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Transfer of a chromosomal locus responsible for mucoid colony morphology in Pseudomonas aeruginosa isolated from cystic fibrosis patients to P. aeruginosa PA0

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Pseudomonas pseudomallei, which causes melioidosis, is most commonly associated with pulmonary infection. We describe seven patients who developed a neurological syndrome as the predominant manifestation of melioidosis: this syndrome was characterized by peripheral motor weakness (mimicking Guillain-Barré syndrome), brain-stem encephalitis, aseptic meningitis, and respiratory failure. Neurological melioidosis occurred in the absence of demonstrable foci of infection in the central nervous system (CNS) in five of six patients whose cerebrospinal fluid was available for culture. Computed tomography and magnetic resonance imaging of the brain and spinal cord of these patients were not suggestive of pyogenic infection, although the latter procedure detected brain-stem encephalitis. Autopsy findings in one case confirmed brain-stem encephalitis without evidence of direct bacterial infection. The clinical presentation of neurological melioidosis includes features of an exotoxin-induced neurological syndrome, with profound neurological disease occurring in the absence of apparent direct infection of the CNS. This syndrome appears to be a newly recognized clinical presentation of melioidosis.

An outbreak of serotype 1 Streptococcus pneumoniae infection involving both adults and children occurred in central Australia during the winter months of 1991. Eighteen patients, mainly Aboriginal men, presented with culture‐positive serotype 1 bacteraemic pneumonia. In this group, 11 of 12 adults for whom medical records were available were alcohol dependent. Thirteen children who were separately studied were hospitalised with acute lower respiratory tract infection: none had bacteraemia but all had upper airway colonisation by type 1 pneumococci. Antibiotics taken by 8 of the 13 children before admission to hospital may have compromised the isolation of type 1 pneumococci from blood cultures. Since the availability of antibiotics, epidemic pneumococcal infection is infrequent and has not been reported in Australia. In three outbreaks of type 1 disease recorded elsewhere crowding and alcoholism were identified as contributory factors. In the 16 month period before this outbreak none of 162 strains of pneumococci isolated from blood (32 strains) and nasopharyngeal secretions (130 strains) from Aborigines with acute lower respiratory tract infection and meningitis in the Alice Springs region were serotype 1 organisms.