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The echinocandins are an important class of antifungal agents. However, instability and, in some cases, lack of solubility have restricted their use to situations in which daily infusions are acceptable. CD101 is a novel echinocandin in development for topical and weekly i.v. administration that exhibits prolonged stability in plasma and aqueous solutions up to 40°C. After incubation for 44 h in rat, dog, monkey and human plasma at 37°C, the percent of CD101 remaining (91%, 79%, 94% and 93%, respectively) was consistently greater than that of anidulafungin (7%, 15%, 14% and 7%, respectively). Similarly, after incubation in phosphate-buffered saline at 37°C, the CD101 remaining (96%) was greater than that of anidulafungin (42%). CD101 exhibited o2% degradation after long-term storage at 40°C as a lyophilized powder (9 months) and at room temperature in 5% dextrose (15 months), 0.9% saline (12 months) and sterile water (18 months). Degradation was o7% at 40°C in acetate and lactate buffers (6 to 9 months at pH 4.5-5.5). The chemical stability and solubility of CD101 contribute to dosing, pharmacokinetic, formulation and safety advantages over other echinocandins and should expand utility beyond daily i.v. therapy.

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A 62-year-old boating enthusiast with Binet stage C chronic lymphocytic leukaemia (CLL) was randomized within the Medical Research Council CLL 4 study to treatment with chlorambucil 10 mg/m 2 /d for 7 d (q 28 d). After four cycles he remained significantly cytopenic and a repeated bone marrow test showed persisting diffuse lymphocytic infiltration. Treatment was therefore changed to oral fludarabine, which normalized his peripheral counts, and he achieved a good nodular partial bone marrow response after six cycles.Eleven months later, he re-presented with weight loss and night sweats. Full blood count and bone marrow showed no evidence of progressive CLL. However, Mycobacterium fortuitum was isolated from two sputum cultures. Initial chest radiology was normal. A high resolution computed tomography scan showed multiple nodules throughout both lung fields but no lymphadenopathy. Immunoglobulins were normal. CD4 cell count was 0.088 · 10 9 /l (normal range 0.7-1.1 · 10 9 /l).A diagnosis of atypical mycobacterial infection was made and the patient was treated with clarithromycin, ciprofloxacin and doxycycline to which the organism was fully sensitive. Clinically, the patient deteriorated and further imaging demonstrated several hypodense splenic lesions (left). Ultrasoundguided aspiration from one such lesion was performed. M. fortuitum was isolated from the aspirate (right). Despite full care the patient failed to improve and died.Atypical mycobacterial infections should be considered in any patient previously treated with purine analogues with a low CD4 count who becomes non-specifically unwell.