Demonstration of uronic acid capsular material in the cerebrospinal fluid of a patient with meningitis caused by mucoid Pseudomonas aeruginosa.

A 39-year-old female with insulin-dependent diabetes mellitus developed Rhizopus infection of the maxillary sinus. Subsequent to successful treatment with amphotericin B and surgical debridement, she developed purulent meningitis due to a mucoid strain of Pseudomonas aeruginosa. Analysis of cerebrospinal fluid documented the presence of a uronic acid polymer at a concentration of 40 micrograms/ml. In spite of parenteral and intrathecal antibiotic therapy, the patient died. This case illustrates that mucoid strains of P. aeruginosa may result in fatal infection and that alginate capsule is produced in vivo in humans.

Role of myeloperoxidase and bacterial metabolism in chemiluminescence of granulocytes from patients with chronic granulomatous disease.

Phagocytosis of catalase-positive microbes by normal polymorphonuclear neutrophils results in increased metabolism as required for microbicidal action. Chemiluminescence is a product of the associated oxygenation reactions. Neutrophils from patients with chronic granulomatous disease are capable of phagocytizing catalase-positive microbes, but there is no associated respiratory burst, microbicidal action is greatly decreased, and chemiluminescence is not detected. However, these defective neutrophils can kill catalase-negative, H2O2-generating bacteria. In the present study, chemiluminescence by neutrophils from patients with chronic granulomatous disease after phagocytosis of H2O2-generating streptococci was detected. Acid extracts of myeloperoxidase from either control or patient neutrophils also yielded chemiluminescence in the presence of streptococci, but not in the presence of catalase-positive microbes.

Amebic liver abscess. Report of a case presenting with nonreactive serologic tests for Entamoeba histolytica.

We present a patient with an acute amebic liver abscess with nonreactive serologic tests. Motile hematophagous trophozoites of Entamoeba histolytica were seen microscopically in scrapings from the wall of the abscess. Postoperative serologies revealed rapidly rising then falling titers by SAFA and IHA antibody assays. Serologic tests for amebiasis may be reative in greater than 95% of patients with invasive amebiasis. Nevertheless, a reactive serologic test should not be relied upon exclusively to establish the diagnosis. Sequential serologic testing and surgical intervention to obtain material for microscopic examination, gram stain and bacteriologic culture are warranted in patients with hepatic abscess and nonreactive serologic tests for antibodies to E. histolytica.

Influenza 1978.

During January and February 1978, an outbreak of respiratory infection occurred at Fort Sam Houston, Texas. Both influenza A/Texas and A/USSR were isolated in the hospitalized patients. Two different strains of influenza A have not previously been documented during a single outbreak. This raises the possibility of recombination with emergence of a new antigenic strain.

Group B streptococcal osteomyelitis in adults.

Osteomyelitis due to group B Streptococcus occurred in two adult male patients. Both patients responded to parenteral penicillin G. A review of the literature verifies that group B Streptococcus has been an exceedingly rare cause of osteomyelitis in adults.

Bacterial endocarditis due to Listeria monocytogenes in a pregnant diabetic.

A case of bacterial endocarditis due to Listeria monocytogenes in a pregnant, Class D diabetic patient is presented. The importance of obtaining proper cultures and instituting appropriate antibiotic therapy promptly is emphasized. A favorable outcome was achieved in spite of the combined risk to the fetus of maternal diabetes and listeria endocarditis.

Haemophilus influenzae pneumonia in adults.

Thirty cases of Haemophilus influenzae pneumonia with clinical and laboratory features have previously been recorded in adults. During the past three years, we have examined 18 patients in whom this diagnosis was established by transtracheal aspirate or blood culture. Our study suggests that H influenzae, both typable and nontypable strains, is a more frequent cause of pneumonia in adults than previously appreciated. We found no clinical values that distinguished H influenzae pneumonia from other bacterial pneumonias. A properly performed Gram's stain of a transtracheal aspirate specimen is classical in its appearance and facilitates instritution of appropriate initial treatment. The emergence of both typable and nontypable organisms resistant to ampicillin makes it important that organisms be isolated from reliable samples for sensitivity testing. With appropriate therapy, the prognosis for patients with H influenzae pneumonia appears to be good.

A family outbreak of serious streptococcal infection.

A localized outbreak of scarlet fever was caused by an M-nontypable T-1 (NT/1) group A beta-hemolytic Streptococcus. The result was a fatal outcome in a 5-year-old child and a near fatality in his 10-year-old sibling. The outbreak was confined to family units that had members with whom the children were close playmates. Extensive epidemiologic studies in neighborhood schools and local hospital emergency rooms did not demonstrate a disemination of the causative serotype in the community.

Therapy for disseminated coccidioidomycosis with transfer factor from a related donor.

A 17 year old caucasian woman in whom disseminated coccidioidomycosis developed with culture positive meningitis during her third trimester of pregnancy was treated with amphotericin B and subsequently with transfer factor prepared from her father's peripheral lymphocytes. Clinical response and in vivo and in vitro immunologic data indicated that this transfer factor afforded a significant contribution to her survival whereas previous therapy with transfer factor from an unrelated donor provided only transient immunologic reactivity. This experience suggests that transfer factor prepared from a related donor with positive responses to C. immitis may be more efficacious than that prepared from an unrelated donor.