Prevalence and antifungal susceptibility of Candida parapsilosis complex isolates collected from oral cavities of HIV-infected individuals.

At present, few data are available on the prevalence and antifungal susceptibility of Candida parapsilosis complex isolates from HIV-infected individuals. The C. parapsilosis complex comprises three species, C. parapsilosis sensu stricto, C. metapsilosis and C. orthopsilosis. Fifteen of 318 Candida isolates were identified as members of the C. parapsilosis complex by PCR and restriction fragment length polymorphism (RFLP). The prevalence of C. parapsilosis complex isolates was 4.7 %, 2.2 % being identified as C. parapsilosis sensu stricto and 2.5 % as C. metapsilosis, while no C. orthopsilosis was isolated. This is believed to be the first study that has identified isolates of C. metapsilosis obtained from the oral cavity of HIV-infected individuals. Antifungal susceptibility tests indicated that all the isolates were susceptible to amphotericin B (AMB), fluconazole (FLC), ketoconazole (KTC), itraconazole (ITC), voriconazole (VRC) and caspofungin (CASPO). Although isolates of C. parapsilosis sensu stricto and C. metapsilosis were susceptible to FLC, isolates of C. metapsilosis showed a tendency for higher MICs (≥1.0 µg ml(-1)). Based upon the frequency of candidiasis and the fact that certain isolates of the C. parapsilosis complex respond differently to FLC therapy, our data may be of therapeutic relevance with respect to susceptibility and potential resistance to specific antifungal agents. Our data suggest that C. metapsilosis can be a human commensal; its importance as a pathogen has yet to be confirmed.

Double-blind placebo-controlled evaluation of levamisole in chronic rheumatoid arthritis.

Thirty-three out-patients with rheumatoid arthritis completed the study intended to compare under double-blind conditions, 50 mg levamisole tablets with placebo. Patients were given the double-blind medication at a dosage of one tablet t.i.d. for 3 months, and at a dosage of one tablet t.i.d., on 2 consecutive days every week for the next 3 months. Pain score, duration of morning stiffness, articular index and E. S. R. were recorded at the start of treatment, after 3 months of treatment and at the end of treatment. The levamisole patients made significantly better progress than did the placebo patients: for E.S.R. after 3 months of treatment, and for E.S.R., pain and morning stiffness by the end of treatment. Ten levamisole patients and 5 placebo patients reported adverse reactions. These were mainly gastrointestinal symptoms in the levamisole-treated patients.

Proximal interphalangeal arthroscintigraphy in rheumatoid arthritis.

Quantitative scintigraphy of proximal interphalangeal joints was performed by a reproducible method using 99m-Technetium in the hands of 40 normal controls and 20 patients with rheumatoid arthritis (RA). The range of the mean uptake varied considerably between proximal interphalangeal (PIP) joints in normal subjects. The mean uptake over PIP joints was not significantly different either between normal controls and RA patients, nor between those rheumatoid arthritis patients with and those without clinical signs of inflammation in the PIP joints. However, the variation in the PIP counts was significantly greater in the rheumatoid hands than in the normal hands. There was no clear correlation between the technetium uptake and the clinical parameters of inflammation in the PIP joints.

Diagnostic value of sacroiliac joint scintigraphy with 99m technetium pyrophosphate in sacroiliitis.

Using a quantitative method, scintigraphy of SI joints was performed by means of 99m technetium pyrophosphate in 21 patients with definite ankylosing spondylitis, in 17 control patients, and in 26 patients 'at risk', i.e. patients with complaints of back pain of the inflammatory type where on clinical grounds there was a possibility of sacroiliitis developing but with normal x-ray findings of the SI joints. Radioisotope uptake was higher in the ankylosing spondylitis group than in the other two groups, although the difference was not statistically significant with regard to the group 'at risk'. The high variance in the three groups considerably reduces the diagnostic value of the examination. In the ankylosing spondylitis group no correlation was found between radioisotope uptake and age, duration of disease, erythrocyte sedimentation rate, or radiological stage of scaroiliitis. Since the specificity and sensitivity of scintiscanning are lower than that of clinical and radiological diagnosis of the disease, we conclude that scintigraphy is not very helpful in the early diagnosis of sacroiliitis, at least by the techniques used here.