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Journal of Clinical Microbiology, September 2005, p. 4592-4601, Vol. 43, No. 9
0095-1137/05/$08.00+0 doi:10.1128/JCM.43.9.4592-4601.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.
Richard R. Facklam,2 and
Lúcia M. Teixeira1*
Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil,1 Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia2
Received 23 March 2005/ Returned for modification 23 May 2005/ Accepted 22 June 2005
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Members of this species are commonly associated with pyogenic infections in swine, such as cervical lymphadenitis, leading to edematous lymph nodes and hemorrhagic abscesses, pneumonia, and sepsis (4, 29). The frequency of these infections ranges from 3 to 6% among swine hosts submitted to slaughtering (12). In addition, S. porcinus strains have also been isolated from other pathologic conditions of swine, in association with abortion and endocarditis cases (10, 13, 21), as well as from healthy swine and, more rarely, from other hosts (29).
Isolation of S. porcinus strains from human sources is rarely documented, and infections in the human host have mostly been related to genitourinary tract, especially women in the reproductive age (6). However, the involvement of these microorganisms as a cause of infections in humans has possibly been hindered by misidentification of S. porcinus strains, mainly due to the biochemical similarities and serological cross-reactivity with Streptococcus agalactiae (Lancefield group B) strains, which are commonly associated with female genitourinary tract infections (6, 24).
In 1995, a study involving the identification of S. porcinus associated with human infections was published by Facklam et al. (6) reporting the phenotypic characteristics of 13 isolates obtained from clinical specimens, mostly from the genitourinary tracts of individuals living in the United States and Canada. The molecular properties of such isolates were not examined. In the following 3 years, a similar number of isolates from human sources was sent to the Centers for Disease Control and Prevention (CDC) for confirmation of the identification, possibly due to an increasing attention given to the potential role of S. porcinus as an etiologic agent of human infections.
The aim of the present study was to investigate the phenotypic and molecular characteristics of 25 S. porcinus isolates obtained from human sources and received for identification by the CDC, including those studied by Facklam et al. (6). Isolates obtained from nonhuman sources, mostly from swine, as well as the type strain of S. porcinus, were also included for comparative purposes.
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TABLE 1. S. porcinus strains from human sources included in this study
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TABLE 2. S. porcinus strains from nonhuman sources included in this study
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Antimicrobial susceptibility testing. MICs were determined by a broth microdilution assay using PML panels (PML Microbiologicals, Wilsonville, Oreg.) according to the manufacturer's instructions. The following 14 antimicrobials were tested: amoxicillin, cefotaxime, cefuroxime, chloramphenicol, clindamycin, erythromycin, levofloxacin, meropenem, penicillin, rifampin, tetracycline, trimethoprim-sulfamethoxazole, trovafloxacin, and vancomycin. The results were interpreted according to Clinical and Laboratory Standards Institute (formerly National Committee for Clinical Laboratories Standards) recommendations for Streptococcus other than Streptococcus pneumoniae (18). The MIC was defined as the lowest concentration of a given drug that inhibited growth as observed by the unaided eye.
Detection of tetracycline resistance genetic determinants. Tetracycline-resistant isolates were screened for the presence of genes tet(K), tet(L), tet(M), and tet(O), according to the method of Trzcinski et al. (25). Briefly, each reaction was carried out in 50 µl of a mixture containing 20 mM Tris-HCl (pH 8.4), 50 mM KCl, 3 mM MgCl2, 0.2 mM concentrations of each nucleotide, 0.5 µM concentrations of each primer, 2.5 U of Taq DNA polymerase, and 5 µl of DNA template. The primers used to amplify the tet determinants were tet(K) (5'-TAT TTT GGC TTT GTA TTC TTT CAT-3' and 5'-GCT ATA CCT GTT CCC TCT GAT AA-3'), tet(L) (5'-ATA AAT TGT TTC GGG TCG GTA AT-3' and 5'-AAC CAG CCA ACT AAT GAC AAT GAT-3'), tet(M) (5'-AGT TTT AGC TCA TGT TGA TG-3' and 5'-TCC GCA TAT TTA GAC GAC GG-3'), and tet(O) (5'-AGC GTC AAA GGG GAA TCA CTA TCC-3' and 5'-CGG CGG GGT TGG CAA ATA-3'). The PCR consisted of 35 cycles of 1 min at 95°C, 1 min at 50°C, and 1 min 30 s at 72°C, followed by a final 5 min at 72°C, except for tet(O), for which the annealing temperature was 55°C. PCR products were resolved by electrophoresis on 1.2% agarose gels in 0.5x TBE buffer (1 mM Tris, 0.01 M EDTA, 1 M boric acid). Gels were stained with ethidium bromide and then visualized and photographed under UV light. The size of each PCR product was estimated by using standard molecular weight markers (100-bp ladder; Pharmacia Biotech, Uppsala, Sweden).
Analysis of whole-cell protein profiles by SDS-PAGE. Isolates were grown on Todd-Hewitt sheep blood agar plates at 37°C for 24 h. Preparation of extracts and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) were performed as described by Merquior et al. (17). The profiles were initially compared by visual inspection. Densitometric analysis, normalization of the densitometric traces and interpolation of the protein profiles with the Pearson correlation coefficient and the UPGMA (for unweighted pair-group method with arithmetic averages) method were performed by using the Molecular Analyst Fingerprinting Plus software package (version 1.12) of the Image Analysis System (Bio-Rad Laboratories, Hercules, Calif.).
Analysis of DNA amplification products obtained by RAPD-PCR. Isolates were grown in brain heart infusion broth at 37°C for 18 to 24 h. The DNA was extracted by boiling as previously described (20). Random(ly) amplified polymorphic DNA-PCR (RAPD-PCR) assays were carried out with primer 1254 (5'-CCGCAGCCAA-3'; synthesized by Gibco-BRL, Gaithersburg, Md.) according to the method of Pacheco et al. (20) with some modifications. The PCR mixture consisted of 2.5 mM MgCl2, 1x PCR buffer without MgCl2 (10 mM Tris-HCl, 50 mM KCl [pH 8.3]), 0.625 mM concentrations of each of the four deoxynucleoside triphosphates, 30 pmol of primer, 1 U of Taq DNA polymerase (Boehringer Mannheim), and 3 µl of bacterial lysate containing DNA in a total volume of 30 µl. Amplification was obtained with a GeneAmp PCR System 2400 (Perkin-Elmer, Branchburg, N.J.) under the following conditions: four cycles of 94°C for 5 min, 37°C for 5 min, and 72°C for 5 min, followed by 30 cycles of 94°C for 1 min, 37°C for 1 min, and 72°C for 2 min, with a final extension step at 72°C for 10 min. RAPD-PCR products were analyzed after electrophoresis on 1.8% agarose gels and staining with 0.5 µg of ethidium bromide/ml. A 100-bp DNA ladder (Gibco-BRL) was used as a molecular weight marker. The profiles derived from DNA amplification of bacterial isolates were analyzed and compared as performed for the analysis of whole-cell protein profiles after SDS-PAGE. The Dice coefficient, in conjunction with the application of the Pearson correlation coefficient, was used to calculate the similarities among the electrophoretic profiles in order to evaluate the best coefficient for evaluating the RAPD-PCR results.
Analysis of the chromosomal DNA restriction profiles by PFGE. Chromosomal DNA was prepared in agarose plugs and treated with the restriction endonuclease SmaI as previously recommended by Teixeira et al. (23). The fragments were separated by pulsed-field gel electrophoresis (PFGE) in 1.2% agarose gels in a CHEF-DRIII system (Bio-Rad), with pulse times increasing from 2 to 30s, over 22 h at 11°C, at a voltage gradient of 6 V/cm. The restriction profiles were analyzed and compared by using the Dice coefficient and clustering by the UPGMA by using the Molecular Analyst Fingerprinting Plus software package, version 1.12, of the Image Analysis System (Bio-Rad).
Discriminatory power of molecular typing techniques.
The discriminatory power of the RAPD-PCR and PFGE techniques for typing S. porcinus strains was evaluated by using the discrimination index as described by Hunter and Gaston (11) as given by the equation: D = 1 [1/N (N 1)]
nj (nj 1), where D is the numerical index of discrimination, N is the total number of strains, and nj is the number of strains pertaining to the jth type. The discrimination indexes were obtained considering the comparison of the profiles by visual inspection and by the automated analysis referred to for each methodology.
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After cultivation on sheep blood agar, most strains presented a wide zone of complete hemolysis surrounding the colonies. Strains SS-9, SS-607, SS-662, 834-94, 3657-98, and 3658-98 were slower-growing variants exhibiting evident growth on agar blood plates after 24 h of incubation if under an atmosphere containing 5% CO2.
The serological characteristics of the isolates are presented in Tables 1 and 2. Most of the isolates (22 isolates; 88%) obtained from human sources harbored the NG1 (C1) antigen, and 3 (12%) reacted with group P antigen, whereas the isolates from nonhuman sources had diverse group antigens.
All of the 42 strains included in the present study (comprising the 25 human isolates and the 17 reference strains) had the following characteristics. They were gram-positive, catalase-negative cocci; they produced leucine aminopeptidase (LAPase) and L-pyrrolidonylarylamidase (PYRase); they were susceptible to vancomycin; they were positive for arginine and esculin hydrolysis; and they produced acids from maltose, mannitol, ribose, sorbitol, sucrose, and trehalose. Most strains were resistant to bacitracin and positive in the CAMP test. All S. porcinus isolates had negative results for hydrolysis of esculin in the presence of bile; starch hydrolysis; production of pigment; production of gas in Lactobacillus deMan, Rogosa, and Sharpe broth; and motility and production of polysaccharides from both broth and agar containing 5% sucrose. They also failed to form acid from arabinose, inulin, raffinose, and sorbose. Variable results were observed for other tests as shown in Table 3.
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TABLE 3. Phenotypic characteristics of S. porcinus isolated from human and nonhuman sources as determined by conventional physiological testsa
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-galactosidase, ß-manosidase, and urease and for the production of acids from L-arabinose, D-arabitol, melezitose, and cyclodextrin. Only 6 (14%) of the 42 S. porcinus strains were correctly identified using the manufacturer's suggested numerical profile system. Most of the isolates (32 isolates; 76%) were identified as Streptococcus uberis biogroup I, 7% (three isolates) as S. agalactiae and 2% (one isolate) as Streptococcus dysgalactiae. On the other hand, the two strains of S. pyogenes and the five strains of S. agalactiae, used as controls, were correctly identified by the manufacturer's profile system. |
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TABLE 4. Phenotypic characteristics of S. porcinus isolated from human and nonhuman sources, as determined by the RAPID ID 32 Strep system, and comparison with expected results and results of related species
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TABLE 5. MICs of different antimicrobial agents for S. porcinus strains isolated from human and nonhuman sources
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FIG. 1. (A) SDS-PAGE profiles of whole-cell protein extracts of representative strains of S. porcinus, S. agalactiae, and S. pyogenes. Lanes 1, 6, and 10, molecular size markers (in kilodaltons); lane 2, S. porcinus SS-1029; lane 3, S. porcinus 1533-95; lane 4, S. porcinus 2885-95; lane 5, S. porcinus 3676-95; lane 7, S. porcinus 4188-95; lane 8, S. porcinus 4189-95; lane 9, S. porcinus 663-96; lane 11, S. agalactiae SS-617; lane 12, S. agalactiae SS-1073; lane 13, S. pyogenes SS-103; lane 14, S. pyogenes SS-745. (B) Dendrogram resulting from computer-assisted analysis of protein profiles of S. porcinus strains included in the present study. UPGMA was used for clustering the correlation coefficients (expressed as percentages). The Pearson product moment correlation coefficient was used for calculating the percentage of similarities among the profiles. The scale represents the average percentage of similarity.
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FIG. 2. (A) RAPD-PCR profiles of representative S. porcinus isolates. Lanes 1 and 10, molecular size markers (100-bp ladder); lane 2, SS-9; lane 3, SS-662; lane 4, SS-670; lane 5, SS-841; lane 6, SS-857; lane 7, SS-997; lane 8, SS-998; lane 9, SS-1024, lane 11, 1217-87, lane 12, 1451-92; lane 13, 638-93; lane 14, 834-94; lane 15, 1013-94; lane 16, 345-95; lane 17, 4188-95; lane 18, 3176-97; and lane 19, 790-98. (B) Dendrogram resulting from computer-assisted analysis of the RAPD-PCR profiles of S. porcinus isolates. The Pearson product moment correlation coefficient was used for calculating the percentage of similarities among the profiles.
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FIG. 3. (A) PFGE profiles of chromosomal DNA of S. porcinus isolates after digestion with SmaI. Lanes 1 and 8, molecular size markers (in kilobases; lambda DNA concatemers ranging from 48.5 to 1,018.5 kb); lane 2, SS-1029; lane 3, SS-558; lane 4, SS-740; lane 5, SS-857; lane 6, SS-997; lane 7, SS-1058; lane 9, 1499-84; lane 10, 369-94; lane 11, 1013-94; lane 12, 4188-95; lane 13, 4189-95; lane 14, 663-96; and lane 15, 4524-96. (B) Dendrogram resulting from computer-assisted analysis of the PFGE profiles of S. porcinus isolates. The Dice coefficient was used for calculating the percentages of similarity among the profiles.
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TABLE 6. Comparison of discriminatory power of the RAPD-PCR and PFGE techniques for typing S. porcinus strains
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S. porcinus isolates may exhibit some characteristics that are similar to those of S. agalactiae or S. pyogenes. S. agalactiae isolates are beta-hemolytic (usually narrow zones), have positive results for the CAMP test, hydrolize arginine and hippurate, produce alkaline phosphatase, are resistant to bacitracin, and produce acids from ribose and trehalose. These microorganisms are known as a common etiological agent of genitourinary tract infections leading to intrauterine or postpartum complications and newborn diseases. Many healthy women asymptomatically carry S. agalactiae in this anatomic site and remain unaffected clinically (22). It is not known whether S. porcinus is carried asymptomatically or not. On the other hand, most S. porcinus strains show positive results for the PYR test, and a few may even be susceptible to bacitracin, resembling S. pyogenes strains, and this may be another explanation for possible misidentification.
The majority of the isolates included in the present study were recovered from clinical specimens related to the genitourinary tract and had characteristics that resemble S. agalactiae as described above. Physiologic characteristics that can help in distinguishing these two species include the wide zone of complete hemolysis produced by S. porcinus strains after cultivation on sheep blood agar, in contrast to the narrow zone produced by S. agalactiae; the production of acetoin observed in the Voges-Proskauer test; the production of PYRase; and the production of acids from mannitol and sorbitol. The inclusion of these tests in a routine basis for the identification of beta-hemolytic streptococci in clinical laboratories would be helpful for a more precise detection and evaluation of the occurrence of S. porcinus infections.
The use of a commercial system (the Rapid ID 32 Strep system) can also lead to misidentification of S. porcinus, as we observed in the present work. Most of the strains were identified as S. uberis. This system seems to be useful for the rapid identification of beta-hemolytic streptococci more commonly associated with human infections (mainly group A and group B streptococci). The limited performance of different systems for the identification of less frequently isolated human or veterinary pathogens has been previously reviewed (1, 28).
An evidence that supports the role of S. porcinus as a newly emerging pathogen is associated with the fact that this microorganism has only been isolated from human beings in the last two decades. Also, the description of this species, as well as the development of studies for a more detailed physiological characterization and definition of the phylogenetic position of S. porcinus, has only been published in a relatively recent period (2, 4, 6, 14). On the other hand, the apparent increase in the frequency of isolation of S. porcinus from human clinical sources may essentially be related to improvements in the identification. As already discussed, this microorganism may have previously been misidentified, since many microbiology laboratories only applied one or a few presumptive identification tests, such as the CAMP test, the PYR test, and evaluation of susceptibility to bacitracin, for the identification of beta-hemolytic streptococci from human sources. Furthermore, some S. porcinus strains cross-reacted with commercial group B serogrouping reagents, as noted earlier (24).
Most of the physiologic characteristics observed for the isolates included in the present study were similar to those described in previous reports (4, 6, 10, 15, 16, 29). However, differences were detected, the most striking being those related to the findings of Collins et al. (4) and Wessman (29), who described the S. porcinus strains as negative for the hippurate test and for production of PYRase. As observed in the present investigation, as well as in other studies (6, 10, 15, 16), S. porcinus strains can be positive for the hippurate test and for production of PYRase. We observed positive PYR test reactions for all S. porcinus strains tested, although some of the reactions were weak. The use of different methodologies for the phenotypic characterization may be a cause of the differences observed.
The only antimicrobial resistance marker found among strains included in the present study was resistance to tetracycline. Resistance was more common among isolates from human sources. Two different genes, tet(M) and tet(O), were found to be associated with tetracycline resistance in S. porcinus, with tet(M) being the predominant among both human and nonhuman isolates. To our knowledge, this is the first report of the presence of these genes in members of this bacterial species. The high prevalence of tetracycline resistance among S. porcinus isolates may be related to the presence of common genetic elements in chromosomal DNA of these microorganisms, such as transposons Tn916 and Tn3701, which code for resistance to tetracycline and are widely distributed among other members of the genus Streptococcus (3).
Analysis of whole-cell protein (WCP) profiles by a standardized method was shown to be a suitable tool for the differentiation of streptococcal species (26, 27). WCP profiles are considered to reflect excellent approximations of genome information, providing indirect analysis of genotypic characteristics (5). Our results indicated that analysis of WCP profiles constitute a relatively simple and a reproducible procedure for the characterization of S. porcinus strains and may be useful for differentiating them from physiologically related beta-hemolytic streptococcal species.
The human isolates included in the present study were obtained from patients living in different locations, and the periods of isolation were also diverse, suggesting the lack of common sources of transmission.
We successfully applied RAPD-PCR and PFGE analysis to investigate the genetic diversity of S. porcinus isolates from different sources. The results of both RAPD-PCR and PFGE analysis revealed a variety of profiles reflecting the substantial genetic diversity among isolates of this species and indicating the potential ability of these techniques for typing these microorganisms. RAPD-PCR analysis, with primer 1254, clearly revealed that most of the S. porcinus isolates from human sources were grouped in the same cluster. When automated analysis was applied by using the Pearson correlation coefficient, two main clusters (I and II) were identified, representing the majority of the isolates from human and nonhuman sources, respectively. The clustering into two groups of similarity was in agreement with the dendrogram structure obtained after analysis of the PFGE profiles, suggesting the lack of clonal relationship among S. porcinus isolates from different hosts. These findings suggest the existence of a few clonal groups of S. porcinus adapted to the human host.
The distinctive PFGE profiles obtained after digestion of chromosomal DNA with SmaI and by computer analysis generated a dendrogram with a more defined distribution of clusters. All of the isolates from human sources were grouped into cluster I and were distinct (48% of similarity) from most of the isolates obtained from nonhuman sources. The PFGE results were in agreement with those obtained by RAPD analysis. A higher similarity among S. porcinus isolates harboring group E antigen was also observed, suggesting a common ancestor for these isolates. Several distinct ancestors may explain the differences in clonality among S. porcinus isolates from nonhuman sources. Both the RAPD-PCR and the PFGE methodologies presented high values for discrimination index (
0.90); however, PFGE showed higher accuracy for the distinction of clones. Although RAPD-PCR is less time-consuming, restriction endonuclease analysis by using PFGE for typing of S. porcinus provided profiles with a more homogeneous distribution and intensity of bands, leading to more clear-cut and easy-to-interpret data. These observations support the usefulness of these techniques for typing of S. porcinus isolates, although the dendrogram structures resulting from the use of different methods revealed distinct distribution of clusters.
In summary, although the number of isolates is still limited, the present report provides information on the largest collection of S. porcinus recovered from human sources examined to date, and it is the first to present a comparison of the molecular properties of this microorganism. The data indicate the high relationship among isolates from humans in contrast to a larger diversity among isolates probably not related to the zoonotic transmission of strains. Therefore, specific clones may be associated with infection in different hosts. We describe a variety of methods and techniques that can be helpful in the precise identification and characterization of S. porcinus. In addition to the three tests (susceptibility to bacitracin, production of PYRase, and CAMP factor) used in the routine conventional test scheme for the presumptive identification of beta-hemolytic streptococci, we recommend the inclusion of supplementary tests, such as acetoin production and the production of acids from mannitol and sorbitol, in order to differentiate S. porcinus from S. agalactiae and S. pyogenes. S. porcinus strains usually present positive results in all of these three tests, and S. agalactiae strains are negative. S. porcinus strains can be differentiated from S. pyogenes on the basis of usually positive results for the CAMP test and of negative results for susceptibility to bacitracin. The use of more accurate procedures to properly detect and characterize members of this species will clarify their role in both human and animal infections.
Present address: Departamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil. ![]()
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