Legionella jordanis isolated from a patient with fatal pneumonia.

A Legionella-like organism was isolated from an open-lung biopsy of a patient with fatal pneumonia. The isolate was shown by growth, physiologic, serologic, and genetic characteristics to belong to the species Legionella jordanis, which had previously been isolated only from the environment.     

Second serogroup of Legionella hackeliae isolated from a patient with pneumonia.

A Legionella-like organism (strain 798-PA-H, ATCC 35999) isolated from a lung aspirate was shown by DNA hybridization to belong to the species Legionella hackeliae. Growth, gas-liquid chromatographic, and physiologic characteristics were consistent with those of the type strain of L. hackeliae, Lansing 2 (ATCC 35250). However, 798-PA-H was minimally reactive with L. hackeliae direct immunofluorescence assay conjugate or slide agglutination test antiserum. Cross-absorption studies with 798-PA-H and Lansing 2 antisera supported placing 798-PA-H in a second serogroup of L. hackeliae.     

Legionella cincinnatiensis sp. nov. isolated from a patient with pneumonia.

A Legionella-like organism (strain 72-OH-H [= ATCC 43753]) was isolated from an open-lung biopsy specimen from a hemodialysis patient with end-stage renal disease and bronchopneumonia. Growth characteristics and gas-liquid chromatographic profiles of the isolate were consistent with those for Legionella spp. The isolate was presumptively identified as a Legionella longbeachae serogroup 1 strain by direct immunofluorescence staining. However, the organism was serologically distinct in the slide agglutination test with absorbed antisera. DNA hybridization studies showed that strain 72-OH-H constitutes a new Legionella species, which is named Legionella cincinnatiensis (ATCC 43753).     

Characterization of a Legionella anisa strain isolated from a patient with pneumonia.

Legionella anisa, previously found only in environmental specimens, was isolated from a bronchial lavage specimen of an immunocompromised patient with pneumonia. Growth, physiologic, gas-liquid chromatographic, serologic, and DNA characteristics were consistent with those of the type strain of L. anisa, WA-316-C3 (ATCC 35292).     

11th serogroup of Legionella pneumophila isolated from a patient with fatal pneumonia.

A Legionella-like organism (strain 797-PA-H; ATCC 43130) was isolated from a specimen taken from an endotracheal tube of a patient 4 days before death and from the left lung at autopsy. Growth characteristics were consistent with those for Legionella species. Strain 797-PA-H gave negative test results with available direct immunofluorescence assay conjugates and with slide agglutination test antisera prepared against the 22 Legionella species and 35 serogroups now recognized. Minimal reactivity (1 to 2 +) was observed with both tests by using reagents prepared against the Legionella-like organism Lansing 3. Reciprocal absorption studies, however, showed that the cross-reactive antibodies could be removed easily. Physiologic, gas-liquid chromatographic, and DNA hybridization tests revealed that the strain belonged to the species Legionella pneumophila. Therefore, strain 797-PA-H was designated as the type strain of a new L. pneumophila serogroup, serogroup 11.     

Legionella lansingensis sp. nov. isolated from a patient with pneumonia and underlying chronic lymphocytic leukemia.

A Legionella-like organism, strain 1677-MI-H, was isolated from the bronchoscopy washings of a patient with pneumonia who had a 2-year history of progressive, chronic lymphocytic leukemia. The growth characteristics, cellular fatty acids, and ubiquinone content of the isolate were consistent with those for Legionella spp. The isolate was serologically distinct in the slide agglutination test with absorbed antisera. DNA hybridization studies showed that strain 1677-MI-H (ATCC 49751) represents a new Legionella species which is named Legionella lansingensis.     

The first cardiac transplant experience in a patient with mucopolysaccharidosis

Hunter syndrome (MPSII) is a rare X-linked lysosomal storage disorder that can affect multiple systems but primarily affects the heart. We report the case of a previously asymptomatic 23-year-old patient who had an attenuated form of MPSII and presented with refractory heart failure that required a heart transplant. The diagnosis was confirmed by detection of an increase in urinary excretion of glycosaminoglycans, a deficiency in enzymatic activity, and molecular analysis. A myocardial biopsy revealed hypertrophic cardiomyocytes, mild fibrosis, and lysosomal storage in interstitial cells. Molecular analysis identified a novel mutation in the iduronate-2-sulfatase gene. Although the clinical outcome was not favorable, we believe that this approach may be valid in end-stage heart failure.     

Thirteenth serogroup of Legionella pneumophila isolated from patients with pneumonia.

A Legionella-like organism (strain 82A3105; ATCC 43736) was isolated from a lung aspirate taken from a patient with pneumonia. Results of physiologic, gas-liquid chromatographic, genetic, and serologic tests showed that strain 82A3105 and four additional clinical isolates belong to a new Legionella pneumophila serogroup, serogroup 13.     

Lasiodiplodia theobromae pneumonia in a liver transplant recipient

We report a case of Lasiodiplodia theobromae pneumonia in a patient who died 14 days after cadaveric-liver transplantation. His condition was complicated by Enterococcus faecium peritonitis. Direct microscopy analysis of the bronchoalveolar lavage specimens showed septate hyphae. A dematiaceous mold was recovered and identified as L. theobromae by microscopic morphology and EF1α gene sequencing.     

Legionella pneumophila serogroup 14 isolated from patients with fatal pneumonia.

Two Legionella-like organisms, one isolated from postmortem lung tissue and the other from a bronchial aspirate, were shown by growth, physiologic, and genetic characteristics to belong to the species Legionella pneumophila. Subsequent serologic testing indicated that both strains belonged to a new serogroup, serogroup 14.     

Legionella tucsonensis sp. nov. isolated from a renal transplant recipient.

A Legionella-like organism (strain 1087-AZ-H) was isolated from a pleural-fluid specimen from a renal transplant patient undergoing immunosuppressive therapy. Growth characteristics and gas-liquid chromatography profiles of the isolate were consistent with those for Legionella spp. The isolate fluoresced blue-white under long-wave UV light. Strain 1087-AZ-H was serologically distinct in the slide agglutination test with absorbed antisera. DNA hybridization studies placed it in a new Legionella species, Legionella tucsonensis (ATCC 49180).     

Legionella birminghamensis sp. nov. isolated from a cardiac transplant recipient.

A Legionella-like organism, strain 1407-AL-H, was isolated from a transbronchial lung biopsy specimen from a cardiac transplant recipient undergoing immunosuppressive therapy. The strain grew on buffered charcoal-yeast extract agar (BCYE) but not on BCYE in the absence of cysteine, and it showed gas-liquid chromatographic fatty acid profiles that were predominantly branch chained. Strain 1407-AL-H was antigenically distinct in slide agglutination tests from the 23 Legionella species and 39 serogroups previously described. DNA hybridization studies placed it in a new Legionella species, Legionella birminghamensis (ATCC 43702).     

Legionella sainthelensi serogroup 2 isolated from patients with pneumonia

Three Legionella-like organisms isolated from patients with pneumonia are shown to belong to the species Legionella sainthelensi by DNA hybridization studies and to a new serogroup, serogroup 2, by serological studies (ATCC 49322). L. sainthelensi serogroup 2 and L. santicrucis are indistinguishable by slide agglutination, but are separable on the basis of their cell wall fatty acid profiles.     

Mycobacterium triplex infection in a liver transplant patient

Mycobacterium triplex was first named in 1996 as an acid-fast bacillus with features that most resemble Mycobacterium simiae and Mycobacterium avium-intracellulare complex but which possesses a distinct mycolic acid pattern as well as a distinctive 16S rRNA hypervariable region. It has been isolated from lymph node, sputum, and cerebrospinal fluid specimens, but to date only rare clinical cases of this organism have been reported in the literature. The following is a case report of M. triplex that was isolated from the pericardial and peritoneal fluid of a 13-year-old female liver transplant patient.     

Legionella micdadei lung abscess in a patient with HIV-associated nephropathy.

A patient with end-stage renal disease due to human immunodeficiency-associated nephropathy developed fever, cough and chest pain over a week's duration. He was diagnosed with lung abscess and started on antibiotic coverage. He underwent bronchoscopy because of progression of his illness and persistent fever and bronchoalveolar lavage culture isolated Legionella micdadei. In spite of appropriate antibiotic therapy, the patient remained febrile for 10 days, necessitating chest tube drainage. After a 6-week course of antibiotics and drainage, the patient made an uneventful recovery. Infections due to L. micdadei may be hard to diagnose because of difficulties in isolating this bacteria.     

Escherichia hermannii as the sole isolate from a patient with purulent conjunctivitis

Escherichia hermannii was isolated in pure culture from a patient with acute purulent conjunctivitis after a minor ocular injury. This is the first report of E. hermannii isolated as the sole pathogen from an infected site without prior antibiotic exposure, confirming the pathogenic potential of the microorganism.     

Histologic changes resembling acute rejection in a liver transplant patient treated with terbinafine

We present a case of histologic changes resembling acute cellular rejection in a liver transplant patient treated with terbinafine. Approximately 5 years after orthotopic liver transplantation, a 51-year-old Hispanic man developed elevated liver enzyme levels. A biopsy sample was interpreted as acute cellular rejection, and the patient was treated with increased immunosuppression. Review of medications showed that the patient had been started on terbinafine approximately 4 weeks earlier for onychomycosis, and it was discontinued. A follow-up visit 2 weeks later revealed progressive jaundice, malaise, and nausea, and evaluation of a second liver biopsy sample revealed marked centrilobular cholestasis and severe bile duct damage, consistent with terbinafine hepatotoxicity. Although these histologic changes have been described in treated patients with both normal and abnormal livers, the potential for confusion with acute rejection in patients with hepatic transplantation has not previously been reported.     

Chryseobacterium indologenes subcutaneous port-related bacteremia in a liver transplant patient

Chryseobacterium indologenes is a rare cause of infection in select immunosuppressed hosts. Most prior reports are from Taiwan, in patients with diabetes mellitus or malignancies. Infections caused by C. indologenes are generally associated with indwelling devices, and the organism may be resistant to many commonly utilized broad-spectrum antibiotics. We report the first case, to our knowledge, of C. indologenes subcutaneous port-related bacteremia in a liver transplant recipient. The isolates were resistant to antibiotics previously reported as active, and device removal was required for treatment success.