A Case of Streptococcus gallolyticus subsp gallolyticus Infective Endocarditis with Colon Cancer: Identification by 16S Ribosomal DNA Sequencing

Although the association between Streptococcus bovis endocarditis and colon carcinoma is well known, very few cases of S. bovis infection associated with underlying malignancies have been reported in Korea The S. bovis group has been recently reclassified and renamed as Streptococcus gallolyticus and Streptococcus infantarius subspecies under a new nomenclature system. We report a case of infective endocarditis with colon cancer caused by S. gallolyticus subsp. gallolyticus (previously named S. bovis biotype 1). A 59-yr-old woman presented with a 1-month history of fever. Initial blood cultures were positive for gram-positive cocci, and echocardiography showed vegetation on mitral and aortic valves. Antibiotic treatment for infective endocarditis was started. The infecting strain was a catalase-negative and bile-esculin-positive alpha-hemolytic Streptococcus susceptible to penicillin and vancomycin. The strain was identified as S. gallolyticus subsp. gallolyticus with the use of the Vitek 2 GPI and API 20 Strep systems (bioMerieux, USA). The 16S rDNA sequences of the blood culture isolates showed 100% homology with those of S. gallolyticus subsp. gallolyticus reported in GenBank. The identification of the infecting organism, and the subsequent communication among clinical microbiologists and physicians about the changed nomenclature, led to the detection of colon cancer. The patient recovered after treatment with antibiotics, valve surgery, and operation for colon cancer. This is the first report of biochemical and genetic identification of S. gallolyticus subsp. gallolyticus causing infective endocarditis associated with underlying colon cancer in a Korean patient. (Korean J Lib Med 2010;30:160-5)Herrero IA, 2002, J CLIN MICROBIOL, V40, P3848, DOI 10.1128/JCM.40.10.3848-3850.2002Beck M, 2008, J CLIN MICROBIOL, V46, P2966, DOI 10.1128/JCM.00078-08Poyart C, 2002, INT J SYST EVOL MICR, V52, P1247, DOI 10.1099/js.0.02044-0Clarridge JE, 2001, J CLIN MICROBIOL, V39, P1549KOH DW, 2001, KOREAN J GASTROINTES, V23, P503Schlegel L, 2000, INT J SYST EVOL MICR, V50, P1425Ellmerich S, 2000, CARCINOGENESIS, V21, P753KWACK KK, 2000, KOREAN J MED, V59, P198Devriese LA, 1998, J CLIN MICROBIOL, V36, P3520COYKENDALL AL, 1989, CLIN MICROBIOL REV, V2, P315Schlegel L, 2003, INT J SYST EVOL MICR, V53, P631, DOI 10.1099/ijs.0.02361-0UH Y, 2006, KOREAN J CLIN MICROB, V9, P36RUOFF KL, 1989, J CLIN MICROBIOL, V27, P305FARROW JAE, 1984, SYST APPL MICROBIOL, V5, P467WILSON WR, 1981, JAMA-J AM MED ASSOC, V245, P360KLEIN RS, 1979, ANN INTERN MED, V91, P560KLEIN RS, 1977, NEW ENGL J MED, V297, P800MC CW, 1951, J MED ASS STATE ALA, V21, P162

IS6110-Restriction Fragment Length Polymorphism and Spoligotyping Analysis of Mycobacterium tuberculosis Clinical Isolates for Investigating Epidemiologic Distribution in Korea

The Beijing family of Mycobacterium tuberculosis has been emerging in the world. However, there are few nationwide data of genotypic distribution in Korea. This study aimed to identify the genotypic diversity of clinical isolates of M. tuberculosis and to demonstrate the population of Beijing family in Korea. We collected 96 clinical M. tuberculosis isolates from 11 university hospitals nationwide in Korea from 2008 to 2009. We observed 24 clusters in IS6110-RFLP analysis and 19 patterns in spoligotyping. Seventy-five isolates were confirmed to be Beijing family. Two isolates of the K strain and 12 isolates of the K family strain were also found. We found that drug resistance phenotypes were more strongly associated with Beijing family than non-Beijing family (P=0.003). This study gives an overview of the distribution of genotypes of M. tuberculosis in Korea. These findings indicate that we have to pay more attention to control of M. tuberculosis strains associated with the Beijing family

Detection and biovar discrimination of Ureaplasma urealyticum by real-time PCR

Prenatal intrauterine infection has been recognized as an important cause of premature birth, and Ureaplasma urealyticum is one of the commonest pathogens. U. urealyticum consists of 14 serovars that can be divided into two biovars (parvo and T960), and the pathogenicity of U. urealyticum may be different according to the biovar. To detect U. urealyticum and determine its biovar simultaneously, we developed a real-time polymerase chain reaction (PCR) assay targeting urease gene. The real-time PCR biovar-typed two reference strains and 42 culture isolates of U. urealyticum as correctly as conventional PCR with direct sequencing. Subsequently, 87 clinical specimens (amniotic fluid, cord blood, vaginal swab) were tested for culture, conventional PCR, and real-time PCR. When compared with conventional PCR, sensitivity and specificity of real-time PCR were 89.5 and 98.5%, respectively, and those of culture were 47.4 and 100%, respectively. Of 18 clinical specimens that were found positive and biovar-typed by real-time PCR, parvo biovar was 66.7% and T960 biovar was 33.3%. This real-time PCR assay can be useful for the simultaneous detection and biovar discrimination of U. urealyticum in clinical specimens. Further study to quantify U. urealyticum would be facilitated on the basis of this method

Melioidosis presenting as a mycotic aneurysm in a Korean patient, diagnosed by 16S rRNA sequencing and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

A case of melioidosis with a mycotic aneurysm is reported. The blood and tissue isolates were identified as three different species of Burkholderia using the automated identification systems, VITEK 2 and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The isolate was confirmed as Burkholderia pseudomallei by 16S rRNA sequencing. The typical features of the Gram staining of colonies and 16S rRNA sequencing can be useful to identify B. pseudomallei

Severe cytomegalovirus colitis with hemolytic anemia mimicking travelers’ diarrhea

A case of cytomegalovirus (CMV) colitis mimicking travelers’ diarrhea following short-term travel is reported. The patient was a Croatian man visiting Korea for work. He presented with fever and severe bloody diarrhea. He was diagnosed with a primary CMV infection complicated with CMV colitis and hemolytic anemia and recovered with antiviral therapy and concomitant steroid therapy