ABSTRACT
A 39-year-old woman with systemic lupus erythematosus suffered a prolonged neurological illness associated with very low levels of glucose in her cerebrospinal fluid (CSF). Six months later, and after numerous CSF investigations, Histoplasma capsulatum was cultured. To our knowledge, this is the first report of cerebral histoplasmosis in Australia in a patient who is not HIV positive.
Subject(s)
Histoplasmosis/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Meningitis, Fungal/diagnosis , Opportunistic Infections/diagnosis , Adult , Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Blood Glucose/metabolism , Brain/pathology , Drug Therapy, Combination , Female , Histoplasmosis/drug therapy , Humans , Itraconazole/administration & dosage , Magnetic Resonance Imaging , Meningitis, Fungal/drug therapy , Neurologic Examination , Opportunistic Infections/drug therapyABSTRACT
Controversy over appropriate disinfection of endoscopes continues with the most commonly utilized solution in Australian hospitals, despite concern over its efficacy, being 1% glutaraldehyde (AIDAL). Review of the in-use concentrations of glutaraldehyde at Princess Alexandra Hospital has documented a significant dilutional effect in 1% glutaraldehyde by gastrointestinal endoscopes. Each hospital should determine the minimum in-use concentration acceptable for any given disinfecting solution and any given range of endoscopes. Once this level is reached, a solution change should routinely occur. Such decisions can only be made by regularly monitoring in-use concentrations of disinfectants.
Subject(s)
Disinfectants , Endoscopes , GlutaralABSTRACT
Two cases of typically appearing crystalline keratopathy both grew an alpha haemolytic streptococcus and had many of the features common to other cases. In one case, the use of topical and systemic antibiotics alone resulted in resolution of the disease, while in the second case even after corneal transplantation, a recurrence occurred which required further long-term antibiotics plus a repeat transplant.
Subject(s)
Corneal Diseases/diagnosis , Eye Infections, Bacterial/diagnosis , Streptococcal Infections/diagnosis , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Cornea/microbiology , Corneal Diseases/microbiology , Corneal Diseases/therapy , Eye Infections, Bacterial/therapy , Female , Humans , Keratoplasty, Penetrating , Male , Reoperation , Streptococcal Infections/therapy , Streptococcus/isolation & purificationABSTRACT
Two patients presented with culture proven Paecilomyces corneal infection, and a further patient with histologic evidence of fungal infection, on deep corneal biopsy. In all three cases the corneal infection was macroscopically present only in the depth of the cornea and on the endothelial surface with an intact epithelium and no overlying stromal involvement. Repeated surgery with large corneo-scleral grafts in two cases, and with medical therapy and a small patch-graft alone in the third case, resulted in long-term eradication of the infection and preservation of the globes. Antecedent modulation with steroid and/or cyclophosphamide may well have delayed the diagnosis, however, as there was no history of trauma in any of these cases, we postulate that these infections were not exogenously derived.
Subject(s)
Eye Infections, Fungal/microbiology , Keratitis/microbiology , Mycoses/microbiology , Paecilomyces , Adult , Aged , Antifungal Agents/therapeutic use , Cornea/pathology , Corneal Transplantation , Eye Infections, Fungal/drug therapy , Female , Humans , Keratitis/drug therapy , Keratitis/pathology , Male , Middle Aged , Mycoses/drug therapyABSTRACT
A 44-year-old woman with proven Acanthamoeba keratitis was successfully treated medically with resultant 6/9 vision. During the treatment, repeated attempts to titrate the patient off topical corticosteroids resulted in recurrent flare-up of inflammatory keratitis from which Acanthamoeba could not be recultured. It is suggested that steroid administration during the course of Acanthamoeba keratitis may need to be withdrawn extremely slowly to avoid the recurrence of what appears to be an immunological corneal reaction.
Subject(s)
Acanthamoeba Keratitis/drug therapy , Acanthamoeba/drug effects , Prednisolone/therapeutic use , Adult , Animals , Cornea/parasitology , Female , Humans , Ketoconazole/therapeutic use , Recurrence , Visual AcuityABSTRACT
A prospective study of plasma luteinizing hormone (LH) and testosterone in 54 men for 5 years following vasectomy revealed no significant continuing alteration in either testosterone or LH. Plasma LH levels 1 year after operation were higher than preoperative levels but did not increase further. Stimulation studies (4 years postvasectomy) using human chorionic gonadotropin confirmed acceptable Leydig cell functional reserve.
