Candida dubliniensis is an emerging fungal pathogen, especially in immunodeficient patients. We report what is to the best of our knowledge the first case of multifocal osteomyelitis following disseminated infection in a patient after haematopoietic stem cell transplantation. PFGE for typing of C. dubliniensis was developed and the necessity of long-term antifungal therapy is discussed. Case reportA 19-year-old white man with congenital haemolytic anaemia of undefined genetic origin, son of consanguineous parents, was referred for peripheral blood stem cell transplantation (PBSCT) to our institution. He suffered from the sequelae of lifelong transfusion therapy including haemosiderosis of the liver (histological grade IV), pancreas and endocrine system, and showed incompliance to chelate therapy.The conditioning regimen for PBSCT consisted of radioimmunotherapy with an yttrium-90-labelled CD66 antibody for myeloablation (calculated bone marrow dose 17 Gy), and chemotherapy with fludarabine (40 mg m 22 for 4 days) and melphalan (140 mg m 22 for 1 day). In addition, antithymocyte globulin [rabbit (Sangstadt) 3.3 mg kg 21 for 3 days] was given. On day 0 the patient received peripheral blood stem cells of a 10/10 human leukocyte antigen-matched unrelated female donor. The number of CD34 + cells in the graft was 4610 6 cells kg 21 , the CD3 cell count was adapted to 1610 7 cells (kg body weight)21 . Graft versus host disease prophylaxis included cyclosporine and mycophenolate.The patient developed fever on day 21 when ceftazidime was started (100 mg kg 21 per day). On day +4 vancomycin (40 mg kg 21 per day) was added, and on day +7 ceftazidime was changed to meropenem (80 mg kg 21 per day). However, spiking temperatures continued and C-reactive protein (CrP) increased to a peak level of 298 mg l 21 on day +10. No infectious focus was detected by computed tomography (CT) scan of the thorax. However, on day +8, he developed generalized papulopustulous skin efflorescences on his trunk and extremities suggestive of septic metastases.A skin biopsy was performed at day +9 and grew Candida spp. in pure culture after 24 h of incubation on Sabouraud dextrose agar. Blue colonies on Candida ID-2 agar (bioMérieux) (Eraso et al., 2006), an abundance of chlamydospores on rice agar, and growth on Sabouraud dextrose agar at 42 u C and 45 u C, suggested Candida albicans; however, biochemical identification by API ID32 (bioMérieux) was ambiguous, suggesting Candida dubliniensis after 48 h (code 7142140015, 99.3 %, T0.67) and C. albicans after 72 h incubation (code 7347150015, 98.4 %, T0.53). In the BichroDubli latex agglutination test (Fumouze) the isolate reacted positively. By sequencing a 550 bp fragment of the internal transcribed spacer regions 1 and 2 using the primers Fungi for (59-TCCGTAGGTGAACCTGCGG-39) and Fungi rev (59-TCCTCCGCTTATTGATATGC-3 9 ) identification of C. dubliniensis was confirmed. The strain showed 99.6 % homology to the C. dubliniensis reference strain DSM 13628 (GenBank accession number DQ105856) using the BL...
BackgroundHealth- and illness-related cognitions of pediatric patients with asthma or somatization and of their caregivers are considered relevant for patient education and for cognitive-behavioral interventions. This study investigates the relationship between diagnosis and illness perception by child and parent in two different chronic conditions such as somatization disorder and asthma.Methods25 patients with somatoform disorders and 25 patients with asthma bronchiale completed the Giessen Complaint List and the Multidimensional Health Locus of Control Scale. Primary caregivers independently answered parallel proxy-report instruments. Analyses of variance were performed to determine the impact of diagnosis and perspective. Correlations were calculated to determine the concordance between patient and caregiver reports.ResultsNo statistically significant differences in illness locus of control beliefs were found between asthma and somatoform disorder children or parents. Parents reported more internal and fatalistic locus of control beliefs compared with their children. Correlations between patient and caregiver reports of symptoms and health locus of control beliefs were low to moderate.ConclusionClinicians should take into account a sense of insufficient symptom control in both diagnostic groups and different viewpoints of patients and their parents.
Subjektive Krankheitstheorien bei Kindern und Jugendlichen mit somatoformen Störungen oder Asthma bronchiale und ihren ElternPraxis der Kinderpsychologie und Kinderpsychiatrie 56 (2007) Summary Illness beliefs of children and adolescents with somatoform disorder or asthma bronchiale and of their parentsIllness beliefs of children and adolescents (age: 8-18 years) with somatoform disorder or asthma bronchiale and of their parents were compared. 25 patients of each diagnostic group and their parents participated independently in semi-structured interviews. The answers were categorized after qualitative content analyses. The frequencies of specific illness beliefs in each group were compared, coefficients of similarity between patients' and their parents' illness beliefs were calculated. Illness beliefs are mostly multi-dimensional, but not consistent. We discriminated seven categories of causal attributions: genetic, mental, somatic, developmental, behavioural, social, and physical/environmental. Children and adolescents reported less complex attributions compared with their parents, moderate similarity between patients' and their parents' illness beliefs is demonstrated. Disease specific attributions were most prominent in the parental perspective, with a preference for psycho-social illness attributions in parents of patients with somatoform disorders and a preference for genetic, physical-external and somatic attributions in parents of patients with asthma. Patients with somatoform disorder considered significantly more often psycho-social illness causes, compared with patients in the asthma-group. Differential apriori assessment of patients' and parents' illness beliefs may contribute to effective cognitive-behavioral interventions.
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