Veillonella species are obligate anaerobes which are part of the human oral, gut and vaginal microbiota. The genus Veillonella consists of 16 characterized species. Very few infections due to Veillonella atypica have been reported till date. Here we present a case of retropharyngeal abscess due to this organism in a 55-year-old lady.

Prompt and accurate diagnosis of polymicrobial bacteremia, which causes the difficulty in anti-infective treatments, poor treatment outcome and high mortality, is essential for initiating effective antimicrobial therapy. Here we present a case of bacteremia caused by two types of uncommon bacteria, Lactobacillus jenseniand and Veillonella montpellierensis in a 29-year-old pregnant woman at 33 weeks of gestation with anemia due to iron deficiency. She had no comorbidity or other chronic illnesses and was successfully treated with appropriate antibiotic use.

BACKGROUND: Veillonella species are an opportunistically pathogenic commensal anaerobic Gram-negative coccus commonly found in the oral, genitourinary, respiratory, and intestinal tract of humans and some animals. Infection is rare, even in immunocompromised hosts, and has been identified to cause a wide array of different infections, including endocarditis, osteomyelitis, and meningitis.
METHODS: An 82-year-old Caucasian male retired ex-gymnast presented to the emergency department with a 2-week history of acute on chronic lower back pain without clear precipitant. He displayed no systemic symptoms, and had not sustained any recent injuries. Initial blood and radiological investigation did not reveal an infective or mechanical cause for his pain; however, a few days into admission, he developed a fever and signs of sepsis. A thorough septic screen was performed, including a spinal magnetic resonance imaging scan, which did not reveal any abnormalities. Blood cultures revealed Veillonella parvula bacteremia, with subsequently repeated magnetic resonance imaging displaying rapid disseminated infection including bilateral psoas abscess, discitis, and osteomyelitis. Infective endocarditis was later identified with echocardiogram. He received intravenous ceftriaxone and later oral amoxicillin and clavulanic and recovered on 6-month follow-up.
CONCLUSIONS: This case illustrates the potential pathogenicity and unexpected rapid course of Veillonella parvula infection even in an immunocompetent host presenting with back pain. This case highlights the critical importance of a thorough septic screen when investigating patients for early signs of sepsis.

UNASSIGNED: While pyogenic spondylodiscitis due to Gram-positive aerobic bacteria and its treatment is well known, spondylodiscitis caused by anaerobic Gram-negative pathogen is rare. In particular, the spondylodiscitis caused by Veillonella species is an absolute rarity. Thus no established management recommendations exist.
UNASSIGNED: A case report of a 79-year-old man with spondylodiscitis caused by Veillonella parvula with intramuscular abscess collection managed conservatively with stand-alone antibiotic therapy without a spinal stabilization procedure. A review of literature of all reported spondylodiscitis caused by Veillonella species was performed. After 3 week-intravenous therapy with the ceftriaxone in combination with the metronidazole followed by 3 weeks per oral therapy with amoxicillin/clavulanate, the complete recovery of the patient with the V. parvula infection was achieved.
UNASSIGNED: Treatment of the spondylodiscitis caused by Veillonella species should contain a beta-lactam with beta-lactamase inhibitor or third-generation cephalosporine. Six weeks of treatment seem to be sufficient for the complete recovery of the patient.

Background: Calcium-based urinary stones rarely grow bacteria on stone culture. The presence of an anaerobic bacteria is even more uncommon. We present a case of Veillonella growth from a primarily calcium phosphate-based urinary stone culture. Case Presentation: A 56-year-old Caucasian woman presented with urosepsis and bilateral nephrolithiasis. A nephrostomy tube was emergently placed in the left kidney. After resolution of her urosepsis, she underwent a left percutaneous nephrolithotomy. The stone culture grew Veillonella, a gram-negative anaerobe. Conclusion: Growth of anaerobic bacteria, such as Veillonella, on stone culture of a calcium-based stone is a rare occurrence; the mechanism of this association remains unexplained.

BACKGROUND: Vertebral osteomyelitis can be attributed to many factors including immunosuppression, diabetes, malignancy, collagen disease, periodontal disease, open fractures, and endoscopic procedures. Anaerobic bacteria, such as Veillonella species, are found in the oral cavity and are rarely implicated in the infection. This report describes vertebral osteomyelitis secondary to a dental abscess with positive Veillonella cultures.
METHODS: A 76-year-old man presented to the hospital due to back pain with a four-day history of fever and chills. CT scans revealed several abscesses in the lumbar region as well as indications of vertebral osteomyelitis. After a psoas drain, the patient began antibiotics with a combination of ampicillin-sulbactam, metronidazole, and levofloxacin, but due to the patient\'s penicillin allergy, he was initially desensitized to this antibiotic for a significant period of time. Laminectomies, foraminotomies, and facetectomies were performed, but the infection spread to vertebral levels. The patient was then switched to a combination of vancomycin, metronidazole, and levofloxacin which eliminated the infection. Final laminectomy was performed with posterior segmental instrumentation and arthrodesis. Post-operatively, there were no signs of infection. The patient recovered well and regained mobility. Deeper examination of the patient\'s medical history revealed a severe tooth abscess immediately before the onset of bacteremia.
CONCLUSIONS: We believe that a delay in the onset of antibiotic treatment is what led to the initial bacteremia that ultimately took root in the lower lumbar vertebrae. To the best of our ability, we could identify only one other case that linked vertebral osteomyelitis to the oral cavity.

UNASSIGNED: Veillonella parvula is usually regarded as a contaminant bacteria associated with polymicrobial infection. Here we report a rare case of sepsis caused by V. parvula, which was successfully treated by chloramphenicol. In addition, the therapeutic strategy for V. parvula infection was reviewed.
METHODS: A 55-year-old woman underwent surgery for lumbar spinal stenosis and developed high fever (39.5°C) after surgery, accompanied by chills and fatigue. V. parvula was isolated in blood culture and shown to be probably sensitive to both meropenem and chloramphenicol. No improvement was seen after 3 days of treatment with meropenem, and then, iv chloramphenicol (1.5 g once daily) was added to the regimen. The symptoms and fever resolved in 2 days. She was continuously treated with chloramphenicol for another 10 days before discharge.
CONCLUSIONS: The reported antibiotics in the therapy of infections caused by veillonella species include penicillins, metronidazole, cephalosporins, aminoglycosides, imipenem, clindamycin, doxycycline, erythromycin and chloramphenicol. To our knowledge, this is the first case describing successful treatment of V. parvula-caused sepsis with chloramphenicol.

BACKGROUND: In general, hematogenous spread of bacteria in children is uncommon. Bacteremia, however, is a known complication of dental procedures and severe caries, but is infrequently associated with primary, asymptomatic, non-procedural-related, dentoalveolar infection.
METHODS: The patient is a 7-year-old previously healthy boy who presented to the Emergency Department (ED) with \"fever, mottling, and shaking chills.\" In the ED, he appeared systemically ill with fever, mottling, delayed capillary refill, and rigors. Physical examination by three different physicians failed to reveal any focus of infection. Laboratory evaluation, including blood cultures, was obtained. The patient later developed unilateral facial swelling and pain, and a dentoalveolar abscess was found. He was started on antibiotics, underwent pulpectomy and eventually, extraction, prior to improvement in symptoms. Blood cultures grew two separate anaerobic bacteria (Veillonella and Lactobacillus). This is, to our knowledge, one of the first reported cases of pediatric sepsis with two different anaerobic organisms secondary to occult dentoalveolar abscess in a pediatric patient. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is imperative for emergency physicians to recognize the possibility of pediatric sepsis in the setting of acute maxillary or mandibular pain, as well as in patients for whom no clear focus of infection can be found. This is particularly important for those who appear ill at presentation or meet systemic inflammatory response syndrome criteria and would benefit from further laboratory evaluation, including blood cultures, and possibly antibiotic therapy.

Previously, Veillonella species had been considered as nonpathogenic and rarely caused serious infections. We report a case of 25-year-old man with osteomyelitis caused by Veillonella species. He was admitted to the hospital due to an open fracture to the left radial bone caused by industrial washing machine accident, and emergency surgery was performed. However, wound infections occurred one week after the operation. Although Acinetobacter baumannii and Serratia marcescens were cultured from the pus, obligate anaerobic bacteria were not detected at that point. Debridement was repeated and antibiotics were changed according to the result of bacterial culture and drug sensitivity. Despite this, the infection was poorly controlled. On the 5th debridement, granulomatous bone tissues on pseudarthrosis were found for the first time at the infection site. Although no bacteria was detected with aerobic culture, anaerobic incubation revealed Gram-negative cocci which was later identified as Veillonella species by 16S rRNA gene sequence analysis. His condition improved without any additional debridement after adding effective antibiotics against Veillonella species. It is well known that prolonged infection with aerobes consumes oxygen in the infection site and leads the environment to more favorable conditions for anaerobic bacteria, thus we speculated that prolonged infection with bacteria such as S. marcescens induced the favorable environment for Veillonella species. Physicians should realize the importance of anaerobic culture method in routine practice, especially in complicated cases such as the present case. In this article, we reviewed case reports of Veillonella infection and summarized the clinical features of this organism.

BACKGROUND: Veillonella is a nonfermentative, strictly anaerobic, Gram-negative coccus that forms part of the human gastrointestinal tract, mouth and vaginal flora. Like other anaerobic infection, Veillonella species usually are involved in polymicrobial processes, which make it difficult to determine their pathogenic role. Isolation of a clinically significant Veillonella species is rare and V. parvula is the most common one reported to cause infection in humans. The most frequently reported infection caused by V. parvula is osteomyelitis, almost always in association with bacteremia.
METHODS: Here, we describe a rare case of nonvertebral osteomyelitis and septicemia caused by Veillonella species in a 49-year-old Saudi man with diabetes. Initial treatment with ciprofloxacin was associated with treatment failure and poor response. Identification of the organism was essential for the selection of appropriate treatment. There have been only seven previous reports of Veillonella vertebral osteomyelitis and one report of V. parvula foot osteomyelitis with sepsis in the literature. This is the second case of Veillonella nonvertebral osteomyelitis associated with septicemia reported to date.
CONCLUSIONS: Veillonella species should be considered a true pathogen in diabetic patients with osteomyelitis and those with underlying immune suppression, particularly if the organism is isolated from blood. The isolation of those obligate anaerobes from blood may signal the presence of severe underlying disease and the probable need for timely surgical intervention.