Isolation of Trichosporon asahii from environmental materials

Trichosporon asahii is the most clinically important pathogenic yeast in the genus Trichosporon, as this species causes both deep-seated infection and summer-type hypersensitivity pneumonitis. We isolated 29 T. asahii colonies from environmental samples using the polymerase chain reaction (PCR) and dichloran rose bengal chloramphenicol (DRBC) medium. Our results suggest that T. asahii is common in nature.

Dose calculation for asymmetric photon fields with independent jaws and multileaf collimators

We have developed a simple method for dose calculation in dual asymmetric open and irregular fields with four independent jaws and multileaf collimators. Our calculation method extends the scatter correction method of Kwa et al. [Med. Phys. 21, 1599-1604 (1994)] based on the principle of Day's equivalent-field calculation. The scatter correction factor was determined by the ratio of the derived doses of a smaller asymmetric open field or irregular field to a larger symmetric field. The algorithm with the scatter correction method can be calculated from output factors, tissue maximum ratios, and off-axis ratios for conventional symmetric fields. The doses calculated by this method were compared with the measured doses for various asymmetric open and irregular fields. The agreement between the calculated and measured doses for 4 and 10 MV photon beams was within 0.5% at the geometric center of the asymmetric open fields. For the asymmetric irregular fields with the same geometrical center, agreement within 1% was found in most cases.

Immunoreactive pit-1 protein in hyperplastic pars intermedia induced by calcitonin of the rat pituitary gland

To elucidate the effects of synthetic salmon calcitonin (sCT) on the cells in the rat pituitary gland, we histopathologically and immunohistochemically examined the early changes after 4 or 13 weeks treatment with sCT 120 IU/kg. Focal proliferative lesions of the anterior pituitary glands were consistently found after treatment with sCT for 13 weeks. Histologically, the cells with the focal proliferative lesions were classified into the following three groups: 1) enlarged basophilic cell focus, 2) vacuolated cell focus and 3) chromophobe cell focus. These focal proliferative lesions had positive staining only for the alpha-subunit and failed to show Pit-1 protein immunoreactivity. The sCT treatment also increased the thickness of the pars intermedia. Hypertrophy of the pars intermediate cells was characteristically seen. Furthermore, Pit-1 protein immunoreactivity was clearly detected in the nuclei of the hyperplastic pars intermediate cells. All pars intermediate cells were equally stained by alpha- or beta-MSH and beta-endorphin in both vehicle- and sCT-treatment. No difference was seen. These findings strongly suggest a very close relationship between Pit-1 protein immunoreactivity and cellular proliferation induced by sCT.

Persistence of cryptococcal antigenemia in an infected dog and uninfected rabbits

A case of cryptococcosis in a dog is reported. The titers of polysaccharide antigen in sera were monitored by latex agglutination (LA) tests during and after treatment with antifungal therapy. Although the LA titers decreased in response to therapy, it took about 3.5 years to achieve a negative LA test. To model the persistence of cryptococcal polysaccharides, we examined the clearance of antigen from the blood of rabbits injected with sterile, cryptococcal capsular polysaccharide isolated from culture supernatant. The distribution half-lives were between 2.6 and 3.9 days and the elimination half-lives were between 10.4 and 39 days. These results suggest that polysaccharide antigen may be stored in tissues. However, we think that slow clearance of antigen cannot explain the extraordinarily slow clearance found in this dog, and that prolonged survival of Cryptococcus neoformans is a more plausible explanation.

DNA ploidy analysis of urinary tract epithelial tumors by laser scanning cytometry

OBJECTIVE

To evaluate a rapid and simple method for DNA content analysis of urinary tract epithelial tumors with laser scanning cytometry (LSC).

STUDY DESIGN

The subjects were 25 patients (37 specimens) who underwent surgery for urinary tract epithelial tumors. Tissue specimens of such tumors were frozen immediately after tumor resection and stored at -80 degrees C until used. Touch preparations were made and fixed in ethanol at room temperature. The cell nucleus was stained with propidium iodide solution containing RNase, and DNA ploidy was analyzed by LSC. Nuclear debris and overlapping nuclei were gated out by special statistical filters. In LSC, a normal diploid reference peak was determined by observing lymphocytes morphologically on the computer display of the instrument and/or under the microscope.

RESULTS

DNA ploidy could be evaluated in all tumor tissues. The time it took from preparing the tumor specimen to the last measurement was about 40 minutes at the shortest, and measurement of all the specimens was completed within one hour. The coefficient of variation was 2.8-7.8% (mean, 4.4%). All eight specimens (100%) at grade 1 (G1) were DNA diploid, but 20% and 85.7% of the G2 and G3 cells, respectively, were DNA aneuploid. In total, 15 of the 37 specimens were DNA aneuploid. All 17 pTa-pT1 specimens (100%) were DNA diploid, but 100% and 50% of the T2 and T3 tumors, respectively, were DNA aneuploid.

CONCLUSION

One can now supplement a morphologic diagnosis with useful information using LSC of touch preparations of tumors obtained at surgery or of imprints of archived, frozen specimens. LSC provides excellent DNA histograms for surgical specimens and has great potential for clinical application in pathology.

Ineffective interferon treatment of chronic hepatitis C-associated porphyria cutanea tarda, but with a transient decrease in HCV RNA levels

Many patients with porphyria cutanea tarda (PCT) have been reported to be hepatitis C virus (HCV) carriers, suggesting that HCV infection plays a role in the pathogenesis of this type of porphyria. In this study, we report a patient with chronic hepatitis C-associated PCT. Therapy with interferon (IFN) transiently decreased HCV RNA levels, but levels of urinary porphyrins and serum transaminases and ferritin remained unchanged. Serum ferritin and urinary porphyrin levels improved after phlebotomy, but this therapy was not effective in improving serum transaminase levels. Although a physiopathological association between HCV infection and PCT has been suggested previously, IFN was not effective in this patient. The transient decrease in HCV RNA levels was a factor independent of porphyrin metabolism.

Hypoparathyroidism potentiates cardiovascular complications through disturbed calcium metabolism: possible risk of vitamin D(3) analog administration in dialysis patients with end-stage renal disease

BACKGROUND/AIM

Progressive cardiovascular calcification in dialysis patients with end-stage renal disease (ESRD) is a serious complication; however, the precise mechanism remains uncertain. We tested whether metabolic calcium abnormalities and hypoparathyroidism might have a correlation with cardiovascular complications in ESRD patients.

METHODS

A series of 48 ESRD patients with cardiovascular diseases and/or congestive heart failure, aged 36-82 (61 +/- 12) years, 23 male and 25 female, were enrolled in this study. Serum total calcium (Ca, mmol/l), inorganic phosphate (mmol/l), and intact parathyroid hormone (iPTH, pg/ml) levels were determined in all cases.

RESULTS

Organic heart disease was confirmed in 28 patients (58.3%), including 15 with coronary artery disease: 8 with aortic aneurysm, 8 with stenotic valvular heart disease, 9 with excessive mitral annular calcification, 3 with dialysis cardiomyopathy, and 7 with obstructive arterial disease. Serum iPTH measurement revealed hypoparathyroidism (iPTH <60) in 20 of 48 (41.7%) and hyperthyroidism (iPTH >/=200) in 13 of 48 (27.1%) subjects. The 20 patients with low iPTH had a higher prevalence of valvular heart disease, a higher total Ca level corrected for serum albumin (2.70 +/- 0.30 in low iPTH vs. 2.47 +/- 0.30 in normal iPTH, 2.35 +/- 0.20 in high iPTH, p = 0.003) and a higher tendency of vitamin D(3) analog use (65% in low iPTH vs. 33% in normal iPTH and 46% in high iPTH, p = 0.078). Moreover, corrected serum Ca exhibited a negative logarithmic correlation with serum iPTH: corrected Ca = -0.284x log (iPTH) + 3.021 (r = 0.637, p = 0.0001). Multiple logistic regression analysis revealed diabetes and hypoparathyroidism (iPTH <60) as risk factors for cardiovascular complications in ESRD.

CONCLUSION

These results suggest that hypercalcemia and hypoparathyroidism in conjunction with vitamin D(3) use might play an important role in cardiovascular complications of chronic dialysis patients.

[Chromophobe cell renal carcinoma: a case report]

Chromophobe cell renal carcinoma is an uncommon subtype of renal cell carcinoma and the number of cases studied is still limited in Japan. We here report a case of chromophobe cell renal carcinoma in a 41-year-old Mexican male. He visited our branch hospital with the symptom of upper abdominal pain. Ultrasound examination showed a left renal mass. He was admitted to our hospital for treatment of a left renal mass. Radiological examinations revealed a hypervascular tumor in the left kidney. Under the clinical diagnosis of possible renal cell carcinoma, left radical nephrectomy was performed. This tumor was diagnosed as chromophobe cell renal carcinoma with a microscopic examination of H & E stained specimens, histochemical staining using Hale's colloidal iron and an ultrastructural study.

Rapid turnover of tryptophan hydroxylase is driven by proteasomes in RBL2H3 cells, a serotonin producing mast cell line

Previously we demonstrated that tryptophan hydroxylase (TPH) undergoes very fast turnover driven by ATP-dependent proteolysis in serotonin producing mast cells [Hasegawa et al. (1995) FEBS Lett. 368, 151-154]. We searched for the major proteases involved in the rapid degradation of TPH in RBL2H3 cells. Among various protease inhibitors tested, proteasome inhibitors MG115, MG101, MG132, and lactacystin effectively inhibited the intracellular degradation of TPH. Administration of the proteasome inhibitors to cultured cells caused more than a 5-fold accumulation of TPH. Administration of the inhibitors together with cycloheximide stabilized the amount of TPH with no appreciable increase or decrease. Although MG-series proteasome inhibitors could inhibit calpain, the involvement of calpain was excluded since the cysteine protease inhibitor E-64-d, which acts on calpain, had no effect. Extracts of RBL2H3 cells were shown to contain a protease that digests TPH in an ATP-dependent manner and is sensitive to proteasome inhibitors. The ubiquitination of TPH could be visualized by Western blot analysis using both anti-TPH and anti-ubiquitin antibodies. Based on these results, we conclude that 26S proteasomes are mainly involved in the degradation of TPH. In the reported amino acid sequences of TPH from various sources including human, rabbit, rat, and mouse, a PEST sequence that is widely shared among short-lived proteins has been recognized. It was noted that the PEST sequence lies within the most conserved portion of the enzyme, the pteridine binding site.

[Treatment of stress incontinence by percutaneous bladder neck stabilization (Vesica)]

We experienced 9 cases of percutaneous bladder neck stabilization (Vesica) for patients with urinary incontinence who were diagnosed with stress incontinence from December 1995 to June 1998. None of the patients were able to control continence with any drugs. Chain cystography was performed on all of the patients before and after surgery. The posterior urethro-vesical angle before surgery was over 130 degrees in all of the patients, and it improved after the operation. Moreover, the mean volume of the pad test greatly decreased from 47 g to 1 g. All of the patients were treated with epidural anesthesia. The operation time was less than 60 minutes. The subjective and objective findings were satisfactory. We conclude that percutaneous bladder neck stabilization is a very useful surgical treatment for stress incontinence.

A significant relationship between glutathione-peroxidase (GSH-PO) localization and biological action of testosterone in rat ventral prostate

In order to confirm the relationship between glutathione-peroxidase (GSH-PO) localization and biological testosterone action in the rat ventral prostate, immunocytochemical localization of GSH-PO in glandular epithelial cells of the rat ventral prostate was investigated. In the untreated group, GSH-PO was predominantly demonstrated in glandular epithelial cells of the ventral prostate. Intracellular localization of GSH-PO in the glandular epithelial cells was mainly observed in cytoplasmic matrix near the rough endoplasmic reticulum and was occasionally noted as a small granular structure (GSH-PO-positive granule) at the supranuclear region. In a castrated animal, the intensity of GSH-PO staining in the glandular epithelial cells was remarkably decreased. By testosterone administration to the castrated animal, GSH-PO was clearly detected in the glandular epithelial cells. Intracellular localization of GSH-PO was mainly observed in cytoplasmic matrix and the number of GSH-PO-positive granules increased remarkably. These findings suggest that immunostainable GSH-PO in the glandular epithelial cells of the rat ventral prostate is testosterone-dependent, and that its staining pattern is a useful marker for biological testosterone action.

Ommochrome deficiency in an albino strain of a terrestrial isopod, Armadillidium vulgare

In order to clarify the cause of ommochrome deficiency in an albino strain of the terrestrial isopod, Armadillidium vulgare, levels of xanthommatin, 3-hydroxykynurenine, 3-hydroxyanthranilic acid and tryptophan in whole body extracts of the albino and the wild type individuals were determined together with enzyme activities of kynurenine-3-hydroxylase, kynureninase and tryptophan-2,3-dioxygenase. Xanthommatin could not be detected in the albinos. The levels of 3-hydroxykynurenine and 3-hydroxyanthranilic acid were determined by high-performance liquid chromatography (HPLC) with electrochemical detection and were markedly low in the albinos compared with the wild type individuals. In contrast to those, the tryptophan levels determined by HPLC with fluorescence detection did not differ significantly between the two phenotypes. In the albino A. vulgare, kynurenine-3-hydroxylase activity was lower and kynureninase activity was higher than in the wild type, although the differences were not statistically significant. Tryptophan-2,3-dioxygenase activity in the albinos was less than 10% that in the wild type. Thus, ommochrome deficiency in the albino A. vulgare is considered to be caused by the extremely low activity of tryptophan-2,3-dioxygenase.

Identification of medically relevant Trichosporon species based on sequences of internal transcribed spacer regions and construction of a database for Trichosporon identification

The nucleotide sequences of the internal transcribed spacer (ITS) 1 and 2 regions in the rRNA gene were determined by directly sequencing PCR-amplified fragments for all of the species (17 species and five varieties) in the genus Trichosporon. Comparative sequence analysis suggests that six medically relevant species, T. asahii, T. asteroides, T. cutaneum, T. inkin, T. mucoides, and T. ovoides, can be readily identified by their ITS sequences. In addition, the sequence analysis showed that conspecific strains have fewer than 1% nucleotide differences in the ITS 1 and 2 regions overall. Molecular phylogenetic trees are also presented.

Immunohistochemical studies in canine prostatic hyperplasia--effect of antiandrogen

To investigated spontaneous benign prostatic hyperplasia (BPH) in dog the effect of a synthetic steroidal antiandrogen, chlormadinone acetate (CMA) was studied. Old male beagle dogs (5-8 years old) were divided into following experimental groups: group 1 consisted of BPH controls; group 2 received CMA 0.3mg/kg/day p.o., for 6 months. In group 1 animals, glandular hyperplasia of the prostate was clearly detected. The glandular epithelial cells showed uniformly intense immunostaining for nuclear androgen receptors (AR). AR was also localized in the nuclei of the fibro-muscular cells. Immunoreactivity of 5alpha-reductase type I was positive in most glandular epithelial cells. The staining was positive in the cytoplasm but not in the nuclei. No fibro-muscular cells were stained. In contrast, CMA produced marked atrophy of the glandular epithelium. The interacinar fibro-muscular stroma was prominent. Furthermore, immunostaining of nuclear AR of both epithelial and stroma cells was remarkably decreased. The intensity of staining for 5alpha-reductase type I in most glandular epithelial cells also decreased. Interestingly, some basal cells exhibited positive staining for 5alpha-reductase type I. These results indicate that the uptake of testosterone and/or its androgenic effect on the prostate may be suppressed by CMA. We further speculate that the basal cells produce sufficient dihydrotestosterone to maintain themselves even in the presence of low testosterone levels.

Developmental changes of sugar residues and secretory protein in mucous cells of the early postnatal rat parotid gland

Mucous cells have been identified in the terminal portions of the early postnatal parotid gland in human and rat, although mature parotid gland acini are composed of serous cells or seromucous cells. Previously, Ikeda et al. demonstrated that mucous cells are present in the rat parotid gland on days 1 to 8 after birth and that the secretory granules within these mucous cells share some histochemical characteristics with mature serous cells. However, it is still not clear whether the mucous cells change into serous cells as the gland develops. The purpose of this study was to determine whether the mucous cells that appear in the early postnatal rat parotid gland change into serous cells. Parotid glands were obtained from male or female Wistar rats (aged 0-14 days and adults). Fixed tissue sections were reacted with soybean agglutinin (SBA) and wheat germ agglutinin (WGA) to detect glycoconjugates, or were stained using an anti-neonatal submandibular gland protein B1 (SMG-B1) antibody to identify serous acinar cells. The sections were observed by transmission electron microscopy. Electron microscopy revealed that cells with characteristics intermediate between those of mucous and serous cells (transitional cells) appeared around day 8 and that the nuclei of these cells did not show chromatin condensation, a characteristic of apoptotic cells. Lectin histochemistry showed that the mucous cells had the same sugar residues as the serous cells, which appeared after day 10. Immunohistochemistry with an anti-SMG-B1 antibody gave a positive reaction not only in the cells with highly electron-dense granules but also in the electron-dense cores of bipartite or tripartite granules in the transitional cells. Cells with morphological characteristics intermediate between those of mucous and serous cells (transitional cells) appearing in the early postnatal rat parotid gland begin to produce B1-immunoreactive protein common to serous acinar cells during development of the gland.

Firearm storage practices and children in the home, United States, 1994

OBJECTIVES

To estimate the national prevalence of firearm ownership and storage practices in the home, to compare storage practices in homes with and without children, and to analyze demographic characteristics related to firearm storage practices in homes with children.

DESIGN

A 1994 random-digit dialing telephone survey. We weighted the data to provide national estimates.

PARTICIPANTS

English- and Spanish-speaking adults in households in 50 states and Washington, DC.

MAIN OUTCOME MEASURES

Ownership of working powder firearm(s) in home and/or vehicle and firearm storage practices in the home.

RESULTS

Of 5238 households surveyed, one third kept at least 1 firearm in the home and/or vehicle. Of 1598 households with firearm(s) in the home and known firearm storage practices, 21.5% kept at least 1 gun loaded and unlocked in the home, 30.0% stored all firearms unloaded and locked, and 48.5% stored firearms in a manners classified between these 2 practices. Households with children were more likely than households without children to store all firearms unloaded and locked (41.5% vs 20.9%); households without children were more likely than households with children to store at least 1 firearm loaded and unlocked (29.8% vs 11.1%). Among households with children and firearms, there were regional differences with respect to storage practices.

CONCLUSIONS

These prevalence data show that children are potentially exposed to firearms in many households. This health threat illustrates the need for education about the issue of pediatric firearm injuries and for interventions to minimize associated risks. Health care providers should take advantage of opportunities to counsel patients regarding firearm safety in the home.

[Prophylaxis of recurrence in superficial bladder carcinoma by intravesical chemotherapy--comparative study between instillation of combined double anticancer agents and single anticancer agent]

We performed a study to compare the usefulness of double or single anticancer agents in the prophylactic treatment after the transurethral resection (TUR) of superficial bladder cancer. We experienced 127 superficial bladder cancer cases. Of these cases, 42 were treated with intravesical adriamycin (ADR) and peplomycin (PEP), 56 with ADR, PEP, epirubicin (epi-ADR) or pirarubicin (THP) only, and the remaining 29 with TUR only. Nonrecurrence rates were significantly higher in the intravesical treated cases than in the cases with TUR only, and also significantly higher in the cases treated with ADR and PEP than the other treated cases. We concluded that intravesical chemotherapy with combined agents was more effective than with a single agent.

Ultrastructural study in canine prostatic hyperplasia--effect of antiandrogen

Ultrastructural changes in canine prostates after treatment with chlormadinone acetate (CMA) were investigated. Old male beagle dogs (5-8 years old ) were divided into two experimental groups; group 1 consisted of benign prostatic hyperplasia (BPH) controls, and group 2 received 0.3 mg/kg/day CMA orally for 6 months. In group 1 animals, the most striking ultrastructural changes were detected in the rough endoplasmic reticulum (rER) and Golgi complexes. The secretory granules were lined up along the apical plasma membrane, and exocytosis was frequently seen. In group 2 animals, the cytoplasm was electron-lucent and contained relatively few, poorly developed organelles. The rER was sparse and consisted of a few scattered, short profiles studded with ribosomes. The Golgi complexes were inconspicuous. The secretory granules were markedly decreased in both number and size. Furthermore, mitochondrial degeneration such as swollen or disappeared mitochondrial cristae or decreased electron density of the matrix were frequently seen in the smooth muscle cells. Based on our data, atrophy after treatment with CMA may be due to shrinkage of both glandular and stromal compartments in the prostate tissue.

Immunolocalization of androgen receptor in canine prostatic hyperplasia--effect of antiandrogen

The effect of a synthetic steroidal anti-androgen, chlormadinone acetate (CMA), on spontaneous benign prostatic hyperplasia (BPH) in the dog was investigated. Old male beagle dogs (5 to 8 years old) were divided into the following experimental groups: group 1 consisting of BPH controls, and group 2 which received CMA of 0.3 mg/kg/day orally for 6 months. In group 1, glandular hyperplasia of the prostate was clearly observed. The glandular epithelial cells showed uniformly intense nuclear immunostaining for androgen receptor (AR). In contrast, CMA produced marked atrophy of the glandular epithelium. The interacinar fibromuscular stroma was prominent. Furthermore, nuclear immunostaining for AR in both epithelial and stroma cells was remarkably decreased. These results indicate that the uptake of testosterone and/or its androgenic effect on the prostate may be suppressed by CMA. The decreased AR-immunostaining may be explained by the decrease in the number of AR and/or antibody binding sites for AR.

Firearm-related injury surveillance. An overview of progress and the challenges ahead

Firearm-related injuries pose a serious public health problem in the United States and are increasingly the focus of public health concern. Despite the magnitude of this problem, ongoing and systematic collection of data on firearm-related injuries to help guide research and policy development has been lacking. The further development of firearm-related injury surveillance systems can provide an objective source of information for policy. Beginning in the mid-1980s, the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control began to support the development of firearm-related injury surveillance systems by augmenting existing national- and state-level data collection systems and establishing cooperative agreements with state and local health departments to identify optimal firearm-related injury surveillance practices. Some progress has been made in improving the capacity to undertake firearm injury surveillance at national, state, and local levels for mortality, morbidity (including disability), and risk/protective factors, but much work remains to be done. The development of state and local firearm-related injury surveillance systems provides the clearest potential for linking basic information on firearm-related injuries to action, given the critical role that states have in both public health surveillance and regulation of firearms. Broader application of external cause-of-injury codes, increased standardization and validation of definitions and data-collection instruments, improved methods for identifying firearm characteristics and types, and the identification of efficient techniques for linking health and criminal justice data sources are among the key challenges we face as we try to build a more uniform system for monitoring firearm-related injuries in the United States.

Washington State Gunshot-Wound Surveillance System

CONTEXT

Gunshot is the second leading mechanism of injury death in Washington State, but data on nonfatal gun-related injuries are limited.

OBJECTIVE

Develop and evaluate a system for surveillance of fatal and nonfatal gunshot injuries.

DESIGN

A gunshot wound surveillance system was pilot-tested. Reports from emergency departments were compared with emergency department logs and reports from medical examiners and coroners were compared with death certificates.

SETTING

Six Washington counties, with 57% of the state's population.

PARTICIPANTS

Hospital emergency departments, coroners, medical examiners, and local law enforcement agencies.

MAIN OUTCOME MEASURES

Surveillance system simplicity, acceptability, sensitivity, and predictive value positive.

RESULTS

The pilot system was found to be simple and acceptable to data providers. The predictive value positive was 99% for reports from hospital emergency departments and 100% for reports from medical examiners and coroners. The sensitivity of hospital emergency department reporting was 76%; the sensitivity of reporting by medical examiners and coroners was 81%.

CONCLUSIONS

States interested in developing gunshot-wound surveillance systems should: (1) verify the existence of a statewide gunshot-wound reporting requirement, (2) consider establishing such a requirement if one does not exist, (3) include hospital emergency departments as a data source, (4) establish the capacity to link records if multiple data sources are used, (5) limit the data reporting requirements to fit on a one-page form, preferably one-side only, (6) periodically review the data and the reporting practices of data providers, and be prepared to make changes if things are not working as planned, and (7) disseminate surveillance data and system evaluation findings on a regular basis.

First report of Trichosporon ovoides isolated from the home of a summer-type hypersensitivity pneumonitis patient

Trichosporon species have been known to cause summer-type hypersensitivity pneumonitis (SHP). During the isolation of yeasts from an SHP patient's house, we recovered a strain belonging to the genus Trichosporon. Morphologically, the isolate produced rectangular arthroconidia when grown on corn meal agar. DNA-DNA hybridization experiments identified the isolate as T. ovoides. A slide agglutination test using specific factor sera demonstrated that the serotype of the strain was type II. Previously, T. asahii, a serotype II species, was considered to be the major antigen of SHP, but it is possible that T. ovoides may also be responsible for SHP. This is the first report of T. ovoides isolated from an SHP patient's home environment.