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The article discusses a study which examined pathogenic Escherichia coli (E. coli) of stools in all inpatients of geriatric wards of Hikariga-oka Sperman Hospital in Sendai, Japan. Topics discussed include the high rate of pathogenic E. coli infection in the patients, therapeutic treatments used, and the possibility that Lactobacillus bifidus might protect infection of pathogenic E. coli in bedridden geriatric patients.

Background: The current recommendation regarding the management of a term newborn delivered of a mother with an intrapartum fever or a diagnosis of clinical chorioamnionitis is that the neonate should have baseline laboratory work drawn along with blood cultures and be universally treated with antibiotics until culture results return. These guidelines report that the rate of intrapartum fever is about 3%; however, a few large studies suggest that the rate is higher at about 7%.Objective: We sought to prospectively evaluate the rate of fever during labor in a large number of deliveries and determine the rate of early-onset neonatal sepsis in newborns delivered from mothers with an intrapartum fever compared with newborns delivered from mothers without intrapartum fever.Study Design: This was a prospective cohort study of all temperatures obtained in women in labor from Jan. 1, 2011, through June 30, 2014. Every patient with a fever of ≥38°C at ≥36 weeks' gestation was evaluated for gestational age, parity, spontaneous or induced labor, group B streptococcus status, regional anesthesia, mode of delivery, treatment with intrapartum antibiotics, and whether a clinical diagnosis of chorioamnionitis was made by the managing physician. Neonates were assessed for blood culture results, neonatal intensive care unit admission, length of stay, and any major newborn complications. Statistical analysis involved χ2, Fisher exact, and Student t test.Results: A total of 412 patients (6.8%; 95% confidence interval, 6.2-7.5%) developed a fever in 6057 deliveries at ≥36 weeks' gestation. No cases of maternal sepsis occurred. Of the 417 newborns (5 sets of twins), only 1 (0.24%; 95% confidence interval, 0.01-1.3%) developed early-onset neonatal sepsis with a positive blood culture for Escherichia coli. There were 4 cases (0.07%; 95% confidence interval, 0.02-0.18%) of early-onset neonatal sepsis in the 5697 newborns (52 sets of twins) delivered from mothers who were not febrile and this difference was not significant (P = .3). The positive blood cultures in these 4 neonates were 3 group B streptococcus and 1 Enterococcus. The overall rate of early-onset neonatal sepsis in this population of newborns delivered at ≥36 weeks' gestation was 0.82/1000 deliveries.Conclusion: The incidence of an intrapartum fever of ≥38°C in pregnancies at ≥36 weeks' gestation is common at 6.8% and this is consistent with the findings of a few other large retrospective studies. The rate of an intrapartum fever occurs in approximately 1 in 15 women in labor. The risk of neonatal sepsis in newborns delivered of mothers with intrapartum fever or a diagnosis of clinical chorioamnionitis is low at 0.24%, a rate that is <1 in 400. The recommendation for universal laboratory work, cultures, and antibiotic treatment pending culture results for this newborn population needs further examination. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 19-month-old girl with a history of myelomeningocele and Chiari malformation type II who was presented with abdominal pain.

The article presents a case study of a 78-year-old woman who was taken to the emergency department because of mild altered mental status and acute onset of back pain. The patient was diagnosed with pyogenic ventriculitis, a complication of the central nervous system and urinary tract infection. It suggests that pyogenic ventriculitis can be a serious complication of sepsis.

The formation of an appendico-cutaneous fistula is rare. Few case reports have been published; most describe the formation of a fistula after appendicitis. Here we describe the case of a 79-year-old woman presenting with an appendico-cutaneous fistula after groin hernia repair. She was referred to our outpatient department with a painful mass in the right groin. An ultrasound showed a fluid containing mass. Incision and drainage was performed. After 9 weeks she was referred again with a persisting open wound. Fistulogram and CT scan showed a fistuleous tract involving the appendix. Wound culture showed Escherichia coli. Diagnostic laparoscopy showed an appendix stuck to the ventral wall of the abdomen without any sign of previous infection. After an appendectomy, pathological investigation revealed an appendix sana. After operation, the fistula persisted due to a polypropylene plug from the previous groin hernia correction. The (infected) plug was removed and the fistula healed. [ABSTRACT FROM AUTHOR]

Ecthyma gangrenosum (EG) is a cutaneous manifestation of invasive infection usually caused by pseudomonas, but can be caused by many bacteria, fungal and viral infections. We present the first reported case of EG caused by invasive Escherichia coli in a neonate. A neonate presented with evidence of sepsis and a rapidly evolving 3 x 3.5 cm[sup 2] well-circumscribed haemorrhagic and necrotic ulcer on the left groin. There was evidence of decreased perfusion of the lower limb owing to pressure effect of the ulcer. The child responded well to anticoagulation and antibiotic therapy. It is crucial to clinically suspect EG and promptly start empiric antibiotic therapy covering pseudomonas to decrease the morbidity and mortality. However, other viruses, fungus and bacteria including E coli should also be considered in the differential diagnosis of EG in a neonate. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a case of Escherichia coli pneumonia with pneumatocele formation in a 42-year-old woman.

We report a 3-year-old boy with enterohemorrhagic Escherichia coli (EHEC) O157-associated hemolytic uremic syndrome (HUS). His anemia was associated with decreased reticulocyte count and persisted after the recovery from HUS. Superinfection of parvovirus B19 (PVB19) was proven by a transient febrile episode associated with IgM antibodies to the virus and the delayed appearance of IgG antibodies and typical rashes. We conclude that PVB19 infection could induce severe persistent anemia in EHEC-associated HUS. Reticulocytopenia is a clue to the diagnosis in such cases. [ABSTRACT FROM AUTHOR]

We aimed to assess the prevalence of antibiotic resistance amongst urinary tract isolates within our clinic. Local protocol has been to prescribe a 3-day course of trimethoprim for uncomplicated urinary tract infections (UTIs). Notes of all culture-proven UTIs (October 1998 to September 1999) were examined. Eighty-six urinary isolates were identified in 84 patients. Seventy-three of the isolates were coliforms with 46 being Escherichia coli. Of the 86 urinary isolates 28 (32.6%) were resistant to trimethoprim, 37 (43.5%) to amoxycillin, 5 (5.8%) to cephradine and 3 (3.5%) to nitrofurantoin. Seventy-four (86%) of the UTIs were known to have been treated; 41 at initial presentation and 33 once sensitivities were available. Of the 41 patients who received treatment initially, 11 needed to return to the clinic for a further course of antibiotics. To try and reduce the number of inappropriate treatments and unnecessary visits a number of options regarding clinic protocol were explored. [ABSTRACT FROM AUTHOR]

The observation that over 50% of healthy blood donors have serum antibodies to the lipopolysaccharide of Escherichia coli O5 and O165 influences the serodiagnosis of infection with verocytotoxin-producing E. coli. [ABSTRACT FROM AUTHOR]

Presents a study to improve detection of Escherichia coli O157:H7 infections in New Jersey. Recommendations to culture all bloody stools; Identification of sources of infections; Implications for the prevention of Escherichia coli infections.

Reports on the recommendation of the Centers for Disease Control and Prevention of a widespread culturing of laboratory specimens for Escherichia coli (E coli). Aim to reduce unnecessary medical treatment and to strengthen the detection of disease outbreaks; Limitations of E coli screening methods; Increasing number of deaths due to E coli infections; Cost and utility of culturing.

Reports on the discovery that in some patients with Escherichia coli infections the antibodies of the disease appear in salivary samples. How the antibodies do not appear in other patients; The requirement of a blood sample for diagnosis of the infection; Questions as to why the infectious antibodies only appear in salivary samples of certain people.