Experience with burns of the eyes and lids in a regional burn unit.

During a 3-year period 1527 patients with burns were admitted to a regional burn unit in Augusta, Georgia. Two hundred thirty patients (15.06%) were referred for consultation by an ophthalmologist. Thirty-two patients had preexisting ophthalmic problems that were believed to warrant consultation. One hundred eighty-nine patients were seen because of facial burns. Of these, 143, or 9.36%, had burn injuries of the eyes or lids that required care. Lid involvement was encountered in 122 (7.98%) cases. In 78 cases lid involvement was bilateral (in the remainder, unilateral). In 61 cases thermal or chemical burns to the conjunctiva or lens were present. Skin grafts to the lids were required for acute care in 11 instances. Tarsorrhaphies were done in 11 instances. In one case the lids were essentially destroyed, and extensive reconstruction with flaps was needed. Late reconstruction with grafting of the lids was done in five cases. In three eyes (two patients) enucleation was eventually required. Ten patients without burns who had toxic epidermal necrolysis were also treated on the unit. Consultation with an ophthalmologist is believed to be important in patients with significant ocular or periocular injury. The importance of maintaining moisture to the globe is stressed.

A comparison of susceptibility to five antifungal agents of yeast cultures from burn patients.

Patients with significant degrees of immunocompromise, such as cancer, AIDS and large burns, who have received significant amounts of antibiotics, may develop infections with yeast organisms. Over a 3-year period, all patients with positive fungal blood cultures and most wounds of patients with large burns considered to be a risk of yeast infection were selected and tested for their susceptibility to five antifungal agents, amphotericin B, ketoconazole, miconazole, diflucan, and 5-fluorocytosine. In all, 244 specimens of yeast were tested: 142 Candida albicans, 52 Candida parapsilosis, 26 Candida tropicalis and 13 Trichosporon beigelii. A limited number of other isolates of Candida (12) were also encountered. All Candida organism were sensitive to amphotericin B. There was wide variation in regard to the susceptibility to the other four agents, with C. albicans and C. tropicalis being largely resistant to miconazole and ketoconazole. T. beigelii was recovered in 13 patients. One-half of these organisms was resistant to amphotericin B. Awareness of variations in species and susceptibility are helpful in the selection of appropriate therapeutic antifungal agents.

DNA probes for the identification of Nocardia asteroides.

DNA probes for the rapid identification of Nocardia asteroides were obtained by constructing a genomic library of strain GUH-2 in the lambda cloning vector EMBL3. Of 50 recombinant clones tested, 2 were identified that hybridized with 31% of the N. asteroides strains in a reference collection without cross-hybridization with related members of the Actinomycetales. Additional libraries were then generated from selected strains of N. asteroides that had failed to hybridize with any of the GUH-2 clones. Four additional clones were obtained from these strains which, when pooled, provided DNA probes specific for all of the N. asteroides strains tested.