Corynebacterium jeikeium pacemaker infection associated with antineutrophil cytoplasmic antibodies: a single positive blood culture could be sufficient for diagnosis

Clinical Characteristics of Corynebacterium Bacteremia Caused by Different Species, Japan, 2014-2020

Corynebacterium bacteremia is most commonly caused by C. striatum or C. jeikeium.

To determine differences in clinical characteristics of patients with bacteremia caused by Corynebacterium striatum, C. jeikeium, and other species of Corynebacterium, we retrospectively reviewed medical records of patients in Japan who had Corynebacterium bacteremia during January 2014–May 2020. Of the 115 records evaluated, 60 (52%) were cases of true bacteremia and 55 (48%) were cases of contamination. Proportions of true bacteremia cases caused by C. striatum (70%) and by C. jeikeium (71%) were significantly higher than those caused by other species of Corynebacterium (9%). These 2 organisms were commonly detected in blood cultures of patients with hematologic malignancies and neutropenia. The mortality rates at 90 days were 34% (C. striatum), 30% (C. jeikeium), and 0 (other species). Given the high mortality rates, assessing true bacteremia when C. striatum or C. jeikeium is detected in blood cultures, especially in patients with hematologic malignancy, is warranted.

Corynebacterium Jeikeium Endocarditis: A Review of the Literature

Corynebacterium jeikeium is a gram-positive, aerobic, pleomorphic, nonspore forming bacillus, commonly present on the skin surface. Infective endocarditis secondary to C. jeikeium most commonly affects left-sided heart valves and has a higher likelihood to require valve replacement compared to other Corynebacterium endocarditis. C. jeikeium endocarditis is extremely difficult to treat as it is characteristically resistant to penicillin, cephalosporins and aminoglycosides, and sensitivity to quinolones, macrolides, tetracyclines and rifampin is variable. Despite treatment, mortality rates as high as 33% have been reported. We hereby review the literature regarding the epidemiology, diagnosis and treatment of this deadly microorganism.

LVAD Vasculitis Case Series: Suggestion of a New Fatal LVAD-Related Phenomenon

Left ventricular assist devices (LVADs) are surgically implanted mechanical devices indicated for patients with advanced heart failure and are known to come with several complications. Here we present a case series, and review 1 documented report, of LVAD vasculitis, a presumed new LVAD immune/humoral related phenomenon. (Level of Difficulty: Advanced.)

Microbial levels on street foods and food preparation surfaces in Mangaung Metropolitan Municipality

Background

The street food sector has become an important component of the food distribution system in many cities in both developing and industrialised countries, particularly for midday meals. However, certain street food can pose a significant risk to consumers because of microbiological contamination.

Aim

The aim of this study was to determine the microbial levels of street foods and preparation surfaces in Mangaung Metropolitan Municipality.

Setting

The study selected study setting was vending sites close to taxi ranks where prepared meals were accessible to consumers.

Methods

The study was conducted in Mangaung Metropolitan Municipality during the winter season. Samples were collected through convenience sampling from the representative towns Thaba Nchu, Botshabelo and Bloemfontein. Using swabs, surface samples were collected and quantified from selective media. Eight beef samples were also collected; the microbial load on each sample was quantified and identified using a RapID kit.

Results

The surface swabs obtained in Botshabelo (1.1 × 10⁴ cfu/m² – 1.1 × 10⁶ cfu/m²) showed higher microbial counts as compared to those obtained in Bloemfontein (1.1 × 10⁴ cfu/m² – 1.1 × 10⁵ cfu/m²) and Thaba Nchu (1.1 × 10⁴ cfu/m² – 1.1 × 10⁵ cfu/m²). Higher microbial counts were observed on meat samples sampled in Thaba Nchu (50 cfu/g x 10⁵ cfu/g), Bloemfontein (48 cfu/g x 10⁴ cfu/g) and Botshabelo (33 cfu/g x 10⁵ cfu/g) when compared to international microbiological standards. After assessing the microbial levels, Staphylococcus aureus, Escherichia coli, Candida guilliermondii, Corynebacterium jeikeium, Psychrobacter phenylpyruvicus and Peptostreptococcus tetradius were identified.

Conclusion

This study confirmed contamination of surfaces and food served by vendors in Mangaung Metropolitan Municipality. The identified foodborne bacteria could pose a public health problem in each specific locality.

Corynebacterium jeikeium-induced infective endocarditis and perivalvular abscess diagnosed by 16S ribosomal RNA sequence analysis: A case report

INTRODUCTION

Corynebacterium jeikeium normally presents on human skin, and it is often judged as contamination when it is cultured from blood. C. jeikeium can cause infective endocarditis, especially, that associated with cardiac surgery and prosthetic valvular endocarditis.

CASE REPORT

A 66-year-old Japanese male patient was diagnosed with C. jeikeium-induced infective endocarditis (IE) and perivalvular abscess after a coronary artery bypass grafting and aortic valve replacement with bioprosthesis; pyogenic spondylodiscitis was also observed. Patch repair for aortic valve annulus and re-Bentall procedure with bioprosthesis was performed for IE and perivalvular abscess. The causative bacterium was confirmed as C. jeikeium on 16S ribosomal RNA sequencing of surgical sample and positive blood culture. The patient underwent six weeks of intravenous antibacterial treatment with vancomycin and an additional two weeks of oral treatment with linezolid, following which, his condition improved. Corynebacterium jeikeium can cause infective endocarditis and perivalvular abscess, which is a more severe condition than IE.

CONCLUSION

16S ribosomal RNA sequencing is useful in diagnosing bacterial species that can cause contamination, such as Corynebacterium spp.

Corynebacterium jeikeium endocarditis: A case report and comprehensive review of an underestimated infection

Diphtheroids are gram-positive pleomorphic bacilli in the family of Coryneform bacteria. These organisms are present as part of the human flora. Past practice habits had been to consider them as contaminants when isolated from clinical samples. Corynebacterium jeikeium is one of the most clinically important nondiphtherial Corynebacteria that can cause different forms of infections specifically in patients with underlying risk factors and co-morbidities including immunocompromised subjects. Through this article, we present a 67-year-old gentleman with extensive co-morbidities including heart failure with reduced ejection fraction and ESRD on hemodialysis through a femoral catheter who presented with chest pain and fatigue. Further investigation confirmed diagnosis of C. jeikeium endocarditis. We go on to review previously reported cases of C. jeikeium endocarditis and we will discuss different aspects of C. jeikeium infection with a focus on microbiology, pathophysiology, and treatment.

Can implantable cardiac electronic device infections be defined as ‘early’ or ‘late’ based on the cause of infection?

Implantable cardiac electronic device (ICED) infections are a major cause of morbidity and mortality. Understanding the pathogenesis of these infections is important in their prevention and management. We hypothesized that ICED infections could be classified as ‘early’ or ‘late’, based on differences in microbiological cause within or beyond 1 year of implantation, respectively. A comprehensive review of the literature was undertaken to test this hypothesis. Prosthetic valve endocarditis cases were included for comparison. Articles were included if the time from device implantation to infection, definite evidence of infection (pocket/bacteraemia/endocarditis) and a positive microbiological diagnosis were included. There were no statistically significant differences in microbiology to support a 1 year cut-off between early and late ICED infection. Staphylococcus aureus and coagulase-negative staphylococci were the predominant causes of ICED infection both within and beyond 1 year of ICED implantation. To further assess the microbiological causes of ICEDs and their implications for pathogenesis a large-scale multi-centre study is required.

Glomerular disease in patients with infectious processes developing antineutrophil cytoplasmic antibodies

To identify differences in treatment and outcome of various types of glomerulonephritis developing in the course of infections triggering antineutrophil cytoplasmic antibody (ANCA) formation, we analyzed published reports of 50 patients. Immunosuppressives were added to antibiotics in 22 of 23 patients with pauci-immune glomerulonephritis. Improvement was noted in 85% of 20 patients with information on outcomes. Death rate was 13%. Corticosteroids were added to antibiotics in about 50% of 19 patients with postinfectious glomerulonephritis. Improvement rate was 74%, and death rate was 26%. Two patients with mixed histological features were analyzed under both pauci-immune and post-infectious glomerulonephritis categories. In 9 patients with other renal histology, treatment consisted of antibiotics alone (7 patients), antibiotics plus immunosuppressives (1 patient), or immunosuppressives alone (1 patient). Improvement rate was 67%, permanent renal failure rate was 22%, and death rate was 11%. One patient with antiglomerular basement disease glomerulonephritis required maintenance hemodialysis. Glomerulonephritis developing in patients who became ANCA-positive during the course of an infection is associated with significant mortality. The histological type of the glomerulonephritis guides the choice of treatment. Pauci-immune glomerulonephritis is usually treated with addition of immunosuppressives to antibiotics.