Spontaneous cryptococcal peritonitis in cirrhotic patients.

Spontaneous bacterial peritonitis is a common complication in patients with cirrhosis and ascites. However, spontaneous peritonitis caused by Cryptococcus neoformans is uncommon. Delayed diagnosis of cryptococcal peritonitis often results in death. We describe three cases of spontaneous cryptococcal peritonitis in patients with decompensated cirrhosis. One case had associated symptomatic human immunodeficiency virus infection. Clinical awareness of this entity may lead to the early diagnosis and proper treatment.

In vitro susceptibility testing of levofloxacin and ofloxacin by microtiter plate Alamar blue against multidrug and non multidrug resistant Mycobacterium tuberculosis in Thailand.

Antituberculous drugs for current therapy of multidrugs resistant tuberculosis (MDR-TB) are limited. The in vitro susceptibility of Mycobacterium tuberculosis (MTB) as well as MDR-TB with other antibiotic drugs were determined in order to find alternative drugs for the treatment of MDR-TB. Forty-seven MDR-TB and 62 MTB of clinical isolates were tested against levofloxacin and ofloxacin. The MDR-TB at the MIC90 of levofloxacin and ofloxcain were 1 microg/ml and 2 microg/ml, respectively. Of these MTB, the MIC90 of both drugs were 0.5 microg/ml and 1 microg/ml, respectively. It seemed that levofloxacin MICs of both MDR-TB and MTB were one dilution less than ofloxcin. The promising activity of ofloxacin and levofloxacin against MDR-TB and MTB suggest that both drugs could be used as second-line drugs for MDR-TB or as a good alternative antituberculous drug for patients who have intolerance to the first line drug.

Mycetoma and phaeohyphomycosis caused by Phialophora parasitica in Thailand.

Phaeohyphomycosis caused by Phialophora parasitica is rare and it has never been documented in Thailand. The first two Thai cases of phaeohyphomycosis caused by P. parasitica were recognized in early 1990 at Ramathibodi Hospital, Bangkok, Thailand. Both patients had underlying diseases. The fungus developed in abscesses with pigmented mycelium at the lower extremity. Cultures from pus and tissue biopsies were positive for dematiaceous fungi. Light microscopic features suggested P. parasitica and which was illustrated by both scanning and transmission electron microscope. The first case was treated with itraconazole with a satisfactory initial response. The second case was successfully treated by surgical removal of the entire lesion.

Overcoming the errors of in-house PCR used in the clinical laboratory for the diagnosis of extrapulmonary tuberculosis.

Our experiences from 1993 to 1997 in the development and use of IS6110 base PCR for the diagnosis of extrapulmonary tuberculosis in a routine clinical setting revealed that error-correcting processes can improve existing diagnostic methodology. The reamplification method initially used had a sensitivity of 90.91% and a specificity of 93.75%. The concern was focused on the false positive results of this method caused by product-carryover contamination. This method was changed to single round PCR with carryover prevention by uracil DNA glycosylase (UDG), resulting in a 100% specificity but only 63% sensitivity. Dot blot hybridization was added after the single round PCR, increasing the sensitivity to 87.50%. However, false positivity resulted from the nonspecific dot blot hybridization signal, reducing the specificity to 89.47%. The hybridization of PCR was changed to a Southern blot with a new oligonucleotide probe giving the sensitivity of 85.71% and raising the specificity to 99.52%. We conclude that the PCR protocol for routine clinical use should include UDG for carryover prevention and hybridization with specific probes to optimize diagnostic sensitivity and specificity in extrapulmonary tuberculosis testing.

Fungal sinusitis the important role of the histopathology in the clinical management.

Four cases of fungal sinusitis are reported. These include one case of aspergillus sinusitis alone, one case of combined aspergillus and paecilomyces sinusitis, and two cases of mucormycotic (zygomycotic) sinusitis. Although fungal sinusitis appears to be rare, it can pose difficulty in clinical diagnosis and we have demonstrated how the pathologist can help to alert the otolaryngologists of possible fungal sinusitis. Since the histopathological examination is important, a specimen for biopsy is mandatory.

Morphological variation in pathogenic strains of Penicillium marneffei.

Penicillium marneffei is a dimorphic fungus known to be pathogenic to animals and man. The natural reservoir of this organism was known to be bamboo rats found in South Vietnam, Thailand and China. The first two human infections were reported in 1959 and 1973 from the United States. Up to 1984, five new cases of human penicillosis were reported from Thailand. Since then several more cases have been reported from different parts of the world mainly from the southern part of China. However, there are very limited mycological descriptions of this fungi. In this report, five Thai strains were studied for colonial morphology in comparison with Reference strain PLM 689. Variation in mycelial pigment was observed ranging from yellowish-green to orange with water soluble red pigment produced in every strain which can be seen early from the reverse side. Ultrastructural study by both scanning electron microscopy (SEM) and transmission electron microscopy (TEM) was compared with that of the reference strain PLM 689. PLM 689 strain had only biverticillate penicilli, but all five strains from Thailand had both monoverticillate and biverticillate penicilli which occasionally appeared on the same branch. The conidia of the Thai isolates were oval in shape and 1.3-2 x 0.7-1.6 microns in size smaller than those of PLM 689 which were 2.5-4 x 2-3 microns. Phialides were also smaller and a little shorter but the number of phialides was similar to those of PLM 689 ranging 4-10 except for one strain which had 3-16 phialides. All Thai strains have stipes smaller and somewhat longer than those of PLM 689.(ABSTRACT TRUNCATED AT 250 WORDS)