Primary Pyomyositis Caused by Kingella kingae in a 21-Month-old Infant: A Case Report.

The authors report a rare case of an unusual primary pyomyositis of the biceps cruralis assigned to Kingella kingae in a 21-month-old girl. The reported case demonstrated that primary pyomyositis may be encountered during invasive infection due to K. kingae even if this manifestation remains rare. This bacterial etiology must, therefore, be evoked when a primary pyomyositis is observed, and this is in particular in children under 4 years of age.

Tolerance to Light of Patients Suffering From Infectious Keratitis.

PURPOSE: With very photophobic patients, the advantages of red or near infrared light to develop new ophthalmology imaging devices seem obvious: no or little glare, possibility of long signal integration, no phototoxicity, and lesser autofluorescence of ocular tissues. Nevertheless, in this range, the shortest possible wavelength facilitates signal detection. The aim of this study was, thus, to determine the maximal irradiance tolerated with 6 wavelengths: 2 red, 2 far red, and 1 near infrared lights to determine the shortest wavelength well tolerated by patients, in comparison with the standard cobalt blue light of ophthalmology slitlamp. METHODS: An interventional, monocentric, single-group assignment study was conducted on 30 eyes of 30 patients with infectious keratitis. Thanks to a customized machine, the photophobic eye was exposed to the 6 lights with increasing intensity. The patients switched off the light when the discomfort was too elevated. The maximal cumulative irradiance possible at 482, 650, 675, 700, 750, and 800 nm were 171, 689, 759, 862, 920, and 889 mW/cm, respectively. RESULTS: The maximal cumulative irradiance tolerated by patients increased significantly with wavelength (P < 0.001), but the difference was not significant between each increment: red at 675 nm gave a significantly higher cumulative irradiance than blue at 482 nm; red at 700 nm did not provide significant gain compared with 675 nm; and far red at 750 nm still provided additional gain compared with 700 nm, but no significant gain was observed between 750 and 800 nm. The shortest wavelengths were stopped more quickly, and more than 50% of patients reached the maximum irradiance delivered by the source at 750 and 800 nm. CONCLUSIONS: We demonstrate that a light source at 750 and 800 nm can be used for ophthalmic imaging with good tolerance in photophobic patients. CLINICAL TRIAL REGISTRATION: NCT03586505.

Acute Cystitis Caused by Commensal Neisseria oralis: A Case Report and Review of the Literature.

BACKGROUND: Neisseria are usually harmless inhabitants of otherwise asymptomatic persons' upper respiratory mucosal surfaces. METHOD: It is, therefore, expected that a disturbance in the physiology leads to nongonococcal, non-meningococcal Neisseria becoming pathogenic. RESULT: We report the case of a diabetic man who initially presented with nonspecific symptoms and was later found to have cystitis caused by N. oralis. CONCLUSION: We also review the pertinent literature and discuss available evidence on pathophysiological mechanisms of infection with such commensal bacteria.

[MYCOTIC ANEURYSM OF THE ASCENDING AORTA AND CEREBRAL INFARCTS IN A 17-MONTH OLD CHILD WITH KINGELLA KINGAE ENDOCARDITIS].

Endocarditis is an uncommon presentation of Kingella kingae infection in children. A previously healthy 17 month old child was referred to our emergency department for evaluation of fever lasting eleven days, aphthous stomatitis and a new systolic murmur. Within a few hours of admission, antibiotic therapy was initiated for a presumptive diagnosis of bacteremia and within 24 hours after admission, gram negative coccobacilli were growing in the blood culture. In addition, echocardiography demonstrated a mycotic aneurysm of the ascending aorta with a mobile vegetation. The presumptive diagnosis of Kingella kingae endocarditis was made. Further evaluation by MRI revealed frontal and occipital cerebral infarcts. Due to the presence of presumed septic emboli in conjunction with progressive left ventricular dysfunction, the child was urgently taken to the operating room where aggressive debridement of the infected tissue was performed and the aortic aneurysm was repaired. The patient had an uneventful post-operative course. This case emphasizes the need for a high index of suspicion when evaluating children with community acquired infection. In addition, it also demonstrates the importance of early diagnosis and appropriate treatment of K. kingae endocarditis.

Murine glia express the immunosuppressive cytokine, interleukin-10, following exposure to Borrelia burgdorferi or Neisseria meningitidis.

There is growing appreciation that resident glial cells can initiate and/or regulate inflammation following trauma or infection in the central nervous system (CNS). We have previously demonstrated the ability of microglia and astrocytes, resident glial cells of the CNS, to respond to bacterial pathogens by rapid production of inflammatory mediators. However, inflammation within the brain parenchyma is notably absent during some chronic bacterial infections in humans and nonhuman primates. In the present study, we demonstrate the ability of the immunosuppressive cytokine, interleukin-10 (IL-10), to inhibit inflammatory immune responses of primary microglia and astrocytes to B. burgdorferi and N. meningitidis, two disparate gram negative bacterial species that can cross the blood-brain barrier in humans. Importantly, we demonstrate that these organisms induce the delayed production of significant quantities of IL-10 by both microglia and astrocytes. Furthermore, we demonstrate that such production occurs independent of the actions of bacterial lipopolysaccharide and is secondary to the autocrine or paracrine actions of other glia-derived soluble mediators. The late onset of IL-10 production by resident glia following activation, the previously documented expression of specific receptors for this cytokine on microglia and astrocytes, and the ability of IL-10 to inhibit bacterially induced immune responses by these cells, suggest a mechanism by which resident glial cells can limit potentially damaging inflammation within the CNS in response to invading pathogens, and could explain the suppression of inflammation seen within the brain parenchyma during chronic bacterial infections.

Clinical judgment predicts culture results in upper respiratory tract infections.

BACKGROUND: We wanted to describe the natural history, familial transmission, microbiology, and accuracy of clinical judgment of potential pathogens of respiratory tract infections in a community family practice. METHODS: The study was a prospective case series in which consecutive patients requesting treatment for respiratory tract infections were evaluated after nurse triage during 3 fall-spring months in a solo family practice in suburban Cleveland, Ohio. According to the physician's usual practice, patients were classified into high-, medium-, and low-risk groups for bacterial illness based on their clinical signs and symptoms. Cultures were performed and sensitivities were determined for pathogens from the infected throat, nasopharynx, conjunctiva, or other sites. Patient symptoms and well-being were scored at the initial visit and at 3, 7 and 14 days later. RESULTS: There were 111 illness episodes in 86 patients; 94% had cultures taken, of which 38% grew a potentially pathogenic bacteria, most commonly group A streptococci, Branhamella catarrhalis or Staphylococcus aureus. The physician's judgment of bacterial infection was associated (P < .001) with having a positive culture (sensitivity 53%, specificity 78%, positive and negative predictive values 60% and 73%, respectively). A positive culture was associated with 2 of 16 signs or symptoms: purulent discharge from any site or a red swollen eye. There was no association of treatment status with clinical outcomes during 2 weeks of follow-up observation. CONCLUSION: Infection with a potentially pathogenic bacteria is difficult to determine solely by clinical signs and symptoms, but clinical judgment is associated with positive culture results. The effect of selective treatment of upper respiratory tract infection based on clinical signs and symptoms and patient and family culture results remains to be determined, but using clinical judgment could result in more selective antibiotic use than found in current practice patterns.

Moraxella catarrhalis: from emerging to established pathogen.

Moraxella catarrhalis (formerly known as Branhamella catarrhalis) has emerged as a significant bacterial pathogen of humans over the past two decades. During this period, microbiological and molecular diagnostic techniques have been developed and improved for M. catarrhalis, allowing the adequate determination and taxonomic positioning of this pathogen. Over the same period, studies have revealed its involvement in respiratory (e.g., sinusitis, otitis media, bronchitis, and pneumonia) and ocular infections in children and in laryngitis, bronchitis, and pneumonia in adults. The development of (molecular) epidemiological tools has enabled the national and international distribution of M. catarrhalis strains to be established, and has allowed the monitoring of nosocomial infections and the dynamics of carriage. Indeed, such monitoring has revealed an increasing number of B-lactamase-positive M. catarrhalis isolates (now well above 90%), underscoring the pathogenic potential of this organism. Although a number of putative M. catarrhalis virulence factors have been identified and described in detail, their relationship to actual bacterial adhesion, invasion, complement resistance, etc. (and ultimately their role in infection and immunity), has been established in a only few cases. In the past 10 years, various animal models for the study of M. catarrhalis pathogenicity have been described, although not all of these models are equally suitable for the study of human infection. Techniques involving the molecular manipulation of M. catarrhalis genes and antigens are also advancing our knowledge of the host response to and pathogenesis of this bacterial species in humans, as well as providing insights into possible vaccine candidates. This review aims to outline our current knowledge of M. catarrhalis, an organism that has evolved from an emerging to a well-established human pathogen.

Pathogenic neisseriae: complexity of pathogen-host cell interplay.

Recent studies have provided insight into the function of important neisserial adhesins (pili and Opa) and their interaction with cellular receptors, including members of heparan sulfate proteoglycan, CD66, and integrin receptor families. These interactions not only allow colonization of the human mucosa but also stimulate cellular signaling cascades involving phosphatidylcholine-dependent phospholipase C, acidic sphingomyelinase and protein kinase C in epithelial cells, and Src-related kinases, Rac1, p21-activated kinase, and Jun N-terminal kinase in phagocytic cells. Activation of these pathways is essential for cellular entry and intracellular accommodation of the pathogens but also leads to early induction of cytokine release, thus priming the immune response. Detailed knowledge of the cellular signaling cascades that are activated by infection will aid us in applying both current and novel interfering drugs (in addition to classical antibiotic therapy) as therapy and prophylaxis for persistent or otherwise difficult-to-treat bacterial infections, including periodontal infections.

Microbiology of chronic sinusitis.

Much controversy still exists about the role of viruses, bacteria and fungi in sinusitis. Until recently, it was not really known that the sinuses take part in the infectious process of a common cold (viral rhinitis). Indeed, CT scans show that in the vast majority of otherwise healthy volunteers with a common cold, and without a previous history of recurrent or chronic sinusitis, the sinuses are involved too. A viral rhinitis alone, however, does not seem to be able to elicit a "clinical" acute sinusitis. Bacteria determine the clinical picture and outcome of sinusitis. There is not much controversy about the role of bacteria in acute sinusitis, S. pneumoniae, H. influenzae and M. catarrhalis being the most frequently involved bacteria. Much more conflicting reports are published about the normal flora of the sinuses, the role of anaerobes and the microbiology of chronic sinusitis. In this chapter the defense and pathophysiologic mechanisms of viral, bacterial and fungal infection of the nasal and sinusal mucosa are described. It is postulated that, although bacteria are very important in acute sinusitis, their role in chronic sinusitis is minimal, the bacteria being opportunistic colonisers.

Bacteremia por kingella kingae en una prescolar / Kingella kingae bacteremia in a preschool girl

Se reporta por primera vez en el país una bacteremia causada por K. kingae en un paciente pediátrico, con evolución favorable. Se revisa la literatura respecto a las expresiones clínicas de K. kingae y las características microbiológicas que permiten su aislamiento e identificación enunciándose recomendaciones para optimizar su estudio

Moraxella septicemia in children with diarrheal disease.

We report 10 cases of Moraxella septicemia associated with diarrheal disease. Their clinical presentations and outcomes are discussed. Recognition of the pathogenicity of these microorganisms in appropriate clinical setting should result in prompt and specific therapy.

Children with persistent cough--outcome with treatment and role of Moraxella catarrhalis?

52 children with severe cough persisting for more than 10 days were randomized to treatment with amoxycillin/clavulanic acid or placebo in a prospective double-blinded study. Clinically suspected cases of pertussis were excluded, yet 12 (23%) of the children had laboratory verified pertussis infection. The nasopharyngeal colonization showed a predominance of Moraxella catarrhalis which was isolated in 37 (71%) children. Streptococcus pneumoniae and Haemophilus influenzae were isolated in 11 (20%) and 16 (30%) children, respectively. The antibiotic-treated group had a significantly better recovery in both the pediatrician's estimation (p = 0.02) and the independent parental judgement (p = 0.002). These findings are consistent with the view that Moraxella catarrhalis could be directly involved in the pathogenesis of persistent cough in children.

Branhamella catarrhalis pathogenesis in SCID and SCID/beige mice. Brief report.

SCID and SCID/beige mice were used to study the pathogenesis of B. catarrhalis administered by intranasal, intraperitoneal or intravenous routes. Challenged adult animals did not appear overtly clinically ill. Similar symptoms were observed regardless of the challenge route, and pretreatment of mice with human transferrin did not enhance clinical virulence. Susceptibility to B. catarrhalis appeared to be age-dependent as some mice under one week of age died following challenge. Postmortem findings included circumscribed pale foci on the liver, splenomegaly and mineralization of the myocardium. Presence of lesions did not correlate with the assessment of clinical well being, and severity of the lesions was found to be challenge strain-dependent. Liver lesions and splenomegaly were not observed in animals challenged with heat-killed bacteria or placebo. SCID/beige mice were more affected than SCID mice both clinically and pathologically, suggesting that natural killer cell and polymorphonuclear cell functions may be important in resolving B. catarrhalis challenge.

Significance of Haemophilus spp. and Branhamella catarrhalis in upper respiratory tract infections.

Haemophilus influenzae and Branhamella catarrhalis can be considered inhabitants of the upper respiratory tract in humans. Although the pathogenetic role of H. influenzae cannot be discussed, the Authors report the mechanisms of pathogenicity of this microorganism; furthermore, they discuss the direct or indirect pathogenicity of B. catarrhalis in respiratory tract diseases and the ability of both microorganisms to produce beta-lactamases. H. influenzae and B. catarrhalis, together with S. pneumoniae, are the most common bacteria responsible for upper respiratory tract infections, namely otitis and sinusitis. The activity of these bacteria in the onset of otitis and sinusitis is reported.