Granulicatella adiacens isolated from sterile body fluids:A case series from India

Abstract

Introduction: The genera Abiotrophia and Granulicatella spp. (previously known as nutritionally variant Streptococcus) are infrequently isolated from clinical specimens. Literature quotes that they account for about 5–6% of the infective endocarditis and bacteremia, and lesser in central nervous system infections (post instrumentation) and others. The objective of the study was to assess the clinical significance and outcome of the patients with laboratory isolations of Granulicatella adiacens. Case Series: We reviewed the clinical records from 2011–12 noting down the demographic details, identifiable risk factors, management of patients in whom Granulicatella adiacens was isolated. Seven cases of Granulicatella adiacens were reported in which five were children (<2 years) and two were male adults. Six strains were from blood and one was isolated from cerebrospinal fluid shunt fluid, and were regarded as clinically significant. Pre-existing comorbidities like nephrotic syndrome, premature birth and dysmorphism were noted in almost all the children. One of the patients had undergone invasive ventriculoperitoneal shunt insertion. All the patients except one (discharged against medical advice) recovered. Conclusion: The study describes the spectrum of infections by Granulicatella adiacens. G. adiacens can grow on routine sheep blood agar without pyridoxal supplementation in CO2 incubator when sub-cultured from automated blood culture bottles. This is one of the largest study from India.