A 20-year-old male presented to the Emergency Department with pyrexia, dyspnoea, chest pain and haemoptysis. Cavitating lung lesions were noted on chest X-ray and the patient was admitted to the ...intensive care unit where he was intubated and ventilated. Routine investigations including serial cultures did not provide an aetiological diagnosis. As such, a CT-guided lung biopsy was carried out and 16S rDNA PCR was undertaken on the sample. This identified
Fusobacterium necrophorum
as the causative organism. The patient was treated for Lemierre’s syndrome and successfully discharged from hospital. This case highlights how DNA tissue typing on a lung biopsy sample can be the key to successful diagnosis in an atypical pneumonia and raises the question as to whether this infrequently used approach should be added to forthcoming community acquired pneumonia guidelines.
SUMMARY
We report the case of successful use of cefiderocol (FDC) in a
Carbapenemase Producing K. pneumoniae
(CPKP) post-surgical meningitis in a 44-year-old man treated with antimicrobial therapy ...and external ventricular drainage (EVD). The patient was known for being colonised by CPKP; for this reason, therapy with ceftazidime/avibactam (CZA) plus fosfomycin and linezolid was started. After an initial response a CZA resistant CPKP strain was isolated from CSF culture, so the antibiotic therapy was modified to FDC with trimethoprim/sulfamethoxazole for 14 days, and EVD was replaced. A complete recovery was obtained. This is the first case report describing FDC administration in CPKP meningitis.
We describe three cases of actinomycosis of the head and neck area, clinically suspected to be malignancies, diagnosed by fine-needle aspiration (FNAC). The patients presented with painless, slowly ...growing masses in the cervicofacial area. Ultrasonography identified the masses as enlarged lymph nodes which were subsequently biopsied by FNAC. Cytological features were similar in all cases, with a background of granulocytes and scattered lymphocytes and histiocytes. At high magnification colonies of branching, filamentous and beaded bacteria were detected. In the Diff-Quik–stained smears, these filamentous colonies showed an evident yellowish color with the typical feature of the “sulfur granules” consistent with the Splendore-Hoeppli phenomenon. A diagnosis of actinomycosis was made and confirmed in all cases by the subsequent microbiological tests. The patients were treated with high-dose penicillin, which caused the masses to progressively shrink. The lymph nodal localization of cervico-facial actinomycosis may be a diagnostic challenge, because in that area, lymphadenopathies may occur both in benign and malignant conditions. FNAC is a safe, fast, and reliable method to perform an accurate diagnosis of actinomycosis avoiding the surgical excision for histological evaluation.
Introduction.
The human oral cavity comprises various niches such as teeth, gingiva, tongue, soft and hard palate, and various dental prostheses, all inhabited by different bacterial species. ...Although more than 600 taxa belong to the oral cavity, identifying
Staphylococcus arlettae
, an incompletely understood bacterium, has been rare.
Methods.
Three patients who underwent periodontal flap surgeries were reported with the incidental finding of
S. arlettae
associated with the intra-oral sutures placed. Environmental sampling was performed, to establish the exact source of this bacterium.
Results.
Staphylococcus arlettae
was isolated in three patients’ intra-oral sutures. All environmental samples were negative for the presence of the bacterium.
Conclusion
. To this date, no studies have identified such an occurrence of
Staphylococcus arlettae
with intra-oral sutures. Its identification in association with foreign materials, such as sutures, can be considered a potential for surgical site infections and requires further investigation.
John Malcolm Harrington Watts, Geoff
The Lancet (British edition),
08/2024, Volume:
404, Issue:
10452
Journal Article
Peer reviewed
According to Jon Ayres, Emeritus Professor of Environmental and Respiratory Medicine at the University of Birmingham, this was an act of polite diplomacy. Harrington trained at the then Westminster ...Hospital Medical School in London, UK, graduated in 1966, completed his house jobs, and 3 years later became a lecturer at the TUC Centenary Institute of Occupational Health. Ayres agrees, adding that “Malcolm encouraged the teaching of occupational health through an excellent master's degree course, short courses for occupational health physicians, and education for GPs.”
Introduction.
Kingella kingae
is a Gram-negative micro-organism that is rarely isolated as a pathogen in the adult population. Although widely reported to affect prosthetic heart valves, there have ...been no previously reported cases of
K. kingae
infecting prosthetic joints in adults.
Case Presentation.
A 61-year-old patient with a history of rheumatoid arthritis presented with insidious onset of pain and swelling in her right shoulder, which had progressed to a discharging sinus. The patient had undergone a total shoulder replacement 11 years previously and had not developed any prior post-operative infections. She had been taking anti-TNF medication for 5 years prior to review for her rheumatoid disease. The patient underwent a two-stage revision replacement procedure, including implant removal, sinus excision and debridement. Deep tissue samples grew
K. kingae
post-operatively. The patient was commenced on intravenous ceftriaxone for 14 days, followed by a further 28 days of oral ciprofloxacin. A second-stage custom shoulder replacement was undertaken 10 months following the first stage and the patient made a good functional recovery.
Conclusion.
The authors suggest that clinicians should be attuned to
K. kingae
as a potential pathogen for prosthetic joint infection, particularly in patients who are immunosuppressed. Two-stage revision procedures can ensure a favourable outcome and eradication of this pathogen from the joint. Beta lactams remain the principal antibiotic of choice.
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