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A Rare Presentation of Community-acquired Pneumonia Caused by Corynebacterium pseudodiptheriticum: A Case Report.

A Rare Presentation of Community-acquired Pneumonia Caused by Corynebacterium pseudodiptheriticum: A Case Report.

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 TRANSLATIONAL BIOMEDICINE
iMedPub Journals
2010Vol.1No. 2:1
doi: 10:3823/408
A Rare Presentation o Community-acquired Pneumonia Caused by
Corynebacterium pseudodiptheriticum
: A Case Report.
Addison Parris
1
, Jane S. Tang
2
and Ganesh D. Kini *
3
1,3
 
Departments o Inectious Diseases and Internal Medicine; The Rockingham Memorial Hospital. 2010 Health Campus Drive, Harrisonburg, VA22801, USA.
2
 
Noblis. Falls Church, VA 22042, USA. *Corresponding Author
Introduction
Corynebacterium
species are ubiquitous and capable o resi-ding in dierent ecological niches. In healthcare settings, theyare ound as commensals o the skin and mucous membra-nes which oten appear as contaminants in clinical specimens[1].
C. pseudodiptheriticum
, in particular, is a member o theoropharyngeal ora and it can potentially cause inection in therespiratory system [2, 3]. In act, published cases indicate thisorganism is capable o inecting immune-defcient as well asimmune-competent patients [1, 4].Among the many etiological agents causing nosocomial pneu-monia or community- acquired pneumonia,
C. pseudodiptheriti-cum
is usually not considered as one o the causative pathogensin spite o clinical evidence indicating this bacterium has beeninvolved in upper and lower respiratory inections o sizableproportions [3, 5]. Furthermore, several reports concluded that
© Under License o Creative Commons Attribution 3.0 License This article is available rom:http://www.transbiomedicine.com
C. pseudodiptheriticum
was responsible or causing pneumoniain HIV-inected patients [4, 6].In this paper, we present a case o pneumonia resulting rom
C. pseudodiptheriticum
inection. Initial diagnostic studies did notidentiy this causative agent. It was recovered rom bronchialalveolar lavage samples ater unsuccessul initial treatment.
Case:
A 69 year old Caucasian woman with a history o asthma, chro-nic and intermittently productive cough or over two yearspresented to her primary care physician or a routine visit orher
Diabetes Mellitus
management. At that time, she did havea productive cough which became progressively worse overthe course o the month prior to this clinic visit. At that time, aCT scan o the chest was ordered as routine ollow-up or some
Background:
As a normal ora in the upper respiratory tract,
Corynebacterium
(C.)
 pseudodiptheriticum
is not otenconsidered as the causative bacterium or community-acquired pneumonia.
Findings:
In this case report, a patient with bronchiectasis was initially suspected as being inected with
Mycobacteriumavium
. When antibiotic treatment was not successul, bronchial alveolar lavage was obtained or microbiological cultur-ing. Once
C. pseudodiptheriticum
was recovered rom this less-requently requested respiratory sample, its antibioticsusceptibility profle was obtained to allow appropriate antimicrobial intervention to arrest the inection. The patientexperienced ull recovery.
Conclusion:
This report shows the importance o considering non-routine, sometimes invasive clinical specimens tomake a diagnosis. Furthermore, commensal microbes should not be dismissed as possible etiological agents in pulmo-nary inections.
 
 TRANSLATIONAL BIOMEDICINE
iMedPub Journals
2010Vol.1No. 2:1
doi: 10:3823/408
lung nodules seen at a prior hospitalization earlier that year.While the nodules were unchanged, patchy airspace diseaseinvolving the let lower lobe was noted. The patient’s past medical history included Non Insulin De-pendent
Diabetes Mellitus
, hyperlipidemia, hypertension, bron-chiectasis, asthma, rheumatic ever at age 22 and Bell’s palsy.Her medical issues, other than the productive cough, were sta-ble on medications.As a result o the patient’s persistent cough, several sputum sam-ples were obtained or culture. One o her many samples grew
Mycobacterium avium intracellulare
(MAI). Since the patient’sclinical presentation and imaging reports were suggestive o alung inection, she was treated or MAI. Subsequently, the pa-tient was prescribed Biaxin, ethambutol and riampin. Unortu-nately, the patient did not tolerate these medications well andher symptoms were not improving ater our weeks o therapy.Given these fndings, she was reerred to an Inectious Diseasespecialist or urther evaluation and management. The initial assessment indicated the patient was likely coloni-zed with MAI. A high resolution CT scan was obtained. This stu-dy showed evidence o bronchiectasis involving the basal seg-ments o both lobes as well as an area in the lingular region o the let upper lobe. The patient was reerred to a Pulmonologistor a bronchoscopy.Bronchial alveolar lavage samples rom both lungs were cultu-red by plating on blood agar, EMB and chocolate agar. Grampositive rods in the orm o diptheroids were noted, and 24,000colony orming units (cu) o 
Corynebacterium
species appearedon media plates. Subsequently, these colonies were identifedas
C. pseudodiptheriticum
by Vitek 2 ANC card (BioMérieux, Inc.,Durham NC). Fungal cultures were negative ater two weeks o incubation, and no acid ast bacilli were detected in multiplelung lavage and sputum specimens (14 in total). Incidentally,
Stenotrophomonas maltophilia
showed up as a minor popula-tion (cu less than 1/10th o 
C. pseudodiptheriticum
).
C. pseudodiptheriticum
was subjected to disk-diusion testingaccording to published CLSI (Clinical and Laboratory StandardsInstitute, ormerly NCCLS) guidelines to determine its antibioticsusceptibility profle. The bacterium was susceptible to amoxi-cillin/clavulanate, cephalothin, ciprooxacin, gentamicin, levo-oxacin, penicillin, trimethoprim/sulamethoxazole and van-comycin; on the other hand, it was resistant to clindamycin anderythromycin.Empirically, the patient was placed on a 10 day course o Leva-quin pending susceptibility results or the
Corynebacterium
iso-late.
Stenotrophomonas maltophilia
was not treated due to itslow number and very small colony ormation seen rom cultu-ring o the bronchial lavage samples. The patient was ollowed
© Under License o Creative Commons Attribution 3.0 License This article is available rom:http://www.transbiomedicine.com
up a ew days later with signifcant clinical improvement. Atthat time, the patient’s susceptibility data was available. Sincethe bacterial isolate was susceptible to Levaquin, this antibioticwas continued or another 4 days or a total o 14-day therapy.Following the treatment course, the patient did quite well withresolution o her purulent sputum producing cough.
Discussion
As a non-ermenting species o 
Corynebacterium
,
C. pseudodip-theriticum
is part o the normal oropharyngeal ora and it hasbeen documented to cause respiratory tract inections and en-docarditis [1-3]. Unlike
C. diptheriae
, this organism is oten ne-glected during routine clinical microbiology laboratory analy-sis. Nevertheless, it has been reported in cases o prostheticinections, sot tissue wounds, keratitis, conjunctivitis, and jointinections [1, 7]. In addition to recovering rom respiratory tractspecimens,
C. pseudodiptheriticum
isolates have been associa-ted with inections in the urinary system as well as intravenoussites rom patients o dierent age groups and immunologicstatus [8].
C. pseudodiptheriticum
is among the many pathogens respon-sible or causing pneumonia [5]. Concerns have been raised orits role in immunocompromised patients, especially those withHIV inections [4, 6]. There is evidence indicating this bacteriumcan potentially inect immunocompetent individuals as well [1].Although not as prevalent as some other respiratory pathogensin causing community-acquired pneumonia (CAP), the numbero CAP incidences with
C. pseudodiptheriticum
was signifcantenough to raise concerns in the medical community [9]. This report describes a case o CAP that was acquired prior to aroutine doctor visit. The clinical eatures associated with bron-chiectasis were frst thought to be caused by MAI. When thepatient did not respond to medications and her symptomswere not subsiding, a decision was made to obtain bronchialalveolar lavage.
C. pseudodiptheriticum
was cultured and iden-tifed rom this non-routine respiratory specimen. Its antibioticsusceptibility profle, specifcally the resistance to erythromycinand clindamycin, agreed with other reports [10]. Administeringappropriate antimicrobial intervention to the patient allowedsuccessul arresting o her inection.While
C. pseudodiptheriticum
is a rare organism causing CAP,this bacterium can produce a myriad o inections in an immu-nocompromised host. The patient presented in this report didhave a history o bronchiectasis, rheumatoid arthritis and Dia-betes Mellitus. Nevertheless, this case report does not minimizethe importance o recognizing MAI as a commensal organismin someone with pre-existing bronchiectasis. It can potentiallycause severe lung inections in the right clinical setting resul-

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