Bartonella (Rochalimaea) quintana causing fever and bacteremia in an immunocompromised patient with non-Hodgkin's lymphoma.

A 48-yr-old man with stage IV non-Hodgkin's lymphoma, became neutropenic following chemotherapy and developed a fever. His blood cultures were processed to enhance the yield of fastidious bacteria. A slow-growing, capnophilic Gram-negative rod was isolated. The febrile episode was treated with cefotaxime, imipenem and vancomycin and resolved. The bacterial isolate was identified as Bartonella (Rochalimaea) quintana by 16S-rDNA gene sequencing. The isolate showed 99.8% sequence homology with the type strain. This is the first isolation of Bartonella (Rochalimaea) quintana from a bacteremic patient in Australia. This bacterium is a fastidious Gram-negative rod requiring prolonged culture for its isolation. Patients with culture-negative pyrexia, especially immunocompromised patients, may need to be investigated for infection with this agent.

Major maxillofacial infections. An evaluation of 107 cases.

A review of 107 cases of acute maxillofacial infections managed at the Royal Melbourne Hospital was undertaken, and details of the presentations, demography, management, and outcomes of these patients are presented. The results indicated that many of the patients had sought treatment from dentists in general practice, and that a significant proportion had received sub-optimal management prior to referral. Thus a review of the principles of management and guidelines for the referral of patients with maxillofacial infections is also presented.

Nocardiosis diagnosed by lung FNA: a case report.

A 63-yr-old woman with systemic lupus erythematosus (SLE) diagnosed 12 mo previously and treated with prednisolone and cyclophosphamide presented with recent fever and dyspnoea. The etiology of a 3 cm diameter centrally cystic coin lesion in the lower lobe of the left lung was obscure. Blood cultures and sputum examination had been non-contributory, and the diagnosis of Nocardia asteroides infection was initially made by cytologic examination of material obtained by lung fine-needle aspiration (FNA). It is notoriously difficult to detect this organism by conventional sputum examination or with histologic sections, and it has rarely been detected by lung FNA. If this organism is demonstrated, appropriate microbiologic cultures for confirmation and susceptibility testing should be instituted. Long-term antimicrobial therapy is needed. In this case, complete resolution of the lung lesion followed 5 mo of therapy.

Opacification of Middlebrook agar as an aid in distinguishing Nocardia farcinica within the Nocardia asteroides complex.

Among 58 aerobic actinomycetes isolated from different sources and geographical locations, none of 23 Nocardia asteroides isolates, at 18 N. farcinica isolates, 1 of 5 N. otitidiscaviarum isolates, and 1 of 4 Rhodococcus species isolates opacified Middlebrook 7H10 medium. Within the N. asteroides complex, this characteristic, together with growth at 45 degrees C and resistance to each of erythromycin, cefotaxime, and tobramycin, provides a simple means of distinguishing N. farcinica from N. asteroides.

Seven patients with respiratory infections due to Corynebacterium pseudodiphtheriticum.

Seven cases of lower respiratory tract infection due to Corynebacterium pseudodiphtheriticum are described. Lower respiratory tract infections with C. pseudodiphtheriticum in immunocompetent patients are usually associated with pre-existing chronic pulmonary disease, and are sometimes associated with endotracheal intubation. Antimicrobial susceptibility testing of these isolates showed uniform sensitivity to penicillin and variable results to erythromycin.

Bacteriological studies of open versus closed contrast medium delivery systems in angiography.

The aim of this study was to evaluate the safety of the 'open' method of contrast medium delivery in the angiographic theatre, in which contrast medium is decanted into open galley pots on sterile trolleys. The air bacterial load within the angiographic theatre was sampled before and during angiographic procedures. The relationship of staff and patient activity to bacterial load was assessed. Samples of Iopromide (Ultravist 370; Schering Pty Ltd, Sydney, NSW, Australia) decanted into galley pots were taken for bacterial culture at the end of seven patient procedures. Air bacterial loads were comparable with operating theatre levels and were heaviest during staff activity. Three of seven samples taken at the end of angiographic procedures from air-exposed galley pots yielded contaminants, but the number of bacteria was below that required to produce septicaemia under normal conditions. These results suggest that the open system of contrast medium delivery can be safely used, providing that bacterial checks of room contamination are performed and personnel entry into the theatre is strictly limited.

Multiple doses of contrast medium from a single container: bacteriological studies.

Preparations of Iopromide (Ultravist 370; Schering Pty Ltd, Sydney, NSW, Australia), brain/heart infusion broth (BHI; positive growth control) and distilled water (negative control) were inoculated with 10(3) to 10(4) Pseudomonas aeruginosa, Escherichia coli or Staphylococcus aureus cells and incubated at 37 degrees C. Slow decreases (up to one log) were observed in each organism's count in Iopromide and distilled water at room temperature and in S. aureus and E. coli in Iopromide and distilled water at 35 degrees C until 6-8 h, when counts stabilized. BHI cultures showed logarithmic increases. P. aeruginosa counts increased (half log over 8 h) in Ultravist at 37 degrees C. Radiology laboratories were shown to have similar airborne bacterial loads to operating theatres. Samples from repeatedly entered Iopromide bottles showed no contamination. Multiple intravenous doses from a single bottle of non-ionic contrast medium can safely be used as a cost-saving measure provided scrupulous attention is paid to aseptic preparation. Unused decanted contrast medium should be discarded after 4 h.

Typing of strains from a single-source outbreak of Pseudomonas pickettii.

Plasmid profiles, genome restriction fragment polymorphisms, carbohydrate oxidation-fermentation reactions, methylumbelliferyl substrate hydrolysis patterns, antimicrobial susceptibilities, and results obtained with the Biolog GN biochemical substrate kit were used to type 19 common-source, but mixed-biotype, outbreak strains and one epidemiologically distinct strain of Pseudomonas pickettii. Biotyping with conventional and methylumbelliferyl substrates failed to distinguish between strains. Plasmid profile testing was found to be inconsistent and not reproducible. The Biolog GN kit allowed greater strain differentiation than restriction fragment polymorphism did (12 biotypes versus 5 biotypes); antimicrobial susceptibility testing yielded 4 biotypes, and oxidation-fermentation tests gave 3 biotypes. Oxidation-fermentation results were consistent with restriction fragment polymorphs in all but 1 of the 20 strains tested. For ease of typing, comprehensive typeability, and reproducibility, oxidation-fermentation tests should be performed initially and followed if necessary by restriction fragment polymorph analysis for the elucidation of P. pickettii infection outbreaks.

The optimal dosage of ceftazidime for severe lower respiratory tract infections.

The optimal dosage of antibiotics for the treatment of patients with severe lower respiratory tract infections (LRTI) has not been determined but may be lower than is commonly administered at present. We have compared the efficacy of a low dosage of ceftazidime (1 g tds) with the more usual dosage (2 g tds) in a prospective, randomized study of the treatment of LRTI in seriously ill patients. Fifty patients on an Intensive Care Unit received one or the other regimen for 5 days; the demographic characteristics of the two groups were comparable. There was no significant difference in terms of clinical and microbiological response rates between the two regimens. Overall, clinical resolution was documented for 86% of patients, there was no change in 8% and 6% deteriorated. Microbiological eradication was achieved in 52% of patients from whom a pathogen was isolated (46% of all patients). We conclude that ceftazidime 1 g tds is effective treatment for severe LRTI in hospitalized patients.

An Australia-wide epidemic of Pseudomonas pickettii bacteraemia due to contaminated "sterile" water for injection.

Nineteen cases of Pseudomonas pickettii bacteraemia and one case of Pseudomonas cepacia bacteraemia were identified in an Australia-wide outbreak of nosocomial sepsis associated with contaminated water for injection. The contamination was limited to one batch of commercially produced water for injection. Four different organisms were identified (three biotypes of P. pickettii and one of P. cepacia). However, P. pickettii biotype 1 appeared to be relatively more virulent than the other biotypes as it was the only identified organism in blood cultures in nearly all cases of sepsis. The ampoules of "sterile" water were each contaminated with approximately 10(3) organisms per millilitre. The lack of an Australian central reporting system for bacteraemia delayed the recognition of this outbreak.

Experience with Nocardia asteroides in renal transplant recipients.

Six cases of Nocardia asteroides infection in renal transplant recipients are described. Respiratory symptoms predominated, complicated in one case by cerebral abscess. General dissemination did not occur in any patient. Environmental testing failed to show source(s) of the organism. Nocardiosis patients should be isolated to prevent airborne spread to renal transplant recipients, who are prone to infection and from whom specimens for culture should be incubated for at least 7 days to exclude Nocardia spp.

The frequency distribution and consistency of assimilation biotypes of Candida albicans.

Two hundred and fifty clinical strains of Candida albicans and six isolates from a cross-infection outbreak were studied for their ability to assimilate 19 carbohydrates in the API-20C system (APILaboratory Products Ltd., Basingstoke, UK). The assimilation profiles were stable on repeat testing; at intervals in the 72 h duration of the test; and when incubated at different temperatures. Although not a complete system of biotyping, the API-20C system shows high typability, and fair reproducibility and discrimination, having a limited role in indicating which isolates should be typed by more elaborate methods.