Staphylococcus lugdunensis endocarditis.

Staphylococcus lugdunensis is a recently described coagulase-negative species which has been associated with human infections, including infective endocarditis. A case of native valve endocarditis caused by this organism is described. The initial laboratory detection of S. lugdunensis is facilitated by a positive test for ornithine decarboxylase. The identification of such isolates should not cause difficulty unless undue reliance is placed upon a small number of tests.     

Staphylococcus lugdunensis endocarditis with isolated tricuspid valve involvement

Staphylococcus lugdunensis is often misidentified as S aureus and as a rare cause of infective endocarditis. The clinical course of S lugdunensis endocarditis is aggressive and the mortality rate is high in contrast to S epidermidis endocarditis. Most reported cases of S lugdunensis endocarditis have involved mitral or aortic valves. Herein, we present a case with isolated tricuspid endocarditis due to S lugdunensis.     

Molecular identification of Staphylococcus lugdunensis in a patient with meningitis

A 12-year-old child developed meningitis 6 days after a third ventriculostomy by endoscopy. A coagulase-negative Staphylococcus sp. was isolated in pure culture from the cerebrospinal fluid and was definitely identified as Staphylococcus lugdunensis after the 16S ribosomal DNA gene and rpoB gene were sequenced. This report describes the first case of S. lugdunensis meningitis.     

Three cases of destructive native valve endocarditis caused by Staphylococcus lugdunensis

Described here are three cases of acute native valve endocarditis due to the coagulase-negative pathogen Staphylococcus lugdunensis with serious complications. Two of the three patients died despite optimal antibiotic therapy and cardiovascular surgery. These cases demonstrate the aggressive nature of S. lugdunensis and emphasize the importance of identifying coagulase-negative staphylococci to the species level and not considering the isolation of S. lugdunensis from normally sterile body fluids as contamination. On the contrary, when this organism is found in patients with endocarditis, early surgery should be considered. The possibility that this organism could be misidentified as S. aureus because of autocoagulation and that commercial identification systems may misidentify it as S. haemolyticus, S. hominis or S. warneri should also be remembered.     

Fatal myocardial necrosis caused by Staphylococcus lugdunensis and cytomegalovirus in a patient with scleroderma

A 42-year-old woman developed a rapidly progressing fatal heart failure. At the autopsy extensive necrosis of the myocardium was seen, with an almost complete absence of inflammatory cells and the presence of bacterial structures identified as Staphylococcus lugdunensis by PCR. In addition, the cytomegalovirus genome was found to be located inside the cardiomyocytes.     

Frequency of isolation of Staphylococcus lugdunensis among staphylococcal isolates causing endocarditis: a 20-year experience

Eighty-nine staphylococcal isolates recovered from patients with bacterial endocarditis at the Mayo Clinic from 1980 to 1999 were studied to determine the prevalence of Staphylococcus lugdunensis among clinical isolates of staphylococci causing endocarditis. Four isolates, all from patients with native mitral valve endocarditis, were identified as S. lugdunensis.     

Nocardia brain abscess in a diabetic patient

Brain abscess due to disseminated nocardia infection is an acute medical emergency among immunocompromised patients. We report a case of rapidly progressive nocardia brain abscess in an apparently healthy diabetic individual. The close similarity of the radiological features with those of malignancy and tuberculosis may delay the diagnosis of central nervous system (CNS) nocardiosis. A high index of suspicion and early intervention like stereotactic brain biopsy remain the cornerstone to increase the chance of positive clinical outcome.     

Splenic abscess associated with endocarditis in a patient on hemodialysis: a case report

Splenic abscess is an unusual condition usually seen in immunocompromised patients or associated with intravenous drug abuses. Several conditions including trauma, immunodeficiency, corticosteroid and/or immunosuppressive therapy and diabetes mellitus have been listed under the predisposing factors for a splenic abscess. Splenic abscess in a patient on hemodialysis is a rare but life-threatening condition if not corrected. We describe a case of splenic abscess with bacterial endocarditis on maintenance hemodialysis. He had staphylococcal septicemia secondary to bacterial endocarditis at the mitral valve from the dialysis access-site infection. Although hematologic seeding from endocarditis has been the predisposing factor for splenic abscess, we postulate that access-site infections may predispose hemodialysis patients to splenic abscess. Splenic abscess may be considered as one of the causes when patients on hemodialysis develop unexplained fever.     

Prostatic abscess by Staphylococcus aureus in a diabetic patient

Prostatic abscess is uncommon and difficult to diagnose because the clinical presentation may mimic symptoms of lower urinary tract infection. We report here a case of prostatic abscess in a 50-year-old known diabetic male patient, who presented with urinary retention. Clinical diagnosis was done by clinical presentation and ultrasonography. The causative agents i.e., Staphylococcus aureus was isolated from the aspirate and the patient responded to intravenous Ciprofloxacin therapy. No other surgical intervention was required to treat the patient.     

Immune response to Bacteroides ureolyticus in a patient with brain abscess

A high titer (1:256) of agglutinating antibodies against Bacteroides ureolyticus was demonstrated in a 35-year-old woman with brain abscess, using a microagglutination test. Tests done with B. ureolyticus and heterologous sera as well as with heterologous strains and the patient's serum were negative. Circulating antibody to B. ureolyticus has not been reported previously.     

Staphylococcus lugdunensis endocarditis following vasectomy – report of a case history and review of the literature

Staphylococcus lugdunensis is a coagulase‐negative Staphylococcus (CoNS), and part of the normal skin flora. The bacterium is an emerging pathogen that, unlike other CoNS, resembles coagulase‐positive Staphylococcus aureus infections in virulence, tissue destruction, and clinical course. We report a fatal case following minor surgery. The frequency of S. lugdunensis infections has probably been underestimated and under‐reported in the past as few clinical laboratories routinely identify coagulase‐negative Staphylococci.     

Rhodococcus equi brain abscess in a patient without HIV

Rhodococcus equi, a Gram positive organism, is a cause of infections in immunocompromised individuals. In humans, it mainly causes disease in those infected with human immunodeficiency virus (HIV), and generally presents as chronic pulmonary infection. It may also cause intracranial infections, which manifest as brain abscesses. This report describes a case of rhodococcus brain and pulmonary infection in a patient who did not have HIV or another disorder of cell mediated immunity. He was treated with intravenous imipenem, vancomycin, and rifampin for eight weeks and recovered from the infection.     

Community-acquired methicillin-resistant Staphylococcus aureus liver abscess in a patient with end-stage renal disease.

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are an emerging problem. Although most liver abscesses are caused by Escherichia coli and Klebsiella pneumoniae, S. aureus can occasionally be isolated as the pathogenic organism. Liver abscess caused by MRSA is rarely reported. Here, we report a case of liver abscess due to MRSA in a 34-year-old man with end-stage renal disease and a 13-year history of hemodialysis treatment.     

Phenotypic variation of Staphylococcus epidermidis isolated from a patient with native valve endocarditis.

Two colonial variants of Staphylococcus epidermidis were isolated from the valvular tissue of a patient with native valve endocarditis. In addition to differing in colonial morphology, the two variants differed in hemolysis on blood-containing media, in adherence capacity, and in the expression of certain enzymes. Under suitable conditions, both variants were themselves capable of phenotypic variation, although they differed in the rate at which variants were generated. The variants yielded identical profiles on restriction endonuclease analysis of plasmid DNA and pulsed-field gel electrophoresis of whole-cell DNA. This report suggests a possible role for phenotypic variation in coagulase-negative staphylococcal virulence. Congo red agar would be an excellent medium for studying the contribution of variation to the virulence of these organisms.     

Staphylococcus lugdunensis Endocarditis in a Young, Previously Healthy Female

 Reported here is a case of native valve infective endocarditis in which Staphylococcus lugdunensis was isolated from blood cultures as well as from the mitral valve. It is suggested that tube coagulase-negative staphylococci isolated from blood cultures of patients with infective endocarditis be considered carefully for possible clinical significance. The use of the ornithine carboxylase test as a simple screening method for identification of Staphylococcus lugdunensis is recommended.