Salmonella bacteremia as manifestation of acquired immunodeficiency syndrome.

Multiple opportunistic infections are characteristic of the acquired immunodeficiency syndrome (AIDS). Although bacterial pathogens have presented few problems, we have noted an emerging problem with salmonellal infection among patients with AIDS. A review of all stool and blood cultures from adults between January 1982 and July 1984 showed that 80 stool cultures were positive for Salmonella species; serogroup B was the most common isolated. Eight (10%) were isolated from patients with AIDS. Nineteen blood cultures were positive for Salmonella species. Six (32%) were isolated from patients with AIDS: three were positive for Salmonella serogroup B; two yielded Salmonella choleraesuis; and one yielded Salmonella serogroup D. In three (50%), Salmonella bacteremia was a presenting manifestation of AIDS. Bacteremias were recurrent in five patients. Thus, it appears that AIDS not only predisposes patients to serious salmonellal infections but also compromises their ability to eradicate these bacteria.

The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection.

We present 2 cases of the Lemierre syndrome (also called postanginal septicemia), along with 36 other cases from a review of recent literature. A review of the literature during the preantibiotic era is also included. This disease is caused by an acute oropharyngeal infection with secondary thrombophlebitis of the internal jugular vein complicated by multiple metastatic infection. The majority of cases are caused by anaerobic gram-negative organisms, most frequently Fusobacterium necrophorum. An enhanced computed tomographic scan of the neck is the technique of choice to demonstrate the thrombosis of the internal jugular vein. Prolonged intravenous administration of antimicrobial agents known to have a good antianaerobic coverage, along with drainage of purulent collections, will usually be successful in the overwhelming majority of patients.

Infective endocarditis caused by Neisseria flavescens.

Neisseria flavescens is a rare cause of human disease. This is the first reported case of endocarditis caused by N. flavescens. The organism produced beta-lactamase, and penicillin therapy failed to cure the infection. Therapy with cefotaxime, to which the organism was highly sensitive, led to a complete and uneventful recovery.

Myocardial abscess in a patient with AIDS-related complex: pericardial patch repair.

A hemophiliac with acquired immunodeficiency syndrome-related complex was seen with sepsis related to a ventricular septal abscess. The abscess was debrided and the septum was patched with a single layer of autologous pericardium. The patient recovered and survived 6 months before dying of acquired immunodeficiency syndrome. At autopsy, the septal patch was well healed with no evidence of recurrent endocarditis.

Infective endocarditis due to Eikenella corrodens: Case report and review of the literature.

Eikenella corrodens is an uncommon cause of bacterial endocarditis. In the 11 reported cases in the literature, the disease was associated with predisposing factors and was clinically indolent or subacute. A case is reported which in contrast to the reported literature was acute in onset with severe heart failure, requiring urgent valve replacement.

Use of an oxacillin disk screening test for detection of penicillin- and ceftriaxone-resistant pneumococci.

In a context of worldwide emergence of resistance among Streptococcus pneumoniae strains, early detection of strains with decreased susceptibility to beta-lactam antibiotics is important for clinicians. If the 1-microgram oxacillin disk diffusion test is used as described by the National Committee for Clinical Laboratory Standards, no interpretation is available for strains showing zone sizes of /=2.0 microgram/ml) to penicillin. For ceftriaxone, among 98 strains with no zone of inhibition in response to oxacillin, 68 had intermediate resistance (MIC, 1.0 microgram/ml), and 22 were resistant (MIC, >/=2.0 microgram/ml). To optimize the use of the disk diffusion method, we propose that the absence of a zone of inhibition around the 1-microgram oxacillin disk be regarded as an indicator of nonsusceptibility to penicillin and ceftriaxone and recommend that such strains be reported as nonsusceptible to these antimicrobial agents, pending the results of a MIC quantitation method.

Treatment of complicated urinary tract infections with lomefloxacin compared with that with trimethoprim-sulfamethoxazole.

The efficacy of lomefloxacin given at 400 mg once daily for 14 days compared with that of trimethoprim-sulfamethoxazole at 160 and 800 mg, respectively, given twice daily for 14 days in the treatment of symptomatic complicated urinary tract infections was studied in a prospective, randomized, single-blind multicenter study. A total of 133 subjects presenting with signs and symptoms of urinary tract infection and an underlying abnormality consistent with complicated urinary tract infection were enrolled in the study. Bacteriologic cure was significantly better in 68 subjects randomized to lomefloxacin than in 65 subjects randomized to trimethoprim-sulfamethoxazole at short-term follow-up (88 versus 52%; 95% confidence intervals [CIs] 77 and 94% and 39 and 65%, respectively) this difference was no longer significant at long-term follow-up (64 versus 47%; CIs, 52 and 75% and 32 and 57%, respectively). Clinical outcomes were similar for both therapeutic regimens at short- and long-term follow-ups. The organisms that infected the subjects pretherapy were more frequently resistant to trimethoprim-sulfamethoxazole, and drug therapy was discontinued more frequently in subjects treated with trimethoprim-sulfamethoxazole because of adverse antimicrobial effects. In secondary analyses, outcomes did not differ with age or underlying genitourinary abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)