Direct detection of indirect transmission of Streptobacillus moniliformis rat bite fever infection.
We describe the evaluation of culture-negative synovial fluid from a 3-year-old boy by PCR and electrospray ionization followed by mass spectrometry (PCR/ESI-MS). Our patient developed a diffuse rash and fever with systemic signs and symptoms of sepsis, but four sets of blood cultures obtained prior to initiation of antibiotics were negative. After 1 week of illness, he developed right-knee swelling. Analysis of synovial fluid was consistent with infection, but cultures of specimens obtained following initiation of antimicrobial treatment were negative for growth. PCR/ESI-MS detected Streptobacillus moniliformis in the synovial fluid sample. Our patient completed an appropriate course of antibiotic treatment and remained completely asymptomatic in follow-up evaluation. This unique case suggests that PCR/ESI-MS may be a useful diagnostic tool for direct detection of unusual or unexpected pathogens directly from clinical specimens, particularly when samples have been obtained from patients following initiation of antibiotic therapy.
Department of Pediatrics, St. Francis Medical Center, Peoria, Illinois, USA.
Joseph R
JR
Mackey
University of Illinois School of Medicine, Department of Medicine and Pediatrics, Peoria, Illinois, USA.
Elsa L Vazquez
EL
Melendez
Department of Medicine, Division of Infectious Disease, University of Illinois College of Medicine, Peoria, Illinois, USA jjf@uic.edu.
John J
JJ
Farrell
Ibis Biosciences, an Abbott Company, Carlsbad, California, USA.
Kristin S
KS
Lowery
Ibis Biosciences, an Abbott Company, Carlsbad, California, USA.
Megan A
MA
Rounds
Ibis Biosciences, an Abbott Company, Carlsbad, California, USA.
Rangarajan
R
Sampath
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Research Service, Cleveland, Ohio, USA Case Western Reserve University, Departments of Medicine, Pharmacology and Molecular Microbiology, Cleveland, Ohio, USA.
Robert A
RA
Bonomo
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods; D011906:Rat-Bite Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D051381:Rats; D021241:Spectrometry, Mass, Electrospray Ionization / Q000379:methods; D013288:Streptobacillus / Q000302:isolation & purification*; D013582:Synovial Fluid / Q000382:microbiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents