Infective endocarditis: a rare organism in an uncommon setting

Facklamia lactis sp. nov., isolated from raw milk

Two strains of a Gram-staining-positive species were isolated from German bulk tank milk. On the basis of their 16S rRNA sequences they were affiliated to the genus Facklamia but could not be assigned to any species with a validly published name. Facklamia miroungae ATCC BAA-466^T (97.3 % 16S rRNA sequence similarity), Facklamia languida CCUG 37842^T (96.9 %), and Facklamia hominis CCUG 36813^T (96.6 %) are the closest relatives. In the 16S rRNA phylogeny and in the core-genome phylogeny strains WS 5301^T and WS 5302 form a well-supported, separate lineage. Pairwise average nucleotide identity calculated using MUMmer (ANIm) between WS 5301^T and type strains of other Facklamia species is well below the species cut-off (95 %) and ranges from 83.4 to 87.7 %. The DNA G+C content of the type strain is 36.4 mol% and the assembly size of the genome is 2.2 Mb. Cells of WS 5301^T are non-motile, non-endospore-forming, oxidase-negative, catalase-negative and facultatively anaerobic cocci. The fastidious species grows at 10-40 °C and with up to 7.0 % (w/v) NaCl in BHI supplemented with 5 g l^-1 yeast extract. Major polar lipids are phosphatidylglycerol, diphosphatidylglycerol and two glycolipids. Predominant fatty acids are C_16 : 1ω9c and C_18 : 1ω9c. On the basis of their genomic, physiological and chemotaxonomic characteristics the strains examined in this study represent the same, hitherto unknown species. We propose the name Facklamia lactis sp. nov. for which WS 5301^T (=DSM 111018^T=LMG 31861^T) is the type strain and WS 5302 (=DSM 111019=LMG 31862) is an additional strain of this novel species.

Facklamia hominis bacteremia after transurethral resection of the prostate: a case report

Background

Transurethral resection of the prostate (TUR-P) is one of the most frequent routine procedures in urology. Because of the semisterile environment, postoperative infections, including sepsis, are a common complication, with Escherichia coli, Klebsiella spp., Proteus mirabilis or Enterococcus faecalis as frequently isolated pathogens. Facklamia hominis is a gram-positive, facultatively anaerobic, alpha-hemolytic, catalase-negative coccus that was first described in 1997. To date, only a few cases of infectious complications have been described. We report the first case of postoperative bacteremia due to Facklamia hominis after TUR-P.

Case presentation

An 82-year-old man developed fever only a few hours after elective TUR-P because of benign prostate syndrome. After cultivation of blood cultures, antibiotic therapy with ceftriaxone was intravenously administered and changed to oral cotrimoxazole before discharge of the afebrile patient. One anaerobic blood culture revealed Facklamia hominis. Under antibiotic therapy, the patient remained afebrile and showed no signs of infections during follow-up.

Conclusions

Fever and bacteremia are frequent complications after TUR-P. This study is the first report of Facklamia hominis in a postoperative blood culture after TUR-P. To date, there are only a few reports of patients with infectious complications and isolation of Facklamia hominis in various patient samples. Because Facklamia hominis resembles viridans streptococci on blood agar analysis, this pathogen may often be misidentified. In this case identification of Facklamia hominis was possible with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. It has been postulated that Facklamia hominis might be a facultative pathogen and that its incidence will increase in the future.

[Unusual complication following placement of an epidural catheter]

We report an unusual complication following placement of a thoracic epidural catheter in a patient that had undergone surgery for pulmonary metastases of a malignant melanoma. The intra- and postoperative course was initially without complications. At 2 days, there was a small, conspicuous swelling above the site of epidural puncture, which was neither reddened nor painful. No neurological deficits were observed, and the patient explained that he had been aware of the swelling for more than 6 months; thus, the epidural catheter was not deemed to be responsible. After catheter removal on day 4, an apparently purulent fluid drained from the puncture site. Although the patient had not reported this in the initial medical examination, he now explained that this cutaneous process had been squeezed out by his wife several times before. We initially obtained an exudate by means of ultrasound-guided puncture, and two epidermal cysts were detected on subsequent magnetic resonance imaging (MRI). The epidural catheter had been placed through one of these epidermal cysts. After reassessing the medical files, we found the earlier reports of two positron emission tomographies in which two epidermoid cysts were described at the level of thoracic vertebra 5/6 and 6/7. Facklamia hominis was detected in the pure culture. To avoid bacterial infection, we treated the patient for 7 days with antibiotics. The clinical course was without further pathological findings.

Facklamia Species as an Underrecognized Pathogen

Facklamia species are a rarely reported etiology of clinical infection with few cases described in literature. However, the prevalence of infection may be underestimated due to challenges in species identification. We describe 3 cases of Facklamia species bacteremia and the unique microbiologic aspects inherent to this genus that make it particularly challenging to identify. In addition, given the unique susceptibility profile of Facklamia species, we discuss the importance of fully identifying this organism when it is a suspected as a pathogen, to optimize therapy based on its distinct antibiotic resistance profile.

Facklamia hominis scapula abscess, Marseille, France

Facklamia hominis is a Gram-positive bacterium that was first isolated from various human samples, excluding abscesses of the scapula. We here report the first scapular abscess infection due to F. hominis, found in Marseille, France. We also reviewed all cases published in the literature.