Tuberculosis osteomyelitis masked by concomitant staphylococcal infection

63 Infectious Diseases Newsletter 11(8) August 1992 1975. Sheikh HA, Mahgoub S, Badi K: Postoperative endophthalmitis due to Trichosporon cutaneum. BrJ Ophathalmo158:591-594, 1974.

Thomas D, Mogahed A, Leclerc JP, Orosgogeat T: Prosthetic valve endocaxditis caused by Trichosporon cutaneum. Int J Cardiol 5:83-87, 1984. Watson KC, Kallichurum S: Brain abscess

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COMMENTS ON CURRENT PUBLICATIONS

Phillips P, Arden D, Radigan G: Nonvalue of antigen detection immunoassays for diagnosis of cand idemia. J Clin Microbiol 28:2320-2396, 1990. This study evaluated the Cand-Tec (Ramco Laboratories, Inc., Houston, TX) and LA-Candida antigen detection system (Immuno-Mycologics, Inc., Norman, OK) tests for the rapid identification of patients with candidemia. Tests were performed on sera from 33 patients with candidemia, 82 patients with fever and risk factors for invasive candidiasis, and 13 heathy controls. All 106 tests performed with the LA-Candida antigen detection system were negative. The Cand-Tec for a threshold positive titer of greater than or equal to 1:4 had a sensitivity of 439% and a specificity of 43%.

Comment This study found that the Cand-Tec was not particularly useful for the detection of candidemia (33 patients) or for the detection of invasive candidiasis (9 patients). There is a great deal of controversy over Candida antigen tests. Clearly, with no positive results, the LA-Candida antigen detection system assay is not useful. The Cand-Tec is more useful although not as useful as previously reported. However, a definitive study in patients with demon-

strated invasive candidiasis remains to be done. It is this group that proves the most difficult to diagnose, because many are not candidemic. Further work on Cand-Tec and additional methods are needed to reliably diagnose invasive candidiasis. CWS

Sinnott JT, Cancio MR, Frankle MA, Gustke R, Spiegel PG: Tuberculosis osteomyelitis masked by concomitant staphylococcal infection. Arch Intern Med 150:1865-1867, 1990.

This study used a systematic bone protocol that included mycobacterial culture over a 14-month period to evaluate patients with chronic osteomyelitis. On examination of 140 bone specimens, four patients were found with unsuspected tuberculous osteomyelitis. Each was culture positive for M. tuberculosis, one also showed granulomas by histological examination. The authors conclude that cryptic tuberculous osteomyelitis can contribute to an infection in association with, and masked by, a concomitant staphylococcal process. © 1992 Elsevier Science Publishing Co., Inc. 0278-2316/92/$0.00 + 3.00

Comment Acute staphylococcal osteomyelitis is somewhat unusual in adults. This study by Dr. Sinnott and colleagues demonstrates that one possible predisposing factor may be occult tuberculous infection of the bone. Adherence to a strict protocol developed by Dr. Sinnott allowed these occult cases of tuberculous osteomyelitis to be diagnosed. Microbiology laboratories should incorporate mycobacterial cultures into their bone culture protocol regardless of what the Gram-stain routine cultures demonstrate. CWS

Kwiatkowski D, Hill AVS, Sambou I, et al: TNF concentrations in fatal cerebral, non-fatal cerebral, and uncorn plicated Plasmodiumfalciparum malaria. Lancet 336:1201-1304, 1990.

This study measured plasma concentrations of tumor necrosis factor (TNF) in 178 Gambian children with uncomplicated malaria due to Plasmodiumfalciparum, in 110 children with uncomplicated malaria due to P. falci-