are no reports of the simultaneous isolation of this bacterium in human patients and their close contact animals. Consequently, the role of zoonotic transmission in the infection of humans with H. cinaedi is unclear and requires further study. Studies conducted in Japan have reported finding H. cinaedi in the feces of healthy humans, as well as in the blood of 46 persons who were concurrently afflicted with H. cinaedi at a single hospital. Hospital-born, medical setting-born, and community-born infections in smaller numbers of patients have also been reported. These studies allow a possibility that H. cinaedi may be, at least in some cases, transmitted between humans either directly (e.g. through oral contact) or indirectly (e.g. through contaminated surfaces, clothing, bedding, or other objects). Human infections Individuals (age range: newborn to elderly) with H. cinaedi infections have presented with acute or chronic gastroenteritis (i.e. inflammation of the stomach and/or intestines), cellulitis (i.e. bacterial infection and inflammation of the inner layers of the skin), and/or bacteremia (i.e. the bacterium circulating in the blood). This bacteremia may be associated with no symptoms except fever or with full-blown sepsis symptoms. Less commonly, infected individuals have presented with septic arthritis, infection of an artificial joint, infection of a vascular bypass graft, or meningitis. Cases of bacteremia are often (~30% of all cases) accompanied by cellulitis at multiple sites in the skin. These infections have tended to occur in persons who are immunocompromised due to HIV/AIDS, X-linked agammaglobulinemia, common variable immunodeficiency, various malignancies (e.g. lung cancer, multiple myeloma, leukemia, lymphoma, or the myelodysplastic syndrome), chemotherapy treatments, or splenectomy. H. cinaedi infection has also occurred in persons whose immune function may be defective as a result of, or in association with, chronic renal failure or autoimmune diseases (i.e. systemic lupus erythematosus and rheumatoid arthritis). Diagnosis The diagnosis of H. cinaedei infection is made difficult by the fastidiousness of this organism; in culture, it grows very slowly and requires high humidity and microaerobic conditions. Furthermore, the bacterium, while being able to be cultured from blood specimens, is far harder to culture from tissue lesions such as those in the skin. Consequently, the diagnosis of H. cinaedie infection has been heavily based on patient clinical presentations, histology of lesions including special staining for the bacterium, and analyses of tissue specimens by DNA sequencing and species-specific polymerase chain reactions to identify nucleotide gene sequences specific to the bacterium. Treatment The