A 4-year-old Holstein cow with progressive atrophy and ataxia was submitted for diagnosis. The postmortem examination revealed multifocal yellowish nodules in the pulmonary parenchyma and vegetative masses in the mitral and tricuspid valve of the heart. Both kidneys were severely enlarged, with multiple yellow nodules on the parenchyma. Histopathologically, pulmonary abscesses, vegetative endocarditis, suppurative glomerulonephritis, and fibrino-purulent arthritis were observed. The tiny β-hemolytic bacterial colonies were isolated from the lesions and identified as Arcanobacterium haemolyticum by the Vitek 2 system (bioMérieux, USA). This is the first documented report of an A. haemolyticum infection in a Holstein cow in Korea.

Chronic/cyclic neutropenia, leukocyte adhesion deficiency syndrome, Papillon-Lefèvre syndrome, and Chédiak-Higashi syndrome are associated with severe periodontitis, suggesting the importance of neutrophils in the maintenance of periodontal health. Various Toll-like receptor (TLR) ligands are known to stimulate neutrophil function, including FcR-mediated phagocytosis. In the present study, the effect of TLR2 activation on the non-opsonic phagocytosis of oral bacteria and concomitant production of reactive oxygen species (ROS) by human neutrophils was evaluated. Neutrophils isolated from peripheral blood were incubated with Streptococcus sanguinis or Porphyromonas gingivalis in the presence of various concentrations of Pam3CSK4, a synthetic TLR2 ligand, and analyzed for phagocytosis and ROS production by flow cytometry and chemiluminescence, respectively. Pam3CSK4 significantly increased the phagocytosis of both bacterial species in a dose-dependent manner. However, the enhancing effect was greater for S. sanguinis than for P. gingivalis. Pam3CSK4 alone induced ROS production in neutrophils and also increased concomitant ROS production induced by bacteria. Interestingly, incubation with P. gingivalis and Pam3CSK4 decreased the amounts of ROS, as compared to Pam3CSK4 alone, indicating the possibility that P. gingivalis survives within neutrophils. However, neutrophils efficiently killed phagocytosed bacteria of both species despite the absence of Pam3CSK4. Although P. gingivalis is poorly phagocytosed even by the TLR2-activated neutrophils, TLR2 activation of neutrophils may help to reduce the colonization of P. gingivalis by efficiently eliminating S. sanguinis , an early colonizer, in subgingival biofilm.
Bacteria* ; Biofilms ; Colon ; Flow Cytometry ; Humans* ; Leukocyte-Adhesion Deficiency Syndrome ; Ligands ; Luminescence ; Neutropenia ; Neutrophils* ; Periodontitis ; Phagocytosis* ; Porphyromonas gingivalis ; Reactive Oxygen Species* ; Streptococcus ; Toll-Like Receptor 2* ; Toll-Like Receptors*

BACKGROUND: The false positive signals of a continuous monitoring blood culture system (CMBCS) increase the reporting time and laboratory cost. This study aimed to determine the highly relevant variables that discriminate false positive signals from true positive signals in a CMBCS. METHODS: Among 184,363 blood culture sets (aerobic and anaerobic), the signal-positive samples according to a BACTEC FX system (Plus Aerobic/F, BDA; Plus Anaerobic/F, BDN) and BacT/Alert 3D system (Standard Aerobic, BSA; Standard Anaerobic, BSN) between April 2010 and November 2013 were classified into two groups: false positive or true positive signals. The data of 15 parameters between the two groups were then statistically compared. RESULTS: Among total blood cultures, the positive rates of CMBCS signals according to BDA, BDN, BSA, and BSN were 4.9%, 2.8%, 3.8%, and 3.2%, respectively. The false positive rates of CMBCS signals according to BDA, BDN, BSA, and BSN were 0.6%, 0.1%, 0.1%, and 0.1%, respectively. The blood volume, detection time, time interval between admission and test, C-reactive protein concentration, leukocyte count, delta neutrophil index, and mean peroxidase index showed statistically significant differences between the two groups. CONCLUSION: There were no variables with diagnostic sensitivity and specificity for discriminating the two groups. Therefore, analysis of bacterial growth curves produced by CMBCS is needed for early and effective detection of false positive signals.
Blood Volume ; C-Reactive Protein ; Leukocyte Count ; Neutrophils ; Peroxidase

BACKGROUND: Bacteremia is a life-threatening infection, and prognosis is highly dependent on early recognition and treatment with appropriate antimicrobial agents. We investigated the diagnostic performance of serum procalcitonin (PCT) for differentiation between contaminants and true pathogens in blood cultures. METHODS: Serum PCT, C-reactive protein (CRP) and blood culture were performed for 473 patients between February 2008 and October 2008. We retrospectively reviewed the patients' clinical characteristics and laboratory results based on medical records. RESULTS: The mean concentration of PCT was significantly different between the two negative and positive blood culture groups (6.45 ng/mL vs 28.77 ng/mL, P<0.001). Procalcitonin levels were found to be markedly higher in those with Gram-negative bacilli (mean+/-SD; 59.58+/-67.00 ng/mL) bacteremia than in those with Gram-positive cocci (mean+/-SD; 17.75+/-42.88 ng/mL) bacteremia (P<0.001). The areas under the receiver operating characteristic curves (95% confidence interval) for PCT and CRP were 0.880 (0.820~0.940) and 0.637 (0.538~0.736), respectively. The use of a PCT level of 2 ng/mL as a cutoff value yielded an 83.6% positive predictive value and a 77.4% negative predictive value for the detection of bacteremia pathogens. CONCLUSION: Serum PCT is a helpful diagnostic marker for rapidly and accurately distinguishing between contaminants and pathogens in blood cultures.
Anti-Infective Agents ; Bacteremia ; C-Reactive Protein ; Calcitonin ; Gram-Positive Cocci ; Humans ; Prognosis ; Protein Precursors ; Retrospective Studies ; ROC Curve

BACKGROUND: The AdvanSure TB/NTM real-time PCR kit (AdvanSure) was newly developed in Korea to detect Mycobacterium tuberculosis and nontuberculous mycobacteria (NTM) utilizing a specific primer and TaqMan probe targeting the IS6110 and rpoB genes which are unique to these species. The purpose of the present study was to evaluate the clinical utility of AdvanSure by comparing the results of acid-fast staining, mycobacteria culture, COBAS Amplicor MTB PCR (Amplicor), and AdvanSure. METHODS: A total of 182 specimens (105 respiratory and 77 nonrespiratory specimens) were obtained from 165 patients, and acid fast bacilli (AFB) staining, mycobacteria culture, and Amplicor were performed on all specimens. AdvanSure was also performed on the above specimens using the SLAN real-time PCR detection system. The sensitivity and specificity of AdvanSure were analyzed using AFB staining and culture. RESULTS: Of the 182 specimens, M. tuberculosis was detected in 43 specimens and NTM was detected in 12 specimens according to PCR and/or culture. The sensitivity and specificity of the AdvanSure based on AFB culture were 97.3% (36/37) and 95.5% (127/133) in M. tuberculosis and 75.0% (9/12) and 100% (0/133) in NTM, respectively. CONCLUSION: AdvanSure could be useful for detecting M. tuberculosis and NTM in the clinical laboratory with high sensitivity and specificity.
Humans ; Korea ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Sensitivity and Specificity ; Tuberculosis

BACKGROUND: Accurate detection of organisms producing extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase is very important for treatment of patients. However, unlike the ESBL confirmatory test, there are no guidelines for detection of organisms producing AmpC beta-lactamase. We evaluated a detection method using boronic acid (BA) for ESBL and AmpC beta-lactamase. METHODS: Clinical isolates of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis showing intermediate resistance or resistance to cefoxitin (FOX) or positive for ESBL were tested. A > or =5 mm increase in zone diameter of ceftazidime/clavulanic acid/BA (CAZ/CA/BA) and/or cefotaxime/clavulanic acid/BA (CTX/CA/BA) versus CAZ/BA and/or CTX /BA was considered positive for ESBL. Likewise, a > or =5 mm increase in zone diameter of FOX/BA and/or cefotetan/BA (CTT/BA) versus FOX and/or CTT alone was considered positive for AmpC beta-lactamase. RESULTS: Among 622 clinical isolates, ESBL positive rates by the CLSI ESBL confirmatory test or by the BA method were 18.1% or 18.4% for E. coli, 38.3% or 40.4% for K. pneumoniae, 8.7% or 8.7% for K. oxytoca, and 14.8% or 14.8% for P. mirabilis, respectively. AmpC beta-lactamase positive rates using the BA method were 3.7% for E. coli, 33.3% for K. pneumoniae, 0% for K. oxytoca, and 7.4% for P. mirabilis. The detection rates of coproducing ESBL and AmpC beta-lactamase were 2.4% in E. coli 27.1% in K. pneumoniae, and 3.7% in P. mirabilis. CONCLUSION: The ESBL confirmatory method using BA was found to enhance the detection of ESBLs, even when potentially masked by AmpC beta-lactamase.
Bacterial Proteins ; beta-Lactamases ; Boron ; Cefoxitin ; Escherichia ; Escherichia coli ; Humans ; Klebsiella ; Klebsiella oxytoca ; Klebsiella pneumoniae ; Masks ; Mirabilis ; Penicillinase ; Pneumonia ; Proteus ; Proteus mirabilis

BACKGROUND: Staphylococcus saprophyticus is the second most common cause of urinary tract infections (UTIs) in young women. As little is known about the incidence of UTIs caused by this organism in Korea, we examined its frequency and clinical characteristics. METHODS: We analyzed the frequency of S. saprophyticus among organisms isolated from urine specimens in Wonju Christian Hospital from July 1996 to June 2008 and reviewed clinical characteristics retrospectively. RESULTS: Of 24,277 strains isolated from urine specimens during the past 12 years, 21 (0.09%) were S. saprophyticus. Outpatients were more common in the S. saprophyticus group than in all patients group (12 of 21, 57% vs 5,098 of 24,277, 21%). The incidence of S. saprophyticus in women was the highest in the group of 15 to 34 years of age. Monthly distributions of isolates were almost constant in all patient groups, while 16 of 21 (76%) cases of the S. saprophyticus group occurred in summer and fall (June to November). CONCLUSION: The fequencies of S. saprophyticus among organisms isolated from urine specimens in all patient groups and women were 0.09% and 0.17%, respectively, and are much lower than those in other countries. However, we need further studies to examine the prevalence of S. saprophyticus UTIs in other regions of this country.
Female ; Humans ; Incidence ; Korea ; Outpatients ; Prevalence ; Staphylococcus ; Staphylococcus saprophyticus ; Urinary Tract ; Urinary Tract Infections

Parvimonas micra is a non-spore-forming anaerobic gram-positive coccus, widely distributed as normal flora in the skin, vagina and mucosa, and able to cause opportunistic infections, particularly endocarditis and brain abscess following dental manipulations. A 49-year-old woman was hospitalized due to fever and headache. She had been diagnosed with periodontitis at the beginning of fever. A brain abscess was noted in the right temporal lobe on the brain CT, and she was treated with ceftriaxone, isepamicin and metronidazole. In the next day, abscess was aspirated and drained by a surgical procedure. An organism was isolated from an anaerobic culture of the abscess aspirate, and was identified as P. micra by a commercial kit and 16S rRNA sequencing.
Abscess ; Brain ; Brain Abscess ; Ceftriaxone ; Endocarditis ; Female ; Fever ; Gentamicins ; Headache ; Humans ; Metronidazole ; Middle Aged ; Mucous Membrane ; Opportunistic Infections ; Peptostreptococcus ; Periodontitis ; Skin ; Temporal Lobe ; Vagina

Although Leuconostoc species have rarely been isolated from clinical specimens, this organism may cause invasive infections such as bacteremia and meningitis in immunocompromised patients. We report a case of Leuconostoc garlicum bacteremia in an 84-year-old male with hemovac catheter placement, vancomycin therapy, and inflammatory enterocolitis as underlying risk factors.
Aged, 80 and over ; Bacteremia ; Catheters ; Enterocolitis ; Humans ; Immunocompromised Host ; Leuconostoc ; Male ; Meningitis ; Risk Factors ; Vancomycin

Although Leuconostoc species have rarely been isolated from clinical specimens, this organism may cause invasive infections such as bacteremia and meningitis in immunocompromised patients. We report a case of Leuconostoc garlicum bacteremia in an 84-year-old male with hemovac catheter placement, vancomycin therapy, and inflammatory enterocolitis as underlying risk factors.
Aged, 80 and over ; Bacteremia ; Catheters ; Enterocolitis ; Humans ; Immunocompromised Host ; Leuconostoc ; Male ; Meningitis ; Risk Factors ; Vancomycin