title: Streptococcus uberis and Staphylococcus aureus forefoot and blood stream co-infection in a haemodialysis patient: a case report.
abstract: BACKGROUND
  Streptococcus uberis, the most frequent cause of mastitis in lactating cows, is considered non-pathogenic for humans. Only a few case reports have described human infections with this microorganism, which is notoriously difficult to identify.
  
  
  METHODS
  We report the case of a 75-year-old male haemodialysis patient, who developed a severe foot infection with osteomyelitis and bacteraemia. Both Streptococcus uberis and Staphylococcus aureus were identified in wound secretion and blood samples using mass spectrometry. The presence of Streptococcus uberis was confirmed by superoxide dismutase A sequencing. The patient recovered after amputation of the forefoot and antibiotic treatment with ampicillin/sulbactam. He had probably acquired the infection while walking barefoot on cattle pasture land.
  
  
  CONCLUSIONS
  This is the first case report of a human infection with Streptococcus uberis with identification of the microorganism using modern molecular technology. We propose that Staphylococcus aureus co-infection was a prerequisite for deep wound and bloodstream infection with Streptococcus uberis.
authors.affiliation: Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800, Feldkirch, Austria. Christine.valentiny@vlkh.net.
authors.forename: Christine
authors.initials: C
authors.lastname: Valentiny
authors.affiliation: Institute for Pathology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria. harald.dirschmid@lkhf.at.
authors.forename: Harald
authors.initials: H
authors.lastname: Dirschmid
authors.affiliation: Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800, Feldkirch, Austria. Karl.lhotta@lkhf.at.
authors.forename: Karl
authors.initials: K
authors.lastname: Lhotta
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000379:methods; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology* / Q000628:therapy; D017848:Blood-Borne Pathogens / Q000302:isolation & purification; D060085:Coinfection / Q000188:drug therapy / Q000382:microbiology*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D005534:Foot Diseases / Q000209:etiology / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D010019:Osteomyelitis / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D035583:Rare Diseases; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013290:Streptococcal Infections / Q000209:etiology / Q000628:therapy; D013291:Streptococcus / Q000145:classification* / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents