Selected animal models: vaginal candidosis, Pneumocystis pneumonia, dermatophytosis and trichosporosis.

A clear understanding of the pathogenesis of fungal disease remains elusive. While technological advances in molecular biology and microbial genetics have provided scientists with major new insights into both microbial virulence factors as well as host susceptibility to infection, there is currently no substitute for animal models in elucidating microbe-host interactions. Animal models are also essential for the evaluation of new antimicrobial agents, including studies of efficacy, adverse reactions and pharmacokinetics.

Vulvovaginitis. When Candida becomes a problem.

Problematic vaginitis due to Candida presents both a diagnostic and therapeutic challenge. An essential first step is confirmation of clinical diagnosis and avoidance of empiricism. Once correctly diagnosed, most episodes of vaginitis due to Candida are uncomplicated, responding to all forms of antifungal therapy.

Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans.

Until recently, Candida glabrata was considered a relatively nonpathogenic commensal fungal organism of human mucosal tissues. However, with the increased use of immunosuppressive agents, mucosal and systemic infections caused by C. glabrata have increased significantly, especially in the human immunodeficiency virus-infected population.

Frequency and response to vaginal symptoms among white and African American women: results of a random digit dialing survey.

The prevalence of vaginal symptoms and response to those symptoms in a nonclinic setting has not been previously described. Two thousand women living throughout the United States identified by random digit dialing completed a computer-assisted telephone interview about history of vaginal symptoms and use of healthcare services in response to these symptoms. The analysis was limited to 1698 white (WA) and 144 African American (AA) women (n = 1842).

Mucosal candidal colonization and candidiasis in women with or at risk for human immunodeficiency virus infection. HIV Epidemiology Research Study (HERS) Group.

The epidemiology of mucosal candidal colonization and candidiasis was studied in a multicenter cohort of 871 human immunodeficiency virus (HIV)-seropositive and 439 demographically and behaviorally similar HIV-seronegative women. Cross-sectional analyses at baseline revealed that oropharyngeal colonization with Candida species was more prevalent among seropositive women and among women reporting recent cigarette smoking and injection drug use. Oropharyngeal candidiasis was also more prevalent among seropositive women.

Infrahepatic interruption of the inferior vena cava with azygos continuation: a potential mimicker of aortic pathology.

Infrahepatic interruption of the inferior vena cava (IVC) with azygos or hemiazygos continuation is a rare finding. In this anatomic entity, the intrahepatic segment of the IVC is absent, and the hepatic veins empty directly into the right atrium. Venous blood flow from the lower body is directed from the IVC into the azygos system at the level of the renal veins, with resultant dilation of the azygos and/or hemiazygos veins.

Reduction of fecal contamination of street-vended beverages in Guatemala by a simple system for water purification and storage, handwashing, and beverage storage.

Street-vended foods and beverages, an integral part of urban economies in the developing world, have been implicated in cholera transmission in Latin America. To improve the microbiologic quality of market-vended beverages in Guatemala, we tested a simple system consisting of dilute bleach (4.95% free available chlorine) for water purification, narrow-mouth plastic vessels with spigots for disinfecting and storing water and for preparing and storing beverages, handwashing soap, and education in using the system.

[Shoulder complaints in family practice; a simple approach].

In two patients with shoulder complaints, a man aged 56 years and a woman aged 43, the function of the shoulder girdle (structures of the cervical spine, the upper thoracic spine and the upper ribs) played an important role. A simple classification of shoulder complaints is presented in which the influence of the shoulder girdle is recognized: (a) synovial disorder: complaints originating from the structures of the glenohumeral joint, the subacromial space, the acromioclavicular joint or combinations of these, (b) shoulder girdle disorder: the complaints are caused by functional problems in the structures of the shoulder girdle, (c) combination disorder: both a synovial disorder and a functional disorder of the structures of the shoulder girdle are causing the complaints, making it impossible to determine which structure is the primary cause. Considering the limited therapeutic choices (at first nonsteroidal antiinflammatory drugs, followed in case of persistent complaints by injections of analgesics and corticosteroids for synovial complaints, or manipulative therapy for shoulder girdle complaints), a more detailed classification is not needed to determine a successful therapeutic strategy.

Stable phenotypic resistance of Candida species to amphotericin B conferred by preexposure to subinhibitory levels of azoles.

The fungicidal activity of amphotericin B (AmB) was quantitated for several Candida species. Candida albicans and C. tropicalis were consistently susceptible to AmB, with less than 1% survivors after 6 h of exposure to AmB.

Oral lesions among women living with or at risk for HIV infection. HIV Epidemiology Research Study (HERS) Group.

Purpose: Our objectives were to compare the prevalence of oropharyngeal mucosal lesions among human immunodeficiency virus (HIV) seropositive and demographically similar seronegative women, and to determine the association of oral lesions with immunosuppression, substance abuse, use of medications, and utilization of dental services.

Population And Methods: Participants in a multicenter, longitudinal cohort study of HIV infection in women were evaluated at baseline by interview, physical examination, and laboratory studies.

Results: Oropharyngeal pathology was found in 40% of seropositive and 23% of seronegative women.

Difficult-to-treat trichomoniasis: results with paromomycin cream.

Vaginal trichomoniasis poses a difficult therapeutic challenge when metronidazole is ineffective or contraindicated. We conducted a retrospective study of 6.25% paromomycin cream in the treatment of nine women referred with cases of vaginal trichomoniasis where metronidazole resistance or allergy was present.

A prolonged outbreak of Shigella sonnei infections in traditionally observant Jewish communities in North America caused by a molecularly distinct bacterial subtype.

During 1994-1996, Shigella sonnei outbreaks occurred in 8 North American traditionally observant Jewish communities. These communities remain relatively separate from neighboring populations while maintaining close contact by travel with coreligionists in other cities. Epidemiologic investigations suggested community-to-community transmission via travel.

In vitro antifungal activity of CAN-296: a naturally occurring complex carbohydrate.

The in vitro activity of a naturally occurring complex carbohydrate, CAN-296, was evaluated by testing 132 clinical and ATCC isolates of yeast and Aspergillus fumigatus, many of which were azole-resistant. The in vitro susceptibility tests were performed by standardized broth micro- and macrodilution methods and results were compared with those obtained for amphotericin B, fluconazole, ketoconazole, flucytosine and the pneumocandin L-733,560. All tested Candida species showed highly uniform susceptibility to CAN-296 at concentrations of 0.

Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations.

Although it is the second most common vaginal infection in North America, vulvovaginal candidiasis is a non-notifiable disease and has been excluded from the ranks of sexually transmitted diseases. Not surprisingly, vulvovaginal candidiasis has received scant attention by public health authorities, funding agencies, and researchers. Epidemiologic data on risk factors and pathogenic mechanisms remain inadequately studied.

Antipeptide monoclonal antibodies to defined fibrinogen Aalpha chain regions: anti-Aalpha 487-498, a structural probe for fibrinogenolysis.

The fibrinogen alphaC domain (Aalpha 220-610) is one of the earliest targets attacked by plasmin following fibrinolytic system activation. Monoclonal antibodies (MoAbs) to defined sequences within the alphaC domain provide the opportunity to explore the structure-function relationships involved in plasmin's interaction with its Aalpha chain substrate at greater resolution and can serve as reagents with potential clinical use for detecting fibrinogenolysis in vivo. The MoAb F-104 was raised against a multiple antigenic peptide derivative modelled after the hydrophilic 12-residue sequence corresponding to Aalpha 487-498 within the alphaC domain.

Management of elevated intracranial pressure in patients with Cryptococcal meningitis.

Background: The most important predictor of early mortality in patients with HIV-associated cryptococcal meningitis is mental status at presentation; patients who present with altered mental status have up to 25% mortality. Historically, cerebrospinal fluid (CSF) diversion in HIV-negative patients with cryptococcal meningitis and signs of elevated intracranial pressure (ICP) has improved survival. In an effort to affect survival and morbidity rates in patients with HIV-associated cryptococcal meningitis, we have initiated aggressive management of elevated ICP in patients with focal neurologic deficits, mental obtundation, or both.

Nosocomial Candida glabrata colonization: an epidemiologic study.

Candida glabrata has emerged as an important nosocomial pathogen, yet little is known about its epidemiology. We prospectively followed 98 patients admitted to a medical intensive care unit and the bone marrow transplant unit of a university hospital. Samples from environmental surfaces and the hands of hospital personnel were also cultured.

Classification of shoulder complaints in general practice by means of cluster analysis.

Objective: To determine if a classification of shoulder complaints in general practice can be made with a cluster analysis of variables of medical history and physical examination.

Method: One hundred one patients with shoulder complaints were examined upon inclusion (week 0) and after 2 weeks. Eleven variables of the medical histories and 19 variables of the physical examinations were used for the analysis.

Development and verification of fingerprinting probes for Candida glabrata.

Since Candida glabrata has emerged as one of the most common Candida pathogens, DNA probes have been developed which fulfil the requirements for effective fingerprinting. Using a screen for complex genomic fragments containing moderately repetitive sequences, seven DNA probes were cloned which generate complex Southern blot hybridization patterns with EcoRI-digested C. glabrata DNA.

Decreasing disability in chronic back pain through aggressive spine rehabilitation.

This paper discusses specific techniques for rehabilitation of chronic low back pain through aggressive physical therapy with behavioral support. The rationale for approaching the outcome dimensions of impairments in back function and pain-related disability as opposed to chronic pain symptoms is explained. This approach requires that impairments in back function are systematically identified through the quantification of trunk flexibility, straight leg raising, back extensor strength, lifting ability, and endurance.

The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain.

Study Design: In this prospective, observational, cohort study of 192 individuals with chronic low back pain, the group of individuals was divided based on compensation involvement, and their presentation pain and disability, treatment recommendations, and compliance were compared. For 85 of these individuals who completed a spine rehabilitation program, their pain and disability at 3 and 12 months were compared.

Objectives: To test the theory that individuals with compensation involvement presented with greater pain and disability and would report less change of pain and disability after rehabilitation efforts.