Arcanobacterium haemolyticum associated with pyothorax: case report

Polymicrobial arcanobacterium haemolyticum intracerebral abscess: A case report and review of the literature

Objective

This article describes a case of polymicrobial Arcanobacterium haemolyticum pharyngitis and sinusitis complicated by intracranial complications and reviews similar cases in the literature.

Case summary

A 21-year-old immunocompetent male presented with symptoms of sore throat, rhinorrhoea, lethargy, headache, and rash. Imaging demonstrated sinusitis, pre-septal sinusitis, peritonsillar abscess formation, subdural empyema and cerebritis. He was managed with endoscopic sinus surgery, craniotomy for evacuation of subdural empyema and antibiotics. Microbiological samples demonstrated growth of A. haemolyticum, strep. anginosus, and fusobacterium necrophorum. He subsequently developed a cerebral abscess requiring stereotactic needle drainage. After a prolonged course of antibiotics, the patient was discharge and made a good recovery.

Discussion

A. haemolyticum is an uncommon cause of non-streptococcal pharyngitis that may occur alongside other microorganisms and is rarely associated with severe intracranial complications. This organism and its antibiotic susceptibility patterns should be considered in complicated upper respiratory tract infections in immunocompetent hosts. Penicillins and macrolide antibiotics form the mainstay of therapy for A. haemolyticum.

Pyothorax Caused by Arcanobacterium haemolyticum and Staphylococcus aureus Co-infection: A Case Report

Arcanobacterium haemolyticum causes pharyngeal and skin lesions but rarely causes severe systemic infections. An 80-year-old woman with diabetes mellitus was admitted for surgery of a left femoral neck fracture and right first toe ulcer. On day 19, chest radiography revealed a massive left pleural effusion.Pleural fluid culture grew Staphylococcus aureus and A. haemolyticum. The fluid was drained via a chest tube, and the patient was treated with cefazolin and clindamycin. Only four cases of pyothorax caused by A. haemolyticum have been reported, and no previous cases of A. haemolyticum pyothorax with bacterial co-infections have been reported.

Arcanobacterium haemolyticum bacteremia presenting as severe sepsis: A case report and review of the literature

Objective

to describe a case of severe sepsis and complicated bacteremia caused by Arcanobacterium haemolyticum and review similar cases in the literature.

Case summary

A 26-year-old gentleman with a history of epilepsy presented with symptoms of sore throat, productive cough, periumbilical abdominal pain, watery diarrhea, nausea and vomiting, subjective fevers along with progressive jaundice for seven days. The patient had acute fulminant liver failure, septic shock, and Multi-organ failure. He required vasopressors, underwent intubation, and had grown Arcanobacterium haemolyticum in the blood and Bronchoalveolar lavage samples. He developed a peritonsillar abscess and cavitary pneumonia and required chest tube drainage followed by thoracotomy for hemothorax. The patient improved on Ampicillin-Sulbactam treatment and was treated with a total antibiotic duration of 6 weeks. He fully improved on post-discharge follow-up.

Discussion

Arcanobacterium haemolyticum is a Gram-positive (sometimes Gram variable), catalase-negative facultatively anaerobic, non-motile, non-spore-forming, and variably β-hemolytic and is known to be a cause of pharyngitis and skin and soft tissue infections. Rarely A. Haemolyticum can be associated with severe systemic infections such as infective endocarditis, systemic abscesses, osteomyelitis, and septicemia. In previous literature reviews, the source of A. haemolyticum depended on the host, and pharyngeal and upper respiratory sources were likely to be associated with immunocompetent hosts.

Conclusion

A. haemolyticum should be included in the differential diagnosis of bacterial pharyngitis complicated by severe systemic illness. Penicillins are the most commonly used antibiotics for treating A. haemolyticum bacteremia, and macrolides can be used for Penicillin's treatment failure.

Arcanobacterium haemolyticum CNS abscess and bacteremia following head trauma: a case report and literature review

Arcanbacterium haemolyticum is an uncommon cause of pharyngitis with rash that occurs predominantly among adolescents and that has been only rarely implicated in severe or systemic infections. We report a case of subdural empyema and bacteremia due to A. haemolyticum in an adolescent woman following physical assault with trauma to the head, which required neurosurgical intervention combined with prolonged antibiotic therapy. We additionally describe the previous occurrences of A. haemolyticum culture positivity recorded over a fifteen-year period by the microbiology laboratories of the two large academic medical centers at which this patient received care, and review the epidemiology, laboratory identification, and treatment of this unusual pathogen.

Orbital necrotizing fasciitis and osteomyelitis caused by arcanobacterium haemolyticum: a case report

The facial region is infrequently affected by necrotizing infections. Orbital necrotizing infections are even rarer, seen following trauma, local skin infection, and sinusitis. The authors report a unique case of orbital necrotizing fasciitis and osteomyelitis resulting from Arcanobacterium Haemolyticum ethmoid sinusitis. No prior occurrences of Arcanobacterial species orbital necrotizing fasciitis/osteomyelitis have been reported.A 16-year-old boy presented to the ER with a 3-day history of fever, chills, headache, and sinus pressure. CT scan revealed soft tissue swelling of the right orbit, forehead, and ethmoid sinusitis. Within 24 hours of admission, he suffered rapidly progressive swelling and erythema of the right orbit and forehead with diminished visual acuity, despite broad-spectrum antibiotics. Orbital exploration revealed frankly necrotic fascia and periosteum along the superior aspect. Lateral canthotomy, cantholysis, decompression of the optic nerve, and soft tissue debridement with bone biopsy was performed. Operative specimens isolated Arcanobacterium Haemolyticum. Pathologic examination revealed right orbital osteomyelitis.

Arcanobacterium haemolyticum in a badger (Meles meles)

A 7.5-kg female European badger ( Meles meles) was submitted under the United Kingdom Government’s Wildlife Incident Investigation Scheme to the Thirsk Regional Laboratory of the Animal Health and Veterinary Laboratories Agency. Postmortem examination revealed a large, poorly encapsulated retropharyngeal abscess full of necrotic debris and pus. Arcanobacterium haemolyticum was isolated from the lymph node and confirmed by phenotypic profiling and 16S ribosomal RNA DNA sequencing. Workers should be aware of the potential for badgers to harbor zoonoses other than those more traditionally associated with the species.

Infective endocarditis caused by Arcanobacterium haemolyticum: a case report

Arcanobacterium haemolyticum is an organism that commonly causes pharyngitis and wound infections. It does not usually cause systemic invasive disease. The organism presents a difficult diagnostic problem because the Clinical Microbiology laboratory has a propensity to view them as diphtheroid organisms of the Corynebacterium species, thus contaminants or normal flora. We describe a case of a 21-year-old female who had endocarditis with cerebral emboli due to Arcanobacterium haemolyticum. This rare condition is associated with significant mortality and to the best of our knowledge; this is the first successfully treated case of A. haemolyticum endocarditis complicated by embolic phenomenon.

Severe sepsis caused by Arcanobacterium haemolyticum: a case report and review of the literature

OBJECTIVE

To describe a case of severe sepsis, cavitary pneumonia, and pyomyositis caused by Arcanobacterium haemolyticum.

CASE SUMMARY

An 18-year-old male with a medical history significant for mild asthma presented to the emergency department complaining of a 7-day history of fever, diffuse myalgias, nausea, vomiting, diarrhea, and pain in his right upper quadrant, right shoulder, and left thigh. Cultures of blood, bronchoalveolar fluid, and surface and surgical swabs from the patient's left lower extremity grew A. haemolyticum. The patient was successfully treated with intravenous penicillin G 4 million units every 4 hours and azithromycin 500 mg once daily for 14 days. Within 36 hours after initiation of focused therapy, he became afebrile, pain decreased, and pulmonary symptoms abated. Oral azithromycin 500 mg/day for an additional 3 weeks was prescribed on discharge, and the patient showed no relapse at 2-month follow-up.

DISCUSSION

A. haemolyticum is a weakly acid-fast, branching gram-positive bacillus most commonly implicated in pharyngitis in healthy adolescents and skin and soft-tissue infections in older, immunocompromised patients. Systemic infections are rarely reported in the literature. This organism remains susceptible to most classes of antimicrobials, including penicillins, cephalosporins, carbapenems, macrolides, tetracyclines, clindamycin, and vancomycin. Routine resistance has been reported only with trimethoprim/sulfamethoxazole.

CONCLUSIONS

To our knowledge, there are no published case reports of severe sepsis caused by A. haemolyticum. While treatment options are numerous, we recommend the use of intravenous penicillin or a cephalosporin as first-line pharmacologic management of deep-seated infections caused by this rare organism.