Adverse reactions associated with pentamidine isethionate in AIDS patients: recommendations for monitoring therapy

Since pentamidine has become commercially available, there is renewed interest in using it as the initial treatment for Pneumocystis carinii pneumonia (PCP) in AIDS patients. We reviewed the use of pentamidine in 24 patients with PCP to gain information on the prevalence and severity of adverse effects from this drug. Twenty out of twenty-four patients (83 percent) experienced some kind of adverse effect. Hepatic abnormalities (58 percent), nausea and vomiting (46 percent), hypoglycemia (33 percent), azotemia (25 percent), and pain at the injection site (25 percent) were the most frequently seen effects. We recommend monitoring guidelines to be applied during pentamidine therapy based on the observed frequency of specific side effects.

A transforming marker that produces merodiploids with high efficiency and stable transformants with low efficiency in Streptococcus

A mutation (ery-r8) conferring a high level of resistance to erythromycin in the Challis strain of Streptoccus sanguis can be transferred to wild-type erythromycin-sensitive recipients via single molecules of donor DNA. The transformants thus produced are of two types: (1) cells slightly more resistant to erythromycin than wild-type and capable of segregating (at a frequency of 2 X 10(-4)/bacterium/generation) either wild-type or highly-resistant cells like the original donor type; (2) cells phenotypically and genotypically identical to the original donor type. The unstable diploids (ery-r8/+) occur with a frequency equivalent to that obtained with high-efficiency (HE) markers, whereas the stable donor-type (ery-r8) transformants occur with about five hundred times lower frequency. Penetration of the wild-type recipient by more than one molecule of DNA bearing the ery-r8 marker increases by as much as seven times the incidence of stable transformants. UV-irradiation of molecules bearing the ery-r8 marker diminishes their ability to cooperate in producing a stable transformant, although the UV sensitivity of stable transformant production by a single DNA molecule is not different from that of diploid production. Hence, stable transformants do not appear to be produced by a process typical of low efficiency (LE) markers, which are generally highly sensitive to ultraviolet irradiation. Moreover, stable ery-r8 transformants are produced with equally low frequencies in strains of S. pneumoniae that discriminate (hex+) and fail to discriminate (hex--) between HE and LE markers. We postulate that all transformations by the ery-r8 marker result in ery-r8/+ diploids, and that segregation results in the infrequent stable transformants of the original donor type. This hypothesis is supported by the observations that rifampin treatment of ery-r8/+ populations increases the frequency of segregation and similar treatment of wild-type recipients under-going transformation by the ery-r8 marker increases the frequency of stable transformants.--In producing the ery-r8/+ transformant the r8 allele is integrated close to the site of its wild-type homolog, since single molecules of DNA from this transformant can be shown to carry both alleles. Segregation of either the ery-r8 or + allele is not detectably enhanced by acridine orange or thymidine deprivation.--The ery-r8 marker occurs close to a site of mutation (ery-r2) which confers erythromycin resistance upon ribosomes. When the r2 and r8 markers are jointly transferred, ery-r2-r8/+ genomes are produced in which the r2 marker is stably integrated but the r8 marker is unstably adjoined to its wild-type homolog. Thus, the duplicated region can be quite short. When the ery-r8 marker is stably integrated, the region of the marker is refractory to subsequent transformation. Markers with properties like ery-r8 are not particularly rare, being found with a frequency of about 4% among spontaneous mutations to erythromycin resistance.

Specific effects of heating of transformable streptococci on their ability to discriminate between homospecific, heterospecific, and hybrid deoxyribonucleic acid

Heating competent bacteria of the Challis strain of Streptococcus at a temperature of 48 C causes them to lose their transformability and mainfest a slight retardation of growth rate without loss of viability. The heat-induced loss of transformability is due to diminution in the ability of the bacteria to bind deoxyribonucleic acid (DNA) irreversibly. Another effect of heat is upon a step in the transformation process subsequent to binding, a step in which DNA molecules will compete if they multiply infect an unheated cell. Despite the reduction in irreversible binding exhibited by heated cells, competition between DNA molecules to transform these cells is decreased. Neither of these sites affected by heat exhibits any specificity with regard to origin of DNA. Since heat treatment causes a relative stimulation of transformation by heterospecific DNA, a third effect of heat must be envisaged. The amount of heat-induced stimulation is dependent upon the amount of heterospecific material in the transforming DNA. Linkage of heterospecific markers is increased as a consequence of heating the recipients. Transformation by markers of different transforming efficiency in homospecific DNA is also affected by heat treatment in a differential manner. Taken together, these results point to a heat-sensitive intracellular mechanism that recognizes DNA base sequences during transformation. The effect of heat upon discrimination against heterospecific DNA has been found to occur also in the pneumococcus and in Bacillus subtilis.