Mycobacterium kansasii among patients infected with human immunodeficiency virus in Kansas City. Kansas City AIDS Research Consortium.

Previous reports of infection due to Mycobacterium kansasii among patients infected with human immunodeficiency virus (HIV) have conflicted with regard to the significance of the isolate; the clinical, radiographic, and laboratory features of the disease; and the response to therapy. To clarify the spectrum of M. kansasii infection in this population, we conducted a retrospective study of 35 patients. Twenty-eight of these patients were believed to have disease due to M. kansasii, while the remaining seven patients were probably colonized with the organism. All but two patients presented with advanced HIV infection; the median CD4 cell count was 12/microL. Most patients with pulmonary disease presented with fever, cough, and dyspnea, but only eight of these 22 patients had radiographic findings of either pulmonary cavitation or predominantly upper-lobe disease. Ten patients had M. kansasii isolated from blood or bone marrow. The majority of patients with pulmonary or disseminated disease responded to therapy. However, 11 patients died either before mycobacterial infection was diagnosed or early in the course of treatment, and two had a relapse of infection during therapy.

Mycobacterium kansasii infection in a patient with AIDS.

We have presented the case of a 45-year-old HIV-positive man who had a 2-week history of shortness of breath and fever and who was found to have pneumonia due to an acid-fast bacillus. Despite treatment with isoniazid, rifampin, ethambutol, and clofazimine, he died of the infection. Culture results obtained after his death showed the organism to be Mycobacterium kansasii. Mycobacterial infections are common in patients with AIDS, but are usually due to M tuberculosis or M avium complex. Of the 35 patients with AIDS and M kansasii infection mentioned in the literature, only eight of these were described; and of the four patients (including our patient) who received therapy considered appropriate for this infection, only two survived.

Klebsiella pneumoniae bacteremia: analysis of 100 episodes.

In 1985, 100 episodes of klebsiella pneumoniae bacteremia in 98 patients were treated at the Veterans General Hospital--Taipei. The disease was community acquired in 58% and nosocomially acquired in 42%; unimicrobial in 86% and part of a polymicrobial bacteremia in 14%. Medical records of 90 episodes were available and were analyzed. Portals of entry, in decreasing order of frequency, were hepatobiliary (24%), respiratory (20%), and urinary tract (19%). Diabetes mellitus, which was found in 25 (28%) patients, was the most common underlying disease, followed by malignancies in 13 (14%), biliary tract abnormalities in 9 (10%), and cirrhosis of the liver in 8 (9%). The most frequent clinical findings were fever (89%) and leukocytosis (60%), followed by thrombocytopenia (27%), jaundice secondary to bacteremia (22%) and shock (21%). The course of one (1%) patient, who was diabetic and had a liver abscess, was complicated by metastatic septic endophthalmitis and meningitis. Overall case fatality was 46%. Poor prognostic factors included inappropriate antibiotic therapy, respiratory tract as a portal of entry and the presence of shock. Cephalosporins and aminoglycosides were the most active antibiotics. The use of one or more antibiotics, which included at least one cephalosporin, with in vitro activity against the corresponding isolate, with adequate dosage and an appropriate route of administration significantly reduced deaths directly attributed to K. pneumoniae septicemia, 32% (18/57), compared with 88% (21/24) in patients who were not treated appropriately (p less than 0.001). Combination therapy with a cephalosporin and aminoglycoside in conjunction with surgery in selected cases is the treatment of choice for K. pneumoniae bacteremia.

Nonenterococcal group D streptococcal septicemia: association with unrecognized endocarditis.

68 patients presented to the Veterans General Hospital, Taipei with nonenterococcal group D streptococcal septicemia in the years 1985-1987. 36 patients (53%) had nonenterococci as part of a polymicrobial bacteremia. The large intestine was not examined in most patients. Five patients (7%) had associated colonic carcinoma, and 17 patients (25%) had colorectal diseases. Only 7/68 patients (10%) were clinically diagnosed as having infective endocarditis by the doctors in charge. The others were regarded as having septicemia. The charts of these patients were reviewed retrospectively to diagnose infective endocarditis based on strict definitions. One (1%) had definite endocarditis proved at autopsy. 16 patients (24%) had probable endocarditis due to the presence of either a new regurgitant murmur or both a predisposing heart disease and embolic phenomena; 39 (57%) had possible endocarditis based on evidence of having either a predisposing heart disease or embolic phenomena; and only 12 (18%) had no evidence of endocarditis. 27 patients (40%) had at least one predisposing heart disease associated with endocarditis. 51 patients (75%) had at least one lesion suggesting embolic phenomena. 30 patients (44%) had electrocardiographic abnormalities. This high incidence of arrhythmia in nonenterococcal septicemia is of particular interest and could be related to cardiac involvement in some patients. The overall mortality, 62% (42/68), was extremely high in our series, but in those who were clinically diagnosed and treated as infective endocarditis, the mortality was low, 14% (1/7). We suggest all patients with nonenterococcal septicemia associated with either heart disease or lesions of CNS, lung, heart, kidney or limbs suggesting embolic phenomena should be regarded as having possible or probable endocarditis. Treating such patients as having infective endocarditis may reduce the mortality in nonenterococcal septicemia.

Campylobacter septic abortion.

We have reported a case of a septic abortion caused by Campylobacter fetus ssp jejuni. This organism is best known for producing diarrhea, but is now being linked with more serious diseases, including pregnancy wastage.