Korean J Lab Med.  2009 Feb;29(1):41-47. 10.3343/kjlm.2009.29.1.41.

A Case of Catheter-Related Bacteremia of Tsukamurella pulmonis

• Shim HE
• Sung H
• Baek SM
• Namgung S
• Kim MN
• Kim YG
• Lee GH

• KMID: 1781592
• DOI: http://doi.org/10.3343/kjlm.2009.29.1.41

Abstract

Tsukamurella pulmonis is an aerobic actinomycete. We report a catheter-related bacteremia of T. pulmonis. A 39 yr-old male with ALL was hospitalized to receive bone marrow transplantation (BMT). Although the patient developed a high fever at the 7th hospital day (HD), it subsided with vancomycin treatment, and he received BMT at 9th HD. Fever resurged at 16th HD despite sustained treatment with vancomycin, meropenem, and amphotericin B, but subsided with removal of Hickman catheter (HC) at 19th HD. Three sets of blood cultures comprising one from the HC and two from venipunctures were taken at 7th, 16th, and 19th HD, and the distal tip of the HC was also cultured. The aerobic vials of all 3 HC-withdrawn blood cultures and one peripheral blood culture taken at 19HD and the HC tip culture grew long, straight, thin gram-positive rods that were positive on modified Kinyoun stain. This organism showed tiny, rough, grey colonies after 3-day incubation and grew to large flat colonies when incubation was extended. It was catalase-positive, urease-positive, and alkaline-slant/alkaline-deep on triple sugar iron agar, and hydrolyzed hypoxanthine. The sequence of 1,296 base pairs of 16S rRNA of this organism showed a 100.0% homology with the published sequence of T. pulmonis DSM 44142T. To our knowledge, this is the first report of T. pulmonis bacteremia in Korea.

Keyword

Tsukamurella pulmonis; Bacteremia; Hickman catheter; 16S rRNA

MeSH Terms

Actinomycetales/classification/genetics/isolation & purification
Actinomycetales Infections/diagnosis/*microbiology/therapy
Adult
Bacteremia/*diagnosis/microbiology/therapy
Bone Marrow Transplantation
Catheter-Related Infections/*microbiology
Humans
Leukemia, Myeloid, Acute/therapy
Male
Phylogeny
RNA, Ribosomal, 16S/genetics

Figure

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  Fig. 1. Microscopy of the colonies showing long, thin, straight Gram-positive rods on Gram stain (A) and acid-fastness on modified Kinyoun stain (B).

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  Fig. 2. Tsukamurella pulmonis cultures grown on sheep blood agar at 35°C in ambient air showing dry, velvety, greytan colonies at day 3 (A) and yellowish granules on the top of flat colonies with fringed edges at day 6 (B).

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  Fig. 3. Unrooted tree showing the phylogenetic relationships of the isolate of this study, 7A1960, and closely related Gram-positive bacteria. The tree was constructed by neighbour joining method using the Kimura two-parameter model and bootstrap values were calculated from 1,000 trees. The scale bar indicates the estimated number of substitutions per 100 nucleotides.

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