Concurrent infection due to Shewanella putrefaciens and Mycobacterium marinum acquired at the beach.

Infection with marine bacteria is uncommon. A patient with systemic lupus erythematosus who developed concurrent infection with Shewanella putrefaciens and Mycobacterium marinum (M. marinum) is described. After bathing leg ulcers in sea water, severe cellulitis of the left leg with necrotic areas and extensive bullae developed. Infection due to S. putrefaciens was confirmed and a long course of hospitalization, oral ciprofloxacin and skin grafting was required. During hospitalization subcutaneous nodules developed on the other leg. Biopsy revealed acid-fast bacilli and culture grew M. marinum. These lesions responded to rifampicin and cotrimoxazole. Patients with leg ulcers, peripheral vascular disease, diabetes, or receiving immunosuppressive drugs may acquire unusual infections after salt water exposure.

Cryptococcal disease of the CNS in immunocompetent hosts: influence of cryptococcal variety on clinical manifestations and outcome.

We performed a retrospective review of cases of cerebral cryptococcosis among patients admitted to 12 Australian teaching hospitals between 1985 and 1992. Of 118 cases identified, 35 occurred in immunocompetent hosts. When cases due to Cryptococcus neoformans variety neoformans were compared with those due to Cryptococcus neoformans variety gattii, we found that the latter tended to occur in healthy hosts whose residence or job was located in a rural area, and cerebral mass lesions and/or hydrocephalus and pulmonary mass lesions were more common. For a subgroup of patients with infection due to C. neoformans variety gattii, multiple enhancing lesions were observed on cerebral computed tomograms, and papilledema, high CSF and serum cryptococcal antigen titers, and a worse prognosis (despite prolonged amphotericin B therapy and intraventricular shunt insertion) were also noted. No significant difference in clinical course or outcome in terms of variety of C. neoformans was noted for patients with cryptococcal meningitis whose computed tomographic scans appeared normal on presentation.

Identification of the microsporidian parasite, Enterocytozoon bieneusi in faecal samples and intestinal biopsies from an AIDS patient.

The microsporidian parasite, Enterocytozoon bieneusi, is currently recognized as a potentially important cause of chronic diarrhoea in patients infected with the human immunodeficiency virus (HIV). Faecal concentrates from a 38-year-old, HIV-seropositive patient examined by light and electron microscopy revealed the presence of numerous microsporidian spores. The structural characteristics of the spores were consistent with those previously described for Enterocytozoon bieneusi. Each spore contained a single nucleus, a posterior vacuole and a polar filament with 6-7 overlapping coils which appeared in cross-section as a series of 3 doublets. Mature spores were surrounded by an inner unit membrane, an electron-lucent endospore and a thin, electron-dense exospore. The identity of the parasite was confirmed by the detection of unique endogenous developmental stages in duodenal biopsies. Both proliferative and sporogonial plasmodia (meronts and sporonts) were observed and all stages were monokaryotic (single nucleus) and apansporoblastic (sporophorous vesicle absent). Proliferative and sporogonial plasmodia divided by plasmotomy and spore organelles (polar filament, attachment disc and polaroplast) were well developed prior to fission of the sporogonial plasmodium.