Letters to the Editor
2IO
References I. Oelberg DG, Fisher DJ, Gross DM, Denson SE, Adcock EW. Endocarditis in high-risk neonates. Paediatrics I983; 7x (3): 392-397. 2. Noel GJ, O'Loughlin JE, Edelson PJ. Neonatal Staphylococcus epidermidis. Right-sided endocarditis. Description of five catheterized infants. Paediatrics I988; 82 (2): 234-239. 3. Millard DD, Shulman ST. The changing spectrum of neonatal endocarditis. Clin Perinatol I988; x5 (3): 587-608. 4. O'Callaghan C, McDougall P. Infective endocarditis in neonates. Arch Dis Child I988; 63 :
53-57.
5. Musker DM. Enterococcus species and group D streptococcus. In: Mandell, Douglas, Bennett, Eds. Principles and practice of infectious disease I99o: I55O-I554. 6. Gersony WM, Hordof AJ. Infective endocarditis and disease of the pericardium. Paediatr Clin I978; 25 (4): 831-846.
Mycoplasma horninis i n f e c t i o n o f a b r e a s t p r o s t h e s i s Accepted for publication II February x99x Sir,
Mycoplasma hominis is often isolated f r o m the uro-genital tract and has been associated with a wide variety of clinical conditions. 1 W e wish to report a case of M. hominis infection in a breast prosthesis. W e are not aware of Mycoplasma species having been isolated in similar circumstances. A 38-year-old w o m a n underwent bilateral subcutaneous m a s t e c t o m y with insertion of silicone gel-filled implants for persistent mastalgia and nipple discharge. T h e operation was uneventful. F o u r weeks later, however, the patient was readmitted to hospital complaining of malaise and headaches during the previous 8 days. She was febrile (38 °C) and had a raised W B C count (I5"3 x Io9/1). T h e r e had been a serous discharge f r o m the left breast and fluid had collected under the right prosthesis. Some of this fluid was aspirated and sent for culture. After 48 h anaerobic incubation, a heavy pure growth of translucent, non-haemolytic pinpoint colonies was obtained on blood agar. Subculture on 20 % serum agar showed the classical ' f r i e d - e g g ' colonies of a Mycoplasma species. T h e organism was later identified as M. hominis, being sensitive to chloramphenicol and tetracycline but resistant to erythromycin by disc sensitivity testing. Neither Mycoplasma hominis nor other m o r e usual pathogens were isolated f r o m superficial w o u n d swabs. Both breast prostheses were removed and the patient was treated with tetracycline and metronidazole. T h e wounds healed and the patient was discharged f r o m hospital. Recovery of a heavy pure growth of M. hominis f r o m the breast aspirate, as well as failure to isolate any other pathogens both f r o m the aspirate and f r o m the skin, suggest that M. hominis played a pathogenic role in this patient. T h e presence of silicone implants p r e s u m a b l y predisposed to the infection. Mycoplasma pneumoniae is a wellrecognised pathogen of the respiratory tract and has also been implicated in m a n y other conditions. Mycoplasma hominis is known to colonise the adult uro-genital tract. It has been implicated in non-gonococcal urethritis, pelvic inflammatory disease 2 and p o s t - p a r t u m fever. 3 I n addition, there is a wide variety of uro-genital conditions to which M. hominis infection has been tentatively linked. W o u n d infections of the sternum with M. hominis have been described 4 although colonisation alone m a y have been difficult to exclude. T h e presence of this organism in such an unusual site led us to speculate on its origin. I m p l a n t a t i o n at the time of operation or post-operatively was possible. I f this had happened, M. hominis would probably have been isolated f r o m the superficial
Letters to the Editor
21I
w o u n d swab also. As this was not the case, these possibilities were discounted. T h e patient had had an 8 days' history of influenza-like symptoms. D u r i n g that time, Mycoplasma species may have entered the bloodstream (possibly following sexual intercourse) thereby resulting in seeding of the organism in the prosthesis. Unfortunately, blood for culture was not taken on admission of the patient to hospital, so this hypothesis could not be proved. We conclude that M. hominis may rarely be found in sites other than the uro-genital tract and may be pathogenic in such sites. T h e isolation, anaerobically, of clear, pinpoint colonies merits further investigation for Mycoplasma species and, if identified, appropriate antibiotic treatment should be given. (We thank Mr R. W. Griffiths and Mr Raftery for permission to report on their patient and Dr R. H. Leach, Mycoplasma Reference Facility, Central Public Health Laboratory, Colindale for confirming the identity of the organism.)
* Public Health Laboratory Service, ~fDepartment of Plastic Surgery, Northern General Hospital, Herries Road, Sheffield $5 7A U, U.K.
D. Sanyal* C. ThurstonJf
References
1. Taylor-Robinson D, Tully JG, Furr PM, Cole RM, Rose DL, Hanna NF. Urogenital mycoplasma infections of man; a review with observations on a recently discovered mycoplasma. IsrJ Med Sci 1981; 17: 524-530. z. Taylor-Robinson D, Csonka GW. Laboratory and clinical aspects of mycoplasmal infections of the human genitourinary tract. In: Harris JRW, Ed. Recent advances in sexually transmitted diseases. London : Churchill Livingstone, 1981 : 15 I-186. 3. Taylor-Robinson D, McCormack WM. Medical progress: the genital mycoplasmas. N EnglJ Med 198o; 302: lOO3-1OlO. 4. Steffenson DO, Dummer JS, Granick MS, Pasculle AW, Griffith BP, Cassell GH. Sternotomy infections with Myeoplasma hominis. Ann Intern Med 1987; lO6: 204-2o8. C e n t r a l v e n o u s l i n e i n f e c t i o n c a u s e d b y B r e v i b a c t e r i u m epiderrnidis
Accepted for publication 25 March 1991 Sir, We wish to report a case of central venous line infection with septicameia due to
Brevibacterium epidermidis. A 4o-year-old man, with a long history of recurrent duodenal ulceration due to Zollinger-Ellison syndrome, was admitted to hospital complaining of vomiting shortly after eating and loss of weight over the previous few months. He was not otherwise unwell. Radiological studies showed pyloric outflow obstruction attributable to fibrosis due to long-standing ulceration. A subclavian Deltacath triple-lumen catheter was inserted so as to provide total parenteral nutrition in preparation for surgery. After 15 days, the patient became septicaemic. T h e r e was no evident focus of infection other than slight erythema around the insertion site of the catheter. He had not received any antibiotics. Removal of the line and administration of erythromycin led to rapid improvement. Peripheral blood cultures yielded coryneform bacteria from the aerobic subculture of both aerobic and anaerobic bottles after 48 h of incubation at 37 °C. T h e central line
2IO
References I. Oelberg DG, Fisher DJ, Gross DM, Denson SE, Adcock EW. Endocarditis in high-risk neonates. Paediatrics I983; 7x (3): 392-397. 2. Noel GJ, O'Loughlin JE, Edelson PJ. Neonatal Staphylococcus epidermidis. Right-sided endocarditis. Description of five catheterized infants. Paediatrics I988; 82 (2): 234-239. 3. Millard DD, Shulman ST. The changing spectrum of neonatal endocarditis. Clin Perinatol I988; x5 (3): 587-608. 4. O'Callaghan C, McDougall P. Infective endocarditis in neonates. Arch Dis Child I988; 63 :
53-57.
5. Musker DM. Enterococcus species and group D streptococcus. In: Mandell, Douglas, Bennett, Eds. Principles and practice of infectious disease I99o: I55O-I554. 6. Gersony WM, Hordof AJ. Infective endocarditis and disease of the pericardium. Paediatr Clin I978; 25 (4): 831-846.
Mycoplasma horninis i n f e c t i o n o f a b r e a s t p r o s t h e s i s Accepted for publication II February x99x Sir,
Mycoplasma hominis is often isolated f r o m the uro-genital tract and has been associated with a wide variety of clinical conditions. 1 W e wish to report a case of M. hominis infection in a breast prosthesis. W e are not aware of Mycoplasma species having been isolated in similar circumstances. A 38-year-old w o m a n underwent bilateral subcutaneous m a s t e c t o m y with insertion of silicone gel-filled implants for persistent mastalgia and nipple discharge. T h e operation was uneventful. F o u r weeks later, however, the patient was readmitted to hospital complaining of malaise and headaches during the previous 8 days. She was febrile (38 °C) and had a raised W B C count (I5"3 x Io9/1). T h e r e had been a serous discharge f r o m the left breast and fluid had collected under the right prosthesis. Some of this fluid was aspirated and sent for culture. After 48 h anaerobic incubation, a heavy pure growth of translucent, non-haemolytic pinpoint colonies was obtained on blood agar. Subculture on 20 % serum agar showed the classical ' f r i e d - e g g ' colonies of a Mycoplasma species. T h e organism was later identified as M. hominis, being sensitive to chloramphenicol and tetracycline but resistant to erythromycin by disc sensitivity testing. Neither Mycoplasma hominis nor other m o r e usual pathogens were isolated f r o m superficial w o u n d swabs. Both breast prostheses were removed and the patient was treated with tetracycline and metronidazole. T h e wounds healed and the patient was discharged f r o m hospital. Recovery of a heavy pure growth of M. hominis f r o m the breast aspirate, as well as failure to isolate any other pathogens both f r o m the aspirate and f r o m the skin, suggest that M. hominis played a pathogenic role in this patient. T h e presence of silicone implants p r e s u m a b l y predisposed to the infection. Mycoplasma pneumoniae is a wellrecognised pathogen of the respiratory tract and has also been implicated in m a n y other conditions. Mycoplasma hominis is known to colonise the adult uro-genital tract. It has been implicated in non-gonococcal urethritis, pelvic inflammatory disease 2 and p o s t - p a r t u m fever. 3 I n addition, there is a wide variety of uro-genital conditions to which M. hominis infection has been tentatively linked. W o u n d infections of the sternum with M. hominis have been described 4 although colonisation alone m a y have been difficult to exclude. T h e presence of this organism in such an unusual site led us to speculate on its origin. I m p l a n t a t i o n at the time of operation or post-operatively was possible. I f this had happened, M. hominis would probably have been isolated f r o m the superficial
Letters to the Editor
21I
w o u n d swab also. As this was not the case, these possibilities were discounted. T h e patient had had an 8 days' history of influenza-like symptoms. D u r i n g that time, Mycoplasma species may have entered the bloodstream (possibly following sexual intercourse) thereby resulting in seeding of the organism in the prosthesis. Unfortunately, blood for culture was not taken on admission of the patient to hospital, so this hypothesis could not be proved. We conclude that M. hominis may rarely be found in sites other than the uro-genital tract and may be pathogenic in such sites. T h e isolation, anaerobically, of clear, pinpoint colonies merits further investigation for Mycoplasma species and, if identified, appropriate antibiotic treatment should be given. (We thank Mr R. W. Griffiths and Mr Raftery for permission to report on their patient and Dr R. H. Leach, Mycoplasma Reference Facility, Central Public Health Laboratory, Colindale for confirming the identity of the organism.)
* Public Health Laboratory Service, ~fDepartment of Plastic Surgery, Northern General Hospital, Herries Road, Sheffield $5 7A U, U.K.
D. Sanyal* C. ThurstonJf
References
1. Taylor-Robinson D, Tully JG, Furr PM, Cole RM, Rose DL, Hanna NF. Urogenital mycoplasma infections of man; a review with observations on a recently discovered mycoplasma. IsrJ Med Sci 1981; 17: 524-530. z. Taylor-Robinson D, Csonka GW. Laboratory and clinical aspects of mycoplasmal infections of the human genitourinary tract. In: Harris JRW, Ed. Recent advances in sexually transmitted diseases. London : Churchill Livingstone, 1981 : 15 I-186. 3. Taylor-Robinson D, McCormack WM. Medical progress: the genital mycoplasmas. N EnglJ Med 198o; 302: lOO3-1OlO. 4. Steffenson DO, Dummer JS, Granick MS, Pasculle AW, Griffith BP, Cassell GH. Sternotomy infections with Myeoplasma hominis. Ann Intern Med 1987; lO6: 204-2o8. C e n t r a l v e n o u s l i n e i n f e c t i o n c a u s e d b y B r e v i b a c t e r i u m epiderrnidis
Accepted for publication 25 March 1991 Sir, We wish to report a case of central venous line infection with septicameia due to
Brevibacterium epidermidis. A 4o-year-old man, with a long history of recurrent duodenal ulceration due to Zollinger-Ellison syndrome, was admitted to hospital complaining of vomiting shortly after eating and loss of weight over the previous few months. He was not otherwise unwell. Radiological studies showed pyloric outflow obstruction attributable to fibrosis due to long-standing ulceration. A subclavian Deltacath triple-lumen catheter was inserted so as to provide total parenteral nutrition in preparation for surgery. After 15 days, the patient became septicaemic. T h e r e was no evident focus of infection other than slight erythema around the insertion site of the catheter. He had not received any antibiotics. Removal of the line and administration of erythromycin led to rapid improvement. Peripheral blood cultures yielded coryneform bacteria from the aerobic subculture of both aerobic and anaerobic bottles after 48 h of incubation at 37 °C. T h e central line
