This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Landais, C.
Right arrow Articles by Brouqui, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Landais, C.
Right arrow Articles by Brouqui, P.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, March 2007, p. 1063-1065, Vol. 45, No. 3
0095-1137/07/$08.00+0     doi:10.1128/JCM.01805-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

CASE REPORT

Application of rrs Gene Sequencing To Elucidate the Clinical Significance of Eggerthela lenta Infection{triangledown}

Cécile Landais,1 Barbara Doudier,1* Guenièvre Imbert,2 Florence Fenollar,3 and Philippe Brouqui1

Service des Maladies Infectieuses et Tropicales Hôpital Nord, Chemin des Bourrelys, 13915 Marseille, France,1 Laboratoire de Microbiologie Clinique, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille, France,2 Laboratoire de Microbiologie Clinique, Hôpital de la Timone, Boulevard Jean Moulin, 13005 Marseille, France3

Received 31 August 2006/ Returned for modification 10 October 2006/ Accepted 3 January 2007


arrow
INTRODUCTION
 
Eggerthella lenta, a bacterium of the intestinal human gut flora, has rarely been reported to cause significant infections. We report two cases of bacteremia and the first case of liver abscess due to Eggerthella lenta identified by rrs gene analysis.


arrow
CASE REPORTS
 
Case 1. An 82-year-old man was admitted with fecal peritonitis related to intestinal perforation. His past medical history was unremarkable except for senile dementia. He complained from an acute abdominal pain. At examination, abdominal contracture and high-grade fever were noted, but blood cultures remained sterile. A bowel colostomy was undertaken, and the patient was started on broad-spectrum antibiotic therapy (tazocillin at 12 g/day and ciprofloxacin at 500 mg/twice a day). After 10 days of such therapy, the fever relapsed. Urinary bacterial culture was sterile, but anaerobic gram-positive bacilli were isolated from one blood culture and identified by rrs sequencing as Eggerthella lenta. The isolate was susceptible to amoxicillin and clavulanic acid, imipenem, metronidazole, and vancomycin. A computed tomagraphy scan did not show any deep abscess, and a transesophageal echocardiography was normal. The patient responded favorably to a 3-week course of imipenem (1.5g/day). He remains well at follow-up.

Case 2. A 33-year-old man was hospitalized with acute appendicitis. No underlying conditions were noted. After surgical removal of the appendix, the histopathologic analysis showed acute inflammation involving appendicular mucosa and submucosa but no suppurative inflammation. The surgical treatment was rapidly complicated by a febrile parietal abscess at the cecum, at the surgical insertion site. Two sets of blood cultures were collected, from which two anaerobic bacteria were identified. Fusobacterium mortiferum was identified by conventional methods by using the API 20NE system (bioMérieux, France), but the other gram-positive bacillus was identified as E. lenta by rrs gene sequencing. They were both susceptible to amoxicillin and clavulanic acid, imipenem, and vancomycin. The patient received amoxicillin and clavulanic acid (3 g/day), which had a quick and favorable outcome.

Case 3. A 42-year-old woman was admitted with fever and abdominal pain. Her medical history included an ovarian carcinoma with peritoneal metastatic involvement for which she received antimitotic chemotherapy. A gastrointestinal derivation had been placed for intestinal obstruction a few months before the admission for infection. At admission, an abdominal computed tomography scan confirmed the presence of a liver abscess that was treated by surgical drainage. Collected pus from the abscess grew two anaerobic bacilli, which were identified by rrs gene sequencing as Clostridium paraputrificum and E. lenta. They were only susceptible to metronidazole and vancomycin. Antibiotic therapy with metronidazole (1.5 g/day) was started. The patient responded favorably.

The bacterial strains in these cases were isolated in blood cultures from patients 1 and 2 and from a liver abscess from patient 3. After 2 to 4 days, gram-positive bacteria were isolated from anaerobic blood cultures with the BACTEC 9240 automated blood system (Becton Dickinson and Co., Sparks, MD). Then, blood and pus were cultured onto Columbia sheep blood agar (bioMérieux, Marcy l'Étoile, France) and incubated in an anaerobic atmosphere for 5 days. Small translucent colonies resulted. A test using API 20A strips (bioMérieux, France) was performed, allowing the identification of E. lenta to between 90% and 96% identity. In order to accurately identify these microorganisms, rrs gene comparisons were performed (Service of Bacteriology, Hospital Timone, Marseille, France), and the three bacteria were identified as E. lenta with 99% of homology upon a 1,499-nucleotide fragment (GenBank accession no. AF 292375) for all three strains (2).

The three clinical cases that we have reported thus far are described in Table 1 (patients 1, 2, and 3), as well as the other five cases cited by Lau et al. (6). The median age was 57 years (range, 33 to 82 years). Two of our patients had underlying severe diseases: notably one has an ovarian carcinoma. In the three cases, we reported, all patients had underlying intestinal diseases and only one had a monomicrobial infection. Antibiotic susceptibilities were different between the three strains. Two strains were susceptible to amoxicillin-clavulanic acid, imipenem, metronidazole, and vancomycin, but one was susceptible to metronidazole and vancomycin only.


View this table:
[in this window]
[in a new window]

  		TABLE 1. Characteristics of the patients with E. lenta bacteremia

Discussion. The genus Eggerthella includes anaerobic, nonsporulating, gram-positive bacilli. These bacteria were named in honor of Arnold Eggerth, who made the first description in 1935 (3). Eggerthella gen. nov. was proposed to substitute for Eubacterium lentum in 1999 on the basis of the rrs sequence divergence from Collinsella aerofaciens and Coriobacterium glomerans and the presence of unique phenotypic characteristics (4, 12). Eggerthella lenta comb. nov. is one species of this new group.

E. lenta (formerly Eubacterium lentum) belongs to the intestinal microflora of humans. Few cases of infection due to E. lenta have been reported in humans. The following are examples of pathological cases due to E. lenta: postgynecological surgery, chorioamniotitis after cervical cerclage required for gravid patients, and infection of the female genital tract due to intrauterine devices (1). Specific and rare cases have been reported implying the same infectious agent, such as a case of frontal sinusitis with intracranial complications that occurred in a young man with sickle cell disease (10), a cutaneous abscess in an intravenous drug user (5), and the occurrence of bacteremia in two single cases—one after a subgingival irrigation (13) and another in association with a concomitant cytomegalovirus pneumonia (9).

E. lenta has also been isolated from appendix tissue samples obtained at surgery from children with suspected appendicitis (11) and isolated in polymicrobial infections with others anaerobic bacteria, notably in colonized aortic aneurysm wall (8). Pelvic inflammatory diseases and infected bed sores might be complicated by E. lenta bacteremia (6). Throughout the available literature, bacteremia associated with Eggerthella sp. was reported in 10 cases, including 5 due to E. lenta only. These five cases and the additional three cases encountered in our unit (Infectious and Tropical Diseases Department, Marseille, France) are described in Table 1.

E. lenta bacteremia has been associated with high risk of morbidity and mortality such as septic shock and disseminated intravascular coagulation (6, 7). Among patients with documented bacteremia, the major risk factors were advanced age and underlying diseases such as neoplasia, immunosuppression, and involvement of the gastrointestinal or genital tract (6, 12). In our three cases, patients had a past history of digestive disease.

To our knowledge, E. lenta has never been isolated in liver abscess, probably because the samples are currently polymicrobial and E. lenta is difficult to isolate by conventional methods.

Molecular techniques are very useful for the specific diagnosis of bacteremia associated with polymicrobial anaerobic nonsporulating gram-positive bacilli. Two novel species, Eggerthella hongkongensis and Eggerthella sinensis, have been identified by rrs gene sequencing (7). For the first time, we have been able to identify E. lenta in a hepatic abscess by molecular techniques.

The three cases that we report confirm that E. lenta is likely to be a more common pathogen than previously expected. Moreover, it is frequently associated with polymicrobial bacteremia, and a remarkable and consistent finding is that E. lenta is susceptible to different antibiotics, explaining the diversity of antibiotic treatment given to these patients.

Based on our findings, we assume that the application of rrs gene sequencing would thus enable us to widen the clinical spectrum of E. lenta infection.


arrow
FOOTNOTES
 
* Corresponding author. Mailing address: Service des Maladies Infectieuses et Tropicales Hôpital Nord, Chemin des Bourrelys, 13915 Marseille, France. Phone: 04 91 96 89 35. Fax: 04 91 96 89 38. E-mail: philippe.brouqui{at}medecine.univ-mrs.fr. Back

{triangledown} Published ahead of print on 17 January 2007. Back


arrow
REFERENCES
 
    1
  1. Charles, D., and W. R. Edwards. 1981. Infectious complications of cervical cerclage. Am. J. Obstet. Gynecol. 141:1065-1071.[Medline]
    2. 2
  2. Drancourt M., C. Bollet, A. Carlioz, R. Martelin, J.-P. Gayral, and D. Raoult. 2000. 16S ribosomal DNA sequence analysis of a large collection of environmental and clinical unidentifiable bacterial isolates. J. Clin. Microbiol. 38:3623-3630.[Abstract/Free Full Text]
    3. 3
  3. Eggerth, A. H. 1935. The gram-positive non-spore-bearing anaerobic bacilli of human feces. J. Bacteriol. 30:277-299.[Free Full Text]
    4. 4
  4. Kageyama, A., Y. Benno, and T. Nakase. 1999. Phylogenetic evidence for the transfer of Eubacterium lentum to the genus Eggerthella as Eggerthella lenta gen. nov., comb. nov. Int. J. Syst. Bacteriol. 49:1725-1732.[Abstract/Free Full Text]
    5. 5
  5. Lattuada, E., A. Zorzi, M. Lanzafame, D. Antolini, R. Fontana, S. Vento, and E. Concia. 2005. Cutaneous abscess due to Eubacterium lentum in injection drug user: a case report and review of the literature. J. Infect. 51:E71-E72.[CrossRef][Medline]
    6. 6
  6. Lau, S. K., P. C. Woo, A. M. Fung, K. M. Chan, G. K. Woo, and K. Y. Yuen. 2004. Anaerobic, non-sporulating, Gram-positive bacilli bacteraemia characterized by 16S rRNA gene sequencing. J. Med. Microbiol. 53:1247-1253.[Abstract/Free Full Text]
    7. 7
  7. Lau, S. K., P. C. Woo, G. K. Woo, A. M. Fung, M. K. Wong, K. M. Chan, D. M. Tam, and K. Y. Yuen. 2004. Eggerthella hongkongensis sp. nov. and Eggerthella sinensis sp. nov., two novel Eggerthella species, account for half of the cases of Eggerthella bacteremia. Diagn. Microbiol. Infect. Dis. 49:255-263.[CrossRef][Medline]
    8. 8
  8. Marques da Silva, R., P. S. Lingaas, O. Geiran, L. Tronstad, and I. Olsen. 2003. Multiple bacteria in aortic aneurysms. J. Vasc. Surg. 38:1384-1389.[CrossRef][Medline]
    9. 9
  9. Marrie, T. J., D. T. Janigan, E. V. Haldane, R. S. Faulkner, C. Kwan, and H. Durant. 1985. Does cytomegalovirus play a role in community-acquired pneumonia? Clin. Investig. Med. 8:286-295.[Medline]
    10. 10
  10. Moon, T., R. Y. Lin, and A. F. Jahn. 1986. Fatal frontal sinusitis due to Neisseria sicca and Eubacterium lentum. J. Otolaryngol. 15:193-195.[Medline]
    11. 11
  11. Rautio, M., H. Saxen, A. Siitonen, R. Nikku, and H. Jousimies-Somer. 2000. Bacteriology of histopathologically defined appendicitis in children. Pediatr. Infect. Dis. J. 19:1078-1083.[Medline]
    12. 12
  12. Wade, W. G., J. Downes, D. Dymock, S. J. Hiom, A. J. Weightman, F. E. Dewhirst, B. J. Paster, N. Tzellas, and B. Coleman. 1999. The family Coriobacteriaceae: reclassification of Eubacterium exiguum (Poco et al. 1996) and Peptostreptococcus heliotrinreducens (Lanigan 1976) as Slackia exigua gen. nov., comb. nov. and Slackia heliotrinireducens gen. nov., comb. nov., and Eubacterium lentum (Prevot 1938) as Eggerthella lenta gen. nov., comb. nov. Int. J. Syst. Bacteriol. 49:595-600.[Abstract/Free Full Text]
    13. 13
  13. Waki, M. Y., D. L. Jolkovsky, J. Otomo-Corgel, J. E. Lofthus, S. Nachnani, M. G. Newman, and T. F. Flemmig. 1990. Effects of subgingival irrigation on bacteremia following scaling and root planing. J. Periodontol. 61:405-411.[Medline]

Journal of Clinical Microbiology, March 2007, p. 1063-1065, Vol. 45, No. 3
0095-1137/07/$08.00+0     doi:10.1128/JCM.01805-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Wurdemann, D., Tindall, B. J., Pukall, R., Lunsdorf, H., Strompl, C., Namuth, T., Nahrstedt, H., Wos-Oxley, M., Ott, S., Schreiber, S., Timmis, K. N., Oxley, A. P. A. (2009). Gordonibacter pamelaeae gen. nov., sp. nov., a new member of the Coriobacteriaceae isolated from a patient with Crohn's disease, and reclassification of Eggerthella hongkongensis Lau et al. 2006 as Paraeggerthella hongkongensis gen. nov., comb. nov.. Int. J. Syst. Evol. Microbiol. 59: 1405-1415 [Abstract] [Full Text]  

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Landais, C.
Right arrow Articles by Brouqui, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Landais, C.
Right arrow Articles by Brouqui, P.

Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»