Aspergillus osteomyelitis in an immunocompetent adolescent: a case report and review of the literature.

A black male adolescent with intact cellular and humoral immunity developed Aspergillus flavus-caused osteomyelitis involving the right tibial epiphysis following penetrating injury to that area. There was an apparent cure following amphotericin B therapy for six weeks. The clinical, pathologic, and therapeutic features of this case are described and compared with those in previously published cases. This case report represents the first well documented case of Aspergillus osteomyelitis in an immunocompetent host. The increasing incidence of invasive disease due to Aspergillus species and the increased awareness of the incidence of mycotic bone infections, particularly in pediatric patients, may allow further definition of pathogenesis and appropriate therapy.

Participation of complement in host defense against encapsulated Haemophilus influenzae types a, c, and d.

Each of the serotypes of Haemophilus influenzae (types a to f) may colonize the respiratory tract of humans, but only type b strains commonly cause invasive systemic infections. To investigate the role of complement in immunity to encapsulated non-type b strains, rats were depleted of C3 with cobra venom factor and challenged with representative serotypes of H. influenzae (type a, b, c, or d) by different routes. After intravenous challenge, rats depleted of C3 had a greater incidence and magnitude of bacteremia with each of the serotypes when compared with normal controls. Intraperitoneal inoculation of type b organisms resulted in meningitis in normal and C3-depleted rats, but only C3-depleted, and not normal, rats developed meningitis after inoculation of serotype a, c, or d. In contrast to systemic inoculation, intranasal challenge with the different serotypes resulted in bloodstream invasion and meningitis only after challenge with type b organisms. These data suggest that complement plays a significant role in immunity to encapsulated, non-type b H. influenzae through its effect on bloodstream clearance.

C-reactive protein in spinal fluid of children with meningitis.

We have evaluated a commercially available latex agglutination system for the detection of C-reactive protein in CSF by a prospective study of 56 patients with CSF pleocytosis. On initial lumbar puncture, C-RP was detected in 100% (24/24) of patients with culture-proven bacterial meningitis, compared to 6% (2/32) of patients in the nonbacterial group (chi 2 c = 44.8, P less than 0.0001). C-RP in CSF had a sensitivity of 1.0 and a specificity of 0.94 for detecting culture-positive, bacterial meningitis. It was a more sensitive test for differentiating bacterial from nonbacterial meningitis on initial CSF examination than was the number of CSF leukocytes, the absolute number of CSF polymorphonuclear leukocytes, CSF glucose concentration, CSF protein concentration, or Gram staining of CSF. Detection of C-RP by latex agglutination may prove to be a practical and reliable method for differentiating bacterial from nonbacterial meningitis.