Safety and efficacy of intravenous sodium stibogluconate in the treatment of leishmaniasis: recent U.S. military experience.

The efficacy and toxicity of sodium stibogluconate (SSG) at a dosage of 20 mg/(kg.d) for either 20 days (for cutaneous disease) or 28 days (for visceral, mucosal, or viscerotropic disease) in the treatment of leishmaniasis is reported. Ninety-six U.S. Department of Defense health care beneficiaries with parasitologically confirmed leishmaniasis were prospectively followed for 1 year. One patient was infected with human immunodeficiency virus; otherwise, comorbidity was absent. Clinical cure occurred in 91% of 83 cases of cutaneous disease and 93% of 13 cases of visceral/viscerotropic disease. Adverse effects were common and necessitated interruption of treatment in 28% of cases, but they were generally reversible. These included arthralgias and myalgias (58%), pancreatitis (97%), transaminitis (67%), headache (22%), hematologic suppression (44%), and rash (9%). No subsequent mucosal leishmaniasis was identified, and there were no deaths attributable to SSG or leishmaniasis.

A child with antibodies targeting both linear IgA bullous dermatosis and bullous pemphigoid antigens.

BACKGROUND: Some patients with subepidermal blistering diseases show clinical, histologic, and immunopathologic features of both linear IgA bullous dermatosis and bullous pemphigoid. Such patients can be further characterized by defining the target of their circulating autoantibodies. We present the first case report of a child with linear deposits of IgA and IgG with circulating autoantibodies characteristic of both linear IgA bullous dermatosis and bullous pemphigoid. OBSERVATIONS: Widely distributed subepidermal vesicles showing neutrophils in the dermal papillae developed in a 3-year-old boy. Direct immunofluorescence microscopy of perilesional skin revealed linear deposits of IgA, IgG, and C3 in the epidermal basement membrane. The patient responded to therapy with dapsone, and after 6 months, it was possible to discontinue treatment. Circulating IgA antibodies from this child bound the epidermal side of 1-mol/L saline-split skin and immunoblotted the 97-kd linear IgA bullous dermatosis antigen. Circulating IgG antibodies bound the epidermal and, at low titer, dermal sides of split skin. These IgG antibodies immunoblotted and immunoprecipitated bullous pemphigoid antigens 1 and 2. CONCLUSIONS: Linear deposits of IgA and IgG in the epidermal basement membrane of patients with subepidermal bullous lesions may signify the coexistence of circulating autoantibodies directed against linear IgA bullous dermatosis and bullous pemphigoid antigens.

Rapid diagnosis of coccidioidomycosis with a DNA probe to ribosomal RNA.

BACKGROUND: Although nucleic acid probe hybridization assays were previously exclusively used as a tool in the research setting, such assays have recently become commercially available for the detection of a variety of infectious microorganisms. OBSERVATIONS: We used a commercially available DNA hybridization probe test that targets organism-specific ribosomal RNA sequences to rapidly diagnose a patient with disseminated coccidioidomycosis. The natural amplification inherent to such DNA:RNA probe systems obviates the need for electrophoretic separation and amplification steps, which are often required in more traditional DNA:DNA probe assays. With this probe, culture confirmation was obtained within 48 hours after the clinical specimens were received. CONCLUSION: Rapid DNA hybridization probe techniques have wide application in infectious diseases, especially those characterized by slow culture growth of pathogens such as deep fungi and atypical mycobacteria.

Combination chemotherapy with 5-fluorouracil, folinic acid, and alpha-interferon producing histologic features of graft-versus-host disease.

Fluorouracil is a common cause of acral erythema and a variety of pigmentary anomalies. These conditions are believed to be the result of a direct toxic effect or a graft-versus-host-like reaction. We describe two cases in which an erythematous eruption that evolved into hyperpigmented, hyperkeratotic lesions developed in two patients who were receiving combination chemotherapy (5-fluorouracil, folinic acid, and alpha-interferon). The histologic features included apoptotic keratinocytes with exocytosis of mononuclear cells, some showing satellitosis, and hydropic change of the basal cell layer with an interface dermatitis that was most marked within the distal eccrine duct and acrosyringium. Clinicopathologic correlation suggests that the eruption was primarily caused by involvement of the sweat glands and hair follicles. Although a direct toxic effect may play some role, the histologic features suggest that the dominant mechanism is a graft-versus-host-like or host-versus-altered-host-type reaction.

An experiment-based model for the petrogenesis of high-alumina basalts.

To understand magmatism at convergent margins, one must know the origin of their characteristic, plagioclase-rich, high-alumina basalts (HABs). Wet melting experiments on basalts at 3 kilobars yielded high-alumina liquids and a coexisting mineral assemblage with little or no plagioclase. An isothermal pressure drop to 1 kilobar caused 20 to 30 percent plagioclase crystallization in these melts, while mafic minerals underwent limited crystallization or even resorption. These results suggest that hydrous (>/=4 percent H(2)O) HAB liquids, presumably formed by fractionation of a hydrous basalt at depth, will precipitate voluminous plagioclase as pressure drops during ascent and eruption. Plagioclase accumulation is not necessarily required to explain the petrogenesis of plagioclase-rich HAB.

Effect of water on the composition of partial melts of greenstone and amphibolite.

Closed-system partial melts of hydrated, metamorphosed arc basalts and andesites (greenstones and amphibolites), where only water structurally bound in metamorphic minerals is available for melting (dehydration melting), are generally water-undersaturated, coexist with plagioclase-rich, anhydrous restites, and have compositions like island arc tonalites. In contrast, water-saturated melting at water pressures of 3 kilobars yields strongly peraluminous, low iron melts that coexist with an amphibolebearing, plagioclase-poor restite. These melt compositions are unlike those of most natural silicic rocks. Thus, dehydration melting over a range of pressures in the crust of island arcs is a plausible mechanism for the petrogenesis of islands arc tonalite, whereas water-saturated melting at pressure of 3 kilobars and above is not.

Classification of endometriotic implants by morphologic appearance and capacity to synthesize prostaglandin F.

The severity of the symptoms of endometriosis has not always correlated well with the anatomic severity of the disease. This lack of correlation may be due to variations in the metabolic activity of the endometriotic implants present at different stages of the disease. Because prostaglandin F (PGF) has been implicated as a hormonal mediator of the clinical symptoms of endometriosis, PGF synthesis and content was measured in implants from 14 patients with mild, moderate, severe, or extensive disease. To assess whether PGF production was related to the status of implants, the authors classified implants, based on gross and histologic criteria, as petechial or reddish; intermediate or brown; or powder-burn or black. PGF production of implants from patients with mild or moderate disease was greater than that of implants from patients with severe or extensive disease (P less than 0.05), and PGF content was similar for all stages of endometriosis. Petechial implants produced twice the amount of PGF than intermediate implants (P less than 0.05), which in turn produced more PGF than powder-burn implants (P less than 0.05). Powder-burn implants did not have the in vitro capacity to produce PGF, and the amount of PGF contained in implants of all classes was similar. Therefore, endometriotic implant PGF production and possibly other biochemical activities are dependent on the physical status of the implant. The classification of implants by morphologic appearance may afford additional assistance in determining the prognosis of the disease and in the examination of the subtle effects of the disease on symptoms.