Unusual pathogens in narcotic-associated endocarditis.

We report the cases of three adults with a history of intravenous drug abuse who developed endocarditis caused by Corynebacterium xerosis, Neisseria subflava, and Neisseria flavescens, respectively. No cases of endocarditis caused by C. xerosis or N. flavescens and only one case caused by N. subflava have previously been reported in association with narcotic addiction. The prominent clinical features in all patients included poor response to antibiotic therapy, persistent fever, and major embolic events. Stigmata of infection with human immunodeficiency virus, as manifested by oral candidiasis, cervical lymphadenopathy, and serologic evidence, were present in two of the three patients. At our institution, where Staphylococcus aureus remains the most frequent etiologic agent of narcotic-associated endocarditis, the occurrence of these three cases in a 9-month period is striking. We speculate that infection with human immunodeficiency virus may play a role in the pathogenesis of endocarditis caused by these unusual organisms.

Ecology of dermatophyte infections in South Bronx, New York, 1969 to 1981.

This survey describes the ecology of superficial dermatophyte infections in South Bronx, New York from 1969 to 1981. The predominant species were Trichophyton rubrum (Castellani) Sabouraud, 1911 (57.5%), followed by Trichophyton tonsurans Malmsten, 1845 (18.5%), Trichophyton mentagrophytes (Robin) Blanchard, 1986 (11.5%), Microsporum canis Bodin var. canis Matsumoto, Padhye, and Ajello, 1902 (5%), Epidermophyton floccosum (Harz) Langeron and Milochevitch, 1930 (3.9%), and M. audouinii Gruby, 1843 (2.8%).

Evaluation of screening tests for the detection of antistreptolysin O antibodies.

The accuracy of two screening tests, one utilizing serum and the other utilizing whole blood, was compared with the accuracy of the conventional macrotitration method for the detection of antistreptolysin O antibodies. Of the 569 specimens tested with the serum screening procedure and the macrotitration method, 235 and 282, respectively, were positive for antistreptolysin O antibodies. Comparative testing of 200 specimens with the peripheral blood screening test and the macrotitration method gave 60.5% by the macrotitration procedure. Discrepant results with both procedures were obtained with specimens having 166 Todd units. The results suggest that these screening procedures can be used to screen specimens for the presence of significant antistreptolysin O antibodies.

Evaluation of modified New York City carbohydrate medium for the speciation of Neisseria.

A comparative study of modified New York City carbohydrate medium, Minitek (BBL Microbiology Systems, Cockeysville, Md.) and cystine-trypticase agar was conducted for determination of the relative accuracies of these media in the identification of pathogenic Neisseria. Of 170 isolates of Neisseria gonorrhoeae, 169 were correctly identified by New York City carbohydrate media, 131 by Minitek, and 117 by cystine-trypticase agar. Of the 72 isolates of Neisseria meningitidis tested, all were accurately speciated by New York City carbohydrate media, whereas Minitek and cystine-trypticase agar identified 61 and 49 strains, respectively. The greater reliability of New York City carbohydrate media is accompanied by advantages not offered by the other media.

Improved recovery of Neisseria gonorrhoeae from clinical specimens by selective enrichment and detection by immunologic methods.

Five thousand eight hundred forty-nine cervical and rectal swabs were cultured for Neisseria gonorrhoeae. Swabs remained in Amies' transport medium for approximately 2 hr before primary plating and enrichment for 6 hr in a selective broth. Neisseria gonorrhoeae was detected in 87 specimens. In 72 (83%) of the 87, N. gonorrhoeae was detected by primary plating, and in 15 (17%), detection was possible only after enrichment. Although enrichment is advantageous in recovering N. gonorrhoeae from swabs that have been in transport medium for several hours, the advantage of the enrichment technique over immediate direct plating remains to be determined. Positive enrichment broth cultures were tested at 6 hr for the presence of N. gonorrhoeae; 52% were positive by counterimmunoelectrophoresis, 71% were positive by coagglutination, and 97% were positive by enzyme-linked immunosorbent assay.

Bacteremia due to Bifidobacterium, Eubacterium or Lactobacillus; twenty-one cases and review of the literature.

Twenty-one cases of bacteremia due to Bifidobacterium, Eubacterium and Lactobacillus are described. Transient bacteremic episodes with these organisms may follow trauma to the mouth, intestine, or vagina. The majority of the patients were female and most had an underlying condition that may have predisposed to bacteremia. Ten of the patients died despite antibiotic treatment.

Rapid grouping of beta-hemolytic streptococci by latex agglutination.

Latex agglutination was compared with fluorescent-antibody staining with group A conjugate and Lancefield precipitation for grouping of beta-hemolytic streptococci. Latex agglutination correctly grouped 98.8% of 82 group A streptococci and more than 95% of 187 group B, C, or G streptococci. Occasional cross-reactions occurred between groups A and C and groups B and G.

Detection of Neisseria gonorrhoeae in broth cultures by immunologic methods.

The feasibilities of use of coagglutination, counterimmunoelectrophoresis, and indirect enzyme-labeled antibody techniques for the detection of Neisseria gonorrhoeae in broth cultures were evaluated. Six-hour broth cultures of 47 subcultures of recent clinical isolates of N. Gonorrhoeae were used for the tests. Positive coagglutination reactions were obtained with 43 of the broth cultures. Precipitin lines were observed with 45 cultures when counterimmunoelectrophoresis was used. All 47 broth cultures gave positive reactions with the indirect enzyme-labeled antibody technique.