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Gemella haemolysans, Streptococcus equinus and Tropheryma whipplei are rare Gram-positive bacteria which may cause endocarditis and are associated with gastrointestinal disorders. We report on three patients with infective endocarditis caused by these microorganisms. G. haemolysans and S. equinus (Streptococcus bovis group) were isolated from blood cultures, and T. whipplei was diagnosed by molecular typing of an excised heart valve. The association between endocarditis caused by these microorganisms and gastrointestinal disorders warranted further examination. Endoscopic examination revealed a colonic carcinoma in the patient with G. haemolysans endocarditis and diverticulosis in the patient with S. equinus endocarditis. No gastrointestinal tract disorders were found in the patient with T. whipplei endocarditis, but this does not exclude Whipple's disease. Examination of the gastrointestinal tract for a focus of infection should be considered in patients with endocarditis caused by G. haemolysans, S. equinus and T. whipplei if no other source of bacteraemia is apparent.

Vibrio vulnificus is a zoonotic bacterium that can be found in raw fish (mainly eel and oysters) and seawater. Human infections may extend from wound infections to fasciitis necroticans or primary sepsis with a mortality rate of more than 50%. Although V. vulnificus is mainly found in the USA, its worldwide spread is also likely to involve the Netherlands, as demonstrated by an increasing number of infected fish farms. Since 2007, V. vulnificus infections have become a notifiable infectious disease in the USA. Due to the high mortality rate and an increase in the number of elderly people with known risk factors for infection, we argue that human V. vulnificus infections should become a notifiable infectious disease in the Netherlands as well. This would provide reliable information on the epidemiology and facilitate correct risk assessment for public health.

Objective: To determine how many family members of methicillin resistant Staphylococcus aureus (MRSA) patients were colonised with MRSA and how this colonisation developed over time., Design: Descriptive, prospective., Method: Two laboratories notified the Public Health Services of newly-diagnosed MRSA patients in three provinces of the Netherlands. These persons and their family members were screened for MRSA colonisation at baseline, after 3 to 4 months and after 6 to 12 months. No advice on medical intervention was given. Relevant medical interventions by general practitioners were registered., Results: Nineteen index patients and their families were included. A total of 41% of the family members (n = 44) proved MRSA positive on at least one of the three tests. At second follow-up the proportion of colonised family members had decreased slightly from 32% to 27%; by the end of the study only a third of the index patients were still MRSA positive. Colonisation of index patients was more persistent if family members were colonised as well., Conclusion: A large and changing number of family contacts of MRSA-positive patients were shown to be colonised over time, and sometimes in the longer term.

Two 41-year-old women, who had previously been splenectomized, were admitted to the intensive-care unit due to fulminant sepsis. On admission, petechiae and ecchymoses characterised the clinical presentation of both patients. Laboratory tests revealed the presence of renal insufficiency and thrombocytopenia with disseminated intravascular coagulation. Streptococcus pneumoniae with serotypes (24 and 38) not included in the current polyvalent pneumococcal vaccine were found in blood cultures from both patients. One patient died as a result of a refractory septic shock. The other patient, who had never been vaccinated with the polyvalent pneumococcal vaccine, survived the sepsis. The clinical course of a fulminant Streptococcus pneumoniae sepsis in both asplenic patients underlines the importance of vaccination. It is also important to educate the patient about seeking immediate medical help if an infection is suspected on the basis of these symptoms. Vaccination does not provide complete protection.

The first documented Dutch case of an ovine Chlamydia psittaci infection concerned a 20-year-old woman in the 26th week of pregnancy, following contact with lambing sheep. She had a severe sepsis and had to be artificially ventilated. Finally, the patient made a full recovery. The preterm born child died directly after birth. The placenta showed an acute intervillitis in which chlamydial antigen was demonstrated immunohistologically. Infection with an ovine C. psittaci was confirmed by sequence analysis of amplified chlamydial DNA from the placenta. Infections with C. psittaci are typically associated with contact with (sick) birds. However, mammals also may act as a source of human infection, especially sheep in which C. psittaci is an important cause of abortion. Infections with ovine C. psittaci are a particular hazard for pregnant women, in whom there is severe placentitis and frequently foetal loss. Such infections are mainly associated with contact with lambing sheep.

Two males aged 41 and 32 years developed pneumonia which responded inadequately to antibiotic treatment and necessitated mechanical ventilation. It was only after surgical and digital opening, drainage of pus pockets and daily pleural lavage that the clinical picture improved. The microorganisms cultured from both patients included Streptococcus milleri, probably acquired by aspiration. Thoracic empyema as a complication of pneumonia is clinically recognised by lack of response to antimicrobial agents. For the diagnosis, ultrasonographic and CT imaging, followed by pleural puncture are used. Simple parapneumonic effusions are managed by drainage with or without rinsing with normal saline, while in advanced empyema, instillations with fibrinolytic agents have proved safe and effective. Sometimes, video-assisted thoracoscopic or conventional surgery is necessary to clear the pleural space, while in complicated cases, extensive surgical procedures are warranted.