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CORRESPONDENCE
Year : 2014  |  Volume : 32  |  Issue : 4  |  Page : 456-458
 

Kocuria kristinae, an unusual pathogen causing opportunistic infections in patients with malignancy


1 Department of Laboratory Medicine, Delhi State Cancer Institute, Delhi, India
2 Department of Clinical Oncology, Director and Chief Executive Officer, Delhi State Cancer Institute, Delhi, India

Date of Submission02-Sep-2013
Date of Acceptance06-Feb-2014
Date of Web Publication4-Oct-2014

Correspondence Address:
N H Ahmed
Department of Laboratory Medicine, Delhi State Cancer Institute, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.142232

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How to cite this article:
Ahmed N H, Biswal I, Roy P, Grover R K. Kocuria kristinae, an unusual pathogen causing opportunistic infections in patients with malignancy . Indian J Med Microbiol 2014;32:456-8

How to cite this URL:
Ahmed N H, Biswal I, Roy P, Grover R K. Kocuria kristinae, an unusual pathogen causing opportunistic infections in patients with malignancy . Indian J Med Microbiol [serial online] 2014 [cited 2019 Nov 18];32:456-8. Available from: http://www.ijmm.org/text.asp?2014/32/4/456/142232


Dear Editor,

Kocuria kristinae
is a Gram-positive bacterium normally residing on human skin and oral cavity, but it can be pathogenic in immune-compromised hosts. Kocuria belongs to the family Micrococcaceae, having 17 species, of which K. kristinae has been reported to cause human infections. [1],[2],[3] We present here five instances where K. kristinae was isolated from different clinical specimens of cancer patients undergoing treatment, who were having leukocytosis with neutrophillia.

K. kristinae was isolated from sputum samples of three patients suffering from small cell carcinoma of lung, carcinoma soft palate and carcinoma of lip and gingivo-buccal sulcus; and pus samples of two patients suffering from ductal carcinoma of breast and squamous cell carcinoma of buccal mucosa as shown in [Table 1]. These samples were processed and after overnight incubation at 37°C, blood agar showed non-haemolytic 0.5-1-mm diameter colonies, which were creamish-white, opaque, round-convex with well-defined edges and matted texture; growth on Mac-Conkey agar showed 0.25-0.5-mm diameter, light pink, opaque, round colonies with well-defined edges [Figure 1]. Gram-stained smear from the growth revealed Gram-positive cocci, which were catalase-positive and slide coagulase negative. The growth was identified as Kocuria kristinae by automated VITEK R 2 Compact (C) (Biomeriux, North Carolina/USA) using Gram-positive GP REF 21342 identification (GPID) card. The pathogen in all cases was confirmed by promptly culturing a repeat sample from the patients. As there was no database for MIC calculation for Kocuria spp. in the Vitek system, the antimicrobial susceptibility testing (AST) was done using database of Coagulase-negative Staphylococcus, and interpretation was done according to the criteria of the Clinical Laboratory Standards Institute M100- S23, 2013. [4] All the isolates were resistant to all first-line antibiotics except the one isolated from lip and gingivo-buccal sulcus which was sensitive to gentamicin and fluoroquinolones. All the isolates were susceptible to vancomycin, linezolid and tigecycline. The patients were successfully treated with intravenous vancomycin or oral linezolid; the one with carcinoma of lip and gingivo-buccal sulcus was treated with intravenous levofloxacin. Following treatment, the patients' symptoms subsided and their haematological parameters returned to normal.
Table 1: Details of the patients and the isolates of Kocuria kristinae obtained from their sputum/pus samples

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Figure 1: Colonies of Kocuria kristinae on Blood agar (a) and MacConkey agar (b)

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Cancer patients have a deficit of immunity due to the malignancy per se, long duration of treatment with cytotoxic drugs, immune-suppression and radiotherapy. Although K. kristinae is mainly a commensal of skin and oral cavity, it can be an opportunistic pathogen in such patients. This organism is very difficult to identify by conventional microbiological techniques, but can be recognised by modern automated identification systems. [5] Monotherapy with oxacillin, vancomycin, piperacillin/tazobactam and ciprofloxacin; and combination therapy with teicoplanin and vancomycin, ciprofloxacin and clindamycin as well as ceftriaxone and ofloxacin have been used successfully in the reported cases. [1]

To the best of our knowledge, this is the first case series of infections caused by K. kristinae in patients with underlying malignancy. This case-series expands the existing clinical spectrum of diseases caused by this unusual pathogen around the world and adds to the growing body of literature documenting the virulence of these organisms in humans.

 
 ~ References Top

1.Martinaud C, Gaillard T, Brisou P, Gisserot O, de Jaureguiberry JP. Bacteraemia caused by Kocuria kristinae in a patient with acute leukaemia. Med Mal Infect 2008;38:165-6.  Back to cited text no. 1
[PUBMED]    
2.Basaglia G, Carretto E, Barbarini D, Moras L, Scalone S, Marone P, et al. Catheter-related bacteremia due to Kocuria kristinae in a patient with ovarian cancer. J Clin Microbiol 2002;40:311-3.  Back to cited text no. 2
    
3.Ma ES, Wong CL, Lai KT, Chan EC, Yam WC, Chan AC. Kocuria kristinae infection associated with acute cholecystitis. BMC Infect Dis 2005;5:60.  Back to cited text no. 3
    
4.Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty first Informational supplement. CLSI document M100-S23 ; 2013;3.  Back to cited text no. 4
    
5.Savini V, Catavitello C, Masciarelli G, Astolfi D, Balbinot A, Bianco A, et al. Drug sensitivity and clinical impact of members of the genus Kocuria. J Med Microbiol 2010;59:1395-402.  Back to cited text no. 5
    


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