Case Report

Facial Herpes Zoster Accompanied by Herpes Zoster Conjunctivitis Caused by Dolosigranulum Pigrum

Haijian Zhou*
Department of Respiratory Infectious Diseases, National Institute for Communicable Disease Control and Prevention, China


*Corresponding author: Haijian Zhou, Department of Respiratory Infectious Diseases, National Institute for Communicable Disease Control and Prevention, China


Published: 31 Oct, 2016
Cite this article as: Zhou H. Facial Herpes Zoster Accompanied by Herpes Zoster Conjunctivitis Caused by Dolosigranulum Pigrum. Ann Infect Dis Epidemiol. 2016; 1(1): 1004.

Abstract

Dolosigranulum pigrum is considered as an emerging opportunistic pathogen. It was isolated from a patient with facial herpes zoster accompanied by herpes zoster conjunctivitis and identified by 16S rRNA DNA sequence analysis. Furthermore, literature data were collected together to describe the characteristics of D. pigrum and the infections.
Keywords: Dolosigranulum pigrum; conjunctivitis; 16S rRNA DNA sequencing


Introduction

Dolosigranulum pigrum is catalase-negative gram-positive cocci arranged in pairs, tetrads, and clusters and usually colonize the normal floras of the oral cavity, the skin, and the respiratory and alimentary tracts [1]. However, there have been very few reports about this bacterium. Here we report D. pigrum associated with a facial herpes zoster accompanied by herpes zoster conjunctivitis in a patient hospitalized in China, and summarize literature data to describe the characteristics of D. pigrum and the infections.

Case Presentation

A 92-year-old female was hospitalized in May 2015 suffered from facial erythema, blisters and pain for 2 days. She had several underlying diseases including hypertension, coronary heart disease, and diabetes. She firstly visited the Department of Dermatology and was diagnosed as facial herpes zoster with follows symptoms: patchy edema erythema was observed along the trigeminal nerve and covered by cluster of blisters; the diameters of the blisters were between 0.2 mm and 0.4 mm, local exudation and crusting with a small amount of purulent secretion. The patient then visited the Department of Ophthalmology and was further diagnosed as herpes zoster conjunctivitis in right eye. No other abnormal condition was observed among the examination of blood routine, urine routine, liver function, renal function, blood lipids, myocardial enzymes, and electrolytes, excepting abnormal glucose content in blood (6.92 mmol/L).
Purulent secretion from herpes were collected and sent to bacterial culture. The secretion yielded gram-positive cocci after 2-day incubation at 37°C on 5% sheep-blood agar under anaerobic atmosphere. Biochemical testing gave a positive result of α hemolysis and a negative result for production of catalase. The cocci were identified by using the BD Phoneix-100 system (Becton Dickinson, New Jersey, USA) as Alloiococcus otitis, by using VITEK 2-compact system (bioMérieux, Lyons, France)as Micrococcus Kristinae, and by using matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry (Bruker, Leipzig, Germany) as “not reliable identification”. Sequencing the 16S rDNA PCR product obtained from the isolate yielded 1406/1419 bases (99%) sequence similarity with the homologous sequence of D. pigrum reference strain (Gen Bank accession no. X70907.1) by BLAST analysis.
The D. pigrumstrain was susceptible to moxifloxacin, cefuroxime, penicillin G, vancomycin, cefotaxime, ceftriaxone, linezolid, meropenem, but was intermediate to oxacillin and resistant to erythromycin and clindamycin. The antimicrobial pattern of our strain is similar to those of other study. Previous studies showed D. pigrum isolates were sensitive most tested drugs, but resistant to erythromycin and/or clindamycin [2-6].
The patient was received azithromycin injection (0.5 g, one time/day), local wet dressing with benzalkonium chloride solution, extract from rabbit skin inflamed by vaccinia vaccine injection(3.6 iu, one time/day), oral vitamin B1 (10 mg, three times/day), mecobalamin tablets (500 μg, three times/day). The patient’s facial erythema, blisters and pain improved after antibiotic administration and she was considered clinically cured and discharged on the fourth day of hospitalization.
We collected 33 D. pigrum infection cases reported up to now (Table 1) [2-9]. The sex of 29 of them is known and 17 were male. The age of 25 of them is known, ranging from 2 months to 92 years. Seven patients were under 3 years and 17 patients were over 60 years, suggesting this D. pigrum more easily infected infants and the elderly people, regardless of gender. D. pigrum were isolated from blood of 15 patients and eye of 10 patients. The isolates of remaining eight patients were from spinal cord (n=1), sputum (n=1), sinus (n=1), urine (n=1), stomach (n=1), bronchial aspirate (n=1), synovial biopsy (n=1), purulent secretion (n=1). The clinical diagnosis of 20 of them is known. They were diagnosed as eye diseases (n=6), sepsis (n=5), pneumonia (n=3, one of them was complicated by septicemia), sinusitis (n=1), arthritis (n=1), synovitis (n=1), acute cholecystitis accompanied by acute pancreatitis (n=1).

Table 1

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Table 1
Information of 33 cases of D. pigrum-related infections reported in 8 publications and here.

Discussion

D. pigrum is difficult to identify D. pigrum by using commercial systems because the profiles generated by D. pigrum are not included in the databases provided by the manufacturers. In previous reports, the API system (bioMérieux) wrong identified D. pigrum as Gemella species [5,7]. In this study, by using the BD Phoneix-100 system, VITEK 2 system and the Bruker Daltonik MALDI Biotyper, we were unable to identify D. pigrum.16S rRNA gene sequencing is the effective method to identify D. pigrum, as confirmed by here and previous reports [4-9].
D. pigrum is considered as an emerging opportunistic pathogen [6,10]. It can cause a wide spectrum of disease. However, this bacterium is rarely described, and little is known about its habitat and pathogenicity. Because of the invalid of conventional biochemical identification systems and the MALDI-TOF Mass spectrometry identification system, appropriate molecular methods should be developed and used to determine the D. pigrum infection.


References

  1. Audit tools for monitoring infection control guidelines within the community setting 2005.
  2. Flanagan P. Current standards for infection control: audit assures compliance. Br J Nurs. 2009; 18: 970-975.
  3. Ige OK, Adesanmi AA, Asuzu MC. Hospital-acquired infections in a Nigerian tertiary health facility: An audit of surveillance reports. ICNA audit tools for monitoring infection control standards. Niger Med J. 2011; 52: 239–243.
  4. Hysong SJ, Teal CR, Khan MJ, Haidet P. Improving quality of care through improved audit and feedback. Implement Sci. 2012; 7: 7-45.
  5. Al-Shidhani TA, Bhargava K, Rizvi S. An audit of hypertension at University Health Center in Oman. Oman Med J. 2011; 26: 248–252.
  6. Millward S, Barnett J, Thomlinson D. A clinical infection control audit program: evaluation of an audit tool used by infection control nurses to monitor standards and assess effective staff training. J Hosp Infect. 1993; 24: 219-32.
  7. Ward KA. Education and infection control audit. J Hosp Infect. 1995; 1: 248-52.
  8. Scheckler WE, Brimhall D, Buck AS, Farr BM, Friedman C, Garibaldi RA, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: A consensus panel report. Am J Epidemiol. 1985; 121: 182-205.
  9. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. JAMA. 1995; 274: 639-44.
  10. Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985; 121: 182-205.
  11. Friedman C, Barnette M, Buck AS, Ham R, Harris JA, Hoffman P, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings: a consensus panel report. Infect Control Hosp Epidemiol. 1999; 20: 695-705.
  12. Wideman, J. In: Ruth Carrico, et al. eds. APIC Text of Infection Control and Epidemiology 3rd edition, Association for Professionals in Infection Control and Epidemiology. Washington. DC 2009.
  13. Ling ML, How KB. Impact of a hospital-wide hand hygiene promotion strategy on healthcare-associated infections. Antimicrob Resist Infect Control. 2012; 1:13.
  14. Larson E, Leyden JJ, McGinley KJ, Grove GL, Talbot GH. Physiologic and microbiologic changes in skin related to frequent hand washing. Infect Control. 1986; 7: 59-63.
  15. Pittet D, Boyce JM. Hand hygiene and patient care: Pursuing the Semmelweis legacy. Lancet Infect Dis. 2001; 1: 9-20.
  16. Casewell M, Phillips I. Hands as route of transmission of Klebsiella species. Br Med J. 1977; 2: 1315-1317.
  17. Sánchez-Payá J, Galicia-García MD, Gracia-Rodríguez RM, García-González C, Fuster-Pérez M, López-Fresneña N, et al. Compliance with hand hygiene guidelines and determinants of compliance. Enferm Infecc Microbiol Clin. 2007; 25: 369-375.
  18. Garner JS. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol. 1996; 17: 53-80.
  19. Scheckler WE, Brimhall D, Buck AS, Farr BM, Friedman C, Garibaldi RA, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: A consensus panel report. Infect Control Hosp Epidemiol. 1998; 19: 114-24.
  20. Goodman RA, Solomon SL. Transmission of infectious diseases in outpatient health care settings. JAMA. 1991; 265: 2377-2381.
  21. Siegel JD, Rhinehart E, Jackson M, Chiarello L. Guideline for isolation precautions: Preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007; 35: 164-165.
  22. Mayank D, Anshuman M, Singh RK, Afzal A, Baronia AK, Prasad KN. Nosocomial cross-transmission of Pseudomonas aeruginosa between patients in a tertiary intensive care unit. Indian J Pathol Microbiol. 2009; 52: 509-513.
  23. Alvarez-Lerma F, Gasulla Guillermo M, Abad Peruga V, Pueyo Pont MJ, TarragóEixarch E. Effectiveness of contact isolation in the control of multi resistant bacteria in an intensive care service. Enferm Infect Microbiol Clin 2002; 20: 57-63.
  24. Lee F, Lind N. Infection control committee. Infect Control Today. Online Magazine Accessed. 2012.