| We report a case of sepsis caused by bifidobacterium longum in a 19-year-old male who had developed high fever, jaundice, and hepatomegaly after acupuncture therapy with small gold needles. Anaerobic, non-spore-forming, gram-positive bacilli were isolated from his blood and finally identified as B. longum. He recovered completely after treatment with ticarcillin and metronidazole. To our knowledge, this is the first report of incidental sepsis caused by B. longum. ( info) |
2/237. Pulmonary malacoplakia associated with rhodococcus equi infection in a patient with AIDS. An AIDS patient with a cavitary lung lesion was found to have pulmonary malacoplakia associated with rhodococcus equi infection. The diagnosis was based on the typical histologic features of transbronchial biopsy and a positive bacterial culture. All 13 reported cases of AIDS patients with pulmonary malacoplakia were associated with R equi. The recognition of this unique entity is important because of its responsiveness to therapy. ( info) |
| Systemic infection caused by arcanobacterium haemolyticum is uncommon. We report a case of empyema and bacteraemia caused by this organism concomitant with mycoplasma pneumoniae infection. ( info) |
4/237. Detection of tropheryma whippelii dna (Whipple's disease) in faeces. To date the diagnosis of Whipple's disease is based mainly on the histopathological analysis of duodenal biopsies since tropheryma whippelii cannot be cultured in vitro. We investigated the possibility to diagnose Whipple's disease by detection of bacterial dna in faces. Nested polymerase chain reaction with amplification of part of the 16S rRNA gene of this bacterium in dna extracted from faeces of a patient with Whipple's disease was performed. Sequencing of the polymerase chain reaction product revealed the sequence of tropheryma whippelii. We conclude that Whipple's disease will be able to be diagnosed non-invasively by dna analysis from the faeces as soon as more specific sequences of this bacteria are known. ( info) |
| rhodococcus equi pneumonia with systemic dissemination is being reported increasingly in immunocompromised patients. This is the first case report of disseminated R equi infection with biopsy documented involvement of the large intestine. The patient was a 46 year old male with AIDS who was diagnosed with cavitating pneumonia involving the left lower lobe. R equi was isolated in culture from the blood and lung biopsies. Subsequently, the patient developed anaemia, diarrhoea, and occult blood in the stool. colonoscopy revealed several colonic polyps. Histological examination of the colon biopsies showed extensive submucosal histiocytic infiltration with numerous Gram positive coccobacilli and PAS positive material in the histiocytes. Electron microscopy showed variably shaped intrahistiocytic organisms which were morphologically consistent with R equi in the specimen. Disseminated R equi infection may involve the lower gastrointestinal tract and produce inflammatory polyps with foamy macrophages which histologically resemble those seen in Whipple's disease and mycobacterium avium-intracellulare infection. ( info) |
6/237. Relapsing Whipple's disease presenting with hypopituitarism. A 44-year-old man with a history of Whipple's disease 8 years ago presented with recurrent grand mal seizures and signs of hypopituitarism on physical examination. magnetic resonance imaging of the brain revealed a hypothalamic lesion of 1 cm diameter in the region of the rostral infundibulum. hypopituitarism was confirmed by low levels of serum cortisol, free testosterone and free thyroxine without an elevated TSH. Whipple encephalitis with hypothalamic involvement was suggested and verified by positive polymerase chain reaction (PCR) for tropheryma whippelii in the cerebrospinal fluid. PCR for T. whippelii has become an important diagnostic tool for establishing the diagnosis of Whipple's disease especially in patients with unusual presentations and if the diagnosis cannot be confirmed histologically. Whipple's disease should be included in the differential diagnosis in hypopituitarism caused by infectious disease. ( info) |
| Rothia dentocariosa, an organism inhabiting the oral flora, has been reported to cause endocarditis in adults but not in children. Most patients reported with Rothia endocarditis have a history of poor dentition. We report a case of Rothia endocarditis in a child with congenital heart disease without other known risk factors. ( info) |
8/237. Infection of a knee prosthesis with Tsukamurella species. A 69-year-old woman with a history of multiple infections of a postoperative wound from a knee replacement was diagnosed with an infection with Tsukamurella sp. The infection was treated with a course of vancomycin and pipercillin/tazobactam, followed by a course of clarithromycin, ciprofloxacin, and ethambutol. The patient responded well. This represents the first report of a Tsukamurella infection of an artificial joint. ( info) |
9/237. Aureobacterium masquerading as 'corynebacterium aquaticum' infection: case report and review of the literature. A gram-positive bacillus was isolated repeatedly from blood taken through the lumina of a central venous catheter of a patient with multiple myeloma who developed febrile neutropenia following chemotherapy. The bacterium was identified by the API CORYNE system as 'corynebacterium aquaticum'. Gene analysis targeting the 16S rRNA indicated that the organism had a 99.5% identity with Aureobacterium liquefaciens although there were two phenotypic characteristics at variance with the description of this species. Problems remain with the routine identification of 'C. aquaticum' and Aureobacterium species. The few clinical reports on patients infected with 'C. aquaticum' and A. liquefaciens indicate that these are rare infections often associated with immunocompromise. ( info) |
10/237. Severe otitis and mastoiditis due to rhodococcus equi in a patient with AIDS. Case report. We report a case of otitis media associated with pneumonia due to rhodococcus equi. A 31-year-old patient with AIDS presented with cough and right facial palsy. Imaging revealed right otitis media and severe temporal bone destruction, associated with pneumonia. R. equi was isolated from ear secretions, blood, and sputum. The radiologic findings are described. This unusual pathogen should be included in the differential diagnosis of the immunocompromised patient with aggressive otitis. ( info) |