Gabriel Weber

An Outbreak of Streptococcus pneumoniae Serotype 1 in a Closed Community in Southern Israel

An outbreak of Streptococcus pneumoniae serotype 1 occurred in a closed community that was characterized by poverty and crowding. Vaccine was administered to individuals aged >2 years; no new cases occurred among vaccine recipients. Six weeks after vaccination, carriage of serotype 1, but not of other serotypes, decreased 8.8-fold. This suggests that the reduction in serotype 1 carriage reflects the natural course of the outbreak rather than a vaccine effect. Polysaccharide vaccine may be helpful in terminating pneumococcal outbreaks but may not affect pneumococcal carriage.

Meningitis following spinal anesthesia: 6 cases in 5 years.

We describe 6 cases of meningitis after spinal anesthesia associated with a single anesthesiologist over the course of 5 years. The earliest case occurred in 2000, and the other 5 cases occurred over the course of 14 months in 2004-2005. The case identified in 2000 was culture-positive for Streptococcus salivarius. The other 5 cases were culture-negative for this organism but in 2 cases, the cerebrospinal fluid was found to be positive for bacterial DNA that was identified as belonging to S. salivarius by sequencing of the 16S rRNA gene. The association with a single anesthesiologist and a single hospital during a relatively short interval, however, lead us to believe that these occurrences are part of a series associated with possible violations of aseptic technique.

Massive pumonary haemorrhage caused by leptospirosis successfully treated with nitric oxide inhalation and haemofiltration

A patient with leptospirosis who developed oliguric renal failure, massive pulmonary haemorrhage and respiratory failure is described. The patients clinical condition and arterial oxygenation failed to improve despite vigorous supportive measures. Nitric oxide inhalation and haemofiltration resulted in a marked clinical improvement and subsequent full recovery. We suggest that the addition of haemofiltration and nitric oxide inhalation therapy should be considered in patients with pulmonary haemorrhage and renal failure caused by leptospirosis, in whom conventional therapy fails.

Acremonium Vertebral Osteomyelitis: Molecular Diagnosis and Response to Voriconazole

We present a case of Acremonium vertebral osteomyelitis that relapsed despite surgical debridement and prolonged treatment with liposomal amphotericin B, but which responded to voriconazole therapy. The report highlights the role of molecular diagnosis of rare fungal osteomyelitis. The patient was successfully treated with voriconazole.

Incidence and clinical significance of bacteremia and sepsis among cardiac patients treated with intra-aortic balloon counterpulsation pump

In this prospective study, a significant incidence of fever (47%), true bacteremia (15%), and sepsis (12%), were found in 60 cardiac patients treated with an intra-aortic balloon counterpulsation pump. The benefit of antibiotic prophylaxis in this setting should therefore be evaluated.

Pleural Empyema Caused by Leuconostoc spp.

A rare case of pleural empyema caused by Leuconostoc spp. is reported. The patient was treated successfully with clindamycin. To our knowledge this is the first reported case of pleural empyema caused by Leuconostoc spp. In a patient with characteristic predisposing factors, such as a serious underlying disease, previous vancomycin therapy and thoracic access device. Our case illustrates that Leuconostoc spp. can cause pleural infection as further evidence of its human pathogenicity.

Infective endocarditis due to Fusobacterium nucleatum in an intravenous drug abuser.

Abstract Infective endocarditis due to anaerobic non-spore-forming gram-negative bacilli in intravenous drug abusers is exceedingly rare, with only two cases being previously reported in the literature. A case of endocarditis due to Fusobacterium nucleatum in an intravenous drug abuser is reported, accompanied by a review of the literature.

Initial Effects of the National PCV7 Childhood Immunization Program on Adult Invasive Pneumococcal Disease in Israel

Background PCV7 was introduced as universal childhood vaccination in Israel in July 2009 and PCV13 in November 2010. Here we report data on adult invasive pneumococcal disease (IPD), two years post PCV7 implementation and before an expected effect of PCV13. Methods An ongoing nationwide active-surveillance (all 27 laboratories performing blood cultures in Israel), providing all blood & CSF S. pneumoniae isolates from persons >18 y was initiated in July 2009. Capture-recapture method assured reporting of >95% cases. All isolates were serotyped in one central laboratory. IPD outcome and medical history were recorded in 90%. Second year post PCV implementation is compared to the first year. Results During July 2009 to June 2011, 970 IPD cases were reported (annual incidence [/100,000] of 9.17 and 10.16 in the two consecutive years, respectively). Respective case fatality rates (CFRs) were 20% and 19.1%. Incidence of IPD and CFR increased with age and number of comorbidities. Incidence rate was significantly greater during the second winter, 7.79/100,000 vs. 6.14/100,000 in first winter, p = 0.004, with a non-significant decrease during summer months (3.02 to 2.48/100,000). The proportion of IPD cases due to PCV7-serotypes decreased from 27.5% to 13.1% (first to second year) (p<0.001). Yet, non-PCV13-strains increased from 32.7% to 40.2% (p = 0.017). The increase in non-PCV13-strains was highly significant in immunocompromised patients and to a lesser degree in non-immunocompromised at risk or in older patients (>64 y). Among younger/healthier patients serotype 5 was the major increasing serotype. Penicillin and ceftriaxone resistance decreased significantly in the second year. Conclusions While overall annual incidence of IPD did not change, the indirect effect of PCV7 vaccination was evident by the significant decrease in PCV7 serotypes across all age groups. Increase in non-VT13 strains was significant in immunocompromised patients. A longer follow-up is required to appreciate the full effect of infant vaccination on annual IPD.

Septic arthritis due to bacteroides fragilis after pilonidal sinus resection in a patient with rheumatoid arthritis.

SummaryBacteroides fragilis is a rare cause of septic arthritis. Most patients with B.fragilis septic arthritis have a chronic joint disease, particularly rheumatoid arthritis, and sources of infection are lesions of the gastrointestinal tract and the skin. We report a 69-year-old male, who developed B.fragilis septic arthritis after pilonidal sinus resection. High level of suspicion of development B.fragilis septic arthritis must be present in patients with chronic joint disease in whom gastrointestinal or skin surgery was previously performed.