Arcobacter butzleri is an opportunistic pathogen: recurrent bacteraemia in an immunocompromised patient without diarrhoea.

INTRODUCTION: Arcobacter butzleri is attracting increasing interest due to its possible pathogenic properties. Researchers have described cases in which A. butzleri is isolated in stool samples from patients with gastrointestinal symptoms, mostly diarrhoea. The relevance of adding our case to the literature lies in its description of recurrent A. butzleri bacteraemia in a patient without diarrhoea. CASE PRESENTATION: An immunocompromised patient was hospitalized three times within 12 months due to A. butzleri-induced bacteraemia. At no time did the patient experience diarrhoea even though examination of stool samples showed growth of A. butzleri . The isolate was susceptible to gentamicin, colistin and tetracyclines. The patient was successfully treated with doxycycline. CONCLUSION: For the first time in the literature we describe recurrent A. butzleri bacteraemia in a patient without diarrhoea. This case supports the classification of A. butzleri as an opportunistic pathogenic species, which clinical microbiology laboratories should be able to identify.

Substantial interobserver variation of thyroid volume and function by visual evaluation of thyroid (99m)Tc scintigraphy.

INTRODUCTION: (99m)Tc-pertechnetate scintigraphy is much used in the evaluation of patients with nodular goitre. We investigated the ability of experienced observers to estimate the thyroid 24-h (131)I uptake (RAIU) and the thyroid volume by visual evaluation of the scintigram. MATERIAL AND METHODS: Two endocrinologists and two nuclear medicine specialists visually evaluated thyroid scintigrams from 171 patients with nodular goitre. The variables were assessed in a blinded fashion according to predefined categories and then compared with the true values. The assessments were repeated after four weeks. Kappa (κ ω) statistics were used. RESULTS: There was a low probability (range 6-22%) for the observers to assess the thyroid RAIU correctly. The probability of assessing the thyroid volume correctly was in the 14-22% range. Endocrinologists tended to underestimate the thyroid RAIU, mostly in patients with a RAIU > 30%. All observers significantly underestimated the thyroid volume if this was > 80 ml. There was a low interobserver agreement for the thyroid RAIU assessment (κ ω-values: 0.03-0.43) as well as for the thyroid volume assessment (κ ω-values: 0.19-0.48). The corresponding κ ω-values for the intraobserver agreement were 0.34-0.68 and 0.37-0.62, respectively. Nuclear medicine specialists achieved a significantly higher agreement than endocrinologists in their evaluation of both thyroid parameters. CONCLUSION: Thyroid (99m)Tc scintigraphy has poor interobserver agreement and is inaccurate for assessment of quantitative thyroid parameters, even when performed by experienced specialists. FUNDING: This study was supported by grants from the Danish Agency for Science, Technology and Innovation. TRIAL REGISTRATION: not relevant.