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|Year : 2014 | Volume
| Issue : 3 | Page : 323--324
Corynebacterium striatum: An emerging nosocomial pathogen in a case of laryngeal carcinoma
I Biswal1, S Mohapatra1, M Deb1, R Dawar2, R Gaind1,
1 Department of Microbiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
2 Department of Microbiology, Indraprastha Apollo Hospital, New Delhi, India
Department of Microbiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi
Corynebacterium striatum is an emerging nosocomial pathogen associated with wound infections, pneumonia and meningitis. It is also a multidrug-resistant pathogen causing high morbidity. This is a report of an unusual case of wound infection in a patient with laryngeal carcinoma. Accurate diagnosis of the infection and prompt management helped in a favourable outcome for the patient. This case highlights the role of C. striatum as an important nosocomial pathogen in immunocompromised patients.
|How to cite this article:|
Biswal I, Mohapatra S, Deb M, Dawar R, Gaind R. Corynebacterium striatum: An emerging nosocomial pathogen in a case of laryngeal carcinoma.Indian J Med Microbiol 2014;32:323-324
|How to cite this URL:|
Biswal I, Mohapatra S, Deb M, Dawar R, Gaind R. Corynebacterium striatum: An emerging nosocomial pathogen in a case of laryngeal carcinoma. Indian J Med Microbiol [serial online] 2014 [cited 2020 Nov 28 ];32:323-324
Available from: https://www.ijmm.org/text.asp?2014/32/3/323/136589
Corynebacterium species are widely disseminated in the environment and comprise a part of normal skin and mucosal flora. These are Gram-positive, non-motile bacilli with clubbed ends in palisade arrangement.  Majority of the Corynebacterium spp. other than Corynebacterium diphtheriae were referred to as "diphtheroids" and often considered as commensal flora. However, C. striatum, C. amycolatum, C. jeikeium and C. urealyticum are some of them, which are recently recognised as pathogens.  C. striatum is reported as an emergent multidrug-resistant nosocomial pathogen affecting both immune-compromised and immune-competent host.  Here, we describe a case of C. striatum associated skin and soft tissue lesions in a patient suffering from laryngeal carcinoma.
A 57-year-old male was admitted in the Department of Otorhinolaryngology at Safdarjung Hospital, Delhi in the month of April 2013, complaining mainly of difficulty in swallowing and change in voice over a period of 1 month. He was diagnosed with squamous cell carcinoma of the left piriform fossa (T 2 N 0 M x ), and underwent total laryngectomy with selective neck dissection. After surgery the patient was shifted to the ward for palliative care with a neck drain in-situ. During the stay, he developed high grade fever and severe pain in the throat. Injection amikacin (500 mg twice daily for 5 days) and injection clindamycin (600 mg twice daily for 5 days) were intravenously administered. Despite medications, the condition of the patient deteriorated. On the sixth post-operative day, a fistula was noticed at the operative site with salivary leakage. The fistula site generated copious amounts of pus. The pus samples were sent to the department of Microbiology for culture and sensitivity. Gram-stain of the sample revealed Gram-positive bacilli in palisade arrangement with plenty of pus cells. The sample was inoculated on 5% Sheep blood agar and MacConkey agar medium. After overnight incubation at 37°C, a confluent growth of cream coloured non-haemolytic colonies were observed on blood agar medium. Gram stain of the growth showed Gram-positive bacilli comparable to the ones observed in direct microscopy resembling diphtheroids. Considering diphtheroids are commensals of throat and buccal cavity, the colonies were not processed further and the report was despatched with request for a repeat specimen. However, similar growths were obtained from three successive samples sent on three consecutive days, suggestive of a probable association of the bacteria with the lesions. Albert stain from the growth showed thin bacilli with plenty of metachromatic granules. The clinician was informed accordingly regarding the isolate (suspected to be Corynebacter species) and was advised to start with intravenous vancomycin (1 g i.v. twice daily). The patient responded to the therapy and became afebrile on the third day. Simultaneously, the isolates were processed in the laboratory for phenotypic identification and antibiotic sensitivity pattern. These were catalase positive, oxidase negative, reduced nitrate to nitrite, Christensen's urea negative, esculin hydrolysis negative, fermented only glucose and sucrose and was CAMP negative. It was finally confirmed as C. striatum using the automated system (VITEK-MS, Biomerieux, France) with anaerobic bacteria and Coryneform bacteria identification card. The strain was sensitive to trimethoprim-sulfamethoxazole, imipenem, meropenem and vancomycin, and was resistant to penicillin, tetracycline, levofloxacin, amikacin, clindamycin and erythromycin (CLSI guidelines, 2012).
C. striatum, which is often considered as a saprophyte of skin and mucous membrane, has been recently reported as a multidrug-resistant pathogen causing long standing open wound infection. Isolation of C. striatum from a clinical specimen should not be ignored in view of its propensity to establish nosocomial infections.  Although, the mortality rates were observed to be low, mild skin and soft tissue infections may lead to bacteraemia, hence considered important.  C. striatum can establish de novo cutaneous infections through disruption of skin barriers or can invade previous cutaneous lesions, , Evidence of confluent growth isolated in pure culture on repeated cultures support its role in pathogenesis of lesion. It has been shown that the VITEK identification system is an accurate and useful method to identify Corynebacterium species.  Since majority of the strains are sensitive to carbapenems, linezolid and glycopeptides, the initial therapy with vancomycin could be beneficial.  Here, favourable outcome of the treatment occurred due to prompt introduction of intravenous vancomycin. Moreover, immediate management of C. striatum also helps in prevention of the spread of the multidrug-resistant pathogen in the hospital environment.
C. striatum is an established nosocomial pathogen in hospital settings causing pyogenic lesions, meningitis, pneumonia, bacteraemia and endocarditis. This case report highlights the growing importance of C. striatum as a nosocomial pathogen. However, timely diagnosis and prompt treatment with intravenous vancomycin lead to favourable outcome of the patient.
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