Disseminated trichosporonosis in a burn patient: meningitis and cerebral abscess due to Trichosporon asahii.

A 44-year-old diabetic female presented to a hospital in Jamaica with thermal burns. Trichosporon asahii was isolated from facial wounds, sputum, and a meningeal swab. Dissemination of the fungus was demonstrated in stained histological sections of the meninges and a brain abscess at autopsy. Pure growth of the fungus from patient samples submitted and an environmental isolate obtained from a wash basin in the hospital supported the diagnosis.

Systemic phaeohyphomycosis in pregnancy and the puerperium

Systemic fungal infections are rare. In pregnancy, treatment is problematic because of the risk of possible teratogenic effects of the antifungal drugs. We present the case of a 32 year-old woman who presented during pregnancy with a two-month history of painless subcutaneous nodules. Excision biopsy of one lesion showed dematiaceous fungal elements. Anti-fungal treatment was deferred and the pregnancy proceeded uneventfully. The remaining nodules were excised at the time of caesarean section delivery. Three weeks into the puerperium, she developed generalised seizures and investigations indicated systemic fungal infection with positive cultures for Aureobasidium spp which responded to appropriate antifungal therapy of flucytosine and itraconazole.(Au)

Systemic phaeohyphomycosis in pregnancy and the puerperium

Systemic fungal infections are rare. In pregnancy, treatment is problematic because of the risk of possible teratogenic effects of the antifungal drugs. We present the case of a 32 year-old woman who presented during pregnancy with a two-month history of painless subcutaneous nodules. Excision biopsy of one lesion showed dematiaceous fungal elements. Anti-fungal treatment was deferred and the pregnancy proceeded uneventfully. The remaining nodules were excised at the time of caesarean section delivery. Three weeks into the puerperium, she developed generalised seizures and investigations indicated systemic fungal infection with positive cultures for Aureobasidium spp which responded to appropriate antifungal therapy of flucytosine and itraconazole.

Bacteriuria in pregnancy: a comparative study of women seen in two antenatal clinics in Kingston, Jamaica using a group of non-pregnant women as controls

Significant bacteriuria in pregnancy, particularly when asymptomatic remains a major problem due to the many complications that have been associated with this condition. In this study, 457 samples of midstream urine from pregnant women attending the UWI-ANC and the CHC-ANC and 164 from non-pregnant women attending the Freezone clinic were collected between March 18 and April 11, 1994. Laboratory investigations to determine significant bacteriuria, the distribution of isolates and their antimicrobial susceptibility were performed. Population characteristics such as age, parity, socio-economic status and gestational age as well as the presence of symptoms consistent with urinary tract infection and choice of treatment were ascertained via the use of a questionnaire. The level of contamination among the samples was compared with that found in the Microbiology Laboratory UWI within the same period. While the prevalence of significant bacteriuria in pregnancy was 19.6 percent, that of asymptomatic bacteriuria was 13.3 percent compared with 7.3 percent among non-pregnant women. This difference was of statistical significance (p < 0.01). Statistical significant association existed between bacteriuria and the presence of symptoms, pyuria, gestational age. None was found with age, parity and socio-economic status. The three most common isolates were Streptococcus group B, Streptococcus faecalis and Staphylococcus aureus. Resistance to Ampicillin was high (37.8 percent) while resistance to Bactrim was low (3.3 percent). The level of contamination of samples from pregnant women was 4.2 percent compared to 11.5 percent found in the laboratory. This study highlighhts the problem of asymptomatic bacteriuria and suggests the need for further studies using larger samples to confirm these interesting findings (AU)

Antibiotic resistance of N. gonorrhoeae in Jamaica - abstract

A total of 885 women and 515 men, who were symptomatic, were screened by culture for gonorrhoea. Men were screened initially with Gram stain. Of these, 313 women and 440 men were proven to have uncomplicated gonorrhoea and were randomly assigned to treatment with procaine penicillin (4.8 mega units) or ampicillin (3.5g) each with probenecid (1g). Of this number, 61 women and 120 men were subsequently excluded from the study, leaving 252 women and 320 men for analysis. In this report, only the first 148 men are analysed. Test of cure (TOC) was performed 3-7 days post-treatment. One hundred and eighty women and 129 men completed treatment and follow-up within this period. The TOC was done after 7 days in 72 women and 19 men; these late returnees were analysed separately. Eliminating the late TOC cases, the total failure rates for penicillin and ampicillin were 4.8 percent and 4.3 percent respectively; for men 5.2 percent and 7.0 percent, for women 4.5 percent and 2.2 percent. Of the 14 failures to both regimes followed up within 7 days, 5 had PPNG infections, 2 were reinfections and 1 had pelvic complications. Urethral swabs from males and endocervical swabs from females were inoculated on to Thayer-Martin medium and gonococcal isolattes were identified by standard methods. Isolates were tested for penicillinase production using chromogenic cephahalosporin. Using the agar dilution technique and supplemented Protease No. 3 agar, the MICs to penicillin, ampicillin, spectinomycin, tetracycline, erythromycin, sulfamethoxazole-trimethoprim (19:1), cefuroxime and thiamphenicol were determined on isolates from these patients. Preliminary data on the determination of auxotype indicated that the prototrophic and proline-requiring groups comprised over 60 percent of the isolates tested to date. However, several other auxotype groups, especially Orn- and Pro-Cit-Ura-, were prevalent as well. Plasmid analysis of the strains indicated that all the Pro-Cit-Ura- isolates were plasmid-free, a result noted by others, and that 26 percent of the isolates carried transfer plasmids. To date, 16 PPNG cases have been detected among the 440 male cases, and 1 among 277 female cases. The PPNG isolates harboured either the African (3.2 Md) or the Asian (4.8 Md) penicillinase-producing plasmids. This is the first time that PPNG strains have been identified in Jamaica (AU)