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Screening for cell-mediated immunity in children.

Skin testing and in vitro lymphocyte blastogenesis with Monilia and tetanus toxoid were examined as methods of screening cell-mediated immunity (CMI) in infants and children. With increasing age, all assays were more likely to be positive. Tetanus toxoid was a better single screening antigen than Monilia, particularly for young infants. Combining all assays, at least one was positive in 88% of children over 6 weeks of age. Combining the two skin tests, at least one was positive in 73% of children in the same age range. Results for the blastogenic assays indicated that this in vitro test is more sensitive than the in vivo skin test for demonstrating CMI to these two antigens. Infants with documented histories for Monilia diaper rash had a significantly higher probability of having a positive skin or blastogenic reaction with Monilia.

Age Factors↗

[Microbiological study of dehydrated garlic (Allium sativum L.) and onion (Allium cepa L.)].

A microbiological study during the process and the storage of garlic (Allium sativum L.) and onion (Allium cepa L.) dehydrated, with the additional barriers of blanching or brine immersion, was made. In all raw materials the average counts of aerobic mesophilic bacteria expressed in CFU/g ranged from 1.2 x 10(2) to 1.6 x 10(3), molds and yeasts from 60 to 1.6 x 10(3), Lactobacillus spp. and Leuconostoc mesenteroides subsp. mesenteroides between 10 and 50. Microorganisms identified were Penicillium spp., Monilia spp., Lactobacillus brevis, Leuconostoc mesenteroides subsp. mesenteroides and yeasts in garlic; Mucor spp., Penicillium spp., Monilia spp., Lactobacillus brevis and yeasts in both types of onions. Leuconostoc mesenteroides subsp. mesenteroides was detected in only kind of onion. In dehydrated garlic storage, Penicillium spp., Monilia spp., Lactobacillus brevis and yeasts were detected. In garlic, when a blanching step was carried out no microflora was detected. Mucor spp., Penicillium spp., Monilia spp. and Lactobacillus brevis were identified in both types of dehydrated onions. When brine immersion was included the microflora detected was significantly lower and only Penicillium spp. were found. The use of additional barriers such as blanching or brine immersion produces an important effect on the microbiological stability in these products.

Bacteria↗

Chronic mucocutaneous candidiasis with macrophage dysfunction, a plasma inhibitor, and co-existent aplastic anemia.

A 56-year-old man developed chronic mucocutaneous candidiasis (MCC) and pernicious anemia. Nine years later he developed aplastic anemia which ultimately was fatal. A small thymoma was found at autopsy. He was anergic and his mononuclear leukocytes (MNL) failed to undergo a proliferative response in culture to soluble antigens. His monocytes did not mediate a proliferative response by lymphocytes from sensitized control donors when stimulated with Monilia albicans antigen but did mediate a mixed leukocyte reaction normally. His plasma contained a poten inhibitor of -3H-thymidine incorporation by sensitized control MNL when stimulated with soluble antigens but was not inhibitory of the mixed leukocyte reaction, lymphoproliferative responses to plant mitogens, and was not shown either in vivo or in vitro to depress hematopoiesis. Patient lymphocytes were responsive to plant mitogens, Monilia antigen, in the mixed leukocyte reaction, and produced macrophage migration inhibitory factor in response to Monilia antigen. After plasmapheresis, delayed hypersensitivity and lymphoproliferative responses to soluble antigens were temporarily restored. This case implicates the macrophage in the pathogenesis of MCC and demonstrates some consequences of chronic monocyte dysfunction. The inhibitor of some expressions of cell-mediated immunity was removed by plasmapheresis.

Aged↗

[Study of the susceptibility of black yeasts of the Exophiala genus to antifungals using the Sensititre System].

Black yeasts belong to a group of dematiaceous fungi which are difficult to classify and identify. One of the genera that cause human infection, mainly phaeohyphomycosis, is Exophiala, which includes the species E. berger, E. castellanii, E. dermatitidis, E. jeanselmei, E. lecanii-corni, E. moniliae, E. pisciphila, E. salmonis and E. spinifera. We carried out a susceptibility study of five of these species (E. castellanii, E.dermatitidis, E, jeanselmei, E. lecanii-corni and E. moniliae), isolated from cutaneous exudates, to the usual antimycotic agents. Strains were cultured on Sabouraud agar and potato-dextrose agar. Species identification was made by conidiogenous microscopic observation and the following characteristics: maximum growth temperature, tolerance to cicloheximide and carbohydrate assimilation. Susceptibility to antimycotic agents (amphotericin B, fluconazole, itraconazole, ketoconazole and 5-fluorocytosine) was determined by the Sensititre YeastOne (Aamar Blue) commercial method. Amphotericin B activity was good for the five tested species, although the MIC for E. jeanselmei was high (1 mg/l. MICs for fluconazole were high for all the species, but only E. moniliae and E. lecanii-corni c be considered resistant. Activity of itraconazole, ketoconazole and 5-fluorocytosine was good.

Antifungal Agents↗

[Hypersensitivity to "Candida albicans" and other fungi in patients with chronic urticaria].

Considering the high incidence of chronic urticaria among female patients and the frequent difficulty in identifying the etiologic factor of factors the author decided to investigate the possible role of Candida albicans and other yeasts usually found as contaminants in certain foods and beverages or purposely cultivated for industrial products, as the sensitizing agents leading to the clinical picture of chronic urticaria. One hundred female patients with urticaria which had persisted for more than 6 weeks were selected and investigated, disregarding those with dermographism or cholinergic and cold urticaria. Aside from a careful history and laboratory tests to complement the physical examination that could rule out chronic bacterial infectious foci, intestinal parasitic infestation and thyroid disorders, intradermal skin tests with standard doses of Candida albicans and Saccharomyces cerevisiae and other common environmental and food allergens were done. The patients' age ranged from 4 to 70 years. The skin tests sites were examined for Type I reactions at 15 and 20 minutes; for Type III reactions at 8 and 12 hours; and for Type IV reactions at 48 and 72 hours. When tested with Candida albicans antigen, 35% had Type I/III reactions and 60% presented Type IV reaction. When Saccharomyces cerevisiae antigen was used for testing, 29% had Type I/III reactions and none presented Type IV. Forty-nine of the sixty patients who presented Type IV reaction to Candida albicans had in the past significant vaginal discharge (or vaginal symptoms: burning, itching) that obliged the patients to consult a gynecologist, but only ten had stained smears and cultures from the vaginal secretions and four were told to have a monilia vaginal infection confirmed by the microbiological tests, although forty of them received Nistatin therapy at the time of the gynecological complaints. At the time the patients were seen by the allergist, complaining about urticaria, only four had symptoms and signs of monilia infection and were confirmed by culture: one presented oral moniliasis following broad-spectrum antibiotic, two had vaginal moniliasis developing right after their menstrual period; one had intestinal and cutaneous manifestations (perineal and crural) developing also after broad-spectrum antibiotic therapy. All the four patients had exacerbation of the urticaria while undergoing the monilia infection. After 1-2 weeks of elimination diet, each patient was challenged with yeasts-containing foods (bread, buns, sausages, beer, wines, grapes, cheese, vinegar, tomato catsup). Twenty-five patients (71%) of the group who positively reacted with a Type I/III reaction when tested with Candida antigen, showed a positive provocation test (reappearance of urticaria) and twenty patients (69%) of the group who reacted with Saccharomyces had a positive challenge test...

Adolescent↗

Postchemotherapy esophagitis: the endoscopic diagnosis and its impact on survival.

Eighteen cancer patients receiving intensive chemotherapy developed leukopenia, fever, dysphagia, and oropharyngeal soreness. Superficial esophageal ulceration suggestive of esophagitis was demonstrated by radiographic examination in 33% of the patients (5/15). Upper gastrointestinal endoscopy revealed superficial ulceration and white mucosal patches in all patients. There was no morbidity associated with the endoscopic procedures. Sixty-one percent of the patients (11/18) had monilia albicans cultured from the oropharyngeal cavity, and 50% (9/18) had monilia cultured from the esophageal lesions. The evolution of the esophagitis correlated well with the survival of the patients. The monilial esophagitis persisted in six patients who all died within 24 days of systemic moniliasis. After initial improvement five additional patients succumbed; three of them from severe fungal infection. There was resolution of the esophagitis in the remaining seven patients who survived longer. However, two of them had recurrent monilial esophagitis and succumbed to systemic candidiasis. The other five have remained free of esophagitis, their underlying malignancies have remained under control, and so far they have survived an average of one and a half years. Endoscopy is more accurate than radiography in detecting postchemotherapy esophagitis. This complication can be fatal, since it is often followed by systemic candidiasis.

Adult↗

Fungi in bathwater and sludge of bathroom drainpipes. 1. Frequent isolation of Exophiala species.

Samples of bathwater from 14 homes and 22 public bathhouses and sludge in drainpipes from 19 household bathrooms were plated out onto potato dextrose agar supplemented with chloramphenicol. Several media were used to study colony morphology of the isolates and the thermotolerance and alkaline tolerance of each isolate were examined. Eleven sludge samples produced 12 isolates of Exophiala jeanselmei, 2 of E. dermatitidis and 1 of E. moniliae. Five household bathwater samples produced 2 isolates of E. jeanselmei, 4 of E. dermatitidis and 1 of E. alcalophila. One isolate of E. jeanselmei, 2 of E. dermatitidis, 3 of E. moniliae and 2 of unidentified Exophiala species were recovered from 6 samples of the bathwater dissolving 'Chinese medicine' in the bathtubs of public bathhouses. One isolate of E. jeanselmei was recovered from the 15 samples of bathwater from public bathhouses. Bathwater and sludge in bathroom drainpipes may be an important habitat of Exophiala species.

Baths↗