W. Edmund Farrar

Case Report: Bacteremia and Ecthyma Caused by Streptococcus Pyogenes in a Patient with Acquired Immunodeficiency Syndrome

Ecthyma is an ulcerated form of impetigo due to Streptococcus pyogenes, seen primarily in children with poor hygiene. The authors report a homosexual man with acquired immunodeficiency syndrome (AIDS) who developed severe ecthyma and bacteremia caused by S. pyogenes. Opsonizing antibody to the M protein of S. pyogenes is important in immunity to this organism. Patients with AIDS may have defective humoral immunity as well as defective cellular immunity, and such a defect may have rendered this patient abnormally susceptible to severe infection with S. pyogenes.

Hemorrhagic Cystitis and Ureteritis, and Interstitial Nephritis Associated with Administration of Penicilling

Hemorrhagic cystitis and ureteritis, and interstitial nephritis developed in a patient receiving penicillin G and streptomycin as therapy for bacterial endocarditis. After therapy was changed to vancomycin there was prompt resolution of these abnormalities.

Transferable Antibiotic Resistance Associated with an Outbreak of Shigellosis

Excerpt Shigellae resistant to multiple antibiotics were first encountered in Japan in 1955, shortly after the clinical use of streptomycin, tetracycline, and chloramphenicol became widespread in t...

Phaeohyphomycosis Due to Curvularia Lunata Involving Skin and Subcutaneous Tissue After an Explosion at a Chemical Plant

Cases of phaeohyphomycosis due to dematiaceous fungi have been reported in increasing numbers and diversity. The optimal roles of antifungal chemotherapy and surgical debridement in the management of these infections have not been determined. A case of acute cutaneous and subcutaneous phaeohyphomycosis due to Curvularia lunata after an explosion at a chemical plant is reported, in which the organisms may have been inoculated into the tissues by the force of the blast. No organisms were found by histopathologic examination or culture of excisional biopsy specimens taken 10 days after initiation of therapy with intravenous amphotericin B; the antifungal therapy may have eradicated the infection.

Case Report: Fatal Cardiac Tamponade in a Young Man with Group C Streptococcal Endocarditis

The case of a previously healthy man with endocarditis due to the group C streptococcus, complicated by myocardial abscess and fatal cardiac tamponade, is presented. Group C streptococcus is an unusual cause of endocarditis which tends to produce extensive valve destruction. Early surgery should be considered in patients with endocarditis caused by this organism.The case of a previously healthy man with endocarditis due to the group C streptococcus, complicated by myocardial abscess and fatal cardiac tamponade, is presented. Group C streptococcus is an unusual cause of endocarditis which tends to produce extensive valve destruction. Early surgery should be considered in patients with endocarditis caused by this organism.

Case Report: Thorn-Induced Phialophora parasitica Arthritis Treated Successfully with Synovectomy and Ketoconazole

A 30-year-old woman developed chronic arthritis of the left ankle 4 months after a penetrating injury due to a pyracantha thorn. Phialophora parasitica was isolated from synovial tissue and fluid and later from the plant that caused the injury. She was treated with synovectomy followed by oral ketoconazole for 6 months. Fourteen months after completion of therapy, she remains well.

Use of Penicillinase-Resistant Penicillins to Increase the Susceptibility of Gram-Negative Bacteria to Antibiotics

Excerpt Many gram-negative bacteria elaborate beta-lactamases capable of inactivating penicillin and related antibiotics (1-4). The presence of such enzymes appears to be an important factor in the...

Evolution among Antibiotic Resistance Plasmids in the Hospital Environment

Plasmid mediated resistance to antibiotics was first discovered about 25 years ago in Japan because of the unexpected appearance of multiple drug resistance during an outbreak of bacillary dysentery (1). Ever since this time the unexpected appearance of a new or unusual drug resistance marker or an unusual pattern of multiple drug resistance has been a clue that plasmids might be involved as carriers of the resistance genes, and in many cases the ‘epidemic strain’ of the pathogen involved in the outbreak has been found to contain one or more resistance plasmids. Spectacular examples of this are the extensive epidemic of bacillary dysentery due to Shigella dysenteriae Type I in Central America and southern Mexico during 1969–70, investigated by Mata, et al. (2) and the somewhat smaller but still dramatic epidemic of typhoid fever which occurred in and around Mexico City in 1972, investigated by Olarte et al. (3). In both instances the epidemic strain was found to contain a plasmid which conferred resistance to multiple antibiotics. On a smaller scale, many outbreaks of hospital-associated infection have been shown to be due to a particular strain of a gram-negative organism which contains one or more plasmids.

A Poisoned Tooth

Excerpt To the Editors:Human bite wounds are notoriously prone to the development of infection. The combination of trauma to tissues and deep inoculation of the abundant and varied microorganisms p...

Parzival's Pericardial Puncture

Excerpt According to Kotte and McGuire (1) aspiration of the pericardium was first performed in 1819 by Romero. But I believe the procedure was described at least 600 years earlier—inParzival, the ...