Systemic infection of an immunocompromised patient with Methylobacterium zatmanii.

We describe the identification of Methylobacterium zatmanii as the causative agent of bacteremia and fever in an immunocompromised patient. The patient, a 60-year-old man, had a 5-month history of acute myeloid leukemia and had been on chemotherapy throughout this period. Seven days after the onset of neutropenia, the patient developed fever. The combination of ciprofloxacin, co-trimoxazole, imipenem, amikacin, and vancomycin led to a complete defervescence. On subculture from six positive blood cultures, the organism grew only on buffered charcoal yeast extract agar and not on standard agars. Identification by universal PCR and subsequent sequence analysis of the amplified 16S rRNA gene segment was achieved. This identification by molecular biology techniques was confirmed by conventional biochemical tests. To our knowledge, this is the first description of M. zatmanii isolated from patient material.

Typing of Nocardia farcinica by pulsed-field gel electrophoresis reveals an endemic strain as source of hospital infections.

Severe postoperative wound infections caused by Nocardia farcinica were repeatedly observed in a German hospital surgical ward. A pulsed-field gel electrophoresis (PFGE) protocol was established to characterize the genetic relatedness of the bacterial isolates from these infections. All 18 isolates from postoperative infections that have occurred since 1985 belong to a common endemic genotype; organisms of this genotype were also detected in the air of two rooms of the department where these postoperative infections occurred. In contrast, two environmental isolates from another building on the same campus showed a distinct genotype. Three cases of pulmonary infections, at a department which is located in proximity to the surgical department, were also caused by the endemic type, which suggests aerogenic spread of the endemic strain to these patients. Controls consisting of epidemiologically unrelated isolates from sporadic infections in other towns belonged in each case to a different genotype. PFGE was well suited to differentiate various types of N. farcinica and revealed an endemic strain causing postoperative wound infections possibly after aerogenic transmission.

[Pulmonary nocardiosis]. / Pulmonale Nocardiose.

The radiological appearances and pulmonary changes during the acute stage and after recovery from pulmonary nocardiosis are described on the basis of 10 confirmed cases. Amongst the 10 patients there were 3 with malignant disease, 1 patient with AIDS, 3 patients following organ transplantation and 3 patients on steroids. In one patient cerebral involvement was demonstrated by MRI.

[Taenia crassiceps infection in AIDS]. / Taenia-crassiceps-Infektion bei AIDS.

A 33-year-old patient with AIDS, and a history of episodes of Pneumocystis carinii pneumonia and cerebral toxoplasmosis, developed a subcutaneous paravertebral infiltrate, which at first resembled a haematoma. Over a period of several weeks, the lesion spread to cover almost the entire back. Initially, numerous investigations failed to reveal the aetiology. His general condition worsened progressively, and intermittent bleeding into the soft tissue of the back occurred, requiring transfusion. This was associated with the development of an isolated deficiency of clotting factor V and a fall in Quick values to 10%. On the 22nd day after admission, the infiltrate ruptured spontaneously, releasing blood and a large number of whitish spherical masses 2-3 mm in diameter. These were identified as Cysticerci longicolles, the larval form of Taenia crassiceps, a tapeworm occurring in Canidae. The blood clotting values returned to normal within two days of incision of the infiltrate and commencement of therapy with mebendazole (6 g/day) and praziquantel (3.6 g/day). The infiltrate subsequently regressed almost completely. After combination treatment for 2 weeks, treatment was continued with praziquantel alone, which, however, the patient stopped himself after 10 weeks. A recurrence at the same site 4 months later was successfully treated with a further course of mebendazole and praziquantel.

Nocardial endocarditis after aortic valve replacement. Reports of two cases.

Nocardial sepsis occurred after aortic valve replacement in two patients. A septic suture aneurysm of the aortotomy was resected and the prosthesis exchanged in one of them. The other received conservative treatment for sternal osteomyelitis and local mediastinitis. Clinical cure was followed by relapse and death from cerebral infarction, and necropsy revealed a septic suture aneurysm of the aortotomy. Radical surgical revision seems to be necessary for lasting cure in such infections.

[Septicemia caused by enteritis due to Campylobacter fetus subspecies fetus]. / Septikämie durch Campylobacter fetus subspecies fetus bei Enteritis.

In a 55 year old man with renal insufficiency requiring hemodialysis after bilateral nephrectomy who had been hospitalized with febrile illness and enteritis, Campylobacter fetus subspecies fetus could be isolated from the blood and feces. Antibodies against the homologous strain (isolated from the blood) could be detected in the serum by means of the Widal test and the indirect immunofluorescence test. Culturing of Campylobacter fetus subspecies fetus (especially from blood cultures) may be difficult because of the poor growth conditions for microaerophilic bacteria. It is quite possible that this organism occurs more frequently in blood and feces than suggested by the routine investigations carried out so far.