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PubMed1992

Immunohistologic diagnosis of systemic mycoses: an update.

Fluorescent antibody, immunoperoxidase and gold-silver staining methods for the rapid and accurate diagnosis of systemic mycotic infections are currently performed in a few specialized laboratories. These methods have proved applicable to formalin-fixed, paraffin-embedded tissues, and are reliable for identifying therein antigens of infectious dimorphic, monomorphic filamentous, and yeast-like fungal pathogens, i.e., Aspergillus spp., Blastomyces dermatitidis, Candida spp., Coccidioides immitis, Cryptococcus neoformans, Fusarium spp., Histoplasma capsulatum, Paracoccidioides brasiliensis, Pseudallescheria boydii, and Sporothrix schenckii. Most of the available reagents are derived from multiple adsorbed polyclonal antisera. However, problems occur in the production of uniform and standardized species- or genus- specific antibodies. Monoclonal antibodies, although promising, have to date not eliminated these problems. Immunohistologic methods will become more routinely used in clinical laboratories as these problems are resolved and more sensitive and specific reagents become commercially available.

Antibodies, Fungal↗
PubMed1984

Influence of animal hibernation on the development of mycoses.

The development of adiaspiromycosis and trichophytosis depending upon the state of activity of red-cheeked squirrels is described. The conidia of Chrysosporium (Emmonsia) parvum var. crescens, are not transformed into adiaspores when injected into hibernating animals. During the hibernation period of four months, most of the conidia die. After awakening, the remaining viable conidia are transformed into adiaspores. During hibernation the squirrels, which had been infected with Trichophyton mentagrophytes var. granulosum, developed a symptom-free infection.

Animals↗
PubMedDate not supplied

Amphotericin B versus amphotericin B plus 5-flucytosine: poor results in the treatment of proven systemic mycoses in neutropenic patients.

Twenty-eight neutropenic (< 500 granulocytes/microliters) adults with microbiologically or histologically proven systemic mycosis were randomly assigned to receive either amphotericin B alone (0.5 mg/kg/day; n = 14) or amphotericin B (0.5 mg/kg/day) plus 5-flucytosine (150 mg/kg/day; n = 14) intravenously. Therapy was given for an average duration of 10 days in both groups, amounting to a total dose of amphotericin B of 338 mg and 308 mg, respectively. The mean duration of granulocytopenia was 18 days in the amphotericin B group and 20 days in the combination group. Only two patients treated with amphotericin B alone and three given the combination survived. Adverse events were similar in both groups with an elevation of the serum creatinine in six cases during the administration of amphotericin B alone and in seven cases treated with the combination. No other serious adverse events were encountered. Treatment with both regimens was disappointing partly because mycosis was too far advanced by the time therapy was begun and neutrophils were recovered in only half the patients.

Adult↗
PubMed1997

[Importance of mycoses in intra-abdominal infections].

Although there is a 20% yeast colonization in the gastrointestinal tract of the population, fungal infections appear only rarely in secondary peritonitis. The risk of severe mycosis increases after a major operation and when a patient is taking broad-spectrum antibiotics, is on total parenteral nutrition, is catheterized, and/or is immune-suppressed. In the past years the incidence of nosocomial fungal infections (usually Candida spp.) has risen significantly. Five percent of CAPD-related peritonitis is caused by fungi. In enteral anastomosis breakdown, invasive mycosis occurs more often, with an accompanying lethality of up to 80%. In severe pancreatitis, up to 5% of peripancreatic necrosis is infected with fungi. The clinical course of severe mycosis, like the septic syndrome, is associated with fungemia in up to 50% of cases. As most of the facultative pathogenic fungi are part of the physiological flora, it is difficult to interpret mycological cultures. In order to diagnose invasive fungal infections, histopathological techniques and serologic tests for antigens and antibodies are available. Three antifungal agents (amphotericin B, flucytosine, fluconazole) are available for intravenous administration. Amphotericin B is given at doses of up to 1 mg/kg per day, in liposomal galenism up to 3 mg/kg per day. Combining amphotericin B with flucytosine (150-200 mg/kg per day) a synergistic effect is reached. Fluconazole at a dosage of 200-800 mg per day represents an alternative with similar antifungal activity and lower side effects.

Antifungal Agents↗