570
Correspondence
patients with B. fragilis arthritis, a high frequency of debilitating disease (75%) and local joint pathology (92%) were present. Although our patient had no history of degenerative joint disease, she had a neurogenic bladder requiring placement of an indwelling catheter; her bedridden status in association with calculous obstruction were probably the key factors that contributed to this uncommon arthritis.
M. Chomarat, R. Cahen, I. Durieu, G. Jean, and B. Francois Laboratory ofBacteriology and Nephrology Division. Centre Hospitalier Lyon-Sud. Lyon. France
References I. Bagley D. Kliger A. Weiss RM. Anaerobic urinary infections: Bacteroides fragilis bacteremia from the urinary tract. J Urol 1980; 124:160-1. 2. Nakata MM. Lewis RP. Anaerobic bacteria in bone and joint infections. Rev Infect Dis 1984;6(suppl):S 165-70. 3. Rosenkranz P, Lederman MM. Gopalakrishna KV, Ellner JJ. Septic arthritis caused by Bacteroides fragilis. Rev Infect Dis 1990; 12:20-30.
Isolation of Chlamydia pneumoniae from the Maxillary Sinus of a Patient with Purulent Sinusitis SIR-Chlamydia pneumoniae is recognized as a pathogen of acute respiratory tract infections [1-4]. Sinusitis is one of the clinical features associated with lower respiratory tract diseases caused by C pneumoniae; Grayston et al. demonstrated that there was evidence of sinusitis in 12% of the patients with bronchitis and 7% of those with pneumonia due to C pneumoniae [4]. However, to our knowledge, there is no report yet of isolation of this organism directly from the sinuses of a patient with C pneumoniae infection. We recently isolated the organism from a patient with acute sinusitis. A 47-year-old man came to our clinic on 28 December 1991 because of a stuffy nose and purulent nasal discharge of 3 days' duration. On examination his nasal mucosa was moderately swollen with pus in the postnasal space. We treated him with 600 mg of clindamycin per day for 5 days, but his symptoms did not subside. When he came to the clinic again on 4 January 1992, he had pain in the right side of the cheek and a headache. Radiographs (Water's view, figure I) showed an opacity in the right maxillary sinus. Puncture through the inferior meatus was performed and a mucoid effusion was aspirated, from which C. pneumoniae was isolated by culture with use of HL cells [5]. Identification was performed with use of the fluorescent antibody technique with monoclonal antibodies (Washington Research Foundation, Seattle). The inclusion bodies did not react
Correspondence: Dr. Kazuhiro Hashigucci, Department of Otorhinolaryngology. The Kitasato Institute Hospital. 5-9-1. Shirogane, Minato-ku, Tokyo 108. Japan. Clinical Infectious Diseases 1992;15:570-1 © 1992 by The University of Chicago. All rights reserved. 1058-4838/92/1503-0041$02.00
Figure 1. Radiographs of sinuses of a patient with C. pneumoniae infection. A, Water's view reveals an opacity in the right maxillary sinus (black arrow). B, Examination 2 weeks later reveals decreased opacification of the right antrum (white arrow).
with fluorescein-conjugated monoclonal antibody to Chlamydia trachoma tis (MicroTrak, Syva, Palo Alto, CA). No aerobic or anaerobic bacteria were cultured from the effusion. The patient was treated with 300 mg ofroxithromycin (a 14membered-ring macrolide antibiotic) per day for 10 days. When seen 2 weeks later, he had recovered completely, and a radiograph showed decreased opacification of the right maxillary sinus (Water's view, figure I). Samples of the patient's serum were drawn on 21 January, 6 February, and 2 March. Antibodies to C pneumoniae were determined with use of the microimmunofluorescent method with C. pneumoniae antigen (Washington Research Foundation) [6]. The titers of IgM antibody were I: 16, 1:
Correspondence
patients with B. fragilis arthritis, a high frequency of debilitating disease (75%) and local joint pathology (92%) were present. Although our patient had no history of degenerative joint disease, she had a neurogenic bladder requiring placement of an indwelling catheter; her bedridden status in association with calculous obstruction were probably the key factors that contributed to this uncommon arthritis.
M. Chomarat, R. Cahen, I. Durieu, G. Jean, and B. Francois Laboratory ofBacteriology and Nephrology Division. Centre Hospitalier Lyon-Sud. Lyon. France
References I. Bagley D. Kliger A. Weiss RM. Anaerobic urinary infections: Bacteroides fragilis bacteremia from the urinary tract. J Urol 1980; 124:160-1. 2. Nakata MM. Lewis RP. Anaerobic bacteria in bone and joint infections. Rev Infect Dis 1984;6(suppl):S 165-70. 3. Rosenkranz P, Lederman MM. Gopalakrishna KV, Ellner JJ. Septic arthritis caused by Bacteroides fragilis. Rev Infect Dis 1990; 12:20-30.
Isolation of Chlamydia pneumoniae from the Maxillary Sinus of a Patient with Purulent Sinusitis SIR-Chlamydia pneumoniae is recognized as a pathogen of acute respiratory tract infections [1-4]. Sinusitis is one of the clinical features associated with lower respiratory tract diseases caused by C pneumoniae; Grayston et al. demonstrated that there was evidence of sinusitis in 12% of the patients with bronchitis and 7% of those with pneumonia due to C pneumoniae [4]. However, to our knowledge, there is no report yet of isolation of this organism directly from the sinuses of a patient with C pneumoniae infection. We recently isolated the organism from a patient with acute sinusitis. A 47-year-old man came to our clinic on 28 December 1991 because of a stuffy nose and purulent nasal discharge of 3 days' duration. On examination his nasal mucosa was moderately swollen with pus in the postnasal space. We treated him with 600 mg of clindamycin per day for 5 days, but his symptoms did not subside. When he came to the clinic again on 4 January 1992, he had pain in the right side of the cheek and a headache. Radiographs (Water's view, figure I) showed an opacity in the right maxillary sinus. Puncture through the inferior meatus was performed and a mucoid effusion was aspirated, from which C. pneumoniae was isolated by culture with use of HL cells [5]. Identification was performed with use of the fluorescent antibody technique with monoclonal antibodies (Washington Research Foundation, Seattle). The inclusion bodies did not react
Correspondence: Dr. Kazuhiro Hashigucci, Department of Otorhinolaryngology. The Kitasato Institute Hospital. 5-9-1. Shirogane, Minato-ku, Tokyo 108. Japan. Clinical Infectious Diseases 1992;15:570-1 © 1992 by The University of Chicago. All rights reserved. 1058-4838/92/1503-0041$02.00
Figure 1. Radiographs of sinuses of a patient with C. pneumoniae infection. A, Water's view reveals an opacity in the right maxillary sinus (black arrow). B, Examination 2 weeks later reveals decreased opacification of the right antrum (white arrow).
with fluorescein-conjugated monoclonal antibody to Chlamydia trachoma tis (MicroTrak, Syva, Palo Alto, CA). No aerobic or anaerobic bacteria were cultured from the effusion. The patient was treated with 300 mg ofroxithromycin (a 14membered-ring macrolide antibiotic) per day for 10 days. When seen 2 weeks later, he had recovered completely, and a radiograph showed decreased opacification of the right maxillary sinus (Water's view, figure I). Samples of the patient's serum were drawn on 21 January, 6 February, and 2 March. Antibodies to C pneumoniae were determined with use of the microimmunofluorescent method with C. pneumoniae antigen (Washington Research Foundation) [6]. The titers of IgM antibody were I: 16, 1:
![[Isolation of Chlamydia pneumoniae from a patient with acute bronchitis].](/assets/img/hold.png)
