Bloodstream Infection Due to Brachyspira pilosicoli in a Patient with Multiorgan Failure

Abstract

Brachyspira pilosicoli is an etiological agent of human intestinal spirochetosis. Bloodstream infection due to this microorganism is rare. We report a case of B. pilosicoli bacteremia in a 70-year-old patient who presented with multiorgan failure. CASE REPORTA 70-year-old Spanish man with a history of high blood pressure, concentric hypertrophy of the left ventricle, and chronic obstructive pulmonary disease (COPD) with emphysema was referred from a regional hospital to the intensive care unit (ICU) at our center for severe dyspnea. He arrived intubated and oxygen saturation was 75%. On examination he presented with multiorgan failure, hypothermia, tachycardia, and oliguria. Laboratory tests revealed a leukocyte count of 16.5 ϫ 10 9 /liter with 93.7% polymorphonuclear (PMN) cells. A chest X ray showed diffuse emphysema and an upper lobe image suggesting old tuberculosis. Blood and urine specimens for culture were collected on arrival. As respiratory infection was suspected to have exacerbated his COPD, empirical treatment with amoxicillin-clavulanic acid was started. Stool cultures were not performed as the patient had no previous or present signs of gastrointestinal disorders. Initial urine culture was negative. Culture of the bronchoalveolar lavage (BAL) fluid specimen collected on the second day revealed nonsignificant counts of Staphylococcus aureus and scarce colonies of Aspergillus fumigatus, initially considered colonization of the respiratory tract. The patient was hemodynamically unstable for several days due to persistence of rapid atrial fibrillation. Noradrenalin was administered for 3 days, and continuous hemodiafiltration was required. As the patient's condition remained critical, empirical amoxicillinclavulanic was changed to voriconazole and cloxacillin on the fifth day and continued for 10 days.The anaerobic bottle (SN anaerobic medium) from the blood culture set taken on arrival was positive after 6.5 days of incubation in a BacT/Alert automated system (bioMérieux). Gram staining revealed Gram-negative, spiral-shaped bacteria, initially suggesting either a member of the Campylobacter genus or a spirochete (Fig. 1). A subculture of the isolate on Schaedler agar plates (bioMérieux) supplemented with sheep blood (5%) at 37°C yielded growth as a thin, smooth, and beta-hemolytic film under anaerobic conditions only. Catalase, oxidase, and indole test results were negative while the result for hippurate hydrolysis was positive. The isolate was identified as Brachyspira pilosicoli by 16S rRNA gene sequencing and compared to sequences available from GenBank using BLAST (http://blast.ncbi.nlm .nih.gov/Blast.cgi). The nucleotide sequence of the isolate displayed 100% identity to B. pilosicoli strains ATCC 51139 T and P43/6/78 (GenBank accession numbers AY155458 and U14927, respectively).Antibiotic susceptibility of the strain was studied by Etest according to the manufacturer's instructions for anaerobes (AB Biodisk, Sweden). Susceptibility assays were performed on Schaedler agar plates and incubated at ...

Development of a Real-Time PCR for Identification of Brachyspira Species in Human Colonic Biopsies

“…Invasive spirochaetaemia has been reported in critically ill and/or immuno-compromised patients. [21], [22].…”

Oral treatment of chickens with Lactobacillus reuteri LM1 reduces Brachyspira pilosicoli-induced pathology

“…3b). B. pilosicoli have previously been isolated from the liver (Kostman et al, 1995) and bloodstream (Bait-Merabet et al, 2008;Prim et al, 2011) in humans, and Brachyspira infection was associated with hepatic and splenic amyloidosis in duck flocks (Glávits et al, 2011). This is the first report of Brachyspira in the liver of chickens.…”

The Spirochete Brachyspira pilosicoli, Enteric Pathogen of Animals and Humans

“…Clear evidence for the invasive potential of strains of B. pilosicoli has come from reports of the spirochete being recovered from the bloodstream of elderly or critically ill humans with various immunosuppressive conditions (95)(96)(97)(98)(99)(100)(101). It is interesting that other spirochetal diseases, including those caused by Leptospira species and Borrelia species, have a spirochetemia as a central part of their pathogenesis.…”

“…A number of patients with a B. pilosicoli spirochetemia have been described (95)(96)(97)(98)(99)(100)(101). In all cases these individuals have been chronically ill and/or immunocompromised, and the spirochetemia is likely to have been secondary to the immunosuppression.…”

“…B. pilosicoli can be detected using some manual blood culture systems, with an incubation period of up to 10 days followed by subculture (38). The most commonly described media in which the spirochete have been detected are the Hémoline and BBL Septi-Chek formulations, although they have been detected in automated systems after prolonged incubation of up to 15 days (38,(95)(96)(97)(98)(99)(100)(101). Growth may not always be automatically signaled, and the medium should be visually checked for turbidity and aliquots examined for spirochete cells using phase-contrast microscopy.…”