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In Reply.— The concerns raised by Sturges are quite valid. In our study, 1 we did not obtain specific data on meat consumption or meat contact, and, consequently, we cannot be certain that our Seventh-Day Adventist participants did not eat or handle meat. However, assuming that a substantial percentage of the Seventh-Day Adventists were adherent to a strict vegetarian diet (a not unreasonable assumption, as blood samples were collected from church attendees at the close of Sabbath services), we would have expected to see some evidence of decreased seroprevalence if meat consumption was a significant risk factor for Helicobacter pylori infection. We would also have expected to find a greater degree of heterogeneity in the responses of the Seventh-Day Adventists compared with their meateating neighbors (ie, if meat consumption was a risk factor, and there were both meat eaters and strict vegetarians within our group of Seventh-Day Adventists, the range

•Vibrio vulnificuswas isolated from blood and stool cultures from a 65-year-old man who had underlying alcoholic liver disease. The patient had eaten raw oysters the day before he became ill. To our knowledge, this is the first published report of isolation of the organism from stool in a patient with primary septicemia, and it provides support for epidemiologic studies suggesting that the infection is acquired through the gastrointestinal tract by eating raw seafood containing the organism. It was also possible, in this case, to demonstrate the presence of high antibody titers to the blood isolate by indirect immunofluorescence but not by agglutinating or vibriocidal tests. (Arch Intern Med1983;143:837-838)

• We examined 45 (80%) of 56 consecutive adult patients with malignant hematologic disorders who were hospitalized during a 15-week period at Emory University Hospital, Atlanta. Stool samples for Clostridium difficile culture and cytotoxin assay were obtained on admission and then weekly during each patient's hospitalization. On admission, four patients had detectable C difficile in their stool samples, which was associated with prior antimicrobial use but not with prior cancer chemotherapy. One of the four patients with positive stool samples also had toxin present in the stool sample and was the only one with diarrhea. Eight (36%) of 22 patients hospitalized for one or more weeks had C difficile isolated from at least one stool specimen. The positive cultures showed no clustering in time, and no risk factors were identified for colonization. Only seven of 15 culture-positive stool samples and three of seven toxin-positive samples were associated with diarrhea. ( Arch Intern Med 1984;144:967-969)

• The acridine orange derivative amsacrine (National Services Center No. 249992) was used to treat a patient with T-cell acute lymphoblastic leukemia (ALL). A 17-year-old boy had a tumor lysis syndrome after a single 200 mg/sq m dose of amsacrine. This was followed by a prolonged period of marrow hypoplasia leading to death from infection. Review of the literature and our own experience would suggest that T-cell ALL may be exquisitely sensitive to amsacrine. (Arch Intern Med1983;143:165-166)

Bacillus cereus is a recent addition to the growing list of organisms known to cause food-borne disease. In the 1950s, Hauge 1 published the first description of a food-borne B cereus outbreak based on his investigation of several outbreaks in Norway. Illness in these outbreaks was characterized preponderantly by diarrhea, with an incubation period of from ten to 12 hours. In the early 1970s, a second clinical syndrome associated with B cereus was identified in which vomiting was the primary symptom and in which the incubation period ranged from one to six hours. 2 Unlike outbreaks of diarrheal B cereus food-borne disease, which have been associated with a variety of foods, rice has been implicated as the vehicle in almost all reported outbreaks of the emetic syndrome. These two different clinical syndromes seem to be associated with two different toxins produced by the bacteria: one toxin is heat labile—causes fluid