Unraveling the secrets of Histoplasma capsulatum: a model to study morphogenic adaptation during parasite/host interaction.
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An indirect micro-ELISA system is presented for diagnosing histoplasmosis. The diagnostic criteria are defined by using sera from 12 patients who are histoplasmosis carriers. For this group, the optical density values were superior to 1,000; use was made of 43 sera from blood bank donors and 9 sera from children without a history of exposure. The optical density values in these cases were inferior to 0,200. The significant difference found led to the diagnostic criterion for confirming 3 histoplasmosis carriers who showed clinical manifestations but had been negative to double immunodiffusion. Thus, the usefulness of the proposed micro-ELISA system for early diagnosis was proved.
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In this study, 66 patients with presumed ocular histplasmic maculopathy and in whom the edge of the neovascular membrane was at least 200 micron from the center of the fovea were selected for treatment with argon laser photocoagulation. They were divided into three groups depending on the time elapsed between the beginning of symptoms and treatment with argon laser photocoagulation. The size of the neovascular membrane, the distance from the center of the fovea, and the presence of hemorrhage in the foveal area were also noted. We found that the most important prognostic factor for best final visual acuity was the interval of time between onset of symptoms and treatment. The study showed that 73.3% (22 of 30) of patients with symptoms of short duration (four weeks or less) compared with 17.6% of those with symptoms of long duration (16 weeks or more) retained 6/15 (20/50) or better final visual acuity following argon laser photocoagulation treatment.
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Disseminated histoplasmosis (DH) and progressive multifocal leukoencephalopathy occur in acquired immunodeficiency syndrome (AIDS). At autopsy, DH patients with central nervous system involvement almost always show extensive involvement of the lungs and reticuloendothelial system in addition to the brain, and progressive multifocal leukoencephalopathy is manifest as multiple demyelinating lesions in several locations in the brain. We describe an AIDS patient with a long history of aggressively treated DH who died with DH in the brain only; fungus was not found elsewhere at autopsy. In addition, there was a papovavirus infection restricted to the cerebellum with predominant involvement of the internal granular cell layer; again, demyelinating lesions were not found elsewhere in the brain. Each of these patterns of brain involvement is rare. As the incidence of AIDS increases and patients are treated aggressively, the frequency of unusual neuropathologic patterns of opportunistic infections may be expected to increase.
We report 2 cases of epididymal histoplasmosis. In 1 patient an epididymal abscess was the sole manifestation of histoplasmosis and in the other an epididymal abscess occurred with paratracheal lymphadenopathy. Although uncommon histoplasmosis can cause symptomatic genitourinary tract disease and must be differentiated from tuberculosis, tumors and other fungal and bacterial infections.
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