, according to the European Committee on Antimicrobial Susceptibility Testing data. The data indicate that the lowest MIC values were obtained for clarithromycin, rifampicin, imipenem, and vancomycin. The majority of R. equi strains can be classified as wild type in relation to the majority of antibiotics. A small percentage of strains presented non-WT (NWT) with the exception of SXT, for which 35% of strains were classified as NWT. The lack of interpretative criteria for R. equi creates a real problem in the assessment of antibiotic sensitivity both for clinical and scientific purposes.
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Vergidis P, Ariza-Heredia EJ, Nellore A, Kotton CN, Kaul DR, Morris MI, Kelesidis T, Shah H, Park SY, Nguyen MH, Razonable RR. Rhodococcus Infection in Solid Organ and Hematopoietic Stem Cell Transplant Recipients 1. Emerg Infect Dis 2018; 23:510-512. [PMID: 28221102 PMCID: PMC5382763 DOI: 10.3201/eid2303.160633] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We conducted a case–control study of 18 US transplant recipients with Rhodococcus infection and 36 matched controls. The predominant types of infection were pneumonia and bacteremia. Diabetes mellitus and recent opportunistic infection were independently associated with disease. Outcomes were generally favorable except for 1 relapse and 1 death.
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Diagnosing Rhodococcus equi infections in a setting where tuberculosis is highly endemic: a double challenge. J Clin Microbiol 2015; 53:1431-3. [PMID: 25631800 PMCID: PMC4365230 DOI: 10.1128/jcm.02284-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rhodococcus equi infection is increasing in regions with high HIV prevalence worldwide. The microbiological features and clinical mimicry of tuberculosis infection pose diagnostic challenges in high-tuberculosis-incidence settings. We present two HIV-associated cases of R. equi infection from Vietnam and discuss the unique diagnostic challenges in such settings.
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Bruker biotyper matrix-assisted laser desorption ionization-time of flight mass spectrometry system for identification of Nocardia, Rhodococcus, Kocuria, Gordonia, Tsukamurella, and Listeria species. J Clin Microbiol 2014; 52:2371-9. [PMID: 24759706 DOI: 10.1128/jcm.00456-14] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated whether the Bruker Biotyper matrix-associated laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system provides accurate species-level identifications of 147 isolates of aerobically growing Gram-positive rods (GPRs). The bacterial isolates included Nocardia (n = 74), Listeria (n = 39), Kocuria (n = 15), Rhodococcus (n = 10), Gordonia (n = 7), and Tsukamurella (n = 2) species, which had all been identified by conventional methods, molecular methods, or both. In total, 89.7% of Listeria monocytogenes, 80% of Rhodococcus species, 26.7% of Kocuria species, and 14.9% of Nocardia species (n = 11, all N. nova and N. otitidiscaviarum) were correctly identified to the species level (score values, ≥ 2.0). A clustering analysis of spectra generated by the Bruker Biotyper identified six clusters of Nocardia species, i.e., cluster 1 (N. cyriacigeorgica), cluster 2 (N. brasiliensis), cluster 3 (N. farcinica), cluster 4 (N. puris), cluster 5 (N. asiatica), and cluster 6 (N. beijingensis), based on the six peaks generated by ClinProTools with the genetic algorithm, i.e., m/z 2,774.477 (cluster 1), m/z 5,389.792 (cluster 2), m/z 6,505.720 (cluster 3), m/z 5,428.795 (cluster 4), m/z 6,525.326 (cluster 5), and m/z 16,085.216 (cluster 6). Two clusters of L. monocytogenes spectra were also found according to the five peaks, i.e., m/z 5,594.85, m/z 6,184.39, and m/z 11,187.31, for cluster 1 (serotype 1/2a) and m/z 5,601.21 and m/z 11,199.33 for cluster 2 (serotypes 1/2b and 4b). The Bruker Biotyper system was unable to accurately identify Nocardia (except for N. nova and N. otitidiscaviarum), Tsukamurella, or Gordonia species. Continuous expansion of the MALDI-TOF MS databases to include more GPRs is necessary.
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de Carvalho CCCR, Costa SS, Fernandes P, Couto I, Viveiros M. Membrane transport systems and the biodegradation potential and pathogenicity of genus Rhodococcus. Front Physiol 2014; 5:133. [PMID: 24772091 PMCID: PMC3983516 DOI: 10.3389/fphys.2014.00133] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/18/2014] [Indexed: 11/13/2022] Open
Abstract
The Rhodococcus genus contains species with remarkable ability to tolerate toxic compounds and to degrade a myriad of substrates. These substrates have to cross a distinctive cell envelope dominated by mycolic acids anchored in a scaffold of arabinogalactan covalently attached to the cell wall peptidoglycan, and a cellular membrane with phospholipids, whose composition in fatty acids can be rapidly altered in response to environmental conditions. The hydrophobic nature of the cell envelope facilitates the entrance of hydrophobic molecules but some substrates require active transport systems. Additionally, toxic compounds may also be extruded by energy spending efflux systems. In this review, physiological evidences of the use of transport systems by Rhodococcus strains and genomic studies that corroborate their existence are presented and discussed. The recently released complete genomes of several Rhodococcus strains will be the basis for an in silico correlation analysis between the efflux pumps present in the genome and their role on active transport of substrates. These transport systems will be placed on an integrative perspective of the impact of this important genus on biotechnology and health, ranging from bioremediation to antibiotic and biocide resistance.
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Affiliation(s)
- Carla C C R de Carvalho
- Department of Bioengineering, Centre for Biological and Chemical Engineering, Institute of Biotechnology and Bioengineering, Instituto Superior Técnico, Universidade de Lisboa Lisboa, Portugal
| | - Sofia S Costa
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa Lisboa, Portugal ; Centro de Recursos Microbiológicos, Universidade Nova de Lisboa Caparica, Portugal
| | - Pedro Fernandes
- Department of Bioengineering, Centre for Biological and Chemical Engineering, Institute of Biotechnology and Bioengineering, Instituto Superior Técnico, Universidade de Lisboa Lisboa, Portugal
| | - Isabel Couto
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa Lisboa, Portugal ; Centro de Recursos Microbiológicos, Universidade Nova de Lisboa Caparica, Portugal
| | - Miguel Viveiros
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa Lisboa, Portugal ; Centro de Malária e Outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa Lisboa, Portugal
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vanO, a new glycopeptide resistance operon in environmental Rhodococcus equi isolates. Antimicrob Agents Chemother 2013; 58:1768-70. [PMID: 24342631 DOI: 10.1128/aac.01880-13] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe here the sequence and gene organization of a new glycopeptide resistance operon (vanO) in Rhodococcus equi from soil. The vanO operon has low homology to enterococcal van operons and harbors a vanHOX cluster transcribed in the direction opposite that of the vanS-vanR regulatory system and composed of three open reading frames with unknown function. This finding has clinical interest, since glycopeptides are used to treat R. equi infections and resistance has been reported in clinical isolates.
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Al Akhrass F, Al Wohoush I, Chaftari AM, Reitzel R, Jiang Y, Ghannoum M, Tarrand J, Hachem R, Raad I. Rhodococcus bacteremia in cancer patients is mostly catheter related and associated with biofilm formation. PLoS One 2012; 7:e32945. [PMID: 22427914 PMCID: PMC3302794 DOI: 10.1371/journal.pone.0032945] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 02/07/2012] [Indexed: 11/18/2022] Open
Abstract
Rhodococcus is an emerging cause of opportunistic infection in immunocompromised patients, most commonly causing cavitary pneumonia. It has rarely been reported as a cause of isolated bacteremia. However, the relationship between bacteremia and central venous catheter is unknown. Between 2002 and 2010, the characteristics and outcomes of seventeen cancer patients with Rhodococcus bacteremia and indwelling central venous catheters were evaluated. Rhodococcus bacteremias were for the most part (94%) central line-associated bloodstream infection (CLABSI). Most of the bacteremia isolates were Rhodococcus equi (82%). Rhodococcus isolates formed heavy microbial biofilm on the surface of polyurethane catheters, which was reduced completely or partially by antimicrobial lock solution. All CLABSI patients had successful response to catheter removal and antimicrobial therapy. Rhodococcus species should be added to the list of biofilm forming organisms in immunocompromised hosts and most of the Rhodococcus bacteremias in cancer patients are central line associated.
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Affiliation(s)
- Fadi Al Akhrass
- Department of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States of America
| | - Iba Al Wohoush
- Department of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States of America
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States of America
| | - Ruth Reitzel
- Department of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States of America
| | - Ying Jiang
- Department of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States of America
| | - Mahmoud Ghannoum
- Department of Dermatology, Center for Medical Mycology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jeffrey Tarrand
- Department of Microbiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States of America
| | - Ray Hachem
- Department of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
| | - Issam Raad
- Department of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States of America
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Guerrero R, Bhargava A, Nahleh Z. Rhodococcus equi venous catheter infection: a case report and review of the literature. J Med Case Rep 2011; 5:358. [PMID: 21827681 PMCID: PMC3174126 DOI: 10.1186/1752-1947-5-358] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 08/09/2011] [Indexed: 05/26/2023] Open
Abstract
Introduction Rhodococcus equi is an animal pathogen that was initially isolated from horses and is being increasingly reported as a cause of infection in humans with impaired cellular immunity. However, this pathogen is underestimated as a challenging antagonist and is frequently considered to be a mere contaminant despite the potential for life-threatening infections. Most case reports have occurred in immunocompromised patients who have received organ transplants (for example kidney, heart, bone marrow) or those with human immunodeficiency virus infection. Infections often manifest as pulmonary involvement or soft tissue abscesses. Bacteremia related to R. equi infections of tunneled central venous catheters has rarely been described. Case presentation We report the case of a 63-year-old non-transplant recipient, non-HIV infected Caucasian woman with endometrial carcinoma who developed recurrent bloodstream infections and septic shock due to R. equi and ultimately required the removal of her port catheter, a subcutaneous implantable central venous catheter. We also review the medical literature related to human infections with R. equi. Conclusion R. equi should be considered a serious pathogen, not a contaminant, particularly in an immunocompromised patient who presents with a central venous catheter-related bloodstream infection. Counseling patients with central venous catheters who participate in activities involving exposure to domesticated animals is recommended.
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Affiliation(s)
- Rosalinda Guerrero
- Department of Internal Medicine, TTUHSC-Paul L Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX 79905, USA.
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Lai C, Wang C, Liu C, Tan C, Lin S, Liao C, Chou C, Huang Y, Lin H, Hsueh P. Infections caused by Gordonia species at a medical centre in Taiwan, 1997 to 2008. Clin Microbiol Infect 2010. [DOI: 10.1111/j.1469-0691.2010.03085.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Giguère S, Lee E, Williams E, Cohen ND, Chaffin MK, Halbert N, Martens RJ, Franklin RP, Clark CC, Slovis NM. Determination of the prevalence of antimicrobial resistance to macrolide antimicrobials or rifampin inRhodococcus equiisolates and treatment outcome in foals infected with antimicrobial-resistant isolates ofR equi. J Am Vet Med Assoc 2010; 237:74-81. [DOI: 10.2460/javma.237.1.74] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Russo G, Lichtner M, Carnevalini M, Mascellino MT, Mengoni F, Oliva A, Miccoli GA, Iannetta M, Trinchieri V, Massetti AP, Mastroianni CM, Vullo V. Primary retroperitoneal abscesses due to Rhodococcus equi in a patient with severe nephrotic syndrome: successful antibiotic treatment with linezolid and tigecycline. Int J Infect Dis 2010; 14:e533-5. [DOI: 10.1016/j.ijid.2009.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 06/10/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022] Open
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Mutant selection window and characterization of allelic diversity for ciprofloxacin-resistant mutants of Rhodococcus equi. Antimicrob Agents Chemother 2010; 54:3520-3. [PMID: 20498313 DOI: 10.1128/aac.01670-09] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mutant prevention concentration (MPC) for ciprofloxacin was determined for two Rhodococcus equi strains. The MPC for both strains was 32 mug/ml, which is above the peak serum concentration of ciprofloxacin obtainable by oral administration in humans. Nine single nucleotide changes corresponding to eight amino acid substitutions in the quinolone resistance-determining regions of DNA gyrase subunits A and B were characterized. Only mutants with amino acid changes in Ser-83 of GyrA were highly resistant (>or=64 microg/ml). Our results suggest that ciprofloxacin monotherapy against R. equi infection may result in the emergence of ciprofloxacin-resistant mutants.
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Rahamat-Langendoen JC, van Meurs M, Zijlstra JG, Lo-Ten-Foe JR. Disseminated Rhodococcus equi infection in a kidney transplant patient without initial pulmonary involvement. Diagn Microbiol Infect Dis 2009; 65:427-30. [DOI: 10.1016/j.diagmicrobio.2009.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 08/06/2009] [Accepted: 08/08/2009] [Indexed: 11/24/2022]
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Roda RH, Young M, Timpone J, Rosen J. Rhodococcus equi pulmonary-central nervous system syndrome: brain abscess in a patient on high-dose steroids--a case report and review of the literature. Diagn Microbiol Infect Dis 2009; 63:96-9. [PMID: 19073303 DOI: 10.1016/j.diagmicrobio.2008.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 08/28/2008] [Accepted: 08/28/2008] [Indexed: 10/21/2022]
Abstract
Rhodococcus equi has emerged as an opportunistic pathogen usually causing necrotizing pneumonia in immunosuppressed patients but has been found increasingly in extrapulmonary sites. We report the 1st case of R. equi brain abscess in a patient receiving corticosteroid monotherapy and review the literature for risk factors and sites of infection.
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Affiliation(s)
- Ricardo Horacio Roda
- Department of Neurology, Johns Hopkins University Hospital, Baltimore, MD 21287, USA
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von Bargen K, Haas A. Molecular and infection biology of the horse pathogen Rhodococcus equi. FEMS Microbiol Rev 2009; 33:870-91. [PMID: 19453748 DOI: 10.1111/j.1574-6976.2009.00181.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The soil actinomycete Rhodococcus equi is a pulmonary pathogen of young horses and AIDS patients. As a facultative intracellular bacterium, R. equi survives and multiplies in macrophages and establishes its specific niche inside the host cell. Recent research into chromosomal virulence factors and into the role of virulence plasmids in infection and host tropism has presented novel aspects of R. equi infection biology and pathogenicity. This review will focus on new findings in R. equi biology, the trafficking of R. equi-containing vacuoles inside host cells, factors involved in virulence and host resistance and on host-pathogen interaction on organismal and cellular levels.
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Huang YT, Liao CH, Teng LJ, Hsueh PR. Daptomycin susceptibility of unusual gram-positive bacteria: comparison of results obtained by the Etest and the broth microdilution method. Antimicrob Agents Chemother 2007; 51:1570-2. [PMID: 17220420 PMCID: PMC1855499 DOI: 10.1128/aac.01352-06] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
MICs of daptomycin, linezolid, and vancomycin against 212 isolates, including Listeria monocytogenes and Pediococcus, Leuconostoc, Rhodococcus, and Nocardia spp., were determined by the broth microdilution method; daptomycin MICs were also determined by the Etest. Except with those for Leuconostoc spp., daptomycin Etest MICs showed >90% agreement with MICs obtained by the broth microdilution method.
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Affiliation(s)
- Yu-Tsung Huang
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei County, and Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan
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Abstract
Rhodococcus equi, a Gram positive organism, is a cause of infections in immunocompromised individuals. In humans, it mainly causes disease in those infected with human immunodeficiency virus (HIV), and generally presents as chronic pulmonary infection. It may also cause intracranial infections, which manifest as brain abscesses. This report describes a case of rhodococcus brain and pulmonary infection in a patient who did not have HIV or another disorder of cell mediated immunity. He was treated with intravenous imipenem, vancomycin, and rifampin for eight weeks and recovered from the infection.
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Affiliation(s)
- M Kamboj
- Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA
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Torres-Tortosa M, Arrizabalaga J, Villanueva JL, Gálvez J, Leyes M, Valencia ME, Flores J, Peña JM, Pérez-Cecilia E, Quereda C. Prognosis and clinical evaluation of infection caused by Rhodococcus equi in HIV-infected patients: a multicenter study of 67 cases. Chest 2003; 123:1970-6. [PMID: 12796176 DOI: 10.1378/chest.123.6.1970] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To assess the clinical characteristics and the factors that influenced the prognosis of patients with HIV and infection caused by Rhodococcus equi. DESIGN Observational, multicenter study in 29 Spanish general hospitals. SETTING These hospitals comprised a total of 20,250 beds for acute patients and served a population of 9,716,880 inhabitants. PATIENTS All patients with HIV and diagnosed R equi infection until September 1998. RESULTS During the study period, 19,374 cases of AIDS were diagnosed. Sixty-seven patients were included (55 male patients; mean +/- SD age, 31.7 +/- 5.8 years). At the time of diagnosis of R equi infection, the mean CD4+ lymphocyte count was 35/ micro L (range, 1 to 183/ micro L) and the stage of HIV infection was A3 in 10.4% of patients, B3 in 31.3%, C3 in 56.7%, and unknown in 1.5%. R equi was most commonly isolated in sputum (52.2%), blood cultures (50.7%), and samples from bronchoscopy (31.3%). Chest radiographic findings were abnormal in 65 patients (97%). Infiltrates were observed in all of them, with cavitations in 45 patients. The most active antibiotics against the strains isolated were vancomycin, amikacin, rifampicin, imipenem, ciprofloxacin, and erythromycin. After a mean follow-up of 10.7 +/- 12.8 months, 23 patients (34.3%) died due to causes related to R equi infection and 6 other patients showed evidence of progression of the infection. The absence of highly active antiretroviral therapy (HAART) was independently associated with mortality related to R equi infection (relative risk, 53.4; 95% confidence interval, 1.7 to 1,699). Survival of patients treated with HAART was much higher than that of patients who did not receive this therapy. CONCLUSIONS Infection by R equi is an infrequent, opportunistic complication of HIV infection and occurs during advanced stages of immunodepression. In these patients, it leads to a severe illness that usually causes a bacteremic, cavitary pneumonia, although HAART can improve the prognosis.
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Dabbs ER, Naidoo S, Lephoto C, Nikitina N. Pathogenic Nocardia, Rhodococcus, and related organisms are highly susceptible to imidazole antifungals. Antimicrob Agents Chemother 2003; 47:1476-8. [PMID: 12654698 PMCID: PMC152489 DOI: 10.1128/aac.47.4.1476-1478.2003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rhodococcus equi and species of Nocardia and Gordonia may be human opportunistic pathogens. We find that these, as well as several isolates from closely related genera, are highly susceptible to the imidazoles bifonazole, clotrimazole, econazole, and miconazole, whose MICs are </=1 micro g/ml. In liquid cultures 1 micro g of the drug/ml was bacteriostatic and 10 micro g/ml was bactericidal. On solid media at 10 micro g of azole/ml no resistant mutants could be isolated. An MIC of 1 to 15 micro g/ml was observed with ketoconazole, whereas none of these organisms was inhibited by the triazoles fluconazole and voriconazole (100 micro g/ml). Imidazoles may offer the prospect of treatment of nocardioform mycetomas and may provide the basis for the development of additional antimicrobial agents to combat these pathogens.
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Affiliation(s)
- Eric R Dabbs
- School of Molecular and Cell Biology, University of the Witwatersrand, Johannesburg, South Africa.
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Weinstock DM, Brown AE. Rhodococcus equi: an emerging pathogen. Clin Infect Dis 2002; 34:1379-85. [PMID: 11981734 DOI: 10.1086/340259] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2001] [Revised: 01/08/2002] [Indexed: 11/03/2022] Open
Abstract
More than 100 cases of Rhodococcus equi infection have been reported since the first description of human disease caused by this organism. The vast majority of patients infected with R. equi are immunocompromised, and two-thirds have human immunodeficiency virus infection. The clinical manifestations of R. equi infection are diverse, although 80% of patients have some pulmonary involvement. The organism is easily cultured from specimens of infected tissue or body fluid, but it may be misdiagnosed as a contaminant. Treatment is often prolonged, and relapses at distant sites are common. This article summarizes the history, diagnosis, clinical features, and treatment of infection with this emerging pathogen.
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Affiliation(s)
- David M Weinstock
- Department of Medicine, Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Abstract
This review presents data on in vitro susceptibilities of aerobically growing Gram-positive rods and in vivo activities of antibiotics used against Gram-positive rods. While in some instances susceptibility and efficacy are predictable (e.g. penicillin vs. Listeria and microaerophilic coryneforms, or metronidazole vs. Gardnerella) susceptibility testing by dilution techniques seems necessary for many Gram-positive rods as long as they are deemed clinically relevant.
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Affiliation(s)
- A von Graevenitz
- Department of Medical Microbiology, University of Zurich, Switzerland.
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Nasser AA, Bizri AR. Chronic scalp wound infection due to Rhodococcus equi in an immunocompetent patient. J Infect 2001; 42:67-8. [PMID: 11243757 DOI: 10.1053/jinf.2000.0761] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A case of chronic scalp wound infection due to Rhodococcus equi in an immunocompetent individual following heavily contaminated traumatic injury was successfully treated by combining antibiotics and surgery. The agents used were erythromycin and rifampicin.
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Affiliation(s)
- A A Nasser
- Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract
OBJECTIVES To describe three cases of Rhodococcus equi infection in a cohort of HIV-1 infected adults in Entebbe, Uganda and to compare this to the rates and presentation of tuberculosis in this cohort. METHODS Consecutive HIV-1 infected adults registering with a community HIV/AIDS clinic in Entebbe were enrolled in a cohort between October 1995 and June 1998 as part of an intervention trial of pneumococcal polysaccharide vaccine. Participants were routinely reviewed every 6 months and had open access to the clinic when unwell. Standard protocols were followed for investigation and management of illness. Microbiological investigations followed standard procedures. RESULTS 1372 (71% female) study participants were followed for 2141 person years of observation (pyo). Rhodococcus equi was isolated from three study participants from blood, a lymph node aspirate and stool. The individuals were undergoing investigation of acute pneumonia, acute cough with cervical lymphadenopathy and chronic fever with wasting, respectively. The clinical features of these cases are described. All had a CD4 T-cell count of <300/ml. The rate of R. equi infection in the cohort was 1.4/1000 pyo. There were 132 cases of pulmonary and extrapulmonary tuberculosis in the cohort which were diagnosed either microbiologically or clinically. The rate of laboratory confirmed mycobacterial disease was 50.1/1000 pyo. The ratio of mycobacterial disease to R. equi disease was 36:1 (95% CI 11-113:1). CONCLUSIONS Rhodococcus equi infection occurs in HIV-1 infected adults in Africa. The infection is clinically indistinguishable from pulmonary and extra-pulmonary tuberculosis in the cohort described here. Although the rate of R. equi disease is much less than that of tuberculosis, it is important to consider it in the differential diagnosis of tuberculous infection in cases which are smear negative. Rhodococcus equi infection is probably underdiagnosed in Africa due to a lack of microbiological facilities and its resemblance to common commensal organisms.
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Affiliation(s)
- K J Gray
- MRC Programme on AIDS, Entebbe, Uganda
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