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A 22-year-old woman, a neurosurgical comatose patient developed suppurative thrombophlebitis of the superior vena cava due to Klebsietta pneumoniae, as a complication of catheterisation for parenteral nutrition. The diagnosis was established by gallium scan, computed tomography and digital vascular imaging. Conservative treatment with antibiotics and heparin resulted in the emergence of a resistant mutant of the causative agent. The infection could only be eradicated after surgical thrombectomy.

Lipid formulations of amphotericin B have demonstrated reduced toxicity compared with conventional amphotericin B desoxycholate, allowing higher daily dosages. Three preparations with entirely different pharmacokinetic properties are currently approved in several countries amphotericin B lipid complex (Abelcet®), liposomal amphotericin B (AmBisome®) and amphotericin B colloidal dispersion (Amphocil®). All three lipid formulations of amphotericin B share a decreased nephrotoxicity even at dosages of 5 mgkg. These drugs may therefore be given successfully in patients intolerant to conventional amphotericin B, although the rates of acute infusion-related reactions may differ between them. Although several animal studies showed a higher therapeutic index, high dosages were needed for treatment to be effective. It is unclear whether and at what dose these formulations would have a better efficacy than amphotericin B in clinical use. In-vitro studies, animal experiments and some clinical data suggest that one should avoid low dosages (1 mgkg) of the current lipid formulations in the initial treatment of acute fulminant fungal infections, because the efficacy may be inferior compared with equal dosages of conventional amphotericin B. A final judgement of the clinical efficacy and relative total cost of treatment with each individual formulation can only be made by direct comparative, clinical and pharmacoeconomic studies.

The clinical features and management of eight patients with parapharyngeal space infection who presented with swelling of the neck subsequent to sore throat are described. In four patients the interval between the initial throat symptoms and swelling was 2 days or less, and the disease was rapidly progressive with stridor or a descending mediastinitis. In the other four cases, this interval was longer (4 to 14 days) and the infection was fairly localized. Computed tomography was useful for making the diagnosis, establishing that the infection had spread into other deep neck spaces and the mediastinum, distinguishing abscesses from diffuse cellulitis, guiding drainage aspiration, and assessing the reponse to therapy. None of the patients underwent extensive surgical drainage of the deep neck spaces. A nonsurgical approach with antibiotics, including high doses of benzylpenicillin, and computed tomography-guided selective needle aspirations proved successful. Even patients with distinct abscesses were completely cured.

Case histories of 692 patients with meningococcal disease due to serogroup B, C, or W (W-135)were reviewed to study the association of the serotypes 2a and 2b with the course of disease. The case-fatality rate in group B disease was significantly associated with serotype 2b (B:2b) strains (P = 0.03). Age and year of admission did not account for this association. Septicemia was also found more frequently with B:2b than with other B serotypes, but neurological complications and sequelae were not. Neither C:2a nor W:2a was associated with a higher case-fatality rate, with more cases of septicemia, or with more sequelae than were other C or W serotypes. We concluded that the 2b antigen, although not likely a causal factor, is a virulence marker among group B strains and that the protective effect of a vaccine containing this protein (among others) needs to be studied.