From NTM (Nontuberculous mycobacterium) to Gordonia bronchialis-A Diagnostic Challenge in the COPD Patient

Monika Franczuk; Magdalena Klatt; Dorota Filipczak; Anna Zabost; Paweł Parniewski; Robert Kuthan; Lilia Jakubowska; Ewa Augustynowicz-Kopeć

doi:10.3390/diagnostics12020307

From NTM (Nontuberculous mycobacterium) to Gordonia bronchialis-A Diagnostic Challenge in the COPD Patient

Diagnostics (Basel). 2022 Jan 25;12(2):307. doi: 10.3390/diagnostics12020307.

Authors

Monika Franczuk¹, Magdalena Klatt², Dorota Filipczak², Anna Zabost², Paweł Parniewski³, Robert Kuthan⁴, Lilia Jakubowska⁵, Ewa Augustynowicz-Kopeć²

Affiliations

¹ Respiratory Physiopathology Department, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland.
² Microbiology Department, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland.
³ Institute of Medical Biology, Polish Academy of Sciences, 90-001 Lodz, Poland.
⁴ Chair and Department of Medical Microbiology, Medical University of Warsaw, 02-091 Warsaw, Poland.
⁵ Radiology Department, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland.

Abstract

In patients with chronic obstructive pulmonary disease, respiratory infections are of various aetiology, predominantly viral and bacterial. However, due to structural and immunological changes within the respiratory system, such patients are also prone to mycobacterial and other relatively rare infections. We present the 70-year old male patient with chronic obstructive pulmonary disease (COPD) and coexisting bronchial asthma, diagnosed due to cough with purulent sputum expectoration lasting over three months. The first microbiological investigation of the sputum sample revealed the growth of mycobacteria. The identification test based on protein MPT64 production indicated an organism belonging to NTM (nontuberculous mycobacterium). However, further species identification by genetic testing verified the obtained culture as not belonging to the Mycobacterium genus. Based on observed morphology, the new characterisation identified an aerobic actinomycete, possibly a Nocardia spp. The isolated strain was recultured on standard microbiological media. The growth of colonies was observed on Columbia blood agar plates and solid Löewenstein-Jensen medium. The Gram and Zhiel-Nielsen stains revealed the presence of Gram-positive acid-fast bacilli. The extraction protocol and identification were performed in two repetitions; the result was G. bronchialis, with a confidence value of 99% and 95%, respectively. The gene sequencing method was applied to confirm the species affiliation of this isolate. The resulting sequence was checked against the 16S ribosomal RNA sequences database (Bacteria and Archaea). The ten best results indicated the genus Gordonia (99.04-100%) and 100% similarity of the 16S sequenced region was demonstrated for Gordonia bronchialis. The case described indicates that the correct interpretation of microbiological test results requires the use of advanced microbiology diagnosis techniques, including molecular identification of gene sequences. From a clinical point of view, Gordonia bronchialis infection or colonization may present a mild course, with no febrile episodes and no significant patient status deterioration and thus, it may remain undiagnosed more often than expected.

Keywords: Gordonia bronchialis; microbiological diagnostics; respiratory infection.

Publication types

Case Reports