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Vaginal Culture of a Pregnant Woman

PRESENTED BY CASTRO & PAASA

CLINICAL HISTORY
A 24-year old pregnant woman presents to her obstetrician for a routine perinatal visit.
no significant medical and surgical history pregnancy has been without incident no history of drug use nonsmoker currently only takes a prenatal vitamin has one sexual partner immigrated to the US from Jamaica 2 years ago

A routine rectal/vaginal culture was taken and it showed the following results:

Fig 1. Culture on 5% Sheep Blood Agar

Fig 2. Gram stain

Hemolysis was detected

Gram positive streptococcus

Fig 3. CAMP Test

Fig 4. Lancefield Typing

-Streptococcus; enhanced hemolytic activity

Classified as Group B

Table 1. Biochemical Results of Unknown Organism

Used to differentiate to other Group B Streptococcus

DIAGNOSIS

Streptococcus pseudoporcinus
a -hemolytic Streptococcus with a wide-zone of hemolysis genetically and biochemically different from S. porcinus different strain (determined after sequencing with 16S rRNA)

S. pseudoporcinus VS S. agalactiae
S. Pseudoporcinus can be confused with Group B Streptococcus (S. agalactiae) which is also -hemolytic, CAMP positive, bacitracin resistant and cross-reacts with reagents in Lancefield typing.

Fig 5. Streptococcus agalactidae (left) and Streptococcus pseudoporcinus (right) on 5% Blood Sheep Agar

Table 2. Biochemical Characteristics of Streptococcus pseudoporcinus, Streptococcus porcinus and Streptococcus agalactiae

*Data taken from Duarte et al, 2005. + Data taken from Bekal et al, 2007. ++ Data taken from Gaudreau et al, 2007. ** Data taken from lab strains of Streptococcus agalactiaeand patient's sample of Streptococcus pseudoporcinus.

Streptococcus pseudoporcinus
has wider band of hemolysis has not been associated with neonatal sepsis In a small study in Canada, it has been associated with chorioamnionitis and preterm delivery; and affected women were almost exclusively immigrants from the Caribbean Islands.

References:
Bekal S, Gaudreau C, Laurence RA, Simoneau E, Raynal L. Streptococcus pseudoporcinus sp. nov., a novel species isolated from the genitourinary tract of women (2006). Journal of Clinical Microbiology; 44(7):2584-6 Gaudreau C, Simoneau E, Labrecque O, Laurence RA, Laferrire C, Miller M, Raynal L, Rallu F. Epidemiological, biochemical and antimicrobial susceptibility characteristics of Streptococcus pseudoporcinus isolated in Quebec, Canada, from 1997 to 2006 (2007). Journal of Medical Microbiology; 56(Pt 12):1620-4 Duarte RS, Barros RR, Facklam RR, Teixeira LM. Phenotypic and genotypic characteristics of Streptococcus porcinus isolated from human sources (2005). Journal Clinical Microbiology; 43(9):4592-601