Kytococcus schroeteri endocarditis successfully managed with daptomycin: a case report and review of the literature.

Kytococcus shroeteri is a rare cause of prosthetic valve endocarditis. Here, we report what is believed to be the first case of K. schroeteri endocarditis to be treated successfully by daptomycin and review the published literature of K. schroeteri endocarditis. There are no published daptomycin susceptibility data for Kytococcus and additional work was carried out on six other isolates stored at the Laboratory of HealthCare Associated Infections (LHCAI), Health Protection Agency (HPA) Centre for Infections, Colindale, London.

Characterisation of Exiguobacterium aurantiacum isolates from blood cultures of six patients.

Exiguobacterium spp. are alkaliphilic, halotolerant, non-spore-forming Gram-positive bacilli, hitherto uncharacterized from human infections. Six isolates of Exiguobacterium aurantiacum were obtained from patients with bacteraemia, three of whom had myeloma. All isolates formed orange-yellow pigmented colonies on blood agar, were catalase- and DNase-positive, and grew on nutrient agar at pH 10 and in the presence of NaCl 6% w/v. The six isolates were susceptible to all antimicrobial agents tested and were uniform in their fatty acid and mass spectrum profiles.

Fatal Pasteurella dagmatis peritonitis and septicaemia in a patient with cirrhosis: a case report and review of the literature.

Pasteurella species cause zoonotic infections in humans. Human pasteurella infections usually manifest as local skin or soft tissue infection following an animal bite or scratch. Systemic infections are less common and are limited to patients at the extremes of age or those who have serious underlying disorders, including cirrhosis. Most human pasteurella infections are caused by the multocida species. We report a case of Pasteurella dagmatis peritonitis and septicaemia in a patient with cirrhosis. The infection followed a scratch inflicted by a pet dog. Despite appropriate antibiotic treatment the infection proved fatal. Spontaneous bacterial peritonitis caused by P dagmatis has not been reported previously. Pasteurella dagmatis is a relatively recently described species, which is rarely reported as a human pathogen. This species may be misidentified unless commercial identification systems are supplemented by additional biochemical tests.

A series of infections due to Capnocytophaga spp in immunosuppressed and immunocompetent patients.

OBJECTIVE: To investigate the epidemiology, microbiology and outcome of infections caused by Capnocytophaga spp. at a single center. METHODS: We report on ten documented infectious episodes caused by Capnocytophaga observed between 1994 and 1999 at the Innsbruck University Hospital. RESULTS: In seven of ten patients, Capnocytophaga septicemia was diagnosed during periods of neutropenia. In contrast, the remaining three patients had normal white blood cell counts when acquiring Capnocytophaga septicemia (one) and pleural empyema (two). Blood cultures containing long, slender, Gram-negative rods, which grew slowly under anaerobic conditions and lacked susceptibility to metronidazole, were subcultivated in a CO2-enriched atmosphere (5%). Subcultivation yielded Capnocytophaga in all ten cases within 2-12 days. The patients were then placed on appropriate antibiotic therapy, with or without additional surgical intervention, and the organism was eradicated. CONCLUSION: Identification of Capnocytophaga facilitates appropriate, and in most cases effective, antimicrobial therapy.

Neisseria elongata endocarditis: case report and literature review.

We describe a case of infective endocarditis due to Neisseria elongata, and review the literature. N. elongata is a constituent of the normal oral flora and a rare cause of infective endocarditis. Unfamiliarity with the organism and its rod-shaped morphology may lead to a delay in microbiological diagnosis. Although the organism is relatively sensitive to antibiotics, our experience in the management of the described case and a review of previous reports suggest that antibiotic therapy alone may not be sufficient. It is likely that patients with N. elongata endocarditis will require surgery.

Phocoenobacter uteri gen. nov., sp. nov., a new member of the family Pasteurellaceae Pohl (1979) 1981 isolated from a harbour porpoise (Phocoena phocoena).

Phenotypic and phylogenetic studies were performed on a Gram-negative, rod-shaped bacterium isolated from the uterus of a porpoise. Biochemical and physiological studies indicated that the bacterium was related to the family Pasteurellaceae. Comparative 16S rRNA gene sequencing studies confirmed these findings and demonstrated that the bacterium represents a hitherto unknown subline within this family of organisms. Based on the results of the phylogenetic analysis and phenotypic criteria, it is proposed that the bacterium be assigned to a new genus, Phocoenobacter uteri gen. nov., sp. nov. The type strain of Phocoenobacter uteri sp. nov. is NCTC 12872T.

Distribution of genes encoding putative transmissibility factors among epidemic and nonepidemic strains of Burkholderia cepacia from cystic fibrosis patients in the United Kingdom.

In the last 15 years, Burkholderia cepacia has emerged as a significant pathogen in cystic fibrosis (CF) patients, mainly due to the severity of infection observed in a subset of patients and the fear of transmission of the organism to noncolonized patients. Although patients who deteriorate rapidly cannot be predicted by microbiological characteristics, three genetic markers have been described for strains that spread between patients. These are the cblA gene, encoding giant cable pili; a hybrid of two insertion sequences, IS1356 and IS402; and a 1.4-kb open reading frame known as the B. cepacia epidemic strain marker (BCESM). The latter two are of unknown function. An epidemic strain lineage was previously identified among CF patients in the United Kingdom that apparently had spread from North America and that was characterized by a specific random amplified polymorphic DNA (RAPD) pattern. We searched for the described genetic markers using specific PCR assays with 117 patient isolates of B. cepacia from 40 United Kingdom hospitals. Isolates were grouped according to genomovar and epidemic strain lineage RAPD pattern with a 10-base primer, P272. A total of 41 isolates from patients in 12 hospitals were classified as the epidemic strain, and 40 of these were distributed in genomovars IIIa (11 isolates), IIIb (1 isolate), and IIIc (28 isolates). All isolates of the epidemic strain were positive for the cblA gene and BCESM, but two lacked the insertion sequence hybrid. None of the 76 sporadic isolates contained cblA or the insertion sequence hybrid, but 11 of them were positive for BCESM. Nonepidemic isolates were distributed among genomovars I or IV (9), II (49), IIIa (11), IIIb (3), and IIIc (4). There were three clusters of cross-infection (one involving two patients and two involving three patients) with isolates of genomovar II. We conclude that in the United Kingdom, a single clonal lineage has spread between and within some hospitals providing care for CF patients. The presence of the cblA gene is the most specific marker for the epidemic strain. We recommend that all isolates of B. cepacia from CF patients should be screened by PCR to influence segregation and infection control strategies.

Evaluation of three oligonucleotide primer sets in PCR for the identification of Burkholderia cepacia and their differentiation from Burkholderia gladioli.

AIMS: To evaluate three oligonucleotide primer pairs--two specific for 16S and 23S rRNA sequences of Burkholderia cepacia, and the third specific for internal transcribed spacer region of 16S-23S sequences of B gladioli--for the identification and differentiation of reference and clinical strains of these and other species. METHODS: The three primers sets were applied in polymerase chain reaction (PCR) to a collection of 177 clinical isolates submitted for identification from diagnostic laboratories as presumed B cepacia. RESULTS: At an annealing temperature of 63 degrees C, all eight B cepacia and four B gladioli reference strains reacted with their specific primers. B vandii was the only other species that was positive with both B cepacia primers but five Burkholderia or Ralstonia species reacted with one of these primers. Seventy eight isolates were typical of B cepacia in biochemical tests and 75 of these reacted with specific primers; three, however, were positive with the B gladioli primers. Fifteen asaccharolytic isolates were confirmed as B cepacia by PCR but other non-fermenting Gram negative species were negative with each of the primers. CONCLUSIONS: PCR using 16S rRNA sequences is recommended for identification of B cepacia that give atypical results in biochemical tests.

Distribution of Acinetobacter species on skin of healthy humans.

The distribution of the 19 currently known genospecies of Acinetobacter on human skin, i.e. forehead, forearm and toe webs, was determined. Three selective media were compared for their specificity for all genospecies of Acinetobacter. A minimal-salts agar supplemented with 1% acetate proved to be more efficient than the Leeds medium for the isolation of most genospecies in mixed culture with other bacterial species. Acinetobacter isolates were provisionally identified using biochemical tests and the DNA transformation assay of Juni. Genospecies identification was performed using amplified ribosomal DNA restriction analysis, and duplicate isolates of the same genospecies from individuals were ruled out by random amplified polymorphic DNA analysis. Over 40% of 192 healthy volunteers carried Acinetobacter spp. at one or more body sites, and the frequencies of colonisation were as follows: forearm (51%), forehead (47%) and toe web (34%). Genospecies 8/9 (Acinetobacter lwoffii) was the most common (61%), followed by genospecies 15BJ and 12 (Acinetobacter radioresistens) at 12.5% and 8%, respectively. The Acinetobacter baumannii-Acinetobacter calcoaceticus group (genospecies 1, 2, 3 and 13TU) that predominates in hospital-acquired infections was found in only one individual.

Culture-positive Bartonella quintana endocarditis.

A 50-year-old alcoholic man with a 1-year history of pyrexia of unknown origin was admitted with symptoms of endocarditis. Large vegetations on his mitral and aortic valve were found on echocardiography. Using the Bactec 9240 system. Bartonella quintana could be grown from two culture sets of blood collected before the start of antimicrobial therapy. This is the first case report of culture-proven bartonella infection in the UK. and is noteworthy because Bartonella quintana was detected in conventional blood culture systems after prolonged incubation.

A case of peritonitis caused by Roseomonas gilardii in a patient undergoing continuous ambulatory peritoneal dialysis.

A case of peritonitis caused by Roseomonas gilardii in a patient receiving continuous ambulatory peritoneal dialysis is presented. The patient's domestic water supply was implicated as the probable source of infection. This is the first report of R. gilardii causing such an infection.

Anaerobiospirillum thomasii sp. nov., an anaerobic spiral bacterium isolated from the feces of cats and dogs and from diarrheal feces of humans, and emendation of the genus Anaerobiospirillum.

Thirty-seven similar strains isolated from feces of cats and dogs and from human diarrheal feces had characteristics of the genus Anaerobiospirillum. These organisms were distinguished from the only previously described Anaerobiospirillum species, Anaerobiospirillum succiniciproducens, by producing acid from adonitol but not from fructose, raffinose, or sucrose and by the lack of alpha-glucosidase. The G + C contents of the DNAs of the new strains were 39 to 42 mol%. The results of morphological, physiological, DNA G + C content, and DNA homology studies support the proposal that the description of the genus Anaerobiospirillum should be emended so that a new species can be included in the genus. The new species Anaerobiospirillum thomasii is proposed, with strain A273/88 (= NCTC 12467) as the type strain.

First reported African case of Anaerobiospirillum succiniciproducens septicemia.

The first reported African case of septicemia caused by Anaerobiospirillum succiniciproducens is presented. The source of the infection was not identified. The clinical presentation and relative risk factors of the infection, and biochemical characteristics and antimicrobial susceptibility of the organism are described. Recommendations on appropriate antimicrobial therapy and postinfection sequelae are discussed.

Actinobacillus delphinicola sp. nov., a new member of the family Pasteurellaceae Pohl (1979) 1981 isolated from sea mammals.

We performed phenotypic and phylogenetic studies of a gram-negative, rod-shaped bacterium isolated from cetaceans. The results of a 16S rRNA gene sequence analysis demonstrated that this bacterium represents a previously unknown line of descent in the family Pasteurellaceae. On the basis of the results of our phylogenetic analysis and phenotypic criteria, we propose that this organism should be classified as a new species, Actinobacillus delphinicola sp. nov. The type strain of A. delphinicola sp. nov. is strain NCTC 12870.

Haemophilus paraphrophilus infection: a pitfall in laboratory diagnosis.

Many clinical laboratories have difficulty in identifying a group of organisms which are catalase negative, oxidase positive, Gram negative rods. We describe a case of purulent sacroiliitis due to Haemophilus paraphrophilus where the organism was initially misidentified as Eikenella corrodens leading to inappropriate antimicrobial chemotherapy. We review the strains of H. paraphrophilus and E. corrodens that were identified by the National Collection of Type Cultures over the last ten years. Only 21 of 100 strains identified as E. corrodens were submitted as E. corrodens. Seven strains submitted as possible E. corrodens were identified as H. paraphrophilus. Several different species of Gram negative rods may produce pitting on agar and this seems to be poorly recognised. However, further tests are available to facilitate correct identification of these strains.

Septicaemia caused by a penicillin-resistant Moraxella-like organism in a neutropenic patient.

Invasive infections with Moraxella and related species are unusual. In this report we describe a case of septicaemia in an immunocompromised patient caused by a Moraxella-like organism. The organism was difficult to identify in the laboratory and was also unusual in that it was resistant to penicillin.