Disseminated atypical mycobacterial infection in hairy cell leukemia.

The clinical features are described of disseminated atypical mycobacterial infection of the subcutaneous tissues occurring in a patient 3 yr after the diagnosis of hairy cell leukemia. Skin biopsy identified the causative organism as an atypical mycobacterium of the M. avium-intracellulare-scrofulaceum (MAIS) complex. In vitro studies showed that the patient had impaired mononuclear cell phagocytosis. These findings, lend support to the hypothesis of a specific defect of immunity in hairy cell leukemia.

Oral histoplasmosis treated with miconazole.

A case of localised histoplasmosis of the gingivae, with no osseous involvement is described in a 50-year-old man. The diagnosis was based on histology, growth on culture and a positive histoplasmin latex test. Therapy was commenced with intravenous amphotericin but was changed to intravenous miconazole because of serious immediate side effects and the development of marked renal impairment and moderate suppression of erythropoiesis. Rebiopsy of the gingival margin showed therapy to be effective. No source of the infection could be traced.

Mycobacteria with a growth requirement for ferric ammonium citrate, identified as Mycobacterium haemophilum.

Three previously unidentified strains of pathogenic mycobacteria which had been isolated on media containing ferric ammonium citrate were found to be identical with the new species, Mycobacterium haemophilum.

Unusual mycobacteria in 5 cases of opportunistic infections.

Five cases of infection due to an unusual mycobacterium are recorded, and the growth requirements and histological findings are discussed. On initial culture, these mycobacteria could be grown only on Lowenstein-Jensen medium containing ferric ammonium citrate, and the histology of the skin lesions was not always typical of mycobacterial disease.

Management of bacterial infections in severely neutropenic subjects.

The safety and efficacy of tobramycin, a new aminoglycoside, have been evaluated in combination antibiotic therapy in 49 episodes of infection in 25 neutropenic patients. Tobramycin was used in combination with a cephalosporin in 40 episodes and with carbenicillin in 6. The most common infections were respiratory (21 episodes) and septicaemic (16 episodes). One or more pathogens were identified in 38 episodes, of which 36 were due to Gram-negative organisms. The clinical response was satisfactory in 71% of episodes, and the pathogens were eliminated in 50% of episodes in which follow-up bacteriological investigation was available. No renal, auditory, or vestibular toxicity was observed.

Lung abscess due to Corynebacterium equi in a renal transplant recipient.

A case of Corynebacterium equi infection in a renal transplant recipient is reported. This not uncommon pathogen of farm animals caused a lung abscess in a graft recipient who had received continuous immunosuppression with azathioprine and prednisone for seven years. Antibiotic therapy yielded radiological improvement, although the patient died from other causes. C. equi joins a growing list of rare opportunistic organisms which may cause disease in subjects who have received transplants.

Tobramycin and cephalothin sodium in treatment of infected patients with acute leukemia.

Tobramycin has been shown to be safe and effective when given intravenously in combination antibiotic therapy for infected patients with acute leukemia or other profound pancytopenic states. Tobramycin in combination with one or more antibiotics (usually cephalothin) produced satisfactory clinical results in 21 of 30 episodes of fever. Toxic effects were minimal and were limited to occasional mild thrombophlebitis.