Letter to the Editor
Chronic Obstructive Pulmonary Disease Exacerbation by Corynebacterium propinquum
Exacerbación de la enfermedad pulmonar obstructiva crónica por Corynebacterium propinquum
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The patient was hospitalized with a 1-week history of fever, increased dyspnea, and cough with purulent expectoration. Empirical treatment with levofloxacin began in the emergency room and samples were collected for microbiological analysis, including sputum for standard culture and urine for pneumococcal and <span class="elsevierStyleItalic">Legionella</span> spp. antigen testing, in view of initially suspected pneumonia. Rhonchi and wheezing were heard in both lung fields on physical examination. Clinical laboratory testing showed 17,040<span class="elsevierStyleHsp" style=""></span>leukocytes/mm<span class="elsevierStyleSup">3</span> (92% neutrophils) and blood biochemistry results were normal. Lung function tests revealed FVC: 1.6<span class="elsevierStyleHsp" style=""></span>l (52%), FEV<span class="elsevierStyleInf">1</span>: 0.63<span class="elsevierStyleHsp" style=""></span>l (27%) and FEV<span class="elsevierStyleInf">1</span>/FVC 39%. No infiltrates were seen on chest X-ray.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The sputum Gram stain showed fewer than 10 epithelial cells and more than 25 polymorphonuclear leukocytes/100× field, and Gram positive bacilli with morphology suggestive of <span class="elsevierStyleItalic">Corynebacterium</span> spp. (10/1000× field). Culture was negative at 24<span class="elsevierStyleHsp" style=""></span>h, so it was reincubated. At 48<span class="elsevierStyleHsp" style=""></span>h, there was abundant growth of creamy, round, whitish, catalase-positive colonies. <span class="elsevierStyleItalic">C. propinquum</span> was identified using the API<span class="elsevierStyleSup">®</span> Coryne system (bioMérieux), and subsequently confirmed by mass spectrometry (MALDI-TOF) and 16S rRNA gene sequencing. The disk diffusion method was used for antibiotic sensitivity testing, showing the isolate to be sensitive to penicillin, ampicillin, ciprofloxacin, tetracycline, cefotaxime, vancomycin and rifampicin, and resistant to erythromycin and clindamycin.</p><p id="par0020" class="elsevierStylePara elsevierViewall">One of the main problems in establishing the etiological diagnosis of respiratory infections is the fact that the microorganisms that cause most respiratory infections often occur in the upper airways as part of the normal flora or as colonizers. Thus, to determine the clinical significance of these microorganisms, the quality of the respiratory specimen must first be evaluated by Gram stain. In this evaluation, generally performed in sputum, epithelial cells, suggestive of oropharyngeal contamination, and polymorphonuclear leukocytes, indicative of a pulmonary focus, are quantified. In our case, the Gram stain report suggested that the specimen was representative of a lower respiratory tract sample, so the cause of the exacerbation, in the absence of other causes, could be attributed to <span class="elsevierStyleItalic">C. propinquum</span> infection. The patient progressed well with clinical respiratory improvement, confirmed with a subsequent negative culture.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Since <span class="elsevierStyleItalic">C. propinquum</span> was first described in 1993, very few clinically significant cases have been published. Most authors report it as an opportunistic pathogen and an emerging infection in both the respiratory tract and other sites.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> As mentioned, <span class="elsevierStyleItalic">C. propinquum</span> respiratory infection is rare, and has been documented mainly in hospitalized, immunosuppressed patients, and in patients with underlying respiratory disease, such as COPD or bronchiectasis, receiving wide-spectrum antibiotics.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The few cases reported in the literature agree on the importance of the Gram stain for establishing the pathogenic role of <span class="elsevierStyleItalic">C. propinquum</span>, particularly in immunosuppressed or hospitalized patients who have received previous antibiotic treatment.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3,5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although <span class="elsevierStyleItalic">C. propinquum</span> is generally sensitive to vancomycin, multiresistant strains do exist,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> so antibiotic sensitivity testing is recommended for prescribing the appropriate treatment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In our opinion, although few cases have been published, <span class="elsevierStyleItalic">C. propinquum</span> can behave as an emerging pathogen. It can be responsible for COPD exacerbations, particularly if the patient presents predisposing factors, and the strain is isolated from a lower respiratory tract sputum sample.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Prats-Sánchez I, Soler-Sempere MJ, Sánchez-Hellín V. Exacerbación de la enfermedad pulmonar obstructiva crónica por <span class="elsevierStyleItalic">Corynebacterium propinquum</span>. Arch Bronconeumol. 2015;51:154–155.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manual of clinical microbiology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.R. Murray" 1 => "E.J. Baron" 2 => "A. Michael" 3 => "M.A. Pfaller" 4 => "F.C. Tenover" 5 => "R.H. Yolken" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "7th ed." "fecha" => "2007" "editorial" => "Saunders" "editorialLocalizacion" => "New York" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of community-acquired pneumonia caused by <span class="elsevierStyleItalic">Corynebacterium propinquum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Furumoto" 1 => "H. Masaki" 2 => "T. Onidzuka" 3 => "S. Degawa" 4 => "T. Yamaryo" 5 => "S. Shimogama" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Kansenshogaku Zasshi" "fecha" => "2003" "volumen" => "77" "paginaInicial" => "456" "paginaFinal" => "460" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12872696" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Three adult cases with <span class="elsevierStyleItalic">Corynebacterium propinquum</span> respiratory infections in a community hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Motomura" 1 => "H. Masaki" 2 => "M. Terada" 3 => "T. Onizuka" 4 => "S. Shimogama" 5 => "A. 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Babay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Saudi Med" "fecha" => "2001" "volumen" => "21" "paginaInicial" => "337" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17261942" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000003/v2_201502230226/S157921291400408X/v2_201502230226/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000003/v2_201502230226/S157921291400408X/v2_201502230226/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291400408X?idApp=UINPBA00003Z" ]
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| 2024 April | 97 | 35 | 132 |
| 2024 March | 106 | 21 | 127 |
| 2024 February | 63 | 23 | 86 |
| 2023 March | 18 | 3 | 21 |
| 2023 February | 85 | 25 | 110 |
| 2023 January | 78 | 47 | 125 |
| 2022 December | 107 | 49 | 156 |
| 2022 November | 95 | 45 | 140 |
| 2022 October | 91 | 58 | 149 |
| 2022 September | 108 | 37 | 145 |
| 2022 August | 121 | 44 | 165 |
| 2022 July | 123 | 39 | 162 |
| 2022 June | 73 | 38 | 111 |
| 2022 May | 81 | 50 | 131 |
| 2022 April | 119 | 50 | 169 |
| 2022 March | 98 | 49 | 147 |
| 2022 February | 132 | 41 | 173 |
| 2022 January | 168 | 56 | 224 |
| 2021 December | 130 | 57 | 187 |
| 2021 November | 254 | 52 | 306 |
| 2021 October | 204 | 57 | 261 |
| 2021 September | 177 | 58 | 235 |
| 2021 August | 192 | 61 | 253 |
| 2021 July | 163 | 44 | 207 |
| 2021 June | 195 | 47 | 242 |
| 2021 May | 217 | 50 | 267 |
| 2021 April | 347 | 131 | 478 |
| 2021 March | 226 | 45 | 271 |
| 2021 February | 207 | 45 | 252 |
| 2021 January | 162 | 30 | 192 |
| 2020 December | 167 | 38 | 205 |
| 2020 November | 161 | 18 | 179 |
| 2020 October | 143 | 14 | 157 |
| 2020 September | 175 | 18 | 193 |
| 2020 August | 163 | 24 | 187 |
| 2020 July | 212 | 28 | 240 |
| 2020 June | 184 | 26 | 210 |
| 2020 May | 168 | 20 | 188 |
| 2020 April | 160 | 23 | 183 |
| 2020 March | 203 | 26 | 229 |
| 2020 February | 225 | 20 | 245 |
| 2020 January | 251 | 17 | 268 |
| 2019 December | 276 | 28 | 304 |
| 2019 November | 207 | 25 | 232 |
| 2019 October | 225 | 23 | 248 |
| 2019 September | 211 | 29 | 240 |
| 2019 August | 151 | 22 | 173 |
| 2019 July | 142 | 28 | 170 |
| 2019 June | 138 | 18 | 156 |
| 2019 May | 198 | 26 | 224 |
| 2019 April | 214 | 33 | 247 |
| 2019 March | 222 | 23 | 245 |
| 2019 February | 214 | 31 | 245 |
| 2019 January | 186 | 25 | 211 |
| 2018 December | 168 | 28 | 196 |
| 2018 November | 224 | 23 | 247 |
| 2018 October | 232 | 25 | 257 |
| 2018 September | 152 | 18 | 170 |
| 2018 May | 71 | 0 | 71 |
| 2018 April | 157 | 5 | 162 |
| 2018 March | 124 | 3 | 127 |
| 2018 February | 138 | 4 | 142 |
| 2018 January | 130 | 8 | 138 |
| 2017 December | 132 | 6 | 138 |
| 2017 November | 144 | 4 | 148 |
| 2017 October | 158 | 11 | 169 |
| 2017 September | 135 | 10 | 145 |
| 2017 August | 158 | 11 | 169 |
| 2017 July | 212 | 11 | 223 |
| 2017 June | 183 | 16 | 199 |
| 2017 May | 119 | 8 | 127 |
| 2017 April | 103 | 9 | 112 |
| 2017 March | 85 | 7 | 92 |
| 2017 February | 79 | 13 | 92 |
| 2017 January | 63 | 11 | 74 |
| 2016 December | 79 | 13 | 92 |
| 2016 November | 118 | 15 | 133 |
| 2016 October | 90 | 16 | 106 |
| 2016 September | 162 | 15 | 177 |
| 2016 August | 91 | 14 | 105 |
| 2016 July | 41 | 8 | 49 |
| 2016 April | 1 | 0 | 1 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 63 | 3 | 66 |
| 2015 September | 54 | 10 | 64 |
| 2015 August | 53 | 10 | 63 |
| 2015 July | 39 | 6 | 45 |
| 2015 June | 30 | 12 | 42 |
| 2015 April | 0 | 1 | 1 |
| 2015 March | 0 | 1 | 1 |
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