Mycobacteriophages Cambiare, FlagStaff, and MOOREtheMARYer are newly isolated phages of Mycobacterium smegmatis mc2 155 recovered from soil samples in Pittsburgh, PA. All three genomes are closely related to cluster G mycobacteriophages but differ sufficiently in nucleotide sequence and gene content to warrant division of cluster G into several subclusters.
An elderly woman with previously known valvular disease presented to the emergency department due to altered mental status. In addition to obtaining an infectious work-up, a bedside echocardiogram was performed and revealed right heart strain prompting a formal echocardiogram evaluation and treatment for a possible pulmonary embolism. Initial laboratory work returned with blood and urine cultures positive for Aerococcus urinae. A transthoracic echocardiogram further revealed new aortic regurgitation. Given this, a transesophageal echocardiogram was completed, confirming new aortic insufficiency as well as findings of infective endocarditis. She did not undergo surgical intervention; however, she was discharged with a plan to continue intravenous antibiotics for six weeks. Although typically seen in genitourinary infections, A. urinae is a rare cause of infective endocarditis and is increasingly identified due to improved speciation techniques. We describe a unique presentation of invasive A. urinae infection to increase awareness and further research on a less commonly encountered bacteria that may present as a urinary tract infection and has the potential to cause invasive disease.
Diffuse brucellar spondylodiscitis is the most severe subtype of osteoarticular brucellosis and is defined as a brucellar infection involving an entire vertebral body, typically a lumbar vertebra, with spread to the adjacent disc space, vertebra, and even extravertebral spaces, including epidural, paraspinal, or intramuscular locations. Although it is a relatively rare diagnosis in the US healthcare system, it should be considered in all patients with severe back pain, radicular symptoms, and a history of extensive exposure to an endemic area. Any delays in treatment can be associated with an increased risk of permanent neurological deficits or death. Here, we present a case of diffuse brucellar spondylodiscitis in a patient who presented to our facility with a history of extensive exposure to an endemic area. While an MRI can reveal pathognomonic findings in brucellar spondylodiscitis, for our case, it was nonspecific. The MRI provided early evidence of an infectious etiology which prompted immediate broad-spectrum antimicrobial coverage until causal organisms were identified and culture sensitivities directed targeted antibiotic therapy. The patient was able to recover over the course of four months without surgical intervention. At her final clinical follow-up, she had no neurological deficits and had complete resolution of her radicular symptoms.
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