The SAPS II assessment of severity of illness in patients admitted to an intermediate care unit is reliable. These results will need to be confirmed, using different patient samplings from intermediate care units.

We studied fluconazole penetration in the brain in five patients who had a deep cerebral tumor whose removal required the excision of healthy brain tissue. Plasma and brain samples were simultaneously obtained after oral ingestion of 400 mg of fluconazole daily for 4 days (90% of steady state). Fluconazole penetration in healthy cerebral parenchyma was determined. Plasma and brain samples were assayed by high-pressure liquid chromatography. Concentrations in plasma and brain tissue were 13.5 ؎ 5.5 g/ml and 17.6 ؎ 6.6 g/g, respectively. The average ratio of concentrations in the brain and plasma (four patients) was 1.33 (range, 0.70 to 2.39). Despite the lack of data concerning the penetration of fluconazole in brain abscesses, these results should permit the use of a daily dose of 400 mg of fluconazole in prospective clinical studies that evaluate the effectiveness of this drug in the treatment of brain abscesses due to susceptible species of fungi.Fluconazole, a triazole compound, is a systemic antifungal synthetic agent. Its fungistatic action is the inhibition of fungal cytochrome P-450 sterol C-14 alpha demethylation (18). During recent years, an increase in the rate of central nervous system fungal infections mainly due to an increased prevalence of immunosuppressed states (e.g., AIDS, malignancies, and organ transplantation) has been reported. Treatment by fluconazole of invasive infections due to various fungi has been a significant advance in antimicrobial chemotherapy (1,19,21). Its efficacy in treating cryptococcal and coccidioidal meningitis (2,3,5,14,22,23) is well established in clinical studies.In acute AIDS-associated cryptococcal meningitis fluconazole was shown to be as effective as amphotericin B (23) and more so in preventing relapse (3,22). However, use of fluconazole for treatment of this disease remains controversial (6,20,24), and the optimal dose remains uncertain. The incidence of cryptococcal intracerebral lesions is unknown and probably underestimated (6,8,11,27). Inadequate control of these lesions is perhaps one of the risk factors for failure or relapse of cryptococcal meningitis. Actually, therapeutic failures and relapses may occur when using amphotericin B or fluconazole (400 mg/day), and higher doses of fluconazole as salvage therapy have been proposed (2).While the penetration of fluconazole in human cerebrospinal fluid is known to be good (60 to 80% of levels in serum) (10, 25), data regarding its penetration in brain tissue other than in animals are lacking (17,26). The objective of this research was to study the penetration of fluconazole in human brain tissue and to determine the ratio of concentrations in the brain and plasma at steady state. MATERIALS AND METHODSObtaining brain tissue samples from patients with cryptococcal meningitis is not acceptable in light of current diagnostic and therapeutic strategies. Obtaining tissue samples from healthy volunteers is not conceivable. We therefore decided to study the penetration of fluconazole in the healthy cerebral parenchyma...

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Nocardia infection classically occurs in immuno-compromized patients. Only a few cases of mediastinal infection due to this pathogen have been described in the literature. We report a patient who developed mediastinitis due to Nocardia asteroides after cardiac transplantation. The treatment was surgical debridement, dressing, sugaring and antibiotic therapy. The emergence of a severe acute renal failure possibly induced by drug interaction between Cyclosporin, cyclines and aminoglycosides, led us to modify the antimicrobial treatment. The intravenous use of Imipenem 2 g per day and Ciprofloxacin 400 mg per day for four weeks and then oral Ciprofloxacin 1.5 g per day for 1 year, was effective and allowed a good outcome, without any drug interaction with Cyclosporin, adverse effect, graft rejection episode or infection relapse.