Tags: bacterial endocarditis

Candida Species

Essentials of Diagnosis Characteristic appearance of yeast and hyphae on KOH preparations. Formation of germ tubes in serum is presumptive diagnosis for Candida albicans. Cultures must be interpreted with caution because positive culture may represent colonization rather than infection. Serology not useful. General Considerations Epidemiology Candida organisms are commensal with humans and, in the absence of alterations in host defense mechanisms, usually do not cause disease. Candida exists as normal flora within the oral cavity, throughout the gastrointestinal (GI) tract, in expectorated sputum, in the vagina, and in the bladder of patients with indwelling catheters. There are >150 species within the genus Candida, although the majority are not known to cause […]

Treponema Pallidum

Essentials of Diagnosis Spiral, motile, coil-shaped, elongated (0.10 um × 5-20 um) spirochete. No reliable method for sustained in vitro cultivation. Direct detection with darkfield microscopy or immunofluorescent antibody in early syphilis. Nontreponemal antibody tests (rapid plasma reagin, Venereal Disease Research Laboratory [VDRL]) for screening, treatment follow-up. Treponema-specific antibody tests (fluorescent treponemal antibody test, microhemagglutination-T pallidum test) for confirmation. Cerebrospinal fluid (CSF) lymphocytosis, elevated CSF protein, or reactive CSF VDRL test suggests neurosyphilis. PCR, DNA probes, and immunoblotting techniques promising in congenital syphilis, early syphilis, or neurosyphilis. All patients with T pallidum infection should be tested for HIV coinfection and vice versa. General Considerations The term syphilis was first used in […]

Brucella, Francisella, Pasteurella, Yersinia, & Hacek

BRUCELLOSIS Essentials of Diagnosis Suspected in patients with chronic fever of unknown etiology who have a history of occupational exposure or come from a high prevalence area. Leukopenia. Blood culture or bone marrow cultures on appropriate media. Serum antibody titer = 1:160. Polymerase chain reaction. General Considerations Brucellosis (also called undulant fever, Mediterranean fever, Malta fever) is an infection that causes abortion in domestic animals. It is caused by one of six species of Brucella coccobacilli. It may occasionally be transmitted to humans, in whom the disease could be acute or chronic with ongoing fever and constitutional symptoms without localized findings. Epidemiology Brucellosis is transmitted to humans by either direct contact […]

Other Gram-Positive Cocci

The following organisms are too rare to merit extensive discussion of clinical syndromes, diagnosis, and treatment. STREPTOCOCCUS INIAE S iniae has recently been described as a cause of cellulitis, bacteremia, endocarditis, meningitis, and septic arthritis associated with the preparation of the aquacultured fresh fish tilapia.   LEUCONOSTOC SPECIES Leuconostoc spp. are gram-positive cocci or coccobacilli that grow in pairs and chains; Leuconostoc spp. may be morphologically mistaken for streptococci. They are vancomycin-resistant facultative anaerobes that are commonly found on plants and vegetables and less commonly in dairy products and wine. Leuconostoc spp. have been documented to cause bacteremias, intravenous line sepsis with localized exit site infection and/or bacteremia, meningitis, and dental […]

Streptococcus Dysgalactiae Subspp. Equisilimis & Streptococcus Zooepidemicus: Clinical Syndromes

PHARYNGITIS The symptoms of pharyngitis caused by these organisms mimic those of S pyogenes pharyngitis (Box 50-1; see also site). Poststreptococcal glomerulonephritis has been described following S dysgalactiae subspp. equisimilis and S zooepidemicus pharyngitis. Notably, however, no antistreptolysin O antibody response will be detected as these organisms do not produce streptolysin O. S dysgalactiae subspp. equisimilis pharyngitis has been associated with sterile reactive arthritis. Acute rheumatic fever, however, has not been described in association with S dysgalactiae subspp. equisimilis and S zooepidemicus pharyngitis. SKIN & SOFT TISSUE INFECTIONS Cellulitis, wound infections, pyoderma, erysipelas, impetigo, and cutaneous ulcers can be caused by these organisms (see site). Breaches in skin integrity may provide […]

Other Gram-Positive Cocci

VIRIDANS GROUP STREPTOCOCCI, INCLUDING ABIOTROPHIA DEFECTIVA & ABIOTROPHIA ADJACENS Essentials of Diagnosis Facultatively anaerobic gram-positive cocci, catalase negative, coagulase negative. a or ß hemolytic on blood agar. Abiotrophia defectiva and Abiotrophia adjacens require pyridoxal or thiol group supplementation. Streptococcus milleri group organisms often exhibit Lancefield antigens A, C, F, or G and often have a butterscotch odor. General Considerations Epidemiology Viridans streptococci are part of the normal microbial flora of humans and animals and are indigenous to the upper respiratory tract, the female genital tract, all regions of the gastrointestinal tract, and, most significantly, the oral cavity. Clinically significant species that are currently recognized as belonging to the viridans group of […]

Viridans Group Streptococci: Clinical Syndromes

ENDOCARDITIS Viridans streptococci have a strong association with bacterial endocarditis (see site) (Box 1). A defectiva and A adjacens were once an important cause of culture-negative endocarditis. However, current laboratory media and techniques enable these "nutritionally variant streptococci" to be identified more readily. BACTEREMIA Viridans streptococci account for 2.6% of positive blood cultures reported from clinical laboratories; however, of these, only about one-fifth are thought to be clinically significant (the remainder are attributed to contamination or transient bacteremia). Viridans streptococci are, however, one of the leading causes of bacteremia in febrile neutropenic patients. Viridans streptococcal bacteremia in neutropenic patients usually occurs in association with aggressive cytoreductive therapy for acute leukemia or […]

Enterococci: Clinical Syndromes

URINARY TRACT INFECTION Urinary tract infections, including uncomplicated cystitis, pyelonephritis, prostatitis, and perinephric abscess, are the most common type of clinical infections produced by enterococci (Box 1). Most enterococcal urinary tract infections are nosocomial and are associated with urinary catheterization or instrumentation. BACTEREMIA & ENDOCARDITIS Nosocomial enterococcal bacteremias are commonly polymicrobial. Portals of entry for enterococcal bacteremia include the urinary tract, intra-abdominal or pelvic sources, wounds (especially burns, decubitus ulcers, and diabetic foot infections), intravascular catheters, and the biliary tree. Metastatic infections other than endocarditis are rare in enterococcal bacteremia. Enterococci account for ~5-10% of all cases of infective endocarditis (see site). Most cases are caused by E faecalis, but E […]


STAPHYLOCOCCUS AUREUS Essentials of Diagnosis Large gram-positive cocci (0.7-1.5 um in size). Colonies surrounded by zone of hemolysis on blood agar. Colonies pigmented pale yellow to deep orange macroscopically. Cluster in grapelike bunches microscopically. Biochemically differentiated from streptococci by presence of the enzyme catalase. Biochemically differentiated from other staphylococci by presence of the enzyme coagulase. Analysis of chromosomal DNA can identify clonal isolates (useful in epidemiologic studies). General Considerations Epidemiology Staphylococcus aureus colonizes the human skin, vagina, nasopharynx, and gastrointestinal tract. Colonization occurs shortly after birth and may be either transient or persistent. Published studies differ widely in estimates of the prevalence of S aureus carriage. Between 10% and 35% of […]

Primary Bacteremia & Endocarditis

Staphylococci (both S aureus and CoNS) have emerged as the two most common organisms cultured from patients with primary bloodstream infections. The term "primary bacteremia" refers to positive blood cultures without an identifiable anatomic focus of infection. Differentiation of primary bacteremia from infective endocarditis (IE), in which infection of the cardiac valves leads to continuous bacterial seeding of the bloodstream, may challenge even the most experienced clinician. Primary S aureus bacteremia is associated with insulin-dependent diabetes, the presence of a vascular graft, and, most significantly, the presence of an indwelling intravascular catheter. Risk factors for IE include structurally abnormal valves, recent injection drug use, and the presence of a prosthetic cardiac […]