- Volume 2, Issue 6, 2015

Achromobacter xylosoxidans is a non-fermentative aerobic Gram-negative bacillus, which most frequently causes nosocomial infections. Endocarditis from the pathogen has only rarely been reported and has a near-fatal outcome without surgical intervention.

We present a case of A. xylosoxidans endocarditis and septic arthritis in an infant affected by generalized arterial calcification of infancy. The patient was successfully treated with 6 weeks of intravenous colistin, meropenem and trimethoprim/sulfamethoxazole.

This is the first reported case of colistin used to treat A. xylosoxidans endocarditis. We discuss the antibiotic challenges of treating multidrug-resistant A. xylosoxidans endocarditis in a patient who is not a surgical candidate.

Diagnosis of infections due to Mycobacterium tuberculosis has been recently facilitated with the worldwide implementation of rapid molecular tests. However, the diagnosis of non-TB mycobacteria (NTM) remains a major challenge for laboratories, as this group of bacteria contains over 150 different species with highly variable bacteriological properties. The development and implementation in clinical practice of techniques allowing rapid identification of NTM at the species level is, therefore, important for clinical laboratories. We report the case of an HIV-1 positive patient presenting with severe NTM infection who benefited from a novel rapid diagnostic technique, based on the direct sequencing of the rpoB gene from smear-positive clinical samples.

A 43-year-old HIV-1 positive woman was hospitalized for bicytopenia in the presence of an inflamed supraclavicular lymph node. The diagnosis of disseminated Mycobacterium genavense infection, which involved the bone marrow and several lymph nodes, was missed by conventional mycobacteriological techniques. Identification was obtained by performing direct sequencing of the rpoB gene.

We describe a novel technique that allows the rapid diagnosis of NTM infections directly from biological samples. This technique is now implemented in our routine workflow for smear and culture-positive samples, after the exclusion of TB, by rapid molecular assays.

Toxoplasma gondii is a parasite estimated to infect one-third of the global population, surviving in tissues in a latent form. Although cerebral toxoplasmosis is predominantly recognized as an opportunistic infection in hosts immunocompromised secondary to human immunodeficiency virus or bone marrow transplant, there is increasing recognition that this infection can occur in patients receiving immunomodulating agents such as mAb therapy targeted against T-cells, B-cells and TNF. The indications for these therapies are expanding, resulting in a larger at-risk population for this rare but serious and potentially avoidable complication.

This is one of the few case reports of cerebral toxoplasmosis following rituximab-based chemotherapy in a patient with a haematological malignancy. We describe a patient presenting with focal neurological deficits and radiographic evidence of multi-focal cerebral ring-enhancing lesions following completion of rituximab therapy for splenic marginal zone lymphoma. Brain biopsy confirmed a diagnosis of cerebral toxoplasmosis. Antibiotic treatment with trimethoprim/sulfamethoxazole resulted in near-complete radiological and clinical resolution of the neurological deficits, and a return to baseline functional status.

Reactivation of toxoplasmosis resulting in intracerebral disease is a potential severe and preventable complication of rituximab therapy. Further studies are required to assess the need both for screening and prescribing primary chemoprophylaxis for toxoplasmosis when initiating rituximab therapy.

Cerebral aspergillosis is a highly fatal infection. Its origin is most likely blood-borne from the lungs and most patients are immunosuppressed. Mortality is over 90 % and the treatment chosen is key for survival.

We report a 32-year-old female with a history of acute myeloid leukaemia (M3) who was admitted to the hospital due to a nodular infiltrate in the right superior lobe. A lung computed tomography (CT) scan displayed a right upper lobe cavitated nodule. A brain CT scan showed a right hemisphere deep abscess. Pulmonary aspergillosis was diagnosed after bronchoalveolar lavage. Three weeks later, while on antifungal treatment with voriconazole and liposomal amphotericin B, she suffered left motor focal deficits, and brain abscess puncture and aspiration by neuronavigation were performed for diagnosis and decompression. A PCR assay was positive for Aspergillus fumigatus. One week later, she developed an intraventricular brain haemorrhage requiring external ventricular drainage and intrathecal fibrinolysis with recombinant tissue plasminogen activator. She eventually achieved a good neurological outcome. A control brain CT showed an important reduction in mass size.

Antifungal treatment is the mainstay for brain abscess treatment, and its combination with stereotactic needle aspiration is a better option compared with open surgery, particularly in abscesses located in deep motor areas.

We report an unusual case of Campylobacter jejuni bacteraemia in a patient with Philadelphia chromosome-positive, BCR-ABL-positive chronic myelogenous leukaemia in complete cytogenetic and major molecular remission after dasatinib/IFN therapy.

On admission, the patient presented with fever and acute haemorrhagic diarrhoea. Initial empiric antibiotics consisted of ceftriaxone and metronidazole. Stool and blood culture samples were collected and submitted for evaluation; these specimens were processed as per laboratory protocol. Several Gram-negative, spiral rods could be identified microscopically in Gram-stained slides from bottled blood and stool cultures. Isolate identification was performed on the Vitek 2 system using a GN identification card and API Campy strips and by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Discrepant identification was obtained between the Vitek versus the API Campy test and MALDI-TOF. Erythromycin susceptibility testing was done using an Etest, whereas all other susceptibility testing and breakpoint analysis was done following the EUCAST procedure. Initial empiric antibiotic treatment was switched from ceftriaxone to ciprofloxacin according to antibiotic susceptibility testing (AST) and Etest (ciprofloxacin MIC of 0.094 μg ml− 1) results. C. jejuni bacteraemia was successfully eradicated after 1 week of ciprofloxacin therapy.

This case describes the rare event of a Campylobacter bacteraemia, which could have been falsely interpreted because of non-specific colony morphology and the initial Vitek result. Only the combination of microscopy, MALDI-TOF and an API Campy test was able to rapidly identify this bacterium as C. jejuni. This case also shows the importance of immediate AST- and MIC-adapted antibiotic treatment in immunocompromised febrile patients suffering from Campylobacter-induced bloody diarrhoea.

The family Picornaviridae is divided into several genera, including the genus Enterovirus, which includes the species Human enterovirus A to -C and Human rhinovirus A to −C. These viruses are frequently associated with respiratory and gastrointestinal diseases. Coxsackie virus and echoviruses can induce a rash in children, such as hand-foot-and-mouth disease caused by coxsackie virus A16, while rhinoviruses are associated mainly with respiratory infections.

We describe a clinical case of mild rhinitis in a 9-week-old female infant with HBoV and enterovirus co-infection accompanied by an unusual rash that strongly resembled granuloma annulare, having plaques with raised non-scaly erythematous borders. The child was afebrile, displayed a garland-like rash that within minutes changed its pattern and had moderately elevated expression of tryptase. No other pathogens were detected.

It was concluded that the rash originated from the double infection with enterovirus and HBoV, as no further rash-associated pathogens were detected. The case is important as it is the first description, to the best of our knowledge, of this unusual rash seen with enterovirus/HBoV co-infection, and as this condition should be taken into account in future.

Bacille Calmette–Guérin (BCG), an attenuated strain of Mycobacterium bovis, is a rare cause of infection, with few published cases in immunocompetent individuals.

We present the case of a cutaneous abscess in an immunocompetent infant returning from Morocco, where he received a BCG vaccination. The abscess developed at the site of inoculation in the forearm (a non-recommended site) in the absence of lymphadenopathy or systemic signs. The lesion did not recur after aspiration of the abscess and further treatment was not required.

Infections caused by M. bovis BCG may be difficult to diagnose without systemic signs or lymphadenopathy but should be suspected in children returning from regions where BCG vaccination is widely applied. The present report suggests that abscess formation after BCG vaccination is a continuing problem, particularly in tuberculosis-endemic areas and when recommendations concerning dosage or injection techniques are not followed. Moreover, we highlight here the importance of combining phenotypic and genotypic methods for quick identification of Mycobacterium bovis BCG in abscess drainage fluids.