Uncommon Organism Research Articles

<i>Parvimonas micra</i>-Induced Paraspinal Abscess and Pyogenic Spondylitis Following Dental Extraction: A Case Report with a Brief Literature Review

The increasing prevalence of pyogenic spondylitis in older adults is primarily driven by Staphylococcus aureus. Cases caused by anaerobic bacteria are rare. This report focuses on a 71-year-old man diagnosed with spondylitis due to an anaerobic bacterial infection. The causative pathogen—Parvimonas micra—is typically found in the oral cavity. Interestingly, the patient had undergone a tooth extraction before the diagnosis. He was successfully treated with antibiotics; therefore, surgery was not necessary. This case is notable for the uncommon infective organism and, along with a concise literature review, this report provides valuable insights for the medical community.

Achromobacter denitrificans blood stream infection in adult patients: Clinical and microbiological features from a tertiary care centre in North India

Genus Achromobacter is ubiquitous, opportunistic pathogen. Treating Achromobacter infections are a challenge as the bacterium is intrinsically resistant to several empirically used antibiotics. There is a dearth of data on this organism so; the present prospective study was undertaken to understand various aspects of this uncommon organism.

ALCALIGENES FAECALIS, AN UNEXPECTED AGENT OF URINARY TRACT INFECTION IN A 14-YEARS-OLD BOY

Introduction: Alcaligenes faecalis is a rare cause of urinary tract infection (UTI) in humans, especially in pediatrics. It is a potentially emerging pathogen, usually opportunistic, and it is often difficult to treat due to its increased resistance to several antibiotics. Urinary tract infection due to Alcaligenes faecalis in pediatrics it is not yet describe in literature. Case report: We report the occurrence of Alcaligenes faecalis (spp faecalis) Urinary Tract Infection (UTI), presenting as acute cystitis, in a 14-years-old boy with previous history of non-obstructive bilateral renal lithiasis due to hyperuricosuria, pyelocaliceal duplicity in the right kidney and recurrent UTI. He was treated with empirical antibiotic with amoxicillin/clavulanate, with clinical improvement. A repeated urine culture was sterile after treatment. Discussion: We review literature in pediatrics, and we found out that this agent is a very uncommon organism of infection and difficult to treat due to its increased resistance to several antibiotics such as penicillin, cephalosporins, carbapenems, aminoglycosides, and quinolones. In pediatric literature, there is still few cases of infection described, due to Alcaligenes faecalis. Conclusions: Clinicians should continue to direct initial empiric antimicrobial therapy toward the more commonly encountered bacteria. If Alcaligenes faecalis is identified in culture, it can represent a true pathogen, and not merely a contaminant. Alcaligenes faecalis is an unexpected agent of UTI that clinicians should keep in mind.

Exit-Site Infection Caused by Lysinibacillus Sphaericus: Unusual Organism From A Usual Site

Exit-site infection is an unwanted complication in patients with an indwelling catheter. However, such an infection by an uncommon organism like Lysinibacillus which is otherwise considered an environmental contaminant needs to be mentioned. Our report describes one such case. The patient was given antibiotic as per antibiotic susceptibility report to which he responded.

Unusual Case of Surgical Site Infection with Uncommon Organism – Burkholderia pseudomallei

Melioidosis is an infection caused by a facultative intracellular Gram-negative bacterium, Burkholderia pseudomallei, previously termed as Pseudomonas pseudomallei. This case report is an unusual case of surgical site infection with uncommon organism-B. pseudomallei. We report a case of melioidosis. A 62-year-old patient complained of swelling, redness, discharge from the surgical site right hip, and on and off generalized temperature from the last 15 days. The patient was toxic. Erythrocyte sedimentation rate was 130, C-reactive protein – 92, and Hb – 9.2, and on further blood investigation, the patient was diagnosed with surgical site infection with an implant in situ and underwent implant removal and surgical debridement of right hip, by intraoperative pus culture shows Staphylococcus aureus growth, and the patient was started on intravenous cefoperazone-sulbactam 1.5 g for 1 week, following which symptoms reappear. Later, Gram-stain shows the growth of B. pseudomallei. He was started on injection ceftazidime 2 g thrice daily (TDS) (Q8 hourly) for 2 weeks followed by oral cotrimoxazole for the next 9 months, the patient is on regular follow-up. Diagnosis of melioidosis is missed in many parts of the world due to lack of awareness of this infection caused by B. pseudomallei. Delay in diagnosis or treatment against melioidosis can worsen the outcome. With increasing awareness and better diagnostic facilities, probably musculoskeletal melioidosis will be increasingly diagnosed in future.

An uncommon organism causing necrotizing pneumonia in a toddler

Necrotizing pneumonia (NP) is an uncommon complication of bacterial pneumonia in children, which must be looked into if a severe pneumonia has poor response to recommended antibiotics. The present case is a toddler with NP in whom fever and cough persisted despite treatment with first-line antimicrobial therapy, computed tomography (CT) scan revealed consolidation with multiple cavities, pseudomonas aeruginosa was the pathogen isolated from bronchoalveolar lavage, which a very uncommon organism is causing NP. Community acquired necrotizing pneumonia caused by pseudomonas is not reported in paediatric population. Hence, we report this case.

Acute endophthalmitis caused by Ochrobactrum anthropi following cataract surgery in an immunocompetent patient – A case report

A 54-year-old man developed left eye inflammation three days after cataract surgery and was diagnosed with endophthalmitis. Aqueous culture revealed Ochrobactrum anthropi resistant to vancomycin and cephalosporin. Systemic and intravitreal ciprofloxacin injections caused only transient improvement and eventually, pars plana vitrectomy was done. There was complete resolution, good visual recovery, and no recurrence. O.anthropi is an uncommon organism with a characteristic resistance to empirical antibiotics and usually causes chronic infection in immunocompromised. We report a rare case of acute endophthalmitis in an immunocompetent patient. To the best of our knowledge, this is the first report of O. anthropi endophthalmitis from India.

Etiology, Characteristics, and Outcomes of Community-Onset Pyomyositis in Korea: A Multicenter Study.

BackgroundPyomyositis (PM) is a serious soft tissue infection and despite its clinical importance, previous studies have not been able to fully determine the clinical characteristics and microbial epidemiology of PM in Korea, which we therefore aimed to investigate.Materials and MethodsWe retrospectively identified 140 adult patients diagnosed with PM from 13 general hospitals between January 2012 and December 2015. We analyzed the clinical and microbial characteristics of community-onset PM and compared them with community-acquired (CA) and healthcare-associated (HCA) PM.ResultsOne hundred eleven organisms were isolated from 96 (68.6%) patients with PM. Staphylococcus aureus (38 patients) was the most common pathogen, followed by streptococci (24 patients), and enteric Gram-negative organisms (27 patients). Methicillin-resistant S. aureus (MRSA) was identified in four (2.9%) patients and in-hospital mortality reached 8.6% (12/140). Enterococci isolates were identified in the HCA PM subgroup only The proportion of MRSA isolates was not comparable between CA and HCA PM subgroups. In the 83 patients with PM infected by monomicrobial pathogens, isolates of Gram-negative organisms were more commonly found in HCA PM subgroup than in CA PM subgroup (47.6% [10/21] of patients with HCA PM vs. 20.7% [12/58] of patients with CA PM; P = 0.01).ConclusionGram-positive cocci such as S. aureus and streptococci were dominant etiologies in community-onset PM, whereas MRSA appears to an uncommon causative organism of PM in Korea. Enteric Gram-negative organisms should also be considered as major etiologies, especially in HCA PM patient population in Korea.

A rare lumbar pyogenic spondylodiscitis caused by staphylococcus caprae with initial misdiagnosis: case report and literature review

BackgroundStaphylococcus caprae (Sc) is an uncommon causative organism for human. Lumbar pyogenic spondylodiscitis (LPS) of Sc is extremely rare and only a few cases have been reported. As far as we know, there is no specific literature on the diagnosis and treatment for LPS of Sc with L5 nerve root irritation.Case presentationA 65-year-old male patient complained of chronic low back pain for 10 years, acute worsening with radiating pain to left lower extremity over a month. Physical examination revealed tenderness point on his low back, 3/5 dorsiflexor strength in his left 1st toe and decreased sensation of pin prick over the left lateral shank and medial dorsal foot. The individual was initially misdiagnosed with lumbar disc herniation (LDH) without further examination in outpatient, which was then found to be LPS of Sc with L5 nerve root irritation after admission to our hospital. Magnetic resonance images (MRI) of lumbar spine exhibited inflammation signal at L4-L5 level of the vertebral body and disc with hypointense on T1-weighted images (T1-WI) and hyperintense on T2-weighted images (T2-WI). The causative organism was confirmed by the culture of irrigation fluid obtained from L5 vertebrae by needle puncture. After systemic conservative treatment including using sensitive antimicrobial agents and immobilization, the rare infection was finally cured. The patient also showed a satisfactory recovery during the 36-month follow-up period.ConclusionsConfirming the diagnosis and identifying the causative organism as soon as possible is the key point for the treatment of LPS. LPS of Sc causing nerve root irritation is rare but curable with early diagnosis and proper therapy. The culture of irrigation fluid obtained from vertebrae by needle puncture may be an effective and sensitive attempt for potential infection of spine to identify the causative organism at early stage of the disease.

False-Positive Blood Cultures: The Need for Follow-up

AbstractThe diagnosis of blood-borne infections in immunocompromised patients is a major challenge for the clinical microbiology laboratory. Isolation of bloodborne pathogens in these patients has profound clinical implications, yet is fraught with technical problems, including the presence of unusual and difficult to isolate pathogens. Coupled with this is the problem of false-positive blood culture signals from automated blood culture systems which further delays the definitive diagnosis. Here, we present a case of an 8-year-old boy with Ph +ve acute lymphoblastic leukaemia who has repeated ‘false positive’ blood cultures and later grew an uncommon organism.

Unique presentation of Aggregatibacter aphrophilus in a superficial left temporal abscess.

Aggregatibacter aphrophilus, previously Haemophilus aphrophilus, is an uncommon organism that historically has been associated with HACEK infective endocarditis and brain abscesses. This organism is most often isolated as part of normal oral flora, and patients with A. aphrophilus infection usually have an underlying periodontal infection or immunocompromised state allowing for infection. This case report outlines a unique presentation of left superficial temporal abscess due to A. aphrophilus infection in an immunocompetent individual.

1147. Pseudo-Outbreak of Clostridium paraputrificum Related to Anaerobic Tent Contamination

BackgroundOver a 2-month period, eight patient cultures in our clinical microbiology laboratory were positive for Clostridium paraputrificum, an uncommon spore-forming microbe. The possibility of a pseudo-outbreak related to contamination in the laboratory’s anaerobic tent was considered.MethodsThis study occurred at a 505-bed tertiary care university-affiliated teaching hospital. Patient samples were cultured and evaluated following standard protocols, and isolates of C. paraputrificum were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). To identify additional cases, MALDI-TOF MS testing reports were manually reviewed and matched to patient records. Concurrently, the laboratory’s anaerobic tent was sampled after cleaning with isopropyl alcohol (and later with bleach or sporicidal disinfectant) following standard procedures and protocols recommended by the tent manufacturer (Coy). Pulsed-field gel electrophoresis (PFGE) was performed on isolates from patients (n = 8) and the anaerobic tent (n = 6).ResultsDespite cleaning with isopropyl alcohol or bleach, surface samples from the anaerobic tent grew C. paraputrificum. PFGE analysis revealed all patient and anaerobic tent isolates to be indistinguishable, suggesting that they originated from a common source. Growth of the organism from patient samples was therefore regarded as potential contamination. Prior to this, six of the eight patients received antibiotics related to this positive culture and had Infectious Disease consultations. Providers of the patients were contacted regarding the contamination issue. The anaerobic tent manufacturer was consulted and ultimately recommended using Peridox Sporicidal Disinfectant. Six months later, the tent was re-sampled and did not yield positive cultures.ConclusionA pseudo-outbreak of the uncommon organism C. paraputrificum was related to insufficient disinfection practices of an anaerobic culture tent. This had negative effects on our institution and patient care in terms of cost, time, and unnecessary treatment. The use of sporicidal disinfectant has since proven effective to prevent contamination from spore-producing microbes.Disclosures All authors: No reported disclosures.

A Case Report on Fever of Unknown Origin in a School Going Child– An Uncommon Answer in a Common Question

Fever is one of the commonest complaints in paediatrics outpatient as well as inpatient department. Fever of unknown origin (FUO) is a diagnosis of exclusion given to the febrile condition lasting more than three weeks with temperature 38.30C or more with unknown cause despite of one week in patient care. Here we present a case of FUO in a child which was investigated thoroughly and managed on the line of enteric fever. However, the patient remained febrile. Hence, further investigations were undertaken and finally, bone marrow culture grew a very uncommon organism- Escherichia coli. The child was treated as per the sensitivity and responded well to treatment and was discharged after improvement. Here, we would like to present this case of FUO to highlight the possibility of bone marrow invasion by an uncommon organism as a source of fever in children.

CORYNEBACTERIUM PROSTHETIC AORTIC VALVE ENDOCARDITIS SUCCESSFULLY TREATED WITH EDWARDS SAPIEN 3 TRANSCATHETER VALVE REPLACEMENT

Corynebacterium species is an uncommon organism involved in prosthetic valve endocarditis (PVE). It is a common skin flora, however it can be a pathogen in endocarditis especially in immunocompromised patients or patients with prosthetic valves. The treatment for congestive heart failure (CHF) in

Streptococcus Pyogenes Myopericarditis and Purulent Pericardial Tamponade Secondary to Pneumonia

SESSION TITLE: Bacterial Infections 2 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Purulent bacterial pericarditis is a high mortality entity and represents only 1% of the causes of pericarditis, among these only a few cases have been reported of Streptococcus pyogenes pericarditis. Here we present a rare case of S. pyogenes pneumonia with contiguous spread to the pericardium causing myopericarditis and pericardial tamponade. CASE PRESENTATION: 40 year old male visiting New York City from Mexico with history of hypertension, presented with of 3 days of chest tightness, shortness of breath, and objective fevers. Patient stated that wife had flu-like symptoms 3 weeks prior presentation. Upon arrival to the ED vital signs were BP 114/80mmHg and HR 114 beats/min, suddenly he became diaphoretic and hypotensive with a systolic blood pressure of 60 mmHg. He was adequately fluid bloused but due to persistent hypotension dopamine was added. His EKG showed diffuse ST elevations and a bedside transthoracic echo revealed a diffusely hypokinetic left ventricle with a large pericardial effusion causing cardiac tamponade. The patient was taken emergently to surgery and a pericardiocentesis was performed obtaining 500cc of purulent material. After the procedure patient was transferred to the Cardiac Care Unit and was weaned off vasopressors. Laboratory results showed a WBC of 22.4x103cells/µl and troponin of 1.9 ng/ml (normal range <0.035ng/ml). Fluid cytology was positive for inflammatory cells and culture grew S. pyogenes. CT of the chest revealed consolidative changes with air bronchograms at the left lung base with contiguous contact with pericardium consistent with pneumonia. Patient initially treated with Vancomycin and Ceftriaxone and later transitioned to Augmentin once results of culture were available. Patient had an uneventful hospital course and was discharged 10 days after admission. DISCUSSION: Acute pericarditis cases are labeled “idiopathic” after a diagnostic workup in about 80% to 90%, most of these are presumed to be viral. Bacterial pericarditis is seen in less than 1% of all causes of pericarditis, but has a mortality of 40% when treated, and 85% if untreated [1]. The most common causative microorganism is S. aureus. S. pneumoniae is the most common cause of contiguous spread due to pneumonia. Interestingly, S. pyogenes pericarditis is much rarer entity with less than a dozen cases reported in the literature. CONCLUSIONS: This case highlights a common presentation of pericardial tamponade with an uncommon organism, S. pyogenes. Unrecognized and untreated bacterial pericarditis has a high mortality rate and must be recognized and appropriately treated. Reference #1: Pankuweit S, Ristić AD, Seferović PM, Maisch B. Bacterial pericarditis: diagnosis and management. Am J Cardiovasc Drugs. 2005;5(2):103-12. DISCLOSURE: The following authors have nothing to disclose: Rodrigo Garcia Tome, Carolina Hurtado Schwarck, Jonathan Stoever, Robert Leber No Product/Research Disclosure Information

Ventilator-associated pneumonia caused by Chryseobacterium indologenes: a rare infant case and review of the literature.

Background Chryseobacterium indologenes is an uncommon organism that has been documented to cause a variety of invasive infections mostly in hospitalized patients with severe underlying diseases.Case presentationA three-month-old female infant born at term by caesarean section with meningomyelocele and congenital diaphragmatic hernia had two surgeries for the repair of meningomyelocele and diaphragmatic hernia on her 3rd and 14th day, respectively. On the 3rd month of her life, she deteriorated clinically with fever, leukocytosis and increase of acute-phase reactants. Gas exchange condition became worse than it was before. Respiratory secretions, oxygen requirements and ventilator demand increased. Chest X-ray showed bilateral pulmonary infiltrates. Bacteriological blood, urine and cerebrospinal fluid culture test results were negative. C. indologenes was isolated from tracheobronchial secretion sample obtained by endotracheal aspiration. Although susceptible to ciprofloxacin (MIC:0.5 gr/L), levofloxacin and piperacillin–tazobactam, the isolate was resistant to meropenem, imipenem and colistin. She was treated with ciprofloxacin successfully. Her fever resolved and gas exchange condition improved after 72 h of the treatment. The antibiotic treatment was given for a course of 14 days.Conclusion Chryseobacterium indologenes may emerge as a potential pathogen in infants with the factors such as invasive equipment, having underlying diseases and prolonged hospitalization.

Acute infectious purpura fulminans caused by group A β-hemolytic Streptococcus: An uncommon organism.

Acute infectious purpura fulminans caused by group A β-hemolytic Streptococcus: An uncommon organism.

Pseudomonas mendocina as an Agent of Bacteremia, Case Study and Literature Review

Pseudomonas mendocina is a Gram-negative, non-fermenting rod bacterium. It is generally isolated from soil and water samples. So far, it has been isolated from several human clinical samples. We report the seventh case of infection in human caused by this uncommon organism.

Nocardia mikamii a Novel Species Causing Disseminated Nocardiosis: A Literature Review of Disseminated Nocardiosis.

Nocardia is an uncommon Gram-positive organism. It typically appears as delicate filamentous Gram-positive branching rods. In the United States it was estimated to be approximately 500 to 1000 new cases per year. The organism causes disease in immunocompromised individuals with pulmonary infection representing the most common site of infection. Nocardia mikamii has been a recently isolated pathogen and not many cases of disseminated infection with this organism has been reported in the literature; we present a case of disseminated nocardiosis (mikamii sp.) in an immunocompromised patient. We also present a literature review on nocardiosis.

Pneumocystis jiroveci: Epidemiology and diagnosis

The Pneumocystis organism was initially described in 1909 by Chagas. Pneumocystis jiroveci is an uncommon opportunistic organism, which induces a severe and mostly fatal pneumonia in immunocompromised people. Pneumocystosis comes from reactivation of latent infection acquired while childhood or active acquisition while immunosuppression state. The epidemiology of Pneumocystis pneumonia (PCP) has changed considerably through the course of the HIV/AIDS epidemic. The establishments of PCP prophylaxis in 1989 and effective combination antiretroviral therapy in 1996, have resulted in substantial reduces in the incidence of PCP. Due to the insufficient specificity of clinical symptoms as well as the possibility of toxicity with therapy, the affirmation of PCP is important details for correct patient management. The traditional method for diagnosis of PCP depends on the microscopic visualization of organisms in respiratory samples. PCR diagnosis of P. jiroveci was introduced experimentally in 1990. Molecular methods, could detect P jirovecii DNA in respiratory samples from patients without clinically apparent PCP. In this review both epidemiology and diagnosis of Pneumocystis jiroveci will be discussed.