A rare and fatal case of Terrisporobacter glycolicus bacteremia: Case report and review of literature

Abstract

Background: Terrisporobacter glycolicus (formerly known as Clostridium glycolicum) is a rare cause of infection and emerging anaerobic pathogen. It is a gram-positive, rod shaped obligate anaerobic organism, first identified in 1963 by Gaston and Stadman. However, the first human infection was reported only in 2007, more than 4 decades after its discovery. There are few published case reports reporting these gram-positive bacilli causing infection to human and mostly as part of a polymicrobial infection. Here, we described a case of septicaemia with mortality. Case description: We described a case of a 78-year-old gentleman with multiple co-morbidities and sacral sore admitted for altered sensorium due to cerebrovascular accident with uremia. During admission he developed urinary tract infection and was treated with intravenous cefuroxime, which he has responded well. However, he deteriorated later with poor oral intake and reduced in Glasgow coma scale of 8/15. Blood culture from anaerobic bottle isolated greyish colonies on anaerobic plate after 48 h of incubation, susceptible to metronidazole. By using Vitex 2.0 system, there was low discrimination between T. glycolicus and Clostridium sporogenes. The isolate was later identified by Matrix-assisted laser desorption/ionization – time of flight (MALDI-TOF) mass spectrometry as Terrisporobacter glycolicus. The result from the reference laboratory showed two anaerobic organisms were isolated (Gram-positive anaerobic bacilli and gram-negative anaerobic bacilli). The gram-positive anaerobic bacilli was identified as Terrisporobacter glycolicus which was susceptible to penicillin [minimum inhibitory concentration (MIC) of 0.380 ug/mL], amoxycillin-clavulanate (MIC of 0.750 mg/mL), imipenem (MIC of 0.500 ug/mL), clindamycin (MIC of 0.064 ug/mL) and metronidazole (MIC of 1.000 ug/mL). The patient however deteriorated further and was decided for DNR status. He succumbed to illness on day 15 of admission. Discussion: MALDI-TOF MS has become the method of choice for identification of anaerobic bacteria, replacing 16S rRNA gene sequencing and gas–liquid chromatography. The advent of MALDI-TOF MS has demonstrated increased specificity, cost-effectiveness, and decreased turnaround time. Conclusion: Infection by this organism could be fatal in elderly patient with co-morbidities. In this group of patients, the presentation is usually atypical. In addition, up-to-date laboratory identification such as MALDI-TOF plays important role in confirming the identity of this organism.