First clinical case of KPC-3-producing Klebsiella michiganensis in Europe.

Klebsiella michiganensis is a newly emerging human pathogen. We describe a case of bloodstream infection in an immunocompromised patient. The pathogen was repeatedly isolated from blood and one rectal swab, and was identified using routine standard procedures. Further investigations revealed that the K. michiganensis was multidrug resistant, carrying a plasmid harbouring a Klebsiella pneumoniae carbapenemase (KPC)-3 carbapenemase gene. This plasmid has been frequently encountered in K. pneumoniae isolates in Europe but has never been described in K. michiganensis.

A dangerous hobby? Erysipelothrix rhusiopathiae bacteremia most probably acquired from freshwater aquarium fish handling.

Erysipelothrix rhusiopathiae is a facultative anaerobic Gram-positive rod that occurs widely in nature and is best known in veterinary medicine for causing swine erysipelas. In humans, infections are rare and mainly considered as occupationally acquired zoonosis. A case of E. rhusiopathiae bacteremia most likely associated with home freshwater aquarium handling is reported. The route of transmission was probably a cut with the dorsal fin of a dead pet fish. A short review of clinical presentations, therapeutic considerations and pitfalls of E. rhusiopathiae infections in humans is presented.

Antimicrobial resistance in the 21st century: a multifaceted challenge.

Antimicrobial resistance, the ability of (pathogenic) bacteria to withstand the action of antibiotic drugs, has recently been rated of having an impact on humans similar to that of global climate change. Indeed, during the last years medicine has faced the development of highly resistant bacterial strains, which were, as a consequence of worldwide travel activity, dispersed all over the globe. This is even more astonishing if taking into account that antibiotics were introduced into human medicine not even hundred years ago. Resistance covers different principle aspects, natural resistance, acquired resistance and clinical resistance. In the modern microbiology laboratory, antimicrobial resistance is determined by measuring the susceptibility of micro-organisms in vitro in the presence of antimicrobials. However, since the efficacy of an antibiotic depends on its pharmacokinetic and pharmacodynamics properties, breakpoints are provided to translate minimal inhibitory concentration to categorical efficacy (i.e. susceptible or resistant). Resistance in one microorganism against one particular drug may drive treatment decisions of clinicians, thereby fostering selection pressure to resistance development against another antibiotic. Thereby, bacteria may acquire more and more resistance traits, ending up with multi-resistance. To this end, antimicrobial resistance becomes a public health concern, not only in terms of limited treatment options but also due to its economic burden. The current paper provides a summary of the main topics associated with antimicrobial resistance as an introduction to this special issue.

Landouzy septicemia (sepsis tuberculosa acutissima) due to Mycobacterium microti in an immunocompetent man.

Even in developed countries, tuberculosis still contributes significantly to morbidity and mortality. The most frequent causative agent is Mycobacterium tuberculosis, while infections due to other mycobacterial species are usually associated with immunocompromised patients. In the following, we describe the case of a previously healthy man who underwent laparotomy for suspected adrenal carcinoma. Peritoneal "cancerous nodules" turned out to be tuberculous granulomas. After surgery the patient developed a protracted septic shock and died 6 days after surgery. Isolation and identification of the causative agent yielded Mycobacterium microti, an uncommon species of the M. tuberculosis complex. No other pathogen could be isolated during the clinical course, which finally led to the diagnosis of Landouzy septicemia (sepsis tuberculosa acutissima).

Staphylococcus aureus positive for Panton-Valentine leukocidin genes but susceptible to methicillin in patients with furuncles.

A total of 75 Staphylococcus aureus isolates obtained from patients with either recurrent skin abscesses or furuncles (n=48) or chronic infections from other body sites (n=27) were screened for the presence of the lukS-PV and lukF-PV genes encoding Panton-Valentine leukocidin. Significantly more isolates (70.8% vs. 7.4%, p<0.001) from patients suffering skin abscesses or furuncles were positive for lukS-PV and lukF-PV. These isolates belonged to the accessory gene regulator (agr) group Ia (9/48), group III (13/48), or group IV (19/48). In contrast with results of other investigations, none of the isolates positive for the Panton-Valentine leukocidin genes in this study exhibited methicillin resistance.

Autovaccination of dairy cows to treat post partum metritis caused by Actinomyces pyogenes.

Autovaccines are therapeutic vaccines manufactured from a disease causing micro-organism for individual treatment of patients, animals, or sometimes herds to treat chronic or recurrent infections. Despite the common use of autovaccines in veterinary medicine, their mechanism of action, i.e. the immunologic effector mechanism activated after administration, has never been investigated. Here we present data concerning the use of autovaccines to treat metritis infection in a group of dairy cows. Following autovaccination we observed a significant decrease in CD4+ cells paralleled by an increase in T-cells expressing the gammadelta-T-cell receptor (gammadelta-TCR) in the peripheral blood of the treated animals. Lymphocyte proliferation assays showed an initial increase in antigen-specific responsiveness followed by a decrease in this responsiveness during autovaccination treatment. We therefore conclude that administration of an autovaccine leads to the activation of immunologic effector mechanisms which contribute to recovery of the diseased animals.

Ribosomal genes of Histoplasma capsulatum var. duboisii and var. farciminosum.

A total of 1704 basepairs of the 18S rDNA of Histoplasma capsulatum var. duboisii (HCD, strain CBS175.57) and H. capsulatum var. farciminosum (HCF, strain CBS478.64) were sequenced (EMBL accession no. Z75306 and no. Z75307). The 18S rDNA of HCD was 100% identical to a published sequence of H. capsulatum var. capsulatum (HCC). The 18S rDNA of HCF showed one transversional point mutation at the nucleotide position 114 (ref. Saccharomyces cerevisiae). Hybridization confirmed that, in the 18S rDNA of two out of five strains of HCF, guanine was substituted for cytosine at the nucleotide position 114. Furthermore, identical group 1C1 introns (403 bp) were found to be inserted after position 1165 in four out of five strains of HCF, including the two strains with point mutations in the 18S rDNA, and a slightly different group 1C1 intron (408 bp) was detected in one strain of HCC without this point mutation. Intraspecific sequence variability in the highly conserved 18S rDNA because of occurrence of introns and mutations as a possible source of error in molecular diagnostics is discussed. In addition, internal transcribed spacer regions between the 18S rDNA and the 5.8S rDNA (ITS1) of three strains of HCF, and one strain each of HCC and HCD showed significant sequence variability between varieties and strains of H. capsulatum.

Rifampicin resistance in Neisseria meningitidis: evidence from a study of sibling strains, description of new mutations and notes on population genetics.

To provide direct evidence for the mechanism leading to resistance to rifampicin, two Neisseria meningitidis strains from one clonal lineage (so-called sibling strains) were studied; one of these strains was resistant, the other sensitive to rifampicin. The polymerase chain reaction (PCR) was used to amplify fragments of the known rifampicin resistance region on the rpoB gene coding for the beta subunit of DNA-directed RNA polymerase and the amplimers were then sequenced. In addition to the DNA from the sibling strains, DNA from further strains was analysed, including two Spanish, rifampicin-resistant strains, eight further N. meningitidis strains, strains of four further Neisseria spp. and one reference strain. The results demonstrated how quickly and easily N. meningitidis can acquire resistance to rifampicin, and also suggest a clonal population structure within the collection of strains studied. This finding is discussed with respect to recent studies that indicate a more panmictic population structure within particular serogroups of N. meningitidis.