The bane of coastal marine environment: A fatal case of Vibrio vulnificus associated cellulitis and septicaemia

Vibrio vulnificus is a Gram negative motile bacterium known to cause fatal septicaemia and wound infection. It is commonly associated with the consumption of under-cooked seafood or exposure to marine environment. We report a case of a 55 year old male patient, who was presented with right lower limb cellulitis and septicaemia due to V. vulnificus. V. vulnificus infection in India are rare. However, increasing reports of V. vulnificus from India recommends considering the pathogen while dealing necrotising fasciitis especially in the proximity of marine environment.     

Aetiology of neonatal septicaemia in Qatif, Saudi Arabia

Neonatal septicaemia (NNS) is a major cause of neonatal morbidity and mortality. Neonatal septicaemia was studied to determine the incidence, common bacterial aetiology and antibiotic susceptibility in Qatif Central Hospital, Saudi Arabia. Of 1,797 babies admitted into the unit over a 3 year period, 144 (8.0%) had documented neonatal septicaemia consisting of 94 (65%) late onset and 50 (35%) early onset septicaemia. The incidence was 8.2/1000 of the total live births in the hospital.

Gram negative bacteria were encountered in 66.2%, gram positive bacteria in 29.2% and Candida albicans in 4.4% of the case. Klebsiella spp., E. coli, and Pseudomonas accounted for 81.8 % of the gram negative while Staphylococcus epidermidis, Staphylococcus aureus and group B Beta haemolytic Streptococcus accounted for 73.9% of the gram positive bacteria.

Most of Gram negative bacteria had a high sensitivity to Aminoglycosides and third generation Cephalosporins. Coagulase negative staphylococci were frequently resistant to most antibiotics but always sensitive to Vancomycin. The overall mortality rate was 18.7%.     

Plasma fibronectin concentrations in healthy and septic infants

The concentration of plasma fibronectin was determined by Laurell's electroimmunoasay [15] in 75 preterm or term newborns within the first 2 days of life, in 97 healthy infants aged from 3 days to 12 months, in 40 septic infants and in 38 healthy adult subjects. The mean fibronectin concentration in citrated plasma of normal adults was 318±84 ml/l. Healthy eutrophic term newborns 1–2 days old had approximately one-third of the fibronectin concentration of adults. There was no significant difference in the values between healthy term and eutrophic preterm newborns or between eutrophic and hypotrophic newborns. The plasma fibronectin increased strongly over the 1st month of life. No significant difference was observed between fibronectin levels in infant boys and girls. The values in septic newborns and septic older infants were significantly lower when compared with those of age-matched healthy controls. It is speculated that this deficiency, because of linkage to fibrin in disseminated intravascular coagulation or due to increased utilisation as a non-specific opsonin and sequestration at sites of tissue injury, may contribute to organ failure in septicaemia.Abbreviations SB surface binding - DIC disseminated intravascular coagulation     

Early-onsetPseudomonas aeruginosa sepsis andYersinia enterocolitica neonatal infection: a unique combination in a preterm infant

The purpose of this communication is to report the occurrence of early-onsetPseudomonas aeruginosa sepsis andYersinia enterocolitica neonatal infection. This case serves as a reminder of the changing spectrum of neonatal septicaemia.     

The changing pattern of bloodstream infections associated with the rise in HIV prevalence in northeastern Thailand

A survey of bloodstream infections was conducted in the large regional hospital in Ubon Ratchatani, northeastern Thailand between 1989 and 1998, during the onset of the HIV epidemic. The incidence of Staphylococcus aureus, Escherichia coli, Klebsiella/Enterobacter and Pseudomonas aeruginosa bacteraemias remained constant whereas infections caused by Burkholderia pseudomallei, non-typhoid Salmonellae, Cryptococcus neoformans, Penicillum marneffei and to a lesser extent Streptococcus pneumoniae all rose. Burkholderia pseudomallei infections were unrelated to HIV, whereas the other infections were associated directly with HIV. Group D non-typhoid Salmonellae bloodstream infections (mainly Salmonella enteritidis) rose coincident with the increase in HIV seroprevalence, and preceded the increase in the other HIV-associated infections. Other non-typhoid Salmonella bacteraemias increased two years after the rise in group D infections, and invasive yeast infections increased four years later, coincident with the increase in AIDS. Increasing Group D non-typhoid Salmonella bloodstream infections are an early warning signal of an impending rise in AIDS.     

免疫低下宿主败血症160例临床分析

目的 探讨免疫低下宿主败血症的病原谱和临床特征.方法 回顾性分析160例免疫低下宿主败血症患者的基础疾病、外周血粒细胞计数、血培养时的体温、治疗及转归.结果 160例患者中,8例发生2次败血症,3例为复数菌败血症,共检出病原体171株;其中革兰阳性球菌37株(21.6%)、革兰阳性杆菌6株(3.5%)、革兰阴性杆菌113株(66.1%)、真菌15株(8.8%).革兰阳性球菌以葡萄球菌属和链球菌属为主,分别为17株和14株;革兰阳性杆菌以棒状杆菌属为主,有5株;革兰阴性杆菌中以大肠埃希菌、肺炎克雷白杆菌和铜绿假单胞菌多见,分别为60株、20株和15株.17株葡萄球菌中,金黄色葡萄球菌有12株,均对甲氧西林敏感(MSSA);113株革兰阴性杆菌中有20株产超广谱β-内酰胺酶(ESBLs),分别为大肠埃希菌17株、肺炎克雷白杆菌2株和产酸克雷白杆菌1株.真菌败血症均由念珠菌属感染所致,白色念珠菌4株、非白色念珠菌11株.中性粒细胞减少者120例(75%),其中103例为粒细胞缺乏症(粒缺)患者.70%的败血症患者出现高热.所有患者均接受了广谱抗生素治疗,58.8%的患者同时采取了抗真菌治疗.死亡20例,19例因病情恶化而放弃治疗,治愈好转率为75.6%.结论 免疫低下宿主败血症中,细菌感染是首要病因,真菌的检出率呈上升趋势,粒缺是败血症发生的危险因素之一,高热是其重要体征.     

SEPTICAEMIA OF HTE NEWBORN, ASSOCIATED WITH RUPTURED FOERAL MEBBRANES, DISCOLOURED AMNIOTIC FLUID OR MATERNAL FEVER

ABSTRACT. The incidence of neonatal septicaemia associated with prolonged rupture of foetal membranes, discoloured amniotic fluid and/or maternal fever was investigated. A total of 807 blood cultures were performed on 329 neonates, the placental end of 239 umbilical cords and on 239 mothers. The study showed that in 97% of the neonates with a complicated delivery there was no evidence of septicaemia. Septicaemia was verified in 3% of the infants, and was intimately associated with low birth weight (p = 0.02), neonatal asphyxia (p < 10^-4) clinical evidence of septicaemia (p < 10^-4) and maternal fever(p = 0.002). The incidence was particularly high in premature infants with neonatal asphyxia (27%) and in neonates born to febrile mothers (20%). None of the mothers showed any evidence of septicaemia, and haematogenous, transplacental spread of infection to the child was not seen. Routine prophylactic antibiotic therapy in neonates with a complicated delivery should therefore be reserved, in our opinion, for those infants at high risk of infection.     

Meningococcal disease: treatment and prevention

Many countries have been experiencing a significant increase in meningococcal disease. With the strains currently circulating, septicaemia is now a more frequent manifestation than meningitis and early recognition of disease manifestations by patient, parent or physician as well as early recognition of disease severity are the most important factors in attempting to reduce mortality and morbidity. Ceftriaxone is the treatment of choice but must be accompanied by aggressive supportive therapy in those with severe disease. The role of steroids is unknown. The evidence to support their use in both meningitis and severe systemic sepsis is discussed. The purified polysaccharide vaccines that have been available for some years may play a limited role in disease prevention. The recently introduced conjugate vaccine for preventing serogroup C disease represents a major advance but no vaccine is currently available to prevent serogroup B disease, cases of which will continue to challenge clinical practice.     

Outbreak of septicaemic cases caused by Acinetobacter ursingii in a neonatal intensive care unit

Neonatal infections may be caused by various microorganisms, but as far as we are aware, Acinetobacter ursingii has not yet been reported in connection with nosocomial infections of premature infants. During 2 months, 3 premature babies were treated with nosocomial infection caused by A. ursingii at the same ward, and on the basis of molecular typing results the same strain was responsible for all of these cases. Traditional biochemical methods and automatic identification systems failed to identify this bacterium on the species level, and only 16S rDNA sequencing gave acceptable species identifications. The isolated strains proved to be susceptible to all of the tested antimicrobials, including ampicillin/sulbactam, doxycyclin, netilmicin, ciprofloxacin, piperacillin/tazobactam, ceftazidime, imipenem, meropenem, trimethoprim/sulfametoxazole, gentamicin, tobramycin, amikacin, and levofloxacin according to the CLSI standard. In spite of the environmental screening, the source of the infection could not be clarified. One of 3 neonates died, the others recovered and were discharged home after several months of hospitalization.