An atypical, pigment-producing Metschnikowia strain from a leukaemia patient.

A yeast strain was isolated from the sputum sample of a leukaemia patient in the Spirito Santo Hospital of Pescara, Italy. The fungus produced a pigment that formed a reddish halo around colonies, and was identified and deposited as a Metschnikowia spp. (accession number IHEM 25107-GenBank accession number JQ921016) in the BCCM/IHEM collection of biomedical fungi and yeasts (Bruxelles, Belgium). Although the physiology of the strain was close to that of Metschnikowia sinensis, the D1/D2 sequence did not correspond to any previously described Metschnikowia species. Phylogeny of the genus Metschnikowia is complex and requires far more analysis. We present the first non-M. pulcherrima Metschnikowia spp. isolate recovered from a human, and emphasize the role of man as a transient carrier of environmental yeasts, the pathogenicity of which still needs to be defined.

What do we know about Candida guilliermondii? A voyage throughout past and current literature about this emerging yeast.

Candida guilliermondii is an uncommon isolate throughout most of the world, the behaviour of which as an environmental fungus, a human saprophyte and an agent of serious infections has been emphasised over the years. Notably, illnesses caused by this pathogen mostly involve compromised cancer hosts and commonly lead patients to unfavourable outcomes. It is of concern that the yeast may acquire or inherently express reduced in vitro sensitivity to all antifungal classes, although widespread resistance has not yet been described, and poor correlation exists between MICs and clinical outcome. However, the organism appears as constitutively less susceptible to polyenes and echinocandins than other yeast-like fungi, so that the emergence of such pathogen in the clinical settings is of concern and may appear as a new challenge in the context of mycoses and antifungal therapy.

Pan-azole-resistant Candida guilliermondii from a leukemia patient's silent funguria.

Isolation of Candida non-albicans yeasts as commensals or pathogens from hospitalised hosts is acquiring increasing importance, due to the frequent drug resistance expressed by such organisms.Particularly, the recover of antifungal resistant C. guilliermondii is of worrisome concern, even if recovered as a saprophyte, since commensal yeasts may behave as reservoirs for resistance elements;furthermore, they may enter the bloodstream after chemotherapy-related mucosal damage has developed,thus causing life-threatening and difficult-to-treat fungemias. This communication deals with the unusual isolation of a pan-azole resistant C. guilliermondii strain from a leukaemic patient with silent candiduria and emphasizes the importance of monitoring less recurring species within the nosocomial setting to better understand fungal epidemiology within the wards and face the spread of resistance determinants. Also, we highlight the controversial significance of silent candiduria, clinical relevance of which should be investigated case by case, to exclude and/or prevent candiduria as well as renal impairment.

A case report of the eradication of pseudomonas aeruginosa from leg ulcer in a patient with essential thrombocythemia.

A patient treated with hydroxyurea had a lower extremity ulcer that was found infected with Pseudomonas aeruginosa. Drug discontinuation and ceftazidime treatment did not initially lead to resolution due to misidentification of inducible betalactamases expressed by the organism and subsequent clinical failure of the cephalosporin in eradicating infection. These class C enzymes may be strongly induced after betalactam exposure and confer resistance to penicillins, cephalosporins, betalactamase inhibitors but not to carbapenems. Though hydroxyurea represents a major cause of essential thrombocythemia-related ulcers, lesion infections by difficult-to-treat organisms should be eradicated to promote wound healing.

Beta-lactam failure in treatment of two group G Streptococcus dysgalactiae subsp. equisimilis Pharyngitis patients.

We present two cases of exudative pharyngitis due to Streptococcus dysgalactiae subsp. equisimilis, Lancefield group G. While the participation of this organism as an agent of pharyngitis is well documented, we focus on failure of beta-lactam therapy, a phenomenon that is well described for pharyngitis due to Streptococcus pyogenes. Therefore, these case reports add to our knowledge of pharyngitis caused by non-S. pyogenes streptococci.

Femoral prosthesis infection by Rhodotorula mucilaginosa.

This case report is a case history of a femoral prosthesis infection caused by Rhodotorula mucilaginosa in a human immunodeficiency virus patient. Though the pathogenicity of this organism for bone tissue has been previously reported, this is the first reported case of an orthopedic prosthesis infection by this species of the genus Rhodotorula.

Multidrug-resistant Escherichia fergusonii: a case of acute cystitis.

We report a case in which Escherichia fergusonii, an emerging pathogen in various types of infections, was associated with cystitis in a 52-year-old woman. The offending strain was found to be multidrug resistant. Despite in vitro activity, beta-lactam treatment failed because of a lack of patient compliance with therapy. The work confirms the pathogenic potential of E. fergusonii.

Graft versus host disease-related Hafnia alvei colonization and probable infection.

We describe the case of a graft versus host disease (GvHD) patient, in whom Hafnia alvei was cultured as a single organism, and at high bacterial counts from stool samples, from the onset of the disease until its resolution. This case is a further example of the contentious role of this species in causing human intestinal disease. Furthermore, it focuses on enteric damage by GvHD as a risk factor for acquiring H. alvei colonization, and probably infection.

First report of vaginal infection caused by Enterococcus raffinosus.

The authors have reported the first case of vaginal infection caused by Enterococcus raffinosus. The latter is a rarely identified species, but some of the infections described in the literature should direct some attention to this, often opportunistic pathogen, and its emerging multidrug resistance.

A case of pharyngitis caused by Streptococcus pneumoniae.

Throat cultures from an adult pharyngitis patient yielded Streptococcus pneumoniae as a single organism, with a very high bacterial count. The isolate was found to be macrolide and fluoroquinolone resistant, and the same strain was cultured from the patient's denture washing solution. Ceftriaxone therapy, a gradual reduction in the bacterial count and progressive clinical improvement proceeded at the same pace, so we labelled this clinical case as a pneumococcal pharyngitis.

Multidrug-resistant Enterococcus raffinosus from a decubitus ulcer: a case report.

A case of decubitus ulcer infected with multidrug-resistant Enterococcus raffinosus is reported in this article. This is the first report of wound infection caused by an Enterococcus raffinosus isolate resistant to antibiotics other than beta-lactams, gentamicin, and ciprofloxacin. This case adds to the knowledge base concerning the onset of antibiotic resistance in this uncommon species and confirms the emerging role of daptomycin as a promising alternative in therapy of severe difficult-to-treat enterococcal infections.

Ulcer infection by ESbetaL-producing Proteus mirabilis: a case report.

In this article, a case of decubitus ulcer infection caused by an extended-spectrum beta-lactamase-producing Proteus mirabilis strain, successfully treated with oral amoxicillin-clavulanate (1-month therapy) is described. This article focuses on diffusion and clinical effect of extended-spectrum beta-lactamases-producing Proteus mirabilis on treatment of gram negative lower extremity infections.

Review of airway illnesses by kytococcus and rothia and a look at inhalatory vancomycin as a treatment support.

Seriously compromised patients may acquire deep airway ailments by Gram positive, commensal bacteria including Kytococcus and Rothia, pathogenic tracts of which still remain quite unexplored. Resistances they express have been poorly investigated over the years, and no published guidelines for susceptibility testing and antibiotic therapy exist. We would therefore revise the current knowledge about these opportunistic organisms' clinical impact, as well as discuss on recent patents focusing on lung infection management. Particularly, these deal with the use of inhalatory vancomycin, even as lipidic complex, that appears a promising adjunctive treatment to systemic antimicrobials.

Brief Tale of a Bacteraemia by Rhodococcus equi, With Concomitant Lung Mass: What Came First, the Chicken or The Egg?

Rhodococcus equi is an uncommon Gram positive, variably acid-fast pathogen, that appears as hard to treat mostly owing to the establishment of intracellular niches. Lack of interpretive criteria for susceptibility testing may lead to under-reporting or overestimation of resistances, whereas knowledge about this pathogen's clinical impact may be affected by erroneous phenotype-based characterization at a genus and species level.We present the case of a bacteraemia with a concomitant lung mass in a lymphoma patient, that further highlights the emergence of rhodococcal diseases as a matter for concern in the fields of infectious diseases and haematology.

Drug sensitivity and clinical impact of members of the genus Kocuria.

Organisms in the genus Kocuria are Gram-positive, coagulase-negative, coccoid actinobacteria belonging to the family Micrococcaceae, suborder Micrococcineae, order Actinomycetales. Sporadic reports in the literature have dealt with infections by Kocuria species, mostly in compromised hosts with serious underlying conditions. Nonetheless, the number of infectious processes caused by such bacteria may be higher than currently believed, given that misidentification by phenotypic assays has presumably affected estimates of the prevalence over the years. As a further cause for concern, guidelines for therapy of illnesses involving Kocuria species are lacking, mostly due to the absence of established criteria for evaluating Kocuria replication or growth inhibition in the presence of antibiotics. Therefore, breakpoints for staphylococci have been widely used throughout the literature to try to understand this pathogen's behaviour under drug exposure; unfortunately, this has sometimes created confusion, thus higlighting the urgent need for specific interpretive criteria, along with a deeper investigation into the resistance determinants within this genus. We therefore review the published data on cultural, genotypic and clinical aspects of the genus Kocuria, aiming to shed some light on these emerging nosocomial pathogens.

Enterococcus raffinosus sinusitis post-Aspergillus flavus paranasal infection, in a patient with myelodysplastic syndrome: report of a case and concise review of pertinent literature.

A case of Enterococcus raffinosus nosocomial sinusitis which appeared to complicate a previous Aspergillus flavus paranasal infection is presented. This uncommon enterococcal species is rarely responsible for human diseases, and has never previously been associated with sinusitis.

Bacterial contamination of platelets and septic transfusions: review of the literature and discussion on recent patents about biofilm treatment.

In spite of the improvements in transfusion safety occurred in the last decades, platelet septic transfusions still represent a cause for concern. Microbial screening of blood products cannot ensure transfusion sterility, so that pathogen inactivation methods and a timely management of infectious events actually play the most relevant role. Biofilm production has been associated to several human illnesses; also, it promotes bacterial adherence to platelet bags and colonization of recipient's catheter after transfusion. Therefore, facing biofilm communities is required to reduce the contamination risk and the occurrence of post-infusion events. In this context, the use of tigecycline as a wide-spectrum antibiofilm drug is discussed, along with recent patents about biofilm treatment by quorum-sensing blockers, bacteriophage-based therapy and antibiofilm oral compounds.