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We report a rare case of a 53-year-old man with no significant past medical history who reported multiple tick bites within a 2-month period. The patient reported not "feeling well" for the 2 ½ weeks. He complained of generalized body aches, pains, and chills. He did not report nausea, vomiting, or yellowish discoloration of the eyes or skin. He presented to the emergency room with syncope preceded by severe abdominal pain. Upon presentation, he was pale and hypotensive. He had not experienced any trauma. Computed tomography revealed a splenic rupture, hemoperitoneum, and active extravasation of contrast material. The estimated amount of hemoperitoneum was 1.5 liters of blood. Subsequently, an infectious disease work-up revealed a positive Anaplasma phagocytophilum polymerase reaction in blood. The patient was aggressively resuscitated, and a splenectomy was performed followed by doxycycline therapy. He successfully recovered., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Background/aims: Severe hemorrhage may induce bacterial translocation (BT) from the bowel. Presence of hemoperitoneum is supposed to further increase the incidence of BT., Methodology: Blood was drawn from the femoral artery of rats and hemoperitoneum was created by replacing the drawn blood. Rats were randomly segregated into 5 groups. Control group rats received a sham operation. Rats in groups 1 and 2 received mild hemorrhage (15mL blood/kg body weight withdrawn) with and without hemoperitoneum respectively. Rats in groups 3 and 4 received severe hemorrhage (25mL blood/kg body withdrawn) with and without hemoperitoneum respectively. Twenty-four hours after the above manipulation, mesentery lymph nodes, livers, spleens, and finally cecums were removed for bacterial cultures., Results: Rats that received severe hemorrhage had a significantly higher incidence of BT, both in tissues and in individuals, than rats that received mild hemorrhage did. group 1 rats had a higher incidence of BT in tissues compared with group 2, although the difference in individuals was not significant. On the other hand, group 3 had a higher incidence of BT either in tissues or in individuals compared with group 4. Cecal populations of bacteria assessment showed that groups with hemoperitoneum had higher levels of bacteria in comparison with groups without hemoperitoneum., Conclusions: Severe hemorrhage in rats increases the incidence of BT and the incidence is even greater in the presence of hemoperitoneum.

A 65-year-old man developed massive hemoperitoneum secondary to spontaneous splenic rupture. Histopathological analysis of the spleen demonstrated necrotizing granulomas. Results of serological tests indicated infection with a species of Bartonella, and immunohistochemical staining established Bartonella henselae as the cause of splenitis. To our knowledge, this represents the first reported case of spontaneous splenic rupture caused by infection with a species of Bartonella.

Two clinical cases of infection with Ralstonia mannitolilytica are described: a recurrent meningitis on an implanted intraventricular catheter and an infected hemoperitoneum as a complication of a cholangiocarcinoma. The strains were first misidentified as Pseudomonas fluorescens and Burkholderia cepacia. Further testing lead to the identification as Ralstonia pickettii biovar 3/"thomasii," which was recently shown to represent a separate species, R. mannitolilytica (List editor N. Weiss, Int. J. Syst. Evol. Microbiol. 51:795-796, 2001), originally described as R. mannitolytica (De Baere et al., Int. J. Syst. Evol. Microbiol. 51:547-558, 2001). R. mannitolilytica can be distinguished from all described Ralstonia species by its acidification of D-arabitol and mannitol and by its lack of nitrate reduction and of alkalinization of tartrate. In order to determine the true prevalence of infections with this species, colistin-resistant "P. fluorescens" strains and strains growing on B. cepacia selective medium deserve further attention.