Elastase production in clinical isolates of Aspergillus.

Clinical isolates of Aspergillus species were tested, both retrospectively and prospectively, for elastase activity using rose bengal-elastin agar plates. Patient records were then reviewed to determine the clinical diagnosis including the presence or absence of aspergillosis. All isolates that caused invasive aspergillosis produced elastase, but not all isolates producing elastase were associated with invasive disease.

Paecilomyces variotii. An unusual cause of isolated sphenoid sinusitis.

Isolated fungal sphenoid sinusitis is an unusual head and neck infection. We describe the first reported case (to our knowledge) of Paecilomyces variotii sphenoid sinusitis. In addition, it represents one of the few reported cases of isolated fungal sphenoid sinusitis. Diagnosis and management of this condition are described. Aggressive surgical management is advocated when fungal sphenoid sinusitis is suspected.

An ambulatory medical education program for internal medicine residents.

Teaching the fundamentals of ambulatory medicine has many well known difficulties. An education program with specific topics covered and modeled after continuing medical education programs for practicing physicians was instituted for residents in a university hospital clinic and was evaluated. The program was effective in improving the residents' knowledge, in enhancing their attitudes toward the clinic, and in improving their performance of influenza vaccinations. No adverse effects of the program were found. This approach, in which a curriculum is carefully defined and participation of the house staff is required, makes the ambulatory medical education process more accountable for what is taught.

Clinical evaluation of efficacy, pharmacokinetics, and safety of teicoplanin for serious gram-positive infections.

Nineteen patients hospitalized for serious gram-positive infections were treated with teicoplanin, a new glycopeptide antibiotic. A variety of infections were treated, including endocarditis, septic thrombophlebitis, osteomyelitis, pyogenic arthritis, and soft tissue infection. Of 13 infections that could be evaluated in 12 patients, there were 8 clinical cures, 2 improvements, 1 recurrence, and 2 failures. Of the eight patients with Staphylococcus aureus bacteremia, seven were clinically cured or improved with teicoplanin therapy. Of the nine patients in whom the bacteriological response to treatment could be fully evaluated, six were cured; there was recurrence of infection in one, and treatment failed in two patients. In vitro testing showed the 13 bacterial isolates (9 S. aureus, 3 S. epidermidis, and 1 group B streptococcus) to be uniformly susceptible to teicoplanin, with MICs ranging from 0.12 to 0.5 microgram/ml. Every isolate was more susceptible in vitro to teicoplanin than to vancomycin. Three of the staphylococcal isolates were resistant to methicillin. Pharmacokinetic studies demonstrated that after an initial drug-accumulation period, a single daily dose adequately maintained the teicoplanin concentrations in serum within therapeutic ranges. Teicoplanin also penetrated well into synovial fluid. The drug was well tolerated by either intravenous or intramuscular administration. The most significant adverse reaction was an urticarial rash which required discontinuation of therapy in one patient; a second patient experienced a modest decrease in high-frequency auditory threshold. Asymptomatic eosinophilia and mild elevation of serum transaminases were noted as well. The results of this study suggest that teicoplanin is a safe and effective new agent for treatment of serious infections caused by gram-positive organisms.

Vibrio cincinnatiensis sp. nov., a new human pathogen.

A halophilic gram-negative rod was isolated from blood and cerebrospinal fluid collected from a 70-year-old male having no known contact with seafood or salt water. Positive biochemical tests included oxidase, sensitivity to 0/129, O-nitrophenyl-beta-D-galactopyranoside, lysine decarboxylase and fermentation of glucose, salicin, n-inositol, sucrose, L-mannose, L-arabinose, and arbutin. Negative tests included indole, ornithine decarboxylase, arginine dihydrolase fermentation of lactose, and production of gelatinase and urease. The DNA base composition was 45.0 mol% guanine plus cytosine. Numerical taxonomy indicated 70% similarity with known reference Vibrio sp. strains. The 5S rRNA sequence for this strain has been determined: 5'-U G C C U G G C G A C C A U A G C G U U U U G G A C C C A C C U G A U U C C A U G C C G A A C U C A G U A G U G A A A C G A A A C A G C G U C G A U G G U A G U G U G G G G U C U C C C C A U G U G A G A G U A G A A C A U C G C C A G G C A U-3'. Based on the phenetic, molecular genetic, and nucleic acid sequencing data, it is concluded that Vibrio cincinnatiensis represents a new species of the genus Vibrio sensu strictu (as defined by 5S rRNA sequencing results). On a basis of 5S rRNA comparative sequence analysis, the organism appears to share a recent common ancestor with V. gazogenes (98% homology) and close ancestry with V. mimicus, V. fluvialis, and V. metschnikovii.