A case of septic arthritis in multiple joints due to Bacteroides fragilis in a patient with rheumatoid arthritis

A case of arthritis in multiple joints due to B. fragilis ssp. fragilis is described. The patient was a 55-year-old man badly disabled by rheumatoid arthritis. The patient's immune response to the isolated strain was studied and a significant titre reduction during the course of the disease was observed. The serum antibodies of the patient cross-reacted with heterologous strains of B. fragilis ssp. fragilis. It is suggested that indirect immunofluorescence tests against a certain number of B. fragilis strains could be performed with serum from a patient in whom an infection with B. fragilis is suspected.

Clotting and fibrinolytic activities of Bacteroides melaninogenicus

106 strains of Bacteroides melaninogenicus ss. asaccharolyticus, intermedius and melaninogenicus were tested for production of extracellular blood clotting and fibrinolytic factors. 78.3% of tested strains caused clotting of rabbit plasma and 79.2% activated human plasminogen. Strains producing the clotting or fibrinolytic factor only were isolated. Both factors were quite active, as positive results for most strains were detected within one hour of incubation in controlled test system.

A fever index evaluation of chloramphenicol or clindamycin in patients with serious pelvic infections

The fever index measured the responses of 102 women with serious pelvic infections who had received either chloramphenicol or clindamycin, in combination with other antibiotics. There was no statistical difference in the number of degree hours in the two populations. Patients with salpingo-oophoritis had significantly more fever than those with a septic abortion. Bacteremia did not delineate a group of women with a markedly elevated febrile response. Within the populaton with salpingo-oophoritis, neither black women nor women with an intrauterine device in place had significantly more fever, but patients requiring operation had more fever while those with an endocervical culture positive for the gonococcus at the time of admission had the most favorable clinical response. The significance of these findings is discussed.

Non-clostridial gas gangrene in the diabetic lower limb

Three cases of non-clostridial gas gangrene in diabetic lower limbs are reported. This rare condition occurs only in diabetes with peripheral neuropathy and is invariably fatal unless treated surgically. The clinical picture is deceptive with a slow, but insidiously progressive course, and the late appearance of skin necrosis. Antibacterial therapy is ineffective in preventing death. A serious delay may be fostered by inconclusive bacteriological investigations. Urgent radical amputation is required to save the patient's life.

The syndrome of inappropriate secretion of antidiuretic hormone associated with anaerobic thoracic empyema

The syndrome of inappropriate secretion of antidiuretic hormone has been associated with many pulmonary diseases, including tuberculosis and bacterial and viral pneumonia: however, it has not been reported with anaerobic infections or empyema in the absence of pneumonia. We report a patient with empyema due to Bacteroides melaninogenicus, Bacteroides oralis, and Peptostreptococcus who developed the syndrome. Eight hours before the start of therapy, his serum sodium concentration was 127 mEq per liter; serum osmolality, 255 mOsm per kg; urine osmolality, 522 mOsm per kg; urinary sodium concentration, 39 mEq per liter. The creatinine clearance and the adrenocorticotropic hormone stimulation test were normal, and there was no evidence of dehydration. No other causes of the syndrome of inappropriate secretion of antidiuretic hormone were apparent. With drainage and antimicrobial drug therapy, the empyema cleared, and the syndrome resolved in 8 days. The patient has been well, without evidence of inappropriate secretion of antidiuretic hormone, for 9 months. Anaerobic infections and/or empyema without pneumonia can be associated with the syndrome of inappropriate secretion of antidiuretic hormone.

Experimental infections with anaerobic bacteria in mice

Experimental anaerobic infections in mice are reviewed with a description of a model of pure Bacteroides fragilis infection. In this experimental situation, B. fragilis produces large subcutaneous abscesses in the groins of mice that can be diagnosed without autopsy. This infection was treated effectively with clindamycin in doses that produced levels of drug in blood similar to those attainable in humans.

An unusual bilateral pathological fracture

An unusual case of a bilateral pathological fracture of the mandible has been presented. The fracture of the right side of the mandible was through an area of bacteroides osteomyelitis and the fracture of the left side of the mandible was through a large cementifying fibroma, which had replaced the left body of the mandible.

Bacteroides infection in a patient requiring extracorporeal membrane oxygenation

A case of fulminant bacteroides plus anaerobic streptococcus bacteraemia is reported. Therapy included the use of extracorporeal membrane oxygenation for the resultant acute respiratory failure. The problem of bacteroides infections is reviewed.

Limb infections in infancy presenting with pseudoparalysis

Three cases of pseudoparalysis in infancy are reported in which the appearance of localized infection in the affected limb was delayed for a variable period after the onset of pseudoparalysis. Blood cultures on admission in all cases were positive, and bacteraemia due to the three organisms isolated is discussed.

Some clinical, immunological and bacteriological observations in a case of pyogenic arthritis due to bacteroides fragilis

A case of recurrent pyogenic arthritis in a knee joint and abscess formation of the lower limb is described. The infection occurred in a 70-year-old male patient treated with steroids for rheumatoid arthritis. A strain of Bacteroides fragilis was repeatedly isolated both from the knee joint and the abscess. The isolated strain was used as antigen in tube agglutination tests and significant titre changes were observed during the course of the disease. The isolated strain was initially sensitive to doxycycline but developed resistance to this drug during therapy. The sensitivity to lincomycin remained unaffected.

Wound infections due to Bacteroides fragilis following intestinal surgery

Ninety-six wound infections due to Bacteroides fragilis occurring after intestinal surgery are described. Most infections followed appendicectomy or colectomy for diverticulitis. B. fragilis was isolated in pure growth from 47 per cent of infections, and in mixed culture the other common bacteria were Klebsiella spp., Escherichia coli and Enterobacter spp. Fifty-three per cent of the infections responded rapidly to either non-specific measures or antibiotic therapy, but 47 per cent of patients developed complications, usually abscess formation. The successful isolation of bacteroides from clinical material requires special precautions. The specimen for bacteriological examination must be sent to the laboratory in a transport medium which maintains an anaerobic environment and the culture techniques must include a selective agar for the isolation of anaerobic bacteria. The role of antibiotic therapy in preventing postoperative wound infection after intestinal surgery is discussed. Bacteroides has an unusualy pattern of antibiotic susceptibility and it is essential that an effective antibiotic such as lincomycin is included in the treatment of infection originating from the intestinal tract.

Stagnant loop syndrome resulting from small-bowel irradiation injury and intestinal by-pass

Stagnant or blind-loop syndrome includes vitamin B12 malabsorption, steatorrhea, and bacterial overgrowth of the small intestine. A case is presented to demonstrate this syndrome occurring after small-bowel irradiation injury with exaggeration postenterocolic by-pass. Alteration of normal small-bowel flora is basic to development of the stagnant-loop syndrome. Certain strains of bacteria as Bacteriodes and E. coli are capable of producing a malabsorption state. Definitive therapy for this syndrome developing after severe irradiation injury and intestinal by-pass includes antibiotics. Rapid symptomatic relief from diarrhea and improved malabsorption studies usually follow appropriate antibiotic therapy. Recolonization of the loop(s) with the offending bacterial species may produce exacerbation of symptoms. Since antibiotics are effective, recognition of this syndrome is important. Foul diarrheal stools should not be considered a necessary consequence of irradiation injury and intestinal by-pass.

Bacteroides bacteriaemia in surgical patients

In a general surgical unit, during a 6-year period between June, 1967, and May, 1973, anaerobic bacteriaemia was noted in 23 patients, of whom 4 had Gram-positive clostridial bacteriaemia. Nineteen patients had Gram-negative Bacteroides species in their blood. In these patients the infection appeared to have come from bacteria that were normal commensals of the patients' gastro-intestinal tracts. The use of antibiotics to which Bacteroides species were resistant may have suppressed more invasive bacteria, allowing the selective proliferation of bacteroides.

Anaerobic liver abscess complicating radiation enteritis

Multifocal liver abscess developed in a 68-year-old woman with radiation enteritis. Two strains of Bacteroides fragilis were cultured from the liver and blood. Surgical drainage was not possible, and in spite of appropriate antibiotic therapy the patient died.