Human alveolar echinococcosis in Slovenia

Between January 2001 and December 2005, 1263 patients suspected of having echinococcosis were screened serologically by indirect haemagglutination assay (IHA). IHA-positive patient sera were then retested by western blot for confirmation and differentiation between Echinococcus granulosus and Echinococcus multilocularis infection. Of 43 sera confirmed as Echinococcus-positive, nine appeared to be specific for alveolar echinococcosis (AE) caused by E. multilocularis. AE-positive serological results corresponded to the clinical and/or imaging findings concerning the patients' liver cysts. The detected incidence of AE was 0.45/10(5) inhabitants, which suggests that clinicians and health authorities in Slovenia should give greater attention to AE in the future.

Epidemiological typing of imipenem-resistant Pseudomonas aeruginosa

The level of genetic heterogeneity of nine isolates of Pseudomonas aeruginosa resistant or intermediately susceptible to imipenem was determined by epidemiological typing using macrorestriction analysis of chromosomal DNA. The strains were isolated between December 2000 and February 2001 from a variety of specimens from nine patients hospitalized in five different departments of the University Medical Center in Ljubljana and in the nursing home. They belonged to seven genotypes or clones (A-G). Six isolates were heterogeneous, with different B-G genotypes. Three isolates had an identical A genotype but it is more likely that this genotype was more prone to develop imipenem resistance than to spread among the patients.

A case of recurrent Candida parapsilosis prosthetic valve endocarditis: cure by medical treatment alone

A patient with recurrent fungal endocarditis on prosthetic mitral valve is presented. Candida parapsilosis was the causative agent. The patient was treated medically with conventional amphotericin during the first episode. When the disease recurred conventional amphotericin B was used again, but had to be stopped because of severe side effects. Treatment was continued with amphotericin B colloidal dispersion, followed by fluconazole for 8 months. The patient is healthy 16 months after discontinuation of fluconazole. Medical treatment of fungal endocarditis on prosthetic valves can be successful in selected cases.

Sequential treatment of deep fungal infections with amphotericin B deoxycholate and amphotericin B colloidal dispersion

Amphotericin B colloidal dispersion (ABCD) is a novel lipid formulation of amphotericin B designed to diminish toxic effects of the drug. In the following report, nine cases of suspected (n = 4) and proven (n = 5) deep Candida infection, treated sequentially with amphotericin B deoxycholate and ABCD, are presented. The treatment was successful in seven cases. During treatment with amphotericin B deoxycholate, a rise in serum creatinine was observed in seven patients, hypokalemia in five, and metabolic acidosis in four. After replacing amphotericin B deoxycholate with ABCD, laboratory parameters improved in four of the seven patients with increased creatinine, in four of the five patients with hypokalemia, and in two of the four patients with metabolic acidosis. Infusion-related rigors were observed in four patients receiving amphotericin B deoxycholate and in one patient treated with ABCD. Reversible elevation of liver enzymes was found in one patient receiving ABCD. In this study ABCD proved less toxic than amphotericin B deoxycholate. The efficacy of ABCD alone cannot be assessed because of previous treatment with amphotericin B deoxycholate, but sequential treatment of deep Candida infections with amphotericin B deoxycholate and ABCD seems to be an effective therapeutic modality, especially in patients requiring prolonged administration of amphotericin B.

Influence of ceftriaxone on emergence of Clostridium difficile

The influence of long-term ceftriaxone administration on the emergence of Clostridium difficile was studied with 80 patients receiving ceftriaxone for 14 days. In five patients (6.3%) C. difficile was cultured. The appearance of gastrointestinal disturbances during treatment with ceftriaxone was common, but the rate of emergence of C. difficile in immunocompetent patients was not high.