{"id":9217,"date":"2019-06-02T19:09:15","date_gmt":"2019-06-02T23:09:15","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9217"},"modified":"2019-06-06T14:27:23","modified_gmt":"2019-06-06T18:27:23","slug":"a-highly-subjective-guide-to-clinically-important-infections-that-have-changed-names","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/a-highly-subjective-guide-to-clinically-important-infections-that-have-changed-names\/2019\/06\/02\/","title":{"rendered":"A Highly Subjective Guide to Clinically Important Infections That Have Changed Names"},"content":{"rendered":"<p>Why do many clinically important microorganisms change names?<\/p>\n<p>They haven&#8217;t married and taken their spouse&#8217;s name or gone to Hollywood and adopted a stage name.<\/p>\n<p>Instead, through the tireless work of microbiologists, taxonomists, and geneticists, they have undergone sufficient reclassification so that their old name just doesn&#8217;t make sense anymore.<\/p>\n<p>Or more graphically:<\/p>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\">Why do clinical microbiologists love taxonomy? <a href=\"https:\/\/t.co\/BdgGEUOFlh\">https:\/\/t.co\/BdgGEUOFlh<\/a> <a href=\"https:\/\/twitter.com\/ASMicrobiology?ref_src=twsrc%5Etfw\">@ASMicrobiology<\/a> <a href=\"https:\/\/twitter.com\/hashtag\/ASMClinMicro?src=hash&amp;ref_src=twsrc%5Etfw\">#ASMClinMicro<\/a> <a href=\"https:\/\/t.co\/fL3qgemYea\">pic.twitter.com\/fL3qgemYea<\/a><\/p>\n<p>&mdash; JClinMicro EIC (@JClinMicro) <a href=\"https:\/\/twitter.com\/JClinMicro\/status\/1129356105572864001?ref_src=twsrc%5Etfw\">May 17, 2019<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<p>What we gain in accuracy, alas, is accompanied by an increase in confusion, and a heavy taxation on our memory reserves. Even we ID types can barely keep the names straight; imagine how non-ID clinicians feel?<\/p>\n<p>Our colleagues in clinical microbiology recognize this problem &#8212; <em>really they do.<\/em> But spend a little time reading <a href=\"https:\/\/jcm.asm.org\/content\/57\/2\/e01183-18\" target=\"_blank\" rel=\"noopener noreferrer\">Name Changes for Fungi of Medical Importance<\/a>, and pretty soon you get deep into the weeds with no available machete to hack your way out. How&#8217;s this for an example?<\/p>\n<blockquote><p>The <em>Ajellomycetaceae<\/em> contains the teleomorph species <em>Ajellomyces dermatitidis<\/em>, <em>Ajellomyces capsulatus<\/em>, and <em>Ajellomyces duboisii<\/em>, the anamorphs of which are the genera <em>Blastomyces<\/em> and <em>Histoplasma<\/em>. The <em>Ajellomycetaceae<\/em> also contains some genera that have no known teleomorphs, including <em>Paracoccidioides<\/em> and the newly described genus <em>Emergomyces<\/em>.<\/p><\/blockquote>\n<p>Well, I&#8217;m sure glad we cleared that up!<\/p>\n<p>So if you&#8217;re looking for an in-depth, detailed review of some recent name changes, take a look at the references section in <a href=\"https:\/\/jcm.asm.org\/content\/55\/1\/3#ref-list-1\" target=\"_blank\" rel=\"noopener noreferrer\">this editorial<\/a>, kindly sent to me by ID doctor and medical microbiologist Kim Henson. Warning &#8212; they are not for the faint of heart!<\/p>\n<p>But here is a more subjective list of name changes that I&#8217;ve weathered over the years, along with a few miscellaneous comments:<\/p>\n<p><strong><em>C<\/em><\/strong><strong><em>lostridium difficile<\/em> became <em>Clostridioides difficile. <\/em><\/strong>This recent change will take a while to get used to, as it&#8217;s such a common infection that <em>Clostridium<\/em> is pretty hardwired in our neural circuits. Also, the ubiquitous abbreviation &#8220;C. diff&#8221; still works fine, so there&#8217;s not much motivation to learn how to write, or to say, <em>Clostridioides &#8212;\u00a0<\/em>in fact, I just had to teach my spell checker not to flag it.<\/p>\n<p><strong><em>Pneumocystis carinii<\/em> became <em>Pneumocystis jirovecii.<\/em> <\/strong>It&#8217;s now quite clear that pneumocystis is a fungus (and not a protozoan, as originally thought). It&#8217;s also widely accepted (finally) that the <a href=\"https:\/\/academic.oup.com\/cid\/article\/41\/12\/1756\/345174\" target=\"_blank\" rel=\"noopener noreferrer\">species encountered in corticosteroid-treated rats is different from the one infecting humans<\/a> &#8212; the rat gets <em>Pneumocystis carinii<\/em>, and humans <em>Pneumocystis jirovecii<\/em>. What&#8217;s still a matter of substantial debate is how to abbreviate the pneumonia caused by <em>Pneumocystis jirovecii,\u00a0<\/em>as demonstrated by this hotly-contested poll:<\/p>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"und\" dir=\"ltr\">What&#39;s the current preferred abbreviation for Pneumocystis jirovecii pneumonia? cc <a href=\"https:\/\/twitter.com\/UpToDate?ref_src=twsrc%5Etfw\">@UpToDate<\/a> <a href=\"https:\/\/twitter.com\/hashtag\/IDtwitter?src=hash&amp;ref_src=twsrc%5Etfw\">#IDtwitter<\/a> <a href=\"https:\/\/t.co\/uIq2dJEb1S\">https:\/\/t.co\/uIq2dJEb1S<\/a><\/p>\n<p>&mdash; Paul Sax (@PaulSaxMD) <a href=\"https:\/\/twitter.com\/PaulSaxMD\/status\/1127242250730262528?ref_src=twsrc%5Etfw\">May 11, 2019<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<p><strong><em>Haemophilus aphrophilus<\/em> became <\/strong><em><strong>Aggregatibacter aphrophilus. <\/strong><\/em>I attended a meeting a few years back which included several other ID geeks like myself, and we were discussing various aspects of our work. One mentioned she had just seen a case of endocarditis due to the wonderfully named <em>Cardiobacterium hominis<\/em>, which is of course the &#8220;C&#8221; in the <a href=\"https:\/\/emedicine.medscape.com\/article\/218158-overview\" target=\"_blank\" rel=\"noopener noreferrer\">HACEK group<\/a> of organisms. I then mentioned that <em>Haemophilus aphrophilus<\/em> had been renamed <em>Aggregatibacter aphrophilus &#8212; <\/em>and\u00a0suddenly there was a palpable sadness in the room. How could anyone be so heartless as to change the name of this whimsical and mellifluous-sounding microbe? Such a deep injustice, we&#8217;re still in mourning.<\/p>\n<p><em style=\"font-weight: bold\">Streptococcus milleri<\/em><b> became <\/b><em><b>Streptococcus anginosus,\u00a0<\/b><\/em><b><i>intermedius<\/i>, and <\/b><em><strong>constellatus.<\/strong><\/em> The name change to these abscess-forming streptococcal infections happened so long ago that many youngsters out there might not have even heard of <em>Strep milleri<\/em>. But trust me, it was tricky enough that for a while these three species were called &#8220;Strep milleri group&#8221; to help bridge the pain; now they&#8217;re called &#8220;<em>Streptococcus anginosus<\/em>\u00a0group,&#8221; and milleri is no more. For the record, streptococcal taxonomy is mega-complicated and confusing &#8212; but if you think that is bad, wait until you start getting into the fungi!<\/p>\n<p><strong><em class=\"genus-species\">Pseudallescheria boydii<\/em> became <\/strong><em class=\"genus-species\"><strong>Scedosporium boydii.<\/strong> <\/em>Big improvement &#8212; <em>Scedosporium<\/em> is a wonderful word, replacing the strange and unspellable <em>Pseudallescheria<\/em><strong><em class=\"genus-species\">. <\/em><\/strong>I remember attending an ID conference during medical school that had two cases, both of which included details that caused me great confusion. The first was a streptococcal endocarditis case complicated by a &#8220;mycotic aneurysm.&#8221; Aren&#8217;t fungal infections called &#8220;mycoses&#8221;? So how did the strep cause a <em>fungal<\/em> complication &#8212; isn&#8217;t it a bacterial infection? (Turns out <em>any<\/em> infectious aneurysm is called &#8220;mycotic&#8221; &#8212; who knew?) The second was a post-traumatic fungal infection due to <em class=\"genus-species\">Pseudallescheria boydii,\u00a0<\/em>which I heard as &#8220;Pseudo &#8230;&#8221; which of course means &#8220;not genuine&#8221; or &#8220;sham&#8221; &#8212; you know, like &#8220;pseudo-intellectual.&#8221; So, if <em>Pseudallescheria<\/em> is the fake one, what&#8217;s the real one? I guess the real one is <em>Scedosporium<\/em>. Or not &#8212; fungal taxonomy is a total mess, right Andrej?<\/p>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\">Just when you thought you understood Scetosporium. It gets more complicated, more difficult to treat, and like all of fungus, a taxonomic mess. <a href=\"https:\/\/twitter.com\/hashtag\/MSGERC2018?src=hash&amp;ref_src=twsrc%5Etfw\">#MSGERC2018<\/a> <a href=\"https:\/\/twitter.com\/hashtag\/MedEd?src=hash&amp;ref_src=twsrc%5Etfw\">#MedEd<\/a> <a href=\"https:\/\/t.co\/xZ7J0XABlv\">pic.twitter.com\/xZ7J0XABlv<\/a><\/p>\n<p>&mdash; Andrej Spec, MD, MSCI (@FungalDoc) <a href=\"https:\/\/twitter.com\/FungalDoc\/status\/1045330541229236224?ref_src=twsrc%5Etfw\">September 27, 2018<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<div id=\"attachment_9243\" style=\"width: 185px\" class=\"wp-caption alignright\"><a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/06\/bacteria-297172_640.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-9243\" class=\"wp-image-9243\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/06\/bacteria-297172_640.png\" alt=\"\" width=\"175\" height=\"276\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/06\/bacteria-297172_640.png 406w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/06\/bacteria-297172_640-190x300.png 190w\" sizes=\"auto, (max-width: 175px) 100vw, 175px\" \/><\/a><p id=\"caption-attachment-9243\" class=\"wp-caption-text\">I am a cutie-bacterium.<\/p><\/div>\n<p><strong><em><i>Propionibacterium<\/i> acnes <\/em>became<\/strong><em><strong> Cutibacterium acnes.<\/strong>\u00a0<\/em>Of all the recent name changes, this is easily my favorite! I have already thoroughly embraced this new name, and even pedantically correct people stuck on the old one &#8212; making me excellent company on rounds. Maybe <em>Cutibacterium<\/em> will give greater attention to this under-appreciated pathogen, infamous for causing prosthetic joint (especially shoulder) and neurosurgical infections. And why do I like it? First, <i>Propionibacterium<\/i>\u00a0is a devil to say, good riddance. Second, <em>Cutibacterium<\/em> is adorable, especially if you pronounce it &#8220;Cutie-bacterium.&#8221;<\/p>\n<p><strong><em>Xanthomonas maltophilia<\/em> became<em> Stenotrophomonas maltophilia<\/em>.<\/strong> This problematic, highly antibiotic-resistant gram-negative rod changed names long ago &#8212; so as with <em>Streptococcus milleri<\/em>, many might not even have heard of <em>Xanthomonas<\/em>. I first learned about this bug when imipenem had just been FDA-approved (yes, I&#8217;m that old), as it is one of the rare gram negatives intrinsically resistant to carbapenems. Two other points worth emphasizing:\u00a0 1) <em>Xanthomonas<\/em> sounds very cool, could almost be the name of a science fiction series, &#8220;The Galactic Empires of Xanthomonas&#8221;; 2) <em>Stenotrophomonas<\/em> is real mouthful. Takes a while to learn how to say that comfortably &#8212; which is why, to many cystic fibrosis clinicians and patients, it&#8217;s just known as &#8220;steno.&#8221;<\/p>\n<p><strong><em>Enterobacter aerogenes<\/em> became <\/strong><em><strong>Klebsiella aerogenes.<\/strong>\u00a0<\/em>C&#8217;mon, that&#8217;s just mean, flipping one enteric gram-negative rod name to another. I suppose we&#8217;ll get used to it eventually, grumble grumble.<\/p>\n<p><strong><em>Rochalimaea henselae\u00a0<\/em>became <\/strong><em><strong>Bartonella henselae.<\/strong>\u00a0<\/em>These agents of cat scratch disease, endocarditis, bacillary angiomatosis, and peliosis hepatis haven&#8217;t been <em>Rochalimaea<\/em> for many years. But my friend Joel Gallant used to call my other friend Rochelle Walensky &#8220;Rochalimaea&#8221; long ago when they were at Johns Hopkins together &#8212; which just goes to show that we ID doctors have a <em>very<\/em> strange sense of humor, one that may be difficult to explain to others.<\/p>\n<p><strong><span title=\"synonym\"><em>Diphyllobothrium latum<\/em> became <em><span title=\"scientific name\">Dibothriocephalus latus.<\/span><\/em><\/span><\/strong><span title=\"synonym\"><span title=\"scientific name\"> This fish tapeworm of gefilte fish fame wasn&#8217;t easy to learn in medical school, so I&#8217;m going to resist this change for as long as possible. Note that even CDC hasn&#8217;t <a href=\"https:\/\/www.cdc.gov\/parasites\/diphyllobothrium\/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">updated their page<\/a>, <a href=\"https:\/\/www.uniprot.org\/taxonomy\/60516\" target=\"_blank\" rel=\"noopener noreferrer\">taxonomy notwithstanding<\/a>, so I appear to be on safe ground holding out at least for now. <em>Dibothriocephalus<\/em> indeed, hmmph. Try saying that three times fast.<\/span><\/span><\/p>\n<p><strong><em>Penicillium marneffei<\/em>\u00a0became <\/strong><em><strong>Talaromyces marneffei.<\/strong>\u00a0<\/em>This dimorphic fungus, endemic to Southeast Asia, causes disseminated disease in severely immunocompromised hosts. I always liked that we had a clinically important fungus that included the name <em>Penicillium,<\/em> reminding us of the source of our first beta lactam antibiotic. Oh well. This <em>Talaromyces<\/em> name is taking a while to get used to, probably because it&#8217;s not a common infection here.<\/p>\n<p><strong><em>Pseudomonas cepacia<\/em> became <em>Burkholderia cepacia.<\/em><\/strong> It hasn&#8217;t been <em>Pseudomonas cepacia<\/em> for ages. But did you know that <em>Burkholderia cepacia<\/em> is really at least two different species, <em>Burkholderia\u00a0multivorans<\/em> and <em>Burkholderia<\/em> <em>cenocepacia? <\/em>Isn&#8217;t microbiology fun?<\/p>\n<p><strong><em>Streptococcus bovis<\/em> became <em>Streptococcus gallolyticus<\/em><\/strong> &#8212; and a <a href=\"http:\/\/jcm.asm.org\/content\/54\/7\/1694.full\" target=\"_blank\" rel=\"noopener noreferrer\">whole host of other things<\/a>. Medical school curricula indelibly impart certain ID facts to every student &#8212; three of them are 1) daptomycin is inactivated by lung surfactant; 2) <a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/a-mysteriosis-about-listeroisis\/2011\/11\/05\/\" target=\"_blank\" rel=\"noopener noreferrer\">listeria and its various dietary associations<\/a>; and 3) endocarditis due to <em>Streptococcus bovis<\/em> should prompt a look for colon cancer. However, they haven&#8217;t yet gotten around to updating the species name, perhaps because hardly anyone remembers it. And did I mention that streptococcal taxonomy is confusing, irrational, and complicated? Sure I did, many times &#8212; and further reviewed the whole clinical world of clinical streptococcal infections <a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/id-learning-unit-clinically-important-streptococcal-infections-you-need-to-know\/2018\/04\/29\/\" target=\"_blank\" rel=\"noopener noreferrer\">here<\/a>.<\/p>\n<p>And last, but not least &#8230;<\/p>\n<p><strong><em>Ixodes dammini<\/em> became <em>Ixodes scapularis.<\/em> <\/strong>Hey, no fair &#8212; I have enough trouble with microorganism taxonomy, do I have to start keeping track of <del datetime=\"2019-06-03T10:56:07+00:00\">insects<\/del> arthropods too? All I know is that <a href=\"https:\/\/www.nytimes.com\/1991\/10\/13\/nyregion\/gustave-dammin-pathologist-80-authority-on-organ-transplants.html\" target=\"_blank\" rel=\"noopener noreferrer\">Gustave Dammin<\/a> was an esteemed pathologist here at the Brigham for many years, and studied both Lyme Disease and babesiosis. Which begs the question &#8212; is it an honor, or a curse, to have such a nasty little critter named after you? Let the debate begin.<\/p>\n<p>Any other name changes that deserve highlighting?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Why do many clinically important microorganisms change names? They haven&#8217;t married and taken their spouse&#8217;s name or gone to Hollywood and adopted a stage name. Instead, through the tireless work of microbiologists, taxonomists, and geneticists, they have undergone sufficient reclassification so that their old name just doesn&#8217;t make sense anymore. Or more graphically: Why do [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[616],"class_list":["post-9217","post","type-post","status-publish","format-standard","hentry","category-health-care","tag-microbiology"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9217","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=9217"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9217\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=9217"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=9217"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=9217"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}