Severe Isospora (Cystoisospora) belli Diarrhea Preceding the Diagnosis of Human T-Cell-Leukemia-Virus-1-Associated T-Cell Lymphoma.

Isospora (Cystoisospora) belli diarrhea can sometimes be fulminant in immunocompromised patients. It is endemic in tropical and subtropical areas, and sporadic episodes have been reported in nonendemic areas in nursing homes, day-care centers, and psychiatric institutions. We describe isosporiasis in an HIV-negative Sudanese-American female who presented with a debilitating diarrheal illness and profound weight loss. Isospora belli was detected in her stool by modified acid-fast staining. Serologic testing was negative for HIV but positive for HTLV-1 infection. Treatment with TMP-SMZ led to improvement in her diarrhea which recurred after stopping antibiotics. Subsequently, she developed generalized lymphadenopathy which was diagnosed as ATLL on immunohistochemical staining. Chemotherapy was initiated, but her condition continued to worsen due to persistent diarrhea and resulting profound electrolyte abnormalities. The patient opted for comfort measures and died a few weeks later at a nursing facility. This case emphasizes that the detection of I. belli should trigger testing for HIV, HTLV-1, and other causes of immunocompromise. We suggest that treatment with TMP-SMZ should be initiated and continued for a prolonged period of time in immunocompromised patients with I. belli diarrhea.

Infected abdominal aortic aneurysm due to penicillin-, ceftriaxone-, and cefotaxime-resistant Streptococcus pneumoniae.

The clinical course for a patient hospitalized with pneumonia and meningitis due to penicillin-, ceftriaxone-, and cefotaxime-resistant Streptococcus pneumoniae is described. The pneumonia and meningitis responded to antimicrobial therapy, but the patient died following rupture of an infected abdominal aortic aneurysm; gram-positive cocci resembling S. pneumoniae were detected within the aneurysm.

Relationship of maternal to neonatal colonization with coagulase-negative staphylococci.

Infections with coagulase-negative staphylococci (C-S) have become problems of major clinical importance among very low birthweight infants in neonatal intensive care units. Colonization with slime-producing strains of C-S may be a risk factor for these infants in the development of invasive infections. The present study evaluated the maternal genital tract as a possible source for neonatal colonization with C-S. Specific objectives were to determine the incidence of vaginal colonization with C-S in pregnant women with special reference to slime-producing strains and whether transmission of C-S occurs from mother to infant during the process of vaginal delivery. Antenatal vaginal cultures were done on 465 women at different gestations of pregnancy. Additionally, 101 women and their newborn infants were cultured after vaginal delivery. Fifty-one percent of women were colonized with C-S during pregnancy, and no significant differences in colonization rates by trimester were found. Slime-positive isolates from pregnant women increased significantly from the first to the third trimester (40 to 68%; chi-square, 11.21, p less than 0.005). However, the proportion of slime-positive strains among the 30 infants who were colonized with C-S at birth was 40% (12 of 30). Although 30 infants were colonized with C-S at birth, only three were shown to have acquired the organism by maternal transmission determined by similarity of species, biotype, antibiotic sensitivity pattern, slime production, phage type, and plasmid pattern profile. Therefore 27 infants (26% of the total) most likely acquired C-S from environmental sources, including nursery attendants.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of coagulase-negative staphylococcal isolates from serial nasopharyngeal cultures of premature infants.

The present study was undertaken to determine whether very low birth weight infants in a neonatal intensive care unit became colonized with virulent strains of coagulase-negative staphylococci (C-S) over time (i.e., those characterized as Staphylococcus epidermidis, slime positive, and/or multiply antibiotic resistant), and if so, whether the initial colonizing strains developed these characteristics or whether the strains themselves changed. Nasopharyngeal (NP) cultures were obtained weekly on 28 very low birth weight (less than 1750 g) infants hospitalized for a mean of 8 wk (range 4-15 wk). There were 105 isolates of C-S recovered from 96 cultures that were characterized by species, biotype, antibiotic susceptibility pattern, and slime production (screening parameters). Isolates from the same infant with highly similar screening parameters then underwent phage typing and plasmid analysis to increase the likelihood of establishing strain identity. C-S colonization rose from 12% on admission to 75% by wk 2, then gradually declined to 30% by wk 6 and remained stable through wk 10. There were no significant differences among C-S isolates from wk 1 compared with wk 10 of hospital stay with respect to distribution of species, slime positive, or multiply antibiotic resistant strains. One biotype of S. epidermidis was recovered from 46% of study infants, but only one infant was colonized with a predominant biotype of S. epidermidis throughout hospitalization. Thirteen pairs of isolates recovered from 12 of the infants on two or more wk were found to be identical by phage typing and plasmid analysis. Only seven of these 13 pairs of isolates had concordant results for all the screening parameters.(ABSTRACT TRUNCATED AT 250 WORDS)