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• Administration of cancer chemotherapeutic agents to humans and animals is frequently complicated by diarrhea and enterocolitis.Clostridium difficileand its toxin were found in the stools of two patients with colitis after chemotherapy for malignant neoplasms. Diarrhea in both patients resolved with oral vancomycin hydrochloride therapy.Clostridium difficilewas also isolated from several fomites within the room of one of these patients and also from the hands of his nurses. Based on these two recent experiences, we believe patients with cancer and diarrhea or signs suggestive of colitis should be studied for toxigenicC difficileand appropriate isolation techniques employed. (Arch Intern Med1982;142:333-335)

Thirty patients received gallium citrate Ga 67 for scintiscanning in a search for abscesses and other covert infections—25 intra-abdominal and 5 extra-abdominal. Abnormal areas of isotope uptake were found in 25 patients; of these, six had proven infections; 15 had clinically established infections (but confirmatory tissue diagnostic procedures were not performed); one scan was false-positive; and three abnormal scans were due to tumor. This noninvasive scanning procedure has proved useful in identifying sites of inflammation. (JAMA230:82-85, 1974)

AN UNUSUAL case of mycobacterial meningitis caused by Mycobacterium bovis is reported. Sparse growth of the initial isolate, obtained from the CSF, raised the possibility of M bovis or resistant M tuberculosis infection. Enhanced growth on a glycerol-free medium and results of biochemical testing led to the identification of M bovis . Report of a Case A 63-year-old male dentist was admitted to a community hospital on Aug 20, 1980, after ten days of headache, stiff neck, and photophobia. He was confused, but there were no focal neurological findings. Cerebrospinal fluid analysis disclosed 290 WBCs per cubic millimeter, with 90% lymphocytes and 10% neutrophils. The CSF protein level was 193 mg/dL and the glucose level was 22 mg/dL, with a serum glucose level of 105 mg/dL. He did not respond to administration of intravenous penicillin G potassium, 24 million units/ day, became more confused, and was transferred to the University of

Candida parapsilosis is rarely isolated from blood cultures. Our hospital surveillance detected an increased rate of isolation of C parapsilosis during a fourmonth period. Fourteen postoperative patients receiving intravenous (IV) hyperalimentation and eight burn patients receiving IV albumin were involved. Hectic fever, the major clinical manifestation, was seen in 61% of cases. Therapy in the postoperative patients consisted merely of discontinuing IV catheters and hyperalimentation, while amphotericin B was needed in five of eight burn patients to control persistent fungemia. Epidemiologic analysis identified a source of the organism in the IV-additive preparation room, where C parapsilosis was found contaminating a vacuum system. Organisms apparently refluxed into IV bottles when aliquots were removed to accommodate additives. Of 103 patients who received fluids prepared with the contaminated system, 21% became infected with C parapsilosis . Infection surveillance was instrumental in detection and control of the outbreak. Routine guidelines should be established to insure the sterility of IV fluids containing additives. ( Arch Intern Med 137:1686-1689, 1977)

• The clinical findings of pemphigus vulgaris, rheumatoid arthritis, and Sjogren's syndrome were found in a patient displaying immunological abnormalities found in pemphigus vulgaris, systemic lupus erythematosus, rheumatoid arthritis, and Hashimoto's thyroiditis. Some of the antigen-antibody systems detected in this case were further identified. Our patient may be an example of severe failure in immune regulation. (Arch Dermatol116:77-79, 1980)

• Cell-mediated immunity was evaluated in 11 children with diabetes mellitus; six children were evaluated during ketoacidosis and five were evaluated with ketonuria in the absence of acidosis. Five of the six ketoacidotic children had at least one positive delayed-hypersensitivity skin test. Lymphocytes from two ketoacidotic patients were unresponsive to phytohemagglutinin and pokeweed mitogen, and lymphocytes from these two patients plus a third patient were unresponsive to concanavalin A. Lymphocytes from all six patients responded to these three mitogens after one week of therapy. In the five diabetic children without ketoacidosis, lymphocyte responses were normal to all three mitogens. Similarly, the addition of glucose to normal plasma did not alter the lymphocyte transformations of three healthy nondiabetic controls. These data suggest that cell-mediated immunity may be transiently defective in children with acute diabetic ketoacidosis. ( Am J Dis Child 132:1014-1017, 1978)

• The quantitative nitro blue tetrazolium (NBT) test did not show increased NBT reduction in bacterial infections as frequently as has been reported with the qualitative NBT test in untreated infections. Lower than normal values were seen in septic shock and bacterial endocarditis, and normal results were seen in most other bacterial infections. Increased NBT reduction was seen with reticulum cell sarcoma, Hodgkin disease, postoperative wound infections, and upper respiratory tract infections. Thus, the quantitative NBT was of little use in diagnosis of acute infections. The correlation between quantitative tests and tests of bactericidal capacity of leukocytes was poor. These data suggest that NBT reduction and bactericidal activity are dissociative events within phagocytes. Patients with low NBT results usually had bactericidal activity within normal limits. (Arch Intern Med135:1569-1574,1975)

From mid-July through late September 1970, 221 persons developed an illness characterized by acute gastroenteritis, myalgias, and lethargy. Encephalopathy became evident in 18 patients. The latter was relapsing and had a slow convalescence. Physical findings were few, and laboratory examinations were not helpful in establishing a diagnosis. This epidemic appears to be a variant of so-called "epidemic neuromyasthenia," which may be more common than medical literature would indicate.