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Granulicatella adiacens isolated from sterile body fluids: A case series from India
Sushma Krishna1, Kavitha Dinesh2, Deepa Harichandran3, Neeba Jayasurya4, Shamsul Karim 5
1MD, MPH, Assistant Professor, Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
2MD, Professor, Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
3MD, Postgraduate Student & Tutor, Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
4MSc, MBA, Chief Laboratory Supervisor, Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
5MD, Professor and Head, Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

doi:10.5348/ijcri-201464-CS-10050

Address correspondence to:
Sushma Krishna
MD, MPH, Assistant Professor, Department of Microbiology
Amrita Institute of Medical Sciences, Kochi - 682041
Kerala
India
Phone: 91-9740882970
Email: chummu.dummu@gmail.com

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How to cite this article
Krishna S, Dinesh K, Harichandran D, Jayasurya N, Karim S. Granulicatella adiacens isolated from sterile body fluids: A case series from India. Int J Case Rep Images 2014;5(12):802–807.


Abstract
Introduction: The genera Abiotrophia and Granulicatella spp. (previously known as nutritionally variant Streptococcus) are infrequently isolated from clinical specimens. Literature quotes that they account for about 5–6% of the infective endocarditis and bacteremia, and lesser in central nervous system infections (post instrumentation) and others. The objective of the study was to assess the clinical significance and outcome of the patients with laboratory isolations of Granulicatella adiacens.
Case Series: We reviewed the clinical records from 2011–12 noting down the demographic details, identifiable risk factors, management of patients in whom Granulicatella adiacens was isolated. Seven cases of Granulicatella adiacens were reported in which five were children (<2 years) and two were male adults. Six strains were from blood and one was isolated from cerebrospinal fluid shunt fluid, and were regarded as clinically significant. Pre-existing co-morbidities like nephrotic syndrome, premature birth and dysmorphism were noted in almost all the children. One of the patients had undergone invasive ventriculoperitoneal shunt insertion. All the patients except one (discharged against medical advice) recovered.
Conclusion: The study describes the spectrum of infections by Granulicatella adiacens. G. adiacens can grow on routine sheep blood agar without pyridoxal supplementation in CO2 incubator when sub-cultured from automated blood culture bottles. This is one of the largest study from India.

Keywords: Abiotrophia, Blood, India, Granulicatella adiacens, Shunt infectious, Streptococcus


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Author Contributions:
Sushma Krishna – Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Kavitha Dinesh – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Deepa Harichandran – Substantial contributions to conception and design, Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Neeba Jayasurya – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Shamsul Karim – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
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None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2014 Sushma Krishna et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Sushma Krishna works as an Assistant Professor in the Department of Microbiology at Amrita Institute of Medical Sciences & Research Center, Kochi, Kerala, India. She earned undergraduate degree (MBBS) from MS Ramiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India and postgraduate degree (MD, Microbiology) from Kasturba Medical College, Manipal University, Manipal, India. She has an MPH (Disease Control) from Institute of Tropical Medicine, Antwerpen, Belgium. She has published over 20 research papers in national and international academic journals. Her research interests include emerging infectious diseases, tropical diseases, hospital-acquired- infections.



Kavitha Dinesh is a Professor, Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India. She has over fifteen years of experience and has published over 25 publications in international and national academic journals. Her interests include clinical immunology and infectious diseases. She has contributed a chapter on Microbiology in a textbook of clinical gastroenterology and in handbook on Diabetic foot care protocols.



Deepa Harichandran is a Postgraduate Student and Tutor, Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India. She works on Salmonella and enteric infections.



Neeba Jayasurya is a Chief Laboratory Supervisor, Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India. She has over ten years of experience in laboratory management and supervision



Shamsul Karim is a Professor and Head in Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India. His interests include medical education and antibiotic susceptibility profiles. He has over twenty years of experience in research and academics and has published over 20 publications in international and national peer-reviewed journals.