ABSTRACT
Fungal infections in patients with chronic granulomatous disease (CGD) are a poor prognostic factor. We describe the first case of CGD with femoral osteomyelitis due to Cladophialophora arxii, which is a member of the dematiaceous group. The causative fungus was identified on the basis of its morphological characteristics, growth temperature profile, and nucleotide sequence on the internal transcribed space region of the ribosomal gene. The patient was successfully treated with surgical debridement, subsequent administration of itraconazolem and interferon-gamma.
Subject(s)
Ascomycota/isolation & purification , Femur/pathology , Granulomatous Disease, Chronic/complications , Mycoses/diagnosis , Osteomyelitis/microbiology , Antifungal Agents/therapeutic use , Ascomycota/cytology , Ascomycota/genetics , Ascomycota/physiology , DNA, Fungal/chemistry , DNA, Fungal/genetics , DNA, Ribosomal Spacer/chemistry , DNA, Ribosomal Spacer/genetics , Debridement , Humans , Immunologic Factors/therapeutic use , Interferon-gamma/therapeutic use , Itraconazole/therapeutic use , Male , Mycoses/drug therapy , Mycoses/microbiology , Mycoses/surgery , Osteomyelitis/drug therapy , Osteomyelitis/surgery , Sequence Analysis, DNA , Young AdultABSTRACT
Three-dimensional analysis of nystagmus was carried out in patients with peripheral vestibular diseases using a computerized image recognition technique developed by us. In the present study, we analyzed data from patients with Meniere's disease and vestibular neuritis with the central premise of localizing the pathology in the peripheral vestibular organs. In Meniere's disease, the recordings of all subjects showed two components of eye movements, namely the horizontal and torsional components. On the other hand, most of the patients with vestibular neuritis exhibited all three components of spontaneous nystagmus. The horizontal and vertical components of nystagmus in patients with vestibular neuritis were directed towards the contralateral side of the lesion and upwards. Based on these results and with reference to animal experiments that have related the eye movements with each labyrinthine end organ, it can be speculated that in Meniere's disease the pathological changes may involve all semicircular canals, whereas the main site of lesion in vestibular neuritis could be localized to the superior vestibular nerve.