Staphylococcus caprae is a coagulase-negative, DNase-positive member of the genus Staphylococcus usually associated with goats, but since 1991 a few laboratories have reported isolating the organism from human clinical specimens. We report on the isolation of 14 strains from human specimens and note that 10 strains were obtained from patients with bone and joint infections. Nine of the 10 infections started with traumatic fractures, and the other was a case of mastoiditis. Seven of these 10 infections were in patients with orthopedic prostheses, which appears to be a risk factor. Three of the 14 strains were from transplant patients. For three of the patients, S. caprae was the only organism isolated. S. caprae may be misidentified because it is not represented in the current MicroScan or Vitek identification systems which are in use in many laboratories, but the organism can be differentiated by a few biochemical tests. S. caprae produces positive results for DNase, pyrrolidonyl aminopeptidase, and acid production from mannitol and maltose; it produces negative results for ornithine decarboxylase and tube coagulase.

The fatty acid compositions of 39 type strains and 529 clinical or reference strains of pathogenic aerobic actinomycetes were analyzed after standardized culture by using the Microbial Identification System (MIS). Library entries for each type strain were created by using the MIS Library Generation Software, and the fatty acid profiles of clinical and reference strains were compared to these library entries. The bacteria separated into two large groups based upon major amounts of branched-chain or of saturated or monounsaturated straight-chain fatty acids. Identification of isolates was possible by using only the type strains for comparison, but fatty acid heterogeneity occurred within most species. The genera Gordona, Mycobacterium, Nocardia, Rhodococcus, Rothia, and Streptomyces, as well as strains of Amycolatopsis orientalis, Dermatophilus congolensis, Nocardiopsis dassonvillei, Pseudonocardia autotrophica, Saccharothrix aerocolonigenes, and Tsukamurella paurometabola, are aerobic actinomycetes that have been implicated in human infections (3, 29, 40). Prior attempts to improve the identification of these aerobic actinomycetes by cellular fatty acid analysis have used various culture media, growth conditions, incubation times, extraction methods, and chromatography techniques, all factors which affect the fatty acids expressed (9, 20, 22, 23, 26). The Microbial Identification System (MIS; Microbial Identification Inc., Newark, Del.) standardizes the chromatography variables associated with quantitative fatty acid analysis and facilitates fatty acid analysis as a means of identifying bacteria (53). We analyzed the type strains of 39 pathogenic aerobic actinomycete species after standardized growth and incubation and created library entries for each species. The fatty acid profiles of 529 clinical and reference strains were then compared to these library entries. Fatty acid analysis is a limited, but practical method for the rapid identification of aerobic actinomycetes, and our results are consistent with some prior claims for the existence of subgroups within defined taxa (8, 33, 39, 42, 48). MATERIALS AND METHODS Bacteria. The sources of the type strains, reference strains, and other strains that were used to establish additional taxa defined by fatty acid profiles are listed in Table 1. Other isolates were obtained from commercial culture collections, the collections of other researchers, and clinical specimens. Actinomadura madurae and Actinomadura pelletieri were excluded from this study due to their fastidious growth requirements and need for prolonged incubation. Culture conditions. All strains, with the exception of Nocardia brevicatena, were grown at 28°C for 96 h in ambient air on four TSBA plates composed of Trypticase soy broth (no. 11768; BBL) and 1.5% agar (no. 11849; BBL). Isolates of N. brevicatena were cultured on plates of TSBA with 1% Tween 80 (T164-500; Fisher Scientific), because we found a slight growth enhancement in the presence of Tween 80. Identification by biochemical tests. Clinical ...

Staphylococcus lugdunensis is a recently described coagulase-negative species which has been associated with human infections, including infective endocarditis. A case of native valve endocarditis caused by this organism is described. The initial laboratory detection of S. lugdunensis is facilitated by a positive test for ornithine decarboxylase. The identification of such isolates should not cause difficulty unless undue reliance is placed upon a small number of tests.

Renewable energy demands have increased the need for new wind farms. In turn, concerns have been raised about potential adverse health effects on nearby residents. A case definition has been proposed to diagnose “Adverse Health Effects in the Environs of Industrial Wind Turbines” (AHE/IWT); initially in 2011 and then with an update in 2014. The authors invited commentary and in turn, we assessed its scientific merits by quantitatively evaluating its proposed application. We used binomial coefficients to quantitatively assess the potential of obtaining a diagnosis of AHE/IWT. We also reviewed the methodology and process of the development of the case definition by contrasting it with guidelines on case definition criteria of the USA Institute of Medicine. The case definition allows at least 3,264 and up to 400,000 possibilities for meeting second- and third-order criteria, once the limited first-order criteria are met. IOM guidelines for clinical case definitions were not followed. The case definition has virtually no specificity and lacks scientific support from peer-reviewed literature. If applied as proposed, its application will lead to substantial potential for false-positive assessments and missed diagnoses. Virtually any new illness that develops or any prevalent illness that worsens after the installation of wind turbines within 10 km of a residence could be considered AHE/IWT if the patient feels better away from home. The use of this case definition in the absence of a thorough medical evaluation with appropriate diagnostic studies poses risks to patients in that treatable disorders would be overlooked. The case definition has significant potential to mislead patients and its use cannot be recommended for application in any health-care or decision-making setting.