Survival of a heart transplant recipient after pulmonary cavitary mucormycosis.

Pulmonary infections can be a major complication of heart transplantation. Bacterial pneumonia has decreased markedly in the last few years among heart recipients receiving cyclosporine as immunosuppressive therapy. Fungal infections of the lung can cause serious problems in the compromised condition of these patients, with several deaths attributed to Aspergillus and Candida. To our knowledge, however, there has been no report of pulmonary mucormycosis in heart transplant recipients. We describe, therefore, a heart transplant patient with insulin-dependent diabetes mellitus who developed serious cavitary pulmonary mucormycosis. Diagnosis was made by transbronchial biopsy, and treatment required both prolonged administration of amphotericin B and surgical resection to effect a cure. The diagnostic problems and therapeutic considerations associated with pulmonary mucormycosis are discussed.

Reevaluation of an experimental streptococcal canine brain abscess model.

An experimental cerebral abscess model in which alpha-hemolytic Streptococci were inoculated into the brain parenchyma of dogs was evaluated for assessment of antimicrobial therapy. Intracerebral ring-enhancing lesions were visualized by computerized tomography, but they resolved after time without therapeutic intervention. Histopathological study demonstrated evolution of the lesions into sterile granulomas. Quantitative cultures were performed and uniformly became sterile in the early cerebritis stage, approximately 3 days after bacterial inoculation. Therefore, this brain abscess model should not be utilized for the evaluation of new antimicrobial treatment regimens. Rather, other models which document persistent viable organisms within cerebral abscesses need to be developed.

Streptococcus MG-intermedius endocarditis.

Subspeciation of penicillin susceptible alpha-hemolytic streptococci is not routinely performed. However, Streptococcus MG-intermedius is an extremely virulent organism in this strep subgroup and is associated with abscess formation. Our patient, who had endocarditis due to this organism, remained chronically ill despite appropriate antibiotic therapy, and had a perforated aneurysm of the sinus of Valsalva with a myocardial abscess that required extensive surgical debridement. Persistent fever in patients with S MG-intermedius endocarditis should warrant further work-up for metastatic or myocardial abscess formation.

Bactericidal effects of photoradiation therapy with hematoporphyrin derivative.

Hematoporphyrin derivative (Hpd) localizes selectively in malignant and rapidly metabolizing tissues and undergoes a cytotoxic reaction when exposed to light of a specific wavelength. Hpd has been studied extensively with regard to the diagnosis and treatment of tumors but not with regard to bactericidal activity. This investigation assessed the effect of light-activated Hpd on various microorganisms, on human polymorphonuclear leukocytes, and on the interactions of polymorphonuclear leukocytes and bacteria. Light-activated Hpd was 99.9% bactericidal against Staphylococcus aureus, Streptococcus faecalis, Bacteroides fragilis, Streptococcus M-G intermedius, Streptococcus mutans, Peptostreptococcus anaerobius, Peptococcus magnus, and Clostridium perfringens, but did not affect Escherichia coli, Pseudomonas aeruginosa, or Candida albicans. Photoactivation of Hpd rendered 98% of polymorphonuclear leukocytes inviable. Combinations of light-activated Hpd and polymorphonuclear leukocytes had a 4-log (99.99%) bactericidal effect on both intra- and extracellular S. aureus. The ability of Hpd to localize in inflammatory tissues may have therapeutic applications in the treatment of abscesses.

Complications of mastoiditis with special emphasis on venous sinus thrombosis.

Two children with intracranial venous sinus thrombosis complicating mastoiditis prompted review of the experience with these disorders at the The Children's Memorial Hospital in Chicago over the past decade. Fifteen patients, 1.5 to 14 years of age, with mastoiditis were identified, including nine cases categorized as acute and six as chronic, the latter without fever but with chronic otorrhea. All six patients with chronic, but none with acute, mastoiditis were found to have cholesteatomas. Venous sinus thrombosis developed in four children and intracerebellar abscess in one child. Contrast-enhanced computerized tomography has proved valuable in the diagnosis of these rare, serious complications of mastoiditis in recent patients. Arteriography is still desired to confirm venous patency or occlusion prior to surgery because of well-documented developmental variations in venous drainage patterns. Optimal therapy of mastoiditis and its complications generally requires surgical drainage in addition to administration of antibiotics.

Progressive cutaneous protothecosis.

The diagnosis of severe progressive cutaneous protothecosis in a 34-year-old woman was made by skin biopsy and culture. Analysis of host defense mechanisms revealed a persistent defect in the ability of the patient's PMN to kill the infecting organism. Specific IgG and IgE antibody was demonstrated. Serum levels of complement and immunoglobulins were normal or elevated. The patient was not anergic and peripheral blood lymphocytes responded to nonspecific mitogens. Treatment with amphotericin B and tetracycline resulted in resolution of skin lesions and negative cultures.