A 12-year-old girl with acute lymphoblastic leukemia was referred to King Faisal Specialist Hospital and Research Center. The diagnosis without central nervous system (CNS) involvement was confirmed on admission, and chemotherapy was initiated according to the Children Cancer Group (CCG) 1882 protocol for high-risk-group leukemia. During neutropenia amphotericin B (AMB) (1 mg/kg of body weight/day) was initiated for presumed fungal infection when a computed tomography (CT) scan of the chest revealed multiple nodular densities. After 3 weeks of AMB therapy, a follow-up chest CT revealed progression of the pulmonary nodules. The patient subsequently suffered a seizure, and a CT scan of the brain was consistent with infarction or hemorrhage. Because of progression of pulmonary lesions while receiving AMB, antifungal therapy was changed to liposomal AMB (LAMB) (6 mg/kg/day). Despite 26 days of LAMB, the patient continued to have intermittent fever, and CT and magnetic resonance imaging of the brain demonstrated findings consistent with a brain abscess. Aspiration of brain abscess was performed and the Gomori methenamine silver stain was positive for hyphal elements. Culture of this material grew Acrophialophora fusispora. Lung biopsy showed necrotizing fungal pneumonia with negative culture. The dosage of LAMB was increased, and itraconazole (ITRA) was added; subsequently LAMB was discontinued and therapy was continued with ITRA alone. The patient demonstrated clinical and radiological improvement. In vitro, the isolate was susceptible to low concentrations of AMB and ITRA. A. fusispora is a thermotolerant, fast-growing fungus with neurotropic potential. We report the first case of human infection involving the CNS.Acrophialophora resembles Paecilomyces but differs in having colonies that become dark and in the development of phialides along the sides or at the tips of echinulate brown conidiophores. Conidia are borne in long chains and are smooth or ornamented with fine-to-coarse echinulations, sometimes in spiral bands. The taxonomy of the genus Acrophialophora is reviewed, and Acrophialophora nainiana andAcrophialophora levis are considered as synonyms ofA. fusispora.
A commercially available method for the rapid detection of methicillin-resistant Staphylococcus aureus (BBL Crystal MRSA ID System) was evaluated and compared with conventional methods. All 52 isolates of methicillin-susceptible and 142 isolates of intrinsic methicillin-resistant S. aureus were correctly identified in 4 h by the test method, whereas correct identification took 11 to 24 h by conventional methods. The test is simple, rapid, and easy to perform and the results are easy to interpret.
The in vitro activity of sparfloxacin (CI-978, AT-4140), a new fluoroquinolone, was compared with ciprofloxacin, norfloxacin and other commonly used antimicrobial agents against 650 strains of Enterobacteriaceae, 237 isolates of other gram-negative bacilli and 318 strains of gram-positive cocci. The MICs of sparfloxacin against 90% of the members of Enterobacteriaceae were between 0.12 and 0.5 μg/ml. All the 48 isolates of notoriously drug-resistant Serratia marcescens were inhibited by < 0.03-4.0 μg/ml of sparfloxacin. All the 90 isolates of Acinetobacter, 80 of the 88 strains of Pseudomonas aeruginosa and all the 28 isolates of Xanthomonas maltophilia were susceptible to sparfloxacin. The MIC90 for all the cocci tested ranged between 0.5 and 4.0 μg/ml of sparfloxacin. It inhibited 92% of enterococci as compared with 27% for ciprofloxacin and 22% for norfloxacin. It was better or comparable in activity to other fluoroquinolones and superior to penicillins, cephalosporins and aminoglycosides tested. There was cross-resistance between ciprofloxacin, norfloxacin and sparfloxacin.
BRL 42715 is a new penem which inhibits a wide range of plasmid as well as chromosomally mediated bacterial β-lactamases. We used a total of 902 recent clinical isolates, consisting of 455 Enterobacteriaceae, 247 staphylococci and 200 other gram-negative bacteria to evaluate its ability for potentiation of amoxycillin. MICs for all the 104 strains of methicillin-susceptible Staphylococcus aureus were reduced from 8– > 32.0 to ≤ 0.06 μg/ml in the presence of 1–5 μg/ml of this penem. It was also highly effective in inhibiting the β-lactamase of a wide variety of gram-negative bacteria, thereby bringing their MIC values for amoxycillin from a ‘resistant’ range ( > 32.0 μg/ml) to a ‘susceptible’ range (≤ 8.0 μg/ml). Commonly resistant bacteria like Klebsiella, Enterobacter, Citrobacter, Morganella, Serratia, Acinetobacter and Aeromonas were rendered susceptible to amoxycillin in the presence of 1.0–5.0 μg/ml of BRL 42715.
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