An outbreak of Candida parapsilosis prosthetic valve endocarditis

The histologic features of normal and hyperplastic epithelia of the extra-glandular excretory ducts of human minor salivary glands were studied, and their pathologic significance evaluated. Normal duct epithelium consisted of two layers: inner columnar cells, and basal cubical or squamous cells. A few goblet cells were present among the inner cells. Hyperplasia of the duct epithelia occurred focally or entirely, and was classified into the following histologic types: (1) simple hyperplasia, and (2) metaplastic hyperplasia, which were divided into (a) mucous cell hyperplasia, (b) oncocytic hyperplasia and (c) squamous cell hyperplasia. Squamous cell hyperplasia was subdivided into (i) acanthotic type and (ii) reserve cell-like type with or without dysplasia. Simple or metaplastic epithelial hyperplasia of the extra-glandular excretory ducts of minor salivary glands may be induced by chronic inflammation or other types of irritation, and proliferating cells of such regenerating tissue sometimes exhibit features reminiscent of a neoplastic process. Furthermore, it is suggested that metaplastic epithelial hyperplasia of the excretory minor salivary gland ducts could be the site of origin of tumor development, i.e., some oral squamous cell carcinomas may arise from primary lesions in the hyperplastic epithelium of the extraglandular excretory minor salivary gland ducts.     

Saprophytic pleuritis with Candida parapsilosis

A 73-year-old man was admitted to our hospital with pneumonia in the right S6 induced by Streptococcus milleri and with left pleural thickening. He had histories of diabetes mellitus for 30 years and pulmonary tuberculosis 35 years ago. The pneumonia resolved completely after administration of ceftazidime and clindamycin for 10 days, but the pleural thickening remained and computed tomography revealed that it was an encapsulated effusion without calcification. An aspirate was turbid yellow with a high concentration of lipids, and consisted of dominant crystals and scattered cells, 80% of which were yeasts and 20% of which were macrophages phagocytizing them. Only Candida parapsilosis developed in culture. The same silent pleural shadow was identified on chest X-ray films obtained over the previous 7 years. The persistent pleuritis was diagnosed as saprophytic infection with C. parapsilosis.     

Pseudo-outbreak of candidaemia with Candida parapsilosis

Vibrio cholerae was isolated from 1008 of 3496 stool samples (28.8%) examined in Tamil Nadu State, India, between November 1992 and December 1995. During November and December 1992, 363 of the 370 isolates serotyped (98%) were V. cholerae O139 (Bengal). The epidemic predominantly affected adults (91%; 597/656). Both V. cholerae O1 and O139 serotypes were sometimes isolated in the same locality from different individuals. From January 1993 onwards, the rate of isolation of V. cholerae O139 declined, and in 1995 V. cholerae E1 Tor (serotype O1) was isolated from most of the cases (85.6%; 131/153). V. cholerae E1 Tor has clearly not been replaced by serotype O139, but can survive during inter-epidemic periods and reappear at an opportune moment. The decline of serotype O139 may be due to the development of immunity as a result of repeated exposure.     

Candida parapsilosis infection in a rose thorn wound

Candida parapsilosis should be recognized by primary care physicians as an important nosocomial pathogen, which is also frequently associated with sporadic skin and appendage infections. Its association with environmentally acquired skin ulcers can mimic fixed cutaneous sporotrichosis.     

Candida parapsilosis fungemia associated with implantable and semi-implantable central venous catheters and the hands of healthcare workers

Hypertension in the elderly features differently from its younger counterpart in terms of diagnosis, associated condition, atypical manifestation, management and complication. Epidemiological study in this increasing age group in the community is, therefore, needed. 334 elderly subjects living in various parts of Bangkok were randomly recruited by appointment at 7 geriatric day centers situated in local health offices of Bangkok Metropolitan Authority. Each subject received blood tests before being interviewed and measured by digital sphygmomanometer. Blood pressure and heart rate changes were recorded during lying, sitting and standing. The prevalence of hypertension was 36.5 per cent, 33.2 per cent were already aware of its existence while 3.3 per cent were newly detected by the survey. Isolated systolic hypertension, a unique subtype found in the elderly, was 4.5 per cent of all or 37.5 per cent among the hypertensive group. The associated medical conditions among the case group were diabetes mellitus 22.9 per cent, hyperlipidemia 13.9 per cent, hyperuricemia 33.3 per cent and heart disease 18.0 per cent. As far as postural hypotension is concerned, 14.8 per cent of case group whereas 11.3 per cent of the control group were affected. On the other hand, the symptom of postural dizziness was found to be 31.1 per cent and 55.2 per cent in the case and control group respectively. Following the statistical logistic regression analysis, the independent associated factors in the hypertension group were: history of hyperlipidemia, increased serum uric acid and poor heart rate response after standing. These findings, as parts of the multiple pathology and potential complications prevalent among this group, should be of concern by any physician looking after the elderly.     

Myocardial infarction in Girona, Spain: attack rate, mortality rate and 28-day case fatality in 1988. Regicor Study Group

This study was conducted to establish the attack rate, mortality rate and 28-day case-fatality rates of acute myocardial infarction (AMI) occurring in Girona, Spain, between October 1987 and September 1988. The study was carried out using a population register of AMI, and took place in one central hospital, and eight county hospitals in Girona (in the autonomous community of Catalonia, northeast Spain). Subjects comprised 222 fatal cases selected from 4069 death certificates, and 210 non-fatal cases from hospital records, among subjects aged between 25 and 74 years (reference population 263,778). The age standardized attack rate was 105.6 per 100,000 inhabitants in the age group 35-64 (193.6 in men and 17.6 in women). The age standardized mortality rate was 36.3 per 100,000 inhabitants in the age group 35-64 (63.1 among men and 9.9 among women). The age standardized 28-day case-fatality was 34.6% in men and 50.1% in women in this same age group. Attack and mortality rates of AMI in a region of Spain are presented for the first time. These rates are lower than in other developed countries, nevertheless the 28-day case-fatality is similar to that of these countries.     

Dyslipemia in a population with a high rate of cardiovascular mortality

The activity of N-acetyltransferase (NAT) and catalase was measured in the tissues of placenta, full venous blood and full umbilical cord blood in 141 complicated pregnancies. The control group consisted of 34 physiological pregnancies. The enzymes activity was marked by use of biochemical methods. It has been shown that NAT and catalase is the most active in the group of physiological pregnancies. The decrease of NAT and catalase in venous and umbilical cord blood is correlated with the decrease of the activity these enzymes in placenta.     

BVD outbreak can be costly: a case report

The losses caused by an BVD-outbreak on a Dutch dairy farm with approximately 100 dairy cows were determined. In this particular farm, calves which were born around the same time as a detected carrier calf were not sampled. These carrier calves were kept on as replacement heifers and caused additional loss on top of the losses already caused by the primary outbreak. The total economic loss was more than f 96.000,- or nearly f 1000,-per cow. This case report illustrates the potential for serious economic loss when an BVD free herd is reinfected combined with less adequate control measures.     

Clinical and epidemiological findings during a measles outbreak occurring in a population with a high vaccination coverage

Malignant mesothelioma is caused almost exclusively by occupational exposure to asbestos. During the past few years, however, increasing evidence has mounted that background exposure to asbestos could be sufficient to cause mesothelioma. Treatment of malignant mesothelioma remains a big problem. Some new approaches are on their way, and the most exciting ones are local immunotherapy in very early cases. Some success has been reported with local interferon treatment. As for treatment of metastatic pleural disease, the main purpose is symptomatic relief of dyspnea caused by fluid accumulation. The best way to achieve a lasting palliation is pleurodesis, and the most common way to do this, is by chemical means. The drug of choice in the United States has for many years been tetracycline, but since injectable tetracycline is no longer available, some substitute must be found. The substance that will "win" is not yet clear, but the two leading contestants are talc and doxycycline. Bleomycin also has its supporters, and a dark horse is quinacrine, which although not easily available in the United States, has been used in many European centers for decades.     

Systemic lupus erythematosus and pulmonary hypertension during pregnancy: report of a case fatality

The case of a 25-year-old pregnant woman with systemic lupus erythematosus and severe pulmonary hypertension is presented. The pregnancy was complicated by worsening right heart failure and pre-eclampsia, requiring a caesarian section at 29 weeks' gestation. On the fourth day postpartum, the patient's respiratory status worsened and she was transferred to the coronary care unit where she soon died from combined right heart failure and respiratory arrest. The presumed pathogenesis and etiology of lupus-related pulmonary hypertension are discussed, in addition to noninvasive tests and proposed management. Given that the mortality rate is very high during pregnancy and therapy is of limited value, women with lupus-associated pulmonary hypertension should avoid conceiving. Those who choose to become pregnant must be carefully managed by a multidisciplinary team.     

Neonatal lupus syndrome: a case with chondrodysplasia punctata and other unusual manifestations

We report a case of a newborn infant whose mother had systemic lupus erythematosus (SLE) diagnosed before pregnancy. The child had clinical manifestations of neonatal lupus as well as chondrodysplasia punctata and other findings that resemble the congenital anomalies associated with the use of oral anticoagulants, with no history of exposure. We speculate that the combined action of the different maternal autoantibodies may produce the whole spectrum of manifestations.     

Neonatal adrenal haemorrhage at bone scintigraphy: a case report

We report the case of a girl with known large right-sided and small left-sided neonatal adrenal haematomas who underwent bone scintigraphy 23 days after birth for suspected osteomyelitis. The radionuclide examination showed uptake of bone tracer around the right-sided haematoma, but no abnormality on the left side.     

Early hepatocellular carcinoma as an entity with a high rate of surgical cure

We present a case of central nervous system (CNS) infection due to Stomatococcus mucilaginosus involving a patient with leukemia and summarize 12 additional published reports of CNS infection due to this organism in immunocompromised hosts. The infection was diagnosed most commonly in the setting of hematologic malignancy accompanied by chemotherapy-induced neutropenia. S. mucilaginosus was recovered from blood prior to discovery of the CNS infection in 62% of cases. Signs or symptoms of CNS infection were observed in all patients. Although a number of patients responded to regimens containing intravenous vancomycin, the addition of intrathecal vancomycin appeared to be of benefit in some cases.     

Intra-abdominal Candida infection during acute necrotizing pancreatitis has a high prevalence and is associated with increased mortality

OBJECTIVES: To analyze the frequency of intra-abdominal Candida infection during acute necrotizing pancreatitis and to compare the outcome to patients without Candida infections. DESIGN: Retrospective analysis of data from 37 patients with and without Candida infection. SETTING: Surgical intensive care unit (ICU) in a university hospital. PATIENTS: Thirty-seven patients with acute necrotizing pancreatitis. INTERVENTIONS: Patients were subject to necrosectomy and programmed lavage. MEASUREMENTS AND MAIN RESULTS: Clinical parameters contained in the Acute Physiology and Chronic Health Evaluation (APACHE) II score were monitored, as were microbiological results from the intra-abdominal primary focus and from sites of secondary infections. Body mass index, distribution of underlying diseases, length of ICU stay, number of operations, and outcome were recorded. Multivariate logistic regression analysis for mortality as the dependent variable was performed. Intra-abdominal Candida infection was observed in 13 of 37 cases and was associated with a four-fold greater mortality rate compared with intra-abdominal bacterial infection alone. Multivariate logistic regression analysis demonstrated that Candida infection contributed to mortality significantly (p < .025) and independently from APACHE II (p < .006; mortality odds ratio for the two parameters=12.5). Lack of antimycotic treatment was associated with an increase to 29.2 (p<.001) in the odds ratio. CONCLUSIONS: Given the impact of Candida infection on mortality to acute necrotizing pancreatitis and the apparent benefit from antimycotic chemotherapy, the data argue for an early fungicide chemotherapeutic intervention.     

Neonatal encephalopathy with a pungent body odour

A neonate had transient unexplained bleeding into the gut, severe encephalopathy, and an abnormal pungent body odour. An inherited metabolic defect was excluded. The malodour was due to methanethiol and hydrogen sulphide, identified in urine. These sulphur compounds may have contributed to encephalopathy. Colonic bacteria were the probable source.     

Candida costochondral osteomyelitis, report of a case and review of the literature

A 49-year-old man was admitted to the hospital with swelling and redness overlying the left anterior chest wall. He had been treated by percutaneous transluminal coronary recanalization for acute myocardial infarction with central venous catheter one year and four months earlier. Since then, he had had no symptoms. An incision and drainage was performed and specimen showed acute and chronic granulation tissue containing pus with involvement of underlying left third rib and cartilage. Candida albicans was cultured from the drainage specimen. Treatment with fluconazole was began. The lesion failed to clear following incision and drainage, continuing to exude pus, then open surgical excision and curettage of the cartilage and rib was performed. After 2 months of therapy, the lesion had resolved. This is a rare case of candida costochondral osteomyelitis without a definite proof of former hematogenous candida infection.     

Neonatal skin lesions due to a spirochetal infection: a case of congenital Lyme borreliosis?

A 73-year-old female developed middle meningeal arteriovenous fistula during embolization of a falx meningioma. The cause of this complication was thought to be perforation by the guide wire during catheterization at the sharp bend in the sphenoidal portion of the middle meningeal artery. Embolization of the fistula and the feeding artery to the meningioma with polyvinyl alcohol particles 250-355 microns size resulted in complete obliteration of the fistula. Computed tomography showed no epidural or subdural hematoma. Introduction of the microcatheter beyond the sharp bend in the middle meningeal artery should not be attempted to avoid the possibility of iatrogenic middle meningeal arteriovenous fistula.