- Volume 2, Issue 4, 2015

Staphylococcus lugdunensis is a coagulase-negative staphylococci that is increasingly being reported as a human pathogen.

Here, we describe a clinical case of urinary tract infection (UTI) due to S. lugdunensis in a 70-year-old woman with cystocele grade 3 who was successfully treated with cotrimoxazole. Although S. lugdunensis has rarely been reported to cause urinary tract infections and especially in immunosuppressed patients, we describe a case of UTI caused in an adult without the presence of an indwelling catheter or immunosuppression.

S. lugdunensis can be a urinary tract pathogen in adults without the presence of indwelling catheters or other obvious medical problems. Urine cultures that show S. lugdunensis should not be attributed to skin contamination, especially when the clinical findings are compatible with cystitis or pyelonephritis.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus. The disease is found most commonly in the liver and lungs, but no organ is immune. Patients with hydatid cysts at unusual locations present with atypical presentations and pose a diagnostic dilemma.

A 25-year-old woman presented with complaints of pain in the lower abdomen. Ultrasonography revealed cystic disease of the ovary. An exploratory laparotomy was done and the ovary with the cyst was removed. The diagnosis of hydatid cyst was confirmed on histopathology.

Primary involvement of the pelvic organs, especially the ovary, is very rare in hydatid disease. A high index of suspicion is required in order to make a correct diagnosis pre-operatively to prevent spillage of the cyst contents during surgery.

The number of fungal infections caused by uncommon fungi has increased in recent years. Cyberlindnera fabianii is a yeast species that is a rare cause of human infections. In previous cases, isolation of Cyberlindnera fabianii has been reported only from blood specimens and only infrequently. This report describes what we believe is the first case of isolation of Cyberlindnera fabianii from a urine specimen of an immunocompromised 5-year-old child who had a history of prolonged hospitalization and exposure to multiple antibacterial agents and who was neutropenic.

A 5-year-old male child presented in paediatric emergency in a febrile (103 °F), conscious but confused and irritable state. A number of risk factors were present in the child including an immunocompromised state, prolonged prior hospitalization, exposure to multiple antibiotics, indwelling catheters and neutropenia. A urine culture showed pure and significant growth of Candida sp., which was identified as Candida utilis (resistant to amphotericin B) by Vitek 2 Compact (bioMérieux). Subsequent 26S rRNA gene sequencing identified it as Cyberlindnera fabianii.

Molecular assays have a major role in confirming the identity of uncommon fungal isolates, as correct identification is important for epidemiological purposes. It is imperative that antifungal susceptibility should be performed along with identification of the Candida sp.

Klebsiella pneumoniae is a common human bacterial pathogen known to cause invasive infections such as primary liver abscesses, necrotizing fasciitis, meningitis and endophthalmitis with bacteraemia among patients in eastern Asia. Over the last decade, geographical spread and emergence of invasive K. pneumoniae infection has occurred in the USA. The majority of reported cases involve males with diabetes mellitus, of Asian ethnicity and who have recently travelled to Asia.

We identified eight invasive cases with liver abscesses and necrotizing fasciitis at our institution. The most common risk factors associated with invasive infection were male gender and diabetes mellitus, which is consistent with other reported cases. However, Caucasians and Hispanics represented the majority of invasive disease (n = 7), and history of recent travel to Asia was not identified in any of the cases.

Further studies with larger cohorts involving multiple healthcare institutions in the USA are warranted to confirm these two unusual characteristics of infection. Healthcare professionals should be informed of the possible association between K. pneumoniae and invasive disease in male diabetic persons of non-Asian descent and without recent travel to Asia in the USA.

Haemophilus influenzae has the potential to lead to invasive disease including necrotizing fasciitis, especially in immunocompromised individuals. There are only eight previous reports of monomicrobial necrotizing fasciitis due to this organism, and, to the best of our knowledge, none of the head and neck. There is also limited epidemiological and clinical data on infections caused by non-b serotypes of H. influenzae, including serotype e.

A 60-year-old female, with systemic lupus erythematosus, Sjogren's syndrome and hypocomplementaemia, presented with rapidly progressive right-sided facial and neck pain, swelling and erythema. She was treated initially with broad-spectrum antibiotics and underwent emergent debridement of the infected tissues. Intraoperative cultures and blood cultures grew H. influenzae. She required two additional debridements and was treated with ceftriaxone for 3 weeks with resolution of her symptoms.

Here, we present the first reported case, to the best of our knowledge, of cervical necrotizing fasciitis due to H. influenzae serotype e. This case highlights the continued clinical importance of H. influenzae as a cause of invasive disease, including necrotizing fasciitis, particularly in immunocompromised individuals. Moreover, the case provides an example of invasive H. influenzae infection caused by a non-b serotype, an emerging concern in the era of widespread H. influenzae serotype b vaccination.

Staphylococcus intermedius group (SIG) comprises coagulase-positive staphylococci isolated from veterinary wounds, with anecdotal association of this pathogen and disease in humans. To date, 28 human cases have been described in the literature. Here, we described four cases of human infection caused by SIG members and, through a literature review, identified potential common characteristics and risk factors for this infection.

Cases were obtained via electronic query of existing microbiology records for S. intermedius isolates at three teaching hospitals in Denver, CO, USA, between 2003 and 2008. Four cases were identified. Three cases were soft tissue and/or bone infection and one case was a urinary tract infection.

Staphylococcus intermedius infections in humans are rarely identified. Dog ownership as well as diabetes or other causes of immunosuppression may place patients at higher risk. Misidentifying SIG infections could lead to delays in treatment as well as undertreatment of this zoonosis.