- Volume 2, Issue 2, 2015

Moesziomyces spp. are connected with poaceous plants (Grass family), and Moesziomyces bullatus is commonly associated with smut in pearl millet. Currently, the scientific knowledge of this pathogen is limited to only a few taxonomic studies and there are no clinical reports that describe the isolation of M. bullatus from humans.

A female neonate born prematurely at 32 weeks of gestation was referred to the University Teaching Hospital in Jos, Nigeria, with a provisional diagnosis of preterm low birth weight at risk for sepsis. The birth weight of the newborn was 2000 g and her body temperature on admission was 34.3 °C. Blood cultures revealed the presence of a fungal isolate that was identified as M. bullatus by molecular methods. This fungus showed high MIC values for anidulafungin, caspofungin and micafungin, as well as fluconazole and 5‐flucytosine, and exhibited varying degrees of susceptibility to itraconazole, amphotericin B, posaconazole and voriconazole. To the best of our knowledge, this is the first case of a human M. bullatus bloodstream infection.

Here, we report the first case of an unusual human infection caused by the fungal plant pathogen M. bullatus and highlight a high level of resistance to classical and modern antifungal drugs.

Melioidosis is an emerging infection in South Asia. It has a spectrum of presentation causing many difficulties in early diagnosis and the control of infection. Here we report a rare case of melioidosis causing an inguinal sinus in a Sri Lankan male.

This 54‐year‐old male had recurrent admissions to hospital with multiple acute infections including acute inguinal lymphadenitis, left lobar pneumonia and septic arthritis of the left knee joint. He was treated with short courses of antibiotics. Blood cultures revealed no bacterial growth. Ultrasound scan of the abdomen showed multiple loculated abscess formation typical of melioidosis. Repeat blood culture in selective Ashdown's medium was positive for the growth of Burkholderia pseudomallei. He was treated with ceftazidime and imipenem for 4 weeks but was lost to follow‐up before starting an eradication regimen. Later, he presented with a large left inguinal sinus and a draining sinus in the left thigh.

Presence of multiple septic foci in this patient within a short span of time was due to discharge of bacilli into the bloodstream from the hidden infection in the spleen. This is a good example of an immune organ itself acting as a source of infection under suboptimal immune response. This case also highlights the importance of full screening and complete eradication of the infection at the initial diagnosis before establishment in relatively avascular tissues.

Nocardia puris is a rare cause of infection worldwide, with very few published cases. Here we report the first case to our knowledge of brain abscess caused by N. puris.

Our patient, currently undergoing treatment with rituximab for non‐Hodgkin lymphoma, presented with a 2 week history of worsening headache and nuchal rigidity. Magnetic resonance imaging of the brain revealed a ring‐enhancing mass in the right temporal lobe. The abscess was surgically resected and the causative organism was identified as N. puris by culture and then 16S PCR of the rRNA gene. Our patient was successfully treated with a combination of imipenem and trimethoprim–sulfamethoxazole (15 mg kg−1 day−1) for 3 months, followed by 9 months of monotherapy with trimethoprim–sulfamethoxazole.

Treatment of nocardiosis remains challenging, with each species having a unique antimicrobial susceptibility profile. Our patient was successfully treated with a combination of imipenem and trimethoprim–sulfamethoxazole, followed by monotherapy with trimethoprim–sulfamethoxazole.

Over the past 20 years there has been an increasing awareness of a distinct invasive clinical syndrome caused by Klebsiella pneumoniae in patients from Asian descent.

Here we report two cases of invasive K.pneumoniae infection in Asian patients who both presented in Glasgow, UK, with liver abscesses within a 6‐month period.

Clinicians should be vigilant for mucoid strains of K. pneumoniae isolated from patients with liver abscesses of Asian descent and thorough in their investigation for metastatic complications.

We report Aspergillus antigen and antibody responses in a case of multiple invasive fungal diseases.

The patient, a double‐lung transplant recipient, had candidaemia and invasive pulmonary aspergillosis with cerebral involvement. The follow‐up of the serum Aspergillus galactomannan antigen by ELISA showed a level increase that correlated with the patient’s aggravation. It was retrospectively completed by kinetics analysis using different anti‐Aspergillus antibody assays (ELISA and Western blotting).

A balance between the Aspergillus antigen and anti‐Aspergillus antibodies was shown using different anti‐Aspergillus antibody assays. The results of these two antibody techniques appeared rather congruent.

The treatment of chronic Pseudomonas aeruginosa infections is challenging, with resistance and antibiogram diversity accumulating during successive therapies. Some isolates are resistant to all licensed agents, creating treatment problems and an urgent need for new therapies. Among antibiotics in advanced development, ceftolozane/tazobactam has potent in vitro antipseudomonal activity, with low MICs even for strains with AmpC β‐lactamase‐, impermeability‐ and efflux‐mediated resistance to other β‐lactams.

A bronchiectasis exacerbation in a 59‐year‐old man involved pan‐resistant P. aeruginosa. Meropenem/colistin therapy failed. Named‐patient ceftolozane/tazobactam 2+1 g every 8 h for 14 days restored baseline respiratory and inflammatory marker status, and the patient was discharged; the ceftolozane/tazobactam MIC was 8 µg ml−1, with most growth inhibited at 2 µg ml−1.

A positive outcome in this difficult infection due to an otherwise pan‐resistant P. aeruginosa is notable, especially as the patient had failed prior therapy with other agents. We urge formal evaluation of ceftolozane/tazobactam in chronic pseudomonal lung infections.

Bursitis may arise from non‐infectious and infectious aetiologies. Clinically, distinguishing one from the other can be challenging. Aseptic retrocalcaneal bursitis is a common disorder among athletes and physically active people. In contrast, infectious (septic) bursitis, although a common diagnosis in the olecranon and prepatellar bursa, has rarely been reported in the retrocalcaneal bursa.

Here, we present an unusual case of retrocalcaneal septic bursitis as a complication of a delayed‐healing heel wound in a patient with underlying calcific insertional Achilles tendinopathy and aseptic retrocalcaneal bursitis.

Physicians should be aware of this clinical entity as a possible complication of a heel wound and initiate appropriate management if an infectious process is suspected.

Bordetella hinzii has been isolated mainly from respiratory specimens and from blood of immunocompromised patients, and Bordetella trematum from ear infections or leg, arm and ankle wounds and from diabetic foot ulcers. Bordetella holmesii is instead associated with bactaeremia in young adults, mostly with underlying conditions. Only three septic arthritis cases due to this species have been described in the literature.

Herein we describe four cases of infections due to Bordetella species that have been recovered from unusual infection sites: two cases of B. hinzii infections, one recovered from the urine of a patient with chronic prostatitis and the other from a liver cyst in an immunocompetent patient; one B. trematum case from a bone biopsy of a patient with chronic osteomyelitis of the hip; and one B. holmesii case isolated from the joint fluid of an immunocompetent patient with diagnosed septic arthritis. The organisms were identified using standard biochemical tests, by API 20 NE version 6.0, by automated system VITEK 2, by mass spectrometry using the Bruker Daltonics MicroFlex LT spectrometer with MALDI Biotyper 3.1, and by PCR amplification of 16S rRNA.

Antibiotic susceptibility testing was performed using the VITEK 2 system, except for B. holmesii, for which the epsilometric method (Etest technique; bioMérieux) was used.

We highlight the importance of isolating Bordetella species from severe infections and unusual sites, and also of combining both phenotypic and genotypic methods for definitive identification.

Actinobaculum schaalii is a Gram‐positive facultative anaerobic coccoid rod bacterium that grows slowly in culture. This bacterium was classified as a new genus in 1997 but is often overlooked or considered a contaminant because of both its resemblance to the normal bacterial flora on skin and mucosa and the overgrowth of other bacteria. During the past decade, A. schaalii has emerged as a more common urinary tract pathogen than previously thought.

Here, we describe the case of a patient with an untreated A. schaalii urinary tract infection that turned into urosepsis.

This case shows that the invasive potential of this bacterium should not always be ruled out.