Exceptional association of two species of bacteria causing mediastinitis: Haemophilus influenzae (H. influenzae) and Aggregatibacter aphrophilus (A. aphrophilus).

BACKGROUND: Post cardiac surgery mediastinitis is the major infectious complication, despite the development of surgical techniques and the application of strict preventive measures. The Haemophilus influenzae mediastinitis is very rare. The mediastinitis caused by the association between Haemophilus influenzae and Aggregatibacter aphrophilus has never been described to our knowledge. CASE PRESENTATION: We report the case of an exceptional combination of Haemophilus influenzae and Aggregatibacter aphrophilus in a patient operated for single bypass which is complicated by mediastinitis the 10th day after the surgical act. CONCLUSION: The conclusion to be drawn from this work is to think in unusual seeds in case of mediastinitis post cardiac surgery for the elaboration of recommendations for antibiotic prophylaxis.

Aggregatibacter aphrophilus Sacroiliitis Following Gastroscopy in a Young Sportsman.

We report a case of Aggregatibacter aphrophilus sacroiliitis in a young sportsman, presenting 48 hours after endoscopy and biopsy. Microbiological diagnosis was made only after repeated attempt at joint aspiration. The patient was cured after radiologically guided drainage and a prolonged course of directed antibiotics.

CT-Guided Biopsy in Suspected Spondylodiscitis--The Association of Paravertebral Inflammation with Microbial Pathogen Detection.

OBJECTIVES: To search for imaging characteristics distinguishing patients with successful from those with futile microbiological pathogen detection by CT-guided biopsy in suspected spondylodiscitis. METHODS: 34 consecutive patients with suspected spondylodiscitis underwent CT-guided biopsy for pathogen detection. MR-images were assessed for inflammatory infiltration of disks, adjacent vertebrae, epidural and paravertebral space. CT-images were reviewed for arrosion of adjacent end plates and reduced disk height. Biopsy samples were sent for microbiological examination in 34/34 patients, and for additional histological analysis in 28/34 patients. RESULTS: Paravertebral infiltration was present in all 10/10 patients with positive microbiology and occurred in only 12/24 patients with negative microbiology, resulting in a sensitivity of 100% and a specificity of 50% for pathogen detection. Despite its limited sensitivities, epidural infiltration and paravertebral abscesses showed considerably higher specificities of 83.3% and 90.9%, respectively. Paravertebral infiltration was more extensive in patients with positive as compared to negative microbiology (p = 0.002). Even though sensitivities for pathogen detection were also high in case of vertebral and disk infiltration, or end plate arrosion, specificities remained below 10%. CONCLUSIONS: Inflammatory infiltration of the paravertebral space indicated successful pathogen detection by CT-guided biopsy. Specificity was increased by the additional occurrence of epidural infiltration or paravertebral abscesses.

Presumed Aggregatibacter aphrophilus endogenous endophthalmitis.

We hereby report a case of endogenous endophthalmitis, presumably caused by a rare culprit-Aggregatibacter aphrophilus. A. aphrophilus is a member of the HACEK group, a group of fastidious Gram-negative bacteria with low pathogenicity and a rare cause of human infections. For ophthalmic infection, it has been reported to cause canaliculitis and exogenous endophthalmitis. A middle-aged gentleman with good past health presented with decreased vision (20/200) in his left eye. Other than fever, he was well on presentation, with no apparent focus of infection. Subsequently, he developed an episode of high fever reaching 39.2 °C, with CRP of 233 mg/L. CT abdomen showed presumed kidney abscess and a rare Gram-negative coccobacillus. A. aphrophilus [formerly Haemophilus aphrophilus (Nørskov-lauritsen and Kilian in Int J Syst Evol Microbiol 56:2135-2146, 2006)] was found in blood culture, Vitreous sample was analysed using 16S ribosomal DNA amplification but failed to identify the organism. After appropriate treatment, his vision improved drastically from 20/200 to 20/30. A. aphrophilus isolated from blood cultures during septicemia in a patient with kidney abscess may be associated with metastatic endophthalmitis, which may appear as a first sign. Our case demonstrates that with prompt diagnosis and appropriate treatment, visual prognosis of A. aphrophilus endophthalmitis can be promising.