Treatment with E5 antiendotoxin antibody appears safe. It reduces mortality and enhances the resolution of organ failure among patients with gram-negative sepsis who are not in shock when treated.
Blastomycosis is a late and frequently fatal infectious complication in a few patients with AIDS. In these patients, overwhelming disseminated disease including involvement of the central nervous system is common, and it is associated with a high early mortality. Initial therapy with amphotericin B is appropriate in patients with AIDS and presumptive blastomycosis.
Achromobacter xylosoxidans was isolated from six patients. The organism causes opportunistic infections in patients who are compromised. A. xylosoxidans is a catalaseand oxidase-positive, motile, gram-negative rod that oxidizes xylose and glucose. The organism exists in a water environment and may be confused with Pseudomonas species. Unlike pseudomonas, achromobacter has peritrichous flagella. The clinical and laboratory characteristics of A. xylosoxidans are presented. Achromobacter xylosoxidans, an aerobic, nonfermentative, gram-negative rod, is rarely isolated from clinical material. The organism was initially characterized by Holmes et al. (3) and further studied and named by Yabuuchi and Ohyama (12). A. xylosoxidans can be confused with other nonfermentative, gram-negative rods, especially pseudomonas species, in clinical specimens so that its role as a significant pathogen may be underestimated. The purpose of this report is to describe our experience with A. xylosoxidans isolated from different body sites of six patients on seven occasions during the last three years. CASE REPORTS Case 1. A 69-year-old black male was admitted in July 1976 for generalized exfoliative dermatitis and bilateral otitis externa. Past history revealed treatment of the exfoliative dermatitis for 12 years with prednisone and a history of asthma and diabetes mellitus. During the patient's hospital stay, cultures from a purulent discharge from both ears grew A. xylosoxidans, Proteus mirabilis, and Staphylococcus aureus. The patient was treated with eardrops containing neosporin and was discharged after 1 week without evidence of an external otitis. Case 2. A 68-year-old black male was admitted in October 1976 with symptoms of a urinary tract infection that had lasted 5 months. Past history was significant for moderate alcohol in
Body fluids suspected of bacterial infection were cultured and examined for the presence of D-lactic acid, a specific bacterial metabolite. We examined 206 patients and 264 specimens. D-Lactic acid was found in concentrations of greater than or equal to 0.15 mM in 11 of 11 infected and 6 of 40 noninfected ascitic fluids, 6 of 6 infected and 4 of 33 noninfected pleural fluids, 4 of 4 infected and 0 of 13 noninfected synovial fluids, and 26 of 27 infected and 2 of 130 noninfected cerebrospinal fluids. The overall sensitivity was 79.7%, and the specificity was 99.5% when the D-lactic acid concentration was at least 0.15 mM. The most important clinical utility of the D-lactic acid measurement appears to be for patients with bacterial infection in various body compartments and in patients who have already received antimicrobial therapy. An elevation in D-lactic acid may indicate the presence of bacterial infection even when cultures are negative.
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