Massive empyema caused by Mycoplasma pneumoniae in an adult: A case report

BACKGROUND: Mycoplasma pneumoniae is responsible for more than 20% of community acquired pneumonia cases, and capable of causing upper respiratory illness as well. Complications of M.pneumoniae infections include CNS involvement but other as pericarditis were also reported. The lack of feasible culture methods and under appreciation of the pathogens ability to cause invasive disease leads to reduced number of diagnosed M.pneumoniae related complications. In contrast to many other respiratory pathogens causing pneumonia, M. pneumoniae related severe pleural complications were almost never reported. CASE PRESENTATION: We report a previously healthy 57 years old woman presented with indolent massive right pleural effusion, leukocytosis and elevated ESR. Extensive microbiological evaluation didn't reveal any pathogen in the pus even before antibiotic treatment was started. Surprisingly, M.pneumoniae DNA was detected in the pus from the empyema using PCR designed to detect M.pneumoniae. A serological assay (Serodia-Myco II) using convalescent serum was indeterminate with a titer of 1:80. The patient responded well to a treatment that included right thoracotomy with pleural decortication and a combination of antibiotics and anti-inflammatory medications. CONCLUSION: M.pneumoniae related empyema was never reported before in adult patients and was reported in only a few pediatric patients. In our patient there was no evidence to any common pathogens even before initiating antibiotic treatment. The only pathogen detected was M.pneumoniae. In this patient, serology was not helpful in establishing the diagnosis of M.pneumoniae related diseases, as was suggested before for older patients. We suggest that M.pneumoniae related empyema is probably under-diagnosed complication due to insensitivity of serology in older patients and under use of other diagnosis methods

Acetobacter cibinongensis Bacteremia in Human

Acetobacter cibinongensis Bacteremia in Human To the Editor: The genus Acetobacter belongs to the group of acetic acid bacteria that oxidize alcohols or sugars incompletely, leading to the accumulation of acetic acid. Acetic acid bacteria are of great industrial interest because of their use to produce vinegar from spirits, wine, beer, and cider in temperate regions of Europe, the Americas, and Japan. Several species seem to be associated with tropical climates. In Southeast Asia, Acetobacter spp. have been found in fermented foods such as tea fungus beverage, palm vinegar, palm wine, nata de coco, and pickles (1). A. cibinongensis is mainly found in tropical fruits and fl owers (2). We describe a case of human infection with a member of the genus Acetobacter. The patient was an HIV-seronegative, 40-year-old man who for 1 year had been receiving chronic hemodialysis for end-stage renal failure. He had a history of intravenous drug use, and continued use was suspected. In February 2005, when admitted for a routine dialysis session, he had fever (38°C) and bronchitis and was receiving empiric treatment with amoxicillin (2 g/day). His respiratory status improved slightly, but fever persisted after 48 hours. On his right forearm, he had a large infl ammatory skin lesion that followed the course of an arteriovenous fi stula, suggestive of staphylococcal infection. Treatment was switched to pristinamycin (2 g/ day for 4 days). The patient's leukocyte count was within normal limits, but his C-reactive protein level was elevated (50 mg/L). Two blood samples were drawn, 1 through a subclavian catheter implanted in 2004 and the other through the arteriovenous fi stula. After 4 days, a gram-variable polymorphic rod, named nîmes373

Evaluation of Four Commercial IgG- and IgM-specific Enzyme Immunoassays for Detecting Mycoplasma pneumoniae Antibody: Comparison with Particle Agglutination Assay

Diagnosis of Mycoplasma pneumoniae infection is important due to its variable clinical manifestations and absence of response to beta-lactams. Introduction of enzyme immunoassays (EIAs) for serologic diagnosis of M. pneumoniae has made it possible to separate the analyses of specific IgG and IgM antibodies. We compared four different commercial EIAs, ImmunoWELL IgG, IgM (GenBio), Medac IgG, IgA, IgM (Medac), Platelia IgG, IgM (Sanofi Pasteur), and Ridascreen IgG, IgA, IgM (r-Biopharm) with indirect particle agglutination assay (PA), Serodia-MycoII (Fujirebio). We tested 91 specimens from 73 pediatric patients (2-17 yr) hospitalized at a tertiary-care hospital between December 2005 and January 2006. The measurements of IgM EIAs were correlated with PA titers (Spearman's correlation coefficient, from 0.89 to 0.92) with high concordance rates, ranging from 82.4% to 92.3%. However, some negative IgM-EIA results in PA-positive specimens indicated that serial samplings with convalescent sera would be necessary to confirm M. pneumoniae infection

Cat or Dog Ownership and Seroprevalence of Ehrlichiosis, Q Fever, and Cat-Scratch Disease

Concerns have been raised about the role of domestic cats or dogs in the acquisition of zoonoses, in particular in pregnant women or immune-suppressed persons. We report that cat or dog ownership is not associated with an increased seroprevalence of antibodies to Anaplasma phagozytophilum, Coxiella burnetii, and Bartonella henselae in symptom-free persons in Styria, Austria

Retrospective survey for sialidase activity in Mycoplasma pneumoniae isolates from cases of community-acquired pneumonia

<p>Abstract</p> <p>Background</p> <p>Sialidase is a well-known virulence factor of other respiratory pathogens, but was only recently documented to occur in some species of <it>Mycoplasma</it>. The sialidase activity expressed can vary quantitatively among strains within a species of mycoplasma, from undetectable to amounts that correlate positively with strain virulence. Very few isolates of <it>Mycoplasma pneumoniae </it>had ever been examined for sialidase activity, so it was unknown whether sialidase may contribute to diseases involving this species.</p> <p>Findings</p> <p>No sialidase activity was detected by spectrofluorometric assay of 15 laboratory strains and 91 clinical isolates of <it>M. pneumoniae </it>banked over many years from patients having radiologically-confirmed, uncomplicated community-acquired pneumonia.</p> <p>Conclusions</p> <p>The annotated genome of strain M129 (GenBank <ext-link ext-link-id="NC_000912" ext-link-type="gen">NC_000912</ext-link>, <ext-link ext-link-id="ATCC29342" ext-link-type="gen">ATCC 29342</ext-link>), also isolated from a patient with pneumonia, accurately represents the absence of sialidase genes from strains of <it>M. pneumoniae </it>typically associated with uncomplicated community-acquired pneumonia. A possible involvement of sialidase in neurologic or other extra-respiratory manifestations of <it>M. pneumoniae </it>mycoplasmosis remains to be investigated.</p

Distributions of Antibody Titers to Mycoplasma pneumoniae in Korean Children in 2000-2003

The aim of study was to describe Mycoplasma pneumoniae epidemics in a hospital-based population. Special attention was paid to the relationship between antibody titer to M. pneumoniae and sex, age, and atopy. During the eight 6-month periods between January 2000 and December 2003, serum samples were obtained from 1,319 Korean children who presented with respiratory symptoms, and were examined for antibodies to M. pneumoniae using the indirect particle agglutination test. Geometric mean antibody titers peaked in the second half of 2000 and then decreased gradually, a second peak occurred in the second half of 2003. Likewise, the frequency of high antibody titers (≥1:640) also peaked during these two periods. Antibody titers in children aged 0-3 yr were lower than in older children during both peak periods and for 2 yr after the first peak. Sex and atopy had no effect on antibody titers. During the years 2000-2003, geometric mean antibody titers and the frequencies of high antibody titers varied with time. These changes suggest a cyclic pattern of M. pneumoniae infection, with two epidemic peaks separated by 3 yr