Faculty Bibliography

Bartonella henselae was isolated from the blood of five febrile immunosuppressed patients using BacT/Alert (Organon Teknika, Durham, NC) automated microbial detection system. An immunofluorescence assay (using 1:1000 dilutions) was used to confirm identification of fastidious, pleomorphic, non-Gram staining, argyrophilic bacilli displaying rachety motility that had been presumptively identified as Bartonella spp. The practicality of identification of Bartonella henselae using goat antisera for use in a routine clinical microbiology laboratory was demonstrated by this study

Sixty-six stool specimens were evaluated by the ProSpecTR Cryptosporidium rapid enzyme immunoassay (EIA) (Alexon, Sunnyvale, Calif.). Approximately 2 g of untreated stool suspended in buffer was filtered through membranes labelled with anti-Cryptosporidium-specific antigen antibody. Anti-Cryptosporidium-specific antigen antibody was labelled with biotin, horseradish peroxidase conjugated to streptavidin, and tetramethylbenzidine, and each labelled antibody was added in sequence to the membranes. Each membrane had a positive control and test area. EIA results were compared with those of the modified acid-fast procedure. Twenty-three specimens were positive by the initial acid-fast procedure and the EIA. Forty-two specimens were negative by the initial acid-fast test and the EIA. One specimen was negative by the initial acid-fast test and positive by the EIA (sensitivity, 100%; specificity, 98.5%). This technique is easy to use by comparison with the cumbersome, labor-intensive, and more subjective microscopic methods currently available, and its sensitivity equals that of current microscopic methods

Objective: Although the incidence of reported cases of toxic shock syndrome (TSS) has declined in recent years, the disease continues to occur in menstruating women using the newer, less-absorbent tampons or barrier contraceptives. Extant tampons and other vaginal devices were tested for the ability to induce TSS toxin-1 (TSST-1) by a TSS strain of Staphylococcus aureus MN8, a known high-toxin producer. Tested for the first time were 20 varieties of tampons, including 2 all-cotton brands newly introduced in the United States, a polyurethane contraceptive sponge, a latex diaphragm, and a polymer menstrual collection cup.Methods: All products were washed in sterile distilled water prior to use to reduce the effect of leachable chemicals. Duplicate experiments with unwashed products were also performed. Entire tampons and other test products were immersed in brain heart infusion broth plus yeast extract (BHIY) and inoculated with S. aureus MN8, a known TSST-1 producer. After incubation, the culture supernatants were assayed for TSST-1 by gel immunodiffusion.Results: Except for all-cotton tampons, greater amounts of TSST-1 were detected in the supernatant fluid of washed tampons than detected in those which were not washed. While TSST-1 levels in unwashed non-cotton tampons ranged from 0.5 to 8 mug/ml, when these products were washed, TSST-1 levels increased to 2-32 mug/ml. In all-cotton tampons, whether washed or not, there was no detectable TSST-1.Conclusions: The propensity for all-cotton tampons not to amplify TSST-1 in vitro suggests they would lower the risk for tampon-associated TSS

It has been suggested that bacillary (epithelioid) angiomatosis (BEA) is a manifestation of cat scratch disease (CSD). Because of clinical similarity between this condition and the verruga peruana phase of bartonellosis, we sought to further characterize this disease as well as its causative agent and to compare it to bartonellosis. We isolated a small flagellated pleomorphic bacillus from skin lesions of two patients with BEA. Organisms were stained successfully with Warthin-Starry silver stains, but immunohistochemistry failed to demonstrate binding with a polyclonal antibody directed against the cat scratch bacillus. Whole cell fatty-acid gas chromatography performed on both BEA organisms and Bartonella bacilliformis demonstrated marked similarity between the two. Electron microscopy of BEA organisms in tissue and in suspension revealed features characteristic of a gram negative bacillus. Based on these findings, we propose that this unusual rickettsial infectious disease with vascular proliferation may represent an unusual variant of infection with a bartonella-like organism rather than a manifestation of cat scratch disease

Toxic shock syndrome has been associated with rhinologic surgery and medical devices, and it has been linked to a circulating exotoxin of a toxogenic strain of Staphylococcus aureus. One hundred forty patients with rhinosinusitis were studied. Nasal cultures were obtained. The microbiological characteristics are described. The carrier rate for Staphylococcus aureus was 35%. Thirty percent of patients selected for surgery were Staphylococcus aureus carriers. Toxin-capable isolates were identified in 40% of those tested. Users of cocaine, topical decongestants, and steroid sprays had a statistically higher rate of Staphylococcus aureus carriage compared to nonusers. It is hoped that by identifying the population at risk and defining the factors associated with the development of toxic shock syndrome, a cogent policy of prevention can be established

Within the last several years, a newly characterized condition known as bacillary epithelioid angiomatosis (BEA) has been described in a number of patients with human immunodeficiency virus (HIV) infection. All cases heretofore described have been seen in patients with the HIV infection. We recently evaluated a 37-year-old healthy man who had a localized form of BEA confirmed by biopsy, special strains, electron microscopy, and culture. We conclude that BEA as previously defined may occur in healthy, non-HIV-infected individuals