- Volume 2, Issue 4, 2015

Listeria monocytogenes, the aetiological agent of foodborne listeriosis, can cause a severe and potentially fatal foodborne infection. Listeriosis is associated with acquired immunodeficiency or the underlying immunosuppression found in pregnant women, cancer patients and the elderly. Listeriosis emerged in developed countries in the early 1980s with the emergence of human immunodeficiency virus/AIDS and the popularity of minimally processed foods; however, few cases have been reported from developing countries. Here, we present a successfully treated case of listeriosis in a patient undergoing chemotherapy.

An elderly female patient with thyroid carcinoma metastasized to the lungs became seriously ill following the initiation of chemotherapy. The patient was admitted with symptoms of generalized convulsion and an altered level of consciousness and was treated empirically with meropenem, amikacin and linezolid injection. Cultures of blood and cerebrospinal fluid revealed Listeria monocytogenes on day 5 post-admission. The patient was treated with ampicillin (2 g intravenously every 4 h), which resolved the bacterial infection by day 9. To the best of our knowledge, this is the first diagnosed and successfully treated case of listeriosis in a cancer patient to be reported from Bangladesh.

Early diagnosis is critical for successful treatment of listeriosis. We recommend raising awareness among healthcare professionals about the diagnosis and treatment of this potentially fatal disease. Patients undergoing immunosuppressive treatments that elevate the risk of listeriosis should be monitored, and the medical histories of patients presenting with possible listeriosis should be carefully reviewed for immunosuppression. The incidence of listeriosis should be established to identify susceptible populations and to implement food safety procedures in this rapidly developing country.

The Gram-stained morphology of organisms from positive blood culture bottles often suggests diagnoses and therapeutic options. In vitro aggregate formation by the organism in this case led to initial confusion in the diagnosis.

A 57-year-old woman with a recent stroke returned to the emergency department with acute exacerbation of her neurological deficit. Although afebrile, she had an elevated white blood cell count. Urine analysis revealed 4+ blood, nitrates, leukocyte esterase and bacteria. Blood and urine cultures were collected and intravenous piperacillin/tazobactam treatment was begun. The urine culture grew >100 000 colonies Escherichia coli ml− 1; the antibiotic was changed to ceftriaxone when susceptibilities became available at 48 h. At 61 h, the aerobic blood culture bottle was flagged as positive. A Gram stain revealed spherical structures, which stained predominantly Gram-negative but were Gram-positive in some areas of the smear. Subcultures grew overnight on blood, chocolate and MacConkey agars and on brain–heart infusion (BHI) broth. Growth on MacConkey agar was sparse. A Gram stain of the snow-white, mucoid colonies revealed Gram-negative rods, spherical aggregates and thick-walled tetrads. Subsequent cultures on solid medium grew only Gram-negative rods, but inoculation of isolated colonies from these cultures into BHI broth or negative blood culture bottles caused the thick-walled spheres and tetrads to reappear.

MicroScan and matrix-assisted laser desorption/ionization time of flight failed to identify the organism, but 16S rRNA gene sequencing identified it as Roseomonas genomospecies 5 (100 % match). To the best of our knowledge, there are no reports in the literature of aggregate-forming Roseomonas.

Cephalotheca foveolata is a saprobic fungus recently described among clinical isolates.

A 59-year-old man presented with fevers, upper back pain and shortness of breath after gastric tube removal following an oesophagectomy, oesophagojejunostomy and gastrostomy for management of oesophogeal adenocarcinoma. He had a suspected oesophageal leak and polymicrobial empyema. Blood cultures grew only C. foveolata. He improved clinically on empiric antifungal and broad-spectrum antibacterial therapy.

We report a probable case of C. foveolata bloodstream infection. This is a newly recognized pathogen requiring molecular diagnostic methods to make an accurate diagnosis.

Group B Streptococcus (GBS) is a rare infectious endocarditis. Patients with GBS infective endocarditis have a high rate of local and systemic complications.

A 30-year-old male presented to the Emergency Department with fever, chills, fatigue and a recent onset of symptoms suggestive of stroke following a bout of pyelonephritis. Echocardiography confirmed a diagnosis of endocarditis and blood cultures grew GBS. Antibiotic therapy was initiated with penicillin G and gentamicin. Urological evaluation revealed a urethral stricture. He was taken to the operating room on hospital day 10 for the debridement of his aortic annulus, reconstruction of his aortic root and replacement of his aortic valve. On post-operative day 7, he died of sudden cardiac arrest. A large myocardial abscess located within the interventricular septum was identified post-mortem.

Recurrent or complicated urinary tract infections are rare among the young male population. Without evaluation and treatment for the underlying pathology, patients are at risk of developing antimicrobial-resistant infections, which may disseminate rapidly. Although a common pathogen of the urinary tract, GBS is a rare infectious agent for endocarditis. We propose urethral stricture as a risk factor for developing GBS endocarditis. Operative timing for these infections can be challenging; however, urgent and radical surgical debridement appears to yield favourable results.

Supraventricular re-entry tachycardia is a common neonatal and childhood illness often based on accessory pathways or dual atrioventricular-nodal physiology. However, there is only a limited description of atrial rhythm disorders associated with enterovirus infection. Publications of concurrent atrial tachyarrhythmia and hepatitis in infants are even rarer.

We report on a 3-month-old female patient with recurrent supraventricular re-entry tachycardia and concurrent hepatic inflammation due to systemic enterovirus infection.

Timely diagnosis of multisystem enterovirus infection helps to anticipate complications.

Viridans group streptococci (VGS), which are commensal flora in the oral cavity, can act as opportunistic pathogens causing serious infections such as infective endocarditis (IE). Species identification of these organisms is difficult because of variability in phenotypic traits among strains of the same species.

We report a case of endocarditis in a 64-year-old male patient caused by Streptococcus oligofermentans, which was identified by 16S rRNA gene sequencing. S. oligofermentans is a commensal of the oral cavity and rarely causes disease. This is the second report of IE caused by S. oligofermentans.

Molecular methods are necessary to ascertain the identity of VGS strains, particularly those that rarely cause human disease.

Acute bacterial supraglotittis in adults is a distinct although rare condition that differs aetiologically and clinically from the classic paediatric form of the disease. Only a handful of cases of supraglotittis produced by Neisseria meningitidis have been described in the literature.

Here, we present the first description, to the best of our knowledge, of meningococcal supraglotittis in an immunosuppressed patient, with unique features of rapidly progressive symptoms, septic shock and multiorgan compromise.

In view of the recent reports describing a growing incidence of this condition in adults, increasing awareness about its clinical features, natural history and potential complications is needed to enable early recognition and optimal management of emerging cases.

We present here a rare case of severe acute encephalopathy with extra-pulmonary symptoms in a two-year-old girl caused by human parainfluenza virus type 2 (HPIV2) infection.

The patient was brought in by ambulance, presenting with fever, hypoxia and generalized tonic-clonic seizure, and was admitted into Fukuyama Medical Center. She had a depressed level of consciousness with drowsiness. Her Glasgow coma score was 6. Based on the results of laboratory examinations, brain computed tomography, brain magnetic resonance imaging and electroencephalography, we diagnosed her with acute encephalopathy. Treatment was initiated with high-dose intravenous immunoglobulin, methylprednisolone pulse therapy and edaravone along with mechanical ventilation. We confirmed HPIV2 infection using samples of sputum from the intra-tracheal tube, throat swab and blood using next-generation sequencing and the PCR method. After continued steroid and anti-inflammatory therapy, the patient recovered completely.

Extra-pulmonary symptoms in parainfluenza viral infections are rare. HPIV2 infection can cause severe acute encephalopathy via a systemic immunological reaction along with airway symptoms.

This report describes 13 cases of fatal haemorrhagic enteritis in newborn calves.

Clostridium perfringens type A was isolated both from the intestinal contents of seven calves and from three visibly worn and soiled bucket teats and stomach tubes used for colostrum administration. After replacement of the colostrum delivery device and introduction of hygienic measures, no new cases appeared on any of the farms.

The results suggested that contamination of colostrum with C. perfringens caused these cases of neonatal haemorrhagic enteritis.

Amoebic colitis is a common worldwide infection with a risk of serious complications, including invasive intestinal and extra-intestinal disease. Although newer tests are available, the mainstay of diagnosis remains stool microscopy. Early treatment with metronidazole followed by paromomycin generally results in a clinical cure.

We describe a case of fulminant colitis secondary to Entamoeba histolytica requiring bowel resection that went unrecognized until the operative histology was reviewed.

Clinicians worldwide need to be aware of this condition, particularly in patients originating from endemic areas, to ensure early diagnosis and appropriate treatment leading to optimal clinical outcomes.

To the best of our knowledge, this is the first reported case of isolation of Cryptobacterium curtum from an infected site outside the oral cavity.

We report a patient who presented with fever and abdominal pain following an endoscopic procedure. Imaging confirmed a retroperitoneal abscess secondary to duodenal perforation complicating the endoscopic procedure. Surgical drainage of the abscess was carried out. Microbiological analysis of the pus revealed, among other bacteria, an anaerobic Gram-positive rod-shaped bacterium that was definitively identified as Cryptobacterium curtum by 16S rRNA gene sequencing. The patient improved after multiple episodes of retroperitoneal lavage and a prolonged course of antibiotics.

This case demonstrates that C. curtum can be isolated outside the oral cavity in polymicrobial infected sites. The pathogenic significance of this organism in contributing to pyogenic infection requires further study.

Candida infection of the salivary glands is extremely rare, and a parotid gland infection with Candida tropicalis in an immunocompetent patient has, to the best of our knowledge, never been described before.

A 76-year-old male with known bilateral oncocytic parotid lesions and antibiotic suppression therapy for a vascular endograft infection presented with fever and a tender red mass in the left parotid region. Although a bacterial infection of the parotid gland was suspected at first, cultures of parotid cyst aspirate yielded C. tropicalis. Once the Gram stain indicated the presence of yeast cells, fluconazole therapy was initiated. Follow-up after 3 weeks showed resolution of the infection and antifungal therapy was ceased.

With increasing and widespread antibiotic use, this case underlines the emergence of uncommon pathogens by antibiotic selection pressure. This shift in causative pathogens will not only result in an increase in Candida infections at known body sites but will also lead to infection of less common anatomical sites. Clinicians should recognize this trend and adjust their differential diagnosis accordingly.

Nocardia exalbida is an uncommon Nocardia sp., first described in 2006. We report a case of pulmonary infection due to this organism, which became evident after treatment of antecedent pneumococcal pneumonia.

A 68-year-old man was hospitalized because of pneumococcal pneumonia. Although his symptoms improved immediately after administration of anti-pneumococcal antibiotics, patchy opacity on the chest X-ray remained and pyrexia recurred. Administration of trimethoprim/sulfamethoxazole, given after seropositivity against human immunodeficiency virus type 1 was confirmed and Nocardia-like organisms were detected from the sputa, completely resolved his symptoms. The recovered organism was identified as N. exalbida by comparison of 16S rRNA gene sequences.

To the best of our knowledge, only six other cases of N. exalbida infection have been described. Most of these cases were reported from Japan, suggesting that the organism is more prevalent in this country than in other areas. The present case also highlights that underlying nocardiosis should be considered when an immunocompromised patient with acute bacterial pneumonia demonstrates refractory respiratory manifestations, despite receiving appropriate treatments.

Dimorphic fungi of the Sporothrix schenckii complex are the aetiological agent of sporotrichosis in humans and animals. Cats in particular have gained importance in transmission of the disease to humans. Therefore, it is crucial to identify unusual aetiological agents and the varying clinical appearances of the disease.

We describe the case of a 10-year-old cat with a 2-month history of nasal discharge after a fight with another cat. Severe thrombocytopenia was diagnosed, whilst routine testing for feline leukemia virus (FeLV) was negative. A computed tomography scan revealed profound destruction of several parts of the nasal cavity. Histological and cytological examination of biopsies taken from these locations showed a chronic pyogranulomatous inflammation with several yeast-like structures. Mycological cultivation at 28 and 37 °C yielded fungal growth with smooth to wrinkled colonies consisting of hyphae and non-pigmented sympodial, round to oval-shaped conidia. Molecular typing, including sequence analysis of the ITS region, resulted in a consensus sequence which allowed classification of the fungus into the Sporothrix schenckii complex. Although the thrombocytopenia persisted, treatment with itraconazole dissolved any respiratory symptoms and improved the clinical status of the cat, indicating an antimycotic-responsive infection.

Amelanotic members of the Sporothrix schenckii complex should be considered a putative aetiologic agent in the pathogenesis of feline sporotrichosis in Germany. Besides being classified in close proximity to species in the environmental clade this isolate has proven to cause serious infection implying a possible zoonotic potential.

Mycoplasma hominis frequently colonizes the adult genitourinary tract and causes significant diseases such as chorioamnionitis in adults. It also causes systemic infections such as pneumonitis and meningoencephalitis in neonates via vertical transmission. Here, we present a case of septic hip arthritis in a full-term neonate born to a woman who had intrapartum fever with premature rupture of the membranes.

A 0-day-old newborn female, whose mother had a significant history of intrapartum fever and 52 h of premature rupture of the membranes, developed a fever after birth. Empiric antimicrobial therapy was initiated for sepsis; however, the fever did not subside. Subsequently, she developed a subcutaneous scalp abscess and right hip joint arthritis despite continued cell-wall-active antimicrobial therapy. Blood and scalp lesion samples were found to be positive by bacterial culture, and pinpoint non-haemolytic colonies were observed on blood agar plates; however, no organisms were observed by Gram staining. Microbiological analyses using Mycoplasma-specific growth plates demonstrated that the samples were positive for Mycoplasma hominis, and PCR analysis was positive for 16S rRNA in blood, abscess and joint fluid samples. The patient was treated with surgical debridement and a 3-week course of clindamycin and was discharged from hospital without sequelae.

To the best of our knowledge, this is the first report of M. hominis causing septic hip arthritis in a neonate. Therefore, M. hominis should be included as a causative organism when treatment with empiric antimicrobial therapy is not effective in septic neonates.

The therapeutic choice for treating cutaneous leishmaniasis (CL) can be difficult, notably in countries where autochthonous cases are rare. In France, CL is mostly due to imported cases. Leishmania infantum, which is the endemic species in the French south-eastern region, is usually responsible for visceral leishmaniasis but rarely causes the autochthonous cutaneous form of the disease. Intralesional injection of antimonials seems to be the most recommended therapy in the latter case, but particular situations can justify the use of systemic amphotericin B (AmB).

We report and illustrate a French case of locally acquired CL due to L. infantum that was surprisingly unresponsive to systemic AmB, with clinical worsening and parasitic invasion of the lesion. Thereafter, the patient was successfully treated by intralesional pentavalent antimonial.

This case supports the choice of intralesional therapy as the first therapeutic option in L. infantum CL, an infrequent situation in France.

Pneumococcal pyomyositis is a rare disease. To our knowledge, only 28 cases of this disease have been reported in adults.

We report two new cases of pneumococcal pyomyositis managed at an inter-regional referral centre for bone and joint infections in the south of France. One of our patients had heterozygous sickle-cell disease, and the second had no apparent immunodeficiency. The pneumococcal pyomyositis was localized primarily to the psoas muscle and was complicated by hip arthroplasty infection in one of our cases. In the other case, it was localized to the abductor muscle, which has not been reported previously.

We report two new cases of this disease with favourable outcomes following long-term antimicrobial treatment and surgery debridement.

Bursitis is a rare complication of brucellosis that has only once been described in a country where disease has been eradicated in domestic animals.

A 63-year-old diabetic man presented with an 11-year history of painless swelling over his right knee. Magnetic resonance imaging (MRI) showed a large, multiloculated cyst overlying the knee joint. The patient underwent bursectomy which revealed caseous necrosis. Operative samples cultured Brucella abortus. The patient was treated with a combination of surgery and antimicrobials (doxycycline, rifampicin and gentamicin). His only risk factor for acquiring Brucella was drinking unpasteurized milk during childhood. Fifty eight cases of Brucella bursitis have been described in the English-language medical literature. Half have involved the prepatellar bursa. Only one case, from Australia, occurred in a country that has eradicated brucellosis in domestic animals. Although symptoms are often prolonged, local features of inflammation are usually absent. Diagnosis is primarily by bursal fluid culture. Treatment involves antimicrobials with or without aspiration or excision of the bursa. As the diagnosis was unexpected, several laboratory workers were exposed to the Brucella isolate before its identification. Follow up according to UK guidelines revealed no cases of occupationally acquired infection.

Bursitis is an unusual manifestation of brucellosis. It is extremely rare outside countries where the infection is endemic, but the chronicity of symptoms and increase in global travel mean that patients with the condition may present in non-endemic settings. Clinicians should therefore consider the diagnosis in cases of unexplained chronic bursitis.

Bacterial infection of the vertebral column is uncommon, but when it occurs, the meninges are at high risk.

A patient presented with acute-onset back pain and signs of inflammation, excluding an elevated white count and bacteraemia. Laminectomy specimens showed infection with Streptococcus pneumoniae. No previous source of possible seeding of the bacteria was identified.

The infection responded to intravenous ceftriaxone. This case informs us to be aware of infection in a case of back pain even without a prior source of infection.