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Letter to the Editor
Soft tissue infection due to catalase-negative Staphylococcus lugdunensis: First case reported in Europe
Infección de tejidos blandos por Staphylococcus lugdunensis catalasa negativa: primer caso descrito en Europa
Iker Falces-Romeroa,
Corresponding author
falces88@gmail.com

Corresponding author.
, Sonia Jiménez-Rodrígueza, Alicia Rico-Nietob
a Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
b Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario La Paz, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Skin and soft tissue infections caused by different staphylococci &#40;coagulase-positive or negative&#41; can show similar clinical findings and thus can be impossible to distinguish from one another without culture of the lesion&#46; Coagulase-negative staphylococci infections predominantly present as abscesses and paronychia&#46; They are most common in elderly or immunosuppressed patients&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The bibliographic search was performed using the PubMed database with the following keywords</p><p id="par0015" class="elsevierStylePara elsevierViewall">&#8220;soft tissue&#8221;&#44; &#8220;infection&#8221;&#44; &#8220;<span class="elsevierStyleItalic">Staphylococcus</span><span class="elsevierStyleItalic">aureus</span>&#8221;&#44; &#8220;<span class="elsevierStyleItalic">Staphylococcus</span><span class="elsevierStyleItalic">lugdunensis</span>&#8221;&#44; &#8220;mutation&#8221;&#44; &#8220;catalase negative&#8221;&#46; Years covered by the search&#58; 2005&#8211;2018&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We report a case of soft tissue infection due to catalase-negative <span class="elsevierStyleItalic">Staphylococcus lugdunensis</span> in our tertiary-care hospital&#46; A 46-year-old female was admitted to the Emergency Room with an infection in the fourth finger of the right hand after an accidental wound with a fishbone 3 months before&#46; She had received empirical treatment with amoxicillin&#47;clavulanic acid and clindamycin together with several surgical cleanings without clinical improvement&#46; At the Emergency Room&#44; a tissue sample was obtained and sent to the Microbiology Department&#46; The sample was cultured in conventional media and standard conditions and <span class="elsevierStyleItalic">S&#46; lugdunensis</span> was isolated&#46; According to EUCAST criteria&#44; the strain was resistant only to penicillin due to production of a betalactamase&#46; One week later&#44; the patient was admitted to Plastic Surgery Unit for a new debridement and intravenous antibiotherapy with cefazolin &#40;2<span class="elsevierStyleHsp" style=""></span>g&#47;8<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; A new tissue sample was obtained and <span class="elsevierStyleItalic">S&#46; lugdunensis</span> was isolated again&#46; Magnetic resonance imaging &#40;MRI&#41; and radiography were performed to rule out osteomyelitis and osteolytic lesions&#44; respectively&#46; After 7 days of treatment&#44; she presented clinical improvement and was discharged with oral levofloxacin &#40;750<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41; to complete the treatment for 2 weeks&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the first sample&#44; after 24<span class="elsevierStyleHsp" style=""></span>h of incubation&#44; a pure culture of a non-haemolytic&#44; white and flat colonies grew&#46; Gram stain revealed gram-positive cocci but catalase test was negative on analysis with 3&#37; H<span class="elsevierStyleInf">2</span>O<span class="elsevierStyleInf">2</span>&#46; MALDI-TOF mass spectrometry &#40;Bruker Daltonics GmbH&#44; Bremen&#44; Germany&#41; identified the microorganism as <span class="elsevierStyleItalic">S&#46; lugdunensis</span> &#40;Score&#58; &#62;2&#41;&#44; in agreement with the biochemical identification &#40;99&#46;9&#37; probability&#41; performed in the broth microdilution panel where the antibiotic susceptibility was tested &#40;MicroScan Pos Combo Panel Type 37 &#8211; Beckman Coulter&#44; Brea&#44; CA&#41;&#46; The same catalase-negative <span class="elsevierStyleItalic">S&#46; lugdunensis</span> was obtained in the second sample&#46; The catalase gene was amplified by PCR using primers Sl-F1 &#40;5&#8242;-GAAGCATTAGTCTTGAAAGGAGC-3&#8242;&#41;&#44; Sl-R1 &#40;5&#8242;-TGGGTATTCACCATGATACC-3&#8242;&#41;&#44; Sl-F2 &#40;5&#8242;-CGATGAAGAAGCGGCAGATGTGA-3&#8242;&#41; and R2 &#40;5&#8242;-CAAGGATGCAATATCTTCTAG-3&#8242;&#41; and sequenced using the same four primers and Sl-F3 &#40;5&#8242;-CCATTCCCAACAGATGGTG-3&#8242;&#41; and Sl-R3 &#40;5&#8242;-ATGCATACGGCGTTCTGG-3&#8242;&#41;&#46; The sequence was deposited in Genbank accession number&#58; MK416184 and it was compared with other sequences deposited in the same database&#46; A G&#8594;A mutation in position 1427 was found that would produce a change from Glycine to Glutamic Acid at position 476 &#40;G476E&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Staphylococcus lugdunensis</span> is a coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span> &#40;CNS&#41;&#44; which is part of the normal skin microbiota&#46; However&#44; in terms of its pathogenicity and virulence it is more similar to <span class="elsevierStyleItalic">Staphylococcus aureus</span> than to CNS&#44; causing serious infections such as infective endocarditis&#44; bloodstream infections&#44; catheter-related infections&#44; bone and joint infections&#44; meningitis or brain abscesses&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Production of catalase is considered to be a virulence determinant in pathogenic staphylococci like <span class="elsevierStyleItalic">S&#46; aureus</span>&#44; because it confers the bacteria the ability to better resist intra- and extra-cellular killing by hydrogen peroxide&#46; Strains which do not produce catalase are thought to be less virulent&#46; Catalase activity assay is a classical test for identification of gram-positive cocci belonging to the genus <span class="elsevierStyleItalic">Staphylococcus</span>&#46; Only two <span class="elsevierStyleItalic">Staphylococcus</span> species&#44; <span class="elsevierStyleItalic">S&#46; aureus</span> subsp&#46; <span class="elsevierStyleItalic">anaerobius</span> and <span class="elsevierStyleItalic">S&#46; saccharolyticus</span>&#44; are known not to produce catalase&#46; Catalase-negative <span class="elsevierStyleItalic">Staphylococcus aureus</span> strains with mutations in the <span class="elsevierStyleItalic">katA</span> gene have been reported<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> but&#44; to our knowledge&#44; only one case of molecular characterization of catalase-negative <span class="elsevierStyleItalic">Staphylococcus lugdunensis</span> has been reported in a patient with a chronic suppurative otitis media in China&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The mutation found in our strain has not been previously reported in other strains of catalase-negative <span class="elsevierStyleItalic">Staphylococcus</span> spp&#46; Some reports of catalase-negative <span class="elsevierStyleItalic">S&#46;</span><span class="elsevierStyleItalic">aureus</span><a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;5</span></a> have discussed the clinical relevance of these strains because there is some evidence that catalase is not an absolute requirement for pathogenicity&#46; In our case&#44; catalase did not seem to be relevant for pathogenicity because the patient had an aggressive deep soft tissue infection which required intravenous antibiotherapy and surgical debridement&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although the frequency of catalase negative mutants is low&#44; we should be aware that the interpretation of catalase activity assays may be misled by atypical isolates&#46; This underlines the value of performing an adequate identification by either&#44; MALDI-TOF mass spectrometry or classical microbiological methods&#46;</p></span>"
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Article information
ISSN: 23870206
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos