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Zusammenfassung Es wird eine Methode zur quantitativen Bestimmung von Sprospilzen im Rachengurgelwasser, Sputum, Stuhl und Urin beschrieben. Sie ist fur die Routineuntersuchung geeignet, da sie einfach durchzufuhren ist und die Ergebnisse bereits nach 24 Stunden vorliegen. Die Methode kann kritische Sprospilzkonzentrationen erfassen und dient somit der mykologischen Uberwachung von immundefizienten Patienten. Summary: A method for the quantitative determination of yeasts in throat washings, sputa, faeces and urine specimens is described. It is useful for routine examination because of its simple practicability and because of the availability of the results after 24 hours. This method is supposed to render critical yeast cell concentrations and consequently serves to the mycological control of risk patients.

A case of fasciitis with eosinophilia and hypergammaglobulinaemia (Shulman's syndrome) in a 33-year-old patient is described. Both the lower arms and the lower legs were affected. The diagnosis was established by biopsy which revealed cellular infiltration of the deep fascia with thickening. In addition to typical symptoms there was hepatosplenomegaly. Gastrointestinal or haematological disease was excluded. Under systemic corticosteroid administration all symptoms of fasciitis quickly disappeared.

To identify the characteristic features of lues in patients infected with HIV, 402 HIV-positive patients were examined for serological and clinical signs of lues. 141 patients (133 male, 8 female, mean age 36 [18-69] years) had a positive lues serology. Treatment for lues was required in 20 of the 141 cases (14%). In ten patients (one case of lues I, nine cases of lues II) dermatological signs were predominant, macular exanthemas (n = 4) and palmo-plantar syphilides (n = 3) being most frequent. Three patients had seropositive latent lues. Eight patients presented with signs of an active neurolues (lues II: n = 1; lues III: n = 6; lues IV: n = 1). In three of the eight cases the serum FTA-ABS-IgM findings were negative. In these three patients the need for a specific treatment was realized only on the basis of cerebrospinal fluid (CSF) examination in conjunction with the clinical findings and the anamnesis. This result makes it very clear that indication for CSF puncture should be more liberal in some HIV infected patients. The markedly high proportion of cases of neurolues (40% of the luetic patients requiring treatment) is possibly due to reactivation of old lues infections.

Candidose, cryptococcosie, and histoplasmosis often occur as HIV-associated mycoses. However, aspergillosis can be observed quite recently. The morphology of the pathogen of HIV-associated mycoses in vivo and in vitro is demonstrated and discussed

In a prospective study, 29 patients were observed over a period of 42 weeks for signs of oral candidosis (OC), immunological parameters and other typical AIDS-related events. Before the study started, no OC was observed in any of the patients. During the observation period, OC was diagnosed in 12 of the 29 patients (41%). 5 of these 12 patients (42%) developed full-blown AIDS during the 42 weeks. In contrast, a progression to AIDS was observed in only 1 of the 17 patients (5.9%) without OC. The laboratory findings for patients with and without OC showed statistically significant differences for neopterin (23.6 against 14.4 nmol l-1), CD4 counts (417 against 763/mm3) and CD4/CD8 ratios (0.45 against 0.85). Based on these results, it seems justifiable to consider prophylactic measures such as pentamidine inhalation and/or treatment with zidovudine in HIV-infected patients with immunodeficiency and occurrence of OC.

Summary. A livid, sharply defined enanthema of the oral mucosa with ulcerations on the soft palate in a patient presenting with de novo acute myeloid leukaemia with prolonged, therapy-induced granulocytopenia (lt 0.5 nl-1 for 113 days!) was diagnosed as geotrichosis. Geotrichum capitatum was identified both in vivo and in vitro. Pneumonic infiltrates in the upper lobes of both lungs were treated with amphotericin B infusions. Healing of the aforementioned enanthema was only achieved after addition of 5-fluorocytosine to therapy. Susceptibility determinations with several Geotrichum capitatum isolates led to the conclusion that amphotericin B was unsuitable as a therapeutic agent in this case. 5-Fluorcytosine and itraconazole exhibited superior antifungal and antimycotic activity. Zusammenfassung. Ein livides, scharf begrenztes Enanthem der Mundschleimhaut mit Ulzerationen am weichen Gaumen bei einer de novo akuten myeloischen Leukamie mit extrem langer, therapiebedingter Granulozytopenie (lt 0.5 nl-1uber 113 Tage!) wird als Geotrichose angesehen. Geotrichum capitatum wurde in vivo und in vitro nachgewiesen. Pneumonische Infiltrate in beiden Lungenoberlappen waren Anlas zu einer Infusionstherapie mit Amphotericin B. Eine Abheilung des obengenannten Enanthems wurde allerdings erst nach Umstellung der Therapie auf 5–Fluorcytosin-Infusionen erzielt. Resistenzbestimmungen mit mehreren Isolaten hinterliesen den Eindruck, das Amphotericin B als Therapeutikum hier nicht geeignet war. 5–Fluorcytosin und Itraconazol zeigten einen besseren antimyzetischen Effekt und antimykotische Wirksamkeit.

Das humane Herpesvirus 8 wurde erstmals 1994 in Biopsien eines Kaposi-Sarkoms (KS) nachgewiesen [2], nachdem vorher bereits epidemiologische Hinweise auf einen Infektionserreger bei dieser Erkrankung diskutiert worden waren [1]. Inzwischen mehren sich die Indizien fur die Bedeutung von HHV-8 bei der Entstehung eines KS. So ist mit hoher Sicherheit HHV-8 DNA in Biopsien von alien Formen des KS nachweisbar, sowohl in der epidemischen, HIV-assoziierten Form wie in der sporadischen bzw. der in manchen Gegenden endemischen Form wie auch in der iatrogen, z. B. durch Immunsuppression nach Nierentransplantation induzierten Form [8]. Der Verlauf der HIV-assoziierten Variante ist jedoch deutlich schwerer als der ubrigen Varianten, so das andere Faktoren ebenfalls eine Rolle zu spielen scheinen [3]. In retrospektiven Studien konnte gezeigt werden, das eine HHV-8 Infektion dem Auftreten eines KS vorausgeht [9]. Die Durchseuchung mit HHV-8 in definierten Kollektiven ahnelt dem Risiko fur die Entwicklung eines KS. In einer neuen Studie konnte auch gezeigt werden, das solche Patienten, die zum Zeitpunkt der HIV-Serokonversion bereits HHV-8 infiziert waren, einen viel milderen Verlauf zeigen als solche, die erst bei HIV-positivem Serostatus einen Erstkontakt mit HHV-8 hatten [12].

The unusual case of an oesophagitis caused by Candida kefyr in a patient with squamous cell carcinoma of the oropharynx is reported. The further implementation of C. kefyr in the production of milk products is discussed.

More than 400 cases of acanthosis nigricans maligna (ANM) and 23 cases of "florid cutaneous papillomatosis" (FCP) were published. ANM is an obligatory paraneoplastic symptom. A 28-year old female patient with an adenocarcinoma of the stomach presented with ANM. We review the number and types of associated cancer with ANM. In most cases and adenocarcinoma of the gastrointestinal tract has been present. We feel that FCP is not an entity of its own but a variant of ANM; the literature supports this view.

Introduced in 1979, isotretinoin remains a major advance in acne therapy. Both hospital- and community-based dermatologists have experience with this valuable drug, which, owing to its causal principle of action, offers a large proportion of patients the prospect of a cure. Isotretinoin is now in use in more than 80 countries and has been prescribed for some six million patients. Based on accumulated clinical findings with the drug, more comprehensive recommendations can now be made with respect to indications, dosing and duration of treatment than was possible when the drug was launched. Experience with the drug also provides a basis for reevaluating its safety profile. Finally, at a time when healthcare resources are limited, it is important to examine the cost-benefit ratio of this acne treatment versus other options. This paper is accordingly intended to provide a critical status report as well as a detailed and balanced set of recommendations for clinical practice.

Background: Kaposi’s sarcoma (KS) is the most frequent neoplasm in patients with AIDS, responsible for death in about 20–30% of the affected patients. Objective: To determine the frequency of opportunistic infections (OI) and change of CD4+ cell counts in patients with KS treated with chemotherapy compared to a group of matched-pair patients without chemotherapy. Methods: In a prospective study, the clinical courses of 35 HIV-infected patients with KS treated with chemotherapy were compared with 35 matched-pair patients without chemotherapy. Results: During the observation period of 6 months, 11 OI occurred in 10 patients of the chemotherapy group and 5 OI in 5 patients of the control group. With respect to the changes of CD4+ cell counts, no significant differences could be observed. Conclusion: The risk for OI in HIV-infected patients with KS is increased while receiving chemotherapy. This should be reflected upon when chemotherapy is taken into consideration.

Bacillary angiomatosis (BA) is a rare infectious disease usually associated with HIV infection. Recent molecular biologic investigations confirm that both Rochalimaea henselae and Rochalimaea quintana can cause BA. The bacteria can be identified by Warthin-Starry staining and electron microscopy. The typical clinical signs are solitary or multiple dermal or subcutaneous nodules. Bone, liver, spleen and other organs may also be involved. We describe the clinical and histological features of a 39-year-old HIV-infected patient with cutaneous and bony lesions of BA. All manifestations of BA disappeared during therapy with erythromycin.

We report on a retrospective study in 544 HIV-positive patients, (42 women, 502 men, mean age 35 years) showing CD4 lymphocyte counts below 200 c/mcl or after their cure of Pneumocystis carinii pneumonia, who received 300 mg pentamidine aerosol as prophylaxis against Pneumocystis carinii pneumonia every four week.277 patients were asymptomatic, 120 in the AIDS related complex stage (ARC) and 147 in the full stage of AIDS. The mean follow-up was 14.4 months.A total of 25 cases of Pneumocystis carinii pneumonia was observed (3.83/year): in the primary prophylaxis group 18 (3.25%/year), in the secondary prophylaxis group seven (6.8%/year). By introducing the loading dose (one inhalation per day for five consecutive days for patients with CD4 cell counts below 150 c/mcl) we reduced the percentage of early manifestations within the first three months from 61% to 14%. No extrapulmonary Pneumocystis carinii manifestation was observed.This study supports the efficacy of pentamidine aerosol prophylaxis of primary and secondary Pneumocystis carinii pneumonia.

Bituminous shale, developed from marine sediments during the Jura era, is the raw substance for the production of shale oil. The shale oil undergoes heating, distillation, fractionated refining and sulfonation (according to a patented method) resulting in water-soluble sulfonated shale oils (Ichthyol) for medical purposes. The antifungal effect of sulfonated shale oils have been described earlier. In this study an in vitro method is applied which is based upon the CO2 detection as a measure for the sensitivity of fungi to sulfonated shale oils. In addition to the minimal inhibitory concentration values (MIC values), sub-inhibitory concentrations are also determined. The actual efficacy of these antifungal agents is demonstrated via dose-effect curves. Our results show that the fractions of sulfonated shale oils refined at 150 to 210 degrees C (Ichthyol, dark) are fungicidal in concentrations between 0.2 and 16.8% for yeasts, dermatophytes and other hyphomycetes. The fractions of sulfonated shale oils refined at 85 to 150 degrees C (Ichthyol, light), on the other hand, showed a clearly higher antifungal activity (concentrations between 0.1 and 5.9%) for all fungi tested. An extended exposition (24 to 168 h) of Candida albicans to these fractions resulted in a further increase of fungicidal activity. Due to the complex nature of sulfonated shale oils the chemically defined antifungal substance(s) have not yet been identified.

In a prospective, open, uncontrolled study 25 patients infected with the human immunodeficiency virus with chronic refractory diarrhea and either confirmed cryptosporidiosis (n = 7) or absence of demonstrable pathogenic organisms (n = 18) were treated with a daily oral dose of 10 g of an immunoglobulin preparation from bovine colostrum over a period of 10 days. Among the 7 patients with cryptosporidiosis, this treatment led to complete remission in 3 and partial remission in 2. Among the 18 patients with diarrhea and negative stool culture, complete remission of diarrhea was obtained in 7 and partial remission in 4. In the remaining 2 patients with cryptosporidiosis and the 7 patients with diarrhea but no demonstrable pathogens treatment produced no significant improvement of the diarrhea. Subsequent doubling of the Lactobin dose (2 x 10 g daily) in 8 of the nonresponders led to complete remission in one case and at least partial remission in a further 4 patients. Treatment of refractory diarrhea with 10 g immunoglobulins from bovine colostrum per day constitutes an important therapeutic approach and led to complete (40%) or partial (24%) remission of diarrhea in 64% of the patients described here.

We report the case of a 20-year-old homosexual man with HIV-1 infection presenting with AIDS. An erythemato-squamous, papulo-crustous, non-itching dermatosis of 4 months duration was finally diagnosed as Norwegian scabies in the immunosuppressed. For clinical and epidemiological reasons the high contagiosity of this rare entity requires an appropriate therapy without delay.

Diarrhoea and weight loss are found in more than 50% of patients with the acquired immunodeficiency syndrome (AIDS). In some patients the symptoms can be very severe, leading to death even in the absence of opportunistic infections. In 30% of these patients, enteric pathogens cannot be identified, and approximately only half of the identifiable aetiologic agents of diarrhoea in patients infected with the human immunodeficiency virus (HIV) were treatable with antibiotics. Immunoglobulins from bovine colostrum (Lactobin, Biotest, Dreieich, FRG) contain high titers of antibodies against a wide range of bacterial, viral and protozoal pathogens as well as against various bacterial toxins. Lactobin (LIG) is quite resistant to 24-h incubation with gastric juice. In a multi-center pilot study 37 immunodeficiency patients with chronic diarrhoea [29 HIV-infected patients, 2 patients with common variable immunodeficiency (CVID), one unidentified immunodeficiency, five patients with graft versus host disease (GvHD) following bone marrow transplantation] were treated with oral LIG (10 g/day for 10 days). Good therapeutic effects were observed. Out of 31 treatment periods in 29 HIV-infected patients 21 gave good results leading to transient (10 days) or long-lasting (more than 4 weeks) normalisation of the stool frequency. The mean daily stool frequency decreased from 7.4 to 2.2 at the end of the treatment. Eight HIV-infected patients showed no response. The diarrhoea recurred in 12 patients within 4 weeks (32.4%), while 19 patients were free of diarrhoea for at least 4 weeks (51.3%). In 5 patients intestinal cryptosporidiosis disappeared following oral LIG treatment. LIG treatment was also beneficial in 4 out of 5 GvHD patients. No serious side effects were recorded in any of the treated patients.

A number of in vivo and in vitro results suggest that interferons have an antiretroviral effect on HIV. To check this, 15 HIV-positive patients who had no full-blown AIDS, were treated with recombinant interferon alpha 2b (5 mill. IU s. c. three times a week) over a period of six months. Twelve to 16 weeks after the initiation of treatment, an increase in CD 4 lymphocytes (+16%), NK cells (+16%), lymphocytes stimulation by con A (+ 176%), neopterin (+66%), and beta-2-microglobulin (+19%) was observed. By the end of the study, all these parameters had slightly decreased again. In all patients with CD4 lymphocytes greater than 0.2 c/nl, we observed a decrease in p24 antigen levels, but in patients with CD4 lymphocytes less than 0.2 c/nl, an increase. It would thus seem that any antiretroviral effect of IFN (as shown by the p24 antigen parameter) is more pronounced in patients with superior immune parameters.

To identify the characteristic features of lues in patients infected with HIV, 402 HIV-positive patients were examined for serological and clinical signs of lues. 141 patients (133 male, 8 female, mean age 36 [18-69] years) had a positive lues serology. Treatment for lues was required in 20 of the 141 cases (14%). In ten patients (one case of lues I, nine cases of lues II) dermatological signs were predominant, macular exanthemas (n = 4) and palmo-plantar syphilides (n = 3) being most frequent. Three patients had seropositive latent lues. Eight patients presented with signs of an active neurolues (lues II: n = 1; lues III: n = 6; lues IV: n = 1). In three of the eight cases the serum FTA-ABS-IgM findings were negative. In these three patients the need for a specific treatment was realized only on the basis of cerebrospinal fluid (CSF) examination in conjunction with the clinical findings and the anamnesis. This result makes it very clear that indication for CSF puncture should be more liberal in some HIV infected patients. The markedly high proportion of cases of neurolues (40% of the luetic patients requiring treatment) is possibly due to reactivation of old lues infections.

In 23 patients with HIV-associated Kaposi's sarcoma 53 tumor lesions were treated with fractioned radiotherapy. Indication for the radiotherapy were mostly cosmetic reasons in stigmatizing tumors, but also in several cases pain, oedema or functional deficits as a result of the tumor lesions. 21 patients received orthovoltage irradiation, the remaining four patients were treated with telecobalt therapy. A complete response was observed in 17%, a partial response in 76% and unchanged lesions in 4%. In two cases (4%), both were treated with telecobalt-therapy by large tumor masses, there occurred a further tumor progression inspite of the radiotherapy. In ten lesions, all with partial remission, we later observed a repeated tumor progression. Important side effects were signs of inflammation as mucositis and edema or hyperpigmentation. The occurrence of acute side effects can be reduced by fractionating of the radiotherapy.

Da der Anteil der HIV-infizierten Frauen wahrend der letzten Jahre kontinuierlich zugenommen hat, werden auch Gynakologen immer haufiger mit Fragen hinsichtlich der Diagnostik und Therapie von HIV-positiven Patientinnen konfrontiert.

47 HIV-positive male patients with cutaneous Kaposi's sarcoma (KS) were treated with recombinant interferon alpha-2A (IFN) in an open, prospective study. 45 patients received 18 million I.U. IFN s.c. daily for the first three months. From the fourth month, the patients received 18 million I.U. IFN s.c. three times weekly. Four of the 45 patients withdrew from therapy because of side effects during the first weeks (weeks 2 to 6) of treatment. The remaining 41 patients were treated for a minimum period of two years or until their death. Two further patients received 36 million I.U. IFN daily for three months. After three months of IFN therapy we observed complete remission (CR) in five of the 41 patients (12%), partial remission (PR) in seven patients (17%), stable disease in seven patients (17%) and progressive disease (PD) in 22 patients (54%). The mean survival time from the beginning of IFN therapy to date is 26 months for the 19 responders (patients with CR, PR or SD; six are still alive) and nine months for the 22 non-responders (patients with PD; all died). Recurrence of tumor progression occurred in 15 of the 19 responders after an average of ten months of continuous IFN therapy. The longest time of survival in this group is 54 months up to now. Of the four remaining patients, all in the CR group, two died after 24 and 26 months of IFN therapy, without any recurrence of KS growth (causes of death: Burkitt's lymphoma and unknown). The two other patients, both still alive, have not suffered any recurrence of tumor progression after 40 and 41 months, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The pathogenesis of the HIV associated Kaposi's sarcoma is still unclear, but it appears to be a multifactorial process. Different investigations have shown, that cytokines and growth factors influence the development of KS. Several cases with tumor manifestation after irritation of the skin are demonstrated. Therefore a mechanism of development comparable with the Koebner Phenomenon can be postulated.

Acid-soluble calf collagen was modified by succinylation, methylation or deamination. These modified collagens showed no loss of serologic activity when investigated with antibodies detecting three distinct groups of antigenic determinants on unmodified collagen. A single antiserum exhibiting a very rare specificity did not, however, react with methylated collagen. Treatment of collagen with strong alkali which results in a complete deamidation and probably also in a removal of terminal peptide sequences caused the destruction of the protease-labile antigenic determinants but had no effect on the other. In rabbit antisera to methylated or succinylated collagen mainly antibodies specific for the modified collagen were detectable. These antibodies are adapted to haptenic structures since they could be effectively inhibited by γ-methyl glutamic acid and succinylated ε-amino caproic acid, respectively. In antisera to deamidated collagen, antibodies of this kind could not be demonstrated.

Rabbit antisera prepared against collagens from carp and two invertebrate species were fractionated using an immunoadsorption technique. The two antibody fractions, one with and one without affinity for the rabbit collagen immunoadsorbent, were investigated for cross-reaction with various collagens derived from mammalian, fish and invertebrate species by hemagglutination and hemagglutination-inhibition studies. The antibody fractions without affinity for rabbit collagen, representing the main fractions, reacted only with the kind of collagen used for immunization or, to a smaller extent, with collagens from closely related species. The second type of antibody fractions (with affinity for rabbit collagen) exhibited cross-reaction with all the collagens investigated.

A report is given on a progeroid disease affecting three brothers, 11, 13, and 14 years old. The difficult differential diagnosis of such progeroid syndromes is discussed. The clinical signs were mostly consistent with Werner's syndrome. Since some of the symptoms of this disease were not present, probably because of the young age of the patients, this progeroid syndrome was classified as Werner syndrome-like. Electronmicroscopic findings of the patients skin showed changes of the blood vessels and nerves, which were until now not described in Werner's syndrome or other progerias. The latter findings may give some hints with regard to the pathogenesis of this disease.

This short review deals with the cutaneous manifestations of the acquired immune deficiency syndrome (AIDS), which comprise Kaposi's sarcoma, as an important marker disease for AIDS, as well as various skin infections caused by bacteria, fungi and viruses. In patients at risk of acquiring AIDS, an extensive immunological investigation should be performed if skin infections are established. In addition, a large number of cutaneous complications encountered in AIDS patients have an immunological background, e.g. an extreme hypersensitivity to trimethoprim-sulfamethoxazole. Therefore, the dermatological investigation of patients at risk of acquiring AIDS is urgently recommended as a regular part of the general check-up.

The author presents his personal therapeutic principles with regard to atopic dermatitis using glucocorticoids antibiotics, and antihistamines. The role of diet as well as treatment with evening primrose seed oil are discussed.

Retinoids possess regulatory influences on growth and differentiation of epithelial tissues. They induce a population of keratinozytes with normal pattern of differentiation, they have antiproliferative properties, and they show antineoplastic effects by inhibition of malignant transformation of cells in vitro. Also the dermis undergoes distinct alterations under oral administration of retinoids. By stimulating T-lymphocytes and by inhibition of neutrophil migration retinoids seem to develop immunmodulating and antiinflammatory effects. The aromatic retinoid Etretinate is therapeutically used in severe forms of psoriasis and in various genodermatoses with disorders of keratinization as for example ichthyosis, dyskeratosis follicularis Darier, and pityriasis rubra pilaris.

We present a patient with neuro-trophic ulceration of the forehead and right nostril following the section of the trigeminal nerve because of tic douloureux. The condition is differentiated from basal cell carcinoma. The literature is briefly reviewed.