Infectious Disease Compendium

Brevibacterium

Microbiology

Gram positive rod

Epidemiologic Risks

Skin flora.

Syndromes

Mostly line infections.

Treatment

Vancomycin has the best MIC's.

Notes

For your 'entertainment' and a change of pace, my Medscape post on the bug.

Stinky Feet, Cheese and Sepsis

Fever and chills on dialysis are a common enough problem problem. I am not prone to the naturalistic fallacy, but having a dialysis catheter in your subclavian is not natural. But it is often better than death.

All catheter eventually either break or get infected and with the fever and chills it looked like the second option. Usually it is some sort of Staphylococcus but this time it was gram positive rods in all the blood cultures.

That is curious, probably some sort of corynebacterium or even a P. acnes, although we do not often look for that beast

Propionibacterium acnes was detected in significant counts in the vascular catheters of 39 patients. This represents 14.7% (95% CI, 12.5-16.9) of all positive catheters. Propionibacterium is the second most frequent genus-colonizing catheter tips after Staphylococcus spp. Methodological shortcomings impair the detection and proper adscription of P. acnes as a potential cause of catheter-related infections.

and Listeria in the elderly. So he was put on ampicillin and we waited. After two days, nothing so I called the lab. The microbiologist tells me the MALDI says it is Brevibacterium.

And that is? Never heard of that bug.

There are at least 26 Brevibacterium, the most famous being

Brevibacterium linens is ubiquitously present on the human skin, where it causes foot odor. The familiar odor is due to sulphur containing compounds known as S-methyl thioesters. The same bacterium is also employed to ferment several cheeses such as Munster, Limburger, Port-du-Salut, Raclette, Livarot, Pont l'Eveque and Năsal. Its aroma also attracts mosquitoes

According the the Microbe Wiki

B.linens plays a big role in the metabolism of cheeses. The ripening of the cheese goes from a yeast and mold flora to a bacterial flora. The yeast uses the lactate in the curd for energy, increasing the pH, allowing growth of B.linens. These cheeses are high in salt concentration with allows only halotolerant microorganisms to grow on the surface of the cheese.

Maybe these cheeses came from our less fastidious forebears and one author asks

And is today's concern for scrupulous cleanliness in the dairy depriving future gourmets of delicious aromas still confined to the crevices of the human body?

Ick. Toe cheese is bad enough, but belly button cheese? I’ll pass.

I asked the tech if the plates smelled like cheese. She said she is not in the habit of sniffing unusual organisms. Words to live by from a wise microbiologist. The patient? No cheese consumption and it was likely B. casei anyway.

There are 13 hits for this organism causing bacteremia, mostly catheter related infections but not a lot of information as to whether catheters can be salvaged. Vancomycin had the best MIC’s so we went for a course of therapy to see if we can save the catheter as the patient is short on further access.

I know ID is not a popular specialty, but what other area of medicine can offer human body cheese? Kids today just do not know a good thing when they see it.

Rationalization

J Infect. 2008 Apr;56(4):257-60. doi: 10.1016/j.jinf.2008.01.012. Epub 2008 Mar 12. Propionibacterium acnes is a common colonizer of intravascular catheters.

Infection. 2006 Apr;34(2):103-6. Central venous catheter infection with Brevibacterium sp. in an immunocompetent woman: case report and review of the literature.

Cheese, toes, and mosquitoes. BMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7038.1105

Scientists create toe, belly button cheese from human bacteria.

The 2015 ID Fellowship Match “Historic Bad”: Part 1, Debating the Cause.