Hemophagocytic lymphohistiocytosis and dengue infection: rare case report.

We describe a 21-year-old female patient returning from a journey to Cambodia, who developed dengue fever complicated with hemophagocytic lymphohistiocytosis. Hectic fever, rash, leukopenia, thrombocytopenia, hepatocellular dysfunction, a markedly elevated ferritin level, and a bone marrow demonstrating abundant hemophagocytosis were present. The patient recovered within 14 days. To our knowledge, this is only the second reported case of dengue virus-associated hemophagocytosis in Europe. As dengue is a rising pathogen in tropical import diseases, clinicians must be aware of its rare but serious complications.

Soft tissue infections with atypical mycobacteria in two patients with inflammatory rheumatic diseases using TNF-inhibitors and/or leflunomide.

Infections of the soft tissues due to atypical mycobacteria are relatively uncommon. We describe two cases. A 61-year-old woman with rheumatoid arthritis (RA) who was treated with the combination of the TNF inhibitor etanercept (Enbrel) and leflunomide (Arava), developed paronychia and cellulitis of the index finger due to Mycobacterium chelonae/abscessus complex. The patient was successfully treated with clarithromycin and surgical debridement. A second case describes a 50-year-old man with ankylosing spondylitis, receiving infliximab (Remicade) and low dose corticosteroids, who developed a granulomatous infection of the right thumb and forearm due to Mycobacterium marinum.The patient was successfully treated with clarithromycin and ethambutol. The increased risk for subcutaneous mycobacterial infections in these cases are probably related to the DMARD treatment with a TNF-inhibitor and leflunomide.

Comparison of pap smear, visual inspection with acetic acid, human papillomavirus DNA-PCR testing and cervicography.

OBJECTIVE: To assess the test qualities of four screening methods to detect cervical intra-epithelial neoplasia in an urban African setting. METHOD: Six hundred fifty-three women, attending a family planning clinic in Nairobi (Kenya), underwent four concurrent screening methods: pap smear, visual inspection with acetic acid (VIA), PCR for high risk human papillomavirus (HR HPV) and cervicography. The presence of cervical intra-epithelial neoplasia (CIN) was verified by colposcopy or biopsy. RESULT: Sensitivity (for CIN2 or higher) and specificity (to exclude any CIN or cancer) were 83.3% (95% CI [73.6, 93.0]) and 94.6% (95% CI [92.6, 96.5]), respectively, for pap smear; 73.3% (95% CI [61.8, 84.9]) and 80.0% (95% CI [76.6, 83.4]) for VIA; 94.4% (95% CI [84.6, 98.8]) and 73.9% (95% CI [69.7, 78.2]) for HR HPV; and 72.3% (95% CI [59.1, 85.6]) and 93.2% (95% CI [90.8, 95.7]) for cervicography. CONCLUSION: The pap smear had the highest specificity (94.6%) and HPV testing the highest sensitivity (94.4%). The visual methods, VIA and cervicography, were similar and showed an accuracy in between the former two tests.

One case each of recurrent meningitis and hemoperitoneum infection with Ralstonia mannitolilytica.

Two clinical cases of infection with Ralstonia mannitolilytica are described: a recurrent meningitis on an implanted intraventricular catheter and an infected hemoperitoneum as a complication of a cholangiocarcinoma. The strains were first misidentified as Pseudomonas fluorescens and Burkholderia cepacia. Further testing lead to the identification as Ralstonia pickettii biovar 3/"thomasii," which was recently shown to represent a separate species, R. mannitolilytica (List editor N. Weiss, Int. J. Syst. Evol. Microbiol. 51:795-796, 2001), originally described as R. mannitolytica (De Baere et al., Int. J. Syst. Evol. Microbiol. 51:547-558, 2001). R. mannitolilytica can be distinguished from all described Ralstonia species by its acidification of D-arabitol and mannitol and by its lack of nitrate reduction and of alkalinization of tartrate. In order to determine the true prevalence of infections with this species, colistin-resistant "P. fluorescens" strains and strains growing on B. cepacia selective medium deserve further attention.

[Avoidable "fever of unknown origin" due to Ralstonia pickettii bacteremia]. / Vermijdbare "febris e causa ignota" door Ralstonia pickettii bacteriemie.

Ralstonia pickettii bacteraemia from the atrial part of a ventriculo-atrial shunt was diagnosed as the cause of recurring febrile episodes with systemic toxicity in a 38-year old female. A prior neurosurgical resection of intracerebral cavernoma was complicated by postoperative recurrent meningitis with this non-fermenting gram-negative rod, due to an intra-operative contamination of a in situ shunt, from which only the intracerebral part of the ventriculo-atriostomy had been removed, following the episodes of meningitis. Ralstonia pickettii is a rare isolate and is seldom identified as a human pathogen. It formerly belonged to the genera Pseudomonas and Burkholderia. There are some casuistic reports of nosocomial bacteraemias, associated with the use of contaminated IV products or aerosols. There was an important diagnostic delay due to (1) insufficient communication between the different medical doctors in several hospitals, in different episodes of the clinical follow-up and (2) a misinterpretation of a positive blood culture with R. pickettii, which was interpreted as contamination. This misinterpretation and insufficient data transfer caused a considerable delay in the diagnostic process.

Isolation of Moraxella canis from an ulcerated metastatic lymph node.

Moraxella canis was isolated in large numbers from an ulcerated supraclavicular lymph node of a terminal patient, who died a few days later. Although the patient presented with septic symptoms and with a heavy growth of gram-negative diplococci in the lymph node, blood cultures remained negative. M. canis is an upper-airway commensal from dogs and cats and is considered nonpathogenic for humans, although this is the third reported human isolate of this species.