Positive Rods Research Articles

A RARE CASE OF CORYNEBACTERIUM STRIATUM NATIVE VALVE ENDOCARDITIS

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Corynebacterium diphtheroids species are aerobic, Gram-positive bacilli often considered as part of normal skin flora and mucous membranes. Though frequently isolated in cultures, they are often assumed to be skin contaminants. Nonetheless, over the last decade they are reported to cause life threatening diseases including bacteremia and endocarditis. They cause 4-9% of prosthetic vale endocarditis but are only responsible for 0.2 to 0.4% of native valve endocarditis (NVE)(1). CASE PRESENTATION: 54 years old female with past medical history significant for hypertension, hyperlipidemia, mild intermittent asthma, anemia, seizure disorder, transient ischemic attack, cerebrovascular accident without any residual deficit, atrial fibrillation on coumadin, schizophrenia, chronic back pain, cocaine use, recent colitis presented with complains of intermittent fever, chills for few weeks and mechanical fall one day prior to presentation. She was recently treated for colitis at outside hospital (OH) and was discharged on oral co-amoxiclav. She reported that she had bacteremia. Vitals: temp 101.5F, Blood pressure (BP) 102/67mmhg. Physical examination: irregular heart rate, wheezing, positive cervical and lumbar paraspinal tenderness. Labs: normocytic anemia with hemoglobin of 10.4, platelet count of 115 x 109/L, sub-therapeutic international normalized ratio (INR) of 1.11 and cervical spine X-ray suggestive of disc space narrowing at C5-C6. Cefepime 1gm IVSS q8h and vancomycin 1gm IVSS q12h were started. Hospital course was complicated by hypotension with BP of 80s-90s systolic/50’s to 60’s diastolic, non-responsive to intravenous fluids and drop in oxygen saturation to 80’s due to development of pulmonary edema. Blood cultures were positive for gram positive rods. Medical records from OH revealed blood cultures positive for gram positive rods. Antibiotic was changed to ampicillin to cover possible listeria monocytogenes (blood cultures positive for gram positive rods). Transthoracic echocardiogram (TTE) was suggestive of aortic valve vegetation with severe regurgitation (See Figure 1). She was considered candidate for aortic valve replacement and transferred to cardiothoracic surgery. She successfully underwent aortic valve replacement. Final results of blood cultures grew “Corynebacterium Striatum (C. Striatum)”. DISCUSSION: This case highlights a patient with native valve endocarditis secondary to C. Striatum and its management. C. striatum is being recently recognized as a nosocomial opportunistic pathogen (2,3) and can rarely cause NVE. CONCLUSIONS: We stress that clinicians should be vigilant and consider Corynebacterium species as potential culprits while managing patients with bacteremia due to gram positive bacilli and should be cautious while labelling them as skin contaminants. Reference #1: Belmares J, Detterline S, Pak JB, Parada JP. Corynebacterium endocarditis species-specific risk factors and outcomes. BMC Infect Dis. 2007;7:4. Reference #2: Lee JY, Lee SH, Kim WH. Three-valve Endocarditis Caused by Corynebacterium striatum. Korean Circ J. 2018;48(9):861-2. Reference #3: McMullen AR, Anderson N, Wallace MA, Shupe A, Burnham CA. When Good Bugs Go Bad: Epidemiology and Antimicrobial Resistance Profiles of Corynebacterium striatum, an Emerging Multidrug-Resistant, Opportunistic Pathogen. Antimicrob Agents Chemother. 2017;61(11). DISCLOSURES: No relevant relationships by Moses Bachan, source=Web Response No relevant relationships by Zinobia Khan, source=Web Response No relevant relationships by Dileep Kumar, source=Web Response

1730 Esophageal Actinomycosis in a Patient With Long-Standing Esophageal Stent

INTRODUCTION: Actinomyces is a commensal in aero-digestive tracts which rarely causes infection. The commonest site is cervicofacial region. Risk factors are low immunity and pre-existing tissue damage. Esophageal involvement is rare. We report a case of esophageal actinomycosis in an immunocompetent patient. CASE DESCRIPTION/METHODS: A 71-year-old male presented with recurrent dysphagia. The patient had multiple prior EGDs for management of refractory peptic stricture due to gastrin secreting pancreatic neuroendocrine tumor. He undewent multiple prior procedures with placement of fully-covered self-expanding metal stents (SEMS) for therapy of refractory stricture, as surgical esophagectomy was not possible due to co-morbidities and patient preference. On previous EGD, one of the stents could not be removed due to tissue ingrowth at the distal end, and another SEMS was placed overlapping the imbedded stent and extending to the gastric cardia. The patient was lost to follow up for 7 months until presenting with recurrence of dysphagia. EGD now showed proximal migration of the distal stent with severe stenosis, inflammation, and nodularity distal to the esophageal stents. The distal stent was imbedded in the abnormal mucosa and could not be removed. Following balloon dilation another SEMS was placed in the distal esophagus. Pathology revealed ulcerated acute esophagitis with actinomycetes colonies. The patient was placed on a long course of IV penicillin-G. At subsequent EGD a month later, the tissue ingrowth improved allowing removal of the esophageal stents. Repeat biopsies did not reveal actinomyces. DISCUSSION: Actinomyces, a gram positive anaerobic rod, is unable to penetrate healthy tissue. It requires mucosal compromise to invade tissue, leading to abscess and sinus formation across tissue planes. Our patient had multiple risk factors - mucosal damage, endoscopic dilations and stenting. Esophageal stent in situ for longer than 3 months increases the risk of embedment. Discovery of esophageal ulceration or tissue ingrowth in this setting should raise suspicion for possible actinomycosis (among other diagnoses) and biopsies should be obtained. Gram stain and histology would reveal necrosis with yellow sulfur granules and gram-positive filamentous pathogen. Early diagnosis is necessary to initiate treatment in a timely manner to prevent the potentially debilitating sequelae of chronic infection. Treatment includes penicillin G or amoxicillin for 3-12 months.

A CASE OF EMPYEMA SECONDARY TO ACTINOMYCES NEUII

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Actinomyces neuii is a gram-positive organism infrequently recognized and can cause a myriad of infections. To date, no infections have been described in the pleural space. We present a case of empyema secondary to A. neuii. CASE PRESENTATION: 74 year old woman presented with 2 months of dyspnea on exertion, 5 days of acute pleuritic chest pain, fever, and oxygen desaturation to 88% on room air as outpatient prompting hospitalization. She denied weight loss, had a history of hypothyroidism, remote history of removed left breast fibro-adenoma and quit smoking 40 years prior. She received antibiotics for an upper respiratory infection a month prior. She had a neutrophil predominant leukocytosis to 19.4 and elevated liver enzymes. Computed tomography of chest showed right hilar lymphadenopathy and loculated pleural effusion. She was admitted and started on broad spectrum antibiotics. A chest tube was placed yielding purulent drainage and fluid analysis revealed 85% neutrophils with lactate dehydrogenase of 1843 U/L indicating an exudate. She was treated according to the MIST II protocol for empyema. Further workup revealed negative respiratory viral, HIV, immunoglobulin and hepatitis panels. Blood culture grew gram positive rods 84 hours after admission in anaerobic media which speciated 2 weeks after as A. neuii. Pleural fluid cytopathology was negative for malignancy and culture, including acid fast bacilli. CT of her abdomen and pelvis was negative for intra-abdominal source of infection, but revealed fibroid uterus and an intrauterine device (IUD) without evidence of infection. She completed 4 weeks of Ceftriaxone followed by 4.5 months of Amoxicillin with resolution of leukocytosis, lymphadenopathy and complete resolution of pleural space on outpatient interval imaging. DISCUSSION: A. neuii is an aerobic and facultative anaerobic organism that does not produce sulfur granules or branching filaments. It can cause soft tissue abscesses especially surrounding foreign bodies, post intravitreal injection endopthalmitis, and 2 cases of neonatal sepsis that resulted in premature delivery. One mother had emergent placement of cervical cerclage while the other had prolonged use of IUD. A. neuii is susceptible to beta-lactam antibiotics, clindamycin and erythromycin. Fluoroquinolones and trimethoprim-sulfamethoxazole have less in-vitro activity against isolates. Surgical resection is usually indicated for soft tissue infections. Though inconclusive, the preceding respiratory infection or the prolonged use of IUD may have been sources for infection. We suspect A. neuii was the causative organism for the empyema despite the fact that it was only cultured from blood and not from the pleural space. CONCLUSIONS: To date, no cases of empyema due to A. neuii have been reported in literature. We describe a case with successful non-surgical management. Reference #1: 1. Zelyas N, Gee S, Nilsson B, Bennett T, Rennie R. Infections Caused by Actinomyces neuii: A Case Series and Review of an Unusual Bacterim. Can J Infect Dis Med Mircobiol. 2016;2016:6017605 Reference #2: 2. Olson JM, Vary JC Jr. Primary Cutaneous Actinomyces neuii Infection of the Breast Successfully Treated with Doxycycline. Cutis 2013;92(16)E3-4 Reference #3: 5. Alsohime F, Assiri RA, Al-Shahrani F, Bakeet H, Elhazmmi M, Somily AM. Premature labor and neonatal sepsis caused by Actinomyces neuii. J Infect Public Health 2018 S1876-0341(18)30037-6 DISCLOSURES: no disclosure on file for Stella Hahn; no disclosure on file for Gita Lisker; No relevant relationships by Etieno Umobong, source=Web Response

Synthesis and biological evaluation of tetrazole derivatives as TNF-α, IL-6 and COX-2 inhibitors with antimicrobial activity: Computational analysis, molecular modeling study and region-specific cyclization using 2D NMR tools

A group of tetrazole bearing compounds were synthesized and evaluated for their in vitro cyclooxygenase (COX) isozymes (COX-1/COX-2) inhibitory activity, in vitro anti-inflammatory activity through measuring levels of expression of IL-6 and TNF-α and antimicrobial activity. Cyclization of pyridine derivative 5b was confirmed using 2D NMR such as NOESY and HMBC experiments. Within the synthesized compounds, compound 7c was identified as effective and selective COX-2 inhibitors (COX-2 IC50 = 0.23 uM; COX-2 selectivity index = 16.91). Moreover 7c was the most effective derivative on TNF-α (37.6 pg/ml). While, the most active compound on IL-6 was isoxazole derivative 6 (42.8 pg/ml). Dual inhibitory activity on both IL-6 and TNF-α was exhibited by compounds 2 and 3 (IL-6 = 47.5 and 82.7 pg/ml, respectively) and (TNF-α = 31.7 and 33.8 pg/ml, sequentially).Additionally, compound 7a, showed broad spectrum antimicrobial activity against Gram positive cocci, Gram positive rods and yeast fungus (inhibition zone = 20 and 19 mm). None of the test compounds exhibited activity against Gram negative rods. Compounds 3 and 7c exhibited good antifungal activity at MIC equal to 64.5 µg/ml. While compound 6 showed antibacterial activities against Micrococcus lysodicticus and Bacillus subtilis at MIC = 32.25 and 64.5 µg/ml, respectively.Computational analysis was used to predict molecular properties and bioactivity of the target compounds. To confirm the mode of action of the synthesized compounds as anti-inflammatory agents, molecular docking was done. Appreciable binding interactions were observed for compound 7c containing COX-2 pharmacophore (SO2NH2), with binding energy −10.6652 Kcal/mol, forming two hydrogen bonding interactions with His90 and Tyr355 amino acids. It was fully fitted within COX-2 active site having the highest COX-2 selectivity index between all the test compounds (S.I. = 16.91).

Treatment of a Non-healing Wound Formed After a Faulty Injection with the Larvae of Lucilia sericata

Because of the risk of intramuscular (IM) injection, the healthcare staff who will be injecting should know the anatomy of the region to be treated well and should do well in choosing the region. Most of the common IM injection complications are due to the lack of information and the use of inappropriate technique. A.Ö., who is 48-year old male with gout disease, had a pain so the injection of a diclofenac sodium bulb was done by his mother at his home 5 months ago and a wound was formed in this region afterwards. The patient was given a trimetoprim+sulfametoksazol intravenous vial (İV) 2*1, and the wound has grown and deepened although conventional wound treatments have been applied. When the patient applied to our policlinic on 24.03.2017, the patient had a 8x5x2 cm, infected, and purulent wound on his right hip ¼ in the lower outer quadrant. A sample was taken from the wound and sent to the medical microbiology laboratory. According to the wound size and depth, 500-600 first stage sterile larvae of Lucilia sericata were placed directly on the wound. Pseudomonas aeruginosa (P. aeruginosa) was proliferated in first wound culture. Gram positive difteroid rods were proliferated in the material taken before the 4th session, P. aeruginosa was not proliferated. The wound of the patient was healing with 12 sessions larvae treatment in 2 months. As a result; Larval Debridement Therapy (LDT) with L. sericata larvae may be an option for the treatment of any non-healing wound that is infected with antibiotic-resistant bacteria.

Flavivirga rizhaonensis sp. nov., a marine bacterium isolated from intertidal sand.

A bacterial strain designated RZ03T was isolated from an intertidal sand sample from the Yellow Sea in China and characterised using a polyphasic taxonomic approach. Cells of strain RZ03T were observed to be Gram-stain negative, aerobic, and oxidase and catalase positive rods showing gliding motility and forming yellow colonies. Growth was found to occur at 7-30°C (optimum, 25°C), at pH 5.5-9.5 (optimum, pH 6.5-7.0) and with 0.5-5% NaCl (optimum, 1.5-2%). Phylogenetic analysis based on 16S rRNA gene sequences indicates that strain RZ03T clusters within members of the genus Flavivirga of the family Flavobacteriaceae and is closely related to the type strains Flavivirga amylovorans JCM 17112T and Flavivirga jejuensis JCM 17113T (97.9% and 97.5% similarity, respectively). The predominant cellular fatty acids are iso-C15:0, iso-C15:1 G, iso-C17:0 3-OH and iso-C15:0 3-OH and the major respiratory quinone is MK-6. Polar lipids include phosphatidylethanolamine, three unidentified aminolipids, an unidentified phospholipid and four unidentified lipids. The genome of strain RZ03T is 4.88 Mbp with a G+C content of 32.2mol%. A total of 4152 genes are predicted, with 4052 protein-coding genes, 51 RNA genes and 49 pseudogenes. This polyphasic study suggests that strain RZ03T represents a novel species in the genus Flavivirga, for which the name Flavivirga rizhaonensis is proposed. The type strain is RZ03T(= KCTC 62833T = MCCC 1K03615T).

Production of Bioethanol from Cassava using Zymomonas mobilis: Effect of Temperature and Substrate concentration

The production of ethanol from cassava flour using Zymomonas mobilis a gram negative bacterium was conducted at 30oC, 33oC, 35oC and 37oC. The fermentation reaction was also carried out at different substrate concentrations; 5% W/V, 7% W/V and 10% W/V. The microorganism Zymomonas mobilis was detected in palm wine, isolated and identified. It was found to be gram negative, oxidase negative, catalase positive, anaerobic and plump rods with an unusual width. Results obtained from the simultaneous saccharification and fermentation reactions carried out with Zymomonas mobilis showed that maximum theoretical ethanol yield of 63% was obtained for 7% W/V cassava flour at 35oC. This was followed by a theoretical yield of 56.23 and 54.12 for 5% W/V and 10% W/V cassava flour, respectively. Fermentations at 30oC and 33 oC gave similar results with 7% W/V cassava producing higher ethanol yield when compared to 5% W/V and 10% W/V. Fermentation reactions at 37oC gave the lowest ethanol yields. The optimum pH for the simultaneous saccharification and fermentation of cassava was found to be pH of 6.

Preliminary and Biochemical Characterization of Bacterial Strains Isolated from Ramie Cane Soils

For the present study a total of 18 bacterial isolates were isolated from Ramie canes soils. Preliminary characteristics like colony characteristics and substrate concentrations were studied for the microorganisms. Physicochemical factors affecting the bacterial growth. The three seasons winter, summer and rainy seasons were also affected the growth of the bacteria. Various substrates like starch peptone, xylan peptone, Glycerol, Aspargine, glucose nitrate agar, carboxymethyl cellulose agar and pectin peptone agar media were studied. Maximum colony growth was recorded in pectin peptone agar media. Cream white, orange, red, yellow, lemon yellow and watery white colonies were recorded. The size of the bacterial strains was recorded in 1-55 mm in diameter. All the strains were entire lobed, convex having smooth and rough surface. of the 18 strains 11 were gram positive rods and the remaining strains were negative rods. Among the 18 strains, we were selected six strains for further studies like effect of seasons on growth and amino acid infilteration of bacteria. Maximum growth was recorded in winter season with 85.0 colony count in the presence of CCLS strain. There are 10 amino acids were introduced into the bacteria, with maximum growth was WCES bacterial strain. The results of this study reveal that the soil microflora associated with the ramie cane soils. These bacterial strains were used in the process of decortication and degumming.

First Report of Clavibacter michiganensis subsp. michiganensis Infecting Potato in Russia

Yellow-pigmented clavibacteria were isolated from diseased potato plants and tubers from five regions of Russia between 2011 and 2017. Severe outbreaks of the disease were recorded in the central and northwest parts of the Russian Federation. Plants exhibited yellowing and necrosis of the leaf and wilting of whole leaves and plants, and brown veins around potato tuber eyes were visible on cross sections. Vascular tissue was removed from discolored nodes, crushed in sterile 10 mM phosphate buffer, and dilution plated on yeast extract dextrose calcium carbonate agar. Creamy yellow colonies developed from the extracts after 7 days incubation at 26°C. Isolates from each diseased potato plant (35 isolates deposited to the State Collection of Phytopathogenic Microorganisms at Russian Research Institute of Phytopathology, Bolshie Vyazemy) were identified as Clavibacter michiganensis subsp. michiganensis (Cmm) using taxon-specific polymerase chain reaction (PCR) with primers CMM5/CMM6 that gave expected product of 614 bp (Dreier et al. 1995). Additionally, isolates were positive for Cmm and negative for C. michiganensis subsp. sepedonicus using a commercial ELISA test (Agdia Biofords, France). Bacteria were gram positive aerobic rods with biochemical traits uniform and similar to the type strain Cmm NCPPB2979T (Schaad et al. 2001). All isolates were positive for esculin hydrolysis, gelatin liquefaction, H₂S production from peptone, utilization of citrate and succinate, and acid from d(+)mannose, and negative for starch hydrolysis, casein hydrolysis, methyl red reaction, acid from inulin, mannitol, d(+)melezitose and d(–)sorbitol, and utilization of acetate, formate, lactate, propionate, and ribose. Sequencing of the 16S rRNA (Weisburg et al. 1991) and gyrB gene (Zaluga et al. 2011) was performed for all 35 isolates. 16S rRNA sequencing (GenBank accession nos. MH035728.1 to MH035762.1) showed a >99% relatedness to Cmm type strain NCPPB2979ᵀ. gyrB gene analysis grouped the new potato-isolated strains (GenBank accession nos. MH042254 to MH042288) with Cmm strains from tomato obtained from the same regions. Pathogenicity of four typical isolates was tested on tomato (cv. Dubok) and potato (cv. Lion Heart) plants using suspensions of about 10⁸ cells/ml in sterile tap water. Four to six plantlets with two to four fully developed leaves were inoculated by stem infiltration (Zaluga et al. 2013) with 10 µl of bacterial suspension and were placed in a growth chamber at 20 to 25°C. The type strain of Cmm from tomato was used as a pathogenic control. The first symptoms appeared 14 days after inoculation and progressed slowly. In both tomato and potato plantlets, the four Cmm isolates displayed chlorosis of leaf margins, mottling and yellowing between veins, wilting or necrosis of individual leaf parts, and finally wilting of whole leaves. Each isolate was recovered from infected test plants and reidentified as Cmm by PCR with primers CMM5/CMM6. No symptoms were observed on negative control plants inoculated with sterile water and on potato inoculated with the Cmm type strain. 16S rRNA gene (GenBank accession nos. MH035728.1 to MH035762.1) showed a >99% relatedness to Cmm type strain NCPPB2979ᵀ. This is the first report of Cmm affecting potato in Russia.

The promises and risks of probiotic Bacillus species.

Supplementing the human microbiome with probiotic microorganisms is a proposed solution for civilization syndromes such as dysbiosis and gastrointestinal tract (GIT) disorders. Bimodal probiotic strains of the Bacillus genus constitute the microbiota of the human environment, and are typically found in soil, water, a number of non-dairy fermented foods, as well as in human and animal GIT. Probiotic Bacillus sp. are Gram positive rods, with the ability of sporulation to survive environmental stress and preparation conditions. In vitro models of the human stomach and human studies with probiotic Bacillus reveal the mechanisms of its life cycle and sporulation. The Bacillus sp. probiotic biofilm introduces biochemical effects such as antimicrobial and enzymatic activity, thus contributing to protection from GIT and other infections. Despite the beneficial activity of Bacillus strains belonging to the safety group 1, a number of strains can pose a substantial health risk, carrying genes for various toxins or antibiotic resistance. Commercially available Bacillus probiotic preparations include strains from the subtilis and other closely related phylogenetic clades. Those intended for oral administration in humans, often encapsulated with appropriate supporting materials, still tend to be mislabeled or poorly characterized. Bacillus sp. MALDI-TOF analysis, combined with sequencing of characteristic 16S rRNA or enzyme coding genes, may provide accurate identification. A promising future application of the probiotic Bacillus sp. might be the microflora biocontrol in the human body and the closest human environment. Environmental probiotic Bacillus species display the potential to support human microflora, however controversies regarding the safety of certain strains is a key factor in their still limited application.

Clinical Features and Risk Factors of Post-Engraftment Bloodstream Infection in Allogeneic HCT

[Introduction]Bloodstream infection (BSI) is a serious complication of HCT that may be life-threatening. BSI frequently occurs before neutrophil engraftment (pre-engraftment BSI), but has also been reported after neutrophil recovery (post-engraftment BSI). In contrast to pre-engraftment BSI, the clinical features and risk factors of post-engraftment BSI remain unclear.[Aims]We investigated the clinical characteristics of and risk factors for post-engraftment BSI.[Methods]This retrospective study included 176 adult patients who underwent HCT and achieved neutrophil engraftment between 2006 and 2017 at our institute. Diagnoses consisted of AML (n=86), ALL (n=36), MDS (n=21), MPN (n=4), CML (n=1), ATL (n=6), aplastic anemia (n=6), and malignant lymphoma (n= 16). The median age at HCT was 42 y (range 16-67 y). Graft sources were BM (n=69), PB (n=57), and CB (n=50). Fifty-five patients (31.2%) had a high (≥3) HCT-CI score on HCT. Sixty-four patients (36.4%) received HCT with an advanced disease status. Fluoroquinolone (FQ) as prophylaxis was administered to 89 patients (50.6%). Central venous catheters (CV) were inserted in all patients before HCT. All patients consulted a dentist before HCT and received guidance on appropriate oral self-care to prevent severe oral mucositis; 92 (52.3%) continuously received intensive oral care after HCT (I-care; visit to a dentist at least once a week until neutrophil engraftment for the assessment of oral mucositis and cleaning), whereas 84 (47.7%) only performed oral self-care (S-care; according to guidance by a dentist). In the present study, BSI was defined as an infectious state with fever (≥38°C) and the isolation of a pathogen on at least 1 blood culture or on 2 or more if a common skin contaminant was isolated. Post-engraftment BSI was evaluated until day 180.[Results]Seventy-five events of BSI (in 69 patients) occurred until day 180. The total cumulative incidence of BSI (CIB) was 39.2%. The CIB of pre- and post-engraftment BSI were similar at 21.6% (n=38) and 21.0% (n=37) (p=1.0), respectively. Six patients developed pre- and post-engraftment BSI. CV was inserted in all patients when BSI occurred. Twenty-five pathogens were isolated in the present study. Regarding the type of pathogen, Gram-positive cocci were the most common in pre-/post-engraftment BSI (63.2%/69.0%). Gram-negative (29.0%/14.3%) and -positive rods (15.8%/19.0%) were detected. Staphylococcus epidermidis was the most frequently detected species in pre/post-engraftment BSI (31.6%/57.1%). Similar to CIB, no significant difference was observed in the pathogens identified between pre-/post-engraftment BSI (p=0.34).We performed further analyses to identify risk factors for post-engraftment BSI. In Fisher's exact test as a univariate analysis, HCT-CI≥3 (p=0.045), TBI≥3 Gy (p=0.041), not administered FQ (p=0.042), no I-care (p=0.003), and a graft source of BM (p=0.002) were identified as risk factors for post-engraftment BSI. Age (p=0.25), conditioning (p=0.197), repeated HCT (0.607), disease stage prior to HCT (p=0.701), and a history of pre-engraftment BSI (p=0.501) did not contribute to post-engraftment BSI. A logistic regression test with backward stepwise selection based on p-values as the multivariate analysis revealed that I-care (OR 0.358, 95%CI: 0.16-0.801, p=0.0124) and a graft source of PB (OR 0.322, 95%CI: 0.124-0.837, p=0.02) reduced the risk of post-engraftment BSI.Furthermore, to confirm the impact of the oral care type on post-engraftment BSI, we compared the CIB of the S- and I-care groups. The CIB of pre-engraftment BSI was similar between the I- and S-care groups (21.4% vs 21.7%, p=1), whereas that of post-engraftment BSI was significantly lower in the I-care group (12.0% vs 29.8%, p<0.001) than in the S-care group.[Conclusion]CIB and isolated pathogens were similar between pre- and post-engraftment BSI, even if neutrophils had recovered sufficiently. Since BSI may occur at any time during transplantation, careful follow-ups are needed. Intensive oral care by a dental specialist may reduce the risk of post-engraftment BSI. DisclosuresNo relevant conflicts of interest to declare.

Clostridium perfringens Bacteremia-Associated Hemolysis

Clostridium perfringens (C. perfringens) is an anaerobic gram positive rod which is part of the normal flora in the gastrointestinal tract. This organism has the potential for causing fatal infections in immunocompromised patients. Twio rare complications of this bacteria are pyogenic liver abscess with the potential for septic shock. as well as severe hemolytic anemia. About 14% of patients with C. perfringens bacteremia develop hemolytic anemia, which has a mortality as high as 74%, with death occurring within 96 hours. Typically, C. perfringens gains access to the blood stream through mucosal defects in the gastrointestinal tract or through the hepatobiliary tract. Conditions that increase the chances of developing sepsis include trauma, abdominal surgeries, and immunocompromised states The alpha toxin produced by C. perfringens hydrolyzes components of cellular walls resulting in tissue death, often causing gas filled abscesses. While streptolysin O and perfringolysin O are more commonly associated with intravascular hemolysis and disseminated intravascular coagulopathy. A 65-year old female with diffuse large B cell lymphoma who underwent right hemicolectomy and completed her first cycle of chemotherapy recently presented with a high grade fever. Blood cultures were drawn on arrival. Initial labs were significant for: hemoglobin of 5.9 g/dl, WBC 0.2, pH 7.04, and bicarbonate 10 mEq/L. While in the ER she became hypotensive requiring pressor support, became unresponsive, was intubated, and started on broad spectrum antibiotics to the intensive care unit. Computed tomography of abdomen reported multiple gas filled liver abscesses for which she underwent a drain by interventional radiology that yielded bloody contents. Despite multiple blood transfusions, her hemoglobin continued to fall without evidence of blood loss and dropped to 1.7 g/dl. Lactate dehydrogenase was over 25,000 U/L, bilirubin was 22.7, which suggested intravascular hemolysis, and negative direct antiglobulin test ruled out immune hemolysis. She developed multiorgan failure and after 36 hours and she died shortly thereafter. Ultimately, her blood cultures grew C. perfringens. In patients with intra-abdominal abscess and a rapidly deteriorating clinical status, C. perfringens bacteremia should be considered as early antibiotic therapy and source control with surgery or drainage by interventional radiology is essential given the rapid clinical deterioration and high mortality rate.2245 Figure 1. CT abdomen showing liver abscess in right and left lobes

ACTINOMYCOSIS

SESSION TITLE: Chest Infections 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Actinomycosis is a rarely encountered infection and technically difficult to culture, hence may pose a challenge for the clinician. Awareness regarding this uncommon infection, when dealing with susceptible patients, can lead to early diagnosis and optimal treatment. CASE PRESENTATION: 37 M with history of chronic alcohol abuse, presented complaining of hemoptysis, SOB, subjective fever and generalized myalgias for 2 weeks. PE revealed tachypnea, fever and left lung crackles. Labs showed acute hypoxic respiratory failure and lactate elevation. CT revealed 9 x 6 cm inflammatory-appearing cavitary lung mass in the left lower lobe most likely representing a lung abscess, along with large left sided loculated pleural effusion. Patient was intubated and empiric antibiotic therapy was started.2 left CT were placed for loculated pleural effusion. Sputum and pleural fluid AFB were negative. Pleural fluid was exudative and revealed Gram positive cocci and Gram positive rods, with identification of sulfur granules which was highly suggestive of Actinomyces. Intrapleural fibrinolytic agents were given with optimal drainage of empyema. Patient was extubated and improved clinically DISCUSSION: Diagnosis of Pulmonary Actinomycosis, solely based on clinical presentation is not possible. Imaging studies commonly show air-space consolidation and/or cavitary or mass-like lesions. Parenchymal disease can also extend to pleural cavity and chest wall. BAL for culture is inappropriate since it may only represent colonization. Acceptable specimen include lung biopsy or pleural fluid. Gold-standard for diagnosing Actinomycosis is growth of the bacteria in culture, but is technically difficult and occurs only in a minority of cases. If the suspicion is high, the clinician should indicate this to the microbiologist to ensure appropriate processing specimen measures. Identification of sulfur granules from pleural fluid is strongly supportive of Actinomycosis and may be enough to lead the clinician into the diagnosis and appropriate management. Carbapenems or combination of a beta-lactam with beta-lactamase inhibitor in the setting of lung abscess, is a proper empiric approach.Therapy should be targeted once Actinomycosis has been diagnosed. Intravenous therapy should be given for 2 to 6 weeks, followed by oral route.Length of the oral antibiotic depends on clinical and radiological response. Resolution of radiographic findings may take several months, with 6 months to 1 yr. of oral antibiotics being recommended. CONCLUSIONS: Actinomycosis should be suspected in patients with history of aspiration or at risk for it and individuals with chronic alcohol abuse. A high clinical index of suspicion could lead to the proper usage of diagnostic tools and facilitate the rare growth of the causative pathogen in culture. Proper diagnosis should guide to targeted treatment and follow up, along with optimal duration of antibiotics. Reference #1: Choi J, Koh WJ, Kim TS, et al. Optimal duration of IV and oral antibiotics in the treatment of thoracic actinomycosis. Chest. 2005 Oct. 128(4):2211-7. Reference #2: De Montpreville VT, Nashashibi N, Dulmet EM. Actinomycosis and other bronchopulmonary infections with bacterial granules. Ann Diagn Pathol. 1999 Apr. 3(2):67-74. Reference #3: Kim TS, Han J, Koh WJ, et al. Thoracic Actinomycosis: CT Features with Histopathologic Correlation. AJR Am J Roentgenol. 2006 Jan. 186(1):225-31. DISCLOSURES: No relevant relationships by Jonathan Arnedo, source=Web Response No relevant relationships by Yesika Garcia, source=Web Response No relevant relationships by Seyedmohammad Pourshahid, source=Web Response No relevant relationships by Theo Trandafirescu, source=Web Response

Isolation of newer probiotic microorganisms from unconventional sources

Probiotics are live microbes in the form of dried or fermented cells that are highly beneficial for human health. The food industry has been revolutionised due to introduction of potential probiotic organisms in a varied formulations derived from mostly dairy products. Isolation of probiotic microbes from unexplored non-dairy sources is gaining attention these days. In the present study, six potential probiotic isolates from non-dairy sources were obtained that are also biocompatible with each other. Out of these, five isolates were gram positive rod shaped and one was gram negative rod shaped. These isolates were able to grow in presence of lysozyme, low pH and bile salts with good adherence ability. The market for probiotic microorganisms from unconventional products is accelerating to deal with lactose intolerant people. These probiotic attribute studies revealed their potential to be exploited at industrial scale.

Electrochemical Growth of Sponge/Raspberry-Like Gold Nanoclusters at the Carbon Rod

For the first time, the positive carbon rod of zinc-carbon battery (battery carbon rod electrode, BCRE) was used as a new working electrode and its electrochemical behavior was compared with carbon paste and glassy carbon electrodes in KCl solution containing Fe(CN6)3–/4– ions as probe agent. Then, the sponge/raspberry-like Au nanoclusters (AuNCs) were synthesized on BCRE by one-step electrodeposition of HAuCl4 in phosphate and nitrate buffer solution and the electrochemical properties of surfaces was investigated in probe media and sulfuric acid. This fabrication method was simple, facile and controllable, without any seed, template or surfactant.

Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) score algorithm for identification of Gordonia species

Gordonia species differentiation is a tedious task. Herein, Gordonia identification was performed according to the standard Bruker score system and a recently proposed score for Gram positive rods identification (≥ 1.5 genus level and ≥ 1.7 species level). New scores significantly improved the identification at genus and species level.

Evaluation of Bacterial Population in the Saliva of Drug Addicts

Background: The human mouth harbors over 700 microbial genera. The large number of them is normal bacteria; few of them are opportunistic pathogens. Objective: The study was aimed to evaluate the bacterial population of drug addicted persons and compare it to that of a normal healthy person. Methods: Five different samples of human saliva; alcohol drunken person, oral moist snuff user, cigarette, hashish and shisha smoker were investigated the involvement of bacteria in them. One sample was collected from normal non-addict person. The bacterial population in drug addictive persons were compared that on normal non-addictive person. Results: The bacteria observed were: Gram negative cocci, mono cocci, streptococci, vibrio, gram negative rod, gram positive staphylococcus, gram positive streptococci and gram-positive rod. Conclusion: The order of bacterial population was; alcohol drunken person&lt;oral moist snuff user ˂ cigarette smoker ˂ hashish smoker ˂ shisha smoker˂ normal non addictive person. From the findings in this study it is concluded that all these drugs have some antibacterial activities.

Assessing the clinical relevance of Fenollaria massiliensis in human infections, using MALDI-TOF MS

Within the European Network for the Rapid Identification of Anaerobes (ENRIA) project eight clinical isolates of Fenollaria massiliensis were encountered. In this study a more extensive description of this species is given and the MALDI-TOF MS database is optimized for its identification.F. massiliensis is an anaerobic Gram positive rod with the tendency to decolorize quickly. It is mostly encountered in clinical samples from the groin region.Less common and non-valid species are not represented in the MALDI-TOF MS database. Therefore, F. massiliensis can only be identified by laboratories performing 16S rDNA gene sequencing. The addition of less common and non-valid species to the database will give insight in their clinical relevance.

Microbial quality assessment of indoor air in a large hospital building during winter and spring seasons

Sensitivity of hospital building environment due to presence of potential sources of wide range of airborne microbes, make it a complex environment. Present study aimed to investigate seasonal (winter & spring) variation in airborne microbial levels as well as species on various locations (i.e. operation theatres (OT1 & OT2), wards (GMW & SW), out-patient department (OPD) and emergency services (ES)) of a large hospital building. Air samples were collected during peak hours, twice a week, covering one month of each season. Statistically significant variation (p > 0.05) in bacterial concentrations over two seasons was found only for OPD. However, fungal concentrations significantly varied (p < 0.05) over two seasons for all sites except for OT1 and OT2. Concentrations among most of sites were significantly different. Highest bacterial level was found in OPD (mean: 1649.7 CFU/m3) while lowest in the two OTs (mean: 221 CFU/m3 for OT1 and 236 CFU/m3 for OT2). Highest fungal level was found in GMW (mean: 193.4 CFU/m3) while lowest in the two OTs (mean: 41.1 CFU/m3 for OT2 and 58 CFU/m3 for OT1). Bacterial identification showed dominancy of gram positive cocci (89.8%) followed by gram positive rods (7.2%) and gram negative rods (3%). Identified bacterial strains belonged to genera staphylococcus, micrococcus, kocuria, aerococcus, kytococcus, bacillus and pseudomonas. The most abundant fungal genera included cladosporium (47%), aspergillus (17.1%), penicillium (7.1%), alterneria (6.2%), geotrichium (3.68%) and ulocladium (3.2%). Cleaning frequencies appeared to be important factor in maintaining low microbial load in air.

Reference standards for the detection of anti-mitochondrial and anti-rods/rings autoantibodies.

AbstractBackground:Anti-mitochondrial antibodies (AMA) are found in &gt;90% of primary biliary cholangitis patients. Anti-rods/rings antibodies (anti-RR) are most commonly associated with interferon-α and ribavirin treatment in hepatitis C patients. Clinical laboratories routinely screen for AMA and anti-RR using indirect immunofluorescence on HEp-2 cells (HEp-2-IFA). Therefore, we sought to establish reference materials for use in AMA and anti-RR testing.Methods:AMA-positive and anti-RR-positive human plasma samples (AMA-REF and RR-REF), identified as potential reference materials based on preliminary data, were further validated by multiple laboratories using HEp-2-IFA, immunoprecipitation (IP), western blotting, IP-western, line immunoassay (LIA), addressable laser bead immunoassay (ALBIA) and enzyme-linked immunosorbent assay (ELISA).Results:AMA-REF showed a strong positive cytoplasmic reticular/AMA staining pattern by HEp-2-IFA to ≥1:1280 dilution and positive signal on rodent kidney/stomach/liver tissue. AMA-REF reacted with E2/E3, E3BP, E1α and E1β subunits of the pyruvate dehydrogenase complex by IP and western blotting and was positive for AMA antigens by LIA, ALBIA and ELISA. RR-REF showed a strong positive rods and rings staining pattern by HEp-2-IFA to ≥1:1280 dilution. RR-REF reacted with inosine monophosphate dehydrogenase by IP, IP-western and ALBIA. RR-REF also produced a nuclear homogenous staining pattern by HEp-2-IFA, immunoprecipitated proteins associated with anti-U1RNP antibody and reacted weakly with histones, nucleosomes, Sm and nRNP/Sm by LIA.Conclusions:AMA-REF and RR-REF are useful reference materials for academic or commercial clinical laboratories to calibrate and establish internal reference standards for immunodiagnostic assays. AMA-REF and RR-REF are now available for free distribution to qualified laboratories through Plasma Services Group.