ACTINOBACULUM SCHAALII INVOLVED IN FOURNIER ’ S GANGRENE 1

ACTINOBACULUM SCHAALII INVOLVED IN FOURNIER’S GANGRENE 1 Isabelle Vanden Bempt 1 , Stefanie Van Trappen 2 , Ilse Cleenwerck 2 , Paul De Vos 2 , Kim 2 Camps 1 , Annemie Celens 1 , Martine Van De Vyvere 1 3 Department of Microbiology, Ziekenhuisnetwerk Antwerpen, Stuivenberg, Antwerp, 4 Belgium 1 and BCCM/LMG Bacteria Collection, Laboratory for Microbiology, Ghent 5 University, K.L. Ledeganckstraat 35, B-9000 Ghent, Belgium 2 6 7 Actinobaculum schaalii , which belongs to the group of gram-positive rods is difficult to 8 culture. Using molecular genetics, Actinobaculum schaalii could be identified as a 9 causing micro-organism in a case of Fournier’s gangrene. 10 11 CASE REPORT 12 13 A 33-year-old man was presented at the emergency ward with fever (37.8°C) and pain and 14 swelling in the left groin area. He was an obese smoker (BMI 36) suffering from diabetes 15 mellitus. Radiological examination revealed an important infiltration of the cutis and subcutis 16 in both the left and right groin area up to the scrotum. Air bubbles were present. Blood 17 analysis showed a C-reactive protein level of 33.6 mg/dL and a leukocyte count of 20.3 x 18 10 9 /L (85.9% neutrophils). Blood cultures were negative. A type of necrotising fasciitis, 19 Fournier’s gangrene, was suspected and prompt surgical procedure was performed: aggressive 20 debridement and cleansing of all involved tissue. Empirical treatment was initiated with 21 amoxicillin-clavulanate (6g/24h intravenously). During surgery, samples were taken from the 22 involved tissue and cultured. After 48 hours of incubation tiny, grey colonies were observed, 23 referred to as isolate 34317. It was the only isolate recovered from the surgical specimens. 24 Colonies grew similarly under aerobic and anaerobic conditions (sheep blood agar, 37°C, 5% 25 CO2). Another 48 hours later, these colonies showed weak beta haemolysis. Gram staining of 26 the cells revealed small, non-motile, non-spore-forming, gram-positive coccoid rods with 27 rudimentary branching. Biochemical test results are presented in Table 1. In vitro 28 susceptibility to benzylpenicillin, amoxicillin, ciprofloxacin, ceftazidim, ceftriaxone, 29 metronidazole, imipenem, amikacin, gentamycin, clindamycin and vancomycin was 30 investigated using the E-test (AB Biodisk, Solna, Sweden). An inoculum suspension of 0.5 31 McFarland was applied to Mueller Hinton blood agar (Becton Dickinson, Heidelberg, 32 Germany). MICs were read after 48 hours of anaerobic incubation (Table 2). Analysis on the 33 Copyright © 2011, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved. J. Clin. Microbiol. doi:10.1128/JCM.00272-11 JCM Accepts, published online ahead of print on 20 April 2011