[A case of abscessed hepatic hemangioma with Edwardsiella tarda].

A 55-year-old man with a history of pancreatic cancer surgery and was undergoing chemotherapy presented with high fever. A computed tomography scan revealed a liver abscess at the location of a previously identified hemangioma. PTAD was performed, and contrast imaging revealed a connection with the bile duct. Edwardsiella tarda was detected in the abscess culture. Hemangioma-related abscess formation is extremely rare, with no reported cases of E. tarda detection in such abscesses.

Klebsiella sp.-related infectious spondylitis in a bearded dragon (Pogona vitticeps).

BACKGROUND: Spondylitis is an inflammation of the vertebrae that leads to a destructive process with exuberant new bone formation. Osteomyelitis can produce a distortion of the bone architecture, degenerative joint changes and ankyloses of adjacent vertebrae. In reptiles, intervertebral discs are absent, so the term discospondylitis is not used. In lizards, vertebral lesions have not been well studied. The present paper describes the first case of Klebsiella sp.-related spondylitis in a pet lizard (Pogona vitticeps). CASE PRESENTATION: A 2-year-old, female bearded dragon (Pogona vitticeps) was presented for clinical examination due to a decreased activity level, decreased appetite and constipation. Blood tests showed no remarkable alterations. The haemogram showed normal parameters with relative lymphocytosis, although the absolute number of lymphocytes did not differ from the reference values. A computed tomography scan revealed a mixed osteolytic-proliferative bone lesion diffusing to the first and last tracts of the pre-sacral vertebrae together. A small amount of material obtained from the spinal swelling was sampled with an aseptic technique for bacterial culture, which was positive for Klebsiella sp. The antibiogram revealed sensitivity to enrofloxacin, marbofloxacin, and chloramphenicol and intermediate sensitivity to gentamicin. Complete return to spontaneous feeding was achieved 15 days after the beginning of antibiotic and anti-inflammatory therapy. CONCLUSIONS: In veterinary medicine, spondylitis represents a well-known disease in small companion animals. In mammals, the most common aetiologic agents are fungi and bacteria. Antibiotic therapy was set based on the antibiogram, and marbofloxacin was chosen at a dosage of 10 mg/kg subcutaneously (SC) once per day (SID). After only 7 days of antibiotic therapy, the clinical condition improved significantly; the patient started feeding and drinking spontaneously and gained weight. This case should remind clinicians of the importance of always performing antibiograms before choosing any antibiotic therapy. Considering reptiles, there have been few papers about spinal diseases, mostly regarding snakes and a few about Iguana iguana. Relative to other species of saurians, the literature remains lacking.

Unusual cranial infection caused by Citrobacter Koseri.

A 60-year-old female had a frontal bone intraosseous meningioma resected 10 years previously. On follow up CT head, an enlarging intraosseous frontal bone lesion was noted. This was thought to be a recurrent frontal meningioma. Intraooperatively, she was found to have an abscess deep to the cranioplasty.

Mycotic Aneurysm Due to Leclercia Adecarboxylata: A Complication of Vertebral Osteomyelitis.

Leclercia adecarboxylata is a gram-negative bacterium and member of Enterobacteriaceae family. It has most frequently been isolated from lower wounds as a part of mixed flora. Mycotic aneurysms were first described by Osler and were mostly associated with infective endocarditis. We present the case of a male who presented with limb vein thrombosis, fatigue, and a history of back pain. The computed tomography scan revealed a saccular aneurysm and combined vertebral osteomyelitis of the third lumbar vertebra. An endovascular aneurysm repair with a tubed endograft was performed. Two years after the initial therapeutic management, he developed buttock claudication because of ostial stenosis of both common iliac arteries and a "kissing-stent" technique was performed. This is the first case described regarding Leclercia adecarboxylata as an etiologic factor of infected aneurysm development, its management and the short-term outcome.

Citrobacter freundii induced endocarditis in a yearling colt.

Endocarditis is a rare pathology in horses and the clinical signs can be misleading. We describe the clinical, echocardiographic, and pathological features of Citrobacter freundii induced bacterial endocarditis in a horse. This bacterium has never been reported before as an agent of vegetative endocarditis in the horse.

Endocardite induite parCitrobacter freundiichez un poulain âgé d'un an. L'endocardite est une pathologie rare chez les chevaux et les signes cliniques peuvent être trompeurs. Nous décrivons les caractéristiques cliniques, échographiques et pathologiques d'une endocardite bactérienne induite par Citrobacter freundii chez un cheval. Cette bactérie n'a jamais été signalée auparavant comme un agent d'endocardite végétante chez un cheval.(Traduit par Isabelle Vallières).

Orbital cellulitis and corneal ulcer due to Cedecea: First reported case and review of the literature.

Cedecea is a gram-negative bacterium from the family Enterobacteriaceae, rarely associated with human infection. We report the first case of an orbital cellulitis and corneal ulcer due to Cedecea in a patient who sustained a motor vehicle accident and was then found to have a retained wooden orbital foreign body.

Non-surgical management of thyroid abscess with ultrasound-guided fine-needle application of an antibiotic followed by sclerotization with absolute alcohol.

Thyroid abscess is a relatively rare yet dramatic condition of the thyroid gland requiring immediate therapeutic intervention. Traditionally, more or less aggressive surgical approaches and administration of broad-spectrum antibiotics have been used. Clinically less severe disease allows non-surgical treatment as well. The case report describes successful treatment of a large abscess of iatrogenic origin after biopsy of a cystic cavity. A combination of broad-spectrum antibiotics was used based on culture results, administered both orally and by repeated application directly into the abscess cavity using an ultrasound-guided fine-needle approach. Concurrent repeated evacuation of the cavity replaced drainage. Ultimately, a small residual cavity with sterile contents was managed by sclerotization with absolute alcohol. Clinical condition permitting, thyroid abscess may be successfully treated by repeated application of a targeted antibiotic, using a fine needle and ultrasound guidance, directly into the abscess cavity, with repeated evacuation replacing drainage.

Infected abdominal aortic aneurysm due to Morganella morganii: CT findings.

An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

Imaging Enterobacterales infections in patients using pathogen-specific positron emission tomography.

Enterobacterales represent the largest group of bacterial pathogens in humans and are responsible for severe, deep-seated infections, often resulting in sepsis or death. They are also a prominent cause of multidrug-resistant (MDR) infections, and some species are recognized as biothreat pathogens. Tools for noninvasive, whole-body analysis that can localize a pathogen with specificity are needed, but no such technology currently exists. We previously demonstrated that positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-d-sorbitol (18F-FDS) can selectively detect Enterobacterales infections in murine models. Here, we demonstrate that uptake of 18F-FDS by bacteria occurs via a metabolically conserved sorbitol-specific pathway with rapid in vitro 18F-FDS uptake noted in clinical strains, including MDR isolates. Whole-body 18F-FDS PET/computerized tomography (CT) in 26 prospectively enrolled patients with either microbiologically confirmed Enterobacterales infection or other pathologies demonstrated that 18F-FDS PET/CT was safe, could rapidly detect and localize Enterobacterales infections due to drug-susceptible or MDR strains, and differentiated them from sterile inflammation or cancerous lesions. Repeat imaging in the same patients monitored antibiotic efficacy with decreases in PET signal correlating with clinical improvement. To facilitate the use of 18F-FDS, we developed a self-contained, solid-phase cartridge to rapidly (<10 min) formulate ready-to-use 18F-FDS from commercially available 2-deoxy-2-[18F]fluoro-d-glucose (18F-FDG) at room temperature. In a hamster model, 18F-FDS PET/CT also differentiated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia from secondary Klebsiella pneumoniae pneumonia-a leading cause of complications in hospitalized patients with COVID-19. These data support 18F-FDS as an innovative and readily available, pathogen-specific PET technology with clinical applications.

Two Cases of Cronobacter Sakazakii Meningitis in Infants: The Importance Of Early Advanced Brain Imaging and Public Health Reporting.

We report 2 infants hospitalized with Cronobacter sakazakii meningitis. Each infant had exposure to powdered infant formula at home. Both infants survived, but 1 infant had a subdural empyema drained and developed left sensorineural hearing loss. Early advanced brain imaging is recommended in infants with C. sakazakii meningitis. Reporting to state and federal public health officials may help identify outbreaks.

The Use of Ultrasonography in Expediting Septic Joint Identification and Treatment: A Case Report.

This case report describes the use of ultrasonography in the identification of a joint effusion to guide diagnosis and management of septic arthritis. Our patient presented with pain, swelling, and erythema of the right thumb after having punctured her thumb with a cactus thorn. Results of physical examination demonstrated tenderness and restricted range of motion. Initial imaging with plain films was unrevealing, without bony and soft tissue abnormalities; however, ultrasound imaging of the interphalangeal joint revealed a focal effusion, and the patient was started on empiric Keflex. Because a focal effusion was visualized with ultrasonography, despite negative x-ray imaging, our patient underwent expedited surgical incision and drainage, foregoing joint aspiration. Intraoperative cultures grew Enterobacter 3 days after surgery, and the empiric antibiotic was adjusted to reflect sensitivities. At 2-wk follow-up, our patient showed near-complete resolution of her symptoms. This case report demonstrates the utility of ultrasonography in the early diagnosis of septic arthritis with the presence of a joint effusion that expedited successful treatment by foregoing joint aspiration in lieu of surgical intervention.

Bacterial Flora in the Genital Area of Patients with Lower Limb Lymphedema.

Background: Patients with lymphedema, especially those having genital lymphangiectasia, experience repeated cellulitis; however, the causative bacteria are not detected in most cases. In this study, we investigated the composition of genital bacterial flora in patients with lower limb lymphedema to appropriately treat or prevent repeated cellulitis in these patients. Methods and Results: We examined 47 women with lower limb lymphedema. The average age was 58.4 (range 36-80) years. We performed indocyanine green (ICG) lymphography to confirm the presence of genital lymphedema. For each patient, we swab the skin in the genital area. The swabs were applied to aerobic agar plates, incubated, and evaluated to assess bacterial colonization and resistance to antibiotics. We numbered the patients who held the antibiotic-resistant bacteria, especially methicillin-resistant Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus, and extended spectrum ß-lactamase-producing Enterobacteriaceae. Among the 47 patients enrolled, 30 patients (63.8%) had a history of cellulitis accompanied by lymphedema and 31 patients (66.0%) had genital lymphedema diagnosed by ICG lymphography. Among 47 patients, 43 (91.5%) had at least one bacterial strain. Coryneform bacterial species were most commonly detected in 19 patients. Of 29 patients with a history of cellulitis, 9 had antibiotic-resistant bacteria (31.0%). In contrast, of 18 patients with no history of cellulitis, only 2 had antibiotic-resistant bacteria (11.1%) (p = 0.12). Conclusions: The percentage of patients with drug-resistant bacteria was higher among those with a history of cellulitis than among those without it.

18-F fluorodeoxyglucose positron emission tomography indicating unsuspected infections in two patients with dermatomyositis.

Dermatomyositis is an idiopathic inflammatory myopathy that may be associated with malignancies. The technique of 18-F fluorodeoxyglucose (FDG)-positron emission tomography (PET) is an important tool to investigate underlying malignancy in patients with a possible paraneoplastic syndrome. We report two consecutive patients with dermatomyositis in whom 18-F FDG-PET revealed unsuspected infections. Physicians should be aware that a positive 18-F FDG-PET is not specific for malignancy and may reveal other conditions including an infectious disorder.

Reactive arthritis secondary to Hafnia alvei enterocolitis.

Diagnosis of postenteritic reactive arthritis (ReA) is a challenge and might have a broad range of differential diagnoses. A 50-year-old man was referred to our attention because of persistent inflammatory low back pain and asymmetric oligoarthritis. The clinical history was positive for diarrhoea in the previous 3 months. Inflammatory bowel disease, Whipple and celiac diseases were carefully excluded. In addition, serology, stool cultures, biopsies from the upper gastrointestinal tract yielded negative results for infections. A presumptive diagnosis of ReA was done and a non-steroidal anti-inflammatory drug trial prescribed. Persistence of symptoms prompted us for a second look of the colon. Biopsy collected from the terminal ileum were cultured and surprisingly colonies of Hafnia alvei, a rod-shaped Enterobacteriaceae, were detected. Treatment with ciprofloxacin leads to fast symptoms resolution. Although enterocolitis from H. alvei has been rarely reported, the culture of intestinal specimens might be recommended in the work-up of patients with suspected postenteritic ReA.

Pneumocephalus in neonatal meningitis.

Pneumocephalus is collection of gas or air within the cranial cavity. This has been described with trauma, cranial surgery, air embolism, and rarely as a result of central nervous system infections. We report a case of diffuse pneumocephalus secondary to Enterobacter cloacae meningitis. The diagnosis was suspected by cranial ultrasound and confirmed by computer tomography.

Evaluation of rapid KPC carbapenemase detection method based on MALDI-TOF VITEK MS spectra analysis.

Clinical microbiology laboratories in hospital settings need to be able to identify patients who carry carbapenemase-producing bacterial strains quickly in order to contain their spread and initiate proper pharmacological therapy. The aim of this study was to confirm the correlation between KPC production and a characteristic mass spectrometry (MS) peak (11 109 Da±8) to validate the use of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) MS as a rapid screening tool. With this aim, 176 selected clinical samples that were KPC-producing and 260 control samples that were carbapenem-susceptible or carbapenem-resistant through other resistance mechanisms, or were producing hydrolytic enzymes other than KPC, were analysed. The presence of the 11 109 Da peak in the spectra of 99.4 % (175/176) of the KPC-producing strains compared to the controls, which all lacked the peak, confirmed a strong correlation between KPC production and the presence of the 11 109 Da peak in the MALDI-TOF MS spectrum. The high sensitivity (98.7 %) and specificity (100 %) of the peak searching in the MALDI-TOF MS spectra mean that 11 109 Da peak searching is a suitable screening tool in KPC-endemic regions.

Severely infected pneumoceles of the frontal sinus in patients with mental retardation and brain atrophy treated by endoscopic sinus surgery.

We herein present three cases of abnormally expanded frontal sinuses (pneumoceles) with severe infection in patients with mental retardation and brain atrophy. Two patients previously underwent laryngotracheal separation surgery, and bacteriological examinations of purulent nasal discharge revealed infections caused by drug-resistant bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. As conservative medical treatments were ineffective, all three patients were treated by computed tomography-guided endoscopic sinus surgery. This navigation system is useful for safer surgery in the area of anatomic deformity. The clinical findings, possible etiologies and surgical treatment of these cases are discussed.

Multiple brain abscesses due to Enterobacter cloacae in an immune-competent child.

Brain abscesses due to Enterobacteriaceae in immune-competent children are rare, and those due to Enterobacter cloacae are even rarer. We report an interesting case of community-acquired E. cloacae neuroinfection resulting in multiple brain abscesses in a young child with no underlying risk-factors. A 10 year-old-boy presented with low-grade fever, headache, neck pain and progressive deterioration of sensorium. On examination, he was conscious but drowsy with photophobia, normal fundii, meningeal signs, mild hypertonia, brisk muscle stretch reflexes and extensor plantar responses. Magnetic resonance imaging of brain showed bilateral, multiple pyogenic abscesses. Culture of the abscess material aspirated at the time of surgical drainage showed growth of E. cloacae. He received intravenous imipenem for 18 weeks guided by clinical and radiological response. A pragmatic approach combining early surgical drainage, targeted antimicrobial therapy and patient-tailored duration based on the clinico-radiological response is needed in such difficult cases.

A novel case of Raoultella planticola osteomyelitis and epidural abscess.

A spinal epidural abscess is the collection of pus in the epidural space, and is a potentially life-threatening condition that requires early detection and prompt management. Almost two-thirds of cases are caused by Staphylococcus aureus, followed by Gram-negative bacilli which account for approximately 16% of cases. Raoultella planticola is an emerging pathogen, and is an extremely rare cause of invasive infection in humans. It has been reported to cause urinary tract infections, pneumonia, bacteraemia, cholangitis, cholecystitis, conjunctivitis and soft tissue infections. We report the first case, to our knowledge, of R. planticola osteomyelitis and spinal epidural abscess.