Differentiation of yeast-like fungi using the commercial Auxacolor system.

Technical factors preclude the use of conventional fermentation and assimilation procedures for the routine laboratory differentiation of yeast-like fungal isolates. Commercial biochemical differentiation systems are therefore used to remedy this situation. The predictive accuracy of three commercially available differentiation systems was tested using 120 yeast-like fungal isolates. The morphological characteristics of these fungal strains were identical in the case of all three differentiation systems. The fungal isolates were correctly identified in 98.3% of cases with Auxacolor, in 90.8% of cases with API 20C AUX and in 76.7% of cases with the Mycotube system. The advantages and disadvantages of these biochemical differentiation systems are discussed.

[Comparative study of the therapy of Candida esophagitis in HIV-1-infected patients with fluconazole or amphotericin B and flucytosine]. / Vergleichende Untersuchung zur Therapie der Candida-Oesophagitis bei HIV-1-infizierten Patienten mit Fluconazol oder Amphotericin B und Flucytosin.

In 20 HIV-patients (17 male homosexuals, 1 male and 1 female i.v. drug abuser and 1 female patient with M. Willebrand-Jürgens) Candida esophagitis was diagnosed by esophagogastroduodenoscopy. Clinically they presented retrosternal pain or an exacerbation of oral candidosis under local antimycotics. The diagnosis of Candida esophagitis was based on histopathologic examination and culture studies of biopsy specimen from macroscopically suspect lesions. Candida antigen was found in the serum of 30% of the patients, immunofluorescence was positive for Candida antibodies in 25%. A CMV- or HSV-esophagitis could be ruled out by direct immunofluorescence, in situ hybridoma experiments and by virus culture assays. In 11/20 patients the Candida esophagitis was the first manifestation of full blown AIDS. 10 patients were treated daily with a combination of amphotericin B 0.4 mg/kg KG and flucytosine 150 mg/kg/KG and 10 patients by oral administration of fluconazole 400 mg/d each for 8 days. Secondary prophylaxis was carried out with 2.4 g/d (24 ml) amphotericin B as oral suspension in the amphotericin group and with 50 mg/d fluconazole p.o. in the fluconazole group. Both therapy regimens showed a complete remission in a control esophagogastroduodenoscopy after 10 days. Side effects were only moderate. After an observation period between 7-24 months there were three relapses in the amphotericin group and four in the fluconazole group. After 24 months 10 patients had died, a rate comparable to that after Pneumocystis carinii pneumonia. In total, there is no difference between both therapy regimens, the oral administration of fluconazole once a day allowed treatment as an outpatient and was appreciated by the patients.

[Cutaneous manifestation of fungal infection]. / Kutane Manifestation einer Pilzsepsis.

A 50-year-old patient with an aplastic syndrome developed disseminated purpuric, necrotic lesions on his skin. Histological examination revealed fungal sepsis. The clinical appearance, the course of the disease are described and the importance of histological examination is pointed out.

[The significance of central venous catheters in the genesis of Candida endomycoses]. / Die Bedeutung zentraler Venenkatheter bei der Entstehung von Candida-Endomykosen.

A high concentration of yeasts in feces creates the possibility of active penetration of yeast cells into the surrounding tissue and thereby into blood vessels. Fungaemia is probably caused by this process more often than generally suspected. It is our opinion that venous catheters are contaminated very rarely by yeasts residing on the skin and it is more likely that fungaemia is the causative mechanisms. Adhesion of Candida albicans cells to the catheter wall could not be demonstrated in these investigations. The catheter material examined had no fungistatic properties. To prevent catheters becoming a secondary source of infection it would be advisable for manufacturers to add fungistatic substances to the plastic material of venous catheters.

Laminar air flow versus barrier nursing in marrow transplant recipients.

Forty-eight patients with acute leukaemia in relapse (n = 14), acute leukaemia in complete remission (n = 19), chronic myeloid leukaemia (n = 8) or severe aplastic anaemia (n = 7) received a marrow transplant. The first 26 patients were nursed in laminar-air-flow plastic isolators while the next 22 patients were treated in barrier nursing rooms. Gnotobiotic parameters and morbidity in the 2 groups are compared. Good decontamination of the gastro-intestinal tract was obtained using either of the 2 isolation techniques. The incidence of bacterial and mycotic infections, as well as the supportive care required by the patients was almost equal in both groups. Our results also suggest that the incidence of graft versus host disease may decrease with efficient decontamination of the patients.

[Bone marrow transplantation for aplastic anaemia and acute leukaemia (author's transl)]. / Knochenmarktransplantation bei Panmyelopathie und akuter Leukämie. Resultate des Westdeutschen Tumorzentrums Essen.

Twenty-six bone marrow transplantations were performed at the West Germany Tumour Centre at Essen between December 1975 and December 1981. Three patients had aplastic anaemia, 23 acute leukaemia. Of the leukaemia patients 13 had a recurrence and ten were in full remission at the time of the transplantation. Two of the patients with a recurrence received deep-frozen autologous marrow from the remission phase. One patient with aplastic anaemia had an identical twin as donour, while all other patients received allogeneic marrow from histocompatible family members. Eleven patients are still alive, all three of those with aplastic anaemia, one of those with leukaemia in a recurrence, and seven of those with acute leukaemia in full remission. Two of the survivors have a chronic graft-host reaction, but the others are symptom-free, after an observation period of up to four years. Main causes of death were leukemic recurrence (6), infection (5), and graft-host reaction (2). It would seem that at present bone marrow transplantation offers the best chance of a cure for severe aplastic anaemic and acute leukaemia in adults, but only if transplantation is undertaken early and not in the end-stage of the disease.

[Resistance to griseofulvin (author's transl)]. / Griseofulvinresistenz.

The antibiotic griseofulvin has been used for more than two decades in the treatment of dermatophyte-induced mycoses. During the first 10 years of use griseofulvin-resistant dermatophytes were demonstrated only in a few cases. During the seventies we did not find an increase in these strains. During this period of time the total number of dermatophytes studied by us was 489 of which 5 proved resistant, that is 4 strains of Trichophyton rubrum and one strain of Trichophyton mentagrophytes, which were still growing at a concentration of 100 gamma griseofulvin per ml culture medium. We consider these strains to have a secondary resistance and did not observe dermatophytes with a primary resistance. Accordingly, the number of non-responders cannot generally be explained by the presence of resistant dermatophytes, but rather by other reasons which have already been discussed. For the time being the problem of an increasing incidence of griseofulvin-resistant dermatophytes does not exist.