We report a case of Leptotrichia species bacteremia in a patient undergoing treatment for acute m... more We report a case of Leptotrichia species bacteremia in a patient undergoing treatment for acute myelogenous leukemia. Like previously reported Leptotrichia species, this is a gram-variable, pleomorphic rod that is catalase negative and utilizes glucose and sucrose. However, it is more fastidious than previously reported isolates of Leptotrichia and may represent a novel species.
Previous studies have demonstrated that the four subspecies of the human pathogen Francisella tul... more Previous studies have demonstrated that the four subspecies of the human pathogen Francisella tularensis , despite showing marked variations in their virulence for mammals and originating from different regions in the Northern Hemisphere, display a very close phylogenetic relationship. This property has hampered the development of generally applicable typing methods. To overcome this problem, we evaluated the use of PCR for discrimination of the subspecies using various forms of long arbitrary primers or primers specific for repetitive extragenic palindromic sequences (REP) or enterobacterial repetitive intragenic consensus (ERIC) sequences. Patterns generated by use of REP, ERIC, or long arbitrary primers allowed differentiation at the species level and of the four subspecies of F. tularensis . With each of these three methods, similar or identical clustering of strains was found, and groups of strains of different geographical origins or differing in virulence showed distinct patt...
Mycobacterium tuberculosis often exhibits serpentine cording when grown in liquid medium, whereas... more Mycobacterium tuberculosis often exhibits serpentine cording when grown in liquid medium, whereas Mycobacterium kansasii can be larger and cross-barred. We assessed the use of these morphologic characteristics as a cost-effective method for rapid presumptive identification of isolates from BACTEC bottles. Without specific training, using the Kinyoun acid-fast stain, definitive cording was found in 237 of 373 specimens positive for M. tuberculosis (64%) and cross-barring was recognized within 63 of 76 (83%) of the specimens positive for M. kansasii , giving sensitivities specificities, positive predictive values, and negative predictive values of 63.5, 96, 92, and 79%, respectively, for M. tuberculosis and 83, 95, 59, and 98%, respectively, for M. kansasii . With training and experience, these results improved to 74.5, 98, 96, and 84% and 93, 98, 79, and 98%, respectively. The major improvements were in distinguishing the pseudocording, or loose aggregation of Mycobacterium avium com...
Moraxella osloensis osteomyelitis of the femur developed in a paraplegic man. He responded to tre... more Moraxella osloensis osteomyelitis of the femur developed in a paraplegic man. He responded to treatment with oral ampicillin. Disease in humans caused by this unusual clinical isolate is reviewed.
Transplant infectious disease : an official journal of the Transplantation Society, Jan 13, 2017
Alternaria species have been reported as a rare cause of fungal infection in organ and stem cell ... more Alternaria species have been reported as a rare cause of fungal infection in organ and stem cell transplant recipients, but to date no reports have been published of infection in humans caused by Alternaria rosae. Here, we report cutaneous A. rosae infection in a 66-year-old farmer with a history of primary myelofibrosis who had undergone allogeneic unrelated donor hematopoietic stem cell transplantation. Forty-nine days post transplant, he presented with a nodule on the thumb with no findings suggestive of disseminated infection. Pathology, culture, and molecular speciation showed the nodule was caused by cutaneous A. rosae. He had been on voriconazole as antifungal prophylaxis, but was found to have a subtherapeutic voriconazole level. He was switched to posaconazole based on published in vitro data showing its superior efficacy in Alternaria treatment. Susceptibility testing showed that the A. rosae isolate was indeed susceptible to posaconazole. His cutaneous lesion remained sta...
Antimicrobial agents and chemotherapy, Jan 14, 2015
Mupirocin is a topical antimicrobial used to decolonize patients who carry methicillin resistant ... more Mupirocin is a topical antimicrobial used to decolonize patients who carry methicillin resistant Staphylococcus aureus (MRSA), and the topical agent retapamulin may be a potential alternative therapy. The goal of this study was to determine the in vitro activity of retapamulin in a naïve population along with a panel of fifteen antimicrobial agents, including mupirocin, for 403 MRSA isolates collected longitudinally at the Veterans Affairs Puget Sound Health Care System. The minimum inhibitory concentration (MIC) for retapamulin had a unimodal distribution ranging from 0.008-0.5 μg/ml. One isolate had an MIC of >16 μg/ml, was also resistant to clindamycin and erythromycin, and was recovered from the nares of a patient receiving hemodialysis. 24 (6%) and 11 (3%) isolates, respectively, demonstrated low level resistance (8-64 μg/ml) and high level resistance (≥512 μg/ml) to mupirocin. Isolates were recovered from 10 patients both pre- and post- mupirocin therapy. Of those, 2 patien...
There are currently over 100 described species in the genus Corynebacterium ( http://www.bacterio... more There are currently over 100 described species in the genus Corynebacterium ( http://www.bacterio.net/c/corynebacterium.html ). Although C. diphtheriae is overwhelmingly the most significant respiratory pathogen within the genus, several of the non-diphtheriae Corynebacterium spp. have been noted as emerging respiratory pathogens in the recent literature. Because Corynebacterium spp., as well as other ‘coryneform’ organisms, are routinely recovered from clinical specimens as part of the normal flora of the skin and upper respiratory tract and sequence-based identification has replaced more rapid and less expensive phenotypic methods as the gold standard method for definitive identification of the non-diphtheriae Corynebacterium spp., distinguishing commensal from disease-associated organisms remains a challenge for clinicians and clinical laboratories. In this chapter we review the classic pathogen, C. diphtheriae , and several non-diphtheriae Corynebacterium spp. that have been associated with respiratory infections or are recovered from respiratory specimens.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 1985
Pacemaker associated infection (PAI) is a rare but often serious complication of permanent or tem... more Pacemaker associated infection (PAI) is a rare but often serious complication of permanent or temporary transvenous cardiac pacemakers. The major risk factor is recent or multiple pacemaker manipulations or surgical procedures. A PAI can occur at the time of insertion, from contiguous spread to the access site, or from transient bacteremia. We report a case of PAI of a retained pacemaker electrode from which a Corynebacterium species was isolated. Multiple preoperative cultures were sterile, but bacteria were isolated from tissue removed at surgery, and were seen around the wire deep inside a thrombus. The importance of cultures and special stains (including electron microscopy) of surgical materials is stressed, especially when dealing with microorganisms of ordinarily low virulence, or those that are commonly considered laboratory contaminants.
We describe the first case of continuous ambulatory peritoneal dialysis (CAPD)-related peritoniti... more We describe the first case of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis due to Lactobacillus paracasei . It occurred in a 65-year-old patient with recurrent episodes of peritonitis while he was receiving a prolonged course of intraperitoneal vancomycin. L . paracasei should be considered in the differential diagnosis of pathogens in CAPD-related peritonitis, especially in patients receiving prolonged vancomycin or glycopeptide treatment.
Previous studies have validated the properties and documented the utility of chromogenic agar for... more Previous studies have validated the properties and documented the utility of chromogenic agar for surveillance of methicillin-resistant Staphylococcus aureus (MRSA). In this study, we used one of the chromagars, MRSA Select (Bio-Rad), as one of the primary isolation media for selected wound and respiratory clinical specimens which, in our institution, were typically polymicrobial. We examined a total of 638 specimens; 142 (22%) MRSA isolates were recovered. Twenty-six of these isolates were recovered only on the MRSA Select plate, representing a 28% (15/54) increase for endotracheal aspirates/sputa and a 15% increase for superficial wounds/ulcers (11/73) compared to the results with conventional culture. One isolate (1 CFU) was recovered by conventional medium alone. MRSA Select has generally been used for surveillance cultures; however, we document that an additional 21% of MRSA isolates would have gone unreported in these selected clinical specimens using only standard culture med...
We report a case of Leptotrichia species bacteremia in a patient undergoing treatment for acute m... more We report a case of Leptotrichia species bacteremia in a patient undergoing treatment for acute myelogenous leukemia. Like previously reported Leptotrichia species, this is a gram-variable, pleomorphic rod that is catalase negative and utilizes glucose and sucrose. However, it is more fastidious than previously reported isolates of Leptotrichia and may represent a novel species.
Previous studies have demonstrated that the four subspecies of the human pathogen Francisella tul... more Previous studies have demonstrated that the four subspecies of the human pathogen Francisella tularensis , despite showing marked variations in their virulence for mammals and originating from different regions in the Northern Hemisphere, display a very close phylogenetic relationship. This property has hampered the development of generally applicable typing methods. To overcome this problem, we evaluated the use of PCR for discrimination of the subspecies using various forms of long arbitrary primers or primers specific for repetitive extragenic palindromic sequences (REP) or enterobacterial repetitive intragenic consensus (ERIC) sequences. Patterns generated by use of REP, ERIC, or long arbitrary primers allowed differentiation at the species level and of the four subspecies of F. tularensis . With each of these three methods, similar or identical clustering of strains was found, and groups of strains of different geographical origins or differing in virulence showed distinct patt...
Mycobacterium tuberculosis often exhibits serpentine cording when grown in liquid medium, whereas... more Mycobacterium tuberculosis often exhibits serpentine cording when grown in liquid medium, whereas Mycobacterium kansasii can be larger and cross-barred. We assessed the use of these morphologic characteristics as a cost-effective method for rapid presumptive identification of isolates from BACTEC bottles. Without specific training, using the Kinyoun acid-fast stain, definitive cording was found in 237 of 373 specimens positive for M. tuberculosis (64%) and cross-barring was recognized within 63 of 76 (83%) of the specimens positive for M. kansasii , giving sensitivities specificities, positive predictive values, and negative predictive values of 63.5, 96, 92, and 79%, respectively, for M. tuberculosis and 83, 95, 59, and 98%, respectively, for M. kansasii . With training and experience, these results improved to 74.5, 98, 96, and 84% and 93, 98, 79, and 98%, respectively. The major improvements were in distinguishing the pseudocording, or loose aggregation of Mycobacterium avium com...
Moraxella osloensis osteomyelitis of the femur developed in a paraplegic man. He responded to tre... more Moraxella osloensis osteomyelitis of the femur developed in a paraplegic man. He responded to treatment with oral ampicillin. Disease in humans caused by this unusual clinical isolate is reviewed.
Transplant infectious disease : an official journal of the Transplantation Society, Jan 13, 2017
Alternaria species have been reported as a rare cause of fungal infection in organ and stem cell ... more Alternaria species have been reported as a rare cause of fungal infection in organ and stem cell transplant recipients, but to date no reports have been published of infection in humans caused by Alternaria rosae. Here, we report cutaneous A. rosae infection in a 66-year-old farmer with a history of primary myelofibrosis who had undergone allogeneic unrelated donor hematopoietic stem cell transplantation. Forty-nine days post transplant, he presented with a nodule on the thumb with no findings suggestive of disseminated infection. Pathology, culture, and molecular speciation showed the nodule was caused by cutaneous A. rosae. He had been on voriconazole as antifungal prophylaxis, but was found to have a subtherapeutic voriconazole level. He was switched to posaconazole based on published in vitro data showing its superior efficacy in Alternaria treatment. Susceptibility testing showed that the A. rosae isolate was indeed susceptible to posaconazole. His cutaneous lesion remained sta...
Antimicrobial agents and chemotherapy, Jan 14, 2015
Mupirocin is a topical antimicrobial used to decolonize patients who carry methicillin resistant ... more Mupirocin is a topical antimicrobial used to decolonize patients who carry methicillin resistant Staphylococcus aureus (MRSA), and the topical agent retapamulin may be a potential alternative therapy. The goal of this study was to determine the in vitro activity of retapamulin in a naïve population along with a panel of fifteen antimicrobial agents, including mupirocin, for 403 MRSA isolates collected longitudinally at the Veterans Affairs Puget Sound Health Care System. The minimum inhibitory concentration (MIC) for retapamulin had a unimodal distribution ranging from 0.008-0.5 μg/ml. One isolate had an MIC of >16 μg/ml, was also resistant to clindamycin and erythromycin, and was recovered from the nares of a patient receiving hemodialysis. 24 (6%) and 11 (3%) isolates, respectively, demonstrated low level resistance (8-64 μg/ml) and high level resistance (≥512 μg/ml) to mupirocin. Isolates were recovered from 10 patients both pre- and post- mupirocin therapy. Of those, 2 patien...
There are currently over 100 described species in the genus Corynebacterium ( http://www.bacterio... more There are currently over 100 described species in the genus Corynebacterium ( http://www.bacterio.net/c/corynebacterium.html ). Although C. diphtheriae is overwhelmingly the most significant respiratory pathogen within the genus, several of the non-diphtheriae Corynebacterium spp. have been noted as emerging respiratory pathogens in the recent literature. Because Corynebacterium spp., as well as other ‘coryneform’ organisms, are routinely recovered from clinical specimens as part of the normal flora of the skin and upper respiratory tract and sequence-based identification has replaced more rapid and less expensive phenotypic methods as the gold standard method for definitive identification of the non-diphtheriae Corynebacterium spp., distinguishing commensal from disease-associated organisms remains a challenge for clinicians and clinical laboratories. In this chapter we review the classic pathogen, C. diphtheriae , and several non-diphtheriae Corynebacterium spp. that have been associated with respiratory infections or are recovered from respiratory specimens.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 1985
Pacemaker associated infection (PAI) is a rare but often serious complication of permanent or tem... more Pacemaker associated infection (PAI) is a rare but often serious complication of permanent or temporary transvenous cardiac pacemakers. The major risk factor is recent or multiple pacemaker manipulations or surgical procedures. A PAI can occur at the time of insertion, from contiguous spread to the access site, or from transient bacteremia. We report a case of PAI of a retained pacemaker electrode from which a Corynebacterium species was isolated. Multiple preoperative cultures were sterile, but bacteria were isolated from tissue removed at surgery, and were seen around the wire deep inside a thrombus. The importance of cultures and special stains (including electron microscopy) of surgical materials is stressed, especially when dealing with microorganisms of ordinarily low virulence, or those that are commonly considered laboratory contaminants.
We describe the first case of continuous ambulatory peritoneal dialysis (CAPD)-related peritoniti... more We describe the first case of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis due to Lactobacillus paracasei . It occurred in a 65-year-old patient with recurrent episodes of peritonitis while he was receiving a prolonged course of intraperitoneal vancomycin. L . paracasei should be considered in the differential diagnosis of pathogens in CAPD-related peritonitis, especially in patients receiving prolonged vancomycin or glycopeptide treatment.
Previous studies have validated the properties and documented the utility of chromogenic agar for... more Previous studies have validated the properties and documented the utility of chromogenic agar for surveillance of methicillin-resistant Staphylococcus aureus (MRSA). In this study, we used one of the chromagars, MRSA Select (Bio-Rad), as one of the primary isolation media for selected wound and respiratory clinical specimens which, in our institution, were typically polymicrobial. We examined a total of 638 specimens; 142 (22%) MRSA isolates were recovered. Twenty-six of these isolates were recovered only on the MRSA Select plate, representing a 28% (15/54) increase for endotracheal aspirates/sputa and a 15% increase for superficial wounds/ulcers (11/73) compared to the results with conventional culture. One isolate (1 CFU) was recovered by conventional medium alone. MRSA Select has generally been used for surveillance cultures; however, we document that an additional 21% of MRSA isolates would have gone unreported in these selected clinical specimens using only standard culture med...
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Papers by Jill Clarridge