Rare case of osteomyelitis caused by Gardnerella vaginalis and Streptococcus parasanguinis in a postmenopausal woman

Vertebral osteomyelitis is an infection of the vertebrae that can lead to spinal degeneration, most commonly caused by Staphylococcus aureus. Here, we report an unusual case of pyogenic osteomyelitis caused by Gardnerella vaginalis and Streptococcus parasanguinis in a 61-year-old postmenopausal woman. The patient presented with a 2-week history of worsening lower back pain and fever and a recent episode of cystitis following re-engagement of sexual activity. Imaging revealed a deterioration of vertebrae discs and spinal canal stenosis at the L3-L4 levels with a formation of abscess in the right psoas muscle. Needle aspiration of the abscess identified G. vaginalis and S. parasanguinis and the patient was successfully treated with a 6-week course of ceftriaxone and metronidazole. This case describes an unusual coinfection of two pathogens that normally reside in the urogenital tract and oral cavity, respectively, and highlights the risk posed when these organisms breach the body’s normal barriers.

Bacterial Profile and Antimicrobial Susceptibility of Isolates Recovered from Lower Respiratory Tract Infection for Patients in Rizgary Hospital, Erbil

Recognition of etiologies of lower respiratory tract infection (LRTI) may help in delivering effective treatment options and circumvent emergence of antibiotic resistance. This study was carried out to uncover bacterial profile and antibiotic sensitivity patterns among 310 LRTI patients attended Rizagary Hospital between January 2014 to December 2016. Standard laboratory techniques were applied in collecting, processing, and culturing sputum and bronchial wash specimens. VITEK® 2 compact systems were used to identify bacteria and their antibiotic sensitivity patterns. Results showed that Streptococcus parasanguinis and Acinetobacter baumannii were the most abundant gram-positive and gram-negative bacteria (GPB & GNB), respectively, isolated from sputum specimens. From bronchial wash specimens, only GNB were detected and Serratia marcescens was the most abundant one. Antibiotic sensitivity tests revealed that Streptococcus parasanguinis was the most resistant GPB and Acinetobacter baumannii was the most resistant GNB. Sputum recovered GPB were highly resistant to Ampicillin, Erythromycin, Levofloxacin, Trimethoprim/Sulfamethoxazole, and Tetracycline. Bronchial wash recovered GNB were highly resistant to Ampicillin, Minocycline, Pefloxacin, Piperacillin, and Ticarcillin. In conclusion, LRTIs are mainly associated with GNB rather than GPB. The recovered Streptococcus parasanguinis and Acinetobacter baumannii were found to be multidrug-resistant pathogens. Ampicillin was ineffective against any of recovered pathogenic bacteria.

Functional Analysis of the Collagen Binding Proteins of Streptococcus parasanguinis FW213

ABSTRACT Streptococcus parasanguinis is a dominant isolate of dental plaque and an opportunistic pathogen associated with subacute endocarditis. As the expression of collagen binding proteins (CBPs) could promote the establishment of S. parasanguinis in the host, the functions of three putative CBP-encoding loci, Spaf_0420, Spaf_1570, and Spaf_1573, were analyzed using isogenic mutant strains. It was revealed that S. parasanguinis FW213 bound effectively to fibronectin and type I collagen, but the strain’s affinity for laminin and type IV collagen was quite low. By using various deletion derivatives, it was found that these three loci mediated the binding of S. parasanguinis to multiple extracellular matrix molecules, with type I collagen as the common substrate. Derivative strains with a deletion in any of the three loci expressed reduced binding to trypsin-treated swine heart valves. The deletion of these loci also reduced the viable count of S. parasanguinis bacteria within macrophages, especially the loss of Spaf_0420, but only strains with deletions in Spaf_0420 and Spaf_1570 expressed reduced virulence in the Galleria mellonella larva model. The deletion of Spaf_1570 and Spaf_1573 affected mainly the structure, but not the overall mass, of biofilm cultures in a flow cell system. Thus, CBPs are likely to be more critical for the initial colonization of S. parasanguinis on host tissues during the development of endocarditis. IMPORTANCE Bacteria generally can utilize multiple adhesins to establish themselves in the host. We found that Streptococcus parasanguinis, a dominant oral commensal and an opportunistic pathogen for subacute endocarditis, possesses at least three collagen-binding proteins that enable S. parasanguinis to successfully colonize damaged heart tissues and escape innate immune clearance. The binding specificities of these three proteins for extracellular matrix molecules differ, although all three proteins participate in biofilm formation by S. parasanguinis. The “multiligand for multisubstrate” feature of these adhesins may explain the high adaptability of this microbe to different tissue sites.

A Rare Cause of Primary Aortoenteric Fistula: Streptococcus parasanguinis Aortitis

Primary aortoenteric fistula is a rare cause of upper gastrointestinal bleed but can lead to significant mortality if the diagnosis is delayed. Aortitis, characterized by inflammation of the aortic wall, is a rare cause of aortoenteric fistula. We present a case report of a 72-year-old male patient with infectious aortoenteric fistula secondary to Streptococcus parasanguinis, along with a review of the literature. This case demonstrates the importance of early diagnosis and aggressive surgical treatment of aortoenteric fistulae and recognizing infectious aortitis as a potential etiology.