Case reportPolymicrobial anaerobic bacteremia due to Atopobium rimae and Parvimonas micra in a patient with cancer
Introduction
Anaerobic microorganisms remain an important cause of bloodstream infection being still an important cause of morbidity. These account for about 5% of positive blood cultures (range 1–17%) depending on patient age, geographic location and patient characteristics [[1], [2], [3]], being those episodes associated with mortality rates between 15 and 35% in adults [4]. Controversial data have been reported regarding trends in incidence of anaerobic bacteremia, with studies reporting increase, stability or a significant decrease in the prevalence [1,5,6]. Most anaerobic bacteremias are caused by Gram-negative bacilli, especially by members of Bacteroides fragilis group, followed by Clostridium, Peptostreptococcus and Fusobacterium species [[1], [2], [3]], and many of these bacteremias are polymicrobial [7,8].
Atopobium rimae and Parvimonas micra, two Gram-positive anaerobic bacteria, have been rarely involved in bloodstream infections. Only few previous reports of bacteremia due to these anaerobes have been published [[9], [10], [11], [12], [13]], and none of them as polymicrobial infection. Moreover, three case reports showed anaerobic bacteremia due to other Atopobium spp [[14], [15], [16]].
We have recently diagnosed a case of polymicrobial bloodstream infection caused by A. rimae and P. micra in a women with cancer. Bloodstream infections caused by these microorganisms are presented based on literature data, and diagnostic methods used discussed.
Section snippets
Case report
A 43-year-old women came to the Emergency Department due to several days history of nausea, vomiting, abdominal pain and fever (38 °C). She was diagnosed of a high degree malignant retroperitoneal leiomiosarcoma four months ago, and she was receiving the 4th cycle of chemotherapy with trabectidine. The physical examination was unremarkable, and in the complete blood count and chemical profile, an increase of C-reactive protein and procalcitonin was observed (206.98 mg/L and 39.71 ng/mL,
Discussion
Predisposing risk factors for anaerobic bloodstream infections mainly include malignant tumors, hematologic malignant diseases, recent surgery such as gastrointestinal or gynecologic, organ transplantation, diabetes mellitus, use of chemotherapy or corticosteroids and undrained abscesses [4]. A study demonstrated an association between anaerobic bacteremia and malignancy, gastrointestinal and genitourinary tracts disease, and Douglas and chest drains [18]. Dental and oral surgery, as well as
Funding
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Conflicts of interest
Authors declare no conflict of interest.
References (28)
The role of anaerobic bacteria in bacteremia
Anaerobe
(2010)Anaerobic infections in children
Microb. Infect.
(2002)- et al.
Bacteremic meningitis caused by Parvimonas micra in an immunocompetent host
Anaerobe
(2015) - et al.
Clinical characteristics associated with mortality of patients with anaerobic bacteremia
Anaerobe
(2016) - et al.
Evaluation of MALDI-TOF mass spectrometry for identification of anaerobic bacteria
Anaerobe
(2014) - et al.
Spiramycin resistance in human periodontitis microbiota
Anaerobe
(2011) - et al.
Is the incidence of anaerobic bacteremia decreasing? analysis of 114,000 blood cultures over a ten-year period
J. Clin. Microbiol.
(2008) - et al.
Are incidence and epidemiology of anaerobic bacteremia really changing?
Eur. J. Clin. Microbiol. Infect. Dis.
(2015) Anaerobic bacteremia
Clin. Infect. Dis.
(1996)- et al.
Reemergence of anaerobic bacteremia
Clin. Infect. Dis.
(2007)
Relevance of routine use of the anaerobic blood culture bottle
J. Clin. Microbiol.
Anaerobic bacterial bacteremia: 12-year experience in two military hospitals
J. Infect. Dis.
A case of bacteremia by Atopobium rimae in a patient with liver cirrhosis
Korean. J. Lab. med
Human case of Atopobium rimae bacteremia
Emerg. Infect. Dis.
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2022, AnaerobeCitation Excerpt :Regarding to the bacteremia-producing strains, most of case reports suggest that Atopobium spp remain susceptible to a wide range of commonly used drugs. A report found that A. rimae isolate was susceptible to all antimicrobials tested [18]. However, high resistance to metronidazole was described in three reports [11,19,20].
Polymicrobial anaerobic sepsis due to Bacteroides fragilis, Eggerthella lenta, Ruminoccocus gnavus, and Bilophila wadsworthia in a patient with myeloproliferative neoplasm
2022, AnaerobeCitation Excerpt :Notably, polymicrobial anaerobic sepsis is associated with a higher mortality [2]. Bacteroides fragilis, a gram-negative bacillus, is the most common anaerobe isolated from blood cultures, followed by Clostridium, Peptostreptococcus, and Fusobacterium species [3]. Because anaerobes are native to the bacterial flora of mucous membranes, bacteremia commonly has an endogenous origin [4].
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2022, Encyclopedia of Infection and ImmunityThe canine skin and ear microbiome: A comprehensive survey of pathogens implicated in canine skin and ear infections using a novel next-generation-sequencing-based assay
2020, Veterinary MicrobiologyCitation Excerpt :The clustering observed for different bacteria was supported by two other analyses, co-occurrence and correlation, which showed two distinct clusters of multispecies consortia. Of special interest here were P. harei and Parvimonas micra, both Gram-positive, anaerobic cocci commonly associated with polymicrobial infections (Cobo et al., 2017, 2018). A molecular diagnostic approach, such as the MiDOG® technology, specifically tailored toward the identification of the specific microbes, could improve our understanding on the formation of polymicrobial infections or biofilms in canine clinical samples and their implications in disease (Abdullahi et al., 2016).
Parvimonas micra bacteremia following endoscopic retrograde cholangiopancreatography: A new route of infection
2018, AnaerobeCitation Excerpt :Parvimonas micra, previously known as Peptostreptococcus micros or Micromonas micros [4], is a non-spore forming, strictly anaerobic, slow-growing, occurring in pairs and short chains, Gram-positive coccus, belonging to commensal flora of oral cavity, gastrointestinal and genital tracts. It was deemed to cause bacteremia [5,6], endocarditis [7], pleural effusion [8], septic pulmonary embolism [9], bone [10–13] and cerebral infections, mainly in patients which have undergone dental medical procedures (DMP) [11–19] or with suboptimal oral hygiene [20–23]. Few data about clinical features and management of P. micra infections after medical procedures, above all in cases of infections after non-dental medical procedures (NDMP), are reported in literature [8,19,22,24–28].