Central Venous Catheter–Related Bacteremia Due to Tsukamurella Species in the Immunocompromised
Host: A Case Series and Review of the Literature

We report 6 cases of bacteremia due to Tsukamurella species, all of which were in immunosuppressed patients
with indwelling central venous catheters (CVCs). Fewer than 20 cases of serious illness due to these grampositive
bacilli have been reported in the medical literature; these cases have mostly been ascribed to the
species Tsukamurella paurometabola. Tsukamurella species are frequently misidentified as Rhodococcus or
Corynebacterium species. We used high-performance liquid chromatography to identify these organisms to
the genus level and 16S ribosomal RNA gene sequencing and DNA-DNA dot blots for species identification.
Three of our isolates were identified as Tsukamurella pulmonis, 1 was identified as Tsukamurella tyrosinosolvans,
and 1 was identified as a unique species. One isolate was not maintained long enough for species identification.
All patients were successfully treated with antimicrobial therapy and CVC removal. Infection with this organism
should be considered in the immunosuppressed patient with an indwelling CVC and gram-positive bacilli in
the blood.
Clinical Infectious Diseases 2002; 35:e72–7

Tsukamurella Conjunctivitis: a Novel Clinical Syndrome

In this report, we describe the first three cases of Tsukamurella conjunctivitis in the literature. All three patients
presented with congestion of one eye with small amounts of serous discharge for 1 to 2 days. All three recovered
after 10 days of treatment with polymyxin B-neomycin or chloramphenicol eyedrops. Sequencing of the 16S rRNA
genes of the three isolates recovered from the serous discharge of the three patients showed that they were all
Tsukamurella species. The phenotypic characteristics of the isolate obtained from one patient best fit the phenotypic
profile of Tsukamurella pulmonis, whereas those of the other two best fit that of Tsukamurella tyrosinosolvens.
J Clin Microbiol. 2003 July; 41(7): 3368–3371.

Tsukamurella strandjordae sp. nov., a Proposed New Species Causing Sepsis

We have isolated a gram-positive, weakly acid-alcohol-fast, irregular rod-shaped bacterium from cultures of
blood from a 5-year-old girl with acute myelogenous leukemia. This isolate was compared with 14 other strains
including reference strains of Tsukamurella species by a polyphasic approach based on physiological and
biochemical properties, whole-cell short-chain fatty acid and mycolic acid analyses, DNA-DNA hybridization,
and sequencing of the 16S rRNA gene. This isolate represents a new taxon within the genus Tsukamurella for
which we propose the name Tsukamurella strandjordae sp. nov. Our study also revealed that Tsukamurella
paurometabola ATCC 25938 represents a misnamed Tsukamurella inchonensis isolate and confirms that
Tsukamurella wratislaviensis belongs to the genus Rhodococcus.

Cavitary pneumonia secondary to Tsukamurella in an AIDS patient. First case and a review of the
Tsukamurella is a Gram-positive, variable rod-shaped, weakly acid-alcohol-fast, non motile, aerobic bacterium that
belongs to the genus Rhodococcus. Tsukamurella has been reported as a cause of infections in humans with
immunosuppression and indwelling foreign bodies. It has also been isolated in one patient with AIDS (Acquired
Immunodeficiency Syndrome) as a saprophytic organism. Optimal management of infections secondary to this
microorganism is still uncertain due to the paucity of cases. The combination of a beta-lactam and an
aminoglycoside, along with removal of medical devices, appear to be the treatment of choice. We report the case of
a 55-year-old male AIDS patient who presented to the Clinical Immunology clinic at Jackson Memorial Hospital in
Miami, Florida, USA with multiple lung cavitary lesions secondary to Tsukamurella. This is the first case reported of
Tsukamurella as a pathogenic agent in an AIDS patient. We also propose a successful oral antibiotic regimen with
fluoroquinolone and rifampin to treat infections secondary to this uncommon microorganism.
Journal of Infection, 2004 (Vol. 49) (No. 1) 17-19