GERMS最新文献

Introduction: Hafnia alvei is a Gram-negative, facultative anaerobic bacillus that is most often found as an enteric commensal. It is seldom considered to be pathogenic in immunocompetent individuals.

Case report: We describe a case of a 23-year-old, previously healthy male, who presented to the emergency department with a two-day history of hemoptysis, mild dyspnea, pleuritic chest pain, fevers, and chills. Bloods revealed leukocytosis and elevated C-reactive protein. Chest X-ray and CT of the thorax revealed a cavitating lesion in the right upper lobe. He was commenced on empiric antibiotic treatment with amoxicillin/clavulanate and clarithromycin for community-acquired pneumonia in accordance with local guidelines. He subsequently underwent a bronchoscopy, and the bronchoalveolar lavage sample revealed a heavy growth of H. alvei. Despite the widely documented natural resistance of H. alvei to penicillin, the patient demonstrated complete resolution of his symptoms and initial raised inflammatory markers.

Conclusions: We present a case of community-acquired cavitary pneumonia in a previously healthy young adult with H. alvei isolated from bronchoalveolar lavage samples. Parallels are drawn between our case and other cases of H. alvei respiratory isolates in our discussion of its clinical significance.

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy associated with severe ADAMTS13 deficiency that can be potentially fatal if not treated in a timely manner.

Case report: A 49-year-old previously healthy woman was admitted with a 3-month history of thoracoabdominal pain and headache associated with loss of appetite, emesis, nocturnal diaphoresis, and unintentional loss of 10 kg. On admission she presented anemia, thrombocytopenia, schistocytes in peripheral blood smear, and ADAMTS13 in 1.4%. Due to laboratory findings a diagnosis of TTP was established, and plasma exchange therapy and steroid pulses were started, with resolution of hematological alterations. Within the studies to determine etiology of TTP, pulmonary tuberculosis (TB) was found, neoplastic and autoimmune pathologies were excluded. The tetraconjugated treatment was initiated with optimal tolerance.

Conclusions: Upon clinical suspicion of TTP, plasma exchange therapy should be initiated urgently; infectious, neoplastic, or autoimmune pathologies can be triggers; in this case, pulmonary TB was confirmed.

Introduction: Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective adjuvant therapy for superficial urinary bladder carcinoma, prolonging disease-free survival. Although it is usually well tolerated, moderate to severe local or systemic infectious complications, including sepsis involving multiple organs, may occur.

Case report: We report the unusual case of a man in his mid '70s who presented with septic shock and severe acute respiratory failure requiring intubation. Lack of response to antibiotics, history of intravesical BCG instillation and consistent imaging findings led to further investigations, with bronchoalveolar lavage (BAL) fluid polymerase chain reaction (PCR) results indicating pneumonitis due to Mycobacterium bovis dissemination. Prompt anti-tuberculosis treatment combined with corticosteroids resulted in significant clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection.

Conclusions: Due to its non-specific clinical presentation and the relatively low diagnostic yield of conventional microbiological tests, a high index of suspicion is required for prompt diagnosis and treatment of systemic BCG infection. PCR-based assays for mycobacterial DNA identification may represent a valuable tool facilitating timely diagnosis of this uncommon, yet potentially life-threatening infection.

Introduction: The annual incidence of infective endocarditis (IE) is 3-9 cases per 100000 in developed countries and most cases are due to staphylococci and streptococci. IE due to Gram-positive anaerobic cocci (GPAC) is very rare.

Case report: We present a case of a 38-year-old female with Anaerococcus hydrogenalis bacteremia and infective endocarditis of the native mitral valve. She presented with fever, chills, and abdominal pain. A computed tomographic scan of the abdomen showed splenic abscesses. Blood cultures and broad-range PCR from the splenic abscess sample were negative. Transthoracic echocardiography showed a mobile filamentous structure on the atrial side of the anterior mitral leaflet which was suggestive for infective endocarditis. Karius test (cell-free microbial DNA testing) showed Gram-positive anaerobic cocci Anaerococcus hydrogenalis. She was successfully treated with antibiotics.

Conclusions: In cases of infection with fastidious organisms like GPACs, the use of next-generation sequencing (NGS) can allow the correct identification of culprit pathogens and streamlined treatment.

Introduction: Bordetella bronchiseptica is a rare cause of hemorrhagic bronchopneumonia. Important to the clinician is a clear understanding that the treatment of this rare organism differs greatly from the successful antibiotic treatment of the more common Bordetella species, pertussis and parapertussis.

Case report: A 64-year-old female presented to the emergency department after experiencing one week of worsening hemoptysis. Upon admission, she was afebrile and all initial laboratory test results were normal. Bronchoalveolar hemorrhage suggested by radiographic imaging was confirmed by bronchoscopy. Bronchoalveolar lavage (BAL) cultures contained unspeciated Bordetella. Rapid worsening of the hemoptysis led to intubation and the decision to perform bronchial artery embolization. However, the intensity of the hemoptysis persisted. Septic shock ensued despite treatment with broad spectrum antibiotics including azithromycin, vancomycin, and cefepime. The microbiological speciation results finalized shortly after the patient's death. The identified organism was B. bronchiseptica.

Conclusions: Although macrolide antibiotics are first line treatment for B. pertussis and parapertussis, macrolide antibiotics are generally not effective against B. bronchiseptica. Clinical suspicion of B. bronchiseptica infection should prompt consideration of alternative antibiotics known to be effective against this rare species, including carbapenems and fluoroquinolones. The use of these latter antibiotics may advisably be considered as an empirical treatment during the delay of microbiological speciation.

Introduction: The aim of this study was to assess the incidence of Corynebacterium striatum prosthetic joint infections (PJI) to determine if an increase has occurred recently. Moreover, susceptibility testing was conducted on C. striatum preserved isolates to determine antibiotic options for these infections.

Methods: Retrospective review of PJI cases was conducted from 1/2017 through 1/2021 compared to 1/2021 through 7/2022 to determine how many cases of C. striatum have occurred for each of these time points. From these cases, demographics, outcomes and risk factors for C. striatum PJI were recorded. The preserved clinical isolates from these cases were tested for susceptibility to different antibiotics.

Results: A statistically significant increase in the proportion of C. striatum PJI cases (1.98 to 7.84, p=0.0489) has occurred over the past 16 months at a single institution. Chronic wounds and exposure to daptomycin were associated with the majority of these cases. Susceptibility testing of the clinical isolates showed uniform susceptibility to vancomycin, linezolid and dalbavancin. Uniform resistance was seen with ciprofloxacin, tetracycline and doxycycline as well. Interestingly, 85.7% of the isolates displayed inducible daptomycin resistance after overnight exposure to daptomycin.

Conclusions: C. striatum is an emerging PJI pathogen. It is important for clinicians to be cognizant that this pathogen can have inducible high level daptomycin resistance and that daptomycin is likely not a reliable antibiotic for these infections. While vancomycin and linezolid are the traditional antibiotics to use in these infections, other antibiotics such as dalbavancin, may also have utility, but more research is needed to determine the effectiveness of this antibiotic in C. striatum infections.

Introduction: Co-infection of human immunodeficiency virus (HIV) with syphilis is common and has significant clinical consequences. HIV infection can change the course and clinical manifestations of syphilis, resulting in atypical syphilis. A rare feature of this infection is malignant syphilis, which frequently resembles other skin lesions and poses a challenge in diagnosis. This report aims to describe a case of malignant syphilis in an HIV-positive patient.

Case report: A 33-year-old man who has sex with men (MSM) came to the dermato-venereology outpatient clinic with chief complaints of ulcerative lesions on the face, trunk, arms, palms, and legs for the past two months. The patient complained of fever, chills, and decreased appetite two weeks prior to presentation. A dermatological examination showed numerous well-demarcated ulcerated plaques and nodules partially covered with crust. Reactive results were found on syphilis serologic tests with high titers. The test for HIV was reactive, with a CD4 cell count of 219 cells/mm³. The patient was then diagnosed with malignant syphilis and received treatment in the form of benzathine penicillin injection 2.4 million units once a week for three consecutive weeks. After treatment, the skin lesions and syphilis serologic titer improved.

Conclusions: Secondary syphilis in patients with HIV infection may present as an atypical variant. As reported in this case, malignant syphilis should always be considered in the differential diagnosis when ulcerative and necrotic lesions are observed in individuals with HIV infection.

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a viral disease with primary pulmonary involvement and systemic impact. This article aims to assess the importance of clinical, biological, demographic and radioimaging parameters in COVID-19 patients in characterizing the incidence and severity of the hepatobiliary involvement.

Methods: We performed an observational cohort study on 132 consecutive patients, evaluating their demographics, hospitalization period, peripheral oxygen saturation (SpO₂) in the ambient air, as well as biochemical markers of hepatobiliary involvement: aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB), direct bilirubin (DB), gamma-glutamyl transferase (GGT), serum albumin, total serum proteins, D-dimers; coagulation tests such as prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR); inflammatory markers: fibrinogen, serum ferritin, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis alpha (TNF-α). Hepatobiliary involvement was further stratified by type of affection pattern: hepatocytolysis, cholestasis or mixed type. All patients received a computerized tomography (CT) chest scan in the first or second day of hospital admission.

Results: We observed lower SaO₂ and longer hospitalization days in patients with hepatobiliary involvement, as well as longer coagulation times (PT and INR), lower serum albumin and higher serum ferritin (p<0.05). No significant correlations have been found between the degree or type of pattern of lung involvement as seen on CT scans performed and biochemical liver changes.

Conclusions: Hepatobiliary involvement occurred in 72% of patients in the study group, associated with longer hospitalization period, prolonged coagulation parameters, lower serum albumin levels, raised serum ferritin and CRP levels. Cholestatic and mixed types of injury were associated with higher ferritin levels, while mixed type alone presented higher D-dimers levels compared with the cholestatic or hepatocytolysis groups. No significant correlation was found between lung involvement by CT evaluation and hepatobiliary involvement.

Introduction: Infectious vaginitis is prevalent in developing countries. Most of the females suffer from vaginal infections at least once per lifetime. Due to limited resources, many infections are misdiagnosed or undiagnosed. Good diagnosis of these infections is critically important and will definitely help to guide treatment and prevent recurrence.

Methods: A total of 1080 vaginal swabs were collected from symptomatic females. Nugent's score and Amsel's criteria were applied to diagnose bacterial vaginosis (BV). A rapid test was used to identify Gardnerella vaginalis. Trichomonal vaginitis (TV) was diagnosed through microscopic examination. Vulvovaginal candidiasis (VVC) was also identified microscopically and using conventional culture. Finally, aerobic vaginitis (AV) was detected using Donder's scale combined with conventional culture and biochemical tests.

Results: There was no statistically significant association between age and type of vaginal infection (p=0.130). Vulvovaginal inflammation, itching and redness were significantly associated with VVC (p≤0.012). BV was detected as single infection in 43.8%, followed by VVC 24.2%. On the contrary, AV and TV were scarcely detected among the participants; 4.9% and 0.5% respectively. Mixed infections between BV and VVC were noted in 26.6%.

Conclusions: BV showed the highest prevalence followed by VVC. Mixed infections between BV and VVC were evidently noted, therefore good reliable diagnosis using cost-effective methods is crucial for proper treatment. Aerobic vaginitis showed low prevalence and most of the Streptococcus spp. were isolated from pregnant females. The low prevalence of Trichomonas vaginalis may be due to the dependance on conventional methods for diagnosis, and thus more advanced diagnostic tools are required.