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LETTER TO EDITOR  
Year : 2012  |  Volume : 55  |  Issue : 4  |  Page : 609-610
Granulicatella adiacens - An unusual causative agent for carbuncle


Department of Microbiology, Institute of Medical Sciences & SUM Hospital, S"O"A University, Bhubaneswar-3, India

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Date of Web Publication4-Mar-2013
 

How to cite this article:
Swain B, Otta S. Granulicatella adiacens - An unusual causative agent for carbuncle. Indian J Pathol Microbiol 2012;55:609-10

How to cite this URL:
Swain B, Otta S. Granulicatella adiacens - An unusual causative agent for carbuncle. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Sep 19];55:609-10. Available from: http://www.ijpmonline.org/text.asp?2012/55/4/609/107859


Sir,

Granulicatella adiacens, one of the nutritionally variant Streptococcus (NVS) is a normal commensal of human mucosal surfaces and rarely contributes to bacteremia, endovascular, central nervous system, ocular, oral, bone, joint and genito-urinary infections. [1] It is difficult to identify them as they have unique culture requirements, exhibit pleomorphic phenotypic features and demonstrate satellitism around colonies of other bacteria.

Here we report a case of carbuncle caused by G. adiacens in a 56-year-old diabetic male presenting with a swelling having multiple discharging sinuses over the back, near the right scapular region. The patient was otherwise healthy with no associated clinical abnormality. He was earlier treated with azithromycin, wound dressing and local herbal medicaments but without any satisfactory result. By aerobic culture in two consecutive day pus samples, we repeatedly isolated G. adiacens which showed growth on sheep blood agar only after 48 hours of incubation. Features like slow growth on blood agar, Gram-variable cocci in small chains from direct smear as well as from the culture and negative result for catalase test gave the impression that the pathogen as NVS. They were further speciated and sensitivity pattern was noted by VITEK-2 system using GP2 cards. The patient was successfully managed by combination of surgery, antibiotics (amoxycillin- clavulanic acid) and control of blood sugar level. The lesion improved significantly by 5 th day and the wound swab did not reveal any significant finding either by Gram stain or culture method.

Although most of the carbuncles are caused by Staphylococcus aureus, it can also occur by other bacteria as in our case G. adiacens is the causative agent. The portal of entry of the organism remains obscure, but they have been thought to be originating from the oral cavity. [2] In any pyogenic lesion Granulicatella should be suspected when direct Gram stain of a smear shows Streptococcal organisms that fail to grow on culture after overnight incubation. Growth is enhanced by placement of a streak of Staphylococcus or incorporating pyridoxal phosphate on blood agar. [3] In our case the bacteria grew on blood agar plate without any additional nutrition [Figure 1] which was also cited by other workers. [4] Vitek-2 system was helpful for us. This system is sensitive as well as specific for diagnosis of G. adiacens. It is easy to use, provides early results for identification and antibiotic susceptibility test and is not expensive. [5] Pre-existing cardiac disease, malignancy, liver cirrhosis and diabetes has been noticed in many cases of Granulicatella infection. [2] Older age, obesity, poor hygiene and poor overall health are associated with carbuncles. As in our patient diabetes was a single risk factor, whether it is the only contributing factor for association of Granulicatella infection with carbuncle to be thoroughly studied.
Figure 1: Non-hemolytic colonies of G. adiacens on blood agar

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In our case the organism was susceptible to most of the antibiotics and resistant to macrolides. In spite of these antimicrobial testing results, treatment of G. adiacens infection may be difficult as it is associated with higher rate of bacteriological failure and relapse than that for other related genera. Fortunately our patient responded well to the susceptible antibiotic and recovered with treatment. A high degree of suspicion for slow growth on blood agar and familiarity with Gram stain appearance is a prerequisite for identification of these organisms particularly in a resource-poor setting.

 
   References Top

1.Bizzaro MJ, Callan DA, Farrel PA, Dembry LM, Gallagher PG. Granulicatella adiacens and early onset sepsis in neonate. Emerg Infect Dis 2011;17:1971-3.  Back to cited text no. 1
    
2.Liao CH, Teng LJ, Hsueh PR, Chen YC, Huang LM, Chang SC, et al. Nutritionally Variant Streptococcal infection at a university hospital in Taiwan: Disease emergence and high prevalence of β-Lactam and macrolide resistance. Clin Infect Dis 2004;38:452-5.  Back to cited text no. 2
[PUBMED]    
3.Forbes BA, Sahm DF, Weissfel AS (Editors). Streptococcus,Enterococcus and similar organisms, Chapter 17,In: Bailey and Scott's Diagnostic Microbiology. 12 th ed. Missouri: Mosby publication; 2007.p.265-79.  Back to cited text no. 3
    
4.Christensen JJ, Facklam RR. Granulicatella and Abiotrophia species from human clinical specimen. J Clin Microbiol 2001;39:3520-3.  Back to cited text no. 4
    
5.Altay M, Akay H, Yildiz E, Duranay M. A novel agent of peritoneal dialysis associated peritonitis: Granulicatella adiacens. Peritl Dia Int 2008;28:96-7.  Back to cited text no. 5
    

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Correspondence Address:
Bichitrananda Swain
HIG 5/4 Ext., Phase-1, Housing Board Colony, Chandrasekharpur, Bhubaneswar, Odisha -751016
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.107859

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