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Abraham Tareq Yacoub
Jayasree Krishnan
Ileana M. Acevedo
Joseph Halliday
John Norman Greene *
(*) Corresponding Author:
John Norman Greene |



Nutritionally variant Streptococci (NVS), Abiotrophia and Granulicatella are implicated in causing endocarditis and blood stream infections more frequently than other sites of infection. Neutropenia and mucositis are the most common predisposing factors for infection with other pathogens in cancer patients. In this study we investigated the clinical characteristics of NVS bacteremia in cancer patients and identified risk factors and outcomes associated with these infections.

 Materials and Methods

We retrospectively reviewed all cases of NVS bacteremia occurring from June 1999 to April 2014 at H. Lee Moffitt Cancer Center and Research Institute. The computerized epidemiology report provided by the microbiology laboratory identified thirteen cancer patients with NVS bacteremia. We collected data regarding baseline demographics and clinical characteristics such as age, sex, underlying malignancy, neutropenic status, duration of neutropenia, treatment, and outcome.


Thirteen patients were identified with positive NVS blood stream infection. Ten patients (77%) had hematologic malignancies, including chronic lymphocytic leukemia (CLL) (1), multiple myeloma (MM) (1), acute myelogenous leukemia (AML) (4), and non Hodgkin’s lymphoma (NHL) (4).  The non-hematologic malignancies included esophageal cancer (2) and bladder cancer (1).


NVS should be considered as a possible agent of bacteremia in cancer patients with neutropenia and a breach in oral, gastrointestinal and genitourinary mucosa (gingivitis/mucositis).

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Article Details

Author Biography

John Norman Greene, Section Chief, Division of Infectious Diseases and Tropical Medicine - Moffitt Cancer Center, Tampa FL Professor of Medicine


Provide the following information for the Senior/key personnel and other significant contributors in the order listed on Form Page 2.
Follow this format for each person.  DO NOT EXCEED FOUR PAGES.



John N. Greene MD FACP



Professor, Division of Infectious Disease & International Medicine


eRA COMMONS USER NAME (credential, e.g., agency login)


EDUCATION/TRAINING  (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable.)



(if applicable)



College of William and Mary, Williamsburg, Virginia



Biology and Psychology

University of South Florida College of Medicine,

Tampa, Florida




University of South Florida College of Medicine, Tampa, Florida



Internal Medicine

University of South Florida College of Medicine, Tampa, Florida



Infectious Disease


A.        Personal Statement

Dr. John N. Greene received his medical degree from the University of South Florida College of Medicine, Tampa, Florida.  He is a Professor of Medicine and currently the Section Chief, Division of Infectious Diseases and Tropical Medicine and Senior Member of the Blood & Marrow Transplant department at Moffitt Cancer Center, Tampa, FL.  He is affiliated with numerous committees, community outreach projects, associations, and boards.  He is an accomplished speaker and writer, having published over 166 manuscripts in peer reviewed journals and has been a speaker for over 160 invited presentations.  He has written and published one book, and written over 30 chapters in other books.  Dr. Greene has been a mentor to hundreds of medical students throughout his career and has taken many students with him on his yearly medical mission trips to third world countries


B.        Positions and Honors


1994-present               “Moffitt Angel” Award (Patients’ Family Request).

1996-present               Citation, “The Best Doctors in America: Southeast Region.”

1997                                        Physician of the Year, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL

1998                                        “Doctor of the Day”, Florida Senate, Tallahassee, FL

2003                                        Nomination for “Outstanding Sophomore Instructor” by the graduating class, University                                                                                of South Florida College of Medicine, Tampa, FL

2003                                        “The Leonard Tow 2003 Humanism in Medicine” Award, “In Recognition of Exemplary                                                                              Compassion, Competence and Respect in the Delivery of Care,” The Arnold P. Gold


2005                      Election to the Gold Humanism Honor Society in Recognition of Exemplary Service to Others

2006                      USF Department of Internal Medicine Faculty Award for H. Lee Moffitt Resident Teaching Award.      

2007-2008             Selected by peers “Best Doctors in America® 2007-2008”

2008-2009                               Biographical candidate representing industry in the Who’s Who Among Executives and                                                                              Professionals “Honors Edition”

2009-2010                               Selected by peers “Best Doctors in America® 2009-2010”

2010-2011                               Who’s Who of Executives Professionals and Entrepreneurs 2010-2011

C.        Selected Peer-reviewed Publications

Marela Velez, Beata Casanas, John N. Greene*, Jose Morey, Dominick Mastroianni, Richard Oehler – Pasteurella multocida Infections in Cancer Patients - Asian Biomedicine Vol. 4 No. 3 June 2010; 449-455


Pham T, Greene JN*, Sandin RL, Vincent AL, Messina J. – A Chronic Nodular Hand and Forearm Lesion  - Infectious Diseases in Clinical Practices “Images in ID – What’s Your Diagnosis? – Vol. 18, No. 4, July 2010; 261-263


Knapp CF, Tucci VT, Keeler JA, Sandin RL, Greene JN*, - Primary Cutaneous Acremonium Infection in a Neutropenic Patient After Trauma – Infectious Diseases in Clinical Practices  – Vol. 18, No. 4, July 2010; 277-278


Choudhry A, Tucci V, Greene JN*, - Disseminated Bipolaris Infection – Review Article:  Infectious Diseases in Clinical Practices Vol. 18, No. 5, September 2010; 296-298


Li, Y, Greene JN, Sandin RL, - “Recurrent Soft Tissue Infection Seventy Years After Initial Trauma”.  – Images in ID – What’s the Diagnosis?  Infectious Diseases in Clinical Practice, November 2010:18:389-391


Greene JN – Prevention of Infections in Patients with Hematologic Malignancies – The spectrum of infections is changing as microbes take advantage of neutropenia – National Comprehensive Cancer Network (NCCN) 5th Annual Congress:  Hematologic Malignancies 2010, pages 30-33


Rivera, RJ, Alrabaa, SF, List, A, Greene, JN*.,  “Successful Treatment of Refractory Disseminated Mycobacterium Abscessus infection using Gamma Interferon” – Case Report - Infections Diseases in Clinical Practices –  Vol. 19, Issue 2,  March 2011;142-145


Prince MD, Suber JS, Aya-ay ML, Cone Jr. JD, Greene JN, Smith Jr. DJ, Smith PD, - “Prosthesis Salvage in Breast Reconstruction Patients with Periprosthetic Infection and Exposure” Plas. Reconstr. Surg. 129: 42, June 2012


Lortholary O, Obenga G, Biswa P, Cailott D, Chachaty E, Bienvenu AL, Cornet M, Greene JN, Herbert R, Lacroix C, Grenouillet F, Raad I, Sitbon K, Troke P; the French Mycoses Study Group – An International, Retrospective Analysis of 73 Cases of Invasive Fusariosis Treated  with Voriconazole – Antimicrobial Agents Chemotherapy, Vol. 54, No. 10, Oct. 2011, p. 4446-4450


Stein, M, Palumbo, B., Letson, DG, Bui, MM, Sandin, RL, Greene, JN – Case Report – “A Case of Coccidioides Synovitis of the Knee Presents Clinically as Pigmented Villonodular Synovitis” Infectious Diseases in Clinical Practice.  (1)6:439-441, November 2011


Osterndorf B., Oehler RL, Greene JN – Case Report “Human Staphylococcus intermedius Infection in a Patient with Post-radiation Changes – Infectious Diseases in Clinical Practices 19(6);426-427, November 2011


Prince MD, Suber JS, Aya-Ay ML, Cone JD Jr, Greene JN, Smith DJ Jr, Smith PD. Prosthesis salvage in breast reconstruction patients with periprosthetic infection and exposure. Plast Reconstr Surg. 2012 Jan;129(1):42-8. PubMed PMID: 22186499.

Manry, Matthew; Cox, Jennifer; Casanas, Beata; Quilitz, Rod; Greene, John N.  Rituximab-Associated Occurrence of Disseminated Miliary Tuberculosis Infectious Diseases in Clinical Practice. 20(1):82-84, January 2012.


Givins P, Velez AP, Sandin RL, Quilitz RE, Greene JN* – Development of Enteroviral Meningoencephalitis Following Rituximab Treatment for Non-Hodgkin’s Lymphoma - Infectious Diseases in Clinical Practice  - July 2012;20(4):291-293


Casanas BC, Kass J, Pathak A, Tucci V, Payor A, Vincent AL, Greene JN*, Sandin RL, - 1 Non-gastrointestinal Aeromonas Hydrophilia Infections in Cancer Patients –  Infectious Diseases in Clinical Practice – July 2012;20(4):268-271

D.        Research Support



1. Senn L, Entenza JM, Greub G, et al. Bloodstream and endovascular infections due to Abiotrophia defectiva and Granulicatella species. BMC Infect Dis. 2006. 20;6:9.

2. Ruoff KL. Nutritionally variant streptococci. Clin Microbiol Rev. 1991;4(2):184-90.

3. Cargill JS, Scott KS, Gascoyne-Binzi D, et al. Granulicatella infection: diagnosis and management. J Med Microbiol. 2012;61(Pt 6):755-61.

4. Perkins A, Osorio S, Serrano M, et al. A case of endocarditis due to Granulicatella adiacens. Clin Microbiol Infect. 2003;9(6):576-7.

5. Koh YR, Yi J, Kim HH, et al. Discrepant satellitism for identification of Granulicatella adiacens isolates. Ann Lab Med. 2014;34(2):174-6.

6. Bouvet A, van de Rijn I, McCarty M. Nutritionally variant streptococci from patients with endocarditis: growth parameters in a semisynthetic medium and demonstration of a chromophore. J Bacteriol. 1981;146(3):1075-82.

7. Giuliano S, Caccese R, Carfagna P, et al. Endocarditis caused by nutritionally variant streptococci: a case report and literature review. Infez Med. 2012;20(2):67-74.

8. Ormerod LD, Ruoff KL, Meisler DM, et al. Infectious crystalline keratopathy. Role of nutritionally variant streptococci and other bacterial factors. Ophthalmology. 1991 Feb;98(2):159-69.

9. Fukuda R, Oki M, Ueda A, et al. Vertebral osteomyelitis associated with Granulicatella adiacens. Tokai J Exp Clin Med. 2010;35(4):126-9.

10. Namdari H, Kintner K, Jackson BA, et al. Abiotrophia species as a cause of endophthalmitis following cataract extraction. J Clin Microbiol. 1999;37(5):1564-6.

11. Shivappa SG, Kulkarni M, Oral B. Granulicatella elegans bacteremia & meningitis in a child without neurosurgical interventions. IOSR Journal of Dental and Medical Sciences . 2014;13(9):PP 01-04

12. Wang Y, Xue J, Zhou X, et al. oral microbiota distinguishes acute lymphoblastic leukemia pediatric hosts from healthy populations. PLoS ONE. 2014. 9(7): e102116

13. Liao CH, Teng LJ, Hsueh PR, et al. Nutritionally variant streptococcal infections at a University Hospital in Taiwan: disease emergence and high prevalence of beta-lactam and macrolide resistance. Clin Infect Dis. 2004;38(3):452-5.

14. Murray CK, Walter EA, Crawford S, et al. Abiotrophia bacteremia in a patient with neutropenic fever and antimicrobial susceptibility testing of Abiotrophia isolates. Clin Infect Dis. 2001;32(10):E140-2.

15. Lopardo H, Mastroianni A, Casimir L. Bacteremia due to Abiotrophia defectiva in a febrile neutropenic pediatric patient. Rev Argent Microbiol. 2007;39(2):93-4.

16. Ohara-Nemoto Y, Tajika S, Sasaki M, et al. Identification of Abiotrophia adiacens and Abiotrophia defectiva by 16S rRNA gene PCR . J Clin Microbiol. 1997;35(10):2458-63.

17. Roggenkamp A, Leitritz L, Baus K, et al. PCR for detection and identification of Abiotrophia spp. J Clin Microbiol. 1998;36(10):2844-6.

18. Biermann C, Fries G, Jehnichen P, et al. Isolation of Abiotrophia adiacens from a brain abscess which developed in a patient after neurosurgery. J Clin Microbiol. 1999;37(3):769-71.

19. Gould FK, Denning DW, Elliott TSJ, et al. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J. Antimicrob. Chemother. 2012;67(2): 269-289.

20. Lin CH, Hsu RB. Infective endocarditis caused by nutritionally variant streptococci. Am J Med Sci. 2007;334(4):235-9.

21. Bouvet A, Cremieux AC, Contrepois A, et al. Comparison of penicillin and vancomycin, individually and in combination with gentamicin and amikacin, in the treatment of experimental endocarditis induced by nutritionally variant streptococci. Antimicrob. Agents Chemother. 1985;28(5):607-611

22. Shelburne SA 3rd, Lasky RE, Sahasrabhojane P, et al. Development and validation of a clinical model to predict the presence of β-lactam resistance in viridans group streptococci causing bacteremia in neutropenic cancer patients. Clin Infect Dis. 2014;59(2):223-230.

23. Yacoub AT, Mojica L, Jones L, et al. The Role of Corticosteroids in Adult Respiratory Distress Syndrome caused by Viridans Group Streptococci Bacteremia in Neutropenic Patients. Mediterr J Hematol Infect Dis. 2014;6(1):e2014055.

24. Bullard KM, Dunn DL. Bloodstream and intravascular catheter infections. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available from:

25. O'Grady NP, Alexander M, Burns LA, et al. Summary of recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections. Clin Infect Dis. 2011;52(9):1087-1099

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