Edward J. Bottone

Fulminant and fatal gas gangrene of the stomach in a healthy live liver donor

A 57‐year‐old male with a history of hypercholesterolemia and anxiety but otherwise in good health volunteered to donate the right lobe of his liver to his brother. The operation was performed uneventfully, without transfusion. Postoperatively he did well, until he developed tachycardia, profound hypotension, and coffee ground emesis on postoperative day 3. Despite resuscitative measures, he arrested and expired. Autopsy demonstrated gas gangrene of the stomach as the underlying cause of the hemorrhage and numerous colonies of Gram‐positive bacilli were identified. Subsequent polymerase chain reaction (PCR) analysis identified these bacteria to be Clostridium perfringens (C. perfringens) type D. This patients death was devastating, both to his family and his medical team. The impact of his death has transcended that of an individual occurrence. In conclusion, herein we present the facts and discuss this extraordinary example of florid clostridial infection and toxin‐mediated shock. It was completely unexpected and probably unpreventable, and its cause was almost inconceivable. (Liver Transpl 2004;10:1315–1319.)

The incidence and outcome of asymptomatic herpes simplex genitalis in an obstetric population

In a prospective study of an obstetric population, 28 of 488 (4%) routine asymptomatic patients had positive cultures for herpes simplex virus from their genital tract. Cesarean section was carried out if the virus was present in the genital tract at the time of delivery. In one instance, a culture which had reverted to negative became positive again. No cases of neonatal herpes were reported in the time of the study. As yet, the infectivity of these subclinical cases is unclear, and the incidence of neonatal herpes is not as high as would be expected from the study. Further studies need to be carried out to evaluate the exact risk of the asymptomatic herpesvirus shedder to the infant at birth.

Unsuspected Toxoplasma gondii Empyema in a Bone Marrow Transplant Recipient

Toxoplasma gondii is an opportunistic parasite that can cause severe disease in immunosuppressed individuals. We report a case of unsuspected T. gondii empyema in a bone marrow transplant recipient that was diagnosed by the visualization of numerous intracellular and extracellular tachyzoites in Giemsa- and Gram-stained smears. The patient was treated with pyrimethamine, sulfadiazine, clindamycin, and atovaquone, and she survived 110 days after diagnosis, despite having a large parasite burden.

Disseminated histoplasmosis presenting as AIDS cholangiopathy

Histoplasma capsulatum is a common opportunistic pathogen that often causes disseminated infection among AIDS patients from endemic areas. Virtually any organ system can be affected, but biliary involvement has not been described. We report the first case of AIDS cholangiopathy associated with H. capsulatum.

Amebiasis: Clinical and Laboratory Perspectives

Entamoeba histolytica, the premier intestinal protozoan, has traversed time in its relentless quest for survival in its dichotomous role of parasite and pathogen. Enigmatic in its transition from human intestinal commensal to invader of human tissue, diverse in its pathogenicity for the human host, and intricate in its bacterial interrelationship in the bowel, E. histolytica has become the focal point of intensive investigation in its basic biology underscoring human pathogenicity. This review will focus on facets of cell biology, pathophysiology, clinical, therapeutic, and epidemiologic, correlates, along with diagnostic modalities and future research trends.

Status of Immunity of Newborns Against Yersinia enterocolitica: A Preliminary Report

Out of 221 cord blood specimens assayed by whole cell agglutination for antibodies against Y. enterocolitica serogroup 0:3, 0:5,27, and 0:8, only four showed agglutinins despite the high percentage (33%) of agglutinating antibodies in 151 sera of pregnant women, ranging in titer from 4 to 32. Of 199 different cord sera tested, 25% to 28% showed low-level antibodies against erythrocytes treated with individual heat-extracts from Y. enterocolitica 0:3, 0:5,27, and 0:8. These sera equally agglutinated erythrocytes sensitized with the heat-extract of a randomly selected Escherichia coli strain. Conversely, when anti-yersinia hemagglutinins were absent in cord sera, concomitant cross-reactivity with E. coli was also absent. None of the 199 cord sera with a HA titer ≥4 were reactive by whole cell agglutination. Under the test conditions used, CEA (common enterobacterial antigen) could be the main antigenic component to which the Y. enterocolitica hemagglutinins were directed. Nine of the reactive sera from pregnant women were treated with staphylococcal protein A with resultant loss of reactivity. Transplacentally acquired antibody directed primarily against the CEA antigen of Y. enterocolitica may protect the newborn against Y. enterocolitica infection.

Cutaneous Herpes Simplex Virus Infection in a Child With Acquired Immunodeficiency Syndrome

Infections with herpes simplex virus (HSV) are common in children with human immunodeficiency virus (HIV) infection and can be severe and atypical.1 Herein, we report a case of a progressive wound of the hand associated with HSV type 1 in a child with the acquired immunodeficiency syndrome (AIDS).