Histoplasmosis in Europe: report on an epidemiological survey from the European Confederation of Medical Mycology Working Group

The purpose of this survey was to systematically collect data on individuals with histoplasmosis in Europe over a 5-year period (from January 1995 to December 1999). This included information on where and how the infection was acquired, the patient's risk factors, the causative organism, how the infection was diagnosed and what therapy the patients received. Data were sent on a standardized survey form via a national convenor to the coordinator. During the survey, 118 cases were reported, with 62 patients having disseminated disease, 31 acute pulmonary infection, chronic pulmonary infection in 6 and localized disease in 2 patients. For 17 patients, the diagnosis of histoplasmosis was incidental, usually secondary to investigations for lung cancer. Most patients had travelled to known endemic areas, but 8 patients (from Italy, Germany and Turkey) indicated that they had not been outside their countries of origin and hence these cases appear to be autochthonous. Notable observations during the survey were the reactivation of the disease up to 50 years after the initial infection in some patients and transmission of the infection by a transplanted liver. Itraconazole was the most commonly used therapy in both pulmonary and disseminated disease. The observation of autochthonous cases of disease suggests that the endemic area of histoplasmosis is wider than classically reported and supports continued surveillance of the disease throughout Europe.

Effect of mebendazole on human cystic echinococcosis: the role of dosage and treatment duration

Fifty-three patients with single, multiple and/or multi-organ hydatid cysts were treated with mebendazole, in varying dosages (30-70 mg/kg.day) and over varying periods (6-24 months). Treatment failure was recorded if the mebendazole had no apparent effect on cyst morphology (monitored by radiology, ultrasonography and computed tomography) or only a parasitostatic effect (characterized by mixed and transitory, hypo- and hyper-echoic changes in the lesions). Cure was indicated by a parasitocidal effect (characterized by a totally echogenic picture, increased density of the cyst contents, reduction in the size or complete disappearance of the cysts, complete detachment of the endocysts and/or calcification of the cyst wall). Treatment failure was seen in about 40% of the patients and cure in about 38%; the other 23% had an intermediate result considered as an improvement. Cure rates increased both with dosage and duration, daily dosages of 60-70, 50 and 30-40 mg/kg curing 48%, 33% and 25%, respectively. The pre-treatment condition of any cysts should be taken into consideration when determining dosage and treatment duration.

[The detection of Peptostreptococcus asaccharolyticus and Bacillus cereus in clinical materials from a child who died of sepsis with a fulminant clinical course]

A case of an acute disease with a rapid clinical course and a fatal outcome in the presence of irreversible toxicoinfectious shock, appearing in two children after the consumption of sheep kidneys, is described. The post mortem examination of the children revealed the presence of hemorrhagic, erosive and necrotic areas on the mucous membrane of the stomach, the duodenum and the upper section of the small intestine. From the material obtained by probing the stomach of one of the children 6 hours before death P.asaccharolyticus and B.cereus were isolated. Hemorrhage, erosions and necrosis were also found in experimental mice, injected with the centrifugates of the gastric secretions of the patient and the cultures of the isolated bacteria, which was indicative of the presence of highly active exotoxin. On the basis of the above facts, compared with similar data in the literature, this case was considered to be etiologically related anaerobic Peptostreptococcus in symbiosis with B.cereus.