Clostridium septicum sepsis and meningitis as a complication of the hemolytic-uremic syndrome

Hemolytic-uremic syndrome (HUS) is recognized by the triad of acute microangiopathic hemolytic anemia, thrombocytopenia, and oliguric renal failure. The condition is usually preceded by gastroenteritis associated with bloody diarrhea. Escherichia coli 0157:H7, an enterohemorrhagic verotoxin producing E. coli, is now recognized as the most common pathogen associated with hemorrhagic colitis and HUS in North America.1

Since its description, a variety of gastrointestinal and neurologic complications of HUS have been noted. An association between HUS and meningitis due to Hemophilus influenzae 2 and Streptococcus pneumoniae3 has been previously reported. In addition, the first reported case of Clostridium septicum sepsis and cerebritis complicating gastrointestinal involvement in HUS was reported in 1988.4

We report the second confirmed case of fatal C. septicum sepsis and meningitis as a complication of HUS, suggesting that this entity may be more common than previously recognized. We review the epidemiology and clinical manifestations of C. septicum infections and speculate on the pathogenesis of the colitis and invasive C. septicum infection in our patient.

Nonsurgical management of deep neck infections in children

Of the 14 pediatric patients with deep neck infections hospitalized at our institution from 1981 through 1990, only 6 were managed surgically. The remaining 8 patients received antibiotic therapy and their infection resolved without the need for surgical drainage. All 8 patients were hospitalized within 4 days (mean, 1.8 days) of onset of illness. Computerized tomography of the neck was performed in 7 and revealed soft tissue swelling and a round or oval cystic lesion in the parapharyngeal region in all 7. Parenteral antibiotic therapy was administered to all patients for 2 to 9 days (mean, 5.5 days) before changing to oral therapy which was continued for 10 to 35 days (mean, 15.1 days). Clinical improvement was evident in all patients 1 to 3 days (mean, 1.6 days) after the onset of antibiotic therapy, with defervescence within 7 days (mean, 3.8 days). Follow-up computerized tomography scans were obtained in 4 patients revealing improvement in 3. It is known that patients with cellulitis of the deep neck tissues may respond well to antibiotic therapy; our experience suggests that some patients with apparent abscess formation as determined by computerized tomography scan may also respond favorably to antibiotic therapy and not require surgical drainage.

Enzyme-linked immunosorbent assay for detection of capsular antibodies against Haemophilus influenzae type b: comparison with radioimmunoassay

An enzyme-linked immunosorbent assay (ELISA) is described for detection of anti-capsular antibodies against Haemophilus influenzae type b. Polyribosephosphate was covalently bonded to poly-L-lysine before adsorption to microtiter plates. ELISA immunoglobulin G and immunoglobulin M anti-polyribosephosphate antibody titers were comparable to total anti-polyribosephosphate antibody concentration determined by radioimmunoassay. The ELISA technique will be useful for further investigations of host response to infections due to H. influenzae type b but is not intended to be used as a serological method for documenting H. influenzae type b infections.

Role of adherence in the pathogenesis of neonatal group B streptococcal infection

The ability of group B streptococci to attach to buccal epithelial cells from adult volunteers, healthy neonates, and infants with invasive group B streptococcal infection was assessed by using (3)H-labeled bacteria incubated at a bacteria-to-cells ratio of 1,000:1. Type III group B streptococcal clinical isolates adhered significantly better to the epithelial cells of healthy neonates than to those of adults (mean bacteria per cell of 31 versus 7, respectively; P < 0.005). In contrast, no statistically significant differences in adherence of type Ia or type II strains to cells of neonates and adults were noted. The adherence of strains isolated from 15 infants with invasive group B streptococcal infection was significantly greater to the cells of infected infants than to those of age-matched controls (mean bacteria per cell of 39 versus 18, respectively; P < 0.005). In contrast, no significant difference was noted in the adherence of a usually adherent type Ia strain and a nonadherent type III strain to the cells of infected infants compared with control infants. These results indicate that the serotype of group B streptococci with the greatest virulence for neonates (type III) adheres better to neonatal than to adult epithelial cells. Infants who develop invasive infection may have an increased number of epithelial cell surface receptor sites for attachment of group B streptococci, the bacteria may elaborate products which unmask receptor sites, or both.

Relapse of Escherichia coli meningitis following therapy with moxalactam

Bacteriologic relapse occurred in a premature infant with Escherichia coli K1 meningitis 11 days following the completion of a 3-week course of therapy with the new 1-oxa-beta-lactam antibiotic moxalactam. Therapeutic failure was most probably the result of sequestration of viable bacteria in ventricular and/or paraventricular sites. While in vitro data and preliminary clinical evaluation of the new beta-lactam antibiotics indicate that these agents may be useful in the treatment of neonatal Gram-negative enteric meningitis, undue optimism regarding their efficacy, as with former agents, may be unwarranted.

Non-group D alpha-hemolytic streptococci: new neonatal pathogens

Review of the bacteriologic records of a large city-county hospital from 1970 through 1980 has indicated a substantial increase in the frequency of isolation of non-group D alpha-hemolytic streptococci from blood and cerebrospinal fluid of neonates since 1978. These organisms accounted for 23% of all cases of neonatal septicemia and meningitis in 1980, and as a group were exceeded only by group B streptococci (28%) in prevalence. Most neonates (91.2%) had early-onset infection (mean age = 1.4 days); approximately one-third were premature (less than 36 weeks' gestation). Maternal obstetrical complications were common. Nearly 80% of the infants had signs or symptoms suggesting bacterial sepsis. Findings such as concomitant meningitis, shock, chest roentgenogram abnormalities, leukopenia, abnormal numbers of immature neutrophils, and death were infrequent when compared to those accompanying other invasive neonatal bacterial infections, suggesting that non-group D alpha-hemolytic streptococci may be less virulent for the neonate or that neonatal host defense mechanisms are more effective in containing the infection. Careful surveillance for these potential neonatal pathogens seems warranted.

Septic Arthritis and osteomyelitis caused by an organism of the genus Rhodococcus

We describe a previously healthy, immunologically normal young girl who presented painless swelling of fingers, a toe, and one knee. Roentgenograms were consistent with osteomyelitis of the phalanges and knee effusion. Rice bodies (corpora oryzoidea) were identified in viscous fluid obtained from the knee during arthroscopy. Culture of this fluid grew an organism initially believed to be a member of the genus Nocardia but which was later presumptively identified as a member of the genus Rhodococcus. The patient was successfully treated with a combination of erythromycin and amoxicillin for a total of 6 months. Previously reported cases of this unusual infection and the microbiological features of the organism are reviewed. The significance of rice bodies found in joint fluid and the therapy of this infection are discussed.