Acute cholestatic hepatitis revealing Mycoplasma pneumoniae infection without lung involvement in an adult patient.

Liver involvement is an unusual manifestation of Mycoplasma pneumoniae infection. Cases of cholestatic hepatitis without pulmonary involvement have been described in children with M. pneumoniae infection but only two cases of cytolytic hepatitis have been reported in adults. We report here the case of an 18-year-old woman who presented with febrile epigastric pain of short duration associated with an elevation of gamma-glutamyl transpeptidase and alkaline phosphatase levels and with a mononuclear syndrome. Serological tests for M. pneumoniae were positive for IgG and IgM. Clinical symptoms and blood test perturbations completely resolved after treatment with macrolide.

[Two cases of severe community-acquired pleural pneumonia due to Streptococcus pyogenes]. / Deux cas de pleuro-pneumopathies communautaires graves à Streptococcus pyogenes.

INTRODUCTION: The microorganisms incriminated in severe community-acquired pneumonia hospitalized in intensive care unit are the following: Streptococcus pneumoniae, enterobacteria isolated in aspiration-related pneumonia and less frequently intracellular bacteria in so-called atypical pneumonia (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila). CASE REPORTS: We report two cases of severe community-acquired pneumonia admitted in intensive care unit and due to Lancefield Group A beta hemolytic streptococcus (Streptococcus pyogenes). Despite the increased incidence of invasive streptococcal infections, this microorganism still has a rare causative role in the pathogenesis of community-acquired pneumonia. The case reports concern two young patients without any significant medical history and with many clinical, radiological and microbiological similarities. However, the prognosis was not the same because of the way the initial management has been provided. DISCUSSION: Group A beta hemolytic streptococcus could be a causative microorganism of severe and possibly fulminating community-acquired pneumonia, even in young and healthy patients as is the case with pneumococcal infections. Medical history, clinical symptoms and radiological signs should be taken into account to evoke the diagnosis and to initiate antibiotherapy early, taking into account that this microorganism is sensitive to Penicillin G.

Seven cases of fungemia with Saccharomyces boulardii in critically ill patients.

Saccharomyces boulardii (Sb) is a particular strain of Saccharomyces cerevisiae (Sc). This viable yeast is used in intensive care adult patients, delivered in packets of 500 mg, for preventing diarrhea associated with antibiotics or enteral feeding at a regimen of 1-2 g/day. Between June 1996 and October 1998, seven cases of fungemia with Sb occurred in a 12-bed intensive care unit (ICU). All the patients concerned were severely ill patients, mechanically ventilated, treated by broad spectrum antibiotics with central venous catheter and were pretreated with Sb, except for one patient. In this study, Sb was identified by specific mycologic methods and confirmed the genomic identity between isolates of blood culture and yeasts from the treatment packets, contrary to a few other reports concerning Saccharomyces species published in international literature. The hypothesis discussed for explaining these cases of Sb fungemia are: (1) an intestinal translocation of Sb administered at a high dosage in severely ill patients, (2) a contamination of the central venous catheter, especially in the patient not pretreated with Sb and (3) a massive colonization of critically ill patients by the yeast as has been reported for Candida species. We note that cases of fungemia with Sc and Sb have become more and more frequent in the international literature during the last 10 years and we do not recommend administering Sb treatment in critically ill patients.