1227

anti-oxidant deficiency and increased production of reactive oxygen

species have been reported. Oxygen species stimulate smooth muscle cell proliferation whereas oxidative modification of LDL is thought to be a prerequisite for macrophage uptake and cellular accumulation of cholesterol,’" the activated monocyte-macrophage being a major source of oxygen species. Finally, we believe that it is the disconnection between CD4 T lymphocyte (which is inhibited) and monocyte-macrophage (which is activated) rather than the chronic immune-induced inflammatory condition, as Hansson et al stated,l which is strongly

culture medium, as occurs in more than 50% of pleuropulmonary cases. The isolation of the organism from blood is rare.2 In-vitro E corrodens resistance to clindamycin, as seen in our case, is characteristic. Section of Infectious Diseases, and Bacteriology Laboratory, Ospedale Civile de Teramo, 64100 Teramo, Italy, and Analysis Microbiology Laboratory,

"LeTorrette", Ancona, Italy

MIRIAM GARGIULO ANNAGIULIA GRAMENZI LICIA DI OTTAVIO PAOLA GANDOLFI ESTHER MANSO

atherogenic.

INSERM U63, Hôpital Cardiologique, 69675 Lyon, France

MICHEL DE LORGERIL PASCALE BOISSONNAT GEORGES DUREAU SERGE RENAUD

1. Hansson GK, Jonasson L, Seifert PS, Stemme S. Immune mechanisms in atherosclerosis. Arteriosclerosis 1989; 9: 567-78. 2. Hansson GK, Jonasson L, Holm J, Clowes MM, Clowes AW. &ggr;-Interferon regulates vascular smooth muscle proliferation and la antigen expression m vivo and in vitro. Circ Res 1988; 63: 712-19. 3. Hansson GK, Holm J. Interferon-&ggr; inhibits arterial stenosis after injury. Circulation 1991; 84: 1266-72. 4. Geng YJ, Hansson GK. Interferon-&ggr; inhibits scavenger receptor expression and foam cell formation in human monocyte-derived macrophages. J Clin Invest 1992; 89: 1322-30. 5. Schectman G, Kaul S, Mueller RA, Borden EC, Kissebah AH. The effect of interferon on the metabolism of LDLs. Arteriosclerosis Thromb 1992; 12: 1053-62. 6. Libby P, Salomon RN, Payne DD, Schoen FJ, Pober JS. Functions of vascular wall cells related to development of transplantation-associated coronary arteriosclerosis. Transplant Proc 1989; 21: 3677-84. 7. Halliwell B, Cross CE. Reactive oxygen species, antioxidants, and acquired immunodeficiency syndrome. Sense or speculation? Arch Intern Med 1991; 151: 29-31. 8. De Lorgeril M, Dureau G, Boissonnat P, et al. Platelet function and composition in heart transplant recipients compared with nontransplanted coronary patients. Arteriosclerosis Thromb 1992; 12: 222-30. 9. Rao CN, Berk BC. Active oxygen species stimulate vascular smooth muscle cell growth and proto-oncogene expression. Circ Res 1992; 70: 593-99. 10. Witztum JL, Steinberg D. Role of oxidized low density liproprotein in atherogenesis. J Clin Invest 1991; 88: 1785-92.

Septic shock from Eikenella corrodens and Staphylococcus epidermidis in HIV infection SIR,7-Eikenella corrodensl usually occurs in periodontitis but also in severe systemic infections of the head and neck or abdomen. In adults, pleuropulmonary infections due to E corrodens require predisposing factors such as immunosuppression and lung disease that alters local pulmonary aspiration.2 In HIV-infected patients E corrodens causes atypical gingivitis and periodontic disease.3 We report septic shock due to E corrodens in an HIV-infected patient. A 21-year-old man, an intravenous cocaine addict and HIV antibody positive, was transferred to our division from the local prison. He had a high temperature and a dental abscess that evolved into neck cellulitis. The patient had never had opportunistic infections. 4 weeks before admission the total lymphocyte count was 21601 Jll with 15 % CD4 + ; and HIV antigen was negative. In prison he had been given zidovudine 500 mg and ceftriaxone 2 g daily for 10 and 3 days, respectively. On the day of admission, under broad-spectrum prophylaxis, a tooth was extracted. Chest radiography was normal. On the 4th day a high temperature and bleeding from the tooth socket persisted; he also had retrosternal pain and unproductive cough. Cefotaxime 6 g, netilmicin 300 mg, and clindamycin 1200 mg were started daily for a suspected aspiration pneumonia. Lymphocyte count was 560, with 7% CD4 +, blood culture for common rods was negative. Computed tomography of the lung on day 7 revealed an abscess in the right apex. Because of the patient’s poor compliance with teicoplanin 400 mg daily, netilmicin 300 mg per day was given intramuscularly. The next day chest radiography revealed a right-sided pleural effusion. On day 11, his general condition worsened (temperature 39’3OC, restlessness, purpura, haemoptysis, shock, and disseminated intramuscular coagulation). The patient died 5t h after the onset of shock. Automatic analysis (NHIC Vitek Bio Merieux) identified Staphylococcus epidermidis and E corrodens from culture of blood taken at the temperature peak. E corrodens was identified in a mixed

1. Rubin

SJ, Granato PA, Wasiluskas BL. Glucose nonfermenting gram-negative bacteria: Eikenella corrodens. In: Lennette EHK, Balows A, Hausler WJ Jr, Shadomy HJ, eds. Manual of clinical microbiology. Washington, DC: American Society for Microbiology, 1985: 266-69. 2. Joshi NO, Bryan T, Appelbaum PC. Pleuropulmonary infections caused by Eikenella corrodens. Rev Infect Dis 1991; 13: 1207-12. 3. Murray PA, Winkler JR, Peros WJ, French CK, Lippke JA. DNA probe detection of periodontal pathogens in HIV-associated periodontal lesions. Oral Microbiol Immunol 1991; 6: 34-40.

Speech

arrest as manifestation of seizures in

non-ketotic

hyperglycaemia

SIR,-Seizures are evidence of non-ketotic hyperglycaemia.1 In they are partial motor seizures although visual and generalised seizures are also describedWe report atypical speech

most cases

seizures as a manifestation of non-ketotic hyperglycaemia. A right-handed, insulin-dependent type II diabetic woman (aged 69) described in the 3 days before admission several 3 min episodes of inability to speak without losing consciousness and comprehension and without motor, visual, or sensory phenomena. Blood pressure and temperature were 140/80 mm Hg and 36-7°C, respectively. She was conscious, well-oriented, with preservation of upper cortical functions; she had mild bilateral hearing loss. While in hospital, she had another episode and two self-limited right oculocephalic seizures for a few seconds, which were observed by staff. On admission, blood glucose was 31-4 mmol/1 with osmolality of 328 mosmol/kg, and she had ketonuria. An interictal electroencephalogram demonstrated sharp waves in the left frontoparietal cortex with slowing of the basal activity, although this focus had disappeared in a subsequent examination. Enhanced magnetic resonance imaging on day 7 was normal. With insulin and intravenous fluids until blood glucose became normal, the seizures disappeared without use of anticonvulsant drugs. Speech arrest as a sole manifestation of partial seizures in non-ketotic hyperglycaemia has been described once, as the initial sign of hyperosmolar decompensated diabetes.4 Language alteration in non-diabetic hyperglycaemia has been described, but always associated with motor focal seizures.3,5 The entity must be differentiated from recurrent transient ischaemic attacks, especially in diabetic and senile patients, because of the different therapeutic and course implications. Speech arrest can be due to an aphemia or other aphasic disorder, which can be distinguished with difficulty.6 arrest

J. M. F. CARRIL Neurology Endocrinology Services, Hospital Clínico de S. Carlos, 28040 Madrid, Spain; and Neurology Service, Hospital Ramón y Cajal, Madrid

1. Maccario

C. GUIJARRO J. S. PORTOCARRERO I. SOLACHE

A. JIMÉNEZ E. VALERA DE SEIJAS

M, Messis CP, Vastola F. Focal seizures

as

a

manifestation of

hyperglycaemia without ketoaddosis. Neurology 1965; 15: 195-206. 2. Harden

CL, Rosembaum DH, Daras M. Hyperglycaemia presenting with occipital Epilepsia 1991; 32: 215-20. 3. Hennis A, Corbin D, Fraser H. Focal seizures and non-ketotic hyperglycaemia. J Neurol Neurosurg Psychiatry 1992; 55: 195-97. 4. Gil Néciga E, Galán Barranco J, Salazar Benitez JA, Bautista Conte J. Bloqueo del lenguaje como expresión de un status de crisis parciales: manifestación inicial de una descompesacion diabéticas hiperosmolar. Neurologia (España) 1987; 2: 56-58. 5. Brick JF, Gutrecht JA, Ringel RA. Reflex epilepsy and non-ketotic hyperglycaemia in the elderly: a specific neuroendocrine syndrome. Neurology 1989; 39: 394-99. 6. Gilmore RL, Heilman KM. Speech arrest in partial seizures: evidence of an associated language disorder. Neurology 1981; 31: 16-19. seizures.

Septic shock from Eikenella corrodens and Staphylococcus epidermidis in HIV infection.

1227 anti-oxidant deficiency and increased production of reactive oxygen species have been reported. Oxygen species stimulate smooth muscle cell pro...
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