Pandoraea bacteremia in a cystic fibrosis patient with associated systemic illness

Pandoraea is a recently classified genus primarily isolated from the sputum of cystic fibrosis patients, but its pathogenic potential is unknown. We describe a case of Pandoraea bacteremia in a 16-year-old cystic fibrosis patient associated with clinical disease, suggesting that this organism should be considered a true pathogen in susceptible patients.     

Enterobacter sakazakii infection in the newborn

Enterobacter sakazakii, a Gram-negative bacillus, previously known as "yellow pigmented Enterobacter cloacae", is a rare cause of neonatal infection. We describe the detailed clinical presentation of two cases in whom E. sakazakii was isolated in our neonatal service during the course of 1 mo. These include one case of sepsis and meningitis complicated by cerebral infarction, and one case of sepsis. In addition, three cases of intestinal colonization were identified. The source of the organism was thoroughly sought and was found to be a blender in the milk kitchen that was used for preparation of the reconstituted powdered milk formula. CONCLUSION: Our paper adds clinical and laboratory information about the disease spectrum caused by this relatively rare organism and emphasizes the importance of a thorough search for the source of the infection.     

A fatal outbreak of <Emphasis Type="Italic">Trichosporon asahii S</Emphasis>epsis in a neonatal intensive care unit

We describe an outbreak of Trichosporon asahii in 8 newborn infants with sepsis. Six out of these 8 infants died. The organism was identified on specific culture and morphologic characteristics. The organism was sensitive to amphotericin-B but resistant to fluconazole. Laminar flow unit was suspected to be the source of the outbreak.     

Neonatal acute suppurative parotitis

Acute suppurative parotitis is highly uncommon in neonates. Approximately 100 cases have been reported in the literature. Dehydration and prematurity are important predisposing factors. Diagnosis is based on clinical signs. White blood cell count and parotid ultrasonography are useful. The most commonly isolated causative organism is Staphylococcus aureus. Initial treatment consists of antistaphylococcal empiric antimicrobial therapy for 7-10 days. The prognosis is good. The illness is not usually associated with recurrences. We describe two 12-day-old newborn infants who presented with fever, unilateral swelling of the parotid region with erythema, warmness and pain, and purulent discharge from Stensen's duct. We also provide a literature review.     

Capnocytophaga gingivalis bacteremia detected only on quantitative blood cultures in a child with leukemia

Capnocytophaga species are inhabitants of the normal mouth flora. We describe the case of a 6-year-old-girl with leukemia and poor oral hygiene who developed bacteremia caused by Capnocytophaga gingivalis. The organism was detected only on quantitative blood cultures.     

Angiogenesis and angiogenesis inhibitors in paediatric diseases

Angiogenesis, the generation of new capillaries from existing blood vessels, is rarely observed in the healthy organism, but can present during various paediatric diseases. In this review, we describe recent progress in the understanding of pathological angiogenesis and approaches for an improved therapy of angiogenic childhood diseases.     

Blastocystis hominis gastroenteritis in a hemophiliac with acquired immune deficiency syndrome

Blastocystis hominis is an enteric protozoan that has occasionally been associated with gastrointestinal illness in man but is not considered an opportunistic pathogen. We describe a 16-year-old hemophiliac with acquired immune deficiency-related complex in whom upper gastrointestinal symptoms in conjunction with high densities of B. hominis in duodenal secretions and stool developed. Furazolidone treatment was associated with eradication of the organism and improvement in clinical symptoms. One month later, the patient had invasive Candida albicans esophagitis and died 2 weeks later of complications of acute pancreatitis. In immunocompetent individuals surveyed in Colorado the frequency of identification of B. hominis in stool concentrates was not different between asymptomatic and symptomatic persons. We suggest that B. hominis may be an opportunistic pathogen in immunocompromised patients and should be sought in duodenal secretions and feces when gastrointestinal symptoms are present.     

Gemella bergeriae endocarditis in a boy

We describe the first pediatric case of Gemella bergeriae endocarditis in a 15-year-old boy with tetralogy of Fallot and pulmonary atresia who presented with weight loss, chills, and cold intolerance. Blood cultures revealed Gram-positive cocci that failed to type with Lancefield group antiserum. The identification of the organism was confirmed by 16S rRNA gene sequencing.     

Photobacterium damsela bacteremia in a child with sickle-cell disease

Photobacterium damsela was identified in a blood culture taken from a child with sickle-cell disease. This is the first report of this organism in humans in the Caribbean. The microbiology of this organism and its identification are discussed. The clinical presentation in humans and the role of the immune status of the patient are reviewed.     

Stenotrophomonas maltophilia: Rare cause of meningitis

Stenotrophomonas maltophilia is a Gram‐negative bacillus, which is an extremely rare cause of meningitis. To our knowledge, there are only five previous pediatrics cases. Here, we describe the case of a 4‐year‐old boy who developed meningitis associated with this organism, after several neurosurgical procedures and previous treatment with a broad‐spectrum antibiotic. He was treated successfully with a combination of trimethoprim–sulfamethoxazole, ceftazidime and levofloxacin. Stenotrophomonas maltophilia should be considered as a potential cause of meningitis, especially among severely debilitated or immunosuppressed patients. Antimicrobial therapy is complicated by the high resistance of the organism to multiple antibiotics.     

Endocarditis caused by Staphylococcus lugdunensis

We describe a case of native valve endocarditis caused by Staphylococcus lugdunensis, a perineal skin commensal, and review 28 other cases from the medical literature. Correctly identifying this coagulase-negative organism is critical because endocarditis is usually associated with left sided valvular disruption and life-threatening embolic complications, reminiscent of disease caused by Staphylococcus aureus. Urgent surgical intervention is necessary in most cases.     

Trichosporon pullulans as a complication of chronic granulomatous disease in a patient undergoing immunosuppressive therapy for inflammatory bowel disease

We describe a patient with chronic granulomatous disease and receiving immunosuppressive therapy for refractory granulomatous colitis who developed fatal fulminant pneumonia, with Trichosporon pullulans isolated from multiple sites. This case highlights potential difficulties in treating chronic granulomatous disease colitis with high dose immunosuppressants and suggests that T. pullulans may represent an opportunistic organism with high morbidity and mortality in such patients.     

Staphylococcus lugdunensis: an emerging cause of ventriculoperitoneal shunt infections

Staphylococcus lugdunensis, a coagulase-negative staphylococcus first described in 1988, has gained recognition as an organism with considerable pathogenic capability in adults. In contrast to the indolent presentation characteristic of other coagulase-negative staphylococci, S. lugdunensis infections resemble the aggressive behavior of Staphylococcus aureus. Although the organism has been isolated from a wide variety of infections in adults, it is a very rare cause of pediatric infections. We describe the first two pediatric patients who developed ventriculoperitoneal shunt infections caused by S. lugdunensis. These cases suggest that coagulase-negative staphylococci should be identified to the species level and that, if S. lugdunensis is identified, greater morbidity compared to that associated with other coagulase-negative staphylococcal shunt infections should be anticipated. A longer course of therapy is recommended for S. lugdunensis infections.     

Cryptococcal sepsis diagnosed by bone marrow examination

Disseminated cryptococcal disease is often associated with immunodeficient states. The diagnosis is usually made using standard antigen tests on serum and cerebrospinal fluid in patients with known immunodeficiency. Often, blood and cerebrospinal fluid cultures also yield Cryptococcus neoformans. The authors describe a child whose diagnosis remained elusive until a bone marrow aspiration, performed as part of an evaluation for suspected neoplasm, revealed the offending organism.     

Recurrent Mycobacterium avium osteomyelitis associated with a novel dominant interferon gamma receptor mutation

Mycobacterium avium causes infections in immunocompromised individuals. Recurrent infection with this organism has been associated with a deletion at the 818 residue of the interferon-gamma receptor (IFN-gammaR). This mutation produces a truncated receptor without an intracytoplasmic tail, resulting in diminished signaling. We describe a substitution at the 832 residue of the IFN-gammaR causing a similar truncated receptor in a 7-year-old girl with recurrent M avium osteomyelitis.     

Diagnosis and therapeutic strategies in pneumonia in childhood

Acute lower respiratory tract infections remain a major cause of morbidity in infants and children. In the majority of patients therapy is complicated by difficulties in securing a specific diagnosis and identification of the causative organism. Treatment is therefore largely based on experiential rather than experimental data. In our study we have tried in 722 patients with pneumonia to correlate the clinical findings with the causative agents. Age and a careful medical history give good clues towards the most probable aetiologic agent. Additional information is gained by the course of the illness. Physical examination, chest X-ray and few limited laboratory tests can also be of help to identify the most likely organism. Once the organism is identified, appropriate antimicrobial agent can be started. It is not only the choice of the antimicrobial substance, but also the choice of the proper total daily dose, dosage interval and mode of administration. By this management we had good results also in elimination of problem organism such as pseudomonas in CF.     

Clinical features of mild systemic meningococcal disease with characterization of bacterial isolates

Neisseria meningitidis is an important cause of fulminant septicemia and meningitis in children. Only limited reports of mild disease associated with this organism exist. In this study, we describe eight children, ages 2.5-19 months, with mild meningococcal disease and characterize the meningococcal isolates from some of these patients. Children with mild meningococcal disease presented with a mean fever of 40.1 degrees C, but without purpura or petechiae. Five were diagnosed as having otitis media and were not thought to be seriously ill when initially observed. Six of the eight children had complete resolution of their clinical symptoms as outpatients. One had apparent meningococcal meningitis that sterilized without antibiotic therapy, and one had persistent low grade bacteremia that cleared within 48 hours after institution of parenteral antibiotics. Characterization of the meningococcal isolates from three of the patients revealed that the organisms were encapsulated, piliated, and contained similar outer membrane proteins. This report confirms that blood stream invasion by N. meningitidis organisms may result in clinically mild disease.     

Three familial cases of drug-resistant Mycoplasma pneumoniae infection

Mycoplasma pneumoniae infection is believed to result from defective host immune response rather than from direct cell injury by the organism itself. In this context, emergence of drug-resistant M. pneumoniae may provide us with special opportunities to study the pathogenesis from a clinical point of view. In this report, three patients with intrafamilial M. pneumoniae infection are presented. M. pneumoniae was isolated with a Hayflick pleuropneumonia-like organism diphasic medium. Minimal inhibitory concentrations of antibiotics were determined by a broth microdilution method. Polymerase chain reaction and restriction fragment length polymorphism analysis were done to determine point mutation in domain V of the 23S rRNA gene. As a result, all three strains from the three intrafamilial cases had the same drug-resistant point mutation, specifically A-to-G transition at position 2063. However, their clinical courses were quite different; a 6-year-old girl suffered severe pneumonia, a 5-year-old girl had mild pneumonia, and a 3-year-old boy had only a fever of 1-day duration without pneumonia. Conclusions: Our clinical and laboratory observations strongly support the idea that the host immune maturity, rather than a virulence factor of the organism, is a major determinant factor of disease severity of M. pneumoniae infection and that drug resistance does not necessarily lead to a serious clinical outcome.     

Ureaplusma ureulyticum in the cerebrospinal fluid of a premature infant

A premature infant, born at 28 weeks' gestation, was found to be colonized with Ureaplasma urealyticum and developed intraventricular hemorrhage and progressive hydrocephalus during the first weeks of life. The organism was isolated from the infant's cerebrospinal fluid in the absence of marked cerebrospinal fluid pleocytosis, but meningitis was suspected on the basis of low glucose and high protein content. Since this organism was resistant to erythromycin by clinical criteria, the infant was treated with chloramphenicol for 20 days. Cerebrospinal fluid sterilization was demonstrated; hydrocephalus, however, was persistent and made intraventricular shunt placement necessary.     

Ureaplusma ureulyticum in the cerebrospinal fluid of a premature infant

A premature infant, born at 28 weeks' gestation, was found to be colonized with Ureaplasma urealyticum and developed intraventricular hemorrhage and progressive hydrocephalus during the first weeks of life. The organism was isolated from the infant's cerebrospinal fluid in the absence of marked cerebrospinal fluid pleocytosis, but meningitis was suspected on the basis of low glucose and high protein content. Since this organism was resistant to erythromycin by clinical criteria, the infant was treated with chloramphenicol for 20 days. Cerebrospinal fluid sterilization was demonstrated; hydrocephalus, however, was persistent and made intraventricular shunt placement necessary.