Authors: Michael O Alberti, Janet A Hindler, Romney M Humphries...

Nutritionally variant streptococci (NVS) are fastidious Gram-positive cocci comprised of the species Abiotrophia defectiva, Granulicatella adiacens, and Granulicatella elegans. NVS are an important cause of bacteremia and infective endocarditis (IE) associated with significant morbidity and mortality. Antimicrobial susceptibility testing (AST) was performed for 14 antimicrobials using the broth microdilution MIC method described in the Clinical and Laboratory Standards Institute (CLSI) M45 guideline. A total of 132 clinical NVS blood isolates collected from 2008 to 2014 were tested. Species level identification of NVS isolates was achieved by 16S rRNA gene sequencing and/or matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Ninety isolates were identified as G. adiacens, 37 as A. defectiva, and 5 as G. elegans. All isolates were susceptible to vancomycin (MIC90 = 1 μg/ml), and none displayed high-level resistance to aminoglycosides. G. adiacens was considerably more susceptible to penicillin than A. defectiva (38.9% versus 10.8% of isolates susceptible) but was less susceptible to cephalosporins than was A. defectiva (43.3% versus 100% of isolates susceptible to ceftriaxone). Several isolates were resistant to levofloxacin (6%), erythromycin (51%), and clindamycin (10%). The MIC90 for daptomycin was ≥ 4 μg/ml for G. adiacens and A. defectiva. G. elegans isolates were 100% susceptible to all antimicrobials tested, with the exception of erythromycin, to which only 20% were susceptible. This study provides antimicrobial susceptibility data for a recent collection of NVS and demonstrates important NVS species-related differences with respect to susceptibility to penicillin, cephalosporins, carbapenems, and daptomycin. Species-level identification of NVS organisms when susceptibility testing is not readily available may aid in treatment decisions.

Topics: Abiotrophia; Anti-Bacterial Agents; Carnobacteriaceae; Gram-Positive Bacterial Infections; Humans; Los Angeles; Microbial Sensitivity Tests; Molecular Typing; RNA, Ribosomal, 16S; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; beta-Lactams

PubMed: 26666926
DOI: 10.1128/AAC.02645-15

Review

Authors: Victoria Holloway, George Jacob, Nicholas Hayes...

A 9-year-old child, with a background of repaired pulmonary atresia and Ebstein's anomaly, presented with fever, night sweats and lethargy. Blood cultures grew , a nutritionally variant and known cause of infective endocarditis (IE). Echocardiogram revealed no clear vegetation, but increased stenosis of the right ventricle to pulmonary artery conduit. The child was successfully managed with high-dose benzylpenicillin, completing 2 weeks in the hospital, and was discharged to complete the final 4 weeks of therapy with ceftriaxone in the community, as per European Society of Cardiology guidance. IE caused by any species is rare, with infection due to rarer still. It is a Gram-positive bacteria that presents a diagnostic challenge due to non-specific symptoms at presentation and difficulty in growing the organism on culture medium. We present a case of endocarditis in a young child, which illustrates the challenges in managing this condition and the importance of considering atypical organism endocarditis in children presenting with fever of unknown origin, in particular those with a background of congenital cardiac disease. We review the literature on endocarditis, and briefly discuss the challenges of managing this condition in a child with an autism spectrum disorder and learning difficulties.

Topics: Autism Spectrum Disorder; Carnobacteriaceae; Child; Endocarditis; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Humans; Streptococcus

PubMed: 33602775
DOI: 10.1136/bcr-2020-240079

Review

Authors: Shinnosuke Fukushima, Hideharu Hagiya, Koji Iio...

Granulicatella species are rare, nutritionally variant streptococci that cause infective endocarditis. Their clinical and microbiological characteristics remain unknown. We reviewed five years of Granulicatella cases in our hospital database (Jan 2017-Jun 2022), finding 6 Granulicatella adiacens cases and 1 Granulicatella elegans case. Clinical backgrounds and bacteremia sources were diverse; 3 cases developed polymicrobial bacteremia. Antimicrobial testing showed non-susceptibility to penicillin G in 4 of 7 cases (57.1%), and high susceptibility to carbapenems and vancomycin in all cases. Determining optimal antibiotic therapy for Granulicatella infections is vital in this era of antimicrobial resistance.

Topics: Humans; Retrospective Studies; Anti-Bacterial Agents; Vancomycin; Endocarditis, Bacterial; Bacteremia

PubMed: 37094959
DOI: 10.18926/AMO/65151

Authors: Sandeep Patri, Yashwant Agrawal

A 63-year-old man with a history of non-ischaemic cardiomyopathy presented with acute worsening of heart failure and septic shock. Echocardiogram revealed a large aortic valve vegetation with new onset severe aortic incompetence. Blood cultures grew Granulicatella elegans, for which antimicrobial sensitivities could not be carried out in our lab. Despite antibiotic therapy and aggressive care, the patient's clinical condition worsened and he died. G. elegans, previously grouped under nutrient variant streptococci (NVS), is an extremely rare cause for bacterial infective endocarditis (IE). Unlike with the Viridans group, IE caused by NVS has a very poor outcome and higher mortality rate. The difficulty in isolation of the bacteria in culture, inability to reliably measure antibiotic susceptibility in vitro, frequent treatment failure and complications such as multivalvular involvement, make this an extremely challenging infection to treat. Early detection of the organism, appropriate antibiotics and early surgical management when indicated, are key to management.

Topics: Anti-Bacterial Agents; Carnobacteriaceae; Endocarditis, Bacterial; Fatal Outcome; Heart Failure; Humans; Male; Middle Aged; Shock, Septic

PubMed: 26921367
DOI: 10.1136/bcr-2015-213987

Authors: Michael O Alberti, Janet A Hindler, Romney M Humphries...

PubMed: 27217443
DOI: 10.1128/AAC.00829-16

Authors: Maribasappa Karched, Radhika G Bhardwaj, Sirkka E Asikainen...

BACKGROUND

Members of fastidious Granulicatella and Aggregatibacter genera belong to normal oral flora bacteria that can cause serious infections, such as infective endocarditis. Aggregatibacter actinomycetemcomitans has long been implicated in aggressive periodontitis, whereas DNA-based methods only recently showed an association between Granulicatella spp. and dental diseases. As bacterial coaggregation is a key phenomenon in the development of oral and nonoral multispecies bacterial communities it would be of interest knowing coaggregation pattern of Granulicatella species with A. actinomycetemcomitans in comparison with the multipotent coaggregator Fusobacterium nucleatum. The aim was to investigate coaggregation and biofilm formation of Granulicatella elegans and Granulicatella adiacens with A. actinomycetemcomitans and F. nucleatum strains.

RESULTS

F. nucleatum exhibited significantly (p < 0.05) higher autoaggregation than all other test species, followed by A. actinomycetemcomitans SA269 and G. elegans. A. actinomycetemcomitans CU1060 and G. adiacens did not autoaggregate. G. elegans with F. nucleatum exhibited significantly (p < 0.05) higher coaggregation than most others, but failed to grow as biofilm together or separately. With F. nucleatum as partner, A. actinomycetemcomitans strains SA269, a rough-colony wild-type strain, and CU1060, a spontaneous smooth-colony laboratory variant, and G. adiacens were the next in coaggregation efficiency. These dual species combinations also were able to grow as biofilms. While both G. elegans and G. adiacens coaggregated with A. actinomycetemcomitans strain SA269, but not with CU1060, they grew as biofilms with both A. actinomycetemcomitans strains.

CONCLUSIONS

G. elegans failed to form biofilm with F. nucleatum despite the strongest coaggregation with it. The ability of Granulicatella spp. to coaggregate and/or form biofilms with F. nucleatum and A. actinomycetemcomitans strains suggests that Granulicatella spp. have the potential to integrate into dental plaque biofilms.

Topics: Aggregatibacter actinomycetemcomitans; Bacterial Adhesion; Biofilms; Carnobacteriaceae; Dental Plaque; Fusobacterium nucleatum; Humans; Species Specificity

PubMed: 26025449
DOI: 10.1186/s12866-015-0439-z

Authors: Saikat Mondal, Venkatesh Kottawar, Sunitaj Parvin...

We report a rare clinical presentation of a 54-year-old male diagnosed with infective endocarditis caused by , a nutritionally variant streptococcus (NVS) characterized by unique growth requirements and high pathogenic potential. The patient presented with prolonged fever and residual hemiparesis following an ischemic stroke. Blood culture confirmed , and imaging identified vegetations on a bicuspid aortic valve. Despite prompt antibiotic therapy, the course was complicated by acute intraventricular hemorrhage (IVH) and hydrocephalus, culminating in a fatal outcome. This report underscores the pathogenic challenges posed by , highlights its catastrophic complications, and reviews its presentation and management in the context of existing literature and emphasizing the importance of prompt diagnosis, tailored antibiotic therapy, and vigilant monitoring.

PubMed: 40071266
DOI: 10.53854/liim-3301-14

Authors: Najeeha T Iqbal, Robert Y Chen, Nicholas W Griffin...

Environmental enteric dysfunction (EED) is a subclinical syndrome of altered small intestinal function postulated to be an important contributor to childhood undernutrition. The role of small intestinal bacterial communities in the pathophysiology of EED is poorly defined due to a paucity of studies where there has been a direct collection of small intestinal samples from undernourished children. Sixty-three members of a Pakistani cohort identified as being acutely malnourished between 3 and 6 months of age and whose wasting (weight-for-length -score [WLZ]) failed to improve after a 2-month nutritional intervention underwent esophagogastroduodenoscopy (EGD). Paired duodenal luminal aspirates and duodenal mucosal biopsies were obtained from 43 children. Duodenal microbiota composition was characterized by sequencing bacterial 16S rRNA gene amplicons. Levels of bacterial taxa (amplicon sequence variants [ASVs]) were referenced to anthropometric indices, histopathologic severity in biopsies, expression of selected genes in the duodenal mucosa, and fecal levels of an immunoinflammatory biomarker (lipocalin-2). A "core" group of eight bacterial ASVs was present in the duodenal samples of 69% of participants. was the most prevalent, followed by sp., , , , and . At the time of EGD, none of the core taxa were significantly correlated with WLZ. Statistically significant correlations were documented between the abundances of and and the expression of duodenal mucosal genes involved in immune responses (dual oxidase maturation factor 2, serum amyloid A, and granzyme H). These results suggest that a potential role for members of the oral microbiota in pathogenesis, notably , and species, warrants further investigation.IMPORTANCEUndernutrition among women and children is a pressing global health problem. Environmental enteric dysfunction (EED) is a disease of the small intestine (SI) associated with impaired gut mucosal barrier function and reduced capacity for nutrient absorption. The cause of EED is ill-defined. One emerging hypothesis is that alterations in the SI microbiota contribute to EED. We performed a culture-independent analysis of the SI microbiota of a cohort of Pakistani children with undernutrition who had failed a standard nutritional intervention, underwent upper gastrointestinal tract endoscopy, and had histologic evidence of EED in their duodenal mucosal biopsies. The results revealed a shared group of bacterial taxa in their duodenums whose absolute abundances were correlated with levels of the expression of genes in the duodenal mucosa that are involved in inflammatory responses. A number of these bacterial taxa are more typically found in the oral microbiota, a finding that has potential physiologic and therapeutic implications.

Topics: Humans; Duodenum; Female; Male; RNA, Ribosomal, 16S; Pakistan; Infant; Gastrointestinal Microbiome; Bacteria; Malnutrition; Child, Preschool; Feces; Cohort Studies

PubMed: 38742887
DOI: 10.1128/msphere.00196-24

Authors: J J Christensen, R R Facklam

One hundred one isolates of nutritionally variant streptococci from 97 patients were phenotypically characterized and compared with the type strains of Granulicatella adiacens (formerly Abiotrophia adiacens) (ATCC 49175(T)) Abiotrophia defectiva (ATCC 49176(T)), and Granulicatella elegans (formerly Abiotrophia elegans) (DSM 11693(T)). Of the isolates, 55 and 43 resembled G. adiacens and A. defectiva, respectively, while 3 strains resembled G. elegans. Phenotypic characteristics useful in differentiating between species within the genera Granulicatella and Abiotrophia (G. adiacens, G. elegans, Granulicatella balaenopterae, and A. defectiva) were production of alpha- and beta-galactosidase; production of beta-glucuronidase; hippurate hydrolysis; arginine dihydrolase activity; and acid production from trehalose, sucrose, pullulan, and tagatose. From the reports submitted with the specimens, the clinical diagnosis was endocarditis in 58% of patients and septicemia or bacteremia in 26% of patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Typing Techniques; Child; Child, Preschool; Gram-Positive Bacterial Infections; Humans; Infant; Male; Middle Aged; Phenotype; Streptococcaceae

PubMed: 11574566
DOI: 10.1128/JCM.39.10.3520-3523.2001

Authors: K Kitada, Y Okada, T Kanamoto...

Serological variations were examined among 12 type or reference strains and 91 oral isolates of vitamin B6-dependent Abiotrophia and Granulicatella spp. Rabbits were immunized with whole cells of 12 selected strains and 10 typing antisera were obtained, which were unreactive with the Lancefield group A to G antigen preparations. The reactivity of the antisera and autoclaved cell surface antigen extracts was tested by double diffusion in agar gel and a capillary precipitin test. These typing antisera categorized all Abiotrophia defectiva strains, all except one Granulicatella elegans strain, three-quarters of the Granulicatella adiacens, and half of the Granulicatella paraadiacens into 8 serotypes and 2 subserotypes. The Granulicatella balaenopterae type strain was unserotypable. All A. defectiva strains were serotype I, some of which were divided into subserotype I-1 and/or I-5. The G. adiacens strains generally belonged to serotype II or III, and the G. paraadiacens strains to serotype IV, V or VI. All G. adiacens or G. paraadiacens serotype II strains were also subserotype I-5. The G. elegans strains were serotype VII or VIII. These Abiotrophia and Granulicatella serotypes were undetectable among 33 strains of the other 11 species including the bacteriolytic enzyme-producing but vitamin B6-independent strains of Streptococcus, Enterococcus, Dolosigranulum and Aerococcus. The proposed serotyping system for Abiotrophia and Granulicatella spp. would be helpful in the identification and classification of these unique coccal isolates in ecological and epidemiological studies.

Topics: Animals; Antibodies, Bacterial; Rabbits; Serotyping; Streptococcal Infections; Streptococcus

PubMed: 11220686
DOI: 10.1111/j.1348-0421.2000.tb02593.x