700 Clinical Microbiology and Infection, Volume 3 Number 6, December 1997 rhabdomyolysis is doubtful in these cases [6]. In our contact. The gastrointestinal tract is also a possible port patient there was no seizure, and ketoprofen has not of entry, since cases of peritonitis after been associated with muscle damage, so that GBS is the endoscopy have been described [2]. Underlying disease only factor that can explain the rhabdomyolysis. The and immunocompromised status increase the sus- pathogenesis is not clear, but it has been suggested that ceptibility to infection [2,3,6,7]. In humans, clinical infection may lead to the production of a proteolytic manifestations of pasteurella infection can be roughly factor or a polypeptide which causes muscle degrada- divided into three groups [2]: a local with tion [6]. or without deep-seated infections [4,5l, a pulmonary infection [1,3,8] or bacteremia with or without meta- D. Barcatl,J Constans', static lesions [2,6,9]. S. Sire', J. M. Ragnaud' Clinique Mkhcale et des Maladm Infectieuses, Case report H6pital Pellegrin, A 25-year-old Liberian woman had been living in Bordeaux, France; Belgium since January 1995. In 1992 and 1993 she had 2Service de Mkdecine Interne terminations of pregnancy. In July 1995 she was found et Pathologie Vasculaire, to be HIV seropositive when she presented with a H8pital Saint-Andri., breast abscess. At that time her CD4 lymphocyte count Bordeaux, France was 184 cells/pL. In August 1995 she was admitted to the Antwerp University Hospital because of high fever Acccepted 16 July 1997 (39 "C), abdominal pain, diarrhea, vomiting and cough. On clinical examination she was found to have general- References ized and hepatosplenomegaly. An 1. Singh U, Scheld WM. Infectious etiologies of rhabdo- abdominal CT scan confirmed the hepatosplenomegaly myolysis; three case reports and review. Clin Infect Dis 1996; and showed an omental 'cake' with adhesions and 22: 642-9. a multi-chambered abscess surrounded by micro- 2. Murioz P, Coque T, Rodriguez Creixems M, Bernaldo de Quirbs JCL, Moreno S, Bouza E. Group B Streptococcus: abscesses in the pouch of Douglas, bilateral pelvic a cause ofurinary tract infection in non pregnant adults. Clin inflammatory disease with salpingitis and a mild right Infect Dis 1992; 14: 492-6. hydronephrosis. The abscess was drained externally 3. Dunne DW, Quagliarello V Group B streptococcal menin- following insertions under CT guidance of a catheter. gitis in adults. Mehcine 1993; 72: 1-10, Pasteurella multocida was cultured from the drained 4. Sarniiento R, Wilson FM, Khatib R. Group B streptococcal hernopurulent fluid. Laboratory results showed anemia meninstis in adults: case report and review of the literature. and abnormal liver function tests. Blood. urine and Scand J Infect Dis 1993; 25: 1-6. fecal cultures were negative. 5. Mason S, Lewno MJ, Schutze GE. Clinical usefulness of The patient was treated with intravenous cipro- cerebrospinal fluid bacterial antigen stuhes. J Pedmtr 1994; floxacin 200 mg twice daily for 7 days, followed by oral 125: 235-8. ciprofloxacin 250 mg twice daily for 9 days, and then 6. Turner MC, Naumburg EG. Acute renal failure in the neonate, Two fatal cases due to groq B ,'jtrepto,cocti with arnoxicillin/clavulanic acid 500 mg/125 mg four times rhabdomvolvsis. Clin Pematr (Phila) 1987; 26: 189--90. a day. After 1 month she had responded well to treatment but the CT-scan appearances remained unchanged. The patient was discharged and sub- sequently lost to follow-up. Pasteurella mulfocida abcess in an African patient with To our knowledge, this is the first description of an human immunodeficiency virus infection HIV-seropositive patient developing an abdominal abscess with Pastewella multocida. Very few cases of Clin Micvobiol Infect 1997; 3: 700-701 pasteurella infection in HIV-seropositive patients have We report here a case of abdominal Pastewella multocida been described. Most of them were cases of peritonitis, abscess in an African HIV-positive patient. Pasteurella and [3,9,10]. It is unclear how our m~ltocidais a Gram-negative which can patient became infected. There was no history of be found in the normal flora of the nasopharynx animal bite or scratch or exposure to animal secretions. and gastrointestinal tract of both domestic and wild She never underwent an endoscopic procedure. mammals and birds [ 11. Human transmission generally Pasteurella infections respond well to benzylpenicikn, occurs via animal bites and scratches and via exposure second- and third-generation cephalosporins, tetra- to animal secretions [2-51. In 5-15% of Pastewella cyclines, chloramphenicol and quinolones. The sus- multocida infections there is no evidence of animal ceptibility to erythromycin is variable and there is Short Communications and Letters to the Editors 701 universal resistance to vancomycin and clindamycin infrastructure was completely destroyed. Several pro- [2,4,111. grams are being developed aimed at improving medical practice as well as at more general educational objec-

K. Depaetere 'r2, R. Colebunders'J2, L. MIS', tives. Our university has recently been involved in A. S. Pym3, M. Ieven2 training courses for medical doctors, given at the 'Institute of Tropical Mehcine, Faculty of Medicine at the University of Phnom Penh. Antwerp, Belgium; The local doctors, 16 in total, differed in age and in 'University Hospital Antwerp, Belgium; their hsciplines (surgeons and non-surgeons) and also 3St Mary's Hospital, London, UK had their practices in different areas of the country. They participated very actively and enthusiastically in the update programs which were organized for several References disciplines. 1. Hubbert WR, Rosen MN. Pasteurella multocida infection in During the microbiology courses it became man unrelated to animal bite. An1 J Public Health 1970; 60: apparent that many infectious diseases are virtually 1109-17. unknown to the doctors. They were almost unaware 2. Rafi F, Barrier J, Baron D, Drugeon HB, Nicolas F, of the problem of schistosomiasis, a parasitic disease Courtieu AL. Pasteurdla multocida bacteremia: report of that must be very frequent in a country living mainly thirteen cases over twelve years and review of the literature. off freshwater fish and rice production. , Scand J Infect Dis 1987; 19: 385-93. endemic in Cambodia and the surrounding countries 3. Drabick JJ, Gasser RA Jr, Saunders NB et al. Parteunlla multocida pneumonia in a man with AIDS and nontraumatic of Vietnam and Thailand, was also unknown to the feline exposure. Chest 1993; 103: 7-11. participants. 4. Brue C, Chosidow 0. Parfeuvella multocida wound infection Furthermore, it appears that many serious infections and cellulitis. Int J Dermatol 1994; 3(7): 471-2. are diagnosed as , and where neurologic 5. Chraibi A, Dang PM, Bedane C, Bonnetblanc JM. Pasteurella involvement occurs this is considered as a possible multocida et ulcCration de jambe. Ann Dermatol Veneorol case of Japanese encephalitis B. The question of how 1994; 121: 399-401. a infection should be treated 6. Genne D, Siegrist HH, Monnier P, Nobel M, Humair L, de remained unanswered, since nobody ever diagnoses this Torrente A. Pusteurella multocida endocarditis: report of a case infection. and review of the literature. Scand J Infect Dis 1996; 28: The major reason for this lack of medical know- 95-7. 7. Caldera L, Dutschriian L, Carmo G, Sousa G. Fatal Pusterir~llu ledge may be the absence of diagnostic microbiological multocida infection in a systenlic lupus erytheniatosus patient. laboratories in the country: none of the 16 parti- Infection 1993; 21(4): 254-5. cipating doctors had ever taken a sample for ~rllcrobial 8. Ruiz-Santana S, Antunez A, Arnas M, Rodriguez de Castro culture or serologic analysis during his entire career. F, Manzano JH. Telescoping plugged catheter: an unusual Detection of hepatitis B and HIV infection in donor way of diagnosing Parteurella mtrltocida pneumonia. Chest blood and microscopic detection of acid-fast bacilli in 1991; 6: 1517. sputum samples were the only exceptions. The absence 9. Baker D, Stahlnian GC. Pasteurellu multocida infection in a of laboratories also results in the inability to perform patient with AIDS. J Tenn Med Assoc 1991; 84: 325-6. susceptibility testing, which leads to inappropriate 10. Elsey RM, Carson RW, DuBose TD Jr. Pustetrrellu multocida antibiotic therapy. This problem was illustrated during peritonitis in an HIV-positive patient on continuous cycling the practical exercises organized for the microbiology peritoneal dialysis. hiJ Nephrol 1991; 1: 61-3. 11. Von Schroeder HP, Bell RS. Pastewella multocidu osteo- course. myelitis: an unusual case presentation. Can J Infect Dis 1996; Each of the 16 doctors performed a culture of 7: 137-9. his own stool, in which antibiotic-containing paper disks were applied on the McConkey agar niediuni of the primary culture. The susceptibility of colonies of resistant coliform was analyzed in more detail High levels Of resistance to antibiotics in ESCherkhh CO/i using firby-Bauer antibiograms. The results were sur- isolated from Cambodian doctors during a postgraduate prising: six of the 16 doctors harbored Escherirhin roli course (identified by conventional techniques) resistant to Clin Micvohiol Infect 1997; 3: 701-702 quinolones, two isolates were gentamicin resistant, and three isolates (from two subjects) were also resistant to Chhodia has ~fferedtremendously from its recent cefiriaxone. The resistance rate in this small sample is turbulent history. The country and its People are higher than that found in hospitalized patients in struggling to recover from their wounds. The medical E~~~~~and the USA, It nyay be that in the absence of