A 70 year old male with a history of multiple system atrophy and left hip fracture presented to his primary care physician after being found by his home health nurse to have a sacral decubitus ulcer. Physical examination revealed an afebrile immobile patient with a 3.0 cm stage III ulcer over the sacrum with purulent exudate. Tissue was obtained and sent to our laboratory for Gram stain and culture.
Gram stain was significant for many polymorphonuclear neutrophils and mixed gram positive and gram negative organisms. Blood and chocolate plates grew mixed organisms with a predominant gram positive coccobacillus. Matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) identified this organism as Trueperella bernardiae.
Trueperella bernardiae is a nonspore-forming, facultatively anaerobic, gram-positive coccobacillus. It was previously categorized within the Actinomyces and Arcanobacterium genera. It is classically associated with pig farming. It is often considered to be a contaminant or normal flora, however, it has been reported as a cause of bone and soft tissue infections. Highly invasive diseases are rare. The incidence of infection may have been underreported previously due to the difficulty to culture and identify it from normal flora prior to the advent of MALDI-TOF. Antibiotic sensitivity data is limited, however, there are reports of susceptibility to beta-lactams, clindamycin, tetracycline, and vancomycin. Minimum inhibitory concentration interpretation is often based on data from bacteria of the Corynebacterium.
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-Jonathan Wilcock, MD is a 1st year anatomic and clinical pathology resident at the University of Vermont Medical Center.
-Christi Wojewoda, MD, is the Director of Clinical Microbiology at the University of Vermont Medical Center and an Associate Professor at the University of Vermont.