Parenteral 5-fluorocytosine in the therapy of systemic mycoses.
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The cellular activities of amphotericin B (AmB) used as Fungizone were compared with those of AmB complexed to either egg lecithin and glycocholate (Egam) or egg lecithin and deoxycholate (Edam). Under conditions in which leakage of K+ from erythrocytes and cultured L cells treated with Fungizone was almost complete, Egam and Edam containing concentrations of AmB severalfold greater than the concentration of AmB in Fungizone had no effect but retained the ability to decrease the level of retention of K+ in fungal cells. Analysis by absorption and circular dichroism spectroscopy demonstrated that when these formulations containing AmB at concentrations of less than 10(-5) M were added to buffer, the AmB dissociated slowly as monomers from Egam or Edam and dissociated rapidly as a mixture of monomers and self-associated species from Fungizone. We propose that in Egam and Edam, the absence of free AmB in the self-associated form reduces the toxicity of AmB to mammalian cells, whereas the presence of monomeric AmB results in the retention of the antifungal activities of these complexes.
The use of serum rather than broth as the diluent in the serum bactericidal test results in a significant decrease in the test level among patients receiving highly protein-bound semisynthetic penicillins.
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Three cases of fatal cerebral mycosis in males with prior histories of intravenous drug use from the United States and Australia are reported. Infection in each case was limited to brain abscess; no other sites of infection were observed. The fungus seen by histopathology and isolated from the brain tissue in each case was identified as Chaetomium strumarium. This is the first report of human infection by this species, and C. strumarium is the second species of Chaetomium known to cause primary brain infection. Chaetomium strumarium is unusual among members of the genus Chaetomium in forming ascocarps covered with pale, thin-walled, flexuous hairs, a feature leading to its original placement in the genus Achaetomium. Presence of pinkish exudate droplets and/or crystals associated with hyphae or ascocarps, sometimes accompanied by a pinkish diffusible pigment; good growth at 42 degrees C; and production of small conidia further distinguish this species. The brain abscess isolates were compared with isolates from prior cases of cerebral infection which had been identified as either Chaetomium atrobrunneum or Chaetomium globosum. With reidentification of one isolate originally identified as C. globosum to C. atrobrunneum, only C. strumarium and C. atrobrunneum have been confirmed to cause infection involving the brain.
Infections by actinomycetes or by true fungi may cause diagnostic difficulties in countries where they are not familiar. Illustrative cases from a series of 353 instances are given together with rare indigenous examples of the same infections. Early, accurate diagnosis is essential for rational and effective treatment.
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212 patients with cultural evidence of yeast-induced vaginal mycosis were treated with a single vaginal tablet of 500 mg clotrimazole. A diagnosis of infection due to a Candida species had been established before therapy in 95% of the patients studied. From the total group of 212 patients a further group was formed who had appeared at the check-ups as scheduled in the trial protocol and whose data were complete. This group included 83 cases. There was no therapeutic difference between the two patient groups. 89% of the patients of the total patient group evaluable were found to be mycologically cured at both check-ups. In the reduced patient group the rates of mycological cure at the times of examination were 87 and 89%, respectively. The clinical results obtained in the total patient group indicated a therapeutic success of 90% at both check-ups. In the reduced patient group the rate of therapeutic success was 93% at the first and 88% at the second check-up. The local tolerability of the Canesten vaginal tablet was good. The side effects observed were rare and mild.