Of 495 patients reported in a large urban histoplasmosis outbreak, we studied 276 whose serologic tests were done in a single laboratory. Serologic test results were positive in 96% of these patients (compared with less than 5% of controls from an endemic area), cultures were positive in 22%, and special stains in 19%. The immunodiffusion test results were negative in 13% of patients who had positive findings by complement fixation, and 1% had positive results only by immunodiffusion. The complement fixation test was almost twice as sensitive as the immunodiffusion test in patients with subclinical infection. The serologic response differed significantly among the clinical syndromes with higher titers in cavitary and lower titers in disseminated disease. Factors associated with titers of 1:64 or greater to both antigens were black race and immunocompetence. High mycelial titers were also associated with more intense exposure, and high yeast titers were associated with age less than 36 years. No prognostic significance could be proved for fourfold titer rises or falls or persistence of precipitins.
white Swiss male mice were allowed to run 3 days on previously sterilized soil that had been seeded with Cryptococcus neoformans 1 year previously. It was determined that the soil contained an average of 1.6 X 106 viable yeast cells per ml. The mice were observed for 24 weeks, at which time the survivors were necropsied. The total mortality rate during this period was 44%; 67% of the mice had positive cultures, including all who had a fatal infection. Two additional experiments were done with the same strain with the use of aerosols produced by a Henderson apparatus. In experiment 1, 39 mice received 11,000 viable cells each; in experiment 2, 40 mice received 14,622 viable cells. Both groups of mice showed similar mortality rates, with a total of 77% dead after 20 weeks in experiment 1, and 80% in experiment 2. All of the mice in experiment 1 had positive cultures, as did 95% of the mice in experiment 2.
Studies were performed to evaluate a method for selective isolation of Histoplasma capsulatum and Blastomyces dermatitidis from contaminated specimens. Ammonium hydroxide placed on an agar medium surface was found to inhibit the growth of many bacteria, yeasts, and saphrophytic fungi normally found in specimens such as animal tissues and sputum. In one study involving the culture of B. dermatitidis from canine tissues, 24% more isolations were obtained on a medium using NH4OH compared with a similar medium. Increases in the isolation of H. capusulatum from sputum specimens were also obtained, ranging from 20 to 32% compared with four other media without NH4OH.
Healthcare technology continues to advance and be implemented in healthcare organizations. Nurse executives must strategically evaluate the effectiveness of each proposed system or device using a strategic planning process. Clinical information systems, computer-chip-based clinical monitoring devices, advanced Web-based applications with remote, wireless communication devices, clinical decision support software--all compete for capital and registered nurse salary dollars. The concept of clinical transformation is developed with new models of care delivery being supported by technology rather than driving care delivery. Senior nursing leadership's role in clinical transformation and healthcare technology implementation is developed. Proposed standards, expert group action, business and consumer groups, and legislation are reviewed as strategic drivers in the development of an electronic health record and healthcare technology. A matrix of advancing technology and strategic decision-making parameters are outlined.
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