Colonization of the respiratory tract with Legionella species.

Pneumonia is the most important manifestation of disease caused by Legionella species. However, it is still not known for certain how these organisms actually enter the lungs. During a 5-month period 318 hospitalized patients without clinical or radiologic features of pneumonia were enrolled in a survey of sputum colonization with Legionella. Diagnostic tests included cultures, direct fluorescent antibody test (DFA) and DNA probe assay of sputum. Colonization was considered to occur when at least one of these tests was positive. According to our definitions, 1.2-10% of of these patients could have been colonized by Legionella spp. However, all cultures were negative and in all but one of these patients the DFA was the only positive test. A case-control study comparing test-positive and test-negative patients failed to identify any different features of disease or epidemiologic characteristics. These findings suggest that a high rate of false-positive DFA results occurred in our study rather than any new evidence of colonization of the respiratory tract with Legionella.

Diagnostic efficacy of a DNA probe in pneumonia caused by Legionella species.

A commercial DNA probe kit (Gen-probe) for the detection of rRNA from legionellae was evaluated for its accuracy in diagnosing Legionnaires' disease in 167 patients with pneumonia. The test was performed on freshly obtained clinical respiratory tract samples. Cultures and direct immunofluorescence antibody (DFA) staining of the samples and serological tests were performed simultaneously for all patients. The probe assay result was positive in six patients; five of them had other laboratory evidence of disease (positive cultures or positive serological results or both). Depending on the diagnostic criteria, the probe test had a sensitivity of 31-67%, a specificity of 99% and positive predictive values of 67-83%. The diagnostic performance of the DNA probe assay in this study was superior to that of the DFA test. The results indicate that the examination of respiratory tract secretions by the Gen-probe kit is a suitable screening test for the diagnosis of Legionnaires' disease.

Characteristics of left-sided endocarditis due to Pseudomonas aeruginosa in the Detroit Medical Center.

Mortality due to left-sided endocarditis caused by Pseudomonas aeruginosa remains high despite the therapeutic regimen of high doses of an aminoglycoside plus a beta-lactam antibiotic. In this series, left-sided pseudomonal endocarditis presented as an acute illness refractory to optimal antibiotic therapy. Complications associated with active valvular infection, such as neurologic sequelae, ring and annular abscesses, congestive heart failure, and splenic abscesses, are frequent. The overall morbidity and mortality remain high; however, outcome appears to improve with surgery. Our present data suggest that early valve replacement accompanied by a 6-week course of high doses of a combination of drugs may be the optimal therapy for left-sided pseudomonal endocarditis. This approach not only may prevent serious and potentially lethal complications of the disease but also may cure them.

Successful treatment of disseminated Trichosporon beigelii (cutaneum) infection with associated splenic involvement.

Fungemia caused by Trichosporon beigelii (cutaneum) has been recently recognized as a fatal infection afflicting immunocompromised patients. The authors report the case of a leukemic patient who developed splenic infection from disseminated T. beigelii. Treatment with amphotericin B, 5-fluorocytosine, and splenectomy proved successful. The etiology of disseminated T. beigelii infection, visceral seeding, and combination antifungal therapy also are discussed.

Legionella feeleii-associated pneumonia in humans.

Legionella feeleii has been implicated by serologic studies as the causative agent in an outbreak of Pontiac fever and has been recovered from an institutional water source. Pneumonia caused by this agent has not been described previously. The authors have isolated L. feeleii from two immunosuppressed patients with community-acquired pneumonia and from an institutional water source. One patient survived after treatment with erythromycin. The other patient was leukopenic and died of pneumonia. Isolates exhibited typical cultural and biochemical features of L. feeleii and reacted with L. feeleii serogroup 1 antiserum. L. feeleii serogroup 1 is now known to cause not only Pontiac fever but also pneumonia in humans.

Outbreak of pseudomonas paucimobilis in an intensive care facility.

During a two-month period, six patients in an intensive care unit (ICU) were colonized or infected with Pseudomonas paucimobilis, a newly described bacterial species. To our knowledge, the epidemic organism has not been found previously in these units. The bacterium was usually recovered from the sputum of persons receiving ventilatory assistance and represented transient colonization. One patient had a symptomatic urinary tract infection. The outbreak was confined to two of the ICUs. Cultures of respiratory equipment were negative, but P paucimobilis was recovered from the ICU hot water line. Water bottles used for rinsing tracheal suction connecting tubing were found to contain P paucimobilis organisms. This resulted from refilling with tap water. No further cases were found during a 20-month follow-up period, when a uniform tracheal suctioning policy was developed.

Candida pachymeningitis with multiple cranial nerve pareses.

A 66-year-old woman complained of right-sided headache and was found to have progressive dysfunction of cranial nerves V and VIII through XII on the right side. At autopsy, there was a granulomatous pachymengitis involving the floor of the right middle and posterior cranial fossae due to Candida tropicalis infection. Inflammatory tissue compressed the clinically affected cranial nerves.

Hypothalamic hypothyroidism and XXY/XY sex chromosome mosaicism. Report of a case.

An 18-year-old boy with clinical features of Klinefelter's syndrome in whose case the buccal smear was chromatin-negative and chromosomal analysis of peripheral blood revealed 46 XY karyotype is described. Diagnosis was confirmed by demonstration of an XXY cell line in cultured skin fibroblasts. Low circulating thyroxine levels were found despite absence of clinical hypothyroidism, and TSH was barely detectable. The studies are consistent with an isolated deficiency of thyrotropin-releasing hormone in a patient with XY/XXY mosaicism.

An extra small metacentric chromosome identified as a deleted chromosome no. 17.

In an 11-year-old girl with multiple congenital abnormalities and mental retardation, an extra, small, metacentric chromosome was identified by banding methods as a deleted chromosome No. 17. This represents the first reported case of partial trisomy 17.

Isolation and characterization of a catalase-negative strain of Staphylococcus aureus.

An unusual, naturally occurring strain of Staphylococcus aureus is characterized. It is typical in colony and cellular morphology, coagulase production, and other biochemical reactions as compared to S. aureus (ATCC-25923), except that it is catalase negative and fails to ferment mannitol anaerobically.