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Macroscopic and microscopic characteristics of an African Blastomyces dermatitidis strain.

This report describes the macro- and microscopic characteristics of a strain of Blastomyces dermatitidis isolated in an Italian hospital from a Libyan patient suffering from cutaneous blastomycosis. The fungus was isolated with great difficulty because of the presence of a Proteus species on the lesion. Conversion of the mycelial into the yeast-like phase achieved the best results, using Columbia ANC culture medium. After 5-6 days, this transformation was only partial and presented swollen hyphae and yeast-like cells. The biological characteristics were typical of B. dermatitidis strains of African origin. The differences between African and North American strains are confirmed, in agreement with findings already reported in the literature.

Blastomyces↗

Geotrichum capitatum septicaemia in neutropenic patients: case report and review of the literature.

We report a case of systemic infection with Geotrichum capitatum in a patient with acute myeloid leukaemia. Three days before death, the patient developed acute renal failure, probably caused by occlusion of glomerula with hyphae of G. capitatum. Up until now, prophylaxis and treatment of infections caused by Geotrichum capitatum have not been established. However, the prophylactic administration of high-dose itraconazole and the therapeutic use of liposomal amphotericin B are subjects of discussion.

Acute Disease↗

Invasive chromoblastomycosis and sinusitis due to Phialophora verrucosa in a child from northern Africa.

We report on a severe, verrucous facial mycosis and sinusitis in a 12-year-old Libyan girl. Her disease started with verrucous, hyperkeratotic plaques and subcutaneous violet nodules of unknown origin on her face and upper extremities. Despite topical antimycotic therapy she needed in-hospital treatment because of severely progressive tumorous cutaneous and nasal lesions. Microscopic examination of scale samples taken from the upper extremities and the face revealed brown, thick-walled fungal elements. Under the assumption of a chromoblastomycosis, an oral treatment with itraconazole and fluorocytosin was initiated, with significant improvement of the lesions. The aetiological agent was identified as Phialophora verrucosa.

Antifungal Agents↗

Perinatal risk factors in birth asphyxia: relationship of obstetric and neonatal complications to neonatal mortality in 16,365 consecutive live births.

Over a period of one year, 16,365 consecutively live born neonates were prospectively studied for evidence of birth asphyxia using the requirement of greater than one minute of positive pressure ventilation for identifying infants suffering from birth asphyxia. Asphyxia occurred in 2.8% of all neonates. Multivariate analysis of high risk factors associated with increased risk of asphyxia showed that low birth weight was the most significant predictor of asphyxia: asphyxia occurred in 68% of infants of less than 1,000 g birth weight and decreased to 1.2% in infants of 3-4 kg birth weight. Perinatal risk factors associated with a higher incidence of asphyxia include: postmaturity, birth weight (less than or equal to 2.5 kg) and with the presence of maternal and/or obstetric complications. The impact of asphyxia on neonatal mortality was most pronounced in more mature infants and the mortality was increased 3 fold in infants of less than 34 week gestation and greater than 27 fold for infants greater than 38 week gestation. Of the asphyxiated neonates, intrauterine growth retardation, fetal macrosomia, hypothermia, hyaline membrane disease, seizures, hypoglycemia and hyponatremia were significantly associated with an increased risk of death.

Adolescent↗

Emergency hysterectomy in obstetrics--a review of 117 cases.

A series of 117 cases of emergency obstetric hysterectomy performed between 1976 and 1985 is reviewed. The indications included ruptured uterus (53.8%), intractable postpartum haemorrhage (20.5%), placenta accreta (7.7%), major degree of placenta praevia (7.7%), haemorrhage at Caesarean section (4.5%), couvelaire uterus (3.4%) and abdominal pregnancy (2.6%). Despite a general aversion to hysterectomy by the women in our society, these procedures were undertaken in a desperate attempt to save life. There were 6 (5.1%) maternal deaths, all due to the severity of the indication for the hysterectomy. Presence of an experienced obstetrician is important to make an early decision to operate before the patient's condition is extreme and to provide the technical skills required to minimize morbidity and mortality.

Adult↗

A mutation in the prion protein gene in Creutzfeldt-Jakob disease in Jewish patients of Libyan, Greek, and Tunisian origin.

A modified host protein encoded by the gene specifying the scrapie amyloid precursor is critically involved in the pathogenesis of transmissible spongiform encephalopathies such as Creutzfeldt-Jakob disease (CJD), Gerstmann-Straussler-Scheinker's syndrome, and Kuru. A mutation in the open reading frame of this gene was recently described in a cluster of patients with CJD in Slovakia. This mutation at codon 200 changes glutamic acid coded by GAG to lysine coded by AAG. We examined the prevalence of this mutation in the cluster of patients with CJD among Sephardic Jews of Libyan descent in Israel. A polymerase chain reaction was used to amplify the open reading frame of the prion protein gene from DNA extracted from frozen brain tissue of five Israeli residents (four of Libyan and one of Greek origin) and two familial cases in Jews born in Greece and Tunisia who later emigrated to France. The existence of the codon 200 mutation was detected by digestion of the open reading frame fragments with the BsmA1 restriction enzyme. All patients had the same codon 200 mutation. These findings implicate this mutation in the high prevalence of CJD among Libyan and Sephardic Jews from other Mediterranean countries.

Creutzfeldt-Jakob Syndrome↗

Screwworm eradication in the Americas.

The screwworm fly, Cochliomyia hominivorax (Coquerel), is a parasite that attacks all warm-blooded animals including humans. This parasite has caused significant losses to the livestock industries of the Americas. Since the screwworm eradication program was initiated in the Southeastern United States in 1957, the eradication program has successfully progressed to its current location in Panama. A variety of technologies and tools have been used in the eradication programs. The cooperative agreement has been a significant tool in the success of the program. In the United States, the State-Federal Cooperative programs provided the mechanism for carrying out screwworm eradication. Once screwworms were eradicated from the United States, the need to expand the program internationally, in order to protect the United States, became evident. A cooperative agreement created the Mexico-United States Commission for the Eradication of Screwworms (Commission). Commission-Guatemala and Commission-Belize Cooperative Agreements were used to eradicate screwworms from these countries. Followup programs in El Salvador, Honduras, Nicaragua, Costa Rica, and Panama were implemented by cooperative agreements between the United States Department of Agriculture and the individual countries. The positive and negative aspects, as well as the necessary elements of successful cooperative agreements, are discussed.

Animal Husbandry↗

Primary nephrotic syndrome in Arab children.

We studied 134 Arab children with primary nephrotic syndrome. The annual incidence was 11.6/100 000 children and the ratio of boys to girls was 1.3:1. Ninety eight per cent were responsive to steroids and the mean age of the children at diagnosis was 5.7 years. On follow up (mean 29.8 months, range 1 month to 11 years) 46% had a frequently relapsing course. Renal biopsy, done in 17 patients with frequently relapsing, steroid-dependent nephrotic syndrome, showed minimal changes in 15 and mesangial proliferative lesions in two. Three of the 129 patients did not respond to steroids; two had focal and segmental sclerosis and the third had mesangial proliferative glomerulonephritis. One patient died.

Adolescent↗