- Volume 1, Issue 3, 2014

Bartonellosis has not been described previously in Greenland. Here, we present a case of infective endocarditis due to Bartonella quintana in a patient living in western Greenland.

A 68‐year‐old man from Disko Island in western Greenland underwent aortic valve replacement because of infective endocarditis. Culture from blood and tissue was negative. PCR of bacterial DNA and DNA sequencing revealed DNA from B. quintana in the valve, and the finding was confirmed by species‐specific PCR.

This case demonstrates the presence of B. quintana in Greenland. The finding emphasizes the importance of testing for unexpected agents when culture fails to identify the cause of a severe disease.

Linezolid has excellent activity against multidrug‐resistant Staphylococcus spp. and linezolid resistance has emerged mainly in isolates recovered from patients who are receiving courses of oxazolidinone therapy.

We report a clinical case of bacteraemia caused by a linezolid‐resistant Staphylococcus epidermidis clone ST‐2 with the G2576T mutation in five copies of the 23S rRNA gene (MIC, 32 µg ml−1) isolated from a patient who did not receive any course of oxazolidinone therapy. The S. epidermidis HSPE24‐SP strain was WT for L3, L4 and L22 ribosomal proteins, cfr negative and indistinguishable by PFGE from the clone that circulated at the same time in another tertiary care hospital located in the same city.

This report suggests the inter‐hospital spread of S. epidermidis clone ST‐2 and calls attention to the possibility of isolation of a linezolid‐resistant strain with multiple 23S rRNA mutated copies in an environment under no oxazolidinone selective pressure.

Cryptococcal infection is the second most common life‐threatening, opportunistic infection in human immunodeficiency virus (HIV)‐infected individuals after Mycobacterium tuberculosis. Most cryptococcal infections start in the respiratory tract and secondarily involve the central nervous system, skin and bone marrow but rarely disseminate to lymph nodes.

Cases of disseminated cryptococcal lymphadenitis with or without meningitis have been reported in HIV‐infected as well as immunocompetent HIV‐negative individuals. Here, we report a rare case of isolated cervical cryptococcal lymphadenitis without meningitis in an immunocompetent HIV‐negative child diagnosed by fine‐needle aspiration cytology (FNAC) of the involved lymph nodes.

Clinical presentations of extrapulmonary cryptococcosis in HIV‐positive hosts are variable and vague. The present case scenario proves that the same might also be true for HIV‐negative individuals. FNAC is a quick, feasible, economical and reliable method for the diagnosis of cryptococcal lymphadenitis when correlated with microbiological, biochemical and histopathological examinations.

Infections due to Staphylococcus aureus are cumbersome to treat and control. Virulent S. aureus is commonly coagulase positive, whilst non‐virulent isolates are coagulase negative. Literature on coagulase‐negative variants of S. aureus and their role in clinical disease in neonates is seldom available.

We report a case of an extremely low‐birth‐weight pre‐term infant who had persistent recalcitrant infection with coagulase‐negative methicillin‐sensitive S. aureus, which resulted in clinical sepsis, thrombocytopaenia and persistence in blood cultures for 7 weeks. The API STAPH‐Ident system (Bio‐Merieux) and 16S rRNA gene sequencing were used to confirm identity. Parallel use of blood culture yielded an isolate with the same phenotypic identity.

Prompt identification of uncommon phenotypes of S. aureus also requires the use of appropriate molecular diagnostics to necessitate timely treatment of life‐threatening systemic infections in neonates.

This report describes the first case, to the best of our knowledge, of pacemaker‐induced endocarditis due to Gordonia bronchialis.

Pacemaker‐induced endocarditis due to G. bronchialis infection was determined in a 92‐year old man. This Gram‐positive bacillus failed to be identified by matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry technology, whereas the taxon was indexed in the database. 16S rRNA and rpoB gene sequencing were required to determine the correct strain identity.

Infections caused by G. bronchialis remain a rare phenomenon affecting immunocompromised patients and/or medical device carriers. Molecular tools may be necessary to ensure accurate identification.

Gordonia spp. are a rare but recognized cause of bloodstream infections (BSIs), particularly catheter‐related BSIs (CR‐BSI). These infections are mostly associated with long‐term central catheters and occur in immunocompromised patients. Their optimal management is still uncertain due to the paucity of cases.

We describe a case of CR‐BSI by Gordonia terrae in a bone‐marrow transplant patient. Definitive diagnosis of the CR‐BSI was confirmed by using the differential time to positivity of blood cultures. The patient was treated with antibiotic therapy without catheter removal and the infection cleared despite the presence of persistent bacteraemia.

Although in the present case report persistent CR‐BSI bacteraemia by G. terrae cleared without catheter removal, further experience is required to confirm that these infections can, in some cases, be successfully treated while retaining the catheter.

Mycobacterium simiae can cause disseminated infection in human immunodeficiency virus (HIV)‐infected patients, mainly with involvement of pulmonary and reticulo‐endothelial systems. Although this organism is also known to cause infections in non‐HIV‐infected individuals, to our knowledge there has been no report of pericardial effusion caused by M. simiae.

We describe a case report with massive pericardial effusion caused by M. simiae in a non‐HIV‐infected female patient, who presented with complaints of gradually increasing breathlessness and cough over a period of 1 month. Acid‐fast bacilli were isolated from the pericardial effusion and subsequently confirmed as M. simiae by PCR‐RFLP.

In an area where Mycobacterium tuberculosis infection is endemic, clinicians and microbiologists must be aware of the possibility of a non‐tubercular mycobacterial infection that could be misdiagnosed as a tubercular infection.

Cavernous sinus thrombosis (CST) is a rare manifestation of cerebral venous thrombosis. We herein describe the first case of CST associated with the oral microbes (Dialister pneumosintes, Slackia exigua and Prevotella baroniae).

An 82‐year‐old previously self‐supported Japanese woman presented with acute onset of impaired consciousness. Computed tomography revealed intracranial haemorrhage complicated with CST. D. pneumosintes, Slackia exigua and P. baroniae were cultivated from two sets of blood cultures and were identified with 16S rRNA sequencing. The patient was successfully discharged after ampicillin–sulbactam treatment, which was performed soon after admission.

To our knowledge, this is the first description of CST caused by D. pneumosintes, Slackia exigua and P. baroniae. CST should be considered in cases of unusual distribution of cerebral haemorrhage.

A 41‐year‐old man with a history of alcoholic cirrhosis presented to Patan Hospital in Kathmandu, Nepal, with a severe headache.

Clinical examination found an isolated sixth nerve palsy of the left side with normal blood parameters and a normal brain scan. An initial cerebrospinal fluid analysis found lymphocytosis, with a significantly elevated protein level and reduced glucose. Tubercular meningitis was considered; however, the patient did not improve and a re‐examination of the cerebrospinal fluid confirmed cryptococcal meningitis.

After diagnosis the patient was treated with amphotericin B. Despite all efforts the patient died 5 days later.

Streptococcus suis is a zoonotic pathogen transmitted to humans from infected pigs. Nearly all human cases of S. suis are caused by serotype 2 organisms, and meningitis is the best‐documented type of human infection. On rare occasions, S. suis can be transmitted to humans from wild boars.

Here we report a case where S. suis of serotype 14 was transmitted from a wild boar to a previously healthy 63‐year‐old man, causing meningitis, spondylodiscitis, a psoas abscess and a prolonged post‐infectious inflammatory condition. The infection was treated with a long course of β‐lactam antibiotics, but signs of inflammation were relieved only after the addition of corticosteroids. The isolate was found to harbour the virulence‐associated gene sly.

S. suis of serotypes other than type 2 can be transmitted to humans from wild boars and the disease may become complicated. Increasing numbers of wild boars in some European countries calls for increased vigilance to this type of infection.

Achromobacter xylosoxidans is a water‐borne organism that causes healthcare‐associated infections and has been isolated from blood, cerebrospinal fluid, stool, urine, sputum, peritoneal fluid, skin, ear discharge, wounds, abscesses, bone, joints, endocardium and central venous catheters, mostly in immunocompromised patients.

We describe here the rare case of a young immunocompetent alcoholic male admitted with symptoms of acute pancreatitis who failed to improve with conventional management. Blood culture later showed the growth of A. xylosoxidans. The patient improved when he was treated with antibiotics as per the sensitivity report.

Although Achromobacter is rarely isolated from clinical samples, it should never be assumed to be a contaminant as this infection has propensity for progression to fatal bacteraemia, even in apparently healthy individuals.

Antibiotic‐associated diarrhoea (AAD) is one of the most common side effects of antibiotic therapy. The main mechanism associated with the development of AAD is significant changes in the composition and quantity of the gut microbiota during the treatment with antibiotics. Probiotic bacteria have been shown to stabilize the gut microbiota and can be used to prevent diarrhoea associated with antibiotic therapy.

We present the results of a single‐centre, randomized, double‐blinded, placebo‐controlled clinical trial. Patients were randomized into three groups: probiotic group 1 received a probiotic containing strains Bacillus subtilis 3 and Bacillus licheniformis 31; probiotic group 2 received a probiotic, containing B. subtilis 3; and the placebo group received an inert composition in vials, formulated to be indistinguishable from the vials with probiotics. Participants received one vial twice a day. Probiotic treatment significantly reduced incidents of AAD in the patients. Among 91 patients in group 1 treated with probiotic mix, nine developed AAD. In group 2, seven patients out of 90 who received only one probiotic strain developed AAD. A considerably higher incidence of AAD was registered in the placebo group – 23 from 90 patients (P<0.001 vs groups 1 and 2). Both probiotics demonstrated a significant effect in the prevention of nausea, bloating, vomiting and abdominal pain.

Treatment with Bacillus probiotics during antibiotic therapy significantly decreased the incidence of AAD and adverse effects related to the use of antibiotics. Both probiotics were well tolerated by the patients without side effects. No significant difference was found in the efficacy of the two probiotics.

Trichuris suis, also called whipworm, is a parasite of the caecum and colon distributed widely and considered as a fairly common parasite in swine. It may be responsible for porcine trichurosis characterized by diarrhoea, anorexia, growth retardation, dehydration, emaciation and anaemia.

This report presents a case of trichurosis diagnosed in a farrow‐to‐finish Belgian pig herd. The infection was associated with severe and persistent diarrhoea, growth retardation, emaciation and/or anaemia in 10 recently purchased gilts and in fattening pigs. In gilts, levamisole [8 mg (kg body weight)−1] administered once per os gave a good clinical response, as diarrhoea resolved in nine gilts out of 10. In parallel, for these nine gilts, the number of eggs of T. suis (g faeces passed)−1 decreased from 12 400 to less than 100 eggs. In fattening pigs, flubendazole (1 mg kg−1) administrated over 5 days in drinking water allowed a reduction in the number of T. suis eggs g−1 and was effective against diarrhoea.

Although most of the time pig whipworm infections are light and asymptomatic, in some cases when large numbers of worms are present, they can cause watery to bloody diarrhoea that can lead to anaemia. This less frequent disease should not be forgotten in the differential diagnosis of persistent diarrhoea in growing pigs.

Non‐typhoidal Salmonella (NTS) are commonly implicated in causing bacteraemia in infants, the elderly and immunosuppressed individuals in sub‐Saharan African countries. However, NTS bacteraemia in otherwise healthy adults from India has been rarely reported. Here, we report a case of bacteraemia caused by Salmonella enterica serovar Choleraesuis (S. Choleraesuis), isolated simultaneously from the blood and urine of an adult febrile patient from Kolkata, India.

A middle‐aged man was admitted to a private hospital in Kolkata with clinical suspicion of acute enteric fever on 25 October 2013. His blood report showed neutropenia and mild thrombocytopenia, with an elevated C‐reactive protein level. The Widal test was negative. S. Choleraesuis isolates were grown simultaneously by microbiological culture of blood and urine samples. The patient recovered without complications following antibiotic therapy. On further characterization, both of the S. Choleraesuis isolates showed identical antibiotic‐susceptibility patterns and virulence‐gene, plasmid and PFGE profiles, confirming their clonality (100% similarity).

This is the first report of S. Choleraesuis bacteraemia associated with a human infection in India. The identification and reporting of uncommon Salmonella serovars from various countries are important for understanding the global epidemiology of salmonellosis.

Enterococci are prevalent human pathogens that display increasing resistance to antimicrobial agents. Twelve species pathogenic for humans have been described to date, including the most common human isolates, Enterococcus faecalis and Enterococcus faecium. Enterococcus hirae is a known member of the intestinal flora of several domestic animal species but rarely encountered in humans.

We report a case of multiple splenic abscesses caused by E. hirae in an adult patient diagnosed with type 2 diabetes mellitus. The patient responded to combined therapy with antibiotics plus splenectomy.

Only 9 human infections due to E. hirae have been reported in the literature. To our knowledge, this is the first reported case of splenic abscess and septicemia caused by E. hirae.

Raoultella ornithinolytica is a Gram‐negative bacillus. This bacillus was until recently often confused with Klebsiella spp. It is known primarily for causing histamine fish poisoning or scombroid syndrome, and rarely causes human infections. This case report discusses a patient who presented with generalized primary peritonitis due to R. ornithinolytica.

A 53‐year‐old Scandinavian man resident in Botswana, sub‐Saharan Africa, presented to the emergency department shortly after onset of lower abdominal pain and dysuria. He was treated for urinary tract infection and discharged. He came back after 16 h with more severe, generalized abdominal pain and a fever of 38 °C. Abdominal sonography was unremarkable. Examination confirmed peritonitis, particularly marked in the right iliac fossa. He had mild leukocytosis 13.1×109 l−1, a C‐reactive protein level of 372.7 mg l−1 and his serum albumin level was 31 g l−1. He was admitted for parenteral antibiotics, laparoscopic peritoneal lavage and appendectomy. He had 500 ml of free pus in the abdomen with no evident focal source. A pus swab grew R. ornithinolytica. The pathology showed mild early acute appendicitis with severe periappendicitis and suppurative peritonitis. He was discharged home after 7 days of parenteral antibiotics.

R. ornithinolytica infections are rare in humans, but they can be life‐threatening.

Disseminated fusariosis is a devastating disease in severely immunocompromised patients and is associated with high lethality.

We describe a patient with severe disseminated fusariosis presenting initially as tonsillitis. Fusarium solani was isolated from cultures of the tonsils, skin and blood, while histological evidence for fungal tissue invasion was detected in tissue samples of the tonsils, tongue, oesophagus, lungs, myocardium, intestine, kidney, mediastinal lymphnodes and skin. Susceptibility testing revealed resistance to voriconazole, posaconazole and caspofungin, and susceptibility to amphotericin B. The patient died, despite treatment with amphotericin B, due to multiorgan failure and refractory cardiac arrhythmia.

Tonsillitis was the primary clinical manifestation of disseminated fatal fusariosis in this immunocompromised patient. It is important to know the spectrum of primary manifestations of less commonly encountered moulds in order to guide clinical decisions and early targeted therapy.

Prior to the introduction of a paediatric conjugate vaccine in the early 1990s, Haemophilus influenzae serotype b (Hib) was a major cause of childhood meningitis and pneumonia. Since becoming part of national immunization programmes, the Hib conjugate vaccine has been very successful in preventing invasive Hib disease worldwide. However, in the post‐Hib vaccine era, the emergence of invasive disease caused by non‐type b H. influenzae has been reported from several countries. Previous studies by our group found an increased incidence of invasive disease caused by H. influenzae serotype a in Northwestern Ontario, Canada, during 2002–2011. Most of the cases of invasive H. influenzae type a disease occurred in young children.

Our continued surveillance identified a case of epiglottitis caused by H. influenzae type a in a 65‐year old woman. This life‐threatening condition was historically associated with invasive Hib disease in young children but had not previously been reported in association with H. influenzae type a. We describe the clinical presentation of this case as well as characteristics of the H. influenzae type a isolate.

Our findings stress the importance of continued surveillance of H. influenzae in the post Hib‐vaccine era, and point to the significance of H. influenzae type a as a cause of severe invasive disease in countries with a universal paediatric anti‐Hib immunization programme.