Non-diphtheriae Corynebacterium species: an emerging respiratory pathogen

The purpose of the study was to describe the microbiological and clinical features of ten cases of lower respiratory tract infection due to Corynebacterium striatum, Corynebacterium propinquum and Corynebacterium pseudodiphtheriticum. Respiratory samples were recovered from hospitalised patients who were diagnosed of pneumonia and exacerbations of chronic respiratory infections. The samples were Gram-stained and seeded on conventional bacterial growing media. Bacteria were identified by matrix-assisted linear desorption/ionisation-time-of-flight mass spectrometry (MALDI-TOF MS). Antibiotic susceptibility was tested by the disk diffusion method. All patients presented an acute respiratory onset, most of them in the context of an underlying disease and/or immunosuppression. In all patients, the microscopical examination of Gram-stained respiratory samples showed numerous polymorphonuclear cells and Gram-positive bacilli, suggestive of the Corynebacterium morphotype. A pure culture growth of Corynebacterium was obtained in the majority (72 %) of samples. The conclusions are that non-diphtheriae Corynebacterium species are an emerging cause of respiratory infection among patients with chronic respiratory disease and/or immunosuppression, and cannot always be considered as mere colonisers. The microorganism's predominance in Gram-stained purulent respiratory samples together with abundant growth in the culture is the key for the microbiological diagnosis.

Streptococcus pneumoniae endophthalmitis: a study of 36 cases with special reference to antibiotic resistance and treatment options

Patients (n = 36) diagnosed with pneumococcal endophthalmitis from six Spanish hospitals between 1986 and 2004 were studied retrospectively. The diagnosis was based on clinical findings, ophthalmological examination, and isolation of Streptococcus pneumoniae from vitreous and/or aqueous humours of 19 patients (definite diagnosis), and from other ocular specimens of 17 patients (probable diagnosis). The mean (+/- SD) age was 69.3 (+/- 16.5) years (range 1.5-89 years), and 20 (55.5%) patients were male. The origin of endophthalmitis was considered exogenous for 34 (94.5%) patients. The most common predisposing factors were previous ocular surgery (n = 25, 69.4%), ocular trauma (n = 5, 13.9%), and close-to-eye radiotherapy (n = 3, 8.3%). Eleven (30.5%) patients underwent evisceration as the first therapeutic measure (primary evisceration), and evisceration was performed after antibiotic treatment failure (secondary evisceration) for six (16.7%) patients. Primary evisceration was performed more commonly (63.6%) during 1998-2004, while secondary evisceration was only performed during 1986-1997. Eighteen (50%) patients received intra-vitreous antibiotics (mainly vancomycin), and 31 (86.1%) patients were given systemic antibiotic therapy. The most frequent pneumococcal serogroups isolated were 6, 19, 9, 15 and 23. Pulsed-field gel electrophoresis analysis of 23 isolates revealed that four belonged to the international clones Spain(23F)-1, Spain(6B)-2, Spain(9V)-3 and Sweden(15A)-25. Non-susceptibility rates (i.e., intermediately-resistant and resistant) were: co-trimoxazole, 44.8%; penicillin, 33.3%; tetracycline, 31.0%; erythromycin, 21.9%; chloramphenicol, 17.9%; rifampicin, 7.4%; cefotaxime, 5.9%; and levofloxacin, 0%. Although uncommon, pneumococcal endophthalmitis is a medical emergency because of the often aggressive clinical course, poor visual outcome and need for evisceration in a large proportion of patients.

Nocardial infection in patients infected with the human immunodeficiency virus

During the period 1981-2000, we diagnosed eight cases of HIV-Nocardia co-infection (0.38% of AIDS cases). Six were males, and the mean age was 28.6 years. The most common risk factor for HIV infection was intravenous drug abuse. Most patients were severely immunodepressed at the time of diagnosis (mean CD4+ count, 35 cells/ micro L). The clinical forms of nocardiosis seen were pulmonary infection in three, skin or soft tissue infection in three, disseminated in one, and pulmonary colonization in one. Most patients were given sulfonamides, and a clinical response was observed in six of seven treated patients. However, two patients with pulmonary disease died from progressive infection. Although its incidence is very low among AIDS patients, nocardiosis is associated with high morbidity and mortality among HIV-infected individuals.

Infection with Nocardia species: clinical spectrum of disease and species distribution in Madrid, Spain, 1978-2001

BACKGROUND

Clinical experience with nocardiosis is very limited in European countries. We describe 34 cases of nocardial infection seen at one Spanish teaching hospital.

PATIENTS AND METHODS

A retrospective review of the clinical features and outcome of nocardial infections was conducted during a 24-year period (1978-2001). All cases were confirmed by culture.

RESULTS

Predisposing factors included immunosuppression and/or pulmonary disease in 85% of patients; eight cases were related to HIV infection. Most isolates were initially identified as Nocardia asteroides complex (97%). The most common clinical form was pulmonary disease (41%), followed by disseminated (15%), cutaneous (12%), cerebral (9%) and articular disease (3%). A high proportion of patients (20%) had pulmonary colonization. Therapy with sulfonamides, imipenem or amikacin was given to 26 patients and a clinical response was observed in 65%. Overall mortality among patients with nocardial disease was 48% (13/27) but only seven patients (26%) died from nocardiosis.

CONCLUSION

Nocardiosis remains a rare opportunistic infection that appears in immunosuppressed patients. HIV infection has become a common predisposing condition. The species distribution and disease spectrum are similar to those described in other European countries. Although most patients develop active disease, pulmonary colonization might not be as rare as has generally been assumed. Treatment with sulfonamides is usually effective and many patients may remain free of nocardial disease for a prolonged period.

Clinical study of 44 cases of Staphylococcus aureus meningitis

In order to describe the clinical features and outcome of Staphylococcus aureus meningitis, the charts of 44 cases seen at one teaching hospital during a 20-year period were retrospectively reviewed. Staphylococcus aureus was the fifth most common cause of bacterial meningitis (10.2% of cases). There were 28 (63%) cases of postoperative meningitis and 16 (37%) of spontaneous meningitis. Patients with postoperative meningitis were younger than patients with spontaneous meningitis (mean age, 40.3 vs. 59.3 years; P=0.04) and had a lower frequency of community-acquired infection (32.1% vs. 93.8%; P<0.01), severe underlying diseases (28% vs. 87%; P<0.01) and associated staphylococcal infection (35% vs. 75%; P=0.01). The clinical presentation was similar in both groups, but patients with postoperative meningitis had a lower frequency of altered mental status (39% vs. 75%; P=0.02), meningeal signs (28% vs. 62%; P=0.02), petechial rash (0% vs. 18%; P=0.04), bacteremia (7% vs. 75%; P<0.01), and septic shock (0% vs. 44%; P<0.01). Most patients were treated with cloxacillin or vancomycin, with or without rifampicin, for a mean period of 22.5 days (range, 1-100 days). Overall mortality was 27%, and the mortality rate was higher for cases of spontaneous than postoperative meningitis (50% vs. 14%; P=0.01). Mortality correlated significantly with advanced age, spontaneous meningitis, altered mental status, and the presence of severe underlying diseases, bacteremia, and septic shock.

Ureaplasma urealyticum reduces motility and induces membrane alterations in human spermatozoa

The in-vitro effects of several concentrations of Ureaplasma urealyticum on the motility, membrane integrity and morphology of washed spermatozoa from healthy donors were studied. A significant reduction in sperm motility and signs of membrane alteration, directly related to U.urealyticum concentration and contact time were observed. Scanning electron microscopy examination showed masses of U. urealyticum attached to the head and middle piece of some of deformed spermatozoa. It is suggested that U.urealyticum is involved in sperm changes leading to male infertility, particularly when there is heavy U. urealyticum colonization or specific infections with this microorganism.

A case of spontaneous peritonitis caused by Weeksella virosa

A case of spontaneous peritonitis caused by Weeksella virosa is reported. This Flavobacterium has never been reported as a cause of spontaneous bacterial peritonitis. The patient responded to antimicrobial therapy. Clinical and therapeutic implications are discussed.

[Evaluation of a selective medium for the isolation of Moraxella catarrhalis]

The recovery rate of Moraxella catarrhalis in a selective culture medium with acetazolamide and in a conventional blood-agar medium was compared from 1291 samples from the respiratory tract and conjunctivae of children and adults with respiratory and ocular symptomatology. M. catarrhalis was recovered in 215 samples on the acetazolamide medium, and only. 18 cases in the blood agar medium (p < 0.001). The highest recovery of M. catarrhalis was in samples with an accompanying flora, either pathogenic or commensal, such as pharyngeal and nasal exudates. The prevalence of M. catarrhalis in adults and children was 2% and 28%, respectively. We therefore, recommend the use of the acetazolamide medium for the recovery of M. catarrhalis in samples where M. catarrhalis is expected to be present with an accompanying flora.

[Prevention of viral infections transmitted by semen in volunteer donors for assisted reproduction. 2 years' experience]

During a 2 years period the serological markers of viral infections were evaluated in the semen of 24 donors who were involved in assisted reproduction techniques. The presence of cytomegalovirus, hepatitis B virus and human immunodeficiency virus were investigated. The results were as expected, no data of viral infection at the time of donation being found because the study population was a highly selected one. Taking into account all the known microorganisms that can be transmitted through semen, a protocol for the prevention of infections in the mother and in the prospective newborn is suggested.

Gas-liquid chromatography in routine processing of blood cultures for detecting anaerobic bacteraemia

Gas-liquid chromatography was performed on 233 positive blood cultures and findings were compared with culture results. Obligate anaerobic bacteria were recovered from 78 out of 79 blood cultures containing butyric or iso-valeric acids, or both; from 28 out of 69 blood cultures containing succinic acid; and from only one out of 41 blood cultures containing succinic but not butyric or iso-valeric acid. Good correlations (88%) were found for the recovery of anaerobic bacteria and the detection of butyric and/or iso-valeric acids. Detecting volatile fatty acids by gas-liquid chromatography performed on blood cultures at the first signs of growth can therefore provide an early and reliable indication of the presence of anaerobic bacteria.