The human 26S proteasome is a target of antiretroviral agents. This suggests that the antiviral action and some clinical and immunological benefits of combined antiretroviral therapy rely not only on its known effects on viral enzymes, but also on host cell components.

We report three cases of invasive Geotrichum capitatum infection in patients with acute leukemia for which an enzyme-linked immunosorbent assay (ELISA) for Aspergillus galactomannan was positive, with no evidence of aspergillosis. Supernatants obtained from suspensions of 17 G. capitatum strains gave positive reactions with the Aspergillus galactomannan ELISA. These clinical and laboratory data seem to suggest that G. capitatum produces a soluble antigen that is cross-reactive with Aspergillus galactomannan.Aspergillus galactomannan detection by a sandwich enzymelinked immunosorbent assay (ELISA) is widely used throughout the world in diagnosing invasive aspergillosis, and it has been introduced among the international microbiological criteria for the diagnosis of this fungal infection in immunocompromised hosts (2, 11). A major problem with the detection of circulating galactomannan is the occurrence of false-positive results, which, in some cases, have been shown to be related to cross-reactivity with other opportunistic fungi (11). We report cases of three acute-leukemia patients who developed disseminated infection by Geotrichum capitatum for which ELISA for Aspergillus galactomannan was positive, with no evidence of aspergillosis.Patient 1 was a 7-year-old child with acute lymphoblastic leukemia in second relapse who underwent salvage chemotherapy in February 2004. Ten days after this treatment, the patient developed fever and periorbital edema; broad-spectrum antibiotics and liposomal amphotericin B were administered. A week later, several serum samples were positive for galactomannan antigen and caspofungin was added. A computedtomography scan showed an abscess of the cerebral base starting from the ethmoidal plan and involving the hypophyseal region. Therefore, a surgical debridement was performed; G. capitatum was isolated from samples of pus, liquor, and bone (identification was performed with the VITEK system [bioMerieux Italia, Rome, Italy]). Galactomannan antigen was detected in the pus. Histology of a bone fragment disclosed necrotic tissue in which mycotic invasion was evident. On periodic acid-Schiff-and Grocott-stained sections, the fungi consisted of septate hyphae, slightly bent with parallel disposition and only occasional branching at a wide acute angle or budding at a right angle. A few spores and fragmentation of the mycelium in arthroconidia were also observed. Caspofungin was replaced with voriconazole. Within a few days, the patient's clinical condition improved and galactomannan antigen, for which tests were previously constantly positive, disappeared from the blood. Two months after surgery, while under voriconazole treatment, the child underwent two consecutive aploidentical bone marrow transplants from his father and his mother, but after a few weeks, the child died from sepsis of an unknown origin. Serum galactomannan antigen was no longer detected.Patient 2 was a 9-year-old girl with a diagnosis of myelodysplasia secondary to acute lymphoblastic leukemia and who underwent an allog...

This study is a retrospective analysis of seven patients with hypoechogenic lesions in the liver and/or spleen due to Bartonella henselae, who were followed from 1998 through to 2005 by the Department of Pediatrics, Turin University. In addition to showing constitutional symptoms, four children had skin lesions suggestive of injuries inflicted by cats, and one child had a history of exposure to cats. The origin of the infection remained undefined in the other two patients. Humoral tests enabled a precise diagnosis in all children. Treatment with macrolides or combinations of two active antibiotics for at least 2-3 weeks led to the definitive clearance of infection, although residual intraparenchymal lesions persisted in five patients for several months or years. Conclusion B. henselae serology allows an easy diagnosis of multiple hepatosplenic granulomata, a clinical picture that appears to be under-recognized. Macrolides or a combination of two active antibiotics for 2-3 weeks leads to a rapid clinical response and a definitive clearance of infection.

Infections are rare events within 30 days from insertion of partially implanted central venous catheters and coagulase-negative staphylococci represent the most frequently isolated cause of these complications.

Invasive aspergillosis is an uncommon but often lethal complication in immunocompromised patients. Despite the progress obtained with new antifungal drugs, intracranial aspergillosis often requires a combined medical and surgical approach. Most cases previously reported in immunocompromised children were fatal. We describe 4 immunosuppressed children with intracranial aspergillosis successfully treated with surgery and antifungal long-term therapy.