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The clinical course and morphological findings are reported of visceral paracoccidioidomycosis or South American blastomycosis with lung involvement in a 47-year-old male after specific antimycotic treatment for 11 years. The patient had been infected during a stay in São Paulo, Brazil, from 1950 to 1954. The diagnosis was established in 1959 after his return to St. Gall, Switzerland, in tissue from buccal mucosa and cervical lymph node biopsy and in fungus cultures. The patient was treated with Fungizone (amphotericin B) and with the sulfonamide Fanasil. He died in 1970 from acute right heart failure. Autopsy revealed multiple encapsulated mycotic foci in both lungs, together with healed foci and pulmonary fibrosis. Histological examination showed a large amount of Paracoccidioides brasiliensis in the mycotic foci, but cultural proof was no longer possible. In the buccal mucosa and lymph nodes, only fungus-free scars were observed. There are only a few effective antimycotic agents. With a thorough knowledge of their side effects and dosage modalities, it is possible to achieve highly satisfactory results.

The author presents the most frequently observed pulmonary infections due to some opportunistic fungi (yeast, Aspergillus, Mucor). He describes the criterial for a correct diagnosis of pulmonary mycosis.

A 47-year-old man who had undergone gastrectomy for duodenal ulcer required repeated hospitalization due to recurrent fistulas in the region of the laparotomy scar and increased cholestasis and cachexia. An intrahepatic and subphrenic abscess was diagnosed clinically and by liver scan and confirmed by laparotomy. The histologic findings revealed actinomycosis. Through early surgical drainage and administration of 20 million units penicillin G daily it proved possible to discharge the patient completely cured after 2 months. The pathogenesis of liver actinomycosis is discussed.

The relatively high lethality of meningitis is due to the delay in beginning treatment (usually caused by nonrecognition of the disease) and to the greater age of the patient (associated diseases). New aspects of the improvement of the prognosis were not obtained by comparison of various patient collectives a decade apart in our clinic, although an improvement in additional measures such as artificial respiration occurred. The reason lies in veiling by antibiotic premedication. Before beginning antibiotic therapy an exact etiological diagnosis should be made. This objective can only be attained by better training of the physician, including neurology.

In a retrospective study the serological results from 1494 patients with community-acquired pneumonia were evaluated. An infectious etiology was found in about 40% of the cases. The majority of pneumonias was caused by Mycoplasma pneumoniae and by influenza virus type A, whereas Legionella pneumophila was the fifth most frequent pathogen. In the second part of the study, 13 hospitalized patients with community-acquired pneumonia were investigated by the whole panel of routinely used microbial methods. The etiological agent was found serologically in 3 cases and in one case by cultivation. These results suggest that the determination of serum antibodies against pathogens is frequently more useful than is generally assumed, although the yield of positive results is dependent on the epidemiological situation. The detection of elevated complement-fixing titers or specific IgM antibodies often leads to diagnosis from the first serum examined.

Four primarily healthy patients with granulomatous hepatitis during acute cytomegalovirus infection are described. Granulomatous hepatitis associated with cytomegalovirus infection has been described previously in only 7 patients. As the authors have observed 4 such cases within a period of one year, this disease pattern may occur more frequently than was formerly assumed.

The case is presented of a 48-year-old woman who, in association with repeated septic temperatures, developed abscesses in the region of the right shoulder and in the right ankly. Histological examination from excisates revealed caseous tuberculoid granulomas. Mycobacterium fortuitum was isolated from the pus of both abscesses. Although the Mycobacterium fortuitum was resistant to nine commonly used tuberculostatics, it was found to be sensitive to ethionamide and capreomycine. The use of these two drugs in combination with local measures proved successful.

Since therapy of an overt attack of rabies fails, we are completely dependent on prophylaxis. This must be carried out with extreme care. A careful detailed history is the most important, the fundamental question being: was this a provoked or unprovoked attack by the animal? In addition some knowledge of the behavior of different animals towards man is essential. Before every treatment, the question whether it is really necessary must be settled. The help of a veterinary colleague should be called upon in taking the history. A rapid diagnosis can be obtained by fluorescence serology of the dead animal.