During a 24-year period, seven patients with leukemia undergoing cytotoxic or immunosuppressive therapy developed pulmonary mucormycosis in our hematology ward. The autopsy incidence in patients with acute leukemia was 2.1 %, with no significant rise during the last decade. Most cases occurred in early autumn. Twopatients diagnosed premortem were successfully treated with antifungal drugs, whereas five patients diagnosed postmortem died within three weeks following radiographic identification. Persistent fever despite antibiotic coverage was the first clinical presentation, followed mostly by the radiographic appearance of rounded densities, subsequently progressing to hemorrhagic infarction with hemoptysis and/or pleuritic pain. Crescentic cavitation developedwhenhematologic remission was achieved. Thus, certain radiographic patterns with or without pulmonary infarct syndrome in the proper clinical setting should arouse suspicion of mucormycosis, providing the opportunity for early diagnosis and adequate treatment. (Internal Medicine 35: 540-544, 1996)

No abstract

We demonstrated in this study that blood group O subjects attracted more Aedes albopictus than other blood groups (B, AB, and A) but were only significantly more attractive than blood group A subjects in 64 human landing tests. We collected saliva from the subjects and tested it for agglutination inhibition, categorized the subjects into secretors or nonsecretors, and studied mosquitoes' landing preferences for those groups. The mean relative percent landing on blood group O secretors (83.3%) was significantly higher than on group A secretors (46.5%). We also compared the attraction to subjects according to blood groups using forearm skin treated with ABH antigens. Blood group O disaccharide (H antigen) attracted significantly more Ae. albopictus than did blood group A trisaccharide (A antigen), and subjects treated with blood group A disaccharide attracted significantly more Ae. albopictus than did subjects treated with blood group B trisaccharide (B antigen), but ABH antigens did not, in general, influence the landing preference of mosquitoes among ABO blood groups.

Bacillus cereus, which used to be considered non-pathogenic, was isolated from the blood of a patient with acute leukemia who was receiving intensive chemotherapy. Fatal bacteremia developed with a clinical syndrome of acute gastroenteritis, followed by both meningoencephalitis with subarachnoid hemorrhage and multiple liver abscesses probably caused by infective vasculitis. Surveillance stool cultures revealed colonization with the organism prior to the onset of diarrhea, and repetitive blood cultures were found to be positive. Thus, this case suggested some new important clinicopathologic features of true B. cereus bacteremia complicating acute leukemia.

An unusual radiographic sign of crescentic cavitation appeared in a case of invasive pulmonary mucormycosis complicating the treatment of a patient with acute myelogenous leukemia and having a normal admission chest radiograph. The first manifestation was a large, wedge‐shaped pleural‐based consolidation, which evolved about 10 days later into a fungus ball‐like lesion, usually known as the air crescent sign. Amphotericin B and 5‐fluorocytosine, which were initiated immediately after appearance of the sign, proved to be effective, probably in association with hematologic improvement. Transbronchial lung biopsy was not only helpful in establishing a definitive diagnosis, but also suggested that an intracavitary mass could have resulted from pulmonary infarction. This experience thus showed that the sign may appear in greater frequency in mucormycosis as well as in aspergillosis, and may be useful as a clinical index for initiating antifungal therapy in immunocompromised patients.

Abstract:The complete genome sequences of two dengue-I virus strains having different growth characteristics (Mochizuki and A88) were compared with other published strains. The sequence analysis indicated several unique amino acid changes throughout the coding region of Mochizuki strain, mostly in envelope (E) protein. A unique amino acid, I1e-69 for Mochizuki strain at E protein resulted in the loss of an Asn-67-linked glycosylation site. A Thr substitution for Ala-114 at C protein and amino acid changes found in E, non-structural NS3, NS4a, and NS5 proteins were unique for A88 strain. These substitutions might be correlated to their different growth characteristics in vitro.

Rhabdomyolysiswith myoglobinuria is an uncommon complication of sepsis, whether monomicrobial or polymicrobial, even in its severe form. Wedescribe a middle-aged womanwith acute leukemia who developed rhabdomyolysis and myoglobinuria during the fatal course of chemotherapy-induced sepsis due to Bacteroides thetaiotaomicron and Enterococcus faecalis, followed by multiple organ dysfunction syndrome. In addition, autopsy revealed disseminated infections with Aspergillus and Candida. None of these organisms has been reported to be involved in the pathogenesis of rhabdomyolysis. Therefore, the etiology of the rhabdomyolysis in this case was probably multifactorial, with polymicrobial septic processes being possibly important contributing factors.

A two-month-old male infant with tetralogy of Fallot underwent a right-sided modified Blalock-Taussig shunt using a 4 mm expanded polytetrafluoroethylene graft through a right thoracotomy. Five months later, the patient developed otitis media, followed by repeated relapses of pneumonia and fever of unknown origin. Multidetector-row computed tomography and angiography, performed at 12 months of age, revealed a pseudoaneurysm of the subclavian artery at the insertion of the modified Blalock-Taussig shunt. After 20 days of antibiotic therapy, the pseudoaneurysm and infected graft were successfully resected through a median sternotomy approach. This report describes the treatment strategy of this rare but potentially fatal complication after a modified Blalock-Taussig shunt operation.