Wangiella dermatitidis endocarditis in an intravenous drug user.

Wangiella dermatitidis is an infrequently encountered dematiacious fungus that usually causes localized infections of the skin and subcutaneous tissues. This report presents the first well-documented case of natural valve infection caused by this organism as it occurred in intravenous drug abuser. His course has been complicated by relapsing infection of two aortic prostheses and dissemination to the vertebral spine. Treatment with a combination of amphotericin B, rifampin, and ketoconazole has arrested the progression of his infection. The microbiologic features and existing clinical information regarding this fungus are reviewed and in vitro susceptibility data for the present isolate are presented.

Intra-abdominal infections in the elderly: diagnosis and management.

With appendicitis, elderly patients commonly delay 2 or 3 days after symptoms begin before seeking medical attention, the patient often attributing the abdominal discomfort to indigestion, "gas," or constipation. Reduced gastric acidity secondary to gastric surgery, aging, or medications can increase susceptibility to many enteric pathogens, leading to a higher risk of infectious diarrhea.

Tricuspid valve group B streptococcal endocarditis following elective abortion.

Streptococcus agalactiae, a group B streptococcus, has been a well-known cause of postpartum and postabortion endocarditis since the preantibiotic era. Streptococcus agalactiae is capable of infecting normal valves and usually produces left-sided disease. We describe a 30-year-old woman who developed tricuspid valve endocarditis due to S. agalactiae. Excision of the valve and a 4-week course of therapy with vancomycin resulted in cure.

Bone cyst of a fishy origin: from an old catfish spine puncture wound to the foot.

A rare first metatarsal unicameral-type bone cyst with a deceptive radiographic appearance and size and an unusual pathological etiology was identified in a female patient. This eccentric cyst was observed only postoperatively by radiograph. Review of the patient's history documented a foot injury from a catfish spine as the etiology of this chronically inflamed cyst.

Novel plasmid-mediated beta-lactamase in members of the family Enterobacteriaceae from Ohio.

Epidemiologic studies of plasmid-mediated resistance at the Cleveland Veterans Administration Medical Center revealed that related plasmids had disseminated among members of the family Enterobacteriaceae. We studied the beta-lactamases encoded by these plasmids in Escherichia coli C600 transformants or transconjugants. Substrate and inhibition profiles of the enzymes determined by two of these plasmids suggested an activity resembling TEM-1; however, isoelectric focusing revealed a pI of 7.0. These two plasmids were originally found in a Serratia marcescens (pDS076) and an Enterobacter cloacae (pDS075) strain isolated from the same sink in the medical intensive care unit and later, in an Enterobacter cloacae (pDS142 identical to pDS076) isolate colonizing a patient in the same unit. The plasmids also carried the aminoglycoside resistance determinant, 2"-aminoglycoside nucleotidyl transferase. A 2-kilobase AvaI restriction endonuclease digestion fragment of pSD075 known to carry the beta-lactamase determinant was used as a molecular probe. This probe did not recognize sequences of any plasmid-mediated beta-lactamase tested including the recently described determinants ROB-1, TLE-1, and OXA-4-7. A TEM-1 probe derived from the 0.7-kilobase PstI-EcoRI fragment of pBR322 failed to recognize the new beta-lactamase gene. Four additional Enterobacter cloacae and two Enterobacter aerogenes strains isolated in Columbus, Ohio, have been shown to produce a pI 7.0 beta-lactamase and to carry plasmids recognized by the 2-kilobase probe. These data suggest dissemination of a novel plasmid-mediated beta-lactamase among members of the family Enterobacteriaceae in Ohio and demonstrate the development and utility of a molecular probe for the new determinant. We suggest that the novel beta-lactamase be named OHIO-1.