Acute enteritis associated with pneumococcal bacteremia.

We describe an elderly male who had a two day history of fever, abdominal pain and watery loose motions. Clinical examination was positive for abdominal right lower quadrant tenderness and moderate dehydration. Stool examination revealed inflammatory diarrhea. Considering the high prevalence of extended spectrum β-lactamases (ESBL) producing Gram-negative infections, he was treated with Piperacillin/Tazobactam. Surprisingly, his blood culture which was taken on admission returned positive for Streptococcus pneumoniae after two days, which was coincident with resolution of fever and diarrhea. This patient had no other clinically apparent source of Pneumococcal infection and we believe that he had Pneumococcal enteritis with bacteremia. There are very few reported cases of isolated Pneumococcal enteritis in the literature. Therefore, we report this unusual form of Streptococcus pneumoniae infection both because of its rarity and its potentially life-threatening but still curable nature. ©

Study of Takayasu's arteritis in children: clinical profile and management.

AIMS: To study clinical features, pattern of involvement and treatment modalities of Takayasu's arteritis (TA) in children. MATERIAL AND METHODS: Retrospective analysis of hospital records of children admitted over a period of 4.5 years. RESULTS: 17 patients in the age group of 5 to 11 years (M: F = 1.1: 1) were diagnosed to have TA on the basis of Ishikawa's criteria. One child was diagnosed post-mortem. The commonest presenting features were hypertension (64. 7%), congestive cardiac failure (47%), weak or absent peripheral pulses, cardiomyopathy (41.1% each) and cardiac valvular affection (35.2%). Retinopathy, hypertensive encephalopathy and abdominal bruits were uncommon. None presented in the prepulseless phase. No patient had an active tuberculous lesion, although Mantoux or BCG test was positive in 6 (35.2%). The predominant pattern of angiographic affection was Type II (52.9%). Nephrotic syndrome and portal cavernoma seen in one patient each were incidental associations. Anti-hypertensive drugs, oral steroids and drugs to control congestive heart failure were the mainstays of medical management. Antitubercular therapy was started in six patients. Angioplasty was attempted in 15 cases and proved to be partially beneficial in six. Three patients who failed to respond to medical management had to undergo surgical procedures, either bypass, nephrectomy or both. In-hospital mortality was 11.7%. CONCLUSIONS: Patients of TA in this study presented acutely in the pulseless phase, with hypertension and its complications. Type II involvement was the commonest pattern. Anti-hypertensive agents and steroids along with angioplasty were partially successful in controlling symptoms in 35.2%. Surgical procedures were reserved for a minority with poor response to drugs and angioplasty.

Thermal stability of penicillin G acylase : effect of stabilizing agents.

The role of sugars, polyhydroxy compounds, phenylacetic acid and 6-aminopenicillanic acid in stabilization of immobilized penicillin G acylase (IMPGA) was studied. The loss in the activity of IMPGA at 50 degrees C, 2 h, after incorporation of sucrose and mannitol at 0.1 M concentration was 16 and 18% respectively; the loss in the activity of the enzyme under these conditions in the absence of stabilizing agents was 40%.