A new variant of food poisoning: enteroinvasive Klebsiella pneumoniae and Escherichia coli sepsis from a contaminated hamburger.

For the first time, we report Klebsiella pneumoniae as an enteroinvasive food-borne pathogen transmitted from a hamburger. A 28-year-old previously healthy African-American male ingested a portion of a hamburger from a fast food chain. Symptoms of gastroenteritis rapidly deteriorated to multiorgan failure. Blood and hamburger cultures grew Escherichia coli and Klebsiella pneumoniae. Since Klebsiella had not previously been reported as enteroinvasive, the isolates were compared. Full biochemical profiles, antimicrobial sensitivity, plasmid profile, and toxin assay by DNA hybridization probe were completely concordant. The patient survived the episode of food-borne sepsis. Deliberate or inadvertent employee contamination of food products with feces may be a potential source of life-threatening food-borne illness.

Severe tinea barbae due to Trichophyton verrucosum infection in dairy farmers.

Trichophyton verrucosum infection, which is acquired from the hide of dairy cattle, is the cause of tinea barbae, a severe pustular eruption on the face and neck. We present the cases of five patients, three of whom had severe pustular tinea barbae and two of whom had eruptions of the forearms. All five patients were dairy farmers. On physical examination, all five patients were afebrile and did not appear toxic. Peripheral leukocyte counts of the three patients with pustular tinea barbae were normal. Gram stain and bacterial cultures of the draining pustules were negative in all three cases. Potassium hydroxide preparation showed hyphae, and cultures yielded T. verrucosum in all three cases. Four patients received therapy with fluconazole, and one received therapy with griseofulvin; in all cases, the lesions healed. T. verrucosum can cause pustular tinea barbae in farmers that may be mistaken for a Staphylococcus aureus infection by clinicians, including infectious disease experts. The answer to a simple question, "Are you a dairy farmer?", may suggest the diagnosis of T. verrucosum in the proper clinical setting.

The acquired immunodeficiency syndrome and Mycobacterium avium-intracellulare bacteremia in a patient with hemophilia.

A 27-year-old previously healthy man with hemophilia presented with Pneumocystis carinii pneumonia. The patient had several episodes of oral candidiasis followed by disseminated infection with Mycobacterium avium-intracellulare. He was not homosexual nor did he take illicit drugs, but he had been self-administering two to four monthly infusions of factor VIII concentrate for 7 years. In-vitro lymphocyte studies showed findings consistent with the acquired immunodeficiency syndrome that had previously been reported only in homosexual men, drug addicts, and Haitian refugees. The cause of this syndrome is unknown, but the possibility that it is associated with a transmissible agent acquired through the use of blood products such as factor VIII concentrate must be considered.

Pulmonary zygomycosis.

An immunosuppressed patient had zygomycosis and was successfully treated with amphotericin B. Infection was rapidly diagnosed by demonstration of hyphae in impression smears of lung tissue and was confirmed by subsequent culture. Rapid diagnosis and prompt therapy are believed to have contributed to the successful outcome.

Radioimmunoassay for Bacteroides fragilis infections.

Radioimmunoassay methods were evaluated for immunoglobulin G and immunoglobulin M antibodies against Bacteroides fragilis antigen. Of 12 serum samples from patients with B fragilis infections, 9 had higher concentrations of immunoglobulin G antibodies than any from 11 control subjects. Of 9 serum samples from infected patients, 6 had higher concentrations of immunoglobulin M than any from control subjects. Six serum samples from patients with Escherichia coli bacteremia did not contain elevated concentrations of immunoglobulin G or immunoglobulin M antibodies against B. fragilis antigen.