Kurthia gibsonii as a sexually transmitted zoonosis: From a neglected condition during World War II to a recent warning for sexually transmitted disease units

Abstract

Context:
Zoonotic sexual transmission.

Aims:
Identification of unknown microorganisms causing sexually transmitted zoonotic infection was a common effort of clinicians and the laboratory.

Settings and design:
A male patient had recurring urethritis and balanitis after having repeated unprotected penetrative sexual intercourse with female piglets. He claimed allergy to metals and plastics. Routine microbiological tests were carried out.

Materials and methods:
Specimens from the urethra, glans, rectum, throat, urine, and blood were cultured. Subsequently, isolates were tested for their biochemical activity and antibiotic susceptibility.

Results:
Kurthia gibsonii was isolated from both urethra and glans. No other concomitant infection was detected. The patient was cured with oral cefuroxime for 15 days and topical gentamicin cream for 2 months.

Conclusion:
This is the first reported zoophilic infection by Kurthia spp. Fecal contamination of animals' genital tract was the possible source of infection. Immune disturbance of the patient might predispose to opportunistic Kurthia infection.

Full text

68 © 2016 Indian Journal of Sexually Transmitted Diseases and AIDS | Published by Wolters Kluwer - Medknow
How to cite this article: Kövesdi V, Stercz B, Ongrádi J. Kurthia
gibsonii as a sexually transmitted zoonosis: From a neglected
condition during World War II to a recent warning for sexually
transmitted disease units. Indian J Sex Transm Dis 2016;37:68‑71.
Kurthia gibsonii as a sexually transmitted zoonosis:
From a neglected condition during World War II to a
recent warning for sexually transmitted disease units
Valéria Kövesdi1,2,3, Balázs Stercz2,3, Joseph Ongrádi1,2,3
1Department of Microbiology, National Institute of Dermato‑Venereology, 2Departments of Public Health and
3Medical Microbiology, Semmelweis University, Budapest, Hungary
Address for correspondence:
Dr. Joseph Ongrádi, Department of Medical Microbiology, Semmelweis University, Nagyvárad Tér 4, Budapest 1089, Hungary.
E‑mail: ongradi.jozsef@med.semmelweis‑univ.hu
Abstract
Context: Zoonotic sexual transmission. Aims: Identification of unknown microorganisms causing
sexually transmitted zoonotic infection was a common effort of clinicians and the laboratory. Settings and
Design: A male patient had recurring urethritis and balanitis after having repeated unprotected penetrative
sexual intercourse with female piglets. He claimed allergy to metals and plastics. Routine microbiological
tests were carried out. Materials and Methods: Specimens from the urethra, glans, rectum, throat, urine,
and blood were cultured. Subsequently, isolates were tested for their biochemical activity and antibiotic
susceptibility. Results: Kurthia gibsonii was isolated from both urethra and glans. No other concomitant
infection was detected. The patient was cured with oral cefuroxime for 15 days and topical gentamicin cream
for 2 months. Conclusion: This is the rst reported zoophilic infection by Kurthia spp. Fecal contamination of
animals’ genital tract was the possible source of infection. Immune disturbance of the patient might predispose
to opportunistic Kurthia infection.
Key words: Antibiotic treatment, balanitis, Kurthia gibsonii, sexual abuse of piglets, Ukrainian gonorrhea, urethritis
INTRODUCTION
Sexual abuse of animals has been known since
ancient times. Its designation (recently: Sex
with animals [SWA]), range of animal species,
and acceptance by the public have been varied
depending on historical times, geographical
locations, demographic characteristics, and related
sexual behaviors.[1] Direct contact of genital organs
between humans and animals predisposes to mutual
transmission of microbes being present either as
members of the normal flora or pathogens. However,
data on zoophilic sexual transmission of nonhuman
pathogens are scarcely available in the literature.
In our laboratory, a bacterial species was identified,
causing sexually transmitted zoonosis.
MATERIALS AND METHODS
A 36‑year‑old male was referred to the National
Institute of Dermato‑Venereology (NIDV), Budapest,
with the accompanying diagnosis, “query zoonosis?”
by his local dermato‑venereologist from a remote
small town. The symptoms of the patient had
started with urethritis and acute prostatitis 3 years
ago. On unknown antibiotic treatment, these
symptoms ceased. Six months later, prostatitis
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DOI:
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Case Report
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Kövesdi, et al.: Kurthia gibsonii zoophilia
Indian Journal of Sexually Transmitted Diseases and AIDS 2016; Vol. 37, No. 1 69
relapsed once, while urethritis relapsed several
times. At the time of the first episode of urethritis,
he also experienced balanitis that became chronic.
During 3 years of supervision, no specimen was
taken for microbiological diagnosis, but urethritis
of the patient was treated with several courses of
various antibiotics. Balanitis was treated either with
the glans rinsed twice daily with chlorogene (1 g
tablet dissolved in 1 L of tap water) or 10% (w/w)
povidone‑iodine antiseptic cream applied twice
a day; both treatments were unsuccessful. Before
admission, his glans was treated with another
antiseptic cream (10 mg hydrocortisone, 10 mg
natamycin, and 3.5 mg neomycin/g) twice a day. The
latter regimen resulted in a mild improvement of the
inflammation.
On admission, the patient was in good physical and
mental health without any general symptoms. He
had no history of chronic disease, did not experience
fever or rigor at any time during the infection
but claimed allergies to nickel, rubber, adhesive
tape, and cosmetic perfumes. He complained
of urethral pain and burning during urination.
Physical examination revealed mild balanitis with
soreness and central induration in a 5 mm diameter
spot. Biopsy was recommended, but he refused
it. The absence of regional lymphadenopathy and
lymphangitis was established. He denied any
sexual contact with female or male partners in the
preceding 3 years but had occasional unprotected
penetrative intercourse with female piglets.
Specimens were taken from his urethra, glans,
throat, rectum, midstream urine, and subsequently
inoculated into different media routinely used in
the laboratory. Standardized test tube biochemical
methods were used to identify the bacteria. Venous
blood was drawn for routine chemistry, blood
culture, and serology. Antibiotic susceptibility
was tested by standard disc diffusion technique
(Oxoid Ltd., Cambridge, UK). Other quantitative
susceptibility methods were not available for routine
use in this laboratory.
RESULTS
According to standard references,[2] the isolates
from the urethra and glans were identified as
Kurthia gibsonii. Differentiation from other
microbes of porcine origin as L. monocytogenes
(e.g., nonhemolytic, carbohydrate fermenter) or
E. rhusiopathiae (e.g., nonhemolytic, catalase and
esculin hydrolysis negative) was considered. No
pathogenic microbes were obtained from any
specimen [Table 1].
Antibiotic sensitivity of isolates was almost
identical [Table 1]. The patient was treated with oral
cefuroxime axetil (500 mg twice a day for 15 days).
He rinsed the surface of the glans with 10% (w/w)
povidone‑iodine solution daily twice in his home
without success for 10 days, so consequently
treatment with 0.1% (w/w) gentamicin sulfate topical
cream to be applied twice daily was prescribed.
After 2 months of treatment, K. gibsonii was not
recovered from repeat specimens taken from the
urethra and glans. Urethral pain and inflammation
on the glans disappeared. The patient was cured and
has not returned in the following 14 months while
authors worked at NIDV.
DISCUSSION
The genus Kurthia contains three recognized
species: K. zopfii, K. gibsonii, and K. sibirica.
Additional species are mentioned in the literature
but have not been validated.[2] K. gibsonii and
K. zopfii are frequently found in the environment,
decomposing organic materials, swine carcasses,[3]
feces of farmyard animals,[4] spoiled pork, and
other food;[4,5] consequently, they might cause
gastroenteral infections. Different Kurthia species
have been isolated from the human feces including
from cases of acute diarrhea.[6] K. massiliensis
sp. nov. was isolated from the feces of a healthy
adult.[7] They are not part of the normal flora,
and in the majority of cases, they have not
normally been regarded as pathogenic.[8] Kurthia
infections rarely become systemic. K. zopfii
was isolated from the blood of an infant with
septicemia.[9] A 31‑year‑old male intravenous drug
user had endocarditis due to K. bessonii infection.[10]
Kurthia species very rarely cause bacteremia in
immunocompromised patients with indwelling
catheters or penetrating injuries.[8] Kurthia sp. might
spread to humans via dog bite.[11] This suggests
possible zoonotic spread. The clinical evidence
of the pathogenicity of Kurthia has never been
confirmed and the virulence factors are unknown:
It probably has low virulence.[8] K. gibsonii might
damage mucous membrane surfaces.[6]
Kurthia spp. have no validated testing methods
by the Clinical and Laboratory Standards
Institute (CLSI, formerly NCCLS, Wayne, PA, USA) or
other organization.[2,8] The complete microbiological
diagnostic procedures and comparison of sensitivity
to chemotherapeutic agents tested so far in the
case of other Kurthia species as well have been
described lately.[12] The complete spectrum of their
susceptibility to chemotherapeutics is unknown; no
definitive treatment guidelines have been suggested.[8]

Kövesdi, et al.: Kurthia gibsonii zoophilia
70 Indian Journal of Sexually Transmitted Diseases and AIDS 2016; Vol. 37, No. 1
Our case is the first to show that K. gibsonii can
spread from an animal to a human by zoophilic
sexual intercourse, and the mucous membranes
of the human genital tract can support bacterial
survival. Fecal contamination of piglets’ genital tract
might have been the source of his infection. On this
occasion, K. gibsonii did not cause disseminated
infection. To what extent this patient’s allergy
might have contributed to the development of his
infection with K. gibsonii is unknown. This could be
a warning sign to those who suffer from any form of
immunosuppression.
Persons who contract infection from animals can
forward microbes to their human sexual partners.
At the end of World War II when the Soviet Red
Table 1: Major characteristics of Kurthia gibsonii isolates obtained from our patient and dierential
diagnostic procedures
Investigations Results
Verication of K. gibsonii
Morphology Gram-positive short rods forming chains or coils
Colony morphology (24 h) Large (2–3 mm in diameter) dry, convex, granular, and circular colonies
as rhizoidal growth
Nonhemolytic on blood agar media
Biochemical activities
Positive Gelatinase, catalase, urease, desoxyribonuclease
Growth at 4°C, 30°C, 42°C and in presence of 2%, 4%, 6% NaCl at 37°C
Negative Carbohydrate fermentation, citrate utilization, nitrate reduction,
oxidase, lecithinase, indole, methyl red, Voges–Proskauer reactions,
starch and esculin hydrolysis, H2S production
Growth under anaerobic conditions
Chemotherapy
Susceptibility Penicillin
Ampicillin
Piperacillin/tazobactam
Cefuroxime
Ooxacin*
Ciprooxacin*
Ceftriaxon+
Gentamicin
Vancomycin
Resistance Tetracycline
Clindamycin
Erythromycin
Bacitracin
Exclusion of co-pathogenic microbes
Urethral specimens
Smear (Gram-staining), culture (Thayer-Martin medium)
Smear (Giemsa-staining), culture (modied CPLM‡
medium base)
Smear (Gram-, Giemsa-, acid-fast staining)
Culture (mycoplasma agar)
Culture (ureaplasma agar)
Dark eld microscopy (native)
Culture (broth, Mueller-Hinton-, blood-, chocolate-,
eosin-methylene blue-, Sabouraud agar)
Smear (direct immunouorescence)
N. gonorrhoeae
T. vaginalis
Any pathogenic bacterium, yeast, protozoa
M. hominis
U. urealyticum
T. pallidum ssp. pallidum
Any pathogenic bacterium or yeast
C. trachomatis D-K
Glans specimens
Smear (Gram-, Giemsa-, acid-fast staining)
Dark eld microscopy (native)
Smear of scraped cells (direct immunouorescence)
Cultures as above
Any pathogenic bacterium, yeast, protozoa
T. pallidum ssp. pallidum
HSV-1, HSV-2
Any pathogenic microbes
Blood
Culture
Serology (ELISA§)
Rapid plasma reagin test and venereal disease
research laboratory test
Any bacteria or yeast
Human immunodeciency virus
T. pallidum ssp. pallidum
*Urethral isolate was moderately susceptible; +Both isolates were moderately susceptible; ‡CPLM=Cysteine-peptone-liver infusion-maltose; §ELISA=Enzyme-
linked immunosorbent assay. HSV=Herpes simplex virus; T. pallidum=Treponema pallidum; C. trachomatis=Chlamydia trachomatis; T. vaginalis=Trichomonas
vaginalis; U. urealyticum=Ureaplasma urealyticum; M. hominis=Mycoplasma hominis; N. gonorrhoeae=Neisseria gonorrhoeae; K. gibsonii=Kurthia gibsonii

Kövesdi, et al.: Kurthia gibsonii zoophilia
Indian Journal of Sexually Transmitted Diseases and AIDS 2016; Vol. 37, No. 1 71
Army invaded Hungary, several females raped by
Ukrainian soldiers suffered from a gonorrhea‑like
disease. No known pathogen was found, and the
public denoted this disease as “Ukrainian gonorrhea”
(Prof. J. Sinkovics, University of South Florida,
Tampa, FL, USA, personal communication). Cases of
SWA among soldiers were suspected; consequently,
animal microbes could be transmitted to females.
Due to disintegrated wartime health system, such
cases have never been studied. Since the “sexual
revolution” in the 60s, both clinicians and the
microbiology laboratories have to be prepared
for diagnosing unusual pathogens. Subjects who
report SWA also report more venereal diseases.[1]
In our laboratories, all procedures were carried out
manually; consequently, discordant biochemical
results were noticed early. Using automated
diagnostic tools not programed for animal or
environmental microbes, such pathogens could be
misinterpreted.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conflicts of interest.
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