Archive for October 8, 2016

A Case of Septic Arthritis of the Shoulder Due to Yersinia enterocolitica with Review of the Literature.

Open Forum Infect Dis. 2014 Aug 2;1(2):ofu054.

Chan J1, Gandhi RT1.

Author information

1Infectious Diseases Division , Massachusetts General Hospital , Boston, MA.


Yersinia enterocolitica infection rarely can cause extra-intestinal infections.

We present a case of septic arthritis of the shoulder due to this organism in an elderly man with liver and cardiac disease.

We review previously published cases of Y. enterocolitica septic arthritis, and discuss risk factors and management.


October 8, 2016 at 6:13 pm

Primary cellulitis and cutaneous abscess caused by Yersinia enterocolitica in an immunocompetent host: A case report and literature review.

Medicine (Baltimore). 2016 Jun;95(26):e3988.

Kato H1, Sasaki S, Sekiya N.

Author information

1Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.


Primary extraintestinal complications caused by Yersinia enterocolitica are extremely rare, especially in the form of skin and soft-tissue manifestations, and little is known about their clinical characteristics and treatments.

We presented our case and reviewed past cases of primary skin and soft-tissue infections caused by Y enterocolitica. We report a case of primary cellulitis and cutaneous abscess caused by Y enterocolitica in an immunocompetent 70-year-old woman with keratodermia tylodes palmaris progressiva.

She presented to an outpatient clinic with redness, swelling, and pain of the left ring finger and left upper arm without fever or gastrointestinal symptoms 3 days before admission.

One day later, ulceration of the skin with exposed bone of the proximal interphalangeal joint of the left ring finger developed, and cefditoren pivoxil was described. However, she was admitted to our hospital due to deterioration of symptoms involving the left finger and upper arm.

Cefazolin was initiated on admission, then changed to sulbactam/ampicillin and vancomycin with debridement of the left ring finger and drainage of the left upper arm abscess. Wound culture grew Y enterocolitica serotype O:8 and methicillin-sensitive Staphylococcus aureus. Blood cultures were negative and osteomyelitis was ruled out. Vancomycin was switched to ciprofloxacin, then skin and soft-tissue manifestations showed clear improvement within a few days.

The patient received 14 days of ciprofloxacin and oral amoxicillin/clavulanate and has since shown no recurrence. We reviewed 12 cases of primary skin and soft-tissue infections caused by Y enterocolitica from the literature. In several past cases, portal entry involved failure of the skin barrier on distal body parts.

Thereafter, infection might have spread to the regional lymph nodes from the ruptured skin. Y enterocolitica is typically resistant to aminopenicillins and narrow-spectrum cephalosporins. In most cases, these inefficient antibiotic agents were initially prescribed, but patient conditions rapidly improved after implementing appropriate therapy and drainage.

In addition, primary skin and soft-tissue infections occurred even in patients lacking risk factors. Physicians should consider the rare differential diagnosis of Y enterocolitica infection when seeing patients with deteriorating skin lesions under standard treatment, even if the patient is immunocompetent


October 8, 2016 at 6:11 pm

Kluyvera ascorbata bacteremia in an adult patient.

Rev Esp Quimioter. 2013 Sep;26(3):226-7.

[Article in Spanish]

López-Larramona G1, Gómez-de-Oña E, Maestre-Muñiz MM, Ruiz-Chicote AM, Galán-Dorado E, González-Delgado L.

Author information

1Germán López-Larramona, Servicio de Medicina Interna. Hospital General de Tomelloso, Vereda de Socuéllamos s/n. 13700 Tomelloso (Ciudad Real), Spain


October 8, 2016 at 6:10 pm

Nosocomial bacteremia due to Kluyvera cryocrescens: Case report and literature review.

IDCases. 2016 Mar 4;4:24-6.

Yoshino Y1, Nakazawa S2, Otani S2, Sekizuka E2, Ota Y3.

Author information

1Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan; Department of Internal Medicine, Saitama National Hospital, 2-1, Suwa, Wako, Saitama 351-0102, Japan.

2Department of Internal Medicine, Saitama National Hospital, 2-1, Suwa, Wako, Saitama 351-0102, Japan.

3Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan.


Kluyvera cryocrescens infection has been considered rare; clinical features of K. cryocrescens bacteremia remain unclear because few reports have been published.

We report a case of K. cryocrescens bacteremia in an adult male patient and review the literature. Our case was one with nosocomial bacteremia in a patient with interstitial lung disease.

The primary infection site was undetermined, although he had an indwelling peripheral intravenous catheter and a urinary catheter. Piperacilin/tazobactam was administered for 2 weeks and the bacteremia resolved.

Unfortunately, there was acute exacerbation of the interstitial lung disease, which was fatal. According to our review, including our case, K. cryocrescens bacteremia tends to occur in immunocompromised hosts, and indwelling catheters might be risk factors.

Extended spectrum cephalosporins, carbapenems, fluoroquinolones and tetracyclines are generally adequate agents for empiric therapy based on susceptibilities of K. cryocrescens clinical isolates.


October 8, 2016 at 6:09 pm

Early Response in Cellulitis: A Prospective Study of Dynamics and Predictors

Clinical Infectious Diseases October 15, 2016 V.63 N.8 P.1034-1041

Trond Bruun, Oddvar Oppegaard, Karl Ove Hufthammer, Nina Langeland, and Steinar Skrede

1Department of Clinical Science, University of Bergen

2Department of Medicine

3Centre for Clinical Research

4National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway


Skin and soft tissue infections are common reasons for medical care. Use of broad-spectrum therapy and costs have increased. Assessment of early treatment response has been given a central role both in clinical trials and everyday practice. However, there is a paucity of data on the dynamics of response, causes of early nonresponse, and how early nonresponse affects resource use and predicts outcome.


We prospectively enrolled 216 patients hospitalized with cellulitis. Clinical and biochemical response data during the first 3 days of treatment were analyzed in relation to baseline factors, antibiotic use, surgery, and outcome. Multivariable analysis included logistic lasso regression.


Clinical or biochemical response was observed in the majority of patients the day after treatment initiation. Concordance between clinical and biochemical response was strongest at days 2 and 3. Female sex, cardiovascular disease, higher body mass index, shorter duration of symptoms, and cellulitis other than typical erysipelas were predictors of nonresponse at day 3. In contrast, baseline factors were not predictive of clinical failure assessed posttreatment. Among cases with antibiotic treatment escalation by day 2, 90% (37/41) had nonresponse at day 1, but only 5% (2/40) had inappropriate initial therapy. Nonresponse at day 3 was a predictor of treatment duration >14 days, but not of clinical failure.


Nonpharmacological factors had a major impact on early response dynamics. Delayed response was rarely related to inappropriate therapy but strongly predictive of early treatment escalation, suggesting that broadening antibiotic treatment may often be premature.


October 8, 2016 at 5:51 pm

Safety Profile of Nifurtimox for Treatment of Chagas Disease in the United States

Clinical Infectious Diseases October 15, 2016 V.63 N.8 P.1056-1062

Colin J. Forsyth, Salvador Hernandez, Wilman Olmedo, Adieb Abuhamidah, Mahmoud I. Traina, Daniel R. Sanchez, Jonathan Soverow, and Sheba K. Meymandi

Center of Excellence for Chagas Disease, Olive View–University of California, Los Angeles Medical Center, Sylmar


Nifurtimox is 1 of only 2 medications available for treating Chagas disease (CD) and currently the only drug available in the United States, but its safety and tolerance have not been extensively studied. This is the first study to evaluate tolerance of nifurtimox in US patients with CD.


This investigation assessed side effects in a sample of 53 patients with CD, all Latin American immigrants, who underwent treatment with nifurtimox (8–10 mg/kg in 3 daily doses for 12 weeks) from March 2008 to July 2012. The frequency and severity of adverse events (AEs) was recorded.


A total of 435 AEs were recorded; 93.8% were mild, 3.0% moderate, and 3.2% severe. Patients experienced a mean of 8.2 AEs; the most frequent were anorexia (79.2%), nausea (75.5%), headache (60.4%), amnesia (58.5%), and >5% weight loss (52.8%). Eleven patients (20.8%) were unable to complete treatment. Experiencing a moderate or severe AE (odds ratio [OR], 3.82; P < .05) and Mexican nationality (OR, 2.29; P < .05) were significant predictors of treatment discontinuation, but sex and cardiac progression at baseline were not. Patients who did not complete treatment experienced nearly 3 times more AEs per 30-day period (P = .05).


Nifurtimox produces frequent side effects, but the majority are mild and can be managed with dose reduction and/or temporary suspension of medication. The high frequency of gastrointestinal symptoms and weight loss mirrors results from prior investigations. Special attention should be paid during the early stages of treatment to potentially severe symptoms including depression, rash, and anxiety.


October 8, 2016 at 5:50 pm

Spondylodiscitis and bacteremia due to Staphylococcus hyicus in an immunocompetent man.

Germs. 2016 Sep 1;6(3):106-10.

Foissac M1, Lekaditi M2, Loutfi B3, Ehrhart A4, Dauchy FA5.

Author information

1MD, Department of Infectious Diseases, Centre Hospitalier Layné, Mont de Marsan, France.

2Department of Pediatrics and Neonatal Intensive Care Unit, Centre Hospitalo-Universitaire Necker Enfants Malades, Paris, France.

3MD, Department of Microbiology, Centre Hospitalier Layné, Mont de Marsan, France.

4MD, Department of Rheumatology, Centre Hospitalier Layné, Mont de Marsan, France.

5MD, Department of Infectious Diseases, Centre Hospitalo-Universitaire de Bordeaux, Groupe hospitalier Pellegrin, Bordeaux, France.



Staphylococcus hyicus is a coagulase-variable Staphylococcus spp. well-known by veterinarians since it is the major agent of a severe cutaneous infection in piglets called exudative epidermitis.

In other species the symptoms of infection are quite different.

Human cases are uncommon but seem to occur more frequently after repeated contacts with farm animals.


We report the case of a 58-year-old man suffering from debilitating subacute lumbar pain, in whom diagnosis of infectious spondylodiscitis was based on spine MRI and positive microbiological results. A strain of S. hyicus was surprisingly isolated from blood cultures and bone biopsy. Identification was confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS, Bruker, USA), and the patient was successfully cured with a six-week course of anti-staphylococcal antibiotic regimen.


The prevalence of S. hyicus in human clinical samples is very low, but may be underestimated. This pathogen may enter the bloodstream through a skin injury, and then induce various pyogenic manifestations in people working with farm animals.

S. hyicus exfoliative toxins, responsible for dermatological lesions in piglets, seem unable to damage the human epidermis, explaining the absence of cutaneous blisters in the previously reported cases.

Precise data about its pathogenicity in humans and the adequate therapy are lacking.


October 8, 2016 at 9:11 am

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