- Volume 1, Issue 2, 2014

Campylobacter fetus subsp. fetus has been reported to have vascular tropism.

C. fetus subsp. fetus aortitis was found in an 82‐year‐old woman who had already undergone aortic valve replacement. The diagnosis was confirmed by positive blood cultures, transoesophageal echocardiography and a positron emission tomography scan.

We report the first case, to the best of our knowledge, of aortitis on a native ascending aorta caused by C. fetus subsp. fetus and confirm the vascular tropism of these bacteria. The origin of the infection was supposedly raw meat ingestion (kreatophagia).

Cellulosimicrobium cellulans is a rare human pathogen that is associated with chronic immunosuppression, such as human immunodeficiency virus infection, post‐transplantation or end‐stage renal disease.

A 59‐year old man with a past medical history of significant cardiovascular, cerebrovascular and peripheral vascular disease was admitted to the intensive care unit (ICU) with intractable seizures. Physical examination, radiographic imaging and culture results suggested the patient had developed metabolic encephalopathy due to pneumonia caused by Staphylococcus aureus and Moraxella catarrhalis. The patient recovered neurologically with the use of broad‐spectrum antibiotics but developed acute renal failure during his stay. Seven days later, he relapsed into seizure activity and two separate blood cultures grew Cellulosimicrobium cellulans. Despite maximal antibiotic therapy, the patient continued to deteriorate. After 16 days, the patient’s family withdrew care and he subsequently died.

We report the isolation of Cellulosimicrobium cellulans from a patient who developed acute renal failure following a prolonged stay in the ICU for sepsis encephalopathy.

Vancomycin remains the mainstay in the treatment of meticillin‐resistant Staphylococcus aureus (MRSA) bacteraemia; however, concerns exist about its continued efficacy in the presence of rising MICs. Daptomycin serves as an alternative but has also witnessed increases in reduced susceptibility. Several published case reports have demonstrated the potential utility of ceftaroline as a viable therapeutic option for invasive MRSA infections, including endocarditis.

A 23‐year‐old pregnant female presented with complaints of foot pain and fevers up to 104 °F. Her past medical history included polysubstance abuse, hepatitis C, intravenous drug use and a right arm abscess 2 years ago due to MRSA. Daptomycin was started empirically due to an allergy (angioedema) to vancomycin. Blood cultures returned positive for MRSA and remained persistently positive for 10 days at which point ceftaroline was added. Subsequent positive blood cultures on day 12 revealed daptomycin‐non‐susceptible MRSA at an MIC of 4 µg ml–1. Consequently, daptomycin was discontinued and gentamicin was added. Blood cultures were negative by day 14 and the patient completed a total of 2 weeks of gentamicin and 4 weeks of ceftaroline after the first negative blood culture. The baby was born premature at 34 weeks and 2 days due to complications of pregnancy; however, no adverse effects of antimicrobial therapy were noted.

We describe the emergence of daptomycin‐non‐susceptibility during treatment and the successful eradication of persistent daptomycin‐non‐susceptible MRSA bacteraemia and endocarditis with a combination of ceftaroline and gentamicin in a pregnant female.

Streptococcus suis, an emerging zoonotic pathogen, causes invasive infections in persons who are in close contact with infected pigs or contaminated pork‐derived products. Although serotype 2 is the most prevalent type in S. suis infections in humans, to the best of our knowledge no human case caused by an unencapsulated strain has been reported previously.

A 53‐year‐old male alcohol misuser with liver cirrhosis was admitted with sepsis to a hospital in Sukhothai Province, Thailand. He had consumed a homemade raw pork product 3 days prior to the onset of illness. An isolate from blood culture was confirmed as S. suis by species‐specific PCR and 16S rRNA gene sequencing, and as untypeable by a coagglutination test. The absence of a capsule around the bacterial cells was also confirmed by transmission electron microscopy. The isolate was also confirmed as sequence type 28 by sequence typing, and analysis of the capsule locus detected disruption of the cpsE–cpsK region, which comprises an approximately 2.5 kb fragment that contains phosphatase and kinase genes.

We have identified the first human S. suis infection caused by an unencapsulated strain in a patient with liver cirrhosis. This unencapsulated strain was attributable to a mutation of the cps gene. Clinicians should be aware of the emergence of S. suis infection caused by unencapsulated strains, especially in patients with liver cirrhosis.

Anaerobic endocarditis is clinically indistinguishable from aerobic causes of endocarditis. This necessitates correct identification of pathogens and determination of their antimicrobial susceptibility for adequate selection of antibiotic therapy effective against these organisms. Clostridia include anaerobic, spore‐forming bacteria that cause a wide range of diseases and have been found to be associated with anaerobic endocarditis rarely.

We describe a case of prosthetic valve endocarditis in a 22‐year‐old man caused by Clostridium bifermentans. Infection was confirmed by culture and molecular identification of the bacterium. The patient was treated with antibiotic therapy with a favourable recovery.

Anaerobic bacteria are an uncommon but important cause of infective endocarditis and therefore correct diagnosis of rare species should not be ignored.

We present a fatal case of disseminated infection in a child with leukaemia, caused by Saprochaete capitata, an ascomycetous yeast.

The aetiological role of disseminated infection by S. capitata in a child with relapsed acute myeloid leukaemia following bone‐marrow transplantation was established by its repeated isolation from blood, tracheal secretion and urine samples. The identity of S. capitata was confirmed by phenotypic and molecular methods. The isolate showed reduced susceptibility to caspofungin.

This report indicates that patients receiving echinocandin prophylaxis are at risk of breakthrough infections caused by S. capitata or other arthroconidial yeast species. To the best of our knowledge, this is the first well‐documented case of S. capitata infection from the Middle East.

Cardiobacterium valvarum is a new member of the HACEK group (Haemophilus, Aggregatibacter, Cardiobacterium and Eikenella) of Gram‐negative bacteria.

We report a case of bicuspid aortic valve subacute bacterial endocarditis in a 36‐year‐old man presenting as an acute myocardial infarction, and review the clinical features of C. valvarum endocarditis.

Although rare, C. valvarum endocarditis appears to affect adult men with bicuspid aortic valves, and may be characterized by a high propensity for profound valvular destruction and embolic phenomena, necessitating prompt surgical intervention.

This case report describes the secondary infection of a total elbow prosthesis with the uncommon Gram‐negative organism Stenotrophomonas maltophilia. To our knowledge, this is the first reported case of an elbow arthroplasty being affected by this organism.

A 57‐year‐old male had a right total elbow replacement in 2009, which subsequently became infected with Stenotrophomonas maltophilia, eventually leading to an above‐elbow amputation.

This case highlights the importance of a combined surgical and microbiological approach for the difficult treatment of deep joint replacement infections. Although Stenotrophomonas maltophilia is currently a rare pathogen in infection following arthroplasty, given the increasing number of multidrug‐resistant organisms, it may represent a future challenge to both surgeons and microbiologists.

Primary sternal osteomyelitis caused by Mycobacterium tuberculosis is a rare manifestation of extrapulmonary tuberculosis.

We present a case of isolated sternal tuberculosis and review the demographic, clinical, diagnostic and therapeutic features of 32 published cases found in a systematic review of the literature. Patients with primary sternal osteomyelitis due to M. tuberculosis are often young and have no co‐morbidity. Diagnosis is frequently delayed. Common symptoms and signs are local swelling and a discharging sinus tract. Patients frequently have at least one systemic symptom, including fever, weight loss and night sweats. Our case and half of those found in the literature review were successfully treated with antituberculous drugs alone.

Treatment concepts for primary sternal tuberculosis are not established and are often derived from those of osteoarticular tuberculosis. These data point towards an interdisciplinary concept without surgery.

Mucormycosis is an aggressive infection that can cause significant disease in immunocompromised patients.

A case of a diabetic patient who developed rhinocerebral mucormycosis while receiving consolidation chemotherapy for leukaemia is described.

Rhizopus oryzae was identified in tissue biopsies by pan‐fungal PCR and DNA sequencing, which provided the only means to identify the pathogen.

Listeria innocua is widespread in food and the environment and is considered to be a non‐pathogenic bacterium in healthy subjects. To date, this species has only been associated with human diseases in a fatal case of bacteraemia in an elderly patient. Here, we describe a case of acute meningitis infection caused by this bacterium.

Our patient had an increased risk of infection because of treatment with etanercept and a corticosteroid given for rheumatoid arthritis. Etanercept use has been described previously as the possible cause of multiple Listeria monocytogenes infections (to date, four cases have been described, of which two were cases of arthritis and two of meningitis), but etanercept has never been associated with L. innocua meningitis. In our case, despite rapid identification of the pathogen and proper antibiotic treatment, the patient had an unfavourable outcome.

To the best of our knowledge, this report constitutes the first documentation of a case of meningitis due to L. innocua, and our experience serves as a warning to microbiologists and clinicians that L. monocytogenes is not the only Listeria sp. that can cause human meningitis.

An uncommon association of chronic odontogenic osteomyelitis and an abscess in the right mandibular region with facial actinomycosis of 6 months duration after several short‐term therapy failures is described.

The patient was a 55‐year‐old man with chronic inflammation of the right parotid area of the face. Actinomyces israelii, Fusobacterium nucleatum and Parvimonas micra were isolated from specimens of the subtemporal abscess. Therapy started as clarithromycin and was followed by amoxicillin/clavulanate because of the resistance patterns of co‐infecting F. nucleatum.

In this case of facial actinomycosis, a successful therapeutic outcome involved a prolonged therapy as well as the detection of drug‐resistant co‐existing anaerobic bacteria.

Kocuria spp. rarely cause infectious disease but can be opportunistic pathogens in immunocompromised patients. The numbers of documented infections are low but rising.

A 74‐year‐old woman presented with acute, painful swelling of the medial canthus of the left eye. The skin surface was red and acutely painful to the touch. Because of several clinical relapses despite antibiotic treatment, surgical dacryocystorhinostomy with marsupialization of the lacrimal sac into the nasal cavity was performed. Lacrimal sac drainage samples were analysed and yielded Kocuria. This is, to our knowledge, the first case of Kocuria dacryocystitis. Furthermore, the dacryocystitis was caused by a novel species of Kocuria, which we suggest should be named Kocuria ocularis.

Kocuria related to ocular infection has not yet been documented. This report expands the clinical spectrum of diseases caused by these potentially underestimated pathogens.

Pneumocystis jiroveci is the most common opportunistic infection in human immunodeficiency virus (HIV)‐infected patients. However, the infection is increasing in other immunosuppressive‐associated conditions, such as haematological malignancies, organ transplantation, connective tissues diseases, primary immunodeficiency and long‐term corticosteroid therapy. Here, we report a HIV‐negative subject.

Here, we report a human immunodeficiency virus (HIV)‐negative subject with chronic obstructive pulmonary disease (COPD), and mild hypogammaglobulinaemia, low levels of total CD19+ B‐cells, and a transitory decrease in IgG and IgG subclasses who evolved to recurrent Pneumocystis pneumonia (PCP). In addition, the patient was co‐infected with Candida spp., and developed oral and oesophageal candidiasis. He was treated with sulfamethoxazole/trimethoprim/pentamidine and improved significantly. Conclusion: These results suggest that, in HIV‐negative subjects, clinicians should be aware of the possible association between mild immunosuppressive illness and COPD in inducing PCP, even with normal levels of T‐cell subsets.

An official American Thoracic Society and Infectious Disease Society of America statement has shown that patients with pulmonary Mycobacterium avium complex (MAC) disease who complete 10–12 months of negative cultures on therapy but then have either single or multiple positive MAC cultures are more likely to have reinfection with a new MAC strain.

A 63‐year‐old woman was diagnosed with pulmonary disease caused by clarithromycin (CAM)‐susceptible MAC. Before initiating chemotherapy using a four‐drug regimen containing CAM, an investigation of the patient’s residential bathroom was conducted and one of the M. avium isolates recovered from the bathtub inlet was found to be genetically identical to sputum‐derived isolates by variable number tandem repeats analysis using M. avium tandem repeat loci (MATR‐VNTR). A second investigation of the bathroom during chemotherapy showed no M. avium isolates, and five consecutive sputum cultures were negative for 12 months until chemotherapy was discontinued. A recurrence occurred 3 months after the end of chemotherapy (at age 65 years). A third investigation of the bathroom was performed and MATR‐VNTR analysis revealed that the VNTR profile of the M. avium isolates recovered from the sputum at recurrence was identical to that of the isolates recovered from the sputum at initial diagnosis and the bathroom at the first investigation.

The recurrence occurred due to endogenous reactivation of the initial M. avium isolate despite drug treatment for 12 months after sputum culture conversion. Further genetic analyses of MAC isolates recovered from patients and environments should be encouraged.

Streptobacillus moniliformis causes rat‐bite fever, an underdiagnosed zoonosis occurring worldwide. A variety of animals including livestock and exotic mammals are known to be susceptible hosts for this species, but little information is available regarding infection in companion animals.

Following the necropsy of a domestic cat, bacteria displaying substantial characteristics of Streptobacillus sp. were cultured from pneumonic lung tissue. Streptobacillus‐like morphological features observed included strictly microaerophilic pleomorphic Gram‐negative rods with bulbar swellings that grew exclusively in the presence of serum. Significant shared biochemical properties included negative reactions for cytochrome oxidase, catalase, urease, nitrate reduction and indole production, as well as broad antimicrobial susceptibility. These characteristics are all indicative of Streptobacillus moniliformis. However, 16S rRNA gene sequencing revealed only 98 % sequence homology to type strain DSM 12112. A mass spectrometry analysis confirmed the affiliation of the domestic cat isolate described in this study with bacteria of the genus Streptobacillus, but matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry indicated that it differed from nine reference strains of Streptobacillus moniliformis isolated from various sources and host species.

This is the first evidence for clinical disease caused by a streptobacillary infection in a domestic cat.

Pseudomonas aeruginosa community‐acquired pneumonia is an extremely rare clinical presentation but has been recognized in anecdotal reports, even in previously healthy patients.

We describe a previously healthy man who developed P. aeruginosa community‐acquired pneumonia (CAP). He died of septic shock with rapidly progressive pulmonary consolidation in the right upper lobe (RUL). We reviewed the literature for P. aeruginosa CAP and identified 19 patients of whom 85 % (n = 17) had cavitations and/or consolidations in the RUL. We found that the odds ratio for death of shock at initial presentation was 8.333 (P = 0.046, 95 % confidence interval 1.034–67.142). We also found that P. aeruginosa CAP should be considered when individuals present with rapidly expanding cavitary pneumonia and/or consolidations in the RUL accompanied by septic shock, even if they have no known severe underlying disease and were previously healthy.

We showed here that radiological findings of P. aeruginosa CAP, such as cavitary pneumonia and/or consolidation in the RUL, might be a clinical clue to a diagnosis of CAP as well as the presence of septic shock.

Mycobacterium heraklionense is a newly described species member of the Mycobacterium terrae complex.

We have described a case of chronic tenosynovitis caused by M. heraklionense using 16S rRNA gene sequencing. The infection was associated with trauma and foreign‐body introduction in an otherwise healthy patient.

M. heraklionense appears to have worldwide distribution and has the ability to cause disease similar to other members of the M. terrae complex.

Linezolid resistance among Staphylococcus aureus has emerged almost exclusively in those organisms with methicillin resistance (MRSA). To our knowledge, recovery of linezolid‐resistant (LR) methicillin‐susceptible S. aureus (MSSA) from humans has been described in only a single case.

A 63‐year‐old Japanese man was referred for removal of an infected cardiac resynchronization device. He had received a 2‐week administration of linezolid approximately 6 months previously. LR MSSA (linezolid MIC = 8 μg ml−1) was recovered from purulent materials around the exposed generator and removed electrode leads, concurrently with linezolid‐susceptible (LS) MRSA and LS MSSA. The LR MSSA and LS MRSA demonstrated close genetic relatedness in a macrorestriction analysis and were categorized into the same molecular types (multilocus sequence type 239 and spa type t137), suggesting that they originated from an identical ancestor. The LR MSSA had a G2576T mutation in the 23S rRNA genes in two of five rrn operons.

Linezolid resistance may occur not only among multidrug‐resistant Gram‐positive organisms but also in those for which a number of antibiotics are still effective.