Unusual extracranial complications of otitis media in a young HIV patient: retropharyngeal and Mouret's abscess

Since the introduction of antibiotic therapy, the incidence of intra- and extracranial suppurative complication of acute and chronic purulent otitis media has sharply decreased. In particular, reports of laterocervical abscesses secondary to this disorder are quite rare, not more than twenty cases of Bezold's or Mouret's abscesses having been reported in the literature during the last ten years. The authors present a case of retropharyngeal and Mouret's abscess developed as a consequence of acute purulent otitis media in a young Aids patient. True otologic manifestations of Aids are rare while the incidental association of otologic disease with Aids is more common. The development of complication in the present case is favoured by the patients severe immunodepression.

Clinical and microbiological characteristics of symptomatic vulvovaginal candidiasis in HIV-seropositive women

OBJECTIVES

To evaluate the clinical and microbiological characteristics of symptomatic vaginal candidiasis in Human Immunodeficiency Virus (HIV)-seropositive women attending a gynaecologic outpatient clinic for sexually transmitted diseases (STDs).

DESIGN

Vaginal, rectal and oral specimens from cases and controls were cultured for Candida spp.

SUBJECTS

Eighty-four consecutive HIV-seropositive and 384 HIV-seronegative women with clinical signs of vulvovaginitis.

SETTING

A gynaecological out-patient clinic in Pavia, Italy.

RESULTS

The overall prevalence of vaginal candidiasis was 61.9% (52/84) in the cases and 32.3% (124/384; p < .001) in the controls. After adjustment by logistic regression analysis for confounding factors (age at first intercourse, lifetime sex partners, new partner/s in the last 6 months, type of contraceptive used), HIV-seropositive patients were at higher risk for both Candida albicans (odds ratio = 2.5; 95% confidence interval 1.31-4.69; p = 0.006) and Torulopsis glabrata vaginitis (OR = 3.5; 95% CI = 1.05-11.60; p = 0.04) than controls. HIV-seropositive subjects had also increased rates of oral and rectal colonisation with Candida spp. Finally, the time to recurrence of vaginal infection was significantly shorter in HIV-seropositive patients than controls and was correlated with the severity of HIV-induced immunodepression.

CONCLUSIONS

Vulvovaginal candidiasis is very common in HIV-seropositive women and its prevalence is correlated with the immunological status of the host. These patients have higher frequencies of Torulopsis glabrata vaginal infection and are more prone to recurrence than HIV-seronegative controls.

Percutaneous renal biopsy utilizing ultrasonic guidance and a semiautomated device

Percutaneous renal biopsy is a fundamental diagnostic technique in urology and nephrology, recently refined by real-time ultrasonic guidance. The technique described in this article is a biopsy method employing real-time ultrasonic guidance and a semiautomated device. The new device has been constructed to improve percutaneous biopsy technique and to obtain more perfect specimens. This technique was successfully performed in 20 patients undergoing renal biopsy. Diagnostically satisfactory material containing an average of ten glomeruli per specimen was obtained. The results obtained with the new device Biopty Bard have been compared with the results obtained from the same number of biopsies performed with the traditional technique.

Frequency and significance of drug resistance in vulvovaginal candidiasis

The rates of non-albicans species and susceptibility to the main antimycotic drugs were evaluated in a series of 472 cultures of vulvar or vaginal specimens positive for Candida species. Torulopsis glabrata was associated more frequently than C. albicans with recurrent vulvovaginal candidiasis (18/40 vs. 72/379; p = 0.003, chi 2 test). As evaluated by the results of susceptibility testing, C. albicans isolates were uniformly sensitive to the antifungals tested, whereas 7.5% (3/40) of T. glabrata strains were resistant to imidazole derivatives. All these patients had a history of repeated antimycotic treatments. Previous antimycotic therapies in susceptible individuals could cause a selection of non-albicans species, especially T. glabrata, which is occasionally resistant to the commonly used antimycotic drugs.

Recurrent vaginal candidiasis. Results of a cohort study of sexual transmission and intestinal reservoir

Yeast cultures from the oral cavity, vagina and rectum were obtained from 125 women experiencing an acute episode of recurrent candidal vaginitis. To investigate the role of sexual transmission, oral, penile and ejaculate cultures were also prepared from all the male sexual partners. The rates of oral and rectal Candida species colonization in the women were 36% (45/125) and 44.8% (56/125), respectively. The male partners' oral cavities were positive in 23.2% (29/125) and the penile coronal sulcus and seminal fluid in 16% (20/125) and 14.4% (18/125), respectively. The susceptibility of the isolated species to the main antimycotic drugs was ascertained with the agar diffusion method. Therapy in the women and the colonized sexual partners was carried out, eliminating the microorganism from every positive site. Control cultures were obtained two weeks after the completion of therapy, and follow-up was continued for one year. The overall clinical and microbiologic cure rate in the study group was 72% (95/125). The rate of relapse was not influenced by the treatment of Candida colonization of the female intestinal tract. The recurrence rate after treatment in the couples in which the man harbored yeast (oral cavity, penile coronal sulcus, seminal fluid) was lower (15.8% vs. 44.8%, P = .0019) than that recorded in the couples without sexual partner involvement. The identification and treatment of the male sexual partner's Candida colonization seems important in the prevention of recurrent vulvovaginitis.

Recurrent Histoplasma capsulatum pneumonia: a case report

The epidemiological, clinical and therapeutical findings are described in a case of recurrent pulmonary histoplasmosis due to Histoplasma capsulatum. The patient, a bulldozer-operator, worked in Africa for a long period in extremely dusty conditions without any protection. Three different episodes of H. capsulatum pneumonia recurred during eighteen months after his return from Africa. A full dose treatment by Amphotericin B failed to eliminate disease recurrence on three occasions. The high concentration of airborne H. capsulatum spores inhaled could have been the main cause of the difficulty obtaining a rapid sterilization of the microorganism by Amphotericin B and disease recurrence. The late start of the treatment or the unexplained ability of some persons to develop repeated infections even with normal immunological parameters could be another explanation for the reported phenomenon.

[Performance of echo-guided renal biopsy using a new semi-automatic instrument]

Percutaneous renal biopsy is a fundamental diagnostic technique in clinical nephrology, recently refined by real-time ultrasonic guidance. The technique described in this paper is a biopsy method employing real-time ultrasonic guidance and a semi-automated device. This technique has been successfully performed in 10 patients undergoing renal biopsy. Diagnostically satisfactory material containing an average of 9 glomeruli for specimen was obtained.

[Vancomycin and "red man's syndrome". Presentation of a clinical case]

This paper describes a case of "Red man's syndrome" in a patient with staphylococcal sepsis. The patient was initially treated with intravenous Vancomycin and afterwards with Teicoplanin. The adverse reaction appeared immediately after the start of pharmacological treatment.

Fluconazole vs amphotericin B: "in vitro" comparative evaluation of the minimal inhibitory concentration (MIC) against yeasts isolated from AIDS patients

Fluconazole, a novel triazole antifungal drug, holds promise as a significant advance in the management of human fungal diseases. This new drug can be both orally and parenterally administered and is reported to be less toxic than other antifungal agents. The Authors studied the in vitro susceptibility of yeasts isolated from AIDS patients to this antimycotic drug, in order to evaluate if fluconazole's MICs were comparable to those of amphotericin B. A sample of 200 yeast strains (100 C.albicans, 20 C.parapsilosis, 20 C.tropicalis, 8 C.guilliermondii, 6 C.krusei, 6 C.pseudotropicalis, 24 T.glabrata and 16 Cr.neoformans) was tested. The results show an average MIC for amphotericin B (MIC90: 3.12 micrograms/ml) ten-fold lower than for fluconazole (MIC90: 100 micrograms/ml). However, C.albicans and Cr.neoformans presented the same MIC value (3.12 micrograms/ml) both for fluconazole and for amphotericin B, suggesting that fluconazole could represent a valid alternative to amphotericin B in the treatment of fungal infections caused by these two agents.

[2 cases of fibroepithelial polyp of the ureter]

Fibroepithelial polyps of the ureter, a mesodermal benign tumor, are rare. The first case of a fibroepithelial ureteral polyp associated with bilateral complete ureteral duplication and another case associated with bilateral hydronephrosis are reported. The first case suggested a malformative congenital etiology. The two fibroepithelial polyps were treated by conservative surgery.

[Changes in the plasma levels of T3-T4 and TSH during surgical stress and anesthesia with isoflurane]

The authors describe the blood level changes of T3, T4 and TSH in 17 patients undergoing urological surgery and isoflurane anaesthesia. The data were statistically processed and showed that isoflurane, used as the only anesthetic agent in 1.5%-2% concentrations, is not sufficient to block hormonal changes of the hypothalamus-hypophysis-thyroid axis caused by surgical stress.

Mediterranean spotted fever in Lombardy: an epidemiological, clinical and laboratory study of 76 cases in the years 1977-1986

This paper describes the epidemiological, clinical and laboratory features of 76 cases of Mediterranean spotted fever occurring during the years 1977-1986. The patients observed all lived in the Lombardy region of Italy, which is not located on the Mediterranean Basin. Our data show the highest prevalence of the disease, as reported by other authors, in southern regions of Italy, in the same years: 1979-1983. No differences were noted between age groups or sexes, and the late spring-summer seasonality was confirmed. The clinical signs and symptoms in our cases were those common to the disease. The microimmunofluorescence method was found to be more sensitive and specific than the Weil-Felix test for serological diagnosis. Finally, we showed that doxycycline and oxytetracycline both induce rapid remission of fever.

Itraconazole vs amphotericin B: in vitro comparative evaluation of the minimal inhibitory concentration (MIC) against clinically isolated yeasts

Itraconazole is a triazole compound which, following several clinical trials, has begun to be used for therapy of mycotic infections. This new drug, with a broad-spectrum antifungal activity, can be orally administered. The Authors studied the in vitro susceptibility to amphotericin B and itraconazole of the following clinical isolates of pathogenic yeasts: 100 Candida albicans, 20 C. tropicalis, 20 C. parapsilosis, 8 C. guilliermondii, 6 C. pseudotropicalis, 24 Torulopsis glabrata and 16 Cryptococcus neoformans. Serial two-fold dilution, from 100 micrograms/ml to 0.04 micrograms/ml, of each drug were prepared in Yeast Nitrogen Base + Glucose 5%, after dissolving the itraconazole in dimethylsulfoxide (DMSO) and amphotericin B in 5% glucose solution. Amphotericin B (MIC90: 3.12 micrograms/ml) was found to have an average in vitro MIC six-fold lower than itraconazole (MIC90: 25 micrograms/ml). Thus, even though itraconazole is active, amphotericin B remains one of the most effective of the antifungal drugs.

[Intraoperative anterograde spermatic phlebography: its usefulness in the treatment of varicocele]

The value of intraoperative anterograde spermatic phlebography in the treatment of varicocele is maintained. The knowledge of the vascular anatomy making it possible to adapt surgical tactics to the needs of the particular patient. Use of this technique significantly reduced the risk of postoperative recurrences.

[Clinical and therapeutic profile of 3 cases of cryptococcal meningitis in patients with AIDS]

We report three cases of cryptococcal meningitis in patients with AIDS observed in our Institution. In addition, we discuss antifungal treatment during and after the acute phase of the disease and the use of fluconazole as a prophylactic treatment of disease relapse.

[Syphilitic encephalitis: a diagnosis to be kept in mind. Epidemiological considerations and description of a case]

Since the introduction of antibiotic treatment there has been a remarkable reduction in the incidence of "classical" neurosyphilis, and, when cerebral involvement occurs, a relative increase in abortive or monosymptomatic cases that are difficult to diagnose because of the prevalence of meninges and/or mental signs. A case of luetic meningoencephalitis is described with emphasis on diagnostic, prognostic and therapeutic aspects.

[Incidence of mycotic infections in children with acute myeloblastic leukemia (AML)]

Opportunistic mycotic infections have a significant influence on the morbidity and mortality of children whose immune systems are depressed by the onset of AML. The present paper assesses the incidence of the pathogenic mycotic flora and the in vitro efficacy of the main antimycotic drugs. Candida was che most commonly encountered pathogen and its in vitro response to the polyenic antibiotics was good.

[Clinical review of 3 cases of aspergillosis]

Three cases of aspergillosis observed in Pavia Infectious Disease Clinic in 1983-85 are described. The cases differed both in the site of the infection (lungs, bones and liver) and in the patients' basic immunological situation. The importance of mycological investigations during diagnosis is emphasised, though they should of course be flanked by instrumental examinations and blood chemical assays. The efficacy of specific treatment with amphotericin B combined with surgery and plasma exchange is also emphasised.

[Post-transfusional AIDS]

Two cases of post-transfusional AIDS in two premature babies who received blood of the same seropositive donor, are reported. The risk of the susceptibility to HIV infection of these patients, in relation to the immaturity of immune system and to the transfusional treatment often necessary in premature newborns, is stressed.

Routine application of the evaluation of yeasts susceptibility to the main antimycotic drugs

We evaluated the susceptibility of 618 strains of yeasts belonging to the genus Candida, isolated from various biological specimens. Amphotericin B, Nystatin, Fluorocytosine, Clotrimazole, Miconazole, Econazole and Ketoconazole were tested with the Kirby-Bauer method, modified according to Drouhet and Dupont. The polyenes Amphotericin B and Nystatin and the antimetabolyte Fluorocytosine were the most effective drugs, while the imidazole derivatives (Clotrimazole, Miconazole, Econazole and Ketoconazole) generally showed a lower activity. We emphasize the importance of routine evaluation of the susceptibility of isolated yeasts to the main antimycotic drugs.

Pulmonary aspergillosis in a case of humoral immunodeficiency

A case of recurrent pulmonary aspergillosis in a young girl with common variable hypogammaglobulinaemia and the treatment adopted is described. We employed the plasma-exchange, at the beginning of immunosubstitutive treatment, to provide a high serum concentration of all classes of immunoglobulins and to better control the patient's state of shock. Intravenous immunoglobulins and Amphotericin B were also given in combination with plasma-exchange, having a synergic therapeutic effect. The good condition of the patient, despite the recurrent episodes of fungal pneumonia, suggests that such an approach can lead to long-term, high quality survival in humoral immunodeficient patients.

[Scintigraphy in the study of varicocele]

Varicocele which is relatively common after puberty may cause even severe alterations to fertility. Sequential Isotopic Scrotal Angiography (SISA) was used for the diagnosis of this condition in both the recognition and confirmation phase. This dynamic and static survey based on the use of 99mTc-pyrophosphate proved able to discriminate between the various degrees of varicocele. No statement can as yet be made on the specificity and sensitivity of the examination since so few cases have so far been checked with other techniques (Doppler-Telethermography-Phlebography) and an insufficient number of postsurgical controls came to our observation.

AIDS: outcome of children born to HTLV-III/LAV infected mothers. Report of 15 Italian cases

The characteristics of acquired immunodeficiency syndrome (AIDS) in children have been described in several reports. The occurrence of specific anti-HTLV-III/LAV seropositivity in children born to seropositive mothers is also becoming more frequent in Italy. We report 15 cases of seropositive children born to 14 seropositive, drug-addicted mothers. Among them, 5 died of AIDS, 8 developed a variable, non-progressive AIDS-related complex (ARC), while only two remained persistently asymptomatic. Liver disease was present in 2 patients, CNS disease in 4, gastrointestinal troubles were never a major problem. Only 2 cases of HBV infection and 3 of thrombocytopenia were observed. In our experience, homosexual behaviour of the parents was never a cause of family risk. Children presented with failure to thrive and/or signs of disease usually within the first five months of life. In one family the first child was affected by fatal AIDS while the younger child showed only passive, transient immunization by maternal specific IgG. One ARC patient, observed for over 3 years, showed apparently complete healing from the disease.

[In-vitro microbiological evaluation of the action of gentamicin and sisomicin o schizomycetes of the Salmonella genus]

The in vitro activity of Gentamicin and Sisomicin towards 142 clinical isolated Salmonella strains was determined and statisically evaluated. The majority of the Salmonella strains was inhibited by concentrations of both antibiotics ranging between 0.75 mcg/ml and 0.02 mcg/ml in the Minimal Inhibitory Concentration (MIC) test and between 1.5 mcg/ml and 0.02 mcg/ml in the Minimal Bactericidal Concentration (MCB) test.