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Allen W. Tustin, MD; Allen B. Kaiser, MD; Robert W. Bradsher, MD; J. Lynwood Herrington, MD

Arch Intern Med. 1980;140(5):643-645.

Abstract
• Deep-seated fungal infections with unusual clinical courses developed in three previously healthy patients following jejunoileal bypass surgery. Pulmonary blastomycosis disseminated and then relapsed despite repeated courses of amphotericin B in a 40-year-old man; chronic progressive pulmonary histoplasmosis developed in a 38-year-old nonsmoking man; and histoplasmosis of mediastinal nodes became symptomatic in a 32-year-old man. Cell-mediated immunity was evaluated in two patients; no defects were found. However, male patients were found to be at a significantly higher risk of infection than female patients (3/32 vs 0/101; P <.02). A significantly higher percentage of prebypass weight was lost by the infected men than the uninfected men (P <.05). Accelerated weight loss clearly preceded the onset of the infection in two of the patients. Jejunoileal bypass surgery should be regarded as a risk factor for serious fungal infection, especially in men with accelerated weight loss.

(Arch Intern Med 140:643-645, 1980)

Author Affiliations
From the Vanderbilt University Medical Center (Drs Tustin and Kaiser); the Division of Infectious Diseases (Drs Tustin and Kaiser) and Department of Surgery (Dr Herrington), St Thomas Hospital; and the Division of Infectious Diseases, Nashville Veterans Administration Hospital (Dr Bradsher), Nashville, Tenn.

Footnotes
Accepted for publication July 23, 1979.

Reprint requests to St Thomas Hospital, PO Box 380, Nashville, TN 37202 (Dr Kaiser).

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