1/12. Intestinal toxemia botulism in two young people, caused by clostridium butyricum type E. Two unconnected cases of type E botulism involving a 19-year-old woman and a 9-year-old child are described. The hospital courses of their illness were similar and included initial acute abdominal pain accompanied by progressive neurological impairment. Both patients were suspected of having appendicitis and underwent laparotomy, during which voluminous Meckel's diverticula were resected. Unusual neurotoxigenic clostridium butyricum strains that produced botulinum-like toxin type E were isolated from the feces of the patients. These isolates were genotypically and phenotypically identical to other neurotoxigenic C. butyricum strains discovered in italy in 1985-1986. No cytotoxic activity of the strains that might explain the associated gastrointestinal symptoms was demonstrated. The clinical picture of the illness and the persistence of neurotoxigenic clostridia in the feces of these patients suggested a colonization of the large intestine, with in vivo toxin production. The possibility that Meckel's diverticulum may predispose to intestinal toxemia botulism may warrant further investigation. ( info) |
2/12. Alteration of colony-stimulating factor output, endotoxemia, and granulopoiesis in cyclic neutropenia. Cellular and humoral factors involved in the regulation of granulopoiesis were evaluated in two patients with cyclic neutropenia by utilizing the agar-gel marrow culture technique to serially study marrow granulocytic colony-forming capacity (CFC) and the urinary output of colony-stimulating factor (CSF). CSF output varied inversely with peripheral neutrophil counts and directly with monocyte counts and evidence for infection (endotoxemia and/or staphylococcal abscesses). Following autologous infusion of one patient's plasma obtained during a period of neutropenia, increased urinary excretion of CSF occurred concomitant with increments in both marrow CFC and the proportion of granulocytic progenitor cells in dna synthesis. Neutrophil periodicity was not altered by the administration of the neutropenic plasma. These findings are consistent with the hypothesis that cyclic neutropenia is caused by a quantitatively decreased entry of stem cells or granulocytic progenitor cells into granulopoiesis. ( info) |
3/12. The expression of surface tissue factor apoprotein by blood monocytes in the course of infections in early infancy. The expression of surface tissue factor procoagulant activity and its shedding by blood monocytes can be induced by several stimuli. Few of these defined situations, other than the presence of bacteria and their toxins, are commonly present in the young human infant. In this study, measurements were made of the percentage of monocytes expressing surface tissue factor apoprotein (TFA) in blood taken from babies in the early weeks of life. Mononuclear cells were separated from blood in an environment free of detectable endotoxin. After exposure to a polyclonal rabbit antibody raised to purified brain TFA and subsequent exposure to a fluorescin-labeled murine anti-rabbit IgG, the cell fluorescent activity was analyzed by flow cytometry. The percentage of monocytes showing strong fluorescence was determined. In every instance when systemic bacterial infection was present, more than 60% of the monocytes examined showed fluorescence indicative of the presence of surface TFA. In a single case of fungal candida septicemia, none of the monocytes was positive. More than 60% of cells were found to be positive in certain instances where infection was highly probable but not proven. Positive cells were found in three cases of isoimmune hemolytic disease of the newborn, as had been anticipated from previous studies, whereas less than 25% of monocytes derived from babies in the absence of discernible infection or isoimmune hemolytic disease expressed surface TFA (p less than 0.001). These findings provide insight into a possible mechanism of coagulation activation in sepsis and may prove to be a useful predictor of the presence of infection or endotoxemia in young infants. ( info) |
4/12. Postpartum amaurosis. blindness is a rare but dramatic complication of pregnancy and delivery. We present the case of a patient who developed toxemia at the time of delivery that with ineffective treatment resulted in cortical blindness without seizure activity. The pathogenesis as well as the diagnostic workup and treatment of this unusual complication are discussed. ( info) |
5/12. Acute spontaneous streptococcal myositis. Case report. Streptococcal myositis of the acute spontaneous type is extremely rare. To the best of our knowledge, this report describes the first case in which a patient has survived, and reviews the differential diagnosis. The treatment is primarily surgical. ( info) |
| Two patients are reported in whom severe toxicity developed about 4 days after relatively minor burn injuries and in whom the burn areas then appeared to enlarge. In both patients, B. cereus and Staph. aureus were isolated and the affected burn areas had subcutaneous thrombosis and necrosis. The management is outlined and the dramatic rapidity of onset of toxicity emphasized, with special reference to increasing pain, lividity and extension of the burns. ( info) |
| An autopsy case with endotoxemia-induced diffuse myelitis and extensive, grossly patchy necrosis of the liver occurring in a 70-year-old female was examined histopathologically and electron microscopically. Leucopenia with prominent leukemoid reaction (myeloblasts 20%) preceded the terminal fulminant hepatitis by two weeks. Soon after the terminal event, bacteremia and endotoxemia were detected and negativity for HB antigen was proved. Diffuse myelitis was characterized by devastation of hyperplastic bone marrow structure mottled with destructed sinus architecture and scattered exudative necrosis, resulting in the loss of mature granulocytes and erythropoiesis. Regenerative clusters of myeloblasts and prominent increase of megakaryocytes were observed. Electron microscopically, the bone marrow contained fibrin and platelets within the exudate of the marrow stroma. Extensive, grossly patchy necrosis of the liver microscopically consisted of well demarcated coagulation necrosis of hepatic parenchyma with scattered fibrin thrombi in the sinusoids at the boundary. There were no definite thrombi but occasional fibrin accumulation in the small blood vessels of the liver. Both extensive diffuse myelitis and extensive, patchy necrosis of the liver seemed to be quite rare in incidence. The pathogenesis of these combined lesions was discussed in relation with endotoxemia. ( info) |
8/12. Fournier's gangrene complicating perinal abscess: report of two cases. Two cases of Fournier's gangrene in which toxemia and gangrene of the scrotum developed due to perianal abscesses are described. Cultures of anaerobic gram-negative bacteroides with a mixed flora of pseudomonas, E. coli and proteus were obtained. early diagnosis, wide and deep incisions, debridement of the necrotic tissue, and adequate antibiotic therapy can prevent a fatal outcome of this disease. A high mortality rate is still prevalent. ( info) |
9/12. Fatal clostridial infection following hemorrhoidal banding. A case is described in which death followed banding of hemorrhoids. The clinical course was suggestive of overwhelming toxemia due to clostridia. ( info) |
10/12. How to deal with a rare entity: the coexistence of a complete mole and a healthy egg in a twin pregnancy? The association of a normal and a molar egg within a twin pregnancy is extremely rare. The key to diagnosis is the fetal karyotype, thus allowing elimination of its principal differential diagnosis: partial triploid mole. We report a case where the evolution of the pregnancy was complicated by severe toxemia. Interruption of pregnancy was then necessary, even though a conservative attitude had first been considered. Throughout this case, we discuss the means of diagnosis and the clinical handling of this rare entity. ( info) |