Zoonotic Endocarditis in a Man, the Netherlands.

In 2017, endocarditis caused by Streptococcus equi subspecies zooepidemicus was diagnosed in a man in the Netherlands who had daily contact with horses. Whole-genome sequencing of isolates from the man and his horses confirmed the same clone, indicating horse-to-human transmission. Systematic reporting of all zoonotic cases would help with risk assessment.

[West Nile virus poliomyelitis after a holiday in Egypt]. / West-Nijl-viruspoliomyelitis na vakantie in Egypte.

BACKGROUND: Due to the worldwide near-extinction of poliovirus infections an acute presentation of poliomyelitis in the Netherlands has become extremely rare. However, in the differential diagnosis of such a disease presentation other pathogens need to be considered as well. CASE DESCRIPTION: A 44-year-old female presented with fever and a flaccid paresis of the left leg, following a holiday in Egypt. The laboratory investigation demonstrated an acute West Nile virus (WNV) infection, after which the diagnosis 'WNV poliomyelitis' was made. CONCLUSION: WNV poliomyelitis is a rare neurological complication of an infection with the WNV. The areas in Europe where WNV transmission to humans occurs are expanding. In the future, the number of neurological disorders caused by WNV is likely to increase, also in the Netherlands.

Development of a real-time PCR for identification of brachyspira species in human colonic biopsies.

BACKGROUND: Brachyspira species are fastidious anaerobic microorganisms, that infect the colon of various animals. The genus contains both important pathogens of livestock as well as commensals. Two species are known to infect humans: B. aalborgi and B. pilosicoli. There is some evidence suggesting that the veterinary pathogenic B. pilosicoli is a potential zoonotic agent, however, since diagnosis in humans is based on histopathology of colon biopsies, species identification is not routinely performed in human materials. METHODS: The study population comprised 57 patients with microscopic evidence of Brachyspira infection and 26 patients with no histopathological evidence of Brachyspira infection. Concomitant faecal samples were available from three infected patients. Based on publically available 16S rDNA gene sequences of all Brachyspira species, species-specific primer sets were designed. DNA was extracted and tested by real-time PCR and 16S rDNA was sequenced. RESULTS: Sensitivity and specificity for identification of Brachyspira species in colon biopsies was 100% and 87.7% respectively. Sequencing revealed B. pilosicoli in 15.4% of patients, B. aalborgi in 76.9% and a third species, tentatively named "Brachyspira hominis", in 26.2%. Ten patients (12.3%) had a double and two (3.1%) a triple infection. The presence of Brachyspira pilosicoli was significantly associated with inflammatory changes in the colon-biopsy (p=0.028). CONCLUSIONS: This newly designed PCR allows for sub-differentiation of Brachyspira species in patient material and thus allows large-scaled surveillance studies to elucidate the pathogenicity of human Brachyspira infections. One-third of affected patients appeared to be infected with a novel species.

[Patient with haemolytic uremic syndrome and Escherichia coli (EHEC) infection]. / Een patiënt met hemolytisch-uremisch syndroom en infectie met enterohemorragische Escherichia coli (EHEC).

BACKGROUND: In infection with the enterohaemorrhagic Escherichia coli (EHEC), toxins produced by the bacteria can induce the potentially lethal disease haemolytic uremic syndrome (HUS). CASE DESCRIPTION: A 71-year-old woman was seen at the Emergency Department with abdominal cramps and bloody diarrhoea. Diagnostic tests revealed ischaemia of the intestinal mucosa. A few days after admission the patient developed acute malfunction of the kidneys and thrombocytopenia. HUS was diagnosed, which was later shown to be caused by infection with EHEC. The patient was treated with plasmapheresis and haemodialysis, which brought her kidney function back to normal. History taking revealed that the patient had visited northern Germany where the EHEC epidemic was raging. CONCLUSION: In cases of bloody diarrhoea, clinicians should consider infection with EHEC - a bacterium for which antibiotics are not appropriate treatment. If the infection becomes complicated by the development of HUS, then the treatment of choice should be administration of fluids, and haemodialysis possibly combined with plasmapheresis.