Aggregatibacter actinomycetemcomitans pneumonia mimicking lung cancer in a previously healthy 12-year-old child from Saudi Arabia: a case report

Aggregatibacter actinomycetemcomitans formely known as Actinobacillus actinomycetemcomitans is a known part of the normal oral flora. It can sometimes cause oral or rarely extra-oral infections secondary to hematogenous extension or aspiration. It is a rare cause of invasive pneumonia. It can resemble tuberculosis or lung cancer in its presentation. Making the diagnosis in such case is crucial for better management that usually require tissue biopsy. We report a case of Aggregatibacter actinomycetemcomitans invasive pneumonia in a 12-year-old previously healthy boy from Saudi Arabia. After a prolonged course of antibiotics, clinical and radiological follow up showed complete resolution of the infection.

The First Known Case of Liver Abscess Caused by Aggregatibacter aphrophilus in Japan

A 48-year-old man presented with a sustained fever. Abdominal computed tomography revealed multilocular liver abscesses. He underwent percutaneous needle aspiration, yielding straw-colored pus. Gram staining revealed Gram-negative coccobacilli. The organism grew only on chocolate II agar in a 7% carbon dioxide atmosphere. Identification of Aggregatibacter aphrophilus was confirmed using mass spectrometry and 16S rRNA gene sequencing. He was successfully treated with antibiotics. Liver abscess caused by A. aphrophilus is extremely rare. We herein report the first such case in Japan. Even fastidious organisms, such as A. aphrophilus, should be correctly identified using mass spectrometry or 16S rRNA gene sequencing for adequate treatment.

Clinical disease and lung lesions in calves experimentally inoculated with Histophilus somni five days after metaphylactic administration of tildipirosin or tulathromycin

OBJECTIVE

To compare clinical disease and lung lesions in calves experimentally inoculated with Histophilus somni 5 days after metaphylactic administration of tildipirosin or tulathromycin. ANIMALS Twenty-four 3-month-old Holstein and Holstein-crossbreed steers.

PROCEDURES

Calves were randomly allocated to 3 groups of 8 calves. On day 0, calves in group 1 received tildipirosin (4 mg/kg, SC), calves in group 2 received tulathromycin (2.5 mg/kg, SC), and calves in group 3 received isotonic saline (0.9% NaCl) solution (1 mL/45 kg, SC; control). On day 5, calves were inoculated with 10 mL of a solution containing H somni strain 7735 (1.6 × 10(9) CFUs/mL, intrabronchially; challenge). Calves were clinically evaluated on days 5 through 8 and euthanized on day 8. The lungs were grossly evaluated for evidence of pneumonia, and bronchial secretion samples underwent bacteriologic culture.

RESULTS

The mean clinical score for each group was significantly increased 12 hours after challenge, compared with that immediately before challenge, and was significantly lower for tildipirosin-treated calves on days 6, 7, and 8, compared with those for tulathromycin-treated and control calves. The mean percentage of lung consolidation for tildipirosin-treated calves was significantly lower than those for tulathromycin-treated and control calves. Histophilus somni was isolated from the bronchial secretions of some tulathromycin-treated and control calves but was not isolated from tildipirosin-treated calves.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that metaphylactic administration of tildipirosin to calves 5 days prior to H somni challenge prevented subsequent culture of the pathogen from bronchial secretions and was more effective in minimizing clinical disease and lung lesions than was metaphylactic administration of tulathromycin.

Clinical and microbiological effects of levofloxacin in the treatment of Aggregatibacter actinomycetemcomitans-associated periodontitis: a randomized placebo-controlled clinical trial

AIM

To evaluate the clinical and microbiological effects of systemic levofloxacin (LFX) in subjects with Aggregatibacter actinomycetemcomitans-associated chronic periodontitis (AA-ACP).

MATERIALS AND METHODS

Subjects with severe periodontitis with subgingival detection of A. actinomycetemcomitans were randomly divided into two treatment groups; a test group (n = 35) that received scaling and root planing (SRP) and LFX (500 mg o.d.) and a control group (n = 34) that received SRP and placebo (o.d.) for 10 days. Plaque index (PI), gingival index (GI), percent of sites with bleeding on probing (% BoP), probing depth (PD) and clinical attachment level (CAL) were recorded and subgingival plaque samples were cultivated for detection of A. actinomycetemcomitans at baseline to 6 months at various intervals.

RESULTS

Subjects receiving LFX showed the greatest improvements in mean PD and CAL. The difference in the reduction of PD and CAL in the two groups was significant at 1, 3 and 6 months for PD and 3 and 6 months for CAL (p < 0.05). The inter-group difference in PI, GI and % BoP was not significant at any interval. Detectable levels of A. actinomycetemcomitans were significantly less in the test group 3 and 6 months post-therapy.

CONCLUSION

Systemic LFX as an adjunct to SRP improves clinical outcomes and suppresses A. actinomycetemcomitans below detectable levels.

HACEK-induced endocarditis

A 61-year-old patient with diabetes had a bio-prosthetic aortic valve replacement 3 years before admission. He complained of lethargy, night sweats, decreased appetite and erratic blood glucose with no weight loss. He had splinter haemorrhage and a systolic ejection murmur at the aortic area. Chest and abdominal examination revealed no abnormality. The erythrocyte sedimentation rate and C reactive protein were raised. He had several sets of blood cultures and he was started on empirical vancomycin, rifampicin and gentamicin. Transthoracic echocardiography showed vegetation on the base of the anterior mitral leaflet, which was confirmed by a trans-oesophageal echocardiography. Blood culture was positive for Haemophilus aphrophilus, and he was started on ceftriaxone for 6 weeks instead of vancomycin and rifampicin and continued gentamicin for 2 weeks. Follow-up echocardiography showed no evidence of vegetations. The patient recovered completely and he was discharged home.

Dose-response met-RANTES treatment of experimental periodontitis: a narrow edge between the disease severity attenuation and infection control

Chemokines and chemokine receptors have been implicated in the selective migration of leukocyte subsets to periodontal tissues, which consequently influences the disease outcome. Among these chemoattractants, the chemokines CCL3, CCL4 and CCL5 and its receptors, CCR1 and CCR5, have been associated with increased disease severity in mice and humans. Therefore, in this study we investigated the modulation of experimental periodontitis outcome by the treatment with a specific antagonist of CCR1 and 5 receptors, called met-RANTES. C57Bl/6 mice was orally infected with Aggregatibacter actinomycetemcomitans and treated with 0.05, 0.1, 0.5, 1.5 and 5 mg doses of met-RANTES on alternate days, and evaluated by morphometric, cellular, enzymatic and molecular methods. At 0.5 mg up to 5 mg doses, a strong reduction in the alveolar bone loss and inflammatory cell migration were observed. Interestingly, 5 mg dose treatment resulted in the maximum inhibition of inflammatory cell migration, but resulted in a similar inhibition of bone loss when compared with the lower doses, and also resulted in increased bacterial load and CRP response. When 0.5 and 5 mg therapy regimens were compared it was observed that both therapeutic protocols were able to downregulate the levels of pro-inflammatory, Th1-type and osteoclastogenic cytokines, and CD3+ and F4/80+ cells migration to periodontal tissues, but the high dose modulates host response in a more pronounced and unspecific and excessive way, interfering also with the production of antimicrobial mediators such as MPO, iNOS and IgG, and with GR1+ and CD19+ cells migration. Our results demonstrate a thin line between beneficial immunoregulation and impaired host defense during experimental periodontitis, and the determination of the exact equilibrium point is mandatory for the improvement of immune-targeted therapy of periodontitis.

A Case of Pasteurella haemolytica Sepsis in a Patient with Mitral Valve Disease who Developed a Splenic Abscess

We report a patient with sepsis caused by Pasteurella haemolytica, an extremely rare etiologic agent of human infection, who had mitral valve disease and developed a splenic abscess.

Detection of tetracycline-resistant and susceptible pasteurellaceae in the nasopharynx of loose group-housed calves

The aim of the present study was to determine which Pasteurella and Mannheimia species are present in the upper respiratory tract of healthy calves with no history of antimicrobial treatment prior to sampling. The presence of subpopulations of tetracycline-resistant Pasteurellaceae was also investigated. Nasal swabs from 61 loose group-housed, clinically healthy calves, 1 to 4 months old, from 16 dairy herds were inoculated aerobically on a selective medium (Columbia agar with 5% ovine blood and 16 mg/L bacitracin) with or without 4 mg/L oxytetracycline (OTC). A total of 43 strains belonging to the family Pasteurellaceae were isolated from 38 calves (62.3%) out of 13 herds (81.3%). The predominant organisms were Pasteurella multocida subsp. multocida (57.4%), Mannheimia varigena (4.9%) and M. haemolytica (3.2%). Growth of Pasteurellaceae on the OTC-containing medium was seen only with samples from two herds (6 animals; 9.8%), and on only one farm this proved to be an OTC-resistant subpopulation. Minimum inhibitory concentration (MIC) determinations by means of agar dilution confirmed a low prevalence of OTC-resistant Pasteurellaceae, with overall MIC(50) and MIC(90) values of 0.25 and 32 mg/L, respectively. These data do not support the hypothesis that the relative high frequency of tetracycline-resistant P. multocida isolates from fatal cases of bovine respiratory disease is related to the presence of minor tetracycline-resistance subpopulations within this species.

Antimicrobial susceptibility patterns of respiratory tract pathogens from sheep and goats

OBJECTIVE

To determine the antimicrobial susceptibility of common respiratory tract pathogens from sheep and goats.

DESIGN

Cross-sectional study.

SAMPLE POPULATION

41 respiratory tract isolates from sheep and 36 isolates from goats.

PROCEDURES

Disk diffusion assay was used to determine antimicrobial susceptibility of isolates to amoxicillin-clavulanic acid, ceftiofur, ciprofloxacin, florfenicol, and tetracycline. Minimum inhibitory concentrations of florfenicol for these isolates were determined by use of the microbroth dilution technique.

RESULTS

The most common isolates were Pasteurella multocida (n = 28) and Mannheimia haemolytica (39). All isolates were susceptible to amoxicillin-clavulanic acid, ceftiofur, ciprofloxacin, and florfenicol. Five percent (4/77) of isolates were resistant to tetracycline.

CONCLUSIONS AND CLINICAL RELEVANCE

Susceptibility of respiratory tract pathogens isolated from sheep and goats to commonly used antimicrobial drugs in this study was high. Treatment of these species for bacterial respiratory tract disease is likely not complicated by antimicrobial resistance.

A tissue cage model in calves for studies on pharmacokinetic/pharmacodynamic interactions of antimicrobials

An in vivo model for studies of pharmacokinetic/pharmacodynamic (PK/PD) interactions of antimicrobials was developed. Tissue cages with a constant surface area but with different volumes were implanted in calves and infected with Mannheimia haemolytica. Penicillin was injected directly into the cages. With this procedure, different concentration-time profiles could be simulated so that the effect of a range of PK/PD indices on the infection could be monitored. The area under the curve to minimum inhibitory concentration (MIC) and time above MIC were equally predictive for effect, but Cmax to MIC was not. If drug dosages in relation to the MIC of strains used for infection are optimised, the model offers an interesting alternative to explore relevant factors for drug dosage optimisation.

Pharmacokinetic/pharmacodynamic relationship of danofloxacin against Mannheimia haemolytica in a tissue-cage model in calves

OBJECTIVE

To evaluate an experimental model of the pharmacokinetic/pharmacodynamic (PK/PD) relationship of danofloxacin against Mannheimia haemolytica infection, using subcutaneously implanted tissue cages in calves.

METHODS

Tissue cages implanted subcutaneously in calves were infected with M. haemolytica and different concentration-time profiles of danofloxacin were simulated. Drug concentrations and bacterial counts were monitored over time and various PK/PD parameters calculated.

RESULTS

By using different types of cage and various doses, a range of PK/PD indices were simulated. The PK/PD index that best predicted the antimicrobial effect was the AUC/MIC ratio. The magnitude of this index needed for near-maximum effect (80%), assessed using the area under the bacterial kill curve to 48 h, was 244 h.

CONCLUSIONS

The model described enabled different concentration-time profiles to be simulated, and PK/PD interactions to be studied in the presence of the host's defences. The validity of this model needs to be confirmed by clinical studies, but the results suggest that it may be a useful intermediary step between in vitro and clinical studies.

Effects of tilmicosin phosphate, administered prior to transport or at time of arrival, and feeding of chlortetracycline, after arrival in a feedlot, on Mannheimia haemolytica in nasal secretions of transported steers

OBJECTIVE

To determine effects of time of administration of tilmicosin and feeding of chlortetracycline on colonization of the nasopharynx of transported cattle by Mannheimia haemolytica (MH).

ANIMALS

454 steers (body weight, 200 kg).

PROCEDURE

3 studies included 4 truckloads of steers assembled and processed in the southeastern United States. For each truckload of steers, a third received tilmicosin before transportation (PRIOR), then all were transported to a feedlot in New Mexico (23 hours). At arrival (day 0), another third received tilmicosin (ARR). The remaining third did not receive tilmicosin (control steers [CTR]). Steers in studies 1 and 2 were housed in a feedlot, and steers in study 3 were housed on wheat pasture. One half of the steers from each group in studies 2 and 3 were fed chlortetracycline on days 5 to 9. Steer with signs of respiratory tract disease were treated. Nasal swab specimens were examined for MH to determine colonization.

RESULTS

PRIOR and ARR steers had a lower incidence of respiratory tract disease and MH colonization than CTR steers, but PRIOR and ARR steers did not differ. Feeding chlortetracycline did not have an effect.

CONCLUSIONS AND CLINICAL RELEVANCE

Tilmicosin can inhibit MH from colonizing the nasopharynx of cattle. Because tilmicosin inhibits the growth of MH in the respiratory tract, medication with tilmicosin prior to transport should reduce the incidence of acute respiratory tract disease during the first week at the feedlot when calves are most susceptible to infectious organisms.