Lab Med Online.  2022 Jan;12(1):68-73. 10.47429/lmo.2022.12.1.68.

A Case of Catheter-Related Bloodstream Infection Caused by Tsukamurella tyrosinosolvens

• Kim S
• Kim TS
• Park H
• Park JH

• KMID: 2538587
• DOI: http://doi.org/10.47429/lmo.2022.12.1.68

Abstract

The genus Tsukamurella is an aerobic actinomycete found in soil, and rarely infects humans. Herein, we report a case of catheter-related bloodstream infection caused by T. tyrosinosolvens. An 8-year-old girl with a central line for home parenteral nutrition was admitted via the emergency room due to fever. Gram-positive bacilli were detected in two aerobic blood culture bottles among the three pairs of blood cultures. The isolate was not identified by VITEK 2 (bioMérieux, USA) but was identified as Tsukamurella spp. by matrix-assisted laser desorption ionization time-of-flight mass spectrometry using the microflex LT (Bruker Daltonics, Germany). The 16S rRNA sequences of these bacteria indicated over 99.73% identity match with T. tyrosinosolvens, T. hominis, and T. ocularis. The groEL gene was sequenced because of low interspecies 16S rRNA sequence variability in the genus Tsukamurella. The isolate showed 99.51% identity with T. tyrosinosolvens. The patient was treated with antibiotics, including vancomycin and piperacillin/tazobactam. T. tyrosinosolvens was detected in one aerobic blood culture bottle among the three pairs of blood cultures on the second day of hospital stay. Three sequential follow-up blood cultures were negative for the microorganisms. To our knowledge, this is the first report of catheter-related bloodstream infection caused by T. tyrosinosolvens in Korea. This study demonstrated the usefulness of groEL gene sequencing for accurate identification of Tsukamurella spp.

Keyword

Tsukamurella tyrosinosolvens; Catheter-related blood stream infection; 16S rRNA; groEL

Figure

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  Fig. 1 Morphological characterization of the Tsukamurella tyrosinosolvens clinical isolate. (A) Tan to gray, rough dry, velvety, non-hemolytic colonies grew on a blood agar plate after 18 hours of incubation at 35°C with 5% CO2. (B) Gram staining of the T. tyrosinosolvens shows long and thin Gram-positive rods (oil immersion, 1,000×).

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  Fig. 2 Phylogenetic tree analysis of Tsukamurella isolates (22 types and reference strains) based on groEL gene sequences (677 nucleotide positions). The tree was constructed based on the maximum likelihood method using the model GTR+I+G and Mycolicibacterium smegmatis MC2 155 (NC_008596.1) as the outgroup. Bootstrap values are expressed as percentages of 1,000 replications, and the scale bar indicates the estimated number of substitutions per base. GenBank database accession numbers are provided in parentheses.

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