Disseminated Nocardia caviae infection.

Disseminated Nocardia caviae infection occurs only rarely. To date, two cases have been recorded in the literature. We describe a third case of systemic N. caviae infection in a compromised host and compare it with the first two cases. Postmortem, microbiologic and antibiotic sensitivity data are included.

A method for determining in-vitro drug susceptibilities of some Nocardiae and Actinomadurae: results with 17 antimicrobial agents.

A simple timesaving method for determining drug susceptibilities in vitro of isolates of Nocardia and Actinomadura is reported. An isolate is considered "susceptible" when the quantity of drug required for inhibition of growth is that concentration which might be obtained in serum by conventional therapy. Sulfonamides remain the drugs of choice for treating disease due to Nocardia species. Although doxycycline and minocycline appear to be very effective against Nocardia species, susceptibility testing may be desirable when a physician is considering substitution of an antibiotic for a sulfonamide. Susceptibility testing also may be desired before a drug is selected for treating disease due to Actinomadura madurae.

Primary cutaneous coccidioidomycosis: a review of the literature and a report of a new case.

A 31-year-old woman working in the laboratory with the mycelial phase of Coccidioides immitis developed a firm, raised, erythematous lesion on the left index finger. A biopsy specimen of the lesion grew a white mold that proved to be C immitis. A sinus tract communicating with the lesion and extending into the proximal phalanx developed. The expressed pus was positive for the tissue form of C immitis by potassium hydroxide and periodic acid-Schiff stains and fluorescent-antibody techniques. The sinus tract was irrigated with an aqueous solution of amphotericin B (Fungizone). The tract closed and the lesion decreased in size. Healing was completed in ten weeks. Primary cutaneous disease must be distinguished from disseminated disease with cutaneous manifestations. In the majority of cases, primary disease heals spontaneously whereas disseminated disease usually requires systemic treatment with amphotericin B.

Traumatic pneumomediastinum resulting from facial trauma.

Pneumomediastinum is an uncommon complication of blunt or penetrating trauma to the head, neck, thorax, or abdomen. Air in the mediastinum can indicate a serious penetrating injury but may also represent a benign finding associated with relatively insignificant neck or facial trauma. We present a case demonstrating the correlation between facial trauma and pneumomediastinum. Echocardiographic and phonocardiographic data are offered as adjuncts in the diagnosis, and were utilized by us. Treatment is directed toward the factors responsible for leakage of air. Only in the rare instance of tension pneumomediastinum are invasive procedures warranted. Our patient, who was treated only with antibiotics, improved.

The recognition of infective endocarditis.

Patients with infective endocarditis are frequently first evaluated in an emergency department at a time when clinical data are insufficient for a conclusive diagnosis. The records of 22 patients with proven bacterial endocarditis first seen in our emergency department were reviewed. The most common feature of the initial history was the presence of fever in 11 (50%). The most common physical finding was a heart murmur in 18 (82%). All patients had positive blood cultures. The most frequently isolated organism was Staphylococcus aureus. Pertinent clinical and laboratory data available on admission that enabled the emergency physician to suspect infective endocarditis were systemic manifestations of fever, malaise and arthralgias together with anemia, leukocytosis and hematuria.

Acute nontraumatic cardiac tamponade.

A 33-year-old man presented with acute nontraumatic cardiac tamponade as a result of pneumococcal pericarditis in association with pneumococcal pneumonia. Hypotension, tachycardia and pulsus paradoxicus, 50 mm Hg, were present. Echocardiographic findings were compatible with cardiac tamponade. Pericardiocentesis was performed. Acute nontraumatic pericardial tamponade in the emergency department presents special problems of diagnosis and management. Diagnosis is based on correlation of data from the history, physical examination, electrocardiogram, chest x-ray films, and a high index of suspicion. Echocardiography to confirm the diagnosis of tamponade and aid in correct placement of the needle in pericardiocentesis is especially helpful.