DNA typing of epidemiologically-related isolates of Aspergillus fumigatus.

Invasive aspergillosis is often nosocomially acquired and carries a high mortality. Molecular typing methods to discriminate isolates have now been developed. Using simple restriction endonuclease (Sal1 and Xho1) digestion of total genomic DNA, we have typed 25 epidemiologically-related isolates of A.

Missed pathology following laparoscopic cholecystectomy: a cause for concern?

Although many have recorded the incidence of complications after laparoscopic cholecystectomy, few have discussed the possibility of missing intra-abdominal pathology after this procedure. We have evaluated the first two years, September 1990-September 1992, of laparoscopic cholecystectomy in our community. Readmissions within 10 months of the original surgery with another diagnosis similar to gallbladder disease were considered "missed pathology" at the original surgical procedure.

Cure of chronic invasive sinus aspergillosis with oral saperconazole.

We report a case of chronic invasive aspergillosis of the maxillary sinus which continued to progress despite treatment with high doses of oral itraconzole. The patient was unable to tolerate treatment with intravenous amphotericin B and had limited response to two different lipid-complexed preparations of amphotericin B (AmBisome, Vestar Ltd; Amphocil, Liposome Technology Inc.).

Delayed pathology of the appendiceal stump: a case report of stump appendicitis and review.

A case of right lower quadrant pain in a 53-year-old postmenopausal female who underwent appendectomy 21 years previously is presented. Recurrent appendicitis with rupture was noted in the appendiceal stump on exploratory celiotomy after diagnosis by computed tomography scan. Although rare, pathology of the appendiceal stump, whether inverted or not, is a real entity that can be encountered on laparotomy.

Oxygen requirements of Aspergillus species.

The growth of 24 Aspergillus isolates at low oxygen tensions was assessed. Isolates selected included A. fumigatus (10), A.

High prevalence of antifungal resistance in Candida spp. from patients with AIDS.

Three hundred and forty-eight isolates of Candida spp. from patients treated at a regional infectious diseases unit for AIDS, immunocompromised patients admitted to the Hope Hospital and isolates referred from around the North West of England were tested for their in-vitro susceptibility to amphotericin B, fluconazole and flucytosine using standardized methods. Candida albicans comprised 73% of isolates, Candida glabrata 10% and Candida parapsilosis 7%.

Hydrocortisone-enhanced growth of Aspergillus spp.: implications for pathogenesis.

Aspergillus fumigatus and Aspergillus flavus are the most common cause of invasive mould infections worldwide and carry a high mortality. Corticosteroid therapy and Cushing's disease are associated with an increase in invasive aspergillosis. Corticosteroids impair immune function in mammals and, specifically, the conidicidal activity of human macrophages, which was thought to be sufficient explanation for this increased risk.

NIAID Mycoses Study Group Multicenter Trial of Oral Itraconazole Therapy for Invasive Aspergillosis.

Background: Invasive aspergillosis is the most common invasive mould infection and a major cause of mortality in immunocompromised patients. Response to amphotericin B, the only antifungal agent licensed in the United States for the treatment of aspergillosis, is suboptimal.

Methods: A multicenter open study with strict entry criteria for invasive aspergillosis evaluated oral itraconazole (600 mg/d for 4 days followed by 400 mg/d) in patients with various underlying conditions.

Successful treatment of sinusitis caused by Cunninghamella bertholletiae.

Seventeen cases of infections due to Cunninghamella species have been reported worldwide in humans, and there have been only three survivors. We report a case of paranasal sinusitis due to Cunninghamella bertholletiae in an elderly patient who had diabetes mellitus and myelodysplasia. After receiving 7 weeks of therapy with deoxycholate amphotericin B (44 mg/kg or a total of 3 g) and rifampin, the patient was cured and did not have to undergo radical surgery.

Invasive aspergillosis in patients with AIDS.

The prolonged survival of profoundly immunocompromised patients with AIDS has contributed to the increasing recognition of aspergillus infections as an emerging problem. Nevertheless, many of these infections continue to be diagnosed only at autopsy. In this article we review details of 293 reported cases.

Bioassay for serum itraconazole concentrations using hydroxyitraconazole standards.

Low concentrations of itraconazole in serum have been associated with therapeutic failure. Variable interpatient bioavailability and detrimental drug interactions with p450 enzyme-inducing agents are well documented. Thus, routine monitoring of serum itraconazole concentrations in patients with life-threatening mycoses is essential for patient care.

Fluconazole-resistant candidosis in an HIV cohort.

Objectives: To report the occurrence of HIV-related mucosal candidosis that fails to respond to fluconazole, to establish the correlation between in vitro susceptibility testing and clinical failure, and to assess the efficacy of alternative treatments.

Design: Chart review of all patients with fluconazole failure and all patients with CD4 counts < 50 x 10(6)/l continuing to respond to fluconazole, and prospective in vitro susceptibility testing of Candida.

Setting: A regional treatment centre for HIV-infected individuals in north-west England.

Treatment of invasive aspergillosis.

Invasive aspergillosis is generally a life-threatening invasive opportunistic mycosis affecting principally the upper and lower respiratory tract. Therapeutic response rates vary considerably from one host group to another with particularly high mortality rates in bone marrow transplant, liver transplant and patients with aplastic anaemia or AIDS. Only two drugs are useful for therapy, amphotericin and itraconazole.

An algorithmic approach to aspergillus sinusitis.

The effective management of paranasal sinus aspergillosis requires early diagnosis, histological classification, surgery and where appropriate, chemotherapy. Fungal sinusitis may be easily missed unless a high index of suspicion is maintained and specific culture and histology requested. The disease is classified into invasive and noninvasive types, each being divided into two subgroups: invasive aspergillosis may be either fulminant or indolent and noninvasive disease localized or allergic.

Diagnosis of infections with Shiga-like toxin-producing Escherichia coli by use of enzyme-linked immunosorbent assays for Shiga-like toxins on cultured stool samples.

Shiga-like toxin-producing (SLT) Escherichia coli, particularly those belonging to serogroup O157, are responsible for haemorrhagic colitis, haemolytic uraemic syndrome and some cases of gastro-enteritis. The rapid and reliable diagnosis of all these infections is necessary for correct patient management and for epidemiological reasons, but is rarely possible with present methods. We compared the efficacy of two methods, (i) the culture of faeces in broth that contained mitomycin C followed by enzyme-linked immunosorbent assay (ELISA) for SLTs, and (ii) the culture of faeces on sorbitol MacConkey agar (SMA), in the detection of infections caused by SLT-producing E.

Administering amphotericin B--a practical approach.

Despite the introduction in recent years of novel antifungal agents, the potency and broad spectrum of activity of amphotericin B have ensured that it remains the treatment of choice for most deep-seated mycoses. However, this agent is not without significant toxicity, particularly in patients who are already seriously ill and/or who are receiving other potentially nephrotoxic drugs. We review the various routes by which amphotericin B can be administered, focusing mainly on the intravenous route.

Unilateral wheeze caused by pseudomembranous aspergillus tracheobronchitis in the immunocompromised patient.

Unilateral wheeze in the immunocompromised patient with unremitting fever may be the first localising sign of aspergillus tracheobronchitis. Two such cases are presented.

In-vitro activity of the new triazole D0870 compared with amphotericin B and itraconazole against Aspergillus spp.

The in-vitro activity of D0870, a new triazole, was compared with amphotericin B (AMP B) and itraconazole (ITZ) against 40 Aspergillus isolates, which included 25 isolates of Aspergillus fumigatus, using a broth macro-dilution method at 37 degrees C. Minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) (killing of > or = 98%) were measured. For 40 isolates, geometric mean (GM) MIC values and ranges were D0870 10.

Empiric amphotericin B therapy: the need for a reappraisal.

Neutropenic patients are at high risk of developing invasive fungal diseases. A number of studies, both randomized and historical, have demonstrated that empiric therapy with amphotericin B in neutropenic patients with fever, refractory to antibiotics, results in a decrease in the frequency and mortality of deep fungal infections. Recent years have seen a number of advances in the management of neutropenic patients.