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Non-insulin-dependent diabetes in older patients
LETTERS
glucose, and growth inhibition only by species-specific antiserum. Serum samples obtained on the 20th and 27th postoperative days were examined by a colony indirect epifluorescence method, and showed antibody titers of 1:200 against M. hominis on both occasions. The patient’s subsequent hospital course was uneventful. Systemic infections with M. hominis occur mainly in two age groups: neonates [3] and sexually active adults [4]. In children, infections caused by this organism are apparently very uncommon, and we are not aware of any previous report of confirmed M. hominis septicemia in this age group. The potential for such infection in children does exist, however, as mycoplasmas can be recovered from the normal genitourinary and respiratory tracts until the age of 10 years [3]. Although delivery is the most common predisposing condition for development of infection [5,6], it has been recognized recently that other circumstances associated with tissue injury, such as burns and multiple trauma [7,8], can also be implicated. The reports by Riccio et al [l] and Steffenson et al [2] and the present case document an additional clinical setting in which M. hominis can produce local or systemic infection. It is our impression, as that of others, that respiratory tract intubation or urinary tract catheterization may be more specifically responsible for the systemic spread of the organism in patients undergoing surgery [2,8]. If this is the case, it can be assumed that M. hominis infections in this setting are probably much more common than actually recognized. They remain unidentified, however, because of their mild course and self-limited nature. In addition, M. hominis may not grow on standard bacteriologic media [9], and detection of the colonies may be missed because of their pinpoint and translucent appearance. Although M. hominis infections are often asymptomatic or associated with an uncomplicated course, this is not always so, especially in immunocompromised hosts [2, lo]. Clinicians should be more aware of the potential of M. hominis to cause postoperative septicemia and wound infection. The possibility of an infection by this organism should be particularly considered in patients with unex-
TO THE EDITOR
plained fever or “sterile” wound infection following urogenital or upper respiratory surgery or manipulation. In such cases, anaerobic blood sugar agar plates should be meticulously examined for pinpoint, translucent colonies, and, when possible, subculture on Mycoplasma agar should be performed. MICHAEL
DAN,
M.D.
E. Wolfson Hospital Holon 58100, Israel JANET
ROBERTSON,
Ph.D.
University of Alberta Edmonton, Alberta, Canada
4. 5.
Riccio JC, Evans DB, MacKay D: Mycoplasma hominis sternal wound infection. Infect Med 1986; 3: 83-69. Steffenson DO, Dummer JS, Granick MS, et al: Sternotomy infections with Mycoplasma hominis. Ann Intern Med 1987; 106: 204-208. Lee Y-H, McCormack WM. Marsy SM. Klein JO: The genital mycoplasmas. Their role in disorders of reproduction and in pediatric infections. Pediatr Clin North Am 1974; 21:457. Taylor-Robinson D, McCormack WM: The genital mycoplasmas. N Engl J Med 1980; 302:1003-1010, 1063-1067. Solomon F, Caspi E, Bukovsky I, Sompolinsky D: Infections associated with genital Mycoplasma. Am J Obstet Gynecol 1973; 116: 785-792. McCormack WM, Rosner B, Lee Y-H, Rankin JS, Lin J-S: Isolation of genital mycoplasmas from blood obtained shortly after vaginal delivery. Lancet 1975; I: 596-599. Dan M, Tyrrell DLJ, Stemke GW, Robertson J: Mycoplasma hominis septicemia in a burned infant. J Pediatr 1961; 99: 743-745.
9.
10.
Ti TY, Dan M, Stemke GW, Robertson J, Goldsand G: Isolation of Mycoplasma hominis from the blood of men with multiple trauma and fever. JAMA 1962; 247: 60-61. Tully JG, Taylor-Robinson D, Rose DL, Furr PM, Hawkins DA: Evaluation of culture media for the recovery of Mycoplasma hominis from the human genital tract. Sex Transm Dis 1963; 10: 256-260. Mokhbat JE, Peterson PK, Sabath LD, Robertson JA: Peritonitis due to Mycoplasma hominis in a renal transplant patient. J Infect Dis 1982; 146: 713. Submitted
August
21, 1987,
and accepted
in revised form March 4, 1988
CORRESPONDENCE NON-INSULIN-DEPENDENT PATIENTS
DIABETES
IN OLDER
Hypertension is greater in diabetic subjects diabetic subjects. This result is statistically
To the Editor: The article by Nathan et al (Am J Med 1986; 81: 837-842) on non-insulin-dependent diabetes in older patients indicates in its results that the association between diabetes mellitus and hypertension did not reach statistical significance. In Table I, hypertension was seen in 40 percent (20 of 50) of nondiabetic subjects and 60 percent (150 of 250) of diabetic subjects; when we applied a chi-square analysis to this result, we found x2 = 6.731, p
Universidad Tegucigalpa, Submitted
December
MORAZAN
than in nonsignificant p GARCIA,
M.D.
National
Autonoma de Honduras Hospital Escuela D.C. Honduras, Central America
11, 1987,
and accepted
February
10, 1988
The Reply: Dr. Garcia is correct that the difference between 40 percent prevalence and 60 percent prevalence of hypertension between the nondiabetic and diabetic groups is significant.
May
1988
The American
Journal
of Medicine
Volume
84
977
glucose, and growth inhibition only by species-specific antiserum. Serum samples obtained on the 20th and 27th postoperative days were examined by a colony indirect epifluorescence method, and showed antibody titers of 1:200 against M. hominis on both occasions. The patient’s subsequent hospital course was uneventful. Systemic infections with M. hominis occur mainly in two age groups: neonates [3] and sexually active adults [4]. In children, infections caused by this organism are apparently very uncommon, and we are not aware of any previous report of confirmed M. hominis septicemia in this age group. The potential for such infection in children does exist, however, as mycoplasmas can be recovered from the normal genitourinary and respiratory tracts until the age of 10 years [3]. Although delivery is the most common predisposing condition for development of infection [5,6], it has been recognized recently that other circumstances associated with tissue injury, such as burns and multiple trauma [7,8], can also be implicated. The reports by Riccio et al [l] and Steffenson et al [2] and the present case document an additional clinical setting in which M. hominis can produce local or systemic infection. It is our impression, as that of others, that respiratory tract intubation or urinary tract catheterization may be more specifically responsible for the systemic spread of the organism in patients undergoing surgery [2,8]. If this is the case, it can be assumed that M. hominis infections in this setting are probably much more common than actually recognized. They remain unidentified, however, because of their mild course and self-limited nature. In addition, M. hominis may not grow on standard bacteriologic media [9], and detection of the colonies may be missed because of their pinpoint and translucent appearance. Although M. hominis infections are often asymptomatic or associated with an uncomplicated course, this is not always so, especially in immunocompromised hosts [2, lo]. Clinicians should be more aware of the potential of M. hominis to cause postoperative septicemia and wound infection. The possibility of an infection by this organism should be particularly considered in patients with unex-
TO THE EDITOR
plained fever or “sterile” wound infection following urogenital or upper respiratory surgery or manipulation. In such cases, anaerobic blood sugar agar plates should be meticulously examined for pinpoint, translucent colonies, and, when possible, subculture on Mycoplasma agar should be performed. MICHAEL
DAN,
M.D.
E. Wolfson Hospital Holon 58100, Israel JANET
ROBERTSON,
Ph.D.
University of Alberta Edmonton, Alberta, Canada
4. 5.
Riccio JC, Evans DB, MacKay D: Mycoplasma hominis sternal wound infection. Infect Med 1986; 3: 83-69. Steffenson DO, Dummer JS, Granick MS, et al: Sternotomy infections with Mycoplasma hominis. Ann Intern Med 1987; 106: 204-208. Lee Y-H, McCormack WM. Marsy SM. Klein JO: The genital mycoplasmas. Their role in disorders of reproduction and in pediatric infections. Pediatr Clin North Am 1974; 21:457. Taylor-Robinson D, McCormack WM: The genital mycoplasmas. N Engl J Med 1980; 302:1003-1010, 1063-1067. Solomon F, Caspi E, Bukovsky I, Sompolinsky D: Infections associated with genital Mycoplasma. Am J Obstet Gynecol 1973; 116: 785-792. McCormack WM, Rosner B, Lee Y-H, Rankin JS, Lin J-S: Isolation of genital mycoplasmas from blood obtained shortly after vaginal delivery. Lancet 1975; I: 596-599. Dan M, Tyrrell DLJ, Stemke GW, Robertson J: Mycoplasma hominis septicemia in a burned infant. J Pediatr 1961; 99: 743-745.
9.
10.
Ti TY, Dan M, Stemke GW, Robertson J, Goldsand G: Isolation of Mycoplasma hominis from the blood of men with multiple trauma and fever. JAMA 1962; 247: 60-61. Tully JG, Taylor-Robinson D, Rose DL, Furr PM, Hawkins DA: Evaluation of culture media for the recovery of Mycoplasma hominis from the human genital tract. Sex Transm Dis 1963; 10: 256-260. Mokhbat JE, Peterson PK, Sabath LD, Robertson JA: Peritonitis due to Mycoplasma hominis in a renal transplant patient. J Infect Dis 1982; 146: 713. Submitted
August
21, 1987,
and accepted
in revised form March 4, 1988
CORRESPONDENCE NON-INSULIN-DEPENDENT PATIENTS
DIABETES
IN OLDER
Hypertension is greater in diabetic subjects diabetic subjects. This result is statistically
To the Editor: The article by Nathan et al (Am J Med 1986; 81: 837-842) on non-insulin-dependent diabetes in older patients indicates in its results that the association between diabetes mellitus and hypertension did not reach statistical significance. In Table I, hypertension was seen in 40 percent (20 of 50) of nondiabetic subjects and 60 percent (150 of 250) of diabetic subjects; when we applied a chi-square analysis to this result, we found x2 = 6.731, p
Universidad Tegucigalpa, Submitted
December
MORAZAN
than in nonsignificant p GARCIA,
M.D.
National
Autonoma de Honduras Hospital Escuela D.C. Honduras, Central America
11, 1987,
and accepted
February
10, 1988
The Reply: Dr. Garcia is correct that the difference between 40 percent prevalence and 60 percent prevalence of hypertension between the nondiabetic and diabetic groups is significant.
May
1988
The American
Journal
of Medicine
Volume
84
977