Downloaded from www.microbiologyresearch.org by IP: 54.70.40.11 On: Tue, 30 Oct 2018 08:41:42 Case Report Bacteraemia caused by Sciscionella marina in a lymphoma patient: phenotypically mimicking Nocardia M. Sinha, 1 M. R. Shivaprakash, 2 A. Chakrabarti, 2 M. Shafiulla, 1 K. G. Babu 3 and R. S. Jayshree 1 Correspondence Mahua Sinha mahuasinha@gmail.com Received 11 October 2012 Accepted 15 March 2013 1 Department of Microbiology, Kidwai Memorial Institute of Oncology, Bangalore, Hosur Road, Bangalore 560029, India 2 Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India 3 Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Hosur Road, Bangalore 560029, India A 55-year-old female patient with malignant lymphoma after induction chemotherapy developed fever. Blood culture yielded an organism biochemically identified as representing Nocardia spp., but molecular identification (16S rRNA gene sequencing) later identified it as representing Sciscionella marina. This is the first report, to the best of our knowledge, of Sciscionella being isolated from a human sample. Introduction Sciscionella are Gram-positive, aerobic, marine actino- mycetes, phenotypically resembling Nocardia. The genus belongs to the family Pseudonocardiaceae and has been described only recently (Tian et al., 2009). The type species is Sciscionella marina, which was isolated from marine sand sediments from the South China Sea. However, Sciscionella spp. have not previously been reported to cause human infections. In the present report, we describe the isolation of S. marina from the blood culture of a patient with malignant lymphoma who developed fever after induction chemotherapy. Case report A 55-year-old female patient from the suburbs of Bangalore, India, was referred to the Kidwai Memorial Institute of Oncology, a regional cancer centre in south India, with a provisional diagnosis of malignant lymphoma. On admission (day 0), she had breathlessness with tachypnoea and coarse, bilateral crepitations. Clinical examination revealed hepato-splenomegaly and generalized lymphadenopathy with firm, non-tender, non-matted lymph nodes that were not fixed to adjacent soft tissues. Lymph node biopsy at the centre confirmed the diagnosis as malignant lymphoma. A chest radiograph revealed medi- astinal widening, small homogeneous opacity in the right lower zone and pulmonary congestion. She was treated with parenteral amoxicillin–clavulanate (1.25 g day –1 ) and dex- amethasone (16 mg day –1 ) for 1 week to which she responded favourably and was discharged with advice to continue oral prednisolone (40 mg day –1 ) and oral cepha- lexin (1.5 g day –1 ) for 7 days and review for initiation of chemotherapy after 10 days. She was readmitted on day 20 with fever and a cough. In view of subnormal absolute neutrophil counts (ANCs) and the possibility of infection, cefotaxime (2 g three times daily) and amikacin (750 mg day –1 ) were administered. She responded favourably. On day 30, the first cycle of induction chemotherapy was administered (parenteral cyclophospha- mide and vincristine on day 1, and oral prednisolone continued at 100 mg day –1 ) with a plan to repeat this cycle every 2 weeks for six to eight cycles. Two days after the first cycle of chemotherapy, she had an episode of fever and oral thrush. Blood was collected and cultured in biphasic brain heart infusion medium (sterility controlled for each batch). After collection of blood for culture she was empirically treated with amoxicillin–clavulanate (1.25 g day –1 ) and oral fluconazole (400 mg day –1 ). A current haemogram showed an ANC of 1500 cells ml –1 (lymphocyte count 1000 ml –1 ). Microbiological investigation of the respiratory sample did not reveal any significant pathogen. On day 37, after 1 week of induction chemotherapy, she developed deep vein thrombosis and became drowsy, and developed features of pulmonary hypertension and congestive cardiac failure. The patient left the hospital against medical advice and could not be followed further. The GenBank/EMBL/DDBJ accession number for the the 16S rRNA gene sequence of Sciscionella marina strain NCCPF 260043 is HM244406.1. Journal of Medical Microbiology (2013), 62, 929–931 DOI 10.1099/jmm.0.053561-0 053561 G 2013 SGM Printed in Great Britain 929