Fungal infections of the base of the skull: two case reports.
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Biomedical subjects
Publications and source records attributed to R J Hay.
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This study concerns the use of the indirect immunoperoxidase technique for labelling Aspergillus species in infected human and animal tissues in smears taken from cultures. Specific labelling without serious cross-reactivity with Candida species or Zygomycete fungi was demonstrated using antiserum to Aspergillus. However, it was not possible to distinguish between two Aspergillus species. A fumigatus and A. flavus with this technique. Pretreatment of sections with sodium azide and normal swine serum was effective in eliminating background staining. The method can be used to produce permanently stained sections and has applications in the recognition of hyphal fragments in tissue from infected patients.
A 58-year-old man, who was entering remission from acute monocytic leukaemia, died unexpectedly after five days of fever. Cultures of necropsy material grew the yeast Trichosporon beigelii, and subsequent histological examination showed a widely disseminated infection. This fungus usually causes a localised lesion of the hair shaft (piedra). Deep-seated infections due to Trichosporon spp. have been recorded infrequently and disseminated infections on only five previous occasions. None of these has been from the United Kingdom. This case report describes some of the difficulties of diagnosis.
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The antigenic sites of cultured and invading Trichophyton rubrum can be located by using an immunoperoxidase technique in light and electron microscopy. The cell wall is identified as a major antigenic determinant in both cultured and invading T. rubrum and, in the cultured dermatophyte, other intracellular structures are also shown to be antigenic. The keratin immediately surrounding invading hyphae shows positive staining, suggesting the diffusion of dermatophyte-derived antigens, possibly keratinolytic enzymes.
A preliminary survey of the incidence of histoplasmosis in the eastern Caribbean was carried out. The percentages of positive histoplasmin skin test reactors in the populations studied were as follows: Barbados (4%), Trinidad (42%) and Guyana (29%). In Trinidad 69% of individuals under 60 had positive test. However a lower proportion (4%) had serological evidence of past infection with Histoplasma capsulatum. The organism was not isolated from the soil although it had been found previously in Trinidad. On this island five previously diagnosed cases of histoplasmosis were identified. The study confirmed the presence of the infection in the area and further investigations are suggested.
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A 31-year-old woman with long-standing renal disease, treated with systemic steroids and azathioprine, developed progressive skin ulceration and subcutaneous nodules. A diagnosis of cryptococcosis was established after histological examination of a cutaneous lesion and confirmed by culture of the organism from the biopsy specimen. A detailed description of the histology and ultrastructure of the cutaneous lesion is presented. Treatment with parenteral amphotericin B and 5-fluorocytosine resulted in dramatic resolution of the skin lesions.
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