Fungus infections after liver transplantation

The problem of fungus infections after liver transplantation was studied. In 100 consecutive recipients of orthotopic liver homografts there were 10 and 8 examples, respectively, of localized and disseminated infections caused by Candida species. Candidemia was demonstrated in 8 of these 18 patients. One patient who had a localized Candida infection also had disseminated cryptococcosis. An additional 31 patients were infested in that Candida could be cultured from sites where it is not normally found, such as the blood (8 examples), urine (8), ascitic fluid (8), and wounds (22). This exorbitant incidence of monilial infections and infestations was associated with a high frequency of complications involving the homograft as well as the hosts' gastrointestinal tract during the post-transplantation period. The yeasts found in blood, urine, ascitic fluid and elsewhere were thought to have originated from the gut. Ten of the 100 patients had aspergillosis which was localized in 7 instances and disseminated in 3. The lung was the most frequently affected organ. The fungus infections played a contributory role in the downhill course of our patients but in the event of death more fundamental and more frequent causes of failure were technical complications involving the homografts, difficulties in controlling rejection with reasonable immunosuppressive doses and bacterial sepsis. Suggestions have been made for the better control of fungal infections in liver recipients.

[Biological properties of strain of Yersinia enterocolitica isolated from humans]

A total of 1300 patients were examined; this number included patients suffering from food poisoning and with suspected dysentery hsopitalized at the isolation hospital; patients with diarrheal diseases under observation of the intestinal unit of the sanitary-epidemiological station, and patients with acute or exacerbation of chronic affection of the bile tracts. A total of 28 Yersinia enterocolitical strains were isolated from these patients, this constituting 2.1% of the total number os examinations. The strains isolated were typical by ciological properties and were referred to the 3rd and 9th serological and the 3rd and 4th biochemical types.

[Use of aminoglycosides and other antibacterial preparations in gastroenterology]

Kanamycin and monomycin were used in the treatment of 945 severe surgical patients. Examination of antibiograms showed that the microflora of the patients was moderately and highly sensitive. The antibotic blood levels defined the tactics of the drug administration rate and route. The antibiotic treatment was accompanied by complex therapy for increasing the host protective forces. The antibiotic treatment was well tolerated by the patients. No impairements of the kidneys or the VIII pair of the cranial nerve were observed. Allergic reactions in the form of urticaria were registered in several patients.

Escherichia coli serotypes throughout the gastrointestinal tract of patients with intestinal disorders

The O and H serotypes of Escherichia coli that were present along the entire length of the gastrointestinal tract of patients with small intestinal bacterial overgrowth were studied. Multiple sero- and biotypes were represented, although usually a single serotype predominated in each patient. In a number of cases the different O:H serotypes were antigenically related indicating that antigenic degradation was occurring. The serotypes isolated from the stomach and small intestine were represented in the faeces. In general, within the limitations of this study, there appears to be a stable ecosystem in each patient and it may require specific oral antibiotics to alter it.

Studies of the duodenal and fecal flora in gastrointestinal disorders during treatment with an elemental diet

The duodenal and fecal flora were studied in 18 patients suffering from gastrointestinal disorders during treatment with an elemental diet (Vivasorb). Before treatment the duodenal flora was found to be abnormal in 6 of 17 patients. After treatment the flora remained abnormal in 2, whereas, it became normal in 4 patients, 3 of whom were suffering from ulcerative colitis. The fecal flora was uninfluenced by the diet. The overall number of colonies per gram of dry feces did not vary significantly, whether anaerobic or aerobic. The ratio of anaerobes to aerobes was significantly changed in only 3 patients. There was no correlation between changes in the duodenal and the fecal flora, on the other hand, and the final clinical result of treatment with elemental diet on the other hand. On an average, daily fecal output remained unchanged. In several cases the volume either increased or decreased, but the fecal flora was unchanged. The findings are in agreement with those made in most of the earlier studies of healthy volunteers and in one study of a patient who was suffering from ulcerative colitis.

[Infectious complications of parenteral nutrition in infants (author's transl)]

Infectious complications found in twenty five infants with parenteral nutrition secondary to gastrointestinal problems are presented. The mean age was of 3.5 months, being mean duration of treatment 39 days/infant and mean weight increment of 19.3 g./day. In two infants a central catheter was used and peripheric veins in the rest using the three elemental nutrients. Clinical, analytic and bacteriologic studies were made during parenteral nutrition. Hemocultives, five of nutrients rests and in four catheters were positive. Three of septicemias were in direct relation with parenteral nutrition, two via central catheter and one by peripheric vein. Finally some rules to avoid infectious complications are pointed out.

Waterborne gastrointestinal illness at a ski resort. --Isolation of Yersinia enterocolitica from drinking water--

Approximately 41 percent of the visitors and employees who were at a ski resort in Montana between December 23, 1974, and January 17, 1975, became ill with diarrhea and other gastrointestinal symptoms. The association between illness and water consumption proved to be significant, and the previously noncontaminated water supply was found to contain coliforms. No pathogens except Yersinia enterocolitica were isolated, and it was isolated from two wells serving the area. The role of Y. enterocolitica in this outbreak is not clear, but it was the only organism isolated that is known to be pathogenic.

Adenovirus type 7; 1971-74

The spread of adenovirus type 7 in England and Wales between 1971 and 1974 and the clinical features of infections with this virus were investigated in a retrospective study of virological reports and patients' clinical records. An epidemic in 1972-74 apparently stared in the North-East and spread to the South-West. Between March 1973 and the end of October 1974 the virus was recovered in 59 of 74 specimens from 42 patients. The mean age of the patients was 9 years, which suggests that a large pool of young susceptibles was important in the dissemination of the epidemic. Sore throats, cervical lymphadenopathy, conjunctivitis, and abdominal pain were common symptoms. Meningism was present in 12 patients; 2 cases had apparent neuropsychiatric sequelae.

Anaerobic Infections

Oxygen-sensitive anaerobic bacteria comprise the largest group of organisms among the human endogenous microflora. The oral cavity, the vagina and the colon are areas where the obligate anaerobes are predominant and can be isolated in high numbers. Clinical clues that indicate anaerobic sepsis include a putrid odor of the exudate and evidence of abscess, necrosis or associated gas formation. A Gram stain is highly valuable in early identification. Surgical drainage and appropriate antibiotics are essential.

Pharyngeal isolations of adenovirus 31 from a family population

During a 14-month period in 1965 and 1966, adenovirus type 31 was isolated from 26 pharyngeal swabs obtained on a routine schedule from children and adults during a study of respiratory viruses among members of a family population. Eighteen isolations were made in a four-day period, seven within the preceding five months, and the last, eight months earlier. A significant association between the isolation of adenovirus 31 and respiratory or gastrointestinal illnesses was not demonstrable. Limited tests demonstrated neutralizing antibody increases in a few paired sera of infected adults. The virus is antigenically related to adenoviruses 12 and 18 and is capable of inducing soft tissue tumors in mice.