BacteriologyCentral nervous system infections due to Abiotrophia and Granulicatella species: an emerging challenge?
Introduction
Abiotrophia and Granulicatella species, first described as nutritionally variant (deficient) streptococci in 1961 (Frenkel and Hirsch, 1961), were originally discovered as small satellite colonies around coagulase-negative bacteria or with supplementation of complex media with cysteine or pyridoxal (Carey et al., 1975). Taxonomic studies of the Abiotrophia spp. concluded that this group of organisms should be reclassified separately into Abiotrophia defectiva and Granulicatella adiacens, G. balaenopterae, and G. elegans (Collins and Lawson, 2000). Although Abiotrophia/Granulicatella are part of the normal flora of the oral cavity, the genitourinary tract, and the intestinal tract, the pathogenic potential of these organisms has been well established. They have been estimated to cause approximately 5-6% of microbiologically proven cases of endocarditis (Roberts et al., 1979), and have likewise been implicated in the pathogenesis of culture-negative endocarditis (Roggenkamp et al., 1998). In addition, Abiotrophia/Granulicatella have been reported as etiologic agents of postpartum or postabortal sepsis, pancreatic abscess, wound infection, vertebral osteomyelitis or discitis, conjunctivitis, cirrhosis, endophthalmitis, infectious crystalline keratopathy, and otitis media (Namdari et al., 1999, Ormerod et al., 1991, Gephart and Washington, 1982, Ruoff, 1991).
While Abiotrophia/Granulicatella were initially identified over four decades ago, isolation of these pathogens from the central nervous system (CNS) was first noted only in 1999 (Biermann et al., 1999). Since that time, two additional cases of CNS infection have been reported (Michelow et al., 2000, Schlegel et al., 1999). We now describe the isolation of A. defectiva and G. adiacens from the CNS in two patients with recent neurosurgical interventions. We also review the existing literature of CNS involvement with Abiotrophia/Granulicatella to help characterize the emerging epidemiology of these infections.Table 1
Section snippets
Case #1
A 32-year-old female in the second trimester of pregnancy presented to her physician with nasal obstruction of approximately three months duration. She described a persistent frontal headache but no subjective fever. Physical examination was notable only for a palpable mass in the medial canthal region. A subsequent magnetic resonance imaging (MRI) scan revealed a mass involving the right anterior ethmoid with extension into the anterior orbit and cribiform plate. Endoscopic biopsy revealed a
Case #2
A 53-year-old female was admitted to the hospital due to subarachnoid hemorrhage following rupture of a middle cerebral artery (MCA) bifurcation aneurysm. She underwent clipping of the MCA aneurysm and placement of a ventriculopleural (VP) shunt. Preoperative antibiotic prophylaxis consisted of cefazolin, which was continued for two days post-operatively. She was discharged in stable condition 22 days later.
Eleven days later, she again presented to the hospital with acute onset of
Discussion
CNS involvement with A. defectiva and G. adiacens has only recently been recognized. Including the two cases presented here, there have been five reports of CNS Abiotrophia/Granulicatella reported (Biermann et al., 1999, Michelow et al., 2000, Schlegel et al., 1999). It is unclear why cases of CNS infection due to Abiotrophia/Granulicatella have only recently been reported. A possible explanation lies in the traditional difficulty in identifying these organisms because of their requirement for
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