Characteristics of candidaemia with Candida-albicans compared with non-albicans Candida species and predictors of mortality.

Candidaemia due to non-albicans Candida species is increasing in frequency. We describe 272 episodes of candidaemia, define parameters associated with Candida albicans and other Candida species, and analyse predictors associated with mortality. Patients with C. albicans (55%) had the highest fatality rate and frequently received immunosuppressive therapy, while patients with Candida parapsilosis (16%) had the lowest fatality and complication rates. Candida tropicalis (16%) was associated with youth, severe neutropenia, acute leukaemia or bone marrow transplantation, Candida glabrata (10%) was associated with old age and chronic disease, and Candida krusei (2%) was associated with prior fluconazole therapy. The overall fatality rate was 36%, and predictors of death by multi-variate analysis were shock, impaired performance status, low serum albumin and congestive heart failure. Isolation of non-albicans Candida species, prior surgery and catheter removal were protective factors. When shock was excluded from analysis, antifungal therapy was shown to be protective. Unlike previous concerns, infection with Candida species other than C. albicans has not been shown to result in an increased fatality rate.

Pseudooutbreak of Candida guilliermondii fungemia in a neonatal intensive care unit.

During a 3-week period multiple blood cultures obtained from 14 Neonatal Intensive Care Unit infants and 3 Newborn Unit babies grew Candida guilliermondii, a yeast rarely associated with infections in humans. At the time of detection of positive cultures, most infants had been hospitalized for days or weeks for serious perinatal conditions and treated with antibiotics and intravenous hyperalimentation. Two critically ill premature infants from whom the yeast was isolated were given amphotericin B. In 7 other infants, however, yeasts were recovered on the day of birth, raising the question of pseudofungemia. Exhaustive interrogation on the blood culture practices revealed that when drawing blood for a culture from small infants, "butterfly" needles were often flushed with a diluted heparin solution to prevent blood clotting. Culture of a single lot of diluted heparin vials, prepared at the hospital pharmacy and distributed to the Neonatal Intensive Care Unit and Newborn Unit shortly before the onset of the epidemic, grew between 10,000 and 15,000 colony-forming units of Candida guilliermondii/ml. Removal of contaminated heparin vials and discontinuation of heparinization of needles used for blood cultures resulted in cessation of the epidemic. The present outbreak illustrates the difficulties in recognizing pseudoinfections in sick premature infants and the importance of intensive investigation and intervention during such an outbreak.

Invasive Aspergillosis in Neutropenic Patients with Hematological Disorders.

Between 1983-1988, 72 patients with acute leukemia and 4 with aplastic anemia were treated in the Hematology Unit of The Chaim Sheba Medical Center. Ten patients with acute leukemia developed invasive pulmonary aspergillosis and 2 with aplastic anemia developed invasive aspergillosis of the nose and paranasal sinuses. These infections were diagnosed during a period of profound neutropenia while these patients were receiving broad spectrum antibiotics. The diagnosis of pulmonary aspergillosis was based on positive sputum cultures in 4 cases and on the appearance of typical clinical and radiologic features in six. In 2 culture-positive and in one culture-negative patient, the diagnosis was confirmed at autopsy. Thus, the diagnosis was definitive in 5 patients and probable in the remaining five patients. The 5 patients who achieved remission responded to antifungal treatment and recovered, while of the 5 who eventually died from the fungal infection, 4 did not achieve remission, and one died while in complete remission. In the 2 patients with aplastic anemia, aspergillosis was detected in cultures from necrotic nasal tissue. Both patients remained neutropenic, failed to respond to antifungal treatment and died within a short time after diagnosis. From this experience it appears that invasive aspergillosis in neutropenic patients is potentially curable if treated early by amphotericin B, provided that the neutrophil count recovers.

Pseudomicrodochium fusarioides sp. nov., isolated from human bronchial fluid.

A fungus from bronchial lavage fluid from a patient with pulmonary infiltration was isolated in pure culture and identified as a species of Pseudomicrodochium. It is compared and contrasted with other species of the genus, in particular P. suttonii, and formally described as P. fusarioides.

Hamster endogenous retrovirus (HaER) isolated from SV-40 induced tumor cells.

A hamster cell line obtained from a secondary transplanted SV-40-induced tumor was found to spontaneously release type C virus particles. The particles possessed all biochemical features characteristic of retroviruses and induced syncytium formation in XC cells but were not oncogenic for hamsters. Nucleic acid hybridization assays demonstrated that the isolated virus was an endogenous retrovirus of hamster, lacking sequence homology with mouse and other animal species.

Hamster endogenous retrovirus (HaER)--distinct properties of structural proteins and DNA polymerase.

The structural proteins as well as some features of the RNA-dependent DNA polymerase of the hamster endogenous retrovirus (HaER) were examined. The polypeptide pattern of this virus is substantially different from that of other known retroviruses in containing major polypeptides with molecular weights of 68,000, 59,000, 27,000 and 24,000 daltons. Double antibody competitive radioimmunoassays showed that the HaER particles do not share any detectable antigenic relatedness with the murine viruses' p30, but manifest a considerable relatedness with the feline leukemia virus p27 and a slight cross-reactivity with the rat virus major protein. The RNA-dependent DNA polymerase of HaER virus has a molecular size of approximately 73,000 daltons and in contrast to other mammalian retroviruses shows no significant preference for Mn2+ over Mg2+. Apart from the lack of antigenic relatedness between the HaER virus proteins and the p30 protein of murine viruses, there is also no antigenic relatedness between HaER and murine viruses insofar as their DNA polymerase is concerned.

Saksenaea vasiformis infection in a burn wound.

Saksenaea vasiformis was isolated, after 18 days, from a burn wound caused by a petrol bomb. The fungus was locally invasive and was treated successfully by excision and systemic administration of amphotericin B. Identification of the isolate was accomplished by inducing sporulation on 1% agar containing grass clippings and on hay infusion agar.

Human Exserohilum and Bipolaris infections: report of Exserohilum nasal infection in a neutropenic patient with acute leukemia and review of the literature.

A neutropenic patient with acute myeloid leukemia developed nasal and perinasal infection caused by the fungus Exserohilum rostratum. Early amphotericin B treatment along with marrow recovery resulted in resolution of the infection. A review of other previously reported cases of Exserohilum and Bipolaris infections show a favourable outcome in most patients who receive systemic antifungal treatment with amphotericin B.

Life-threatening cryptosporidiosis in immunocompetent infants.

Cryptosporidium infection in immunocompetent patients has been described as a mild self-limiting diarrhoea. We describe two immunocompetent infants presented with life-threatening protracted diarrhoea. These two cases expand on the clinical spectrum of cryptosporidiosis in normal hosts.

Gamma-glutamyltranspeptidase in murine lymphomas.

Five murine lymphoma cell lines were assayed for the content and activity of gamma-glutamyltranspeptidase (GTT). All lines [S49; L-12; 230-23-8 (C57 Black); 2M3 and RA3-2C2] contained detectable amounts of GGT. The specific activities of GGT were low and ranged between 1.2 and 2.3 mU/mg protein in cells growth in vitro. A highly malignant variant of the S49 line was also grown in vivo in BALB/c mice. This subline invariably produces both solid and ascitic tumors with infiltrations into the pancreas, liver and spleen. GGT levels in the tumor cells were low and independent of tumor type (solid, ascitic), location, passage number or inoculum size. Infiltrations of S49 tumor cells in liver and spleen were invariably GGT--negative as judged by histochemical examination. GGT activities in suspension cultures prepared from solid, as well ascitic tumors were low. Occasional high GGT activity of solid tumors was due to the presence of pancreas cells in them. The only host tissue significantly responding to the presence of tumors by elevated GGT levels was the liver. Compilation of data from this study and those of others clearly indicates that low GGT level is a typical property of tumors originating in the immune system.

Peritonitis due to Thermoascus taitungiacus (Anamorph Paecilomyces taitungiacus).

The first case of human disease due to the thermophilic ascomycete Thermoascus taitungiacus (the teleomorph of Paecilomyces taitungiacus) is presented. T. taitungiacus was recovered from four dialysate fluid specimens of a 57-year-old patient undergoing chronic peritoneal dialysis. Identification was based upon cylindrical conidia, reddish orange nonostiolate ascomata, lack of growth at 20 degrees C, thermotolerance, and ascospores that appeared pale yellow, elliptical, thick walled, and predominately echinulate by light microscopy but irregularly verrucose by scanning electron microscopy.

Gastrointestinal phycomycosis in acute nonlymphatic leukemia.

A 37-year-old patient with acute nonlymphatic leukemia developed gastrointestinal phycomycosis during failure in bone marrow production. The clinical presentation was of acute typhlitis. Laparotomy revealed a necrotic mass in the region of the iliocecal valve, and on histologic examination hyphae of phycomycetes with invasion of the blood vessels were seen. The patient died as a result of widespread infection.