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A comparative analysis of Orientia Tsutsugamushi (Scrub Typhus): Essential information on causes, symptoms, and care

Q3 Medicine

Clinical Microbiology Newsletter

Pub Date : 2025-01-16 DOI: 10.1016/j.clinmicnews.2025.01.004

Neetesh Jindal , Kumar Abhishek , Ashish Kumar , Manas Ranjan Dikhit , Roshan Kamal Topno , Krishna Pandey , Ganesh Chandra Sahoo

Scrub typhus is a disease caused by the bacteria Orientia tsutsugamushi, spread primarily by chiggers, which are larval mites. These mites are commonly found in Southeast Asia, including countries like India, Indonesia, and Thailand. The disease is often hard to diagnose because its symptoms—fever, headache, muscle pain, and stomach issues—are similar to other illnesses. A key sign of scrub typhus is an “eschar,” a sore that appears at the bite site. Without treatment, which typically involves antibiotics like doxycycline or azithromycin, the disease can lead to severe complications such as sepsis, shock, and multi-organ failure, with a high mortality rate. Scrub typhus has been documented in various regions, with historical records dating back to the 19th century in China. Despite advances in treatment regimen since World War II, no vaccine is available. Diagnostic methods include serological tests and PCR techniques to detect the bacteria. Preventive measures focus on avoiding areas where chiggers are prevalent and using insect repellent. Even if the scrub typhus fever has been reported from regions such as Japan to northern Australia and the Arabian Peninsula, Indian people from different parts are suffering from this endemic disease and doxycycline has become the drug of choice for the treatment of scrub typhus fever. Clinical diagnosis of scrub typhus and research related to this endemic disease must be assorted as the scrub typhus may become resistant to the current treatment regimen.

{"title":"A comparative analysis of Orientia Tsutsugamushi (Scrub Typhus): Essential information on causes, symptoms, and care","authors":"Neetesh Jindal , Kumar Abhishek , Ashish Kumar , Manas Ranjan Dikhit , Roshan Kamal Topno , Krishna Pandey , Ganesh Chandra Sahoo","doi":"10.1016/j.clinmicnews.2025.01.004","DOIUrl":"10.1016/j.clinmicnews.2025.01.004","url":null,"abstract":"<div><div>Scrub typhus is a disease caused by the bacteria <em>Orientia tsutsugamushi</em>, spread primarily by chiggers, which are larval mites. These mites are commonly found in Southeast Asia, including countries like India, Indonesia, and Thailand. The disease is often hard to diagnose because its symptoms—fever, headache, muscle pain, and stomach issues—are similar to other illnesses. A key sign of scrub typhus is an “eschar,” a sore that appears at the bite site. Without treatment, which typically involves antibiotics like doxycycline or azithromycin, the disease can lead to severe complications such as sepsis, shock, and multi-organ failure, with a high mortality rate. Scrub typhus has been documented in various regions, with historical records dating back to the 19th century in China. Despite advances in treatment regimen since World War II, no vaccine is available. Diagnostic methods include serological tests and PCR techniques to detect the bacteria. Preventive measures focus on avoiding areas where chiggers are prevalent and using insect repellent. Even if the scrub typhus fever has been reported from regions such as Japan to northern Australia and the Arabian Peninsula, Indian people from different parts are suffering from this endemic disease and doxycycline has become the drug of choice for the treatment of scrub typhus fever. Clinical diagnosis of scrub typhus and research related to this endemic disease must be assorted as the scrub typhus may become resistant to the current treatment regimen.</div></div>","PeriodicalId":39211,"journal":{"name":"Clinical Microbiology Newsletter","volume":"50 ","pages":"Pages 34-40"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143095475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Soft tissue infection with multidrug-resistant Kluyvera ascorbata of extended-spectrum bêta-lactamase type (CTX-M): Case report and literature review

Q3 Medicine

Clinical Microbiology Newsletter

Pub Date : 2025-01-15 DOI: 10.1016/j.clinmicnews.2025.01.003

Samir Kaddouri , Abderrazak Saddari , Said Ezrari , Ouahiba Hafhaf , Ismail Faiz , Amjad Idrissi , Omar El Mahi , Elmostapha Benaissa , Yassine Ben Lahlou , Mostafa Elouennass , Adil Maleb

Kluyvera ascorbata, which belongs to the Enterobacteriaceae family, is a commensal bacterium that is very rarely described in human infections. In this report, we describe a case of soft tissue infection due to Kluyvera ascorbata in a 72-year-old man with comorbidities. He was admitted to the vascular surgery department for the treatment of a gas gangrene of the left foot. The patient received probabilistic antibiotic therapy with metronidazole, ceftriaxone and gentamicin by parenteral route with an amputation of the left leg following critical ischemia of the left lower limb (LLL). Due to the superinfection of the left leg amputation stump, the patient underwent an amputation of the left thigh, followed by multiple debridements of the left thigh amputation stump and drainage of an abscess on the anterior surface of the left thigh in the operating room. A sample of superficial pus was collected intraoperatively for microbiological examination to identify the pathogen and guide therapeutic adjustments. This examination revealed the exclusive presence of Kluyvera ascorbata. The isolate was resistant to the majority of β-lactams, aminoglycosides and sulfonamides. However, it was susceptible at standard dosage to carbapenems, fluoroquinolones, chloramphenicol, fosfomycin-trometamol and nitrofurantoin. The antibiogram highlighted the potential for multi-resistance type ESBL (extended spectrum B-lactamases) which characterizes this bacterium. In addition, Kluyvera spp. have an innate antibiotic resistance mechanism, and it is now accepted that CTX-M are derived from chromosomal beta lactamases of species of the genus Kluyvera. They are part of the extended spectrum β-lactamases (ESBL). Given the above, the treatment regimen has been adapted according to the results of the antibiogram. The patient received parenteral antibiotic therapy with levofloxacin, and the clinical evolution was favorable. This leads us to discuss the pathogenicity of this germ and its multi-resistant potential.

{"title":"Soft tissue infection with multidrug-resistant Kluyvera ascorbata of extended-spectrum bêta-lactamase type (CTX-M): Case report and literature review","authors":"Samir Kaddouri , Abderrazak Saddari , Said Ezrari , Ouahiba Hafhaf , Ismail Faiz , Amjad Idrissi , Omar El Mahi , Elmostapha Benaissa , Yassine Ben Lahlou , Mostafa Elouennass , Adil Maleb","doi":"10.1016/j.clinmicnews.2025.01.003","DOIUrl":"10.1016/j.clinmicnews.2025.01.003","url":null,"abstract":"<div><div><em>Kluyvera ascorbata</em>, which belongs to the Enterobacteriaceae family, is a commensal bacterium that is very rarely described in human infections. In this report, we describe a case of soft tissue infection due to <em>Kluyvera ascorbata</em> in a 72-year-old man with comorbidities. He was admitted to the vascular surgery department for the treatment of a gas gangrene of the left foot. The patient received probabilistic antibiotic therapy with metronidazole, ceftriaxone and gentamicin by parenteral route with an amputation of the left leg following critical ischemia of the left lower limb (LLL). Due to the superinfection of the left leg amputation stump, the patient underwent an amputation of the left thigh, followed by multiple debridements of the left thigh amputation stump and drainage of an abscess on the anterior surface of the left thigh in the operating room. A sample of superficial pus was collected intraoperatively for microbiological examination to identify the pathogen and guide therapeutic adjustments. This examination revealed the exclusive presence of <em>Kluyvera ascorbata</em>. The isolate was resistant to the majority of β-lactams, aminoglycosides and sulfonamides. However, it was susceptible at standard dosage to carbapenems, fluoroquinolones, chloramphenicol, fosfomycin-trometamol and nitrofurantoin. The antibiogram highlighted the potential for multi-resistance type ESBL (extended spectrum B-lactamases) which characterizes this bacterium. In addition, <em>Kluyvera spp</em>. have an innate antibiotic resistance mechanism, and it is now accepted that CTX-M are derived from chromosomal beta lactamases of species of the genus <em>Kluyvera</em>. They are part of the extended spectrum β-lactamases (ESBL). Given the above, the treatment regimen has been adapted according to the results of the antibiogram. The patient received parenteral antibiotic therapy with levofloxacin, and the clinical evolution was favorable. This leads us to discuss the pathogenicity of this germ and its multi-resistant potential.</div></div>","PeriodicalId":39211,"journal":{"name":"Clinical Microbiology Newsletter","volume":"50 ","pages":"Pages 41-47"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143095477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Phage therapy to treat unresponsive infections: A primer for the clinical microbiology laboratory staff

Q3 Medicine

Clinical Microbiology Newsletter

Pub Date : 2025-01-15 DOI: 10.1016/j.clinmicnews.2025.01.002

Josephine M. Davey-Young , Dinuri D. Punchihewa , Bernadette Ng , Jenna Wong , Greg J. German

With the increase in antimicrobial resistance and subsequent need for alternatives to traditional antibiotics, phage therapy (PT) has gained a renewed interest. Much like antibiotics, bacteriophages or simply phages, have shown promise in eradicating bacterial infections; however, their fundamental differences require specific laboratory protocols and practices. As bacterial-specific viruses, they must be detected, replicated, and purified for safety and efficacy. The narrow spectrum of activity of phages provides a targeted approach to infection but also necessitates expansive libraries and susceptibility testing to match phages to bacteria. Such testing is not standardized, complicating both research and clinical efforts. This review then provides a background on PT in the clinical microbiology laboratory and an overview of such protocols and practices specific to PT, such as classic susceptibility testing methods and updated approaches. Also covered are the challenges and future directions for the field, as well as resources for clinical and research laboratory personnel.

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引用次数: 0

Maximizing the diagnostic potential of 1,3 beta-D-glucan assays for invasive fungal infections

Q3 Medicine

Clinical Microbiology Newsletter

Pub Date : 2025-01-10 DOI: 10.1016/j.clinmicnews.2025.01.001

Sejal Morjaria , N. Esther Babady

Invasive fungal infections (IFIs) pose a serious threat to patients, particularly those who are immunocompromised. Timely and accurate diagnosis of IFIs is critical to improving outcomes, and conventional diagnostic methods often fall short. The 1,3 Beta-D-Glucan (BDG) assay has become a significant test in the early diagnosis and management of IFIs when used in the appropriate clinical context.

引用次数: 0

Acute appendicitis caused by Arcanobacterium haemolyticum

Q3 Medicine

Clinical Microbiology Newsletter

Pub Date : 2025-01-02 DOI: 10.1016/j.clinmicnews.2024.12.001

Ismail Faiz , Abderrazak Saddari , Said Ezrari , Samir Kaddouri , Elmostafa Benaissa , Yassine BenLahlou , Mostafa Elouennass , Adil Maleb

Arcanobacterium haemolyticum is known for causing pharyngitis in young adults and skin/soft tissue infections in older and immunocompromised people. We report here the case of a 25-year-old patient admitted to the emergency room for pain in the right iliac fossa. Abdominal computed tomography (CT) scan showed acute uncomplicated appendicitis. The biological assessment revealed an inflammatory syndrome with CRP at 124 mg/L. The patient underwent an appendectomy by laparotomy. The cytobacteriological analysis of deep pus revealed an important leukocyte reaction to neutrophils, and the growth of Arcanobacterium haemolyticum in culture. Antibiotic susceptibility testing showed that the bacterium was susceptible to clindamycin, tetracycline, linezolid, and rifampicin, and resistant to penicillin G, sulfamethoxazole/trimethoprim, moxifloxacin, ciprofloxacin, and vancomycin. Most studies have shown that this bacterium is susceptible to all classes of antibiotics except sulfamethoxazole-trimethoprim, however, in our case and like certain recent studies, other resistances are emerging.

{"title":"Acute appendicitis caused by Arcanobacterium haemolyticum","authors":"Ismail Faiz , Abderrazak Saddari , Said Ezrari , Samir Kaddouri , Elmostafa Benaissa , Yassine BenLahlou , Mostafa Elouennass , Adil Maleb","doi":"10.1016/j.clinmicnews.2024.12.001","DOIUrl":"10.1016/j.clinmicnews.2024.12.001","url":null,"abstract":"<div><div><em>Arcanobacterium haemolyticum</em> is known for causing pharyngitis in young adults and skin/soft tissue infections in older and immunocompromised people. We report here the case of a 25-year-old patient admitted to the emergency room for pain in the right iliac fossa. Abdominal computed tomography (CT) scan showed acute uncomplicated appendicitis. The biological assessment revealed an inflammatory syndrome with CRP at 124 mg/L. The patient underwent an appendectomy by laparotomy. The cytobacteriological analysis of deep pus revealed an important leukocyte reaction to neutrophils, and the growth of <em>Arcanobacterium haemolyticum</em> in culture. Antibiotic susceptibility testing showed that the bacterium was susceptible to clindamycin, tetracycline, linezolid, and rifampicin, and resistant to penicillin G, sulfamethoxazole/trimethoprim, moxifloxacin, ciprofloxacin, and vancomycin. Most studies have shown that this bacterium is susceptible to all classes of antibiotics except sulfamethoxazole-trimethoprim, however, in our case and like certain recent studies, other resistances are emerging.</div></div>","PeriodicalId":39211,"journal":{"name":"Clinical Microbiology Newsletter","volume":"50 ","pages":"Pages 19-23"},"PeriodicalIF":0.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143095473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A fatal case of community-acquired Acinetobacter pittii necrotising fasciitis, and a review of the literature

Q3 Medicine

Clinical Microbiology Newsletter

Pub Date : 2024-11-28 DOI: 10.1016/j.clinmicnews.2024.11.003

Maja Johanne Søndergaard Knudsen, Peder Worning, Sarah Juel Paulsen, Anne Line Engsbro

We report a fatal case of a comorbid male in his 70s admitted for erysipelas on the right lower leg. The condition developed rapidly and during debridement, the patient was diagnosed with necrotising fasciitis (NF). A. pittii was isolated from both blood and tissue samples. Despite broad-spectrum antibiotics, hyperbaric oxygen treatment and surgical intervention, the patient died from multiple organ failure. A review was conducted with a PubMed search for case reports/cohort studies with cases of Acinetobacter NF. Twenty-three articles were identified reporting on 30 cases with NF caused by Acinetobacter sp. (Acinetobacter baumanii 83 %, A. pittii 0). Infections were polymicrobial in 57 % of cases and fatal in 47 % of cases. For cases unrelated to war, most identified patients suffered from one or more comorbidities. A. pittii should be considered an important finding in a patient with a soft skin infection, and the risk of NF should be assessed.

引用次数: 0

Microbe snapshots: Dengue virus

Q3 Medicine

Clinical Microbiology Newsletter

Pub Date : 2024-11-26 DOI: 10.1016/j.clinmicnews.2024.11.002

Samuel M. Goodfellow , Esther Vaugon

引用次数: 0

Peritoneal Tuberculosis: Navigating diagnostic challenges

Q3 Medicine

Clinical Microbiology Newsletter

Pub Date : 2024-11-22 DOI: 10.1016/j.clinmicnews.2024.11.001

Reanay Berezovskiy , Meher Sultana , Jason Guyotte , Daria Yunina-Distefano , Niyati Goradia , Irene E. Rossmer

Peritoneal Tuberculosis (TB) is an uncommon manifestation of a mycobacterial infection, typically observed in immunocompromised individuals and/or those residing in endemic regions. Usually, patients will contract pulmonary TB, which results in dissemination or reactivation of latent infection months to years following the initial infection. Here, we present a case of peritoneal TB diagnosed in an immunocompetent patient devoid of recent travel history and with negative pulmonary findings. This case highlights the importance of considering peritoneal TB in the differential diagnosis, even in immunocompetent individuals with no apparent risk factors, highlighting the complexity and variability of TB presentations.

引用次数: 0

Bilateral otitis media as an initial manifestation of disseminated tuberculosis disease in a patient with late HIV infection diagnosis 双侧中耳炎是一名晚期艾滋病毒感染患者播散性结核病的初期表现

Q3 Medicine

Clinical Microbiology Newsletter

Pub Date : 2024-11-07 DOI: 10.1016/j.clinmicnews.2024.10.004

Victoria Lobo-Antuña , Marta Lobo-Antuña , Juan Martínez-Andrés , Cristina Rodríguez-Prado , María Remedios Guna-Serrano , Atilio Navarro-Gonzales , Magdalena García-Rodríguez , Carmen Ricart-Olmos

Tuberculous otitis media is a rare form of extrapulmonary tuberculosis, often resulting in delayed diagnosis due to its nonspecific symptoms and low clinical suspicion. We present the case of a 29-year-old woman with initial symptoms of sudden speech impairment without other neurological manifestations. In the previous 3 months, the patient had consulted several times to the health care system due to bilateral otitis media, which did not improve with conventional treatments. Daily fever, diarrhea and weight loss were added to the picture. After admission to the Infectious Diseases department, she was diagnosed with advanced HIV infection and disseminated tuberculosis (TB) with pulmonary, intestinal, lymph node and otic involvement. This case underlines the complexity of diagnosing TB otitis media, especially in the context of HIV co-infection, and highlights the importance of routine HIV screening in patients with persistent, unexplained symptoms to facilitate early diagnosis and prevent complications.

结核性中耳炎是肺外结核的一种罕见形式，由于其症状无特异性且临床怀疑度较低，常常导致诊断延误。本病例是一名 29 岁女性，最初的症状是突然出现言语障碍，但没有其他神经系统表现。在过去的 3 个月中，患者因双侧中耳炎多次就诊于医疗系统，但常规治疗效果不佳。此外，患者还出现了每日发热、腹泻和体重减轻等症状。入住传染科后，她被诊断为晚期艾滋病病毒感染和播散性肺结核（TB），肺部、肠道、淋巴结和耳部均受累。该病例强调了结核性中耳炎诊断的复杂性，尤其是在合并艾滋病病毒感染的情况下，并强调了对有持续性不明症状的患者进行常规艾滋病病毒筛查以促进早期诊断和预防并发症的重要性。

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引用次数: 0

Medically important alphaviruses in the United States and how to test for them 美国医学上重要的字母病毒及其检测方法

Q3 Medicine

Clinical Microbiology Newsletter

Pub Date : 2024-11-04 DOI: 10.1016/j.clinmicnews.2024.10.003

Allison R. Eberly

Alphaviruses are arthropod-borne viruses (i.e. arboviruses) transmitted by mosquitos that are classically divided into two groups that infect humans: encephalitic and arthralgia-associated. While the encephalitic alphaviruses are primarily endemic in North and South America, alphaviruses associated with arthralgia are distributed globally. Given the overlapping clinical manifestations of alphaviruses with other arboviruses, diagnosis is dependent on both exposure history and laboratory testing. In the United States, diagnostic approaches largely rely on detection of host antibodies against these viruses via enzyme-linked immunosorbent assays (ELISAs) or indirect immunofluorescence assays (IFAs) in serum and/or cerebrospinal fluid. Positive results can be confirmed by plaque reduction neutralization testing (PRNT), which remains the reference standard method for anti-alphavirus antibody detection. Increasingly, select public health and reference laboratories are also offering molecular testing for certain alphaviruses, including chikungunya virus and Eastern equine encephalitis virus. Molecular testing, however, is most useful in acutely ill, viremic patients who present within the first week of symptom onset. There are no targeted antivirals for treatment, and prevention relies on protection from mosquito bites.

阿尔法病毒是由蚊子传播的节肢动物病毒（即虫媒病毒），通常分为两类感染人类的病毒：脑炎型和关节痛型。脑炎型阿尔巴病毒主要流行于北美和南美，而与关节痛相关的阿尔巴病毒则分布于全球。鉴于阿尔巴病毒的临床表现与其他虫媒病毒重叠，诊断取决于接触史和实验室检测。在美国，诊断方法主要依靠在血清和/或脑脊液中通过酶联免疫吸附试验（ELISA）或间接免疫荧光试验（IFA）检测宿主对这些病毒的抗体。阳性结果可通过斑块还原中和试验（PRNT）确认，该方法仍是抗阿耳巴病毒抗体检测的参考标准方法。越来越多的公共卫生实验室和参考实验室也开始提供某些阿尔巴病毒的分子检测，包括基孔肯雅病毒和东方马脑炎病毒。不过，分子检测对症状出现后第一周内出现的急性病毒血症患者最有用。目前还没有针对性的抗病毒药物用于治疗，预防措施主要是防止蚊虫叮咬。

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