|Year : 2016 | Volume
| Issue : 3 | Page : 403-405
Granulicatella adiacens : An unusual isolate from urethral discharge
S Arora, N Jindal, P Grover, R Bala, R Bansal
Department of Microbiology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
|Date of Submission||10-Jul-2015|
|Date of Acceptance||22-Jan-2016|
|Date of Web Publication||12-Aug-2016|
Department of Microbiology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Arora S, Jindal N, Grover P, Bala R, Bansal R. Granulicatella adiacens : An unusual isolate from urethral discharge. Indian J Med Microbiol 2016;34:403-5
|How to cite this URL:|
Arora S, Jindal N, Grover P, Bala R, Bansal R. Granulicatella adiacens : An unusual isolate from urethral discharge. Indian J Med Microbiol [serial online] 2016 [cited 2020 Feb 21];34:403-5. Available from: http://www.ijmm.org/text.asp?2016/34/3/403/188383
Sexually transmitted diseases (STDs) produce a set pattern of symptoms and urethral discharge is one of them. The causative agents may be gonococcal caused by Neisseria gonorrhoeae and nongonococcal caused by Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma genitalium and Ureaplasma urealyticum. We present a case of urethral discharge caused by Granulicatella adiacens, a rare pathogen in an adult male.
A 63-year-old male patient, who presented to the Dermatology and Venereal Disease Out-patient Department with the complaint of urethral discharge, was sent to the Microbiology Department for laboratory diagnosis of urethritis. Two urethral swabs were taken, one was subjected to Gram-staining and another was cultured on chocolate agar, 5% sheep blood agar and MacConkey agar media. Gram-staining showed large number of pus cells along with many Gram-positive diplococci, which were present extra-cellularly as well as intra-cellularly. Aerobic cultures on chocolate agar and blood agar media showed minute, opaque, nonhemolytic colonies after 48 h of incubation. There was no growth on MacConkey agar medium. Gram-staining from the growth demonstrated Gram-positive cocci arranged in pairs and short chains [Figure 1]. Culture characteristics such as slow growth of Gram-positive diplococci, which showed negative result for catalase test, gave the impression that the isolate was Nutritionally variant streptococcus (NVS). The organism was speciated and studied for its antimicrobial susceptibility pattern by Vitek-2 Compact system. It was finally identified as G. adiacens (probability 97%). A repeat sample from the patient obtained within 48 h showed similar findings on microscopic examination as well as on culture. Our first concern was to decide whether it was a true pathogen. Since the direct examination had shown the presence of pus cells and extra-cellular as well as intra-cellular Gram-positive diplococci and the isolation in pure form in two consecutive specimens, it was considered as pathogenic. The patient had already been put empirically on single dose of 1 g azithromycin and 400 mg oral cefixime (syndromic management to cover two major pathogens, N. gonorrhoeae and C. trachomatis). Unfortunately, the patient did not return for follow-up. He might have responded to the treatment as the isolate was susceptible to most of the antibiotics tested on Vitek-2 Compact (gentamicin, ciprofloxacin, erythromycin, linezolid, vancomycin, tigecycline and quinupristin/dalfopristin) except penicillin.
|Figure 1: Gram-stained smear of colony showing Gram-positive cocci arranged in pairs and short chains|
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Granulicatella is a fastidious Gram-positive nutritionally variant streptococcus (NVS) that is classified in two genera: Abiotrophia which includes only A. defective and the genus Granulicatella which comprises three species (G. adiacens, G. elegans and G. balaenopterae). NVS are found as part of the normal flora of the upper respiratory, urogenital and gastrointestinal tracts and have been reported as significant pathogen of endocarditis and bacteraemia,  central nervous system infections,  sinusitis, otitis media, prostatitis, cholangitis and arthritis.  To the best of our knowledge, this is the first report of isolation of G. adiacens from urethral discharge.
To conclude, Granulicatella should be suspected in any pyogenic lesion when direct Gram-stain of a smear shows streptococcal organisms that fail to grow on culture after overnight incubation. Growth is enhanced by the placement of a streak of Staphylococcus or incorporating pyridoxal phosphate on blood agar. In our case, the bacteria grew on blood agar plate without any additional nutrition which has also been cited by other workers. , Vitek-2 Compact system is helpful in its identification. This system is sensitive as well as specific for the diagnosis of G. adiacens. It is easy to use and provides early results for identification and antibiotic susceptibility. Clinical microbiologists must make themselves familiar with the clinical settings in which such organisms occur and the laboratory methods that are necessary for their isolation from clinical specimens.
The limitations of the present study are (a) as the patient did not turn up for follow-up, it is not sure whether he responded to the syndromic treatment for urethral discharge and (b) the sample from the partner was not available, thus, it is not clear whether it was sexually transmitted or not. The question thus remains whether G. adiacens could be included in the list of microorganisms causing STDs.
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Conflicts of interest
There are no conflicts of interest.
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