Incidence and Pathogenicity of Arcanobacterium haemolyticum During a 2-Year Study in Ottawa

Abstract

Arcanobacterium haemolyticum has been described as a rare cause of systemic invasive disease and is occasionally isolated from throat swabs. We describe a 2-year study of the incidence and clinical features of A. haemolyticus infection in a pediatric and adolescent population. A total of 11,620 throat swabs were examined for A. haemolyticum with use of a locally developed selective medium. Controls (2,241) were healthy students who were recruited from a separate study. A. haemolyticum was isolated from 42 patients, with the maximum incidence in the 15 to 18-year-old age group; in this subset the incidence was 2.5%. There were no isolates of A. haemolyticum found in the healthy controls, and the difference in incidence between patients and controls in the 15 to 18-year-old age group was highly significant (P < .01). Approximately half of the patients infected with A. haemolyticum had a rash. In 5 patients, A. haemolyticum was associated with a positive monospot test. The organism was highly susceptible to erythromycin and less susceptible to penicillin. The evidence from this study suggests that A. haemolyticum may be a pathogen with maximum incidence in the 15 to 18-year-old age group.

Bacteriological characteristics of Arcanobacterium haemolyticum isolated from seven patients with skin and soft-tissue infections

“…haemolyticum can cause wound infections in immunocompromised patients and pharyngitis in young adults and older people (Mackenzie et al, 1995;Linder, 1997;Tan et al, 2006). Less commonly, A. haemolyticum can cause invasive diseases, which are more frequent in older, immunocompromised patients (Ceilley, 1977).…”

“…Originally known as Corynebacterium haemolyticum, it was later removed from the genus Corynebacterium and assigned to the new genus Arcanobacterium (Yassin et al, 2011). It was first described in 1946 and was reported as a causative agent of acute pharyngitis and skin lesions (Maclean et al, 1946), and was considered a pathogen, causing wound infections and pharyngitis (Miller et al, 1986;Karpathios et al, 1992;Mackenzie et al, 1995;Funke et al, 1997;Linder, 1997). In some cases, A. haemolyticum can cause septicaemia, osteomyelitis, brain abscesses and endocarditis (Jobanputra & Swain, 1975;Vargas et al, 2006;Wong et al, 2011;Brown et al, 2013).…”

Multiforme Eruption Associated with an Arcanobacterium Haemolyticum Infection

“…1 The maximum incidence of infection is reported as 2.5% for the 15 to 18-year-old-age group. 1 The differential diagnosis of an adolescent presenting with pharyngitis and exanthem should also include Streptococcus pyogenes, Mycoplasma pneumonia and Epstein-Barr virus infections. Obtaining antibodies to Mycoplasma pneumonia and Epstein-Barr virus infections helps to rule out such infections.…”

“…haemolyticum infection has the highest incidence in the second decade of life, while group A streptococci infection has the highest incidence during the first decade of life. 1 The negative rapid group A streptococcal antigen test suggests the possibility of an A. haemolyticum pharyngitis; however, a culture is often necessary to distinguish the two.…”

“…Additionally, as A. haemolyticum has a rapid clinical response to most antibiotics used to treat pharyngitis, antibiotic therapy initiated prior to specimen collection could result in a false-negative culture. 1 The exanthem of A. haemolyticum, associated with roughly 50% of cases, appears as an erythematous, blanching, maculopapular eruption that is scarlatiniform in nature. 3,4 It is often pruritic and begins on the extensor surfaces of the arms and legs before progressing to the chest and back.…”