Cutaneous larva migrans in infants in the Adelaide Hills.

Four infants aged between 8 and 13 months presented between November 2002 and May 2006 with dermatitis of the lower abdomen, perineum or buttocks. All lived in semi-rural properties in the Adelaide Hills and had not travelled outside South Australia. Wandering thread-like serpiginous tracks were evident on examination, consistent with a diagnosis of cutaneous larva migrans. No abnormalities were detected on full blood examination, Strongyloides stercoralis serology or faecal analysis. Treatment with oral albendazole resulted in rapid resolution of symptoms. An epidemiological survey was undertaken which suggested possums or millipedes may have been the source of nematode larvae, the precise nature of which is unclear but could include Parastrongyloides trichosuri and Rhabditis necromena.

Successful treatment of pulmonary mucormycosis in a renal transplant recipient with limited pulmonary reserve by combined medical and surgical therapy.

Mucormycosis is a rare opportunistic fungal infection in renal transplant recipients which is associated with exceedingly high mortality when inadequately treated. Risk factors for this infection include diabetes, neutropaenia and immunosuppression. We report a case of pulmonary mucormycosis in a renal allograft recipient with type 2 diabetes and limited pulmonary reserve. The patient was successfully treated with lobectomy and liposomal amphotericin B with preservation of pulmonary and allograft functions. Early recognition of this infection is warranted before dissemination, which carries a poor prognosis.

Late-onset and atypical presentation of Pneumocystis carinii pneumonia in a renal transplant recipient.

Pneumocystis jivorecii (formerly known as carinii) pneumonia (PCP) is potentially a life-threatening opportunistic infection after organ transplantation, occurring most frequently in the first 12 months, where the incidence rate is several-fold higher than in later years. PCP typically presents with fever, cough, dyspnoea and hypoxia. In organ transplant recipients, the onset of symptoms is generally more fulminant compared to patients infected with the human immunodeficiency virus. We present a patient who developed PCP five years after a renal transplantation. His presentation was characterised by atypical symptoms and an indolent onset. Previous acute vascular rejection, ongoing maintenance prednisolone usage, cytomegalovirus seropositivity and past tuberculous infection may have predisposed this patient to PCP.

First report of septicemia caused by an obligately anaerobic Staphylococcus aureus infection in a human.

In this case report, we describe the first instance of septicemia caused by an obligately anaerobic Staphylococcus aureus in a human. A 45-year-old man presented with septicemia, septic arthritis, and multiple pulmonary abscesses, which were caused by an obligately anaerobic S. aureus. The clinical and microbiological features that led to the diagnosis are discussed. Genotyping cannot at present reliably separate S. aureus subsp. aureus from S. aureus subsp. anaerobius, but phenotypic characteristics suggest that the present isolate is a previously undescribed strain of anaerobic Staphylococcus aureus.

Effect of using multiple culture media for the diagnosis of noninvasive fungal sinusitis.

BACKGROUND: This study was designed to assess the relative efficiency of three different culture media for isolating fungi in patients suspected of having noninvasive fungal sinusitis. METHODS: A prospective study was performed of 209 operative samples of sinus "fungal-like" mucin from 134 patients on 171 occasions and processed for microscopy and fungal culture in Sabouraud's dextrose agar, potato dextrose agar, and broth media. RESULTS: Ninety-three (69%) of 134 patients had evidence of fungal infection. Two-thirds of patients had negative microscopy samples yet 56% of these went on to positive cultures. Forty-five percent cultured Aspergillus genus. Discrepancy between the fungi cultured in different media and on different occasions was common. With a single culture medium up to 19% of patients and 15% of samples would have been falsely labeled fungal negative. CONCLUSION: Increasing the number and type of fungal culture media used increases the number and range of fungal isolates from mucin in patients with the features of fungal sinusitis. Negative specimen microscopy is unreliable. All specimens should be cultured in multiple media and on multiple occasions when fungal sinusitis is suspected.

Visceral leishmaniasis: a trip to the Greek Islands is not always idyllic.

Although cutaneous leishmaniasis is occasionally seen in Australia in overseas travellers and migrants, visceral leishmaniasis has been reported rarely and only in people who were immunocompromised. We describe an 18-year-old immunocompetent man who presented with pancytopenia and a 2-week history of fever and lethargy a year after visiting the Greek Islands. Visceral leishmaniasis was diagnosed after a bone marrow biopsy showed protozoa, and the patient responded well to treatment with liposomal amphotericin. To our knowledge, this is the first case of visceral leishmaniasis in an immunocompetent patient in Australia.

Response to re-infection with Brachylaima cribbi in immunocompetent and immunodeficient mice.

The course of infection in C57BL/6J mice re-infected with Brachylaima cribbi was assessed by comparing faecal egg excretion of re-infected mice with age- and sex-matched mice receiving a primary infection only. For both male and female mice there was a significant reduction in the mean number of eggs per gram of faeces at the peak of infection 4 weeks after the challenge infection compared with mice receiving a primary infection only. There was no significant difference in the duration of the infection. This experiment was repeated using age-matched male mice but on this occasion all mice were killed and dissected 4 weeks after the challenge infection and mean eggs per gram of faeces, worm burden and fecundity determined. There was no significant difference in the worm burdens of the re-infected mice compared with age-matched animals receiving a primary infection only. However, there were significant differences in the mean faecal eggs per gram and worm fecundity with the challenge infection group having lower egg counts and reduced fecundity. An enzyme-linked immunosorbent assay using whole worm antigens was developed and used to determine mouse anti-B. cribbi serum antibody levels during the course of infection. Anti-B. cribbi serum antibody absorbance ratios increased six- to sevenfold by 4 weeks after a primary infection beyond which a constant level was maintained. The course of challenge infection in non-obese diabetic severe combined immunodeficient mice showed no significant differences in egg excretion, worm burden or fecundity when primary and challenge infections were compared. These results indicate that the immune response invoked by a previous B. cribbi infection in immunocompetent mice affects fecundity but does not affect the establishment or duration of infection.

Effects of sex and age on the susceptibility of C57BL/6J mice to infection with Brachylaima cribbi and the course of infection in NOD SCID mice.

The C57BL/6J strain of Mus musculus is susceptible to the terrestrial trematode Brachylaima cribbi. The duration of infection in these mice is generally 9-12 weeks with a peak excretion of eggs at 4 weeks post-infection (wpi). The effects of age and sex on the course of infection were investigated by comparing infections in male and female mice aged 8 or 28 weeks at the time of infection. There were no significant differences in the susceptibility of the adolescent mice of either sex or older male mice. However, older, mature female mice were significantly more resistant to B. cribbi infection than older mature males and adolescent females with reduced worm burden, fecundity and egg fertility. In comparison with young males, all three parameters were again reduced but this was only significant statistically for reduced egg fertility. It is likely that mature female sex hormones influence resistance to B. cribbi infection. The susceptibility of immunodeficient NOD SCID mice was evaluated and compared with C57BL/6J mice. NOD SCID mice were susceptible to B. cribbi infection with the infection persisting with a relatively unchanged worm burden for the life of the mouse with the longest surviving mice being 31 wpi. The life-span of B. cribbi is therefore at least 31 weeks. There were no significant differences in egg excretion, worm burden or fecundity among NOD SCID mice at 4, 8 or 18 wpi. As the infection progressed in NOD SCID mice, the location of worms in the small intestine moved from the anterior third in the early stages of the infection to the mid- to posterior intestine in the later stages. Comparison of the infection in NOD SCID mice with C57BL/6J mice indicates that the expulsion of worms in the latter is mediated by an immune response.

Increasing resistance of Helicobacter pylori to clarithromycin: is the horse bolting?

AIMS: To determine whether there has been a change in the patterns of susceptibility to various antibiotics of our isolates of Helicobacter pylori over a 5-year period from 1996 to 2000. METHODS: Five hundred and fourteen isolates of H. pylori grown from gastric biopsies were tested for susceptibility to amoxycillin, clarithromycin, metronidazole and tetracycline. The usage of macrolide antibiotics in Australia was examined by calculating the numbers of prescriptions issued under the Australian pharmaceutical benefits scheme between 1992 and 2000. RESULTS: There were no changes in susceptibility of H. pylori to amoxycillin and tetracycline and there was a slight decline in resistance to metronidazole. In contrast, there was a stepwise 4-fold increase from 3.8 to 15.7% in the number of isolates resistant to clarithromycin and a similar increase in the mean minimum inhibitory concentration of clarithromycin during the 5-year period of observation. There was no change in overall macrolide consumption in Australia over this and the preceding 3 years. However, the pattern changed, with erythromycin usage being halved and being replaced by roxithromycin and clarithromycin. CONCLUSIONS: Resistance of H. pylori to clarithromycin is increasing, possibly as a consequence of increased usage of roxithromycin and clarithromycin. More patients are likely to fail to respond to empirical therapy and will need microbiological investigation.

The susceptibility of inbred mice to infection with Brachylaima cribbi (Digenea: Brachylaimidae).

Susceptibility to infection with Brachylaima cribbi was studied in eight strains of inbred mice (AKR, C3H/HeJ, CBA/CaH, BALB/c, DBA/2J, SJL/J, A/J, C57BL/6J) and Swiss albino outbred mice by quantifying faecal egg excretion over the period of the infection. Preliminary experiments indicated that a combination of filtration/sedimentation/diethyl ether sedimentation was the most sensitive and reliable technique for quantification of eggs in faeces. Mice were infected with 13-15 wild-type B. cribbi metacercariae from naturally infected Cernuella virgata and in a second experiment with human-derived B. cribbi from laboratory-reared Helix aspersa. In both experiments C57BL/6J mice were the most susceptible having the highest egg excretion levels and the longest duration of infection. Worm burdens were assessed at 12 wpi for the wild-type and at 9 wpi for the human-derived infections, when the majority of mice were no longer excreting eggs. The numbers of worms recovered from the small intestine were few and there were no significant differences among the inbred or outbred groups of mice. We have found that C57BL/6J mice were the most susceptible to Brachylaima cribbi infection as assessed by excretion of eggs and provide a suitable model for a laboratory life-cycle.

Aureobacterium masquerading as 'Corynebacterium aquaticum' infection: case report and review of the literature.

A gram-positive bacillus was isolated repeatedly from blood taken through the lumina of a central venous catheter of a patient with multiple myeloma who developed febrile neutropenia following chemotherapy. The bacterium was identified by the API CORYNE system as 'Corynebacterium aquaticum'. Gene analysis targeting the 16S rRNA indicated that the organism had a 99.5% identity with Aureobacterium liquefaciens although there were two phenotypic characteristics at variance with the description of this species. Problems remain with the routine identification of 'C. aquaticum' and Aureobacterium species. The few clinical reports on patients infected with 'C. aquaticum' and A. liquefaciens indicate that these are rare infections often associated with immunocompromise.

Strongyloides ratti and S. stercoralis: effects of Cambendazole, Thiabendazole and Mebendazole in vitro

Os efeitos da incubaçäo de três antihelmínticos, tiabendazol, mebendazol e cambendazol sobre Strongyloides foram comparados. Nenhuma droga afetou a eclosäo dos ovos de S. ratti ou a viabilidade de larvas infectantes ou vermes adultos parasitários, mas todas as três inibiram a formaçäo de larvas de S. ratti. Além disso, cambendazol, mas näo tiabendazol ou mebendazol, diminuiu a viabilidade de larvas de primeiro e segundo estágio de S. ratti. As três drogas näo tiveram efeito sobre vermes adultos de vida livre isolados, de S. stercoralis, mas todas evitaram o desenvolvimento de larvas rabditiformes de S. stercoralis. Tianbendazol e mebendazol näo tiveram efeito sobre a infectividade de larvas infectantes de S. ratti ou de S. stercoralis, mas a infecçäo com esses vermes foi anulada por incubaçäo prévia com cambendazol. Esses resultados indicam que cambendazol age de modo diferente das outras duas drogas. Uma vez que ele é ativo contra larvas migrando através dos tecidos, é potencialmente de muito maior valor que a tiabendazol ou mebendazol na terapêutica da estrongilodíase