ABSTRACT
BACKGROUND: Streptococcus uberis, the most frequent cause of mastitis in lactating cows, is considered non-pathogenic for humans. Only a few case reports have described human infections with this microorganism, which is notoriously difficult to identify. CASE PRESENTATION: We report the case of a 75-year-old male haemodialysis patient, who developed a severe foot infection with osteomyelitis and bacteraemia. Both Streptococcus uberis and Staphylococcus aureus were identified in wound secretion and blood samples using mass spectrometry. The presence of Streptococcus uberis was confirmed by superoxide dismutase A sequencing. The patient recovered after amputation of the forefoot and antibiotic treatment with ampicillin/sulbactam. He had probably acquired the infection while walking barefoot on cattle pasture land. CONCLUSION: This is the first case report of a human infection with Streptococcus uberis with identification of the microorganism using modern molecular technology. We propose that Staphylococcus aureus co-infection was a prerequisite for deep wound and bloodstream infection with Streptococcus uberis.
Subject(s)
Bacteremia/microbiology , Coinfection/microbiology , Foot Diseases/microbiology , Renal Dialysis/adverse effects , Staphylococcus aureus/isolation & purification , Streptococcus/classification , Aged , Amputation, Surgical/methods , Anti-Bacterial Agents/therapeutic use , Bacteremia/etiology , Bacteremia/therapy , Blood-Borne Pathogens/isolation & purification , Coinfection/drug therapy , Combined Modality Therapy , Follow-Up Studies , Foot Diseases/etiology , Foot Diseases/therapy , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Male , Osteomyelitis/etiology , Osteomyelitis/microbiology , Osteomyelitis/therapy , Rare Diseases , Renal Dialysis/methods , Risk Assessment , Severity of Illness Index , Staphylococcal Infections/drug therapy , Staphylococcal Infections/etiology , Streptococcal Infections/etiology , Streptococcal Infections/therapy , Streptococcus/drug effects , Treatment OutcomeABSTRACT
A 75-year-old female patient presented with late relapse of acute myeloid leukemia (AML). She received a single cycle of azacitidine before refusing further treatment. Around 6 weeks after this single azacitidine cycle, complete remission-according to international working group criteria-was observed with continuous improvement in peripheral blood counts to normal values, transfusion-independence, normal blast count (< 5 %) with normal morphology and flow cytometry, as well as a normal bone marrow karyotype and no dysplastic stigmata suggestive of a coexisting myelodysplastic syndrome. The patient also showed a pronounced improvement in performance status. Seven months later a second relapse occurred, followed by one additional azacitidine cycle that showed only a transient and a minor increase in thrombocytes and granulocytes, corresponding to an international working group nonresponse. As azacitidine treatment was interrupted after a single cycle, this case gives insight into the kinetics of response. The lack of response to azacitidine in AML after the second relapse suggests that azacitidine administration should be maintained after response.
