Brief report
Bacteremia and sepsis by Arcanobacterium haemolyticum in a young immunocompetent patient
Bacteriemia y sepsis por Arcanobacterium haemolyticum en un paciente joven inmunocompetente
Julián Veronaa,
, Noelia Cecilia Dirialdia, María Virginia Muttia, Marcelo Carlos Sciolia, Fernando Andrés Thougnon Islasa, Germán Emilio Curi Antúna, Lisandro Juan Sgarigliaa, María Guillermina Homara, José Andrés Legatoa, Agustina Costab, María Laura Maldonadoc, José A. Di Conzab, Mirta R. Litterio Bürkic
Corresponding author
Read
3955
Timeswas read the article
710
Total PDF
3245
Total HTML
Share statistics
array:24 [ "pii" => "S0325754120300043" "issn" => "03257541" "doi" => "10.1016/j.ram.2020.01.001" "estado" => "S300" "fechaPublicacion" => "2020-10-01" "aid" => "381" "copyright" => "Asociación Argentina de Microbiología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Argent Microbiol. 2020;52:283-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0325754120300250" "issn" => "03257541" "doi" => "10.1016/j.ram.2020.04.001" "estado" => "S300" "fechaPublicacion" => "2020-10-01" "aid" => "386" "copyright" => "Asociación Argentina de Microbiología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Argent Microbiol. 2020;52:288-92" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Statistical approach to <span class="elsevierStyleItalic">Trichinella</span> infection in horses handled by rural slaughterhouses across five distinctive socioeconomic regions in Mexico" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "288" "paginaFinal" => "292" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfoque estadístico de la infección por <span class="elsevierStyleItalic">Trichinella</span> en caballos manejados por mataderos rurales en cinco regiones socioeconómicas distintivas de México" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1110 "Ancho" => 2083 "Tamanyo" => 107247 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Western blot reactivity of serum samples obtained from slaughtered horses against the excretory and secretory products of <span class="elsevierStyleItalic">Trichinella spiralis</span>. The horses reacting by Western blot (WB) with the 45, 49 and 53<span class="elsevierStyleHsp" style=""></span>kDa bands were considered positive (PH), while horses with reactivity to the 45<span class="elsevierStyleHsp" style=""></span>kDa (RH) band or without (NH) reactivity were negative. The reactivity of the serum sample from positive (PR) and negative (NR) rats is also shown in addition to the electrophoretic (E) pattern of the excretory and secretory products (ES) of the muscle larvae. The molecular weight (MW) pattern is shown on the left of the panel.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "David Solís-Hernández, Karla-Lorena Saucedo-Gutiérrez, Antonio Meza-Lucas, Fabián-Ricardo Gómez-de-Anda, Miriam-Susana Medina-Lerena, Ricardo García-Rodea, María-Teresa Corona-Souza, Miguel-Ángel Pérez-Ramírez, Vicente Vega-Sánchez, Jorge-Luis de-la-Rosa-Arana" "autores" => array:10 [ 0 => array:2 [ "nombre" => "David" "apellidos" => "Solís-Hernández" ] 1 => array:2 [ "nombre" => "Karla-Lorena" "apellidos" => "Saucedo-Gutiérrez" ] 2 => array:2 [ "nombre" => "Antonio" "apellidos" => "Meza-Lucas" ] 3 => array:2 [ "nombre" => "Fabián-Ricardo" "apellidos" => "Gómez-de-Anda" ] 4 => array:2 [ "nombre" => "Miriam-Susana" "apellidos" => "Medina-Lerena" ] 5 => array:2 [ "nombre" => "Ricardo" "apellidos" => "García-Rodea" ] 6 => array:2 [ "nombre" => "María-Teresa" "apellidos" => "Corona-Souza" ] 7 => array:2 [ "nombre" => "Miguel-Ángel" "apellidos" => "Pérez-Ramírez" ] 8 => array:2 [ "nombre" => "Vicente" "apellidos" => "Vega-Sánchez" ] 9 => array:2 [ "nombre" => "Jorge-Luis" "apellidos" => "de-la-Rosa-Arana" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754120300250?idApp=UINPBA00004N" "url" => "/03257541/0000005200000004/v1_202012180643/S0325754120300250/v1_202012180643/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0325754119301257" "issn" => "03257541" "doi" => "10.1016/j.ram.2019.11.005" "estado" => "S300" "fechaPublicacion" => "2020-10-01" "aid" => "375" "copyright" => "Asociación Argentina de Microbiología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Argent Microbiol. 2020;52:278-82" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 17 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 5 "PDF" => 9 ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Microscopic agglutination test: Variables that affect the time of serological confirmation of human leptospirosis cases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "278" "paginaFinal" => "282" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Test de microaglutinación: variables que afectan el tiempo de confirmación de los casos humanos de leptospirosis" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2868 "Ancho" => 1508 "Tamanyo" => 235620 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Days elapsed between the onset of clinical manifestations and the collection of the first sample for the serological diagnosis of the disease. (B) Days between the collection of the first clinical sample for serological diagnosis and admission at the specific diagnostic laboratory. (C) Cross-reaction between serogroups used as antigens in MAT, according to the days of the course of disease. (D) Antibody titers for serogroups used as antigens in MAT, according to the days of the course of disease.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Exequiel Scialfa, Mariana Rivero, Sergio Moreno, Marcela Ortiz, Fabricio Bongiorno" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Exequiel" "apellidos" => "Scialfa" ] 1 => array:2 [ "nombre" => "Mariana" "apellidos" => "Rivero" ] 2 => array:2 [ "nombre" => "Sergio" "apellidos" => "Moreno" ] 3 => array:2 [ "nombre" => "Marcela" "apellidos" => "Ortiz" ] 4 => array:2 [ "nombre" => "Fabricio" "apellidos" => "Bongiorno" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">64% of cases are confirmed by MAT with the first clinical sample.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Human cases of leptospirosis are confirmed 21 days after the onset of clinical signs.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Ballum and Canicola were the most reactive serogroups.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">The confirmation time depends on the distance of the health region from the reference laboratory.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall">The number of serogroups that cross-reacted decreased as the disease progressed.</p></li></ul></p></span>" ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754119301257?idApp=UINPBA00004N" "url" => "/03257541/0000005200000004/v1_202012180643/S0325754119301257/v1_202012180643/en/main.assets" ] "en" => array:22 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Bacteremia and sepsis by <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> in a young immunocompetent patient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "283" "paginaFinal" => "287" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Julián Verona, Noelia Cecilia Dirialdi, María Virginia Mutti, Marcelo Carlos Scioli, Fernando Andrés Thougnon Islas, Germán Emilio Curi Antún, Lisandro Juan Sgariglia, María Guillermina Homar, José Andrés Legato, Agustina Costa, María Laura Maldonado, José A. Di Conza, Mirta R. Litterio Bürki" "autores" => array:13 [ 0 => array:4 [ "nombre" => "Julián" "apellidos" => "Verona" "email" => array:1 [ 0 => "julianverona@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Noelia Cecilia" "apellidos" => "Dirialdi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "María Virginia" "apellidos" => "Mutti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Marcelo Carlos" "apellidos" => "Scioli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Fernando Andrés" "apellidos" => "Thougnon Islas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Germán Emilio" "apellidos" => "Curi Antún" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Lisandro Juan" "apellidos" => "Sgariglia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "María Guillermina" "apellidos" => "Homar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "José Andrés" "apellidos" => "Legato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "Agustina" "apellidos" => "Costa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 10 => array:3 [ "nombre" => "María Laura" "apellidos" => "Maldonado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 11 => array:3 [ "nombre" => "José A." "apellidos" => "Di Conza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 12 => array:3 [ "nombre" => "Mirta R." "apellidos" => "Litterio Bürki" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Hospital de Balcarce “Dr Felipe A, Fossati”, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad de Buenos Aires, BA, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bacteriemia y sepsis por <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> en un paciente joven inmunocompetente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 864 "Ancho" => 900 "Tamanyo" => 122513 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Gram stain of <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> colony showing irregularly shaped gram-positive rods recovered from blood culture. Microscopic magnification: 1000×.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> (formerly <span class="elsevierStyleItalic">Corynebacterium haemolyticum</span>) is an aerobic or facultative anaerobic, non-motile and non-spore-forming, slightly curved gram-positive rod with pointed ends. It does not hydrolyze esculin, urea or gelatin<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>. It is the causative agent of skin infections and sore throat such as exudative pharyngitis and tonsillitis. Although <span class="elsevierStyleItalic">A. haemolyticum</span> is associated with pharyngitis in young adults, the incidence is low (0.5–2.5%). Moreover, it is not easily detected in the microbiological laboratory because of its slow growth and many characteristics resembling β-hemolytic streptococci such as being catalase negative, β-hemolysis, susceptibility to bacitracin (0.04<span class="elsevierStyleHsp" style=""></span>U) and cross-agglutination with antisera for Lancefield's groups A, B, C, D, F or G<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>. Moreover, this species produces α-mannosidase and yields a positive result in the CAMP test using <span class="elsevierStyleItalic">Streptococcus agalactiae</span> ATCC 13813 and a reverse CAMP test using <span class="elsevierStyleItalic">Staphylococcus aureus</span> ATCC 25923<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">No risk factors for infection have been identified yet, although two distinct subsets are recognized: healthy young adults presenting with upper respiratory tract infections and older, often immunocompromised, patients presenting with skin and soft tissue infections<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Here, we report a case of bacteremia caused by <span class="elsevierStyleItalic">A. haemolyticum</span> in a patient who presented to the emergency room with pharyngitis and fever. Moreover, the presence of Lemierre's syndrome was suspected and investigated.</p><p id="par0040" class="elsevierStylePara elsevierViewall">To the best of our knowledge, this is the first case of bacteremia by <span class="elsevierStyleItalic">A. haemolyticum</span> reported in Argentina.</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case report:</span> a twenty-year old immunocompetent male patient, undergoing a strong emotional shock, consulted at the emergency room for pharyngitis, cutaneous rush and fever for over a week. He had been under antibiotic treatment with amoxicillin/clavulanic acid, 1<span class="elsevierStyleHsp" style=""></span>g by mouth twice daily for three days. Blood tests had been performed two days before and revealed leukocytosis: 12 300 white blood cells/mm<span class="elsevierStyleSup">3</span> (84.8% neutrophils) (Fig. S1, panels a and b), thrombocytopenia: 63 000 platelets/mm<span class="elsevierStyleSup">3</span> (Fig. S1, panel c), increased erythrocyte sedimentation rate: 44<span class="elsevierStyleHsp" style=""></span>mm and mild hepatic inflammation (GOT: 59.0<span class="elsevierStyleHsp" style=""></span>U/l, GPT: 75.0<span class="elsevierStyleHsp" style=""></span>U/l, total bilirubin: 2.03<span class="elsevierStyleHsp" style=""></span>mg/dl, direct bilirubin: 0.29<span class="elsevierStyleHsp" style=""></span>mg/dl, ALP: 378<span class="elsevierStyleHsp" style=""></span>U/l). Laboratory tests were checked with a new sample and blood cultures were carried out. Chest X-ray showed no abnormalities. Antibiotic treatment was changed to ceftriaxone, 1<span class="elsevierStyleHsp" style=""></span>g given intravenously every 12<span class="elsevierStyleHsp" style=""></span>h. Dipyrone was applied in the buttock. Thrombocytopenia persisted until day five (Fig. S1, panel c) and anemia developed from day five until day thirteen (Fig. S1, panel d). Cardiac Doppler and abdominal ultrasounds showed absence of abnormalities. Infectious mononucleosis, streptococcal pharyngitis, hematological alterations, syphilis, HIV, cytomegalovirus and leptospirosis were ruled out. Laboratory reported the presence of diphtheroid gram-positive bacilli in blood cultures (both aerobic and anaerobic bottles), which did not grow in chocolate agar under candle after 48<span class="elsevierStyleHsp" style=""></span>h and were considered presumptively anaerobic. The bottles were sent to a laboratory specialized in anaerobic bacteriology. Additionally, chest and abdominal computed tomography scans were performed (Fig. S3, panels a and b). Defined and irregular nodular opacities of bilateral distribution that did not exceed 2.5<span class="elsevierStyleHsp" style=""></span>cm in diameter were detected, some of which were cavitated, predominantly subpleurally located (Fig. S3, panel a). In addition, a condensation was observed with an air bronchogram at the left lung base associated with a small amount of pleural effusion and bibasal fibroretractable changes. No focal lesions of the parenchyma of both lungs of primary or secondary appearance were detected. There was no evidence of pulmonary hilar or mediastinal lymph nodes. These findings matched those detected in a new chest X-ray that showed left-sided infiltrate and two images of small cavitated subpleural abscesses in the right lung. Furthermore, an abscessed collection of 10<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>cm was observed in the left gluteus medius muscle that displaced and compressed surrounding structures (Fig. S3, panel b). In addition, a soft tissue ultrasound (hip and left gluteus) was performed. A collection that agreed with the tomographic findings was found. Despite six days under treatment with ceftriaxone, fever persisted. Then, treatment with the combination vancomycin (1<span class="elsevierStyleHsp" style=""></span>g every 12<span class="elsevierStyleHsp" style=""></span>h) plus piperacillin/tazobactam (4.5<span class="elsevierStyleHsp" style=""></span>g every 8<span class="elsevierStyleHsp" style=""></span>h), both administered intravenously, was started. The patient was admitted to the intensive care unit because of hypotension and sepsis. He evolved without fever. Drainage of the gluteal abscess was performed by puncture under local anesthesia and a collection of purulent fluid was obtained and sent to the laboratory for culture. Gram stained smears of the material showed plentiful polymorphonuclear leukocytes but no bacteria, and cultures were negative. Subsequently, it was necessary to perform surgical drainage of the abscess. On day 19 of hospitalization the antibiotic scheme was completed (13 days) and the patient was discharged. The patient returned a few days later to undergo a color Doppler ultrasound of the neck arteries on both sides with the intention of ruling out Lemierre's syndrome. The study showed normal myointimal thickening without evidence of thrombosis in both internal jugular veins. On that occasion, a <span class="elsevierStyleSmallCaps">d</span>-dimer test was also performed: <100<span class="elsevierStyleHsp" style=""></span>ng/ml.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Once at the laboratory specialized in anaerobic bacteriology, the two positive blood culture bottles (Adult blood culture bottles, <span class="elsevierStyleItalic">Laboratorios Britania S.A., Argentina</span>) were subcultured into 5% leaked blood agar supplemented with vitamin K, hemin, tween 80, sodium bicarbonate, pyruvate and yeast extract and incubated at 37<span class="elsevierStyleHsp" style=""></span>°C for 2 days under anaerobic conditions. Identification of the recovered microorganism was initially performed based on its microscopic appearance (diphtheroid gram-positive bacillus) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), its ability to grow under aerobic and anaerobic atmospheric conditions, a negative catalase test, partial β-hemolysis on sheep blood agar, total hemolysis on human blood agar and a positive reverse CAMP test (narrowing of the hemolytic zone produced by staphylococcal β-lysine) (Fig. S2). Additional tests performed: β-galactosidase (+), nitrate reduction (−), urease (−), heat-stable nuclease (DNasa) (+). The identification of the isolate was confirmed using Matrix Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) technology (Vitek MS, bioMérieux, Marcy l’Etoile, France) as <span class="elsevierStyleItalic">A. haemolyticum</span> (99.9%). On day 14 of hospitalization, <span class="elsevierStyleItalic">A. haemolyticum</span> (strain 5612) was detected in blood cultures (both aerobic and anaerobic bottles).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The isolate was tested for its susceptibility to penicillin, gentamicin and vancomycin by the Epsilometer test (E-test; AB Biodisc, Solna, Sweden) following the original manufacturer's recommended guidelines (AB Biodisk. 1996. E-test technical guide 1B: susceptibility testing of anaerobes). The breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) were used (Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria, 3rd ed. Approved standard M45. CLSI, Wayne, PA; 2015). The strain was susceptible to penicillin, vancomycin and gentamicin (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Afterwards, the isolate was sent to a laboratory specialized in molecular biology to investigate <span class="elsevierStyleItalic">A. haemolyticum</span> arcanolysin (<span class="elsevierStyleItalic">aln</span>/ALN), a member of the cholesterol-dependent cytolysin (CDC) family. The <span class="elsevierStyleItalic">aln</span> gene was amplified by polymerase chain reaction (PCR) employing oligonucleotide primers designed in-house called <span class="elsevierStyleItalic">aln</span> F (forward) and <span class="elsevierStyleItalic">aln</span> R (reverse) with the following sequences: 5′-GTCAAGTTATGCCGGGAATG-3′ and 5′-CGATGTTCTTGAACCAAGG-3′, respectively, yielding a 1984<span class="elsevierStyleHsp" style=""></span>bp amplicon. According to Ruther et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>, the upstream region of <span class="elsevierStyleItalic">aln</span> was also amplified using primers DM1078 (forward) and DM1080 (reverse) yielding an 830<span class="elsevierStyleHsp" style=""></span>bp amplicon. The final PCR product was sequenced in order to compare with rough or smooth previously reported <span class="elsevierStyleItalic">A. haemolyticum</span> strains. <span class="elsevierStyleItalic">In silico</span> restriction pattern was obtained using NEB cutter V 2.0 free software.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Above, we reported a case of bacteremia by <span class="elsevierStyleItalic">A. haemolyticum</span> with pharyngitis as its starting point. Bacteremias caused by this microorganism are rare and only a few cases have been reported<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>. Pharyngitis by <span class="elsevierStyleItalic">A. haemolyticum</span> affects mostly children and young adults between 10 and 30 years of age<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>. As it is the case, it is considered an opportunistic pathogen. Occasionally, it can lead to episodes of sepsis. Moreover, it liberates extracellular enzymes such as phospholipase D, neuraminidase, hemolysin and DNases which are responsible for its pathogenesis<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A. haemolyticum</span> has two biotypes: smooth and rough. Smooth biotypes show smooth colony edges, moderate to strong β-hemolysis and predominately cause wound infections. Rough biotypes possess rough and irregular colony edges, have weak to no β-hemolysis and are isolated mainly from the respiratory tract. Moreover, there are biochemical differences between strains: rough biotypes are sucrose and trehalose-negative while smooth ones are β-glucuronidase-negative. Although the reason of these two variants is unknown, there seems to be a strong correlation with a polymorphic region upstream of the arcanolysin gene (<span class="elsevierStyleItalic">aln</span>)<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>. This enzyme is a recently discovered hemolysin from <span class="elsevierStyleItalic">A. haemolyticum</span> and, as member of the CDC family, is produced and secreted as a monomer that, upon contact with a eukaryotic membrane, oligomerize to form a large β-barrel pore resulting in the lysis of the cell.</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A. haemolyticum</span> 5612 displayed a rough colony morphology. PCR amplification of the <span class="elsevierStyleItalic">aln</span> open-reading frame and <span class="elsevierStyleItalic">aln</span> upstream region from strain 5612 rendered the 1984<span class="elsevierStyleHsp" style=""></span>bp and 830<span class="elsevierStyleHsp" style=""></span>bp expected amplicons, respectively. Sequence analysis of the 830<span class="elsevierStyleHsp" style=""></span>bp upstream region of <span class="elsevierStyleItalic">aln</span> revealed that the strain 5612 recovered in this work was 100% identical to the rough isolate B0961-98 (GenBank accession number: KP668885) isolated from a Finnish patient with pharyngitis. According to Ruther et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>, the polymorphisms in the intergenic region of <span class="elsevierStyleItalic">aln</span> allow to obtain different restriction enzyme patterns. Thus, the intergenic region from rough isolates can be cleaved by <span class="elsevierStyleItalic">Xcm</span>I but not <span class="elsevierStyleItalic">Cla</span>I (X restriction pattern)<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>. The <span class="elsevierStyleItalic">in silico</span> sequence analysis also allowed to identify the X pattern in <span class="elsevierStyleItalic">A.haemolyticum</span> 5612.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Even though the isolate was susceptible to penicillin (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), treatments with amoxicillin/clavulanic acid or ceftriaxone were not effective. Fairly sure, the intramuscular dipyrone injection applied in the buttock at entrance in the course of thrombocytopenia caused hematoma and, most likely, the gluteal abscess would have resulted from intravascular seeding of the hematoma during bacteremia. The possibility of treatment failures when <span class="elsevierStyleItalic">A. haemolyticum</span> is treated with β-lactams<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> should be taken into account. Nyman et al. concluded that <span class="elsevierStyleItalic">A. haemolyticum</span> is often penicillin-tolerant, suggesting that phenoxymethylpenicillin administration would be ineffective in eradicating it from the pharynx<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>. In this particular case, treatment failure with amoxicillin/clavulanic acid before entrance warned about the possibility of treatment failure with any β-lactam. Moreover, there is a report of a case of bacteremia secondary to a sacral eschar infection in which treatment with amoxicillin/clavulanic acid was not effective despite <span class="elsevierStyleItalic">in vitro</span> susceptibility, and the patient had fatal sepsis<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>. In another report, empiric treatment with ceftriaxone/metronidazole also failed<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>. In infective endocarditis, <span class="elsevierStyleItalic">A. haemolyticum</span> has also demonstrated both penicillin and ampicillin tolerance, resulting in no clinical improvement on empirical therapy with ampicillin/gentamicin<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a>. Regardless, the combination vancomycin plus piperacilin/tazobactam was chosen and our patient improved.</p><p id="par0085" class="elsevierStylePara elsevierViewall">With regard to the hematological parameter, the hematocrit evidenced a hemolytic process possibly caused by arcanolysin (Fig. S1, panel d). As expected, leukocytes were elevated and neutrophils showed a straightforward trend in time compatible with a monomicrobial infection (Fig. S1, panels a and b). Platelets started very low and reached very high values (Fig. S1, panel c). This could be the consequence of a break of its production caused by the septic process from the beginning followed by an acute phase reactant behavior.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Furthermore, Lemierre's syndrome refers to septic thrombophlebitis of the internal jugular vein and disseminated metastatic infection that most often develops as a complication of a bacterial sore throat infection in the young. Lemierre's syndrome is most often caused by <span class="elsevierStyleItalic">Fusobacterium necrophorum</span> (human necrobacillosis). Only a few cases of Lemierre's syndrome caused by <span class="elsevierStyleItalic">A. haemolyticum</span> have been reported in the medical literature<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4,7,15</span></a>. Therefore, the occurrence of Lemierre's syndrome in this patient was worth investigating since he met three out of four criteria to suspect it: primary oropharingeal infection, septicemia, metastatic abscess but not septic or embolic phlebitis of jugular vein. For this purpose, it was necessary to evaluate the presence of any trail of thrombophlebitis of the internal jugular veins by Doppler ultrasound and <span class="elsevierStyleSmallCaps">d</span>-dimmer test. As the results were negative, Lemierre's syndrome was ruled out. Notwithstanding, the diagnosis of Lemierre's syndrome has been achieved elsewhere without the presence of jugular vein thrombophlebitis<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Finally, infections by <span class="elsevierStyleItalic">A. haemolyticum</span> must be considered in patients who underwent treatments with trimethoprim/sulfamethoxazole because of its natural resistance and selection<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Infections by <span class="elsevierStyleItalic">A. haemolyticum</span> represent a challenge for microbiologists and physicians. Gram stains should always be performed to organisms obtained from throat samples to differentiate them from <span class="elsevierStyleItalic">Streptococcus pyogenes</span>. Physician must be aware of the possibility of treatment failures using β-lactams.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Fundings</span><p id="par0105" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1437169" "titulo" => "Highlights" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres1437168" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1311724" "titulo" => "Keywords" ] 3 => array:3 [ "identificador" => "xres1437167" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0015" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1311725" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Fundings" ] 6 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 7 => array:2 [ "identificador" => "xack501427" "titulo" => "Acknowledgements" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-10-13" "fechaAceptado" => "2020-01-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1311724" "palabras" => array:6 [ 0 => "<span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span>" 1 => "Arcanolysin" 2 => "Pharyngitis" 3 => "Bacteremia" 4 => "Sepsis" 5 => "Lemierre's syndrome" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1311725" "palabras" => array:6 [ 0 => "<span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span>" 1 => "Arcanolisina" 2 => "Faringitis" 3 => "Bacteriemia" 4 => "Sepsis" 5 => "Síndrome de Lemierre" ] ] ] ] "tieneResumen" => true "highlights" => array:2 [ "titulo" => "Highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bacteremia by <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> in a twenty-year-old immunocompetent patient.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Rough biotype of this strain correlates with intergenic sequence of <span class="elsevierStyleItalic">aln</span> upstream region.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Treatment with vancomycin plus piperacillin/tazobactam was effective.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">Lemierre's syndrome was discarded.</p></li></ul></p></span>" ] "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We report the case of a twenty-year-old immunocompetent male patient presenting to the emergency room with pharyngitis and fever. Blood cultures were drawn and <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> (rough biotype) was recovered. The presence of the arcanolysin gene was investigated at the molecular level and the upstream region was amplified and sequenced in order to correlate it with the smooth or rough biotype. Although the isolate was susceptible to penicillin, vancomycin and gentamicin, empirical treatments first with amoxicillin/clavulanic acid (1<span class="elsevierStyleHsp" style=""></span>g/12<span class="elsevierStyleHsp" style=""></span>h) and then with ceftriaxone (1<span class="elsevierStyleHsp" style=""></span>g/12<span class="elsevierStyleHsp" style=""></span>h) failed and the infection evolved to sepsis. Finally, treatment with vancomycin (1<span class="elsevierStyleHsp" style=""></span>g/12<span class="elsevierStyleHsp" style=""></span>h) plus piperacillin/tazobactam (4.5<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h) was effective. Lemierre's syndrome was ruled out. To the best of our knowledge, this is the first case of bacteremia by <span class="elsevierStyleItalic">A. haemolyticum</span> reported in Argentina.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se describe el caso de un paciente varón inmunocompetente de veinte años de edad que se presentó en la sala de emergencias con faringitis y fiebre. Se extrajeron muestras para realizar hemocultivos y se recuperó <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> (biotipo rugoso). Se investigó la presencia del gen de la arcanolisina por un método molecular, y se amplificó y secuenció la región <span class="elsevierStyleItalic">upstream</span> de dicho gen para determinar su correlación con los biotipos lisos o rugosos. Aunque el aislamiento fue sensible a la penicilina, la vancomicina y la gentamicina, los tratamientos empíricos primero con amoxicilina/ácido clavulánico (1<span class="elsevierStyleHsp" style=""></span>g/12<span class="elsevierStyleHsp" style=""></span>h) y luego con ceftriaxona (1<span class="elsevierStyleHsp" style=""></span>g/12<span class="elsevierStyleHsp" style=""></span>h) no fueron efectivos, y la infección evolucionó a sepsis. Finalmente, el tratamiento con vancomicina (1<span class="elsevierStyleHsp" style=""></span>g/12<span class="elsevierStyleHsp" style=""></span>h) más piperacilina/tazobactam (4,5<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h) fue efectivo. Se descartó la presencia del síndrome de Lemierre. Según nuestro conocimiento, este es el primer caso de bacteriemia por <span class="elsevierStyleItalic">A. haemolyticum</span> reportado en Argentina.</p></span>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0125" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0020" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 864 "Ancho" => 900 "Tamanyo" => 122513 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Gram stain of <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> colony showing irregularly shaped gram-positive rods recovered from blood culture. Microscopic magnification: 1000×.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">S: susceptible, I: intermediate, R: resistant.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Antimicrobial agent \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CLSI M45MIC (μg/ml)Interpretive criteria</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MIC</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">I \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">R \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">(μg/ml) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Interpretation \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Penicillin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤0.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.25–2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.023 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Susceptible \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vancomycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Susceptible \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gentamicin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Susceptible \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2472137.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Minimal inhibitory concentration (MIC) of <span class="elsevierStyleItalic">A. haemolyticum</span> 5612.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 220464 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Arcanobacterium hemolyticum</span>: identification and susceptibility to nine antimicrobial agents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.N. Almuzara" 1 => "C. de Mier" 2 => "C.M. Barberis" 3 => "J. Mattera" 4 => "A. Famiglietti" 5 => "C. Vay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1469-0691.2002.00535.x" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2002" "volumen" => "8" "paginaInicial" => "828" "paginaFinal" => "829" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12519360" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endocarditis caused by <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.I. Alós" 1 => "C. Barros" 2 => "J.L. Gómez-Garcés" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF01590944" "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Microbiol Infect Dis" "fecha" => "1995" "volumen" => "14" "paginaInicial" => "1085" "paginaFinal" => "1088" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8681985" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0090" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicrobial susceptibility of <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Carlson" 1 => "S. Kontiainen" 2 => "O.V. Renkonen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/aac.38.1.142" "Revista" => array:6 [ "tituloSerie" => "Antimicrob Agents Chemother" "fecha" => "1994" "volumen" => "38" "paginaInicial" => "142" "paginaFinal" => "143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8141569" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0095" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lemierre's syndrome and septicaemia caused solely by <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> in a young immunocompetent patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Fernández-Suárez" 1 => "J.M. Benítez" 2 => "A.M. Vidal" 3 => "J.M. Iglesias" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/jmm.0.007492-0" "Revista" => array:6 [ "tituloSerie" => "J Med Microbiol" "fecha" => "2009" "volumen" => "58" "paginaInicial" => "1645" "paginaFinal" => "1648" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19661210" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0100" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Haemolytic differential identification of <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> isolated from a patient with diabetic foot ulcers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Kang" 1 => "G. Park" 2 => "H. Kim" 3 => "K. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/jmmcr.0.005016" "Revista" => array:5 [ "tituloSerie" => "JMM Case Rep" "fecha" => "2016" "volumen" => "3" "paginaInicial" => "e005016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28348747" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0105" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fatal sepsis due to an emerging bacteria: <span class="elsevierStyleItalic">Arcanobacterium hemolyticum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Frikh" 1 => "A. Lemouer" 2 => "M. Moutawakil" 3 => "A. Maleb" 4 => "M. Elouennass" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.11604/pamj.2016.25.28.6948" "Revista" => array:5 [ "tituloSerie" => "Pan Afr Med J" "fecha" => "2016" "volumen" => "25" "paginaInicial" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28154720" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0110" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lemierre syndrome caused by <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> alone in a healthy man" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "K.J. Lee" 1 => "E.J. Kim" 2 => "S.J. Kang" 3 => "M.O. Jang" 4 => "H.C. Jang" 5 => "S.I. Jung" 6 => "J.H. Shin" 7 => "K.H. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4068/cmj.2012.48.3.190" "Revista" => array:6 [ "tituloSerie" => "Chonnam Med J" "fecha" => "2012" "volumen" => "48" "paginaInicial" => "190" "paginaFinal" => "192" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23323228" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0115" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lemierre's syndrome: case report in a pediatric patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.R. Litterio" 1 => "A.E. Soto" 2 => "C.B. Aguirre" 3 => "M. Uranga" 4 => "E. Rubeglio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Anaerobe" "fecha" => "2004" "volumen" => "10" "paginaInicial" => "151" "paginaFinal" => "154" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0120" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Soft tissue infections with <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span>: report of three cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Malini" 1 => "E.K. Deepa" 2 => "P.V. Manohar" 3 => "K. Borappa" 4 => "S.R. Prasad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0255-0857.40543" "Revista" => array:6 [ "tituloSerie" => "Indian J Med Microbiol" "fecha" => "2008" "volumen" => "26" "paginaInicial" => "192" "paginaFinal" => "195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18445965" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0125" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Other coryneform bacteria and rhodococcus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.K. Meyer" 1 => "A.C. Reboli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "paginaInicial" => "2470" "edicion" => "6th ed." "serieVolumen" => "vol. 2" "serieTitulo" => "Principles and practice of infectious diseases" "serieFecha" => "2005" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0130" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Penicillin tolerance in <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Nyman" 1 => "G. Banck" 2 => "M. Thore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/infdis/161.2.261" "Revista" => array:6 [ "tituloSerie" => "J Infect Dis" "fecha" => "1990" "volumen" => "161" "paginaInicial" => "261" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2105360" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0135" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infections by <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span>: an emerging pathogen" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Puerto Alonso" 1 => "P. García-Martos" 2 => "J.A. Girón González" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Med Intern" "fecha" => "2002" "volumen" => "19" "paginaInicial" => "473" "paginaFinal" => "476" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0140" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Smooth and rough biotypes of <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span> can be genetically distinguished at the arcanolysin locus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "H.S. Ruther" 1 => "K. Phillips" 2 => "D. Ross" 3 => "A. Crawford" 4 => "M.P. Weidner" 5 => "O. Sammra" 6 => "C. Lämmler" 7 => "D.J. McGee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0137346" "Revista" => array:5 [ "tituloSerie" => "PLoS One" "fecha" => "2015" "volumen" => "10" "paginaInicial" => "e0137346" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26382754" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0145" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infective endocarditis caused by <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span>: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Wong" 1 => "T. Turmezei" 2 => "M. Cartmill" 3 => "S. Soo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1476-0711-10-17" "Revista" => array:5 [ "tituloSerie" => "Ann Clin Microbiol Antimicrob" "fecha" => "2011" "volumen" => "10" "paginaInicial" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21569379" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0150" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lemierre syndrome caused by <span class="elsevierStyleItalic">Arcanobacterium haemolyticum</span>: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W.H. Zhang" 1 => "Y.Q. Ji" 2 => "Z.H. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Zhonghua Nei Ke Za Zhi" "fecha" => "2013" "volumen" => "52" "paginaInicial" => "42" "paginaFinal" => "45" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23710815" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack501427" "titulo" => "Acknowledgements" "texto" => "<p id="par0115" class="elsevierStylePara elsevierViewall">We thank Dr. Horacio Lopardo for his conscious contributions while revising this manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03257541/0000005200000004/v1_202012180643/S0325754120300043/v1_202012180643/en/main.assets" "Apartado" => array:4 [ "identificador" => "37861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Microbiología clínica y enfermedades infecciosas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03257541/0000005200000004/v1_202012180643/S0325754120300043/v1_202012180643/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754120300043?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 0 | 4 |
| 2024 October | 78 | 8 | 86 |
| 2024 September | 85 | 23 | 108 |
| 2024 August | 83 | 15 | 98 |
| 2024 July | 77 | 6 | 83 |
| 2024 June | 57 | 7 | 64 |
| 2024 May | 60 | 6 | 66 |
| 2024 April | 52 | 9 | 61 |
| 2024 March | 94 | 11 | 105 |
| 2024 February | 73 | 6 | 79 |
| 2024 January | 71 | 8 | 79 |
| 2023 December | 74 | 12 | 86 |
| 2023 November | 65 | 7 | 72 |
| 2023 October | 98 | 10 | 108 |
| 2023 September | 69 | 8 | 77 |
| 2023 August | 66 | 4 | 70 |
| 2023 July | 47 | 4 | 51 |
| 2023 June | 69 | 15 | 84 |
| 2023 May | 116 | 17 | 133 |
| 2023 April | 97 | 5 | 102 |
| 2023 March | 44 | 1 | 45 |
| 2023 February | 46 | 6 | 52 |
| 2023 January | 53 | 6 | 59 |
| 2022 December | 57 | 10 | 67 |
| 2022 November | 59 | 10 | 69 |
| 2022 October | 44 | 11 | 55 |
| 2022 September | 59 | 8 | 67 |
| 2022 August | 58 | 4 | 62 |
| 2022 July | 32 | 7 | 39 |
| 2022 June | 40 | 9 | 49 |
| 2022 May | 47 | 9 | 56 |
| 2022 April | 72 | 10 | 82 |
| 2022 March | 139 | 8 | 147 |
| 2022 February | 128 | 10 | 138 |
| 2022 January | 115 | 15 | 130 |
| 2021 December | 60 | 8 | 68 |
| 2021 November | 94 | 15 | 109 |
| 2021 October | 61 | 10 | 71 |
| 2021 September | 42 | 10 | 52 |
| 2021 August | 46 | 8 | 54 |
| 2021 July | 23 | 20 | 43 |
| 2021 June | 37 | 8 | 45 |
| 2021 May | 48 | 16 | 64 |
| 2021 April | 128 | 98 | 226 |
| 2021 March | 77 | 18 | 95 |
| 2021 February | 65 | 23 | 88 |
| 2021 January | 34 | 39 | 73 |
| 2020 December | 21 | 27 | 48 |
| 2020 November | 7 | 16 | 23 |
| 2020 October | 12 | 9 | 21 |
| 2020 September | 11 | 10 | 21 |
| 2020 August | 11 | 21 | 32 |
| 2020 July | 14 | 8 | 22 |
| 2020 June | 9 | 11 | 20 |
| 2020 May | 6 | 12 | 18 |
| 2020 April | 7 | 9 | 16 |
| 2020 March | 4 | 9 | 13 |
Show all
