Two term neonates born within four days of each other at a small hospital developed sepsis and meningitis caused by a unique strain of Citrobacter diversus not previously reported to cause meningitis. Eleven (27.5%) of 40 other infants admitted to the nursery during the epidemic period developed rectal or umbilical colonization by C. diversus. Contact soon after birth with either of two nurses was more common among infected or colonized infants than among infants who were not infected or colonized. Hand cultures of both nurses and a rectal culture of one of the nurses yielded the epidemic strain. C. diversus may have been introduced into the nursery by the rectal carrier and spread person to person. Six weeks later continued surveillance identified a second cluster (of four colonized infants) associated with a mother who was a carrier of C. diversus and whose newborn infant became colonized at birth. The outbreak ended after strict control measures were used.

Ten patients with thrombocytopenia (TTP) were treated recently in our institution with plasma exchange (PE), steroids, and antiplatelet drugs. Additionally, fresh frozen plasma (FFP) was administered to nine patients, with folic acid given to eight patients. After 13 to 25 months of follow-up, we found that four patients achieved and remained in remission after initial treatment. Three patients had four relapses, which developed while they were taking antiplatelet therapy, and which were treated successfully with FFP alone, or with PE in addition to FFP. Four patients suffered major neurological or renal damage during their presentation or initial treatment. One of these patients died during his initial hospitalization. Another patient died 7 months after initial treatment. After analyzing this experience, we have concluded that antiplatelet drugs or corticosteroid should be used as the sole initial treatment most cautiously. The relative importance of the exchange process, per se, versus plasma infusion cannot be inferred from our observations, but plasma exchange with FFP appears to have had a real impact on recovery.

Listeria monocytogenes was isolated from both the blood and the synovial fluid of a diabetic patient with a septic arthritis involving the ankle.

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