Toxic-shock-like-syndrome due to Streptococcus pneumoniae sinusitis.

We describe a patient with Streptococcus pneumoniae sinusitis associated with a severe sepsis syndrome and desquamative rash whose clinical illness strongly resembled toxic-shock syndrome. Assay of convalescent serum for antibodies to toxic-shock syndrome toxin 1 was negative. This case suggests the possibility of an additional bacterial pathogen associated with toxic-shock syndrome.

Chlamydia preumoniae in ischemic heart disease.

BACKGROUND: Previous work has suggested an association between Chlamydia pneumoniae infection and coronary artery disease. The infection was demonstrated by titers of antibodies--enzyme-linked immunosorbent assay or immunofluorescence, and polymerase chain reaction--and by the findings of C. pneumoniae in the atherosclerotic plaque. OBJECTIVES: To evaluate the association between chronic infection with C. pneumoniae, as measured by a high titer of IgG antibody, and CAD. Our study was designed to explore the relationship between seropositivity to C. pneumoniae and serious coronary events, and to assess whether or not there may be an additional association between established cardiovascular factors and infection with this organism. METHODS: The serum of 130 patients with proven CAD was tested for the presence of IgG antibodies to C. pneumoniae using an ELISA test. A titer < or = 1:64 using the microinfluorescence method, the recognized "gold standard," correlates with a positive result when using the ELISA method. The mean age was 57 (40-65 years). The patients, 82% male and 18% female, had either myocardial infarction (n = 109) or unstable angina (n = 21) 6 months before the investigation (range 3-24 months). The serum for the control group was obtained from 98 blood donors from the same area matched for age 52 (40-58 years) and sex. The donors had no known cardiac history. RESULTS: In the CAD group 75% of patients were positive for C. pneumoniae compared to 33% in the control group (P = 0.001). No increased correlation could be demonstrated between traditional risk factors and C. pneumoniae infection, except in those patients with diabetes mellitus. We found a lower prevalence of IgG antibody to C. pneumoniae in the diabetes subgroup than in other subgroups (P < 0.006), but a higher prevalence than in the control group. CONCLUSIONS: We demonstrated a more than twofold increase in seropositivity to C. pneumoniae among patients suffering serious coronary events, and this trend was independent of gender, age or ethnic group. These findings suggest that chronic C. pneumoniae infection may be a significant risk factor for the development of CAD, but this correlation should be investigated further.

Severe systemic reactions to typhoid vaccination: two cases and a review of the literature.

Typhoid vaccination is part of the routine immunization of all military personnel on mobility status. We report the cases of Air Force students who presented to our facility with presumed systemic reactions to the typhoid vaccine much more severe than those commonly reported. Review of the literature reveals that an influenza-like reaction of variable severity commonly occurs in these patients, and in addition there are isolated reports of more severe reactions. These findings shed doubt on the overall safety of the currently used vaccine and warrant a consideration of its abandonment. Several safer alternatives, including the new live oral vaccine used in Europe, are discussed.

Efficacies of rapid agglutination tests for identification of methicillin-resistant staphylococcal strains as Staphylococcus aureus.

Four commercially available rapid agglutination tests for the identification of Staphylococcus aureus were compared with the tube coagulase test for the identification of 300 methicillin-resistant isolates of staphylococci. Isolates tested included 207 methicillin-resistant S. aureus and 93 coagulase-negative staphylococci, collected from five medical centers. Strain variability was documented by phage typing and antimicrobial susceptibility patterns. Results of rapid identification tests ranged between 82 and 86% sensitivity, significantly poorer than the 98% sensitivity which the tube coagulase test provided.

Hyperammonemic encephalopathy due to essential amino acid hyperalimentation.

Hyperammonemic associated encephalopathy developed in an adult receiving essential amino acids. Evidence that her encephalopathy was related to her hyperammonemia included (1) elevated CSF glutamine and serum ammonia levels, (2) the absence of any other drug or metabolic cause of encephalopathy, and (3) resolution of her encephalopathy and abnormal ammonia levels with discontinuation of the hyperalimentation. The serum ammonia levels of patients receiving essential amino acid fluid should be monitored. If the levels remain elevated or if toxicity develops, consideration should be given to switching to an alternate fluid.