- Volume 1, Issue 1, 2014

Actinomyces israelii usually causes chronic suppurative and granulomatous infections. Actinomyces bacteraemia is very rare but has been reported for A. viscosus, A. odontolyticus and A. naeslundii due to periodontal disease. We present a rare case of A. israelii bacteraemia.

A 55‐year‐old male with history of metastatic pancreatic cancer on chemotherapy through a portacath was admitted with sepsis with fever/tachycardia and worsening abdominal pain. Four sets of blood cultures grew A. israelii bacteria. The patient died from cardiopulmonary arrest within a week of being started on broad‐spectrum antibiotics. Negative blood cultures were never obtained, and the source of the bacteraemia could not be ascertained.

A. israelii bacteraemia described in this case is very rare. Determining the source of the bacteraemia would have been important in deciding the modality and length of treatment plan. However, the lack of such evidence in our case leaves these questions unanswered.

Group B Streptococcus (GBS) is a usual neonatal pathogen, but the incidence in adult populations has risen recently. Pregnant women are at a higher risk of developing this infection. Invasive GBS is increasingly being recognized as one of the major pathogens in periprosthetic joint infections, but native joint infections are still rare. Serious invasive GBS disease can occur in adults with significant underlying medical conditions such as human immunodeficiency virus and active intravenous illicit drug use, as seen in our patient.

We report the case of a 31‐year‐old man who presented with pain and decreased mobility of the right hip joint. He was human immunodeficiency virus positive and was actively abusing illicit drugs via the intravenous route. He was directly injecting into the groin, which contributed to setting up a focus of infection in the immediate vicinity, resulting in the development of bacteraemia and seeding the region by haematogenous spread. Magnetic resonance imaging revealed severe right‐sided sacroilitis and an iliopsoas abscess from direct contiguous spread. Culture of blood and pus from the iliopsoas abscess revealed GBS. The iliopsoas abscess was drained, and the patient was started on penicillin G therapy. The patient’s symptoms improved dramatically after just 2 weeks of therapy.

We present this unusual clinical setting and site of infection, to highlight the increasing incidence of GBS native joint infections in susceptible non‐pregnant adults. The focus of GBS infection in this patient was unique and atypical, probably representing a contiguous spread of infection from the site of illicit drug injections. With an increasing incidence of GBS infections in non‐pregnant adults, it must be considered among the differential diagnoses of patients presenting with septic arthritis. Early recognition of GBS septic arthritis and prompt institution of treatment might prevent long‐term and often debilitating sequelae.

Clostridium difficile is the leading cause of antibiotic‐associated diarrhoea and is a major burden to healthcare services worldwide. Fidaxomicin is a first‐in‐class macrocyclic antibiotic that was approved for the treatment of C. difficile infection (CDI) in 2011, demonstrating a narrow spectrum of activity and comparable efficacy to vancomycin in clinical trials.

We present the case of a patient with recurrent CDI who was non‐responsive to standard treatment with metronidazole and vancomycin. The patient subsequently developed toxic megacolon, which had to be treated surgically by subtotal colectomy. Fidaxomicin at 200 mg twice daily was delivered in small‐volume enemas directly to the oral part of the sigmoid colon to preserve the remaining rectosigmoid colon and improve the chances of restoring gastrointestinal tract continuity. After 11 days of local fidaxomicin therapy, diagnostic tests revealed that the patient was C. difficile negative and no recurrence of CDI was observed. Restoration of the gastrointestinal tract was successfully completed 5 months after hospital discharge.

This report describes a novel concept of local fidaxomicin delivery to the rectosigmoid colon, with an improved clinical outcome compared with metronidazole and vancomycin treatment. The study suggests that topical application of fidaxomicin may be beneficial in some CDI patients following surgical treatment for toxic megacolon.

bd, twice day−1; i.v., intravenously; MRSA, meticillin‐resistant Staphylococcus aureus; MSSA, meticillin‐sensitive S. aureus; od, once day−1; p.o., by mouth; tds, three times day−1

Bordetella petrii is an emerging pathogen. Whilst association with cystic fibrosis (CF) has been described previously, this is the first report to our knowledge of multidrug‐resistant B. petrii incidence in an Irish CF patient population.

Using a case series of four adult CF patients with varying baselines of health, one of whom was asymptomatic, this report attempts correlation of B. petrii colonization, by one common strain, with incidence of acute exacerbation of symptoms. As definitive guidelines for antimicrobial sensitivity/resistance do not exist for B. petrii, we completed a systematic review of available literature to collate evidence of antimicrobial efficacy against B. petrii. Comparison with the isolates in this study indicated B. petrii sensitivity to piperacillin/tazobactam and minocycline but resistance to antimicrobials in the macrolide, other β‐lactam and fluoroquinolone groups.

To our knowledge, this is the first report of multiple CF patients sharing a strain of B. petrii. Furthermore, B. petrii may be under‐identified in CF patients and should be considered when evaluating exacerbation of CF symptoms.

We present a rare case of hypocomplementaemic urticarial vasculitis in a 1‐year‐old girl with a coxsackievirus type A9 (CA9) infection.

At first, we thought that the patient had Kawasaki disease, but a skin biopsy showed overriding evidence of urticarial vasculitis and serum complement levels were severely reduced. Treatment with prednisolone was effective. We isolated and confirmed CA9 from all samples (nasal fluid, serum and stool). We also analysed CA9 genetically.

CA9 may induce systemic small‐vessel vasculitis resulting in transient decreases in complements.

Gordonia spp. have been recognized as pathogens in immunocompetent and immunocompromised patients, although infections remain a rare event.

We describe the second reported case of recurrent breast infection caused by Gordonia bronchialis in an immunocompetent patient.

Careful observation of the Gram stain from the abscess raised suspicion, and final identification was achieved with 16S rRNA gene sequencing analysis.

Corynebacterium glucuronolyticum is a non‐lipophilic coryneform species and a rare isolate from male patients with genitourinary tract infections. This organism is typically associated with urethritis or prostatitis syndrome, although it can also be isolated from other sites.

We describe a case of urethritis in a 24‐year‐old Croatian male caused by a strain of C. glucuronolyticum showing resistance to ciprofloxacin in an agar dilution susceptibility test procedure. The same drug was used as an empirical treatment before microbiological evaluation was conducted. Upon identification of the organism, the patient was successfully treated with doxycycline, which resulted in complete regression of symptoms and lack of growth of the organism in culture.

Although uncommon detection of this organism hinders research efforts, C. glucuronolyticum should always be regarded as a possible cause of urogenital infections in male patients. In addition, antibiotic susceptibility testing should be performed due to possible resistance.

Chryseobacterium indologenes is a rare pathogen in the human microflora. Nearly half of the published cases refer to nosocomial infections, and the vast majority of patients had underlying immunocompromising conditions. The clinical evolution is usually conducive to antibiotic treatment, but despite being low‐virulent bacteria, infections have often been associated with a high mortality rate as a result of the increased resistance to antibiotics, and the absence of a gold standard for management.

A 60‐year‐old male immunocompetent patient was admitted for acute onset of fever, abdominal pain and dysuria. Blood and urine cultures were positive for multiresistant C. indologenes, susceptible only to ciprofloxacin. Clinical improvement was observed on ciprofloxacin antibiotic therapy.

This is, to the best of our knowledge, the first Portuguese report of community‐acquired C. indologenes bacteraemia in an immunocompetent patient, a rare disease agent with low pathogenicity but capable of causing severe illness.