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A review of atypical mycobacterial infections complicating cardiac operations is presented. Proven sources of infections at different institutions include contaminated porcine valves and municipal water supply, but the mode of transmission in the great majority of patients remains unclear. There are two principal clinical forms of atypical mycobacterial infections after cardiac operations—endocarditis and sternal osteomyelitis. The latter has characteristics resembling tuberculotic "cold abscess." Specialized laboratory testing is necessary to confirm the diagnosis, and surgeons may have to take the initiative to request special microbiological investigation in cases where infection is clinically suspected but routine cultures are reported as "negative." The prognosis for patients who have any atypical mycobacterial infection after a heart operation is severe. Those infected with the strain chelonei and those whose cardiac chambers were entered during operation fare worse. This dim clinical prognosis may be improved by appropriate and aggressive antibiotic and surgical therapy. Awareness of the urgency of special bacteriological studies is the key to successful management.

Butane-2,3-dione and 2,2-dimethyl-propane-1,3-diol react, under the influence of an acidic ion exchange catalyst, to produce the monoketal in high yield.

Two outbreaks of postoperative wound infections due to organisms of the Mycobacterium fortuitum complex (Mycobacterium chelonei and M. fortuitum) occurred among patients who underwent open-heart surgery. In one hospital, 19 of 80 patients who underwent cardiac surgery within a 10-week period developed sternal infection with M. chelonei. In the second hospital, four of nine patients who underwent cardiac surgery within a two-week period developed sternal incisional infection with M. fortuitum. Although epidemiologic investigations uncovered factors that were significantly associated with the development of infection, the source of the infections could not be determined. The results of numerous cultures were negative, but because the investigations were conducted at least two months after many of the patients had had surgery, the materials in use at the time of the surgery were not available for culture. These results emphasize that physicians should be aware that rapidly growing mycobacteria may produce postoperative wound infections.

Recovery rates of Group A beta-hemolytic streptococci in throat cultures from 300 children were studied using three different methods. The swabs were streaked onto plates immediately, streaked from the same dry swabs held at room temperature for 3 to 6 hours and streaked from swabs held in transport media at room temperature for 3 to 6 hours. The cultures were processed in a pediatric office and interpreted by a microbiologist. The recovery rates were similar for the three methods, but the cultures were easier to interpret when the swabs had been allowed to dry before streaking as a result of a decrease in the normal flora on these plates. In a separate study the recovery of Group A beta-hemolytic streptococci from 187 swabs was identical whether the swabs were streaked at 3 to 6 hours or at 18 to 24 hours.

Diphtheria affected 201 persons in San Antonio, Texas, from 1 December 1969 to 31 December 1970. Three unimmunized children died. The predominant signs and symptoms were sore throat, fever...

This report describes a case of endocarditis caused by Erysipelothrix insidiosa . The patient was a butcher who probably contracted the infection via the cutaneous route. Cure of the erysipelothrix endocarditis was achieved by penicillin therapy, but the patient succumbed later to staphylococcal endocarditis following cardiac surgery. Although rare, the possibility of E. insidiosa infection should be considered when diphtheroid organisms are consistently isolated from a patient’s blood cultures.

Apparent spontaneous induction in staphylococcal strains from two clinical specimens was described. One of the two phages associated with these strains was found useful in typing otherwise untypable strains.