Streptococcus pseudopneumoniae is a recently described streptococcus that is phenotypically and genetically distinct from Streptococcus pneumoniae and other viridans streptococci. Key characteristics of S. pseudopneumoniae are the absence of a pneumococcal capsule, insolubility in bile, resistance or indeterminate susceptibility to optochin when incubated in 5% CO 2 but susceptibility to optochin when incubated in ambient air, and a positive reaction with the AccuProbe DNA probe hybridization test. The clinical importance of this bacterium is currently unknown. We report the characteristics and associated clinical data of 35 strains of S. pseudopneumoniae isolated from sputum samples from 33 patients. All isolates produced a positive result with the NOW S. pneumoniae antigen test (Binax, Inc.). No isolate was resistant to penicillin, but 60% were resistant to erythromycin and 77% were resistant to tetracycline. All patients had lower respiratory tract symptoms, 79% had chronic obstructive pulmonary disease (COPD), and 33% had chest radiographic infiltrates. Compared with matched control patients who had Streptococcus pneumoniae isolated from sputum, patients with S. Streptococcus pseudopneumoniae is a recently described streptococcus that is phenotypically and genetically distinct from Streptococcus pneumoniae and other viridans streptococci (1, 5). DNA-DNA homology studies suggest that this species is a member of the Streptococcus mitis-Streptococcus oralis group (1), and it is likely that this species is similar to other strains previously described by several investigators as atypical pneumococci (4, 9, 12). S. pseudopneumoniae can be differentiated from S. pneumoniae and S. mitis by the absence of a pneumococcal capsule, demonstration of insolubility in bile, resistance or indeterminate susceptibility to optochin when incubated in 5% CO 2 but susceptibility to optochin when incubated in ambient air, and a positive reaction with a commercial DNA probe hybridization test (AccuProbe Streptococcus pneumoniae culture identification test; Gen-Probe, San Diego, CA).Although the first-described isolates of S. pseudopneumoniae came from lower respiratory tract samples (1), the pathogenic potential and clinical importance of this bacterium are still undetermined. We report the characteristics and associated clinical data of 35 strains of S. pseudopneumoniae isolated from sputum samples. MATERIALS AND METHODSIsolates. Since May 2001, we have been collecting consecutive alpha-hemolytic streptococcal strains isolated from sputum samples sent to our diagnostic laboratory. Only strains isolated from good-quality samples (Ͼ25 leukocytes and Յ10 squamous epithelial cells/ϫ100 field) showing a Gram stain and culture predominance were archived. Isolates were identified as S. pseudopneumoniae on the basis of tests for pneumococcal capsule, bile solubility, optochin susceptibility, and AccuProbe DNA hybridization.Bile solubility test. 0.5 ml of 2% deoxycholate was added to 0.5-ml suspensions of each isolate prepared in phosphate...

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Streptococcus pseudopneumoniae is a recently described member of the Streptococcus mitis/oralis group of viridans streptococci that shares some characteristics with Streptococcus pneumoniae (1). Key characteristics of S. pseudopneumoniae are the absence of pneumococcal capsule, insolubility in bile, resistance or indeterminate susceptibility to optochin when incubated in 5% CO 2 but susceptibility to optochin when incubated in ambient air, and positive reactions in DNA probe hybridization and antigen detection tests (1, 3). The clinical relevance of S. pseudopneumoniae has not yet been established, although it may be associated with chronic obstructive pulmonary disease (3). As yet, the antibiotic susceptibility profile of S. pseudopneumoniae has not been reported in detail. The aim of this study was to determine the antibiotic susceptibility profile of a large number of S. pseudopneumoniae isolates recovered from clinical specimens. Ninety-five isolates of S. pseudopneumoniae collected between 2000 and 2007 were studied. All isolates had been recovered as the predominant organism from good-quality sputum specimens containing Ͼ25 leukocytes and Յ10 squamous epithelial cells per 100ϫ field. The isolates were identified on the basis of phenotypic characteristics as previously described (1, 3). MICs were determined by broth microdilution with the Micro-Scan Micro STREP plus 1 system (Dade Behring, West Sacramento, CA). The MICs of penicillin, ampicillin, ceftriaxone, cefotaxime, cefepime, meropenem, chloramphenicol, clindamycin, erythromycin, azithromycin, tetracycline, vancomycin, gatifloxacin, levofloxacin, and trimethoprim-sulfamethoxazole were determined. Strains for which the MICs were greater than the highest dilution included on the Micro-Scan panel were retested with the Etest (AB Biodisk, Solna, Sweden) to determine the precise MIC. Susceptibility breakpoints were based on CLSI guidelines (2). Strains showing

Ochroconis gallopava has rarely been isolated in immunosuppressed patients. We report the first case to our knowledge of O. gallopava peritonitis in a cardiac transplant patient on continuous ambulatory peritoneal dialysis. A 58-year-old man who had undergone cardiac transplant 8 years earlier alerted his dialysis nurses to the presence of black material in his catheter lumen. Fungal hyphae were seen on direct microscopy of the black material and from the dialysate effluent, and O. gallopava was cultured from both after 1 day. He was treated successfully with a single dose of intravenous voriconazole, followed by 2 weeks of oral voriconazole.