Gordonia bronchialis Bacteremia and Pleural Infection: Case Report and Review of the Literature

Abstract

Gordonia species are aerobic actinomycetes recently recognized as causing human disease, often in the setting of intravascular catheter-related infections. We describe a case of Gordonia bronchialis bacteremia and pleural space infection in the absence of an indwelling intravascular catheter and review the breadth of reported infections with this emerging pathogen. CASE REPORTA 52-year-old woman with a history of Hodgkin's lymphoma, prior splenectomy, and breast cancer was experiencing recurrent pleural effusions over several months prior to admission and presented with bloody drainage from an indwelling pleural catheter. The patient had been diagnosed with Hodgkin's lymphoma 35 years earlier and was treated with radiation therapy to the neck, chest, and abdomen at that time. She underwent a splenectomy for a splenic artery aneurysm 14 years prior to presentation. Five years prior to presentation, she had cardiac surgery for radiation-induced valvular disease, with placement of a St. Jude's mechanical prosthetic valve at the aortic position and repair of mitral and tricuspid valves with biological prosthetic material; a cardiac pacemaker for a heart block was placed. Four years prior to presentation, she had undergone bilateral mastectomies for breast cancer and was subsequently treated with tamoxifen and then anastrozole. Six months prior to presentation, she developed bilateral pleural effusions. The pleural fluid sampled on two occasions was consistent with exudative effusions, with slight lymphocyte predominance and negative Gram stains and cultures, including mycobacterial culture; cytology for malignant cells was negative. Based on these studies, the etiology of the pleural disease was unclear but was thought to be a late complication of her radiation therapy 35 years previously. Bilateral indwelling pleural catheters were placed, and the left-sided catheter was later removed when drainage ceased. In the weeks prior to the most recent presentation, the patient initiated systemic anticoagulation therapy for atrial fibrillation. She subsequently developed bloody drainage from the remaining right-sided indwelling pleural catheter, at which time she was admitted for further evaluation. She did not experience fever, chills, night sweats, cough, or other new symptoms.At the time of admission, the patient was afebrile. Blood cultures were drawn, and empirical therapy with vancomycin and ceftazidime was initiated. Anticoagulation therapy was discontinued. She subsequently developed rapid respiratory deterioration. On the fourth hospital day, video-assisted thorascopic surgery (VATS) was performed for drainage of a right-sided loculated pleural effusion, decortication, and placement of a right-sided chest tube (Fig. 1). She subsequently improved clinically, remaining afebrile on empirical antibacterial therapy. However, after 4 days of incubation, the aerobic blood culture bottle drawn on the day of admission grew Gram-positive rods, which also stained weakly acid fast (Fig. 2). All further blood cultures after in...

Breast abscess caused by Gordonia bronchialis and the use of 16s rRNA gene sequence analysis for its definitive identification

“…bronchialis, the species isolated in this case, was initially identified from samples of soil and sputum from patients with pulmonary disease (Conville & Witebsky, 2001;Johnson et al, 2011;Siddiqui et al, 2012). Only 13 cases of infection with this species of actinomycete have been described (Siddiqui et al, 2012), including a reported recurrent breast abscess in an immunocompetent patient with no previous medical history (Werno et al, 2005) that shared many features with our case.…”

“…(Werno et al, 2005). Many patients, as in our case, require 6-12 weeks of therapy with different antibiotics, often along with appropriate surgical debridement (Johnson et al, 2011;Siddiqui et al, 2012;Sng et al, 2004;Werno et al, 2005). This prolonged course could be explained by the ability of Gordonia spp.…”

Tibial Osteomyelitis Caused by Gordonia bronchialis in an Immunocompetent Patient

“…In the previously reported cases of Gordonia bacteremia, many different antimicrobials were used, either alone or in a variety of combinations, including vancomycin, cephalosporins, carbapenems, TMP/SMX, and others (12). In our case, the patient did not respond to oral antimicrobials (TMP/ SMX and subsequently amoxicillin-clavulanate) until excisional surgical debridement was performed.…”

“…bronchialis was first identified from samples of soil and sputum obtained from patients with pulmonary disease (20), and it is the causative organism in only a minority of human infections. It is a rare cause of bacteremia, usually in the setting of indwelling intravascular catheters (12). Only 13 cases of G. bronchialis infections in humans had been reported in our review of the literature (Table 1), and to our knowledge, this is the first reported case of osteomyelitis caused by this organism.…”

Sternal Osteomyelitis Caused byGordonia bronchialisafter Open-Heart Surgery

“…Many Gordonia species has been isolated from soil [2] and Gordonia bronchialis has been detected in dogs [3], patients with sternal wounds [4], pleural fluid, tumor specimens, and skin [5, 6] among others.…”