Clinical, phenotypic, and genotypic characteristics of ESBL-producing Salmonella enterica bloodstream infections from Qatar.

Background: Resistant Salmonella infections are a major global public health challenge particularly for multidrug-resistant (MDR) isolates manifesting as bloodstream infections (BSIs). Objectives: To evaluate clinical, phenotypic, and genotypic characteristics of extended-spectrum beta-lactamase (ESBL) producing Salmonella enterica BSIs from Qatar. Methods: Phenotypic ESBL Salmonella enterica from adult patients presenting with positive BSIs were collected between January 2019 to May 2020. Microbiological identification and characterization were performed using standard methods while genetic characteristics were examined through whole genome sequencing studies. Results: Of 151 episodes of Salmonella enterica BSI, 15 (10%) phenotypic ESBL isolates were collected. Recent travel was recorded in most cases (80%) with recent exposure to antimicrobials (27%). High-level resistance to quinolines, aminoglycosides, and cephalosporins was recorded (80-100%) while meropenem, tigecycline and colistin demonstrated universal susceptibility. Genomic evaluation demonstrated dominance of serotype Salmonella Typhi sequence type 1 (93%) while antimicrobial resistance genes revealed dominance of aminoglycoside resistance (100%), qnrS1 quinolones resistance (80%), blaCTX-M-15 ESBLs (86.7%), and paucity of AmpC resistance genes (6.7%). Conclusions: Invasive MDR Salmonella enterica is mainly imported, connected to patients from high prevalent regions with recent travel and antimicrobial use caused by specific resistant clones. In suspected cases of multidrug resistance, carbapenem therapy is recommended.

Streptococcus gordonii-associated infective endocarditis: Case series, literature review, and genetic study.

Key Clinical Message: Streptococcus gordonii-associated endocarditis is a rare occurrence, raising diagnostic challenges, and is often associated with considerable morbidity. However, vigilance can prevent devastating consequences. Abstract: Streptococcus gordonii-associated endocarditis is rarely reported but often associated with considerable morbidity. We describe three cases of infective endocarditis caused by S. gordonii during a four-week period in 2023, and the use of whole-genome sequencing to determine whether these isolates were genetically related. The available literature was reviewed.

Tuberculosis and Takayasu's arteritis: An enigmatic association.

There is indirect evidence signifying a potential link between tuberculosis and Takayasu's arteritis (TAK); however, the exact mechanism and relationship between TKA and Mycobacterium tuberculosis (TB) remain to be elucidated. This case intends to highlight the association between TB and TKA, as early detection can avoid devastating consequences.

Epidemiology, microbiological and clinical characteristics of Enterococcus species bloodstream infections: A 10-year retrospective cohort study from Qatar.

Background and objective: Enterococcus species is one of the leading causes of community and healthcare-associated infections resulting in significant morbidity and mortality. In this study, we aim to evaluate the epidemiology, microbiological and clinical characteristics of Enterococcus Blood Stream Infections (BSIs) over 10 years period in a national secondary care setting. Methods: A retrospective cohort study was conducted on verified cases of enterococcal BSIs in adults from January 2009-December 2018 from specialized care hospitals at Hamad Medical Corporation, Qatar. Epidemiological, microbiological and clinical data were reported and analyzed. Results: A total of 263 enterococcus BSIs cases were identified, predominant were males (65%) with a median age of 63 (IQR 48-74). E. faecalis and E. faecium were predominate at 93.5% (73.38% and 20.15% respectively). Diabetes was the commonest premorbid condition (54.3%) followed by chronic kidney disease (36.5%). Central lines and genitourinary were the most common sources (18.25%, 14.83% respectively) while no identified source was reported in 45.25% of cases. Ampicillin susceptibility was 82.51% while vancomycin resistance was reported in 10.6% of isolates. Successful bacteremia clearance was achieved in 81.37% of cases at a mean of 4 days (Range 2-5 days) while metastatic complications occurred in 5.3% of cases. Univariate mortality risk analysis was associated with ICU admission, low level of consciousness, high bacteremia scores, and presence of catheters. The 30 days mortality was high at 66.54% with CKD and cancer patients at the highest mortality risks (OR 16.334 (CI 4.2-62.4) and 16 (CI 3-84) respectively. Conclusion: Significant mortality was associated with enterococcus BSI despite low rates for ampicillin and vancomycin resistance necessitating early identification of susceptible patients to instigate suitable preventive measures.

Massilia timonae bacteremia: An unusual pathogen of septic abortion.

Massilia timonae infections in humans have rarely been reported. To the best of our knowledge, M. timonae has not been previously recognized as a causative agent of obstetric or gynecological infections. Timely identification of this unusual pathogen and the use of targeted antimicrobial therapy are crucial to avoid consequences and treatment failure.

Vibrio albensis bacteremia: A case report and systematic review.

Vibrio species are gram-negative rods usually known to cause gastroenteritis and infrequently extraintestinal infections in humans. V. cholerae are classically associated with cholera epidemics, particularly serogroup O1 and serogroup O139. However, Vibrio albensis, a non-O1/ non-O-139 serogroup is rarely implicated in human infections. Thus, there is a paucity of data available on the pathogenic profile of V. albensis infections in humans and more research is needed to further delineate the clinical course and management. To fill this gap in the literature, we present the successful management of V. albensis bacteremia in a 64-year-old patient, and we conducted a systematic review of V. albensis infections reported to date, aiming to explore the clinical presentation, course, and management of V. albensis infections.

Mycobacterium abscessus urinary tract infection in an immunocompetent host: A case report and literature review.

Mycobacterium abscessus is one of the nontuberculous mycobacteria (NTM), which can cause many clinical spectra, predominantly pulmonary infections followed by skin and soft tissue infections. The prevalence of Mycobacterium abscessus infections has been growing worldwide over the last two decades. Urinary tract infection (UTI) secondary to M. abscessus is a rare condition, and only five cases have been described in the literature so far. Therefore, managing such a condition is challenging and based on limited evidence. Here, we report a case of an adult male with a history of previous urological procedures who presented with lower urinary tract symptoms (LUTS) and was found to have a UTI secondary to Mycobacterium abscessus. In this case, we described our successful management approach of this rare entity of Mycobacterium abscessus infection, and we reviewed similar cases in the literature.

Concomitant Pulmonary Tuberculosis and Invasive Aspergillosis Infection in an Immunocompetent Host.

Pulmonary tuberculosis (TB) is a common infection in developing countries and is associated with low socioeconomic status. It is considered a serious infection due it its long-term sequelae. Post-TB lung disease decreases life expectancy and increases the risk of recurrent TB infection. It also significantly increases the risk of other bacterial and fungal infections. Aspergillosis develops in the cavitary lesions of TB, worsening them and resulting in a deteriorating clinical situation. Concomitant pulmonary TB (PTB) and invasive aspergillosis is uncommon, particularly in the absence of factors that suppress the immune system. In this report, we describe the case of a healthy young adult without previous structural lung damage who presented with primary PTB and acute invasive aspergillosis infection, discuss the treatment dilemma and provide a literature review. LEARNING POINTS: Aspergillosis can mimic tuberculosis (TB) infection.Concomitant pulmonary TB and invasive aspergillosis is uncommon.The co-administration of antifungal and anti-TB medications presents significant therapeutic challenges.

Cholesterol Granuloma: An Underrecognized Cause of Benign Lung Granuloma.

A cholesterol granuloma is a benign lesion that can occur in various organs, mimicking other pathologies. We present the case of a 35-year-old man presenting with asymptomatic lung and pleural lesions which were suspected to be pulmonary tuberculosis but found to be cholesterol granuloma on biopsy. Cholesterol granulomas are a rare mimic of common lung pathology and should be considered in the differential diagnosis if the initial investigations are not informative. LEARNING POINTS: Pulmonary cholesterol granuloma is a benign lesion that radiologically mimics many sinister pathologies.The pathogenesis of pulmonary cholesterol granuloma remains obscure and extensive work-up is usually needed to rule out malignancy and infectious aetiology.

Underrecognized pathogen; Staphylococcus warneri-associated native mitral valve endocarditis in an immunocompetent host: A case report and literature review.

Staphylococcus warneri-related endocarditis is rarely reported, raising diagnostic challenges and is often associated with considerable morbidity and mortality. We describe a case of native valve endocarditis caused by S. warneri and complicated by a valve perforation in an immunocompetent patient to raise awareness of this emerging organism.

Sausage digit: Isolated tuberculous tenosynovitis of the middle finger.

Isolated tuberculous tenosynovitis is a rare form of extra-pulmonary tuberculosis that frequently eludes assessment and constitutes diagnostic challenges.

Time equals sight: Sphenoid sinus aspergilloma with vision loss.

Sphenoid sinus aspergilloma (SSA) with visual loss has rarely been reported. Timely recognition and prompt surgical intervention are crucial to avoid permanent neurological consequences.

The Role of Post-Bronchoscopy Sputum Examination in Screening for Active Tuberculosis.

Early diagnosis is a fundamental component of global tuberculosis control. The objective of this study was to evaluate the diagnostic yield of post-bronchoscopy sputum (PBS) testing as part of a tuberculosis diagnostic work-up. All new residents in the State of Qatar undergo a tuberculosis (TB) screening program. Those with abnormal chest radiology, negative sputum acid-fast bacilli (AFB) smears, and nucleic acid amplification testing (NAAT) for M. tuberculosis, undergo an additional bronchoscopic evaluation for TB. We prospectively enrolled individuals who were going to undergo bronchoscopy to provide two PBS samples for AFB smears and mycobacterial cultures between 18 September 2018 and 12 March 2021. A total of 495 individuals, with a median age of 31 years, were included. The majority of the patients were males (329, 66.5%). The most frequent country of origin was India (131, 26.5%) followed by the Philippines (123, 24.8%). The addition of PBS to bronchoalveolar lavage (BAL) testing allowed microbiological confirmation of tuberculosis in an additional 13 patients (3.9%), resulting in improved sensitivity (from 77.9% to 81.9%), negative predictive value (from 69.2% to 73.2%), and negative likelihood ratio (from 0.22 to 0.18). Where resources are available, the incorporation of routine PBS examination as part of tuberculosis diagnostic work-up can enhance the diagnostic yield.

Pyelonephritis-associated Staphylococcus saprophyticus bacteremia in an immunocompetent host: Case report and review of the literature.

Staphylococcus saprophyticus is one of the coagulase-negative staphylococcus species. It is the second most frequent causative microorganism in acute uncomplicated urinary tract infections in young women. However, it is potentially capable of causing more invasive infections including bacteremia, particularly secondary to pyelonephritis. We present a young, previously healthy lady who presented with urinary symptoms and hemodynamic instability and was found to have multiple renal and ureteric calculi with pyelonephritis. Later, blood and urine cultures isolated methicillin-resistant S. saprophyticus. The patient was successfully treated with a course of antibiotics targeting the organism with a favorable outcome. The clinical presentations and management of this rare entity of S. saprophyticus bacteremia-related pyelonephritis are outlined. In addition, the literature on similar cases was reviewed to raise awareness and avoid devastating consequences.

Spina Ventosa; Isolated tuberculous osteomyelitis of the little finger: A forgotten differential diagnosis.

Isolated tuberculous dactylitis is a rare form of extra-pulmonary tuberculosis that frequently eludes assessment and constitutes diagnostic challenges. This case reminds physicians of keeping tuberculosis (TB) as a differential when dealing with chronic finger ulcers to avoid devastating consequences.

Ecthyma gangrenosum: a rare manifestation of Stenotrophomonas maltophilia infection in acute myelogenous leukemia patient.

Ecthyma gangrenosum is a cutaneous infection typically associated with Pseudomonas aeruginosa. However, it is rarely caused by Stenotrophomonas maltophilia which might be overlooked leading to devastating consequences. We describe this case to avoid delays in the diagnosis and treatment of this aggressive infection, especially in immunocompromised patients.

Primary tuberculosis cutis orificialis; a different face of the same coin.

Primary tuberculosis cutis orificialis (TCO) is a rare form of extrapulmonary TB. The Lack of respiratory symptoms and similarity of the presentations to other oral lesions can pose a diagnostic dilemma. Hence, delaying treatment and potentially devastating consequences.

Ominous combination: COVID-19 disease and Candida auris fungemia-Case report and review of the literature.

The identification of Candida auris fungemia in critically ill COVID-19 patients is detrimental, with huge implications on patient mortality and infectious control measures.