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Idiopathic gangrene (Fournier) of the male external genitalia, with report of a case and review of the literature.

Fournier's gangrene, originally described by Fournier in 1883, is a rare and unusual ischaemic necrosis of the male external genitalia. Reports on the idiopathic penile and/or scrotal gangrene are relatively rare in newer publications. The aetiology of the disease which is characterized by a sudden onset, most commonly without prodromal symptoms, is still not fully understood. There is strong evidence, however, that Fournier's gangrene is a specific infection due to Streptococcus haemolyticus, group A, and/or anaerobic Streptococci. Presenting a case of our own, we take the opportunity to discuss the pathogenesis, pathomorphology, bacteriology and treatment of the disease.

Adult↗

Evaluation of microdilution trays (sensititre) for antimicrobial susceptibility testing of Bacteroides fragilis.

Microdilution trays (Sensititre) for antimicrobial susceptibility testing of Bacteroides fragilis has been compared for accuracy with the standard agar dilution method. The microtrays were found to be reliable for all antimicrobials tested (benzylpenicillin, clindamycin, doxycycline, chloramphenicol, fusidic acid, cefoxitin, and cephalotin) but not for metronidazole.

Anti-Bacterial Agents↗

Evaluation of the pathogenicity of the Bacteroides fragilis toxin gene subtypes in gnotobiotic mice.

Enterotoxigenic Bacteroides fragilis (ETBF) strains produce a metalloprotease toxin (BFT) related to diarrheal disease in animals, young children, and adults. Three different isoforms of the enterotoxin, designated BFT-1, BFT-2, and BFT-3, have been identified and sequenced. In the present study, the pathogenicity of the ETBF strains carrying bft-1 or bft-2 was evaluated. Each toxin gene subtype of ETBF (bft-1 or bft-2) was intragastrically monoassociated to germ-free mice during 10 days and histopathological data from intestines and liver compared with those from mice monoassociated to a non-enterotoxigenic B. fragilis. Histopathological alterations were observed in all groups of animals related to ETBF. These alterations were characterized mainly by ulceration, edema, and inflammatory infiltration in intestine. However, these lesions were slightly more severe in mice monoassociated with bft-2 subtype. No alteration or lesion was observed in animals associated with the non-enterotoxigenic B. fragilis. In conclusion, strains harboring bft-1 or bft-2 gene subtypes were able to induce histopathological alterations in intestine of a gnotobiotic mice model and it could explain the effect produced for the enterotoxin.

Animals↗

News & notes: adhesiveness of Bacteroides fragilis strains isolated from feces of healthy donors, abscesses, and blood.

Bacteroides fragilis strains attached to oral epithelial cells (ECs) and the cell line Intestine 407 and associated with human phagocytes with different efficiencies depending on their source. The 58%, 75%, and 40% of strains isolated from feces, abscesses, and blood respectively adhered to ECs with good efficiency (11-40 bacteria/cell). Of the strains from feces and abscesses, 17% and 20% exhibited a high adherence (>40 bacteria/cell); however, none of the blood isolates presented this property. Similar results were obtained with the cell line Intestine 407 and human phagocytes. Of the isolates from feces, abscesses, and blood, 20%, 56%, and 71% respectively also exhibited hemagglutination ability, indicating that this property is a virulence trait more frequently present among pathogenic isolates than in commensal strains.

Abscess↗

Surgical drainage for idiopathic suppurative pylephlebitis.

Idiopathic suppurative pylephlebitis is quite rare and only a few cases have been reported. Conservative systemic administration of antibiotics and urokinase is reported to be effective. In this report, surgical drainage was performed on an 18-year-old man who complained of fever and abdominal pain. He had no past history of abdominal inflammatory disease or abdominal surgery. Ultrasonography and computed tomography showed wide spread thrombosis of the portal vein. Laparotomy was performed and the occluded superior mesenteric vein was incised. Massive pus was removed. Thereafter, a drain was placed at the opened mesenteric vein. Drainage resulted in a dramatic decrease in fever. Postoperative radiographic studies of the colon, the small intestine, and other organs did not show any abnormalities. Emergency surgical drainage was performed successfully, instead of systemic administration of antibiotics and urokinase. Surgical drainage may be useful for wide spread pylephlebitis and pylethrombosis.

Abdomen, Acute↗

Gram-Negative anaerobic endocarditis: two case reports and review of the literature.

The rarity of anaerobic gram-negative endocarditis limits the ability of physicians to define its prognosis. Two cases of endocarditis due to Bacteroidesfragilis are described, and a review of the English literature for all cases of anaerobic gram-negative endocarditis reported since 1940 is presented. The disease predominantly affects males. Clinical features are similar to those of endocarditis due to nonanaerobic organisms, but underlying heart disease is less common and the rate of thromboembolic complications is high. All deaths reported were due to Bacteroides spp.; no deaths due to Fusobacterium spp. have been reported. Treatment with metronidazole has dramatically improved the prognosis of patients with endocarditis due to anaerobic gram-negative bacilli.

Aged↗

Symposium on infectious complications of neoplastic disease (Part I). Introduction and epidemiology.

An approach to infections in cancer patients is outlined that divides such infections into those due to underlying disease, those related to underlying disease plus therapy, and those related to therapy alone. The incidence of such infections in each of the categories is discussed, together with a general outline of patterns and trends in regard to involved microorganisms. Several specific areas discussed include: problems of superinfection with newer antimicrobial agents; the current inadequacy of diagnostic techniques; the potential for early treatment with monoclonal antibodies; the potential for augmenting one or more host defenses prior to sundering other defenses during antitumor chemotherapy; the potential value of a variety of nutrients that either may be depleted or might be of benefit in enhancing host defense mechanisms.

Abscess↗

Suppurative pylethrombosis: a changing clinical picture.

In 2 patients presenting with fever of undeterminated origin, cryptogenic suppurative pylethrombosis caused by Bacteroides fragilis was diagnosed. Combined antibiotic and anticoagulant therapy resulted in recanalization of the thrombosed vessels. The role of ultrasonography and computed tomography scan in the diagnosis and follow-up of this rare condition is discussed.

Bacteroides Infections↗