A boy with low-TSH hypothyroidism.

A case of long-standing mild hypothyroidism is described. This was caused by partial TSH deficiency probably of hypothalamic origin, with no other pituitary hormone deficiencies, although with a decreased response of FSH and LH to LHRH.     

A comparative trial of pivmecillinam/pivampicillin and amoxycillin/clavulanate in the therapy of urinary tract infection in a general practice population

Fifty-eight patients seen in general practice presenting with symptoms of acute urinary tract infection were entered consecutively into an open randomized trial of 200 mg pivmecillinam plus 250 mg pivampicillin twice daily or 250 mg amoxycillin plus 125 mg clavulanate 3-times daily for 5 days. The results were analyzed in 41 patients with significant bacteriuria (23 on pivmecillinam/pivampicillin and 18 on amoxycillin/clavulanate). Both antibiotic combinations produced good overall bacteriological cure, but there were a considerable number of persisting symptoms despite the absence of significant bacteriuria. Eight patients in the pivmecillinam/pivampicillin group and 5 in the amoxycillin/clavulanate group had side-effects, principally thrush, vomiting and abdominal pain, and 1 patient from each group ceased treatment for this reason. Sensitivity profiles of urinary isolates (41 trial, 135 non-trial) to both combinations and to ampicillin and mecillinam showed that the majority were fully sensitive to amoxycillin/clavulanate and to a lesser extent to pivmecillinam/pivampicillin; resistance was highest to ampicillin.     

Candida albicans cell walls contain the fluorescent cross-linking amino acid dityrosine.

Several clinical and laboratory isolates of Candida albicans have a natural blue surface fluorescence when cultured and observed with sensitive optics. The localization and color of the fluorescence are similar to those of the natural fluorescence of sporulated Saccharomyces cerevisiae which is caused by the generation and surface deposition of the cross-linking amino acid dityrosine. In S. cerevisiae, dityrosine production results from the direct action of at least two genes and is responsible for resistance of the ascospores to lytic enzymes and physicochemical trauma. Among the criteria for the identification of dityrosine is pH sensitivity of the fluorescence intensity and a highly characteristic shift of the fluorescence excitation maximum with a change in pH. Video microscopy of whole Candida organisms revealed the characteristic dityrosine intensity maximum at pH approximately 10 and the intensity minimum at pH approximately 2. Separation of an acid hydrolysate of Candida cell walls by reverse-phase high-performance liquid chromatography revealed a fluorescence peak that coelutes with the reagent dityrosine. At pH approximately 10, this peak has a fluorescence excitation maximum of 320 to 325 nm, while at pH approximately 2, the excitation maximum is 285 to 290 nm. This excitation maximum shift and the observed emission maximum of approximately 410 nm are characteristic of dityrosine. Two separate strains of C. albicans were injected intraperitoneally into mice and harvested at 24 h. Blue surface fluorescence was observed, suggesting that dityrosine generation occurs in vivo as well as in vitro. This is the first report of the presence of dityrosine in a human fungal pathogen.     

The role of infection in the precipitation of periarteritis nodosa

Circulating immune complexes are thought to play an essential part in the pathogenesis of necrosing angiitis. This theory also allows a role to be attributed to certain infectious agents (viral, bacterial, parasitic) in the development of periarteritis nodosa (PAN). An infectious syndrome was found in all our 9 patients, aged 26 to 69 years, with histologically confirmed PAN: previous infection (over 15 days before hospital admission): otitis, hepatitis B, tonsillitis, ascaris (Case n.7), pulmonary tuberculosis, brucellosis, seropositivity for Chlamydia trachomatis (Case n.9), paratyphoid (Case n.5), seropositivity for Yersiniosis pseudo-tuberculosis (Case n.2), seropositivity for Chlamydia trachomatis (Cases 3 and 4), seropositivity for toxoplasmosis (Cases 4 and 6), seropositivity for rubella (Case n.8). Recent infection (less than 15 days before hospital admission): staphylococcus aureus septicaemia (Case n.1); Group A betahemolytic streptococcal urinary infection (Case n.2); Group A betahemolytic streptococcal otitis media; pseudomonas aeruginosa and Klebsiella septicaemia; enterococcal cystitis (Case n.4); progressive pulmonary tuberculosis (Case n.6), acinetobacter pneumonia (Case n.9). The HBs antigen was only found in one patient (Case n.6), who had an active hepatitis.     

Clinical and pharmacokinetic study of ceftriaxone in the treatment of 14 episodes of ascitic fluid infection

A clinical study and dosages of ceftriaxone were performed during the treatment of 14 ascitic fluid infections. Fourteen cases of ascitic fluid infection were treated with ceftriaxone at doses of 2 grams daily. The isolation of the causative organisms was obtained in 11 out of 14 cases by systematic culture of the ascitic fluid in hemoculture bottles with aerobic and anaerobic medium. Of 11 evaluable infectious episodes ten were cured. Ceftriaxone diffuses rapidly in the ascitic fluid because, within the first hour; mean concentrations were already of 18.6 micrograms/ml largely exceeding the usual MIC for these organisms. A good tolerance for the drug, the well spaced rythm of infections preventing unnecessary parenteral treatment in cirrhotic patients, and its effectiveness against Enterobacteriaceae justify its choice in the treatment of ascitic fluid infections with sensitive organism.     

Factors influencing neurological outcome of children with bacterial meningitis at the emergency department

We performed a cohort study of children who survived bacterial meningitis after the neonatal period at a single pediatric center in France over a 10-year period (1995-2004) to identify predictors of death and long-term neurological deficits in children with bacterial meningitis. We performed multivariate regression to determine independent predictors of death and neurologic deficits. We identified 101 children with bacterial meningitis of which 19 died during initial hospitalization. Need for mechanical ventilation [hazard ratio (HR) 11.5, 95?% confidence interval (CI) 2.4-55.5)] and thrombocytopenia defined as a platelet count <150?×?10(9)?per liter (HR 0.6, 95?% CI 0.4-0.9) at presentation were associated with death during initial hospitalization. At final assessment, 42 of the 70 survivors had no neurologic deficits identified; 20 had a single deficit, and eight had multiple deficits. A delay in initiation of antibiotics (HR 1.3, 95?% CI 1.1-1.7) and hydrocephalus on computed tomographic scan (HR 2.6, 95?% CI 1.1-6.0) were associated with having one or more long-term neurologic deficits. Identification of children at risk of death or long-term neurologic sequelae may allow therapeutic interventions to be directed to children at the highest risk.     

A familial case of Keratitis-Ichthyosis-Deafness (KID) syndrome with the GJB2 mutation G45E

Keratitis-Ichthyosis-Deafness (KID) syndrome (OMIM 148210) is a congenital ectodermal defect. KID consists of an atypical ichthyosiform erythroderma associated with congenital sensorineural deafness. A rare form of the KID syndrome is a fatal course in the first year of life due to severe skin lesion infections and septicaemia. KID appears to be genetically heterogeneous and may be caused by mutations in connexin 26 or connexin 30 genes. GJB2 mutations in the connexin 26 gene are the main cause of the disease. Most of the cases caused by GJB2 mutations are sporadic, but dominant transmission has also been described. To date, the rare lethal form of the disease has been only observed in two Caucasian sporadic patients with the GJB2 mutation, with the p.Gly45Glu (G45E) arising de novo. We have reported an African family with dizygotic twins suffering from a lethal form of KID. The dizygosity of the twins was confirmed by microsatellite markers. The two patients were heterozygous for the G45E mutation of GJB2, whereas the mutation was not detected in the two parents. The unusual transmission of the disease observed in this family could be explained by the occurrence of a somatic or more probably a germinal mosaic in one of the parents.