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.

Bacteraemia in Intensive Care Unit: Clinical, Bacteriological, and Prognostic Prospective Study.

Objectives. We conducted a one-year observational study from December 2012 to November 2013 to describe the epidemiology of bacteraemia in intensive care units (ICU) of Mohammed V Military Teaching Hospital of Rabat (Morocco). Methods. The study consisted of monitoring all blood cultures coming from intensive care units and studying the bacteriological profile of positive blood cultures as well as their clinical significance. Results. During this period, a total of 46 episodes of bacteraemia occurred, which corresponds to a rate of 15,4/1000 patients. The rate of nosocomial infections was 97% versus 3% for community infections. The most common source of bacteraemia was the lungs in 33%, but no source was identified in 52% of the episodes. Gram negative organisms were isolated in 83,6% of the cases with Acinetobacter baumannii being the most frequent. Antibiotic resistance was very high with 42,5% of extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae and 100% of carbapenemase in Acinetobacter baumannii. The antibiotherapy introduced in the first 24 hours was adequate in 72% of the cases. Conclusions. Bloodstream infections in ICU occur most often in patients over 55 years, with hypertension and diabetes. The bacteria involved are mainly Gram negative bacteria multiresistant to antibiotics. Early administration of antibiotics significantly reduces patients mortality.

A Case of Dual Septic Foci in Both the Joint and Pleural Cavity Caused by Streptococcus agalactiae.

Group B Streptococcus (GBS or Streptococcus agalactiae) is a common component of the human flora. However, infections in adults are infrequent, and occurrences of infectious pleurisy or septic arthritis are exceedingly uncommon. To our knowledge, the concurrent manifestation of both conditions has not been previously documented. We present the case of a 61-year-old man who exhibited an unusual association of infectious pleurisy and septic arthritis in the knee, both attributed to GBS. The patient was admitted to the hospital due to thoracic pain and discomfort in the left knee. Clinical examination revealed a pleural effusion in the left lung and arthritis in the left knee. Synovial and pleural fluid samples were sent to the bacteriology laboratory for cytobacteriological examination, confirming the presence of GBS in both fluids. The patient is diabetic and has a history of undergoing total cystoprostatectomy for a urothelial tumor, with the placement of a mono J catheter. The prevailing hypothesis suggests that the colonization of the mono J catheter, followed by hematogenous dissemination, is the probable source of the infection. This unusual clinical case underscores GBS's ability to induce severe invasive infections in adults, particularly in those with underlying medical conditions.

Invasive Streptococcus pyogenes infection: a case report.

The Group A Streptococcus (GAS), also known as Streptococcus pyogenes (S. pyogenes), is a human pathogen causing various infections, ranging from mild, such as tonsillitis and impetigo, to severe and invasive conditions like septicemia and necrotizing fasciitis. Despite a decline in incidence and severity during the twentieth century due to antibiotics, there has been a reported increase in severe cases since the 1980s in industrialized countries. S. pyogenes is a human pathogen with a natural reservoir in the pharynx and skin, exhibits asymptomatic carriage in various body sites. It is responsible for a spectrum of clinical manifestations, from asymptomatic carriage to severe invasive infections. Transmission occurs through respiratory droplets or direct contact with skin lesions. Bacteriologically, S. pyogenes is a Gram-positive ß-hemolytic streptococcus. This summary highlights a case of invasive Group A Streptococcus infection in a 28-year-old diagnosed at the microbiology laboratory of the Mohammed V Military Training Hospital in Rabat, Morocco. A 28-year-old patient, without any specific medical history, presented with acute febrile oligoarthritis. Following a recent flu-like syndrome and febrile tonsillitis, the patient experienced asymmetric inflammatory oligoarthralgia affecting the left knee, left ankle, and right shoulder, accompanied by functional impairment of the left lower limb. Upon admission, clinical examination revealed swelling, positive patellar tap, and sternal involvement. Laboratory and imaging findings indicated an abscessed collection in the left knee and anterior mediastinitis. Emergency aspirations revealed Group A Streptococcus, specifically Streptococcus pyogenes, leading to a diagnosis of septic arthritis. Dual antibiotic therapy and knee joint drainage resulted in symptom resolution after 45 days. The rise in severe Group A Streptococcus infection underscores the need for early detection and treatment. Widely sharing the French High Council for Public Health's antibiotic prophylaxis recommendations is crucial for awareness. Collaborating between clinicians and microbiologists is essential for effective management.

The Evaluation of the BioFire FilmArray Meningitis/Encephalitis Panel for the Detection of Bacteria and Yeast in Cerebrospinal Fluid Specimens.

Background and objective Infectious meningitis and encephalitis are serious diseases that can have fatal consequences, especially in the case of bacterial meningitis. Molecular biology has made it possible to quickly introduce appropriate treatment. Our study aims to evaluate the FilmArray Meningitis/Encephalitis Polymerase Chain Reaction (PCR) Panel (BioFire Diagnostics, Salt Lake City, Utah) implemented in our department compared to traditional methods. Material and methods This was a retrospective single-center study conducted in the Department of Bacteriology of Mohammed V Military Training Hospital, Rabat, for a period of four years. All cerebrospinal fluid (CSF) samples from patients with symptoms of meningitis or meningoencephalitis submitted to the laboratory for cytobacteriological analysis were included in the study. Conventional analysis has been compared with molecular biology.  Results The overall agreement rate with FilmArray in our study was 86%. The sensitivity to Escherichia coli K1, Haemophilus influenzae, Neisseria meningitidis, Streptococcus agalactiae, and Streptococcus pneumoniae was 100%. And for Cryptococcus neoformans it was 83% in our study. Conclusion In summary, this technique can be used to diagnose bacterial meningitis more sensitively than with conventional techniques, while at the same time allowing a rapid and efficacious patient's treatment.

Microbial ecology of protective isolation room: Air and Surfaces.

INTRODUCTION: Healthcare-associated infections pose a significant public health burden, leading to morbidity, mortality, prolonged hospital stays, and substantial social and economic costs. Immunocompromised patients are at a heightened risk of nosocomial infections. AIM: This prospective study conducted at Mohammed VI University Hospital of Oujda aimed to assess the microbial ecology of surfaces and air in an immunosuppressed patient room compared to a double hospitalization room. METHODS: Microbiological air purity tests were conducted employing both the sedimentation method and the collision method with the assistance of Microflow Alpha. The sedimentation method used Mueller Hinton with 5% human blood, facilitating the free fall of contaminated dust particles. The collection program employed was set for 10 minutes per 1 m3. For surface sampling, swabs were taken from a 25 cm2 surface. The swabs were immediately forwarded to the Microbiology Laboratory. We carried out both macroscopic and microscopic identification of colonies, followed by definitive biochemical identification using the BD phoenixTM system. Antibiotic susceptibility was assessed through agar diffusion on Muller Hinton medium coupled with the determination of the minimum inhibitory concentration. RESULTS: The results revealed a decreased bacterial count within the protective isolation room, in contrast to the standard hospital room. We noted the predominance of coagulase-negative Staphylococcus spp and Bacillus spp. Staphylococcus aureus and Aspergillus spp, common pathogens in healthcare-associated infections, were notably absent in the protective isolation room. The findings underline the pivotal role of hospital environments in the transmission of healthcare-associated infections. CONCLUSION: The protective isolation room demonstrated effective control of microbial contamination, with fewer and less resistant germs. The study highlighted the significance of air treatment systems in preventing the spread of opportunistic infections. Our study underscored the critical role of microbiological cleanliness in preventing nosocomial infections.

Exceptional association of two species of bacteria causing acute appendicitis: Haemophilus influenzae and Enterobacter cloacae.

Appendicitis, typically caused by appendiceal lumen obstruction, is a prevalent abdominal surgical emergency worldwide. While most cases involve Enterobacterales, Haemophilus influenzae, primarily known for upper respiratory infections, is infrequently associated with gastrointestinal infections. This article presents an exceptional case of acute appendicitis caused by both Haemophilus influenza and Enterobacter cloacae in a 15-year-old child, highlighting the significance of recognizing uncommon pathogens in appendicitis and emphasizing the necessity for thorough microbiological investigations to refine diagnostic approaches.

Haemophilus influenzae Urethritis: A Localization to Consider.

Urethritis may be acute or subacute and can be classified as gonococcal or nongonococcal. Nongonococcal urethritis is mainly dominated by Chlamydia trachomatis. Other bacteria such as Haemophilus influenzae have been implicated in some cases. We report the case of a 56-year-old diabetic man with H. influenzae urethritis following unprotected oral sex. The patient initially received treatment with ciprofloxacin, but this proved to be ineffective. Once our diagnosis was made, we switched the patient to cefixime for a period of seven days, which resulted in a successful clinical outcome.

Osteoarticular tuberculosis of the ankle, a rare localization: a case report.

Tuberculosis poses a considerable public health problem in countries where the disease is endemic. Osteoarticular tuberculosis represents 3-5 % of all tuberculosis cases and 10-15 % of extra-pulmonary tuberculosis cases. Involvement of the foot and ankle is rarer. We report a case of osteoarticular tuberculosis of the ankle in a 71-year-old patient with type 2 diabetes and hypertension who presented to the trauma department of the Mohammed V Military Hospital with a painful swelling of the ankle. Standard X-rays and computed tomography scans of the ankle showed inflammatory involvement of the bone and joints. Antitubercular therapy was instituted. Given the context of endemicity, any atypical presentation of lingering bone lesions should raise the suspicion of an osteoarticular tuberculosis in order to ensure early therapeutic management.

Isolation of Pasteurella pneumotropica in a Hand Phlegmon Following a Human Bite.

Pasteurella is a commensal microorganism found in the mucous membranes of the upper respiratory and digestive tracts of mammals and birds and it rarely affects humans. Human pasteurellosis typically results from infection through bites or scratches from animals, with dogs and cats being the most common sources. However, various vertebrates, such as rats, rabbits, tigers, and lions, can also transmit the infection. We report a case involving a young woman who developed a hand phlegmon on her right forearm following a rare and unusual human bite during a brawl. Her condition improved after both surgical and medical treatment.

Pre-analytical non-conformities of cytobacteriological examination of urine in the microbiology laboratory of Oujda's Mohammed VI University Hospital.

INTRODUCTION: The pre-analytical step of cytobacteriological examination of urine (CBEU) is one of the most critical in microbiology. AIM: To analyze quantitatively and qualitatively the pre-analytical non-conformities related to the CBEU in order to propose reliable corrective measures. METHOD: This was a 76-month retrospective study from March 2016 to June 2022. The study included all CBEU referred to our laboratory. The conformity of the requests was evaluated according to the requirements of the medical microbiology standard (REMIC). It concerned the CBEU request, the urine sample and its packaging. RESULT: We collected 66631 CBEU requests. The urine was not conform in 1646 (2.47%) cases. The majority of non-conformities came from the emergency department (n= 653; 39.67%). The predominant non-conformities were (i) deteriorated sample (53.53%; n=878), (ii) delayed transport (28.55%; n=469) and (iii) damaged equipment (4.62%; n= 76). CONCLUSION: In our study, pre-analytical non-conformities of CBEU were frequent and affected all steps of the pre-analytical process. They had a direct clinical and economic impact on the patient. Continuous improvement of the pre-analytical phase of the CBEU is necessary in our institution.

Prediction of the bacterial shape in urinary tract infections with the Sysmex UF-1000i analyser: technical note.

Background: The aim of our study was to explore the utility of the Sysmex UF-1000i analyzer as a rapid screening tool for urinary tract infections (UTI) and its ability to predict bacterial shape in order to help physicians choose the appropriate empiric treatment. Materials and methods: This is a retrospective study, including 1023 urine cytobacteriological examinations. Urines were processed according to the recommendations of the medical microbiology reference system (REMIC). Using the Sysmex Uf-1000i analyzer, the authors evaluated bacteria forward scatter (B_FSC) and fluorescent light scatter (B_FLH) in a preliminary discrimination step for UTI caused by bacilli or cocci bacteria. Results: The authors got 1023 positive samples. Comparing baccili and cocci bacteria, the authors observed a statistically significant difference for B_FSC but not for B_FLH. The values of B_FLH are very close for the four categories of microorganisms compared (bacilli, cocci, bacilli-cocci association, and yeasts). For these same categories, tests show different values for the B_FSC. A separate analysis of the B_FSC values for bacilli shows that their distribution is relatively homogeneous and exhibits a peak between 20 and 30 ch. Conclusion: Dimensional parameters of bacteria generated by UF-1000i could be a rapid and useful tool for predicting the bacterial shape causing UTI.

A very rare case of bacteraemia in a 4-year-old girl with osteopetrosis with probable Leuconostoc lactis infection.

Leuconostoc lactis (LLac) is a Gram-positive coccus of the family Leuconostocaceae . It can be found in a variety of vegetables and dairy products. LLac is an opportunistic pathogen with intrinsic resistance to vancomycin and teicoplanin. In this case report, we discuss a rare case of LLac-associated bacteraemia in a patient with osteopetrosis. A 4-year-old girl was admitted to the paediatric emergency department with acute fever without other signs. Blood culture revealed an infection with LLac. Using the streptococcus antibiogram, the isolate was resistant to vancomycin, teicoplanin, rifampicin and sulfamethoxazole-trimethoprim but sensitive to ß-lactams, gentamicin, streptomycin, azithromycin, clarithromycin, lincomycin, clindamycin and erythromycin. The patient was treated with intravenous ceftriaxone and gentamicin, and subsequently with oral amoxicillin. After a favourable course, she was discharged from the hospital on the 10th day. The modes of transmission and physiopathology of LLac remain unknown. Factors associated with this infection include compromised immunity, previous antibiotic therapy especially with vancomycin, and application of a central venous catheter. In our patient, the risk factors for infection were pancytopenia and multiple transfusions used to treat bone marrow failure. The source of the bacteraemia could have been the cutaneous route, but it could also have been digestive due to the reservoir of the bacteria. LLac is known as an opportunistic bacterium. Further studies on its pathogenesis and other risk factors are needed to understand the true prevalence of this potentially fatal bacterium in compromised individuals, such as the case of our patient.

Urinary tract infections older adults at Mohammed VI University Hospital of Oujda: case series.

Due to its incidence, clinical polymorphism and severity, urinary tract infection is an important problem in elderly. The objectives of the authors' work were to establish the bacteriological profile of urinary tract infection and/or colonization in the elderly and then to study drug resistance of bacterial strains isolated. Materials and methods: This is a 36 months retrospective study from 22 March 2016 to 11 May 2019. The study included urinary specimens of persons aged 65 years or over, hospitalized or consulting at the authors' hospital. Urines were processed according to the recommendations of the medical microbiology reference system and European Committee on Antimicrobial Susceptibility Testing. Results: The authors collected 6552 requests for cytobacteriological examination of urine. Most of the specimens was collected in the middle stream (n=5503; 84%). Cultures were sterile in 49.77% of cases. Positive in 50.22% of cases. Among positive samples we had 53.41% polymorphic cultures, 32.75% urinary tract infection, and 13.82% urinary tract colonization. Gender distribution showed a sex ratio at 0.62. Gram-negative bacilli, with Escherichia coli as the main species, dominated the isolated bacteria. Resistance rates of E. coli strains that we isolated were 70% for amoxicillin, 36.31% for amoxicillin-clavulanate and 25% for ciprofloxacin. A high resistance rate was seen for third generation cephalosporins. Least resistance recorded to nitrofurantoin. Conclusion: ITU in the elderly is diverse and significantly different from that of younger patients, through its high contamination rate, difficulty in acquiring clinical information, high rate of asymptomatic bacteriuria, and high proportion of multidrug resistant bacteria.

Pancytopenia revealing acute brucellosis.

Brucellosis is the most prevalent bacterial zoonosis worldwide. The WHO estimates that the infection is responsible for more than 500 000 cases per year across the world [1]. Hematological complications like mild anemia and leukopenia have been frequently associated with acute brucellosis, but pancytopenia and thrombocytopenia are less frequently encountered [2]. We are reporting the case of a 73 year old male patient, with pancytopenia that revealed acute brucellosis. Following 6 weeks of antibiotic therapy, our patient showed favorable clinical outcome, and the complete blood count returned to normal. Acute brucellosis should be highly suspected in patients with pancytopenia.

Leclercia adecarboxylata invasive infection in a patient with Hirschsprung disease: A case report.

INTRODUCTION: Leclercia adecarboxylata is a ubiquitous aerobic, motile, gram-negative bacilli. The human gastro-intestinal tract is known to harbor this rarely opportunistic microorganism. We describe a rare case of invasive infection with a gastrointestinal starting point due to L. adecarboxylata in a patient with Hirschsprung disease. CASE REPORT: It is about a newborn female who was admitted on the 3rd day of life to the neonatal intensive care unit for intestinal obstruction. On the 9th day of life, while managing the neonatal obstruction, the patient developed febrile peaks. Cytobacteriological examination of cerebrospinal fluid, blood cultures and culture of umbilical vein catheter allowed the exclusive isolation of Leclercia adecarboxylata. It was producing extended spectrum beta-lactamase and was treated with intravenous imipenem. After favourable evolution, the patient was transferred to the pediatric surgery department. There, she was diagnosed with Hirschsprung disease. DISCUSSION: Knowledge of the route of transmission of L. adecarboxylata is limited and the possible source of the infection is unclear. However, the authors describe three hypotheses of contamination of our propositus. In our patient, one or more of these routes of contamination would be possible. Indeed, bacteremia could occur as a result of a bacterial translocation across the mucosal barrier of the colon altered by Hirschsprung disease, antibiotic use and feeding practices. CONCLUSION: Infection with L. adecarboxylata revealed a wide range of infection. It has only recently been acknowledged as an emerging pathogen. Further studies of the pathogenesis and risk factors are required.

[Contamination of urine collected for cytobacteriological examination: situation in a university hospital in Morocco]. / Contamination des urines prélevées pour examen cytobactériologique : situation dans un centre hospitalier universitaire au Maroc.

The pre-analytical step of the cytobacteriological examination of urine (CBEU) is one of the most critical in microbiology. The objectives of our study were to determine the rate of urinary contamination and to analyze the factors that would facilitate this in order to propose solutions to this problem. METHOD: This is a 26-month descriptive study including all CBEU requests to our laboratory. Urine was treated in accordance with the recommendations of the medical microbiology recommendations. Urine was considered contaminated in the case of polymorphic culture with at least three different types of germs with a count from 103 CFU/mL. RESULTS: We collected 16,412 CBEU requests. Urine was contaminated in 4,830 cases (29.43%). Of the contaminated urine, 39.23% (n=1,895) was from emergency departments, 79.44% (n=3,837) was collected in the middle of the stream, 69.83% (n=3,373) was from a female patient and 16.34% (n=789) was from children under the age of 5. DISCUSSION AND CONCLUSION: To reduce urine contamination, quality instructions describing sampling procedures should be available and samples in the middle of the stream and through the collection adhesive bags should be replaced by sus-pubic puncture samples in children, whenever the profit/risk ratio of this method is favourable.

Epidemiological profile of funguria in a university hospital in Oujda, Morocco.

BACKGROUND AND PURPOSE: The presence of yeasts in the urine is not synonymous with urinary tract infection since it can result in simple colonization or contamination. Regarding this, it is required to further clarify the epidemiological profile of funguria. Accordingly, the present study was conducted to establish the epidemiology of funguria in the Mohammed VI Teaching Hospital of Oujda, Morocco. MATERIALS AND METHODS: This retrospective study was conducted on all urine samples sent for cytobacteriological examination to a microbiology laboratory over a period of 28 months (i.e., from March 2016 to June 2018). After the removal of duplicates, the urine samples were treated according to the recommendations of the medical microbiology standards. RESULTS: A total of 15,165 urine samples were collected. Urinary colonization accounted for 4.94% (n=749) of cases. The infections of the urinary tract accounted for 5.35% (n=811) of cases. Microbial isolates (n=1,669) in colonization and urinary tract infections were dominated by bacteria (93.47%, n=1,560). Furthermore, the yeasts accounted for 6.53% (n=109) of the isolates. Candida albicans was isolated from 56.88% (n=62) of funguria cases. The risk factors for funguria in our series were essentially old age, admission to intensive care unit, and broad-spectrum antibiotic therapy. CONCLUSION: The current level of knowledge about the clinical situations leading to funguria with the improvement and popularization of efficient identification techniques for yeasts other than C. albicans should redress the epidemiology of funguria. This should allow the knowledgeable societies to establish the rules of interpreting the cytobacteriological examination of the urine in case of funguria, as for bacteriuria.

Whole-Genome Shotgun Sequences of Three Multidrug-Resistant Mycobacterium tuberculosis Strains Isolated from Morocco.

Tuberculosis is a contagious disease that usually attacks the lungs but sometimes attacks other parts of the body, such as the kidneys, glands, and bones. It is an endemic and major public health problem in Morocco. Tuberculosis is transmitted through the airways via the inhalation of microdroplets containing Mycobacterium tuberculosis We present here the whole-genome shotgun sequences of three multidrug-resistant M. tuberculosis strains isolated from Morocco.