Clinical, phenotypic, and genotypic characteristics of ESBL-producing Salmonella enterica bloodstream infections from Qatar

Background

Resistant Salmonella infections are a major global public health challenge particularly for multidrug-resistant (MDR) isolates manifesting as bloodstream infections (BSIs).

Objectives

To evaluate clinical, phenotypic, and genotypic characteristics of extended-spectrum beta-lactamase (ESBL) producing Salmonella enterica BSIs from Qatar.

Methods

Phenotypic ESBL Salmonella enterica from adult patients presenting with positive BSIs were collected between January 2019 to May 2020. Microbiological identification and characterization were performed using standard methods while genetic characteristics were examined through whole genome sequencing studies.

Results

Of 151 episodes of Salmonella enterica BSI, 15 (10%) phenotypic ESBL isolates were collected. Recent travel was recorded in most cases (80%) with recent exposure to antimicrobials (27%). High-level resistance to quinolines, aminoglycosides, and cephalosporins was recorded (80-100%) while meropenem, tigecycline and colistin demonstrated universal susceptibility. Genomic evaluation demonstrated dominance of serotype Salmonella Typhi sequence type 1 (93%) while antimicrobial resistance genes revealed dominance of aminoglycoside resistance (100%), qnrS1 quinolones resistance (80%), blaCTX-M-15 ESBLs (86.7%), and paucity of AmpC resistance genes (6.7%).

Conclusions

Invasive MDR Salmonella enterica is mainly imported, connected to patients from high prevalent regions with recent travel and antimicrobial use caused by specific resistant clones. In suspected cases of multidrug resistance, carbapenem therapy is recommended.

Tuberculosis and Takayasu's arteritis: An enigmatic association

There is indirect evidence signifying a potential link between tuberculosis and Takayasu's arteritis (TAK); however, the exact mechanism and relationship between TKA and Mycobacterium tuberculosis (TB) remain to be elucidated. This case intends to highlight the association between TB and TKA, as early detection can avoid devastating consequences.

Streptococcus gordonii-associated infective endocarditis: Case series, literature review, and genetic study

Key Clinical Message

Streptococcus gordonii-associated endocarditis is a rare occurrence, raising diagnostic challenges, and is often associated with considerable morbidity. However, vigilance can prevent devastating consequences.

Abstract

Streptococcus gordonii-associated endocarditis is rarely reported but often associated with considerable morbidity. We describe three cases of infective endocarditis caused by S. gordonii during a four-week period in 2023, and the use of whole-genome sequencing to determine whether these isolates were genetically related. The available literature was reviewed.

The Role of Post-Bronchoscopy Sputum Examination in Screening for Active Tuberculosis

Early diagnosis is a fundamental component of global tuberculosis control. The objective of this study was to evaluate the diagnostic yield of post-bronchoscopy sputum (PBS) testing as part of a tuberculosis diagnostic work-up. All new residents in the State of Qatar undergo a tuberculosis (TB) screening program. Those with abnormal chest radiology, negative sputum acid-fast bacilli (AFB) smears, and nucleic acid amplification testing (NAAT) for M. tuberculosis, undergo an additional bronchoscopic evaluation for TB. We prospectively enrolled individuals who were going to undergo bronchoscopy to provide two PBS samples for AFB smears and mycobacterial cultures between 18 September 2018 and 12 March 2021. A total of 495 individuals, with a median age of 31 years, were included. The majority of the patients were males (329, 66.5%). The most frequent country of origin was India (131, 26.5%) followed by the Philippines (123, 24.8%). The addition of PBS to bronchoalveolar lavage (BAL) testing allowed microbiological confirmation of tuberculosis in an additional 13 patients (3.9%), resulting in improved sensitivity (from 77.9% to 81.9%), negative predictive value (from 69.2% to 73.2%), and negative likelihood ratio (from 0.22 to 0.18). Where resources are available, the incorporation of routine PBS examination as part of tuberculosis diagnostic work-up can enhance the diagnostic yield.

Microbiological and clinical characteristics of invasive Group B Streptococcal blood stream infections in children and adults from Qatar

INTRODUCTION

Group B Streptococci (GBS) colonize almost one third of human gastrointestinal and genitourinary tracts, particularly in females. The aim of this study is to evaluate the epidemiology, microbiological characteristics, and clinical outcomes of invasive GBS disease in Qatar from all age groups.

METHODS

A retrospective study was conducted on patients with confirmed GBS blood stream infections during the period between January 2015 and March 2019. Microbiological identification was performed using automated BD PhoenixTM system, while additional antimicrobial susceptibility tests were performed using E test and disc diffusion methods.

RESULT

During the four years period, the incidence steadily rose from 1.48 to 2.09 cases per 100.000 population. Out of 196 confirmed cases of invasive GBS infections, the majority were females (63.7%, 125/196) of which 44.8% were pregnant and 53.6% were colonized. Three distinct affected age groups were identified: children ≤ 4 years of age (35.7%), young adults 25-34 (20.9%) and the elderly ≥ 65 year (17.4%). Presenting symptoms were mild with fever in 53% of cases while 89% of cases had Pitt bacteraemia score of ≤ 2. Isolates were universally sensitive to penicillin, ceftriaxone, and vancomycin at 100% but with significant resistance to erythromycin (49%) and clindamycin (28.6%) while 16.8% had inducible clindamycin resistance. Clinical outcomes showed cure rate of 87.25% with complications in (8.76%) and 4% mortality.

CONCLUSION

There is a rising trend of Group B Streptococcal blood stream infections in Qatar with significantly high clindamycin and erythromycin resistance rates. Universal susceptibility rates were demonstrated for penicillin, ceftriaxone, and vancomycin.

Underrecognized pathogen; Staphylococcus warneri ‐associated native mitral valve endocarditis in an immunocompetent host: A case report and literature review

Staphylococcus warneri‐related endocarditis is rarely reported, raising diagnostic challenges and is often associated with considerable morbidity and mortality. We describe a case of native valve endocarditis caused by S. warneri and complicated by a valve perforation in an immunocompetent patient to raise awareness of this emerging organism.

Concomitant Pulmonary Tuberculosis and Invasive Aspergillosis Infection in an Immunocompetent Host

Pulmonary tuberculosis (TB) is a common infection in developing countries and is associated with low socioeconomic status. It is considered a serious infection due it its long-term sequelae. Post-TB lung disease decreases life expectancy and increases the risk of recurrent TB infection. It also significantly increases the risk of other bacterial and fungal infections. Aspergillosis develops in the cavitary lesions of TB, worsening them and resulting in a deteriorating clinical situation. Concomitant pulmonary TB (PTB) and invasive aspergillosis is uncommon, particularly in the absence of factors that suppress the immune system. In this report, we describe the case of a healthy young adult without previous structural lung damage who presented with primary PTB and acute invasive aspergillosis infection, discuss the treatment dilemma and provide a literature review.

Mycobacterium abscessus urinary tract infection in an immunocompetent host: A case report and literature review

Mycobacterium abscessus is one of the nontuberculous mycobacteria (NTM), which can cause many clinical spectra, predominantly pulmonary infections followed by skin and soft tissue infections. The prevalence of Mycobacterium abscessus infections has been growing worldwide over the last two decades. Urinary tract infection (UTI) secondary to M. abscessus is a rare condition, and only five cases have been described in the literature so far. Therefore, managing such a condition is challenging and based on limited evidence. Here, we report a case of an adult male with a history of previous urological procedures who presented with lower urinary tract symptoms (LUTS) and was found to have a UTI secondary to Mycobacterium abscessus. In this case, we described our successful management approach of this rare entity of Mycobacterium abscessus infection, and we reviewed similar cases in the literature.

Massilia timonae bacteremia: An unusual pathogen of septic abortion

Massilia timonae infections in humans have rarely been reported. To the best of our knowledge, M. timonae has not been previously recognized as a causative agent of obstetric or gynecological infections. Timely identification of this unusual pathogen and the use of targeted antimicrobial therapy are crucial to avoid consequences and treatment failure.

Time equals sight: Sphenoid sinus aspergilloma with vision loss

Sphenoid sinus aspergilloma (SSA) with visual loss has rarely been reported. Timely recognition and prompt surgical intervention are crucial to avoid permanent neurological consequences.

Sausage digit: Isolated tuberculous tenosynovitis of the middle finger

Isolated tuberculous tenosynovitis is a rare form of extra-pulmonary tuberculosis that frequently eludes assessment and constitutes diagnostic challenges

Pyelonephritis-associated Staphylococcus saprophyticus bacteremia in an immunocompetent host: Case report and review of the literature

Staphylococcus saprophyticus is one of the coagulase-negative staphylococcus species. It is the second most frequent causative microorganism in acute uncomplicated urinary tract infections in young women. However, it is potentially capable of causing more invasive infections including bacteremia, particularly secondary to pyelonephritis. We present a young, previously healthy lady who presented with urinary symptoms and hemodynamic instability and was found to have multiple renal and ureteric calculi with pyelonephritis. Later, blood and urine cultures isolated methicillin-resistant S. saprophyticus. The patient was successfully treated with a course of antibiotics targeting the organism with a favorable outcome. The clinical presentations and management of this rare entity of S. saprophyticus bacteremia-related pyelonephritis are outlined. In addition, the literature on similar cases was reviewed to raise awareness and avoid devastating consequences.

Spina Ventosa; Isolated tuberculous osteomyelitis of the little finger: A forgotten differential diagnosis

Isolated tuberculous dactylitis is a rare form of extra-pulmonary tuberculosis that frequently eludes assessment and constitutes diagnostic challenges. This case reminds physicians of keeping tuberculosis (TB) as a differential when dealing with chronic finger ulcers to avoid devastating consequences.

Ecthyma gangrenosum: a rare manifestation of Stenotrophomonas maltophilia infection in acute myelogenous leukemia patient

Ecthyma gangrenosum is a cutaneous infection typically associated with Pseudomonas aeruginosa. However, it is rarely caused by Stenotrophomonas maltophilia which might be overlooked leading to devastating consequences. We describe this case to avoid delays in the diagnosis and treatment of this aggressive infection, especially in immunocompromised patients.

Primary tuberculosis cutis orificialis; a different face of the same coin

Primary tuberculosis cutis orificialis (TCO) is a rare form of extrapulmonary TB. The Lack of respiratory symptoms and similarity of the presentations to other oral lesions can pose a diagnostic dilemma. Hence, delaying treatment and potentially devastating consequences

An enemy in shadows-Mycoplasma hominis septic arthritis and iliopsoas abscess: Case report and review of the literature

Mycoplasma hominis (M. hominis) is fastidious and difficult to grow bacteria with the ability to colonize the genitourinary and respiratory tracts. Infrequently can cause a variety of genitourinary tract infections, pregnancy complications, and neonatal diseases. M. hominis rarely reported to cause extragenital infections and seldomly native joint septic arthritis particularly in immunocompromised hosts, raising diagnostic challenges and is often associated with delayed diagnosis and high morbidity and mortality. We report the case of a 30-year-old patient who developed M. hominis native left hip septic arthritis with iliopsoas abscess after receiving rituximab for newly diagnosed thrombotic thrombocytopenic purpura (TTP). The diagnosis of M. hominis hip septic arthritis with iliopsoas involvement was confirmed following repeated joint and abscess aspiration and identification of the organism with the aid of culture and specific Polymerase chain reaction (PCR). The patient was subsequently treated with a prolonged course of antibiotics targeting the organism with a favorable outcome. The clinical presentations, assessment, and management of this rare entity of M. hominis related extragenital infections are outlined. In addition, the literature on similar cases was reviewed to raise awareness and avoid devastating consequences.

Ominous combination: COVID-19 disease and Candida auris fungemia-Case report and review of the literature

The identification of Candida auris fungemia in critically ill COVID-19 patients is detrimental, with huge implications on patient mortality and infectious control measures.

Kikuchi-Fujimoto disease following SARS CoV2 vaccination: Case report

Kikuchi's disease (KD) also known as Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis was first described in 1972 independently by Kikuchi and Fujimoto et al. It is a benign self-limited condition of unknown etiology which usually presents with cervical lymphadenopathy or fever of unknown origin. The diagnosis of KFD is based on histopathologic examination of the involved lymph node, showing the presence of well-defined necrosis without granulocytic cells. There is no special treatment for KFD. However non-steroidal anti-inflammatory drugs or corticosteroids are required occasionally to control the associated systemic manifestations. The outcome of the disease is usually favorable with resolution of symptoms in most cases within one to four months. We report a case of Kikuchi-Fujimoto disease that occurred in a young Qatari male patient 10 days following receiving the first dose of BNT162b2 vaccine. Diagnosis was established by lymph node biopsy and recovery was complete after 10 days.

Schistosoma gallbladder polyp masquerading as a neoplasm: Rare case report and literature review

Schistosomiasis affecting the gastrointestinal tract is common in tropical and subtropical areas but associated polyps presenting as gallbladder pathology are rare clinical entities necessitating high clinical suspicion.

Central line-associated Rhodotorula mucilaginosa fungemia in an immunocompetent host: Case report and review of the literature

Rhodotorula mucilaginosa is an emerging fungal infection with the ability of biofilms formation. The identification of R mucilaginosa fungemia should trigger reflexes of prompt central venous line removal and using Amphotericin therapy.

Antemortem diagnosis of human rabies: A case report

Antemortem diagnosis of rabies is challenging, and usually, more than one test modality is needed to confirm the diagnosis. No effective treatment exists so far, and the Milwaukee Protocol is debatable.

Ancient foe spectra: Case series of Mycobacterium tuberculosis presentations

Extrapulmonary tuberculosis frequently eludes assessment through atypical presentations and constitute diagnostic challenges. High degree of suspicion with aids of GeneXpert MTB/RIF can clinch the diagnosis and avoid unnecessary consequences.

A case of mycetoma-like chromoblastomycosis in Qatar

Chromoblastomycosis is one of the neglected tropical mycoses associated with chronic infection of the skin and subcutaneous tissues. We report a case of 49-year-old patient originally from India presented with a mycetoma-like lesion in his right foot which was slowly progressing over three-year period. The diagnosis of chromoblastomycosis was confirmed following surgical excision and identification of the unique histological pathology of muriform bodies. The patient was subsequently treated with a prolonged course of oral itraconazole with a favorable outcome. The clinical presentations, assessment and management of the disease are outlined.

Evaluating Hydrologic Response in Tile-Drained Landscapes: Implications for Phosphorus Transport

Phosphorus (P) loss in agricultural discharge has typically been associated with surface runoff; however, tile drains have been identified as a key P pathway due to preferential transport. Identifying when and where these pathways are active may establish high-risk periods and regions that are vulnerable for P loss. A synthesis of high-frequency, runoff data from eight cropped fields across the Great Lakes region of North America over a 3-yr period showed that both surface and tile flow occurred year-round, although tile flow occurred more frequently. The relative timing of surface and tile flow activation was classified into four response types to infer runoff-generation processes. Response types were found to vary with season and soil texture. In most events across all sites, tile responses preceded surface flow, whereas the occurrence of surface flow prior to tile flow was uncommon. The simultaneous activation of pathways, indicating rapid connectivity through the vadose zone, was seldom observed at the loam sites but occurred at clay sites during spring and summer. Surface flow at the loam sites was often generated as saturation-excess, a phenomenon rarely observed on the clay sites. Contrary to expectations, significant differences in P loads in tiles were not apparent under the different response types. This may be due to the frequency of the water quality sampling or may indicate that factors other than surface-tile hydrologic connectivity drive tile P concentrations. This work provides new insight into spatial and temporal differences in runoff mechanisms in tile-drained landscapes.

Contribution of Overland and Tile Flow to Runoff and Nutrient Losses from Vertisols in Manitoba, Canada

This study quantified the contributions of overland and tile flow to total runoff (sum of overland and tile flow) and nutrient losses in a Vertisolic soil in the Red River valley (Manitoba, Canada), a region with a cold climate where tile drainage is rapidly expanding. Most annual runoff occurred as overland flow (72-89%), during spring snowmelt and large spring and summer storms. Tile drains did not flow in early spring due to frozen ground. Although tiles flowed in late spring and summer (33-100% of event flow), this represented a small volume of annual runoff (10-25%), which is in stark contrast with what has been observed in other tile-drained landscapes. Median daily flow-weighted mean concentrations of soluble reactive P (SRP) and total P (TP) were significantly greater in overland flow than in tile flow ( < 0.001), but the reverse pattern was observed for NO-N ( < 0.001). Overland flow was the primary export pathway for both P and NO-N, accounting for >95% of annual SRP and TP and 50 to 60% of annual NO-N losses. Data suggest that tile drains do not exacerbate P export from Vertisols in the Red River valley because they are decoupled from the surface by soil-ice during snowmelt, which is the primary time for P loss. However, NO-N loading to downstream water bodies may be exacerbated by tiles, particularly during spring and summer storms after fertilizer application.

Effect of mesenchymal stem cell penile transplantation on erectile signaling of aged rats

Stem cell-based therapy targeted at the penile tissue has been lately considered in preclinical studies. This work aimed to assess the effect of intracavernous administration of mesenchymal stem cells (MSCs) in aged rats (n = 100). They were subjected to single intracavernous injection (ICI) of 1.0 million MSCs, followed up for 3, 4 weeks, 3 and 4 months (each group 25 rats) and compared with both adult and aged controls (n = 50). In dissected cavernous tissues, cGMP and histopathology were assessed in addition to intracavernous pressure (ICP) measurement in some anaesthetised rats. The results showed that cavernous tissue cGMP was significantly increased in MSCs transplanted rats in all investigated groups compared with the controls. The mean cavernous cGMP levels after 3 and 4 months of MSCs transplantation were significantly increased compared with those after 3 or 4 weeks. Cavernous tissue ICP measurement showed significant increase in MSCs transplanted groups compared with the controls, more in the long-term follow up than in the shorter one. Histopathological examination detected markedly dilated sinusoidal vascular spaces in the long-term follow-up study. It is concluded that stem cell-based therapy is feasible for age-associated erectile dysfunction and could improve erectile signaling.

Micturition after gastrocystoplasty and gastric bladder replacement

PURPOSE

We determine the function of gastric tissue as a reservoir for urine and driving force for urination.

MATERIALS AND METHODS

A total of 12 men 15 to 45 years old underwent gastrocystoplasty (8) or gastric bladder replacement (4). In 1 patient bladder neck reconstruction was performed with augmentation using the same gastric segment. Ten patients were followed for 1 to 2 years, and evaluated subjectively and objectively, including a urodynamic study 6 months postoperatively.

RESULTS

No patient had dysuria or hematuria, despite urinary pH of 5 or less. Mean bladder capacity after augmentation increased from 130 (range 60 to 150) to 420 ml. (range 400 to 470), and was 350 ml. (range 340 to 380) after gastric replacement. Uninhibited contractions occurred only when bladder filling reached 71 to 92% of ultimate capacity with a mean amplitude of 22 cm. water (range 5 to 38). Patients with a gastric neobladder demonstrated an interrupted biphasic flow pattern with a mean maximum flow rate of 12 ml. per second (range 11.5 to 12.8). Urine was evacuated mainly by contraction of the gastric bladder (74%) in stage 1 and by abdominal straining (80%) in stage 2 of voiding.

CONCLUSIONS

Stomach seems to be an ideal source of material for bladder augmentation or replacement. The high capacity, low pressure reservoir provided by gastric tissue is probably due to the nature of the involuntary contractions, which occur only late in filling with a low amplitude. Also, the gastric neobladder is evacuated mainly by contraction of its musculature, supplemented with abdominal straining at the end of voiding.