Cryptococcosis in Denmark: an analysis of 28 cases in 1988-1993.

A total number of 31 events of systemic cryptococcal infection in 28 patients was identified in a nation-wide survey over 6 years from 1988 to the end of 1993. All medical records were reviewed, 24 of the patients were HIV-infected. Meningitis was diagnosed in 25 patients, and fungemia in 8 patients. The most frequent symptom was headache followed by fever. The median duration in days of fever, headache, and other neurological signs/symptoms before diagnosis was 12, 8 and 2 days, respectively, and, after diagnosis and start of treatments 7, 11 and 12 days, respectively. There was a significant correlation between the duration of headache and the duration of neurological signs/symptoms but not between headache and fever. More than 50% of the patients died within 5 months after the diagnosis. In 39% of the cases, the patients were orally treated with various antifungal drugs before the diagnosis. The rate of cryptococcosis (cumulative) in Danish AIDS patients was estimated to be 1.7%. The HIV-positive patients were, at the time of the cryptococcal diseases, profoundly immunocompromised, with a median CD4+ cell count of 18 (range: 0-78)/microliters. From 24 patients at least 1 isolate of Cryptococcus neoformans was typed, all being var. neoformans, identical with serotype A/D.

Late bioprosthetic valve endocarditis caused by Phialemonium aff. curvatum and Streptococcus sanguis: a case report.

Dual fungal and Streptococcus sanguis endocarditis is reported in a 63-year-old woman 7 months after placement of a porcine aortic valve prosthesis. Both micro-organisms were isolated by blood cultures, and the patient succumbed after a full course of antibacterial chemotherapy without having received antifungal chemotherapy. The best possible designation of the fungus was Phialemonium aff. curvatum W. Gams & W. B. Cooke, as represented by CBS 331.93. At autopsy hyphae were revealed in the porcine valve tissue by conventional staining. A hyperimmune rabbit antiserum raised towards strain CBS 331.93 and extensively absorbed with heterologous fungal antigens reacted strongly with hyphae in the valve tissue by indirect immunofluorescence technique. We consider it most likely that the Phialemonium infection evolved insidiously from the time of open heart surgery and led to a haematogenous streptococcal infection of a more fulminant course.

Invasive Candida norvegensis infection in immunocompromised patients.

Invasive infection with Candida norvegensis has previously been reported only once. Three new cases of invasive infection with C. norvegensis are described. One patient with acute myeloid leukaemia and neutropenic septicaemia had positive blood cultures with C. norvegensis, and 2 patients with AIDS and prolonged unexplained febrile cachexia had positive cultures of C. norvegensis from multiple sites, including pericardium, liver, kidneys lymph nodes and bone marrow, on autopsy. In severely immunocompromised patients, C. norvegensis appears to be an emerging new pathogen.

A mitochondrial molecular marker, ori-rep-tra, for differentiation of yeast species.

Yeasts exhibit various mechanisms for the inheritance of their mitochondrial genomes. Differences among these mechanisms are based on variations within nuclear as well as mitochondrial genetic elements. Here we report diagnostic differences in the presence of biologically active mitochondrial intergenic sequences, ori-reptra, among related yeasts in the genera Saccharomyces, Arxiozyma, Debaryomyces, Kluyveromyces, Pachytichospora, Torulaspora, and Zygosaccharomyces. A molecular probe containing ori-rep-tra can be employed specifically for the differentiation and identification of isolates belonging to the species complex Saccharomyces sensu stricto.

Mycotic and algal bovine mastitis in Denmark.

A one-year examination of mammary secretions (n = 2,896) from Danish cattle with clinical or subclinical mastitis revealed 45 strains of fungi and algae. The strains originated from 44 mammary secretions of 42 cows in 40 herds. The following species of fungi were identified: Candida catenulata (n = 2), Candida kefyr (n = 6), Candida krusei (n = 17), Candida rugosa (n = 6), Candida tropicalis (n = 3), Candida valida (n = 1), Geotrichum capitatum (n = 5). The algal species Prototheca zopfii was demonstrated in five samples.

[Pulmonary coccidioidomycosis]. / Pulmonal coccidioidomycosis.

Coccidioidomycosis is an acute, generally mild, respiratory disease that rarely becomes chronic or disseminated and fatal. The aetiologic agent is Coccidioides immitis, a dimorphic fungus growing in soil. The fungus is endemic in hot semi-arid areas in the USA and South America. Human beings and animals become infected by inhaling dust with arthroconidia. The fungus gives rise to either a purulent or a granulomatous inflammation or both. Clinically and radiologically, it can be confused with neoplasms and tuberculosis. The disease may be fatal in immuno-deprived persons who are also at risk of reactivation of a latent infection. Coccidioidomycosis can be detected serologically. The standard treatment of severe illness is Amphotericin B. The authors present the first histologically and serologically verified case of pulmonary coccidioidomycosis in Denmark. An increased number of coccidioidomycosis can be expected with increased travelling and an increased number of immuno-deprived persons.

Low yield of screening for cryptococcal antigen by latex agglutination assay on serum and cerebrospinal fluid from Danish patients with AIDS or ARC.

From July 1, 1989 to September 5, 1990, 530 serum specimens and 50 cerebrospinal fluid (CSF) specimens from 334 HIV-1 infected patients, most of whom had AIDS or ARC, were analysed in a cryptococcal antigen latex agglutination assay, and all were negative. Three cases of meningitis due to Cryptococcus neoformans diagnosed by microscopy and culture in 3 HIV-1 infected patients are presented. Stored specimens of serum and CSF from these patients were assayed for cryptococcal antigen, and in all 3 the onset of meningitis was preceded by the presence of cryptococcal antigen in serum. It is concluded that the low occurrence of cryptococcosis in our patient population does not justify a routine serum screening for cryptococcal antigen.

Fungemia in a university hospital 1984-1988. Clinical and mycological characteristics.

118 episodes of fungemia occurring at Rigshospitalet, Copenhagen, between 1984 and 1988 were reviewed retrospectively. Underlying diseases in the patients were dominated by malignancies, primarily hematological disorders, and intraabdominal diseases requiring major abdominal surgery. Predisposing factors identified in the patients were ongoing antibacterial chemotherapy (83%), central venous catheters (72%), major abdominal surgery (39%), and neutropenia (32%). 120 fungal strains were isolated, of which 88 (73%) were Candida albicans, 23 strains representing 8 other Candida species were also isolated, as were 9 strains belonging to 7 other fungal genera. There were only 5 strains resistant to 5-fluorocytosine (MICs greater than or equal to 25 mg/l), and no strain was resistant to amphotericin B. Treatment with antifungal agents was given in 78 patients, generally a combination of amphotericin B and 5-fluorocytosine. In 14 patients (all non-hematological) the only treatment was removal of a permanent central venous catheter. The outcome was poor in patients with hematological disorders (mortality 76%), whereas patients with malignant and non-malignant intraabdominal diseases had a mortality of 35%. All patients with a permanent central venous catheter as the only risk factor recovered rapidly after removal of the catheter.

Candida norvegensis peritonitis and invasive disease in a patient on continuous ambulatory peritoneal dialysis.

We report a case of Candida norvegensis invasive disease in an immunosuppressed renal transplant patient on continuous ambulatory peritoneal dialysis. Multiple cultures of peritoneal fluid, blood, and tracheal suction done over a 2-week period were positive for this unusual isolate. Despite treatment with amphotericin B and flucytosine the patient died. This is the first report of C. norvegensis fungemia documented by culture.

Perioperative blood transfusion and recurrence and death after resection for cancer of the colon and rectum.

Several reports have claimed that perioperative blood transfusion promotes recurrence and death after cancer surgery. We studied the effect of transfusion in 315 patients who had radical resection for carcinoma of the colon and rectum. The disease recurred in 113 (42%) of 268 transfused patients, versus in 15 (32%) in 47 non-transfused patients (P = 0.2). Of the transfused patients 102 (38%) died of colon cancer, versus 13 patients (28%) in the non-transfused group (P = 0.2). The 5-year recurrence-free survival rate was 0.59 in the transfused patients and 0.72 in the non-transfused group (P = 0.10). When differences in confounding background variables were accounted for by Cox multiple regression analysis, the significance of transfusion was even less. The study does not support the hypothesis that perioperative blood transfusion promotes recurrence after operation for colorectal cancer.

[Fatal catheter septicemia with finding of Candida lusitaniae]. / Letal kateterseptikaemi med fund af Candida lusitaniae.

A case of lethal pulmonary infection after catheter septicaemia with demonstration of C. lusitaniae in the blood is reported in a 73 year old patient with terminal Crohn's disease receiving long-term parenteral nutrition.

Fungemia with Saccharomycetaceae. Report of four cases and review of the literature.

Invasive fungal disease with Saccharomycetaceae is very rarely reported and these fungi are usually considered nonpathogenic. We report here 4 cases of positive blood cultures with fungal species belonging to this family. Severe neutropenia, permanent central venous catheter, ongoing antibacterial chemotherapy, and major abdominal surgery were identified as risk factors for fungemia in patients. In the immunocompromised host isolation of such species from sterile fluids cannot be ignored but should be considered an opportunistic infection and treated as such.

[Occurrence of the yeast, Cryptococcus (Cr) neoformans, in pigeon droppings]. / Forekomst af gaersvampen Cryptococcus (Cr.) neoformans i duegødning.

Pigeon droppings were collected in Copenhagen and Odense. In samples from pigeon lofts, cryptococci were found in 33% from Copenhagen and in 16% from Odense. All of the species of cryptococci found were Cr. neoformans. These findings are compared with the previous Danish investigations. The frequent occurrence of cryptococci in AIDS patients is mentioned.

[A prospective evaluation of transvaginal ultrasonic scanning in the initial assessment of suspected pelvic masses]. / Prospektiv evaluering af transvaginal ultralydskanning ved den initiale vurdering af mistaenkt gynaekologisk udfyldning.

Eighty-six patients with suspected pelvic masses were evaluated with transvaginal sonography in connection with pelvic examination. The scans were performed by gynecologists with a limited experience in sonography. Sixty-nine cases could be verified by operation, laparoscopy, autopsy or by clinical follow-up. The predictive value of positive and negative findings were 97.6 and 87.5%, respectively. In 73% of the positive cases, a correct pathoanatomical diagnosis was made. The procedure was readily accepted by the patients. It is concluded that transvaginal sonography may easily be introduced in a gynecological department as a rapid and accurate aid in the evaluation of patients with suspected pelvic masses.

[Can chlorophyll reduce fecal odor in colostomy patients?]. / Nedsaetter klorofyl kolostomiopererede patienters lugtgener?

The effect of 75 mg chlorophyll tablets thrice daily was studied in 28 colostomy patients. The investigation was carried out as a randomized, double-blind, cross-over study. The effect of chlorophyll did not differ from that of a placebo in the patients' subjective assessment of the unpleasant odour.

Cutaneous alternariosis. Case report.

A case of cutaneous alternariosis is reported in the wife of a 73-year-old farmer. The diagnosis was verified culturally and histologically. The skin lesions were localized to legs, arms and face and were characterized by alternating spontaneous healing and formation of new lesions possibly due to autoinoculation from the lesions or re-exposure to the environment. The patient had a decreased resistance to infections owing to cancer - for which she had received X-ray treatment, chemotherapy and cortisone. This is the first reported Danish case.

Reduction of gastric acid secretion by 10 mg and 30 mg omeprazole once daily.

The reduction in gastric acid secretion by 10 mg and 30 mg omeprazole was studied in 12 patients with ulcer disease in a randomized, double-blind, two-way balanced crossover study. A standardized pentagastrin test was performed before the study and 24 h after each treatment period of 6 days. Treatment was followed by a washout period of 7 days. Omeprazole, 30 mg/day, significantly reduced basal acid output (BAO) by 90% and pentagastrin-stimulated acid output (PAO) by 45% (p less than 0.01), whereas BAO and PAO were not significantly reduced by omeprazole, 10 mg/day.

An adhesive protein capsule of Escherichia coli.

The nature of the adhesive capacity of three hemagglutinating Escherichia coli strains that had earlier been described as nonfimbriated was studied. The strains that were isolated from human disease adhered to human buccal and urinary tract epithelial cells, an adhesion that was not inhibited by D-mannose. By crossed immunoelectrophoresis it was shown that the three strains produced a common antigen, Z1, developed after growth at 37 degrees C but not 18 degrees C. One of the strains produced an additional antigen, Z2, of almost the same electrophoretic mobility in crossed immunoelectrophoresis. A mutant of this strain deficient of its polysaccharide K antigen had maintained the adhesive capacity, indicating that the K antigen was not responsible for adhesion. A further mutant of the acapsular mutant produced a strongly reduced amount of the Z antigens and had lost the ability to adhere. The Z1 (and Z2?) antigens were therefore deemed to be responsible for adhesion. In sodium dodecyl sulfate-polyacrylamide gel electrophoresis of extracts of cells of the three strains, a heavy Coomassie-blue stained line was seen, indicating the presence of a protein subunit of molecular weight slightly above 14,400. By immunoblotting with absorbed antiserum, it was shown that this protein was the same as that detected by crossed immunoelectrophoresis. Protease from Streptomyces griseus, but not trypsin, digested the protein. Heating to 100 degrees C did not affect it. By immunoelectron microscopy of embedded and sectioned bacteria that had first been treated with specific antisera and ferritin-labeled antirabbit immunoglobulin, the protein adhesin-antibody complex was found to surround the bacteria as a heavy capsule. After negative staining with uranylacetate (pH approximately 4), the capsule appeared as a mesh of very fine filaments. The possible role of this capsule in the pathogenesis of disease is discussed.