JMM Case Reports: Most Cited Articles http://www.microbiologyresearch.org/content/journal/jmmcr?TRACK=RSS Please follow the links to view the content. A case of NDM-carbapenemase-producing hypervirulent Klebsiella pneumoniae sequence type 23 from the UK http://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.005130?TRACK=RSS Introduction. Hypervirulent capsular type K1 Klebsiella pneumoniae strains of clonal complex 23 (CC23) are associated with severe community-acquired pyogenic liver abscesses, often complicated by metastatic infections and significant mortality. The majority of hypervirulent strains reported are susceptible to most antibiotics except ampicillin. To the best of our knowledge, this is the first case of New Delhi metallo-β-lactamase (bla NDM)-producing hypervirulent K. pneumoniae from the UK. Case presentation. We present a case of pyogenic liver abscess in a 63-year-old female of Bangladeshi origin, with a recent diagnosis of pancreatic cancer. The patient was treated with piperacillin/tazobactam and blood cultures grew a fully susceptible Escherichia coli. Despite antimicrobial therapy and drainage of the abscess, the patient continued to deteriorate and died on day seven of admission. The fluid drained from the liver abscess grew a fully susceptible E. coli and a multi-drug-resistant K. pneumoniae. Two weeks prior to admission, a rectal screening swab grew a metallo-β-lactamase-producing K. pneumoniae. Molecular characterization revealed that both the K. pneumoniae isolates belonged to the hypervirulent K1 cluster of CC23, sequence type 23. The isolate from the rectal screen was positive for the bla NDM metallo-β-lactamase gene. Conclusion. The emergence of carbapenemase-producing hypervirulent K. pneumoniae strains presents a new and significant threat to global public health. Management of these infections will be extremely challenging due to the limited treatment options available and they are likely to be associated with an even greater mortality. Kerry J. Roulston, Tehmina Bharucha, Jane F. Turton, Katie L. Hopkins and Damien J. F. Mack Thu May 17 13:48:32 UTC 2018Z Sternal wound infection caused by Gordonia bronchialis: identification by MALDI-TOF MS http://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.005067?TRACK=RSS Introduction: Gordonia spp. infections are uncommon. However, a few clinical cases have been reported in the literature, particularly those involving immunocompromised hosts. Advanced microbiology diagnosis techniques, such as matrix-assisted laser desorption ionization-time of flight MS (MALDI-TOF MS), have been recently introduced in clinical microbiology laboratories in order to improve microbial identification, resulting in better patient management. Case presentation: Here, we present a new clinical case of persistent wound infection caused by Gordonia bronchialis in a 64-year-old woman after a mitral valve replacement, using two MALDI-TOF-based systems for identifying this micro-organism. Conclusion: Both MALDI-TOF systems were able to identify Gordonia spp.; thus, providing a useful tool that overcomes the current limitations of phenotypic identification associated with this micro-organism. Although the technique validation deserves additional verification, our study provides guidance about MALDI-TOF as a fast and easy method for Gordonia spp. identification. Jesús Rodriguez-Lozano, Enrique Pérez-Llantada, Jesús Agüero, Ana Rodríguez-Fernández, Carlos Ruiz de Alegria, Luis Martinez-Martinez and Jorge Calvo Fri Oct 14 09:18:26 UTC 2016Z Meningitis due to Moraxella nonliquefaciens in a paediatric patient: a case report and review of the literature http://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.005086?TRACK=RSS Introduction. Moraxella nonliquefaciens is an unusual organism to be isolated from cerebral spinal fluid (CSF) and there exists only one case report of M. nonliquefaciens meningitis from a neonate. Moraxella species normally exist as part of the human upper respiratory tract flora and rarely cause invasive human disease. There are only a handful of case reports implicating the organism as a cause of endocarditis, bacteraemia, septic arthritis and endophthalmitis. Identification to the species level based on routine laboratory techniques has been challenging, with final identification often made through 16S rRNA sequencing. With the use of a newer diagnostic tool, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) MS, we were able to rapidly identify the organism and initiate appropriate treatment. Case presentation. We present a rare care of M. nonliquefaciens meningitis in a paediatric patient with an underlying cranial anatomical defect due to Crouzon syndrome. She had been admitted to hospital 3 months previously with Streptococcus pneumoniae meningitis and mastoiditis, and returned to the emergency department with meningismus. CSF culture grew M. nonliquefaciens. She was treated with ceftriaxone with rapid improvement and eventually was taken for endoscopic surgical repair of a right encephalocele defect. Conclusion. The use of MALDI-TOF MS allowed for the rapid identification of the organism. The patient recovered with appropriate antimicrobial therapy and eventual surgical correction. An underlying anatomical defect should be considered in all patients who present with meningitis due to this unusual organism. Carol Kao, Wendy Szymczak and Iona Munjal Wed Feb 01 16:06:10 UTC 2017Z First case of Listeria innocua meningitis in a patient on steroids and eternecept http://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.003103?TRACK=RSS Introduction: Listeria innocua is widespread in food and the environment and is considered to be a non‐pathogenic bacterium in healthy subjects. To date, this species has only been associated with human diseases in a fatal case of bacteraemia in an elderly patient. Here, we describe a case of acute meningitis infection caused by this bacterium. Case presentation: Our patient had an increased risk of infection because of treatment with etanercept and a corticosteroid given for rheumatoid arthritis. Etanercept use has been described previously as the possible cause of multiple Listeria monocytogenes infections (to date, four cases have been described, of which two were cases of arthritis and two of meningitis), but etanercept has never been associated with L. innocua meningitis. In our case, despite rapid identification of the pathogen and proper antibiotic treatment, the patient had an unfavourable outcome. Conclusion: To the best of our knowledge, this report constitutes the first documentation of a case of meningitis due to L. innocua, and our experience serves as a warning to microbiologists and clinicians that L. monocytogenes is not the only Listeria sp. that can cause human meningitis. Marco Favaro, Loredana Sarmati, Giuseppe Sancesario and Carla Fontana Thu Aug 07 08:55:20 UTC 2014Z Acute influenza virus-associated encephalitis and encephalopathy in adults: a challenging diagnosis http://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.005076?TRACK=RSS Background: Acute influenza-associated encephalopathy/encephalitis (IAE) in adults is a rare but well-known complication of influenza virus infection. The diagnosis is difficult to make due to the absence of distinctive clinical symptoms and validated diagnostic criteria. We present an illustrative case and a case review on acute IAE in adults. Methods: We performed a Medline search of the English literature using the terms influenz*, encephal* and adult, and constructed a database of detailed descriptions of patients with influenza virus infection with influenza-like symptoms at the onset of neurological symptoms. Results: A total of 44 patients were included. Confusion and seizures were the most prevalent neurological symptoms, present in 12 (27 %) and 10 (23 %) patients, respectively. Magnetic resonance imaging (MRI) was performed in 21 patients and anomalies were found in 13 (62 %), with lesions located throughout the brain. Influenza virus RNA was detected in cerebrospinal fluid (CSF) in 5 (16 %) of 32 patients. Eight (18 %) of the forty-four patients died. The benefits of antiviral and immunomodulatory therapy have not been well studied. Discussion: Our results show that many different neurological symptoms can be present in patients with acute onset IAE. Therefore, the diagnosis should be considered in patients with fever and neurological symptoms, especially during the influenza season. Laboratory diagnosis consists of demonstration of influenza virus RNA in brain tissue, CSF or respiratory samples, and demonstration of intrathecal antibody production against influenza virus. The presence of brain lesions in MRI and influenza virus in CSF appear to be of prognostic value. Wouter J. Meijer, Francisca H. H. Linn, Anne M. J. Wensing, Helen L. Leavis, Debby van Riel, Corine H. GeurtsvanKessel, Mike P. Wattjes and Jean-Luc Murk Mon Dec 05 10:12:52 UTC 2016Z Ehrlichiosis presenting as severe sepsis and meningoencephalitis in an immunocompetent adult http://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.005162?TRACK=RSS Introduction. Ehrlichia are obligate intracellular pathogens transmitted to vertebrates by ticks. Case presentation. We report the case of a 59-year-old man who presented to the University of Kentucky Albert B. Chandler Medical Center (Lexington, KY, USA) after being found fallen down in the woods. A lumbar puncture revealed what appeared to be bacterial meningitis, yet cerebrospinal fluid cultures, Gram stains and a meningitis/encephalitis panel were inconclusive. However, an Ehrlichia DNA PCR of the blood resulted as being positive for Ehrlichia chaffeensis antibodies. The patient received a 14 day course of doxycycline, and recovered from his multiple organ failure. The aetiology of the ehrlichial meningoencephalitis was likely transmission through a tick-bite, due to the patient’s outdoor exposure. Conclusion. While it is rare to see Ehrlichia as a cause of meningitis, this illness can progress to severe multisystem disease with septic shock, meningoencephalitis or acute respiratory distress syndrome (ARDS). Those with compromised immunity are at a higher risk of developing the more severe form of the disease and have higher case fatality rates. Stephanie L. Buzzard, Brittany D. Bissell and Melissa L. Thompson Bastin Fri Jul 27 11:46:37 UTC 2018Z Difficulty with Gordonia bronchialis identification by Microflex mass spectrometer in a pacemaker‐induced endocarditis http://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.003681?TRACK=RSS Introduction: This report describes the first case, to the best of our knowledge, of pacemaker‐induced endocarditis due to Gordonia bronchialis. Presentation: Pacemaker‐induced endocarditis due to G. bronchialis infection was determined in a 92‐year old man. This Gram‐positive bacillus failed to be identified by matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry technology, whereas the taxon was indexed in the database. 16S rRNA and rpoB gene sequencing were required to determine the correct strain identity. Conclusion: Infections caused by G. bronchialis remain a rare phenomenon affecting immunocompromised patients and/or medical device carriers. Molecular tools may be necessary to ensure accurate identification. Marie Titécat, Caroline Loı¨ez, René J. Courcol and Frédéric Wallet Mon Feb 23 12:11:47 UTC 2015Z R77Q and Q3R HIV1‐VPR mutations in an otherwise asymptomatic 5‐year‐old child with repeated ear infections http://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.002709?TRACK=RSS Introduction: Viral protein R (Vpr) of human immunodeficiency virus type 1 (HIV‐1) has been described as being involved in the progression of AIDS, and specific mutations are associated with long‐term non‐progressor patients. Case presentation: We describe the case of a child with repeated ear infections who was otherwise healthy. The patient, a 5‐year‐old boy, was HIV‐1 positive and the viral load at admission was 1 073 899 RNA copies ml−1 and 0 % CD4+ lymphocytes. A detailed study of the vpr gene sequence of the child revealed mutations leading to amino acid substitutions at positions 3 and 77. Conclusion: The case reported provides clinical support of previous findings that show that the R77Q and Q3R HIV‐1 Vpr variants are associated with patients with delayed disease progression. Rui Soares, Graça Rocha, Célia Nogueira, António Meliço‐Silvestre and Teresa Gonçalves Wed Feb 25 15:10:08 UTC 2015Z In vitro aggregate formation and unusual colony morphology impairing identification of Roseomonas sp. from a septic patient http://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.000034?TRACK=RSS Introduction: 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. Case presentation: 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. Conclusion: 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. Hossein Salimnia, Marilynn R. Fairfax, James J. Gordon and Paul R. Lephart Tue Jul 07 14:53:24 UTC 2015Z First report of neonatal sepsis due to Moesziomyces bullatus in a preterm low‐birth‐weight infant http://www.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.000011?TRACK=RSS Introduction: 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. Case presentation: 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. Conclusion: 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. Ojogba Mark Okolo, Anne D. Van Diepeningen, Bose Toma, Nnaemeka Emmanuel Nnadi, Mebi Grace Ayanbimpe, Ikenna Kenneth Onyedibe, Mohammed Zaino Sabitu, Benle Edmund Banwat, Marizeth Groenewald, Fabio Scordino, Zanyul Daniel Egah, Giuseppe Criseo and Orazio Romeo Tue Jun 02 10:18:20 UTC 2015Z