Endocarditis por Rothia aeria / Rothia aeria endocarditis. case report

Resumen Paciente de sexo femenino de 65 años, con antecedentes de hipertensión arterial crónica, resistencia a la insulina, histerectomía total y fractura tibioperonea antigua, es hospitalizada por cuadro febril, sin foco, de 2 meses de evolución, con sospecha de endocarditis por parámetros inflamatorios elevados y soplo diastólico en foco aórtico 2/6. Se estudia con ecocardiograma, transtorácico (ETT) y transesofágico (ETE), que muestra vegetación en velo aórtico coronario izquierdo de 9 mm por 7 mm e insuficiencia aórtica leve, motivo por el cual se toma hemocultivo resultando positivo para Rothia aeria. La paciente evoluciona con embolia de riñón derecho y bazo, y posteriormente, con hemorragia subaracnoidea. Inicia tratamiento antibiótico con ampicilina, vancomicina y gentamicina, con lo cual presenta una evolución satisfactoria y es dada de alta luego de 28 días de hospitalización. Al revisar la literatura, se puede llegar a la conclusión de que la endocarditis por Rothia es extremadamente infrecuente y que, en cuanto al cuadro clínico, tiene tendencia a una forma de presentación subaguda, con presencia de vegetaciones grandes mayores a 10mm y un alto grado de complicaciones neurológicas.

Abstract A 65-year-old female patient, with a history of chronic hypertension, insulin resistance, total histerectomy, and tibioperoneal fracture, is hospitalized for fever of unknown etiology. Basterial endocarditis was suspected due to elevated inflammatory parameters and a 2/6 diastolic murmur present in the aortic focus. Transthoracic and transesophageal echocardiography, showed a 9 mm by 7 mm vegetation in the left coronary aortic leaflet of and mild aortic insufficiency, Blood cultures were positive for Rothia aeria. She developed embolism of the right kidney and spleen, and subsequently, a subarachnoid hemorrhage. Antibiotic therapy was initiated with ampicillin, vancomycin and gentamicin, with a satisfactory evolution being discharged after 28 days of hospitalization. When reviewing the literature, it can be concluded that Rothia endocarditis is extremely rare and that, tends to have a subacute presentation with large vegetations, larger than 10 mm, and a high incidence of neurological complications.

The first reported catheter-related Brevibacterium casei bloodstream infection in a child with acute leukemia and review of the literature

Brevibacterium spp. are catalase-positive, non-spore-forming, non motile, aerobic Gram- positive rods that were considered apathogenic until a few reports of infections in immunocompromised patients had been published. To the best of our knowledge, this is the first report of B. casei catheter-related bloodstream infection in a child with acute leukemia. We aim to enhance the awareness of pediatric hematology and infectious disease specialists about this pathogen and review of the literature.

Infección por Rhodococcus equi en pacientes con SIDA: Análisis retrospectivo de 13 pacientes en Argentina / Rhodococcus equi infection in AIDS patients: Retrospective analysis of 13 patients in Argentina

Introduction: Rhodococcus equi is a gram positive coccoid rod that causes pulmonary infections in immunosuppressed patients. Methods: We retrospectively analyzed epidemiological, clinical, microbiological, radiological, and immunological features as well as the outcomes of 13 AIDS patients with R. equi infection. Results: Between January 1994 and December 2012, 13 patients attending the AIDS department of the Infectious Diseases reference hospital in Buenos Aires were diagnosed with R. equi infection. All were men, the median age was 27 years. At the time of diagnosis, the median of CD4+ T cell counts was 11 cells/μl Twelve patients presented pulmonary disease with isolation of the microorganism from sputum or bronchoalveolar lavage; in the other patient the diagnosis was postmortem with positive culture of cerebrospinal fluid. The most frequent clinical manifestations were fever, haemoptysis, and weight loss. The predominant radiological finding was lobe consolidation with cavitation. Nine patients died after a median survival of 5.5 months. In all of them, cultures persisted positive until the last admission. The other 4 patients did continue clinical follow-ups. Conclusion: The insidious course of R. equi disease and the difficulties in the isolation of the microorganism contribute to the delay in the diagnosis and to the high mortality rate of this opportunistic infection.

Introducción: Rhodococcus equi es un cocobacilo grampositivo que provoca compromiso pulmonar en pacientes inmunodeprimidos. Métodos: En el presente trabajo se analizaron de manera retrospectiva los hallazgos epidemiológicos, clínicos, microbiológicos, imagenológicos, inmunológicos y la evolución de 13 pacientes con SIDA y enfermedad por R. equi. Resultados: Entre enero de 1994 y diciembre de 2012, 13 pacientes internados en la División de VIH/SIDA del hospital de referencia para Enfermedades Infecciosas de la ciudad de Buenos Aires egresaron con diagnóstico de enfermedad por R. equi. Todos eran varones y la mediana de edad fue 27 años. La mediana de linfocitos T CD4+ fue de 11 céls/μl Doce pacientes presentaron enfermedad pulmonar con aislamiento del microorganismo del esputo o del lavado bronco-alveolar; en el restante se recibió post mortem el cultivo positivo de líquido cefalorraquídeo. Las manifestaciones clínicas más frecuentes fueron fiebre, hemoptisis y pérdida de peso. La imagen radiológica predominante fue la consolidación con cavitación. Nueve pacientes fallecieron, con una mediana de supervivencia de 5,5 meses. En todos ellos el cultivo persistió positivo hasta la última internación. Los cuatro restantes abandonaron los controles y no pudieron ser evaluados en el tiempo. Conclusión: El curso insidioso de la enfermedad por R. equi y las dificultades en la identificación del microorganismo, contribuyen al retardo en el diagnóstico y a la elevada mortalidad de esta infección oportunista en esta población de pacientes.

Bacteremia due to Rhodococcus equi in an immunocompetent infant.

Rhodococcus equi , previously known as Corynebacterium equi, is one of the most important causes of zoonotic infection in grazing animals. Increased cases of human infection with R. equi have been reported especially in immunocompromised patients. Infection in immunocompetent patients is extremely rare. We report a case of R. equi bacteremia in a 26-day-old immunocompetent infant with recurrent swellings on different parts of the body. To the best of our knowledge, this is the first ever report of R. equi bacteremia from an immunocompetent patient from Northern India.

Dermatofilosis humana y animal. Presentación de un caso atípico y revisión de la literatura / Human and animal dermatophilosis. An unusual case report and review of the literature

La dermatofilosis es una infección causada por una bacteria Gram positiva perteneciente al orden de los Actinomycetales, llamada Dermatophilus congolensis. Se presenta como una dermatosis de carácter agudo, subagudo o crónico que afecta preferentemente al ganado pero también a una amplia variedad de animales domésticos y salvajes y al hombre. Tiene distribución universal, pero con mayor prevalencia en climas húmedos, tropicales y subtropicales. Es considerada una zoonosis menor que puede causar grandes perjuicios económicos en la industria del ganado y el cuero. Se realiza una revisión del tema junto con la presentación de un caso clínico sumamente atípico.

Dermatophilosis is an acute, subacute or chronic skin disease affecting a wide range of species of animals and man. It is caused by a Gram (+) bacteria of the order of the Actinomycetales named Dermatophilus congolensis. Presenting as an acute, subacute or chronic dermatosis affecting primarily cattle, but a wide variety of domestic and wild animals, and humans, as well. It is distributed worldwide but more prevalent in the humid tropical and subtropic areas. It is essential to emphasize the importance of this disease in livestock industry and leather production. The disease is reviewed and an unusual case is reported.

Rhodococcus equi isolation from sputum of patients with suspected tuberculosis

Rhodococcus equi has emerged as an opportunistic pathogen associated with pulmonary, invasive or systemic infections in immunocompromised patients. We report the identification of 51 R. equi isolates found in sputum samples of 546 individuals suspected to have pulmonary tuberculosis in two Public Health Hospital Units in Brazil. The epidemiology of R. equi infection as well as the phenotypic identification and drug susceptibility profile of isolates are described in this paper.

Bacteremia por Rhodococcus equi em paciente com síndrome da imunodeficiência adquirida: relato de caso / Bacteremia due to Rhodococcus equi in a patient with acquired immunodeficiency syndrome: case report

Rhodococcus equi é um importante agente de infecções zoonóticas, podendo causar sérias infecções em humanos, principalmente em pacientes imunocomprometidos. Neste estudo, nós relatamos o caso de uma bacteremia fatal devido a Rhodococcus equi em paciente com síndrome da imunodeficiência adquirida (HIV positivo).

Rhodococcus equi is an important agent for zoonotic infections, and may cause serious infections in humans, especially immunocompromised patients. In this study, a case of fatal bacteremia due to Rhodococcus equi in a patient with acquired immunodeficiency syndrome (HIV positive) is reported.

Infecção pulmonar pelo Rhodococcus equi na síndrome da imunodeficiência adquirida: Aspectos na tomografia computadorizada / Rhodococcus equi infection in acquired immunodeficiency syndrome: Computed tomography aspects

OBJETIVO: Apresentar os aspectos na tomografia computadorizada da pneumonia pelo Rhodococcus equi em sete pacientes com síndrome da imunodeficiência adquirida. MÉTODOS: Estudo retrospectivo das tomografias de sete pacientes com síndrome da imunodeficiência adquirida e infecção pelo Rhodococcus equi. RESULTADOS: Os achados mais freqüentes foram: consolidação (n = 7) com escavação (n = 6), opacidades em vidro fosco (n = 6), nódulos do espaço aéreo (n = 4) e nódulos centrolobulares com árvore em brotamento (n = 3). CONCLUSÃO: Os achados mais comuns na infecção pulmonar pelo Rhodococcus equi em pacientes com síndrome da imunodeficiência adquirida foram as consolidações escavadas.

OBJECTIVE: To present the computed tomography aspects of Rhodococcus equi pneumonia in seven patients with acquired immunodeficiency syndrome. METHODS: A retrospective study of the computed tomography scans of seven patients with acquired immunodeficiency syndrome and Rhodococcus equi infection. RESULTS: The most common findings were consolidation (n = 7), consolidation with cavitation (n = 6), ground glass opacities (n = 6), peribronchial nodules (n = 4) and centrilobular nodules presenting a "tree-in-bud" pattern (n = 3). CONCLUSION: The most common finding in patients with Rhodococcus equi pulmonary infection and acquired immunodeficiency syndrome was consolidation with cavitation.

Estudio clínico y microbiológico de los micetomas observados en el Hospital de Infecciosas Francisco J. Muñiz en el período 1989-2004 / Clinical and microbiological study of mycetomas at the Muñiz Hospital of Buenos Aires between 1989 and 2004

Se presentan las características clínicas, microbiológicas y los resultados del tratamiento de 76 casos de micetomas observados en el período 1989-2004 en el Hospital Muñiz. Cuarenta y nueve fueron varones y 27 mujeres, con una edad promedio de 43,4 años. La mayor parte de los pacientes adquirió la infección en nuestro país, las provincias más afectadas fueron Santiago del Estero con 31 casos y el Chaco con 11; 8 enfermos procedían del exterior, 6 de Bolivia y 2 de Paraguay. El promedio de evolución de la enfermedad fue de 9,2 años. Las localizaciones más comunes fueron las de los miembros inferiores: pies 63, tobillos 3 y rodillas 2. Se comprobó compromiso óseo en 48 casos y adenomegalias en 5. Fueron identificados los siguientes agentes causales: Madurella grisea 29 casos, Actinomadura madurae 26, Scedosporium apiospermum 5, Nocardia brasiliensis 5, Acremoniun spp. 4 (Acremonium falciforme 2, Acremonium kiliense 1 y Acremonium recifei 1), Madurella mycetomatis 3, Fusarium solani 2, Nocardia asteroides y Streptomyces somaliensis 1 caso cada uno. Los tratamientos más frecuentemente utilizados fueron ketoconazol o itraconazol en los micetomas maduromicósicos y la asociación de cotrimoxazol con ciprofloxacina o amicacina en los micetomas actinomicéticos. La amputación del miembro afectado se realizó en 6 casos, 25 pacientes alcanzaron la remisión clínica completa y 34 presentaron mejorías importantes.

This work presents clinical, microbiological and outcome data collected from 76 patients with mycetomas at the Muñiz Hospital from 1989 to 2004. Forty-nine patients were male and 27 female; the mean age was 43.4 years. The majority of the patients acquired the infection in Argentina: the most affected provinces were Santiago del Estero with 31 cases, and Chaco with 11; 8 cases came from other countries (Bolivia 6 and Paraguay 2). The mean evolution of the disease was 9.2 years. The most frequently observed sites were: feet 63 cases, ankles 3, and knees 2. Forty-eight patients had bone lesions and 5, adenomegalies. The following etiological agents were identified: Madurella grisea 29 cases, Actinomadura madurae 26, Scedosporium apiospermum 5, Nocardia brasiliensis 5, Acremonium spp. 4 (Acremonium falciforme 2, Acremonium kiliense 1, Acremonium recifei 1), Madurella mycetomatis 3, Fusarium solani 2, Nocardia asteroides 1 and Streptomyces somaliensis 1. The main drugs used in the treatments were ketoconazole and itraconazole for maduromycotic mycetomas, and cotrimoxazole associated with ciprofloxacin or amikacin for actinomycetic mycetoma. Six patients had to undergo amputation, 25 cases achieved complete clinical remission and 34 showed remarkable improvement.

Neumonía cavitada por Rhodococcus equi en paciente inmunocomprometido no infectado por virus de inmunodeficiencia humana: Caso clínico y revisión / Necrotizing pneumonia due to Rhodococcus equi in non HIV immunocompromised host: Case report and review

Rhodococcus equi, es un bacilo grampositivo intracelular que causa infecciones mayoritariamente en pacientes inmunodeprimidos. Reportamos el caso de una mujer de 52 años, en tratamiento de lupus eritematoso sistémico, con historia progresiva de 10 meses de evolución caracterizada por tos, disnea progresiva, expectoración muco-purulenta, ocasionalmente hemoptoica, fiebre intermitente, y pérdida de peso del 10 por ciento. Tuvo respuesta parcial a diversos cursos de tratamiento antimicrobiano y el seguimiento radiológico evidenció la aparición de múltiples focos de consolidación bilaterales, algunos de ellos nodulares. El estudio microbiológico de un lavado broncoalveolar y de una biopsia pulmonar percutánea permitió la identificación de R. equi y la histología de la biopsia pulmonar fue compatible. Recibió tratamiento antimicrobiano bi-asociado prolongado con buena respuesta clínica y radiológica. Se debe considerar este agente en el estudio de pacientes inmunocomprometidos que cursan con neumonías de evolución prolongada.

Septic arthritis due to Arcanobacterium haemolyticum.

Diphtheroids or "coryneform" bacilli are usually considered to be nonpathogenic "normal flora" of human skin and mucous membranes. Because bacterial cultures are frequently contaminated with these organisms the correct diagnosis and treatment may be delayed by the failure to recognize serious infections caused by them. Few confirmed cases of orthopaedic infections due to Arcanobacterium haemolyticum infection have been reported, partly because of inadequate identification of this bacterium. We report a case of septic arthritis due to A. haemolyticum.

Uncommon manifestations of opportunistic infections in an HIV infected patient.

A case of an HIV infected patient complicated with Penicillium marneffei and Rhodococcus equi infection is reported. He presented with chronic ulcer as pyoderma gangrenosum-like on his right calf and submandibular lymphadenitis as scrofuloderma-like. Penicillium marneffei and Rhodococcus equi were isolated from the ulcer and lymph node respectively.

Actinomadura madurae causing mycetomas in Madras.

Two hundred and ten histologically diagnosed cases of mycetoma filed in the Departments of Pathology of four Medical Colleges in Tamil Nadu, India, between 1964-1987 were subjected to detailed histopathological study; Actinomadura madurae, was found in 73 of them. In nine cases of mycetoma pedis, the organism A. madurae has been isolated in pure culture. In one case, the lesions were present in both the feet. The characteristic cream-coloured granules were seen in all. The lesions responded well to a combination of Streptomycin and dapsone.