Isolation of Helcococcus kunzii from a post-surgical foot abscess

A tympanitis-related brain abscess caused by Helcococcus kunzii in China: a case report and literature review

BACKGROUND

Infections attributed to Helcococcus kunzii are rarely documented, especially in relation to brain abscesses. This study aims to report the first documented case of a brain abscess associated with tympanitis caused by H. kunzii in China, alongside a comprehensive review of the existing literature.

CASE PRESENTATION

We detail the case of a 54-year-old female patient with a history of hypertension, who was diagnosed with tympanitis complicated by a brain abscess. An urgent occipital lobectomy was performed, during which pus was collected for culture analysis. Three distinct colony morphologies were identified through matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) analysis, including H. kunzii and two additional anaerobic bacterial species. Subsequent biochemical assays and 16S rRNA gene sequencing corroborated the presence of H. kunzii. Antimicrobial susceptibility testing revealed that the isolated H. kunzii strain exhibited resistance to erythromycin and clindamycin. The patient was subsequently treated with intravenous antibiotics, specifically ceftriaxone, meropenem, and norvancomycin, resulting in complete recovery.

CONCLUSIONS

This case underscores the increasing acknowledgment of H. kunzii as a notable pathogen in invasive intracranial infections. It is imperative for clinicians to consider H. kunzii in the differential diagnosis of patients presenting with intracranial infections, especially those with a history of tympanitis, to ensure prompt and effective management. The utilization of MS and molecular techniques should be prioritized for the accurate identification of these anaerobic bacteria.

Helcococcus kunzii, a skin-colonising microorganism with pathogenic capacity: a case of polymicrobial intracranial empyema

Helcococcus kunzii is a Gram-positive anaerobic facultative coccus that colonises the skin. Human infection is rare, with very few cases being described in the literature. The authors present the case of a 17-year-old man, with a history of cholesteatoma, diagnosed with mastoiditis complicated by intracranial empyema. After urgent surgical drainage, Gram staining revealed a Gram-negative bacillus and a Gram-positive coccus. The latter exhibited fastidious growth, presented as small grey colonies in blood agar, and was afterwards identified as H. kunzii The patient was started on intravenous antibiotics, switched to oral route after 8 weeks and fully recovered. To the best of our knowledge, this is the third case of an intracranial infection in which H. kunzii is involved, two of them occurring in patients with cholesteatoma.

Short communication: Metagenomic evaluation of skin biopsies of udder sores in dairy cows

The objectives of this study were (a) to evaluate skin biopsies of udder sores and negative control cows for the presence of mange and nonbacterial pathogens via histopathology and (b) to identify and compare bacterial abundance in the lesions of cows with udder sores and from the skin of healthy controls from the same farms. Cows from 3 dairy farms with (n = 23) and without (n = 12) udder sore lesions were enrolled, and punch biopsies (23 lesions, 23 negative control samples of cows with lesions, and 12 control samples of cows without lesions) were collected. The biopsies were evaluated histopathologically, and their 16S metagenome was analyzed. No signs of mange or viral or fungal infections were detected histopathologically in any samples. The α diversity of microbial populations decreased in lesions, across all farms, and the abundance of spirochaetes did not notably change, compared with controls. However, compared with control samples, the microbial fractions of Fusobacterium, Helcococcus spp., Anaerococcus spp., Porphyromonas spp., Prevotella spp., and Trueperella spp. increased several-fold in lesions. In summary, our results suggest that spirochaetes, viruses, and mange are unlikely to cause udder sores. Instead, sores were associated with a marked increase in the abundance of Fusobacterium, Helcococcus, Anaerococcus, Porphyromonas, Prevotella, and Trueperella. Future studies are needed to determine which of these bacteria initiates this polymicrobial infection.

Decrease of Staphylococcus aureus Virulence by Helcococcus kunzii in a Caenorhabditis elegans Model

Social bacterial interactions are considered essential in numerous infectious diseases, particularly in wounds. Foot ulcers are a common complication in diabetic patients and these ulcers become frequently infected. This infection is usually polymicrobial promoting cell-to-cell communications. Staphylococcus aureus is the most prevalent pathogen isolated. Its association with Helcococcus kunzii, commensal Gram-positive cocci, is frequently described. The aim of this study was to assess the impact of co-infection on virulence of both H. kunzii and S. aureus strains in a Caenorhabditis elegans model. To study the host response, qRT-PCRs targeting host defense genes were performed. We observed that H. kunzii strains harbored a very low (LT50: 5.7 days ± 0.4) or an absence of virulence (LT50: 6.9 days ± 0.5). In contrast, S. aureus strains (LT50: 2.9 days ± 0.4) were significantly more virulent than all H. kunzii (P < 0.001). When H. kunzii and S. aureus strains were associated, H. kunzii significantly reduced the virulence of the S. aureus strain in nematodes (LT50 between 4.4 and 5.2 days; P < 0.001). To evaluate the impact of these strains on host response, transcriptomic analysis showed that the ingestion of S. aureus led to a strong induction of defense genes (lys-5, sodh-1, and cyp-37B1) while H. kunzii did not. No statistical difference of host response genes expression was observed when C. elegans were infected with either S. aureus alone or with S. aureus + H. kunzii. Moreover, two well-characterized virulence factors (hla and agr) present in S. aureus were down-regulated when S. aureus were co-infected with H. kunzii. This study showed that H. kunzii decreased the virulence of S. aureus without modifying directly the host defense response. Factor(s) produced by this bacterium modulating the staphylococci virulence must be investigated.

Infectious endocarditis caused by Helcococcus kunzii in a vascular patient: a case report and literature review

Background

Helcococcus kunzii is a facultative anaerobic bacterium that was first described by Collins et al. in 1993, and was initially considered as a commensal of the human skin, in particular of lower extremities. Human infections caused by H. kunzii remain rare with only a few cases published in the pubmed database. Nevertheless recent reports indicate that this microorganism has to be considered as an opportunistic pathogen that can be involved in severe infections in human. To the best of our knowledge, we describe here the first known case of infectious endocarditis caused by H. kunzii.

Case presentation

A 79 year-old man reporting severe polyvascular medical history attended the emergency ward for rapid deterioration of his general state of health. After physical examination and paraclinical investigations, the diagnosis of infectious endocarditis on native mitral valve caused by Helcococcus kunzii was established based on Dukes criteria. MALDI-TOF mass spectrometry and 16S rDNA sequencing allowed an accurate identification to the species level of Helcococcus kunzii. The patient was successfully treated by a medico-surgical approach. The treatment consisted in intravenous amoxicillin during four weeks and mitral valve replacement with a bioprosthestic valve. After an in depth review of patient’s medical file, the origin of infection remained unknown. However, a cutaneous portal of entry cannot be excluded as the patient and his General Practitioner reported chronic ulcerations of both feet.

Conclusions

We describe here the first case of endocarditis caused by H. kunzii in an elderly patient with polyvascular disease. This report along with previous data found in the literature emphasizes the invasive potential of this bacterial species as an opportunistic pathogen, in particular for patient with polyvascular diseases. MALDI-TOF mass spectrometry and 16S rDNA sequencing are reliable tools for H. kunzii identification. We also sequenced in this work H.kunzii type strain 103932T CIP and deposited in the Genbank under accession number KM403387. We noticed a 14 base difference between our sequence and the original sequence deposited by Collins et al. under Genbank accession number X69837. Hopefully, the spread of next generation sequencing tools would lead to a more accurate classification of clinical strains.

Identification and Clinical Significance of Helcococcus kunzii in Human Samples

From 2008 to 2013, 39 Helcococcus kunzii strains were collected from human clinical specimens (79% from foot ulcers), and 85% of the 39 patients were infected. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry and molecular methods accurately identified all isolates. This large study of clinical observations confirms the potential pathogenic role of H. kunzii.

Multi-drug resistant helcococcus-like organism isolated from a chest abscess

We report a case of multi-drug resistant Helcococcus-like organism isolated in pure culture from a chest abscess in a 31-year-old pregnant woman.

Identification and clinical significance of Helcococcus species, with description of Helcococcus seattlensis sp. nov. from a patient with urosepsis

Helcococcus spp. are Gram-positive, catalase-negative, facultatively anaerobic cocci that are associated with wound and prosthetic joint infections as well bacteremia and empyema. Five Helcococcus spp. strains were isolated from our patient population, including 2 strains of Helcococcus kunzii from trauma-associated wounds, 2 Helcococcus sueciensis strains from blood and abscess, and a novel Helcococcus spp. strain from blood associated with urosepsis. Based on the phenotypic and phylogenetic evidence, we propose that the unknown bacterium be classified as Helcococcus seattlensis sp. nov. We found that all 5 tested Helcococcus strains grew as satellite colonies around Staphylococcus aureus and, interestingly, both H. kunzii strains were isolated together with S. aureus. In addition to 16S rRNA gene sequencing, conventional methods for leucine aminopeptidase (LAP) and pyrrolidonyl arylamidase (PYR) testing can be cost-effective and efficient for differentiation of Helcococcus spp. from Abiotrophia and Granulicatella species. Using nonstandard methods, we found that all tested Helcococcus spp. had high MICs of >4/76 μg/ml for trimethoprim-sulfamethoxazole, an antibiotic commonly used to treat urinary tract infections. High MICs for erythromycin, azithromycin, and clindamycin, and intermediate to high MICs for moxifloxacin, levofloxacin, and gentamicin were also observed among the Helcococcus strains.

First report of brain abscess caused by a satelliting phenotypic variant of Helcococcus kunzii

Helcococcus kunzii was isolated from a brain abscess in a diabetic patient with cholesteatoma and demonstrated satellitism around Staphylococcus aureus in culture. This is the first reported case of severe central nervous system infection due to H. kunzii and the first description of a satelliting phenotypic variant of this organism.

Management of chronic osteomyelitis of the tibia with life-threatening complications under negative pressure wound therapy and isolation of Helcococcus kunzii

We report the case of an 86-year-old man with severe wound infection originating from a chronic crural ulcer of the lower limb, which under negative pressure wound therapy led to excessive tissue necrosis and perforation of the anterior tibial artery. A swab taken 10 and 7 days preoperatively was positive for Helcococcus kunzii. H. kunzii has been described as a potentially pathogenic organism. The questions whether the negative pressure wound therapy itself caused the bleeding or the negative pressure wound therapy, which generates an anaerobic atmosphere, has triggered the growth and invasion of the facultative anaerobic bacterium H. kunzii and owing to the infection the artery perforated or whether the bacteria has no influence at all remain currently unanswered. After surgical debridement the signs of infection were completely eliminated, and a free musculocutaneous flap led to rapid healing of the wound. Following which H. kunzii was no longer detectable.

Helcococcus kunzii isolated from a sow with purulent urocystitis

Helcococcus kunzii has never been reported in veterinary medicine. The isolation of H. kunzii from a sow with purulent urocystitis is described, suggesting this organism's potential pathogenic role in swine.

Isolation of Helcococcus ovis from sheep with pleuritis and bronchopneumonia

Helcococcus ovis is a newly established species in the genus Helcococcus. The clinical significance of this organism in sheep has not been reported. In the current report, isolation of H. ovis from a 6-month-old mixed-breed ewe lamb that died of respiratory disease is described. Pathologic examination revealed severe, focally extensive, chronic necrotizing pleuritis with intralesional coccobacilli and mild, multifocal, subacute mucopurulent bronchopneumonia, indicating a bacterial etiology. A Gram-positive bacterium was isolated in heavy growth from the lung tissue. DNA sequence analysis on the 16S rDNA gene demonstrated that the isolate was H. ovis. To the authors' knowledge, this is the first report of isolation of H. ovis associated with infection in sheep with pleuritis and bronchopneumonia.

Isolation of Helcococcus kunzii from plantar phlegmon in a vascular patient

Helcococcus kunzii has previously been considered to belong to the normal skin flora of podiatry patients. Here, H. kunzii was isolated in abundance from a pus specimen collected by incision and drainage of plantar phlegmon. This fastidious Gram-positive species was unambiguously identified with the colorimetric VITEK 2 GP card identification system. This suggests that this phenotypic identification system is able to identify promptly H. kunzii, which should be considered a potential pathogen.

Life-threatening invasive Helcococcus kunzii infections in intravenous-drug users and ermA-mediated erythromycin resistance

We report the first two cases of life-threatening invasive Helcococcus kunzii infection, with primary bacteremia and empyema thoracis, respectively. Gram smears of both H. kunzii isolates showed a mixture of gram-positive and gram-negative cocci. The isolate from the first patient, resistant to erythromycin and clindamycin, possessed an ermA gene.