A rare case of complicated pericardial effusion with Elizabethkingia meningoseptica from Iran.

Infections due to Elizabethkingia meningoseptica, a Gram-negative oxidative bacterium are frequently founded in neonatal and immunocompromised individuals. The notable characteristic of this organism is its multi-drug resistance to common antibiotics used for infections caused by Gram-negative bacteria. We report a rare case of complicated pericardial effusion due to E. meningoseptica in a 2-year-old boy, who was admitted with chief complaints of fever and tachypnea (mentioned by his parents) and suffered from a rare lung malignancy (lymphangioleiomyomatosis). He was successfully treated with vancomycin.  E. meningoseptica infection is a rare situation in immunocompetent hosts, and we concluded that this infection was probably originated from device medicine or even hands of healthcare workers.

A strain of pathogenic Bacillus subtilis results in brain damage in ducklings when co-infected with Riemerella anatipestifer.

Bacillus subtilis is a Gram-positive bacterium widely used in medicine and agriculture. So far, little is known about its pathogenicity in animals. In this study, a strain of Bacillus subtilis, HFBF-B11 isolated from brain tissue of ducklings co-infected with Riemerella anatipestifer was characterized. The strain demonstrated consistent characteristics of B. subtilis in staining and morphological, biochemical and physiological analyses. Moreover, its DNA sequence, which was obtained via PCR sequencing of 16S rRNA, exhibited 99% homology with the B. subtilis reference strain. In in vitro cultures HFBF-B11 exhibited ß-hemolysis. The results of experiments showed that a single infection of HFBF-B11 in 9-day-old ducklings did not result in clear clinical symptoms. However, following co-infection with HFBF-B11 and R. anatipestifer, the animals demonstrated liver injury and blood-brain barrier disruption leading to infection and brain damage with a mortality rate of 100%. These results suggest that the HFBF-B11 strain of B. subtilis is an opportunistic pathogen of ducklings. This is the first report about the isolation of a B. subtilis strain with pathogenicity in ducklings.

Chryseobacterium indologenes in four patients with leukemia.

Chryseobacterium indologenes is a rare opportunistic pathogen causing hospital-acquired infection. We present 4 patients with leukemia associated with C. indologenes infection. Two of the patients, undergoing peripheral blood allogeneic hematopoietic stem cell transplantation (alloHSCT) from human leukocyte antigen-identical sibling donors, died of pneumonia caused by C. indologenes with or without Pseudomonas aeruginosa. Blood infection with C. indologenes was found in the other 2 patients during chemotherapy, 1 of which was a central venous catheter-related bloodstream infection. Both patients were cured with or without the sensitive antibiotic. Three of these 4 isolates were susceptible to trimethoprim-sulfamethoxazole only in vitro. Although C. indologenes has a weak toxicity, it can be lethal for the super-immunocompromised patients, such as those treated with alloHSCT.

[Elizabethkingia meningosepticum bacteremia in a patient with Bardet-Biedl syndrome and chronic renal failure]. / Bardet-Biedl sendromlu kronik böbrek yetmezligi olan bir hastada Elizabethkingia meningosepticum bakteriyemisi.

Elizabethkingia meningosepticum, a gram-negative opportunistic pathogen may cause life-threatening nosocomial infections especially in newborns and immunosuppressive patients. This bacterium has a peculiar antibiotic resistance profile. It is resistant to most of the antibiotics against gram-negative bacteria and susceptible to antibiotics that are used to treat gram-positive bacteria, such as vancomycin and trimethoprim-sulphamethoxazole (SXT). For this reason appropriate treatment of E.meningosepticum infections are based on the proper identification of bacteria. In this report, a case of catheter-related E.meningosepticum bacteremia in a patient with chronic renal failure due to Bardet-Biedl syndrome, a genetic disorder characterized by multiorgan dysfunction, was presented. A 25-year-old male patient with Bardet-Biedl syndrome was admitted to the emergency room with the complaints of high fever with shivers that started the day before. The patient had a femoral dialysis catheter. Venous blood samples drawn at the time of administration were cultured immediately. Two days later, blood cultures which yielded positive signals were passaged onto blood and MacConkey agar plates and after incubation at 37°C for 16 hours, wet-raised colonies with clear margin, gray colour and large size similar to gram-negative bacterial colonies were detected on blood agar medium. No growth was observed on MacConkey agar plate at the end of five days. The isolate was found positive for KOH, oxidase, catalase, urease, esculine and MOI (Motility Indole Ornithine) tests, whereas it was citrate negative. Gram staining revealed faintly stained thin gram-negative bacilli. The isolate was identified as E.meningosepticum by Vitek® 2 system (bioMérieux, USA), and confirmed by sequence analysis of 16S RNA gene region amplified with PCR method. The antibiotic susceptibility profile of the strain was detected by the Vitek 2 system, while vancomycin susceptibility was investigated by Kirby-Bauer disc diffusion method. The isolate was found resistant to ampicillin/sulbactam, piperacillin/tazobactam, ceftazidime, cefepime, meropenem, imipenem, amikacin, gentamicin, netilmicin, levofloxacin, tetracycline, colistin and rifampicin; intermediate to tigecyclin and tetracyclin; susceptible to cefoperazone/sulbactam, ciprofloxacin, levofloxacin, SXT and vancomycin. One gram vancomycin once every four days was administered to the patient, however on the ninth day of the treatment he developed fever again. Blood cultures obtained again yielded E.meningosepticum. After changing his dialysis catheter and extending the vancomycin treatment to 15 days, the patient was discharged with cure. In conclusion, clinicians should consider E.meningosepticum as a possible causative agent of bacteremia non-responsive to the empirical antibiotic regimens and when gram-negative bacteria are isolated from the blood cultures of such patients with underlying diseases. Accurate and prompt identification of E.meningosepticum will allow immediate administration of the specific antibiotic treatment, thereby decreasing the mortality and morbidity rates.

Elizabethkingia meningosepticum infections with varied presentations and different antimicrobial susceptibility - A case series.

We report three sporadic infections by Elizabethkingia meningosepticum from Government Medical College Kozhikode in Kerala state, South India over a period of three years. Two cases were commenced in the community in immunocompromised children beyond the newborn period, but both recovered promptly. Another was a hospital-acquired meningitis in a newborn baby who developed neurologic sequelae. In contrast to widespread antimicrobial resistance exhibited by this pathogen, there was good susceptibility to commonly used antimicrobials such as ampicillin, cefotaxime, piperacillin, ciprofloxacin, and vancomycin. Whilst ß lactam antibiotics are found effective in the treatment of Elizabethkingia septicaemia of children, piperacillin-tazobactam, vancomycin combination seems effective empiric choice of antibiotics for neonatal meningitis due to Elizabethkingia; there is a need for guidelines for the management of this infection, especially in neonatal meningitis.

A Flavobacterium lindanitolerans strain isolated from the ascites sample of a Chinese patient with EV71 virus infection.

A strain of Flavobacterium lindanitolerans isolated from a sick child's ascites was described. The 16S rRNA gene of the strain was 100% identical to that of Flavobacterium lindanitolerans which was first identified in India in 2008. It was first described that the isolate required X factor (Hemin) for growth in the optimal conditions of 37 °C with 5% CO(2). The isolate produced indole and H(2)S. It did not present hemolytic feature on blood agar.

[A case of Anaphylactoid purpura suggested to Empedobacter (flavobacterium) brevis infection concerned].

The patient was an 83 Year-old woman with purpura on her right foot and on both crura starting from the end of November 2005. First, she took medical advice from a nearby doctor, but it did not improve. Since blisters were formed besides purpura, she visited Nagoya City Midori Municipal Hospital. When she visited, she had many purpura on her both legs, her right lower crus and her right foot was swelling with redness, blisters and erosion. Histopathological finding showed leukocytoclastic vasculitis, deposit of fibrin and hemorrhage. Only Empedobacter brevis was cultured from right feet lesion. This strain was sensitive to minocycline hydrochloride. Her purpura and right foot swelling were improved just after internal use of minocycline hydrochloride, so Empedobacter brevis infection was speculated to be a trigger, or at least concerned to this Anaphylactoid purpura.

Pathogenesis of Riemerella anatipestifer in turkeys after experimental mono-infection via respiratory routes or dual infection together with the avian metapneumovirus.

Riemerella anatipestifer (RA) is the causative agent of septicaemic and exudative diseases in a variety of bird species. Despite numerous outbreaks, little is known about the pathogenicity of RA for turkeys. We investigated the development of RA-induced disease in commercial turkey poults following RA inoculation via different respiratory routes. Inoculation by aerosol or injection into the abdominal air sac led to systemic infection and mild gross lesions, including pericarditis, epicarditis and airsacculitis, which were less pronounced compared with field outbreaks. It was speculated, that viral pathogens, such as the avian metapneumovirus (aMPV), may exacerbate RA pathogenesis under field conditions. We inoculated turkey poults with virulent aMPV. Subsequently, aMPV-infected and virus-free birds were exposed 3 to 5 days later to a high dose of RA by aerosol (>10(10) colony-forming units/ml in 8 ml aerosol per 11 or 12 birds) or were inoculated 4 days later with a low RA dose (10(4.9) colony-forming units per bird) via the intranasal route. Intranasal RA inoculation with the low bacterial dose led to a respiratory and systemic RA infection in aMPV-infected birds, while virus-free birds remained RA-negative. Following exposure to a high RA dose by aerosol, aMPV-infected groups showed slightly enhanced incidences of gross lesions and RA re-isolation. The present study clearly confirms that RA is pathogenic for turkeys after experimental inoculation via respiratory routes, which are speculated to be the natural route of infection. However, experimental models in this study did not reproduce the severity of RA-related disease as observed under field conditions, which emphasizes the importance of other contributing factors. aMPV-induced respiratory lesions may serve as a predisposing factor for the establishment of RA infection, since they favour colonization of the bacterium.

Successful treatments of polyarteritis nodosa cerebral vasculitis and recurrent E lizabethkingia meningoseptica septicaemia in a dialysis patient.

We report a case of cerebral vasculitis in a 31-year-old woman who presented with chronic kidney disease stage 5, labile hypertension and severe headaches. The diagnosis of cerebral vasculitis made on magnetic resonance angiography (MRA) and late diagnosis of polyarteritis nodosa were made by conventional CT angiography. Immunosuppression was complicated by recurrent septicaemia due to Elizabethkingia meningoseptica Treatment of the vasculitis resulted in marked improvement of MRA appearances, headaches and anxiety and stabilisation of blood pressure. The septicaemia required parenteral quinolone treatment and oral cotrimoxazole.

Chryseobacterium meningosepticum sepsis complicated with retroperitoneal hematoma and pleural effusion in a diabetic patient.

Intra-abdominal infection due to Chryseobacterium meningosepticum is rare, and bacteremia complicated with pleural effusion and retroperitoneal hematoma caused by C. meningosepticum has not been reported previously. A 57-year-old diabetic man presented with bacteremia with retroperitoneal abscess and pleural effusion caused by C. meningosepticum on the 12th day of hospitalization. His clinical condition improved after antimicrobial therapy with levofloxacin and rifampin, debridement of the retroperitoneal hematoma and left-side chest tube insertion. Antibiotics were administered for 1 month, and he was later transferred to a local respiratory care ward under afebrile condition. C. meningosepticum should be included in the list of suspected nosocomial infections, especially in patients with immunocompromised status. Administration of appropriate antibiotics, such as quinolone, minocycline, trimethoprim-sulfamethoxazole or rifampin, and treatment of local infection improve the clinical outcome of patients with C. meningosepticum infection.

Chryseobacterium meningosepticum as a cause of cellulitis and sepsis in an immunocompetent patient.

Chryseobacterium meningosepticum is a Gram-negative rod with a worldwide distribution. A case of C. meningosepticum cellulitis with severe sepsis and hepatitis in a 36-year-old male patient is described.

Efficacy of enrofloxacin, florfenicol and amoxicillin against Ornithobacterium rhinotracheale and Escherichia coli O2:K1 dual infection in turkeys following APV priming.

Experimental groups of 15 susceptible 3-week-old turkeys were inoculated oculonasally with avian metapneumovirus (APV) subtype A and susceptible Escherichia coli O2:K1 and Ornithobacterium rhinotracheale (ORT) bacteria, with a 3 days interval between viral and bacterial inoculation and approximately 8h between the two bacterial inoculations. The aims of the present study were to assess the efficacy of drinking-water administration of enrofloxacin for 3 and 5 days, amoxicillin for 5 days and florfenicol for 5 days for the treatment of the resulting respiratory disease, based on clinical and bacteriological examinations. Antimicrobial treatment started 1 day after dual bacterial inoculation. After infection, the birds were examined and scored for clinical signs daily, weighed at different times, and their tracheae swabbed daily. Five birds were euthanised and examined for macroscopic lesions at necropsy at 5 days post-bacterial inoculation (dpbi) and the remainder at 15dpbi. Samples of the turbinates, trachea, lungs, sinuses, air sacs, heart, pericardium and liver were collected for bacteriological examination. Recovery from respiratory disease caused by an APV/E. coli/ORT triple infection in 3-week-old turkey poults was overall most successful after enrofloxacin treatment, irrespective of treatment duration, followed by florfenicol treatment. Compared with the untreated group, clinical signs as well as ORT and E. coli multiplication in the respiratory tract were significantly reduced by both enrofloxacin treatments and the florfenicol treatment, with the enrofloxacin treatments showing significantly better reductions than the florfenicol treatment. Five-day treatment with amoxicillin, compared with the untreated group, did not cause a significant reduction in any of the aforementioned parameters.

Chryseobacterium indolegenes infection in a patient with chronic obstructive pulmonary disease.

Chryseobacterium indolegenes is a rare pathogen that causes a variety of infections in inviduals who are mostly hospitalized with severe underlying diseases. Here we present a case of C. indolegenes in a 69-year-old male with chronic obstructive pulonary disease (COPD) who was admitted to the chest disease outpatient clinic with symptoms like cough, fever and sputum production and followed up on a suspicion of pneumonia. Despite the fact that our patient did not have any history of hospitalization for at least one year, pneumonia cause was due to C. indolegenes. Clinicians should pay attention to the rare pathogens such as C. indologenes while managing COPD patients without prior hospitalization history.

Co-infection of Chlamydia psittaci with H9N2, ORT and Aspergillus fumigatus contributes to severe pneumonia and high mortality in SPF chickens.

Since 2007, most areas of China have seen outbreaks of poultry airsacculitis, which causes hugely economic losses to the poultry industry. However, there are no effective measures to combat the problem. In this study, 105 rations were collected to isolate Aspergillus spp. from the diseased farms. In subsequent experiments, SPF chickens were inoculated with Ornithobacterium rhinotracheale (ORT), Chlamydia psittaci (C. psittaci) and Aspergillus fumigatus (A. fumigatus), and mortality rate, body weight gain and lesion score were evaluated. Of these ration samples, 63 (60.0%) were A. fumigates, 21 (20.0%) were Aspergillus niger (A. niger) and 11 (10.5%) were Aspergillus candidus (A. candidus). Furthermore, SPF birds infected with C. psittaci, ORT, H9N2 virus and A. fumigatus conidia exhibited a mortality rate of 40%, while simultaneous co-infection with C. psittaci, ORT and A. fumigatus resulted in a mortality rate of 20%. The avian airsacculitis was manifested in the C. psittaci + ORT/A. fumigatus, C. psittaci + H9N2 + ORT/A. fumigatus and C. psittaci + H9N2/A. fumigatus groups while others had transient respiratory diseases without mortality. Our survey indicates that feed-borne A. fumigatus is prevalent in poultry rations. The combination of C. psittaci, ORT, H9N2 and A. fumigatus conidia contributes to the replication of avian airsacculitis by aggravating the severe damage to the air sacs and lungs of chickens.

Outbreak of Elizabethkingia meningoseptica sepsis with meningitis in a well-baby nursery.

Between March and May 2012, three neonates born at a regional maternity hospital developed Elizabethkingia meningoseptica (previously Chryseobacterium meningosepticum) sepsis with meningitis aged <10 days, and were treated successfully with intravenous ciprofloxacin plus vancomycin or piperacillin-tazobactam for three to six weeks. Four (16.6%) of 24 environmental specimens obtained from the nursery and delivery room were positive for this organism. All of the clinical isolates and two isolates from storage boxes for pacifiers and pacifier covers were genetically identical. After changing the storage boxes to stainless steel boxes that underwent regular autoclave sterilization, there were no further cases of infection with E. meningoseptica.

A link between ectoparasite infection and susceptibility to bacterial disease in rainbow trout.

Rainbow trout, Oncorhynchus mykiss, were infected concomitantly with Argulus coregoni and Flavobacterium columnare and their survival was compared with that of fish infected with either the parasite or the bacterium alone. The mortality of fish challenged with A. coregoni was negligible while infection with F. columnare alone led to significantly lower survival. However, compared with single infections, the mortality was significantly higher and the onset of disease condition was earlier among fish, which were concomitantly infected by A. coregoni and F. columnare. This data presents, for the first time, experimental support for the hypothesis that an ectoparasite infection increases susceptibility of fish to a bacterial pathogen.

Unforeseeable presentation of Chryseobacterium indologenes infection in a paediatric patient.

BACKGROUND: We report for the first time a case of community acquired Chryseobacterium indologenes soft tissue infection in an immunocompetent patient. CASE PRESENTATION: A 11 year female child, from South-Asia of Indian origin presented with fever, pain and swelling in right leg for 3 days with no significant past history. Incision and drainage was done and pus was sent for culture and sensitivity. Radiological investigation showed subtle irregular soft tissue density. Pus culture grew multidrug resistant C. indologenes. CONCLUSION: Though of low pathogenicity, our case emphasises its unpredictable nature and the need to determine minimum inhibitory concentration breakpoints for therapy.

Key role of Chlamydophila psittaci on Belgian turkey farms in association with other respiratory pathogens.

Two hundred turkey sera from eight Belgian and two French farms were tested for the presence of antibodies against avian pneumovirus (APV), Ornithobacterium rhinotracheale (ORT), Mycoplasma gallisepticum, Mycoplasma meleagridis and Chlamydophila psittaci. At slaughter, C. psittaci, APV and ORT antibodies were detected in 94, 34 and 6.5% of the turkeys, respectively. No antibodies against M. gallisepticum or M. meleagridis were present. Additionally, turkeys on three Belgian farms were examined from production onset until slaughter using both serology and antigen or gene detection. All farms experienced two C. psittaci infection waves, at 3-6 and 8-12 weeks of age. Each first infection wave was closely followed by an ORT infection starting at the age of 6-8 weeks, which was still detectable when the second C. psittaci infection waves started. Animals on farm A were not vaccinated against APV leading to an APV subtype B outbreak accompanying the first C. psittaci infection wave. Despite subtype A APV vaccination on farms B and C, the second C. psittaci infection waves were accompanied (farm B) or followed (farm C) by a subtype B APV infection. On all farms respiratory signs always appeared together with a proven C. psittaci, APV and/or ORT infection. This study suggests an association between C. psittaci, APV and ORT, and indicates the multi-factorial aetiology of respiratory infections in commercial turkeys. All three pathogens should be considered when developing prevention strategies for respiratory disease.