A contemporary 16-year review of Coxiella burnetii infective endocarditis in a tertiary cardiac center in Queensland, Australia.

BACKGROUND: Coxiella burnetii endocarditis can be difficult to diagnose leading to delays in treatment. This retrospective case series study was undertaken to understand the epidemiologic trends and clinical features of Q fever endocarditis in Southeast Queensland, Australia. METHODS: Clinical records of patients from a single center with coding diagnosis of C. burnetii, or serology consistent with chronic Q fever, were reviewed from 1999 to 2015. Data from patients with probable or confirmed Q fever endocarditis was abstracted. RESULTS: Thirteen patients had confirmed and 5 had probable Q fever endocarditis. Median age at diagnosis in confirmed cases was 60 years. In confirmed cases, 92% (12/13) of patients had an underlying valvular defect. Two patients in the confirmed cases had serology not consistent with a diagnosis of Q fever endocarditis. Eight patient records noted retrospective diagnosis of Q fever endocarditis after surgery. CONCLUSIONS: As pre-existing valve pathology is a major risk for developing endocarditis, prophylactic strategies such as targeted echocardiography and Q fever vaccination could be considered to reduce the incidence of Q fever endocarditis.

Electromagnetic navigation bronchoscopy for the diagnosis of Aspergillus infection.

Electromagnetic navigation bronchoscopy (ENB) is a new diagnostic tool for the evaluation of pulmonary lesions inaccessible by conventional bronchoscopy. Most often, ENB is used for the diagnosis of lung cancer, but can be used to evaluate fungal conditions and other diseases. We present the case of a 44-year-old woman who was diagnosed with Aspergillus via ENB.

Using serology to assist with complicated post-exposure prophylaxis for rabies and Australian bat lyssavirus.

BACKGROUND: Australia uses a protocol combining human rabies immunoglobulin (HRIG) and rabies vaccine for post-exposure prophylaxis (PEP) of rabies and Australian bat lyssavirus (ABLV), with the aim of achieving an antibody titre of ≥0.5 IU/ml, as per World Health Organization (WHO) guidelines, as soon as possible. METHODOLOGY/PRINCIPAL FINDINGS: We present the course of PEP administration and serological testing for four men with complex requirements. Following dog bites in Thailand, two men (62 years old, 25 years old) received no HRIG and had delayed vaccine courses: 23 days between dose two and three, and 18 days between dose one and two, respectively. Both seroconverted following dose four. Another 62-year-old male, who was HIV-positive (normal CD4 count), also suffered a dog bite and had delayed care receiving i.m. rabies vaccine on days six and nine in Thailand. Back in Australia, he received three single and one double dose i.m. vaccines followed by another double dose of vaccine, delivered intradermally and subcutaneously, before seroconverting. A 23-year-old male with a history of allergies received simultaneous HRIG and vaccine following potential ABLV exposure, and developed rash, facial oedema and throat tingling, which was treated with a parenteral antihistamine and tapering dose of steroids. Serology showed he seroconverted following dose four. CONCLUSIONS/SIGNIFICANCE: These cases show that PEP can be complicated by exposures in tourist settings where reliable prophylaxis may not be available, where treatment is delayed or deviates from World Health Organization recommendations. Due to the potentially short incubation time of rabies/ABLV, timely prophylaxis after a potential exposure is needed to ensure a prompt and adequate immune response, particularly in patients who are immune-suppressed or who have not received HRIG. Serology should be used to confirm an adequate response to PEP when treatment is delayed or where a concurrent immunosuppressing medical condition or therapy exists.

A case of cephalothin-associated urolithiasis.

We present a case of osteomyelitis requiring prolonged intravenous cephalothin complicated by symptomatic calcium oxalate urocalculi formation. Patients on long-term ß-lactam antibiotics with lower urinary tract symptoms may have urolithiasis rather than a urinary tract infection.

Chromobacterium violaceum endocarditis and hepatic abscesses treated successfully with meropenem and ciprofloxacin.

Chromobacterium violaceum infection is uncommon but potentially fatal, with a clinical picture similar to melioidosis but with different antibiotic sensitivities and treatment. This infection can involve any organ, but we believe this is the first reported case of C. violaceum endocarditis.