Contamination of dialysis water and dialysate. A survey of 30 centers.

The concentration of bacteria and endotoxin in dialysis water and dialysate of 30 dialysis centers in western Germany was examined. Water samples were obtained after treatment by reverse osmosis or other processing methods. Collection of dialysis samples for bacterial, fungal, and endotoxin analysis was conducted before and 2 hours after start of hemodialysis. In 17.8% of all water samples analyzed, the AAMI standard was exceeded and bacterial and fungal counts greater than 200 colony forming units/ml were found. In 11.7% of all dialysate samples, higher contamination than the recommendations for dialysate of 2000 colony forming units/ml were found. The concentration of endotoxin in water and dialysate varied between 0 and 95 endotoxin units in the water samples and 0 and 487 endotoxin units/ml in the dialysate samples. In 12.2% of all water sampled, and 27.5% of all dialysate samples, values of 5 endotoxin units/ml were found. No correlation was found between the level of contamination of either water or dialysate in a specific center and the following factors: water processing method (reverse osmosis or others), type of dialysate (acetate of bicarbonate), type of dialysate machine, or method of machine disinfection. In view of these results it is suggested that endotoxin testing, especially in the dialysate, be a part of regular quality control in dialysis.

Microsporum racemosum: first isolation in the United States.

What is believed to be the first isolation in the United States of the dermatophyte Microsporum racemosum (2) was obtained from a 79 year old white male. The patient had numerous excoriations on the forehead, scalp, and nape of the neck. (Fig. 1) A culture of scrapings from the forehead grew out a flat, granular, cream-colored colony with a red cherry-colored pigment on the reverse. (Fig. 2). The growth was exceedingly rapid, reaching a thallus of 40 mm. in diameter within 15 days. On microscopic examination the organism was found to produce numerous echinulated macroaleuriospores, (Fig. 3,5) as well as numerous microaleuriospores which are striking in appearance, occurring in wand-like clusters and being frequently stalked. (Fig. 4,5) The macroaleuriospores are quite large, achieving over 60 microns in length and 15-16 microns in diameter. The colony and microscopic appearance was consistent with Borelli's description, with the exception of the wall of the macroaleuriospore. Borelli described the wall as being thin and very similar to M. gypsum, while in the isolation from Illinois, the wall was moderately thick. Drs. Ajello and Padhye of the U.S. Public Health Service, Center for Disease Control, Atlanta, Georgia confirmed the identification.