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CORRESPONDENCE
Year : 2015  |  Volume : 33  |  Issue : 4  |  Page : 606-608
 

Association of Bacillus circulans with non-diabetic foot infection in Bangladeshi patient


Department of Microbiology, University of Dhaka, Dhaka - 1000, Bangladesh

Date of Submission27-Oct-2014
Date of Acceptance22-Feb-2015
Date of Web Publication16-Oct-2015

Correspondence Address:
M A Hossain
Department of Microbiology, University of Dhaka, Dhaka - 1000
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.167346

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How to cite this article:
Sanyal S K, Karmaker M, Sultana M, Hossain M A. Association of Bacillus circulans with non-diabetic foot infection in Bangladeshi patient. Indian J Med Microbiol 2015;33:606-8

How to cite this URL:
Sanyal S K, Karmaker M, Sultana M, Hossain M A. Association of Bacillus circulans with non-diabetic foot infection in Bangladeshi patient. Indian J Med Microbiol [serial online] 2015 [cited 2019 Dec 7];33:606-8. Available from: http://www.ijmm.org/text.asp?2015/33/4/606/167346


Dear Editor,

Bacillus circulans is a Gram positive, spore forming, rod shaped bacterium with an opportunistic pathogenic properties and causes nosocomial infection responsible for sepsis.[1],[2] This organism is rarely associated with foot infection (Cellulitis). A case is presented here concerning association of multidrug resistant B. circulans from foot infection in a 60-years-old farmer non-diabetic but malnourished having a deep tissue foot infection (Cellulitis) for 7 months. He presented an open, large and deep tissue wound in the left leg which turns into gangrenous and his serum C reactive protein value was found 20 mg/L (Normal range 10 mg/L).

Pus specimen from the wound was collected on 8th October 2013 from the infected site of the patient. After collection of pus sample, the swab sticks were immersed in sterile transport container containing sterile transport medium (peptone water) and incubated in a rotary shaker (Thermo Forma, USA) at 120 rpm at 37°C for 1 hour. Collected pus sample was serially diluted with sterile normal saline (0.85% NaCl). From that pus sample the isolate 7CCIP2 was found to be fast growing, whitish, irregular shaped, large and flat in Nutrient Agar media [Figure 2]a. Microscopic examination showed that isolate 7CCIP2 was Gram positive, spore forming, rod shaped [Figure 2]b. The isolate was able to ferment sucrose and lactose but not dextrose, can utilize citrate and able to produce indole. Further identification of the organism (7CCIP2) is confirmed by 16S rRNA gene specific PCR and sequencing (ABI Prism 3130 Genetic Analyzer, USA). Phylogenetic analysis revealed that the isolate was phylogenetically closely related to B. circulans strain NBRC13634 (AB680471.1) with a similarity of 99% [Figure 1].[3] The sequence obtained in this study was submitted to Genbank under the accession number KM066000.1. The isolate (7CCIP2) was found hemolysin positive in blood agar (6% sheep blood) plate as it produced clear zone (β hemolysis) [Figure 2]c. The isolate was multidrug resistant (MDR) in nature. The antimicrobial susceptibility testing (AST) was done and interpretation was done according to the criteria of the Clinical Laboratory Standards Institute M100- S23, 2013.[4] Among the 12 groups of antibiotics tested, it was found resistant to 10 groups of antibiotics [Table 1] such, as Cephalosporin, Monobactams, Penicillins, Quinolones, lincosamide, lincomycins and Rifamycin and was sensitive to Carbapenem group (imipenem, meropenem). The infection was not cured upon administration of Ceftriaxone 500 mg (Oral) for 14 days. The patient was successfully recovered from foot infection after treatment with intravenous administration of Imipenem (1g). The infection of the patient was detected as polymicrobial and the organisms associated were B. circulans, Pseudomonas aeruginosa and Acinetobacter baumanii.
Table 1: Antimicrobial sensitivity pattern of B. circulans 7CCIP2

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Figure 1: Phylogenetic tree of 16S rRNA gene sequences of B. circulans 7CCIP2. (accession number KM066000) and close relative reference isolates retrieved from database. The tree was generated in program MEGA 4 using the Neighbour-Joining algorithm

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Figure 2: Figure No. 2 up left: (a) Isolate 7CCIP2 on nutrient agar plate and (b up right) Microscopic characteristics of the isolates. The isolate is spore forming, gram positive rod. Figure No. 2c (below): Isolate 7CCIP2 showing positive hemolysin tests (β-; hemolysis) in 6% sheep blood agar medium

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B. circulans can cause potential complications of chronic inflammation of the internal coats of the eye, fatal sepsis, disseminated intravascular coagulation and wound infection.[5]B. circulans has also been reported in malignant patients, Non Hodgekin lymphoma patients, infection in teeth and cerebrospinal infected patients,[5] So MDR B. circulans is a threat for immunocompromised and malnourished persons. To the best of our knowledge this is the first case of multidrug resistant B. circulans associated with foot infection in Bangladeshi patient and the findings of this study ensured the successful clinical management of this pathogen in the case of deep tissue infection. The rarity of this pathogen and the high-level antibiotic resistance is the new discovery of this investigation. Therefore, more studies are required to understand how this bacterium has acquired this resistant phenotype and its association with polymicrobial infection.


 ~ Ethical Approval Top


The patient was aware of his involvement in this study and gave his consent to participate in this research work. This study was reviewed by ethics committee of the Diabetic Association of Bangladesh (BADAS) (reference number BADAS-ERC/EC/14/00137).


 ~ Acknowledgments Top


The authors acknowledge the contributions of Dhaka Medical college Hospital and Diabetic foot care hospital. Additional thanks go to the Ministry of Science and Technology, Government of Bangladesh for providing Mousumi Karmaker a fellowship during the 2nd year of her M. Phil research work.

 
 ~ References Top

1.
Alebouyeh M, Gooran Orimi P, Azimi-Rad M, Tajbakhsh M, Tajeddin E, Jahani Sherafat S, et al. Fatal sepsis by Bacillus circulans in an immunocompromised patient. Iran J Microbiol 2011;3:156-8.  Back to cited text no. 1
    
2.
Nakamura L, Swezey J. Taxonomy of bacillus circulans jordan 1890: Base composition and reassociation of deoxyribonucleic acid. Int J Syst Bacteriol 1983;33:46-52.  Back to cited text no. 2
    
3.
Tamura K, Dudley J, Nei M, Kumar S. MEGA4: Molecular evolutionary genetics analysis (MEGA) software version 4.0. Mol Biol Evol 2007;24:1596-9.  Back to cited text no. 3
    
4.
Wikler MA. Performance Standards for Antimicrobial Susceptibility Testing: Nineteenth Informational Supplement. Clinical and Laboratory Standards Institute; 2009.  Back to cited text no. 4
    
5.
Gurol Y, Kipritci Z, Selcuk N, Koc Y, Kocagoz S. Bacillus circulans paracardiac infection in non-hodgkin lymphoma-a case report. Prague Med Rep 2008;109:19-22.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

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