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Abdalla E, Elmudathir A, Ahmed AH, Ali B, Elhadi Ali M, Taha NM, Khan FY. Clindamycin: An Effective Treatment for Granulomatous Mastitis Caused by Corynebacterium Kroppenstedtii in a Pregnant Patient. Eur J Case Rep Intern Med 2023; 11:004184. [PMID: 38223282 PMCID: PMC10783456 DOI: 10.12890/2023_004184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 01/16/2024] Open
Abstract
Corynebacterium spp. are Gram-positive bacteria, and recent studies have proposed a potential link between granulomatous mastitis and Corynebacterium kroppenstedtii infections, posing a challenge in selecting appropriate antibiotics, particularly in pregnant women. A young pregnant woman presented with a palpable lump in her left breast. Subsequent assessment revealed the presence of necrotising granulomatous mastitis attributed to C. kroppenstedtii. Initially treated with amoxicillin/clavulanate, the patient showed no improvement. Consequently, clindamycin was administered based on culture and sensitivity results, which resulted in a favourable response with no recurrence of symptoms. This report aims to emphasise the efficacy of clindamycin as a treatment option for granulomatous mastitis caused by C. kroppenstedtii. LEARNING POINTS Alternative antibiotics for treatment of granulomatous mastitis can be effective.The safety and efficacy of antibiotics in pregnancy is important.
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Yoshino R, Yoshida N, Ito A, Ujiie N, Nakatsubo M, Hayashi M, Kitada M. Granulomatous Mastitis Occurring during Pregnancy: A Case Report. Medicina (Kaunas) 2023; 59:1418. [PMID: 37629708 PMCID: PMC10456481 DOI: 10.3390/medicina59081418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Granulomatous mastitis is a benign disease with a clinical presentation similar to that of breast cancer, and is most commonly observed in women of childbearing age. Although it has been suggested that autoimmune diseases are involved in its pathogenesis, no specific treatments have been established. The occurrence of this disease during pregnancy has rarely been reported. We presented the case of a 37-year-old woman who complained of left breast induration at 24 weeks' gestation. Materials and Methods: She was pregnant and manifested a dichorionic, diamniotic placenta. At 24 weeks of gestation, the patient experienced a sensation of hardness in her left breast. Mastitis was suspected, and she was treated with cephem antibiotics. Simultaneously, she was diagnosed with erythema nodosum in the extremities. As her symptoms did not improve, an incisional drainage was performed. Bacterial cultures were obtained at 31 weeks of gestation, and Corynebacterium kroppenstedtii was detected. Results: An elective cesarean section was performed at 37 weeks of gestation, and the baby was delivered safely. After delivery, a needle biopsy was performed, and the patient was diagnosed with granulomatous mastitis. She was completely cured with prednisolone after weaning. In this case, the patient's condition was maintained through incision and drainage, as well as antibiotic, anti-inflammatory, and analgesic drugs during pregnancy. This approach was chosen, taking into consideration the potential side effects of steroids. Conclusions: This case suggests that incisional drainage and antibiotic therapy, as well as steroids and surgery, may be considered in the treatment of granulomatous mastitis occurring during pregnancy. This may also be true for management during delivery. After delivery, breastfeeding and steroidal therapy proved to be effective in treating the condition.
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Affiliation(s)
- Ryusei Yoshino
- Department of Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-shi 078-8510, Japan; (N.Y.); (A.I.); (N.U.); (M.N.); (M.K.)
| | - Nana Yoshida
- Department of Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-shi 078-8510, Japan; (N.Y.); (A.I.); (N.U.); (M.N.); (M.K.)
| | - Akane Ito
- Department of Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-shi 078-8510, Japan; (N.Y.); (A.I.); (N.U.); (M.N.); (M.K.)
| | - Nanami Ujiie
- Department of Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-shi 078-8510, Japan; (N.Y.); (A.I.); (N.U.); (M.N.); (M.K.)
| | - Masaki Nakatsubo
- Department of Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-shi 078-8510, Japan; (N.Y.); (A.I.); (N.U.); (M.N.); (M.K.)
| | - Manami Hayashi
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-shi 078-8510, Japan;
| | - Masahiro Kitada
- Department of Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-shi 078-8510, Japan; (N.Y.); (A.I.); (N.U.); (M.N.); (M.K.)
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3
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Li S, Huang Q, Song P, Han X, Liu Z, Zhou L, Ning P. Clinical characteristics and therapeutic strategy of granulomatous mastitis accompanied by Corynebacterium kroppenstedtii: a retrospective cohort study. BMC Womens Health 2023; 23:388. [PMID: 37491234 PMCID: PMC10369769 DOI: 10.1186/s12905-023-02509-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/25/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Increasing evidence has suggested that Corynebacterium kroppenstedtii is associated with some cases of granulomatous mastitis, mostly based on pathology or microbiology. We aimed to identify the clinical characteristics and treatment regimens for granulomatous mastitis with Corynebacterium kroppenstedtii infection. Understanding these clinical features is essential for patient care. METHODS We retrospectively collected data on 201 patients who were pathologically diagnosed with granulomatous mastitis and had microbiological results of either Corynebacterium kroppenstedtii or no bacterial growth and recorded and analysed their demographics, clinical characteristics, and clinical outcomes. RESULTS There were 107 patients in the CK group and 94 patients in the negative group. Sinus formation (x2 = 13.028, p = 0.000), time to complete remission at the first treatment period (Z = -3.027, p = 0.002), diameter of breast mass at first-time medical consultancy (Z = -2.539, p = 0.011) and recurrence (x2 = 4.953, p = 0.026) were statistically significant. Age (Z = -1.046, p = 0.295), laterality (x2 = 4.217, p = 0.121), time to presentation since the last delivery (x2 = 0.028, p = 0.868), BMI (Z = -0.947, p = 0.344), lactation time (Z = -1.378, p = 0.168), parity (x2 = 1.799, p = 0.180), gravida (Z = -0.144, p = 0.885), history of lactational mastitis or abscess (x2 = 0.115, p = 0.734), local trauma (x2 = 0.982, p = 0.322), hyperprolactinemia (x2 = 0.706, p = 0.401), erythema nodosum (x2 = 0.292, p = 0.589), and nipple discharge (x2 = 0.281, p = 0.596) did not demonstrate statistical significance. Regarding recurrence related to therapeutic strategy, except for surgery combined with immunosuppressants (x2 = 9.110, p = 0.003), which was statistically significant, none of the other treatment regimens reached statistical significance. The recurrence rate of patients in the CK group using rifampicin in their treatment course was 22.0% (x2 = 4.892, p = 0.027). CONCLUSIONS Granulomatous mastitis accompanied by Corynebacterium kroppenstedtii more easily forms sinuses and has a higher recurrence rate. Both of the clinical characteristics may indicate that Corynebacterium kroppenstedtii plays an important role in the development and progression of granulomatous mastitis. Lipophilic antibiotics may be essential for granulomatous mastitis with Corynebacterium kroppenstedtii infection.
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Affiliation(s)
- ShunBo Li
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617, Riyue Avenue 1St Section, Chengdu, Sichuan, 611731, China
| | - Qian Huang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, 611731, China
| | - PeiPei Song
- Department of Laboratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, 611731, China
| | - XiaoRong Han
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617, Riyue Avenue 1St Section, Chengdu, Sichuan, 611731, China
| | - ZeYu Liu
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617, Riyue Avenue 1St Section, Chengdu, Sichuan, 611731, China
| | - Lin Zhou
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617, Riyue Avenue 1St Section, Chengdu, Sichuan, 611731, China
| | - Ping Ning
- Department of Breast, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617, Riyue Avenue 1St Section, Chengdu, Sichuan, 611731, China.
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4
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Stevenson DR, Das S, Lambourne J, Ledwidge SFC, Johnson L, Rosmarin C. Corynebacterium kroppenstedtii breast abscesses in context, a retrospective cohort study. J Med Microbiol 2022; 71. [PMID: 36748506 DOI: 10.1099/jmm.0.001616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Corynebacterium kroppenstedtii breast abscesses and granulomatous mastitis have gained increased recognition in the 20 years since their association was first described. No studies to date have described this organism in the context of all breast abscess pathogens. We retrospectively reviewed 160 community-acquired breast abscess samples from 135 patients in a 3 year period, describing the organisms isolated along with risk factors, site of infection and outcomes. We compared patient subgroups with acute and chronic abscesses, the latter defined as having a requirement for repeat aspiration more than 1 month apart. The prevalence of C. kroppenstedtii breast abscesses was 8 % in all patients (11/135), rising to 32 % in chronic abscesses (10/31), but only 1 % in acute abscesses (1/104; P<0.01). Only 10 % (1/10) of patients with C. kroppenstedtii chronic abscesses were smokers, whereas 75 % of patients (15/20) with non-C. kroppenstedtii chronic abscesses were smokers (P=0.01). C. kroppenstedtii should be considered in recurrent and prolonged infections, especially in non-smokers, and diagnostic methods altered accordingly. Identifying C. kroppenstedtii provides diagnostic clarity and alters management with recommendations for longer courses of treatment using non-beta-lactam antibiotics.
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Affiliation(s)
- Daniel R Stevenson
- Department of Medical Microbiology, Division of Infection, Barts Health NHS Trust, London, UK
| | - Satya Das
- Department of Medical Microbiology, Division of Infection, Barts Health NHS Trust, London, UK.,Queen Mary University of London, London E1 4NS, UK
| | - Jonathan Lambourne
- Department of Medical Microbiology, Division of Infection, Barts Health NHS Trust, London, UK
| | - Serena F C Ledwidge
- Department of Breast Surgery, Division of Surgery, Barts Health NHS Trust, London, UK
| | - Laura Johnson
- Department of Breast Surgery, Division of Surgery, Barts Health NHS Trust, London, UK
| | - Caryn Rosmarin
- Department of Medical Microbiology, Division of Infection, Barts Health NHS Trust, London, UK
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Chen X, Zhang W, Yuan Q, Hu X, Xia T, Cao T, Jia H, Zhang L. A novel therapy for granulomatous lobular mastitis: Local heat therapy. Exp Ther Med 2021; 22:1156. [PMID: 34504601 DOI: 10.3892/etm.2021.10590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/17/2020] [Indexed: 12/24/2022] Open
Abstract
Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast condition that is characterized by granulomatous inflammation. GLM remains a refractory disease due to its failure to respond to routine anti-inflammatory therapies and its high recurrence rate. Thus, the present study aimed to investigate the application of local heat therapy in GLM as a potential therapeutic strategy. The results revealed that the application of local heat therapy was associated with a shortened remission time for GLM, while the remission and recurrence rates were similar to those of existing therapies. The median first remission time following local heat therapy was significantly decreased compared with that following corticosteroid therapy (5.30 months vs. 11.27 months; P<0.05). The remission rates were not significantly different between the local heat therapy (76.9%), extensive excision (90.4%) and the corticosteroid therapy (85.7%) groups (P>0.05). In addition, the recurrence rates were not statistically different between the groups (local heat therapy, 8.3%; extensive excision, 10%; and corticosteroid therapy, 10%; P>0.05). The local heat therapy showed mild adverse effects and shortened healing times compared to the other therapies; however, further confirmation is required.
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Affiliation(s)
- Xinxin Chen
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China.,Guangdong Provincial Education Department, Key Laboratory of Nano-Immunoregulation Tumor Microenvironment, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Wangjian Zhang
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Qiuer Yuan
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Xiaowu Hu
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Ting Xia
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Tengfei Cao
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Haixia Jia
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Lehong Zhang
- Department of Breast Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
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Li XQ, Yuan JP, Fu AS, Wu HL, Liu R, Liu TG, Sun SR, Chen C. New Insights of Corynebacterium kroppenstedtii in Granulomatous Lobular Mastitis based on Nanopore Sequencing. J INVEST SURG 2021; 35:639-646. [PMID: 34036894 DOI: 10.1080/08941939.2021.1921082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The etiology of granulomatous lobular mastitis (GLM) remains unknown. This study aimed to detect bacteria in GLM using Nanopore sequencing and identify the relationship between GLM and Corynebacterium kroppenstedtii. METHODS AND MATERIALS The bacterial detection on fresh samples (including breast pus and tissue) of 50 GLM patients using nanopore sequencing and culture methods. The bacterial detection rate of participants with different stages were compared and analyzed. Formalin-fixed and paraffin-embedded (FFPE) tissues from 39 patients were performed on Gram staining to identify Gram-positive bacilli (GPB) within lipid vacuoles. Moreover, the clinicopathological characteristics of GLM patients in different bacterial subgroups were also conducted. RESULTS In 50 GLM patients, the detection rate of bacteria was 78% using nanopore sequencing method, especially in the early stage of GLM (over 80%), which was significantly higher than that using culture methods (24%, p < 0.001). The dominant bacteria were Corynebacterium species (64%), especially for the Corynebacterium kroppenstedtii. The detection rate of C. kroppenstedtii in nanopore sequencing method (56%) was higher than that in culture methods (16%, p < 0.001). Gram staining positive of bacteria in 7 patients, and 5 of them were C. kroppenstedtii. Thirty-one patients (31/39, 79.5%) exhibited typical histological structure of cystic neutrophilic granulomatous mastitis (CNGM), and eighteen patients detected with C. kroppenstedtii. CONCLUSION Nanopore sequencing showed rapid and accurate bacteria detection over culture method in GLM patients. GLM is not sterile inflammation and closely related to C. kroppenstedtii. CNGM was associated with Corynebacterium infection, especially for C. kroppenstedtii.
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Affiliation(s)
- Xin-Qian Li
- Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Jing-Ping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Ai-Si Fu
- Key Laboratory of Combinatorial Biosynthesis and Drug Discovery, Ministry of Education and School of Pharmaceutical Sciences, Wuhan University, Wuhan, China
| | - Hong-Li Wu
- Department of Breast Surgery, People's Hospital of Ningxia Autonomous Region, Yinchuan, Ningxia, PR China
| | - Ran Liu
- Key Laboratory of Combinatorial Biosynthesis and Drug Discovery, Ministry of Education and School of Pharmaceutical Sciences, Wuhan University, Wuhan, China
| | - Tian-Gang Liu
- Key Laboratory of Combinatorial Biosynthesis and Drug Discovery, Ministry of Education and School of Pharmaceutical Sciences, Wuhan University, Wuhan, China
| | - Sheng-Rong Sun
- Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Chuang Chen
- Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
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7
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Sanchez Eluchans N, Barberis C, Cittadini R, Ozuna Villca AM, Veiga MF, Vilches V, Vay C, Almuzara M. [ Corynebacterium kroppenstedtii breast infections: Report of four cases]. Rev Argent Microbiol 2021; 53:304-308. [PMID: 33627222 DOI: 10.1016/j.ram.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/06/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022] Open
Abstract
Corynebacterium kroppenstedtii is an immobile, non-sporulated, glucose-fermenting and lipophilic gram-positive rod of the skin microbiota. In recent years, numerous isolates of this species have been reported mainly in breast infections, such as abscesses and granulomatous mastitis. We present here four cases of C. kroppenstedtii infections isolated from breast aspiration samples in women. C. kroppenstedtii was identified by conventional methodology and mass spectrometry (MALDI-TOF MS). Using the epsilometric method, these isolates showed susceptibility to penicillin, ceftriaxone, minocycline, ciprofloxacin, and vancomycin, and variable susceptibility to clindamycin and trimethoprim sulfamethoxazole. Due to the association of C. kroppenstedtii with mammary infections, the identification at the species level of those corynebacteria isolated from this location is highly advisable in order to reach the final diagnosis and to test the antimicrobial susceptibility in order to apply the appropriate antibiotic treatment.
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Affiliation(s)
- Nahuel Sanchez Eluchans
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Catedra de Microbiología Clínica, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina
| | - Claudia Barberis
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Catedra de Microbiología Clínica, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina
| | - Rosana Cittadini
- Laboratorio de Bacteriología Sanatorio Mater Dei, Buenos Aires, Argentina
| | | | - María Florencia Veiga
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Catedra de Microbiología Clínica, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina
| | - Viviana Vilches
- Laboratorio de Bacteriología, Hospital Austral, Buenos Aires, Argentina
| | - Carlos Vay
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Catedra de Microbiología Clínica, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina; Laboratorio de Bacteriología Sanatorio Mater Dei, Buenos Aires, Argentina
| | - Marisa Almuzara
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Bacteriología, Catedra de Microbiología Clínica, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina.
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8
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Naik MA, Korlimarla A, Shetty ST, Fernandes AM, Pai SA. Cystic Neutrophilic Granulomatous Mastitis: A Clinicopathological Study With 16s rRNA Sequencing for the Detection of Corynebacteria in Formalin-Fixed Paraffin-Embedded Tissue. Int J Surg Pathol 2019; 28:371-381. [PMID: 31870201 DOI: 10.1177/1066896919896021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cystic neutrophilic granulomatous mastitis (CNGM) is a histologically characterized variant of granulomatous lobular mastitis that is associated with lipophilic Corynebacterium species. It remains a largely underrecognized entity in India. Our aim was to study CNGM in the Asian Indian population and explore if 16s rRNA sequencing could be used on formalin-fixed paraffin-embedded (FFPE) tissue to identify the causative organism. We studied 24 cases with histological features of CNGM with hematoxylin and eosin, Gram, Ziehl-Neelsen, and Periodic acid-Schiff stains. Tuberculosis-polymerase chain reaction and 16s rRNA gene sequencing on DNA extracted from FFPE was attempted (N = 23). Gram-positive bacilli were seen in 20/24 cases. Routine culture with prolonged incubation yielded Corynebacterium species in 8 cases; 7 of these cases were evaluated by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for species identification. C matruchotti was identified in one case by BD Phoenix. MALDI-TOF MS identified the remaining 7 cases as C kroppenstedtii (N = 4) and C tuberculostearicum (N = 2), with no identification in one. Corynebacteria were identified by 16s rRNA sequencing on DNA extracted from FFPE in 12/23 cases using a primer targeting the V5-V6 region that was found to be more conserved in Corynebacterium species. All cases were negative for the diagnosis of tuberculosis. CNGM can be identified by routine stains. Culture using routine media with prolonged incubation is often adequate to isolate the organism. 16s rRNA sequencing on DNA extracted from FFPE tissue can help make an etiological diagnosis in some cases where only paraffin blocks are available.
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Affiliation(s)
| | | | | | | | - Sanjay A Pai
- Columbia Asia Referral Hospital, Bangalore, India
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9
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Fujii M, Mizutani Y, Sakuma T, Tagami K, Okamoto K, Kuno Y, Harada M, Kubouchi K, Tsutsumi Y. Corynebacterium kroppenstedtii in granulomatous mastitis: Analysis of formalin-fixed, paraffin-embedded biopsy specimens by immunostaining using low-specificity bacterial antisera and real-time polymerase chain reaction. Pathol Int 2018; 68:409-418. [PMID: 29862601 DOI: 10.1111/pin.12683] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/12/2018] [Indexed: 01/30/2023]
Abstract
Granulomatous mastitis (GM) is a rare inflammatory disease of the post-lactation breast, clinically mimicking breast cancer. GM is microscopically characterized by formation of epithelioid granulomas and abscess (suppurative granulomas) with lipid droplet-centered inflammation. Corynebacterium kroppenstedtii (Ck) is known as a causative bacterium of GM, and identification of Ck infection within the lesion should thus be essential for confirming the diagnosis. In the present study, we analyzed formalin-fixed, paraffin-embedded (FFPE) biopsy specimens of a total of 18 GM lesions with immunostaining and real-time PCR for Ck genome. Widely cross-reactive rabbit antisera against Bacillus Calmette-Guerin (BCG), Bacillus cereus, Treponema pallidum and Escherichia coli were chosen. With real-time PCR, Ck genome was demonstrated in 7 of 18 GM lesions. Immunohistochemically, the low-specificity antisera reacted with the cytoplasm of phagocytes and/or granuloma-engulfed lipid droplets in 12 of 18 GM lesions. Antigenic positivity was observed in the following order: BCG > B. cereus > T. pallidum > E. coli. Real-time PCR using DNA extracted from FFPE sections was useful but not consistent for identifying the Ck genome in GM, while immunostaining using cross-reactive antisera against four kinds of bacteria was not Ck-specific but was applicable to visualizing bacterial infection within the GM lesions.
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Affiliation(s)
- Mari Fujii
- Medical student.,Department of Pathology, Fujita Health University School of Medicine, Toyoake
| | - Yasuyoshi Mizutani
- Department of Pathology, Fujita Health University School of Medicine, Toyoake
| | | | | | - Kiichiro Okamoto
- Department of Surgery, Toyohashi Medical Center, Toyohashi, Aichi
| | - Yasushi Kuno
- Hinaga Gastrointestinal and Breast Clinic, Yokkaichi, Mie
| | | | - Koichi Kubouchi
- Yokohama Breast and GI Clinic, Kohoku-ku, Yokohama, Kanagawa, Japan
| | - Yutaka Tsutsumi
- Department of Pathology, Fujita Health University School of Medicine, Toyoake
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10
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Wong SCY, Poon RWS, Chen JHK, Tse H, Lo JYC, Ng TK, Au JCK, Tse CWS, Cheung IYY, Yuk MT, Luk WK, Yuen KY. Corynebacterium kroppenstedtii Is an Emerging Cause of Mastitis Especially in Patients With Psychiatric Illness on Antipsychotic Medication. Open Forum Infect Dis 2017; 4:ofx096. [PMID: 28852671 PMCID: PMC5570011 DOI: 10.1093/ofid/ofx096] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/04/2017] [Indexed: 11/13/2022] Open
Abstract
This retrospective study of patients with Corynebacterium kroppenstedtii infections revealed a predominance of mastitis and a potential association with psychiatric illnesses. At least one third of our patients with C kroppenstedtii mastitis had psychiatric illness, and >92% received antipsychotic medications. Drug-induced hyperprolactinemia may be an important modifiable risk factor in these patients.
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Affiliation(s)
- Sally C Y Wong
- Queen Mary Hospital, Hong Kong.,The University of Hong Kong
| | | | | | | | - Janice Y C Lo
- Centre for Health Protection, Department of Health, Hong Kong
| | | | | | | | | | | | | | - Kwok-Yung Yuen
- Queen Mary Hospital, Hong Kong.,The University of Hong Kong
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Fernández-Natal I, Rodríguez-Lázaro D, Marrodán-Ciordia T, Sáez-Nieto JA, Valdezate S, Rodríguez-Pollán H, Tauch A, Soriano F. Characterization and antimicrobial susceptibility of one antibiotic-sensitive and one multidrug-resistant Corynebacterium kroppenstedtii strain isolated from patients with granulomatous mastitis. New Microbes New Infect 2016; 14:93-7. [PMID: 27818775 DOI: 10.1016/j.nmni.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/03/2016] [Accepted: 09/06/2016] [Indexed: 11/22/2022] Open
Abstract
Human infections associated with Corynebacterium kroppenstedtii are rarely reported, and this organism is usually described as antibiotic sensitive. Almost all published cases of C. kroppenstedtii infections have been associated with breast pathology in women and have been described in New Zealand, France, Canada, India and Japan. Here we describe the microbiologic characteristics of two strains isolated from two women diagnosed of granulomatous mastitis in Spain. One C. kroppenstedtii isolate was antibiotic sensitive while the other was multidrug resistant. Biochemical identification was possible using a wide battery of methods including API Coryne V2.0, API Strep, API NH, API NE, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA gene amplification and sequencing. Antimicrobial susceptibility to 28 antibiotics as determined by Etest showed one isolate being sensitive to benzylpenicillin, ciprofloxacin, moxifloxacin, gentamicin, vancomycin, clindamycin, tetracycline, linezolid and rifampin. The second isolate showed resistance to ciprofloxacin, moxifloxacin, clindamycin, tetracycline and rifampin. The multidrug-resistant isolate contained the erm(X), tet(W), cmx, aphA1-IAB, strAB and sul1 resistance genes known from the R plasmid pJA144188 of Corynebacterium resistens. These genes were absent in the genome of the antibiotic-sensitive isolate. This report confirms the tropism of this microorganism for women's breasts and presents the first description of a multidrug-resistant C. kroppenstedtii strain.
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Tauch A, Fernández-Natal I, Soriano F. A microbiological and clinical review on Corynebacterium kroppenstedtii. Int J Infect Dis 2016; 48:33-9. [PMID: 27155209 DOI: 10.1016/j.ijid.2016.04.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 11/18/2022] Open
Abstract
The genus Corynebacterium represents a taxon of Gram-positive bacteria with a high G+C content in the genomic DNA. Corynebacterium kroppenstedtii is an unusual member of this taxon as it lacks the characteristic mycolic acids in the cell envelope. Genome sequence analysis of the C. kroppenstedtii type strain has revealed a lipophilic (lipid-requiring) lifestyle and a remarkable repertoire of carbohydrate uptake and utilization systems. Clinical isolates of C. kroppenstedtii have been obtained almost exclusively from female patients and mainly from breast abscesses and cases of granulomatous mastitis. However, the role of C. kroppenstedtii in breast pathologies remains unclear. This review provides a comprehensive overview of the taxonomy, microbiology, and microbiological identification of C. kroppenstedtii, including polyphasic phenotypic approaches, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and the use of 16S rRNA gene sequencing. A clinical review presents reported cases, various antimicrobial treatments, antibiotic susceptibility assays, and antibiotic resistance genes detected during genome sequencing. C. kroppenstedtii must be considered a potential opportunistic human pathogen and should be identified accurately in clinical laboratories.
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Affiliation(s)
- Andreas Tauch
- Centrum für Biotechnologie (CeBiTec), Universität Bielefeld, Bielefeld, Germany
| | - Isabel Fernández-Natal
- Department of Clinical Microbiology, Complejo Asistencial Universitario de León, calle Altos de Nava, s/n, 24080 León, Spain; Institute of Biomedicine (IBIOMED), León, Spain.
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