Eikenella corrodens endocarditis and liver abscess in a previously healthy male, a case report

Abstract Background Eikenella corrodens is one of the HACEK bacteria constituting part of the normal flora of the oropharynx, however, still an uncommon pathogen. We report a case of a large Eikenella corrodens liver abscess with simultaneously endocarditis in a previously healthy male. Case presentation A 49-year-old Danish man was admitted because of one-month malaise, fever, cough and unintentional weight loss. On admission there was elevated white blood cell count and C-reactive protein, as well as affected liver function tests. Initially pneumonia was suspected, but due to lack of improvement on pneumonia treatment, a PET-CT scan was performed, which showed a large multiloculated abscess in the liver. The abscess was drained using ultrasound guidance. Culture demonstrated Eikenella corrodens. Transesophageal echocardiography revealed aortic endocarditis. The patient was treated with antibiotics and abscess drainage, on which he slowly improved. He was discharged after 1.5 months of hospitalisation. On follow-up 2 months later, the patient was asymptomatic with normalized biochemistry and ultrasound showed complete regression of the abscess. Conclusions This is the first case of documented Eikenella corrodens concurrent liver abscess and endocarditis. The case report highlights that Eikenella corrodens should be considered as a cause of liver abscess. Empirical treatment of pyogenic liver abscess will most often cover Eikenella corrodens, but the recommended treatment is a third generation cephalosporin or a fluoroquinolon. A multiloculated liver abscess may require drainage several times during treatment. The finding of Eikenella corrodens should elicit an echocardiography to diagnose endocarditis even in patients without clinical signs of endocarditis

CNS infections in Greenland: A nationwide register-based cohort study

<div><p>Background</p><p>Indigenous Arctic people suffer from high rates of infectious diseases. However, the burden of central nervous system (CNS) infections is poorly documented. This study aimed to estimate incidence rates and mortality of CNS infections among Inuits and non-Inuits in Greenland and in Denmark.</p><p>Methods</p><p>We conducted a nationwide cohort study using the populations of Greenland and Denmark 1990–2012. Information on CNS infection hospitalizations and pathogens was retrieved from national registries and laboratories. Incidence rates were estimated as cases per 100,000 person-years. Incidence rate ratios were calculated using log-linear Poisson-regression. Mortality was estimated using Kaplan-Meier curves and Log Rank test.</p><p>Results</p><p>The incidence rate of CNS infections was twice as high in Greenland (35.6 per 100,000 person years) as in Denmark (17.7 per 100,000 person years), but equally high among Inuits in Greenland and Denmark (38.2 and 35.4, respectively). Mortality from CNS infections was 2 fold higher among Inuits (10.5%) than among non-Inuits (4.8%) with a fivefold higher case fatality rate in Inuit toddlers.</p><p>Conclusion</p><p>Overall, Inuits living in Greenland and Denmark suffer from twice the rate of CNS infections compared with non-Inuits, and Inuit toddlers carried the highest risk of mortality. Further studies regarding risk factors such as genetic susceptibility, life style and socioeconomic factors are warranted.</p></div

One-month mortality after CNS infection among Inuits and non-Inuits in Greenland and Denmark, 1990–2012.

<p>The highest mortality was observed the first week after infection. Inuits in Greenland and Denmark carried the highest risk of mortality compared to non-Inuits in the two countries.</p

Incidence rate of laboratory-confirmed bacterial meningitis and the distribution of bacterial agents in meningitis cases in Greenland 1990–2012 and in Denmark 2011–2012 identified by culture in either cerebrospinal fluid (CSF) or blood.

<p>Incidence rate of laboratory-confirmed bacterial meningitis and the distribution of bacterial agents in meningitis cases in Greenland 1990–2012 and in Denmark 2011–2012 identified by culture in either cerebrospinal fluid (CSF) or blood.</p

Incidence rate of CNS infection by age, ethnicity and country in Greenland and Denmark, 1990–2012.

<p>Incidence rate of CNS infection by age, ethnicity and country in Greenland and Denmark, 1990–2012.</p