881

CORRESPONDENCE Pancreatic Abscess Due to Candida albicans

Raja Shekar, Bhagavatlal Morker, and Burton C. West Departments ofInternal Medicine and Medicine, Meridia Huron Hospital, Cleveland, Ohio Correspondence: Dr. Burton C. West, Meridia Huron Hospital, 13951 Terrace Road, Cleveland, Ohio 44112.

Clinical Infectious Diseases 1992;15:881 © 1992 by The Universityof Chicago. All rights reserved. 1058-4838/92/1505-0017$02.00

In Utero Infection Due to Pasteurella multocida SIR-In the February 1992 issue of Clinical Infectious Diseases, Waldor et al. [1] reported an in utero infection due to Pasteurella multocida and reviewed the literature concerning other reports of infections during pregnancy. However, the article contains no information about the method(s) used to identify the organism and no listing of the characteristics of the organism. I am interested in knowing if the characteristics proposed by Mutters et al. [2] for identifying the isolate as one of the three subspecies of P. multocida were determined. It would be interesting to know if the earlier case reports that were cited included enough information to allow one to determine how those isolates would have been identified using the

Reference 1. Keiser P, Keay S. Candidal pancreatic abscesses: report of two cases and review. Clin Infect Dis 1992; 14:884-8.

criteria of Mutters et al. I would not be surprised, however, if these isolates could not be identified, because sorbitol and dulcitol (two key characteristics for differentiating between subspecies; table I) are not among the commonly tested carbohydrates. I make a plea for the inclusion ofat least minimal characterization of causative agents in case reports.

Robert E. Weaver Meningitis and Special Pathogens Branch. Division of Bacterialand Mycotic Diseases, National Centerfor Infectious Diseases, Centersfor DiseaseControl, Atlanta, Georgia

References

Correspondence: Dr. Robert E. Weaver, Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control, 1600 Clifton Road, N.E., Building 5, Room 210, G07, Atlanta, Georgia.

Clinical Infectious Diseases 1992;15:881-2 © 1992 by The University of Chicago. All rights reserved. 1058-4838/92/1505-0018$02.00

I. Waldor W, Roberts 0, Kazanjian P. In utero infection due to Pasteurella multocida in the first trimester of pregnancy: case report and review. Clin Infect Dis 1992;/4:497-500. 2. Mutters R, Ihm P, Pohl S, Frederiksen W, Mannheim W. Reclassification of the genus Pasteurella Trevisan 1887 on the basis of deoxyribonucleic acid homology, with proposals for the new species Pasteurella

dagmatis. Pasteurella canis, Pasteurella stomatis, Pasteurella anatis. and Pasteurella langaa. lnt J Syst Bacterial 1985;35:309-22.

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SIR-We read with interest the recent review [I] by Keiser and Keay that reports candidal pancreatic abscess. We report a case of pancreatic abscess caused by Candida albicans complicating acute pancreatitis. A 71-year-old man was admitted to our facility because of abdominal pain. He had recently undergone cholecystectomy and appendectomy. On admission elevated serum amylase (680 U/L) and lipase levels (645 U/L) were noted. He was treated with nasogastric suction, intravenous fluids, and analgesics. On the l Sth hospital day, the patient developed fever and leukocytosis (white blood cells, 20,900/mL; neutrophils, 74%; lymphocytes, 13%; monocytes, 6%; eosinophils, 2%; basophils, 5%). He was treated with cefotaxime (1 g every 6 hours). After 3 days of treatment, leukocytosis and fever persisted; therapy with cefotaxime was discontinued, and that with vancomycin, metronidazole, and ciprofloxacin was initiated. Abdominal ultrason-

ography revealed a pancreatic pseudocyst. Computed tomography-guided drainage of the pseudocyst was performed. Gram stain of the fluid revealed many polymorphonuclear leukocytes and budding hyphae; therefore, antibiotic therapy was changed to administration of fluconazole, and a pancreatic drain was left in place. Cultures of the pancreatic fluid consistently yielded heavy growth of C. albicans. Because his condition failed to improve, therapy with fluconazole was discontinued and that with amphotericin Band 5fluorocytosine was started on the 25th day. Open drainage was not done because of the patient's critical condition. His condition deteriorated despite therapy, and he died on the 26th hospital day. On the basis of this case and cases reported by Keiser and Keay, we believe that early diagnosis, prompt antifungal therapy, and open surgical drainage of an abscess are crucial in the management of candidal pancreatic abscess.

882

CID 1992; 15 (November)

Correspondence

Table 1 (Weaver,p. 881).

Selected characteristics of the subspecies of Pasteurella multocida [2J. Acid produced within 24-48 hours*

Name of subspecies

P. multocida subspecies multocida P. multocida subspecies septica P. multocida subspecies gallicida

No. of strains

Ornithine

Indole

Mannitol

Sorbitol

+ + +

+ + +

+ + +

+

26 9

6

NOTE. + = positive reaction. * + = ~90% of the strains are positive for production of acid; production of acid.

SIR-In response to Dr. Weaver's inquiry, we describe the characteristics of the isolate from the patient who had an in utero infection due to Pasteurella multocida [I]. Cultures of the patient's blood and vaginal specimens yielded small, gray, shining colonies on blood agar that, on subculture, failed to grow on MacConkey agar. A gram stain revealed gram-negative coccobacillary forms. The isolate produced indole, catalase, and oxidase and reduced nitrate; it did not produce urease. Patterns of sugar degradations (glucose, sucrose) were characteristic of P. multocida. The isolate fermented sorbitol, but the API system used in our microbiology laboratory did not contain dulcitol. Thus, according to the characteristics proposed by Mutters et al. [2], the P. multocida subspecies was either multocida or gallicida. Of the five previous case reports of P. multocida infections in pregnancy cited by Waldor et al. [I], none provided information on reactions to sorbitol and dulcitol [3-7]. Furthermore, this biochemical information was not provided in recent reports of other human infections due to this organism [8-12). Since the clinical relevance of identifying subspecies of P. multocida has not been established, the need for clinical microbiology laboratories to add sorbitol and dulcitol to the commonly tested carbohydrates remains unproven.

Correspondence: Dr. Powel H. Kazanjian, Division of Infectious Diseases, A-3, Brigham and Women's Hospital. 75 Francis Street, Boston, Massachusetts 02115. Clinical Infectious Diseases 1992;15:882 © 1992 by The Universityof Chicago. All rightsreserved.

1058-4838/92/1505-0019$02.00

+

of the strains are negative for

Powel H. Kazanjian and Matthew Waldor Division oflnfrctious Diseases. Brigham and Women's Hospital. Boston. Massachusetts

References l. Waldor M. Roberts D. Kazanjian P. In utero infection due to Pasteurella multocida in the first trimester of pregnancy: case report and review. Clin Infect Dis 1992; 14:497-500. 2. Mutters R.lhm P. Pohl S. Frederiksen W. Mannheim W. Reclassification of the genus Pasteurella Trevisan 1887 on the basis of deoxyribonucleic acid homology. with proposals for the new species Pasteurella dagmatis. Pasteurella canis. Pasteurella stomatis, Pasteurella anatis, and Pasteurella langaa. Int J Syst Bacteriol 1985;35:309-22. 3. Nadler JP. Freedman MS. Berger SA. Pasteurella multocida septicemia. NY State J Med 1979;79:1581-3. 4. Robinson R. Human infection with Pasteurella septica. BMJ 1944;2:725. 5. Strand CL. Helfman L. Pasteurella multocida chorioamnionitis associated with premature delivery and neonatal sepsis and death. Am J Clin PathoI1971;55:713-6. 6. Rasaiah B. Otero JG. Russell Il, et al. Pasteurella multocida septicemia during pregnancy. Can Med Assoc J 1986; 135: 1369-72. 7. Kam WK, Haverkos HW. Rodman HM. Schmeltz R. Van Thiel DR Human pasteurellosis: the first reported case of Pasteurella multocida septicemia and peritonitis during pregnancy. Am J Obstet Gynecol 1980; 138:351-2. 8. Georghiou PRo Mollee TF. Tilse MH. Pasteurella multocida infection after a Tasmanian devil bite. Clin Infect Dis 1992; 14: 1266-7. 9. Morris JT. McAllister CK. Bacteremia due to Pasteurella multocida. South Med J 1992;85:442-3. 10. Kumar A. Kannampuzha P. Septic arthritis due to Pasteurella multocida. South Med J 1992;85:329-30. II. Chevalier X. Martigny J. Avouac B. Larget-Piet B. Report of 4 cases of Pasteurella multocida septic arthritis. J Rheumatol 1991; 18: 1890-2. 12. Armengol S. Mesalles E. Domingo C. Samso E. Manterolas J. A new case of meningitis due to Pasteurella multocida [letter). Rev Infect Dis 1991;13:1254.

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Reply

= ~90%

+

Dulcitol

In utero infection due to Pasteurella multocida.

881 CORRESPONDENCE Pancreatic Abscess Due to Candida albicans Raja Shekar, Bhagavatlal Morker, and Burton C. West Departments ofInternal Medicine an...
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