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By Jesse Convertino
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Jose Luis Magana/AP Photo
WATCH Capital Gazette publishes paper after shooting: 'We are speechless'
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Three days after a gunman opened fire in the Capital Gazette newspaper office, killing five staff, the publication in Annapolis, Maryland, thanked the community for its support in a piece printed on its Sunday opinion section.

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“Thank you. We will not forget,” read the headline.

“Thank you for the outpouring of sympathy for the terrible tragedy that took place Thursday in our Annapolis office,” the article begins.

Not unexpectedly, bacteria commonly associated with biliary tract infections (primarily cholecystitis and cholangitis) are the same organisms recovered from cases of pyogenic liver abscess (see above and Table 29 ). Parasitic causes include Ascaris and Clonorchis spp or any parasite that can inhabit the biliary tree leading to obstruction [ 166 ]. At a minimum, cultures for aerobic bacteria (anaerobes if the aspirate is collected appropriately) and Gram stain should be requested. When signs of sepsis and peritonitis are present, blood and peritoneal cultures should be obtained as well.

For patients with HIV infection, the list of potential agents and subsequent microbiology evaluations needs to be expanded to include Cryptosporidium , microsporidia, Cystoisospora ( Isospora) belli , CMV, and M. avium complex [ 166 ]. As the identification of these organisms requires special processing, it is important to communicate with the laboratory to determine test availability either on-site or at a reference laboratory.

Most cases of splenic abscess are the result of metastatic or contiguous infectious processes, trauma, splenic infarction, or immunosuppression [ 169 ]. Infection is most likely aerobic and monomicrobic with Staphylococcus spp, Streptococcus spp, Enterococcus spp, Salmonella spp, and E. coli commonly isolated. Anaerobic bacteria have been recovered in 5%–17% of culture-positive cases [ 170 ]. Aspirates should be processed in a similar manner as pyogenic liver abscesses including aerobic and anaerobic culture, Gram stain, and concomitantly collected blood culture sets ( Table 30 ). Unusual causes of splenic abscess include Bartonella spp, Brucella melitensis , Streptobacillus moniliformis , Nocardia spp, and Burkholderia pseudomallei (uncommon outside of Southeast Asia or without suggestive travel history) [ 171 ]. The laboratory should be notified if B. melitensis or B. pseudomallei is possible due to the need for increased biosafety/security precautions since they are potential bioterrorism agents. As in biliary disease, the spectrum of organisms to be considered needs to be expanded to include Mycobacterium spp, fungi (including Pneumocystis jirovecii ), and parasites for immunocompromised patients [ 171 ].

Most cases of acute or chronic pancreatitis are produced by obstruction, autoimmunity, or alcohol ingestion [ 172 , 173 ]. Necrotic pancreatic tissue generated by one of these processes can serve as a nidus for infection [ 172 , 173 ]. Infectious agents associated with acute pancreatitis are numerous and diverse; however, superinfection of the pancreas is most often caused by gastrointestinal flora such as E. coli , Klebsiella spp, and other members of the Enterobacteriaceae, Enterococcus spp, Staphylococcus spp, Streptococcus spp, and Candida spp. Necrotic tissue or pancreatic aspirates should be sent for aerobic bacterial culture and Gram stain and accompanied by 2–3 sets of blood cultures ( Table 30 ). Antimicrobial susceptibility results from isolated organisms can be used to direct therapy to reduce the likelihood of pancreatic sepsis, further extension of infection to contiguous organs, and mortality. Sterile cultures of necrotic pancreatic tissue are not unusual but may trigger consideration of an expanded search for fastidious or slowly growing organisms, parasites, or viruses.

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