First report of vaginal infection caused by Enterococcus raffinosus

Abstract

The authors have reported the first case of vaginal infection caused by Enterococcus raffinosus. The latter is a rarely identified species, but some of the infections described in the literature should direct some attention to this, often opportunistic pathogen, and its emerging multidrug resistance. Case reportDuring the second month of hospitalization by the Department of Haematology, a 50-year-old immunocompromised patient with acute leukaemia developed severe vulvovaginal itching and burning. At speculum examination, erythema and discharge were observed. Vaginal pH was 5.2, the amine test was negative and microscopy (Gram stain) showed the presence of numerous Gram-positive cocci and leukocytes. We obtained swab specimens from the middle third of the vagina and placed them on Sabouraud dextrose agar, sheep blood agar, MacConkey agar and Mannitol salt agar (all from Biolife). The plates were incubated in air. A second blood agar plate was inoculated and incubated anaerobically, whilst a third blood agar plate and a Thayer-Martin plate were inoculated and incubated in an atmosphere of 5 % CO 2 . All cultures were kept at 37 u C and examined after 24 and 48 h. After 24 h of incubation, smooth and a-haemolytic colonies (.150 c.f.u.), about 1 mm in diameter, were observed on all blood agar plates. The organism was found to be a Gram-positive coccus that formed pairs and short chains, and non-motile at 36 u C. None of Lancefield group A, B, C, D, F and G antisera produced a positive reaction (SLIDEX Strepto Plus; bioMérieux) (Facklam & Collins, 1989) and the catalase test was negative. No other organisms of known vaginal pathogenicity were isolated. The isolate was identified as Enterococcus raffinosus by using the VITEK 2 system (card GP; bioMérieux) with 99 % certainty, and the identification was confirmed by using the API system (Rapid ID 32 Strep; bioMérieux). Antibiotic susceptibility testing was performed with brain heart infusion agar (Biolife) using the disc diffusion method and was interpreted as per Clinical and Laboratory Standards Institute guidelines (Chirurgi et al., 1991; NCCLS, 2000;Prakash et al., 2005). The organism was found to be resistant to penicillin, ampicillin, amoxicillin/clavulanate, ampicillin/sulbactam, piperacillin/tazobactam, imipenem, meropenem, ciprofloxacin, clindamycin, erythromycin, cotrimoxazole, tetracycline, amikacin, gentamicin, netilmicin and tobramicin, and susceptible only to vancomycin, teicoplanin and rifampicin. Discs were provided by Oxoid.Pending the results from cultures, the patient was treated empirically and unsuccessfully with oral amoxicillin/clavulanate (1000 mg, every 12 h). Instead, the vaginal symptoms disappeared suddenly within the second day of teicoplanin therapy that the patient had received empirically because of the outbreak of a Gram-positive cocci bacteraemia (data not shown). One week after glycopeptide treatment, vaginal examination and cultures were repeated but they did not show signs of inflammation or E. raffinosus colonies, respectively. Fur...

A Rare Cause of Brain Abscess: Enterococcus raffinosus

“…The most frequently isolated species is Enterococcus faecalis. The second species most commonly isolated from clinical samples is Enterococcus faecium, followed by rare cases of Enterococcus casseliflavus and E. raffinosus [1,7,8] . The causative agent of otitis media could not be isolated in our patient since he had no ear discharge.…”

Inter-species diversity and functional genomic analyses of closed genome assemblies of clinically isolated, megaplasmid-containing Enterococcus raffinosus Er676 and ATCC49464

“…Both Er676 and F162_2 encode multiple other predicted drug resistance genes, specifically four and three ARGs within their chromosomes, respectively. The Er676 chromosome encoded tetM, ant [9]-Ia, ant [6]-Ia, and ermA resistance genes, which confer resistance to tetracylines, aminoglycosides and macrolides, respectively. The F162_2 chromosome encoded optrA (oxazolidinones, phenicol), fexA (phenicol) and tetM (tetracycline) resistance genes (Table 1).…”

“…Multidrug-resistant enterococci further complicate treatment of UTIs and other nosocomial infections caused by these opportunistic pathogens [3]. A member of the genus Enterococcus, Enterococcus raffinosus, although less prevalent in human infection than E. faecalis and E. faecium, was found to be associated with nosocomial infections, bacteraemia and UTIs [4][5][6].…”

“…faecalis and E. faecium , was found to be associated with nosocomial infections, bacteraemia and UTIs [4–6]. Despite previous reports of an association with UTI, urinary strains of E.…”

Enterococcus raffinosus, Enterococcus durans and Enterococcus avium Isolated from a Tertiary Care Hospital in Romania—Retrospective Study and Brief Review

“…The remaining seven case reports from our brief review describe infections at different sites of the human body: endophthalmitis, sinusitis, urinary tract infection, vaginal infection, vertebral osteomyelitis, infected hematoma and decubital ulcer. Most of these infections were treated with teicoplanin, a glycopeptide antibiotic, but the other antibiotic regimes seem to offer similar results [69][70][71][72][73][74][75].…”