The zoonotic risk of Brucella canis has been considered fairly high for persons who handle breeding dogs in kennels or are exposed to infected animals. Transmission to humans in other circumstances has been thought to be rare. We describe an uncommon outbreak of brucellosis caused by B. canis which, to the best of our knowledge, is the first reported in the literature. This outbreak involved six persons (three children and three adults), a bitch and three puppies which had close daily contact with the family. The clinical symptoms of the index case led to an erroneous diagnosis and the infection would have gone undiagnosed if culture had not been positive. This report aims to increase awareness of medical personnel of the need to order screening tests for children, immunodeficient persons or pregnant women presenting with fever of unknown origin, unexplained spleen or liver enlargement or other systemic signs. The emerging zoonotic potential of this disease in urban areas and the need to coordinate canine brucellosis surveillance systems should be evaluated.
We report the first case of fulminant sepsis due to Wohlfahrtiimonas chitiniclastica. This case is also the first one reported in South America. We emphasize the importance of recognizing bacteria that live in the larvae of a parasitic fly as the causative agent of severe infections in homeless patients. CASE REPORTA 70-year-old homeless male patient was admitted to the emergency department of Eva Peron Hospital, Buenos Aires, Argentina, in June 2008 because of sensory impairment.He had a history of alcohol abuse, severe smoking, and occlusive peripheral arteriopathy of the lower limbs (with a 30% obstruction of the external iliac artery) without medical control since 1997.On admission, the patient was found to be disoriented, he did not answer simple commands, and he had isochoric pupils which showed hyporeactivity. His vital signs were as follows: nonrecordable blood pressure; pulse (heart) rate, 75 beats/ min; respiratory rate, 40 breaths/min; body temperature, 35°C (95°F), and signs of peripheral hypoperfusion.Physical examination revealed that the patient was in very poor sanitary condition.In both inguinal regions, the presence of multiple erythematous plaques covered by "honey-colored" crusts was observed; these lesions could not be cultivated.On respiratory auscultation, the patient showed coarse crackles in the right lower quadrant. Also, he presented weak peripheral pulses with no edema and jugular vein distention 2/3. The abdomen was soft and tender on palpation with preserved bowel sounds.The clinical picture was interpreted as a probable septic shock.Laboratory findings of the peripheral venous blood sample on admission were as follows: white blood cell count, 5,000/ mm 3 (with 86% neutrophils); hematocrit, 18.4%; hemoglobin count, 6.1 g/dl; and platelet count, 135,000/mm 3 . An arterial blood gas analysis showed a pH of 7. .8 meq/liter; blood urea nitrogen level, 406 mg/dl; and creatinine level, 12.6 mg/dl. Treatment with intravascular fluids (500 ml of 5% dextrose, 1,500 ml of saline [0.9%], and 100 mg thiamine) was initiated. A urinary catheter and central line were placed, and two blood culture sets and a urine culture were performed. Empirical treatment with ciprofloxacin (400 mg given every 12 h intravenously [i.v.]) and ampicillin-sulbactam (1.5 g every 6 h) was started.After admission to the intensive care unit (ICU), the patient presented sustained hypotension, hypoglycemia, respiratory failure, and oliguria, requiring the use of vasopressors (noradrenaline and dopamine), intravascular volume expansion, mechanical ventilation, and transfusion of 2 units of packed red blood cells.Hemodialysis was attempted on the third day of his intensive care unit stay, but it was not tolerated by the patient.The urine culture was negative and in the 2 blood culture sets (BacT/Alert; bioMérieux, Marcy l'Etoile, France) taken at the time of admission, at two different times, there was pure growth of Gram-negative rods. With the preliminary report of nonfermenting Gram-negative bacillus isolation in blood cu...
Herein, we report four cases of Comamonas kerstersii intra-abdominal infections representing the first report of human infections caused by this Comamonas species. In addition, our work demonstrates the association of C. kerstersii with peritonitis secondary to appendix rupture.
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