Sternal osteomyelitis by Gordonia Bronchialis in an immunocompetent patient after open heart surgery.

Gordonia is a catalase-positive, aerobic, nocardioform, Gram-positive staining actinomycete that also shows weak acid-fast staining. Several Gordonia species are commonly found in the soil. The bacterium has been isolated from the saliva of domesticated/wild dogs as well. In hospitalized patients, most commonly it is found in the setting of intravascular catheter-related infections. However, recent reports show that it is being increasingly isolated from sternal wounds, skin/neoplastic specimens and from pleural effusions. Gordonia shares many common characteristics with Rhodococcus and Nocardia. Ergo, it is commonly misrecognized as Nocardia or Rhodococcus. Since this pathogen requires comprehensive morphological and biochemical testing, it is often difficult and cumbersome to isolate the species. Broad-range Polymerase Chain Reaction (PCR) and sequencing with genes like 16S rRNA or hsp65 are used to correctly identify the species. Identification is essential for choosing and narrowing the right antimicrobial agent. Herein, we report our experience with a patient who presented with sternal osteomyelitis after infection with this elusive bug.

The microbiology and treatment of human mastitis.

Mastitis, which is generally described as an inflammation of breast tissue, is a common and debilitating disease which frequently results in the cessation of exclusive breastfeeding and affects up to 33% of lactating women. The condition is a primary cause of decreased milk production and results in organoleptic and nutritional alterations in milk quality. Recent studies employing culture-independent techniques, including metagenomic sequencing, have revealed a loss of bacterial diversity in the microbiome of mastitic milk samples compared to healthy milk samples. In those infected, the pathogens Staphylococcus aureus, Staphylococcus epidermidis and members of corynebacteria have been identified as the predominant etiological agents in acute, subacute and granulomatous mastitis, respectively. The increased incidence of antibiotic resistance in the causative species is also a key cause of concern for treatment of the disease, thus leading to the need to develop novel therapies. In this respect, probiotics and bacteriocins have revealed potential as alternative treatments.

First identification of Gordonia sputi in a post-traumatic endophthalmitis patient - a case report and literatures review.

BACKGROUND: We present a case of post-traumatic endophthalmitis with relatively good prognosis caused by Gordonia sputi, which, to our knowledge is the first case in the literature. CASE PRESENTATION: A 24 year old man, who underwent an intraocular foreign body extraction half a month before presentation in the left eye, was referred to us complaining of blurred vision and slight pain for 5 days. His first presentation showed moderate intracameral and intravitreous purulent inflammation with a best corrected vision of counting fingers. After gram staining of the intravitreous samples revealed a gram-positive bacilli infection, a combination of amikacin and vancomycin was initially injected intravitreously. The left eye kept stable for three days but deteriorated on the 4th day. On the 5th day after presentation conventional culture characterized the bacterium as an Actinomyces sp. while 16S ribosomal RNA gene sequencing confirmed it as Gordonia sputi. Thereby a complete pars plana vitrectomy combined with lensectomy and silicone oil tamponade was performed. During the surgery an intraocular irrigation with penicillin G was adopted, followed by administration of intravenous penicillin G twice one day for a week. A relatively normal fundus with slight intracameral inflammation was observed a week after the operation, and the best corrected vision recovered to 0.15. One year later his vision remained 0.1. CONCLUSION: Gordonia sputi should be taken into consideration in patients with post-traumatic endophthalmitis especially due to foreign body penetration. Compared to conventional laboratories, molecular methods are recommended for an accurate diagnosis. A comprehensive strategy of antimicrobial agents and vitrectomy may render a satisfactory result.

Regulatory effect of interleukin-4 in the innate inflammatory response to Rhodococcus aurantiacus infection in mice.

Interleukin (IL)-4 promotes the regression of granulomas during the late phase of Rhodococcus aurantiacus infection. In this study, the contribution of IL-4 to the initial response against this bacterium was investigated using IL-4-deficient mice. Compared with wild-type (WT) mice, IL-4-deficient mice displayed remarkably lower tumor necrosis factor (TNF)-α and IL-6 secretion in the liver, spleen, and blood at the initial phase of infection, along with improved survival. IL-4-deficient mice also showed diminished IL-10 secretion in the spleen and blood; however, hepatic IL-10 levels were similar to those observed in WT animals, and were concomitant with augmented interferon (IFN)-γ production and decreased bacterial burden in the liver at the early infection phase. Histological examination revealed reduced hepatic granuloma formation in infected IL-4-deficient mice. On challenge with heat-killed R. aurantiacus, IL-4-deficient mouse macrophages showed reduced expression of TNF-α, IL-6, and IL-10 at both the gene and protein levels compared with WT mouse cells. These findings indicate that during the initiation of R. aurantiacus-induced inflammation, IL-4 deficiency attenuates cytokine responses in macrophages, which contributes to amelioration in mouse survival and reduction of granulomatous inflammation, and augments a hepatic IFN-γ response which transiently accelerates bacterial elimination.

Kocuria rosea canaliculitis: a clinicomicrobiological correlation.

Kocuria rosea is usually a nonpathogenic commensal colonizing the skin and oropharynx but can become an opportunistic pathogen in immunocompromised states. Documented cases of any infections with K. rosea are exceedingly rare. This study reports the first case of canaliculitis with K. rosea, its clinicomicrobiological correlation, and management.

Rhodococcus equi pericarditis in a patient living with HIV/AIDS.

INTRODUCTION: Rhodococcus equi, previously called Corynebacterium equi, is known to cause pneumonia in foals and swine. Although it was known to cause infection rarely in humans, R equi infection in humans has increased with the advent of HIV and increased use of immunosuppressants. CASE: We report a case of a 48-year-old male patient with newly diagnosed HIV/AIDS presenting with recurrent R equi bacteremia, pericardial effusion, and pericardial cyst. The infection was treated with drainage of the pericardial effusion and cyst and 2 weeks of intravenous vancomycin and 6 months of oral azithromycin and levofloxacin. DISCUSSION: Rhodococcus equi causes pericarditis and pericardial effusion. It can be effectively treated with debridement, drainage, and a prolonged course of antibiotics. In vitro antibiotic susceptibility should be checked as resistance to antibiotics can develop, especially if drainage is inadequate.

Orbital cellulitis complicated by central retinal artery occlusion.

The authors present a case of a 16-year-old boy who sought treatment in Storm Eye Institute for orbital cellulitis complicated by central retinal artery occlusion. He was examined for severe signs of orbital cellulitis, including decreased vision and an afferent pupillary defect. Intravenous antibiotics failed to provide timely improvement, and the patient was surgically managed with endoscopic orbital decompression. An ocular examination under anesthesia revealed retinal ischemia in the affected eye, and fluorescein angiography confirmed the diagnosis of central retinal artery occlusion. The patient's vision improved slightly following resolution of the infection. Central retinal artery occlusion is a rare complication of orbital cellulitis in adults and has yet to be reported in the pediatric population.

Arcanobacterium hemolyticum orbital cellulitis: a rare but aggressive disease.

The clinical presentation and course of orbital cellulitis in a young adult resulting from Arcanobacterium hemolyticum frontal sinusitis are presented in detail. This case illustrates the importance of a multidisciplinary approach for refractory and aggressive orbital cellulitis. A high level of suspicion for A. hemolyticum must be maintained in such cases, because it has proven to be a rare but aggressive, potentially occult, and life-threatening pathogen.

Minimicetoma por Nocordia brasiliensis: un caso infantil en Veracruz / Minimicetoma by Nocordia brasiliensis: a children's event in Veracruz

El término minimicetoma designa a los micetomas de pequeño tamaño, con morfología atípica y superficial, causados por Nocardia brasiliensis. Se comunica un paciente de sexo masculino, de 10 años de edad, originario y residente de Xalapa (Veracruz), que presentó un minimicetoma por N. brasiliensis, confirmado por estudio micológico e histopatológico. El tratamiento con penicilina procaínica durante 10 días, en conjunto con trimetoprima/sulfametoxazol y diaminodifenisulfona por 6 meses, tuvo resultados satisfactorios.

Minimycetoma is an atypical small mycetoma usually caused by Nocardia brasiliensis. We report a 10-year-old male from Xalapa (Veracruz) with a minimycetoma due to N. brasiliensis confirmed by mycological and histopathological studies. Simultaneous treatment with procainic penicillin for ten days and trimethoprim/sulfamethoxazol and dapsone showed satisfactory results after 6 months.

Brevibacterium casei as a cause of brain abscess in an immunocompetent patient.

Coryneform bacteria belonging to the genus Brevibacterium have emerged as opportunistic pathogens. Of the nine known species of Brevibacterium isolated from human clinical samples, Brevibacterium casei is the most frequently reported species from clinical specimens. We report the first case of B. casei brain abscess in an immunocompetent patient successfully treated by surgery and antimicrobial therapy.

Case report: Rhodococcus erythropolis osteomyelitis in the toe.

The Rhodococcus species rarely cause musculoskeletal infections, with only two cases reported in the literature. We report the case of a 53-year-old woman who had an infection develop after first metatarsophalangeal joint fusion. A year after surgery, she continued to have pain and swelling with nonunion. She underwent revision of the arthrodesis and tissue samples from surgery revealed Rhodococcus erythropolis. The patient's symptoms improved with oral antibiotics. One year after the revision surgery, the fusion had united. We believe this is the first report of a case of a musculoskeletal infection caused by Rhodococcus erythropolis.

[A case of catheter-related bacteremia of Tsukamurella pulmonis].

Tsukamurella pulmonis is an aerobic actinomycete. We report a catheter-related bacteremia of T. pulmonis. A 39 yr-old male with ALL was hospitalized to receive bone marrow transplantation (BMT). Although the patient developed a high fever at the 7th hospital day (HD), it subsided with vancomycin treatment, and he received BMT at 9th HD. Fever resurged at 16th HD despite sustained treatment with vancomycin, meropenem, and amphotericin B, but subsided with removal of Hickman catheter (HC) at 19th HD. Three sets of blood cultures comprising one from the HC and two from venipunctures were taken at 7th, 16th, and 19th HD, and the distal tip of the HC was also cultured. The aerobic vials of all 3 HC-withdrawn blood cultures and one peripheral blood culture taken at 19HD and the HC tip culture grew long, straight, thin gram-positive rods that were positive on modified Kinyoun stain. This organism showed tiny, rough, grey colonies after 3-day incubation and grew to large flat colonies when incubation was extended. It was catalase-positive, urease-positive, and alkaline-slant/alkaline-deep on triple sugar iron agar, and hydrolyzed hypoxanthine. The sequence of 1,296 base pairs of 16S rRNA of this organism showed a 100.0% homology with the published sequence of T. pulmonis DSM 44142T. To our knowledge, this is the first report of T. pulmonis bacteremia in Korea.

Endocapsular cellulomonas as a cause of persistent postoperative endophthalmitis.

Sequestration of bacteria within the capsular fornices after cataract extraction with intraocular lens implantation can cause both acute and chronic inflammation. A case of persistent postoperative endophthalmitis caused by capsular sequestration of Cellulomonas is described. The patient underwent uncomplicated cataract extraction with intraocular lens implantation and subsequently developed acute postoperative endophthalmitis. Inflammation persisted despite several vitreous taps and the injection of intravitreal antibiotics. Definitive treatment required pars plana vitrectomy, intraocular lens explantation, capsular bag removal, and intravitreal and parenteral antibiotics. In patients with postoperative endophthalmitis, one must consider atypical organisms as the source and should consider explantation of the intraocular lens with capsular bag removal.

[Pulmonary malakoplakia and Rhodococcus equi infection. A report of two cases and review]. / Malakoplakia pluca i zakazenie Rhodococcus equi. Opis dwóch przypadków i przeglad pismiennictwa.

Malakoplakia is a rare, chronic, granulomatous disease seen in immunocompromised patients, caused by multiple infectious agents, most often bacteria. Microscopically, accumulations of macrophages with granular cytoplasm and intra- or extracellular structures, called Michaelis-Gutmann bodies are characteristic. Main cause of pulmonary malakoplakia is Rhodococcus equi infection. We report two cases of pulmonary malakoplakia, in one case R. equi infection was confirmed. We also present a summary of recent knowledge about the pathogenesis, morphology and clinical course of the disease.

Mediastinitis due to Gordona sputi after CABG.

Genus Gordona is included in mycolic acid containing bacteria. This genus infection is very rare and occurs classically in immuno-compromised patients. We report a patient who developed mediastinitis due to Gordona sputi after coronary artery bypass grafting (CABG) using left internal mammary artery. Immunocompromised factors were not noticed in this case but postoperative bleeding, the most important risk factor of mediastinitis, was found in his course. The treatment was antibiotic therapy, surgical soft tissue debridement and open irrigation with dilute povidone-iodine solution. However, infectious reaction continued and Gordona sputi repeated cultured from wound. Next procedure, debridement of sternal bone and omental transfer, was performed and skin was closed primarily. Inflammatory reaction was attenuated and the wound was healed Broad debridement and omental transfer were very effective for mediastinitis due to Gordona sputi after CABG.

Mycetoma of the calf.

Actinomycetous infections typically involve either the head and neck or the extremities following a traumatic implantation. Classic clinical associations are draining sinus tracts. This case report describes the pathologic and MR findings of a relatively acute mycetomatous process involving the soft tissues. Pathologic findings in this case included an occasional granule composed of gram positive, thin branching elements. These and other findings were consistent with actinomycetes bacterium infection. The discussion centers around the use of MR, both with and without gadolinium, in evaluating this type of granulomatous infection. Infiltration of the adjacent subcutaneous tissues was easier to appreciate on both the T1-weighted images without gadolinium and the T1-weighted images with gadolinium when compared to the T2-weighted images. Signal characteristics as described in this case report may suggest a granulomatous process.

[Rhodococcus equi--a newly recognized opportunistic pathogen in man]. / Rhodococcus equi--nove poznaný oportunní patogen cloveka.

The review informs about substantial features of Rhodococcus equi with emphasis on the analysis of 115 as yet published and still expanding reports on the isolation of this zoopathogenic nocardioform actinomycete from man. Microbiological laboratories of human medicine have to learn not only how to identify R. equi but also recognize it as an opportunistic pathogen in particular in persons with the deficient immunity. R. equi is a gram-positive, encapsulated diphtheroid coccobacillus, partially acid fast. It grows well on common media, its colonies being after 48 hours characteristically mucoid, coalescing, irregular and mostly lightly pinkish. Biochemically it is little active, nevertheless it causes typical synergic haemolysis of erythrocytes influenced by staphylococcal beta-toxin. R. equi is found in soil and manure, especially in horse manure. It causes above all granulomatous pneumonia in young foals. In humans, it causes mostly pneumonia and lung abscess, more frequently in persons with immunity deficiency incl. AIDS, less often extrapulmonary abscesses, sepsis and wound infections. The disease are commonly chronic and recurrent. The ability of R. equi to persist in macrophages and destroy them is important in the pathogenesis of infection. In resistance to infection the cell-mediated immunity seems to be of major importance. The port of entry are the lungs, less often the alimentary tract or injured skin. About a third of the persons gives a history of contact with animals, manure or soil. The standard treatment is prolonged administration of a combination of rifampin and erythromycin. The isolation of R. equi is easy and if a laboratory suspects the presence of this microorganism, its identification is not difficult.