Laboratory Exposures from an Unsuspected Case of Human Infection with Brucella canis.

We report a case of human infection with a Brucella canis isolate in an adult in Canada who was receiving a biologic immunomodulating medication. We detail subsequent investigations, which showed that 17 clinical microbiology staff had high-risk exposures to the isolate, 1 of whom had a positive result for B. canis.

Liver histology of acute brucellosis caused by Brucella melitensis.

As a major organ of the mononuclear phagocytic system, the liver is probably involved in all cases of brucellosis. In this prospective study, liver slides prepared from percutaneous liver biopsy samples of 20 patients with clinical and laboratory evidence of acute brucellosis due to Brucella melitensis were examined for the presence or absence of granulomas by pathologists in Iran and the United States. Nineteen men and one woman ranging in age from 14 to 62 years were studied. All patients had clinical signs and symptoms compatible with acute brucellosis, and all had significantly elevated titers of antibodies to Brucella in their serum. Liver function tests were mildly elevated in 11 (55%) cases, and C-reactive protein was positive in 15 (65%) patients. Thirteen (65%) patients had blood cultures positive for B melitensis. Iranian and American pathologists reported granulomas in 3 (15%) and in 4 (20%) cases, respectively. There was agreement between Iranian and American pathologists in 17 (85%) cases. The most prevalent findings were mild portal or lobular lymphocytic inflammation (16 cases). Two cases revealed noncaseating epithelioid granulomas, and 2 had microgranulomas. The results show that all patients had microscopic evidence of liver involvement. The predominant histologic finding was mild portal or lobular inflammation with lymphocytes. Granulomas were present in only 4 cases.

Microbial isolates and their antimicrobial susceptibilities in inframalleolar foot infections.

BACKGROUND: Foot infections are especially common among diabetic individuals and often contribute to limb loss. We investigated the microbiology of foot infections in our hospital to further understand the microbes involved and to assist in identifying potential empiric oral antibiotic regimens for foot infections. METHODS: All moderate/severe inframalleolar foot infections that were drained surgically at a single center during a single calendar year were included. Initial isolates obtained intra-operatively were reviewed. RESULTS: A total of 39 patients underwent operative drainage, of whom 34 (87%) had diabetes mellitus. Fifty-two total specimens were obtained, consisting of 26 fluid swabs, 12 soft-tissue specimens, and 11 bone specimens. Nineteen (49%) of the specimens were obtained from toe wounds, 16 (41%) from forefoot wounds, two (5%) from midfoot wounds, and two (5%) from heel wounds. Most specimens (71%) were polymicrobial, yielding a mean of 2.2 isolates. In all, 100 individual isolates, encompassing 39 different bacterial organisms, were identified (55 gram-positive aerobes, 33 gram-negative aerobes, 11 anaerobes, and one fungus). Enterococcus species and Staphylococcus aureus were the most common bacteria, each representing 13% of isolates. Only 9% of isolates were methicillin-resistant S. aureus. Obtaining multiple specimens (e.g., both fluid and tissue) increased the yield for identification of organisms. Oral antibiotics provided adequate coverage for gram-positive organisms but not for gram-negative organisms. CONCLUSIONS: Foot infections are typically polymicrobial and may involve a wide variety of microbes. Initial gram-stain results could be used to choose better initial empiric antimicrobial therapy for such infections.

Candida glabrata spinal osteomyelitis.

Invasive disease caused by Candida spp. is being appreciated with increased frequency especially associated with widespread use of immunosuppressive drug therapy. We report a case of spinal osteomyelitis and epidural abscess caused by Candida glabrata occurring in a patient who had been diagnosed with candidemia 3 months before that patient was treated with fluconazole. The infection was successfully treated with amphotericin B, but the patient eventually required surgical intervention for spondylolisthesis with impingement on the cauda equina.

Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) prevention bundle results in decreased MRSA surgical site infections.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) surgical site infections (SSIs) increase morbidity and mortality. We examined the impact of the MRSA bundle on SSIs. METHODS: Data regarding the implementation of the MRSA bundle from 2007 to 2008 were obtained, including admission and discharge MRSA screenings, overall MRSA infections, and cardiac and orthopedic SSIs. Chi-square was used for all comparisons. RESULTS: A significant decrease in MRSA transmission from a 5.8 to 3.0 per 1,000 bed-days (P < .05) was found after implementation of the MRSA bundle. Overall MRSA nosocomial infections decreased from 2.0 to 1.0 per 1,000 bed-days (P = .016). There was a statistically significant decrease in overall SSIs (P < .05), with a 65% decrease in orthopaedic MRSA SSIs and 1% decrease in cardiac MRSA SSIs. CONCLUSION: Our data demonstrate that successful implementation of the MRSA bundle significantly decreases MRSA transmission between patients, the overall number of nosocomial MRSA infections, and MRSA SSIs.

A nosocomial outbreak of norovirus infection masquerading as clostridium difficile infection.

Noroviruses (NoVs) are increasingly being recognized as important enteric pathogens. At a university-based hospital, we investigated a nosocomial outbreak of NoV infection that was originally attributed to Clostridium difficile. We describe here the unique challenges of the identification of NoVs as the true etiologic pathogen in an outbreak occurring in a health care setting, where C. difficile infection is endemic, as well as the important lessons learned.

Disseminated Actinomyces meyeri infection resembling lung cancer with brain metastases.

Thoracic actinomycosis can resemble bronchogenic carcinoma in its clinical presentation and radiographic appearance. We report a case of pulmonary actinomycosis caused by Actinomyces meyeri in which hematogenous dissemination caused multiple brain abscesses resembling metastatic lung cancer. The correct diagnosis was made by thin-needle aspiration of a pleura-based lung mass. The pathogen isolated was further identified with the use of 16S rDNA sequencing. Antibiotic therapy resulted in rapid improvement of the lung lesion; however, the brain lesions required surgical drainage. Antibiotics were continued for more than a year before magnetic resonance images showed complete resolution of the cerebral abscesses.