Disseminated Cornynebacterium Propinquum (CDC group ANF 3) Infection in a Patient with Reactivated Tuberculosis

摘要

We report the first case in the medical literature of disseminated Cornybacterium propinquum (C propinquum) infection in a patient with extrapulmonary tuberculosis. The microbiology and the treatment of this unusual bacterium is reviewed. Case Report A 76 year old white male with a remote history of pulmonary tuberculosis was admitted to the hospital with chest pain and underwent a coronary artery bypass procedure. He was admitted a few weeks later in cardiorespiratory arrest. During the resuscitation the sternal wound opened and subsequently became infected with Staphylococcus epidermidis. The hospitalization was complicated with a right sided pleural effusion and persistent low grade fevers and night sweats. He was started on nafcillin to treat the sternal wound infection but despite this continued to become progressively ill. Thorocentesis done two weeks later grew mycobacterium TB sensitive to the standard anti tubercular medications. The white blood cell count was 4300 cell/cu mm with a differential of 72 segs, 17 lymphs, 6 monos and 2 bands. Repeated blood and urine cultures were negative. Central lines were changed frequently and the catheter tips had no growth. Despite isoniazid, ethambutol, pyrazinamide and rifampin the patient continued to have low grade fevers. A bone marrow biopsy and repeat blood cultures (2 sets) were preformed. After 48 hours of incubation, the Gram stain of the bone marrow revealed Gram positive pleomorphic bacilli which eventually grew well on 5% sheep's blood and chocolate agars under aerobic conditions. The isolate was subjected to a set of conventional biochemical tests (Specialty Labs, Inc., Santa Monica, AC.) including: Catalse, Oxidase, Motility, Gelatin, Nitrate, Urea, Bile Esculin, TSI, Glucose, Maltose, Sucrose, Mannitol, Xylose and Trealose. Results from these biochemical tests are shown in Table I. The bacterium was noted to be susceptible to ciprofloxacin, cefazolin, gentamicin, vancomycin, imipenem and cephalothin and resistant to norfloxacin and oxacillin. He had been empirically placed on vancomycin before the identification and sensitivity were available and defervesced. He was treated for six weeks with vancomycin and on follow up six months later continued to do well.