Polymicrobial and recurrent bacteremia with Shigella in a patient with AIDS.

Shigella gastroenteritis is uncommon among HIV seropositive patients and may be complicated in some patients by bacteremia; S. flexneri being the most frequently detected serogroup. While recurrent Salmonella bacteremia is common among HIV-seropositive patients, recurrent Shigella bacteremia is not. We report here an HIV-seropositive patient with Shigella gastroenteritis, polymicrobial bacteremia due to S. flexneri and S. boydii, and recurrent gastroenteritis and bacteremia with S. boydii. Relapsing infection with the same strain of S. boydii was determined using pulsed field gel electrophoresis. Thus, HIV-seropositive patients who develop Shigella infections may require prolonged treatment and/or suppressive therapy, similar to those infected with Salmonella. Patients who develop recurrent disease should be suspected as having polymicrobial bacteremia since the incidence of this may be underestimated among patients with AIDS, particularly those with concurrent gastroenteritis.

[A modification of the ortho-toluidine method for determining glucose in the blood]. / Modifikatsiia orto-toluidinovogo metoda opredeleniia gliukozy v krovi.

Modification of the orthotoluidine technique is associated with the necessity to examine blood glucose levels in mice, its dynamics analysis (by 5-6 points), which greatly expands the possibility of an experiment on screening new hypoglycemic agents. Addition of tert-butanol (isobutamol) facilitates the interaction of orthotoluidine with glucose, by enhancing the sensitivity and accuracy of the technique and allowing blood microquantities (10-20 microliters per determination) to be analysed. In terms of its accuracy and reliability, the proposed modification is not virtually inferior to expensive enzymatic techniques. The findings suggest that the modified orthotoluidine technique may be useful in the analysis of glucose levels in dynamics in small laboratory animals.

Multicenter trial of fleroxacin versus ceftriaxone in the treatment of uncomplicated gonorrhea.

In a multicenter, randomized, open, comparative trial, patients with uncomplicated gonorrhea were treated with 400 mg of oral fleroxacin or 250 mg of intramuscular ceftriaxone. A total of 458 men and 447 women were enrolled. Of these, 312 men (68%) and 245 women (55%) were evaluable for efficacy. The treatment groups were demographically similar. Among evaluable men, fleroxacin eradicated 154 of 155 (99%; 95% confidence interval [CI]: 98.1-100%) urethral and 2 of 2 pharyngeal infections, while ceftriaxone eradicated 156 of 156 (95% CI: 99.4-100%) urethral and 5 of 5 pharyngeal infections. Among evaluable women, fleroxacin eradicated 127 of 128 (99%; 95% CI: 97.7-100%) cervical, 20 of 20 anorectal, 16 of 16 urethral, and 7 of 7 pharyngeal infections, while ceftriaxone eradicated 108 of 108 (95% CI: 99.1-100%) cervical, 24 of 24 anorectal, 25 of 25 urethral, and 9 of 9 pharyngeal infections. Adverse events were reported by 68 (16%) of 426 subjects in the fleroxacin group and 20 (5%) of 380 in the ceftriaxone group (p < 0.0001). The most common adverse events reported by the patients who received fleroxacin were nausea (5%), headache (3%), and vaginitis (3%). One patient had severe vomiting, 19 participants had adverse reactions classified as moderate, and 48 patients had mild adverse reactions. Fleroxacin was highly effective in the treatment of uncomplicated gonorrhea and represents an oral alternative to ceftriaxone. Adverse events were more common with fleroxacin than with ceftriaxone.

Splenic complications in malaria: case report and review.

Clinicians are increasingly confronted with diagnosis and management of malarial complications. In nonfalciparum malaria, severe complications usually involve the spleen, most notably among them the condition termed spontaneous splenic rupture. A case of infection due to Plasmodium malariae resulting in a symptomatic splenic hematoma is presented. Malarial splenic enlargement and pathology are reviewed, as well as splenic complications such as spontaneous rupture, hematoma, hyperreactive malarial syndrome, hypersplenism, ectopic spleen, torsion, and formation of cysts. Also evaluated are the 11 reported cases of spontaneous splenic rupture in malaria in the English-language literature from 1960 to 1991. Most cases of spontaneous splenic rupture in malaria occur during acute infection and are associated with Plasmodium vivax. Lack of prior immunity to malaria appears to be a major predisposing factor. Increasingly, splenic complications are managed by supportive care and spleen-conserving procedures to avoid postoperative and asplenic morbidity.