Chronic rhinocerebral phycomycosis in association with diabetes.

Two patients with rhinocerebral phycomycosis associated with diabetes are presented. The chronic nature of the illness in these two cases in emphasized in contrast to the more fulminant course of most previously reported patients. A high index of suspicion is needed to establish the diagnosis as rapidly as possible. Treatment of the underlying disease combined with amphotericin B therapy and radical surgical excision of all infected tissue is important to establish cure of these patients.

Counterimmunoelectrophoresis in the detection of antibodies against Coccidioides immitis.

In recent years counterimmunoelectrophoresis has been increasingly used in the diagnosis of microbial diseases, and our study was undertaken to evaluate its possible use in the rapid detection of antibodies against Coccidioides immitis. One hundred twelve specimens from 50 patients were studied. The study population comprised the following: Group I, 34 patients with an active coccidioidomycosis infection; Group II, five patients with a positive coccidioidin skin test; Group III, five patients with a negative coccidioidin skin test; and Group IV, six patients with other fungal infections. Counterimmunoelectrophoresis was positive in 93 of 96 specimens in Group I and negative in the other groups. The results obtained by counterimmunoelectrophoresis correlated well with complement fixation and double immunodiffusion and indicate that it is an excellent tool for the diagnosis of patients with coccidioidomycosis.

New live attenuated influenza A/England/42/72 (H3N2) vaccine (Alice): reactogenicity,, immunogenicity, and protection efficacy.

The Alice strain of influenza A/England/42/72 (H3N2) live attenuated vaccine, when given by the intranasal route to 133 volunteers, was relatively nonreactogenic; only 12% of the vaccinees had upper respiratory tract symptoms after immunization. Seroconversion in 87.2% of subjects whose titers of humoral hemagglutination-inhibiting antibody before immunization were less than 1:8 demonstrated the immunogenicity of the vaccine. The overall seroconversion rate was 66.1% (geometric mean titer of hemagglutination-inhibiting antibody, 1:40.9). Antibody levels were unchanged at six months in 95.5% and at 12 months in 91.7% of the vaccinees. Because of the lack of natural influenza A infection during the season monitored, an experimental challenge study with homotypic virus (influenza A/Udorn/307/72 [H3N2]) was conducted eight months after immunization of a sample population of 22 subjects. Twelve of these subjects were vaccinees whose titers of hemagglutination-inhibiting antibody were greater than or equal to 1:64, and 10 were unimmunized controls whose titers of hemagglutination-inhibiting antibody were less than or equal to 1:8. The group with titers of greater than or equal to 1:64 represented 40.2% of the immunized population. The vaccine was highly effective in this selected group, with a 91% protection efficacy against illness and a 100% rate of protection against illness associated with influenza A infection.

Recognition and treatment of adult respiratroy distress syndrome secondary to viral interstitial pneumonia.

Four cases of adult respiratory distress syndrome secondary to viral interstital pneumonia were treated successfully. The illnesses started with a prodrome of upper respiratory symptoms. The development of dyspnea was a key symptom from which point respiratory failure developed within 24 to 48 hours. Chest roentgenograms showed alveolar infiltrative patterns which later became coalescent. The clinical course consisted of fever, dyspnea, hypoxia and acidosis, There was no response to therapy with antibiotics, 100 per cent oxygen by mask and intermittent positive pressure breathing (IPPB) over the first 24 hours. Supportive therapy then initiated included endotracheal intubation, the administration of humidified oxygen by volume cycled respirator with positive end expiratory pressures of 10 to 15 cm H2O and corticosteroids. It is concluded that early recognition of the syndrome, coupled with prompt insituition of aggressive supportive respiratory management may be lifesaving in patints with severe interstitial pneumonia.

Changes in small airway function after live attenuated influenza vaccination.

Live, attenuated influenza vaccine was given by intranasal inoculation to 15 young, adult volunteers. Modest symptoms occurred within 3 days of challenge, but the agent was otherwise well tolerated. Hemagglutinin-inhibition antibodies increased in 9 of the 12 subjects whose initial volumes, but closing volume did not change. These changes in airflow reverted to previous levels after 1 week. On a second challenge 2 weeks after the first, symptoms were far less frequent, and no changes in airflow were detected. We conclude that this agent is biologically active and that the airflow changes observed may reflex involvement of small airways.