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1/5. arcobacter butzleri bacteremia in a patient with liver cirrhosis.

    Invasive arcobacter butzleri infection in humans has been rarely described. We report a 60-year-old man with liver cirrhosis who presented with high fever and esophageal variceal bleeding. Two aerobic blood cultures grew campylobacter-like organisms. The biochemical reactions of the isolate were inconclusive, while sequence analysis of the 16S rRNA gene definitively identified the organism as A. butzleri. The patient's bleeding stopped after endoscopic sclerosing therapy. Although the organism appeared to be resistant to cephalosporins on the basis of the minimum inhibitory concentrations determined with the E test, the fever resolved with parenteral cefuroxime. Whether the clinical improvement was related to cephalosporin therapy or to the self-limited nature of arcobacter bacteremia is not known.
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2/5. Recurrent sphingomonas paucimobilis -bacteraemia associated with a multi-bacterial water-borne epidemic among neutropenic patients.

    A cluster of septicaemias due to several water-related species occurred in a haematological unit of a university hospital. In recurrent septicaemias of a leukaemic patient caused by sphingomonas paucimobilis, genotyping of the blood isolates by use of random amplified polymorphic dna-analysis verified the presence of two distinct S. paucimobilis strains during two of the separate episodes. A strain of S. paucimobilis identical to one of the patient's was isolated from tap water collected in the haematological unit. Thus S. paucimobilis present in blood cultures was directly linked to bacterial colonization of the hospital water system. Heterogeneous finger-printing patterns among the clinical and environmental isolates indicated the distribution of a variety of S. paucimobilis clones in the hospital environment. This link also explained the multi-microbial nature of the outbreak.
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3/5. bacteremia due to comamonas species possibly associated with exposure to tropical fish.

    comamonas species are environmental gram-negative rods that grow forming pink-pigmented colonies. Despite their common occurrence in nature, they rarely cause human infection. We present a case of comamonas bacteremia that we think may have been related to tropical fish exposure. The patient was treated successfully with levofloxacin.
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4/5. Clinical and microbiological characteristics of flavobacterium indologenes infections associated with indwelling devices.

    Clinical infections caused by flavobacterium indologenes have never been documented. Thirteen isolates derived from seven patients with indwelling device-associated F. indologenes infections were identified from 1 April through 30 November 1995. The antimicrobial susceptibilities to 20 antimicrobial agents of the isolates, the cellular fatty acid chromatograms for the isolates, and the random amplified polymorphic dna (RAPD) patterns generated by arbitrarily primed PCR of the isolates were studied. The antibiotypes and RAPD patterns differed among the isolates recovered from different patients. However, both antibiotypes and RAPD patterns were identical among the five isolates from one patient with multiple episodes of central venous catheter-associated bacteremia within a 1.5-month period and between the two isolates from another patient suffering from two episodes of catheter-related bacteriuria at an interval of 14 days. It is documented that the recurrent infections in each of these two patients were caused by a single F. indologenes clone, respectively. Identical antibiotypes and RAPD patterns were also demonstrated between two isolates from a patient with ventilator-associated pneumonia, one recovered from an endotracheal aspirate and the other derived from a blood specimen 10 days later, indicating the invasive nature of F. indologenes. Two cellular fatty acid chromatograms were identified among these isolates. All of the isolates showed in vitro resistance to cephalothin, cefotaxime, ceftriaxone, moxalactam, aztreonam, aminoglycosides, erythromycin, clindamycin, vancomycin, and teicoplanin. F. indologenes should be included as an etiologic agent of infections associated with the use of indwelling devices.
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5/5. Acute rhabdomyolysis and myonecrosis complicating aeromonas bacteremia in neutropenic patients with hematologic malignancies: report of two cases.

    Infections by Aeromonas spp. are a rare cause of systemic infection in normal and immunocompromised hosts. We report the cases of two patients with acute non-lymphoblastic leukemia who developed septic shock by Aeromonas species with unusual soft-tissue complications. One patient who was undergoing consolidation chemotherapy developed septic shock by aeromonas hydrophila with rhabdomyolysis and subsequent soft-tissue destruction consistent with myonecrosis. She recovered with combination antibiotic therapy and supportive care. The second patient developed neutropenia due to ganciclovir treatment for post-allogeneic transplant cytomegalovirus antigenemia. He developed a rapidly progressive septic shock due to Aeromonas sobria with rhabdomyolysis, multi-organ failure and bilateral lower limb myonecrosis, and died within 48 hours. The portal of entry was not identified in either case. These cases confirm the potentially aggressive nature of these bacteria in neutropenic cancer patients with an unusual tendency to produce muscular and soft-tissue destruction.
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