Urethritis caused by Neisseria meningitidis in heterosexual patients is presumed to occur via orogenital contact, but confirmation has not been possible in most cases. Presented here is a case of urethritis caused by N. meningitidis, serogroup C, and the isolation of the same microorganism from the nasopharynx and endocervix of the patient's sexual partner. The similarity of the urethral and nasopharyngeal isolates electrophoretic patterns, obtained using pulsed-field gel electrophoresis, proves the infection was transmitted via orogenital contact.

The usefulness of single-enzyme amplified-fragment length polymorphism (AFLP) analysis for the subtyping of Mycobacterium kansasii type I isolates was evaluated. This simplified technique classified 253 type I strains into 12 distinct clusters. The discriminating power of this technique was high, and the technique easily distinguished between the epidemiologically unrelated control strains and our clinical isolates. Overall, the technique was relatively rapid and technically simple, yet it gave reproducible and discriminatory results. This technique provides a powerful typing tool which may be helpful in solving many questions concerning the reservoirs, pathogenicities, and modes of transmission of these isolates.

BACKGROUND:A retrospective study was performed to know the clinical and microbiologic aspects of community-acquired pneumococcal pneumonia in adult patients admitted to a general hospital from 1990-1992. METHODS AND RESULTS:The medical records of 55 patients, aged 20-86 years (man age: 58 year) were reviewed. Streptococcus pneumoniae was isolated from blood in 45 cases (81.8%), transparietal lung puncture in 5 (9.1%), pleural fluid 3 (5.5%) and protected specimen brushing (> 1,000 UFC/ml) in 2 (3.6%) Most isolated (80%) were sensitive to penicillin (CIM < 0.1 microgram/ml); intermediate (CIM > or = 0.1 microgram/ml) 9 (16.4%) and resistant (> 1 microgram/ml) 2 (3.6%). Underlying diseases were present in 39 (70.9%) cases. All patients received empiric treatment with one or more antibiotics effective against Streptococcus pneumoniae. Only in 2 of the 9 cases treated with erythromycin the microorganism was resistant to this drug. Eleven patients died (20%), 5 died before to the fifth day of admission. Mortality was influenced by involvement of 2 or more lobes and immunosuppression (p < 0.05). CONCLUSIONS:This study suggests that 80% of the community-acquired pneumococcal pneumonia in a population with a high prevalence rate of disease requiring hospital admission are very sensitive in vitro to penicillin in contrast with its seldom clinical use in the authors environment. No microorganism presented with CIM above 2 micrograms/ml. Mortality was not due to inadequate therapy but rather to the severity of the underlying disease.

BACKGROUND:To describe the clinical features and response to therapy in Mycobacterium kansasii disease among HIV infected patients, an increasing problem in our setting.METHODS:A retrospective survey of all charts from patients with HIV infection with Mycobacterium kansasii infection recorded between April 1985 and December 1991.RESULTS:A total of 13 patients were identified. All of them had clinically significant respiratory tract samples with a definite M. kansasii isolation. Only three had disseminated disease. In all but two cases, CD4 cell count at diagnosis time was lower than 200/mm3. Chest X-ray films showed interstitial pattern (8 cases) or alveolar condensation (3 cases) and lung cavities were seen in 4 patients. All patients with lung disease and one with disseminated disease responded well to anti-tuberculous therapy.CONCLUSION:Mycobacterium kansasii produces disease in advances stages of HIV-induced immunosuppression. The most common primary location is pulmonary, but disseminated forms can also be seen. The infection can be controlled with standard anti-tuberculous therapy.

Though infection is a common complication of continuous ambulatory peritoneal dialysis (CAPD), tuberculous peritonitis is in frequent. We describe a case of Mycobacterium tuberculosis peritonitis in a patient undergoing CAPD.He developed acute onset of cloudy peritoneal fluid, fever, diarrhea and abdominal pain. Staphylococcus epidermidis was isolated from the peritoneal fluid, and the patient was started on appropiate antibiotic treatment, without change in his clinical status. The predominance of polymorphonuclear leukocytes in peritoneal fluid and concurrent bacterial peritonitis delayed definitive diagnosis of tuberculous peritonitis.The clinical presentations and characteristics of the peritoneal fluid in tuberculous peritonitis are quite similar to that observed in bacterial CAPD-associated peritonitis. Diagnosis rests on clinical suspicion and direct demonstration of M. tuberculosis in peritoneal effluent or biopsy material. To avoid delay in diagnosis, mycobacterial infection must be suspected not only in episodes of culture-negative peritonitis, but also in those with proven bacterial peritonitis not responding to adequate antimicrobial therapy. Early diagnosis carries a good prognosis, and CAPD need not necessarily be discontinued in these patients.

We present 54 cases of tuberculosis (TBC) and Acquired Immunodeficiency Syndrome (AIDS) that were observed during five years and represent 37% of our AIDS patients. TBC was diagnosed before AIDS in 7, after AIDS in 5 and simultaneously in 42. Eighty-seven per cent were intravenous drug users (IVDU) and no hemophilia cases were recorded. The tuberculin skin test (PPD) showed a reaction greater than 5 mm in 43%. Prophylaxis has not been used in any patient. TBC was localized in 39% and disseminated in 61%; the lung was the main organ involved. Diagnosis was established by culture in 42 cases and by pathology exam in 12 cases. Eighteen patients had multiple isolations, while 36 had a single one. Co-occurrence with other opportunistic infections was observed in 27 cases. Death related to TBC was seen in 3 patients, and there were no differences in survival between disseminated and localized presentations. Compliance of treatment was very low and follow-up was not achieved in large number of patients.

Bronchoalveolar washout was performed in 130 patients with pneumonia during a period of 28 months. Microbiological investigation involved common bacteria, Legionella, fungi, viruses (Cytomegalovirus, herpes, RSV), Mycobacterium, and Pneumocystis carinii. Infection HIV was present in 75% of patients. The remaining patients had malignant diseases or severe pneumonia. The overall sensitivity of the technique was 65.4% and the positive predictive value was 92%. The technique was less sensitive in cases of bacterial pneumonia (sensitivity = 34.4%). This was attributed to the fact that 82.8% of these cases received antibiotic therapy. Pneumocystis carinii and Mycobacterium tuberculosis were the most common agents (44.8% and 34.5%, respectively). In seven instances the clinical picture was related to cytomegalovirus, although this diagnosis can not be easily done.

A prospective study was performed to evaluate two culture methods for the diagnosis of bacterial peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD): a total bag volume method, and culture of 50 ml with prior saline wash. Peritonitis was present in 45 patients (47.4%). The wash method was more sensitive (80%) than bag culture method (62.2%), specially in patients with antimicrobial drugs therapy (p < 0.05). Therefore, specificity was greater for the bag procedure (78% vs. 62%).

The presence of a 24,000-dalton surface protein in 215 isolates of Yersinia enterocolitica and related species was examined. By coagglutination with the specific antiserum, a 100% correlation with the pathogenic biogroups was found. Thus, this method is useful for the rapid screening of potential pathogenic Y. enterocolitica isolates.

Yersinia enterocolitica synthesized an exocellular antigen common to the serotypes associated with enterocolitis but absent from other serotypes or from other Yersinia species. Both virulent Ca2+-dependent and avirulent Ca2+-independent isogenic pairs derived from the enterocolitis-associated serotypes synthesized the common antigen. Requirements for the synthesis of this common antigen were (i) the presence of metabolizable sugars and (ii) growth on a solid medium at 37 degrees C. The antigen was identified as a 24,000-dalton protein loosely associated with the cell surface but absent from either the cell envelope or the cytoplasmic fraction.