Applied Biomedical Research Program, Agency for Innovation by Science and Technology (IWT-TBM).

We report a rare case of a fatal Saprochaete capitata breakthrough infection in a patient with acute myeloid leukemia receiving empirical caspofungin therapy. S. capitata is an uncommon, yet emerging cause of invasive infections, especially in patients with haematological malignancies. Blood cultures from our patient yielded S. capitata which was found to be resistant, in vitro, to caspofungin. We consecutively reviewed all published cases of breakthrough infections caused by S. capitata in patients receiving echinocandins. S. capitata should be considered in those patients who remain febrile or who develop invasive mould infections while under echinocandin therapy.

No abstract

An enrichment medium was developed and evaluated for isolation of fluconazole-resistant minority yeast species in a hospital setting. The enrichment medium was made by adding fluconazole (10 micrograms/ml) to yeast nitrogen base/glucose broth. Under laboratory conditions the broth permitted detection of 20 of 20 Candida krusei isolates and 20 of 20 Candida glabrata isolates in mixtures with Candida albicans even when the Candida albicans cells outnumbered those of the other species by 1000:1. Results of culture on the enrichment medium were compared with those obtained on routine agar media and on a yeast differential agar which facilitates detection of mixed yeast species by their colony colours. Only one Candida glabrata isolate was detected on the enrichment broth but not found on routine culture of 68 yeast-positive clinical specimens. However, bacterial over-growth in some broths may have retarded the appearance of other yeast isolates. On the yeast differential agar, 20 clinical specimens were found to contain mixtures of yeast species compared with only 2 on routine culture.

Imported malaria remains a difficult problem in nonendemic areas of the world. We describe the clinical presentation of 101 cases of malaria diagnosed at the Leuven University Hospital between 1 January 1990 and 31 December 1999. Ninety-three patients (92%) presented initially at the emergency department. Diagnosis was initially not suspected by the referring physician in 48 patients (47%). Plasmodium falciparum was the commonest species, accounting for 67% of the cases. All but three patients had fever as the presenting symptom, but only 10 had a typical tertian fever pattern. Haemolytic anaemia, thrombocytopenia and hyponatraemia represented a typical triad in 20% of the cases. Only 13% of the malaria patients had taken correct chemoprophylaxis according to WHO recommendations. Eighty-three per cent of the patients were admitted to the hospital with a median duration of hospitalization of 4 days. All complications occurred in cases with P. falciparum. All patients were cured.