Trachipleistophora hominis infection in the myocardium and skeletal muscle of a patient with AIDS.

OBJECTIVES: To review the literature relevant to microsporidial infection of muscle and to describe a case of human microsporidial infection involving both skeletal and cardiac muscle. METHODS: Samples from an AIDS patient with myositis have been examined by light and electron microscopy. RESULTS: We describe the findings at autopsy of a 47 year old Australian male with late stage AIDS, who had skeletal and cardiac muscle involvement with the microsporidian Trachipleistophora hominis. This is the third definitively identified case of human T. hominis infection and the first to describe infection of the myocardium. CONCLUSIONS: Microsporidial infection of muscle is rare in humans, but more work is needed to elucidate both the organisms and routes of transmission of this group of parasitic protozoa.

Dextromethorphan- and pseudoephedrine-induced agitated psychosis and ataxia: case report.

Pseudoephedrine and dextromethorphan are therapeutic constituents of numerous commonly used, over-the-counter cough and cold preparations. Although this drug combination is generally considered quite safe if utilized in recommended doses, overmedication or overdose can result in serious neurologic and cardiovascular abnormalities that occasionally can be life-threatening. We present a case of a 2-year-old child who developed hyperirritability, psychosis, and ataxia after being overmedicated with a pseudoephedrine/dextromethorphan combination cough preparation, and discuss probable mechanisms of toxicity and risk factors for adverse events.

Abnormalities of serum type III procollagen aminoterminal peptide in methotrexate-treated psoriatic patients with normal liver histology do not correlate with hepatic ultrastructural changes.

In a previous study, it was shown that the serum levels of type III procollagen aminoterminal peptide (P3NP) were significantly greater in patients receiving methotrexate (MTX) treatment for psoriasis than in untreated control patients with psoriasis. Although levels were highest in patients with hepatic fibrosis and cirrhosis, serum P3NP concentrations in those patients with normal liver histology on light microscopy were also shown to be significantly higher than in controls. In the present study, liver biopsies from 22 such 'normal' patients were examined by electron microscopy, in order to determine whether P3NP levels correlated with ultrastructurally demonstrable fibrosis. Fibrosis in the perisinusoidal space of Disse was present in as many as 82% of biopsies. Although the prevalence of such fibrosis in psoriasis patients who have not received MTX is unknown, the high prevalence of Disse space fibrosis and of raised P3NP in MTX-treated patients suggests that MTX causes subtle liver damage in a majority of treated patients. However, we were unable to show a statistical correlation between P3NP and the degree of Disse space fibrosis.

Spinous injury caused by a sea urchin.

A bather on holiday in Kenya injured a finger on a spiny marine creature living on the sea bed. A skin biopsy specimen from the injured finger contained several black spines about 0.5 mm in diameter and up to 1.5 cm in length. Spines removed from the specimen were embedded in plastic resin to facilitate transverse sectioning. Light microscopical examination using crossed polarisers showed an ornate symmetrical structure brightly illuminated against a dark background. These features are characteristic of sea urchin (Echinoderm) spines which are composed of ornately formed calcite crystals covered by an epithelium. The spines of sea mice, on the other hand, are chitinous in nature; they are also much finer and lack the ornate symmetry of sea urchin spines.

A surface polysaccharide forms when gonococci are converted to serum resistance by cytidine 5'-monophospho-N-acetyl neuraminic acid.

A serum-susceptible, guinea-pig chamber-passaged, laboratory strain (BS4 (agar)) of Neisseria gonorrhoeae was converted to serum resistance by incubation with cytidine 5-monophospho-N-acetyl neuraminic acid (CMP-NANA) and examined by electron microscopy after staining with ruthenium-red. In contrast to serum susceptible gonococci incubated without CMP-NANA, the majority (60-70%) of the serum resistant organisms showed a surface accumulation of polysaccharide. This surface polysaccharide was enhanced on all the resistant gonococci after incubation with fresh human serum. Control susceptible gonococci were devoid of the polysaccharide after incubation with heated human serum. Identical results were obtained with a fresh gonococcal isolate which had lost serum resistance on subculture but which, in common with 3 other isolates, was restored to serum resistance by incubation with CMP-NANA.

The light and electron microscopic features of early and late phase radiation-induced proctitis.

The light and electron microscopic features of rectal biopsies from 10 symptomatic patients treated with irradiation for pelvic malignancies are detailed. They are divided into two groups. Group I: biopsies taken during or shortly after the course of irradiation (six patients). Group II: biopsies taken 4 months or more after course completion (four patients). The distinguishing light microscopic features in the first group are epithelial meganucleosis, lack of mitotic activity, and patchy fibroblastic proliferation in the lamina propria. The blood vessels appear normal. In the second group, there are severe vascular changes characterized by narrowing of the arterioles by subintimal fibrosis, telangiectasia of capillaries and post-capillary venules, endothelial degeneration, and platelet thrombi formation. These vascular changes are always associated with severe fibrosis of the lamina propria and crypt distortion. The ultrastructural and light microscopic findings indicate that the cellular epithelial reaction and fibroblastic proliferation antedate the vascular injury, and the latter has no role in the acute phase reaction.