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CASE REPORT
Year : 2018  |  Volume : 20  |  Issue : 1  |  Page : 43-45

Isolation of Corynebacterium xerosis from clinical specimens: A case series


Department of Microbiology, Government Medical College, Thiruvananthapuram, Kerala, India

Date of Web Publication4-Jul-2018

Correspondence Address:
Dr. O Sasikumari
Department of Microbiology, Government Medical College, Thiruvananthapuram, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacm.jacm_68_16

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  Abstract 


Corynebacterium xerosis is a part of the normal flora of the skin, nasopharynx, conjunctiva and vagina. There are three cases of C. xerosis isolated from various clinical specimens. All the patients were immunocompromised. The clinical condition improved after treatment with Ampicillin and Cephalexin.

Keywords: Corynebacterium xerosis, immunocompromised, normal flora


How to cite this article:
Sasikumari O, Thomas S. Isolation of Corynebacterium xerosis from clinical specimens: A case series. J Acad Clin Microbiol 2018;20:43-5

How to cite this URL:
Sasikumari O, Thomas S. Isolation of Corynebacterium xerosis from clinical specimens: A case series. J Acad Clin Microbiol [serial online] 2018 [cited 2018 Dec 13];20:43-5. Available from: http://www.jacmjournal.org/text.asp?2018/20/1/43/235928




  Introduction Top


Corynebacterium xerosis is a Gram-positive bacillus seen as normal flora of the skin. It is usually a commensal of the conjunctival sac. It can become pathogenic when the person gets immunosuppressed.[1]

Here, we report three cases of C. xerosis isolated from various clinical specimens [Table 1].
Table 1: Details of the patients and samples

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  Case Reports Top


Case report 1

A 51-year-old female patient who was a diabetic for 17 years developed surgical site infection following abdominal hysterectomy. She was empirically started on injection Cefoperazone + sulbactam. Double swabs of the pus samples were sent to SATH Microbiology laboratory for culture and sensitivity.

Gram-stain of the direct smear from the pus swabs showed plenty of pus cells and Gram-positive bacilli with palisading arrangement under oil immersion field. After routine culture and overnight incubation, the growth was as follows.

On blood agar

Heavy growth of non-haemolytic opaque minute colonies with yellowish pigmentation was observed.

On MacConkey agar

No growth.

Tellurite blood agar

Black-coloured colonies were noted.

Gram stain of the isolate showed Gram-positive bacilli with the palisading arrangement.

The biochemical reactions of the isolate were as follows [Table 2]:
Table 2: Biochemical reactions

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Identification

From the above biochemical reactions, the isolate was identified as C. xerosis. Antibiotic sensitivity was tested with Ampicillin, Cephalexin, Gentamicin, Erythromycin, Amikacin, Vancomycin and Linezolid discs.

The organism was sensitive to Ampicillin, Cephalexin, Vancomycin and Linezolid.

Since C. xerosis is part of the normal flora of the skin, a repeat sample was taken from the same patient after cleaning the site thoroughly with sterile normal saline. Repeat culture also yielded the same organism with the same antibiotic sensitivity pattern.

On issuing the report, the patient was started on Ampicillin injection 500 mg intravenous sixth hourly. The patient improved after one week of treatment. The repeat culture from the surgical site was sterile after 48 h of incubation.

Case report 2

A 30-year-old female who had gestational diabetes developed surgical site infection following lower segment caesarean section. Pus from the site was sent on sterile double swabs for culture and sensitivity. Gram-stain of the direct smear from the pus swabs showed plenty of pus cells and Gram-positive bacilli with palisading arrangement under oil immersion field.

Here also, C. xerosis was isolated in repeated cultures.

The organism was sensitive to Ampicillin, Cephalexin, Vancomycin and Linezolid. The patient was initially on Cefotaxime and Metronidazole. After the identification of the organism, the patient was treated with Linezolid. The culture became sterile after 8 days of treatment.

Case report 3

A seven-year-old male baby had Steven Johnson syndrome. He was on ventilator and prolonged steroid therapy. Two consecutive samples from his endotracheal aspirate yielded C. xerosis which was sensitive to Cephalexin, Vancomycin and Linezolid but resistant to Ampicillin. The child was already on Vancomycin, which was continued. The endotracheal aspirates became sterile after treatment for one week.


  Discussion Top


C. xerosis is a part of the normal flora of the skin, nasopharynx, conjunctiva and it has recently been isolated from vaginal swabs. During the last few years, there has been an increased number of case reports claiming an association of C. xerosis with diseases, such as septicaemia, endocarditis, pleuropneumonia, peritonitis, osteomyelitis, septic arthritis, mediastinitis, meningitis and ventriculitis, especially in immunocompromised patients or post-operative patients. Infections due to C. xerosis have been reported rarely in newborns also.[2]

In this study, all the three cases were immunocompromised. First two were diabetic and the third case was treated with steroids.

In all these cases repeated samples yielded the same organism, thus ruling out the possibility of contamination.[3]

Cases have been reported by Gaskin et al. where they isolated C. xerosis from cerebrospinal fluid shunt from VP shunt in an immunocompromised patient.[4]

Pessanha et al. reported a case of infective endocarditis due to C. xerosis.[5] This was also noted in an immunocompromised patient on steroid therapy.


  Conclusion Top


C. xerosis is a normal skin flora that can become a major concern in the immunocompromised state. Hence far, not much antibiotic resistance has been reported in this organism, making treatment easy. Repeated isolation of normal skin flora from an infected site should arouse a suspicion of infection with that flora, especially in immunocompromised patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Porschen RK, Goodman Z, Rafai B. Isolation of Corynebacterium xerosis from clinical specimens: Infection and colonization. Am J Clin Pathol 1977;68:290-3.  Back to cited text no. 1
    
2.
Cattani S, Venturelli C, Berardi A, Buffetti C, De Caris V, Casolari C, et al. Sepsis caused by Corynebacterium xerosis in neonatology: Report of a clinical case. Acta Biomed Ateneo Parmense 2000;71 Suppl 1:777-80.  Back to cited text no. 2
    
3.
Lipsky BA. Clinical importance of non-diphtherial Corynebacterium species as human pathogens. Intern Med 1985;6:119-26.  Back to cited text no. 3
    
4.
Gaskin PR, St. John MA, Cave CT, Clarke H, Bayston R, Levett PN, et al. Cerebrospinal fluid shunt infection due to Corynebacterium xerosis. J Infect 1994;28:323-5.  Back to cited text no. 4
    
5.
Pessanha B, Farb A, Lwin T, Lloyd B, Virmani R. Infectious endocarditis due to Corynebacterium xerosis. Cardiovasc Pathol 2003;12:98-101.  Back to cited text no. 5
    



 
 
    Tables

  [Table 1], [Table 2]



 

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Discussion
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