Primary actinomycosis of the breast caused by Actinomyces turicensis with associated Peptoniphilus harei

Actinomycosis of the breast is a rare disease which may mimic malignancy in presentation. Clinical presentation may make it difficult to distinguish primary actinomycosis from mastitis and inflammatory carcinoma. A 22-year-old lady presented with a 3-week history of right breast pain and greenish discharge through her nipple piercing. Physical examination revealed a palpable fluctuant lump in the upper inner quadrant of the right breast and a nipple jewelry in-situ in the upper inner quadrant of the right breast with an abscess at the edge of the areola. Needle aspiration was performed and microbiological examination of the aspirate isolated Actinomyces turicensis and Peptoniphilus harei. Actinomycosis of the breast is rare and the specie, Actinomyces turicensis, is even rarer especially in association with Peptoniphilus harei. Actinomyces is a difficult organism to treat due to its relative indolent course with potential scarring and disruption of local tissue. However, surgical intervention could be avoided with an intensive course of high-dose intravenous antibiotics and prolonged oral antibiotics afterwards.

Identification of Peptoniphilus harei From Blood Cultures in an Infected Aortic Aneurysm Patient: Case Report and Review Published Literature

Gram-positive anaerobic cocci (GPAC) are a commensal part of human flora but are also opportunistic pathogens. This is possibly the first study to report a case of Peptoniphilus harei bacteremia in an abdominal aortic aneurysm (AAA) patient. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) failed to identify the isolate and molecular analysis confirmed it as P. harei. A comprehensive literature review revealed that P. harei is an emergent pathogen. This study serves as a reminder for practicing clinicians to include anaerobic blood cultures as part of their blood culture procedures; this is particularly important situations with a high level of suspicion of infection factors in some noninfectious diseases, as mentioned in this publication. Clinical microbiologists should be aware that the pathogenic potential of GPAC can be greatly underestimated leading to incorrect diagnosis on using only one method for pathogen identification. Upgradation and correction of the MALDI-TOF MS databases is recommended to provide reliable and rapid identification of GPAC at species level in medical diagnostic microbiology laboratories.

A case of Escherichia coli and Peptoniphilus species mixed osteomyelitis successfully identified by MALDI TOF-MS with a review of the literature

BACKGROUND

Peptoniphilus species are Gram-positive anaerobic cocci that are commensals of the human vagina and gut.

METHODS AND RESULTS

We describe a case of mixed Escherichia coli and Peptoniphilus spp. osteomyelitis identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry as Peptoniphilus harei and present a short literature review.

CONCLUSION

To our knowledge, only six cases of P. harei osteomyelitis have been reported to date.

Peptoniphilus vaginalis bacteremia in a patient with diabetic foot infection: First reported case and literature review

BACKGROUND

Peptoniphilus vaginalis, a Gram-positive anaerobic coccus, is a recently characterized species within the Peptoniphilus genus. No studies have detailed its features. This report documents the first case of P. vaginalis bloodstream infection in a patient with diabetic foot infection, with a review of existing literature.

CASE PRESENTATION

A 55-year-old male presented with multiple skin ulcers on both lower extremities and hyperpyrexia. Blood cultures were conducted, and analysis via matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) revealed two distinct colony morphologies, namely Peptoniphilus spp. and Staphylococcus epidermidis. Discrepancies between MALDI-TOF MS results and biochemical identification prompted 16S rRNA sequencing, which confirmed P. vaginalis. The patient underwent surgical debridement and received intravenous antibiotics (levofloxacin, linezolid, and ornidazole), resulting in favorable recovery.

CONCLUSIONS

This is the first report of P. vaginalis bloodstream infection in a patient with diabetic foot infection. It was observed that conventional biochemical identification methods and MALDI-TOF MS technology may not reliably detect P. vaginalis. In the absence of more advanced molecular methods, P. vaginalis could potentially be misidentified as Peptoniphilus harei, even in the previously published literature. Catalase testing may serve as a pragmatic discriminator in resource-limited settings, which required further validation. This underscores the necessity for employing molecular biology techniques to ensure precise diagnosis and optimize treatment strategies.