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<article xml:lang="KO" article-type="case-report">

<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Korean J Clin Microbiol</journal-id>
<journal-id journal-id-type="publisher-id">KJCM</journal-id>
<journal-title>Korean Journal of Clinical Microbiology</journal-title>
<issn pub-type="ppub">1229-0025</issn>
<publisher>
<publisher-name>The Korean Society of Clinical Microbiology</publisher-name>
</publisher>
</journal-meta>

<article-meta>

<article-id pub-id-type="doi">10.5145/KJCM.2012.15.4.143</article-id>

<article-categories>
<subj-group>
<subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>A Case of Diabetic Foot Ulcer Caused by <italic>Arcanobacterium haemolyticum</italic> and <italic>Streptococcus agalactiae</italic></article-title>
</title-group>

<contrib-group>

<contrib contrib-type="author">
<name>
<surname>Choi</surname>
<given-names>Moon Suk</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Dal Sik</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Choi</surname>
<given-names>Sam Im</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Cho</surname>
<given-names>Yong Gon</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>

<contrib contrib-type="author" corresp="yes">
<name>
<surname>Lee</surname>
<given-names>Hye Soo</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>

</contrib-group>

<aff id="A1"><label>1</label>Department of Laboratory Medicine, Chonbuk National University Medical School, Jeonju, Korea.</aff>
<aff id="A2"><label>2</label>Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.</aff>
<aff id="A3"><label>3</label>Chonbuk National University Hospital Culture Collection for Pathogens, Jeonju, Korea.</aff>

<author-notes>
<corresp>Correspondence: Hye Soo Lee, Department of Laboratory Medicine, Chonbuk National University Medical School, 634-18, Geumam-dong, Dukjin-gu, Jeonju 561-712, Korea. (Tel) 82-63-250-1218, (Fax) 82-63-250-1200, <email>leehs@jbnu.ac.kr</email></corresp>
</author-notes>

<pub-date pub-type="ppub">
<month>12</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="epub">
<day>21</day>
<month>12</month>
<year>2012</year>
</pub-date>
<volume>15</volume>
<issue>4</issue>
<fpage>143</fpage>
<lpage>146</lpage>
<history>
<date date-type="received">
<day>10</day>
<month>08</month>
<year>2012</year>
</date>
<date date-type="rev-recd">
<day>26</day>
<month>09</month>
<year>2012</year>
</date>
<date date-type="accepted">
<day>18</day>
<month>10</month>
<year>2012</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2012 The Korean Society of Clinical Microbiology</copyright-statement>
<copyright-year>2012</copyright-year>
</permissions>

<abstract>
<p><italic>Arcanobacterium haemolyticum</italic>, a aerobic Gram-positive rod, has been described as an unusual pathogen causing soft tissue infections such as pharyngotonsillitis, chronic ulcer and cellulitis. In addition, the microorganism causes deep-seated infection and systemic disease including endocarditis, vertebral osteomyelitis and sepsis in patients with predisposing conditions such as diabetes mellitus. Since colonies and microscopic findings of <italic>A. haemolyticum</italic> might be confused with those of streptococci and coryneform bacteria, and it is usually isolated with other microorganisms, it is often considered to be normal flora or a contaminant in wound infections, resulting in missed or delayed diagnosis. <italic>Streptococcus agalactiae</italic> infections in neonates and pregnant women have been well recognized. However, invasive <italic>S. agalactiae</italic> infections in non-pregnant older adults with chronic medical conditions, particularly diabetes mellitus, are increasing. We report a case of diabetic foot ulcer due to <italic>A. haemolyticum</italic> and <italic>S. agalactiae</italic> in an uncontrolled diabetes mellitus patient.</p>
</abstract>

<kwd-group>
<kwd><italic>Arcanobacterium haemolyticum</italic></kwd>
<kwd>Diabetic foot ulcer</kwd>
<kwd><italic>Streptococcus agalactiae</italic></kwd>
</kwd-group>

</article-meta>
</front>

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</back>

<floats-wrap>

<fig position="float" id="F1">
<label>Fig. 1</label>
<caption>
  <p>Diabetic foot ulcer after debridement of necrotic tissue (Left foot).</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="kjcm-15-143-g001" alt-version="no"></graphic>
</fig>

<fig position="float" id="F2">
<label>Fig. 2</label>
<caption>
  <p>(A) Colony morphology of <italic>A. haemolyticum</italic> on blood agar plate. Tiny, gray-white colored colonies with &#x03B2; hemolysis are shown (35&#x2103;, 48 hrs). (B) Gram stain of <italic>A. haemolyticum</italic> shows gram positive polymorphic rod (&#x00D7;1,000).</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="kjcm-15-143-g002" alt-version="no"></graphic>
</fig>

<fig position="float" id="F3">
<label>Fig. 3</label>
<caption>
  <p>CAMP inhibition reaction positive <italic>A. haemolyticum</italic> (white arrow) compared to CAMP reaction positive <italic>S. agalactiae</italic> on blood agar plate.</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="kjcm-15-143-g003" alt-version="no"></graphic>
</fig>

</floats-wrap>

</article>