Iron limitation may cause bacterial pathogens to grow more slowly; however, it may also stimulate these microorganisms to produce greater tissue damage, given that many virulence factors are controlled by the iron supply in the environment. The present study investigated the influence of low iron availability on the expression of proteins and surface sugar residues of two toxigenic strains of Corynebacterium diphtheriae subsp.
A case of pyogenic liver abscess (PLA) due to Rhodococcus equi in an immunocompetent individual was successfully treated by combining surgery and antibiotics. The R. equi-targeted antimicrobial agents erythromycin and rifampin were used only after surgical resection of the lesion and identification of the infective organism. CASE REPORTA 46-year-old man residing in the suburbs of the city of Rio de Janeiro, Brazil, was admitted to the university hospital with fever (39 to 40°C), right upper quadrant pain, nausea, vomiting, coluria, and weight loss (4 kg in 2 weeks). Abdominal ultrasound was done 2 months before hospitalization and revealed cholelithiasis. He had a history of hospitalization and blood transfusions due to gastric ulcers and melena episodes. He reported a smoking habit and sporadic alcohol ingestion. He denied having used illicit drugs and traveling to rural areas. He also denied hypertension, allergy, diabetes, tuberculosis, or other states of immunodeficiency. Clinical diagnosis revealed jaundice (1ϩ/4ϩ), paleness (2ϩ/4ϩ), tender hepatomegaly, and signs of dental infection. Abdominal ultrasonographic scanning procedures revealed the presence of two gallstones in the gall bladder and a 6-cm-diameter liver abscess with involvement of the upper and middle segments of the right lobe. There were no clinical or radiological evidences of brain, bone, or lung infection or pleural effusion. Blood samples were collected for bacteriological cultures, and empirical antimicrobial therapy was initiated with intravenous ampicillin, gentamicin, and metronidazole. In view of the clinical signs of purulent gingivitis and periodontitis, ampicillin was changed to penicillin G. Laboratory findings revealed anemia, leucocytosis (35,200 cells/l), and high levels of liver transaminases and phosphatase alkaline enzymes. The results of screening tests for human immunodeficiency virus and viral hepatitis were negative. On the fifth day after admission, there were still no significant clinical or radiological responses to antibiotics. Until day 25 of hospitalization, the patient remained afebrile with persistent abdominal pain. On day 26, the patient was found to be toxemic and feverish (38.4°C) and started vomiting green vomitus. The patient underwent percutaneous catheter drainage with ultrasound guidance, and 120 ml of chestnut-colored purulent secretion was collected from the abscess. Bacteriological cultures of the liver aspirate were negative. Penicillin G and gentamicin were changed to ceftriaxone and ampicillin. Follow-up of radiological and ultrasonographic scans of the liver indicated persistence of the abscess. Subsequent abdominal computed tomography confirmed the location of the abscess. Fifty days after admission, the patient underwent laparoscopy with drainage of the abscess and cholecystectomy. After surgical drainage and bacteriological identification of the infective organism, the patient was given R. equi-targeted antimicrobial therapy (erythromycin and rifampin) for 4 weeks. The patient was discharged fr...
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