A22-year-old male presented to the Eye Hospital at Wenzhou Medical University in February 2016 with a 1-month history of foreign body sensation and an accompanying slight itch of his right eye. His medical and travel histories were generally unremarkable. The patient worked as a delivery man and reported contact with dogs but no other animals on a regular basis. Following a close inspection of his right eye, two thin white wormlike structures were clearly noted under slit lamp microscopy. One of the structures was moving at the lateral aspect of his eye (Fig. 1A). Another structure, seen by fluorescence angiography, remained in the conjunctival sac (Fig. 1B). Two structures were carefully removed with cotton buds from his right eye (Fig. 1C). His visual acuity and intraocular pressure were normal. The collected specimens were observed under light microscopy. Each structure was thin, threadlike, and creamy white and presented with striated cuticles on the entire body surface (Fig. 1D). The blunt anterior displayed an apparent buccal capsule and did not have sharp hooks or a hexagonal oral opening. Internal features were clearly noted within the structure (Fig. 1E). Finally, a ventrally curved caudal end and 5 pairs of preanal papillae were clearly seen in the structure (Fig. 1D and F). Citation Li Y, Bourbeau P, Zheng M. 2018. Photo Quiz: A delivery man with an itchy eye. J Clin Microbiol 56:e00376-17. https://doi.org/10 .1128/JCM.00376-17. Editor Michael J. Loeffelholz, University of Texas Medical Branch Copyright © 2018 American Society for Microbiology. All Rights Reserved. Address correspondence to Meiqin Zheng, zmqlyllh@126.com. For answer and discussion, see https://doi.org/10 .1128/JCM.00378-17 in this issue. FIG 1 (A) Structure noted by slit lamp microscopy (total magnification, 10). (B) Structure noted by fluorescence angiography in the conjunctival sac (total magnification, 10). (C) Structure removed with a cotton bud from the conjunctival sac of the patient’s right eye (total magnification, 16). (D) Smooth and striated cuticle on the surface of the structures observed under light microscopy (total magnification, 40). The arrow points to the curved caudal end. (E) Apparent buccal capsule, esophagus, and intestine (total magnification, 100). (F) Five pairs of preanal papillae (total magnification, 400). PHOTO QUIZ

ABSTRACT This study compared results from plating urine specimens with the BD InoqulA instrument using a 10-μl inoculum with results from cultures plated manually with a 1-μl loop for comparable 2-month periods. The positivity rates, turnaround times for positive cultures, and BD Phoenix identification and antimicrobial susceptibility test results were comparable for both time periods. We experienced no problems with culture interpretation as the result of moving to the 10-μl inoculum.

Preliminary detection of bacterial pathogens and isolation in pure culture on solid media was followed by culture confirmation using one of the early-generation kits for bacterial identification. In more recent years, the development and, in some cases, very common use of direct antigen testing has revolutionized the algorithms for specimen testing which are used today in physicians’ office laboratories, community hospitals, and tertiary-care medical centers. Early antigen tests sometimes lacked the sensitivity which was offered by conventional testing. Researchers tested 345 strains of coryneform bacteria and 33 strains of Listeria spp. (representing 49 taxa). In this study, 80.9% were identified to the species level and 12.2% were identified to the genus level, with 3.7% of the strains misidentified and 3.2% of the strains not identified. Prepackaged commercially available kit systems for the identification of clinically significant gram-negative bacteria have been available for a number of years and offer the clinical microbiologist several distinct advantages over previously available methodologies. The identification systems have evolved over time and have been based on either growth dependent or enzyme-mediated substrate utilization or on the detection of specific nucleic acid sequences. A section talks about fastidious bacteria that include Haemophilus spp., Neisseria spp., Gardnerella vaginalis, Bordetella spp., and Legionella spp.

The critical role of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician and the microbiologists who provide enormous value to the health care team. This document, developed by both laboratory and clinical experts, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. Sections are divided into anatomic systems, including Bloodstream Infections and Infections of the Cardiovascular System, Central Nervous System Infections, Ocular Infections, Soft Tissue Infections of the Head and Neck, Upper Respiratory Infections, Lower Respiratory Tract infections, Infections of the Gastrointestinal Tract, Intraabdominal Infections, Bone and Joint Infections, Urinary Tract Infections, Genital Infections, and Skin and Soft Tissue Infections; or into etiologic agent groups, including Tickborne Infections, Viral Syndromes, and Blood and Tissue Parasite Infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. There is redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a reference to guide physicians in choosing tests that will aid them to diagnose infectious diseases in their patients.

An 80-year-old female presented to Geisinger Medical Center for evaluation of a subacute onset of dyspnea on exertion and was found to have moderate normocytic anemia and mild thrombocytopenia, with the presence of a high percentage of blasts in a peripheral blood smear. She underwent a bone marrow biopsy that showed acute myeloid leukemia. She underwent a transfusion and was discharged home to start induction chemotherapy with a 5-day course of clofarabine. She also received allopurinol, fluconazole, and acyclovir for prophylaxis. During her induction chemotherapy, she developed severe neutropenia and thrombocytopenia associated with fever and malaise that prompted a second hospital admission. At the time of this admission, the patient was hemodynamically stable and found to have moderate mucositis. The remainder of her physical examination was unremarkable, and she was placed on vancomycin, cefepime, and fluconazole. An extensive infectious-disease workup that included two initial sets of blood cultures was initiated, resulting in the isolation of Gram-negative bacilli from two FN anaerobic-blood-culture bottles (bioMerieux, Durham, NC). The hematology service was consulted and initiated therapy with filgrastim and sargramostim to improve her neutropenia. The patient also required transfusions of red blood cells and platelets. Her fever persisted for 10 days, although two additional sets of blood cultures collected 2 days after the initiation of antimicrobial therapy were negative. The patient underwent computed-tomography (CT) scans of her chest, abdomen, and pelvis in an unsuccessful attempt to identify the source of her bacteremia. The causative agent of her bacteremia is shown in Fig. 1. Fig 1 Gram stain of growth from a positive-blood-culture bottle. Magnification, ×1,000 (oil). (For answer and discussion, see page 737 in this issue [doi:10.1128/JCM.01156-12])

Historically, the trend toward automation in clinical pathology laboratories has largely bypassed the clinical microbiology laboratory. In this article, we review the historical impediments to automation in the microbiology laboratory and offer insight into the reasons why we believe that we are on the cusp of a dramatic change that will sweep a wave of automation into clinical microbiology laboratories. We review the currently available specimen-processing instruments as well as the total laboratory automation solutions. Lastly, we outline the types of studies that will need to be performed to fully assess the benefits of automation in microbiology laboratories.

Answer: Leptotrichia buccalis bacteremia. On the second day of incubation, two FN anaerobic-blood-culture bottles yielded an anaerobic Gram-negative bacillus that could not be identified by the routine identification methods used in our laboratory. The isolate was sent to Mayo Medical Laboratories

Answer: Multibacillary borderline lepromatous Hansen's disease (leprosy). Figure 1 demonstrates the histopathological appearance of the skin lesion biopsy specimen obtained from our patient's right arm, stained with hematoxylin-phloxine B-saffron, which revealed well-delineated patches of

Answer: Tertian malaria. The patient suffered from tertian malaria. The thin Giemsa-stained blood smear revealed several stages of Plasmodium vivax infection (see Fig. 1A, B, and C in the Photo Quiz): young trophozoites (delicate ring form) in normal-sized erythrocytes without Schuffner's dots (

Mycoplasma salivarium infections outside the oral cavity are rare. We describe a 49-year-old man with laryngeal cancer and right pleural space infection with M. salivarium. To our knowledge, this is the first report of empyema due to Mycoplasma salivarium.

A 17-year-old Eritrean woman presented to our emergency room, complaining of headache, intermittent fever, and chills that had occurred approximately every 48 h for the past 7 days. She had spent the last 8 months in Ethiopia, Sudan, and Libya before recently immigrating to Switzerland. She reported that she had already been treated in Libya for similar symptoms. On admission, she was febrile (39.5°C) and in a reduced general condition. Laboratory results showed a thrombocytopenia level of 94 × 109 platelets/liter (reference, 150 × 109 to 450 × 109 platelets/liter), a slightly increased neutrophil level of 7 × 109 cells/liter (reference, 1.3 × 109 to 6.7 × 109 cells/liter) and a left shift (band neutrophils at 29.5% [reference, 5 to 15%] and segmented neutrophils at 53% [reference, 40 to 70%]), with a normal absolute leukocyte count of 8.6 × 109 cells/liter (reference, 3.5 × 109 to 10 × 109 cells/liter). C-reactive protein was clearly increased at 259 mg/liter. Erythrocytes, hemoglobin concentration, and liver and renal parameter values were normal. A thin Giemsa-stained blood smear revealed several stages of a parasite and filiform structures (Fig. 1, a to e). Fig 1 Giemsa stain (magnification, ×1,000) of a blood smear. (For answer and discussion, see page 1833 in this issue [doi:10.1128/JCM.00100-12])

A 78-year-old male presented for evaluation of a cold, painful left foot. He had undergone two recent hospital admissions for unexplained fever, fatigue, arthralgias, and an 8- to 10-lb. weight loss over a 4-month period. The patient had a past medical history of hypertension, hyperlipidemia, benign

The title of this article is loaded with negative innuendo—the question is not “What is the state of research in clinical microbiology in the United States” but, rather, “What has happened to happened to research in clinical microbiology in the United States.” We begin with the premise

Both the arterial embolus and the aortic valve tissue grew Histoplasma capsulatum. Histoplasma urine antigen tests performed on a specimen collected the same week as the valve replacement were negative, as were results for complement fixation antibodies. Postoperatively, the patient received approximately 2 weeks of treatment with intravenous lipid complex amphotericin B, followed by 9 months of treatment with oral itraconazole solution (200 mg twice a day for 4 months and 5 additional months of 200 mg once daily). Seven years later, the patient was physically active and without evidence of valvular dysfunction. Fungi are the causative agents in approximately 5 to 7% of all prosthetic valve endocarditis episodes (1). H. capsulatum is rare; in a review of 270 cases of fungal endocarditis, only 6% were attributed to H. capsulatum (2). The diagnosis of H. capsulatum endocarditis can be difficult to establish, as routine blood cultures are usually negative for fungi and there are no pathognomonic signs or symptoms except for the remarkable chronicity of illness and reported frequent major arterial emboli. Most patients with chronic disease will have positive serum serologies, suggesting the diagnosis. Although H. capsulatum is a dimorphic fungus that typically grows in the yeast form in the human host, in cases of endocarditis the fungi can present in a variety of large and small yeast forms as well as with septate and branching hyphae, as was seen with the present patient (3). Optimal treatment is unknown. Lipid complex amphotericin is considered first-line therapy. Because of his advanced age, the patient was rapidly transitioned from amphotericin to liquid itraconazole following bioprosthetic valve replacement.

Answer: Histoplasma capsulatum prosthetic valve endocarditis with arterial embolism Both the arterial embolus and the aortic valve tissue grew Histoplasma capsulatum. Histoplasma urine antigen tests performed on a specimen collected the same week as the valve replacement were negative, as were

We compared a rigorous culture method with the Gen-Probe AccuProbe Group B Streptococcus Culture Test (APGB) and the BD GeneOhm StrepB assay (GOSB) for the detection of group B streptococci (GBS) from an 18- to 24-h LIM broth. Culture (95.3%) and GOSB ( 95.3%) were more sensitive than APGB (86.5%) for the detection of GBS.