Anaerobic Gram-negative Cocci Research Articles

A Rare Case of Lemierre’s Syndrome due to Veillonella Parvula: A Dangerous and Forgotten Complication of a Septic Condition

AbstractThis clinical case presents an unusual case of Lemierre’s syndrome (LS) in a young woman of 38-year-old. She arrived in the Emergency Department with a high fever and pharyngology resistant to antibiotic therapy with clarithromycin, ceftriaxone, and cortisone for two weeks. At the blood sampling, there is a marked leucocytosis, and the advice of the otolaryngologist is required given the strong pain in the throat. Due to the tonsillar abscess, a neck CT with a contrast medium is necessary for the otolaryngologist’s opinion. The CT shows thrombosis of the jugular vein and left subclavian, with thickening of soft perivascular tissues; these findings suggest Lemierre’s syndrome: a septic thrombophlebitis of the jugular vein that occurs as a complication of a peritonsillar abscess. The diagnostic process is then completed with a chest HR-CT, which reveals lung density and excavation areas suggesting tuberculosis. Blood culture reveals the presence of Veillonella Parvula (an anaerobic gram-negative coccus), sputum culture reveals the presence of some colonies of Enterobacter cloacae complex, real-time PCR examination on sputum reveals the presence of Streptococcus Pneumoniae and the borderline presence of rhinovirus. Microbiologists, after these results and neck and chest CT with a contrast agent, agree with the diagnosis of suspected LS at an early stage: a septic dissemination fortunately limited only to the neck and lungs region.

Severe disseminated Veillonella parvula infection including endocarditis, bilateral psoas abscess, discitis, and osteomyelitis but sparing spinal and hip prostheses: a case report

BackgroundVeillonella species are an opportunistically pathogenic commensal anaerobic Gram-negative coccus commonly found in the oral, genitourinary, respiratory, and intestinal tract of humans and some animals. Infection is rare, even in immunocompromised hosts, and has been identified to cause a wide array of different infections, including endocarditis, osteomyelitis, and meningitis.Case presentationAn 82-year-old Caucasian male retired ex-gymnast presented to the emergency department with a 2-week history of acute on chronic lower back pain without clear precipitant. He displayed no systemic symptoms, and had not sustained any recent injuries. Initial blood and radiological investigation did not reveal an infective or mechanical cause for his pain; however, a few days into admission, he developed a fever and signs of sepsis. A thorough septic screen was performed, including a spinal magnetic resonance imaging scan, which did not reveal any abnormalities. Blood cultures revealed Veillonella parvula bacteremia, with subsequently repeated magnetic resonance imaging displaying rapid disseminated infection including bilateral psoas abscess, discitis, and osteomyelitis. Infective endocarditis was later identified with echocardiogram. He received intravenous ceftriaxone and later oral amoxicillin and clavulanic and recovered on 6-month follow-up.ConclusionsThis case illustrates the potential pathogenicity and unexpected rapid course of Veillonella parvula infection even in an immunocompetent host presenting with back pain. This case highlights the critical importance of a thorough septic screen when investigating patients for early signs of sepsis.

Etiology and antimicrobial susceptibility profiles of anaerobic bacteria isolated from clinical samples in a university hospital in Madrid, Spain

BackgroundThe anaerobic infection management is usually based on empirical treatment because anaerobic culture techniques take a long time due to their fastidious nature. The aim of this study was to analyze the etiological profile of severe anaerobic infections and AST data from clinical anaerobic bacteria isolated in a tertiary hospital in Madrid (Spain). Material and methodsA consecutive study was carried out over 19 months in Ramón y Cajal Universitary Hospital, Madrid. Clinical samples were processed in appropriate anaerobic media and incubated using Anoxomat system. Identification was performed by MALDI-TOF. AST were determined with gradient diffusion method using EUCAST (penicillin, co-amoxiclav, imipenem, clindamycine and metronidazole) or CLSI (cefoxitin) breakpoints. ResultsDuring the period of study, 503 anaerobic microorganisms isolated from 424 clinical samples were included. Twenty-six percent of the cultures were monomicrobial, while 70.0% also contained aerobic bacteria. The most common source of infection was abscesses (26%), while blood infections represented the 11%. Anaerobic gram-negative bacilli were predominant (41%), being Bacteroides fragilis (13%) the most prevalent overall; anaerobic gram-positive bacilli represented 35%, anaerobic gram-positive cocci 19% and anaerobic gram-negative cocci 5%. Metronidazole and imipenem were the most effective agents tested against anaerobic bacteria, while clindamycin presented higher resistance rates. ConclusionAntimicrobial susceptibility surveillance of anaerobic bacteria should be performed to monitor changes in resistance patterns and to be able to optimize empiric antimicrobial treatment. Reliable species identification and quick reporting of results would guide clinicians to select the optimal antimicrobial therapy.

Veillonella nakazawae sp. nov., an anaerobic Gram-negative coccus isolated from the oral cavity of Japanese children.

Two strains of previously unknown Gram-negative cocci, T1-7T and S6-16, were isolated from the oral cavity of healthy Japanese children. The two strains showed atypical phenotypic characteristics of members of the genus Veillonella, including catalase production. Sequencing of their 16S rRNA genes confirmed that they belong to genus Veillonella. Under anaerobic conditions, the two strains produced acetic acid and propionic acid as metabolic end-products in a trypticase-yeast extract-haemin medium containing 1 % (w/v) glucose, 1 % (w/v) fructose and 1 % (v/v) sodium lactate. Comparative analysis of the 16S rRNA, dnaK, rpoB and gltA gene sequences revealed that the two strains are phylogenetically homogeneous and comprise a distinct, novel lineage within the genus Veillonella. The sequences from the two strains shared the highest similarity, at 99.9, 95.8, 96.9 and 96.7 %, using the partial 16S rRNA, dnaK, rpoB and gltA gene sequences, respectively, with the type strains of the two most closely related species, Veillonella dispar ATCC 17748T and Veillonella infantium JCM 31738T. Furthermore, strain T1-7T shared the highest average nucleotide identity (ANI) value (94.06 %) with type strain of the most closely related species, V. infantium. At the same time, strain T1-7T showed the highest digital DNA-DNA hybridization (dDDH) value (55.5 %) with the type strain of V. infantium. The two strains reported in this study were distinguished from the previously reported species from the genus Veillonella based on catalase production, partial dnaK, rpoB and gltA sequences, average ANI and dDDH values. Based on these observations, the two strains represent a novel species, for which the name Veillonella nakazawae sp. nov. is proposed. The type strain is T1-7T (JCM 33966T=CCUG 74597T).

Epidemiology and species distribution of anaerobic Gram-negative cocci: a 10-year retrospective survey (2008-2017)

Introduction: The group of anaerobic Gram-negative cocci (AGNC) includes the genera Veillonella, Megasphaera, Anaeroglobus, Negativicoccus and Acidaminococcus. These bacteria are an integral part of the microbiome of humans but may be causative agents in various infectious processes. The available data on the epidemiology and significance of AGNCs is scarce.
 Aims: To assess and compare the prevalence of different species of AGNCs among inpatients and outpatients at the Albert Szent-Györgyi Clinical Center retrospectively, during a 10-year study period. Methods: Isolates containing AGNC were identified retrospectively by reviewing the online microbiology records of the Institute of Clinical Microbiology.
 Results: The median age of affected patients overall was 52 years (range: 1–90 years), with a male dominance. 59.79% of samples originated from inpatients. 572 individual AGNCs isolates were recovered from clinical samples, most of the isolated GNACs were Veillonella spp. (95.28%), Megasphaera and Acidaminococcus species accounted for a minority of isolates (2.79% and 1.93%, respectively), while Anaeroglobus and Negativicoccus species were not isolated. In the second half of the study period (2013-2017), 91.31% of isolates were identified on the species level (p<0.001) using MALDI-TOF MS.
 Conclusion: The current study represents a long-term surveillance study on the isolation frequency and trends among anaerobic Gram-negative cocci (AGNCs), isolated in the Southern Great Plain of Hungary, highlighting the beneficial effect of MALDI-TOF MS on the diagnostic efficacy of the laboratories.

Veillonella parvula spondylodiscitis

ObjectivesVeillonella parvula is an anaerobic Gram-negative coccus rarely involved in bone and joint infections. Patients and methodWe report the case of a Veillonella parvula vertebral osteomyelitis (VO) in a female patient without any risk factor. ResultsThe 35-year-old patient was immunocompetent and presented with Veillonella parvula VO. She was admitted to hospital for inflammatory lower back pain. The discovertebral sample was positive for Veillonella parvula. Literature data on Veillonella VO is scarce. Reported cases usually occurred in immunocompromised patients. Diagnosis delay can be up to four months. Patients are usually afebrile. Outcome with antimicrobial treatment alone is favorable in half of cases. Other patients must undergo surgery. ConclusionsVeillonella VO may occur in immunocompetent patients and have a clinical spectrum of mechanical lower back pain.

ROLE OF GRAM-NEGATIVE ANAEROBIC COCCI BELONGING TO THE GENUS VEILLONELLA IN INFECTIOUS COMPLICATIONS IN CANCER PATIENTS

We studied capabilities of the Bruker Microflex MALDI-TOF device for species identification of anaerobic gramnegative cocci isolated from clinical specimens of cancer patients. Seventy clinical isolates of Veillonella spp. and one Acidaminococcus spp were analyzed. All isolates were identified to the species level with a scores greater than 1.9. The most common species were V. parvula (37 strains), followed by V. dispar (16), V. atypical (16) and V. denticariosi (1). Susceptibilities of the isolates were determined by the E-test methodology. All Veillonella isolates were susceptible to imipenem, whereas high resistance rates were observed for penicillin G, amoxicillin/clavulanate and metronidazole. The proportion of resistant isolates of V. parvula, V. dispar and V. atypica to penicillin was 86 %, 85 % and 100 %, respectively. The resistance to amoxicillin/clavulanate was observed in 28.6 % of V. parvula isolates, 23.1 % of V. dispar isolates and in 6.7 % of V. atypica isolates. Resistance to metronidazole (MIC ≥ 8 µg/ml) of V. parvula, V. dispar and V. atypica was 88.6 %, 53.8 % and 40 %, respectively.

Species Identification of Clinical Veillonella Isolates by MALDI-TOF Mass Spectrometry and Evaluation of Their Antimicrobial Susceptibility

We investigated the possibilities of the MALDI-TOF MS for species identification of anaerobic gram-negative cocci isolated from clinical specimens of cancer patients. A total 70 <i>Veillonella</i> clinical isolates and one <i>Acidaminococcus intestini</i> isolate were analysed by the Bruker Microflex MALDI-TOF instrument with the Biotyper 3, 0 software. All isolates were identified to the species level with a scores greater than 1.9. The most common species were <i>V. parvula</i> (37 strains), then followed by decreasing the frequency <i>V. dispar</i> (16), <i>V. atypica</i> (16) and <i>V. denticariosi</i> (1). Susceptibilities of the isolates were determined by the E-test methodology. All <i>Veillonella</i> isolates were susceptible to imipenem, whereas a high resistance rates were observed for penicillin G, amoxicillin/clavulanate and metronidazole. The proportion of intermediate/resistant isolates of <i>V. parvula</i>, <i>V. dispar</i> and <i>V. atypica</i> to penicillin (MIC ≥ 1 µg/ml) was 86%, 85% and 100%, respectively. The resistance to amoxicillin/clavulanate (MIC 16 - 32 µg/ml) was observed in about 28,6% <i>V. parvula</i> isolates, 23,1% <i>V. dispar</i> isolates and 6,7% <i>V. atypica</i> isolates. According to EUCAST criteria, resistance to metronidazole (MIC ≥ 8 µg/ml) of <i>V. parvula</i>, <i>V. dispar</i> and <i>V. atypica</i> was 88,6%, 53,8% and 40%, respectively.

Studying the microbial landscape of peritoneal exudate in acute diffuse purulent peritonitis

Aim. To study current trends in changing microbial landscape of peritoneal exudate for improving treatment outcomes, as well as the generalization of the methods of predicting fatal outcomes of postoperative peritonitis, its etiological and pathogenetic treatment.Methods. A bacteriological study of peritoneal exudate in 60 patients with purulent peritonitis at toxic and terminal phases, who were treated in the department of purulent surgery, and their comparison with the results obtained 10 years ago were performed. Laboratory testing was performed, APACHE II (Acute Physiology And Chronic Health Evaluation - scale for the evaluation of various acute and chronic diseases), Mannheim peritoneal index, albumin-globulin ratio, leukocyte index of intoxication were calculated.Results.During the 10-year period change in the microbial landscape of peritoneal exudate in patients with postoperative peritonitis was registered, with a statistically significant decrease in representation of Enterobacter, Staphylococcus, Escherichia coli, Pseudomonas aeruginosa bacteria, and increase in representation of Streptococci, Enterococci and anaerobic gram-negative cocci, Citrobacter, Klebsiella. Study results of microflora sensitivity to antibiotics showed that the vast majority (over 90%) of peritoneal infection pathogens has full or partial resistance to all antibiotics; antimicrobial effect increased in case of combined treatment using two or three drugs with a synergistic effect. With a decrease in the albumin-globulin ratio by 0.1 from 1.5 the mortality rate increased by 5-10%, and in patients with multiple organ failure was doubled (pConclusion. Prediction of postoperative peritonitis, complications and outcomes allows their timely prevention and treatment; basic conditions of preventing peritonitis are primary qualitative debridement of the abdominal cavity, the right choice of surgical volume, starting adequate antibiotic therapy, qualified perioperative anesthetic management and a complex of adequate pathogenetic treatment.

The fourth case of Veillonella parvula meningoencephalitis diagnosed by stereotactic brain biopsy

IntroductionVeillonella parvula is a small, nonfermentative anaerobic gram-negative coccus. Meningitidis due to V. parvula seen extremely rare. Here we want to report the fourth case with meningoencephalitis due to V. parvula and emphasize the significance of brain biopsy in encephalitis cases with unknown ethiology. Case reportA 64-year-old male admitted to the emergency room with a frontal and bitemporal headache. On physical examination, the patient was concious and oriented, his reaction time was prolonged. There was no focal neurological deficit, fever and meningeal signs. The magnetic resonance imaging scan showed hyperintensity on the T2-FLAİR weighted sequences and diffusion restriction at the same place, concordant with encephalitis. On the third day of admission, oromandibular focal motor seizures were observed. We could not define any microbiological agent by analysis of cerebrospinal fluid. Stereotactic brain biopsy performed and the bacterial culture of the biopsy material grew V. parvula. DiscussionWe reported the fourth V. parvula encephalitis case in the literature. The aim of this case report is to emphasize that brain biopsy should be considered in patients with encephalitis of unknown etiology.

Veillonella Dispar and Streptococcus Bovis Septic Arthritis in a Native Shoulder Joint

Veillonella spp. comprise anaerobic Gram-negative cocci that are a rare cause of septic arthritis in native joints. We report a case of septic arthritis of a native shoulder joint due to Veillonella dispar and Streptococcus bovis Biotype II in an elderly patient, with growth of both isolates from joint fluid. Streptococcus bovis was also isolated from blood culture. The Veillonella isolate was referred to the anaerobic reference laboratory for speciation and was confirmed to be V. dispar by use of a molecular method. The patient had an arthroscopic joint washout along with 1 month of appropriate antibiotic treatment and made a full recovery.

Identification by 16S rRNA Gene Sequencing of Negativicoccus succinicivorans Recovered from the Blood of a Patient with Hemochromatosis and Pancreatitis

We describe a case of Negativicoccus succinicivorans bacteremia in an adult man with hemochromatosis and acute pancreatitis. Conventional phenotypic tests and commercial identification systems failed to definitively identify the tiny anaerobic Gram-negative coccus isolated from two sets of blood cultures. The bacterium was identified by 16S rRNA gene sequencing and analysis using the SmartGene Integrated Database Network System software. This is the first published report of the recovery of this organism from a patient with invasive infection.

Receptor Recognition of and Immune Intracellular Pathways for Veillonella parvula Lipopolysaccharide

Veillonella parvula is an anaerobic gram-negative coccus that is part of the normal flora of the animal and human mouth and gastrointestinal and genitourinary tracts. Oral V. parvula is involved in the development of early periodontal disease as well as different types of serious infections. Present data on molecular mechanisms responsible for innate immune response against Veillonella are very scanty. The aim of this study was to investigate the Toll-like receptor (TLR) pathways responsible for V. parvula lipopolysaccharide (LPS) and to identify the intracellular pathways induced by this recognition. V. parvula LPS stimulated tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) release in human peripheral blood mononuclear cells (PBMC) in a dose-dependent manner. Pretreatment of cells with a TLR4 antagonist significantly reduced TNF-alpha and IL-6 production in PBMC stimulated with either Veillonella or Escherichia coli LPS. However, V. parvula LPS was 10- to 100-fold less active than E. coli LPS for cytokine induction. TNF-alpha, IL-1beta, IL-6, and IL-10 were released in wild-type and TLR2(-/-), but not TLR4(-/-), mouse macrophage cultures. V. parvula LPS was able to activate the human PBMC p38 mitogen-activated protein kinase (MAPK). A specific p38 MAPK inhibitor strongly inhibited V. parvula LPS-induced TNF-alpha, IL-1beta, IL-6, and IL-10. In conclusion, V. parvula LPS is able to induce cytokine production in both human and murine in vitro models, although it is less effective than Enterobacteriaceae LPS. V. parvula LPS-stimulated cytokine induction, as well as p38 MAPK activation, are TLR4-dependent features.

Molecular identification of the first human isolate belonging to the Veillonella ratti–Veillonella criceti group based on 16S rDNA and dnaK gene sequencing

Anaerobic Gram-negative cocci belonging to the genus Veillonella are currently subdivided into eight species. Among them, four have been isolated either from human flora or from clinical samples during infectious processes: Veillonella atypica, V. dispar, V. parvula and V. montpellierensis. To date, the four other species have only been found in animals. In particular, V. ratti and V. criceti, since their characterization, have been exclusively reported from mouth and intestine of rodents. We report here for the first time a human isolate belonging to the V. ratti– V. criceti group recovered in mixed aerobic–anaerobic flora from a semen sample in a 24-year-old man attending the urology unit of our hospital for infertility. Identification of the isolate was based on 16S ribosomal DNA and dnaK gene sequencing. Since then, two strains of Veillonella sp. recovered from semen samples remained unidentified to the species level, and 16S rDNA-based phylogenetic analysis revealed that they might represent novel taxa within the genus Veillonella. Taken together, these observations suggest that host restriction may not exist in the genus Veillonella and that bacterial diversity remains underestimated both within this genus and in human semen.

Phylogenetic analysis of some Sporomusa sub-branch members isolated from human clinical specimens: description of Megasphaera micronuciformis sp. nov.

Two unknown, Gram-negative, catalase-negative and strictly anaerobic cocci were isolated from two independent human samples (strains AIP 49.01 and AIP 412.00T). Comparative 16S rRNA gene sequencing demonstrated that these two organisms displayed 99.8% sequence identity and that they are members of the Sporomusa sub-branch of the low-G + C Gram-positive bacteria. The most closely related 16S rDNA sequences were from Megasphaera sp. oral clone BU057 (99.8%) and from isolates of Megasphaera cerevisiae and Megasphaera elsdenii (94.5 and 93.8%, respectively). Phylogenetic analysis based on 16S rDNA sequences showed that these two strains were most closely related to M. elsdenii and belonged to the Megasphaera genus. Differences from previously described Megasphaera species in terms of size, biochemical tests (particularly the analysis of metabolic end products), gas production and DNA G+C content indicated that the two strains studied represent a novel species of anaerobic Gram-negative cocci. The name Megasphaera micronuciformis sp. nov. is proposed for these two isolates. It is also proposed that the uncultured organism previously deposited as Megasphaera sp. oral clone BU057 should be named 'Candidatus Megasphaera micronuciformis'. The type strain of Megasphaera micronuciformis is AIP 412.00T (=CIP 107280T =CCUG 45952T).

Three independent yearly analyses of the spectrum and potency of metronidazole: a multicenter study of 1,108 contemporary anaerobic clinical isolates

To comply with ongoing United States Food and Drug Administration (FDA) recommendations about the validation of prescribing information, in each of three years (1994, 1996, 1997) at six medical centers, metronidazole was tested against ≥50 strains of a range of contemporary anaerobic clinical bacteria. Species having ≥90% susceptibility (MIC, ≤ 8 μg/ml) to metronidazole (fulfilling FDA requirements) included Bacteroides fragilis, B. distasonis, B. ovatus, B. thetaiotaomicron, B. vulgatus, Fusobacterium spp. and Clostridium spp. Only Eubacterium spp. and anaerobic Gram-negative cocci failed to achieve the required proportion of susceptibility throughout the 3 year period. Metronidazole appears to remain highly active versus anaerobic species associated with strict anaerobic organisms.

ACI-1 from Acidaminococcus fermentans: characterization of the first beta-lactamase in Anaerobic cocci.

Acidaminococcus fermentans belongs to the group of strictly anaerobic gram-negative cocci. All previously described Acidaminococcus strains are susceptible to beta-lactam antibiotics. An A. fermentans strain (RYC-MR95) resistant to penicillin and expanded-spectrum cephalosporin (amoxicillin and cefotaxime MICs, 64 microgram/ml) was isolated from a human perianal abscess. A fragment encoding a beta-lactamase from genomic DNA was cloned in Escherichia coli K-12 strain HB101, and the recombinant strain expressed resistance to amoxicillin (MIC, 1,024 microgram/ml) and cefotaxime (MIC, 4 microgram/ml). Clavulanic acid decreased the MICs to 8 and 0.03 microgram/ml, respectively. Analysis of the nucleotide sequence revealed a new class A beta-lactamase, ACI-1. In accordance with its biochemical properties, we propose to assign ACI-1 to functional group 2be. The ACI-1 enzyme (estimated pI 4.3) had <50% amino acid identity with any other class A beta-lactamases, the closest being ROB-1 from Haemophilus influenzae (44%). ACI-1 was closer to class A beta-lactamases from some gram-positive organisms (41 to 44% amino acid identity with Bacillus beta-lactamases) than to most class A enzymes from gram-negative organisms (TEM-1, 24.6%). The aci1 gene had a G+C content of 42.1%, in contrast with 56% G+C content for genomic DNA from A. fermentans, thus suggesting that aci1 may have been obtained by horizontal gene transfer.

Significant Role of Chemotherapy in the Treatment of Multiloculated Liver Abscesses Evaluated with CT and Angiographic Examinations

The role of chemotherapy was evaluated in 2 cases of solitary multiloculated liver abscesses. Both patients were free of biliary tract diseases, liver trauma, iatrogenic causes and colorectal diseases. Angiography revealed a hypervascular abscess wall and increased flow of the hepatic artery. In the first case, pyelonephritis was accompanied by left renalstones, and Escherichia coli was isolated from the urine. Since a laboratory examination revealed liver dysfunction, a CT was performed which disclosed a liver abscess. A percutaneous nephrostomy and chemotherapy were performed. Pus from the abscess yielded Streptococcus sanguis, along with unidentified gram-positive rods and anaerobic gram-negative cocci. The liver abscess did not resolve in spite of percutaneous drainage and administration of imipenem, which may have been due to the presence of multiple septa. After the administration of piperacillin, the body temperature normalized, and fistulography revealed adequate drainage of the liver abscess which subsequently resolved. In the other case, the patient had pyorrhea with an accompanying right subphrenic abscess. Fusobacterium sp. were recovered from the pus of liver abscess. Flomoxef was administered for 17 days prior to percutaneous drainage. Serial CT examinations revealed the disappearance of septa in the liver abscess cavity, and the patient made an uneventful recovery after percutaneous drainage. Piperacillin and flomoxef are excreted into bile fairly well in the absence of biliary obstruction, which may indicate that the high biliary concentrations of these antimicrobial agents is responsible for the elimination of multiple septa and the favorable response of multiloculated liver abscesses to percutaneous drainage.

Effect of piperacillin/tazobactam treatment on human bowel microflora.

The effect of piperacillin/tazobactam treatment on the bowel microflora was studied in 20 patients with intra-abdominal infections. The patients were treated with piperacillin 4 g and tazobactam 500 mg administered intravenously every 8 h for four to eight days. Stool specimens were collected before, during and after treatment. Six patients had measurable faecal concentrations of piperacillin (1.2-276 mg/kg) and four patients measurable concentrations of tazobactam (0.8-22.2 mg/kg) during treatment. The mean numbers of enterobacteria, enterococci, bifidobacteria, eubacteria, lactobacilli, clostridia and Gram-positive cocci decreased while the numbers of anaerobic Gram-negative cocci and bacteroides were unaffected. The aerobic and anaerobic microflora returned to normal in all patients after the treatment had stopped.

Osteomyelitis Due to Veillonella parvula: Case Report and Review

Anaerobic gram-negative cocci of the genus Veillonella are generally normal flora of the oropharynx and upper respiratory tract. When isolated in clinical specimens, these bacteria are usually regarded as commensal organisms rather than as pathogens. We report a case of spinal osteomyelitis in which Veillonella parvula was isolated in pure culture from bone as well as blood. Osteomyelitis of the spine due to anaerobic bacteria may occur more frequently than has been recognized, and anaerobic cultures of biopsy specimens should be routinely performed.