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Journal of Clinical Microbiology, September 2004, p. 4189-4198, Vol. 42, No. 9
0095-1137/04/$08.00+0 DOI: 10.1128/JCM.42.9.4189-4198.2004
Roger E. Morey,1 Anne M. Whitney,1 Don J. Brenner,1 Arnold G. Steigerwalt,1 Leta O. Helsel,1 Patti M. Raney,2 Jean B. Patel,2 Paul N. Levett,1 and June M. Brown1
Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases,1 Division of Healthcare Quality Promotion, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia2
Received 5 September 2003/ Returned for modification 17 October 2003/ Accepted 21 May 2004
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Presented herein is a polyphasic study of 45 strains in this group, including morphological, biochemical, cellular fatty acid, antimicrobial susceptibility, DNA-DNA hybridization, and 16S rDNA analyses. This study indicates FCG4 to be a heterogeneous group that contains strains of charcoal-black-pigmented variants of R. dentocariosa isolated predominately from respiratory sources and of charcoal-black-pigmented variants of a recently described Corynebacterium species, Corynebacterium aurimucosum, isolated predominately from female urogenital sources.
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TABLE 1. CDC FCG4 strains studieda
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DNA relatedness. Total DNA relatedness studies were performed on a set of 22 FCG4 strains which included all phenotypic variants. The methods used to cultivate cells and to prepare, isolate, and purify labeled and unlabeled DNA, as well as the methods used for DNA reassociation and the separation of single-stranded and double-stranded DNA on hydroxyapatite, have been described elsewhere (1). DNA relatedness was determined at optimal (60°C) and, on selected strains, stringent (75°C) reassociation criteria. Percent divergence was calculated to the nearest 0.5%.
16S ribosomal DNA (rDNA) sequencing. The 16S rRNA gene of strains Rothia-like FCG4a ATCC BAA-907 (C5560) and Corynebacterium-like FCG4b ATCC 700540 (B8037) along with the type strains of C. aurimucosum and C. nigricans were amplified by PCR utilizing the primers fD1 and rD1 originally described by Weisburg et al. (18). The PCR product was then cycle sequenced with several subunit primers as previously described (2). Related sequences were identified in a BLAST search against the GenBank database. Similarity searches were performed with Clustal W, and a distance matrix was created. In Treecon, the phylogenetic tree of aligned sequences was constructed with the neighbor-joining method and bootstrapped based on 1,000 replications (2).
Antimicrobial susceptibility testing. Antimicrobial MICs were determined using the broth microdilution method in accordance with the National Committee for Clinical Laboratory Standards (NCCLS) (9). The bacteria were initially subcultured onto trypticase soy agar plates containing 5% defibrinated sheep blood and incubated at 35°C in ambient air supplemented with 5% CO2 for 24 h. Inocula were prepared by direct colony suspension method or by the broth method if a uniform suspension was not possible by direct colony suspension because of clumping. The broth microdilution plates were prepared in-house with cation-adjusted Mueller-Hinton broth (Difco, BD) containing 5% lysed horse blood (Lampire Biological Laboratories, Pipersville, Pa.). After inoculation, broth microdilution plates were incubated at 35°C in ambient air. MICs were read at 24 and 48 h. The antimicrobial agents and the concentrations tested were as follows: cefotaxime (Sigma, St. Louis, Mo.), 0.008 to 8 µg/ml; ceftriaxone (Sigma), 0.008 to 8 µg/ml; cefepime (Bristol Myers Squibb, Syracuse, N.Y.), 0.008 to 8 µg/ml; chloramphenicol (Sigma), 0.25 to 32 µg/ml; clindamycin (USP, Rockville, Md.), 0.015 to 2 µg/ml; erythromycin (Eli Lilly and Co., Indianapolis, Ind.), 0.015 to 2 µg/ml; levofloxacin (Johnson and Johnson, Spring House, Pa.), 0.12 to 16 µg/ml; penicillin (Sigma), 0.008 to 16 µg/ml; tetracycline (Sigma), 0.06 to 8 µg/ml; trimethoprim-sulfamethoxazole (SXT; Sigma), 0.006 to 8 µg/ml; and vancomycin (Eli Lilly and Co.), 0.015 to 2 µg/ml. Susceptibility testing performance was monitored by testing Streptococcus pneumoniae ATCC 49619 (10) daily during the study.
Nucleotide sequence accession number. The 16S rRNA sequences were submitted to GenBank, and the assigned accession numbers are listed below in Table 3.
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TABLE 3. Percent similarity of 16S rRNA gene sequence of Corynebacterium-like FCG4b strain B8037 (ATCC 700540) to sequences in Rothia-like FCG4a and related species of Rothia and Corynebacterium
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Cells of FCG4, grown on heart infusion agar at 35°C for 18 to 24 h, were small coccoid to short coryneform rods. The organisms were gram positive and generally stained uniformly, although some strains produced a beaded reaction. When grown on rabbit or sheep blood agar, either aerobically or in a candle jar atmosphere for 18 to 24 h, colonies ranged in size from punctate to 1.5 mm in diameter, and they were circular, convex, entire, opaque, and charcoal-black in color. Colonies of most strains were smooth, but some strains produced rough and adherent colonies that appeared to grow into the agar. Some strains produced a mixture of smooth, rough, and very rough colony types with variable gray to black pigmentation (4). Subculture of the individual colony types produced the same mixture, indicating that individual strains were capable of colonial variation. For most strains, no hemolytic reaction was observed on rabbit blood agar after overnight incubation at 35°C; however, 12 strains produced green discoloration. Three other strains produced a dark brown to black discoloration of the medium.
CFA analysis of these strains revealed the presence of two distinct groups: FCG4a, which was Rothia-like, and FCG4b, which was Corynebacterium-like. The Rothia-like FCG4a group included eight strains (B4122, B8899, C5560, C9139, E5063, E3087, G4818, and G8825), all of which produced a CFA profile similar to the profile of R. dentocariosa and R. mucilaginosa reference strains. This profile was characterized by the presence of major amounts of a-C15:0 (22 to 43%), i-C16:0 (7 to 14%), C16:0 (9 to 23%), a-C17:0 (11 to 20%), C18:2 (6 to 11%), and C18:1T9c (4 to 12%). The remaining 37 strains (Table 1) (Corynebacterium-like FCG4b) produced a CFA profile similar to the profile of C. matruchotii, C. amycolatum, C. minutissimum, C. aurimucosum (21), C. singulare (11), and C. nigricans (13). This profile was characterized by major amounts of C16:0 (33 to 47%), C18:1T9c (37 to 54%), and C18:0 (4 to 12%). A small amount (
6%) of tuberculostearic acid (10-CH3-C18:0) was detected in 23 Corynebacterium-like FCG4b strains, of which all but one contained
3%, while strain G6250 contained 6%. CFA profiles of strains that contained tuberculostearic acid were more closely related to C. minutissimum, C. aurimucosum (21), or C. nigricans (13), whereas strains that did not contain tuberculostearic acid had CFA profiles more closely related to those of C. matruchotii, C. amycolatum, or C. singulare (11).
The phenotypic characteristics of the Rothia-like FCG4a and Corynebacterium-like FCG4b isolates and the reference strains are listed in Table 2. All FCG4 strains fermented D-glucose, sucrose, and maltose. Other positive characteristics for all strains included growth at 35°C and growth in nutrient broth without NaCl. Negative characteristics shared by all strains included motility, fermentation of D-xylose and lactose, growth on MacConkey agar, citrate alkalinization, reduction of nitrate to gas, indole production, and H2S production in the butt of the triple sugar iron agar slant. In general, these strains were also D-mannitol, urease, and oxidase negative; however, one Corynebacterium-like FCG4b strain produced a weak and late urease reaction, three Corynebacterium-like FCG4b strains fermented D-mannitol, and one strain each of Rothia-like FCG4a and Corynebacterium-like FCG4b produced a positive oxidase reaction.
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TABLE 2. Biochemical characteristics of Rothia-like FCG4a, Corynebacterium-like FCG4b, R. dentocariosa, R. mucilaginosa, C. aurimucosum, C. nigricans, C. matruchotii, C. minutissimum, C. amycolatum, and C. singularea
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The reference strains most similar to the Rothia-like FCG4a group were R. dentocariosa and R. mucilaginosa. The Rothia-like FCG4a group shared a common CFA profile and many common biochemical reactions. The charcoal water-insoluble pigmentation differentiated the Rothia-like FCG4a strains from all the reference strains. The morphology and sometimes catalase activity differed from that of the type strains of R. dentocariosa and R. mucilaginosa.
The reference strains most similar to the Corynebacterium-like FCG4b strains were C. amycolatum, C. aurimucosum, C. matruchotii, C. minutissimum, C. nigricans, and C. singulare. In addition to the charcoal pigmentation, Corynebacterium-like FCG4b strains could also be differentiated from some of the reference strains by nitrate reduction and urea hydrolysis.
The 16S rDNA from a Rothia-like FCG4a strain (ATCC BAA-907, C5560), a Corynebacterium-like FCG4b strain (ATCC 700540, B8037), and the type strains of C. aurimucosum and C. nigricans were amplified and sequenced. The resulting sequences were aligned with several relevant Corynebacterium 16S rDNA sequences from GenBank, as well as the 16S rDNA sequences of two uncultured Corynebacterium-like organisms and R. dentocariosa. A phylogenetic tree was generated from an edited alignment and demonstrated the close relationships among most of the species in the genus Corynebacterium (Fig. 1). Rothia-like FCG4a ATCC BAA-907 was positioned with R. dentocariosa with 100% similarity. Corynebacterium-like FCG4b strain ATCC 700540 (CDC B8037) was positioned in a group with C. aurimucosum, C. nigricans, C. singulare, C. minutissimum, and two sequences from uncultured Corynebacterium-like organisms, strains MTcory1P and MTcory16R, which were similar to those given by Yassin et al. (21) and Shukla et al. (13). A similarity matrix (Table 3) generated from the edited alignment indicated that the Corynebacterium-like FCG4b strain ATCC 700540 sequence was 99.9% similar to that of C. nigricans, 99.7% to that of C. aurimucosum, 99.5% to that of MTcory1P, 99.0% to that of C. minutissimum, 98.9% to that of C. singulare, and 98.5% to that of MTcory16R. The similarity values between Corynebacterium-like FCG4b ATCC 700540 and the remaining Corynebacterium sequences ranged from 91.4% for C. glucuronolyticum to 97.0% for C. striatum.
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FIG. 1. Phylogenetic tree, including selected relevant Rothia-like, Corynebacterium-like, and Corynebacterium species organisms. The tree was rooted using R. dentocariosa as the outgroup. Bootstrap analysis was done with 1,000 resamplings; bootstrap values are indicated at some branch points. The scale bar represents a 2% difference in DNA sequence. The strain numbers and GenBank accession number for the sequences used in the study are shown. DMMZ, Department of Medical Microbiology, University of Zurich; DSM = DSMZ, Deutsche Sammlung von Mikroorganismen und Zellkulturen; NCTC, National Collection of Type Cultures.
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TABLE 4. DNA relatedness of Rothia-like FCG4a; Corynebacterium-like FCG4b, R. dentocariosa, C. aurimucosum, C. nigricans, C. minutissimum, C. matruchotii, C. amycolatum, and R. mucilaginosa strainsa
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Results for the 11 antimicrobial agents are shown in Table 5. At present there are no interpretive criteria for the determination of breakpoints recommended by NCCLS for the coryneform group of organisms. As a conservative approach, it has been suggested that the NCCLS interpretive criteria for streptococci be used when reporting erythromycin, penicillin, and vancomycin results (19). Using NCCLS breakpoints for streptococci (10), the Rothia-like FCG4a isolates were susceptible to cefepime, cefotaxime, ceftriaxone, chloramphenicol, levofloxacin, penicillin, tetracycline, and vancomycin. One of the five isolates was resistant to erythromycin (>4 µg/ml), and three of the five isolates were resistant to clindamycin (1 and >2 µg/ml). There are no interpretive breakpoints for SXT established for streptococci. However, for the Rothia-like FCG4a isolates, MICs of SXT were low.
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TABLE 5. MICs of 11 antimicrobial agents for Rothia-like FCG4a and Corynebacterium-like FCG4b
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1 µg/ml). Two isolates demonstrated decreased susceptibility to tetracycline (MICs of 4 µg/ml [intermediate] and >8 µg/ml [resistant]). The Corynebacterium-like FCG4b isolates consistently demonstrated decreased susceptibility to SXT. |
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The results of this study indicate that FCG4 is a heterogeneous group. Using biochemical methods and CFA analysis, we identified two distinct subgroups: Rothia-like FCG4a and Corynebacterium-like FCG4b. These subgroups differ in their CFA profiles and nitrate reduction. The clinical sources of most of the Rothia-like FCG4a strains (mammary pustule, throat, sputum, left bronchus, urine, and blood) also differed from the sources of the larger Corynebacterium-like FCG4b subgroup, which were predominately isolated from the female genitourinary tract.
Phenotypically, except for pigmentation, the Rothia-like strains generally agreed with the type strain of R. dentocariosa. The phenotypic characteristics of the Corynebacterium-like strains, C. aurimucosum, and C. nigricans were similar except on pigmentation and sometimes esculin hydrolysis, which may be a strain variation.
The similarity values derived from the 16S rDNA sequence alignment of Rothia-like FCG4a ATCC BAA-907, Corynebacterium-like FCG4b ATCC 700540, and 21 Corynebacterium or Corynebacterium-like organisms with R. dentocariosa indicated that Rothia-like FCG4a ATCC BAA-907 was most closely related to R. dentocariosa and that Corynebacterium-like FCG4b CDC B8037 (ATCC 700540) was most closely related to C. aurimucosum, C. nigricans, C. singulare, C. minutissimum, and two uncultured organisms. This close phylogenetic relationship between CDC B8037 and C. aurimucosum was shown previously by Yassin et al. (21), and that between CDC B8037 and C. aurimucosum and C. nigricans, which was investigated by Shukla et al. (13). In the former report, DNA hybridization studies did not include the CDC isolate, and in the latter report of Shukla et al. (13) no DNA hybridization studies were included. It should be emphasized that the description of a new species based on 16S rDNA sequencing and production of charcoal pigment requires caution. In addition, the relationships with uncultured bacteria should be viewed with caution. Sequencing 16S rDNA from clinical specimens can be problematic; there is a distinct possibility that an apparently new species is actually a hybrid sequence from two or more organisms (16).
The DNA-DNA hybridization results in this study were consistent with the morphological and CFA results. This analysis showed the Rothia-like FCG4a subgroup to be a charcoal-black-pigmented variant of R. dentocariosa. It shares a common CFA profile with R. dentocariosa. Rothia-like FCG4a strains and the type and reference strains of R. dentocariosa form a highly related DNA hybridization group. Even though the 16S rDNA sequence similarity values between Corynebacterium-like FCG4b ATCC 700540, C. aurimucosum, and C. nigricans were high (99.7 and 99.9%, respectively), ATCC 700540 produced charcoal-black-pigmented colonies, suggesting that it is physiologically different from C. aurimucosum, an organism with slightly yellow-pigmented colonies that has only recently been described based on two clinical isolates, one from blood and one from an unknown source (21), but it is similar to C. nigricans, a more recently named black-pigmented Corynebacterium species recovered from the human female urogenital tract (13). Although no rigid criterion exists for defining species based on close 16S rDNA sequence similarity, sequencing of 16S rDNA has been recommended by Stackebrandt et al. (15) as one of the minimal characteristics in species description along with DNA-DNA reassociation. Because of the existing high sequence similarity values between the three organisms (Corynebacterium-like FCG4b ATCC 700540, C. aurimucosum, and C. nigricans), DNA-DNA hybridization was investigated. DNA relatedness studies determined that the Corynebacterium-like FCG4b subgroup, C. aurimucosum, and C. nigricans belong to the same species (Table 4). The strains are within the limits of the same species that include strains with approximately 70% or greater DNA-DNA relatedness and with less than 5°C divergence (17). Both C. aurimucosum and C. nigricans were recently proposed, but the name C. aurimucosum was published first (21) and would have nomenclature priority. Similarly, high levels of sequence similarities were observed when the Corynebacterium-like FCG4b ATCC 700540 sequence was aligned with the C. singulare (98.9%) and C. minutissimum (99.0%) sequences. Corynebacterium-like FCG4b strain B8037 (ATCC 700540) can be differentiated from C. singulare based on phenotypic characteristics. Unlike C. singulare, Corynebacterium-like FCG4b strain B8037 (ATCC 700540) is a urease-negative organism with charcoal-black-pigmented colonies. Further, DNA-DNA hybridization data indicated that Corynebacterium-like FCG4b strain B8037 (ATCC 700540) was not the same species as C. minutissimum (39% relatedness at 60EC). Therefore, as previously reported by Yassin et al. (21), high 16S rDNA sequence similarity values between strains belonging to the same genus do not invariably indicate membership of the same species.
For clinically significant infections caused by organisms from the coryneform group, antimicrobial susceptibility testing of organisms from the coryneform group is often warranted, because resistance may be found in many classes of antimicrobial agents (5). However, because of the lack of a recommended method and interpretive criteria, only a dilution method should be used, in which case MICs can be reported without an interpretation. Although the isolates in the Rothia-like FCG4a group were all extremely susceptible to penicillin, the Corynebacterium-like FCG4b group MICs were more likely to be in the range of 0.25 to 0.5 µg/ml, and it is unknown whether penicillin would be effective. Data for 10 strains of R. dentocariosa tested with the disk diffusion method have been published (7). Although clindamycin was not included (7), results with other antimicrobial agents were susceptible and comparable to our results. Data given for five C. nigricans isolates based on results using the Etest (13) were in agreement with the present study of 16 isolates of Corynebacterium-like FCG4b.
Although R. dentocariosa opportunistic infection of the oral cavity and pharynx is well established, serious infections such as endocarditis and bacteremia are rare. In a recent review of R. dentocariosa bacteremia and endocarditis cases, the authors suggested this rarity may be attributed to lack of awareness and inadequate identification methods (12). In the present study, two of eight of charcoal-black-pigmented Rothia-like isolates were from blood specimens, which emphasizes the pathogenic potential of R. dentocariosa.
The observation that these charcoal-black-pigmented Corynebacterium-like isolates have been predominantly isolated from specimens associated with female genitourinary tract infections merits further investigation. Limited clinical information was available in this study; however, based on recent reports by Shukla et al. (13, 14) and the number of strains that have been submitted to us, this organism does appear to be clinically significant. The awareness of these charcoal-black-pigmented isolates may result in increased recognition of these organisms by clinical microbiologists and physicians and, thereby, a better understanding of their pathogenic potential.
On the basis of the results in this study, C. nigricans is a later synonym of C. aurimucosum, and an amended description of R. dentocariosa and C. aurimucosum is given.
Amended description of R. dentocariosa Georg and Brown 1967 emend. Daneshvar et al. 2004. The description below is based on the studies of the type strain ATCC 17931 by Georg and Brown (6) as well as the results of this study. Mycelia are composed of branched filaments, often with clavate ends (1 µm or less in diameter) which fragment readily into bacillary and coccoid forms. Occasionally cultures are isolated in diplococcoid or coccoid form; however, filaments can be demonstrated in subcultures either on the surface of agar plates or in liquid medium. Microcolonies on agar surfaces may be completely filamentous or may present a filamentous border only, with the center of colony a mass of rods and cocci. Mature colonies may be raised and highly convoluted, reflecting a filamentous micromorphology, or they may be round, convex, and smooth surfaced, reflecting a bacillary or coccoid micromorphology. All mature colonies, whether rough or smooth, are creamy white or sometimes charcoal-black, entire, and of a soft texture. No aerial hyphae or spores are produced. In broth there is usually a mixture of soft, turbid, and finely granular or floccose growth. Requires organic nitrogen for growth. Poor growth on pyruvate, lactate, or acetate. Gram positive, non-acid fast, nonmotile. Aerobic to microaerophilic. Very poor growth or none anaerobically. CO2 not required for growth. Cell walls composed of galactose, alanine, glutamic acid, lysine, and possibly ornithine. Ferments fructose, D-glucose, maltose, sucrose, and glycerol. Lactic acid is the major product produced from glucose, together with acetic acid and a small amount of succinic acid. Voges-Proskauer test positive. Gelatin usually liquefied. Starch, albumin, and casein not hydrolyzed. Milk unchanged or slowly peptonized. Nitrate and nitrite reduced. Indole not produced. Nonhemolytic on human and sheep blood, variable on rabbit blood. Catalase is variable.
Amended description of C. aurimucosum Yassin et al. 2002 emend. Daneshvar et al. 2004.
The description below is based on the studies of the type strain DSM 20651 by Yassin et al. (21) as well as the results of this study. Cells are gram positive and non-acid fast. They are thin, nonmotile, non-spore-forming, and pleomorphic coryneform. On Columbia blood agar supplemented with 5% sheep blood, the colonies are sticky and slightly yellow or charcoal black in color. On trypticase soy agar they appear colorless or charcoal black and slimy. On brain heart infusion agar supplemented with 1% Tween 80, some strains are able to form a coralloid precipitin in agar when grown in the presence of CO2. Growth is facultatively anaerobic. Catalase positive. It contains meso-diaminopimelic acid as wall diamino acid in addition to galactose and arabinose in whole-cell hydrolysates (i.e., the cell wall chemotype is chemotype IV). Short-chain corynemycolic acids are present. The fatty acid profile contains saturated, unsaturated, and tuberculostearic acids. It has type PI phospholipid pattern with no nitrogen-containing compounds. Acid is produced from fructose, D-glucose, maltose, sucrose, and occasionally D-mannitol but not from adonitol, amygdalin, arabinose, cellobiose, glycerol, glycogen, inulin, lactose, mannose, melezitose, raffinose, rhamnose, ribose, salicin, sorbitol, trehalose, or xylose. It hydrolyzed hippurate and occasionally gelatin and urea but not starch. Esculin hydrolysis is variable, and nitrate reductase is rare. Positive for alkaline phosphatase, leucine arylamidase, and pyrazinamidase activities, but negative for acid phosphatase, arginine dihydrolase, esterase (C4), ester lipase (C8), lipase(C14),
-glucosidase, ß-glucosidase,
-galactosidase, ß-galactosidase, ß-glucuronidase, N-acetyl-ß-glucosaminidase,
-mannosidase,
-fucosidase, naphthol-AS-bi-phosphohydrolase, pyrrolidonyl arylamidase, valine arylamidase, cystine arylamidase, trypsin, and chemotrypsin. Acetoin positive, indole negative. Lactate is the major product of glucose fermentation. The GC content of the type species is 63.7 mol%. The type strain of C. aurimucosum is strain IMMIB D-1488T (DSM 44532T).
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