Respiratory viruses in children attending a major referral centre in Saudi Arabia.

Viral respiratory infections are common causes of illness in infants and children. Examination of clinical specimens submitted for diagnosis during a 3-year period (August 1993-July 1996) at King Faisal Specialist Hospital and Research Center (KFSH & RC) in Riyadh revealed a wide spectrum of diseases associated with the isolation of five respiratory viruses. Severity of disease ranged from mild upper respiratory illness to threatening lower respiratory illnesses including bronchiolitis and pneumonia. Of the 256 isolates, respiratory syncytial virus (RSV) accounted for 73 (28.5%), adenoviruses for 70 (27.3%), influenza viruses for 61 (23.8%), enteroviruses for 39 (15.2%) and para-influenza for 13 (2.3%). Viruses were found more frequently in children attending emergency or paediatric wards than in outpatients. RSV appears in November and the seasonal peak occurs during January and February. Influenza activity begins in September and peaks in November and December. Para-influenza type I emerges in winter and para-influenza type III follows the influenza epidemic and may be detected sporadically in summer. The other viruses (enteroviruses, adenoviruses) were isolated throughout the year.

Controlled study of fluconazole in the prevention of fungal infections in neutropenic patients with haematological malignancies and bone marrow transplant recipients.

The efficacy and safety of oral fluconazole versus a polyene regimen in preventing mycoses in neutropenic patients was compared. Patients with haematological malignancy or bone marrow transplantation received as antifungal prophylaxis either fluconazole 200 mg daily or a regimen consisting of clotrimazole trouches 10 mg twice daily with mycostatin, 500,000 I.U. four times daily, benadryl and cepacol mouthwash. Ninety patients at risk for fungus infection were evaluable. Four of 42 patients (9.5%; confidence interval 2%-23%) on fluconazole and 17 of 48 patients (35.4%; confidence interval 22%-52%) (p < 0.01) on the clotrimazole regimen developed a clinically significant fungal infection, including 3 (7.1%) and 11 (22.9%) patients respectively who had severe fungal infection, mainly pulmonary aspergillosis. Death directly due to a fungal infection within 100 days of the start of prophylaxis occurred in 2 of 42 patients (4.8%) and 9 of 48 patients (18.8%) respectively (p < 0.06). Kaplan-Meier analysis showed that the chance of survival on fluconazole was statistically greater than for the clotrimazole regimen (p < 0.04). A decrease of candidal colonisation of the gastrointestinal and genitourinary tracts occurred only in patients receiving fluconazole. No significant toxicity occurred. A 200 mg daily dose of fluconazole given to these patients thus appears to be well tolerated and to provide a protective effect against the development of fungal infection and death from severe fungal disease.

Diagnostic dilemma and therapeutic non-compliance in a case of intracranial tuberculoma.

A case of extensive intracranial tuberculoma is presented. The patient had been treated for 5 years with a standard antituberculosis regimen but she had been grossly non-compliant. This had led to emergence of multi-resistant Mycobacterium tuberculosis producing progressive disease and extensive cranial nerve damage and proptosis. The unusual CT and angiographic appearances cast doubt on the original diagnosis and a brain biopsy was necessary. Mycobacterium tuberculosis resistant to isoniazid, rifampicin, ethambutol, ethionamide, pyrazinamide, clofazimine and PAS was cultured from the brain biopsy specimen and from an associated groin abscess. A novel regimen of isoniazid, cycloserine, amikacin and ciprofloxacin produced clinical improvement of symptoms and radiological resolution.

Gel filtration high performance liquid chromatography of envelope polypeptide variants of herpes simplex type 1 strains.

High performance liquid chromatography (HPLC) with a TSK-4000SW gel filtration column was used to compare envelope polypeptides from four strains of herpes simplex virus type 1 (HSV-1). The chromatographic profiles demonstrated polypeptide variability among three clinical strains and the wild-type F strain. Radioimmunoprecipitation of the HPLC fractions with polyclonal anti-HSV-1 followed by SDS-polyacrylamide gel electrophoresis (PAGE) of the immunoprecipitates revealed molecular weight differences of various polypeptides in fractions from the area containing major peaks. This HPLC method could prove useful for the analysis of polypeptide polymorphism in clinical isolates of HSV-1, as well as in other viruses.

Susceptibility of clinical isolates of yeasts to anti-fungal agents.

The antimicrobial activity of amphotericin B, 5-fluorocytosine, nystatin, clotrimazole and miconazole were compared in vitro against 244 strains of yeasts that had been isolated from clinical specimens. The yeasts used in this study included 20 species of Candida, Cryptococcus, Saccharomyces Geotrichum, Rhodotorula, Torulopsis and Trichosporon. The majority of the strains (78%) had an MIC of less than or equal to 0.5 microgram/ml for amphotericin B, 81% an MIC of less than or equal to 1 microgram/ml for 5-fluorocytosine, 99% less than or equal to 8 micrograms/ml for nystatin, 91%, less than or equal to 8.0 micrograms/ml for clotrimazole and 98% had an MIC of less than or equal to 4.0 for miconazole. Of the anti-fungal agents tested, 5-fluorocytosine and nystatin were found to have the greatest antifungal activity.

Rapid detection of methicillin-resistant staphylococci with the MS-2 system.

The ability of the updated Abbott MS-2 system to detect methicillin-resistant Staphylococcus aureus (MRSA) was compared with disk agar diffusion and broth microdilution. Of the 87 MRSA isolates tested, the MS-2 system correctly detected 85 (97.7%) in 5 h. Seventy-two of the isolates were detected by disk agar diffusion within 24 h, and 15 more by 48 h. Broth microdilution detected 71 MRSA by 24 h of incubation and 11 more by 48 h. The updated MS-2 system yielded reliable results that were highly comparable with the standard techniques.

An evaluation of the gram stain and chocolate agar culture as part of a routine urine culture set-up.

A total of 219 urine specimens were Gram stained and inoculated onto 5% sheep blood, eosin methylene blue and chocolate agars. Culture and smear results were evaluated to determine if the Gram stain and chocolate agar culture yielded further meaningful information. Additional information was gained in 42 (19%) of the specimens; however, most of the results were not considered significant. The analysis suggests that a Gram stain and/or chocolate agar culture is not warranted for routine urine culture set-up.