Numerous Gram-positive Cocci Research Articles

Diagnosis of Enterococcus hirae infection in association with piglet diarrhea

Various viral and bacterial pathogens interact with environmental factors to cause diarrhea in piglets. Enterococcus spp. are Gram-positive anaerobic bacteria that are commonly found in the gastrointestinal tract of several animal species, including pigs. Enterococcus spp. have been reported to infect several animal species as a pathogen. However, gastrointestinal infection by Enterococcus hirae is rare in pigs; only a few cases have been reported worldwide. Four piglets with diarrhea were examined in the diagnostic laboratory of Optipharm Inc. (Cheongju, Korea). During the initial post-mortem examination, no disease lesions were observed. Upon microscopic examination, we found numerous Gram-positive cocci that were adhered to epithelial villi in the jejunum and ileum. However, the villi did not exhibit significant structural damage. Cultured bacteria were identified as E. hirae using the VITEK 2 system and polymerase chain reaction (PCR). Using PCR, we also confirmed that viruses and protozoa that can potentially infect piglet intestines were absent. In antibiotic susceptibility test, the bacteria were resistant to most types of antibiotics. This study presents rare cases of E. hirae infection of the piglet small intestine, which can occur in association with diarrhea possibly by the continuous use of antibiotics.

Gastric Gangrene Due to Acute Necrotizing Gastritis Secondary to Group A Streptococcus Bacteremia

Introduction: Acute necrotizing gastritis, a variant of phlegmonous gastritis is an extremely rare cause of gastric necrosis where major gastric vessels remain patent yet gastric gangrene occurs secondary to a necrobiotic infection. We present such a case secondary to Group A Streptococcal infection. Case Presentation: A 73 year-old-female with a history of polymyalgia rheumatica on chronic prednisone presents with one day history of retrosternal chest pain radiating to the back with associated nausea and non-bloody emesis. There was an antecedent two week history of sore throat with a severe post-nasal drip. On presentation, the patient was toxic appearing with features of septic shock. Cross sectional imaging reveals marked gastric wall thickening with patent gastric vasculature. Upper endoscopy defines areas of gastric ischemia with necrotic ulcerations on the lesser curvature (Figure 1). Exploratory laparotomy with distal gastrectomy demonstrates acute necrotizing gastritis with gastric wall gangrene; histopathology reveals numerous gram-positive cocci in chains (Figure 2, 3). Blood cultures were positive for Group A Streptococcus. There was no evidence of an underlying hypercoagulable or rheumatological disorder; an extensive infectious disease evaluation inclusive of TEE, CT chest and sinus, bronchoscopy, and thoracentesis was negative. The patient was successfully treated with penicillin.Figure 1Figure 2Figure 3Conclusion: This case highlights an atypical presentation of Group A Streptococcal pharyngitis with consequent gastric gangrene. There is scant literature regarding acute nectrotizing gastritis secondary to an inciting infectious etiology. Early recognition remains the cornerstone in mitigating against significant morbidity and mortality.

Isolation ofStaphylococcus simulansfrom Dermatitis in a Captive African Pygmy Hedgehog

Staphylococcus simulans, a coagulase-negative staphylococcal species, can cause several diseases in humans and animals. This report describes a case of dermatosis characterized by broad, well-circumscribed hyperkeratosis and alopecia on the back of a household pygmy hedgehog (Erinaceous albiventris). Quills and exudates were studied by microscopy. The microscopic examination of the exudates collected from the lesion revealed several leukocytes and numerous gram-positive cocci. An aerobic bacterial culture revealed overgrowth of the same gram-positive bacteria. The bacterium was identified as S. simulans by polymerase chain reaction amplification and direct sequencing targeted to the 16S ribosomal RNA gene. This report is the first to show that S. simulans could be related to the dermatitis of hedgehogs.

Streptococcus suisMeningitis, Hawaii

<i>Streptococcus suis</i>Meningitis, Hawaii

Infected right ventricular myxoma and pulmonary valve endocarditis

Case Summary A 44-year-old man with a history of intravenous drug use, hepatitis C, and bipolar disease came to hospital with septic shock and hypoxia requiring low-dose vasopressor support and high-flow oxygen by face mask. Echocardiographic examination revealed a 4.3-cm solid, hyperechoic nodule in the right ventricle. He was treated with intravenous trimethoprim/sulfamethoxazole, vancomycin, and gentamicin for Streptococcus viridans, which had been isolated from the blood and sputum. Computerized tomographic imaging revealed no evidence of any masses in the abdomen or thorax, although there was evidence of pulmonary microemboli and bilateral empyemas. The patient was treated with antibiotics for 6 weeks, with no change noted in the size of the right ventricular mass on serial echocardiography. During this period, the patient’s condition was clinically stable; however, persistent fever and elevated white blood cell count ( 18,000 cells/ L) prompted cardiac surgical consultation. The patient was subsequently taken to the operating room, where the initial intraoperative echocardiography confirmed a solid hyperechoic mass originating in the right ventricle (Figure 1), which was prolapsing across an abnormal pulmonic valve and causing pulmonic insufficiency. An attempt was made to remove the mass through the right atrium. Because of the size of the mass and concern of damaging the tricuspid valve, however, a right ventriculotomy was performed and the mass removed en bloc. The ventriculotomy was closed with running 3-0 Prolene sutures (Ethicon, Inc, Somerville, NJ) and felt. During weaning from cardiopulmonary bypass, transesophageal echocardiography showed severe pulmonary insufficiency secondary to a flail anterior leaflet that had previously been obscured by the ventricular mass. The pulmonary valve was then replaced with a No. 25 Hancock II bioprosthesis (Medtronic, Inc, Minneapolis, Minn). The patient was weaned from cardiopulmonary bypass without difficulty, had an uncomplicated postoperative course, and remains alive and well. The final pathology report confirmed infection of a tricuspid pulmonary valve with gram-positive cocci. The right ventricular mass, which measured 8 5 3 cm, was found to be an infected benign cardiac myxoma with necrosis and numerous gram-positive cocci (Figure 2).

劇症型Ａ群β溶連菌感染症の救命にＭＲＩと術中迅速病理診断を用いた１症例

A 33-year-old man was admitted to our emergency room with tachycardia and hypotension. Diffuse swelling, extensive blistering were noted in the body region extending from the left thigh to the left scrotum. Laboratory data revealed severe metabolic acidosis with an elevated anion gap and high lactate level, leukocytosis and renal dysfunction. Bacteriological examination of the exudate obtained from the blisters revealed numerous Gram-positive cocci. Although computed tomography revealed only swelling of the left thigh and scrotum, MRI, which was performed when the patient was clinically stable at the previous hospital, clearly suggested extensive myofascitis of the left thigh. An emergency debridement of the infected wounds was carried out, and intraoperative histopathological diagnosis guided the area of debridment. The resected tissues from the left thigh and scrotum revealed widespread necrosis and large numbers of Gram-positive cocci, which were identified as Group A β-hemolytic streptococci. In this case report, we show that MRI and intraoperative histopathological examination are more effective than computed tomography for the early diagnosis of TSLS.

Septic pulmonary thrombosis in streptococcal toxic shock syndrome

A 60-year-old woman who was previously in good health presented with a sore throat, fever, and a flu-like syndrome. Treated initially with acetaminophen and fluids for a presumed viral infection, she had a syncopal episode 4 days later, was admitted to the hospital, and died 3 hours after admission. Laboratory test results suggested sepsis with disseminated intravascular coagulation (DIC), whereas blood cultures grew group A beta-hemolytic streptococci. A postmortem diagnosis of streptococcal toxic shock syndrome was established. It was of particular interest that the pulmonary microcirculation was filled with thrombi that contained numerous gram-positive cocci. Although death from sepsis with DIC is not uncommon, septic pulmonary thrombosis has not been previously described. We speculate that this paradox may reflect unique properties of the virulent strains of Streptococcus pyogenes that are associated with streptococcal toxic shock syndrome.

Clinicopathology of meningoventriculitis due to Streptococcus bovis infection in neonatal calves.

Three neonatal calves ranging in age from 4 to 14 days were examined pathologically and bacteriologically. The calves showed depression, anorexia, pyrexia, and difficulty or inability to stand followed by cloudiness of the ocular aqueous humor or cornea. Autopsy revealed congestion, petechiae, and cloudy areas in the meninges. Histologically, the central nervous system (CNS) lesions were prominent and limited to the meninges where fibrinous exudate and infiltrations of neutrophils, macrophages, and lymphocytes were present. There were mild or slight degrees of choroid plexitis and ependymitis. Endophthalmitis was seen as a concurrent lesion in all cases. Fibrinous or fibrinopurulent changes were found in the peritoneum and epicardium as well as in several other organs. Numerous Gram-positive cocci were detected in affected areas of the whole body. Bacteriologically, Streptococcus bovis was isolated from all examined materials consisting of the brain, cerebrospinal fluid, ocular aqueous humor, and several other organs. These results suggest that the lesions were associated with infection of the organism and that the present cases were in the process of septicemia.

Staphylococcus-Induced Gangrenous Dermatitis in Broilers

An infectious bursal disease (IBD)-vaccinated flock of 23,900 broilers, 17 days of age, experienced sudden onset of depression, dermatitis, and mortality. Postmortem examination showed extensive subcutaneous serosanguineous fluid accumulation over the pectoral muscles, discrete hepatic whitish foci, fluid-filled intestines, and small, flaccid bursae of Fabricius. Gram-stained impression smears from the affected areas revealed numerous gram-positive cocci. Aerobic culture of liver and subcutaneous tissue consistently produced heavy growth of penicillin-sensitive Staphyloccus aureus. Histopathologically, subcutaneous tissue showed diffuse hemorrhage and large numbers of gram-positive cocci with severe congestion and hemorrhage of the underlying skeletal muscle. Liver sections showed multiple, randomly scattered areas of acute coagulation necrosis with numerous gram-positive cocci. Bursal lesions were characterized by extensive follicular necrosis and collapse. A diagnosis of staphylococcal gangrenous dermatitis secondary to IBD was made. Mortality returned to preinfection levels within 72 hours after penicillin was added to the drinking water.

Cutaneous botryomycosis in a patient with acquired immunodeficiency syndrome

A patient with acquired immunodeficiency syndrome presented with multiple pruritic papules and nodules over the trunk and extremities. Biopsy specimens from two of these lesions contained granules within abscesses of the papillary dermis. There were numerous gram-positive cocci within the granules. Culture of one lesion failed to produce growth. A mouse inoculated with tissue from a lesion revealed no evidence of sepsis or organ involvement. The skin lesions showed no obvious response to systemic antimicrobial therapy but gradually resolved after treatment had been discontinued. Such lesions should be clinically distinguished from other cutaneous manifestations of acquired immunodeficiency syndrome, such as Kaposi's sarcoma.