Acalculous Cholecystitis Associated withPlasmodium falciparumInfection

Abstract

characteristic yellow colonies, which were the only type of organism identified. Cultures were negative for Salmonella, Shigella, Campylobacter, and Escherichia coli O157:H7.Antimicrobial susceptibility testing for the isolate revealed susceptibility to aminoglycosides, fluoroquinolones, trimethoprimsulfamethoxazole, and tetracycline and resistance only to ampicillin. The patient was treated with a single 1-g oral dose of ciprofloxacin and subsequently reported complete resolution of his diarrhea.V. alginolyticus has only rarely been associated with acute diarrheal illness [2][3][4][5][6][7][8]. In the seven studies, a total of 15 cases of diarrhea due to V. alginolyticus were reported from 1980 to 1995. In four of these 15 cases, another enteric pathogen along with V. alginolyticus, including Campylobacter, Shigella, E. coli, and Vibrio parahaemolyticus, was isolated, suggesting that V. alginolyticus may not have even been the causal agent in these cases [5][6][7]. In an additional eight cases, it was not specified whether V. alginolyticus was the sole organism recovered [3, 4]. Only three prior cases clearly demonstrate pure isolation of V. alginolyticus from a patient with acute diarrhea [2,6,8]. Chronic diarrhea was not described in any of the 15 cases. A MEDLINE search of the English-language literature from 1966 to 1999 revealed no reports of chronic diarrhea associated with V. alginolyticus.Our case is also of interest because it involved a homosexual man who was immunocompromised secondary to AIDS. This situation raises the question of whether patients with AIDS or homosexual males are at increased risk of developing V. alginolyticus infections. An AIDSLINE search of the English-language literature from 1980 to 1999 revealed no other case reports of such infections. There have, however, been several case reports of gastroenteritis caused by other Vibrio species in patients with AIDS. One report described acute diarrhea caused by Vibrio fluvialis in a man with AIDS [9], and another discussed a case of sepsis, peritonitis, and gastroenteritis in a homosexual man with AIDS that was found to be caused by Vibrio vulnificus [10]. In both of these cases, the patients had eaten seafood (scallops and raw oysters, respectively) prior to symptom onset, suggesting that the infections were food-borne.In conclusion, we report what we believe to be the first case of chronic diarrhea associated with V. alginolyticus, thereby suggesting that this organism may be a cause of chronic diarrhea in immunocompromised hosts.

Reply to Dr. Sanchez et al. (Clin Infect Dis 2000; 31:622-3)

“…Demonstration of the malaria infection occurred only after the AC had resolved. This clearly contrasts with the case that Dr. Al-Azragi and I reported [2], in which the patient failed to respond to broad-spectrum antibiotics and in which no bacterial pathogen was isolated from the blood cultures. Clinical and radiological resolution occurred only after administration of specific therapy for P. falciparum.…”

“…There are important differences between their case and the one that Dr. Al-Azragi and I reported [2]. In the case reported by Sánchez et al [1], the results of multiple smears for malaria parasites were negative at the time of presentation of AC.…”

“…It has been reported elsewhere [2] that other agents (sparfloxacin, grepafloxacin, erythromycin, and clarithromycin) have prolonged QT in either animals or hu-…”

“…Sir-During the year 2000, Hooper [1] and Ball [2] reviewed the adverse drug reaction (ADR) profiles of the quinolone class antimicrobial agents. Within the last year, 2 quinolones have been recognized to produce either unacceptable hepatotoxicity (trovafloxacin) or cardiotoxicity (grepafloxacin) and have had their use restricted or have been withdrawn.…”

Acalculous cholecystitis occurring in the context of Plasmodium malariae infection: a case report

“…Since the first reported case in 1999 [5] there have been 25 reported cases of AAC occurring in the context of malaria: 19 associated with P. falciparum infections; three associated with P. vivax (two in adults and one in a child), two cases involving a mixed infection with P. vivax and P. falciparum and our case associated with P. malariae infection as detailed above.…”