Rapidly fatal Haemophilus influenzae serotype f sepsis in a healthy child.

A previously healthy 4-year-old child became acutely ill with vomiting and low-grade fever. The following day she suddenly became limp and unresponsive. She experienced acute septic shock and despite aggressive treatment died. Blood cultures grew ampicillin-resistant Haemophilus influenzae type f. There was no evidence of bacterial pneumonia or meningitis. To our knowledge, this represents the first case of fatal H. influenzae type f sepsis in a child without an identifiable focus or underlying predisposing condition. Despite the overwhelming success of the H. influenzae type b vaccine, physicians need to be aware of the potential for severe and fatal H. influenzae infections other than type b.

Physiological aspects of disinfection resistance in Pseudomonas cepacia.

A Pseudomonas cepacia population was isolated which had reduced susceptibility to iodine and maintained resistance when subcultured several times in phosphate buffer. This population was also resistant to iodine after growth in a minimal medium containing glycerol but not glucose. Addition of cAMP to glucose-grown cells caused increased resistance to iodine. Iodine-resistant cultures also demonstrated reduced susceptibility to chlorination but not to heat or metals (Cu/Ag). The results indicate that halogen resistance can be expressed in varying degrees, dependent on the carbon source, and cAMP may promote this expression. Thus, a catabolite repression-like mechanism may cause resistant cultures grown in some media to become more sensitive to halogens.

Optimization of dialysate flow and mass transfer during automated peritoneal dialysis.

The purpose of this study was to evaluate the effect of patient position on the mass transfer area coefficient (KoA) and to characterize drain/fill profiles in an effort to enhance efficiency of automated peritoneal dialysis. Over 100 exchanges were performed in 38 stable peritoneal dialysis patients to either determine the small solute KoA in the supine versus upright position or to characterize fill/drain profiles. The KoA for all solutes tested was significantly greater in the supine position compared with the upright position (P < 0.05). Fill profiles revealed the fill rate to be a function of fill height (P < 0.001) and patient position (supine > upright [P < 0.001]). Analysis of drain flow rate versus time revealed an initial segment of high outflow (350 +/- 89 mL/min) followed by an abrupt transition to a segment characterized by slow drainage (36 +/- 21 mL/min). The first segment of drain only took 5.6 +/- 2.3 minutes (42% of the total drain time); in that time, 83% +/- 10% of the dialysate was drained. The transition volume (volume of dialysate remaining at the time the transition occurs, excluding residual volume) correlated with body surface area (R = 0.52, P < 0.01). In conclusion, automated peritoneal dialysis treatment (including intermittent peritoneal dialysis, which may be done in the upright position) should be done in the supine position to optimize the KoA, and shortening drain time to include only the initial segment of high outflow will improve the efficiency and convenience of therapy.

Enumeration of Enterobacter cloacae after chloramine exposure.

Growth of Enterobacter cloacae on various media was compared after disinfection. This was done to examine the effects of monochloramine and chlorine on the enumeration of coliforms. The media used were TLY (nonselective; 5.5% tryptic soy broth, 0.3% yeast extract, 1.0% lactose, and 1.5% Bacto-Agar), m-T7 (selective; developed to recover injured coliforms), m-Endo (selective; contains sodium sulfite), TLYS (TLY with sodium sulfite), and m-T7S (m-T7 with sodium sulfite). Sodium sulfite in any medium improved the recovery of chloramine-treated E. cloacae. However, sodium sulfite in TLYS and m-T7S did not significantly improve the detection of chlorine-treated E. cloacae, and m-Endo was the least effective medium for recovering chlorinated bacteria. Differences in recovery of chlorine- and chloramine-treated E. cloacae are consistent with mechanistic differences between the disinfectants.