No abstract

The risk of fungemia in this outbreak can be attributed to a larger number of antibiotics and a longer period of TPN administered to the patients. Analysis of events suggests that the outbreak may have been the result of cross-infection between staff and patients.

No abstract

Polymorphonuclear leucocyte function was investigated in 19 patients with active Behçet's disease. Spontaneous free leucocyte migration was found to be significantly reduced, yet after stimulation the leucocyte's chemotactic activity was considerably increase (p less than 0-05) when compared to control leucocytes. Control leucocytes migrated more rapidly when incubated in serum taken from patients with Behçet's disease (p less than 0-005). The enhanced chemotactic activity in Bechçet's disease appears to be due to both serum and intrinsic leucocyte factors. Spontaneous nitroblue tetrazolium reduction was found to be normal, although after stimulation leucocyte nitroblue tetrazolium reduction was lower than in the control group (P less than 0-025), as was leucocyte oxygen utilisation. It is suggested that the hyperreactive cellular inflammatory response that characterises Behçet's disease may be due to increased chemotactic activity and minor alterations in functional metabolic activity of leucocytes.

A 7-year-old boy suffering from aortic regurgitation and mitral stenosis and regurgitation was admitted with endocarditis caused by Rhodotorula pilimanae and was treated successfully with orally administered antifungal agent, namely 5-fluorocytosine (5-FC). A dose of IOO mg per kg body weight, divided into four equal parts, was prescribed. After a prolongedfebrile period his temperature dropped to normal on thefourth day of 5-FC therapy. Review of the published reports disclosed few cases of endocarditis due to Rhodotorula spp. and this case seems to be the first treated with 5-FC. Follow-up in one year, after discharge from the hospital, revealed no evidence of relapse. Cardiac impulse was maximal at the apex, and visible outward pulsations at that area were noted.At the apex, M1 was diminished and a third sound was heard. A grade 3/6 pansystolic murmur radiating to the left axilla and a grade i/6 short diastolic murmur were heard as well. At Erb's area, a grade 2/6 ejection type systolic murmur and a grade I/6 early diastolic murmur were heard. The liver was palpable 3 cm below the right costal margin but the spleen was not palpable. No joint involvement was observed on admission, but on the following day he complained of pain in the knees and ankles, and the left ankle was mildly swollen and hot. These complaints continued for three days. Funduscopic examination was normal. Laboratory examination revealed a haemoglobin of 9 g/ioo ml, with slight hypochromia, and white blood cell count (WBC) of 19,400/mm3 of which 3 per cent were band forms and 78 per cent were segmented neutrophils. Urine analysis normal. Throat swab negative. Erythrocyte sedimentation rate (ESR) I25 mm in the first hour (Westergren). Blood urea nitrogen 23 mg/IOO ml. Total protein was 7-I g/IOO ml, of which albumin was 3.9 g/ioo ml and globulin was 3-2 g/ioo ml. Blood serological tests were negative. C-reactive protein + + +. Antistreptolysin-0 titre was 256 Todd units and 5I2 three days later. Multiple blood and urine cultures were negative.An electrocardiogram showed normal sinus rhythm, normal PR interval, QRS axis + 300, and signs of hypertrophy of left atrium and ventricle. Chest x-ray disclosed an enlarged heart silhouette, with straightening of the left border, raised left main bronchus, and signs of venocapillary hypertension. The barium-filled oesophagus was indented by the left atrium and there was enlargement of the left ventricle.