Liver abscess caused by Gemella morbillorum]

Gemella morbillorum, an anaerobic-to-aerotolerant Gram-positive coccus, is a normal flora of the oral cavity, respiratory tract, urogenital organ and gastrointestinal tract, and infections caused by this organism are unusual. It has been associated mainly with endocarditis and bacteremia, and rarely with arthritis, spondylodiscitis, meningitis, brain abscess and septic shock. Liver abscess caused by G. morbillorum is very rare, and only a few cases were reported. We experienced a case of liver abscess by G. morbillorum in a 56-year-old woman presented with fever. We report this case with a review of literatures.     

Recurrent aortic valve endocarditis caused by Gemella morbillorum--report of a case and review of the literature.

Gemella morbillorum (G. morbillorum) is part of the commensal flora of the oropharynx and intestinal tract, and on rare occasions causes infective endocarditis. A 55-year-old man with massive aortic regurgitation caused by recurrent infective endocarditis with G. morbillorum had a history of prior endocarditis caused by alpha-hemolytic streptococcus and multiple antibiotic allergies 5 years prior, and was successfully treated by aortic valve replacement. Almost all the reported cases of endocarditis caused by G. morbillorum have been bacteriologically cured with antibiotics and this is the first reported case of recurrent endocarditis caused by G. morbillorum in which the initial infection was bacteriologically cured by antibiotics and the secondary infection treated with valve replacement. This organism can be one of the causes of infective endocarditis and prompt surgical repair is mandatory if the infection is refractory or there is progression of congestive heart failure under antibiotic cover.     

A fatal case of Ludwig's angina and mediastinitis caused by an unusual microorganism, Gemella morbillorum

We present a case of Ludwig's angina in a 48-y-old immunocompetent male caused by an unusual pathogen, Gemella morbillorum. The infection was complicated with mediastinitis and despite aggressive management of the disease the patient died after 12 d of hospitalization. This is the first reported case of Ludwig's angina caused by G. morbillorum and emphasizes that the disease remains a potentially lethal infection.     

An unusual case of brain abscess by Gemella morbillorum

A case of deep brain abscess by Gemella morbillorum is described. Due to high fever, lethargy, severe headache, and the risk of intraventricular rupture of the suppurative lesion, a CT-guided stereotactic aspiration of the abscess was successfully performed. The patient responded well to a 6-week course of meropenem, metronidazole, and fluconazole. Gemella spp. should not be considered as trivial commensals of the mucous membranes, but appear as emerging pathogens involved in endocarditis, septic shock, and necrotizing pneumonia, as well as in serious intracranial infections.     

Gemella endocarditis: consider the colon

Gemella species, including Gemella morbillorum, are part of the normal flora of the human oropharynx, upper respiratory tract and gastrointestinal tract. Differentiation of Gemella from viridans streptococci in the laboratory may be difficult. Although uncommonly pathogenic, they have been implicated in a variety of human infections, most notably infective endocarditis. Dental instrumentation appears to be the usual source of infection. The case is reported of Gemella morbillorum native valve endocarditis, which was associated with an underlying colonic carcinoma. An association with colonic neoplasm has been described in three previous cases of endocarditis attributed to Gemella. It is well documented that Streptococcus bovis endocarditis may occur in the setting of colonic neoplasia. It is suggested that colonic investigation should be considered in patients with Gemella endocarditis, in whom no other source is apparent.     

麻疹孪生球菌致感染性心内膜炎一例并国内外文献复习

麻疹孪生球菌是人体口咽及肠道中共生菌丛中的条件致病菌,很少引起感染性心内膜炎。1例26岁女性无心脏基础疾病,患麻疹孪生球菌感染所致二尖瓣受累感染性心内膜炎,经抗生素和二尖瓣置换术后治愈。本例患者出现了颈内动脉栓塞,国内外报道较少见。     

Pleural empyema associated with Gemella morbillorum: report of a case and review of the literature

Gemella morbillorum, a microaerophilic Gram-positive coccus, is a natural inhabitant of the human oropharyngeal, gastrointestinal and urogenital flora. However, it is an infrequently isolated organism and a rare cause of pulmonary or pleural infections. We report on a 26-y-old male subject with a past medical history of epilepsy and intravenous drug abuse, who presented with imminent sepsis and respiratory failure. Computed tomography of the thorax revealed a pleuropulmonary consolidation of the left lower lobe, and ultrasound guided thoracentesis resulted in aspiration of pus. Microbiological analysis revealed Gemella morbillorum in the pleural fluid. Thoracic drainage and antibiotic therapy resulted in full recovery. We discuss previous cases of pleuropulmonary infections due to Gemella morbillorum and review the available literature of this rare occurrence.     

Endocarditis caused by Gemella morbillorum resistant to beta-lactams and aminoglycosides

Two rare cases of Gemella morbillorum endocarditis, caused by a strain resistant to penicillin and gentamicin are reported. G. morbillorum is usually sensitive to beta-lactams and aminoglycosides. The present 2 cases raise concern that appropriate prophylaxis and empirical treatment may be more complicated than believed in the past.     

Pulmonary nodules associated with Gemella bacteremia: CT findings in two children with osteosarcoma

Gemella morbillorum and Gemella haemolysans are normal oral flora that can also be pathogenic. We report 2 cases of adolescents with osteosarcoma who developed multiple pulmonary nodules associated with Gemella bacteremia. These nodules mimicked metastatic disease. To our knowledge, this manifestation of Gemella infection has not been previously reported. In the setting of malignancy, infectious pulmonary nodules must be distinguished from metastatic nodules in order to treat appropriately.     

Endocardite por Gemella: uma entidade agressiva

The authors present a rare case of subacute endocarditis caused by Gemella morbillorum. A 72-year-old man, with a history of hypertension, aortic valve disease and upper and lower endoscopy six months previously, was admitted due to fever and abdominal pain. He also complained of long-standing dyspnea on exertion and petechiae on his lower limbs. Imaging scans showed a consolidation in the lower left lung field, a splenic infarct and a left subphrenic abscess. Transthoracic echocardiogram findings were highly suggestive of endocarditis affecting three valves, with destruction of the mitral valve anterior leaflet. G. morbillorum was identified in three blood cultures and was considered the etiologic pathogen. Due to the patient's worsening condition, he underwent cardiac surgery, aiming to control the infection and to resolve the associated mechanical complications. This case highlights the need for a complete and thorough history to arrive at likely diagnostic hypotheses that, together with complementary exams, will lead to correct diagnosis and the prompt institution of appropriate therapy.     

Gemella morbillorum liver abscess

We report a case of liver abscess caused by Gemella morbillorum. G. morbillorum was isolated and confirmed from both pus and blood. The patient recovered uneventfully after catheter drainage and treatment with cefmetazole. This is the first case report of liver abscess caused by G. mobillorum in the English literature.     

Infectious endocarditis due to Gemella morbillorum found by splenic infarction--a case report

A 64-year-old man with prostate cancer and bone metastasis admitted for nausea, left abdominal pain showed no abnormal, and fever, abdominal ultrasound or chest X-ray findings. Despite antibiotics, left abdominal pain persisted for several days. Abdominal computed tomography (CT), showed splenic infarction. Transesophageal echocardiography suggested infectious endocarditis (IE) as a possible infarction cause, and roth spots were found on the retina. Gemella morbillorum was detected from blood culture. IE commonly causes Fever of Unknown Origin found by infarction. G. morbillorum, an anaerobic gram-positive, viridans group streptococci, is indigenous to the oropharynx, upper respiratory, urogenital, and gastrointestinal tracts, and is thought to have weak toxicity and pathogenicity in the body.     

Septic pulmonary emboli secondary to internal jugular vein phlebitis (postanginal sepsis) caused by Eikenella corrodens

Postanginal sepsis is the term used to describe the life-threatening infection caused by suppurative phlebitis of the internal jugular vein secondary to infection of the parapharyngeal spaces. This begins with a history of pharyngitis followed by infection of the parapharyngeal spaces, septic pulmonary embolism, and septicemia caused by hematogenous dissemination of the infection. The oral anaerobes are the most common pathogens associated with this syndrome. Recently, we managed 2 patients who had septic pulmonary embolism from postanginal sepsis syndrome caused by Eikenella corrodens. Previously, E. corrodens has not been described in association with this syndrome. The clinical presentation, anatomic, bacteriologic, and management aspects of postanginal sepsis syndrome are reviewed based on our experience with these 2 cases. In patients with clinical evidence of septic pulmonary embolism, particularly in the nonintravenous drug abusers, postanginal sepsis and septic jugular phlebitis have to be considered as a source of septic pulmonary embolism.     

Septic arthritis in patients with acquired immunodeficiency syndrome with human immunodeficiency virus infection.

We have evaluated the presence and characteristics of septic arthritis in intravenous (iv) drug users with human immunodeficiency virus (HIV) infection. Sixteen patients with both HIV infection and septic arthritis were studied and compared with 5 patients with septic arthritis but no HIV infection. Clinical profile, laboratory findings at the time of onset, localization, causative organisms, mean hospitalization time and presence of complications were the same in HIV positive and HIV negative patients. Staphylococcus aureus was the most commonly isolated organism in both groups. We conclude that septic arthritis in HIV infected iv drug users is not uncommon, it is produced by the same organisms and presents similar characteristics to the ones found in iv drug users without HIV infection. Therefore, the presence of HIV infection does not appear to modify the characteristics of septic arthritis.     

Polyarticular septic arthritis

Seven adult patients with nongonococcal polyarticular septic arthritis are presented with a literature review of the clinical features of polyarticular bacterial infection. Polyarticular septic arthritis occurred in 19% of reported cases of septic arthritis in adults. Similar to monoarticular disease, the knee was the most commonly affected joint, and Staphylococcus aureus was the most frequently isolated microorganism. Pneumococcus, group G streptococcus, and Hemophilus influenzae had an increased association with polyarticular infection. Five of our 7 patients had underlying rheumatic diseases and the immediate mortality rate was 57%. Review of the literature yielded an overall mortality of 23% for polyarticular septic arthritis compared to the 9% mortality of septic arthritis in general. The subset of patients with polyarticular infection superimposed on rheumatoid arthritis had a mortality rate of 56%.     

Pneumococcal septic arthritis as the initial presentation of multiple myeloma

Septic arthritis induced by Streptococcus pneumoniae is an uncommon manifestation of pneumococcal infection. Pneumococcus has been identified as the inciting pathogen in only 6% of cases of septic arthritis in recent retrospective studies (Ross et al., 2003). Approximately 50% of patients with pneumococcal septic arthritis have a preceding or concurrent extra-articular focus of infection. The septic joint evolves from hematogenous seeding of the highly vascular synovial membrane by bacteria. Polyarticular disease occurs in only approximately 36% of patients. Most pneumococcal septic arthritis occurs with coexistant joint disease, prosthesis, alcoholism, HIV infection, or rheumatoid arthritis (Baraboutis & Skoutelis, 2004; Raad & Peacock, 2004). We report a case of polyarticular septic arthritis as the first manifestation of an underlying disease. Our literature review discloses that this is the first reported case of multiple myeloma initially presenting as pneumococcal septic arthritis in the USA and the third internationally (Cuesta et al., 1992; Renou et al., 2007).     

Bacterial arthritis.

The 1991 literature on septic arthritis included a concise review of adult septic arthritis, examples of pseudoseptic arthritis, and two interesting animal studies. One animal study examined the induction of acute synovitis by the intra-articular injection of bacterial endotoxin and the cytokines tumor necrosis factor-alpha, and interleukin-1 beta; and the other studied the effects of early and delayed synovectomy in the management of septic arthritis. The predispositions to septic arthritis can be divided into local joint abnormalities, systemic factors, or both. Examples of the local joint abnormalities include osteoarthritis of the hip and apatite-associated arthropathy. Septic arthritis in a patient with rheumatoid arthritis, in a patient with diabetes mellitus and hip arthropathy associated with hemochromatosis, or in a patient with acquired immunodeficiency syndrome and hemophilic arthropathy are examples of how systemic predisposition is coupled with local joint pathology to increase the vulnerability of the host to joint infection. Other examples of systemic disease that predispose to septic arthritis are systemic lupus erythematosus, hypogammaglobulinemia, and human immunodeficiency virus infection, as well as intravenous drug abuse. Unusual microorganisms causing septic arthritis in the adult include Achromobacter xylosoxidans, Moraxella catarrhalis, meningococci, and diphtheroids. Uncommon pathogenesis is represented by a case of intra-articular inoculation of Mycobacterium gastri into the small joint of the hand and a case of mixed bacterial infection of the hip resulting from an extension of a contiguous pelvic infection associated with trauma. Two cases of immune complex glomerulonephritis illustrate the extra-articular complications of septic arthritis: one due to group G streptococcus and the other due to pneumococcus. Finally, septic bursitis is reviewed from the community practice perspective.     

Common variable hypogammaglobulinemia presenting as nontypable Haemophilus influenzae septic arthritis in an adult

Haemophilus influenzae is a rare cause of septic arthritis in adults. We describe a case of septic arthritis with nontypable Haemophilus influenzae presenting as the first invasive infection leading to a diagnosis of common variable hypogammaglobulinemia. Although nontypable strains have been shown to cause serious infections in adults, they are a rare cause of septic arthritis. Underlying immune deficiency should be considered in an adult who presents with invasive infection with Haemophilus influenzae, regardless of serotype.     

Effects of exopolysaccharide production by viridans streptococci on penicillin therapy of experimental endocarditis

The influence of exopolysaccharide production by viridans streptococci on penicillin therapy of endocarditis was studied in rabbits with experimental aortic-valve endocarditis. Animals were first infected with penicillin-susceptible streptococci known to produce varying amounts of exopolysaccharide in cardiac vegetations. Treatment with procaine penicillin, 300,000 U every 12 hr, was begun one to two days after infection. After five days of therapy, animals infected with Streptococcus sanguis II and Streptococcus morbillorum, both vigorous exopolysaccharide producers, continued to have infected vegetations, while animals infected with Streptococcus salivarius and a different Streptococcus sanguis II, both deficient in exopolysaccharide production, had sterile vegetations. These findings indicate that failure to eradicate streptococci from vegetations correlates with exopolysaccharide production and that this property may be important in determining outcome of therapy.     

Serum procalcitonin for discrimination between septic and non-septic arthritis

BACKGROUND: Early differentiation between septic and non-septic arthritis is difficult. A previous study showed promising diagnostic accuracy of serum Procalcitonin (PCT) in septic arthritis, limited by a low sensitive PCT test kit. OBJECTIVE: To investigate the diagnostic value of PCT in patients with septic and non-septic arthritis using a novel test with low detection limit. METHODS: Forty-two patients, 28 with non-septic and 14 with septic arthritis were prospectively included. For each patient, gram stain, culture and polarization microscopy of synovial fluid was done and PCT, C-reactive protein (CRP), white blood cell count, uric acid and blood cultures were taken. Patients with septic arthritis, patients with non-septic arthritis with and without concomitant infection were compared. RESULTS: Patients with septic arthritis had a significant higher PCT concentration than patients with non-septic arthritis (p<0.0001). At a cut-off of 0.1 (0.25) ng/ml, sensitivity for septic arthritis was 100(93)% and specificity 46(75)%. Specificity rose to 93% after exclusion of patients with non-septic arthritis and concomitant infection. Both sensitivity and specificity for the diagnosis of septic arthritis were higher for PCT than CRP. CONCLUSIONS: Our data suggest that PCT seems to be a highly sensitive and specific marker for septic arthritis, depending on the clinical setting. Further studies are warranted.