A Rubber-degrading Organism Growing from a Human Body

Abstract

Introduction: Patients with hematological malignancies are susceptible to unusual infections because of the use of broad-spectrum anti-infective agents and their immunocompromised state. Case: A 17 yr old lady with Undifferentiated Myeloblastic leukemia (AML - M1 type) on Cytarabine and Mitoxantrone, presented to the hospital with 4 days of fever, rhinorrhea and productive cough. One month earlier she developed Rhodococcus equi bacteremia. Examination did not show any source of infection. Laboratory exam, WBC of 300. Chest × ray showed right lower lobe consolidation in the lung which was confirmed on CT scan. She was started on Vancomycin and Ceftazidime. Ambisome was also added for aspergillus coverage. All the cultures remained sterile and an echo done did not show vegetations. Bone marrow aspirate and biopsy done to rule out recurrence of leukemia showed only hypocellular marrow. The cultures continued to be negative until 4 weeks after admission when the blood grew a Gram-positive weakly acid-fast organism identified by Center for Disease Control (CDC) to be Gordonia polyisoprenivorans. Discussion: Gordonia polyisoprenivorans is a ubiquitous environmental aerobic Actinomycetes belonging to the family of Gordoniaceae in the order Actinomycetales. Most of the 21 identified species are typically gram positive, catalase positive, weakly acid fast, thin beaded coccobacilli. G. polyisoprenivorans was first described in 1999 as a rubber-degrading bacteria isolated from stagnant water inside a deteriorated automobile tire. Extensive literature review has only identified 2 case reports of bacteremia due to this unusual organism. The 2 earlier case reports highlighted patients with hematological diseases (one with bone marrow transplant and the other with Osler-Weber-Rendu and myelodysplastic syndrome). Our patient although is free from leukemia, is similar in being neutropenic. We believe that hematologically immunocompromised patients with broad-spectrum antibiotics and long term central catheters select the possibility of infection with G. polyisoprenivorans.