Skin and soft tissue infection caused by Streptococcus pneumoniae: report of 15 cases

Introducción

Streptococcus pneumoniae es una causa muy infrecuente de infección de piel y partes blandas (IPPB). El objetivo de este estudio fue conocer las características clínicas y microbiológicas que presentan estas infecciones.

Material y métodos

Se revisaron retrospectivamente las historias clínicas de los enfermos con IPPBs por S. pneumoniae diagnosticadas en el Hospital Universitario de Guadalajara entre enero de 2012 y diciembre de 2020. La identificación microbiológica se efectuó utilizando procedimientos convencionales. La sensibilidad antimicrobiana se llevó a cabo mediante el sistema automático MicroScan WalkAway-96 plus y tiras de E-test siguiendo las recomendaciones del European Committee on Antimicrobial Susceptibility Testing (EUCAST).

Resultados

Se diagnosticaron 15 casos de IPPBs. El 73,3% presentaron patologías de base, siendo las neoplasias las más frecuentes. El 60% tuvieron factores predisponentes, siendo la inmunosupresión el más habitual. Las presentaciones clínicas fueron: abscesos en diferentes localizaciones, úlceras, heridas quirúrgicas, mastitis lactacional y fascitis necrotizante. El 73,3% de las infecciones fueron polimicrobianas y el 6,6% nosocomiales. La evolución clínica fue favorable en el 90,9% de los casos. Los antibióticos con mayores porcentajes de sensibilidad frente a S. pneumoniae fueron cefotaxima, levofloxacino, vancomicina, linezolid y rifampicina.

Conclusiones

S. pneumoniae debería valorarse como posible agente causal de IPPBs, sobre todo en pacientes con neoplasias e inmunodeprimidos. Debemos destacar su implicación en infecciones como la mastitis lactacional y fascitis necrotizante. La evolución clínica es favorable en la mayoría de los pacientes, pero es importante prestar especial atención en los casos de fascitis necrotizante debido a la gravedad que presentan estas infecciones.

'Aeromonas intestinalis' and 'Aeromonas enterica' isolated from human faeces, 'Aeromonas crassostreae' from oyster and 'Aeromonas aquatilis' isolated from lake water represent novel species

Four Aeromonas strains from clinical and environmental samples differed from known species on the basis of rpoD gene sequence. Multilocus phylogenetic analysis and in silico DNA-DNA hybridization confirmed them as four new species even though their 16S rRNA gene sequence similarity with their closest relatives was >98.7%, as occurred for other Aeromonas spp.

Meningitis caused by Abiotrophia defectiva: case report and literature review

The genus Abiotrophia comprises fastidious Gram-positive bacteria previously classified as nutritionally variant streptococci (NVS). The isolation of NVS from the central nervous system (CNS) is very rare. We describe a case of meningitis due to Abiotrophia defectiva in a patient who underwent a total hip arthroplasty 4 days previously. It is possible that the organism could be introduced through the spinal anesthesia. We also review all cases of CNS infections caused by NVS.

[Rapidly progressive myonecrosis by Aeromonas veronii biotype sobria]

Myonecrosis due to Aeromonas spp is exceptional. We report the case of a diabetic patient with liver cirrhosis who developed a rapidly progressive myonecrosis by Aeromonas veronii biotype sobria. The portal of entry was an injury after falling down in an irrigation canal. The outcome was not favourable and surgical amputation of left leg was performed in spite of antibiotic treatment with cefotaxime and tobramicin. Aeromonas spp can be very aggressive and this microorganism should be considered in the differential diagnosis of skin and soft tissue infections with myonecrosis, specially after posttraumatic wound infections with a history of freshwater exposure.

Outbreak of long-term intravascular catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit

Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term intravascular catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under XbaI restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The catheter was removed in only one patient. The three patients in whom the catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous catheters and should be called into question. Patients with long-term intravascular catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without catheter removal.

[Urinary infection caused by non typhi Salmonella]

BACKGROUND

The aim of this study was to know the frequency and the clinical characteristics of urinary infection by non typhi Salmonella in our area in Spain.

PATIENTS AND METHODS

The clinical histories of patients with urinary infection by non typhi Salmonella diagnosed in the Hospital General del Guadalajara from January 1990 to July 1999 were reviewed.

RESULTS

During the period studied nine patients with urinary infection by non typhi Salmonella were diagnosed, representing 0.056% of the urinary infection diagnosed in our hospital over the same period. All the patients presented underlying disease and five were undergoing immunosuppressor treatment. Four patients presented urological disease. The most frequent serogroup was Salmonella enteritidis (7 cases). All the episodes were symptomatic. The same microorganism was isolated in stools in four patients. The evolution was favorable in five of the nine cases. Recurrence was observed in two patients and secondary bacteremia in one. Six patients required antibiotic treatment over two or more weeks. The mean length of treatment was of 2.5 weeks.

CONCLUSIONS

Urinary infection by non typhi Salmonella is predominantly observed in patients undergoing immunosuppression or with urological disease. Prolonged antibiotic treatment is recommended due to its bad evolution.

[Scedosporium apiospermum external otitis.]

We report a case of Scedosporium apiospermum external otitis. The patient was topically treated with miconazole cream and achieved a clinical and mycological cure. The etiology, diagnosis and treatment of external fungal otitis are discussed.

[Antifungal treatment: Recent advances in dermatology.]

In this paper we discuss the published relevant mycology dermatological reports which appeared in 1997 and 1998. The aims of this review is to give an actual view on antifungal therapy with a critical discussion on the efficacy of antifungals.

Human infection with Hymenolepis diminuta: case report from Spain

We report a case of Hymenolepis diminuta infection in a human. The patient was a 5-year-old girl referred to us through the onset of a cyanotic attack. Treatment with a single dose (10 mg/kg of body weight) of praziquantel was ineffective, but the parasite was eradicated after three treatment cycles with the same drug at dosages of 25 mg/kg/day for 5 days.