Staphylococcus aureus meningitis in a patient with acquired immunodeficiency syndrome.

Meningitis due to Staphylococcus aureus is well described but uncommon. Most cases arise as a complication of neurosurgical interventions or head trauma, although some arise spontaneously. To our knowledge, no case of S. aureus meningitis has been previously reported in a person with the acquired immunodeficiency syndrome (AIDS). Herein we describe a case of S. aureus meningitis in a person with AIDS who had no history of a neurosurgical procedure, head trauma, or overwhelming bacteremia. Treatment of this infection was successful. S. aureus should be added to the list of potential pathogens that can cause spontaneous meningitis in people with AIDS.

Brain abscess.

The past 20 years have seen major advances in the diagnosis and management of brain abscess, with a corresponding improvement in the survival rates. The advances in radiographic scanning, the availability of new antimicrobials, and the development of novel surgical techniques have all contributed to the decreases in associated morbidity and mortality. The relative rarity of brain abscess and the frequent delays in making the diagnosis render this condition a significant challenge for the clinician. A high index of suspicion is required so that effective therapy can be instituted as soon as possible. Close coordination of care between neurosurgeons and infectious diseases specialists is increasingly important in the complicated management of brain abscess. Adequate abscess drainage and appropriate antimicrobial therapy remain the cornerstones of proper treatment of this condition.

Comparison of mycobacterial lymphadenitis among persons infected with human immunodeficiency virus and seronegative controls.

Lymphadenitis is a common extrapulmonary manifestation of mycobacterial disease in persons with human immunodeficiency virus (HIV) infection. We compared the clinical, mycobacterial, and diagnostic characteristics of mycobacterial adenitis in 11 HIV-seropositive and 29 HIV-seronegative patients. Ninety-three percent of the HIV-seronegative patients and 54% of the HIV-seropositive patients were foreign-born. In contrast to the HIV-seronegative patients, seropositive patients were more likely to be febrile and have negative purified protein derivative skin tests and abnormal chest roentgenograms. Sputum samples were rarely diagnostic in either group. Mycobacterium tuberculosis was the most commonly isolated organism in both groups, although United States-born patients with HIV infection were more likely to be infected with nontuberculous mycobacteria. In contrast to results for seronegative patients, fine-needle aspiration was usually diagnostic in the HIV-seropositive population, especially in those at risk for M. tuberculosis infection. Similarly, the rate at which smears were positive for acid-fast bacilli was significantly higher in the HIV-seropositive group, a circumstance suggesting a higher burden of organisms in this population. Finally, although preceding opportunistic infections were uncommon in the HIV-seropositive group, both tuberculous and nontuberculous adenitis were associated with advanced immunosuppression.

Treatment of severe falciparum malaria during pregnancy with quinidine and exchange transfusion.

Malaria during pregnancy may be associated with significant morbidity and mortality in both mother and fetus. Treatment of severe chloroquine-resistant malaria during pregnancy may be problematic since quinine and related compounds may have a deleterious effect on the course of labor. This article reports the case of a 21-year-old primigravida Liberian woman who presented with high-grade (greater than 12%) parasitemia with Plasmodium falciparum. The patient was initially treated with chloroquine; however, she developed bilateral pulmonary infiltrates and premature labor, and her condition appeared to clinically deteriorate. Therapy was changed to intravenous quinidine, and red blood cell exchange transfusion was instituted. This resulted in a decreased parasitemia and clinical improvement. The patient underwent a cesarean section, and a healthy child was delivered. Although most cases of malaria may be managed with conventional chemotherapy, the use of intravenous quinidine in combination with exchange transfusion with careful monitoring should be considered in selected cases of severe, complicated malaria in pregnant women.

Postoperative pancreatic abscess due to Plesiomonas shigelloides.

Plesiomonas shigelloides is being recognized with increasing frequency as a human pathogen. The organism is ubiquitous in fresh and brackish water, and clinical illness has been associated with foreign travel and ingestion of inadequately cooked seafood. We describe a 64-year-old Filipino woman who presented 2 weeks after elective cholecystectomy and pancreatic biopsy with left upper quadrant pain, abdominal distention, and fever. Computerized tomography of the abdomen revealed an abscess in the tail of the pancreas with fluid accumulation in the lesser omental sac. Percutaneous aspiration yielded purulent material, and P. shigelloides was recovered in pure culture. To our knowledge, this is the first reported case of pancreatic abscess due to P. shigelloides.

Complications of corticosteroid therapy in patients with the acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia.

We retrospectively studied the acute toxicity of corticosteroid therapy in 23 episodes of PCP occurring in the setting of AIDS and determined the incidence of HIV-related complications following these and 16 other contemporaneous episodes of AIDS-related PCP treated with antimicrobials alone. The mean duration of corticosteroid therapy was 5.4 days and the mean total dose was 660 mg of methylprednisolone. Cryptococcus neoformans and Listeria monocytogenes infection each occurred once within one month of therapy in corticosteroid-treated patients; no other noteworthy acute corticosteroid toxicity was noted. Since all patients with imminently lethal PCP received corticosteroids, we could not assess the effect of these agents on acute mortality. After six months the rates of new AIDS-related diagnoses and of post-hospitalization mortality were equivalent in the two groups. We also have critically reviewed the available literature regarding this use of corticosteroids.