Pneumococcal soft-tissue infections: possible association with connective tissue diseases.

Streptococcus pneumoniae is not a well-recognized cause of soft-tissue infections. In less than 4 years, 12 cases of pneumococcal soft-tissue infection were identified through discussions with infections disease subspecialists in the Philadelphia area. Principal sites of involvement included skin and fascia, tongue, epiglottis, thyroid, brain, and breast. Pneumococcal bacteremia was documented in six cases (50%); in three of these, pneumococci were also cultured from the involved soft tissues. In the cases in which bacteremia was not demonstrated, pneumococci were isolated from the infected sites. Six patients had connective tissue diseases, of which five were diagnosed as systemic lupus erythematosus. Four of these patients were receiving corticosteroids when their infections developed. Two additional patients were HIV-seropositive intravenous drug users. S. pneumoniae may be a more important cause of soft-tissue infections than previously appreciated, especially in patients with connective tissue diseases.

Renal aspects of therapy for human immunodeficiency virus and associated opportunistic infections.

Patients with human immunodeficiency virus infection and the acquired immunodeficiency syndrome are often treated with a variety of potentially nephrotoxic drugs. This review summarizes the renal, fluid, and electrolyte complications of drugs used to treat human immunodeficiency virus and associated opportunistic infections. The pharmacokinetics of the drugs are also briefly reviewed, and dosing guidelines for the use of these drugs in patients who have renal insufficiency or who are receiving dialysis are provided.

Immunization with R mutants of Salmonella minnesota. II. Comparison of the protective effect of immunization with lipid A and the Re mutant.

The protective effect of active immunization with Salmonella minnesota Re bacilli or lipid A was assessed in the granulocytopenic rabbit model. Animals were immunized with Re bacilli, lipid A, or Pseudomonas aeruginosa as a nonspecific immunogen. After colonization with one of three enterobacterial strains (two Escherichia coli, one Enterobacter aerogenes), the immunized rabbits as well as controls given saline injections were made leukopenic with nitrogen mustard and monitored for fever, bacteremia, and death. Survival rates were significantly greater in Re-immunized animals than in saline controls or P. aeruginosa-immunized animals. Immunization with lipid A afforded no protection. In addition, rabbits immunized with Re mutant bacilli developed bacteremia less frequently than the others, indicating that antibody to Re may inhibit invasion of the intestinal mucosa as well as protect after bacteremia has developed.

Clinical spectrum of gonococcal infection in women.

The medical records of 278 women infected with Neisseria gonorrhoeae during a 6-month period were reviewed. These represented 75% of the infections in women at Boston City Hospital during this time. Women who presented to the venereal-disease clinic because they had had contact with an infected man and women who were found to be infected during routine examinations in the obstetrics-and-gynaecology clinic were usually free of symptoms or had non-specific symptoms such as vaginal discharge. However, these women accounted for only 108 (39%) of the 278 infections. Most of the infections were in women who presented to the emergency-care areas of the hospital with symptomatic gonococcal infections. At least 86 (31%) of the 278 infections were in women who had pelvic inflammatory disease. These data indicate that the clinical spectrum of gonococcal infection varies according to where the patients are seen and that the widely held concept that most gonococcal infections in women are asymptomatic may be erroneous.