Propionibacterium avidum as the etiologic agent of splenic abscess.

Propionibacterium avidum was isolated from an intrasplenic abscess in a patient recovering from coronary artery bypass surgery. This organism has not previously been reported as an etiologic agent of splenic abscess nor has splenic abscess been described as a complication of coronary bypass surgery. This report emphasizes the potential pathogenicity of normal microbial flora following surgical manipulation.

Sensitivity, specificity, and predictive value of anti-candida serum precipitin and agglutinin quantification: comparison of counterimmunoelectrophoresis and latex agglutination.

Many serological techniques have been developed to aid in the discrimination of significant candidiasis from other clinical states. Serum anti-candida precipitin and agglutinin quantification by counterimmunoelectrophoresis and latex agglutination were statistically evaluated as to their respective ability to accomplish this discrimination. Forty-five serum specimens from 16 patients with documented disease and 2 with presumptive disease and 81 specimens from 70 control patients were studied. The control population consisted of patients with candida colonization, transient candidemia, bacteremia, other systemic mycoses, and healthy medical personnel. The two techniques were compared as to sensitivity, specificity, and predictive value of a positive and a negative test. Using a precipitin or agglutinin titer of greater than or equal to 1:8 as the criterion for a positive test, we obtained the following results: counterimmunoelectrophoresis, 78, 97, 88, and 94%, respectively; latex agglutination, 94, 50, 33, and 97%, respectively.

Alterations in serum opsonic activity and complement levels in pneumococcal disease.

Pneumococcal opsonic activity and concentrations of pneumococcal capsular polysaccharide antigen, C3, C4 factor B, C3 and factor B breakdown products were measured in the serum obtained acutely from 12 patients with serious pneumococcal disease. One patient showed markedly reduced pneumococcal opsonic activity, borderline-low C3, and the presence of C3 and factor B breakdown products and died. Although eight additional patients showed depressed levels of C3 or C4 or the presence of C3 or factor B breakdown products, none had reduced pneumococcal opsonic activity. All of the three remaining patients had normal opsonic activity and C3 and C4 levels. Covalescent serum was obtained from eight patients; six had normal C3 and C4 levels, and two had persistent C4 depression. These data show that complement is activated during pneumococcal disease and suggest that extensive complement activation may impair pneumococcal opsonic activity in certain patients and thereby compromise an important host defense mechanism.

Stability of anti-Candida precipitating antibody in stored sera as determined by counterimmunoelectrophoresis.

Prolonged storage of sera at -20 degrees C did not significantly affect anti-Candida precipitin titers measured by counterimmunoelectrophoresis when compared with the original determinations.

Correlation of antistaphylococcal antibody titers with severity of staphylococcal disease.

Counterimmunoelectrophoresis (CIE) was utilized to determine antistaphylococcal precipitin antibody titers in patients with various staphylococcal diseases and in control subjects. Patients with staphylococcal disease comprised five cases of endocarditis, 22 of deep tissue infection (including seven cases of osteomyelitis), six of bacteremia and six of skin infection. Control subjects consisted of 31 patients with nonstaphylococcal bacteremias, 29 hospitalized patients without infection and 30 healthy subjects. Antistaphylococcal antibodies were present in all patients with staphylococcal endocarditis and deep tissue staphylococcal infection, and all but three had titers greater than or equal to 1:4. No significant difference in titers was found between these two groups of patients. Antibodies, although present in some patients in the other categories, were detected less frequently; only two patients had titers greater than or equal to 1:4. Thus, an antistaphylococcal antibody titer by CIE of 1:4 or greater may be an additional diagnostic parameter helpful in distinguishing patients with staphylococcal endocarditis or deep tissue infection from those with other forms of staphylococcal infection and from noninfected subjects.

Gentamicin and tobramycin penetration into synovial fluid.

The penetration of gentamicin and tobramycin into the synovial fluid of 12 patients with nontraumatic joint effusions was studied. Simultaneous serum and synovial fluid specimens taken after the intramuscular or intravenous administration of an antimicrobial agent were assayed. Synovial fluid levels of antibiotic were >50% of serum levels in all subjects studied. In five patients, synovial fluid levels were equal to or exceeded simultaneous serum values. These results suggest that intra-articular injection of aminoglycoside antibiotics is not necessary in the treatment of infectious arthritis.

Immunologic studies in pneumococcal disease.

Many patients die from pneumococcal disease despite the availability of effective antimicrobial agents. Immunologic studies including detection, typing, and quantitation of serum pneumococcal capsular polysaccharide (PCP) antigen by counterimmunoelectrophoresis (CIE), quantitation of PCP antibody by radioimmunoassay (RIA), and quantitation of serum complement components C3, C4, and C3PA and serum immunoglobulins IgG, IgM, and IgA by the radial immunodiffusion technique of Mancini were performed with the sera of 18 patients. Five patients died (group I), and 13 survived (group II) pneumococcal infection. Both groups were comparable in age, underlying disease, and leukopenia on admission. All patients of group I and 10 of 13 (77%) of group II patients were bacteremic. Two patients in each group had an extrapulmonary focus infection. PCP antigen was detected in the sera of all group I and nine of 13 group II patients. PCP antigen levels were larger than or equal to 15 microng/ml in four of five group I and two of 13 group II patients (p = 0.022). Levels of antibody to PCP exceeded 100 ng/ml of antibody nitrogen (AbN) in 10 of 12 group II and one of five group I patients (p = 0.027) during the course of illness. All group I patients and three of 12 group II patients had decreased levels of one or more complement components on admission (p less than 0.01). One or more complement components remained decreased until death in four group I patients but returned to normal or elevated levels in all group II patients. No difference in serum immunoglobulin concentrations were found.

Detection of candida serum precipitins by counterimmunoelectrophoresis: an adjunct in determining significant candidiasis.

We report our experience with the use of counterimmunoelectrophoresis for the detection and quantitation of candida serum precipitins in 164 patients. Group I consisted of 24 patients with significant candidiasis; group II consisted of 97 patients with either colonization or transient candidemia; and group III consisted of 43 subjects with noncandida systemic mycoses, bacterial infections, and normal controls. Prospective studies were done in ten patients. Double immunodiffusion was performed in all cases. Ratios of counterimmunoelectrophoresis precipitin detection were significantly different between groups I and II and groups I and III (P less than 0.001). Precipitin titers of 1:8 or greater were found more often in group I as compared to group II or III (P less than 0.001). All prospectively studied patients who developed significant candidiasis had peak precipitin titers of greater than or equal to 1:8(greater than fourfold titer increase) during the period of observation. Quantitation of candida serum precipitins by counterimmunoelectrophoresis is helpful in diagnosing significant candidiasis.

Detection of Aspergillus fumigatus serum precipitins by counterimmunoelectrophoresis.

Detection of serum precipitins to Aspergillus fumigatus by counterimmunoelectrophoresis is compared with the immunodiffusion technique. Eight of nine (89%) sera from patients with proven A. fumigatus infection were positive by both methods. No serum from subjects with other systemic mycoses, bacterial infections, or healthy controls had detectable precipitins. The highest serum precipitin titers were found in sera of patients with the mycetomal and invasive forms of the disease. Detection of A. fumigatus serum precipitins by counterimmunoelectrophoresis compares favourably with immunodiffusion and has the advantage of significantly reducing the time required for results.

Clinical application of counterimmunoelectrophoresis in detection of Candida serum precipitins.

Precipitin antibodies to candida antigens were found by counterimmunoelectrophoresis (CIE) and double immunodiffusion (DID) in 100 per cent of sera from patients with significant candida infection. Such antibodies were also found by CIE in 63 per cent of individuals with candida colonization, 47 per cent of bacteremic patients, and 14 per cent of normal control subjects. No sera from these patients and normal control subjects were positive by DID. Serum precipitin titers by CIE in patients with significant candidiasis were significantly higher than in patients of the other groups. Detection of candida serum precipitins by CIE, when precipitin titers are obtained, compares favorably with DID as a diagnostic tool in significant candidiasis.