Mycobacterium haemophilum: microbiology and expanding clinical and geographic spectra of disease in humans.

Reports of the association of Mycobacterium haemophilum with disease in humans have greatly increased. At least 64 cases have now been reported, with symptoms ranging from focal lesions to widespread, systemic disease. The organism is now known to cause primarily cutaneous and subcutaneous infection, septic arthritis, osteomyelitis, and pneumonitis in patients who are immunologically compromised and lymphadenitis in apparently immunocompetent children. Underlying conditions in the compromised patients have included AIDS; renal, bone marrow, and cardiac transplantation; lymphoma; rheumatoid arthritis; marrow hypoplasia; and Crohn's disease. Reports have originated from diverse geographic areas worldwide. The epidemiology of M. haemophilum remains poorly defined; there appears to be a genetic diversity between strains isolated from different regions. The organism is probably present in the environment, but recovery by sampling has not been successful. M. haemophilum has several unique traits, including predilection for lower temperatures (30 to 32 degrees C) and requirement for iron supplementation (ferric ammonium citrate or hemin). These may in the past have compromised recovery in the laboratory. Therapy has not been well elucidated, and the outcome appears to be influenced by the patient's underlying immunosuppression. The organisms are most susceptible to ciprofloxacin, clarithromycin, rifabutin, and rifampin. Timely diagnosis and therapy require communication between clinician and the laboratory.

Primary amoebic meningoencephalitis with Naegleria fowleri: clinical review.

Two children with primary amoebic meningoencephalitis secondary to Naegleria fowleri are reported. Both children died, and the causative agent was identified at autopsy. Presentation and outcome conformed to the usual course of primary amoebic meningoencephalitis and reaffirm the gravity and rapid progression of this infection. The epidemiology, microbiology, diagnostic considerations, and treatment are discussed. Primary amoebic meningoencephalitis should be considered in the differential diagnosis of children with meningitis or encephalitis.

Haemophilus influenzae meningitis with prolonged hospital course.

A retrospective evaluation of Haemophilus influenzae type b meningitis observed over a 2-year period documented 86 cases. Eight of these patients demonstrated an unusual clinical course characterized by persistent fever (duration: greater than 10 days), cerebrospinal fluid pleocytosis, profound meningeal enhancement on computed tomography, significant morbidity, and a prolonged hospital course. The mean age of these 8 patients was 6 months, in contrast to a mean age of 14 months for the entire group. Two patients had clinical evidence of relapse. Four of the 8 patients tested for latex particle agglutination in the cerebrospinal fluid remained positive after 10 days. All patients received antimicrobial therapy until they were afebrile for a minimum of 5 days. Subsequent neurologic examination revealed a persistent seizure disorder in 5 patients (62.5%), moderate-to-profound hearing loss in 2 (25%), mild ataxia in 1 (12.5%), and developmental delay with hydrocephalus which required shunting in 1 (12.5%). One patient had no sequelae.

Degree of pathology as related to readiness to accept labels in process and reactive schizophrenics.

Two experiments were performed in order to determine whether readiness to accept deviant labels, as measured by acquiescence set, interacts with type of schizophrenia (process vs. reactive) to influence level of pathology. It was found on both a behavioral measure and a psychometric measure of psychopathology that high acquiescent process schizophrenics manifested more pathology than did either low acquiescent process or reactive schizophrenics, both of whom showed more pathology than high acquiescent reactive schizophrenics. The results suggest that one's acceptance of deviant labels as well as one's past history of being assigned social and evaluative labels may influence the patient's level of pathology. Scheff (1966), in viewing the mental patient from a sociological perspective, suggests that an important determinant of mental disorder is the acceptance by the deviant individual of the various labels which stigmatize him as mentally ill. If this is the case, then individual differences in readiness to accept or agree with labels about oneself may be related to the degree of pathology manifested in a psychiatric population. The present authors sought to determine if acquiescence set, as measured by the Agreement Response Scale (Couch & Keniston, 1960), is related to degree of pathology in schizophrenic patients. The Agreement Response Scale was used as a measure of the general tendency to acquiesce to or agree with personality statements or labels. The investigators performed two experiments, in Experiment 1 a behavioral measure of pathology was used and in Experiment 2 a psychometric measure of pathology was used. In addition, the schizophrenic Ss were grouped according to the process-reactive distinction as the reactive schizophrenic may be expected to have a more favorable history of labeling than would the process schizophrenic.