Candida myocarditis without valvulitis.

Thirty-one patients with systemic candidiasis at postmortem examination were found to have Candida involvement of the myocardium without valvulitis. Retrospective examination of their clinical course demonstrated that a new conduction disturbance was seen in 10, supraventricular arrhythmias in 5,QRS changes mimicking myocardial infarction in 3, and pronounced T wave changes in 13. Hypotension or shock was seen in 13 patients and could not be explained by coexistent bacteremia or blood loss in 8. One patient died suddenly. Of 19 patients with systemic candidiasis without myocardial invasion, 4 had minor T wave changes and one had a supraventricular arrhythmia. Candida invasion of the heart significantly complicates the clinical course in systemic candidiasis and should be suspected when a young person without preexistent heart disease has cultures positive for a Candida organism, a significant arrhythmia, conduction distrubance or other dramatic QRS change. The effect of therapy on Candida invasion of the heart is unknown.

The identification of lupus erythematosus cells. A comparison of supravital fluorochromation with a standard Wright's stain method.

A comparison of standard Wright's stained lupus erythematosus preparations and an acridine orange fluorochromatic method was conducted using 354 consecutive lupus erythematosus preparations involving 264 patients. The results of this comparison and a discussion of the fluorochromatic procedure are presented.

Combined vs. single-drug studies of susceptibilities of Mycobacterium kansasii to isoniazid, streptomycin, and ethambutol.

The effects of combined drugs were compared uith the effects of single drugs in vitro against Mycobacterium kansasii. The single drugs isoniazid 1.0 microgram/ml, streptomycin 2.0 microgram/ml, and ethambutol 5.0 microgram/ml and the combinations of 1.0 microgram/ml isoniazid and 2.0 microgram/ml streptomycin, 1.0 microgram/ml isoniazid and 5.0 ethambutal and 1.0 microgram/ml isoniazid, 2.0 microgram/ml streptomycin and 5.0 microgram/ml ethambutol were evaluated as to their effects on M. kansasii organisms from 22 patients with pulmonary mycobacterial disease. These drugs were incorporated into Middlebrook 7H11 medium. Colonial growth was then observed and assigned numerical values for statistical analysis. The results showed that isoniazid was not significantly better than ethambutol. Streptomycin, however, was significantly better than both isoniazid and ethambutol alone. The double combinations were better than the single drugs, with isoniazid--streptomycin being better than isoniazid--ethambutol. The combination isoniazid--ethambutol was not significantly better than streptomycin alone. However, the triple combination of isoniazid--streptomycin--ethambutol was markedly better than all single drugs, better than isoniazid--ethambutol, but not better than isoniazid--streptomycin. Combined-drug testing thus showed a pattern of susceptibility not demonstrated by single-drug testing.

A practical strategy for diagnosis of urinary tract infections.

Because urine specimens are not all identical, clinical microbiology laboratories should tailor specimen handling and processing to the specific clinical setting. To quantify uropathogens requires specific ranges that depend on the clinical presentation of a patient and the collection method. A single quantitative breakpoint, for example, the classic "100,000 CFU/mL" cannot be applied to patients with AUS or with indwelling catheters. This article has attempted to review rational adjustments in the traditional urine culture protocol to fit both the clinical setting and the mode of collection.

Human growth hormone. Its use and abuse.

The use of hGH may become a significant challenge to the sports world. Scientific and ethical questions regarding its use may become more pressing if synthetic hGH becomes available to the public. The potential appeal of hGH to athletic competitors is obvious, but at present no benefits of this hormone as an ergogenic aid have been clearly demonstrated. Indeed, clinical experience with acromegalics suggests that prolonged exposure to elevated doses of hGH produces detrimental neuromuscular responses. Perhaps an even more intense ethical issue concerns the use of hGH in children and adolescents. The use of hGH to increase height and thereby increase chances for athletic success may be tempting to both coaches and parents. Athletes, parents, coaches, and team physicians must be aware that hGH has not been shown to enhance athletic performance and that its potential long-term side effects are irreversible and even may be life threatening.

Managing opportunities under managed care.

Health care reform is driving significant changes in associations between physicians, hospitals, insurers, and patients. This restructuring of the delivery of care will affect the practice of pathology. At these crossroads, practices have to decide to continue without change or to adopt new approaches. Horizontal mergers between pathology practices offer one opportunity under health care reform. Such mergers reflect the general trend toward consolidation of operations as a cost-effective approach to health care delivery. They will require a reevaluation of the manpower needs in pathology. The move to consolidated health plans also suggests that pathology practices should consider vertical integration with other physicians. Restructuring of practices is not the sole answer to addressing health care reform. Practices must become involved in cost-saving strategies in the systems.

Laboratory diagnosis of parasitic and fungal diseases of the central nervous system.

This review is presented to bring attention to those fungal and parasitic organisms that have been associated with central nervous system (CNS) infection and to offer an approach for handling their laboratory diagnosis. Treatment of the cerebrospinal fluid (CSF) to yeild best results on direct smear examination and culture are discussed. Culture procedures and staining methods to be done are given in chart form. Those immunologic tests useful in supporting the diagnosis of fungal or parasitic CNS infections are also included.

Decisions related to automation in microbiology.

The selection of instruments for the microbiology laboratory poses unique problems. The author of this article recommends useful steps in this process.

Identification of malaria parasites by fluorescence microscopy and acridine orange staining.

The need for a technique that is more sensitive than the use of Romanowsky-stained thick blood films for detecting malaria parasites at low concentration in the blood is well recognized. One of the more promising methods appeared to be fluorochrome staining with acridine orange. However, reports on the efficacy of the technique were contradictory and it was not clear to what extent blood films taken under survey conditions would contain fluorescing artefacts that might confuse diagnosis. An investigation indicated that, provided reasonable care was taken, blood films made under survey conditions contained few confusing artefacts. However, it was found that, while acridine orange staining might have a slight advantage when large malaria parasites were present, it was inferior to routine Romanowsky staining for the detection of young trophozoites, the inferiority becoming more pronounced as the parasite concentration decreased.

Clinical evaluation of the minitek differential system for identification of Enterobacteriaceae.

Forty-one stock organisms and 581 fresh clinical isolates were used in comparing the Minitek system to conventional tubed media to determine if this system is feasible and accurate for a high-volume clinical microbiology laboratory. In addition to comparison with tubed media, the following parameters were tested: (i) reproducibility of disks, (ii) the effect of variation in inoculum size, (iii) the effect of the age of culture, and (iv) the effect of predispensing disks. A total of 5,947 disks were compared with tube reactions; 95.9% agreed on the initial reading. After repeating questionable tube and disk reactions, this agreement rose to 98.2%. Using the disk reactions and the identification schema currently in use with tubed media, 94.9% of the Minitek final identifications agreed with those of tubed media; 1.5% gave differing identifications and 3.6% were inconclusive. This system is accurate, inexpensive, flexible, and convenient.