Skin protothecosis in a patient with renal allograft.

The case history of a 30-year-old male kidney transplant patient who developed cutaneous protothecosis is presented. The lesions, initially located over the forearm and around the site of previous AV shunt, consisted of maculopapular areas which opened spontaneously and drained purulent sanguineous material. Culutre of drainage grew Prototheca wickerhamii. Other virulent organisms, ie. Klebsiella pneumoniae and Pseudomonas aeruginosa, were also grown. The patient died of Klebsiella septicemia and shock. Protothecosis is an uncommon algal infection in man. This is the first report of the disease among recipients of a renal transplant.

Mechanisms of endotoxin tolerance. The role of the spleen.

Splenectomy markedly impaired the production of circulating anti-endotoxin antibodies during the initial 10 days after .v. administration of a Boivin preparation of Escherichia coli endotoxin (ET) in both rabbit and man. Increase in antibodies with secondary (flocculating and bactericidal) activities were virtually abolished, whereas increases in antibodies with primary (binding) activity were significantly reduced. On the basis of these findings, splenectomized rabbit and man were employed to test the hypothesis that the early phase (less than 72 h) of pyrogenic tolerance to endotoxin is independent of anti-endotoxin antibody but that such antibody contributes significantly to the later phase (less than or equal to 72 h) of tolerance. In the splenectomized rabbit, the initial pyrogenic reponses to ET and the subsequent tolerant responses at 24 and 48 h were comparable to sham-operated controls...

Early detection of acute rejection in renal allografts using radioiodinated autologous fibrinogen.

131I-labeled autologous fibrinogen was used to detect acute renal allograft rejection in the early postoperative period. Ratios of radioactive counts over transplanted kidneys to those over the heart increased with deposition of radioactive fibrinogen in kidneys undergoing rejection. The test was positive in all instances of acute rejection twelve to twenty-four hours prior to clinical ro biochemical changes. False-positive test results were noted in instances of perinephric hematoma, seroma, and wound abscess and in one patient with urinary tract infection. The test was negative in cases of renal failure secondary to acute tubular necrosis, uric acid nephropathy (in the absence of acute rejection), and chronic rejection. This test is simple, rapid, and practical. It can be performed at the bedside and is free from complications, particularly serum hepatitis.