Coccidioidomycosis of the uterus.

We have described a case of coccidioidomycosis of the endometrium in a postpartum woman, living in a nonendemic area, who presented with vaginal bleeding. Diagnosis was made by demonstration of spherules in the endometrial biopsy and culture of the tissue. Eight cases of coccidioidomycosis involving the female genital tract have been reported so far. Of these, three patients died of dissemination.

Vibrio metschnikovii bacteremia in a patient with cholecystitis.

Vibrio metschnikovii was isolated from the blood of an 82-year-old patient with peritonitis and an inflamed gallbladder. This is probably the first clinically significant isolate of this new vibrio.

Edwardsiella tarda osteomyelitis in a patient with SC hemoglobinopathy.

Edwardsiella tarda is a recently identified gram-negative organism of the family Enterobacteriaceae. Reports of human infections with E tarda have been infrequent. We review 14 cases of systemic edwardsiellosis reported in the literature and report a case of E tarda osteomyelitis in a patient with sickle cell-hemoglobin C disease. In our case the remains of a snake may have been the source of the organism. Systemic edwardsiellosis is rare, and it may present as meningitis, endocarditis, bacteremia, liver abscess, or osteomyelitis. In 12 of 15 cases reported, systemic E tarda infection occurred in patients suffering from additional debilitating illnesses.

Clinical significance of tolerant strains of Staphylococcus aureus in patients with endocarditis.

We have studied 50 cases of endocarditis and 54 cases of bacteremia due to Staphylococcus aureus to ascertain the clinical significance of the newly described phenomenon of tolerance. In 32 of the patients with endocarditis and 35 of those with bacteremia strains were classified as tolerant (minimum bactericidal concentration/minimum inhibitory concentration greater than or equal to 16). Patients with endocarditis due to a tolerant strain responded less favorably than did patients with a sensitive strain. A larger number of patients with a tolerant strain had prolonged fever (58% versus 19%), a higher mean number of complications (1.6 versus 0.73), a greater number of intensive-care unit admissions (66% versus 33%), and a higher mortality (25% versus 11%). In contrast there was no difference in response to therapy in bacteremic patients without endocarditis having sensitive and tolerant strains. We conclude that infection with a tolerant organism adversely influences the outcome of staphylococcal endocarditis.

Primary meningococcal pericarditis.

We have described two patients with primary meningococcal pericarditis. The first patient required open surgical drainage. In the second patient, pericardiectomy was eventually required. Thirteen cases of primary meningococcal pericarditis have now been reported. All the patients survived, in contrast to purulent pericarditis of other causes.

Clinical significance of amniotic fluid, amniotic membranes, and endometrial biopsy cultures at the time of cesarean section.

When we compared amniotic fluid and amniotic membranes, as a source of organisms at the time of cesarean section, amniotic membranes proved to be superior. During labor, intact membranes do not protect the amniotic cavity from contamination with pathogenic anaerobes and commensals. Ruptured membranes in the presence of prolonged labor predisposes the amniotic cavity to contamination with pathogenic anaerobes, commensals, and pathogenic aerobes. Cultures of the endometrial biopsy specimens taken from the site of incision at the time of cesarean section showed the presence of pathogens in 50% of the women with prolonged labor and ruptured membranes.

Spontaneous bacterial peritonitis due to a group IIk-2 strain.

This paper describes a patient with spontaneous bacterial peritonitis caused by a group IIk-2 strain. No other organism was isolated from the peritoneal fluid cultured aerobically and anaerobically.