- Volume 3, Issue 2, 2016

Intra-uterine infection is a major cause of spontaneous pre-term birth before 30 weeks of gestation. In addition, intra-amniotic inflammation is present in approximately 80 % of patients with acute cervical insufficiency. The microbiome is known to cause intra-amniotic infection causing pre-term birth. Recently, surveys of the microbial communities in the vagina or in amniotic fluid using sequencing of the 16s rRNA gene have been carried out. Here, we reported the microbiome compositions in mid-trimester amniotic fluids in two pregnant women with cervical insufficiency identified using 16S rRNA sequencing.

A 35-year-old primipara and a 37-year-old nullipara were admitted to Hallym University Medical Center, Korea. They were negative for nitrazine and Actim PROM (Medix Biochemica) tests, and their amniotic membranes had prolapsed beyond the external os. A physical examination indicated that cerclage using a uniconcave balloon should be carried out, and amnioreduction was performed. Thereafter, they delivered at very early pre-term birth of below 24 weeks and the birth outcomes were pre-natal death. Analysis of mid-trimester amniotic fluids in these two pregnant women with cervical insufficiency identified Sneathia sanguinegens and Fusobacterium nucleatum. These bacteria were not identified using vaginal or amniotic cultures.

These results suggest that 16S rRNA gene sequencing can be used to identify the predominant microbiome causing pre-term birth in pregnant women with cervical insufficiency. Further studies are needed in large samples to improve our understanding of microbes causing pre-term birth and to prevent pre-term birth in pregnant women with cervical insufficiency.

Helicobacter spp. colonizing the human stomach other than Helicobacter pylori have been rarely described in children.

We identified an uncultured Helicobacter heilmannii sensu lato by histology and PCR in biopsies from a symptomatic child. Surprisingly, the PCR assay demonstrated the presence of the vacA gene in this uncultured H. heilmannii sensu lato and its sequence related highly to H. pylori vacA virulence factor. The analysis of the 16S ribosomal sequence showed higher identity with uncultured Helicobacter spp. and the H. heilmannii strain, respectively.

This is the first report that shows the presence of vacA in an uncultured H. heilmannii sensu lato extracted from human gastric mucosa.

Rhodococcus spp. have been implicated in a variety of infections in immunocompromised and immunocompetent hosts. Rhodococcus equi is responsible for the majority of reported cases, but Rhodococcus erythropolis, Rhodococcusgordoniae and Rhodococcusruber infections have been described. There are no prior reports of human infection with Rhodococcus fascians.

We describe the unexpected finding of R. fascians in liver lesions incidentally noted at autopsy in an immunosuppressed patient status after bone-marrow transplant for acute lymphoblastic leukaemia who died of unrelated causes (septic shock due to Clostridium difficile colitis). At autopsy, an otherwise unremarkable liver contained several dozen well-demarcated sclerotic-appearing lesions measuring 0.1–0.3 cm in size. The absence of other bacterial or fungal DNA in the setting of histologically visible organisms argues against its presence as a contaminant and raises the consideration that R. fascians represents a human pathogen for the immunocompromised.

Whether it represents the sole infectious agent responsible for the miliary lesions or a partially treated co-infection is impossible to determine, but our finding continues to reinforce the importance of molecular techniques in associating organisms with sites of infection and optimizing treatment of infectious diseases.

Coccidioidomycosis is commonly associated with mild symptoms, and disseminated disease is rare in healthy individuals.

A 2-month-old male presented for further management of Stenotrophomonas maltophilia pneumonia. Respiratory and blood cultures showed a yeast-like growth that was later identified and confirmed as Coccidioides species.

We present a fatal case of disseminated coccidioidomycosis in a 2-month-old infant with unclear exposure and mode of transmission. The diagnosis of coccidioidomycosis may have been complicated by the premature diagnosis of Stenotrophomonas maltophilia, highlighting the importance of further investigation into co-infection or alternative pathogens when patients do not respond to initial therapy.

Nocardia species have a worldwide distribution and are commonly found as saprophytes of soil or water. However, they can cause human disease especially in immunocompromised patients, with respiratory infection being the most frequent clinical manifestation of the disease. The aim of the present work was to describe the first clinical isolation of Nocardia grenadensis from the sputum of a patient from the north of Spain suspected of having tuberculosis.

In November 2012, a chest X-ray showed a mass in the left upper lobe of the lung of a 75-year-old man with persistent cough with bloody expectoration. The patient was sent to the outpatient pulmonology consultation for further studies. In the sputum sent for mycobacterial study, a Nocardia isolate was present that was identified by sequencing a 1440 bp fragment of the 16S rRNA gene as N. grenadensis at the Special Bacteriology Reference Laboratory at the Centers for Disease Control and Prevention (USA).

The clinical significance of N. grenadensis in the sputum of this patient was uncertain, as symptoms of persistent cough with haemoptysis in the absence of other identified causes suggested the possible involvement of N. grenadensis in a bronchial lung infection. However, the spontaneous resolution of symptoms without specific antimicrobial treatment pointed to the possibility of a transient colonization. To the best of our knowledge, this is the first evidence in the literature of the isolation of N. grenadensis in humans.

Non-tuberculous mycobacteria are ubiquitous micro-organisms that rarely cause disease in humans, unless they are immunocompromised or have undergone trauma.

We describe a case of spontaneous breast abscess due to Mycobacterium fortuitum in an immunocompetent patient, identified using DNA-STRIP technology. This is the third report that, apart from being caused by the same agent, has the localization on the left breast in common, raising the question of a laterality effect.

Careful inspection of cultures and accurate agent identification are procedures to be emphasized in clinical microbiology laboratories. In fact, they may reveal unusual growth due to uncommon micro-organisms.

Elephant endotheliotropic herpesvirus-1 (EEHV-1) is one of the major causes of fatality in juvenile Asian elephants (Elephas maximus). On occasions, other EEHV genotypes, i.e. EEHV-3, -4 and -5, have also been reported as the cause of Asian elephant deaths. In this case report we describe the investigation into a juvenile Asian elephant fatality in a European zoo.

A fatal case of haemorrhagic disease in a juvenile Asian elephant from a European zoo was diagnosed with co-infection of EEHV-1 and -4. EEHV-4 had a wider organ distribution and a higher viral load; both viruses presented the highest load in the mesenteric lymph nodes.

Detection of EEHV-4 in this fatal case in Europe underlines the importance of inclusion of all known Asian EEHVs in routine blood monitoring to facilitate early therapeutic intervention.

Mycoplasma hominis is a rare but recognized cause of post-operative wound infection. There are very few cases reported in the literature of M. hominis infection following neurosurgery.

A 30-year-old woman with a history of chronic low back pain and symptoms consistent with sciatica underwent a microdiscectomy and anterior lumbar inter-body fusion for cord compression. Following surgery she developed an abscess overlying the lumbar surgical wound. Initial microbiological samples were negative on routine culture and the abscess recurred following surgical washout. Culture of a second specimen taken 1 month following the initial surgery revealed small colourless colonies that were not able to be seen on Gram stain. Molecular testing with 16S rRNA gene analysis confirmed M. hominis infection and the patient was treated with long-term oral moxifloxacin.

Infection with M. hominis should be considered in culture-negative cases of post-operative wound infection where routine antibiotics fail. Diagnosis of Mycoplasma can be delayed due to the fastidious nature of the organism and may require molecular techniques. Initiation of appropriate antimicrobial treatment is often associated with a good clinical outcome.