- Email: [email protected]
Pseudomonas gladioli (marginata) isolated from a patient with cystic fibrosis
CASE REPORT I
Pseudomonas gladioli (marginata) Isolated from a Patient With Cystic Fibrosis Joel E. Mortensen, Ph.D. Daniel V. Schidlow, M.D. Elizabeth M. Stahl, M.T.(HEW)
Section of Pulmonary Diseases and Department of Laboratories St. Christopher's Hospitalfor Children and Department of Pediatrics Temple University School of Medicine Philadelphia, Pennsylvania 19133 Pseudomonas aeruginosa and Pseudomonas cepacia are isolated from the respiratory tract and can be associated with exacerbation of the pulmonary disease in some patients with cystic fibrosis (CF) (3). In addition to P. aeruginosa and P. cepacia, other Pseudomonas spp., such as P. putida,
P. paucimobilis, Xanthomonas (Pseudomonas) maltophilia, P. putrefaciens, have been isolated from as many as 11% of the CF patients at our center. The role of these pseudomonads in pulmonary disease associated with CF is not clear. However, the isolation and identification of these Pseudomonas spp. from CF patients may be important epidemiologically and for prognosis and treatment. We report here the isolation of P. gladioli (marginata) from a CF patient. A 20-year-old male with CF who had a very mild clinical course with minimal pulmonary involvement was diagnosed as having CF at 4 years of age because of a history of recurrent pneumonia and abnormal stool pattern compatible with intestinal malabsorption. An abnormal sweat test confirmed the clinical diagnosis. He has since had a very mild course, complicated only by mild airway hyperreactivity treated with inhaled bronchodilators, and nasal polyps that required surgical excision. He had mild clubbing of the fingers, characteristic of his disease, but the rest of his examination was essentially normal. His Shwachman-Kulczyki clinical score was 93 points, reflecting
Clinical MicrobiologyNewsletter10:4,1988
mild disease. The Shwachman-Kulczyki clinical score is a demerit system from a maximum possible of 100 for the healthiest and a minimum of 25 points for the sickest patients. The routine respiratory surveillance culture from the patient's most recent specimen grew the following organisms: Staphylococcus aureus, nonmucoid P. aeruginosa, and an oxidase negative, glucose-nonfermenting gramnegative rod resembling P. cepacia. Because this patient had no previous cultures positive for P. cepacia, identification was important. The isolate was identified by UNI-N/F Tek Plate (Flow Laboratories, Inc., McLean, Va.) as a Pseudomonas group VE-2 and by the API 20E System (Analytab Products, Inc., Plainview, N.Y.) at 48 h as a Pseudomonas group VE-1. Further analysis by the Pennsylvania Department of Health, Bureau of Laboratories, identified the organisms as "Pseudomonas marginata." The biochemical reac-
tions of this isolate are compared with some biochemically similar Pseudomonas spp. in Table 1. P. gladioli (marginata) was first described by Severini in 1913 as causing rot of gladiolus corms (8). In 1921 McCulloch described Bacterium marginatum as causing a spot and basal rot of the leaves of Gladiolus spp. (5). P. gladioli is the preferred taxonomy based upon the work of Hildebrandt and associates who, in 1973, demonstrated synonymy between P. gladioli and P. marginata (4). P. gladioli is classified in Bergy's Manual of Systematic Bacteriology in the rRNA group II of the family Pseudomonadaceae (7). It shares this rRNA homology group with P. caryophylli, P.
cepacia, P. mallei, P. picketti, P. pseudomallei, and P. solanacearum. In D N A homology studies of the members of this rRNA group, P. gladioli shows varying amounts of homology with P. caryophylli, P. cepacia, P. mallei, and P. pseudo-
Table 1 Biochemical Characteristics of Pseudomonas marginata and Related Species a
Gram stain Pigment Motility Oxidase Catalase Citrate Urease Nitrate Indole Gelatinase Lysine Arginine Ornithine O/F Glucose Lactose Maltose Mannitol Sucrose Xylose
Isolateb
P. marginata
VE-I
VE-2
P. cepacia.
GNR Light green + . + + + . . .
GNR + . + + + . . .
GNR Yellow +
GNR Yellowc +
+ + V V
+ + V -
GNR V + V + + V V
.
. . .
+ + +
+ + +
.
.
. V
V
+
-
+ + V +
+ V + + V +
. .
V + V + + + + V +
° Weaver RE, Hollis DG, Clark WH and Riley P. 1982: Revised Tables from "Identification of Unusual Pathogenic Gram Negative Bacteria (Elizabeth O. King)" United States Department of Health and Human Services. b Species identification established by Pennsylvania Department of Health, Laboratory Services. c One hundred percent positive for insoluble yellow pigment [Weaver et al. (see above)]. GNR, gram-negative bacillus.
© 1988 ElsevierSciencePublishingCo., Inc.
0196-4399/88/$0.00 + 02.20
29
mallei but little or no homology with the other two species (1). P. gladioli can be isolated from decaying onions, Gladiolus spp., and Iris spp. and is thought to be pathogenic for these plants (7). Previous reports concerning P. gladioli have centered on its taxonomy and role in plant diseases (5, 6, 8). Its role in disease in this patient or other human infections is not clear, however, this case is of interest to document that this unusual organism can be isolated from an impaired host. In order to determine the role of this and other pseudomonads in pulmonary disease, an appreciation of all possible pathogens in pulmonary disease is needed. Studies can then be undertaken to examine the factors pro-
duced by the specific organisms that contribute to colonization or disease (3).
References 1. Ballard, R. W. et al. 1970. Taxonomy of the aerobic pseudomonads: Pseudomonas cepacia, P. marginata, P. allicola and P. caryophylli. J. Gen. Microbiol. 60:199-214. 2. Dees, S. B. et al. 1983. Cellular fatty acid composition of Pseadomonas marginata and closely associated bacteria. J. Clin. Microbiol. 18:1073-1078. 3. Gilligan, P. H., and D. V. Schidlow, 1984. The role of Pseudomonas cepacia in pulmonary disease of cystic fibrosis patients. Clin. Microbiol. Newsl. 6:42-44. 4. Hildebrand, D. C., N. J. Palleroni, and
5. 6.
7.
8. 9.
M. Doudoroff, 1973. Synonomy of Pseudomonas gladioli Severini 1913 and Pseudomonas marginata (McCulloch 1921) Stapp 1928. Int. 1~ Sy,st. Bacteriol. 23:433-437~ McCulloch, L. 1921. A bacterial disease of gladiolus. Science 54:115- 116. McCulloch, L. 1924. A leaf and corm disease of gladioli caused by Bacterium marginatum. J. Agric. Res. 29:159177. Palleroni, N. J. 1984. Family Pseudomonadaceae, pp. 141-218. In N. R. Krieg, et al. (eds.), Bergy's manual of systematic bacteriology, volume 1. Williams and Wilkins, Baltimore. Severini, G. 1913. Una bacteriosi dell'Ixia maculate e dei gladiolus colvilli. Ann. Bot. (Rome) 11:413-424. Welch, D. F. 1984. Clinical microbiology of cystic fibrosis. Clin. Microbiol. Newl. 6:39-42.
Letters to the Editors i
To the Editors: With regard to recent articles discussing rapid direct tests for the diagnosis of group A streptococcal pharyngitis (1, 2), data from the Mayo Clinic (3) raises the possibility that clinical sensitivity may be significantly decreased when the antigen extraction step is performed immediately after obtaining the pharyngeal swab. The sensitivity of the Directogen result was 42% when the test was performed less than 1 h after collecting the swab and rose to the same 75% sensitivity mentioned by Dr. Campos after 2 - 4 h. I have discussed this issue with Hynson, Wescott, and Dunning as well as seven other vendors of rapid group A streptococcal antigen detection kits. None have data bearing upon the effectiveness of these kits when they are used shortly after swabs are obtained. This is a serious drawback to the widespread application of this kit in emergency room and physician office settings, and raises an important issue beyond the accuracy and cost-effectiveness of group A stretococcal antigen diagnosis within the microbiology laboratory itself. I have found no other premarketing or postmarketing evalua-
30
0196-4399/88/$0.00
+ 02.20
tion published in referred journals which bear upon this issue. John W. Ross, M.D. Director, Department of Pathology and Clinical Laboratories Kennestone Hospital Marietta, Georgia 30060
To the Editors: In general, I agree with the views expressed by Dr. Campos (2) in his correspondence with Dr. Smith (5). I also share the concerns of Dr. Ross and am particularly concerned that most evaluations of the kit methods do not try to simulate the conditions that will be encountered in routine practice. Lack of specificity does not seem to be a problem with any of the methods. However, the wide variations in sensitivity being observed need further investigations. The vendors do not seem to have much interest in addressing this latter point. A cost-benefit analysis does not give a single answer on whether rapid testing should be used. Dr. Campos refers to this, and I think it should be emphasized strongly. Individual practice situations will give different an-
© 1988 Elsevier Science Publishing Co., Inc.
swers. Consideration of what the patient wants and how this would affect long-term cost (e.g., a patient who goes elsewhere is costly) is sometimes omitted. One should also consider the recent report by Pichichero et al (4) of adverse effects from early treatment. I would really like to see a similar study done in an outpatient practice where specimens could be tested within minutes of being obtained and compare the results with testing done after overnight storage and with cultures. The study design, however, requires unusual time requirements for laboratory staffing. John P. Anhalt, Ph.D., M.D. Head, Section of Clinical Microbiology Department of Lab Medicine Mayo Clinic Rochester, Minnesota 55905
References 1. Campos, J. M., and C. C. Charilaou 1985. Evaluation of Detect-A-Strep and Culturette Ten-Minute Strep ID kits for detection of group A streptococcal antigen in oropharyngeal swabs from children. J. Clin. Microbiol. 22:145148.
Clinical Microbiology Newsletter 10:4.1988
Pseudomonas gladioli (marginata) Isolated from a Patient With Cystic Fibrosis Joel E. Mortensen, Ph.D. Daniel V. Schidlow, M.D. Elizabeth M. Stahl, M.T.(HEW)
Section of Pulmonary Diseases and Department of Laboratories St. Christopher's Hospitalfor Children and Department of Pediatrics Temple University School of Medicine Philadelphia, Pennsylvania 19133 Pseudomonas aeruginosa and Pseudomonas cepacia are isolated from the respiratory tract and can be associated with exacerbation of the pulmonary disease in some patients with cystic fibrosis (CF) (3). In addition to P. aeruginosa and P. cepacia, other Pseudomonas spp., such as P. putida,
P. paucimobilis, Xanthomonas (Pseudomonas) maltophilia, P. putrefaciens, have been isolated from as many as 11% of the CF patients at our center. The role of these pseudomonads in pulmonary disease associated with CF is not clear. However, the isolation and identification of these Pseudomonas spp. from CF patients may be important epidemiologically and for prognosis and treatment. We report here the isolation of P. gladioli (marginata) from a CF patient. A 20-year-old male with CF who had a very mild clinical course with minimal pulmonary involvement was diagnosed as having CF at 4 years of age because of a history of recurrent pneumonia and abnormal stool pattern compatible with intestinal malabsorption. An abnormal sweat test confirmed the clinical diagnosis. He has since had a very mild course, complicated only by mild airway hyperreactivity treated with inhaled bronchodilators, and nasal polyps that required surgical excision. He had mild clubbing of the fingers, characteristic of his disease, but the rest of his examination was essentially normal. His Shwachman-Kulczyki clinical score was 93 points, reflecting
Clinical MicrobiologyNewsletter10:4,1988
mild disease. The Shwachman-Kulczyki clinical score is a demerit system from a maximum possible of 100 for the healthiest and a minimum of 25 points for the sickest patients. The routine respiratory surveillance culture from the patient's most recent specimen grew the following organisms: Staphylococcus aureus, nonmucoid P. aeruginosa, and an oxidase negative, glucose-nonfermenting gramnegative rod resembling P. cepacia. Because this patient had no previous cultures positive for P. cepacia, identification was important. The isolate was identified by UNI-N/F Tek Plate (Flow Laboratories, Inc., McLean, Va.) as a Pseudomonas group VE-2 and by the API 20E System (Analytab Products, Inc., Plainview, N.Y.) at 48 h as a Pseudomonas group VE-1. Further analysis by the Pennsylvania Department of Health, Bureau of Laboratories, identified the organisms as "Pseudomonas marginata." The biochemical reac-
tions of this isolate are compared with some biochemically similar Pseudomonas spp. in Table 1. P. gladioli (marginata) was first described by Severini in 1913 as causing rot of gladiolus corms (8). In 1921 McCulloch described Bacterium marginatum as causing a spot and basal rot of the leaves of Gladiolus spp. (5). P. gladioli is the preferred taxonomy based upon the work of Hildebrandt and associates who, in 1973, demonstrated synonymy between P. gladioli and P. marginata (4). P. gladioli is classified in Bergy's Manual of Systematic Bacteriology in the rRNA group II of the family Pseudomonadaceae (7). It shares this rRNA homology group with P. caryophylli, P.
cepacia, P. mallei, P. picketti, P. pseudomallei, and P. solanacearum. In D N A homology studies of the members of this rRNA group, P. gladioli shows varying amounts of homology with P. caryophylli, P. cepacia, P. mallei, and P. pseudo-
Table 1 Biochemical Characteristics of Pseudomonas marginata and Related Species a
Gram stain Pigment Motility Oxidase Catalase Citrate Urease Nitrate Indole Gelatinase Lysine Arginine Ornithine O/F Glucose Lactose Maltose Mannitol Sucrose Xylose
Isolateb
P. marginata
VE-I
VE-2
P. cepacia.
GNR Light green + . + + + . . .
GNR + . + + + . . .
GNR Yellow +
GNR Yellowc +
+ + V V
+ + V -
GNR V + V + + V V
.
. . .
+ + +
+ + +
.
.
. V
V
+
-
+ + V +
+ V + + V +
. .
V + V + + + + V +
° Weaver RE, Hollis DG, Clark WH and Riley P. 1982: Revised Tables from "Identification of Unusual Pathogenic Gram Negative Bacteria (Elizabeth O. King)" United States Department of Health and Human Services. b Species identification established by Pennsylvania Department of Health, Laboratory Services. c One hundred percent positive for insoluble yellow pigment [Weaver et al. (see above)]. GNR, gram-negative bacillus.
© 1988 ElsevierSciencePublishingCo., Inc.
0196-4399/88/$0.00 + 02.20
29
mallei but little or no homology with the other two species (1). P. gladioli can be isolated from decaying onions, Gladiolus spp., and Iris spp. and is thought to be pathogenic for these plants (7). Previous reports concerning P. gladioli have centered on its taxonomy and role in plant diseases (5, 6, 8). Its role in disease in this patient or other human infections is not clear, however, this case is of interest to document that this unusual organism can be isolated from an impaired host. In order to determine the role of this and other pseudomonads in pulmonary disease, an appreciation of all possible pathogens in pulmonary disease is needed. Studies can then be undertaken to examine the factors pro-
duced by the specific organisms that contribute to colonization or disease (3).
References 1. Ballard, R. W. et al. 1970. Taxonomy of the aerobic pseudomonads: Pseudomonas cepacia, P. marginata, P. allicola and P. caryophylli. J. Gen. Microbiol. 60:199-214. 2. Dees, S. B. et al. 1983. Cellular fatty acid composition of Pseadomonas marginata and closely associated bacteria. J. Clin. Microbiol. 18:1073-1078. 3. Gilligan, P. H., and D. V. Schidlow, 1984. The role of Pseudomonas cepacia in pulmonary disease of cystic fibrosis patients. Clin. Microbiol. Newsl. 6:42-44. 4. Hildebrand, D. C., N. J. Palleroni, and
5. 6.
7.
8. 9.
M. Doudoroff, 1973. Synonomy of Pseudomonas gladioli Severini 1913 and Pseudomonas marginata (McCulloch 1921) Stapp 1928. Int. 1~ Sy,st. Bacteriol. 23:433-437~ McCulloch, L. 1921. A bacterial disease of gladiolus. Science 54:115- 116. McCulloch, L. 1924. A leaf and corm disease of gladioli caused by Bacterium marginatum. J. Agric. Res. 29:159177. Palleroni, N. J. 1984. Family Pseudomonadaceae, pp. 141-218. In N. R. Krieg, et al. (eds.), Bergy's manual of systematic bacteriology, volume 1. Williams and Wilkins, Baltimore. Severini, G. 1913. Una bacteriosi dell'Ixia maculate e dei gladiolus colvilli. Ann. Bot. (Rome) 11:413-424. Welch, D. F. 1984. Clinical microbiology of cystic fibrosis. Clin. Microbiol. Newl. 6:39-42.
Letters to the Editors i
To the Editors: With regard to recent articles discussing rapid direct tests for the diagnosis of group A streptococcal pharyngitis (1, 2), data from the Mayo Clinic (3) raises the possibility that clinical sensitivity may be significantly decreased when the antigen extraction step is performed immediately after obtaining the pharyngeal swab. The sensitivity of the Directogen result was 42% when the test was performed less than 1 h after collecting the swab and rose to the same 75% sensitivity mentioned by Dr. Campos after 2 - 4 h. I have discussed this issue with Hynson, Wescott, and Dunning as well as seven other vendors of rapid group A streptococcal antigen detection kits. None have data bearing upon the effectiveness of these kits when they are used shortly after swabs are obtained. This is a serious drawback to the widespread application of this kit in emergency room and physician office settings, and raises an important issue beyond the accuracy and cost-effectiveness of group A stretococcal antigen diagnosis within the microbiology laboratory itself. I have found no other premarketing or postmarketing evalua-
30
0196-4399/88/$0.00
+ 02.20
tion published in referred journals which bear upon this issue. John W. Ross, M.D. Director, Department of Pathology and Clinical Laboratories Kennestone Hospital Marietta, Georgia 30060
To the Editors: In general, I agree with the views expressed by Dr. Campos (2) in his correspondence with Dr. Smith (5). I also share the concerns of Dr. Ross and am particularly concerned that most evaluations of the kit methods do not try to simulate the conditions that will be encountered in routine practice. Lack of specificity does not seem to be a problem with any of the methods. However, the wide variations in sensitivity being observed need further investigations. The vendors do not seem to have much interest in addressing this latter point. A cost-benefit analysis does not give a single answer on whether rapid testing should be used. Dr. Campos refers to this, and I think it should be emphasized strongly. Individual practice situations will give different an-
© 1988 Elsevier Science Publishing Co., Inc.
swers. Consideration of what the patient wants and how this would affect long-term cost (e.g., a patient who goes elsewhere is costly) is sometimes omitted. One should also consider the recent report by Pichichero et al (4) of adverse effects from early treatment. I would really like to see a similar study done in an outpatient practice where specimens could be tested within minutes of being obtained and compare the results with testing done after overnight storage and with cultures. The study design, however, requires unusual time requirements for laboratory staffing. John P. Anhalt, Ph.D., M.D. Head, Section of Clinical Microbiology Department of Lab Medicine Mayo Clinic Rochester, Minnesota 55905
References 1. Campos, J. M., and C. C. Charilaou 1985. Evaluation of Detect-A-Strep and Culturette Ten-Minute Strep ID kits for detection of group A streptococcal antigen in oropharyngeal swabs from children. J. Clin. Microbiol. 22:145148.
Clinical Microbiology Newsletter 10:4.1988