Extra-abdominal Infections Caused by Gemella morbillorum.
GARCIA-LECHUZ JM, CUEVAS-LOBATO O, HERMIDA A, GUINEA-ORTEGA J, MARIN M, PELAEZ T,
BOUZA E; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1999
Sep 26-29; 39: 716 (abstract no. 1074).
Hosp. Gen. Gregorio Maranon, Madrid, SPAIN.
Gemella morbillorum is a Gram-positive pyogen, usually a component of the normal flora of the
human gastrointestinal tract. The real spectrum of extra-intestinal infections caused by these
microorganisms is not well known.METHODS: Between 1994 and 1998, 128 patients had one or
more isolates of G. morbillorum in our institution. The 11 patients with isolates from non-significant
specimens or representing intra-abdominal infections were excluded. The clinical records of the
remaining 17 patients were reviewed.RESULTS: Mean age was 41 yrs. Underlying diseases were:
IVDU 7 cases (c). (3 HIV+), alcoholism 2c., heart disease 3c., diabetes 1c., kidney transplant 1c. The
extraabdominal sites of infection were: skin and soft tissue abscesses 5, empyemas 5 (1
bacteremic), primary bacteremia 2, brain abscesses 2, lung abscess 1, septic thrombophlebitis with
bacteremia 1 and, a complicated UTI. The infection was monomicrobial in 6 and, polymicrobial in 11
c. Surgical drainage and betalactams were the standard therapy used. The outcome after a mean
follow-up of 24 months was favourable in all cases.CONCLUSION: G. morbillorum should be included
as a cause of localized soft tissue abscess, empyema and bloodstream infections. No single case of
infective endocarditis was found in our institution.
Gemella morbillorum peritonitis in a patient being treated with continuous ambulatory peritoneal
Özlem Kurt Azap,
Siren Sezer and
+ Author Affiliations
Baskent University Faculty of Medicine Infectious Disease and Clinical Microbiology Ankara Turkey
Peritonitis is a serious problem for peritoneal dialysis (PD) patients, and is a major cause of
hospitalization, catheter loss and transfer to haemodialysis . We present a peritonitis episode
caused by an unusual pathogen, Gemella morbillorum. A 55-year-old man was admitted to hospital
after noticing that his dialysis effluent was slightly cloudy. He received three exchanges of 1.36% and
one exchange of 2.27% 2000 ml of PD solution (Baxter-Dianeal 137, Deerfield, IL) in a day. He had
no prior history of peritonitis. The clinical picture was dominated by mild diffuse abdominal pain and
tenderness. Analysis of the peritoneal effluent demonstrated a white blood cell (WBC) count of
480/μl with 90% neutrophils. Gram stain of the effluent revealed no bacteria. Culture of the specimen
grew slow-growing, Gram-positive, pleomorhic, catalase-negative bacteria that were identified as G.
morbillorum. The minimal inhibitory concentrations determined by E Test® for penicillin and
vancomycin were 0.006 and 1 mg/l, respectively, which were interpreted as susceptible. Prior to
identification of the bacteria, ampicillin–sulbactam (1.5 g bid) and ciprofloxacin (200 mg bid) were
started intravenously as the regular therapy for CAPD peritonitis in our institution, and the same
combination continued for 14 days. The WBC of the peritoneal effluent dropped to zero at the end of
the first week of therapy. The patient was well when he was seen 1 month after his discharge.
Gemella morbillorum and Gemella hemolysans are Gram-positive coccal commensal organisms of
the mucous membranes of humans. Only a few cases of Gemella infection have been reported to
date, and have been predominantly endovascular infections . The first episode of peritonitis
caused by G.morbillorum was successfully treated with cefazolin .
Gemella may be more involved in clinical disease than is presently recognized. They can be
incorrectly identified as viridans streptococci, identified as Neisseria spp. because they are easily
decolorized during Gram staining or left unidentified . Our patient had no other underlying disease
besides end-stage renal failure and no other infectious foci prior to this peritonitis episode.
Translocation from the gastrointestinal tract may be responsible for this episode. We did not culture
the stool of the patient before antimicrobial therapy to demonstrate Gemella. It is difficult to estimate
how this microorganism caused this episode.
Gemella infections are seldom seen, and the identification in the laboratory has some limitations
because of the characteristics of this bacteria. Therefore, the microbiological samples should be
interpreted carefully and Gemella should be taken into consideration when slow-growing, catalase-
negative, Gram-positive cocci are seen in samples. There are fatal Gemella infection reports in the
literature [4,5]. Our case improved well with a β-lactam antibiotic as in the other patient mentioned
above . The response of two patients to therapy is not enough to reach a general conclusion
about the prognosis, but the in vitro susceptibility results may be a useful guide in the management
of these patients.
Conflict of interest statement. None declared.
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Abstract/FREE Full Text
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