1166
Prophylactic treatment with varicella-zoster immune globulin
(VZIG) is recommended for susceptible immunocompromised
persons who have been exposed to varicella [8]. Because VZIG
should be administered as soon as possible after exposure, vari-
cella susceptibility is generally determined by the patient's his-
tory of exposure. The risks associated with administration of
VZIG are minimal, but the cost of treatment can be substantial.
For these reasons, we recommend that clinicians caring for
HIV-infected women obtain a careful history of varicella infec-
tion at the time of baseline evaluation. Women who are not
certain about past varicella infection should be serologically
tested to determine if they are immune, and those found to be
susceptible should be counseled about their risk for varicella and
about prophylaxis with VZIG.
In addition, patients who are not immune to varicella may be
eligible in the future for vaccination with the live attenuated
Oka-strain of the varicella-zoster virus; the vaccine has been
tested in healthy adults and in healthy and immunocompro-
mised children. Its safety and efficacy have been established,
and the vaccine may benefit nonimmune immunocompromised
persons, including the HIV-infected population, by preventing
primary varicella [9J.
Rebecca Clark, Sheryl Wilson, Troylynn Williams
HIV Outpatient Program. Medical Center ofLouisiana at New Orleans.
New Orleans. Louisiana
Mobiluncus curtisii Bacteremia Following Septic
Abortion
SIR-The genus Mobiluncus comprises motile, curved anaerobic
rods that are associated with bacterial vaginosis [I]. However,
the isolation of Mobi/uncus species alone in blood cultures has
seldom been reported in the literature [2]. In this report we
describe a case of bacteremia due to Mobi/uncus curtisii follow-
ing septic abortion.
A 33-year-old woman was admitted to the hospital for evalua-
tion of a 5-day history of fever, nausea, and continuous head-
ache. She reported a spontaneous abortion that coincided with
the commencement of symptoms. She had not consulted her
physician. The patient had a history ofsix pregnancies (resulting
in four live births and two abortions) before the episode in ques-
tion occurred.
The only significant findings on physical examination were
diffuse abdominal pain and a temperature of 38.8°C. She had
no significant cardiopulmonary abnormalities.
Laboratory studies revealed the following values: white blood
cell count, 9,800jmm 3 (75% polymorphonuclear cells, 15% lym-
phocytes, 8%band forms, and 2%monocytes); hemoglobin, 10.9
Reprints or correspondence: Dr. Jose Luis Gomez-Garces. Servicio de
Microbiologia, Hospital de Mostoles. c/Rio Jucar sin. 28935 Mostoles, Ma-
drid. Spain.
Clinical Infectious Diseases 1994;19:1166-7
© 1994 by The University of Chicago. All rights reserved.
1058-4838/94/1906-0034$02.00
Correspondence CID 1994; 19 (December)
References
I. Brunell PA. Varicella in pregnancy. the fetus. and the newborn: prob-
lems in management. J Infect Dis 1992;1 66(suppl 1):S42-7.
2. Centers for Disease Control and Prevention. Update: acquired immuno-
deficiency syndrome-United States. 1992. MMWR Morb Mortal
Wkly Rep 1993;42:547-51. 57.
3. Centers for Disease Control and Prevention. 1993 Revised classification
system for HIV infection and expanded surveillance case definition for
AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep
1992;41 (No. RR-17):1-19.
4. Van Loon F. Markowitz L. McQuillan G. et al. Varicella seroprevalence
in US population [abstract no 1311]. In: Program and abstracts of the
33rd Interscience Conference on Antimicrobial Agents and Chemo-
therapy (New Orleans). Washington. DC: American Society for Micro-
biology. 1993:359.
5. McGregor JA. Mark S. Crawford GP. Levin MJ. Varicella zoster anti-
body testing in the care of pregnant women exposed to varicella. Am J
Downloaded from http://cid.oxfordjournals.org/ at The Univesity of Calgary on May 24, 2015
Obstet Gyneco11987; 157:281-4.
6. Williams V, Gershon A. Brunell PA. Serologic response to varicella-zos-
ter membrane antigens measured by indirect immunofluorescence. J
Infect Dis 1974; 130:669-72.
7. Centers for Disease Control. AIDS in women-United States. MMWR
Morb Mortal Wkly Rep 1990;39:845-6.
8. Centers for Disease Control and Prevention. Recommendations of the
Advisory Committee on Immunization Practices (ACIP): use of vac-
cines and immune globulins in persons with altered immunocompe-
tence. MMWR Morb Mortal Wkly Rep 1993;42 (No. RR-4):1-18.
9. Takahashi M. Current status and prospects oflive varicella vaccine. Vac-
cine 1992; 10: 1007-14.
g/dl.; hematocrit, 34.3%;and platelet count, 153,000jmm 3• The
results of blood-chemistry analysis were normal. The patient
was positive for HBsAgand seronegative for human immunodefi-
ciency virus. Findings on a chest roentgenogram were unremark-
able. A diagnosis of septic abortion was made, and she was
transferred to the gynecology department. Empirical therapy
with gentamicin and metronidazole was begun.
On hospital day 3 cultures of two blood specimens that were
obtained on admission yielded a gram-variable, curved, motile
anaerobic rod that was identified as M. curtisii by means of con-
ventional tests and the Rapid ID 32A (biolvlerieux, Lyon,
France). Therapy was then changed to iv gentamicin (80 mg
every 8 hours) and clindamycin (500 mg every 8 hours). Dila-
tion and curettage were performed, and the patient was dis-
charged a few days later.
The genus Mobiluncus is divided into two species, M. curtisii
and M. mulieris, classified on the basis of biochemical reactions
and DNA homology studies [3]. However, to date the genus is
poorly characterized partly because large numbers of clinical
isolates are not easily recovered due to the organism's fastidious
nature.
Isolates associated with extragenital infections are rare [2],
and those from blood cultures are extremely rare. This fact has
led some authors to suggest that these extragenital isolates
(mainly from mammary abscesses) may be the result of exoge-
nous contamination of the mammary gland; sexual or other
practices could lead to the entrance of Mobiluncus species as
well as other organisms through cracks or the canaliculi in the
nipple. This occurrence is especially likely when any alteration
is present in the canaliculi [4]. However. other possibilities in-
CID 1994:19 (December) Correspondence
elude hematogenous dissemination as a result of parturition
with surgical intervention, postpartum endometritis, and septic
abortion, as occurred in our case and has been described in cases
of Gardnerella vaginalis infection [5].
The sensitivity of Mobiluncus species to some antimicrobial
agents seems to depend on the species. For example, M. mulieris
seems to be more susceptible to tetracyclines than M. curtisii [6],
while the susceptibilities to other antibiotics that have been re-
ported are much the same for both species. On the basis of
MICs, our isolate was considered susceptible to the following
agents: amoxycillin, 0.12 mg/L; cefoxitin, 0.5 mg/L: gentami-
cin, 0.25 mg/L; elindamycin, 0.12 mg/L: and imipenem, ~0.03
mg/L. It was determined to be highly resistant to metronidazole
(~64 rng/L). As a result, the metronidazole therapy prescribed
empirically in the emergency department was changed to treat-
ment with clindamycin.
Mobiluncus species may be a causative agent of bacteremia
following a gynecologic infection; particularly when microorgan-
isms belonging to the vaginal flora enter the bloodstream. The
true incidence of this type of bacteremia may be underestimated
as a result of the difficulties involved in the isolation and identi-
fication of these microorganisms.
Myelitis Due to Toxoplasma gondii in a Patient with
AIDS
SIR- Toxoplasma gondii is frequently a cause of encephalitis in
patients who are infected with the human immunodeficiency
virus (HIV) [1]. In contrast, myelitis due to T. gondii has rarely
been described in such patients [2-6]. We describe a case of
thoracic myelitis due to T. gondii in a woman with AIDS.
A 34-year-old woman from Zaire developed transfusion-
related infection due to HIV-1 in April 1990. She was treated
with oral zidovudine (500 mg/d) between September 1990 and
March 1992 and received monthly therapy with aerosolized
pentamidine (300 mg/mo), She presented to the hospital in
April 1992 with a temperature of 40°C and headache.
Physical examination revealed only weakness of the right up-
per extremity. Blood cell counts were normal, and findings on a
chest roentgenogram and an electrocardiogram did not reveal
any abnormalities. The CD4 cell count was 16/mm 3 . The serum
titer oflgG antibody to Toxoplasma was 1:3,000. The results of
serological tests for syphilis were negative, and culture of blood
for mycobacteria were negative. Findings on a cerebral com-
puted tomographic scan did not reveal any abnormalities, and
the results of CSF analysis were normal. Magnetic resonance
imaging (MRI) of the head revealed four lesions that were sug-
gestive of toxoplasmosis in the left cerebellar lobe and in the
frontal and parietal white matter bilaterally. Therapy with oral
Reprints or correspondence: Professor Catherine Lepore Service des Ma-
ladies Infectieuses et Tropicales, Groupe Hospitalier Bichat-Claude Ber-
nard. 46 rue Henri Huchard, 75877 Paris Cedex 18, France.
Clinical Infectious Diseases 1994;19:1167-8
© 1994 by The University of Chicago. All rights reserved.
1058-4838/94/1906-0035$02.00
1167
Jose Luis Gomez-Garces, Delia Balas,
Maria Teresa Merino, and Juan Ignacio Alos
Departments ofMicrobiology and Obstetrics and Gynecology, Hospital de
Mostoles. lnstituto Nacional de la Salud. Mostoles. Madrid. Spain
References
I. Holst E, Wathne B. Hovelius B. Mardh PA. Bacterial vaginosis: microbio-
logical and clinical findings. Eur J Clin Microbiol 1987;6:536-41.
2. Glupezynski Y. Labbe M. Crockaert F, Pepersack F. Van der Auwera P,
Yourassowsky E. Isolation of Mobiluncus in four cases of extragenital
infections in adult women. Eur J Clin Microbiol 1984; 3:433-5.
3. Spiegel CA, Roberts M. Mobiluneus gen. nov., Mobiluneus eurtisii subsp.
eurtisii sp. nov .. Mobiluneus curtisii subsp. holmesii subsp. nov., and
Mobiluncus mulieris sp. nov., curved rods from the human vagina. Int
J Syst Bacteriol 1984; 34:177-84.
4. Weinbren MJ, Perinpanayagam RM. Malnick H, Ormerod F. Mobilun-
Downloaded from http://cid.oxfordjournals.org/ at The Univesity of Calgary on May 24, 2015
cus spp: pathogenic role in non-puerperal breast abscess [letter]. J Clin
Pathol 1986;39:342-3.
5. Catlin BW. Gardnerella vaginalis: characteristics. clinical considerations.
and controversies. Clin Microbiol Rev 1992;5:213-37.
6. Spiegel CA. Susceptibility of Mobiluncus species to 23 antimicrobial
agents and 15 other compounds. Antimicrob Agents Chern other
1987; 31:249-52.
pyrimethamine (50 mg/d), oral sulfadiazine (4 g/d), and oral
folinic acid was administered for 6 days.
Six days later. the patient presented with numbness of her
right thigh up to the right iliac fossa. She had moderate parapare-
sis but no sacral sparing or Babinski's signs. Deep tendon re-
flexes were symmetrical. Sensory examination revealed right
T-5 and left T-I 0 sensory levels and no pallesthetic abnormali-
ties on the lower limbs. An MRI scan of the thoracic spine re-
vealed an intramedullary cavitary lesion located in T-4 that en-
hanced with gadolinium and was suggestive of an abscess.
Therapy with increased doses of pyrimethamine (75 mg/d) and
sulfadiazine (6 g/d) was administered for 3 weeks. and she then
received the initial lower-dose regimen for an additional 2 weeks
because of neutropenia. She did not receive any antibacterial
treatment. Therapy with methylprednisolone (120 mg/d iv) was
added to her regimen for 7 days and progressively tapered over
the next 10 days. After 6 weeks of acute antiparasitic therapy
with pyrimethamine and sulfadiazine, sensory examination dis-
closed hypoesthesia between T-5 and T-8 on the right side. and
weakness and paraparesis were no longer noted. MRI of the
spine did not reveal any abnormalities.
In one previously reported study, 28% of neurologically symp-
tomatic patients with AIDS had toxoplasmic encephalitis [1]. In
contrast, only five cases of spinal cord toxoplasmosis in AIDS
patients have been previously described [2-6]. In three cases the
patients had toxoplasmic encephalitis, and two cases apparently
involved only the spine. One case of toxoplasmosis involved the
cervical spine [2], one involved the thoracic spine [4], and three
involved the conus medullaris [4-6]. One case of spinal cord
toxoplasmosis was diagnosed only at autopsy [2]. Four cases of
spinal cord toxoplasmosis were confirmed by biopsy, but para-
paresis worsened after surgery in one case [3], and a large epidu-
ral hematoma required surgical drainage in another case [4].
Clinical improvement was noted after treatment in three cases