Bacillus cereus bacteremia in a patient with an abdominal stab wound / Bacteriemia por Bacillus cereus en paciente con herida de arma blanca abdominal

Abstract Bacillus cereus is a gram positive microorganism commonly involved in gastrointestinal infection but capable of causing severe infections and bacteremia. We describe here a case of bacteremia caused by B. cereus in a previously healthy young woman admitted to the intensive care unit following emergency surgery due to a penetrating abdominal stab wound and subsequent hepatic lesion. She developed fever during admission and cultures were taken. B. cereus was isolated in blood and hepatic fluid collection cultures. Treatment was adjusted according to the isolate, with good clinical results. It is important to highlight the pathogenic potential of this microorganism and not underestimate it as a contaminant when it is isolated from blood samples.

Resumen Bacillus cereus es un microorganismo gram positivo comúnmente involucrado en infecciones gastrointestinales, pero capaz de causar infecciones graves y bacteriemia. Presentamos un caso de bacteriemia por B. cereus en una mujer joven previamente sana que ingresa en la unidad de cuidados intensivos luego de una cirugía de emergencia, debido a una herida abdominal por arma blanca con lesión hepática. La paciente desarrolla fiebre durante la internación, por lo que se toman cultivos. Se aísla B. cereus en hemocultivos y material de colección hepática. Se ajusta el tratamiento según los hallazgos, con buena evolución clínica. Esta comunicación ilustra una fuente poco común de bacteriemia por B. cereus. Asimismo, destaca el potencial patogénico de este microorganismo, cuyo hallazgo en muestras de sangre no siempre debe conducir a su rápida desjerarquización como contaminante.

Bacillus cereus bacteremia in a patient with an abdominal stab wound.

Bacillus cereus is a gram positive microorganism commonly involved in gastrointestinal infection but capable of causing severe infections and bacteremia. We describe here a case of bacteremia caused by B. cereus in a previously healthy young woman admitted to the intensive care unit following emergency surgery due to a penetrating abdominal stab wound and subsequent hepatic lesion. She developed fever during admission and cultures were taken. B. cereus was isolated in blood and hepatic fluid collection cultures. Treatment was adjusted according to the isolate, with good clinical results. It is important to highlight the pathogenic potential of this microorganism and not underestimate it as a contaminant when it is isolated from blood samples.

Cervical spondylodiscitis with epidural abscess after knife stab wounds to the neck: A case report.

INTRODUCTION: Cervical spondylodiscitis is usually caused by pyogenic infections, associated with retropharyngeal abscesses, or due to the swallowing of foreign bodies. No cases of cervical spondylodiscitis caused by a penetrating neck injury have been published in the literature. We describe a case of cervical spondylodiscitis after multiple knife stab wounds to the lateral soft tissue of the neck. MATERIALS AND METHODS: Case report and review of the literature. RESULTS: A 54-year-old patient was brought to our clinic with destructive spondylodiscitis C3/4 with paravertebral and epidural abscesses. He had been involved in a fight and had suffered multiple stab wounds to his neck with a knife 1 month prior. The initial CT scan had revealed one deeper wound canal behind the sternocleidomastoid muscle on the left side without any injury to the vessels. The wound was cleaned and an antibiotic therapy with cefuroxime was given for 1 week. After an uneventful and complete healing of the wound the patient developed severe neck pain. Inflammatory laboratory parameters were elevated, and a MRI of the neck revealed a distinct spondylodiscitis C3/4 with paravertebral and epidural abscess formations. Surgery was performed and included debridement, abscess drainage, decompression of the spinal canal, fusion of the C3/4 segment using an autologous iliac crest bone graft and a plate osteosynthesis. A course of calculated antibiotic therapy was administered for 8 weeks. Normal laboratory parameters and no radiological signs of an ongoing inflammatory process were observed during follow-up examinations. The C3/4 segment was consolidated. CONCLUSION: Stab wound injuries to the neck not only bear the risk of injuries to the nerves, vessels and organs of the neck but also increase the risk of developing secondary spondylodiscitis. Specifically, cervical spondylodiscitis can result in distinct neurological symptoms, and surgical intervention should be performed in a timely manner.

Necrotizing streptococcal myositis of an extremity: a rare case report.

Necrotizing myositis is a severe and very rare streptococcal soft tissue infection involving the superficial fascia and muscle. Its clinical symptoms are nonspecific until the appearance of a fulminant clinical course with soft tissue destruction and septic shock. A high mortality and morbidity rate has been reported in the few cases over the last century. Despite several attempts to better define the different entities causing this necrotizing soft tissue infection, no clear treatment has been outlined. We present the case of a 47-year-old woman who had an acute necrotizing myositis after a stab wound. The diagnosis of necrotizing myositis was only established after surgical treatment with a pathology report. We reviewed the literature to highlight the clinical difficulty of a preoperative diagnosis and surgical treatment.

Rapidly progressive effusive constrictive pericarditis caused by methicillin sensitive Staphylococcus aureus (MSSA). samraakhtar@hotmail.com.

Effusive-constrictive pericarditis is a clinical syndrome characterized by concurrent pericardial effusion and pericardial constriction, where constrictive hemodynamics are persistent after effusion is drained. It may present at any point along the clinical course, from the occurrence of an effusion to the development of chronic pericardial constriction. We refer an unusual case of effusive constrictive pericarditis developing rapidly within days, following purulent pericarditis secondary to chest trauma.

[Bacillus licheniformis: an unusual cause of erysipelosis]. / Bacillus licheniformis: agent causal d'érysipèle.

The authors report a case of a cutaneous infection due to Bacillus licheniformis. It occurred after a wound due to a wicker splinter. The bacteriological identification was easy thanks to the very typical aspects of culture. First intention antibiotherapy given for bacterial dermo-hypodermatitis may be ineffective because Bacillus licheniformis secretes a biofilm and is frequently resistant to Beta-lactams.

[Effects of splenectomy on peritonitis produced by a colonic injury: study in rats]. / Efeitos da esplenectomia na peritonite causada por lesão traumática do cólon: estudo em ratos.

BACKGROUND: Study the effects of splenectomy on the intra-abdominal infection by bowel flora, consequent to a colonic injury in Wistar rats. METHODS: We used 64 animals, 20 for Group A1 (normal with colon lesion left open), 22 for Group A2 (normal with colon lesion sutured) and 22 for Group B (spleen removed). The animals were submitted to a laparatomy through a midline abdominal incision and peritonitis was induced by a colonic lesion in the colon previously distended with 2 ml of saline introduced in the rectum. Bacteriological studies of the abdominal wash obtained with a sterilized swab and microscopic studies of samples of the segment of the sutured colon obtained at 48 hrs, 96 hrs and on the 12 post op day, were made in each group. All rats were submitted to an autopsy on the day of death or on the 12th post op day when the survivors were sacrificed. RESULTS: Similar bacteria were found in the three groups. E. coli (100%); Enterococcus fecalis (97%); Klebsiela pneumoniae (70%); Citrobacter freundi (70%) and Enterobacter aglomerans (63%). In the first 96 hours the rats without spleen had a lesser inflammatory reaction when compared to the group with spleen. The leading cause of death was generalized peritonitis in the first 96 hours. There was a significant statistical difference in the mortality rate between Group B (80%), Group A2 (no mortality) and Group A1 (35%). CONCLUSION: There was a significant statistical difference in the mortality rate caused by peritonitis between the groups with splenectomy when compared to the group with no splenectomy.

[Vaccination for stab and bite injuries in the facial region]. / Impfschutz bei Stich- und Bissverletzungen im Gesichtsbereich.

In cases of stab and bite injuries to the face there is a risk of general infection and the necessity for an active and/or passive immunization must be considered by the first treating physician. In Central Europe tetanus, rabies, hepatitis B and C as well as HIV must be taken into account as possible consequences of such injuries. With regard to a tetanus immunization the indication for the post-exposition prophylaxis (PEP) should generally be as wide as possible. For other protective vaccinations a differentiated decision in co-operation with other fields of activity and public health authorities should be realized. The current recommendations for the systemic infections relevant in Central Europe are described.

Efeitos da esplenectomia na peritonite causada por lesão traumática do cólon: estudo em ratos / Effects of splenectomy on peritonitis produced by a colonic injury: study in rats

OBJETIVO: Estudar o efeito da esplenectomia na infecção intra-abdominal com bactérias da flora enteral, liberadas para a cavidade abdominal através de uma lesão induzida no cólon de ratos Wistar. MÉTODOS: Foram utilizados 64 animais, sendo 20 do Grupo A1 (normais sem sutura da lesão), 22 do Grupo A2 (normais com sutura da lesão) e 22 do Grupo B (esplenectomizados e com sutura da lesão). Os animais foram submetidos à laparotomia mediana e a indução da peritonite intra-operatória foi obtida através de lesão do cólon previamente distendido pela introdução de uma sonda naso-gástrica via retal e injeção de 2 ml de soro fisiológico. Foram realizados exames bacteriológicos de lavado abdominal obtido por swab esterelizado e exame microscópico de segmento suturado do cólon de amostras obtidas dos grupos A2 e B com 48hs, 96hs e 12 dias de pós-operatório. Todos os animais foram submetidos a necropsia por ocasião do óbito ou no 12º. dia de pós-operatório quando os sobreviventes foram sacrificados. RESULTADOS: Agentes bacterianos semelhantes foram encontrados nos três grupos: E.coli (100 por cento); Enterococcus faecalis (97 por cento); P. mirabilis (90 por cento); Klebsiela pneumoniae (70 por cento); Citobacter freundi (70 por cento) e Enterobacter aglomerans (63 por cento). O exame microscópico revelou menor reação inflamatória no grupo esplenectomizado. A causa da morte na maioria foi peritonite nas primeiras 96hs. Houve alto índice de significância de mortalidade entre os animais do Grupo B (80 por cento) em relação ao Grupo A2 (sem mortalidade) e em relação ao Grupo A1 (35 por cento). CONCLUSAO: Houve alto índice de significância de mortalidade em vigência de peritonite nos animais esplenectomizados em relação aos animais que não foram esplenectomizados.

Wound shock: a history of its study and treatment by military surgeons.

The treatment of wounds has received considerable attention from the time of the Trojan War. However, it was not until the American Civil War that shock was described as an entity distinct from the wounds themselves and that efforts were directed at more than just treatment of the wound. The need for fluid resuscitation in the treatment of hemorrhagic shock was first recognized in the Spanish American War, as was the association of sepsis with shock. World War I showed the need for blood in the treatment of "wound shock," a lesson that had to be relearned in World War II through bitter experience. Studies in the Korean War described the concept of disseminated intravascular coagulation and multiple organ failure, and the existence of disseminated intravascular coagulation was confirmed by studies in Vietnam. The treatment of hemorrhagic shock is now very effective, but the treatment of traumatic and septic shock remains unsatisfactory.

STAT4 is required for antibacterial defense but enhances mortality during polymicrobial sepsis.

The signal transducer and activator of transcription factor 4 (STAT4) pathway mediates the intracellular effects of interleukin-12 (IL-12), leading to the production of gamma interferon, induction of a T helper type 1 response, and increased natural killer cell cytotoxicity. The purpose of this study was to determine the role of the STAT4 pathway during polymicrobial peritonitis in the cecal ligation and puncture (CLP) model. CLP was performed on STAT4-deficient (STAT4(-/-)) and wild-type control (BALB/c) mice. At 4 h after CLP, STAT4(-/-) mice had significantly higher bacterial counts in the peritoneal lavage fluid, liver, and blood. This difference persisted for 18 h in the peritoneal lavage fluid and blood. Neutrophil migration to the site of infection and into remote tissues was unaffected. Despite higher bacterial counts locally and systemically, STAT4(-/-) mice had a lower mortality rate than BALB/c controls. In contrast, blockade of IL-12 in BALB/c mice was detrimental to host survival. A blunted serum IL-12 response at 18 h after CLP was exhibited in STAT4(-/-) mice. These results suggest several critical roles for the STAT4 pathway in the resolution of polymicrobial infections. Additionally, the disparate effects observed with IL-12 blockade and STAT4 deficiency on host survival suggest that IL-12 may activate alternate pathways promoting survival.

[Frequency and antibiotic susceptibility of oxacillin resistant Staphylococcus aureus in a teaching hospital]. / Häufigkeit und Antibiotikaempfindlichkeit von Oxacillin-resistenten Staphylococcus aureus-Stämmen in einem Lehrkranhaus.

From October 1993 till October 1994, 115 oxacillin resistant Staphylococus aureus strains were isolated in the laboratory of a teaching hospital. This was 2.4% of all of the Staphylococcus aureus strains. The bacteria were isolated from 30 patients, 7 medical personnel and in the environment of the infected patients. Most of the isolates were cultured from blood cultures, wound swabs and drains. If the referring hospitals has been informed about the MRSA status of the patients, several transmissions could have been prevented. In 10 infected patients, the MRSA strains were isolated from the nose, throat and hands. The isolates were also found on the hands of several personnel and in the patients environment, suggesting that the strains had been widely spread. The MRSA strains predominated in the medical and surgical intensive care units and in 2 general surgical wards. They were only found sporadically in other departments (Ophthalmology, Gynaecology, Paediatrics and Urology). MRSA-strains were more resistant to imipenem, ofloxacin, gentamicin, trimethoprim-sulfamethoxazole, tetracycline, erythromycin and clindamycin as oxacillin-sensitive Straphylococcus aureus strains. Genotyping (Restriction-Fragment-Length-Polymorphism) revealed six different strain patterns. The same RFLP types were mainly found on different wards. We conclude that various clones of MRSA may have emerged independently within one hospital and that their spread between wards was remarkably limited. Subsequent intensive hygiene measures have been successful in reducing the number of new isolates.

[Infection by Vibrio vulnificus after a prick from from the spine of a Tilapia].

Vibrio vulnificus is a Gram-negative bacterium living in warm salty water that produces a spectrum of human disease which may progress to devastating, sometimes fatal infections in susceptible individuals. Such infections have rarely been reported in Israel. However, over the past few months we have been seeing a sharp increase in V. vulnificus infections with a common history of injury to extremities by the sharp spines of Tilapia zillii, ("amnon" or St. Peter's fish). Clinical suspicion and prompt intervention prevent the untoward consequences of misdiagnosis or delay.

Puncture wounds of the foot: can infective complications be avoided?

The bacteriological flora of the foot and shoe was studied concurrently in 200 volunteers without foot injuries, and 80 patients with puncture wounds of the foot. Seven of 28 child patients developed clinical infections, three with Pseudomonas aeruginosa. Eleven of 52 adult patients also developed infections. No patients developed infection if oral antibiotics were given within the first 24 h after injury (P < 0.05). Oral antibiotic prophylaxis is recommended for puncture wounds of the foot.

Can microorganisms produce alcohol in body cavities of a living person?: a case report.

Unusual endogenous ethanol production in intraabdominal bloody fluid of an individual who was stabbed in the abdomen and who developed peritonitis after a peritoneotomy is discussed. In the intraabdominal bloody fluid, 2.45 mg/g ethanol and 0.079 mg/g n-propanol were detected. The level of ethanol in the heart blood was about 1 mg/g. The level of n-propanol indicates that a large quantity of ethanol was produced endogenously in the intraabdominal bloody fluid. In an animal experiment in which rats were injected with 20 mL of 10% glucose mixed 5:1 with a presumed volume of rat blood into the abdominal cavity after injury of the small intestine to allow enterobacteria to spread into the cavity, a significant quantity of ethanol was produced in the administered fluid while the animals were alive. The antemortem ethanol production in the intraabdominal bloody fluid of the victim might have been caused by the microorganisms responsible for the peritonitis after the operation.

Post-traumatic toxic shock syndrome.

Toxic shock syndrome (TSS) associated with Staphylococcus occurs most commonly in menstruating women, although cases in both sexes have been reported. This report describes a severe case of TSS after a relatively minor stab wound. The male patient exhibited all of the major characteristics of this multisystem disease including anuric renal failure. TSS, which can be fatal, may result from surgical and traumatic wound infections and demands prompt recognition and treatment.

Butcher's knife wounds, are they really so contaminated?

The aerobic flora found in wounds caused by butcher's knives was compared with the flora in similar wounds caused by other sharp objects. Gram-positive bacteria predominated in the wounds caused by butcher's knives while the other cuts were colonised predominantly by Gram-negative flora. Identically low concentrations of colonising bacteria were found in both groups. The qualitative analysis provided no bacteriological argument for treating a wound from a butcher's knife as being more infected and therefore produced no contraindication for the primary reconstruction of damaged structures (i.e., tendons and nerves) together with skin closure in this type of injury.