Sporadic military meningococcal disease: a diversity of presentations.

Thirty-four cases of meningococcal disease were identified in a retrospective survey of nine US Army posts in the southeastern United States from June 1977 to August 1979. Group B organisms predominated in dependents and civilian communities surrounding two of the posts, while active-duty personnel had a greater variety of organisms, with groups Y and C predominating. The spectrum of clinical presentation and severity was diverse. Six cases of pneumonia with bacteremia occurred, all in basic trainees. A case of chronic meningococcemia was identified, as was one case of dermatitis-arthritis in a pregnant woman, which mimicked gonococcemia. Clinicians should be alert to the possibility of sporadic meningococcal disease in military personnel and their dependents.

Use of systemic antibiotics in the burned patient.

A diagnosis of clinical sepsis is the primary indication for administration of systemic antibiotics. Choices of antibiotics for sepsis, where cultures are unavailable, requires a knowledge of current strains in the unit where the patient resides and coverage for both Staphylococcus aureus and Pseudomonas. Dosage requirements are increased in burned patients and serum antibiotic levels must be monitored for maximal effectiveness and minimal toxicity. Localized foci of infection must be identified and eradicated with regional antibiotic therapy or surgery when possible. Gram-negative pneumonia in the patient with an inhalation injury poses special difficulties in therapy. Resistance to antibiotics must be constantly guarded against and isolation procedures followed to avoid its propagation in the burn unit. Combination drug regimens and plasmid-directed therapy may in the future slow down the acquisition of further antibiotic resistance and lead to improved salvage of severely burned patients.

Group B streptococcal osteomyelitis in adults.

Osteomyelitis due to group B Streptococcus occurred in two adult male patients. Both patients responded to parenteral penicillin G. A review of the literature verifies that group B Streptococcus has been an exceedingly rare cause of osteomyelitis in adults.

Recurrent herpetic whitlow due to herpes simplex virus type 2.

Herpes simplex virus type 2 was demonstrated to be the cause of a recurrent painful and disabling digital infection in a young man. It is possible that this was originally venereally transmitted. With increasing incidence of genital herpes infections, digital herpetic infections may become more common in the nonmedically employed community.

Infections caused by Rhodochrous.

Organisms conforming to "rhodochrous taxon" were isolated from three immunocompromised patients, suggesting a pathogenic role for the organisms. The organisms are partially acid-fast, gram-positive catalase positive rods which form orange or red colonies aerobically in three or four days on Sabouraud, Mueller-Hinton and Middlebrook 7H-10 agars. They are differenitated from Nocardia by morphology and ability to degrade ethylene glycol in 7H-10 media. Two of these clinical isolates and a reference strain were injected intraperitoneally into guinea pigs, half of which received methylprednisolone intramuscularly beginning three days prior to inoculation. Steroid-treated animals exhibited clinical illness, diffuse peritonitis and recovery of inoculated organisms whereas one of three nonsteroid-treated animals exhibited a localized abscess without recovery of organisms. This study suggests that rhodochrous may be pathogenic under conditions of immune compromise.

Postoperative hemorrhage associated with carbenicillin administration. Report of two cases and review of the literature.

Two patients receiving preoperative carbenicillin manifested platelet dysfunction and severe wound hemorrhage. Platelet transfusions appeared beneficial. Investigations indicate that hemostatic abnormalities, especially platelet aggregation defects, may be produced by carbenicillin. Extreme caution and awareness of possible hemorrhage are advised when carbenicillin is used preoperatively.

Non-ionic diffusion of pentobarbital across human chorion laeve.

Diffusion of the weak organic acid, pentobarbital, across human chorion laeve in vitro shows an inverse correlation with pH, when corrected for extracellular space permeation by the concurrent measurement of membrane permeability to the lipid insoluble molecule, p-aminohippurate. The temperature dependence of pentobarbital diffusion at different pHs supports the concept that the additional net flux of solute at lower pH occurs by transcellular permeation by the non-ionized moiety, the observed increase corresponding roughly to the dissociation curve for pentobarbital.