Elsevier

Anaerobe

Volume 54, December 2018, Pages 260-263
Anaerobe

Case report
Polymicrobial anaerobic bacteremia due to Atopobium rimae and Parvimonas micra in a patient with cancer

https://doi.org/10.1016/j.anaerobe.2018.02.002Get rights and content

Highlights

  • Atopobium rimae and Parvimonas micra caused polymicrobial bloodstream infection.

  • Anaerobic bacteremia is especially associated with malignant processes.

  • Mass spectrometry method may help to diagnose rare anaerobe pathogens on species level.

  • A. rimae and P. micra bloodstream isolates were highly susceptible to antimicrobials.

Abstract

Atopobium rimae and Parvimonas micra are both Gram-positive anaerobes involved infrequently in human infections. We report a polymicrobial anaerobic bacteremia caused by these microorganisms. A 43-year-old woman receiving coadjuvant chemotherapy due to a retroperitoneal leiomiosarcoma presented with nausea, vomiting, abdominal pain and fever (38 °C). The two blood cultures resulted in isolation of A. rimae and P. micra, being identified at species level by matrix assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF MS) technology with high log scores. The microorganisms were susceptible to penicilllin, amoxicillin-clavulanate, piperacillin-tazobactam, clindamycin, metronidazole, imipenem, and moxifloxacin. Treatment with levofloxacin was started and subsequently it was changed to piperacillin/tazobactam plus metronidazole and completed for 10 days, but the patient died days later due to her underlying disease.

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

None.

Conflicts of interest

Authors declare no conflict of interest.

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