Dieter Gröschel

Fungemia due to Torulopsis glabrata in the compromised host

Ten episodes of Torulopsis glabrata fungemia occurring in nine patients with terminal illnesses are described. Eight patients had underlying malignancies and one patient had aplastic anemia. Two episodes of fungemia were considered transient since they were clearly related to the administration of intravenous hyperalimentation (IVH). Most patients were adult women and had solid tumors of the genitourinary tract. Contributory factors were: antibiotic therapy (100%), immunosuppressive drugs (75%), abdominal surgery (63%), IVH (50%), neutropenia (38%), and diabetes mellitus (13%). The clinical course was indistinguishable from a severe bacterial infection. However, endotoxic shock was not observed. The infection was rapidly fatal in four patients. In the remaining five patients, the infection was altered favorably by the discontinuation of infected intravenous hyperalimentation catheters. However, tissue invasion by T. glabrata was found in two of these patients who died shortly thereafter from tumor progression. At autopsy, T. glabrata was identified in tissue sections of the lungs, kidneys, and mucosas of the gastrointestinal and genitourinary tracts. In all cases there was tissue necrosis with a minor inflammatory response consisting of mononuclear cells. To our knowledge, this is the single largest series of T. glabrata fungemia ever reported.

Gas gangrene‐like infection with Bacillus cereus in a lymphoma patient

A patient with a diffuse histiocytic lymphoma developed an infection caused by Bacillus cereus during a period of induced granulocytopenia. A fulminant process resembling gas gangrene developed shortly after the accidental penetration by a small piece of metal into his right hand. Incision and drainage as well as antimicrobial therapy did not prevent the loss of the third, fourth and fifth fingers; however, localization and subsequent control of the infection was achieved concomitant with bone marrow recovery.

Current concepts of bacteremia in children with malignancies.

One hundred fifteen episodes of bacteremia occurred among 2790 children with malignancies hospitalized during a 45‐month period. The mean age was 9.3 years with a male predilection (62%). A greater (p < .025) number of chldren over 10 years of age died with bacteremia when compared to younger children. The majority of episodes occurred in children with leukemia (56%); however, once bacteremia developed, a significantly (p < .05) greater number of children with lymphoma died when compared to children with other malignancies. Absolute polymorphonuclear leukocyte counts were greater in survivors (p < .025) than in children who died. Thirty‐seven different microorganisms were isolated with E. coli, S. aureus, P. aeruginosa, and K. pneumoniae accounting for 50% of the episodes. Anaerobes were isolated from blood of 12 (10%) children. Twelve children had polymicrobial bacteremia and 14 had recurrent bacteremia which occurred during antibiotic therapy. Mortality (78%) in these children was significantly (p < .001) greater then in children from whom one microorganism was isolated (47%). Interesting aspects include the resurgence of S. aureus, failure of development of meningitis in children with bacteremia, and unchanged antibiotic susceptibility since the last review of bacteremia in this institution. Polymicrobial and recurrent bacteremia necessitate obtaining simultaneous and sequential blood cultures to facilitate administration of appropriate antimicrobial therapy until bone marrow function improves.

Amphotericin B Susceptibility Testing of Yeasts with a Bactec Radiometric System

The effect of amphotericin B on CO2 production was studied using a Bactec 225. A radiometric procedure for yeast susceptibility testing that requires 3 h of incubation was developed. A total of 48 yeast isolates was tested in this system and the results were correlated to tube dilution studies. The drug concentration causing at least a 44% decrease in CO2 production correlated to the tube dilution minimal inhibitory concentration in 85% of isolates tested and was within one tube dilution of the minimal inhibitory concentration in over 95% of yeasts tested.

Radiometric Determination of the Concentration of Amphotericin B in Body Fluids

A new assay was developed to determine the concentration of amphotericin B in body fluids. The Bactec radiometric system was used to measure CO2 production by a test strain, Candida albicans MDA 448, in the presence of amphotericin B. After 5-h incubation, drug concentrations as low as 0.2 μg/ml could be detected. The results are comparable to those of the commonly used agar diffusion assay with Paecilomyces varioti.

Radiometric Method for Determining the Susceptibility of Yeasts to 5-Fluorocytosine

A rapid method for determining the susceptibility of yeasts to 5-fluorocytosine by using the Bactec radiometric system is described.