Group B streptococcus amnionitis with intact membranes associated with quintuplet delivery.

Chorioamnionitis is a frequent cause of premature labour and delivery, as well as of maternal and neonatal mortality. Group B streptococcus (GBS) has emerged over the past decade as a common pathogen in the etiology of neonatal sepsis. The case of chorioamnionitis reported here is unusual for three reasons: the premature labour was associated with intact membrane and amniotic fluid infected with GBS; all 5 infants were contaminated with GBS and all infants survived. Chorioamniotitis with intact membranes raises some questions regarding the antepartum use of steroids (potent anti-inflammatory agents), etc. The likelihood of chorioamnionitis in spite of cervical mucus, intact membranes, and the bacteriostatic activity of the amniotic fluid should alert the obstetrician to take special precautions, such as weekly vaginal cultures and appropriate vaginal antimicrobial treatment, in cases of imminent premature delivery.

Prepatellar bursitis due to anaerobic Streptococcus.

A previously healthy 65-yr-old man developed clinical signs of prepatellar bursitis. Aerobic cultures from fluid aspirated from the inflamed prepatellar bursa were negative. Direct microscopic examination of the fluid showed gram-positive cocci, and anaerobic cultures grew Streptococcus hemalyticus group A. The bacterial etiology of bursitis has recently been emphasized in the literature; in most of our cases Staphylococcus was responsible. Negative cultures were next in frequency. Other microorganisms may indeed be responsible for prepatellar bursitis and should be sought where aerobic cultures are negative.

Acute necrotising fasciitis due to streptococcal infection in a newborn infant.

A 3-day-old baby girl developed septicaemia, meningitis, and necrotising fasciitis due to group A beta-haemolytic streptococcus, type M52, which was also cultured from the mother's cervix. Necrotising fasciitis is a severe infection of the skin and subcutaneous tissues with infarction, necrosis, and sloughing of the affected areas. Early recognition of this condition is essential so that appropriate treatment can be given.

Exogenous mycotic infections of the eye and adnexia.

Three cases of exogenous mycotic infections of the eye are presented. The first is a case of keratitis in a patient suffering from glaucoma simplex who removed a foreign body from the cornea, caused by Fusarium solani, generally known as a saprophytic soil and plant inhabitant. As factors predisposing the patient to infection, trauma to the cornea like injury by a foreign body, as well as the preexisting disease of the eye, are discussed. The other case illustrates the change in the pathogenicity of an otherwise innocent fungus like Penicillium, which penetrated the sclera after injury of the eye by a broken airpiece of a drill and caused a severe endophathalmitis. The infection responded well to treatment with 5-fluorocytosine. The last case represents a rather mild well-known mycotic infection by Streptomyces somaliensis causing canaliculitis in a patient admitted for cataract surgery. Curettage of the infected canaliculus followed by iodine washout proved to be effective. The importance of the early clinical and laboratory diagnosis in order to avoid mistreatment with antibiotics and steroids and to ensure the right antimycotic treatment is stressed.

Brain abcess following dental infection.

A 48-year-old woman underwent root canal treatment of the upper left lateral incisor and lower right second premolar. Close to the conclusion of the endodontic treatment she complained about headaches. Later on, because of aggravation of her condition, with headaches, fever, malaise, weakness, and numbness of the right limbs, she was admitted to the hospital. The disease progressed to an epileptic state, with appearance of a right hemiparesis. A brain scan and carotid arteriogram revealed the presence of a mass occupying the left parietal space. Craniotomy disclosed an abscess containing yellow pus from which Streptococcus viridans was cultured. After thorough surgical cleansing of the area, removal of the bone for decompression, and treatment with ampicillin the patient improved gradually and slowly regained the mobility of her right side.

Urine xanthine oxidase activity in urinary tract infection.

Xanthine oxidase (XO) activity was found to be negligible in sterile human urines (less than 480 units, as presently defined, per litre). Significant XO activity was found in all urines containing more than 10(5) bacteria/ml, except for urines infected with Staphylococcus aureus, in which XO activity ranged from 347 to 714 units per litre. Plasma XO is not transferred to the urine, as demonstrated by the negligible XO activity found in sterile urines from patients with raised plasma XO activity. Determination of urinary XO activity is a suitable procedure for the detection of urinary tract infection.

The microbiologic approach in endodontics.

The results of an investigation of the microbiologic flora of gangrenous teeth are presented. The rationale of the concept of the microbiologic approach is discussed. A possible explanation for the small differences in the success of endodontically treated teeth obturated after positive and negative bacteriologic cultures is suggested.