DOI: 10.1097/01.inf.0000393562.72903.d9

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PMID: 21242749

Issn Print: 0891-3668

Publication Date: 2011/02/01


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The Pediatric Infectious Disease Journal® Newsletter: February 2011

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IRON AND THE STAPHYLOCOCCUS All bacteria require iron for growth, but iron also can be toxic to bacterial cells. The ability of an organism to release, bind and utilize iron from the host is an important determinant of its pathogenicity. Investigators from Vanderbilt University Medical School in Nashville, TN delineated this process for Staphylococcus aureus and provided support for the organism's unique ability to cause disease in humans (Cell Host and Microbe 2010;8:544). Hemoglobin is an important factor that impacts the susceptibility of the host to S. aureus by way of its interaction with the organism's surface hemoglobin receptor, Isdβ, which binds preferentially to human versus mouse and other species' hemoglobin. Experimental staphylococcal infection was studied in two strains of mice: one with mouse hemoglobin and the other with human-mouse hemoglobin. Increased susceptibility to systemic infection in the humanized mice was a result of the ability of the S. aureus to bind and utilize the human hemoglobin in those mice. The Vanderbilt researchers are now studying the hemoglobin genes of patients with staphylococcal disease compared with uninfected controls to determine whether there are polymorphisms that determine susceptibility to infection. This is a beautifully conceived and conducted study that we recommend to those interested in the pathogenesis of staphylococcal infection.
MISSOURI CRAYFISH When you think of paragonimiasis, developing nations, but not Missouri, come to mind. In the December 10, 2010 Morbidity and Mortality Report from the Centers for Disease Control and Prevention in Atlanta, GA 9 cases of Paragonimus kellicotti, a lung fluke, infection were described. All the cases occurred in Missouri and involved males from 10 to 32 years of age who ate undercooked or raw crayfish taken from local rivers while canoeing or camping. Onset of symptoms was 2 to 16 weeks after ingestion and consisted of fever, cough, weight loss, chest pain, dyspnea and myalgias. All patients had eosinophilia and pleural effusion. Diagnosis was confirmed by direct observation of P. kellicotti eggs in bronchoalveolar fluid or sputum or by serology, or both. All were treated with praziquantel with prompt improvement. Do you wonder why anyone would eat raw crayfish (i.e. crawfish and crawdads)? Interviews revealed that it was related to alcohol consumption, dares and demonstration of survival skills in the wilderness.
UNIQUE VACCINE CAMPAIGN IN AFRICA On December 6, 2010 a large vaccine drive was initiated to inoculate millions of West Africans with a conjugate meningococcal group A vaccine to prevent overwhelming sepsis and meningitis. The vaccine was developed by researchers at the Food and Drug Administration and manufactured by the Serum Institute of India for less than $100 million ($0.50 per dose) that was provided principally by the Bill and Melinda Gates Foundation. To implement the campaign, close to $600 million will be needed to vaccinate approximately 300 million people in 25 nations from Senegal in the west to Ethiopia in the east. A remarkable achievement.
PLANT THORN SYNOVITIS We recently managed an 11-year-old boy with recurrent suppurative arthritis after having a plant thorn imbedded in his elbow from a fall. Drainage revealed purulence but the culture was sterile. He responded to clindamycin therapy for 3 weeks but developed recurrence after therapy was stopped. After several recurrences with drainage of pus, sterile cultures and clindamycin therapy, one of the cultures yielded Pantoea agglomerans, an environmental Gram-negative bacterium that is frequently found on plants and reported as a cause of suppurative arthritis after thorn injury (Arch Dis Child 2003;88:542). The organism, formerly named Enterobacter agglomerans and earlier referred to as Erwinia herbicola, can be found in animal and human feces. Treatment with ciprofloxacin was effective.
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