Capnocytophaga cynodegmi (formerly "DF-2 like organism"), a commensal organism of the canine oral cavity, is a capnophilic, gram-negative, facultative bacillus. C. cynodegmi has rarely been encountered in human diseases. We report the first known case of cellulitis, bacteremia, and pneumonitis caused by C. cynodegmi in a diabetic man from central India following a dog bite. CASE REPORTA 59-year-old non-insulin-dependent diabetic man was hospitalized with a 24-h history of fever, purulent expectoration, and painful leg swelling. Two days earlier, he had been bitten by a stray dog. Immediately after the bite, the wound was cleaned, tetanus prophylaxis was administered, and an antirabies immunization schedule was initiated. On examination, he was toxic, febrile, tachypneic, and hypotensive, with signs of lower left lobe pneumonitis. Cellulitis over the ankle and the lower third of the left leg, pus discharge from the puncture wound, and regional lymphadenopathy were noticed. His hemoglobin was 122 g/liter, and his total white-cell count was 12.2 ϫ 10 9 /liter (80% polymorphs, 10% bands). A chest radiograph revealed left perihilar pneumonitis. Ankle and leg radiographs showed soft tissue swelling with no bone involvement. Blood glucose (random sample) was 21 mmol/liter (378 mg/dl). Echocardiography and renal and hepatic function test results were normal. Incision and drainage of the wound yielded 30 ml of pus. Penicillin, ciprofloxacin, gentamicin, metronidazole, saline, and crystalline insulin were administered intravenously. Over the next 5 days, the patient exhibited fluctuations of temperature (38.5 to 40°C) and remained ill. Three days after the initial collection and incubation, the blood, bronchoalveolar lavage fluid, sputum, and pus specimens obtained for culture yielded a capnophilic, gram-negative, facultative anaerobic bacillus that was positive for oxidase and catalase. Species identification of Capnocytophaga cynodegmi was based on the criteria of Brenner et al. (2). Punctate colonies of less than 1 mm in diameter were noted after 72 h on chocolate agar in 5% CO 2 . The colonies appeared convex and smooth, exhibited confluent growth, and increased in size to 3 mm 120 h after initial incubation. The bacteria were gram negative, and they appeared as thin, 2-to 4-mm-long fusiform bacilli with slightly curved ends. The isolate was microaerophilic and exhibited luxuriant growth on heart infusion agar supplemented with 5% sheep blood and incubated at 35 to 72°C in the presence of 5% CO 2 (candle extinction jar). The organism was identified as C. cynodegmi and was differentiated from Capnocytophaga canimorsus by its ability to ferment sucrose, raffinose, xylose, and inulin and by its growth at 72°C. The isolate had gliding mobility, showed beta-hemolysis on blood agar with 5% rabbit blood, was positive for catalase, oxidase, arginine dihydrolase, O-nitrophenyl-␤-D-galactopyranoside, and esculin, and produced acid from cellobiose, dextrin, fructose, D-glucose, glycogen, lactose, maltose, D-mannose, melibiose, D...

The case of a young woman is described who suffered from acute pancreatitis related to the ingestion of zinc phosphide. This unusual complication was successfully managed with conservative treatment.

Abstract. The emergence of chloroquine resistance, and a world-wide scarcity of quinine, have resulted in a search for newer antimalarial drugs directed against falciparum malaria. Allopurinol causes virtually complete inhibition of purine biosynthesis of malaria parasites, which may prove lethal to the parasites. This study was designed to examine if allopurinol is additive to quinine in the treatment of acute falciparum malaria. Forty-seven Asian-Indian adults with acute complicated falciparum malaria were assigned to a treatment period of five days. They were randomly assigned to receive either oral allopurinol (12 mg/kg in three divided doses for five days) plus quinine (600 mg intravenously every 8 hr for two days, followed by 600 mg orally every 8 hr for three days ) (n ϭ 24), or quinine alone (600 mg intravenously every 8 hr for two days, followed by 600 mg orally every 8 hr for three days) (n ϭ 23). The responses were assessed by parasite clearance time, defervescence time, splenomegaly disappearance time, and cure rate. In the allopurinol-quinine (ALLQUIN)-treated group, all the durations were significantly shorter than those in the quinine alone (QUIN)-treated group. They were ALLQUIN versus QUIN (mean Ϯ SD ϭ 65.33 Ϯ 11.47 hr versus 76.78 Ϯ 18.20 hr; P ϭ 0.0214; 57.66 Ϯ 13.01 hr versus 82.52 Ϯ 23.55 hr, P ϭ 0.0002; 10 Ϯ 1.64 days versus 14.65 Ϯ 2.4 days; P ϭ 0.0002), respectively. The cure rate was higher in the ALLQUIN group (91.7%) than in the QUIN group (87%). However, this difference was not statistically significant. Therefore, this study indicates that allopurinol can be an additive to quinine to bring about both faster eradication of Plasmodium falciparum and clinical remission than with quinine alone.With the emergence of Plasmodium falciparum strains resistant to chloroquine and/or to sulfadoxine/pyrimethamine in almost all endemic areas, 1 quinine has remained one of the few drugs for treatment of falciparum malaria 2 and has caused a resurgence of its use. 3 Quinine administered daily for three days clears parasitemia within a few days; but after two to four weeks, parasitemia recrudesces. 4 Although, during successful antimalarial treatment, parasite clearance time in African children with severe P. falciparum infection did not usually exceed 60 hr, some parasites remained alive despite exposure to extremely high concentrations of quinine for up to 96 hr. 2 Allopurinol has a broad antiprotozoal activity. 5 Due to a lack of a de novo purine biosynthesis pathway, 6 and malaria parasite's nonspecific hypoxanthine guanine phosphoribosyl transferase, malaria parasites use allopurinol as a hypoxanthine analog. 7 Consequently, 4-aminopyrazolopyrimidine ribonucleotide triphosphate, a highly toxic analog of adenosine triphosphate is formed and incorporated into protozoal ribonucleic acid. 8 Allopurinol thus brings about virtually complete cessation of intraerythrocytic (IE) plasmodial purine biosynthesis and protein metabolism, which prove lethal to the parasites. Allopurinol (11-36 mg/kg/day) is ra...

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Pediococci are homofermentative, gram-positive, nonmotile, catalase-negative facultative anaerobes of the family Streptococcaceae and are used in the biotechnology and food industries (1, 2, 7). The ecologic niche of pediococci in humans appears to be the enteral tract (7). Although pediococci have been described as harmless bacteria (5), they have been infrequently recovered from the human respiratory tract and saliva and also from other clinical specimens, viz., stool, urine, wounds, abscesses, peritoneal fluid, and blood from immunocompromised patients with various underlying conditions including burns, malignancies, cardiovascular disease, chronic lung disease, and diabetes mellitus (1-3, 5-8). They have not, however, previously been recovered from pregnant women. Of the eight species of the genus Pediococcus currently recognized (1), only Pediococcus acidilactici and P. pentosaceus have been described as human pathogens causing septicemia, hepatic abscesses, and bacteremia (2, 3, 5, 8). Pediococci appear on Gram's stains to be arranged in tetrads (1, 2, 5, 7) and clusters and are universally resistant to vancomycin and teicoplanin (1, 2, 6, 7). We report a case of pneumonitis and bacteremia caused by P. acidilactici in a pregnant woman. A 26-year-old primigravida with a history of chronic bronchitis was admitted to Jawaharlal Nehru Hospital, Madhya Pradesh, India, at 14 weeks of pregnancy after 6 days of fever and purulent expectoration. She had received oral amoxicillin at 250 mg three times a day for 7 days 8 months prior to the diagnosis of pregnancy. She was febrile (40°C), tachypneic, and normotensive and had mild hepatosplenomegaly, patchy bilateral pneumonitis, and a single viable fetus as assessed by physical examination and guarded-skiagram chest and abdominal ultrasonography. Echocardiography and routine hematologic and biochemical investigations did not contribute any significant data. Ceftriaxone (1 g intravenously at 12-h intervals) and 100-g inhalations of salbutamol sulfate, a beta 2 agonist, as a bronchodilator three or four times daily for 7 days and subsequently by mouth at 4 mg three times daily were administered. A sputum smear (Gram's stain; magnification, ϫ1,000) showed abundant gram-positive cocci in tetrads and clusters with many leukocytes. Over the next 5 days, the patient exhibited fluctuations in temperature (38.5 to 40.5°C) and remained very ill. Three days after collection and incubation of the blood and sputum samples, gram-positive cocci were seen in clusters and tetrads on Gram's smears from blood culture broths. Broth was subcultured on solid media. After 1 day of incubation at 37°C (growth, 1 to 2 mm at 48 h), white, opaque, nonhemolytic colonies, tolerant to 50°C on blood agar plates, were obtained. The organism, identified as P. acidilactici, did not produce gas in lactobacillus Mann-Rogosa-Sharp (MRS) broth; gave positive bile-esculin reactions; and was negative for pyrrolidonylarylamidase. The colonies were oxidase and catalase negative. The arginine hydrolysis test was...