The Journal of infectious diseases
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Seven patients with fungal infections in the bones and joints were treated with ketoconazole. One patient had aspergillosis, two had sporotrichosis, and four had coccidioidomycosis. All of the organisms that were tested demonstrated in vitro sensitivity to ketoconazole. ⋯ Treatment failure may be due to poor penetration of ketoconazole into bone. Ketoconazole will not cure fungal osteomyelitis, but it may be useful in conjunction with surgical debridement. Chronic suppressive therapy with ketoconazole is well tolerated but may not prevent metastatic fungal infection.
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In 1979, an outbreak of plasmid-borne, multiply drug-resistant Vibrio cholerae serogroup O1 biotype El Tor (V. cholerae O1) occurred in the Matlab area of Bangladesh. The outbreak could have resulted from the introduction into the area of a single resistant strain or from multiple conjugations of drug-sensitive V. cholerae O1 with C plasmids in other environmental flora. Resistant strains were phage typed to determine their relatedness, and plasmid studies were conducted to determine the frequency of C plasmids in nonvibrio flora of family contacts of cholera patients. ⋯ Group C plasmids were in nonvibrio strains from five of 36 family contacts of patients with drug-resistant cholera but none of 82 family contacts of patients with sensitive cholera. This outbreak most likely began from the introduction into the area of a single, multiply drug-resistant strain of V. cholerae O1. C plasmids detected in the nonvibrio flora of family contacts probably came from the resistant strain of V. cholerae O1.
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Diarrheal disease was studied prospectively in 35 Peace Corps volunteers during their first five weeks in rural Thailand. Twenty (57%) developed the syndrome of travelers' diarrhea. Recognized bacterial enteric pathogens were isolated from stools during 47% of 39 episodes of travelers' diarrhea. ⋯ Other enteric pathogens, including Campylobacter jejuni/coli, Yersinia enterocolitica, Salmonella, rotavirus, Norwalk agent, and Entamoeba histolytica, were associated with episodes of travelers' diarrhea. Aeromonas hydrophila, isolated from 31% of 39 episodes of travelers' diarrhea, was of unknown pathogenic importance. Thus, episodes of travelers' diarrhea in Thailand were associated with a variety of organisms, among which antibiotic-resistant bacterial enteropathogens were common.