A high index of suspicion for Chromobacterium violaceum infection is required along with prompt diagnosis, optimal antimicrobial therapy, and adequate therapeutic duration for a successful therapy.

A case of nonpigmented Chromobacterium violaceum bacteremic cellulitis after fish bite in Taiwan is reported. The patient was successfully treated with ciprofloxacin and doxycycline for an extended period. Chromobacterium violaceum should be listed in the differential diagnosis of patients with nonspecific cellulitis associated with marked leukocytosis and rapid progression to septicemia either with or without a distinct history of exposure to water or soil. A combination of prompt diagnosis, optimal antimicrobial therapy, and adequate therapeutic duration for C violaceum infection is the key for successful therapy.

We describe a case of infective endocarditis of the native aortic valve due to Gemella sanguinis in a 67-year-old Taiwanese man who had pre-existent valvular heart disease. He was successfully treated with aortic valve replacement accompanying a 6-week intravenous antibiotic treatment. To the best of our knowledge, this is the first report of G sanguinis endocarditis in Taiwan.

Case ReportIt has been estimated that almost 1 million individuals proven of scrub typhus throughout a widespread area in eastern Asia and the western Pacific region [1]. Scrub typhus is curable; however, it is still a potential life-threatening disease with the mortality rate reaching 30% if unrecognized or left untreated [2]. Although it has been found that the hepatitis-scrub typhus relation is present in the literature few studies have emphasized this association. Many studies have reported the prevalence of elevated liver transaminases (up to 90%) in patients with scrub typhus that is far more 60% addressed in the textbook [3][4][5][6][7][8][9][10][11]. Most of the reports about hepatic dysfunction in scrub typhus were mild to moderate elevation of hepatic transaminases. Acute hepatitis associated with high liver enzymes levels in scrub typhus has rarely been described in the literature. The possibility of scrub typhus should be kept in mind when patients present with fever and varying degrees of hepatic dysfunction, even acute hepatitis, particularly if skin lesions (including eschar and maculopapular rash) exist, along with a history of exposure in an endemic area.Since recently a previously healthy 36-year-old female presented to the emergency room (ER) with a 7-day history of intermittent high fever, rigors, dizziness and flu-like symptoms despite receiving treatment at outpatient department for several times on July 22 nd , 2010. She noted non-pruritic skin rash over face and bilateral upper limbs since 3 days ago. She had history of travel to Lanyu (Orchid Island), an island in the Pacific Ocean to the southern-east of Taiwan, two weeks ago. On admission, she presented acute ill looking with marked prostration. Significant physical examinations were as follows: a temperature of 39.5˚C, blood pressure of 112/74 mmHg, respiratory rate of 20/min and heart rate of 109/min; maculo-papular skin rashes found over upper and lower limbs; not icteric; an eshcar-like ulcerative wound about 0.5 cm x 1.0 cm in size over right lower abdomen. Laboratory investigations revealed a white blood cell count of 7.2 x 10 9 /L, with neutrophil count of 65%, lymphocyte count of 22%, monocyte count of 6% and band form of 4%; platelet count, 134x 10 3 /μL; hemoglobin, 12.6 g/dL; hematocrit, 36.7%. Results of liver function test were as follows: aspartate transaminase (AST) 419 IU/L and alanine transaminase (ALT) 997 IU/L; LDH, 896IU/L; alkaline phosphatase (ALP) 778IU/L; total bilirubin 1.34 mg/dL; serum albumin, 3.3 g/dL. C-reactive protein revealed 9.41 mg/dL (range, 0-0.5 mg/dL). Her chest radiograph was clear. Abdominal ultrasound revealed normal study. An intensive workup for acute hepatitis, including viral hepatitis, mycoplasma infection, syphilis, scrub typhus and leptospirosis were performed. Blood cultures were obtained before treatment. Initial antimicrobial therapy consisted of intravenous moxifloxacin (400 mg daily) and oral doxycycline (100 mg twice per day). Twelve hours after admission, she developed a spiking f...

Although the presence of rheumatoid factors in clinical practice is always indicative of rheumatoid disorders, there is also a link between rheumatoid factors and infection. The presence of rheumatoid factors in the course of typhoid fever has only rarely been described in the literature. Reported herein are the cases of 3 consecutive patients with typhoid fever, one of whom had extremely high levels of rheumatoid factors, which may be considered of clinical significance, though the other 2 cases were negative for rheumatoid factors. This study indicates that the link between rheumatoid factors and typhoid fever remains controversial.