Role of aeromonas isolated from feces of Finnish patients.

Aeromonas species were isolated from 249/13,027 (1.9%) stool samples submitted to the Dept. of Bacteriology and Immunology, University of Helsinki, during 1 year, to be cultured for bacterial enteropathogens. Aeromonas was the third most common enteropathogen isolated, after campylobacter (3.6%) and salmonella (3.3%). Isolates and clinical information from 234 Aeromonas patients were available for further study. A. caviae (41%), A. hydrophila (27%), and A. veronii biovar sobria (22%) were the most frequent isolates. In 15% of the patients, other enteropathogens were found along with aeromonas. Only 2% of all aeromonas-positive patients were found to be asymptomatic, whereas no aeromonas isolates were detected in the stools of 343 asymptomatic individuals. Almost all (96%) patients with aeromonas in their feces had gastroenteritis. Patients infected with A. veronii biovar sobria had a shorter illness course and had more often travelled abroad. In conclusion, Aeromonas spp. were found to be a potential cause of diarrhea in Finnish patients.

Ketoconazole is effective against the chronic mucocutaneous candidosis of autoimmune polyendocrinopathy-candidosis-ectodermal dystrophy (APECED).

Ketoconazole was administered as a single daily oral dose of 200 mg to 12 patients with chronic mucocutaneous candidosis (CMC) of autoimmune polyendocrinopathy-candidosis-ectodermal dystrophy (APECED). The study was double-blind and placebo-controlled, with 4-month therapy periods and crossover, and transfer to open-label ketoconazole therapy in cases of failure. During the double-blind trial, all six initially ketoconazole-treated patients showed a clear clinical and mycological improvement. In contrast there was no change or worsening in the initially placebo-treated group (p = 0.001). Oral candidosis cleared up in all patients, but more rapidly (less than 2 weeks) in those aged less than 25 years than in older patients (4-10 weeks; p = 0.001). Similarly, nail candidosis improved more rapidly in the younger group. All patients had a recurrence of the candidosis during 36-48 months of post-therapy follow-up. The recurrences likewise responded to ketoconazole. In one patient serum transaminase activities were transiently and marginally elevated during 2-6 weeks of therapy.

Fungal arthritis simulating juvenile rheumatoid arthritis.

Petriellidium boydii is often isolated from maduromycosis but has recently been associated with arthritis. A previously healthy 6-year-old boy developed chronic purulent arthritis of the knee after a bicycle accident. Culture of aspirate grew no pathogens and antibiotic treatment had no effect. Culture of synovial fluid grew P boydii, which responded initially to amphotericin but reappeared after six months. Subsequent treatment with miconazole was stopped after development of haematuria. The fungus was sensitive to ketoconazole, and treatment with this drug cured the infection. With the introduction of ketoconazole it is of practical importance to recognise fungal infections.

Oral mycoses and their treatment.

Mycoses of the mouth and nearby areas can be caused by both yeasts and filamentous fungi. They may appear either independently or as part of a systemic infection. It is typical of many mycoses that they occur as a consequence of local factors operating in the mouth, or in patients debilitated by severe diseases. Yeasts that are part of the normal microbial flora of man, among them especially Candida species, are the most frequent causative agents. Some tropical or semitropical infections may occur in Scandinavia and Finland, but they are rare. Local therapy with antimycotics is often effective in acute infections, whereas some chronic ones may make systemic administration necessary. Some of these infections are treated surgically.

Three cases of pulmonary sarcoidosis associated with aspergilloma.

Three cases of parenchymal sarcoidosis with aspergilloma are described. Emphysematous bullae due to the basic disease were thought to predispose to aspergillomas. The roles possibly played by disturbances in cell-mediated immunity, associated with sarcoidosis, and by corticosteroid therapy are discussed. Antimycotics were effective in this difficult combination of diseases. Although the aspergillomas were not completely cured, a decrease in the amount of sputum and in the frequency of haemoptysis was noted for long periods. These drugs may also be useful as protective medication against invasive aspergillosis during corticosteroid therapy in patients with aspergilloma.

The first two cases of coccidioidomycosis in Finland.

Endemic areas of coccidioidomycosis are described. The mycology of Coccidioides immitis is reviewed, with special reference to the risk of laboratory infection. A classification of coccidioidomycosis is listed and two cases from Finland are presented. The first patient had typical X-ray and clinical findings, including a positive coccidioidin test. The second case, occurring soon after a visit to Arizona, was confirmed by positive fungal cultures from the sputum and from a resected specimen. Because the latter patient became pregnant and the risk of dissemination was considered great, legal abortion was performed. The resection of the pulmonary cavitation with infiltration around it took place under coverage of pre- and postoperative amphotericin B medication. Complete recovery was obtained. The indications for thoracic surgery are briefly listed. Diagnostic and mycologic aspects of this rare and exotic disease are discussed. Among other things, the importance of a good medical history in finding the contact with infective environment or material is stressed.