- Volume 2, Issue 5, 2015

The bacterium Mycoplasma capricolum subsp. capricolum is known as a pathogen in goats. There have been no reports on a zoonotic potential so far.

A case of septicaemia and meningoencephalitis in a 62-year-old patient has been associated with infection by M. capricolum subsp. capricolum. No other infectious agent could be detected.

Although it was impossible to identify the source of infection, coincidental contact with small ruminants or consumption of food products from goats during a tourist trip may have played a role.

Oligella infections are rare and have been only rarely reported in the literature. This may be due to the misidentification of Oligella as a Moraxella-like organism. To the best of our knowledge, we present what we believe to be the first case report on Oligella urethralis bacteraemia in India.

A 65-year-old female patient with compromising underlying illness presented with signs and symptoms of bacteraemia. The organism was initially identified as Fransciella tularensis by a bioMérieux colorimetric VITEK 2 Compact GN ID card, but 16S rRNA gene sequencing confirmed the isolate as O. urethralis.

The case emphasizes the importance of O. urethralis as an emerging opportunistic pathogen. Although automated systems allow accurate and rapid identification of commonly isolated bacterial organisms, they are less likely to correctly identify slow-growing, fastidious, rare or biochemically inert organisms. Therefore, it is good to confirm such isolates with a second method such as 16S sequencing and/or matrix-assisted laser desorption/ionization time-of-flight MS.

Myroides spp. are aerobic, yellow-pigmented, non-fermentative Gram-negative rods considered to be low-grade opportunistic pathogens. However, their intrinsic resistance to commonly used antibiotics necessitates prompt identification and evaluation.

Here, we report a case of septicaemia caused by Myroides sp. A 36-year-old pregnant female was admitted to the intensive care unit at week 18 of gestation with a diagnosis of hydatidiform mole with acute renal failure and anaemia. Blood culture under aerobic conditions showed growth of round, smooth, convex, yellow-pigmented colonies on blood agar but which failed to grow on MacConkey agar, and the organism was identified as Myroides sp. Susceptibility testing showed that it was susceptible only to piperacillin+tazobactam and, following treatment, the patient recovered.

Myroides spp. has, until now, been regarded as an opportunistic pathogen and a rare cause of serious disease in immunocompromised subjects. However, it may cause serious disease, even in immunocompetent hosts, and its intrinsic resistance warrants appropriate testing and timely intervention.

The most common cause of acute myocarditis in developed countries is viruses. Bacterial myocarditis is very rare and caused by various bacteria, but only three cases have been reported in the past where Shigella sonnei was the aetiology. Two out of the three cases reported were in a paediatric population.

A 38-year-old female was presenting with chest pain and an increased level of troponins with the EKG (electrocardiogram) showing non-specific T-wave changes. Preceding the chest pain, the patient had Shigella sonnei gastroenteritis confirmed by stool culture. The patient's cardiac catheterization showed normal findings. Thus a diagnosis of bacterial myocarditis was made. The event resolved after successful treatment of the gastroenteritis with ciprofloxacin.

We are reporting a very rare case of Shigella sonnei gastroenteritis that resulted in the development of acute myocarditis and was successfully treated with antibiotics.

Eggerthella lenta is an obligate anaerobic, non-spore-forming, Gram-positive rod found as a normal commensal of the human intestinal flora, which is capable of reducing digoxin into several metabolites. Disease caused by this micro-organism is unusual, although more frequent than reported.

A 74-year-old man presented to the emergency room and was admitted with a mild acute cholangitis syndrome. One anaerobic blood culture became positive after 5 days of incubation. After an additional 5 days, the usual aerobic subcultures were negative, whereas anaerobically incubated Columbia blood agar presented tiny smooth colonies. The isolate was capable of reducing digoxin and was identified as Eggerthella lenta. Adequate antibiotic treatment with meropenem had been started and the patient recovered fully.

We have described a patient with a potentially fatal bacteraemia with E. lenta that may have gone unnoticed. More case reports are necessary, not only to understand the pathogenicity and clinical course of infections by this neglected bacterium, but also to investigate its digoxin degradation and antimicrobial susceptibility variability.

Mycobacterium abscessus is a non-tuberculous mycobacterium ubiquitous in the environment, which rarely causes endovascular infections. We report the first published case, to the best of our knowledge, of M. abscessus endocarditis in a patient with Marfan syndrome.

A female in her 40s with a history of Marfan syndrome status-post mechanical aortic valve replacement and a chronic indwelling venous access port presented with a 2-day history of confusion and 3-month history of intermittent fevers. Her blood cultures grew M. abscessus. An echocardiogram revealed a 1 cm vegetation attached to the prosthetic aortic valve and a perivalvular abscess. The patient was started on imipenem/cilastatin, amikacin and linezolid. Her course was complicated by septic emboli to the brain and subarachnoid haemorrhage. She was deemed a poor surgical candidate. The patient ultimately developed cardiac arrest and died.

M. abscessus endocarditis is rare and is associated with high mortality. Late recognition of M. abscessus as a causative pathogen of endovascular infection, extensive antimicrobial resistance and limited surgical options at the time of diagnosis make the management of M. abscessus endocarditis very challenging.

Neonatal brain abscess is an uncommon intracranial suppuration that usually occurs as a complication of bacterial meningitis or septicaemia. Staphylococcus aureus rarely causes brain abscesses during the first months of life.

A case of a premature infant who developed cerebellar, left temporal and left occipital lobe abscesses after S. aureus sepsis is presented. The pus provided the same S. aureus strain of the sepsis. The patient was treated with vancomycin for 37 days, accompanied by extraction of the purulent material. The abscesses resolved and no sequelae remained.

It appears that long antibiotic treatment regimes, when associated with early pus drainage, are effective in resolving infection and abscesses caused by S. aureus in neonates.

Mycetoma is a chronic granulomatous inflammatory disease predominantly affecting the foot and hand. The cervical region is an uncommon site for mycetoma and spinal cord compression is a rare complication.

This communication reports on a 40-year-old male farmer from Western Sudan who presented with quadriparesis due to cervical spine cord compression caused by Actinomadura pelletieri actinomycetoma. His condition started with a small painless subcutaneous swelling in the right shoulder region that gradually increased in size to involve the right side of the neck and the cervical spinal cord ending in progressive quadriparesis. He made a good response to an extended course of antibiotics, but was left with mild disability.

A. pelletieri is an uncommon cause of actinomycetoma, and the clinical presentation of the reported patient is a rare and serious sequela of mycetoma. The literature contains only a very few reports on such presentation, and our case report will add to the knowledge and experience in managing such a presentation.

Porphyromonas endodontalis (formerly Bacteroides endontalis) is a black-pigmented, non-motile, obligate anaerobe. It has an established role in endodontal infections and has rarely been isolated from other sites. To the best of our knowledge, this is the first time that this organism has been detected as the sole cause of meningitis. This was made possible by the use of direct-on-sample 16S rRNA gene amplification and sequencing.

We present a case of meningitis that progressed to a cerebral abscess in an elderly but otherwise immunocompetent male. Despite broad-spectrum antibiotic therapy, the patient died.

Although anaerobic meningitis is rarely described, it should be considered if there are clinical and biochemical features of meningitis but no organism isolated on standard aerobic culture.

Cryptococcal meningitis is a disease that remains a significant cause of morbidity and mortality. This report describes the importance of conducting a detailed clinical investigation and the treatment challenges in cases of meningitis caused by Cryptococcus gattii. In recent years this species has received considerable interest due to its increased emergence and virulence.

A patient with apparent good health (a fitness practitioner) showed symptoms including intermittent headache that became more intense and frequent when he began experiencing nausea, vomiting, dizziness and temporal headache without nuchal rigidity. The patient had human immunodeficiency virus-negative serology and had no chronic disease. Analysis of cerebrospinal fluid was performed and cryptococcal meningitis was diagnosed. Immunophenotyping by flow cytometry evidenced the presence of an anomalous lymphoid population. RFLP analysis of the URA5 gene indicated Cryptococcus gattii genotype VGII and considerable virulence was observed for the isolated strain.

This case suggests the importance of a detailed investigation in patients who apparently have a competent immune system with meningitis caused by Cryptococcus spp., particularly C. gattii.

Enterohaemorrhagic Escherichia coli (EHEC) cause haemorrhagic colitis and haemolytic uraemic syndrome in humans. Although EHEC infection typically results in haemorrhagic colitis in all ages of human patients, in cattle it is usually limited to 1- to 5-week-old nursing calves.

A 1-year-old feedlot beef heifer was moribund with neurological signs and bloody diarrhoea. At necropsy, the colonic mucosa contained multiple grossly visible haemorrhagic erosions, each measuring < 1 mm in diameter. Histologically, foci corresponding to the gross erosions had E. coli O165 antigen-positive bacterial rods adherent to the apical surfaces of degenerate and necrotic colonic mucosal epithelial cells in association with attaching and effacing lesions, and also within cytoplasmic vacuoles in some of these cells. An E. coli O165 : H25 strain was isolated from the colonic mucosal tissue, and by microarray analysis was found to contain virulence genes corresponding to type III secretion system (T3SS) structure and regulation (cesD, cesT, escD, escF, escN/escV, escR, escT, ler, sepL, sepQ), T3SS effectors (espA, espB, espC, espD, espD, espF, espH, espJ, nleB, nleC, nleD, nleH, tir), serine proteases (eatA, espC, espP), Shiga toxin (stx 2), EHEC-haemolysin (ehxA), and adhesins [intimin-ϵ (eae-ϵ), type 1 fimbria (fimA, fimB, fimH), type IV pili (pilA, pilB, pilC, pilM, pilP, pilQ) and non-fimbrial adhesin (efa1/lifA)].

To the best of our knowledge, this is the first report of disease in cattle associated with EHEC O165 : H25 infection, the oldest bovine EHEC disease case with isolation of the pathogen and the first bovine case to demonstrate grossly evident, haemorrhagic, colonic mucosal erosions associated with EHEC infection.

We report a case of keratitis caused by a member of the Phoma species of fungi.

A 59-year-old contact lens wearer developed a non-healing corneal ulcer. Microbiological culture and subsequent PCR analysis were performed using samples obtained from corneal scraping. A fungus, phenotypically identified as a member of the Phoma species of fungi, was cultured. PCR from infected tissue confirmed the diagnosis.

Although rarely pathogenic to humans, members of the ubiquitous Phoma species of fungi can occasionally cause keratitis. Corneal microtrauma associated with contact lens wear is probably important in precipitating such infections.

Psittacosis is a zoonotic infectious disease caused by Chlamydia psittaci and most cases involve avian contact history. In humans, psittacosis induces symptoms ranging from mild ‘flu-like’ symptoms to serious atypical pneumonia. Unless specifically thought of, the diagnosis of psittacosis can be missed and the disease is usually treated as atypical pneumonia. Here, we detail cases of psittacosis related to pet birds.

A 16-year-old male was admitted with fever and persistent cough. The patient reported previous treatment with broad-spectrum antibiotics that led to limited improvement of his condition, and owning pet birds; thus, psittacosis was suspected. Serum samples from the patient were obtained and tested using a microimmunofluorescence assay, revealing an IgG titre of 64. An epidemiological investigation was conducted in five family members related to the patient; two possessed anti-C. psittaci antibodies (IgG titre = 64 and IgM titre = 20; IgG titre = 128 and IgA titre = 20). Additionally, C. psittaci DNA was detected by PCR carried out on the family's pet birds.

Psittacosis probably occurs more often than reported. Individuals with milder cases may not seek medical attention, and physicians may not inquire about bird exposure. There is a need for awareness campaigns directed at health workers and birds owners.

Corynebacterium ulcerans, a potentially toxigenic zoonotic agent, may produce diphtheria toxin and causes varied types of infections in humans. Cases of infection due to toxigenic C. ulcerans infection have been increasingly reported.

A 6-year-old Japanese girl who had been vaccinated using diphtheria toxoid presented with fever and swelling in the left neck. Ultrasonography showed cervical lymphadenitis with cellulitis. C. ulcerans was isolated from the drainage specimen. The infection was cured with erythromycin administration. Her anti-diphtheria toxoid antibody level was at an adequate level for diphtheria prevention on admission and was significantly increased 3 weeks later. Zoonotic infection was considered likely, because a family cat had shown rhinitis and skin ulcers prior to symptom onset in the child.

In addition to the number of reported cases of infection in adults, C. ulcerans infection in previously vaccinated children should also be a subject of concern in Japan.

Actinomyces neuii is a rare cause of peritoneal dialysis-related peritonitis.

A 66-year-old male had end-stage renal disease on peritoneal dialysis treatment for 30 months. He developed exit-site leak with infection. Diphtheroids were isolated and considered initially as skin commensals. Dialysis treatment was suspended and on reinstitution he developed peritoneal dialysis-related peritonitis. The organism isolated from the peritoneal dialysis fluid was A. neuii.

This case was treated successfully with peritoneal dialysis catheter removal and oral amoxicillin.

Campylobacter jejuni is the most common cause of human bacterial enteritis in developed countries and is a rare cause of extra-intestinal infections.

In this paper, we report a case of septic arthritis related to C. jejuni infection in an immunocompetent 53-year-old man with prosthetic devices who presented to us with enteritis. Following treatment with ciprofloxacin, loperamide hydrochloride and acetaminophen, he developed articular pain with painful swelling and redness in the region of the outer side of the left thigh. A diagnosis of a monoarticular non-migratory manifestation was postulated and vancomycin was started but was stopped 1 day later due to the development of skin erythema, and levofloxacin, teicoplanin and rifampicin treatment was started. An X-ray of the hip excluded dislocation of the prosthesis, while ultrasound showed an abscess in the soft tissue, confirmed by a triphasic bone scan. Aspiration of the joint fluid revealed the presence of moving, curved, Gram-negative bacilli 72 h after incubation, while growth on agar plates and tryptose broth remained negative after 5 days. Reactions for Campylobacter diagnosis were positive, and the micro-organism was identified as C. jejuni. Antimicrobial susceptibility tests revealed a sensitivity for ampicillin, ciprofloxacin, imipenem, tetracycline, erythromycin and gentamicin. Antimicrobial treatment was continued for a further 10 days with complete resolution of symptoms.

Clinicians should consider Campylobacter in infections without a history of a travel in the tropics. Antibiotic treatment must be carefully evaluated to take into account the local resistance to avoid clinical failure.

We present a case of cutaneous penicilliosis in a paediatric patient with acute myeloid leukaemia (AML).

A 2-year-old boy with AML first developed probable pulmonary aspergillosis during induction chemotherapy in an overseas centre in May 2013, and was treated with AmBisome and voriconazole. When he was admitted to our centre with relapsed AML in October 2013, he was given a fifth course of chemotherapy, and treated with AmBisome for probable pulmonary aspergillosis in view of pulmonary nodular opacities on computed tomography. He thereafter developed an erythematous skin lesion with central eschar on his right hand and left calf. Serum and bronchoalveolar lavage galactomannan antigen (GM Ag) indices increased to a value of >10. AmBisome was changed to voriconazole, and caspofungin was added for 10 days. The left calf skin biopsy showed abundant fungal hyphae with septations. A skin culture grew Penicillium citrinum with MICs (μg ml− 1) of: caspofungin 0.016, itraconazole 0.5, amphotericin 1.5 and voriconazole >256.Caspofungin and itraconazole were commenced, and voriconazole was discontinued. The skin lesions and serial GM Ag indices improved. The patient later developed increasing GM Ag indices to a value of >10, which was attributed to Aspergillus flavus left pulmonary mycetoma, which was surgically resected. He eventually succumbed to relapsed AML after a bone-marrow transplant.

To the best of our knowledge, this is the first paediatric case of P. citrinum infection. Rising GM Ag indices were attributed to cross-reactivity of Penicillium spp. with GM Ag enzyme immunoassays.

Neisseria meningitidis is a human pathogen with five serogroups causing the majority of invasive disease worldwide. Pharyngeal carriage of N. meningitidis is known to occur, but it is not considered a significant pathogen in skin and soft tissue infections secondary to human bites. We present a rare case of meningococcal septicaemia and pericarditis resulting from a human bite to the breast.

A 43-year-old female with type 2 diabetes mellitus and hypertension presented with fever, tachycardia, hypotension and a history of a human bite to the left breast. On examination, there was an erythematous, infected wound on the left breast. Blood cultures obtained on admission were positive for N. meningitides subtype W and the patient was treated for 7 days with intravenous ceftriaxone. However, the patient was readmitted 10 days later with a relapse of fever, dyspnoea and chest pain. A chest X-ray showed an enlarged cardiac silhouette, and echocardiography confirmed the presence of a large pericardial effusion. Intravenous ceftriaxone was recommenced and an urgent pericardiocentesis performed to relieve the cardiac tamponade. Blood cultures remained sterile and no organisms were detected from the pericardial fluid.

The patient unfortunately suffered a cardiopulmonary arrest and died while undergoing treatment. A post-mortem examination revealed myocardial necrosis and inflammatory debris within the pericardial sac. The most likely pathogenesis was considered to be inflammatory pericarditis secondary to meningococcal septicaemia with subsequent cardiac tamponade.

Melioidosis, a potentially life-threatening disease caused by Burkholderia pseudomallei, is common in Northern Australia and south-east Asia, but it is rarely encountered in the western world. However, due to increased travel, imported cases have been observed among tourists to endemic areas. The clinical manifestations are highly variable.

We report a case of melioidosis presenting as pyelonephritis/urosepsis in a previously healthy German tourist who had travelled to several endemic regions.

The described case highlights the fact that the diagnosis of melioidosis may be surprising to a routine diagnostic laboratory. An accidental and unwitting exposure of laboratory staff may occur before a definite identification is achieved. Good communication between the clinician and laboratory staff is crucial, especially with respect to travel histories.