2012 C. kroppenstedtii 1 161 Corynebacterium kroppenstedtii 1 1 2 3 4 5 1 6 1 2 3 4 5 6 24 1 6 24 4 16 36 flomoxef, clindamycin 5 BD Corynebacterium kroppenstedtii C. kroppenstedtii C. kroppenstedtii Key words: Corynebacterium kroppenstedtii, mastitis, lipophilic corynebacteria 2 10 Staphylococcus aureus coagulase negative staphylococci viridans streptococci 1 Corynebacterium kroppenstedtii 2 5 1 6 C. kroppenstedtii 951 8580 1 8 TEL: 025 267 1500 713 FAX: 025 267 1134 E-mail: sugayo@ngt.ndu.ac.jp 36 34 35 2006 12 2007 1 4 cefcapene pivoxil CFPN-PI 1 8 38 1 10 Fig. 1 14.2 10 3 /μl CRP 7.36 mg/dl 33 mm 17 mm Vol. 22 No. 2 2012. 57
162 Fig. 1. Clinical course. CFPN-PI: cefcapene pivoxil, FMOX: flomoxef, CLDM: clindamycin, LVFX: levofloxacin, MEPM: meropenem, CEZ: cefazorin, BT: Body temperature, WBC: White blood cell count, CRP: C-reactive-protein Fig. 2. Ultrasonograph. A: 1/11. A hypoechoic lesion measuring 33 mm 17 mm with abscess was observed in the right breast.b: 1/11. multifolicular abscess formation. C: 1/12. 36 mm 20mm with abscess. D: 1/14. Reduction of abscess. E: 1/22. 10 mm 20 mm with abscess. F: 1/30. 10 10 mm with abscess. Fig. 2A, B 3 12 ml flomoxef FMOX 1 g 2/day clindamy cin CLDM 600 mg 2/day Fig. 2 1 14 1 16 levofloxacin LVFX 100 mg 6/day 1 22 58 Vol. 22 No. 2 2012.
C. kroppenstedtii 1 163 10 20 mm Fig. 2E meropenem MEPM 0.5 g 2/day 1 25 1 26 CLDM 150 mg 4/day, CFPN-PI 100 mg 3/day 1 30 2 14 2 20 1. 1 11, 16, 25 26 11 2 5 BD GAM 48 5 216 11 25 26 2. 1 11 25 26 3 Api Coryne Corynebacterium argentoratense No. 2100104 79.2 7 11, 25 2 16S rrna C. kroppenstedtii DDBJ accession number; CP001620 99.7% 1446/1451 C. kroppenstedtii 2 23 C. kroppenstedtii 1 Tween80 24 3. MIC Clinical Laboratory Standard Institute CLSI document M45-A 8 24 48 1 31 MIC Table 1 C. kroppenstedtii Tween80 1Tween80 35 1 CLSI Table 1 4. 3 28 Fig. 3 C. kroppenstedtii 1998 Collins 9 C. kroppenstedtii annotation 10 C. kroppenstedtii C. kroppenstedtii Vol. 22 No. 2 2012. 59
164 Table 1. Comparison of antibiotic susceptibility with Brucella broth and CAMHB added Tween80 Burucella broth CAMHB added Tween80 Incubation time 24 h 48 h 24 h 48 h MIC μg/ml) MIC μg/ml) MIC μg/ml) MIC μg/ml) MPIPC 0.12 1 2 2 ABPC 0.12 0.5 0.25 0.25 CEZ 0.5 0.5 0.5 0.5 FMOX 0.5 0.5 0.5 0.5 IPM 0.25 0.25 0.25 0.25 GM 0.25 0.25 0.25 0.25 MINO 2 2 2 2 EM 0.12 0.12 0.12 0.12 CLDM 0.12 0.25 0.25 0.25 VCM 1 1 0.5 1 TEIC 1 1 2 4 FOM >128 >128 >128 >128 LVFX 0.25 0.25 0.25 0.25 CAMHB: Cation-adjusted Mueller-Hinton broth MPIPC: oxacillin, ABPC: ampicillin, CEZ: cefazolin, FMOX: flomoxef, IPM: imipenem, GM: gentamicin, MINO: minocycline, EM: erythromycin, CLDM: clindamycin, VCM: vancomycin, TEIC: teicoplanin, FOM: fosfomycin, LVFX: levofloxacin Fig. 3. Histopathology biopsy revealed inflammation with a major presence of lymphocytes and macrophages hematoxylin eosin stain; original magnification, 100. C. kroppenstedtii 2 6 C. kroppenstedtii 21 Table 2 20 40 2 3 60 Vol. 22 No. 2 2012.
C. kroppenstedtii 1 165 Table 2. References of cases of mastitis isolated Corynebacterium kroppenstedtii Year Age Specimen Histological findings Reference 1 2002 abscess 12) 2 2002 39 pus swab no granulomas 2) 3 2002 33 granulomas 2) 4 2002 28 pus GLM 2) 5 2002 29 aspirated pus no granulomas 2) 6 2002 30 aspirated pus 2) 7 2002 22 pus 2) 8 2002 41 tissue lipogranulomas 2) 9 2002 31 pus GLM with suppurative lipogranulomas 2) 10 2002 28 pus 2) 11 2002 34 pus 2) 12 2002 26 aspirated pus suppurative lipogranulomas 2) 13 2002 24 aspirated pus no granulomas 2) 14 2002 36 pus swab GLM with suppurative lipogranulomas 2) 15 2003 36 granuloma 3) 16 2003 27 no granulomas 3) 17 2004 38 aspirated pus mass 4) 18 2006 26 puncture granulaomatous mastitis 5) 19 2008 41 pus granulaomatous mastitis 6) 20 2009 47 granulaomatous mastitis 11) 21 2012 36 abscess no granulomas Present case GLM: granulomatous mastitis 11 5 C. kroppenstedtii 2 C. kroppenstedtii C. kroppenstedtii Riegel 4 2 3 Trypticase Soy 1 Tween80 24 Tween80 CLSI document M45-A 8 48 MIC Tween80 24 MIC Tween80 4 3 1 β- C. kroppenstedtii C. kroppenstedtii β- 2 MEPM 0.5 g 2/day 3 g/day C. kroppenstedtii Vol. 22 No. 2 2012. 61
166 11 C. kroppenstedtii 1 2005 90: 708 710. 2 Paviour, S., S. Musaad, S. Roberts, et al. 2002. Corynebacterium species isolated from patients with mastitis. Clin. Infectious Diseases 35: 1434 1440. 3 Taylor, G. B., S. D. Paviour, S. Musaad, et al. 2003. A clinicopathological review of 34 cases of inflammatory breast disease showing an association between corynebacteria infection and granulomatous mastitis. Pathology 35: 109 119. 4 Riegel, P., P. Liegeois, M. P. Chenard, et al. 2004. Isolations of Corynebacterium kroppenstedtii from a breast abscess. Int. J. Med. Microbiol. 294: 413 416. 5 Kieffer, P., R. Dukic, M. Hueber, et al. 2006. A young woman with granulomatous mastitis: A corynebacteria may be involved in the pathogenesis of these disease. Rev. Med. Interne. 27: 550 554. 6 2008. Corynebacterium kroppenstedtii 1 69: 3069 3073. 7 Riegel, P., R. Ruimy, D. D. Briel, et al. 1995. Corynebacterium argentoratense sp. nov., from the human throat. Int. J. Syst. Bacteriol. 45: 533 537. 8 Clinical and Laboratory Standards Institute. 2006. Methods for antimicrobial dilution and disk susceptibility testing of infrequently isolated or fastidious bacteria, approved guideline CLSI document M45- A. Clinical and Laboratory Standards Institute, Wayne, Pa. 9 Collins, M. D., E. Falsen, E. Akervall, et al. 1998. Corynebacterium kroppenstedtii sp. nov., a novel corynebacterium that does not contain mycolic acids. Int. J. Syst Bacteriol. 48: 1449 1454. 10 Tauch, A., J. Schneider, R. Szczepanowski, et al. 2008. Ultrafast pyrosequencing of Corynebacterium kroppenstedtii DSM44385 revealed insights into the physiology of a lipophilic corynebacterium that lacks mycolic acids. J. Biotechnol. 136: 22 30. 11 Beatrice, B., K. Caroline, O. Claire, et al. 2009. First description of NOD2 variant associated with defective neutrophil responses in a woman with granulomatous mastitis related to corynebacteria. J. Clin. Microbiol. 47: 3034 3037. 12 Bernard, K. A., C. Munro, D. Wiebe, et al. 2002. Characteristics of rare or recently described corynebacterium species recovered from human clinical material in Canada. J. Clin. Microbiol. 40: 4375 4381. A Case of Recurrent Mastitis Caused by Corynebacterium kroppenstedtii Yoshiaki Sugahara 1, Kiyofumi Ohkusu 2, Yoshihito Ohtsuka 3 Eiko Sakata 4, Takeyasu Suda 5 Masataka Nakae 1, Koichi Sibasaki 6 1 Department of Clinical Laboratory Medical Hospital, The Nippon Dental University School of Life Dentistry at Niigata 2 Department of Microbiology Regeneration and Advanced Medical Science, Gifu University Graduate School of Medicine 3 Devision of Clinical Laboratory, Kameda General Hospital 4 Devision of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences 5 Department of Surgery Medical Hospital, The Nippon Dental University School of Life Dentistry at Niigata 6 Department of Internal Medicine Medical Hospital, The Nippon Dental University School of Life Dentistry at Niigata We report a 36-year-old woman with an abscess of her right breast whose primary complains were breast pain and fever. Gram staining revealed Gram-positive rods eated polymorphonuclear leukocytes. The specimen of abscess was cultured at 35, on the second day colonies formed which appeared white,nonhemolytic in the blood agar. The biochemical profile of the isolate was determined by the API Coryne system,but was not recognized by the database.comparative 16S rrna gene sequence analysis demonstrated the strains represent within the species Corynebacterium kroppenstedtii. C. kroppenstedtii is characterized by lipophilic corynebacteria. They grew well on Trypticase Soy agar which contains 1%Tween80 in aerobic condition. We would propose that Gram staining and culture by Trypticase Soy agar added Tween80 is important in the clinical specimen with granulomatous mastitis and persistent mastitis. 62 Vol. 22 No. 2 2012.