We report herein on a case of bacteremia caused by Rhodococcus corynebacteroides in a 77 year-old woman who was under medical treatment in hospital for cerebral infarction. She had a high fever (41.3̊C) on day 8 of her hospitalization and two sets of blood cultures yielded Gram-positive rods finally identified as R. corynebacterioides by 16S rRNA gene sequencing. After administration of tazobactam/piperacillin (TAZ/PIPC) her fever rapidly abated, and the inflammatory reaction also became negative. On the 11th day, antibiotics were de-escalated to cefazolin (CEZ) following the results of the susceptibility test. After confirming the negative blood culture results, antibiotic therapy was completed on the 17th day. Infectious exacerbation was not observed, and the patientʼs clinical course was uneventful.
The genus Rhodococcus is mostly non-pathogenic and inhabits in environments, such as soil and groundwater. R. corynebacterioides was isolated and identified as the causative agent of bacteremia in the current case study, has been reported only once in the past and thus ours would be a remarkably rare case.
Invasive pneumococcal disease (IPD), which is defined as an infectious disease caused by Streptococcus pneumoniae in blood or cerebral spinal fluid, is the target of notifiable disease surveillance for Category V infectious disease in the Infectious Disease Control Law. Recently the incidence of IPD has decreased reciprocally since the vaccine for S. pneumoniae was developed. The infection by non-vaccine serotype (nVT) S. pneumoniae has, however become a new threat in Japan.
A-75-year-old male was admitted our hospital with a fever. Physical examination showed disturbance of consciousness and neck stiffness. A spinal tap showed an increase in the white blood cell count in his cerebrospinal fluid (CSF) and positivity for the S. pneumoniae antigen. S. pneumoniae was detected in both blood and CSF cultures. MRI findings showed an abscess in the left frontal lobe of the brain. Based on these findings, the diagnosis of IPD was made. Further studies revealed his serotype of S. pneumoniae was 7C. He had received 23-valent pneumococcal polysaccharide vaccine (PPSV23) once before this episode. Serotype 7C was not included in PPSV23. At the same time, untreated diabetes mellitus was found and insulin therapy was started immediately. He was treated successfully with the administration of several antibiotics and the surgical resection of the brain abscess. The nVT S. pneumoniae is an emerging pathogen and has the capability to cause IPD.
Fusobacterium species have been notable as a cause of Lemierreʼs syndrome. Portal vein thrombosis due to Fusobacterium bacteremia is uncommon. It is sometimes referred to as Lemierreʼs syndrome variant of the gut. We describe herein an 87-year-old man who presented with a fever and chills. Computerized axial tomography with contrast material revealed portal vein thrombosis and a sign of ascending colon diverticulitis. Blood cultures turned positive 75 hours after admission, and Fusobacterium nucleatum was isolated in two sets of anaerobic bottles. He received intravenous antimicrobial therapy with anticoagulation therapy. However, anticoagulation therapy was discontinued because of hematochezia. He underwent colonoscopy and colon cancer in an early stage was diagnosed. We discuss the entry site of F. nucleatum including a possible association between F. nucleatum infection and colon cancer. In addition, a literature review was performed and a total of 17 patients with pylephlebitis due to Fusobacterium species was identified. The characteristics of patients, complications, entry sources, antimicrobial therapies, anticoagulation therapies, and patientsʼ outcomes are summarized.
Varicella zoster virus (VZV) is known to cause immune reconstitution inflammatory syndrome (IRIS) in a high frequency in people infected with human immunodeficiency virus (HIV). However, severe cases of IRIS resulting in multiple cerebral nerve palsy are rare. We herein report on a case of an HIV-infected man who developed IRIS caused by VZV, presenting as multiple cranial nerve palsy involving cranial nerves V,VII, VIII, IX, X, and XII. The patient was a 40-year-old man who was diagnosed as having AIDS triggered by esophageal candidiasis 3 months previously. About 3 months after starting antiretroviral drug treatment,he was hospitalized with difficulty in swallowing, fever, and an exacerbated rash. His CD4 cell count was 42 cells/μL, and the HIV-RNA level was undetectable. The characteristic symptom of papules and scabs of different stages all over the body enabled us to quickly reach the correct diagnosis of VZV-IRIS. The patient was treated with acyclovir, corticosteroid pulses, and antiretroviral therapy. Although the patientʼs hypoglossal nerve palsy quickly improved, his swallowing difficulty required over 8 months to improve.