Gordona: a rare cause of peritoneal dialysis peritonitis

A Patient of Spontaneous Bacterial Peritonitis in Hepatitis C Cirrhosis Caused by Gordonia terrae: A Case Report

Background

Gordonia terrae is an opportunistic pathogen that rarely causes clinical infections. Here, we first report a case of spontaneous bacterial peritonitis in patients with hepatitis C cirrhosis caused by Gordonia terrea.

Case Presentation

A 71-year-old male patient was diagnosed with spontaneous bacteria peritonitis secondary to hepatitis C cirrhosis. The result of bacterial culture in ascites was positive, and the pathogenic bacteria was preliminarily identified as the Gordonia genus by matrix-assisted laser desorption ionization-time of flight mass spectrometry. After 16S rRNA sequencing analysis, it was determined to be the Gordonia terrea. Symptoms relieved after treatment with ceftazidime.

Conclusion

This case indicates that the clinical infections caused by Gordonia terrea should be brought to the forefront. Accurate and rapid bacterial identification results are highly beneficial to the diagnosis and therapeutic regime.

Gordonia sputi-associated bloodstream infection in a renal transplant patient with chronic indwelling central venous catheter: a case report and literature review

Introduction

Although rare, human infections caused by Gordonia spp. have been reported, especially within the immunocompromised population and those with long-term indwelling devices. We report a case of Gordonia spp. bacteraemia in a renal transplant patient and present a literature review on microbiological identification methods of this organism.

Case Presentation

A 62-year-old female renal transplant recipient admitted to hospital with a 2-month history of dry cough and fevers occurring weekly when receiving electrolyte replacement infusions via a Groshong line. Over 2 weeks, blood cultures repeatedly isolated a Gram-positive bacillus solely in aerobic bottles, and this was initially reported as Rhodococcus spp. by the local microbiology laboratory. Chest computed tomography (CT) showed multiple ground-glass lung opacities suggestive of septic pulmonary emboli. As central line-associated bloodstream infection was suspected, empirical antibiotics were initiated and the Groshong line was removed. The Gram-positive bacillus was later confirmed by the reference laboratory as Gordonia sputi via 16S rRNA sequencing. Vancomycin and ciprofloxacin for a duration of 6 weeks were completed as targeted antimicrobial therapy. After treatment, the patient remained symptom-free with marked improvement on repeat CT chest imaging.

Conclusion

This case illustrates the challenges surrounding identification of Gordonia spp. and other aerobic actinomycetes. 16S rRNA gene sequencing may be a preferred identification method, especially when initial workup of a weakly acid-fast organism fails to make an identification or shows discrepant results using traditional diagnostic modalities.

A Chinese patient with peritoneal dialysis-related peritonitis caused by Gordonia terrae: a case report

Background

Gordonia terrae is a rare cause of clinical infections, with only 23 reported cases. We report the first case of peritoneal dialysis-related peritonitis caused by Gordonia terrae in mainland China.

Case presentation

A 52-year-old man developed peritoneal dialysis-related peritonitis and received preliminary antibiotic treatment. After claiming that his symptoms had been resolved, the patient insisted on being discharged (despite our recommendations) and did not receive continued treatment after leaving the hospital. A telephone follow-up with the patient’s relatives revealed that the patient died 3 months later. Routine testing did not identify the bacterial strain responsible for the infection, although matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identified the strain as Gordonia rubropertincta. However, a 16S rRNA sequence analysis using an isolate from the peritoneal fluid culture revealed that the responsible strain was actually Gordonia terrae. Similar to this case, all previously reported cases have involved a delayed diagnosis and initial treatment failure, and the definitive diagnosis required a 16S rRNA sequence analysis. Changes from an inappropriate antibiotic therapy to an appropriate one have relied on microbiological testing and were performed 7–32 days after the initial treatment.

Conclusions

The findings from our case and the previously reported cases indicate that peritoneal dialysis-related peritonitis caused by Gordonia terrae can be difficult to identify and treat. It may be especially challenging to diagnose these cases in countries with limited diagnostic resources.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-017-2283-2) contains supplementary material, which is available to authorized users.

Rhizobium radiobacter peritonitis: the first case report from India and review

Background:

Rhizobium radiobacter is an opportunistic human pathogen in debilitated patients with foreign plastic intravascular devices and peritoneal dialysis (PD) catheters. We performed a Medline search of the English-language literature on R. radiobacter continuous ambulatory peritoneal dialysis (CAPD) peritonitis in end-stage renal disease (ESRD) and reviewed 13 cases.

Case presentation:

A 54-year-old male with ESRD secondary to chronic long-standing type II diabetes mellitus presented to the nephrology outpatient department with fever, abdominal pain and cloudy PD effluent. The patient was admitted to the hospital. PD fluid was sent for cell count, Gram stain and culture. The white blood cell (WBC) count in the PD fluid was 6400 mm⁻³ with 82 % neutrophils. Gram staining of the fluid showed plenty of Gram-negative bacilli. A presumptive diagnosis of CAPD peritonitis was made and empiric intraperitoneal cefazolin and tobramycin were started. The PD fluid culture grew non-fermenting, Gram-negative bacilli identified as R. radiobacter. Empiric antibiotic therapy was continued and the patient’s abdominal pain subsided. The peritoneal fluid counts decreased to 50 WBCs mm⁻³ on day 4. However, his abdominal pain recurred on day 8 and his PD fluid count increased to 300 cells mm⁻³. The catheter was therefore surgically removed.

Conclusion:

Although R. radiobacter is considered a contaminant, it can cause relapsing symptomatic peritonitis peritoneal catheter removal.

Gordonia species as emerging causes of continuous-ambulatory-peritoneal-dialysis-related peritonitis identified by 16S rRNA and secA1 gene sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)

We report here four cases of continuous ambulatory peritoneal dialysis-related peritonitis caused by three different species of Gordonia. The portal of entry was likely through Tenckhoff catheters. 16S rRNA and secA1 gene sequencing are so far the most reliable methods for the accurate identification of Gordonia species.