Comparison of preservation media and freezing conditions for storage of specimens of faeces

To evaluate the long-term recoverability of bacterial enteropathogens, two freezing conditions (deep-freezing at -70 degrees C and liquid nitrogen) and three preservation media (Cary-Blair, Amies, and buffered glycerol-saline) were tested. These were compared with storage in containers with no preservation medium and refrigeration at 4 degrees C. At 4 degrees C, viability of organisms could not be consistently maintained beyond one month; Cary-Blair medium generally gave the best results and storage without preservation medium was the least efficient. Storage in liquid nitrogen and deep-freezing effectively preserved all organisms except Campylobacter jejuni for the entire period of study (12 months). There was no difference between the various preservation media, or between storage with or without medium. Storage in preservation medium was superior to storage without such supplement for C. jejuni. We conclude that most enteropathogens survive in faecal specimens for as long as 12 months when stored at very low temperatures (-70 degrees C) whether or not preservation media are used.

Left ventricular papillary fibroelastoma with coronary embolization

We describe a patient who survived an acute myocardial infarction caused by coronary embolization from a left ventricular papillary fibroelastoma. The tumour, which was detected by 2-D echocardiography, was successfully excised.

Penetration of third-generation cephalosporins into human peritoneal tissue

Each of 40 patients underwent elective laparotomy following administration of a single 1.0-gram intravenous dose of ceftizoxime, ceftriaxone, cefoperazone or cefotaxime. Therapeutic concentrations of cefoperazone and ceftriaxone were achieved in peritoneal tissue in 20/20 patients. Only 9/20 samples from patients receiving the other two antibiotics had detectable antibiotic activity. The antibiotic concentration in peritoneal fluid (7 samples) was 2.36-11.15 times higher than that of concurrently obtained peritoneal tissue. When adjusted for the in vitro susceptibility (MIC) of potential peritoneal pathogens, our data suggest that ceftriaxone and cefoperazone may be preferable to other third-generation cephalosporins for the prophylaxis and therapy of intraabdominal infection.

Cutaneous manifestations of infection with Corynebacterium group JK

Multiple necrotic soft tissue lesions were observed in the groin of a granulocytopenic patient with Corynebacterium group JK septicemia. Complete healing followed vancomycin therapy. Review of the English-language literature disclosed that skin and soft tissue manifestations were seen in one-quarter of the patients with Corynebacterium group JK septicemia, all of whom were granulocytopenic; in no case of endocarditis were similar findings reported. The majority of lesions consisted of local infections at sites of previous bone marrow biopsy, intravascular catheter insertion, or perianal fissure; they preceded septicemia and were designated primary lesions. Less often, skin and soft tissue manifestations--including papular skin rash, soft tissue abscesses, and necrotic soft tissue lesions--developed in patients with established septicemia and were considered secondary.

The epidemiology of shigellosis in Israel

Analysis of Shigella isolates referred for serotyping to the Central Shigella Reference Laboratory has revealed a slight predominance of S. sonnei (47%) over S. flexneri (44%) in Israel. In female patients, the predominance of S. sonnei isolates was more accentuated (54 v. 37.5% for S. flexneri). On the other hand, an increased incidence of S. flexneri was observed in military personnel (59 v. 32% for S. sonnei), and even more so in the Arab population (69 v. 19%). Incidence peaked in summer (July, August) for all subgroups.

Isolation of Chlamydia trachomatis from the liver of a patient with prolonged fever

Chlamydia trachomatis was isolated from liver biopsy specimens on two separate occasions in a young, sexually inactive patient with a 10 month history of recurrent episodes of fever, chills, and abdominal pain. Liver function tests showed a five fold increase in alkaline phosphatase, and a 20 fold increase in 5'-nucleotidase. Liver histology changes consisted of mild inflammatory infiltrates in the portal tracts. Treatment with doxycycline was followed by complete recovery. We are not aware of any previous report describing isolation of this organism from the liver parenchyma, or of C trachomatis infection presenting as fever of obscure origin.

Incidence of erysipelas following venectomy for coronary artery bypass surgery

The incidence of erysipelas in extremities used for saphenous vein donation was evaluated by interviewing 302 patients who had undergone coronary artery bypass surgery. Erysipelas occurred in 6.2% of patients, and was twice as common as in patients with a history of varicose vein stripping. The difference, however, was not statistically significant.

Bacteremic hypocalcemia. A comparison between the calcium levels of bacteremic and nonbacteremic patients with infection

Hypocalcemia has been documented in critically ill patients, including those with sepsis and shock. However, its incidence and significance in bacteremic patients without shock has not been established. In the present study the presence of hypocalcemia was evaluated in a group of 67 consecutive bacteremic patients, as compared with 64 infected but nonbacteremic patients. After correction of serum calcium level for serum protein, 25 of the bacteremic patients (37.3%) had "corrected" hypocalcemia (less than 8.5 mg/dL [2.12 mmol/L]), compared with only three in the nonbacteremic group (4.5%). The incidence and magnitude of hypocalcemia in gram-positive and gram-negative infections was similar. In hypocalcemic patients, the "corrected" calcium level was found to be inversely correlated with day of disease and attained a nadir on day 6 to 8 of bacteremia. This nadir was significantly lower in male than in female subjects. Hypocalcemic patients had a significantly higher maximal temperature than normocalcemic ones, but hypocalcemia was unrelated to serum levels of albumin, transaminase, and creatinine.

Concentration of norfloxacin in human gallbladder tissue and bile after single-dose oral administration

Concomitant concentrations of norfloxacin in serum and in gallbladder tissue and bile were determined in 10 patients after a single oral dose of 400 mg given before cholecystectomy. Concentrations in gallbladder bile ranged from 0.6 to 15.6 micrograms/ml, with a mean bile/serum ratio of 7.0. The mean concentration in gallbladder tissue was 1.8 +/- 0.8 (standard error) micrograms/g.

Comparison of an agar slide blood culture device with Bactec 6B for the detection of bacteremia

Each of 1,018 blood culture specimens was inoculated into Bactec 6B (Johnston Laboratories, Towson, MD) and a biphasic blood culture system that incorporates internal removable agar dip slides (Hylab). Ninety clinically significant pathogens were recovered: 66 from both systems, 14 from Bactec only, and 10 from Hylab only. The mean incubation times to positive of the two systems did not differ when data were examined for gram-negative bacilli, gram-positive cocci, total isolates, and contaminants (P greater than 0.05). Contamination rates were also comparable: Bactec 5.4%, Hylab 7.3% (P greater than 0.05). The Hylab system may offer a practical alternative to Bactec 6B.

Penetration of norfloxacin into human prostatic tissue following single-dose oral administration

Concomitant concentrations of norfloxacin in serum, urine and prostatic tissue were determined in 12 patients following a single oral dose of 400 mg. Tissue levels ranged from 0.3 to 1.73 mg/kg, and therapeutic concentrations were demonstrable for as long as 8 h following dosage. The mean ratio of tissue to serum concentration was 1.01 +/- (SE) 0.13.

Concentrations of ciprofloxacin in human liver, gallbladder, and bile after oral administration

We have measured concentrations of ciprofloxacin in serum, hepatic tissue, gallbladder, and bile in 10 patients after a single oral dose of 750 mg given before cholecystectomy. Mean liver and gallbladder tissue concentrations were 12.76 micrograms X g-1 +/- 2.79 (SEM) and 5.94 micrograms X g-1 +/- 1.35, respectively. Concentrations in bile taken from the gallbladder (7 patients) ranged from 68 to 225 micrograms X ml-1, with a mean bile/serum concentration ratio of 49. Concentrations in bile taken from the common bile duct (2 patients) were 17 and 16 micrograms X ml-1.

Failure of oral ketoconazole to cure cutaneous ulcers caused by Leishmania braziliensis

Ketoconazole failed to cure cutaneous lesions caused by Leishmania braziliensis in two patients. A prior study had suggested that ketoconazole was efficacious against this form of leishmaniasis.

Concentration of ciprofloxacin in human prostatic tissue after oral administration

Concomitant concentrations of ciprofloxacin in serum, urine, and prostatic tissue were determined in 15 patients after single oral doses of 750 mg. Levels in tissue ranged from 0.6 to 4.18 micrograms/g, and therapeutic concentrations were demonstrable for up to 9 h after administration. The mean ratio of tissue to serum concentration was 0.93 +/- 0.08 (standard error).

Long-term suppression of recurrent herpes labialis by low-dose oral acyclovir in an immunocompromised patient

A patient with chronic lymphocytic leukemia and severe and frequently recurring herpes labialis received oral acyclovir for more than 18 months, during most of this period at a low dosage (400 mg/d). This regimen was fully successful in preventing recurrences, with no adverse effects.

Hypersensitivity pneumonitis induced by nalidixic acid

Interstitial pneumonitis developed in a patient one week after therapy with nalidixic acid was initiated. The causal association between the drug and the lung disease is based on the temporal relationship, an increased eosinophil count in both peripheral blood and fluid obtained by bronchoalveolar lavage, a positive migration inhibitory factor test with nalidixic acid, and exclusion of other causes. This is, to the best of our knowledge, the first report of a pulmonary hypersensitivity reaction to nalidixic acid.

Septicemia caused by the gram-negative bacterium CDC IV c-2 in an immunocompromised human

A 37-year-old man with plasma cell leukemia developed nonfatal septicemia caused by the gram-negative bacterium CDC IV c-2. Recovery followed appropriate treatment with antibiotics. The biochemical features of this organism are reviewed.

Mixed bacterial subdural empyema complicating subdural peritoneal shunt

Bilateral subdural empyema occurred in a nine-month-old boy with a subdural-peritoneal shunt. Because of the mixed composition of bacterial growths, representative of faecal flora, it is assumed that the infection originated from perforation of the bowel by the distal tip of the shunt catheter, although no abnormal abdominal signs or symptoms were noted.

Influence of patient hemogram on growth index values generated from a radiometric detection device

Blood samples from 20 patients with widely varying concentrations of erythrocytes and leukocyte subtypes were inoculated into BACTEC 6B bottles (Johnston Laboratories, Inc., Towson, Md.). There was no relationship between growth index value and hemogram. Although sterile blood is capable of generating small amounts of 14CO2, the mechanism for this phenomenon is not related to the concentration of a specific type of blood cell.

Multiple neuropathic arthropathy in a patient with syphilis

An unusual case of neuropathic arthropathy in a patient with tabes dorsalis is presented. The special feature consisted of multiple joint involvement in the upper limbs and spine. This uncommon location of Charcot joints can probably be attributed to the patient's occupation which involved heavy strains on his upper limbs.

Intravenous acyclovir for herpesvirus in immunocompromised patients

Severe herpesvirus infections in 18 immunocompromised patients (25 episodes) were treated with i.v. acyclovir. Six patients had 13 episodes of mucocutaneous herpes simplex infections, eight children had varicella, three patients had generalized zoster, and one patient had cytomegalovirus pneumonia. No patient died from infections. In 18 episodes treatment with acyclovir produced a beneficial effect, in 5 episodes acyclovir was probably beneficial, and in 2 patients the effect could not be evaluated. No serious side effects could be definitely attributed to acyclovir administration. These data support the previous experience that i.v. acyclovir may be useful in the treatment of herpesvirus infections in immunocompromised patients.

Recurrent breast abscesses caused by Corynebacterium minutissimum

A 42-year-old woman developed severe, recurrent breast abscesses caused by Corynebacterium minutissimum. Prior reports of C. minutissimum infection have been limited to erythrasma, a minor dermatosis. The microbiological and clinical features of this species were reviewed.

Endocarditis caused by Staphylococcus warneri on a normal aortic valve following vasectomy

Endocarditis caused by Staphylococcus warneri and necessitating valve replacement occurred in a previously healthy 32-year-old patient following vasectomy. No sign of an underlying valvular defect was noted during the operation. S. warneri is a recently identified species of coagulase-negative staphylococci. Endocarditis caused by coagulase-negative staphylococci is uncommon in young, healthy patients with normal heart valves and has not previously been described as a complication of vasectomy. Similarly, infections caused by S. warneri have not previously been described in humans.

Development of Hodgkin's disease in the course of liver cirrhosis and impaired monocyte function

The monocyte function, as measured by phagocytosis and killing of Candida albicans and Candida pseudotropicalis by peripheral blood monocytes, was found impaired in a patient with cirrhosis of the liver on two separate determinations before the occurrence of bleeding from oesophageal varices. Unexpectedly, Hodgkin's disease was diagnosed in enlarged abdominal lymph nodes found on the occasion of an emergency portocaval shunt operation.

Primary actinomycosis of the thyroid mimicking carcinoma

Primary actinomycosis of the thyroid was diagnosed in a 59 year old farmer who presented with a hard, non-tender, thyroid nodule. The difficulties encountered in the diagnosis of actinomycetal infections, its pathogenesis, and treatment are discussed.

Septic arthritis in young infants: clinical and microbiologic correlations and therapeutic implications

In order to assess and correlate the bacteriology of neonatal septic arthritis with its clinical presentation, the records of nine infants with this disease that were diagnosed at Edmonton hospitals between 1964 and 1981 were reviewed and 92 other cases reported in the English-language literature since 1960 were evaluated. All Edmonton cases developed outside of the hospital in previously healthy infants. A Streptococcus species was isolated in four of six patients from whom joint fluid was obtained before antibiotic therapy. Analysis of cases from the literature revealed a more variable bacteriology that seemed dependent on whether the case was hospital or community acquired. In 52 hospital-acquired cases, staphylococci were the predominant isolates (62%); next in frequency were Candida species (17%) and gram-negative enteric bacilli (15%). Community-acquired neonatal septic arthritis was most often caused by streptococci (52% of cases), staphylococci (26%), and gonococci (17%). Since 1970 the relative imbalance between staphylococcal (5%) and streptococcal (75%) isolates in community-acquired neonatal septic arthritis is even more pronounced. This pattern emphasizes the importance of ensuring optimal coverage against penicillin-sensitive organisms in community-acquired neonatal septic arthritis; this is in contrast to the situation with hospital-acquired arthritis, where wider-spectrum coverage against staphylococci and gram-negative enteric bacilli remains mandatory.

Allopurinol-induced toxic epidermal necrolysis

An erythematous eruption with itching developed in an 84-year-old man 4 days after therapy with allopurinol was initiated. The diagnosis of toxic epidermal necrolysis, suspected when separation of the epidermis was noted, was confirmed by skin biopsy. This is the third reported case that can be attributed exclusively to allopurinol and the first patient who did not die.

Neonatal septic arthritis

To assess and correlate the microbiology of neonatal septic arthritis with the clinical presentation, we reviewed the records of nine infants with neonatal septic arthritis (NSA) diagnosed at Edmonton hospitals between 1964 and 1981, and evaluated 92 other cases reported in the English literature since 1960. Our analysis revealed that the microbiology of NSA seemed to be dependent on whether it was hospital or community acquired. In the hospital-acquired cases, staphylococci were the predominant isolates (62%), followed by Candida species (17%) and gram-negative enteric bacilli (15%). Community-acquired arthritis was caused most often by streptococci (52%), followed by staphylococci (26%) and gonococci (17%). Since 1970, the relative infrequency of staphylococcal (5%) in favor of streptococcal (75%) isolates in community-acquired NSA is even more pronounced.

Virilizing adrenal adenoma in a 2-year-old girl

A 2-year-old girl with virilization had an adrenal tumor that produced testosterone with little evidence of excessive urinary androgen excretion. Plasma testosterone concentration was 407 ng/dL and urinary 17-ketosteroid (17KS) levels were 3 and 2 mg/day. Excretion of 17KS decreased to 1.8 mg/day after suppression of dexamethasone therapy, but urinary 17-hydroxycorticosteroid excretion did not change from 1.0 to 0.7 mg/day after administration of dexamethasone. She had a blunted response to administration of metyrapone and insulin and a small diurnal variation in cortisol concentration suggesting suppression of corticotropin secretion, even though the plasma cortisol concentration was in the normal range and there were no clinical signs of cortisol excess. High-performance liquid chromatography was used to analyze the steroid content of tumor tissue. Those portions of the tumor that were rich in steroids contained predominantly testosterone.

An increased familial frequency of gallstones

Despite the very high prevalence of gallstone disease, studies of familial factors are very few, and asymptomatic family members were not studied. We studied, in a prospective manner, the frequency of gallstones in 171 first-degree relatives of patients with proven gallstones compared with 200 matched controls. All subjects were studied by oral cholecystography, and their height, weight, blood glucose, cholesterol, and other parameters were measured. Gallstones were found in 20.5% of the family group and in 9.0% of the control group. Gallstones were found in 22.8% of the female and 16.7% of the male family members as opposed to 10.3% of the female and 8.0% of the male controls. All these differences were statistically significant. Known risk factors, such as Ashkenazi community group, higher age, and overweight, were more frequent in the control group, as were blood glucose and cholesterol. These findings strengthen the validity of the twofold higher frequency of gallstones found in the family group and are likely to be due to genetic factors. A formal genetic family study of gallstone disease is now indicated, using the ultrasonic method.

Typhoid hepatitis with immunoglobulins and complement deposits in bile canaliculi

Documented typhoid fever in a 26-year-old patient was complicated by acute hepatitis with unusually profound jaundice. Liver biopsy revealed focal cell necrosis, mononuclear cell infiltration. Kupffer cell proliferation, and mild cholestasis. Immunofluorescent studies of the liver biopsy revealed deposits of IgG, IgA, IgM, and C3 in the bile canaliculi, suggesting a role for damage by immune complexes in typhoid hepatitis.

Membranous glomerulonephritis in renal transplant. A case report and review of the literature

A patient with membranous glomerulonephritis (MGN) presented with recurrent disease after renal transplantation. The disease on the original and the transplanted kidney was characterized by diffuse subepithelial electron-dense deposits on the glomerular basement membranes. Including this case, 23 cases of MGN have been reported in renal transplants, of which 8 are 'recurrent' and 15 are 'de novo'. This incidence of 'de novo' MGN makes it the most common type of 'de novo' glomerulonephritis in renal transplants. Survey of clinical and morphological features of the cases of both the 'de novo' and the 'recurrent' disease failed to identify a specific cause of the MGN. Hypothetically, immunosuppression in transplanted patients may lower the antibody response to levels that favor the development of membranous glomerulonephritis.