Disseminated candidiasis: evidence of a distinctive syndrome in heroin abusers.

Seven young men developed similar manifestations of disseminated candidiasis after a single episode of intravenous heroin abuse. Sequential development of lesions of the eye, skin, and bone or costal cartilage was noted within 10 days after injection. Skin lesions were confined to the scalp and other hair bearing areas. Candida albicans was cultured readily from affected skin and costal cartilage. Histological examination of scalp biopsy specimens showed infiltration of hair follicles with chronic inflammatory cells and C albicans. Pseudohyphas of C albicans were also identified in and around hair shafts. The skin, skeletal, and small eye lesions resolved on systemic treatment with 1 g amphotericin B plus flucytosine. Pars plana vitrectomy plus local instillation of amphotericin B cured progressive chorioretinitis. These features may represent a distinctive syndrome of disseminated candidiasis in heroin abusers. Systemic antifungal treatment is curative in most cases.     

76例儿童隐球菌性脑膜炎临床分析

目的分析儿童隐球菌性脑膜炎临床特点。方法回顾性分析76例隐球菌性脑膜炎患儿临床资料。结果男47例,女29例,平均年龄(6.34±3.67)岁;主要临床表现为发热(100%)、头痛(78.95%)、呕吐(81.58%);首次脑脊液墨汁染色阳性46例(60.53%),首次脑脊液真菌培养阳性21例(27.63%),两性霉素B联合5-氟胞嘧啶抗真菌治疗好转率(74.19%),两性霉素B联合氟康唑治疗好转率(62.96%),差异无统计学意义(P=0.75)。结论儿童隐球菌性脑膜炎极易误诊、漏诊,反复、多次腰穿有助于早期诊断;两性霉素B联合5-氟胞嘧啶是抗真菌治疗首选方案,早期诊断、积极降颅压是改善预后的关键。     

Cutaneous manifestations in non-Hodgkin's lymphoma

OBJECTIVE: To examine and subtype cutaneous lymphoma specimens for diagnosis. STUDY DESIGN: Aspiration smears from skin lesions and lymph nodes diagnosed as non-Hodgkin's lymphoma (NHL) on cytology in 6 cases over a period of 1 year were reviewed. Two were follow-up cases of nodal lymphoma and were receiving chemotherapy, during which they developed skin lesions. In 4, the patients had cutaneous lesions as a presenting manifestation. Cytologic findings were correlated with histologic and hematologic findings and immunocytochemical markers for subtyping. RESULTS: Patients ranged from 14 to 50 years, with equal sex ratio. All presented with 0.5-5 cm multiple nodular, ulcerated and fungating skin lesions at various body sites. The aspirate was satisfactory in all cases. Cytologically, all cases were diagnosed as NHL. They were then immunocytochemistry subtyped as various lymphomas. CONCLUSION: Cutaneous lymphoma should always be considered in the presence of predominantly atypical lymphoid cells in smears from nodular and fungating skin lesions, even in the absence of a definitive clinical diagnosis.     

Disseminated cutaneous and peritoneal hyalohyphomycosis caused by Fusarium species: Three cases and review of the literature

Three recent cases of hyalohyphomycosis caused by Fusarium sp. illustrate differing aspects of infections produced by these organisms. One patient was undergoing continuous ambulatory peritoneal dialysis when peritonitis developed caused by Fusarium moniliforme. Removal of the catheter and amphotericin B were used in successful management. In a neutropenic patient on therapy for leukemia, multiple persistent infections occurred including JK diptheroids, and Candida albicans sepsis. Finally, numerous florid skin lesions caused by Fusarium oxysporum developed even while the patient was receiving amphotericin B and he died. In a second neutropenic patient on treatment for leukemia, sinus and cutaneous lesions developed due to Fusarium. These resolved on amphotericin B therapy following the return of circulating neutrophils. The literature on Fusarium infections and aspects of the biology of the organism are reviewed.     

急性淋巴细胞白血病患者侵袭性头状地霉感染1例及文献回顾

目的:通过报道1例急性淋巴细胞白血病患者侵袭性头状地霉感染的临床资料,并结合文献探讨头状地霉感染的临床特点、有效的诊断及治疗方法。方法:报道国内首例急性淋巴细胞白血病患者化疗后骨髓抑制期感染头状地霉病例,并对该病的诊断及治疗等进行系统文献回顾。结果:该白血病患者经血培养证实为头状地霉感染,并累及肺脏、肝脏和皮肤,治疗过程中先后采用卡泊芬净、脂质体两性霉素B和脂质体两性霉素B联合伏立康唑等治疗,虽然脂质体两性霉素B联合伏立康唑治疗患者体温正常,临床症状稍有改善,但是患者在化疗后40天放弃治疗并死于心肺功能衰竭。结论:头状地霉感染的发病率低,临床症状不够典型,诊断困难,预后差。根据患者的临床表现,结合血培养、GM实验、G实验和CT扫描等检查,可有助于诊断。头状地霉感染尚无非常有效的治疗方式,采用脂质体两性霉素B或两性霉素B联合伏立康唑或其他新的抗真菌药物可能获得一定的疗效,早期诊断、早期联合治疗和患者早期脱离粒缺状态是治疗成功的关键。     

Chronic Cavitary Histoplasmosis of the Lung

Four main clinical types of disease result from infection by the fungus Histoplasma capsulatum: (1) the primary complex; (2) acute pulmonary histoplasmosis; (3) chronic cavitary pulmonary histoplasmosis; (4) disseminated systemic histoplasmosis.Chronic cavitary histoplasmosis of the lung is indistinguishable clinically and radiographically from pulmonary tuberculosis. In this disease, however, the histoplasmin skin test and the histoplasmin complement fixation test are positive in more than 80% of cases and sputum cultures are usually positive for Histoplasma capsulatum. The mortality rate of the chronic cavitary type is greater than 30%. The antibiotic, amphotericin B, is the most effective drug in treatment. If surgical resection of the cavitary lesion is feasible, under amphotericin coverage, this is the treatment of choice.During the past year, two patients with chronic cavitary histoplasmosis illustrating the aforementioned features were diagnosed at the Toronto Hospital for Tuberculosis.     

Coccidioidomycosis: Evaluation of parameters used to predict outcome with amphotericin B therapy

A literature review of case histories describing the use of amphotericin B for the treatment of disseminated coccidioidomycosis was performed to detect parameters that were predictive of therapeutic outcome. Several factors were significantly different between patients who were well during prolonged follow-up versus those with active or recurrent disease: 1) mean complement fixation (CF) titer before treatment was lower in patients who were well; 2) well patients had a greater magnitude fall in CF titer during amphotericin B therapy; 3) mean CF titer after amphotericin B treatment was lower in patients who were well; and 4) patients with a positive coccidioidin skin test before therapy were more likely to be well at 6 months. There was no correlation between total amphotericin B dose or duration of therapy and therapeutic outcome.     

肾移植术后隐球菌性脑膜炎合并肺炎1例并文献复习

目的 探讨肾移植术后隐球菌性脑膜炎合并肺炎的诊断及治疗.方法 对1例肾移植术后隐球菌性脑膜炎合并肺炎患者的临床及实验室检查特点进行分析,并结合文献复习进行讨论.结果 给予患者两性霉素B脂质体联合伏立康唑诱导、伏立康唑维持治疗后头痛、咳嗽等症状消失,影像学检查示肺部病灶吸收.治疗过程中未发生急性排斥.结论 肾移植术后隐球菌性脑膜炎并发肺炎患者的临床表现缺乏特异性,脑脊液墨汁染色和隐球菌抗原乳胶凝集试验是诊断的主要手段.及时诊断和有效抗真菌治疗可改善患者的预后.治疗过程中免疫抑制药物需作相应调整.     

Sensitivity of scopulariopsis brevicaulis to some antimicrobial agents

Sensitivity tests were done against two isolates of Scopulariopsis brevicaulis, using amphotericin B in combination with chloramphenicol, Chloramphenicol alone, amphotericin B in combination with 5-fluorocytosine, and 5-fluorocytosine, myxin and clotrimazole alone. Results indicated that the effectiveness of amphotericin B was improved in the presence of chloramphenicol or 5-fluorocytosine. Growth inhibitory values recorded for chloramphenicol alone and combined with amphotericin B did not show much variation. Resistance of the fungus has been noticed to 5-fluorocytosine; but the organism's response was much better when tested against 5-fluorocytosine in the presence of amphotericin B. Both myxin and clotrimazole proved very effective and their ED50 was 50 and 2.5 ug/ml of the medium, respectively. Thus, clotrimazole may be the drug of choice in the cases of deep scopulariopsis.     

1982至2020年中国肾移植受者合并隐球菌病的系统分析

隐球菌病是威胁肾移植患者生命的严重感染性疾病,本文旨在报道我国肾移植患者合并隐球菌病(cryptococcosis in kidney transplant patients,C-KT)的情况.通过对208例患者的资料进行分析,发现隐球菌病平均发病时间为肾移植后(5.48±4.09)年,就诊时间为发病后(27.28±3...     

Affections dermatologiques de la muqueuse genitale masculine et de la verge

A wide variety of infectious, inflammatory or dysplasic disorders may affect both male genital skin and mucous membranes. We review here the clinical patterns or the most common disorders. The diagnosis is based upon the existence of erythematous balanitis, erosions or ulcerations. Among infections, candidiosis, genital herpes, HPV papillomas are the most common. Most of inflammatory skin disorders may affect the male organ, especially psoriasis, lichen planus or erosive lichen planus, allergic dermatitis, auto-immune bullous dermatoses, drug-reactions. Chronic balanitis, or recurrent inflammatory balanitis, lichen sclerosus may lead to the emergence of intraepithelial neoplasias (PIN) or invasive carcinomas. The management of genital lesions needs in fact: the observation or oral mucous membrances and of the skin it-self with a special attention to very peculiar body sites for the presence of typical skin disease lesions; a surgical biopsy for microscopic observation; in some cases immunopathology with direct and indirect immunofluorescence for the diagnosis of auto-immune disorders.     

Comparative levels of amphotericin B in the skin and subcutaneous fatty tissue after cutaneous application of amphotericin ointment by phonophoresis and with preliminary treatment by dimethyl sulfoxide]

A comparative study of the amphotericin B contents in the skin and subcutaneous fatty tissue was performed on guinea pigs after local application of amphotericin ointment by phonophoresis and with preliminary treatment of the skin by dimethyl sulfoxide (DMSO). When the amphotericin ointment was used in combination with ultrasound the content of amphotericin B in the skin and subcutaneous fatty tissue 1, 3, 24, 48 and 72 hours after the application was much higher than that after the ointment local application without the ultrasonic treatment. When the amphotericin ointment was applied locally after the preliminary treatment with DMSO the maximum content of the antibiotic in the skin and subcutaneous fatty tissue was observed 3 hours after the application which was significantly higher than the content observed after the ointment application by phonophoresis and especially locally without the ultrasonic treatment. In 24, 48 and 72 hours the amphotericin B concentration in the skin and subcutaneous fatty tissue under any conditions lowered and in 24 hours had a tendency to level in the areas treated with ultrasound and DMSO. In 48 and 72 hours the highest concentrations of the antibiotic were in the skin and subcutaneous fatty tissue after the ointment application by phonophoresis.     

Synergism of amphotericin B and 2-deoxyglucose against Histoplasma capsulatum yeasts in vitro.

The glucose analogue, 2-deoxyglucose (2DG), enhances both the fungistatic and the fungicidal action of amphotericin B in Fungizone (Squibb) against Histoplasma capsulatum yeasts in vitro. This synergistic effect is more pronounced when the test substances are incorporated in double-diffusion agar plates than in liquid medium. Minimum inhibitory concentrations for 2DG and amphotericin B in Fungizone have been established. The effects of components of Fungizone other than amphotericin B as clinically administered were also studied. Neither sodium desoxycholate nor phosphate buffer had any effect on the test organisms when used in recommended clinical concentrations. The 5% glucose infusion solution greatly enhanced the growth of the pathogen and markedly decreased the effectiveness of amphotericin B. H. capsulatum yeasts quickly became resistant to stepwise increases of Fungizone but not of 2DG. Susceptibility to amphotericin B and to 2DG increased with time within certain limits of exposure. The A (albino) phenotype of H. capsulatum is considerably more resistant to amphotericin B than the B (brown) phenotype, but there are no differences in susceptibilities to 2DG. The potential clinical applications of these studies are discussed, since experimental animals and man are reported to tolerate large amounts of 2DG. The incorporation of 2DG in the polyene antibiotic preparation would render it more effective at lower doses and would decrease clinical toxicity.     

两性霉素B治疗侵袭性肺部真菌感染的临床分析

目的 分析两性霉素B治疗ICU内侵袭性真菌感染的疗效与不良反应.方法 回顾性分析98例合并侵袭性肺部真菌感染的重症患者接受两性霉素B微泵静脉给药的临床资料.结果 两性霉素B的临床有效率77.55％,真菌清除率75.51％.不良反应包括寒战发热（9.18％）、皮疹（4.08％）、静脉炎（1.02％）、恶心呕吐（6.12％）、低钾血症（16.32％）、肝损害（1.02％）和肾损害（4.08％）.结论 国产两性霉素B对于重症患者侵袭性真菌感染疗效确定,采用持续微泵静脉给药不良反应发生率低.     

中国大陆地区接合菌病流行现状的回顾性分析

目的了解中国大陆地区近30 a接合菌病流行情况及诊治现状。方法通过CNKI和Pubmed数据库搜索1976年来中国大陆地区接合菌病相关文献,进行数据分析和总结。结果病例报告206篇,共428例患者。感染类型以胃溃疡基础上合并胃肠毛霉菌病为主,其他常见感染类型为肺部、鼻眶脑和皮肤软组织。继发于糖尿病、消化道溃疡、外伤手术烧伤和其他无基础疾病患者多见。病原学诊断主要依赖镜检、培养和病理,仅35株菌鉴定至种的水平,其中6例进行分子生物学鉴定。单独系统抗真菌药物治疗为主,体外药敏试验少,两性霉素B和两性霉素B脂质体为首选用药。428例患者中共死亡126例,占发病总人数的29.43%;其中以全身播散型感染死亡率最高,占此型感染人数的83.34%。结论中国大陆地区接合菌病感染率有上升趋势。感染类型以胃溃疡基础上合并胃肠毛霉菌病为主。应该提高形态学诊断水平,并积极开展分子鉴定,同时有条件情况下应进行菌种的体外药物敏感性检测,为临床提供更为准确的参考信息。     

非HIV感染的马尔尼菲青霉病2例报道并文献复习

目的 探讨非HIV感染的马尔尼菲青霉病的临床特征,提高对本病的早期诊断与治疗水平.方法 分析广州医科大学附属第一医院广州呼吸疾病研究所收治的2例非HIV感染的马尔尼菲青霉病患者的临床、影像、微生物和病理资料,并复习相关文献.结果 例1,男,37岁,反复咳嗽、发热1个月,双肩关节疼痛伴消瘦,广谱抗生素治疗无效,左锁骨上及左腹股沟淋巴结肿大,头颅MR发现颅内及咽后脓肿,经纤维支气管镜肺活检及脓液培养确诊马尔尼菲青霉病,继发性癫痫.予两性霉素B脂质体静滴治疗后好转出院,继续予伊曲康唑口服液治疗3个月症状消失,复查胸部CT及头颅MRI病灶吸收,患者自行停药后复发,再次予两性霉素B脂质体治疗仍有效.例2,男,32岁,咳嗽、咳痰5月余,皮下肿块伴发热3月余,胸部CT示纵膈脓肿伴胸骨骨髓炎形成,抽吸脓液培养有马尔尼菲青霉生长.予两性霉素B脂质体抗真菌治疗过程中,患者继发感染性休克,弥漫性血管内凝血.结论 马尔尼菲青霉病属于少见病,侵犯颅内的是国内首例报道,经纤维支气管镜肺活检和脓液培养可确诊.复发病例予两性霉素B脂质体治疗仍有效.早期诊断是提高治愈率的关键.     

No evidence of oxidant events in amphotericin B cytotoxicity versus L. infantum promastigotes.

Amphotericin B is used for the treatment of systemic mycoses and visceral leishmaniasis. The objective of our study was to evaluate the impact of catalase, ascorbic acid and ketoconazole on the amphotericin B toxicity towards Leishmania promastigotes membrane by two flow cytometric tests, the membrane potential assay using a cationic dye, [DiOC5(3)], and the membrane permeability test using propidium iodide. The collapse of membrane potential appeared at amphotericin B concentrations weaker than those assessed by the membrane permeability test. The binding of amphotericin B to membrane sterol was not modified by catalase or ascorbic acid whereas amphotericin B-induced growth inhibition could be modulated by these products. The permeabilizing effect of amphotericin B on parasite membrane was strongly reduced in the presence of ketoconazole. These results confirmed the pore hypothesis of amphotericin B action and suggested that flow cytometric methods constituted a valuable alternative to conventional methods for assessing the effect of drugs on cellular membrane and evaluating parasite susceptibility to polyene antibiotics.     

Comparison of tests for the diagnosis of spontaneous encephalitozoonosis in rabbits

The effectiveness of immunofluorescence, complement fixation, microagglutination serologic tests, intradermal skin test, and detection of histologic lesions were compared for use in diagnosis of spontaneous encephalitozoonosis in rabbits. The India ink and microbead agglutination reactions were compared with immunofluorescence and complement fixation by testing 11 single or pooled sera. Serologic tests correlated best with each other and less well with intradermal tests or presence of lesions. Immunofluorescence, India ink reaction and microbead agglutination were equally useful in detecting antibodies to Encephalitozoon cuniculi. The intradermal test correlated best with the presence of detectable lesions.     

Hepatosplenic candidiasis after neutropenic phase of acute leukaemia

Hepatosplenic candidiasis following granulocytopenic periods is a relatively recently recognised problem in immunocompromised patients, particularly in those with acute leukaemia. We present three patients in whom diagnosis of hepatosplenic candidiasis was suspected on the basis of ultrasonographic (US), computed tomographic (CT) findings and confirmed by laparoscopy and biopsy of liver lesions. All three patients were successfully treated briefly with amphotericin B, followed by a longer period of fluconazole. In one patient laparotomy and surgical evacuation of abscesses was performed. This condition could be more often recognised by careful follow-up of liver function test, C-reactive protein level, ultrasonography, CT and MRI after recovery from chemotherapy-induced neutropenia.     

Perforation of the Nasal Septum as the First Sign of Histoplasmosis Associated with AIDS and Review of Published Literature

Disseminated histoplasmosis in South America is associated with AIDS in 70–90 % of cases. It is visceral and cutaneous, compromising the oral, pharynx, and laryngeal mucous membranes. The involvement of the nasal mucosa is unusual. Two patients with perforation of the nasal septum as the only sign of their disease were clinically and histopathologically diagnosed as leishmaniasis. The revision of the biopsies and the culture of nasal discharge secretions showed that the pathogens seen were not amastigotes but Histoplasma capsulatum. Other mycotic lesions were not detected, nor there was history of cutaneous leishmaniasis. The leishmanin skin test, available only for the male patient, was negative. The PCR and immunofluorescence antibody titers for Leishmania were negative in both patients. They were HIV positive; in the male, his CD4+ T cell count was 60/mm³ and in the female 133/mm³. The nasal ulcer was the only manifestation of histoplasmosis and the first of AIDS in both patients. The male patient recovered with amphotericin B and itraconazole treatment. The female has improved with itraconazole. Both patients received antiretroviral treatment. Nasal mucous membrane ulcers should include histoplasmosis among the differential diagnosis. In conclusion, two patients had perforation of their nasal septum as the only manifestation of histoplasmosis, a diagnosis confirmed by nasal mucosa biopsy and by culture of H. capsulatum, findings which demonstrated that both patients had AIDS.