International Journal of Infectious Diseases RSS feed: Current Issue. The International Journal of Infectious Diseases (IJID) is published bimonthly by the International Society for Infectious Diseases. IJID welcomes manuscripts in the following categories: epidemiology, clinical diagnosis, treatment and control of infectious diseases with particular emphasis placed on those diseases that are most common in less-developed countries. IJID publishes original clinical and laboratory-based research, together with reports of clinical trials, reviews and some case reports. Please note that the International Journal of Infectious Diseases will become an e-only publication from January 2010 and all accepted papers will be published online only. http://www.ijidonline.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. International Journal of Infectious Diseases1201-9712142February 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.ijidonline.com/article/PIIS1201971210000226/abstract?rss=yesEditorial Board10.1016/S1201-9712(10)00022-6International Journal of Infectious Diseases 14, 2 (2010)2010-02-01International Journal of Infectious Diseases2010-02-01142S1201-9712(10)X0002-9e89e89http://www.ijidonline.com/article/PIIS1201971209001568/abstract?rss=yesSummary: Background: Mycoplasma hominis and Ureaplasma urealyticum are important opportunistic pathogens implicated in urogenital infections and complicated pregnancy. We aimed to study the role of these pathogens in symptomatic and asymptomatic pregnant women and determine their clinical significance and antibiotic susceptibility.Methods: One hundred pregnant women were included in the study, 50 symptomatic patients and 50 asymptomatic controls. Duplicate endocervical samples were taken from each individual and analyzed using the Mycoplasma IST-2 kit and A7 agar medium. Antimicrobial susceptibility was tested against doxycycline, josamycin, ofloxacin, erythromycin, tetracycline, ciprofloxacin, azithromycin, clarithromycin, and pristinamycin using the Mycoplasma IST-2 kit.Results: Twelve symptomatic pregnant women had spontaneous abortions. Of these, eight (66.7%) cases had been colonized with M. hominis and/or U. urealyticum. Of the pregnant women infected with M. hominis and/or U. urealyticum, 40.7% delivered a low birth weight infant. M. hominis was successfully cultured in five women (5%) and U. urealyticum in 27 (27%). Among positive cultures, 15.6% and 84.4% of isolates were M. hominis and U. urealyticum, respectively. M. hominis and U. urealyticum were uniformly susceptible to doxycycline, tetracycline, and pristinamycin, which may be successfully used in the empirical therapy of infected individuals.Conclusions: It can be concluded that genital colonization with M. hominis and U. urealyticum may predispose to spontaneous abortion and low birth weight.Prevalence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in pregnant womenMehmet Refik Bayraktar, Ibrahim Halil Ozerol, Nilay Gucluer, Onder Celik10.1016/j.ijid.2009.03.020International Journal of Infectious Diseases 14, 2 (2010)2009-06-10International Journal of Infectious Diseases2009-06-10142S1201-9712(10)X0002-9Original Reportse90e95http://www.ijidonline.com/article/PIIS1201971209001581/abstract?rss=yesSummary: Objectives: This study was a retrospective investigation of botulism cases over a period of 18 years following major political and economic changes, addressing the question of whether this disease is still an important health concern in southwest Romania.Methods: The medical records of botulism cases were used as the source of data. Patients from five southwest Romanian counties were hospitalized at Victor Babes Hospital of Infectious Diseases in Timisoara during the period 1990–2007.Results: The median annual incidence of botulism cases in southwest Romania decreased from 0.1 per 100 000 persons during 1990–1998, to 0.05 per 100 000 persons during 1999–2007. Most of the cases (18.6%) were diagnosed in 1990, immediately following the communism period. The median age of the patients was 38 years (range 16–73 years); 24 (55.8%) were male; the case fatality rate was 2.3%. A significantly higher incidence rate of 2.7 cases per 100 000 persons occurred in rural areas, even though most of the cases (53.5%) were inhabitants of urban areas. The clinical pattern included: difficulty swallowing (79.1%), double and/or blurred vision (69.8%), dry mouth (60.5%), drooping eyelids (51.2%), vomiting (39.5%), mydriasis (37.2%), constipation (27.9%), abdominal pain (23.3%), and slurred speech (18.6%). All cases were attributed to contaminated food sources, mainly home-prepared traditional pork products.Conclusions: Although the botulism cases decreased over the study period in southwest Romania, this life-threatening disease continues to be an important concern. A strategy addressing individual behaviors in the home is needed to improve food safety.Foodborne botulism in southwest Romania during the post-communism period 1990–2007Adriana Maria Neghina, Iosif Marincu, Roxana Moldovan, Ioan Iacobiciu, Raul Neghina10.1016/j.ijid.2009.03.022International Journal of Infectious Diseases 14, 2 (2010)2009-06-17International Journal of Infectious Diseases2009-06-17142S1201-9712(10)X0002-9Original Reportse96e101http://www.ijidonline.com/article/PIIS1201971209001593/abstract?rss=yesSummary: Objectives: The purpose of this study is to amplify the knowledge base of the epidemiology, symptoms, and signs of extrapulmonary tuberculosis (EPTB) in Afghanistan.Methods: This is a retrospective review of EPTB diagnosed at CURE International Hospital and CURE Family Health Center (FHC) in Kabul, Afghanistan during a recent 20-month period.Results: One hundred eighteen cases were identified from patients presenting to the hospital and FHC. This group represents the spectrum of EPTB seen at a single referral center in Kabul. The ratio of females to males was 2.03:1. Lymph node tuberculosis comprised the greatest number of EPTB cases (37.3%, n=44). The central nervous system was the next most frequent site of EPTB involvement (20.3%, n=24), followed in descending order by skeletal, pleural, abdominal, cutaneous, genitourinary, pericardial, miliary, and breast tuberculosis.Conclusions: The 2:1 ratio of female to male EPTB cases coincides with the unusual epidemiologic pattern seen in smear-positive pulmonary TB in Afghanistan. As the first epidemiological report of EPTB from Afghanistan, this study illustrates the varied presentations of EPTB that should be known by healthcare workers throughout the country.Extrapulmonary tuberculosis in Kabul, Afghanistan: A hospital-based retrospective reviewTim Fader, John Parks, Najeeb Ullah Khan, Richard Manning, Sonya Stokes, Nasir Ahmad Nasir10.1016/j.ijid.2009.03.023International Journal of Infectious Diseases 14, 2 (2010)2009-06-22International Journal of Infectious Diseases2009-06-22142S1201-9712(10)X0002-9Original Reportse102e110http://www.ijidonline.com/article/PIIS1201971209001842/abstract?rss=yesSummary: Objectives: This study describes the role of adults in 57 household outbreaks of pertussis.Methods: Parents/guardians of children with suspected pertussis seen at a university hospital were interviewed. Once a case of pertussis was confirmed, all household members were enrolled in the study. The US Centers for Disease Control and Prevention (CDC) definitions for pertussis were used .Results: Among 349 household members, 150 were adults and one in five had pertussis during the household outbreaks. Of the adult cases, 70.6% were aged 19–39 years. The secondary attack rate in adults was 12.6%. Adults were the primary case in a 21.1% of households, resulting in 43% of all secondary cases. Most adult cases had typical symptoms of pertussis, but none had been diagnosed before the investigation.Conclusions: Adults, particularly those aged between 19 and 39 years, play an important role in pertussis transmission in households. Pertussis vaccination in adolescents/young adults may decrease the dissemination of pertussis in households.The role of adults in household outbreaks of pertussisP.N. Baptista, V.S. Magalhães, L.C. Rodrigues10.1016/j.ijid.2009.03.026International Journal of Infectious Diseases 14, 2 (2010)2009-06-26International Journal of Infectious Diseases2009-06-26142S1201-9712(10)X0002-9Original Reportse111e114http://www.ijidonline.com/article/PIIS1201971209001878/abstract?rss=yesSummary: Objectives: In Saudi Arabia, viral hepatitis ranked the second most common reportable viral disease in 2007, with almost 9000 new cases diagnosed in that year. The objective of this study was to determine the incidence trends of viral hepatitis seropositivity among the population served by the National Guard Health Affairs (NGHA) hospitals in the central, eastern, and western Saudi Arabia regions.Methods: The surveillance system at King Abdulaziz Medical City in Riyadh receives weekly reports of laboratory confirmed hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV) cases from all NGHA-served regions. In this study the viral hepatitis surveillance data for the period from January 2000 through December 2007 were analyzed.Results: Between 2000 and 2007, a total of 14 224 seropositive cases of viral hepatitis were reported to the surveillance system. The average annual incidence of seropositivity per 100 000 served population was highest for HBV (104.6), followed by HCV (78.4), and lowest for HAV (13.6). Saudis had higher HBV and HAV incidence, but lower HCV incidence compared to non-Saudis. Over the eight years (2000–2007), the incidence of all three viral hepatitis types showed a 20–30% declining trend. Only HAV incidence followed a clear seasonal cyclic pattern.Conclusions: Despite the declining trend over the eight-year period, viral hepatitis, especially that caused by HBV and HCV, remains a major public health problem in Saudi Arabia, and has probably been underestimated in previous reports. There is a need for more comprehensive prevention strategies.Incidence trends of viral hepatitis A, B, and C seropositivity over eight years of surveillance in Saudi ArabiaZiad A. Memish, Bandar Al Knawy, Aiman El-Saed10.1016/j.ijid.2009.03.027International Journal of Infectious Diseases 14, 2 (2010)2009-06-22International Journal of Infectious Diseases2009-06-22142S1201-9712(10)X0002-9Original Reportse115e120http://www.ijidonline.com/article/PIIS120197120900188X/abstract?rss=yesSummary: Background: Mycobacterium avium subspecies paratuberculosis (MAP) causes Johne's disease in ruminants, a chronic enteritis evocative of human inflammatory bowel disease. In industrialized countries MAP has been cultured from pasteurized milk, compounding the increasing concern that MAP may be zoonotic. The purpose of this study was to evaluate commercially available unpasteurized and pasteurized milk and its products for the presence of viable MAP or MAP DNA from an area of northern India with a population of 150 million people.Methods: We studied 43 samples (16 unpasteurized, 27 pasteurized) purchased in Mathura, Agra, or New Delhi, for the presence of MAP by culture or by PCR for IS900 MAP DNA. Positives results were confirmed as MAP by restriction endonuclease analysis and/or DNA sequencing.Results: Colonies appeared in 1.5–20 months post-inoculation. Of the unpasteurized samples, 44% (7/16) were MAP culture-positive and 6% (1/16) were positive for IS900 MAP DNA. Of the pasteurized samples, 67% (18/27) were MAP culture-positive and 33% (9/27) were IS900-positive. Subsequently, 100% (25/25) of the cultured colonies were IS900 and IS1311 MAP DNA-positive.Conclusions: This is the first report from a developing country of MAP cultured from both pasteurized and unpasteurized milk and milk products. Thus we corroborate the presence of viable MAP in the food chain reported from industrialized countries. With the increasing concern that MAP may be zoonotic, these findings have major implications for healthcare in India. The decreased sensitivity in detecting MAP DNA by PCR directly from milk should be ascribed to our employing only one set of PCR primers.Presence, characterization, and genotype profiles of Mycobacterium avium subspecies paratuberculosis from unpasteurized individual and pooled milk, commercial pasteurized milk, and milk products in India by culture, PCR, and PCR-REA methodsH. Shankar, S.V. Singh, P.K. Singh, A.V. Singh, J.S. Sohal, R.J. Greenstein10.1016/j.ijid.2009.03.031International Journal of Infectious Diseases 14, 2 (2010)2009-07-03International Journal of Infectious Diseases2009-07-03142S1201-9712(10)X0002-9Original Reportse121e126http://www.ijidonline.com/article/PIIS1201971209001921/abstract?rss=yesSummary: Objective: To describe the causes of mortality among the HIV-infected in southern India in the era of highly active antiretroviral therapy (HAART).Methods: Analyses of this patient cohort were conducted using the YRG Centre for AIDS Research and Education HIV Natural History Observational Database. Causes of death were then individually confirmed by patient chart review.Results: Sixty-nine deaths occurred within the inpatient unit; 25% were female and the median age of the 69 patients was 34 years. Over half of the patients (55%) died within three months of initiating HAART. At the time of enrollment into clinical care, the median CD4 cell count was 64 cells/μl (interquartile range (IQR) 37–134). At the time of initiating HAART, the median CD4 cell count was 58 cells/μl (IQR 31–67) for patients who died within 3 months of initiating HAART and 110 cells/μl (IQR 77–189) for patients who died more than 3 months after initiating HAART. Close to three-fourths of patients (70%) died from an AIDS-defining illness (ADI). The major ADI causes of death included Pneumocystis jiroveci pneumonia (22%), extrapulmonary tuberculosis (19%), CNS toxoplasmosis (12%), and pulmonary tuberculosis (10%). A tenth of patients died from cerebrovascular infarcts. Three patients (4%) died from non-Hodgkin lymphoma.Conclusions: AIDS-related events continue to be the major source of mortality among the HIV-infected in southern India in the era of HAART. This mortality pattern justifies increased proactive efforts to identify HIV-infected patients and initiate HAART earlier, before patients present to care with advanced immunodeficiency.Factors associated with mortality among HIV-infected patients in the era of highly active antiretroviral therapy in southern IndiaN. Kumarasamy, Kartik K. Venkatesh, Bella Devaleenol, S. Poongulali, Tokugha Yephthomi, A. Pradeep, Suneeta Saghayam, Timothy Flanigan, Kenneth H. Mayer, Suniti Solomon10.1016/j.ijid.2009.03.034International Journal of Infectious Diseases 14, 2 (2010)2009-07-27International Journal of Infectious Diseases2009-07-27142S1201-9712(10)X0002-9Original Reportse127e131http://www.ijidonline.com/article/PIIS1201971209001933/abstract?rss=yesSummary: Objectives: The addition of cladribine to the standard regimen consisting of daunorubicin and cytarabine has been reported to increase the efficacy of induction therapy in acute myeloid leukemia (AML). The goal of this study was to determine the effect of this modification on the incidence and spectrum of infectious complications.Methods: Case report forms of 309 patients with newly diagnosed AML who had been enrolled in the prospective, randomized ‘DAC-7 vs. DA-7’ trial were reviewed. The frequency, etiology, localization, severity, and outcome of infections were compared for patients receiving only daunorubicin and cytarabine (DA-7) and those additionally treated with cladribine (DAC-7).Results: A total of 443 febrile episodes were reported with no significant difference between the treatment groups. A trend towards a higher frequency of bacteremias was observed among DA-7 patients compared to those in the DAC-7 group (31% vs. 21%; p=0.08). The treatment arms did not differ in terms of the distribution of the isolated Gram-positive, Gram-negative, fungal, and viral organisms. However, when bacteremias were considered, Gram-positive blood cultures tended to be more frequent in the DA-7 compared to the DAC-7 group (16% vs. 8.5%; p=0.07). This difference reached statistical significance when major blood bacteremias were analyzed separately (13% vs. 5%; p=0.02). Complete recovery from infections was observed in the majority of patients across both treatment arms and no significant difference was noted regarding infection-related mortality.Conclusions: The addition of cladribine to standard induction chemotherapy has no impact on the incidence and spectrum of infectious complications in newly diagnosed AML patients.Infectious complications in patients with acute myeloid leukemia treated according to the protocol with daunorubicin and cytarabine with or without addition of cladribine. A multicenter study by the Polish Adult Leukemia Group (PALG)Ewa Lech-Maranda, Marek Seweryn, Sebastian Giebel, Jerzy Holowiecki, Beata Piatkowska-Jakubas, Joanna Wegrzyn, Aleksander Skotnicki, Marek Kielbinski, Kazimierz Kuliczkowski, Monika Paluszewska, Wieslaw Wiktor Jedrzejczak, Magdalena Dutka, Andrzej Hellmann, Marcin Flont, Barbara Zdziarska, Grazyna Palynyczko, Lech Konopka, Tomasz Szpila, Krzysztof Gawronski, Kazimierz Sulek, Jaroslaw Sokolowski, Janusz Kloczko, Krzysztof Warzocha, Tadeusz Robak10.1016/j.ijid.2009.02.021International Journal of Infectious Diseases 14, 2 (2010)2009-07-08International Journal of Infectious Diseases2009-07-08142S1201-9712(10)X0002-9Original Reportse132e140http://www.ijidonline.com/article/PIIS1201971209001945/abstract?rss=yesSummary: Objectives: To study the etiology of viral encephalitis (VE) in the children of western Uttar Pradesh, India and to assess the clinico-epidemiological profile of these children in relation to VE.Methods: Both cerebrospinal fluid and serum samples were collected from pediatric patients suffering from encephalitis hospitalized at Jawaharlal Nehru Medical College, Aligarh from July 2004 to November 2006. Viral isolation was done on RD cells, HEp-2 cells, and Vero cells from the cerebrospinal fluid samples of children with suspected VE. A microneutralization test was performed for enterovirus 71. An enzyme immunoassay for IgM antibodies was performed for measles virus, mumps virus, varicella zoster virus, herpes simplex virus 1, and Japanese encephalitis virus.Results: Eighty-seven patients were enrolled in the study. The most common etiology of VE was enterovirus 71 (42.1%), followed by measles (21.1%), varicella zoster virus (15.8%), herpes simplex virus (10.5%), and mumps (10.5%). Japanese encephalitis virus was not found in any case. Enterovirus 71 infection caused significant morbidity in children; mortality occurred in 50%. A preponderance of cases occurred in December. In our study generalized convulsions along with altered sensorium were the significant findings in patients with VE.Conclusions: Enterovirus 71, the major etiology of VE in our study, was associated with significant mortality and morbidity. Such studies should be conducted frequently to assess the role of emerging VE in different regions.Etiology and clinico-epidemiological profile of acute viral encephalitis in children of western Uttar Pradesh, IndiaFarzana K. Beig, Abida Malik, Meher Rizvi, Deepshikha Acharya, Shashi Khare10.1016/j.ijid.2009.03.035International Journal of Infectious Diseases 14, 2 (2010)2010-01-27International Journal of Infectious Diseases2010-01-27142S1201-9712(10)X0002-9Original Reportse141e146http://www.ijidonline.com/article/PIIS1201971209001519/abstract?rss=yesSummary: Candida intermedia is rarely reported as a human pathogen. We report two cases of catheter-related fungemia caused by C. intermedia which were treated successfully with intravenous fluconazole and catheter removal. The isolates were identified by commercial biochemical methods, oligonucleotide array, and partial sequencing analysis of rRNA genes.Catheter-related fungemia caused by Candida intermediaSheng-Yuan Ruan, Jung-Yien Chien, Yi-Chung Hou, Po-Ren Hsueh10.1016/j.ijid.2009.03.015International Journal of Infectious Diseases 14, 2 (2010)2009-06-04International Journal of Infectious Diseases2009-06-04142S1201-9712(10)X0002-9Case Reportse147e149http://www.ijidonline.com/article/PIIS1201971209001520/abstract?rss=yesSummary: Dengue infection is a mosquito-borne disease caused by a flavivirus, and is recognized in over 100 countries with 2.5 billion people living in areas of risk. Neurological manifestations such as encephalitis, myelitis, Guillain–Barré syndrome, cranial nerve palsies, neuromyelitis optica, and encephalomyelitis have been recognized as clinical consequences of dengue infection. Meningitis is a rare complication. We report the case of a 24-year-old woman who presented with fever, headache, and nuchal rigidity without the typical symptoms of dengue infection. Cerebrospinal fluid analysis showed lymphocytic pleocytosis with a normal glucose value and negative bacterial and fungal cultures. The etiology of meningitis was confirmed by positive dengue PCR in the serum. This case report highlights dengue infection as a potential cause of meningitis in endemic areas. Also, meningitis can be the first manifestation of the infection. Dengue should be investigated even in the absence of a typical picture of the infection.Meningitis determined by oligosymptomatic dengue virus type 3 infection: Report of a caseC.N. Soares, M.J. Cabral-Castro, J.M. Peralta, M.R.G. Freitas, M. Puccioni-Sohler10.1016/j.ijid.2009.03.016International Journal of Infectious Diseases 14, 2 (2010)2009-06-08International Journal of Infectious Diseases2009-06-08142S1201-9712(10)X0002-9Case Reportse150e152http://www.ijidonline.com/article/PIIS1201971209001532/abstract?rss=yesSummary: Nocardiosis is a cause of significant morbidity and mortality in the immunocompromised host, and is an infrequent complication of tumor necrosis factor alpha (TNF-α) blockers in chronic inflammatory diseases. Nocardiosis occurs at a rate of 3.55 and 0.88 per 100 000 patients treated with infliximab or etanercept, respectively. Disseminated nocardiosis remains an uncommon complication of these agents. Here, we present a fatal case of disseminated systemic nocardiosis in a patient with psoriasis following sequential therapy with alefacept and then infliximab therapy. The patient developed disseminated disease involving the brain, lymph nodes, and adrenal glands. The diagnosis was made by blood culture and aspiration of the adrenal gland abscess, which revealed Gram-positive bacilli and later grew Nocardia farcinica. The organism was identified by DNA sequencing, and was susceptible to moxifloxacin, gatifloxacin, ciprofloxacin, amoxicillin–clavulanic acid, linezolid, sulfamethoxazole, and amikacin. It was resistant to clarithromycin, ceftriaxone, and tobramycin and was intermediately susceptible to imipenem.Disseminated systemic Nocardia farcinica infection complicating alefacept and infliximab therapy in a patient with severe psoriasisJaffar A. Al-Tawfiq, Adil A. Al-Khatti10.1016/j.ijid.2009.03.017International Journal of Infectious Diseases 14, 2 (2010)2009-06-08International Journal of Infectious Diseases2009-06-08142S1201-9712(10)X0002-9Case Reportse153e157http://www.ijidonline.com/article/PIIS1201971209001544/abstract?rss=yesSummary: We describe the case of a 29-year-old woman who presented with pancytopenia and myelofibrosis. Brucella melitensis was identified in her blood. The patient recovered completely with doxycycline and rifampin. A repeat bone marrow biopsy showed hypercellularity without myelofibrosis. Bone marrow findings in cases of pancytopenia due to brucellosis reveal normocellularity, hypercellularity, hemophagocytosis, or granuloma. To our knowledge this is the first report of brucellosis causing myelofibrosis. Brucellosis should be considered as a possible cause of myelofibrosis in endemic areas.Brucellosis presenting as myelofibrosis: First case reportFaris G. Bakri, Nazzal M. Al-Bsoul, Ahmad Y. Magableh, Asem Shehabi, Musleh Tarawneh, Azmy M. Al-Hadidy, Mohammed A. Abu-Fara, Abdallah S. Awidi10.1016/j.ijid.2009.03.018International Journal of Infectious Diseases 14, 2 (2010)2009-06-08International Journal of Infectious Diseases2009-06-08142S1201-9712(10)X0002-9Case Reportse158e160http://www.ijidonline.com/article/PIIS1201971209001556/abstract?rss=yesSummary: Varicella zoster virus (VZV) infection may trigger Guillain–Barré syndrome (GBS), but this is rare and almost always in the context of reactivation disease from latent VZV, ‘shingles’. We report here a case of severe GBS following primary VZV infection in an adult. A 40-year-old man of Indian origin developed features of GBS including quadriplegia, bulbar paralysis, and bilateral facial nerve palsies 14 days after primary VZV infection contracted from a known case in a family member. Nerve conduction studies confirmed acute inflammatory demyelinating polyneuropathy. Anti-ganglioside antibodies were negative. The mechanism of Schwann cell attack following VZV infection is poorly understood but this case suggests that primary VZV infection may be a sufficient stimulus to drive antibody generation and precipitate severe clinical symptomatology. The morbidity associated with the complications of VZV infection in adulthood could be avoided if patients who are seronegative for VZV (frequently from the Asian subcontinent) are offered prophylaxis after an exposure in adulthood.Severe Guillain–Barré syndrome following primary infection with varicella zoster virus in an adultFiona Cresswell, James Eadie, Nicky Longley, Derek Macallan10.1016/j.ijid.2009.03.019International Journal of Infectious Diseases 14, 2 (2010)2009-06-08International Journal of Infectious Diseases2009-06-08142S1201-9712(10)X0002-9Case Reportse161e163http://www.ijidonline.com/article/PIIS120197120900157X/abstract?rss=yesSummary: Primary tuberculous osteomyelitis of the sternum is a rare clinical entity. Sternal tuberculosis can result from direct extension of the disease from hilar lymph nodes, hematogenous or lymphatic dissemination from other sites, and following BCG vaccination in children. An unusual case of primary tuberculous osteomyelitis of the sternum that presented with a swelling and pain over the manubrium sterni is reported. Diagnosis was confirmed by demonstration of epithelioid granulomas and acid-fast bacilli and a positive M. tuberculosis culture from the aspirate taken from the sternal swelling. Extensive diagnostic work-up did not reveal any other focus of tuberculosis in this case. The patient was successfully managed with anti-tubercular treatment.Primary tubercular osteomyelitis of the sternumKondanath Saifudheen, T.M. Anoop, P.N. Mini, Manjula Ramachandran, P.K. Jabbar, R. Jayaprakash10.1016/j.ijid.2009.03.021International Journal of Infectious Diseases 14, 2 (2010)2009-06-15International Journal of Infectious Diseases2009-06-15142S1201-9712(10)X0002-9Case Reportse164e166http://www.ijidonline.com/article/PIIS1201971209001763/abstract?rss=yesSummary: Disseminated disease caused by non-tuberculous, environmental mycobacteria (EM) reflects impaired host immunity. Disseminated disease caused by Mycobacterium scrofulaceum has primarily been reported in patients with AIDS. Moreover, observing M. scrofulaceum as the agent of localized disease in childhood has become increasingly rare. We report the first case of disseminated disease caused by M. scrofulaceum in a child with inherited interferon-γ receptor 1 (IFN-γR1) complete deficiency. As in this case, mycobacterial bone infections in IFN-γR1 deficiency can sometimes mimic the clinical picture of chronic recurrent multifocal osteomyelitis.Disseminated Mycobacterium scrofulaceum infection in a child with interferon-γ receptor 1 deficiencyMaria Grazia Marazzi, Ariane Chapgier, Anna-Carla Defilippi, Vito Pistoia, Sara Mangini, Cesarina Savioli, Anna Dell’Acqua, Jacqueline Feinberg, Enrico Tortoli, Jean-Laurent Casanova10.1016/j.ijid.2009.03.025International Journal of Infectious Diseases 14, 2 (2010)2009-11-02International Journal of Infectious Diseases2009-11-02142S1201-9712(10)X0002-9Case Reportse167e170http://www.ijidonline.com/article/PIIS1201971209001775/abstract?rss=yesSummary: Foreign body ingestion is not an uncommon problem encountered in clinical practice. The accidental ingestion of fish bones may sometimes lead to penetration injuries with complicating abscess formation. The ingestion of foreign bodies results in gastrointestinal perforation in about 1% of patients. Fish bones are the most commonly seen objects leading to bowel perforation. Fish bones are usually invisible on plain films. A computed tomography (CT) scan of the abdomen is helpful to determine the cause of unexplained and persistent abdominal pain. If encapsulated abscess formation cannot be completely resolved by CT-guided drainage, surgical intervention should proceed to prevent profound sepsis. We present the case of a 75-year-old man who had fever and left lower abdominal pain. CT showed a hypodense lesion with a linear foreign body in the abdomen. An intra-abdominal abscess was diagnosed and after surgical intervention, a foreign body, which proved to be a fish bone, was removed. The man could not remember swallowing this bone.Fish bone-related intra-abdominal abscess in an elderly patientChien-Kan Chen, Yu-Jang Su, Yen-Chun Lai, Henry Kam-Hong Cheng, Wen-Han Chang10.1016/j.ijid.2009.03.024International Journal of Infectious Diseases 14, 2 (2010)2009-06-22International Journal of Infectious Diseases2009-06-22142S1201-9712(10)X0002-9Case Reportse171e172http://www.ijidonline.com/article/PIIS1201971209001891/abstract?rss=yesSummary: Paracoccus yeei was identified as the etiologic agent of peritonitis in an ambulatory peritoneal dialysis patient. While the old biochemical identification kits are not able to identify this species, the new colorimetric VITEK 2 GN card correctly identified this isolate in 7hours. Its identity was confirmed by sequencing of the 16S rRNA gene.Paracoccus yeei: a new unusual opportunistic bacterium in ambulatory peritoneal dialysisFrédéric Wallet, Nicolas Blondiaux, Célia Lessore de Sainte Foy, Caroline Loïez, Sylvie Armand, Dominique Pagniez, René J. Courcol10.1016/j.ijid.2009.03.030International Journal of Infectious Diseases 14, 2 (2010)2009-06-25International Journal of Infectious Diseases2009-06-25142S1201-9712(10)X0002-9Case Reportse173e174http://www.ijidonline.com/article/PIIS120197120900191X/abstract?rss=yesSummary: We present three cases of pericarditis caused by Streptococcus pneumoniae diagnosed in children. The presenting symptoms were fever, dyspnea, tachycardia, and hepatomegaly. Chest X-rays showed an enlarged heart silhouette and echocardiographic examination revealed a pericardial effusion in all cases. S. pneumoniae was recovered from the pericardial fluid and/or blood in all cases. Systemic antibiotic treatment and dopaminergic agents were used; all patients recovered completely. Another 10 cases of S. pneumoniae pericarditis in children reported since 1980 are presented. Most cases had preceding respiratory symptoms and had a good outcome. While rare and life-threatening, pericarditis caused by S. pneumoniae has a good outcome if diagnosed early and treated adequately.Acute pericarditis caused by Streptococcus pneumoniae in young infants and children: Three case reports and a literature reviewYael Feinstein, Oana Falup-Pecurariu, Maria Mitrică, Eitan N. Berezin, Rodrigo Sini, Hana Krimko, David Greenberg10.1016/j.ijid.2009.03.033International Journal of Infectious Diseases 14, 2 (2010)2009-07-01International Journal of Infectious Diseases2009-07-01142S1201-9712(10)X0002-9Case Reportse175e178http://www.ijidonline.com/article/PIIS1201971209001854/abstract?rss=yesThe Rift Valley fever (RVF) virus of the family Bunyaviridae is a cause of zoonotic viral disease. Since the first isolation of the virus in the 1930s, there have been several epidemic outbreaks in the tropics, mainly in Africa, including Sudan, the largest country in Africa. RVF infection in humans can be acquired through mosquito bites and contact with infected animals, and vertical transmission has been reported. RVF can present as an uncomplicated acute febrile illness. However, severe complications, such as hemorrhagic disease, meningoencephalitis, renal failure, and blindness have been reported.Manifestations of severe Rift Valley fever in SudanAhmed A. Adam, Mubarak S. Karsany, Ishag Adam10.1016/j.ijid.2009.03.029International Journal of Infectious Diseases 14, 2 (2010)2009-07-02International Journal of Infectious Diseases2009-07-02142S1201-9712(10)X0002-9Correspondencee179e180http://www.ijidonline.com/article/PIIS1201971209001908/abstract?rss=yesA 48-year-old man presented to our hospital complaining of a 7-day history of sudden onset of fever, chills, nausea, and vomiting. On admission his temperature was 38.7°C, his heart rate was 104 bpm, and his blood pressure was 110/60 mmHg. He presented with jaundice, liver tenderness, intense myalgias, dyspnea with hemoptysis, meningism, coarse crackles on basal and middle pulmonary segments, and a systolic heart murmur. A chest X-ray showed bilateral patchy infiltrates and his electrocardiogram showed tachycardia and T inversion in III and aVL. He was questioned about contact with animals, and recalled being startled by a rat while carrying dry wood in his garden. Blood, cerebrospinal fluid (CSF), and urine samples were taken for analysis, and empirical antibiotic therapy with ceftriaxone was started.Severe Weil's syndrome complicated by hemolytic anemiaStefan Zschiedrich, Karl-Georg Fischer10.1016/j.ijid.2009.03.032International Journal of Infectious Diseases 14, 2 (2010)2009-07-02International Journal of Infectious Diseases2009-07-02142S1201-9712(10)X0002-9Correspondencee181e182