Robert C. Kimbrough

Infections Caused by Kluyvera Species in Humans

Kluyvera is a relatively newly described genus in the family Enterobacteriaceae that infrequently causes infections in humans. The organism has been isolated from various clinical specimens, but its significance has not been clearly established. In fact, it has been regarded alternatively as saprophytic, opportunistic, or pathogenic. Since the redefinition of this genus in 1981, case reports of diverse clinical infections occurring under various host conditions have been published. Here we present a critical review of all Kluyvera infections reported in the literature, along with our experience involving 5 additional cases. Most patients received prompt antimicrobial treatment on the basis of susceptibility testing, and overall the clinical outcomes were good. Antimicrobial agents active against most Kluyvera strains include third-generation cephalosporins, fluoroquinolones, and aminoglycosides. In contrast, the resistance to ampicillin, extended-spectrum penicillins, and first- and second-generation cephalosporins is significant. Kluyvera is a potentially virulent pathogen that deserves aggressive treatment designed with an awareness of the organisms antimicrobial resistance patterns.

Organizing Pneumonia and Pulmonary Eosinophilic Infiltration Associated with Daptomycin

Objective: To report a case of organizing pneumonia with pulmonary eosinophilic infiltrates in a patient receiving daptomycin. Case Summary: An 84-year-old man developed bilateral, irregularly shaped nodules and infiltrates in the mid and peripheral lung and multiple mediastinal lymph nodes following treatment with intravenous daptomycin for infection of his left knee prosthesis. His other symptoms included decreased appetite, weight loss (6.8 kg over 4–6 wk), malaise, and generalized weakness after 4 weeks of daptomycin therapy. Transthoracic needle biopsy revealed organizing pneumonia with scattered eosinophils. His symptoms and results of computed tomography (CT) scan improved in the month following discontinuation of daptomycin. The Naranjo probability scale indicated a probable reaction to daptomycin. Discussion: Pulmonary reactions have been reported with numerous drugs and have a wide range of clinical and radiographic presentations. Clinical trials have shown that daptomycin is well tolerated and has an adverse effect profile similar to that of vancomycin and the semisynthetic penicillins. This case report suggests that chronic use of daptomycin caused organizing pneumonia with eosinophilic infiltrates in a patient treated for an infected knee prosthesis. A definite mechanism for this reaction is not known. We speculate that the chronic administration of daptomycin allowed drug accumulation in surfactant in the alveolar spaces. This may result in higher concentrations of drug near the alveolar epithelial surface, which could injure the epithelium, resulting in organizing pneumonia. Conclusions: Development of new pulmonary infiltrates in patients treated with chronic daptomycin therapy should alert healthcare workers to this potential association.

Stability of Single and Combination Antimicrobial Agents in Various Peritoneal Dialysates in the Presence of Insulin and Heparin

The antimicrobial activity of ampicillin, azlocillin, cefotaxime, cephapirin, clindamycin, mezlocillin, nafcillin, piperacillin, tobramycin, and vancomycin was tested in peritoneal dialysate at room temperature for 24 hours and 48 hours. All of the antimicrobial agents were active at 24 hours. The bioactivity of cefotaxime, nafcillin, and vancomycin declined 15% to 20% after 48 hours (P less than 0.001). The addition of heparin or insulin did not affect the activity of any of the study drugs. The combination of cephapirin and tobramycin remained bioactive for 24 hours at room temperature and 35 degrees C. The preparation of drug-dialysate solution every one to two days is feasible for the treatment of peritonitis in patients on continuous ambulatory or continuous cycled peritoneal dialysis.

Salmonella enteritidis brain abscess: case report and review

Intracranial infections are unusual manifestations of salmonellosis. Even with adequate medical and surgical interventions these infections are often associated with significant morbidity and mortality. We report a case of brain abscess caused by Salmonella enteritidis associated with a brain neoplasm and review previous reports in the literature.

Bartonella quintana associated neuroretinitis.

We report an observational case of Bartonella quintana-associated neuroretinitis. The patient had a positive IgM IFA titer for Bartonella quintana early in the disease. After treatment, the neuroretinitis and IgM resolved. Given the patients history, symptoms, response to treatment, and IgM course, we believe his neuroretinitis was secondary to Bartonella quintana.

Fatal infection caused by Francisella tularensis in a neutropenic bone marrow transplant recipient

Abstract.Francisella tularensis is one of the most infectious pathogenic bacteria known. Even though immunity against this organism is thought to be primarily T cell mediated, some evidence suggests that neutrophils may also play an important protective role. We report a case of tularemia in a neutropenic bone marrow transplant recipient that sheds light on the importance of neutrophils in protection against this infection and review clinical aspects of this fascinating infection emphasizing areas of interest for immunocompromised hosts.

Salvage of a prosthetic knee joint infected with resistant pneumococcus. A case report.

Septic arthritis in a native joint is most commonly caused by Staphylococcus aureus, whereas coagulase-negative staphylococcal, streptococcal, and gram-negative organisms are common infections involving joints with prostheses1-3. Streptococcus pneumoniae is an uncommon cause of infection in a total knee joint, and pneumococcal infections resistant to multiple antibiotics are encountered even more rarely. In one study of 3210 total hip replacements, none of the forty-two documented infections were secondary to Streptococcus pneumoniae 4 . Poss et al. reviewed the records on 4240 hip, knee, and elbow replacements performed over a ten-year period and found that only one of fifty-three infections was due to Streptococcus pneumoniae 5 . In reviewing the literature, we were able to find only four case reports involving penicillin-resistant pneumococcal septic arthritis in adults and only one case involving both penicillin and ceftriaxone-resistant Streptococcus pneumoniae in septic arthritis. We describe our management of a patient who was found to have a multidrug-resistant pneumococcal infection in the prosthetic knee joint, and we discuss the treatment strategies for this emerging pathogen. Our patient was informed that data concerning the case would be submitted for publication. Aseventy-three-year-old man with a history of chronic sinusitis and degenerative joint disease in both knees had progressive difficulty in walking secondary to pain in the right knee. In December 2000, he underwent a right total knee arthroplasty. There were no postoperative complications, and he was able to walk comfortably after rehabilitation. In March 2001, he returned to the hospital with a sudden onset of pain, swelling, and an inability …

Haemophilus influenzae osteomyelitis in adults: A report of 4 frontal bone infections and a review of the literature

Haemophilus influenzae occasionally causes hematogenous long-bone osteomyelitis in children. In adults, however, bone infections caused by this organism are extremely rare. We report four adult cases of H. influenzae frontal bone osteomyelitis and review 12 cases from the literature.Haemophilus influenzae occasionally causes hematogenous long-bone osteomyelitis in children. In adults, however, bone infections caused by this organism are extremely rare. We report four adult cases of H. influenzae frontal bone osteomyelitis and review 12 cases from the literature.

Aspergillus terreus endophthalmitis

We report a case of Aspergillus terreus endophthalmitis and review the 4 previously reported cases. Immunosuppression, intravenous drug use, intraocular surgery or trauma, and a compatible clinical picture should raise suspicion of the diagnosis. This species often exhibits resistance to amphotericin B and outcomes are poor despite current therapies.

Novel Swine-Origin (S-OIV) H1N1 Influenza A Pneumonia in a Lung Transplant Patient: A Case Report and Review of the Literature on Performance Characteristics of Rapid Screening Tests for the S-OIV

Rapid screening tests are insensitive for detecting the novel swine-origin influenza A (H1N1) virus (S-OIV), and false negatives can delay the diagnosis and initiation of appropriate antiviral therapy. The case of a 26-year-old double lung transplant recipient presenting with fever, bilateral pulmonary infiltrates, and a negative influenza direct immunofluorescent antibody on bronchoalveolar lavage is presented. A diagnosis was made, and antiviral therapy was started 10 days after the initial bronchoalveolar lavage on receipt of a positive culture for S-OIV. The published literature on the performance characteristics of rapid screening tests for S-OIV is reviewed in this clinical context.