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Journal of Clinical Microbiology, April 1999, p. 1227-1228, Vol. 37, No. 4
Departments of Clinical
Pathology,1 Internal
Medicine,2 and
Microbiology,
Received 4 September 1998/Returned for modification 16 October
1998/Accepted 1 December 1998
We report a case of sepsis caused by Bifidobacterium
longum in a 19-year-old male who had developed high fever,
jaundice, and hepatomegaly after acupuncture therapy with small gold
needles. Anaerobic, non-spore-forming, gram-positive bacilli were
isolated from his blood and finally identified as B. longum. He recovered completely after treatment with ticarcillin
and metronidazole. To our knowledge, this is the first report
of incidental sepsis caused by B. longum.
A 19-year-old male was admitted to
the hospital due to high fever, jaundice, and hepatomegaly. A month
prior to admission, he had developed a herniated intervertebral disk of
the lumbar spine. He had a partial laminectomy and began receiving
acupuncture therapy in a local clinic practicing oriental medicine. Due
to continuing lumbar pain, several 1-cm-long gold needles had been inserted into the lumbar area 10 days prior to admission; 5 days later,
the patient started to develop chills, fever, nausea, vomiting, and diarrhea. Upon presentation, hepatic enlargement was
observed by ultrasonography and several gold needles were located on
X-ray film near the lumbar area (Fig. 1). The blood
culture grew anaerobic, non-spore-forming, gram-positive bacilli.
A clinical diagnosis of sepsis by anaerobic bacilli was made, and
empiric treatment with ticarcillin and metronidazole was begun. The
patient was fully recovered after 10 days, and a checkup 1 week later
showed a normal range of hepatic function.
Microbiological investigation.
Three blood samples, which were
taken from three different sites at 30-min intervals, inoculated into
both tryptic soy broth and thioglycollate medium, and incubated at
37°C for 2 days, yielded gram-positive bacilli. The three cultures in
thioglycollate grew much better than those in tryptic soy broth,
suggesting that the bacilli were anaerobic. The gram-positive
bacilli appeared to be very pleomorphic and produced no
endospores. When the Dongguk isolate was subcultured on 5% sheep blood
agar at 37°C for 2 days, the anaerobically grown colonies
were 0.5 to 1 mm in diameter and appeared whitish, raised, mucoid, and
nonhemolytic, while aerobically grown colonies were hardly visible even
after 5 days. The isolate was inoculated onto thioglycollate medium
without dextrose or indicator (Difco, Detroit, Mich.) and tested
by conventional biochemical means according to Holdeman et al.
(5). These tests were repeated twice. Gas-liquid
chromatography (GLC) with a Capco instrument (Clinical Analysis
Products, Sunnyvale, Calif.) was performed to analyze the metabolic end
products. Acetic acid and lactic acid were detected as volatile and
nonvolatile fatty acids, respectively. The isolate showed the
biochemical characteristics and GLC profile of
Bifidobacterium longum, as described by Holdeman et al.
(5) (Table 1).
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
Case of Sepsis Caused by
Bifidobacterium longum
ABSTRACT
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Abstract
References
CASE REPORT
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FIG. 1.
Radiological findings of the simple abdomen showing many
small needles (arrows).
TABLE 1.
Culture and biochemical characteristics of the
B. longum type strain and the Dongguk isolate
Discussion. Anaerobic bacterial sepsis is often caused by organisms found in the gastrointestinal tract, skin, urogenital tract, or oral cavity. Bacteroides fragilis and Clostridium perfringens are the anaerobic agents isolated most frequently from infections (3, 7). Bifidobacterium spp. colonize the intestinal tract, the mouth, and, in some instances, the vagina in humans (1) and are rarely isolated from clinical specimens, with the exception of Bifidobacterium dentium as one of the causative agents of dental caries and related diseases (2, 6). It is known to be difficult to identify Bifidobacterium spp. due not only to variability in aerotolerance, colony morphology, and stainability on Gram staining but also to the difficulty in distinguishing the organisms from other gram-positive, non-spore-forming, anaerobic bacilli by conventional biochemical tests (1). Definitive identification of the genus Bifidobacterium requires analysis of metabolic products, volatile and nonvolatile fatty acids, in broth media by GLC (4, 8).
We encountered a case of sepsis due to B. longum, an anaerobic, non-spore-forming, gram-positive bacillus which has been widely regarded as being of benefit to the host by preventing other pathogens from overgrowing in the intestinal tract (1). Since there were no obvious predisposing conditions preceding anaerobic infection in the young male patient other than acupuncture therapy, it is speculated that the organism was introduced to the blood circulation either from improperly sterilized acupuncture needles or from the colon via minute perforations caused by those needles. This case emphasizes the potential for serious infections caused by normally harmless gastrointestinal tract flora when invasive acupuncture therapy is improperly provided.| |
FOOTNOTES |
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* Corresponding author. Mailing address: Department of Clinical Pathology, Kyongju Hospital of Dongguk University, Kyongju, Kyongbuk 780-714, Korea. Phone: 82-561-770-8280. Fax: 82-561-749-5538. E-mail: hskim{at}mail.dongguk.ac.kr.
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REFERENCES |
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| 6. | Scardovi, V., and F. Crociani. 1974. Bifidobacterium catenulatum, Bifidobacterium dentium, and Bifidobacterium angulatum: three new species and their deoxyribonucleic acid homology relationships. Int. J. Syst. Bacteriol. 24:6-20. |
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Journal of Clinical Microbiology, April 1999, p. 1227-1228, Vol. 37, No. 4
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
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