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Enteroccocus pallens as a potential novel human pathogen: three cases of spontaneous bacterial peritonitis.

ABSTRACT: INTRODUCTION:Enterococcus pallens is one of the four yellow-pigmented members of the genus Enterococcus. To date, a single report of E. pallens isolated from a human sample has been published. CASE PRESENTATION:We report three cases of E. pallens spontaneous bacterial peritonitis in patients with liver cirrhosis that all occurred in Quebec, Canada. Ascitic fluid analysis revealed the presence of E. pallens in culture. Identification was made by classical biochemical testing and MALDI-TOF MS, as well as 16S rRNA and elongation factor (tuf) gene sequencing. Two of the three patients recovered after antimicrobial treatment. CONCLUSION:This report identifies E. pallens as a novel human pathogen that appears to possess particular but as-yet unidentified virulence factors that favour the development of peritoneal fluid infections, as previously reported for other Enterococcus species. Clinical microbiologist should be aware of this micro-organism which can be identified by phenotypic and molecular methods.

SUBMITTER: Levesque S

PROVIDER: S-EPMC5343133 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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<i>Enteroccocus pallens</i> as a potential novel human pathogen: three cases of spontaneous bacterial peritonitis.

Lévesque Simon S Longtin Yves Y Domingo Marc-Christian MC Massé Cynthia C Bernatchez Harold H Gaudreau Christiane C Tremblay Cécile C

JMM case reports 20160223 1

<h4>Introduction</h4><i>Enterococcus pallens</i> is one of the four yellow-pigmented members of the genus <i>Enterococcus</i>. To date, a single report of <i>E. pallens</i> isolated from a human sample has been published.<h4>Case presentation</h4>We report three cases of <i>E. pallens</i> spontaneous bacterial peritonitis in patients with liver cirrhosis that all occurred in Quebec, Canada. Ascitic fluid analysis revealed the presence of <i>E. pallens</i> in culture. Identification was made by c ...[more]

PMID: 28348751

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Project description:Background & aimsV-set Ig-domain-containing 4 (VSIG4) is an immunomodulatory macrophage complement receptor modulating innate and adaptive immunity and affecting the resolution of bacterial infections. Given its expression on peritoneal macrophages (PMs), we hypothesised a prognostic role of peritoneal VSIG4 concentrations in patients with spontaneous bacterial peritonitis (SBP).MethodsWe isolated PMs from patients with cirrhosis and analysed VSIG4 expression and release by flow cytometry, quantitative real-time PCR, ELISA, and confocal microscopy. We measured soluble VSIG4 concentrations in ascites from 120 patients with SBP and 40 patients without SBP and investigated the association of soluble VSIG4 in ascites with 90-day survival after SBP using Kaplan-Meier statistics, Cox regression, and competing-risks regression analysis.ResultsVSIG4 expression was high on resting, large PMs, which co-expressed CD206, CD163, and tyrosine-protein kinase Mer (MERTK). VSIG4 gene expression in PMs decreased in patients with SBP and normalised after resolution. During SBP, VSIG4hi PMs were depleted (25% vs. 57%; p <0.001) and soluble VSIG4 in ascites were higher in patients with SBP than in patients without (0.73 vs. 0.35 μg/ml; p <0.0001). PM activation by Toll-like receptor (TLR) agonists or infection with live bacteria in vitro resulted in a loss of surface VSIG4 and the release of soluble VSIG4. Mechanistically, shedding of VSIG4 from PMs was protease-dependent and susceptible to microtubule transport inhibition. Soluble VSIG4 in ascites exceeded serum concentrations and correlated with serum creatinine, model for end-stage liver disease score and C-reactive protein during SBP. Concentrations of 1.0206 μg/ml or higher indicated increased 90-day mortality (hazard ratio 1.70; 95% CI 1.01-2.86; p = 0.046).ConclusionsVSIG4 is released from activated PMs into ascites during SBP. Higher peritoneal VSIG4 levels indicate patients with organ failure and poor prognosis.Lay summaryPatients with liver cirrhosis who develop ascites have an increased risk of infection and mortality. Our study shows that in patients with infected ascites, the complement receptor VSIG4 is released by resident macrophages into the abdominal fluid where it can be measured. Patients with elevated levels of this protein in ascites are at high risk of dying within 90 days.

Dataset Information

Enteroccocus pallens as a potential novel human pathogen: three cases of spontaneous bacterial peritonitis.

Publications

<i>Enteroccocus pallens</i> as a potential novel human pathogen: three cases of spontaneous bacterial peritonitis.

Similar Datasets

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