Urinary tract infection caused by Hansenula anomala.

A case of urinary tract infection due to Hansenula anomala is reported. The infection occurred in a cadaver kidney transplant patient who was receiving immuno-suppression therapy. Survey of the literature revealed that human infections due to this organism are rare and its causal relationship in urinary tract infection has not been previously reported.

Nosocomial Legionnaires' disease.

Legionella is being recognized as an increasingly important cause of community-acquired nosocomial pneumonia. Cases of nosocomial pneumonia caused by Legionella particularly occur in hospitals with a water supply colonized with various Legionella species. The recognition of Legionella as a significant nosocomial pathogen depends on the recognition of its association with the aquatic environment of water systems in hospitals. The diagnosis and treatment of legionnaires' disease is discussed, as well as infection control measures needed to prevent the spread of legionnaires' disease in the hospital.

Laboratory aids in the diagnosis of bacterial meningitis.

Bacterial meningitis is a uncommon but serious infectious disease. Critical care personnel have a great deal of difficulty in differentiating aseptic meningitis from partially treated meningitis from bacterial meningitis. Such a differentiation has obvious implications for therapy and prognosis. This article provides guidelines in using clinical criteria as well as cerebrospinal fluid parameters to diagnosis the commonly encountered infectious causes of meningitis. The current interpretation of laboratory tests such as countercurrent immunoelectrophoresis, latex agglutination, enzyme-linked immunosorbent assays, limulus assays, and lactic acid levels are discussed.

Escherichia coli sacroiliitis: report of a case and review of the literature.

Pyogenic sacroiliitis is rare and usually occurs in patients with an underlying illness. Typically, the responsible organisms are Staphylococcus aureus or Streptococcus pneumoniae. We describe a healthy 17-year-old boy with bacterial sacroiliitis caused by Escherichia coli. This case illustrates the importance of considering this diagnosis in febrile patients with no obvious source of infection.

Streptococcus mutans vertebral osteomyelitis.

Vertebral osteomyelitis is a disease most often encountered in the adult population, especially in the elderly. The usual etiologic agent is Staphylococcus aureus. We report a case of Streptococcus mutans endocarditis resulting in hematogenous osteomyelitis of the lumbar vertebrae.

Clinical clues to AIDS. Recognizing the dermatologic and nondermatologic manifestations.

As more types of human immunodeficiency virus (HIV) are recognized and as the incidence of acquired immunodeficiency syndrome (AIDS) increases, more and more manifestations of HIV infection will be recognized. Dermatologic conditions often provide a means of making the presumptive diagnosis. Months or years of asymptomatic disease may have elapsed before cutaneous symptoms appear. However, care must be taken not to over-diagnose on the basis of a single nonspecific finding. To say that all patients with psoriasis have AIDS, for example, would be absurd. Yet an explosive flare of psoriasis or an atypical new presentation should alert the clinician to the possibility of HIV infection. Certainly, multiple suggestive dermatologic findings in any patient would essentially confirm the diagnosis of AIDS regardless of the status of antibody reactivity. A wide range of nondermatologic physical findings can also signal HIV infection. None are specific for AIDS, but again, findings that are rare, atypical, or severe in a normal host should be viewed with suspicion, and any of the signs in an at-risk patient should prompt the clinician to consider AIDS and to include specific tests in the workup. By becoming familiar with the many faces of HIV infection, the clinician can recognize its varied manifestations that may suggest the diagnosis in the absence of other findings.

Streptococcus mutans endocarditis: report of three cases and review of the literature.

Our findings indicate that S. mutans endocarditis is capable of causing significant morbidity and mortality, as exemplified by the prolonged and complicated hospital course of our patients and the ultimate death of one of them. S. mutans endocarditis is probably underreported because most clinical laboratories do not speciate the viridans streptococci. Isolates of S. mutans should be tested for tolerance that would require the addition of an aminoglycoside to the penicillin regimen. Our experience agrees with the literature and indicates that S. mutans is primarily a pathogen in elderly patients with heart disease and may be associated with IHSS.

Clinical and laboratory aspects of Legionnaire's disease.

Legionnaires' disease is an illness with protean manifestations that are due to infection with Legionella pneumophila. It occurs both in epidemic and sporadic form and usually presents as an atypical pneumonia. Relative bradycardia, abnormal liver function test results, and a patient presenting with an atypical pneumonia should alert the clinician to the possibility of Legionella. The presence of systemic involvement, specifically neurological, gastrointestinal, and renal abnormalities, should further suggest the diagnosis. Patients may demonstrate multiple extrapulmonary manifestations of legionnaires' disease, sometimes without pneumonia. Several methods are available to aid the clinician in making the diagnosis of legionnaires' disease, and the use of all tests will increase the overall sensitivity.

Legionella and mycoplasma pneumonia--a community hospital experience with atypical pneumonias.

The clinician should be alert to the possibility of Legionella pneumonia in the community hospital setting. Importantly, degree of suspicion, that is, familiarity with extrapulmonary clinical and laboratory features of the typical pneumonias, nearly always leads to a correct presumptive diagnosis that may later be confirmed by serologic testing. Serologic testing has confirmed only a minority of cases. Since early empiric therapy is critical to survival in many of these patients, knowing how to arrive at a presumptive diagnosis based upon the clinical clue present or absent is essential in the community hospital setting.

Cerebral abscess caused by Klebsiella ozaenae.

Klebsiella ozaenae is the putative cause of ozena or atrophic rhinitis. It has also been commonly isolated as a colonizing organism, but recent reports demonstrate its role as an invasive pathogen, especially in immunosuppressed hosts. We report the first known case of a cerebral abscess caused by K. ozaenae.