A 64-year-old Indonesian male was in good health until 3 months ago when he awoke with back pain localized to the upper thoracic area. His symptoms were not improved with physical therapy or acupuncture. A bone scan was positive for inflammation at C5 and C6, and he was treated with antibiotics for 2 weeks. His symptoms returned when antibiotics were discontinued. A vertebrectomy of C5 and C6 was performed, and bone tissue was sent for culture. A nonhemolytic gram-negative bacillus was isolated that was catalase negative and oxidase positive but did not grow on MacConkey. Colonies showed pits in the agar and exuded an odor of bleach. When questioned, the patient indicated that he had no dental procedures before the illness but indicated he had previously sought medical attention for a swallowed fishbone that was not successfully removed. Review of the radiology films indicated a dense area that could have been the foreign body

Questions

1. What organism do you suspect is the cause of this infection and what clues from the case lead you to this suspicion?

2. What key biochemical reactions could be used to confirm your suspicion and help identify the organism? Because the bacterium is catalase negative, it needs to be separated from the genera described in Chapters 27 and 30. However, one unique positive biochemical reaction will definitively identify the organism. What is that test?

3. Why was the physician interested in whether dental work had been performed before the onset of symptoms?

4. Explain why this bacterium is included in the HACEK (AACEK) group.