Candida albicans arthritis in a renal allograft recipient with an interaction between cyclosporin and fluconazole Get access J. A. J. Barbara, J. A. J. Barbara 1Renal Unit, Royal Adelaide HospitalAdelaide, South Australia Correspondence and offprint requests to: Dr Jeffrey A. J. Barbara, c/o the Renal Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia Search for other works by this author on: Oxford Academic PubMed Google Scholar A. R. Clarkson, A. R. Clarkson 1Renal Unit, Royal Adelaide HospitalAdelaide, South Australia Search for other works by this author on: Oxford Academic PubMed Google Scholar J. LaBrooy, J. LaBrooy 2Department of Medicine, Royal Adelaide HospitalAdelaide, South Australia Search for other works by this author on: Oxford Academic PubMed Google Scholar J. D. McNeil, J. D. McNeil 2Department of Medicine, Royal Adelaide HospitalAdelaide, South Australia Search for other works by this author on: Oxford Academic PubMed Google Scholar A. J. Woodroffe A. J. Woodroffe 1Renal Unit, Royal Adelaide HospitalAdelaide, South Australia Search for other works by this author on: Oxford Academic PubMed Google Scholar Nephrology Dialysis Transplantation, Volume 8, Issue 3, 1993, Pages 263–266, https://doi.org/10.1093/oxfordjournals.ndt.a092444 Published: 01 January 1993 Article history Received: 22 July 1992 Accepted: 16 September 1992 Published: 01 January 1993

EX645 is a derivative of Salmonella typhi Ty21a which carries a plasmid specifying production of Vibrio cholerae O antigen. When cultured with exogenous galactose to overcome the galE defect of the vector, EX645 also synthesizes S. typhi O antigen, and this can result in the masking of the shorter V. cholerae O antigen on the bacterial surface. To determine whether the potential for such masking at least partly underlies the inconsistency of anti-V. cholerae responses elicited by EX645, a derivative of this strain has been isolated, characterized, and tested for immunogenicity in human volunteers. EX880 has an rfb defect which prevents synthesis of S. typhi O antigen, and consequently V. cholerae O antigen is still detectable on the surface of the clone following growth in the presence of galactose. Compared with EX645, EX880 more consistently elicited significant rises in serum bactericidal antibody levels, although individual responses within a cohort still varied widely.

A live oral vaccine consisting of attenuated Salmonella typhi Ty21a expressing Vibrio cholerae O1 Inaba lipopolysaccharide (LPS) O antigen was constructed and tested in volunteers for safety, immunogenicity, and efficacy. Fourteen adults ingested three doses of 10(10) viable organisms with buffer. One month later, 8 vaccinees and 13 unimmunized controls were challenged with 10(6) pathogenic V. cholerae O1 E1 T or Inaba organisms. No significant adverse reactions to vaccination were observed. All volunteers had significant rises in serum immunoglobulin G (IgG) antibody to S. typhi LPS. Only 2 (14%) of 14 had significant rises in serum IgA or IgG antibody to Inaba LPS, and 5 (36%) of 14 had fourfold rises in vibriocidal antibody. In the challenge study, diarrhea occurred in 13 of 13 controls and 6 of 8 vaccinees (vaccine efficacy, 25%; P = 0.13). The vaccine significantly reduced the severity of the clinical illness (P less than 0.05) and caused decreased excretion of challenge vibrios (P less than 0.05). Although the typhoid-cholera hybrid vaccine did not provide significant protection overall against experimental cholera, this study demonstrates the importance of antibody to V. cholerae O antigen in ameliorating clinical illness and illustrates the use of an S. typhi carrier vaccine strain expressing a foreign antigen.

The efficacy, safety and disposition of olsalazine was assessed in patients with left-sided ulcerative colitis or proctitis in a double-blind placebo controlled trial. Thirty patients with a mild-to-moderate attack of ulcerative colitis were randomly allocated to olsalazine capsules, 1 g b.d., or placebo for 6 weeks. Good clinical response was found in six patients receiving olsalazine and in two receiving placebo. Improvement in sigmoidoscopic findings and histological appearance of rectal biopsies was also seen more often in olsalazine-treated patients. Plasma concentrations of olsalazine were significantly higher in patients who improved. Olsalazine showed an advantage over placebo which needs to be confirmed by further studies; it was safe in sulphasalazine-sensitive patients but appeared to cause watery diarrhoea in two patients.

A randomized double-blind study was carried out in patients with unresolving antibiotic-associated colitis due to Clostridium difficile, to compare the effect of bacitracin (80,000 U/day) with vancomycin (500 mg/day) on the resolution of symptoms, clearance of organism, and prevention of relapse. Forty-two patients with colitis, 9 of whom had a pseudomembrane, were randomized, 21 patients to each treatment group. The two groups were comparable in age, disease severity, and antibiotic exposure. For a 50% reduction in stool frequency the mean times (+/- SE) were 4.1 +/- 0.4 days for bacitracin and 4.2 +/- 0.4 days for vancomycin. Sixteen patients (76%) had symptom resolution after 7 days of treatment with bacitracin, compared with 18 patients (86%) given vancomycin. Patients who failed to respond were crossed over (blind) to the alternative antibiotic, but tended to be refractory to the alternative medication as well. Vancomycin-treated patients had negative toxin (83% vs. 53%, p = 0.04) and negative stool cultures (81% vs. 52%, p = 0.02) more frequently than did those patients given bacitracin. Similar numbers of patients in each group had symptomatic relapse during 1 mo of follow-up, but most of them relapsed yet again after blinded crossover therapy. Although bacitracin was significantly less effective than vancomycin in clearing C. difficile from the stools, both were of similar value in the control of symptoms in a group of patients with predominantly nonpseudomembranous colitis. In view of its low cost, bacitracin is a reasonable first-line alternative to vancomycin in the treatment of antibiotic-associated colitis.

Incorporation of the protease inhibitor phenylmethylsulphonyl fluoride in a solid-phase enzyme-linked immunoassay increased the sensitivity of this assay for detecting antibodies to dietary proteins present in human intestinal aspirate. Its effect was due in part to the prevention of antigen degradation.

Review of the limited data currently available on the ratios of helper (OKT4+) to suppressor (OKT8+) T cells in autoimmune liver disease (primary biliary cirrhosis and chronic active lupoid hepatitis) and virally induced liver disease indicates that this OKT4+:OKT8+ ratio is elevated in autoimmune liver disease manifesting hyperglobulinemia. This ratio was decreased in patients with chronic hepatitis B virus infection during the HBe antigen-positive phase of viral replication but reverts to normal in the majority of patients in whom HBV replication has ceased (HBe antibody-positive) and these individuals exhibit normal liver histology. Patients with HBV infection who continue to show elevated ratios after the appearance of HBe antibody also continue to exhibit signs of active hepatitis. The implications of these findings for further research in the management of these disorders is discussed.

A mucocele of the sphenoid sinus caused persistent headache and destroyed the pituitary fossa before it was diagnosed and treated surgically via the transnasal route. The possible absence of clinical leads to the nature of this condition, and the importance of establishing a tissue diagnosis with destructive lesions in this area, are emphasized by this case.