308

Letters to the Editor

50/0 m m Hg. An infusion of haemacel was started and her condition quickly improved. She was then c o m m e n c e d on IV penicillin. Blood cultures and swabs from the wound yielded a growth of a G r a m - n e g a t i v e bacillus which was later identified as P. multocida sensitive to penicillin. D u r i n g the next 72 h she improved dramatically and the treatment was changed to oral amoxycillin, 500 mg t.d.s, on which she was discharged. N o follow up was arranged. T h i s case illustrates two unusual features of infection with P. multocida; the presence of septicaemia in an otherwise normal individual and the rapid onset of clinical G r a m - n e g a t i v e endotoxic shock. While it is unlikely that empirical antibiotic cover for presumed Gram-negative septicaemia would not cover P. multocida, the presence of this organism in clinical G r a m - n e g a t i v e shock following injuries inflicted by cats or dogs, should not be overlooked.

Departments of Medical Microbiology and Medicine, Walton Hospital, LiverPool, U.K.

A. E. Murray S. J. Mills

References I. Hubbert WT, Rosen MN. Pasteurella multocida infection due to animal bite. Am J Pub Health I97O; 6o: IIO3. 2. Weber DJ, Wolfson JS, Swartz MN, Hooper DC. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore) I984; 63: 133-I54. 3. Jones AGH, Lockton JA. Fatal Pasteurella multocida septicaemia following a cat bite in a man without liver disease. J Infect I987; I5: 229-235.

Laboratory infection with human parvovirus BI9 Accepted for publication 4 December I99o Sir, Adults with a primary infection due to h u m a n parvovirus B I 9 ( H P V / B I 9 ) are known to show various clinical features. 1-5 Descriptions of the entire clinical courses of such infections, however, are still sparse, although experimental parvovirus infection in h u m a n beings has been recorded. 6 Here, we wish to report the entire clinical features of two adults accidentally infected in the laboratory with H P V / B I 9 . A 3o-year-old male research worker was suspected to have a laboratory infection caused by H P V / B I 9 (Fig. I). H e had felt unwell and had been febrile since 27 August i987. H e had worked with materials containing H P V / B I 9 from I3 August to 20 August, thereby suggesting that he was infected with H P V / B I 9 during this period. H P V / B I 9 D N A (o'I mg/1) was detected in his serum on 27 August. I g M antibody to H P V / B I 9 became detectable on 2 September after which time its concentration gradually decreased. I g G antibody to H P V / B I 9 became detectable on 7 S e p t e m b e r and lasted for more than a year. His body temperature ranged between 38"5 and 39'3 °C for the initial 5 days. H e complained of pain in his knees and feet on day 9 of the episode. General malaise and headache still remained, while swelling of the eye lids and lower arms was also observed. On 6 September, a fine reticular erythematous rash developed on his arms and legs but not on his face. L a b o r a t o r y tests revealed mild liver dysfunction ( S G O T 5 2 U / l ; S G P T I o 9 U / l ) at that time. W B C and R B C counts were 3"2 × 109/1 and 4'3 x io12/1, respectively. By 19 September the patient was afebrile and without clinical signs but still felt tired until the beginning of October.

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Letters to the Editor Case I, 5 0 - y e a r - o l d male 1987 Aug Sep 27 51 2 HPV/BI9 DNA*-]-

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0 Fig. I. HPV/BI9 DNA was detected by dot blot hybridisation. The HPV/BI9 DNA probe, p G E M - I , was supplied by Dr J. P. Clewley. 1° t Anti-HPV/Bx9 (IgM and IgG) was detected by indirect immunofluorescence staining and the use of HPV/BI9-infected fetal erythroid lineage cells, n

A 36-year-old female research assistant was also expected to have a laboratory infection due to H P V / B T 9 . She started to work with materials containing H P V / B I 9 at the beginning of June I987. On 3o July, she had headache, malaise, sore throat, conjunctivitis and fever. I g M antibody to H P V / B I 9 became detectable on 4 August and its titre increased until I I August after which time it gradually diminished. I g G antibody to H P V / B I 9 was undetectable on 4 August but became detectable on I I August and lasted until at least 25 January I988. L a b o r a t o r y tests did not reveal any abnormality of liver function such as raised concentrations of G O T and G P T . T h e patient had recurrent febrile episodes and arthralgia for m o r e than 2 months. T h e date of exposure to H P V / B I 9 in the first case was suspected to be 7 - I 4 days before the onset of illness, thereby indicating an incubation period ranging f r o m 7 - I 4 days. T h i s estimation of the incubation period in ' n a t u r a l ' laboratory infection is consistent with other reports of experimental inoculation of H P V / B z 9 in adults 6 and natural infection as seen in hospital. 3 Liver dysfunction was observed in some cases including the present case, although in most of t h e m was not severe3 T h e long lasting arthralgia of m o r e than 2 months duration supports a possible causative relationship

Letters to the E d i t o r

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between H P V / B I 9 infection and rheumatoid arthritis which we and others have previously observed epidemiologically. 7-9

Miyagi Prefectural Institute of Public Health, 4-7-2, Saiwaicho, Sendai 983 The Second Department of Internal Medicine Department of Microbiology, Tohoku University School of Medicine, 2 - I , Seiryo-machi, Sendai 980, Japan

Hiroyuki Shiraishi Takeshi Sasaki Masataka Nakamura Nobuo Yaegashi Kazuo Sugamura

References I. White DG, Woolf AD, Mortimer PP et al. Human parvovirus arthropathy. Lancet I985;

i: 419-42I. 2. Plummer FP, Hammond GW, Forward K et al. An erythema infectiosum-like illness caused by human parvovirus infection. N Engl J Med I985; 3x3 : 74-79. 3. Bell LM, Naides SJ, Stoffman P e t al. An erythema infectiosum-like illness caused by human parvovirus infection. N EnglJ Med z989; 32x: 485-49I. 4. Shiraishi H, Umetsu K, Yamamoto H et al. Human parvovirus (HPV/BIg) infection with purpura. Microbiol Immunol I989; 33: 369-372. 5. Nunoue T, Koike T, Koike R et al. Infection with human parvovirus (BI9), aplasia of the bone marrow and a rash in hereditary spherocytosis. J Infect I987; x4: 67-70. 6. Anderson MJ, Higgins PG, Davis LR et al. Experimental parvovirus infection in humans. J Infect Dis I985; x52: 257-265. 7. Sasaki T, Takahashi Y, Yoshinaga K et al. An association between human parvovirus B-r 9 infection and autoantibody production. J Rheumat z989; x6: 708. 8. Reid DM, Reid TMS, Brown T et al. Human parvovirus-associated arthritis: a clinical and laboratory description. Lancet I985; i: 422-425 . 9. Cohen BJ, Buckley MM, Clewley JP et al. Human parvovirus infection in early rheumatoid and inflammatory arthritis. Ann Rheum Dis x986; 45: 832-838. zo. Clewley JP. Detection of human parvovirus using a molecularly cloned probe, ff Med Virol I985; I5: I73-I8I. II. Yaegashi N, Shiraishi H, Takeshita T et al. Propagation of human parvovirus BI9 in primary culture of erythroid lineage cells derived from fetal liver, ff Virol I989; 63: 2422-2426.

C l o s t r i d i u m d i ~ c i l e i n the elderly Accepted for publication IO December 199o Sir, Corrado et al., 1 report in the N o v e m b e r I99o issue of this journal a low carriage rate (4 %) of Clostridium difficile in elderly patients on a mixed-function geriatric ward. As their findings support the low carriage rate reported by Campbell et al.fl and contradict the higher rates reported by othersf1-5 they r e c o m m e n d further comparative studies of various institutional settings so as to ensure that earlier reports of high carriage rates do not merely reflect outbreaks of infection. W e conducted a short similar study on C. difficile carriage in elderly patients in hospital that m a y therefore be of interest. Nineteen specimens were collected over a period of 13 weeks from I7 patients (mean age 78 years, range 68-97 years) consisting of nine m e n and eight women. N o n e of t h e m had diarrhoea at the time of sampling or had received antibiotics in the preceding 4 weeks. All faecal specimens were tested both directly ~ and following enrichment in a selective broth for C. difficile and for cytotoxicity to V E R O cells/

Laboratory infection with human parvovirus B19.

308 Letters to the Editor 50/0 m m Hg. An infusion of haemacel was started and her condition quickly improved. She was then c o m m e n c e d on IV...
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