Orthostatic hypotension revealed by BASCULE syndrome

pathogens before the first culture. Talan et al. [1] examined 50 patients with dog bites and 57 with cat bites, and the cultures yielded a median of five bacterial species; of the 107 cases reported, Bacteroides species were detected in 31 cases, but Bacteroides pyogenes was not present. Bacteroides pyogenes is an anaerobic Gram-negative bacillus, first isolated from pigs [2] and later detected in the oral flora of dogs and cats [3, 4]. The first reported case of human infection with Bacteroides pyogenes was bacteraemia due to a cat bite [5]. To the best of our knowledge, to date, only one other study of Bacteroides pyogenes infection due to an animal bite has been reported. Lau et al. also described four dog-bite and three cat-bite cases [6], and of the eight dog/cat-bite cases in these two reports, seven were treated with penicillin, and one was treated with penicillin and ciprofloxacin. In our case, as Bacteroides pyogenes was sensitive to penicillin and new quinolone, the use of sitafloxacin proved effective. Notably, five of eight previously described cases required multiple (a maximum four times) surgical treatments (incision or debridement) [5, 6]. In our case, three incisions were made. Bacteroides pyogenes associated with dog/cat bites may be recalcitrant and warrant additional surgical treatments after the primary treatment. Therefore, careful observation during the management of dog/cat bites is imperative. Recently, MALDI-TOF MS has gained popularity for the identification of microorganisms. In this technique, a single isolated bacterial or fungal colony is smeared onto a metal plate, conjugated with a chemical reagent matrix and dried, followed by MALDI-TOF MS analysis to generate protein fingerprint signatures. Finally, the microorganisms are identified by comparing fingerprint spectra with reference spectra in a database. Several studies have revealed that MALDI-TOF MS is a precise and high-throughput method for identifying microorganisms [7, 8]. Although the results of MALDI-TOF MS and 16S ribosomal RNA sequencing often correlate well for various microorganisms, discrepancies are sometimes reported [9, 10]. Lau et al. demonstrated a perfect identification match for MALDITOF MS and 16S ribosomal RNA sequencing in their seven Bacteroides pyogenes-infected cases [6]. Thus, the identification of Bacteroides pyogenes in our case is likely to be accurate. In conclusion, Bacteroides pyogenes can potentially cause recalcitrant infection after dog/cat bites. Careful observation, surgical treatment, and appropriate antibiotics are vital for managing these infections. In the future, MALDI-TOF MS usage will facilitate detection of Bacteroides pyogenesassociated infectious disease in daily clinical practice.