Pasteurella multocida: a case report of bacteremic pneumonia and 10-year laboratory review.

Pasteurella multocida is a normal oral commensal in animals. Animal bites are often complicated by severe wound infection due to P. multocida, but systemic infection is rare. We report a patient with bacteremic pneumonia successfully treated with ceftriaxone and ciprofloxacin. We also review the clinical isolates of P. multocida reported by a major teaching hospital laboratory over a 10-year period. There were 23 patients, comprising the present case, 17 patients with wound infections following animal bites, one case of neonatal meningitis and associated maternal vaginal carriage of P. multocida, and three sputum isolates of doubtful significance.

Leptospirosis presenting as a haemorrhagic fever in a traveller from Africa.

Leptospirosis is usually a mild illness, although the severity of clinical manifestations may vary between the serovars of leptospires. In May 1993, a 48-year-old man from Ghana presented with severe icteric leptospirosis, initially managed as viral haemorrhagic fever. The causative serovar, bataviae, had not been previously diagnosed in human infection in Australia.

Hepatitis A and evidence against the community dissemination of Helicobacter pylori via feces.

Seroprevalence data from 1501 subjects was used to test the hypothesis that Helicobacter pylori may be transmitted by the fecal-oral route. Antibody to hepatitis A virus was used as a marker of fecal-oral exposure. Of the 1501 subjects, 35.5% were seropositive for both H. pylori and hepatitis A, 19.1% were seronegative for both, 36.5% were seropositive for hepatitis A only, and 8.8% were seropositive for H. pylori only. Cross-sectional data from rural areas supported an association between hepatitis A and H. pylori. However, in the urban area there was no evidence of hepatitis A infection in persons < 10 years old, yet the seroprevalence of H. pylori was high in this group (approximately 32%). From our data, we suggest that communitywide fecal-oral spread of H. pylori may be of limited importance.

Evaluation of direct disc diffusion susceptibility testing for bacteriuria using diluted urine against standard CDS method.

Consecutive urine specimens with > or = 10(9) organisms/L on microscopy were diluted 1:100 and direct disc diffusion susceptibility tests performed. Subsequently, the standard Calibrated Dichotomous Sensitivity (CDS) test was performed on all isolates. Urines with > 2 Isolates or where growth was < 10(8) colony forming units (CFU)/L were excluded. Only Gram negative organisms were considered. 361 urines were evaluated, 324 with one and 37 with 2 isolates, comprising 255 Escherichia coli, 49 klebsiella, 41 proteus, 29 either citrobacter, enterobacter, providencia, serratia or alcaligenes, and 14 Pseudomonas aeruginosa. There were 2272 organism/antimicrobial test comparisons. A concordance of 98.5% was obtained. The results are considered acceptable for routine clinical use.

Haemophilus paraphrophilus vertebral osteomyelitis.

OBJECTIVE: To report the first case of Haemophilus paraphrophilus vertebral osteomyelitis--the second reported case of osteomyelitis of any site caused by this organism. CLINICAL FEATURES: A 41-year-old male bus driver with no significant previous medical history presented with severe abdominal and back pain, which was eventually localised to the eleventh thoracic vertebra (T11). H. paraphrophilus was isolated from pus aspirated from the vertebral body. INTERVENTIONS AND OUTCOME: The patient was treated with penicillin given intravenously for four weeks, then with antibiotics given orally for a further three weeks, with good clinical response. CONCLUSION: H. paraphrophilus is an infrequent pathogen which may be difficult to identify and test for antibiotic susceptibility, but can cause serious infection, including primary haematogenous osteomyelitis.

Pasteurella multocida meningitis in a two-day old neonate.

A normal full-term baby boy, born by vaginal delivery, became ill on day 2 with fever and failure to feed. CSF examination revealed 260 x 10(6)/l leucocytes, mainly mononuclears, protein 2 g/l and glucose zero. Pasteurella multocida was isolated in pure culture from the baby's CSF, blood and umbilicus and from the mother's vagina. The baby was treated with i.v. penicillin for 7 weeks. Progress was complicated by mild hydrocephalus, which resolved, and prolonged low grade fever. Recovery was complete, without neurological sequelae. This case illustrates that P. multocida can infect the vagina where it presents a hazard to a newborn infant delivered vaginally. Early diagnosis is critical, intravenous high dose penicillin being the treatment of choice.

Listeria monocytogenes peritonitis associated with CAPD.

Listeria monocytogenes peritonitis developed in a 67-year-old man on continuous ambulatory peritoneal dialysis following a catered luncheon. Alcoholic liver disease was a predisposing factor. L. monocytogenes multiplies at 4 degrees C. It is often present in imported soft cheese, less often in chicken and other refrigerated food. Listeria peritonitis has not been previously reported in Australia.

Shigella dysenteriae type 1 enterocolitis.

Shigella dysenteriae type 1 is much more virulent than Shigella flexneri and sonnei which are endemic in Australia. This report describes a 22 year old woman who acquired Shigella dysenteriae type 1 whilst travelling in India. During the course of her illness, she developed severe enterocolitis for which a subtotal colectomy was performed. The illness resembled fulminant ulcerative colitis and its infectious nature was difficult to establish because several fecal cultures failed to grow the pathogen. Her infection was complicated by shigella bacteremia, disseminated intravascular coagulation, and renal cortical necrosis which requires continued hemodialysis.

Two concurrent epidemics of enteroviral meningitis in an obstetric neonatal unit.

A small epidemic of viral infection occurred in a neonatal unit. It involved 11 infants, all of whom recovered. Echovirus 11 was the cause of illness in six infants, coxsackie B3 in four, and one infant had a biphasic illness, due first to echo 11, then to coxsackie B3. The epidemic coincided with a major outbreak of echovirus 11 and a smaller outbreak of coxsackie B3 in the community. Several staff became ill. Five infants were considered to have been infected by perinatal materno-infant spread, others by cross-infection. The epidemic ended when the nursery was closed.

Possible role of enteric organisms in the pathogenesis of ankylosing spondylitis and other seronegative arthropathies.

One-hundred eighty-five clinical isolates of Salmonella sp., Shigella sp., Escherichia coli, and Campylobacter sp. were tested for their ability to absorb the lymphocytotoxic activity of an antiserum (anti-Klebsiella sp. K43) directed against a specific HLA-B27-associated cell surface determinant on the lymphocytes of patients with ankylosing spondylitis (AS). Seven of these isolates (three Salmonella sp., two Shigella sp., one E. coli, and one Campylobacter sp.) were found to cross-react with the B27-positive cells of AS patients (B27+ AS+); an E. coli organism isolated from the rectal swab of an HLA-B27-negative clinically normal individual also cross-reacted with B27+ AS+ cells. These cross-reactive enteric organisms elaborate a factor (modifying factor) which specifically modifies the B27-positive lymphocytes of normal individuals; this factor is structurally and antigenically related to a functionally similar factor secreted by certain isolates of Klebsiella sp. These data suggest that certain enteric organisms share a common determinant which cross-reacts with B27+ AS+ cells. It is suggested that this cross-reactivity is somehow related to an early event in the pathogenesis of AS and possibly of other seronegative arthropathies.

Pulmonary strongyloidiasis and lung abscess.

We report a case of lung abscess associated with pulmonary strongyloidiasis which occurred in an asthmatic patient three years after migrating to Australia from Burma where strongyloidiasis is endemic. Thiabendazole was effective in eradicating the Strongyloides infection.

Chronic pulmonary infection with Salmonella typhimurium.

The first report of a case of chronic sputum carriage of salmonella is presented. The patient was a 51-year-old male with pulmonary cavitation and mycetoma, who developed pulmonary infection with Salmonella typhimurium after rectal surgery, and subsequently has carried the salmonella in his sputum for 18 months to date.