Abstract
In patients with chronic obstructive pulmonary disease, respiratory infections are of various aetiology, predominantly viral and bacterial. However, due to structural and immunological changes within the respiratory system, such patients are also prone to mycobacterial and other relatively rare infections. We present the 70-year old male patient with chronic obstructive pulmonary disease (COPD) and coexisting bronchial asthma, diagnosed due to cough with purulent sputum expectoration lasting over three months. The first microbiological investigation of the sputum sample revealed the growth of mycobacteria. The identification test based on protein MPT64 production indicated an organism belonging to NTM (nontuberculous mycobacterium). However, further species identification by genetic testing verified the obtained culture as not belonging to the Mycobacterium genus. Based on observed morphology, the new characterisation identified an aerobic actinomycete, possibly a Nocardia spp. The isolated strain was recultured on standard microbiological media. The growth of colonies was observed on Columbia blood agar plates and solid Löewenstein-Jensen medium. The Gram and Zhiel-Nielsen stains revealed the presence of Gram-positive acid-fast bacilli. The extraction protocol and identification were performed in two repetitions; the result was G. bronchialis, with a confidence value of 99% and 95%, respectively. The gene sequencing method was applied to confirm the species affiliation of this isolate. The resulting sequence was checked against the 16S ribosomal RNA sequences database (Bacteria and Archaea). The ten best results indicated the genus Gordonia (99.04–100%) and 100% similarity of the 16S sequenced region was demonstrated for Gordonia bronchialis. The case described indicates that the correct interpretation of microbiological test results requires the use of advanced microbiology diagnosis techniques, including molecular identification of gene sequences. From a clinical point of view, Gordonia bronchialis infection or colonization may present a mild course, with no febrile episodes and no significant patient status deterioration and thus, it may remain undiagnosed more often than expected.
Highlights
In patients with chronic obstructive pulmonary disease, respiratory infections are of various aetiology, predominantly viral and bacterial
We present a 70-year old male patient, with a diagnosis of chronic obstructive pulmonary disease (COPD) and coexisting bronchial asthma, a former smoker for 15 years, with previous exposure of about 43 pack-years
The protocol for Mycobacterium and Nocardia identification was applied with the following modifications: initial extraction step, as described by the manufacturer, bacterial mass suspended in 70% ethanol, vortexed in the presence of glass bead, and extracted with formic acid has been changed—10 μL
Summary
In patients with chronic obstructive pulmonary disease, respiratory infections are of various aetiology, predominantly viral and bacterial. Due to structural and immunological changes within the respiratory system, such patients are prone to nontuberculous mycobacterial pulmonary disease and other rare infections. The relatively rare species G. bronchialis has been recognised as an etiological factor for respiratory infection, it was identified for the first time in sputum cultures obtained from patients with bronchiectasis and cavitary tuberculosis [1]. Despite many years since the first case report, the available data on the G. bronchialis infection or colonization, the prevalence and diagnostical procedures remain very scarce. The diagnosis and effective treatment of patients with such infection remain a challenge
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