Malignant Mediterranean spotted fever. Report of a case with multiple organ failure, hypocalcemia, and euthyroid sick syndrome.

A patient with Mediterranean spotted fever presented an initial history of enteritis, pyrexia, and rash. He subsequently developed shock, multiple organ failure, thrombocytopenia, hypocalcemia with hypercalcitoninemia, and a euthyroid sick syndrome.

[Stomatococcus mucilaginosus meningitis in immunocompromised child]. / Méningite à Stomatococcus mucilaginosus chez un enfant immunodéprimé.

BACKGROUND: Opportunistic infections are responsible for significant morbidity and mortality in patients with malignancy developing granulocytopenia as a result of therapy. A case of Stomatococcus mucilaginosus meningitis is reported. CASE REPORT: A 2 year-old boy was admitted because he had developed fever and neutropenia during chemotherapy given for neuroectodermal tumor. He was previously treated for a Stomatococcus mucilaginosus septicemia with vancomycin given for 15 days through an intravenous catheter which has subsequently been left in place. At admission, fever was associated with severe degree of aplasia (70 WBC/mm3). The patient was given IV ceftazidime plus amikacin. Two days later, the boy developed acute meningitis due to Stomatococcus mucilaginosus; he was then given IV vancomycin (40 mg/kg/d) and imipenem (100 mg/kg/d). Persistence of abnormal clinical and bacteriological findings required subsequent intrathecal administration of vancomycin (1.5 mg/d) for 5 days. CSF cultures were negative 2 days later, leading to stop IV antibiotics after 3 weeks. The catheter was removed 1 week later. CONCLUSION: This patient represents the third reported case of Stomatococcus mucilaginosus meningitis. Combined intrathecal and systemic administration of vancomycin seems to have been useful in our case.

Bactericidal effect and regrowth of Streptococcus faecalis exposed to amoxicillin following beta-lactamase.

Streptococcus faecalis usually requires high concentrations of penicillin or ampicillin to achieve killing (i.e. a high MBC/MIC ratio). However, most strains show the Eagle or paradoxical effect. We subjected 12 strains of S. faecalis to 0.1, 1, 10 and 100 micrograms/ml of amoxicillin. Turbidometry studies have shown that 3 h after the inactivation of amoxicillin by penicillinase, there was a longer effect for 1 micrograms/ml following beta-lactamase (12 h 31 min +/- 2 h 09 min) than for 10 micrograms/ml (7 h 0 min +/- 1 h 12 min) or 100 micrograms/ml (5 h 22 min +/- 0 h 52 min). After 3 h, the reduction of CFU/ml (inoculum 10(6) CFU/ml) was -1.8 +/- 0.6 for 1 micrograms/ml, -0.56 +/- 0.56 for 10 micrograms/ml and -0.21 +/- 0.20 for 100 micrograms/ml. The more rapid killing at 3 h was not the only reason for the longer effect following beta-lactamase observed with 1 micrograms/ml. Indeed, the growth curve obtained with an inoculum of 10(3) CFU/ml was 2 h delayed from the control curve (10(6) CFU/ml). In conclusion, a paradoxical effect (killing curves and effect following beta-lactamase) was observed for all S. faecalis strains included in this series.

Fatty acid composition of Streptococcus milleri.

The cellular fatty acids of 31 strains belonging to the Streptococcus milleri group were analysed by capillary gas-liquid chromatography. Results were compared with findings from biochemical differentiation of the strains into Streptococcus constellatus (two strains), Streptococcus anginosus (16 strains) and Streptococcus intermedius (13 strains). Eight strains of various other streptococci were included as internal references, including three strains of streptococcus morbillorum, three strains of beta-hemolytic streptococci, and two strains of enterococci. The Streptococcus milleri strains formed a very homogeneous group according to fatty acid composition and were easily differentiated from other groups. However, within the group, it was not possible to differentiate Streptococcus constellatus, Streptococcus anginosus and Streptococcus intermedius by fatty acid composition alone.

Lung cancer-related changing profile of B-cell epitopes recognized on mucosal antigens: the Der p1 model.

BACKGROUND: The natural immunoglobulin G (IgG) response towards antigens presented at the mucosal level in patients with lung cancer, the most frequent mucosal malignancy in humans was studied. Compared with healthy control subjects, patients with lung cancer display lower IgG antibody titers toward antigen p1 of the house dust mite, Dermatophagoides pteronyssinus (Der p1), chronically presented to the respiratory mucosa. The present study further characterizes this defect in terms of antibody specificity. METHODS: Antibody specificity was studied by comparing the IgG binding to native Der p1 (nDer p1) and its products of pepsin hydrolysis (dDer p1) in a solid phase enzyme-linked immunosorbent assay (ELISA) in 148 patients with lung carcinoma, 148 healthy control subjects, and 50 patients with chronic bronchitis. Antibody specificity was also evaluated before and after (5 +/- 1 weeks) surgical excision of the tumor in competition ELISA using streptavidin-biotin technology. RESULTS: Lung cancer sera had a higher degree of binding to dDer p1 compared with nDer p1, whereas control group sera bound similarly to the two forms of the antigen. Lung cancer sera and control group sera showed distinct capacities to prevent the binding of pooled IgG from each group to nDer p1. The inhibition capacity displayed by cancer sera is changed 5 weeks after cancer removal. CONCLUSION: These results, somewhat similar to those observed for bovine betalactoglobulin, document the recognition of a different set of epitopes on Der p1 and more generally on mucosal antigens by lung cancer IgG compared with the IgG from control patients. This distinct profile of epitope specificity changes partially soon after cancer removal, suggesting a tumor-dependent disturbance and opens the way to a new class of markers in lung cancer. Furthermore, this study documents a surprising but striking influence of the clinical status on the choice of B-cell immunodominant epitopes in mucosal responses.