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It is reported a case of life-threatening septic shock due to BCG septicemia after radical cystectomy in a patient with a previous treatment with BCG therapy. In the absence of response to standard antimicrobial therapy and a negative CT scan, a PCR-based technique detected the presence of BCG bacilli in bloodstream. Immediate antimycobacterial therapy resolved the sepsis, thus suggesting either the awareness of this infection or the prompt antimycobacterial therapy as the key for the appropriate management. Furthermore, isoniazid prophylaxis should be taken into consideration in patients with history of intravesical BCG therapy undergoing cystectomy.

A detailed critical review on the role of endotoxins from gram-negative bacteria in the pathogenesis of most of the intestinal experimental models of surgical interest is presented. Data of an investigation on 10 cases of acute appendicitis and 2 cases of intestinal occlusion associated with toxaemia are then presented: in all these cases the Limulus test significatively revealed the presence of endotoxin in the blood and in the peritoneal fluid, also in absence of bacteria in the blood. The implications of these results and the use of the test in clinical practice are discussed.

The injection in the peritoneum of Limulus amebocyte lysate at the same time of inoculation of lethal dose of E. coli LPS is able to protect the rats against endotoxin lethality.

Protection against endotoxin challenge. The AA. have summarized shortly some experimental data dealing with trials of protection against endotoxin challenge pointing out, mostly, the effects of phosphate-containing compounds, as well as dextrane, anticoagulants, platelets, polymyxin B, and serum antiendotoxin and Lipid A antiserum. They have reported some experiments carried out by means of Limulus amebocyte lysate.