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Arcanobacterium haemolyticum

What are you

missing in your
throat cultures?

A Case History A. haemolyticum is a beta-

hemolytic gram-positive,
In May 2005, ten students in pleomorphic, facultative
South Korea were hospitalized anaerobic rod that has been
for an unidentified illness. implicated as an etiologic agent
Their symptoms were similar to of non-streptococcal pharyngitis,
those seen with scarlet fever, especially in adolescents and
by Daniel Berger including rashes and fevers. young adults.
The most severe cases also
exhibited low blood pressure. Corynebacterium haemolyticum,
now named Arcanobacterium
Daniel Berger is a Research and During the investigation, many haemolyticum, was first
Development Microbiologist at more students presented with described in 1946 as the
Hardy Diagnostics.
similar symptoms, again with pathogenic agent causing
He earned his Bachelors Degree in an unknown cause. pharyngitis and cutaneous
Microbiology from California infections among U.S service
Polytechnic State University in San In early July 2005, the Korea members and indigenous
Luis Obispo, CA. Center for Disease Control and peoples of the South Pacific.
Prevention finally determined
Daniel has been instrumental in the
development of many new and that the cause of the outbreak It has also been described as a
innovative products released by the was Arcanobacterium cause of skin and wound
Hardy Diagnostics R&D Dept. haemolyticum. It was believed infections, osteomyelitis, sepsis,
over the past four years, among that the disease had spread central nervous system
them are: HardyCHROM SS, through student contact in
HardyCHROM Carbapenemase, infections, endocarditis,
Arcanobacterium Selective Agar, classrooms and dormitories. cellulitis, sinusitis, meningitis,
and Shigatoxin Induction Broth. pharyngotonsillitis, peritonsillar
By this time, the outbreak had abscesses, and systemic
spread significantly and a total infections in all age groups. In
of 142 students had become one study, it was found that half
infected by the rare bacterium. of the infected patients with
This was the first reported case pharyngitis also presented with
of mass infection by A. a rash, usually found on the
haemolyticum in South Korea. arms and legs.
Since the symptoms of A. bacteria, is very appropriate. identification of this organism
haemolyticum pharyngitis and differentiation from group A
may be confused with Because it is often overlooked, strep is of extreme importance.
those of group A A. haemolyticum may result in
streptococci, diphtheria missed or delayed diagnoses. Hardy Diagnostics has just
and drug allergies, it is released Arcanobacterium
important to screen and The use of a selective medium Selective Agar (also known as
test for this organism that effectively inhibits S. Berger's Agar, Cat no. A134), a
appropriately. pyogenes, as well as novel medium for the isolation
commensal organisms, may of Arcanobacterium
It is estimated that the significantly increase the haemolyticum, especially from
number of throat detection rate of A. respiratory specimens.
infections caused by A. haemolyticum.
haemolyticum ranges from Selective agents have been
5 to 13% compared to added to the medium to inhibit
those caused by group A Streptococcus pyogenes and
streptococci, but this may normal oral flora without
be an underestimate. In affecting the growth of
one study, it was found Arcanobacterium haemolyticum.
that the most affected age
group was 15 to 18 year Also released by Hardy
olds. Diagnostics is a bi-plate,
consisting of Group A Beta
Early isolation and Strep Selective Agar and
identification of A. Arcanobacterium Selective
haemolyticum is necessary Agar (Cat. no. J134) so that
to ensure proper treatment throat cultures can be
and prevent potential effectively screened for both
outbreak. Group A Strep and
If sheep blood agar, or simultaneously.
even a selective strep agar,
is used to set up throat Figure 1: Arcanobacterium
cultures, this overlooked haemolyticum (ATCC BAA-1784) Daniel Berger
and underreported cause colonies growing on Santa Maria, California
of non-streptococcal Arcanobacterium Selective Agar
(Cat. no. A134). Incubated The information contained in this article is for
pharyngitis is often missed. anaerobically for 48 hours at 35 deg. educational purposes only and is not intended
C. The top photo shows the colonies nor recommended as a substitute for medical
advice, diagnosis, or treatment.
A. haemolyticum typically by reflected light. The bottom photo
grows slowly and exhibits shows the beta-hemolysis by
less well defined beta- transmitted light.
hemolysis on sheep blood
agar and is easily masked Although A. haemolyticum is
by commensal throat flora usually sensitive to penicillin in
or interpreted as an oral vitro, there are many reported
contaminant; thus the treatment failures. For this
genus Arcanobacterium, reason, erythromycin is the
meaning secretive drug of choice, rather than
penicillin. This is why