"Flexispira rappini" bacteremia in a child with pneumonia

We describe a case of "Flexispira rappini" bacteremia from a 9-year-old girl who presented with a 5-day history of fever, productive cough, and malaise. A chest X-ray result was compatible with right middle lobe pneumonia. Blood culture grew a gram-negative spiral fusiform bacterium 2 days after the inoculation. Biochemical tests showed the organism to be catalase negative, oxidase positive, sodium hippurate hydrolysis negative, and urea hydrolysis negative. 16S rRNA gene sequencing identified this organism as "F. rappini," showing a six-base substitution from the type strain. This is the first report of "F. rappini" bacteremia in a human, suggesting that this organism has the potential of causing invasive infection, but its role in pneumonia is uncertain and could be unrelated to the bacteremia.     

Necrotizing fasciitis after Plastibell circumcision

Necrotizing fasciitis is a potentially life-threatening infection of subcutaneous tissues and Scarpa's fascia that rarely affects neonates. We report the occurrence of this devastating infection in two neonates after routine Plastibell circumcision. These case reports highlight the presentation and management of this complication after a relatively routine and frequently performed operation. This report also emphasizes the differences between cellulitis and necrotizing fasciitis and suggests strategies for management.     

Insight into auditory hallucinations and psychosis

PURPOSE: To report a case of Xanthomonas maltophilia endophthalmitis and to increase awareness of its potential as an intraocular pathogen. METHOD: Case report. RESULTS: A 76-year-old woman developed X maltophilia endophthalmitis after cataract extraction. To eradicate the infection, we performed two vitrectomies and treated the patient with numerous intravitreal antibiotic injections. CONCLUSIONS: X maltophilia is a potential intraocular pathogen in an immunocompetent host. If the infection takes a persistent course, persistent topical and intravitreal antibiotic treatment and possibly vitrectomy are needed to eradicate the infection.     

Defect coverage with a bilobed flap with reference to special aspects regarding the nose]

Acute disseminated encephalomyelitis (ADEM) is a well known complication of measles infection. Electroencephalographic abnormalities may occur frequently, in the form of moderate to severe diffuse high voltage theta-delta activity. We report a case of measles encephalitis with rapid benign outcome, that showed peculiar EEG features both of a "spindle coma" pattern and of an "alternating pattern." Possible physiological explanations of the EEG findings are discussed.     

Radiological case of the month. Cystic meningioma of the posterior fossa

This short report serves as a warning to the unwary of possible "pseudoclusters" of infection with Aspergillus fumigatus as shown by the typing system, random amplification of polymorphic DNA (RAPD). This was demonstrated by typing 10 epidemiologically distinct isolates of A fumigatus using two different preparations of Taq DNA polymerase. One of the enzymes did not discriminate between the isolates, giving the false impression that a cluster of infection had occurred. Enzyme source is thus a key variable when using RAPD to distinguish between isolates of A fumigatus.     

Telethermographic studies on the effect of immunoglobulins (Beriglobin) on heat radiation behavior in radiodermatitis

OBJECTIVES: To determine the criterion-related validity of alternative approaches to the measurement of sexual intercourse using sexually transmitted diseases (STD) as a biomarker (the criterion). STUDY DESIGN: Analyses are based on an urban sample of 255 adolescent women, 15 to 19 years of age, treated for genitourinary infections with Neisseria gonorrhoeae, Chlamydia trachomatis or Trichomonas vaginalis who returned 3 months later for reexamination. Subjects completed self-administered questionnaires at enrollment and at 3 months. Genitourinary cultures were obtained at enrollment, 2 to 4 weeks later at a test-of-treatment visit (TOT), and at 3 months. RESULTS: Two hundred fourteen of the 255 adolescents also returned for a TOT culture; 186 of these 214 (73%) were free of infection 2 to 4 weeks after enrollment and 30% (56/186) acquired a subsequent STD by 3 months. The validity of questions about sexual behavior differed. No adolescent who denied interim intercourse by reporting "0" sexual partners or "0" coitions acquired an interval STD. Adolescents who denied regular intercourse (vaginal sex) or failed to indicate the number of interim coitions were at high risk for new STD-23% and 21%, respectively. A new measure of sexual intercourse using both the number of sexual partners and the number of coitions contained no missing data; adolescents classified as not having had interim sexual intercourse were free of infection at 3 months, whereas 32% of those who reported intercourse acquired an interim infection. CONCLUSIONS: These data suggest that high-risk urban adolescent women can accurately report whether they have engaged in vaginal intercourse. The validity of the report appears sensitive to the wording and content of the questions.     

CT-verified intracranial calcifications and contrast enhancement in acute disseminated encephalomyelitis: a case report

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease which follows viral infection or vaccination. We report the CT findings in a 13-year-old boy with ADEM after infection with Epstein-Barr virus. After 11 days, the patient developed intracranial calcifications in addition to demyelinating lesions. This is a rare finding in ADEM.     

Osteomyelitis due to Pseudallescheria boydii

This report describes an unusual opportunistic fungal infection in an immunocompetent young man who had no cutaneous involvement and whose infection was diagnosed 6 years after an accident. The unusual clinical presentation and difficulties in making a correct diagnosis are discussed and prophylactic antifungal chemotherapy is suggested.     

Spontaneous pubertal development in Turner''s syndrome. Italian Study Group for Turner''s Syndrome

Stent infection is a rare complication of coronary angioplasty. We report a case of a coronary stent bacterial infection due to Pseudomonas aeruginosa, shortly after implantation of the stent in the left circumflex artery, which presented as an acute pericarditis. Surgical treatment consisted of stent removal and partial excision of the circumflex artery without coronary artery bypass grafting.     

Hospital construction-associated outbreak of ocular aspergillosis after cataract surgery

OBJECTIVE: This study aimed to report an outbreak of Aspergillus endophthalmitis after cataract extraction during hospital construction. DESIGN: The study design is a case series of an outbreak of Aspergillus endophthalmitis. PARTICIPANTS: Five patients in whom Aspergillus endophthalmitis developed during a period of hospital construction in Jeddah, Saudi Arabia, participated. Severe postoperative uveitis occurred in all five patients and failed to subside with topical steroid therapy. The patients were referred to the King Khaled Eye Specialist Hospital for treatment. The causative organism was identified as Aspergillus fumigatus in each case. INTERVENTION: All five patients were subjected to aqueous or vitreous tap. Three patients had vitrectomy. Patients were given systemic, periocular, and intravitreous antifungal agents. MAIN OUTCOME: The final outcome in each patient was evisceration or enucleation, despite an intensive course of antifungal therapy. RESULTS: There were five patients, three females and two males, ranging in age from 51 to 65 years. Postoperative signs of infection developed in the patients 4 to 15 days after surgery. In all five cases, cultures of aqueous or vitreous grew A. fumigatus. CONCLUSION: Aspergillus endophthalmitis is a serious and devastating complication of ocular surgery. The outbreak, herewith, may have been related to hospital construction. The infection can be prevented, notably, by proper maintenance of old, "sick" buildings and by following certain procedures during hospital construction.     

Physiological compensation in antisense transformants: specific induction of an "ersatz" glucan endo-1,3-beta-glucosidase in plants infected with necrotizing viruses

Plant class I glucan endo-1,3-beta-glucosidases (beta-1,3-glucanase; 1,3-beta-D-glucan glucanohydrolase, EC 3.2.1.39) have been implicated in development and defense against pathogen attack. Nevertheless, beta-1,3-glucanase deficiencies generated by antisense transformation of Nicotiana sylvestris and tobacco have little biological effect. We report here that another beta-1,3-glucanase activity is induced in these deficient mutants after infection with necrotizing viruses. Induction of class I beta-1,3-glucanase was markedly inhibited in leaves of N. sylvestris and tobacco antisense transformants infected with tobacco necrosis virus and tobacco mosaic virus, respectively. A serologically distinct beta-1,3-glucanase activity was present in the infected antisense transformants but was absent in both healthy and infected control plants and in antisense transformants treated with the stress hormone ethylene. Immunoblot analyses, localization studies, and measurements of antibody specificity indicate that this compensatory beta-1,3-glucanase activity is an intracellular enzyme different from known tobacco beta-1,3-glucanases. Therefore, plants can compensate for a deficiency in enzyme activity by producing a functionally equivalent replacement--i.e., "ersatz"--protein or proteins. The fact that compensation for beta-1,3-glucanase activity occurs in response to infection argues strongly for an important role of these enzymes in pathogenesis.     

Hypopituitarism as a late complication of Plasmodium falciparum malaria: a possible relationship?

Plasmodium falciparum infection causes serious symptoms in the acute phase of the illness. Long-term sequelae are less common. In the following case report we describe a patient who developed hypopituitarism after a severe cerebral malaria infection, which was only recognized 17 years thereafter.     

An international evaluation of the cancer-preventive potential of nonsteroidal anti-inflammatory drugs

The most common complication in children with varicella is cutaneous superimposed infection with pyogenic bacteria. Group A beta-hemolytic streptococci, which are known to cause life-threatening infections in both previously healthy children and those with underlying diseases, are the most frequently associated pathogens. A newly recognized disease, called streptococcal toxic shock syndrome, is associated with severe morbidity and mortality. We report a 3-year-old boy with a diagnosis of this syndrome who presented with increasing fever, vomiting, and lethargy 7 days after the development of a classic varicella skin lesion. In spite of aggressive fluid supply, administration of inotropic agents, and cardiopulmonary resuscitation, a rapidly deteriorating clinical course led to death 4 hours after hospitalization. This is the first report of this association in Taiwan. Pediatricians evaluating children with varicella must be mindful of the potential for Group A beta-hemolytic streptococcal infection.     

Mycobacterium bovis osteomyelitis involving a hip arthroplasty after intravesicular bacille Calmette-Guérin for bladder cancer

Bacille Calmette-Guérin (BCG), an attenuated strain of Mycobacterium bovis, is one of the most effective agents in the treatment of superficial bladder cancer. BCG osteomyelitis is an infrequent complication of intravesicular BCG therapy; only five cases of BCG vertebral osteomyelitis have been reported in the literature. Similarly, the infection of an indwelling extravascular device by BCG is rare; there is only one previous report documenting infection associated with an automated implantable cardiac defibrillator. We report a case of BCG osteomyelitis involving a hip arthroplasty that occurred after intravesicular administration of BCG for bladder cancer, and we review the risk factors predisposing to such infections and their treatment.     

Three cases of Pasteurella multocida infection in the respiratory tract

Pasteurella multocida (P. multocida) is well recognized as "normal flora" in the upper respiratory tract of cats, dogs and other animals. Recently, various infections due to P. multocida in human have been noted as pulmonary infections in the patients with chronic pulmonary diseases as well as skin abscesses or septicemia after an animal bite or scratch. We report here three cases of respiratory tract infections caused by P. multocida. The first two patients had acute exacerbation of bronchiectasis caused by P. multocida and the other patients with pulmonary emphysema developed pneumonia. These three patients improved by antibiotic therapy. In Japan, P. multocida respiratory tract infection is rare, but it may become more common in the future. Therefore, it seems to be important to take this pathogen into consideration in the management of chronic lung disease.     

Ocular and sinus microsporidial infection cured with systemic albendazole

PURPOSE: To report treatment of a patient with acquired immunodeficiency syndrome (AIDS) and ocular and paranasal sinus microsporidial infection. METHOD: Case report. RESULTS: A patient with AIDS and ocular microsporidial infection experienced resolution of ocular symptoms with topical fumagillin, but symptoms recurred upon cessation of therapy. Paranasal sinus microsporidial infection was diagnosed. The patient received sequential systemic treatment with itraconazole followed by albendazole. Sinus symptoms resolved with albendazole. He remained symptom-free with a normal examination 17 months after concluding therapy. CONCLUSIONS: Although fumagillin and itraconazole may have played a role, systemic albendazole appears to be responsible for clinical resolution of microsporidial infection.     

MAP2, synaptophysin immunostaining in rat brain and behavioral modifications after cerebral postischemic reperfusion

Infection rates are important markers for clinical quality assurance. For internal control, they may only be used under the condition of homogeneous data collection and evaluation according to identical standard operating procedures during the entire investigation period. For inter-hospital comparison, they may only be used if additionally the observed patient groups are well defined and comparable. A survey of the infection rates published during the last 6 years in the German traumatological literature (n = 71) indeed shows (concerning series later than 1985) similar infection rates for procedures in less and in more problematic anatomical regions and in clean and contaminated situations of about 2-3%, after open injuries sporadically max. 10%. Finally, it is demonstrated that conclusions concerning a general "risk of infection" based on infection rates for specific surgical procedures are not possible and vice versa. We strongly recommend the future application of a standardized definition of wound infection. The differentiation between deep and superficial infection should be abandoned. For all mentioned "infection rates" it should be indicated whether it is with reference to the risk of infection of a specific procedure or only a general statement.     

Müller cell-specific autoantibodies in a patient with progressive loss of vision

The cause of Ménétrier's disease is unknown, although various autoimmune, allergic, and infective causes have been postulated. This case report describes a 37-yr-old man with Ménétrier's disease associated with protein-losing enteropathy and Helicobacter pylori infection. Clinical, endoscopic, histological, and biochemical resolution occurred after treatment of Helicobacter pylori infection. The improvement observed in this case supports an etiological role for H. pylori infection in Ménétrier's disease.     

Pulmonary Nocardia otitidiscaviarum infection in a patient with chronic respiratory infection

We report a case of pulmonary Nocardia (N.) otitidiscaviarum infection in a 76-year-old man with chronic respiratory infection. The patient responded poorly to intravenous imipenem and oral minocycline, but later improved after treatment with trimethoprim-sulfamethoxazole. Pulmonary infection with N. otitidiscaviarum should be considered in the differential diagnosis of chronic respiratory infections. Further studies are needed to evaluate the correlation between species and drug susceptibility.     

Pappataci fever

Sandfly fever virus is known to cause pappataci fever. The sandfly fever virus belongs to the Genus Phlebovirus (family: Bunyaviridae) and is endemically found in areas of South Europe, Asia and Africa. In Germany, pappataci fever is only described in connection with travelling to endemic areas. We report on a 15 year-old girl suffering from sandfly fever virus infection after vacation in Turkey. The initial symptoms started with fever for about three days, frontal headache, nausea and arthralgia. After a short time of clinical improvement symptoms recurred and our patient entered hospital with signs of severe meningitis. Liquor analysis showed a lymphocytic meningitis. Due to multiple insect bites on her legs sandfly fever was suspected. Blood analysis confirmed an acute infection with sandfly virus Sicilian from which she completely recovered. ELISA and immunoblot analysis revealed an infection with sandfly virus serotype Sicilian, which was not encountered with meningitis so far. Our case report illustrates that due to increased tourism sandfly fever virus infection has to be considered as a cause of aseptic meningitis in travellers.