Complete Genome Sequences of Two Isolates of Fusobacterium necrophorum subsp. funduliforme, Obtained from Blood from Patients with Lemierre's Syndrome.

Two isolates (F1260 and F1291) of Fusobacterium necrophorum subsp. funduliforme were recovered from blood from patients with Lemierre's syndrome. Here, we report the complete genome sequences of these two isolates. The genomes of F1260 and F1291 comprise one chromosome with lengths of 2.29 and 2.14 Mb, respectively.

The role of Fusobacterium necrophorum in pharyngotonsillitis - A review.

Fusobacterium necrophorum is a gram-negative anaerobic bacterium that is the causative agent of the invasive disease Lemierre's syndrome. In addition, it is also associated with peritonsillar abscess formation and otitis media in small children. Recent research has shown that F. necrophorum may be involved in pharyngotonsillitis especially in adolescent and young adults and that it may be the second most common bacterial cause of pharyngotonsillitis after Streptococcus pyogenes (Group A streptococci). Peritonsillar abscesses and Lemierre's syndrome due to F. necrophorum are also found in this age group, suggesting that they may be complications of F. necrophorum pharyngotonsillitis. In this review we present the present knowledge about the role of F. necrophorum in pharyngotonsillitis with special emphasis on the age distribution. We argue that F. necrophorum is an important pathogen involved in pharyngotonsillitis in the age group of 13-40 years of age and we urge clinical microbiology labs to set up the appropriate techniques to be able to detect F. necrophorum from throat swabs.

Fusobacterium necrophorum findings in Denmark from 2010 to 2014 using data from the Danish microbiology database.

Fusobacterium necrophorum findings in Denmark and estimation of the incidence of F. necrophorum bacteraemia was described using data from the nationwide Danish microbiology database (MiBa). All microbiological reports on any Fusobacterium species in Denmark were extracted for a period of 5 years from 2010 to 2014 from MiBa and from the local department of clinical microbiology. The overall incidence of F. necrophorum bacteraemia from 2010 to 2014 was 2.8 cases per million/year vs 9.4 in the age group 15-24 years. F. necrophorum was rare in blood cultures from children and middle-aged patients and then raised again. However, 48 of 232 cases of Fusobacterium bacteraemia were not identified to species level, so the incidences of F. necrophorum bacteraemia may be underestimated in our study. F. necrophorum was found in throat swabs in the age group between 13 and 40 years and in otitis media in children below 2 years in those departments which performed anaerobic culture. The incidence of F. necrophorum bacteraemia found was comparable to earlier reported figures for Lemierre's syndrome. Fusobacterium bacteraemia should always be identified to species level.

Helicobacter cinaedi knee infection after arthroscopy in an immunocompetent patient.

An otherwise healthy 36-year-old man was hospitalised due to a traumatic tear of the meniscus in the left knee. An arthroscopy was performed and his meniscus was partially resected. Thirty days later, he was rehospitalised with arthritis in the left knee and cellulitis on the left tibia. Helicobacter cinaedi was isolated from the synovial fluid, which was incubated in a BACTEC Paediatric bottle. The patient was treated with oral rifampicin and moxifloxacin for 6 weeks with good clinical response without relapse. The source of the infection was not found. The case emphasises the importance of incubating the synovial fluid in a rich medium such as a BACTEC Peds Plus/F bottle. Physicians and microbiologists should be aware of H. cinaedi as a human pathogen causing a range of disease manifestations, including infective arthritis and cellulitis, particularly if symptoms evolve in the weeks following a surgical procedure.

Complete Genome Sequence of Actinobaculum schaalii Strain CCUG 27420.

Complete genome sequencing of the emerging uropathogen Actinobaculum schaalii indicates that an important mechanism of its virulence is attachment pili, which allow the organism to adhere to the surface of animal cells, greatly enhancing the ability of this organism to colonize the urinary tract.

Neonatal bloodstream infections in a pediatric hospital in Vietnam: a cohort study.

Septicemia and bloodstream infections (BSIs) are major causes of neonatal morbidity and mortality in developing countries. We prospectively recorded all positive blood cultures (BSI) among neonates admitted consecutively to a tertiary pediatric hospital in Vietnam during a 12-month period. Among 5763 neonates, 2202 blood cultures were performed, of which 399 were positive in 385 neonates. Among these, 64 died, 62 in relation to septicemia. Of the BSI isolates, 56% was known pathogenic and 48% was gram-negative bacteria, most frequently Klebsiella spp. (n = 78), Acinetobacter spp. (n = 58) and Escherichia coli (n = 21). Only three Streptococcus spp. were identified, none group B. Resistance against antibiotics applied was common. The mortality was highest in neonates with gram-negative BSI compared with no confirmed BSI and gram-positive BSI (P < 0.01). In this setting, the majority of BSI were likely to have been transmitted from the environment. Improvement of hygienic precautions and systematic BSI surveillance are recommended.

Actinobaculum schaalii, a commensal of the urogenital area.

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Actinobaculum schaalii is considered to be a part of the normai flora in the genital and urinary tract area. It has been associated to urinary tract infection (UTI), sepsis, osteomyelitis, endocarditis and Foumier's gangrene. So far it has mainly been isolated from urine, blood and pus, and predominantly in elderly patients. This study examined the habitat of A. schaalii by collecting samples from skin and urine in patients with kidney or ureter stones before and after treatment with Extracorporeal Shock Wave Lithotripsy (ESWL). Additionally faeces and vaginal swabs from routine specimen in patients not undergoing ESWL and without known urinary calculi were also analysed. The study does not find A. schaalii in faeces but shows it to be presents on skin and mucosa in the genital area. A. schaalii is also shown a possible pathogen in the stone-patient group undergoing ESWL. OBJECTIVE: To study the habitat of Actinobaculum schaalii by examing groin swabs, faeces samples and vaginal swabs, and to determine whether it is a common uropathogen in patients with kidney or ureter stones. PATIENTS AND METHODS: A quantitative real-time PCR assay was used to analyse all samples, which were collected between 2010 and 2011. A total of 38 patients (24 men and 14 women), with kidney or ureter stones and undergoing extracorporeal shock wave lithotripsy (ESWL), provided urine samples and had groin swabs taken. In addition, 30 faecal samples and 19 vaginal swabs that had been sent for routine microbiological examinations from patients outside the ESWL group were analysed. A chi-squared test was used to analyse the differences between patient groups, studying samples from urine, faeces samples, groin swabs and vaginal swabs. RESULTS: Actinobaculum schaalii was found in the urine samples from 14 (37%) patients undergoing ESWL, and in both urine and groin swabs from seven (18%) patients. Actinobaculum schaalii was not found in faeces samples but it was found in six (32%) of the vaginal swabs, predominantly in patients >50 years (P = 0.06). CONCLUSION: The study indicates that A. schaalii is a commensal found on skin, urine and vaginal mucosa in the human urogenital area and supports other investigations in its finding that the elderly are at greatest risk of being colonized with A. schaalii.

[Severe phimosis as cause of urosepsis with Actinobaculum schaalii]. / Svær fimose som årsag til urosepsis med Actinobaculum schaalii.

Actinobaculum schaalii is a small, Gram-positive, facultative anaerobic, CO2-requiring rod. It is now an acknowledged uropathogen, but often overlooked because of its slow growth. It is part of the normal bacterial flora in the urogenital area, but can be the cause of both local and invasive infections. We present a case of A. schaalii urosepsis in a 68-year-old male with phimosis caused by a severe lichen sclerosus et atrophicus. The only bacteria found in blood and urine was A. schaalii.

[The quality of susceptibility examinations of urine in general practice is generally good]. / Kvaliteten af resistensbestemmelser på urin i almen praksis er generelt god.

In Denmark, many microbiological tests (microscopy, culture and susceptibility examinations) are done in general practice for the diagnosis of urinary tract infections (UTI). In 2006, the costs of susceptibility examinations were 28 million DKK. Some regional health authorities have established a program for quality assessment. National quality requirements for susceptibility examinations have already been established. The clinical microbiological departments send simulated urines with bacteria of common UTI strains. The specimens are examined in general practice with routine methods. The results for a two-year period of susceptibility examinations are reported. Generally, the quality criteria were met.

Actinobaculum schaalii, a cause of urinary tract infections in children?

AIM: To inform that Actinobaculum schaalii can colonize the urine and cause urinary tract infection in children. METHODS: Urine samples were examined by wet smear microscopy, incubated in 5% CO(2) for 1-2 days, and species-specific real-time polymerase chain reaction (PCR) for A. schaalii was performed. RESULTS: In 5 of the 29 screened urines, A. schaalii was found only by real-time PCR in quantities equivalent to ≥ 10(4) -10(5) CFU/mL. In addition, A. schaalii was found in quantities equivalent to ≥ 10(6) CFU/mL by both culture and PCR in two children with a urinary tract infection and large numbers of leucocytes in the urine. CONCLUSION: Actinobaculum schaalii is CO(2)-dependent. Therefore, if there are clinical symptoms and/or a negative culture despite the presence of leucocytes in the urine, Gram staining and incubation in 5% CO(2) or species-specific real-time PCR should be performed to identify A. schaalii.

Fusobacterium necrophorum- detection and identification on a selective agar.

Within the last decade, Fusobacterium necrophorum subsp. funduliforme has been considered a clinically important pathogen causing pharyngitis especially in adolescents and young adults. F. necrophorum pharyngitis can progress into Lemierre's syndrome, which is a severe and life-threatening infection. However, throat swabs are not cultured anaerobically in the routine and even if cultured anaerobically, it can be difficult to identify F. necrophorum from the normal flora of the throat. F. necrophorum is therefore often overlooked as the cause of pharyngitis. In our laboratory, a F. necrophorum selective agar has been developed containing vancomycin and nalidixin, which inhibit the growth of most Gram-positive and many Gram-negative bacteria, respectively. ß-haemolysis of horse blood can be detected, which further facilitates the detection and identification of F. necrophorum. The F. necrophorum selective agar was evaluated against a quantitative real-time polymerase chain reaction assay and shown to have a significantly higher sensitivity for detecting F. necrophorum than the anaerobic agar commonly used in Denmark. Furthermore, the F. necrophorum selective agar does not require experienced laboratory technicians, require fewer subcultures, is probably less expensive and is faster to perform than other culture methods.

Actinobaculum schaalii: a common cause of urinary tract infection in the elderly population. Bacteriological and clinical characteristics.

To-date only 21 clinical cases of Actinobaculum schaalii infection have been published, and A. schaalii has been considered a rare cause of urinary tract infection (UTI) and urosepsis. Between y 2005 and 2008, we isolated A. schaalii from 55 predisposed elderly patients. In these cases, microscopic findings of coccoid rods in wet smears of urine gave rise to clinical suspicion and subsequently to its isolation from urine. Typically only scant growth of A. schaalii occurred after incubation of the urine for 24 h, but it became visible after 2 days of incubation in 5% CO(2). Preliminary biochemical identification was carried out by combining the API Coryne and Rapid ID32A test systems, and the identification was later confirmed by partial 16S rDNA gene sequencing. During the 4-y period, A. schaalii caused septicaemia, UTIs and asymptomatic bacteriuria. One patient was later infected with Actinobaculum massiliense. The incidence of A. schaalii infections is much higher than previously reported. We present numerous case reports and describe the bacteriological and clinical characteristics of this overlooked uropathogen.

Actinobaculum schaalii, a common uropathogen in elderly patients, Denmark.

Actinobaculum schaalii can cause urinary tract infections and septicemia but is difficult to identify by cultivation. To obtain a fast diagnosis and identify A. schaalii, we developed a TaqMan real-time quantitative PCR. Routine urine samples were obtained from 177 hospitalized patients and 75 outpatients in Viborg County, Denmark, in 2008-2009. The PCR detected A. schaalii in 22% of samples from patients >60 years of age. This assay showed that A. schaalii is more common than implied by routine cultivation. In 90% of PCR-positive urine samples, other common uropathogens were identified. This finding suggests that A. schaalii is a common, undetected, bacterial pathogen. Our results suggest that A. schaalii may be a more common pathogen than previously thought, especially in patients with unexplained chronic urinary tract infections, who are often treated with trimethoprim or ciprofloxacin, to which A. schaalii is resistant.

[Fusobacterium necrophorum: from tonsillitis to Lemierre's syndrome]. / Fusobacterium necrophorum: fra tonsillitis til Lemierres syndrom.

Fusobacterium necrophorum plays a role in non-GAS-tonsillitis in adolescents and probably also in small children with recurrent otitis media. Anaerobic culture on selective anaerobic media is recommended to detect F. necrophorum and treat such patients. Denmark sees at least 20 annual cases of Lemierre's syndrome with a mortality reaching 9%. Early suspicion of Lemierre's syndrome in adolescents with non-GAS-tonsillitis, who develop septicaemia, pulmonary symptoms and unilateral swelling on the neck, is mandatory to lower morbidity and mortality.

[Can anaerobic culture of throat swabs prevent Lemierre's syndrome?]. / Kan anaerob dyrkning af svaelgpodning forhindre Lemierres syndrom?

Six cases of Lemierre's syndrome were reported from 2004 to 2007 at Viborg Hospital, corresponding to 33 cases per year in Denmark. All six patients were healthy younger persons presenting with a suspected bacterial tonsillitis which had been found strep A antigen negative. Fusobacterium necrophorum was found in throat swabs by anaerobic culture on selective media and/or by real-time PCR. We recommend that all patients 10 to 40 years of age with strep A antigentest negative bacterial tonsillitis have throat swabs anaerobically cultured on selective media. We believe early identification and therapy may prevent progression to Lemierre's syndrome.

Staphylococcus lugdunensis, a common cause of skin and soft tissue infections in the community.

Staphylococcus lugdunensis, a rare cause of severe infections such as native valve endocarditis, often causes superficial skin infections similar to Staphylococcus aureus infections. We initiated a study to optimize the identification methods in the routine laboratory, followed by a population-based epidemiologic analysis of patients infected with S. lugdunensis in Viborg County, Denmark. Recognition of a characteristic Eikenella corrodens-like odor on Columbia sheep blood agar combined with colony pleomorphism and prominent beta-hemolysis after 2 days of incubation, confirmed by API-ID-32 Staph, led to an 11-fold increase in the detection of S. lugdunensis. By these methods we found 491 S. lugdunensis infections in 4 years, corresponding to an incidence of 53 per 100,000 per year, an increase from 5 infections per 100,000 inhabitants in the preceding years. Seventy-five percent of the cases were found in general practice; these were dominated by skin abscesses (36%), wound infections (25%), and paronychias (13%). Fifty-six percent of the infections occurred below the waist, and toes were the most frequently infected site (21%). Only 3% of the patients suffered from severe invasive infections. The median age was 52 years, and the male/female ratio was 0.69. Our study shows that S. lugdunensis is a common cause of skin and soft-tissue infections (SSTI) and is probably underrated by many laboratories. S. lugdunensis should be accepted as a significant pathogen in SSTI and should be looked for in all routine bacteriological examinations, and clinicians should be acquainted with the name and the pathology of the bacterium.

Eight cases of lower respiratory tract infection caused by Stomatococcus mucilaginosus.

Stomatococcus mucilaginosus was isolated from 8 patients suffering from lower respiratory tract infections over a 4-y period (1999-2003). The infections ranged from mild cases of pneumonia to a life-threatening case of recurrent lung abscesses in a neutropenic patient. The various strains were cultured from specimens obtained by bronchoscopy, blood, and sputum specimens. All strains were fully susceptible to rifampicin, vancomycin and gentamicin. They showed variable susceptibility to penicillin and ciprofloxacin. S. mucilaginosus is likely to be under-reported as a pathogen due to difficulties in obtaining samples for culture as well as misidentification due to its biochemical characteristics.

Granulicatella elegans bacteraemia in patients with abdominal infections.

Bloodstream infections with Granulicatella (previous Abiotrophia) elegans are rare. A few reported cases were associated with infective endocarditis. Three cases of bacteraemia with G. elegans in patients who were operated for acute abdominal diseases are described. Abdominal foci should be considered when G. elegans is recovered from blood.