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Shim, Sung, Baek, Namgung, Kim, Kim, and Lee: A Case of Catheter-Related Bacteremia of Tsukamurella pulmonis
Original Article

Korean J Leg Med 2009;29(1):41-47.

Published online: 14 February 2009

DOI: https://doi.org/10.3343/kjlm.2009.29.1.41

A Case of Catheter-Related Bacteremia of Tsukamurella pulmonis

Hyoeun Eun Shim, M.D.1, Heungsup Sung, M.D.1, Seung Mi Baek, M.T.1, Seung Namgung, M.T.1, Mi-Na Kim, M.D.1, , Yong Gyun Kim, M.D.2, Gyu Hyung Lee, M.D.2

1Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

2Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

Corresponding author: Mi-Na Kim, M.D. Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-4511, Fax: +82-2-478-0884 E-mail: mnkim@amc.seoul.kr

Received 28 October 20085 January 2008       Accepted 9 January 2008

Copyright © 2009 by the Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tsukamurella pulmonis is an aerobic actinomycete. We report a catheter-related bacteremia of T. pulmonis. A 39 yr-old male with ALL was hospitalized to receive bone marrow transplantation (BMT). Although the patient developed a high fever at the 7th hospital day (HD), it subsided with vancomycin treatment, and he received BMT at 9th HD. Fever resurged at 16th HD despite sustained treatment with vancomycin, meropenem, and amphotericin B, but subsided with removal of Hickman catheter (HC) at 19th HD. Three sets of blood cultures comprising one from the HC and two from venipunctures were taken at 7th, 16th, and 19th HD, and the distal tip of the HC was also cultured. The aerobic vials of all 3 HC-withdrawn blood cultures and one peripheral blood culture taken at 19HD and the HC tip culture grew long, straight, thin gram-positive rods that were positive on modified Kinyoun stain. This organism showed tiny, rough, grey colonies after 3-day incubation and grew to large flat colonies when incubation was extended. It was catalase-positive, urease-positive, and alkaline-slant/alkaline-deep on triple sugar iron agar, and hydrolyzed hypoxanthine. The sequence of 1,296 base pairs of 16S rRNA of this organism showed a 100.0% homology with the published sequence of T. pulmonis DSM 44142T. To our knowledge, this is the first report of T. pulmonis bacteremia in Korea.

Keywords: Tsukamurella pulmonis, Bacteremia, Hickman catheter, 16S rRNA

REFERENCES

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Fig. 1.
Microscopy of the colonies showing long, thin, straight Gram-positive rods on Gram stain (A) and acid-fastness on modified Kinyoun stain (B).
kjlm-29-41f1.tif
Fig. 2.
Tsukamurella pulmonis cultures grown on sheep blood agar at 35°C in ambient air showing dry, velvety, greytan colonies at day 3 (A) and yellowish granules on the top of flat colonies with fringed edges at day 6 (B).
kjlm-29-41f2.tif
Fig. 3.
Unrooted tree showing the phylogenetic relationships of the isolate of this study, 7A1960, and closely related Gram-positive bacteria. The tree was constructed by neighbour joining method using the Kimura two-parameter model and bootstrap values were calculated from 1,000 trees. The scale bar indicates the estimated number of substitutions per 100 nucleotides.
kjlm-29-41f3.tif
Table 1.
Physiological and biochemical characteristics of the isolate of this study as compared to the biochemical reactions of published type strains [16]
Characteristic The isolate of this study T. pulmonis DSM 44142T T.incho nensis DSM 44067T T.paurometabola DSM 20162T T.tyrosinosolvens DSM 44234T
Utilization of          
 D-glucose +∗ + + + +
 Arabinose –† – – – –
 D-mannitol +‡ + + – +
 D-maltose -‡ – – + +
 Gluconate +‡ + + + +
 Citrate -† - + - +
 Gelatin -‡ - - - -
 Sucrose +∗ + + + +
 Inositol -† - + + +
 Sorbitol +∗ + + - +
 Rhamnose -† - - - -
Presence of          
 Urease +§ + + + +
 Catalase + + + + +
 Nitrate reductase -‖ - - - -
 β-Glucosidase + + + + +
 β-Galactosidase -‖ + + + +
Growth at          
 24°C + + + + +
 31°C + + + + +
 37°C + + + + +
 45°C - - + - -
Hydrolysis of          
 Hypoxanthine + -/+ + - +
 Tyrosine - - - - +
 Xanthine - - - - +
 Casein - - - - -
 Esculin +‖ + + + +

Tested by

∗ API 20C Aux,

† API E,

‡ API NE,

§ Christensen's urea agar,

‖ API Coryne,

RapidID CB Plus.

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