J Med Vet Mycol, 1993, 31(1), 87 - 9 Cryptococcosis produced by a urease negative strain of Cryptococcus neoformans; Bava AJ et al.; A urease negative strain of Cryptococcus neoformans was isolated form a patient with AIDS . The identification of the yeast was confirmed by physiological and pathogenicity tests . Clinically, the disseminated cryptococcal infection in our patient was identical to those reported in other patients with AIDS. J Med Vet Mycol, 1993, 31(1), 55 - 64 Conditions affecting the adherence of Cryptococcus neoformans to rat glial and lung cells in vitro; Merkel GJ et al.; Conditions affecting the adherence of clinical isolates of Cryptococcus neoformans to rat glial and lung cell cultures were studied . Adherence to glial cells was a time-dependent process that was affected by the yeast culture age and growth temperature . The most adherent yeasts were those from 48 h cultures grown at 37 degrees C . Formalin-treating the yeasts did not affect adherence but formalin-treating the glial monolayers prevented yeast binding . Treating the yeasts with trypsin reduced adherence to glial monolayers, indicating that the yeast adhesin had a trypsin-labile protein component . Certain carbohydrates inhibited cryptococcal adherence to glial and lung cells in a time and concentration-dependent manner . Of the carbohydrates tested, N-acetyl-D-glucosamine, sucrose, lactose, sorbitol and myo-inositol were the most inhibitory, while mannose, galactose and xylose were the least inhibitory . The results collectively indicated that the mechanisms of adherence of C . neoformans to lung cells were similar to those of glial cells and that both involved a protein-containing adhesin on the cryptococcal surface that was expressed only after growth at 37 degrees C . Carbohydrate receptors also appeared to be involved with these interactions. J Infect, 1993 Jan, 26(1), 83 - 6 Disseminated Mycobacterium flavescens in a probable case of chronic granulomatous disease; Allen DM et al.; We report the case of a diabetic Chinese male with no previous history of recurrent infections . His course was at first notable for relapsing Salmonella blockley infections, following which he developed repeated soft-tissue infections and Cryptococcus neoformans pneumonia . He was diagnosed as having chronic granulomatous disease and was treated with gamma interferon . During the latter stages of his illness he developed Mycobacterium flavescens infection in soft tissues, joints, bones and lung . This is the first report of disseminated M . flavescens infection. Clin Infect Dis, 1993 Jan, 16(1), 54 - 8 Blastomycosis in transplant recipients: report of a case and review; Serody JS et al.; Fungi cause serious, often fatal infections in immunocompromised hosts . Recipients of solid organ and bone marrow transplants are predisposed to invasive fungal infections with Candida species, Aspergillus species, and Cryptococcus neoformans . In contrast, infections with Blastomyces dermatitidis have rarely been diagnosed in transplant recipients . We describe a patient who received an orthotopic heart transplant and developed recurrent disseminated blastomycosis . Other reported cases of blastomycosis in transplant recipients are summarized . Clinical presentation, treatment options, and morbidity associated with infections with B . dermatitidis in transplant patients are reviewed. Can J Microbiol, 1993 Jan, 39(1), 129 - 33 Mannosyl transfer in Cryptococcus neoformans; White CW et al.; A particulate enzyme preparation from Cryptococcus neoformans transferred the mannosyl residue from GDP-mannose to an acceptor consisting of a commercial preparation of methyl 3-O-alpha-mannopyranosyl-alpha-mannopyranoside (containing 10% 2-O-alpha-mannopyranosyl-alpha-mannopyranoside) . The configuration of the new bond was alpha by its susceptibility to alpha-mannosidase; the amount of product was dependent on the concentration of enzyme, of GDP-mannose, and of acceptor . The optimal temperature and pH were 37 degrees C and 7.0, respectively . Manganous ion was required for activity and acetyl coenzyme A was stimulatory . Studies suggested that dolichyl phosphate intermediates were not involved in this mannose transfer . The fact that none of the several acapsular mutants tested were deficient in this mannosyltransferase suggested that this enzyme was not involved in synthesis of backbone mannan linkages in capsular polysaccharide . NMR analysis of the methylmannotriose product showed only alpha(1-->2) linkages between sugar moieties . This mannosyltransferase evidently extends alpha(1-->2) mannan by adding another alpha(1-->2)-linked mannosyl residue . Its activity is appropriate for a role in synthesis of "high mannose" oligosaccharide moieties of glycoproteins. Thorax, 1993 Jan, 48(1), 75 - 8 Diagnosis of pulmonary cryptococcosis by ultrasound guided percutaneous aspiration; Lee LN et al.; BACKGROUND: Ultrasound is useful for locating thoracic lesions and guiding biopsy procedures . The use of sonographic appearances and ultrasound guided needle aspiration has led to the diagnosis of pulmonary cryptococcosis at this hospital . METHODS: Six hundred and eight patients who had ultrasound guided lung aspirations were reviewed retrospectively and nine with documented pulmonary cryptococcosis were collected . All patients had nodules or infiltrates on the chest radiograph . The needle aspirates obtained under ultrasound guidance were stained by Riu's or Papanicolaou's method or with India ink, and six were sent for culture . Five patients also underwent bronchoscopy and biopsy . RESULTS: The nine patients had 18 pulmonary lesions, of which 15 were nodules and three infiltrates . Fifteen lesions were detectable by ultrasound, which showed the nodules to be hypoechoic with eccentrically located air echoes . In eight of the nine cases cryptococci were detected after the lung aspirates had been stained with Riu's or Papanicolaou stain or with India ink . In five of the six aspirates sent for fungal culture Cryptococcus neoformans was isolated . The diagnostic yield was higher than that of bronchoscopy . None developed post-aspiration pneumothorax or any evidence of late dissemination . CONCLUSIONS: Because they tend to be subpleural pulmonary cryptococcal lesions seem to be identifiable by ultrasound . Ultrasound guided lung aspiration is an effective, rapid, and safe method for diagnosis. Ann Pharmacother, 1993 Jan, 27(1), 53 - 60 Antifungal prophylaxis in immunocompromised hosts; Reents S et al.; OBJECTIVE: To review the literature on the efficacy and safety of antifungal agents for prophylaxis of fungal infections in populations of immunocompromised hosts (key words: hematology-oncology, surgical, solid organ transplant, HIV infection), and to develop guidelines and recommendations regarding safe and effective drug regimens for antifungal prophylaxis in this patient population . DATA EXTRACTION: Comprehensive review of clinical trials of antifungal prophylaxis published in the English literature, with an emphasis on controlled trials, and discussion of key clinical trials illustrating efficacy and safety of agents for antifungal prophylaxis in immunocompromised patients . RESULTS: Much of the clinical data evaluating the efficacy and safety of antifungal prophylaxis has been generated in cancer patients . The choice of antifungal agent for prophylaxis in this population remains controversial . However, azole compounds such as clotrimazole, ketoconazole and fluconazole appear to be more effective and better tolerated than nystatin suspension . Although ketoconazole has been shown to reduce fungal colonization in surgical patients, current data do not support the routine use of antifungal prophylaxis in this population . In renal transplant recipients, clotrimazole troches have been shown to be more effective than placebo or nystatin suspension . Selective bowel decontamination with nonabsorbable antibiotics and nystatin may be useful in reducing Candida colonization in liver transplant patients but no definitive recommendations may be made at this time regarding optimal antifungal prophylaxis in these patients . In patients with advanced HIV disease or history of prior fungal disease prophylaxis for oropharyngeal candidiasis is indicated, although the agent of choice remains controversial . Fluconazole is the drug of choice for prevention of relapse of cryptococcal meningitis in patients with AIDS . Finally, only limited data exist assessing the relationship between local colonization and systemic fungal infection . Adverse effects associated with antifungal prophylaxis, generally limited to nausea and vomiting and transient elevations in hepatic transaminases, occur with similar frequency among available oral or topical agents . However, the incidence of nausea and vomiting with resultant poor patient tolerance and compliance is usually higher with nystatin . CONCLUSIONS: Based on available data from controlled clinical trials, azole agents are currently the most effective and best-tolerated drugs for antifungal prophylaxis in immunocompromised hosts . Choice of one agent in this group over another may be dictated by cost . As new antifungal treatments are released onto the market, these drugs should be compared with existing agents in controlled clinical trials . Future studies should be designed to evaluate the relationship between local colonization and disseminated infection. J Infect Dis, 1993 Jan, 167(1), 186 - 90 Regulation of cryptococcal capsular polysaccharide by iron; Vartivarian SE et al.; Iron is tightly controlled in mammalian tissues and regulates virulence factors in various pathogenic organisms . The influence of Fe availability upon production of cryptococcal capsular polysaccharide was studied . Polysaccharide, measured as cell-bound glucuronyl residues, increased more than threefold as available Fe in the culture medium was varied from repletion to tight sequestration and depletion in five incremental steps . Since physiologic CO2 concentration may serve as stimulus for cryptococcal polysaccharide synthesis, the combined effect of Fe availability and CO2 on encapsulation was studied . Addition of dissolved, loosely chelated Fe moderated the effect of CO2 . Tight chelation of dissolved Fe potentiated the CO2 effect . Tissue from infected mice showed heavily encapsulated organisms, consistent with results with physiologic CO2 concentration and Fe deprivation . In conclusion, cryptococcal polysaccharide synthesis is increased by limitation of ferric iron availability to the cell and by dissolved CO2, and the two effects are additive. J Clin Microbiol, 1993 Jan, 31(1), 97 - 101 Evaluation of an enzyme immunoassay for detection of cryptococcal capsular polysaccharide antigen in serum and cerebrospinal fluid; Frank UK et al.; The Premier enzyme immunoassay (Meridian Diagnostics, Inc., Cincinnati, Ohio) was compared with a latex agglutination assay (CALAS; Meridian) for the ability to detect cryptococcal capsular polysaccharide antigen (CrAg) in serum and cerebrospinal fluid (CSF) . A total of 594 specimens (471 serum samples and 123 CSF samples) obtained from 430 patients, most of whom were at risk for or had AIDS, were tested in parallel by both systems . Both tests were independently evaluated for their ability to (i) detect CrAg when used as a screening test and (ii) quantitate the CrAg present when used as a titration assay . Chart review to assess clinical outcome after the time of specimen collection was conducted for all patients . When both assays were used as screening assays, 103 serum samples and 18 CSF samples were positive and 356 serum samples and 104 CSF specimens were negative by both assays (97.8% concordance) . Thirteen specimens (12 serum samples, 1 CSF sample) gave discrepant screening results . When the tests were used as semiquantitative assays for titer determinations, the CrAg titers determined by the enzyme immunoassay were generally higher than those obtained with the latex agglutination assay . In summary, results obtained with the enzyme immunoassay correlated well with those obtained with the latex agglutination test for screening for the presence of CrAg and for determining the titer of CrAg in serum or CSF. Virchows Arch B Cell Pathol Incl Mol Pathol, 1993, 64(1), 57 - 66 Ultrastructural study of hepatic granulomas induced by Cryptococcus neoformans by quick-freezing and deep-etching method; Sakaguchi N; The ultrastructure of hepatic granulomas induced by Cryptococcus (C.) neoformans was studied by a quick-freezing and deep-etching (QF-DE) method . Viable yeast cells were inoculated intravenously into rats and the livers were prepared for QF-DE replicas . Two cytoskeletal components were identified in the cytoplasm of macrophages composing the cryptococcal granulomas . These were: intermediate filaments, mainly located in the perinuclear region, and actin filaments, which were extensively decorated with myosin subfragment 1 (S1) and formed networks in the peripheral portion of the cytoplasm . In addition, two types of macrophage pseudopodia were observed in the granulomas . These were cobble stone-like pseudopodia at the yeast-macrophages contract areas, and thin, long and occasionally interdigitating pseudopodia in which actin filaments were consistently observed . Dense networks of actin filaments were also seen in pseudopodia protruding into the tight structure of the capsule of C . neoformans . These results suggest a role for actin filaments as one of the main factors in the force generating system of the phagocytic process. EXS, 1993, 67, 311 - 20 DNA- and PCR-fingerprinting in fungi; Meyer W et al.; DNA-fingerprinting has been successfully used to detect hypervariable, repetitive DNA sequences (minisatellites and microsatellites) in fungi . Combined with methods used to identify random amplified polymorphic DNA (RAPD), conventional DNA-fingerprinting hybridization probes can also be used as single primers to detect DNA polymorphisms among fungal species and strains . The oligonucleotides (CA)8, (CT)8, (CAC)5, (GTG)5, (GACA)4 and (GATA)4, as well as the phage M13 and its core sequence, have been used as specific probes in hybridization experiments and as primers for PCR analysis . Both methods have enabled the differentiation of all the fungal species and strains that were examined, including species of Penicillium, Trichoderma, Leptosphaeria, Saccharomyces, Candida and Cryptococcus . These methods have been used 1) to clarify the taxonomic relationships among relevant species of the Trichoderma aggregate, 2) to discriminate between aggressive and non-aggressive isolates of the rape seed phytopathogen, Leptosphaeria maculans, and 3) to identify strains of the pathogenic yeasts, Cryptococcus neoformans and Candida albicans . PCR-fingerprinting allowed serotypes of C . neoformans to be distinguished . The application of DNA- and PCR-fingerprinting to fungal DNA should aid in clarification of their taxonomy and improved diagnosis of mycotic disease. J Clin Lab Anal, 1993, 7(3), 168 - 73 Dual organism infection in biopsy specimens from immunocompromised patients: two cases demonstrated by immunocytochemistry; Reed JA et al.; We report two cases in which immunocytochemistry demonstrated simultaneous infections within a single biopsy specimen obtained from each of two immunocompromised patients in whom multiple organism infection was not suspected . Using a rapid immunocytochemical technique, Pneumocystis carinii and Cryptococcus neoformans were demonstrated in a transbronchial lung biopsy from the first patient; Candida and cytomegalovirus were demonstrated in an endoscopic biopsy of the esophagus from the second patient . Routine hematoxylin and eosin as well as special stains failed to establish the presence of more than one infectious agent in either case . Mycology cultures ultimately confirmed the presence of Cryptococcus in the first case, but cultures were not performed in the second case due to the scant amount of tissue obtained from the biopsy . The results indicate that concurrent infection by more than one opportunistic organism in immunocompromised patients can easily remain unrecognized . The use of immunocytochemistry may thus provide an important adjunct to routine and special stains or specific cultures. Radiol Med (Torino), 1993 Jan-Feb, 85(1-2), 40 - 8 {Opportunistic infections in AIDS . The pulmonary manifestations}; Scialpi M et al.; The initial and follow-up chest radiographs of 31 patients with the acquired immunodeficiency syndrome (AIDS) were reviewed to assess the spectrum and frequency of opportunistic pulmonary infections . In our series, the most common pulmonary infections seen on chest films were: Pneumocystis carinii pneumonia (PCP) (n = 17), PCP associated with Cytomegalovirus (CMV) (n = 2), PCP associated with Mycobacterium avium-intracellulare (MAI) (n = 1), Mycobacterium tuberculosis (n = 7), CMV (n = 2), MAI (n = 1) and Cryptococcus neoformans (n = 1) . Diffuse or focal interstitial infiltrate is the most common finding in PCP; bilateral focal or multilobar interstitial infiltrates are also frequently observed: they are usually caused by PCP or by PCP associated with CMV . Infiltrating cavitating lesions and multiple interstitial well-defined nodules < 10 mm diameter were seen only in Mycobacterium tuberculosis infections . Normal chest findings and/or pleural effusions were uncommon; no case exhibited pulmonary cysts on initial radiographs . In this retrospective study we emphasize the high incidence of Mycobacterium tuberculosis infections; other pulmonary infections are emerging in AIDS . The X-ray patterns of pulmonary infections in AIDS must be known for a prompt and accurate diagnosis and to plan the appropriate treatment. Nephrol Dial Transplant, 1993, 8(2), 168 - 72 High mortality in systemic fungal infections following renal transplantation in third-world countries; Chugh KS et al.; Amongst 310 recipients of live related renal transplants, systemic fungal infections were observed in 19 patients (6.1%) . These included cryptococcosis in eight (42%), candidiasis in seven (37%), mucormycosis in two (11%), aspergillosis in one (5.5%), and a mixed cryptococcal and Aspergillus infection in one patient (5.5%) . Infections occurred within 12 months of transplantation in seven patients and after 13-37 months in the remaining patients . Prolonged fever not responding to antibiotics was the most common presentation . Central nervous system was involved in all patients with cryptococcosis, while Candida infection primarily involved the urinary tract . Both patients with mucormycosis exhibited signs and symptoms of florid rhinocerebral disease and a rapid downhill course . Pulmonary manifestations were the most prominent features of patients with aspergillosis . Parenteral amphotericin B with or without 5-fluorocytosine was started in all, but three patients could receive the therapy only for 1-3 weeks . Three patients with cryptococcosis developed amphotericin-related complications and were changed to oral fluconazole . Seven patients recovered and 12 (63%) died . None of the patients had cytomegalovirus infection preceding the onset of fungal disease . The high frequency of fungal infections amongst our allograft recipients could not be ascribed to over immunosuppression, since 16 patients (84%) were only on maintenance doses of immunosuppressive drugs and in 13 (68.4%) graft function was normal at the time of diagnosis . The high frequency of fungal infections in our patients was most probably related to the poor hygienic and sanitary conditions which continue to be prevalent in the tropical environment of third-world countries . Delays in the diagnosis and late institution of therapy result in a high mortality.(ABSTRACT TRUNCATED AT 250 WORDS) J Med Vet Mycol, 1993, 31(3), 189 - 99 Differential binding of acapsulate and encapsulated strains of Cryptococcus neoformans to human neutrophils; Richardson MD et al.; Investigations into mechanisms of binding of encapsulated and acapsulate strains of Cryptococcus neoformans by human neutrophils were performed, using a monolayer assay . The two strains bound to neutrophils by different mechanisms although both had an absolute requirement for opsonization with complement components in normal human serum for binding to occur . Neutrophil binding of encapsulated yeasts required conformational changes in actin yet did not appear to lead to phagocytosis of the organism . A maximum of 12 acapsulate cells bound per neutrophil compared with only four encapsulated yeasts . Cytochalasin D treatment reduced the maximum numbers able to bind per neutrophil by 50% . The encapsulated cryptococci appeared to compete with each other for binding to neutrophils whereas the acapsulate yeast cells bound to neutrophils in an approximately Poisson distribution, suggesting independent binding . Binding of acapsulate cryptococci did not require actin filaments and appeared to trigger phagocytosis . Thus, the capsule of C . neoformans appeared to inhibit binding and internalization by neutrophils. Pathology, 1993 Jan, 25(1), 76 - 80 Comparative evaluation of cryptococcal latex tests; Warren RJ et al.; One hundred and seven specimens (24 CSF and 83 sera) from 90 patients were tested for the presence of Cryptococcus neoformans antigen using the Fairfield Hospital in-house latex agglutination technique and the IMMY and Meridian commercial latex agglutination kits . Forty one specimens (14 CSF and 27 sera) from 27 patients with culture-proven cryptococcosis were positive by both the Fairfield and IMMY latex tests . Thirty nine of these specimens were positive by the Meridian latex test . Two were negative . Sixty six specimens (10 CSF and 56 sera) from 63 patients not known to have cryptococcosis were negative by all 3 tests. Mycoses, 1993 Jan-Feb, 36(1-2), 31 - 4 Evaluation of a commercial enzyme immunoassay for the detection of cryptococcal antigen; Sekhon AS et al.; A total of 143 cerebrospinal and serum samples, from proven and suspected cases of cryptococcosis, were concurrently examined using a recently introduced enzyme immunoassay (EIA Premier, Meridian Diagnostics, Inc., Cincinnati, OH, USA) and three latex agglutination (LA) procedures (Immunomycologics, Inc., Norman, OK, USA; IBL, Inc., Cranbury, NJ, USA and a non-commercial LA test) . Of these 143 specimens, 115 were negative for cryptococcal antigen (CrAg) with the EIA and LA tests . The remaining 28 specimens were evaluated by the LA tests, and all were positive for CrAg (with titres ranging from 1:2 to 1:8192) . Of these 28 LA-positive specimens, 26 were also tested by the EIA . This procedure detected CrAg in 23 specimens (88.5%), with antigen levels ranging from 1:4 to 1:266,857 . There were 3 LA-positive specimens (tires 1:4 to 1:32) which were negative by the EIA procedure (10.7%) . One LA-negative specimen demonstrated CrAg (titre 1:30) by the EIA procedure . The sensitivity of the EIA and LA tests was 85.2 and 100%, respectively . The specificity of the LA test was 100%, whereas that of the EIA was 97% . The agreement among laboratories for testing the specimens with the three LA tests was 100%. Arch Med Res, 1993 Autumn, 24(3), 211 - 8 Opsonization and phagocytosis of Cryptococcus neoformans; Kozel TR; Cryptococcus neoformans is unique among the pathogenic fungi because the yeast is surrounded by an antiphagocytic polysaccharide capsule . Host resistance to cryptococcosis is dependent on natural defense mechanisms that cope with this essential fungal virulence factor . Recent studies in several laboratories indicate that, under appropriate circumstances, the antiphagocytic activity of the capsule can be overcome . A reversal of the antiphagocytic properties of the capsule requires (i) activation of the alternative complement pathway by encapsulated cryptococci, leading to deposition of the opsonic ligand iC3b at the capsular surface, (ii) presence of essential cytokines which up-regulate the efficiency of complement-dependent phagocytosis, and (iii) availability of phagocytic cells whose complement receptors are capable of appropriate up-regulation . Deficiencies in one or more components of the opsonization-phagocyte-cytokine triad may account, in part, for several features of the pathogenesis of cryptococcosis as well as the susceptibility of some immunocompromised patients to cryptococcosis . It may be possible to overcome some deficiencies by passive immunization with anticapsular IgG which takes advantage of phagocyte Fc receptors that are constitutively competent for phagocytosis or by therapeutic use of cytokines that up-regulate complement-dependent phagocytosis. Microbiol Immunol, 1993, 37(10), 759 - 64 Characterization of a phenol oxidase from Cryptococcus neoformans var . neoformans; Ikeda R et al.; In Cryptococcus neoformans, enzymic oxidation of various catechols leads to melanin, a proposed virulence factor . A phenol oxidase enzyme of Cryptococcus neoformans var . neoformans produced at 25 C has been purified from an ultracentrifugal supernatant of an extract of broken cells . Hydrophobic interaction chromatography followed by anion-exchange column chromatography allowed purification of the phenol oxidase . The molecular weight of the enzyme estimated by gel filtration was about 80,000 and a dimeric species (Mw = 160,000) was suggested . The isoelectric point of the protein was approximately 4.1 . An NH2-terminal 31 amino acid sequence was determined using phenol oxidase electroblotted onto a PVDF membrane after nondenaturing gel electrophoresis . Upon searching the Peptide Institute (Osaka) data base, no proteins with high degrees of homology were found. Rev Inst Med Trop Sao Paulo, 1993 Jan-Feb, 35(1), 81 - 7 {Treatment with fluconazole of severe fungal infections in immunocompromised patients}; Boulos M; Fluconazole therapy was evaluated prospectively in 108 patients with immunosupression and serious fungal infections . Patients were enrolled if they had a life-threatening fungal infection and conventional therapy had failed to eradicate infection, had caused serious toxic reactions, or was contraindicated . Patients were treated with 50 to over 400 mg/day initially . AIDS was underlying risk factor in 66.6% of the patients evaluated in the study and in 92.9% of 57 patients with cryptococcal infection . Satisfactory clinical response was observed in 43 patients with active cryptococcal infection and in 39 patients with active candidiasis, 90.7% and 92.3% respectively . Concerning mycologic response, 63.3% and 80.7% of 30 patients with cryptococcal infection and 26 patients with candidiasis respectively had final negative cultures . Eleven patients (10.2%) had adverse effects possibly due to fluconazole therapy . Fluconazole may be effective in the treatment of cryptococcal infection and candidiasis and can be an alternative to conventional antifungal therapy. Rev Inst Med Trop Sao Paulo, 1993 Jan-Feb, 35(1), 77 - 9 {Cryptococcus neoformans var . neoformans isolated from soil}; Machado CC et al.; We inquiry, in the epidemiologic history of 42 patients with cryptococcosis, the contact with pigeon, trying to find the possible source of infection . Of these patients, the information compatible with ecologic niche of Cryptococcus neoformans was positive in 16 . Fifty nine samples were recovered from soil, associated with pigeon habitat . We found C . neoformans in four occasions, one in the capital and three in the interior of state . C . neoformans, serotype A, recovered from a central spine fluid coincides with the serotype of the fungus recovered downtown Porto Alegre, in a place suggested by the patient as possible source of infection, characterizing of a case of Cryptococcus neoformans . var . neoformans. Rev Neurol (Paris), 1993, 149(5), 326 - 30 {Neurological form of cryptococcosis . Apropos of 2 atypical cases in non HIV-infected patients}; Donnet A et al.; Cryptococcal infection is the most common fungal infection of the central nervous system . More than 50% of the cases of cryptococcal infection are superimposed on an immunosuppressive or other general debilitating condition . Cerebral cryptococcosis usually presents as meningitis or meningoencephalitis, although cerebral granuloma has also been reported . Hydrocephalus is the most common neurosurgical complication of cerebral cryptococcosis . The majority of patients require only medical treatment with antifungal drugs . However, when complications ensue, surgical intervention is mandatory . We suggest that chronic meningitis be ruled out in all patients prior to the placement of shunts . In the two cases reported here treatment of cryptococcal meningitis was a combination of amphotericin B and flucytosine for six weeks . Fluconazole is a new alternative and at least as effective as amphotericin B. Curr Top Med Mycol, 1993, 5, 1 - 26 Activation of the complement system by the capsule of Cryptococcus neoformans; Kozel TR; In vitro studies indicate that encapsulated cryptococci are among the most powerful particulate activators of the complement system reported to date . The capsule itself is the site at which activation occurs . Activation occurs solely via the alternative complement pathway . Initiation occurs at apparently random focal sites in the capsule that expand through alternative pathway amplification to fill the capsule with C3 fragments . The C3 fragments are rapidly converted to iC3b, suggesting that phagocyte receptors for iC3b will be important in phagocytosis of the yeast . There is abundant evidence that a similar form of activation occurs in vivo during a cryptococcal infection . Cryptococcemia in humans and experimental animals is accompanied by a depletion of serum complement levels . Studies with complement deficient guinea pigs and mice indicate that the complement system plays an essential role in resistance to cryptococcosis . It is likely that the complement system contributes to host resistance by opsonization of the yeast to facilitate attachment and ingestion by phagocytic cells as well as by releasing chemotactic fragments of the complement cascade which contribute to the inflammatory response . The absence or unavailability of a functional complement system in the central nervous system may account in part for the predilection of the yeast for the brain. Ann Biol Clin (Paris), 1993, 51(2), 83 - 90 Immunological methods for the detection of structural components and metabolites of bacteria and fungi in blood; Gutierrez J et al.; This review compares the clinical usefulness of immunological methods for the detection of structural components and metabolites of bacteria and fungi . Bacterial antigens (especially those of Mycobacterium, Neisseria, Staphylococcus aureus, Yersinia enterocolitica, Escherichia coli, Salmonella, Chlamydia, and Brucella) are best detected by enzyme-linked immunosorbent assay . Methods involving antibodies are more expensive and are effective only when performed in series . The detection of antibodies that recognize S aureus teichoic acid merely confirms the presence of a metastatic complication . Tissue invasion by Candida albicans is not yet reliably detectable by the presence of a specific antigen . Simple, but not completely reliable methods are available such as the latex test for mannans detection and/or agglutination with liposomes for detecting 48-kDa cytoplasmic protein antigen and an assay for detecting enolase antigen . A latex agglutination test has also been developed for the mannans antigen of Aspergillus and for Cryptococcus neoformans capsular polysaccharide; the latter test is more cost effective . The sensitivity of both tests is improved by serial assays . A negative finding with hemagglutination-based antibody tests rules out C albicans infection, and titers of 1/640 or higher have been associated with disseminated infection by Aspergillus . Concentrations of C albicans blastopore antigen antibodies higher than 400 IU/ml can be seen in disseminated candidiasis . High concentrations of endotoxin are indicative of imminent septic shock . Some biological indicators (C reactive protein, angiotensin converting enzyme, fibronectin, elastase-alpha 1-antitrypsin complex, tumor necrosis factor and interleukin-6) have been used to rule out a bacterial cause of fever.(ABSTRACT TRUNCATED AT 250 WORDS) Nat Toxins, 1993, 1(5), 294 - 5 Toxicity of cotton phytoalexins to zoopathogenic fungi; Mace ME et al.; The sesquiterpenoid phytoalexins desoxyhemigossypol, desoxymethoxyhemigossypol, and hemigossypolone formed in cotton (Gossypium hirsutum and G . barbadense) stem xylem infected with Verticillium dahliae were shown to be highly toxic to zoopathogenic fungi . This appears to be the first study of the toxicity of terpenoid phytoalexins to zoopathogenic fungi . The toxicities of the phytoalexins expressed as MIC (micrograms ml-1) values were 8 to 128 against four isolates of Candida albicans and one isolate of Cryptococcus neoformans . These highly toxic compounds or their derivatives may prove useful for the treatment of animal mycoses. Ann Dermatol Venereol, 1993, 120(9), 612 - 5 {Septicemic cutaneous localization of cryptococcosis following renal transplantation in a female}; Dupond AS et al.; Cryptococcosis is a systemic disease caused by the yeast-like fungus Cryptococcus neoformans . Cutaneous manifestations, although rare, may precede other organ involvements . A case of cutaneous cryptococcosis is described herein . The skin lesions in our patient (a 47-year old female with renal transplant) consisted of acute cellulitis over her left and right thighs, revealing a septicemic infection . The patient received immunosuppressive drugs (prednisone, azathioprine) . Clinical, mycological and histopathological data are described in details . Amphotericin B and fluconazole were initially successful, but a relapse with Cryptococcus meningitis required the adjunction of itraconazole to treatment . This case report underlines the insufficient effectiveness of fluconazole and the success of itraconazole. Acta Clin Belg, 1993, 48(6), 405 - 9 Fluconazole-resistant Cryptococcus neoformans var gattii in an AIDS patient; Peetermans W et al.; We describe a case of meningitis due to Cryptococcus neoformans var gattii in an AIDS patient . The reasons for the observed predominance of C . neoformans var neoformans infections in AIDS patients living in areas endemic for the gattii variety are not understood thus far . Treatment with fluconazole resulted in poor clinical and mycological response . In vitro sensitivity testing of the fungus revealed high minimal inhibitory concentrations, suggesting fluconazole resistance . Treatment with amphotericin B was successful. Arch Med Res, 1993 Winter, 24(4), 403 - 12 Treatment of systemic mycoses in patients with AIDS; Graybill JR; Far and away the most common fungal infection associated with HIV infection is candidiasis . This tends to produce mucosal topical infections and local treatment may be enough to control them . Generally we prefer courses of 1-2 weeks rather than chronic suppression, for fear of eliciting overgrowth of resistant isolates . Fluconazole resistant Candida species may be an increasing problem over the next decade . For cryptococcoses the problem is both simpler and more complicated . Fluconazole is highly effective for chronic suppression, but not very effective for initial therapy . Here a short course of amphotericin B, just 2 weeks in length, is followed by chronic azole suppression . Fluconazole appears excellent, but itraconazole may also be effective . For histoplasmosis itraconazole appears to be the most advantageous drug, with excellent clinical response within 2 weeks . A role for fluconazole is unclear . Coccidioidomycosis is uncommon, but difficult . I cannot offer any suggestions on "ideal" therapy here . Other diseases, such as aspergillosis, are extremely uncommon but still are AIDS associated mycoses . It is my personal fear that as we go along identifying the AIDS virus and its complications, aspergillosis and zygomycosis may establish themselves as the future "black hats" for which we will need to pull something out of the "box" . What to pull is not very clear. Arch Med Res, 1993 Winter, 24(4), 387 - 93 Itraconazole: pharmacokinetics and indications; Negroni R et al.; Itraconazole is a highly lipophilic triazolic compound, scarcely soluble in acidified polyethylene glycol, and soluble in hydroxypropyl-beta-cyclodextrin . It possesses an excellent digestive adsorption and its peak plasma level after oral administration of 100 mg is 0.16 microgram/ml at 3 or 4 h after drug intake . Half-life of itraconazole ranges between 17 to 21 h and 99.8% binds to plasmatic proteins, especially albumin . Metabolization is mainly done in the liver where inactive metabolites are formed with the exception of hydroxy-itraconazole, which exhibits a discrete antifungal activity . Stabilization of blood levels with repeated drug administration is reached at day 14, showing an increase both in plasma concentrations and in its half-life . Tissue levels of itraconazole are 3- to 20-fold higher than plasmatic concentrations, whereas only negligible concentrations are in CSF and urine . In the skin and particularly nails, itraconazole persists for a long time after discontinuation of therapy . Its mechanism of action is similar to other azolic compounds, inhibiting the alpha-14-demethylase of lanosterol which interferes with the synthesis of ergosterol . This drug behaves as a wide spectrum antifungal agent, acting against most pathogenic fungi with the exception of the Zygomycetes . Daily doses vary, according to indications, from 100 to 400 mg . The efficacy and results obtained in dermatomycosis, candidiasis, paracoccidioidomycosis, keratomycosis, sporotrichosis, chromoblastomycosis, coccidioidomycosis, blastomycosis, cryptococcosis, phaeohyphomycosis and maduromycotic mycetomas are detailed. J Med Vet Mycol, 1993, 31(1), 65 - 75 Detection and differentiation of fungi in clinical specimens using polymerase chain reaction (PCR) amplification and restriction enzyme analysis; Hopfer RL et al.; We have developed a method for processing and detecting fungi in clinical specimens using the polymerase chain reaction (PCR) methodology . This PCR amplification of a segment of a ribosomal DNA gene results in a 310 bp product . The gene sequences used as amplimers have been highly conserved throughout the fungal kingdom and positive PCR results have been obtained for all genera and species of fungi tested (n = 42) . Neither human nor a variety of pathogenic bacteria (n = 24) gave an amplified product . This PCR method can detect as few as 15 cells of Candida albicans in clinical specimens following a simple processing procedure . The sensitivity of the PCR for detecting other fungi remains to be determined . Analysis of the 310 bp amplified product, following digestion with the restriction enzyme HaeIII, can be used to further characterize the identity of the fungus involved into the following five groups: (i) Candida species and closely related yeasts; (ii) Cryptococci and Trichosporon species; (iii) Aspergilli and clinically related septate molds; (iv) the Zygomycetes; and (v) the dimorphic fungi. Rev Pneumol Clin, 1993, 49(5), 211 - 5 {Pulmonary diseases and retrovirus infections . A pathological study in 70 cases}; N'Dhatz M et al.; A necroscopic study, conducted in the Pathology Department of the Centre Hospitalier Universitaire (CHU) de Treichville in Abidjan, included 70 seropositive subjects who died in the Pneumophtisiology Department . We attempted to determine the different pulmonary affections occurring during infection with the human immunodeficiency virus (HIV) . This study demonstrated the predominant role of tuberculosis (44%) and bacterial pneumonia (30%) which remain the predominant aetiologies . Other opportunistic affections were rare including: Pneumocystises, Mycobacteriaceae, and Cytomegalovirus infection and the Kaposi sarcoma . The absence of pulmonary cryptococcosis and non-Hodgkin lymphoma were also noted . Necroscopic examinations do not necessarily provide evidence of the in vivo pathologies, the autopsy being able to identify only the causal diseases or those present at death. Bull Soc Belge Ophtalmol, 1993, 250, 67 - 76 {Cryptococcal chorioretinitis and acquired immunodeficiency syndrome: apropos of a case}; Bibas P et al.; A patient with acquired immune deficiency and antecedents of pancreatitis presented with headaches, fever, dyspnea and bilateral decrease of vision . A diagnosis of disseminated cryptococcosis was made by lumbar puncture, alveolar washing and elevated cryptococcal antigen in blood, urine and stool . Bilateral chorioretinitis with ischaemic maculopathy was responsible of the low vision and attributed to cryptococcal infection after vitreous puncture and isolation of yeast from the vitreous . Systemic treatment with Amphotericin led to resolution of the chorioretinitis . A retinitis due to cytomegalovirus was associated short time before the patient died . Post-mortem anatomopathologic analysis revealed cryptococcus in high number in the choriocapillaris. Adv Exp Med Biol, 1993, 335, 235 - 40 Epidemiology and infectious complications of human immunodeficiency virus antibody positive patients; Yangco BG et al.; From July 1, 1991 to March 31, 1992, 156 patients (pts) with positive antibody titers to the human immunodeficiency virus (HIV) were seen in our clinic . A retrospective review of the epidemiology and infectious complications of these patients is presented . There were 129 males and 27 females (4.8:1, ratio) . Only 10/156 (12.8%) were non-whites (13 blacks and 7 hispanics) . The majority, 126 (80.7%), were 25 to 44 years old . The most common risk factor was homosexuality or bisexuality 100 (64.1%), followed by heterosexual acquisition 25 (16%), intravenous drug abuse 23 (13.7%), unknown 6 (3.8%) and transfusion-related 3 (1.9%) . Sixty-five pts had no infections . In the remaining 91 pts, the infections noted were: candidiasis (54 pts); Pneumocystis carinii pneumonia (25 pts); Herpes simplex (13 pts); cytomegalovirus (CMV) retinitis (11 pts) and CMV esophagitis (1 pt), central nervous system toxoplasmosis (8); Herpes zoster (6 pts); cryptococcal meningitis (5 pts); Mycobacterium avium complex bacteremia (4 pts); Molluscum contagiosum, hepatitis-B, staphylococcal infection, perirectal abscess and oral hairy leukoplakia (2 pts each); syphilis, cryptosporidiosis, nocardiosis, histoplasmosis and laryngeal papillomatosis (1 pt each) . Infections were multiple in 57/91 (62%) pts and tend to occur more often when the helper cells are < 200 47/57 (82%) pts . Appropriate antimicrobials for prophylaxis and maintenance therapy appeared to decrease the occurrence or relapse of infections such as pneumocystosis, candidiasis, cryptococcosis, tuberculosis and toxoplasmosis. Bull Soc Pathol Exot, 1993, 86(5 Pt 2), 484 - 8 {Human protothecosis and environment}; Huerre M et al.; Protothecosis are uncommon infections caused by Prototheca, considered to be achlorophylous algae . Nearly 80 human cases are reported in the literature since the first case described by Davies and Wakelin in 1964 in Sierra Leone (11) . The disease have been identified in Europe, Asia (Japan, Thailand, China), Oceania and in the United States with 40 cases, particularly in the Southeast . Clinically, three clinical manifestations can be observed: 1) cutaneous lesions: papules, plaques or eczematoid, papulo-nodular areas of the extremities, 2) olecranon bursitis which occurred in 25% of cases, 3) systemic protothecosis . An immunosuppressive factor local or general can be found in half of the cases and the first description of algal meningitis was reported in a patient with AIDS in association with Cryptococcus neoformans . Because the disease is clinically not suspected, the diagnosis is often provided by histology showing a dermic granuloma with endospores . The characteristic feature of protothecosis in tissues is the presence of specific mature sporangia of Prototheca wickerhamii with the pattern of morula . The organism was PAS, Grocott and mucicarmin positive . The ecology was studied by Clark (7), Pidoux (23), Pore (25) and Sudman (27) . Prototheca are ubiquitous inhabitants of sewages and are found in slime flux and animal wastes contaminating different aquatic systems . The transmission generally occurred by traumatic inoculation . Prototheca are also found in the digestive system of man and animals without never invasion of the epithelium and mucosae in experimental models . The pathogenicity and virulence are moderate and they are considered as rare opportunistic agents. Mod Pathol, 1993 Jan, 6(1), 80 - 4 Combined histochemical stains in the differential diagnosis of Cryptococcus neoformans; Lazcano O et al.; Three combinations of histochemical stains were used to study 69 routinely processed tissues containing various "yeast-like" fungal organisms (Cryptococcus neoformans, Blastomyces dermatitidis, Coccidioides immitis, Histoplasma capsulatum, Paracoccidioides brasiliensis, and Candida albicans) . Fontana-Masson stain combined either with mucicarmine or Alcian blue produced distinctive staining of C . neoformans (Fontana-Masson-positive wall and mucin-positive capsule) that was not identified in other fungi . The Alcian blue stain combined with periodic acid-Schiff reaction also was useful for fungal classification, because the Alcian blue component reacted with only C . neoformans (capsule) and B . dermatitidis (wall) and the periodic acid-Schiff reaction reacted with the cell wall and body of each fungus . We concluded that the combined histochemical stains used in conjunction with morphologic study of hematoxylin and eosin- and Gomori methenamine silver-stained sections are helpful in the differential diagnosis of yeast-like fungal organisms. J Clin Microbiol, 1992 Dec, 30(12), 3138 - 45 Collaborative comparison of broth macrodilution and microdilution antifungal susceptibility tests; Espinel-Ingroff A et al.; A collaborative comparison of macro- and microdilution antifungal susceptibility tests was performed in five laboratories . MICs of amphotericin B, fluconazole, flucytosine, and ketoconazole were determined in all five centers against 95 coded isolates of Candida spp., Cryptococcus neoformans, and Torulopsis glabrata . A standard protocol with the following National Committee for Clinical Laboratory Standards Subcommittee on Antifungal Susceptibility Testing recommendations was used: an inoculum standardized by spectrophotometer, buffered (RPMI 1640) medium (pH 7.0), incubation at 35 degrees C, and an additive drug dilution procedure . Two inoculum sizes were tested (1 x 10(4) to 5 x 10(3) to 2.5 x 10(3) CFU/ml) and three scoring criteria were evaluated for MIC endpoint determinations, which were scored as 0 (optically clear), < or = 1 (slightly hazy turbidity), and < or = 2 (prominent decrease in turbidity compared with that of the growth control) . Overall intra- and interlaboratory reproducibility was optimal with the low-density inoculum, the second-day readings, and MICs scored as either 1 or 2 . The microdilution MICs demonstrated interlaboratory agreement with most of the four drugs higher than or similar to that of the macrodilution MICs . In general, there was good interlaboratory agreement with amphotericin B, fluconazole, and flucytosine; ketoconazole gave more variable results. Antimicrob Agents Chemother, 1992 Dec, 36(12), 2722 - 8 Activity of MS-8209, a nonester amphotericin B derivative, in treatment of experimental systemic mycoses; Saint-Julien L et al.; The in vitro and in vivo toxicities and activities of MS-8209, a new hydrosoluble amphotericin B (deoxycholate-amphotericin B {D-AmB}; Fungizone) derivative, were studied . In vitro, MS-8209 was less toxic than AmB against renal tubular cells in primary culture and less active against Candida albicans and Cryptococcus neoformans . However, at 10-fold the AmB concentration, MS-8209 in vitro antifungal activity paralleled that of AmB . Fifty-percent lethal doses of MS-8209 and D-AmB in OF1 noninfected mice were 26 and 2.3 mg/kg, respectively . Therapeutic efficacy of MS-8209 was assessed in murine candidiasis, cryptococcosis, and aspergillosis . In each model of infection, we determined the maximum tolerated dosages of MS-8209 and D-AmB, i.e., the dosage inducing less than 15% mortality due to toxicity; the efficacies of MS-8209 and D-AmB at their respective maximum tolerated dosages were compared . In candidiasis, MS-8209 (15 mg/kg) significantly increased the survival time compared with D-AmB (0.5 mg/kg) . Both compounds were equally effective at reducing CFU counts in the kidney . MS-8209 was the most effective agent for increasing the survival time in cryptococcal meningoencephalitis and for reducing CFU counts in spleen, brain, and lung during both cryptococcal pneumonia and meningoencephalitis . In aspergillosis, MS-8209 and D-AmB similarly prolonged the survival of treated mice compared with controls . These results show that when MS-8209 and D-AmB were used at the maximum tolerated dosage, MS-8209 was as effective as or more effective than D-AmB for the treatment of systemic mycoses . These findings warrant further experiments to study the pharmacokinetic properties and toxicity of MS-8209 under conditions of chronic administration. Antimicrob Agents Chemother, 1992 Dec, 36(12), 2656 - 60 Efficacy and safety of amphotericin B colloidal dispersion compared with those of amphotericin B deoxycholate suspension for treatment of disseminated murine cryptococcosis; Hostetler JS et al.; The efficacy and safety of amphotericin B colloidal dispersion (ABCD) were compared with those of amphotericin B deoxycholate suspension (ABDS) (Fungizone) in a murine model of disseminated cryptococcosis . Mice were treated intravenously with either ABDS at 0.2, 0.8, or 3.2 mg/kg of body weight per dose or ABCD at 0.8, 3.2, 6.4, 12.8, or 19.2 mg/kg dose three times per week for 2 weeks . Excluding mice treated with ABDS at 3.2 mg/kg, which was acutely lethal in 100% of mice, and ABCD at 19.2 mg/kg, which also resulted in two early deaths, the survival of ABCD- and ABDS-treated groups was prolonged over survival of controls (P < or = 0.05) . Survival of ABCD (3.2 mg/kg)-treated mice was improved over that of ABDS (0.2 mg/kg)-treated mice (P < 0.05); however, comparisons of mice given all other dosages of ABCD with mice given sublethal dosages of ABDS did not demonstrate differences in survival . Comparative fungal burdens in organs showed a decrease in liver (P < 0.05) and spleen (P < 0.05) burdens for ABCD with the 19.2-mg/kg therapy versus those with ABDS with the 0.8-mg/kg therapy and liver burdens for ABCD with the 12.8-mg/kg therapy versus ABDS with the 0.8-mg/kg therapy (P < 0.05) . There was no difference in organ burdens between therapy with ABCD at 0.8 mg/kg and ABDS at 0.8 mg/kg . These data show that the efficacy of ABCD is equal to that of ABDS on a milligram-per-kilogram basis for murine disseminated cryptococcosis . Because of its decreased toxicity, greater efficacy with ABCD could be achieved through doses fourfold higher than the 100% lethal dose for ABDS . Thus, ABCD shows promise as an effective but less toxic alternative to ABDS for the treatment of disseminated cryptococcosis. Am Rev Respir Dis, 1992 Dec, 146(6), 1434 - 8 HIV-1 envelope protein (gp120) inhibits the activity of human bronchoalveolar macrophages against Cryptococcus neoformans; Wagner RP et al.; Cryptococcus neoformans infections are a major cause of morbidity and mortality for HIV-infected persons . Containment of the initial respiratory inoculation to the lung appears defective in patients with AIDS despite the low burden of HIV in bronchoalveolar macrophages . We have studied the fungistatic activity of human bronchoalveolar macrophages (BAM) cultured with an encapsulated strain of C . neoformans in the presence of pooled human serum . We observed 51.6% fungistasis after 24 h of culture . Fungistasis was diminished if the pooled human serum was heat-inactivated but was not affected by anticryptococcal capsular IgG . HIV envelope protein (gp120) has been shown to interfere with lymphocyte activation in vitro . We studied the effects of gp120 on BAM function and found that fungistatic activity was inhibited 25% (p < 0.001) . Although binding of yeasts was not affected, gp120 inhibited the internalization of bound yeasts by 46% (p = 0.025) . These experiments indicate that gp120 decreases the internalization and fungistasis of C . neoformans by human BAM, and they suggest a mechanism to explain how a small number of HIV-1-infected cells in the lung could impair the containment of C . neoformans. J Clin Microbiol, 1992 Dec, 30(12), 3239 - 42 Value of extended agitation and subculture of BACTEC NR 660 aerobic resin blood culture bottles for clinical yeast isolates; Prevost-Smith E et al.; From 10,351 blood cultures, we prospectively studied 1,000 BACTEC NR 660 aerobic resin blood culture bottles (26+ and Peds Plus) for patients suspected of having yeast septicemia to determine whether extended agitation and subculturing would increase the recovery of yeasts . Aerobic bottles were agitated continuously for 144 h . On day 7, 1,000 culture-negative aerobic bottles which had fungal blood culture requests were agitated for an additional 14 days . During this time they were subcultured twice and read twice by BACTEC NR 660 . ON days 1 to 7, 81 bottles were cultured positive for yeasts from 36 patients, which included 44 isolates of Candida albicans, averaging 1.4 days to detection, and 12 isolates of Cryptococcus neoformans, averaging 3.8 days to detection . The average detection time for all yeasts was 2.2 days . On days 7 to 21, no yeasts were detected by BACTEC or recovered from the subcultures . We conclude that when continuously agitated for at least 5 full days (120 h), the BACTEC NR 660 aerobic resin bottles reliably isolate yeasts, and it is unnecessary to subculture or hold these bottles beyond 5 days . It also eliminates the need for an additional blood culture system for yeast detection, thus saving (i) confusion in the collection process, (ii) patients' blood and money, and (iii) laboratory technologists' time. Gene, 1992 Dec 1, 122(1), 213 - 7 Cloning the Cryptococcus neoformans TRP1 gene by complementation in Saccharomyces cerevisiae; Perfect JR et al.; We have cloned the phosphoribosyl anthranilate isomerase (PRAI)-encoding gene (TRP1) of Cryptococcus neoformans by genetic complementation in Saccharomyces cerevisiae . Sequence analysis of this gene revealed it to be 939 bp in length, and without known promoter or termination sequences . Unlike some of the filamentous fungi, where PRAI enzymatic activity is controlled by a trifunctional gene product, the C . neoformans PRAI appears to be unifunctional . PRAI of C . neoformans exhibits 39% amino acid (aa) sequence identity compared to the S . cerevisiae counterpart . The TRP1 gene of C . neoformans maps to different size chromosomes in strains with different serotypes . The cloning of this gene for vector constructions, and the demonstration that S . cerevisiae can be used as a surrogate for C . neoformans gene expression, should help with the molecular studies of this significant fungal pathogen in our increasing immunocompromised population. Plast Reconstr Surg, 1992 Dec, 90(6), 1065 - 7 Primary cutaneous cryptococcosis as the presenting manifestation of AIDS; Song IC et al.; Presented is a case of primary cutaneous cryptococcosis, presenting as a papular facial lesion with subsequent ulceration, as the initial manifestation of AIDS . This unusual condition must be considered in the workup of unexplained or therapeutically unresponsive skin lesions . If it is diagnosed in an ostensibly "healthy" individual, evaluation for evidence of immunosuppression, and its underlying cause, must be undertaken. J Pediatr, 1992 Dec, 121(6), 873 - 9 Cryptococcal osteomyelitis and cellular immunodeficiency associated with interleukin-2 deficiency; Sorensen RU et al.; We describe an unusual example of cellular immunodeficiency associated with interleukin-2 deficiency in an otherwise healthy 15-year-old boy who had isolated cryptococcal osteomyelitis of the scapula at 10 years of age . His previous medical history was remarkable only for prolonged, severe varicella infection at 6 years of age . He had persistent moderate lymphopenia, anergy, and absent lymphocyte blastogenic responses to mitogens, antigens, or monoclonal T cell antibodies . Subnormal blastogenic responses were seen after exposure to high concentrations of phorbol esters . Immunoglobulin levels and specific antibodies were normal . The patient has been in good health since treatment of his osteomyelitis . However, his lymphocyte blastogenic responses to mitogens have remained absent during 4 years of observation; investigation of the cause revealed a specific interleukin-2 deficiency resulting from defective generation of interleukin-2 messenger ribonucleic acid . Secretion of interleukin-1 by monocytes was normal, suggesting that the abnormal blastogenic response and interleukin-2 production were due to a problem intrinsic to T lymphocytes . The generation of messenger ribonucleic acid for interleukin-4 was not affected . Interferon-gamma was produced at subnormal levels . The addition of recombinant interleukin-2 restored lymphocyte blastogenic responses and increased the expression of interleukin-2 receptors . The clinical findings and immunologic abnormalities present in this patient differ from other primary and secondary immunodeficiencies associated with interleukin-2 deficiency . Thus our observations in this patient extend the spectrum of immunodeficiencies associated with abnormalities in the production of this important cytokine. Arq Neuropsiquiatr, 1992 Dec, 50(4), 491 - 6 CSF in 85 patients with AIDS and CNS cryptococcosis; Livramento JA et al.; In an eight years time period (July 1984-June 1992) CSF samples of 40718 patients were studied, and 610 were from patients with AIDS clinically diagnosed and immunologically confirmed through HIV antibodies detection . Among opportunistic infections detected in them 85 were CNS cryptococcosis . For the purpose of this study the CSF of these 85 patients are the AIDS group of CNS cryptococcosis . For comparison, CSF data from 50 patients with CNS cryptococcosis but without AIDS were taken (non-AIDS group); in this group, 22 patients were immunosuppressed after renal transplant . In AIDS group, the more frequent CSF findings were: yeast presence at direct exam (Fuchs-Rosenthal cell counting chamber), growing of the yeast in cultures, and gamma globulins increase . In non-AIDS group were more frequent: hypercytosis, neutrophil cells presence, and total protein increase . Differences between the two groups are discussed taking into account CNS/CSF immune changes induced by HIV infection . It is concluded that in CNS cryptococcosis of patients with AIDS the CSF evidenced more extensive signs of the fungal opportunistic infection than signs of inflammatory response to the infection . The latter were more prominent among patients of the non-AIDS group of CNS cryptococcosis. Intern Med, 1992 Dec, 31(12), 1401 - 5 Disseminated cryptococcosis presenting with adrenal insufficiency and meningitis: resistant to prolonged antifungal therapy but responding to bilateral adrenalectomy; Takeshita A et al.; A case of disseminated cryptococcosis with features of primary adrenal insufficiency and meningitis in an immunocompetent host is presented . Despite antifungal chemotherapy, neither meningitis nor bilateral adrenal gland enlargement was improved . Aspiration biopsy of the adrenal gland revealed necrotic tissue with numerous fungi, suggesting that the adrenal glands were the focus of the persistent fungemia . Removal of bilateral adrenal glands led to improvement by making the patient more sensitive to antifungal chemotherapy. Enferm Infecc Microbiol Clin, 1992 Dec, 10(10), 607 - 10 {Pulmonary cryptococcosis in AIDS}; Martos A et al.; We present here three AIDS patients with disseminated cryptococcal infection and lung involvement . Two patients presented with respiratory symptoms and in the third one, pulmonary disease was only a radiologic finding . Chest X-ray films showed an interstitial pattern in two cases and pulmonary cavitation in one case . One patient has also simultaneous infection by P . carinii . Diagnosis was established by culture from bronchoalveolar lavage in all cases and also by non-induced sputum exam in two cases . All patients were treated with amphotericin B, with good clinical outcome, and without relapses under maintenance therapy with fluconazole . Cryptococcosis must be included in differential diagnosis of AIDS patients with diffuse interstitial lung infiltrates . The presence of C . neoformans in respiratory samples does not rule out the existence of other opportunistic infections, and therefore bronchoalveolar lavage is advisable. Ann Soc Belg Med Trop, 1992 Dec, 72(4), 283 - 8 Evaluation of the cryptococcal antigen test as a diagnostic tool of AIDS-associated cryptococcosis in Rwanda; Swinne D et al.; To evaluate the latex test, two different retrospective studies were undertaken . A positive culture for Cr . neoformans was used as the golden standard of active cryptococcal infection . 439 sera selected at random sent to the NSP laboratory for screening of HIV antibody were tested as well as--71 CSF from patients with meningeal symptoms sent to the laboratory of the Centre Hospitalier de Kigali . In total, two discrepancies were found: two CSF samples from ancient cases of cryptococcosis under treatment were positive with the latex test and negative by culture . If it stands to reason that the antigen test cannot differentiate between active and inactive cryptococcal diseases, the persistence of small amounts of soluble antigens in a CSF implies that the patient must remain under surveillance, a relapse being very frequent in AIDS patients . As a conclusion, the latex test is a fast, easy to perform and quite reliable test for the diagnosis of cryptococcosis. J Antimicrob Chemother, 1992 Dec, 30(6), 781 - 90 A non-azole inhibitor of lanosterol 14 alpha-methyl demethylase in Candida albicans; Capobianco JO et al.; 6-Hydroxy-N-methyl-N-(2-{4-phenylphenyl} ethyl)-1,2,3,4-tetrahydro-1- napthalene methanamine (A60586), a new non-azole inhibitor of ergosterol biosynthesis in Candida albicans ATCC62376 has been identified . In whole cells A60586 produced a dose related reduction of {14C}acetate incorporation into ergosterol and a concurrent increase in the radiolabelling of 4,4-dimethylated sterols . Similar observations were made with {14C}mevalonic acid lactone labelled cell free extracts . The IC50s for inhibition of ergosterol in the whole cell and cell free systems were 22 microM (10 mg/L) and 7.8 microM (3.5 mg/L), respectively . Analysis by gas chromatography of sterols from cells previously incubated at 37 degrees C for 24 h with A60586 (200 mg/L) confirmed the presence of lanosterol and 14 alpha-methyl fecosterol . These data indicate that A60586, inhibits the demethylation of the C-14 methyl group of lanosterol . The MIC of A60586 for several candida strains ranged from 12.5 to 50 mg/L, and against Cryptococcus albidus and Aspergillus niger ranged from 50 to 100 mg/L . The best in-vitro activity of A60586 was against Torulopsis glabrata (MIC range = 3.12 to 50 mg/L) . The membrane permeabilizing effect of this compound (50% leakage of {14C}aminoisobutyric acid at 70 mg/L A60586) may have contributed to its in-vitro antifungal activity. J Am Vet Med Assoc, 1992 Nov 15, 201(10), 1591 - 2 Cryptococcal pneumonia and abortion in an equine fetus; Blanchard PC et al.; Cryptococcus neoformans was the causative agent of pneumonia in a 9-month-old equine fetus aborted by a healthy American Paint mare . Endometritis was diagnosed on biopsy, and vaginal specimens obtained for culture were Cryptococcus-positive 1 month following abortion but not 5 months after abortion . Infection resolved without treatment between 1 and 5 months after abortion, and the mare was bred the following year and delivered a live premature foal without evidence of Cryptococcus infection. J Clin Microbiol, 1992 Nov, 30(11), 2881 - 6 Susceptibility testing of Cryptococcus neoformans: a microdilution technique; Ghannoum MA et al.; We studied a series of test conditions in a microtiter system to define the optimal method for determining the susceptibility of Cryptococcus neoformans to antifungal agents . Twenty-one isolates of C . neoformans were grown for 24 or 48 h in four chemically defined media: yeast nitrogen base (BYNB 7); RPMI 1640; synthetic amino acid medium--fungal (SAAMF), buffered at pH 7.0 to select the medium that best supported growth of this fastidious yeast; and yeast nitrogen base, pH 5.4 (YNB 5.4) . Maximum growth of C . neoformans, at 35 degrees C, was obtained in YNB 5.4, with the next highest growth levels in BYNB 7, SAAMF, and RPMI . Growth at 24 h was uniformly poor in all media and lacked reproducibility . In contrast, incubation for 48 h gave adequate growth with low standard deviations, and 48 h was selected as the optimal incubation period for this study . Comparison of the relationship between growth kinetics and initial inoculum size for eight cryptococcal isolates showed that 10(4) cells per ml yielded optimal growth in BYNB 7 and YNB 5.4, whereas 10(5) cells per ml was optimal in RPMI and SAAMF . Furthermore, variation of inocula from 10(3) to 10(5) cells per ml showed small but significant inoculum effects in determining MICs of fluconazole, amphotericin B, and flucytosine for C . neoformans . Therefore, 10(4) cells per ml was chosen as the optimal inoculum for susceptibility testing in this study . Mean MICs of fluconazole, amphotericin B, and flucytosine for 21 crytococcal isolates in RPMI and BYNB 7 were low (for example, fluconazole had mean MICs of 1.2 and 1.3 micrograms/ml in RPMI and BYNB 7, respectively) and differed significantly from medium to medium . In contrast, the MICs obtained in SAAMF were significantly higher (e.g., fluconazole had a mean MIC of 2.2 micrograms/ml) . Variance in MICs was large with fluconazole and flucytosine but small with amphotericin B, irrespective of the medium used . A microtiter system employing BYNB 7 as the medium, 48 h as the incubation period, and 10(4) cells per ml as the final inoculum is a simple, accurate, and reproducible method for the testing of C . neoformans susceptibility to fluconazole, amphotericin B, and flucytosine. Enferm Infecc Microbiol Clin, 1992 Nov, 10(9), 543 - 6 {Fungemia caused by Rhodotorula mucilaginosa in relation to total parenteral nutrition}; Jimenez-Mejias ME et al.; BACKGROUND: Fungal infections are nowadays more common in clinical practice . The most frequently isolated fungi are Candida and Cryptococcus . Infection due to Rhodotorula mucilaginosa is very uncommon . We describe here our experience with R . mucilaginosa fungemia, with emphasis on total parenteral nutrition related episodes . METHOD: A retrospective review identified 3 patients with R . mucilaginosa, and predisposing conditions, clinical features, treatment used and outcome were analyzed . The case definition includes the repeated isolation of R . mucilaginosa in several blood-cultures and/or the isolation of R . mucilaginosa in one single blood culture together with its isolation in any other site . RESULTS: Three patients were identified . In all of them there are some defects in immune response (skin anergy in two, immunosuppressive therapy in the remaining patient), had an iv line placed, under antibiotic therapy and total parenteral nutrition . All factors could have been related to the development of R . mucilaginosa infection . CONCLUSION: Although its pathogenic role is controversial, in two or our patients R . mucilaginosa infections correlates well with clinical signs and symptoms of invasive infections (fever, hemodynamic changes) . The treatment is still not clear. Nihon Kyobu Shikkan Gakkai Zasshi, 1992 Nov, 30(11), 1911 - 6 {A comparison of community-acquired lung infection and nosocomial infection--review of autopsy cases in Hisayama town}; Miyazaki H et al.; All people in Hisayama town who died either at home or in hospital are autopsied in Kyushu University Hospital . We examined the incidence and the pathogen of community-acquired lung infection and nosocomial infection from the records of 463 autopsy cases from 1977 to 1988 . Of these cases, 243 died at home . Among them, pulmonary infections were present in 122 cases (50.2%), and pulmonary infection was the cause of death in 87 cases (35.8%) . Of 220 cases that died in hospital, pulmonary infections were present in 133 cases (60.5%) and were the cause of death in 83 cases (37.7%) . In the cases that died at home, the incidence of pulmonary infections during the first 6-year period of the study was almost the same as that during the last 6 years . In the case that died in hospital, the incidence of pulmonary infections during the last 6-year period was higher than that during the first 6-year period . Regarding the pathogenic organisms of the fungal infections, only Candida was detected in case that died at home, while Candida, Aspergillus and Cryptococcus were detected in the case that died in hospital. J Nat Prod, 1992 Nov, 55(11), 1664 - 8 Antifungal activity of meridine, a natural product from the marine sponge Corticium sp; McCarthy PJ et al.; Meridine {1}, a polycyclic alkaloid derived from the marine sponge Corticium sp., was found to inhibit the growth of Candida albicans and Cryptococcus neoformans . Activity was also observed against Trichophyton mentagrophytes and Epidermophyton floccosum . Studies of the mechanism of action of this agent have shown an inhibition of nucleic acid biosynthesis. Clin Infect Dis, 1992 Nov, 15 Suppl 1, S274 - 81 Evaluation of new antifungal drugs for the treatment of systemic fungal infections . Infectious Diseases Society of America and the Food and Drug Administration; Medoff G et al.; These guidelines are applicable to all fungal pathogens that produce systemic infections in humans . Specific examples are provided whenever they might clarify special issues . Systemic fungal infections usually are divided into two broad categories: endemic systemic fungal diseases, which occur classically in healthy hosts, and opportunistic fungal diseases, which occur almost exclusively in patients with impaired host defenses . Both the increasing frequency of disseminated histoplasmosis and coccidioidomycosis in patients with AIDS and the occurrence of candidemia due to vascular-line infections have begun to blur this distinction . The fungi included in these guidelines are Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Candida species, Cryptococcus neoformans, Aspergillus species, and Sporothrix schenckii . Diagnosis of infections caused by these fungi should be based on culture of infected body fluids or tissues whenever possible . Cryptococcal and coccidioidal meningitis are exceptions . Amphotericin B remains the standard comparative agent for most new agents . Further studies of the efficacy of new oral agents used alone or after a hospital course of amphotericin B are needed . The agents currently available are usually inadequate for eradication of fungal infections in patients with AIDS, who may need prolonged treatment . Final assessment for these patients may need to be classified as clinical cure with presumed microbiologic persistence. Clin Infect Dis, 1992 Nov, 15 Suppl 1, S189 - 94 Evaluation of new anti-infective drugs for the treatment of cryptococcal meningitis . Infectious Diseases Society of America and the Food and Drug Administration; Lentnek A et al.; Cryptococcus neoformans may infect persons with intact or compromised host defenses . Clinical manifestations generally correlate directly with the degree of immunosuppression . Treatment is prescribed on the basis of the severity of disease and the degree of immunosuppression . Cryptococcal meningitis is the most common clinical form of cryptococcal infection and the most amenable to study in clinical trials . The current standard of care for cryptococcal meningitis is therapy with amphotericin B . Despite clinical improvement and microbiological suppression of the organism at the completion of therapy, the microbiological outcome will be identified as presumptive persistence if treatment is continued . Patients should be observed for 1 year after completion of therapy before a final assessment is made. FEMS Microbiol Lett, 1992 Nov 1, 77(1-3), 187 - 90 Dimorphism in Itersonilia perplexans: yeast and hyphal phases differ in their sensitivity to mycocins produced by tremellaceous yeasts; Golubev W et al.; The monokaryotic yeast phase of the heterobasidiomycete Itersonilia perplexans, unlike the hyphal phase, was found to be sensitive to mycocins produced by killer strains of Cryptococcus humicola, Cr . laurentii, Cystofilobasidium bisporidii and Rhodotorula fujisanense . Both the yeast and hyphal phases wer resistant to mycocins of Cr . podzolicus, Filobasidium capsuligenum, Rhodotorula glutinis, Rh . mucilaginosa, Rh . pallida, Sporidiobolus johnsonii, Sb . pararoseus and Sporobolomyces alborubescens . The different sensitivity patterns of yeast and hyphal phases are probably caused by biochemical differences in the cell walls. J Clin Microbiol, 1992 Nov, 30(11), 2960 - 7 DNA probe for strain typing of Cryptococcus neoformans; Varma A et al.; A 7-kb linear plasmid, harbored by a URA5 transformant, hybridized to all the chromosomes of Cryptococcus neoformans separated by contour-clamped homogeneous electric field electrophoresis . Its linear maintenance was determined to have been facilitated by the presence of telomere-like sequences at its free ends . Hybridization of this plasmid to AccI-digested genomic DNAs of 26 C . neoformans strains generated 21 unique DNA fingerprints . The DNA fingerprints of isolates within the same serotype were more similar to one another than to those from different serotypes . An acapsular clinical isolate, strain 602, widely used in immunological studies and previously thought to be in serotype D, showed DNA fingerprints typical of serotype A isolates . Isogenic strains of C . neoformans exhibited DNA fingerprints that were identical to one another . The DNA fingerprints were stable and reproducible in spite of repeated transfers in the laboratory on either complex (1% yeast extract, 2% Bacto Peptone, 2% glucose) or minimal (yeast nitrogen base) medium . The DNA fingerprints of isolates recovered from primary blood and cerebrospinal fluid cultures of patients for whom AIDS had been diagnosed showed that the original infection in each of these patients contained a homogeneous population of C . neoformans . The DNA fingerprints of isolates recovered from different tissues of infected mice and from patients undergoing different drug therapy regimens were also found to be very stable. Infect Immun, 1992 Nov, 60(11), 4534 - 41 Protective murine monoclonal antibodies to Cryptococcus neoformans; Mukherjee J et al.; Several murine monoclonal antibodies (MAbs) specific for the capsular glucuronoxylomannan of Cryptococcus neoformans were studied for their capacity to confer protection when passively administered to lethally infected mice . The MAb group studied recognized at least three distinct epitopes and included immunoglobulin M (IgM), IgG3, IgG1, and IgA isotypes . The protection model used A/J and BALB/c mice infected intraperitoneally with 10(8) cryptococci . The MAbs were administered either immediately preceding or, in one experiment, 24 to 48 h prior to infection . Protective efficacy was assessed by the ability of passively administered MAbs to prolong the survival of lethally infected mice . Three IgM MAbs, each of which recognized a distinct epitope, were able to prolong survival of lethally infected mice to different extents . A set of IgM, IgG3, IgG1 and IgA MAbs which utilize the same immunoglobulin gene elements and were derived from the same B-cell clone exhibited significant class differences in protective efficacy with IgA, IgG1 > IgM > IgG3 . The results confirm that protective MAbs against C . neoformans capsular polysaccharide exist and strongly suggest that both epitope specificity and isotype are important determinants of protective efficacy. Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1992 Nov, 25(4), 270 - 5 Cryptococcus albidus isolated from pigeon excreta in Taiwan; Jen TM; Cryptococcus albidus (Saito) Skinner, found frequently in the air of El-Minia, Egypt; in New Zealand and Budapest, and isolated occasionally from clinical specimens, has now been recognized as the cause of human diseases . Since isolation of this fungus from pigeon droppings has not previously been reported, this first paper reports results of its drug-susceptibility testing to gentamicin and 5-fluorocytosine, as well as its fungal cell antigenic cross reactivity with C . neoformans as detected by a Latex-Crypto-Antigen Detection System (LCAS). Acta Otorhinolaryngol Ital, 1992 Nov-Dec, 12(6), 605 - 10 {Blastomycosis of the cervicofacial area: a review of the literature and case report}; Cavalot AL et al.; A literature review concerning blastomycosis has been conducted . The involvement of the head and neck area appears to be very unusual, on the basis of autoptic observations . The most common diagnostic and subsequent therapeutic mistakes are pointed out . A new case is described and its clinical appearance, symptoms, diagnostic work up and therapeutic approach are discussed . This case report is of interest for three reasons: the rarity of this disease in our country, the possibility of confusing a Blastomyces infection with a cryptococcal one {correction of criptococcosy} and finally the therapeutic response to a new drug, not yet commercialized in Italy. Mycoses, 1992 Nov-Dec, 35(11-12), 289 - 92 Pathogenic fungi in human dwellings; Staib F; Airborne invasive fungal infections in various risk groups of people suffering from immunodeficiencies are an increasing problem for modern medicine . Because of the acute and rapid course of invasive infections, prevention is of principal significance . Such prevention mainly concerns the control of fungal spores in indoor air . In this connection the immediate environment offering ecological niches for growth and morphogenesis of infective particles of Aspergillus spp., Mucoraceae, Cryptococcus neoformans and some other yeast-like fungi is of main interest . The current problems of indoor air mycology, i.e . the epidemiology and ecology of pathogenic fungi in indoor air, can only be recognized and interpreted by centres routinely performing mycological diagnosis for all the various risk groups of patients . Models of specific surveillance of the most important fungal pathogens (e.g . Aspergillus spp . and Cryptococcus neoformans) in indoor air will be outlined and discussed. J Infect Dis, 1992 Oct, 166(4), 866 - 73 Binding of unopsonized Cryptococcus neoformans by human bronchoalveolar macrophages: inhibition by a large-molecular-size serum component; Levitz SM et al.; Infection with Cryptococcus neoformans usually begins after inhalation of airborne organisms . Since levels of opsonins in the alveolar space may be low, the ability of human bronchoalveolar macrophages to bind C . neoformans in the presence and absence of opsonins was studied . Bronchoalveolar macrophages bound unopsonized C . neoformans . Surprisingly, component(s) in pooled human serum (PHS) inhibited binding, as evidenced by 26% and 71% inhibition of binding when 20% PHS and heat-inactivated PHS (HI-PHS), respectively, were added to the system . Separation of PHS by molecular size revealed that the inhibitory component had an apparent molecular weight greater than 10(6) and was inhibitory at nanomolar concentrations . PHS stimulated and HI-PHS had no effect on binding of acapsular C . neoformans and zymosan particles to bronchoalveolar macrophages . These data demonstrate that bronchoalveolar macrophages can bind unopsonized, encapsulated C . neoformans, but that serum component(s) inhibits binding. Med Trop (Mars), 1992 Oct-Dec, 52(4), 435 - 8 {Cryptococcosis caused by Cryptococcus neoformans var . Gattii . A case associated with acquired immunodeficiency syndrome (AIDS) in Kinshasa, Zaire}; Muyembe Tamfum JJ et al.; Since the introduction of AIDS, the biovar neoformans of Cryptococcus neoformans has replaced the biovar gattii as the predominant agent of cryptococcal meningitis in Kinshasa and in other tropical areas . That this is not an absolute rule is demonstrated by the present case of a HIV-positive patient, observed at the Kinshasa University Hospital, with cryptococcal meningitis due to the biovar gattii . Only four cases of this association have been published before . The authors conclude that both biovars are capable of infecting HIV-positive patients but that the apparent decline of the biovar gattii is related to the rarity of its natural reservoir in the urban environment, where the AIDS epidemic is concentratedPIP: In July 1990 in Zaire, a 36-year-old man was admitted to the University Clinic in Kinshasa for intense headaches, fever, vertigo, vision troubles, hallucinations, and irregular speech . He exhibited moderate wasting, left facial paralysis, and prurigo spots on the legs . Laboratory examinations revealed HIV seropositivity, antibodies to cryptococci, protein in the cerebrospinal fluid, and glucose in the cerebrospinal fluid . He was placed on 400 mg/d fluconazole . He died on August 4, two days after slipping into a coma . Cryptococcus neoformans var . gattii was isolated . The man had lived in a free union with two women . One died in 1989 of an illness characterized by persistent fever, considerable wasting, and pulmonary tuberculosis . The other woman is still alive although often having febrile episodes . She is HIV seropositive . Before AIDS arrived, cryptococcosis was rare in Zaire and Cryptococcus neoformans var . gattii was the most common etiologic agent . With AIDS, cryptococcosis has become an opportunistic infection . Since 1983, all cryptococcosis cases at the university clinics were a complication of AIDS . Cryptococcus neoformans var . neoformans was the etiologic agent in all these cases . It is possible that exposure to neoformans variety is more common than exposure to gattii variety . It is therefore an epidemiologic problem intimately associated with the geographic topography specific to ecological niches of these two varieties . Neoformans variety is found in pigeon droppings, while gattii variety has never been found in bird droppings . Gattii's natural host is the eucalyptus tree, found in Zaire . The case lived 400 m from a eucalyptus plantation . He was the only gattii variety cryptococcosis case in 1990-1991 among the 49 cryptococcosis cases at the Kinshasa University Clinics . In conclusion, gattii variety rarely causes cryptococcosis among AIDS patients because its natural reservoir is rare in urban areas where the AIDS epidemic is centered . Mycopathologia, 1992 Oct, 120(1), 23 - 8 Immunodeficiency secondary to juvenile paracoccidioidomycosis: associated infections; Shikanai-Yasuda MA et al.; Four patients with acute paracoccidioidomycosis, hypoalbuminemia, ascites and associated infections are reported . They have been admitted to hospital 35 times, 4 of them due to active paracoccidioidomycosis, 14 to associated infections, 14 to ascites, edema and diarrhoea and 3 to herniorrhaphy . Two of them recovered after sepsis and central nervous system, muscular and subcutaneous cryptococcosis . The remaining two died . One had infectious diarrhoea (S . flexneri), peritoneal tuberculosis and sepsis (S . epidermidis); the other had bacterial meningitis, erysipelas, beta-hemolytic Streptococcus sepsis and miliary tuberculosis . Their immunodeficiency was attributed to enteric protein loss and/or malabsorption and malnutrition and was recognized by reduced response to delayed hypersensitivity skin tests in four patients and hypogammaglobulinemia in three of them . The authors discuss the need for prospective studies to be carried out, aiming at the mechanisms involved in secondary infections . Alternatives for maintaining the patients' adequate nutritional state should be investigated, to guarantee proper immune response and thus the ability to control intervening infections in patients with juvenile paracoccidioidomycosis. Neuropathol Appl Neurobiol, 1992 Oct, 18(5), 478 - 88 Pathology of the central nervous system in patients infected with the human immunodeficiency virus (HIV): a report of 252 autopsy cases from Brazil; Chimelli L et al.; The central nervous system (CNS) was studied in 252 HIV-infected patients from the States of Rio de Janeiro and Sao Paulo in Brazil, the regions with the highest incidence of AIDS in the country . We compared the frequency and morphology of opportunistic infections and CNS changes caused by the HIV, with those described in other series and briefly analysed the risk factors involved in our cases . There were CNS lesions in 230 cases (91.3%), 30 (11.9%) with multiple infections and/or tumours . Most infections were opportunistic (65.4%), including 15.4% viral and 50% bacterial, fungal or protozoal infections . The most frequent was toxoplasmosis (34.1%), followed by cryptococcosis (13.5%), cytomegalovirus (CMV) infection (7.9%) and nodular encephalitis (6.7%) . Primary lymphomas were observed in 4% of the cases and HIV encephalitis or leukoencephalopathy in 10.7% . Other opportunistic and HIV associated lesions were present in a limited number of cases and there were also vascular and non-specific lesions . Our study confirms the high frequency of CNS lesions in HIV infected patients . They are morphologically similar to those previously described . However, the higher incidence of toxoplasmosis and cryptococcosis, a lower incidence of viral opportunistic and HIV-associated lesions, and the presence of rarer lesions such as histoplasmosis and chagasic encephalitis, differ from other series, and may reflect geographical and/or socio-economic factors. J Acquir Immune Defic Syndr, 1992 Oct, 5(10), 978 - 87 Variations in inpatient mortality for AIDS in a national sample of hospitals; Turner BJ et al.; In this project, we examined the spectrum of AIDS-related conditions and variations in associated inpatient mortality for AIDS patients treated in a national sample of hospitals . We identified 10,538 adult discharges with a diagnosis indicating AIDS from 258 hospitals from a national sample of 438 acute-care hospitals with 6 million discharges in 1986-1987 . Opportunistic and other infections occurred in 55.9 and 37.9%, respectively, of AIDS discharges, and inpatient fatality rates varied considerably depending on complication type(s) and comorbidities . Clinical conditions were more important predictors of inpatient death than demographic or treatment site characteristics . Among opportunistic infections, odds of inpatient death were significantly increased for progressive multifocal leukoencephalopathy (odds ratio {OR} = 2.8), Pneumocystis carinii pneumonia (OR = 2.4), cryptococcosis (OR = 1.6), atypical mycobacterial infections (OR = 1.6), and toxoplasmosis (OR = 1.3) . Odds of inpatient death were also significantly increased by non-AIDS-defining infections causing septicemia (OR = 3.1) or CNS involvement (OR = 1.6) or pulmonary involvement (OR = 1.5) . After controlling for clinical conditions, significant differences in odds of death persisted across regions, age, and ethnic groups . Increases in hospitals' AIDS treatment experience were associated with a significant decrease in odds of inpatient death . These analyses provide a national perspective on the diversity of AIDS-related clinical conditions and their relative effects on inpatient mortality. Clin Radiol, 1992 Oct, 46(4), 292 - 4 Case report: complete lung collapse--an unusual presentation of cryptococcosis; Carter EA et al.; Cryptococcosis presenting as an intrabronchial mass is not a recognized cause of complete lung collapse . This case report illustrates this extremely rare manifestation of pulmonary cryptococcosis, which mimicked primary pulmonary carcinoma clinically, radiologically and bronchoscopically. Clin Infect Dis, 1992 Oct, 15(4), 704 - 6 Meningitis due to Prototheca wickerhamii in a patient with AIDS; Kaminski ZC et al.; The first documented case of algal meningitis due to Prototheca wickerhamii is reported in a patient with AIDS . The initial CSF culture yielded only Cryptococcus neoformans . P . wickerhamii was isolated on four subsequent lumbar punctures . The patient died, and at autopsy the alga was isolated from leptomeninges over the brain and about the spinal cord . Histologic sections from numerous locations of the brain revealed masses of cryptococci and prototheca. J Neurosci Nurs, 1992 Oct, 24(5), 265 - 8 Cryptococcal meningitis in patients with AIDS; Mocsny N; In the U.S., cryptococcal meningitis is the most common form of fungal meningitis and a major cause of morbidity and mortality among immuno-suppressed patients . In the AIDS patient, cryptococcal meningitis often presents with fever and headache and is best treated with intravenous amphotericin B and oral flucytosine, or fluconazole . However, toxic effects may result from the therapy . This disease frequently relapses necessitating life-long treatment to prevent reactivation . Essential management principles focusing upon health education are presented to promote comprehensive nursing care for patients testing positive for the human immunodeficiency virus who also have cryptococcal meningitis. J Clin Microbiol, 1992 Oct, 30(10), 2544 - 50 Evaluation of a monoclonal antibody-based latex agglutination test for diagnosis of cryptococcosis: comparison with two tests using polyclonal antibodies; Temstet A et al.; Cryptococcal antigen detection has become a routine biological test performed for patients with AIDS . The poor prognosis of cryptococcosis explains the need for reliable tests . We evaluated the performances of a newly commercialized agglutination test that uses a monoclonal antibody specific for cryptococcal capsular polysaccharide (Pastorex Cryptococcus; Sanofi-Diagnostics Pasteur, Marnes-la-Coquette, France) and compared them with those of tests that use polyclonal immune sera (Cryptococcal Antigen Latex Agglutination System, Meridian Diagnostics, Inc., Cincinnati, Ohio; and Crypto-LA, International Biological Labs Inc., Cranbury, N.J.) . The sensitivities and specificities of the tests were compared by using purified polysaccharides and yeast suspensions . Clinical specimens (131 serum samples, 41 cerebrospinal fluid samples, 34 urine samples, and 19 bronchoalveolar lavage samples) from 87 human immunodeficiency virus-positive subjects with (40 patients) and without (47 patients) culture-proven cryptococcosis were retrospectively tested during a blinded study . The effect of pronase treatment of samples was assessed for Pastorex Cryptococcus and the Cryptococcal Antigen Latex Agglutination System, and the antigen titers were compared . Our results show that (i) during the screening, concordance among the three tests was 97%; (ii) the use of pronase enhanced both the sensitivities and specificities of the Pastorex Cryptococcus test; (iii) titers agreed for 67% of the cerebrospinal fluid samples and 60% of the serum samples; and (iv) cryptococcosis was detected equally well with Pastorex Cryptococcus and with the other tests, whatever the infecting serotype (A, B, or D) . The meaning of in vitro sensitivity and the relationship between titers and sensitivity are discussed . The results show that Pastorex Cryptococcus is a rapid and reliable test for the detection of cryptococcal antigen in body fluids and suggest that kits cannot be used interchangeably to monitor antigen titers in patients. Infect Immun, 1992 Oct, 60(10), 4080 - 7 The glucuronoxylomannan of Cryptococcus neoformans serotype A is a type 2 T-cell-independent antigen; Sundstrom JB et al.; The humoral immune response of inbred mice to immunization with the glucuronoxylomannan (GXM) of Cryptococcus neoformans was investigated both serologically and in plaque-forming cells (PFCs) . The T-helper-cell-independent quality of the GXM was demonstrated by using BALB/c nu/nu mice . Primary and secondary dose responses to three antigenic forms of GXM, (i) the native antigen, (ii) a GXM-bovine serum albumin protein conjugate, and (iii) a cryptococcal whole-cell vaccine, revealed a lack of isotype class switching and anamnestic responses . Both the levels of complement-fixing anti-GXM antibody in serum and the PFC responses in the athymic mice showed no significant differences from those in the wild-type controls . However, T cells are involved in the suppression of the primary response to GXM . When BALB/cBy mice were given rabbit anti-mouse thymocyte serum along with 0.5 microgram of GXM, both antibody levels in serum and PFC responses were significantly increased over those of control mice that received GXM and normal rabbit serum . In addition, T cells were also shown to enhance the primary immune response to GXM . BALB/cBy mice were given GXM and anti-mouse thymocyte serum on day 1 . On day 2, the experimental group was given anti-mouse thymocyte serum and the control group was given saline . On day 5, comparison of the PFC responses and anti-GXM antibody titers of the two groups revealed a significant increase in the immune response of the control over the experimental group . The type 2 T-cell-independent quality of GXM was also demonstrated in CBA/cHN xid mice . These mice lack the Lyb+ subset of B cells and are unable to respond to type 2 T-independent antigens but respond normally to type 1 T-independent antigens . Type III pneumococcal polysaccharide, a type 2 T-independent antigen, was used as a negative control, and trinitrophenyl-lipopolysaccharide, a type 1 T-independent antigen, was used as a positive control . The CBA/cHN xid mice failed to respond to either type III pneumococcal polysaccharide or GXM but did not respond to immunization with trinitrophenyl-lipopolysaccharide . BALB/cBy mice responded normally to all three antigens. Hum Pathol, 1992 Oct, 23(10), 1106 - 14 Neuropathology of the spinal cord in the acquired immunodeficiency syndrome; Henin D et al.; The neuropathologic findings in the spinal cord were reviewed in 138 consecutive autopsies of patients with the acquired immunodeficiency syndrome . In all cases both the brain and spinal cord were examined by conventional histologic techniques, and in 63 cases immunohistochemistry was used to detect human immunodeficiency virus (HIV), Toxoplasma gondii, cytomegalovirus, and JC papovavirus antigens . The most common observation was a normal spinal cord (60%) . Vacuolar myelopathy (VM) was observed in 23 (17%) cases . Human immunodeficiency virus myelitis was evident in 8% of cases . Human immunodeficiency virus myelitis was associated with HIV encephalitis in 65% of the cases . Opportunistic infections of the spinal cord were uncommon, consisting of cryptococcosis (five cases), cytomegalovirus (four cases), toxoplasmosis (one case), and progressive multifocal leukoencephalopathy (one case), and almost always were seen with cerebral and/or systemic infection by these agents . Malignant lymphoma rarely involved the spinal cord (four cases); all were B-cell lymphomas and were associated with cerebral and/or systemic lymphoma . Other abnormalities rarely observed were Wallerian degeneration of the corticospinal tracts or posterior columns (6%) and focal microinfarcts . Most cases of VM (78%) were not associated with HIV myelitis, and in the five patients with both VM and HIV myelitis, HIV-infected cells were not found in the regions affected by VM . In contrast, 65% of cases with VM were associated with HIV encephalitis . The pathogenesis of VM remains unknown; it is probably not due to direct infection by HIV. Rev Latinoam Microbiol, 1992 Oct-Dec, 34(4), 259 - 65 {Biological features and experimental pathogenicity of Candida strains isolated by hemoculture at the Hospital Infantil de México "Federico Gómez"}; Ramirez Aguilar ML et al.; In a period of 15 months (1990-1991) it was carried out 5781 blood cultures in which 180 strains of yeast-like were isolated . 116 of these strains were selected for biochemical classification, cellular and colonial morphology and experimental determination of virulence in mice . Most of the strains were classified as Candida albicans (60%) and the others were C . tropicalis (15.5%); C . guillermondii (10.3%); T . glabrata (6.8%); Rhodotorula rubra (3.4%); Cryptococcus neoformans (2.58%) y C . parapsilosis (0.86%) . C . albicans ATCC14053, y C . tropicalis ATCC14056 and T . glabrata ATCC15545 were employed as controls . The virulence test was performed using mice of 20-30 gr (4-6 weeks age) by intravenous injection in caudal vein with 0.5 ml of different suspension from 10(5) to 10(9) CFU/ml . Observation time was 10 days . Target organ was kidney by macro and microscopic observation of micro-abscess death . LD50 was estimated by the Reed-muench method . Intraspecific and interspecific differences were observed . It is more valid if we take into account that the experiment was done in homogenous population of host without risk factor which influences the human population in hospitals . Experimental virulence was compared with the evolution of diseases in the human host of which the strain was isolated. Rev Soc Bras Med Trop, 1992 Oct-Dec, 25(4), 241 - 6 {A retrospective therapeutic study of neurocryptococcosis in 112 AIDS and non-AIDS patients}; de Campos EP et al.; A total of 112 AIDS and no AIDS cryptococcosis patients admitted at Emilio Ribas Hospital--Sao Paulo, Brazil, were treated with amphotericin B (AMB) or amphotericin B and 5 fluorocytosine (5FC) . Age, race, predisposing and epidemiological factors, respiratory symptoms were evaluated . Goodman tests applied in three patients groups (I, II and III) with associate or unique therapy revealed: 1 . prognostic factors: leukocytes ang glucose showed similar response in groups I, II and III and protein spinal fluid after 1.5g/AMB; 2 . India ink tests and Cryptococcus culture were often positive until 1.0g/AMB; 3 . significant hypokalemia during monotherapy . Hypo and hyperkalemia had similar data in associate therapy; 4 . significant difference in adverse reactions often appeared above 0.7g AMB/250g 5FC; 5 . early and late death were common in group III (unique) and group I (no AIDS) and III (2.5 to 4.0g) respectively; 6 . similar remission and deaths were verified in AIDS/cryptococcosis . Conclusions: adverse reactions were observed above 0.75g/AMB plus 250g 5FC . Association was important in initial therapy and AMB maintenance permitted late relapses. J Med Assoc Thai, 1992 Oct, 75(10), 606 - 8 Itraconazole in cryptococcal meningitis in pregnancy: a case report; Chotmongkol V et al.; A 25-year-old pregnant women with cryptococcal meningitis treated with itraconazole during the first few weeks and 12th-16th week of pregnancy is reported . She delivered a normal baby . Itraconazole should be another drug for treatment of fungal infection in pregnancy. East Afr Med J, 1992 Oct, 69(10), 550 - 3 World Health Organization clinical case definition for AIDS in Africa: an analysis of evaluations; Keou FX et al.; In 1985 at a World Health Organization (WHO) workshop on AIDS in Bangui, Central African Republic, a clinical case definition of Acquired Immune Deficiency Syndrome (AIDS) was developed for developing countries, such as sub-Saharan Africa, where sophisticated diagnostic equipment is not widely available . A particular cachectic syndrome, the "slim disease", which is highly suggestive of AIDS in Africa, constitutes the substratum for the clinical definition for AIDS . The WHO/Bangui definition in adults has a sensitivity of 60%, a specificity of 90%, and a high predictive value especially in endemic areas . The WHO/Bangui clinical case definition for paediatric AIDS is less easy to use in practice . Its low sensitivity (about 35%) is in relation to its incapacity to diagnose many of the frequently observed secondary infection for paediatric AIDS according to the CDC criteria . The WHO/Bangui clinical definition for AIDS seems to be convenient for epidemiological surveillance of the HIV epidemic in Africa . Nevertheless, the low sensitivity and the low specificity result in the failure to detect some cases of full blown AIDSPIP: In 1985, at a WHO workshop on AIDS in Bangui, Central African Republic, a clinical case definition of AIDS was developed for developing countries . This 1st definition contained 4 major criteria (chronic asthenia, major weight loss, chronic fever, and chronic diarrhea) and 6 minor criteria (chronic cough, persistent lymphadenopathy, herpes zoster, recurrent herpetic infection, pruritic dermatitis, and oropharyngeal candidiasis) . Kaposi's sarcoma and cryptococcal meningitis were sufficient by themselves for the diagnosis of AIDS . In children, the temporary definition of AIDS consisted of 3 major clinical criteria (weight loss and/or abnormally slow growth, chronic diarrhea lasting more than 1 month, and fever lasting more than 1 month), and 6 secondary clinical criteria (generalized lymphadenopathy, oropharyngeal candidiasis, repeated common infections such as otitis and pharyngitis, persistent cough, generalized pruritic dermatitis, and confirmed maternal HIV infection) . The revised Bangui definition was evaluated in 174 adult patients hospitalized at the Mama Yemo Hospital of Kinshasa, Zaire . 46% of 174 patients met the criteria of the WHO/Bangui definition . Overall, the sensitivity of the definition for HIV-1 infection was 59%, the specificity was 90%, and the positive predictive value (PPV) was 74% . However, the clinical case definition of African AIDS lacks specificity when it is applied to patients suffering from cachectic syndromes . The Bangui definition was also evaluated at the pediatric ward of Mama Yemo Hospital with 159 hospitalized children whose mean age was 33 months . 21 (13%) were infected by HIV-1 . The sensitivity of the definition was 35%, its specificity was 86%, and its PPV was 26% . Although the specificity was relatively high, the low values of sensitivity and PPV underline the weakness of the Bangui clinical case definition for diagnosing pediatric AIDS cases . Leuk Lymphoma, 1992 Oct, 8(3), 213 - 20 Treatment of AIDS-related non-Hodgkin's lymphoma with a twelve week chemotherapy program; Sawka CA et al.; Current treatment options for acquired-immunodeficiency syndrome (AIDS)-related non-Hodgkin's lymphoma (NHL) are unsatisfactory because of excessive toxicity rates and frequent recurrence of lymphoma . In this phase II study, we evaluated a novel 12 week chemotherapy program with respect to feasibility, toxicity and therapeutic results . Thirty HIV-seropositive patients with intermediate grade or small non-cleaved cell NHL received a 12 week program of weekly intravenous and oral chemotherapy consisting of etoposide, adriamycin, cyclophosphamide, bleomycin, vincristine, methotrexate and prednisone as well as biweekly intrathecal cytosine arabinoside . Prophylaxis against Pneumocystis carinii pneumonia (PCP) and candida were given routinely . The overall objective response rate was 73% with 33% complete responders . The time to progression for those stable or responding was 9.4 months . Five of 10 complete responders are well and free of disease 13.2 to 24.5 months from diagnosis . Median survival for the 30 patients was 8.1 months . NHL was the most common cause of death (13/22); opportunistic infection caused only one death (cryptococcal meningitis) . Only 1 case of PCP occurred . The major toxicity was neutropenia . In conclusion this regimen resulted in response rates similar to other reports with acceptable toxicity and a very low incidence of PCP . Relapse of NHL remains a major challenge, however, and further studies are needed . Routine PCP prophylaxis should be incorporated into new trials of therapy for AIDS-related NHL. J Immunol Methods, 1992 Sep 18, 154(1), 27 - 35 Monoclonal antibody based ELISAs for cryptococcal polysaccharide; Casadevall A et al.; Mouse monoclonal antibody (MAb)-based enzyme-linked immunosorbent assays (ELISAs) have been developed to detect Cryptococcus neoformans capsular polysaccharide from the four serotypes A, B, C and D . The ELISAs avoid the problem of unreliable polysaccharide binding to polystyrene plates by using MAbs to capture and immobilize the polysaccharide antigen . The presence of polysaccharide is detected using MAbs of a different isotype from that of the capture MAb . The capturing MAbs are themselves immobilized on the plates using commercial goat anti-mouse polyclonal sera . The MAbs bind to the glucuronoxylomannan component of cryptococcal polysaccharide . The ELISAs can be used to measure the concentration of polysaccharide in biological fluids and are potentially useful tools for basic research and clinical studies. Med Klin (Munich), 1992 Sep 15, 87(9), 454 - 9 {Clinical diagnosis and neuropathologic examination findings in 20 AIDS patients}; van Lunzen J et al.; Disorders of the central nervous system (CNS) associated with HIV infections are becoming increasingly important in the area of clinical diagnosis and treatment of patients with AIDS . The aim of this retrospective analysis of 20 patients with AIDS who died in 1989 was to compare clinical diagnosis, neuroradiological findings and treatment with the results of neuropathological studies . The neuropathological examinations revealed primary CNS lymphoma (high-grade non-Hodgkin's lymphoma) in seven cases, cerebral toxoplasmosis in four cases, haemorrhagic infarction in three cases, cerebral cryptococcosis in three cases, and one case each of infiltration of the dura by a peripheral Burkitt's lymphoma, cytomegalovirus encephalitis and bacterial meningitis . A remarkably high percentage of CNS lymphomas with no distinct clinical or neuroradiological differentiation criteria were found in this study . On the basis of these data, we conclude that stereotactic biopsy and histological diagnosis should be recommended for patients with focal intracerebral lesions who fail to respond to suitable anti-parasitic treatment. J Thorac Imaging, 1992 Sep, 7(4), 51 - 5 Pulmonary cryptococcosis; Patz EF Jr et al.; Cryptococcus neoformans is a ubiquitous soil fungus that rarely causes pneumonia in normal hosts but is a common cause of opportunistic infection . Pulmonary disease is initiated by inhalation of the organism, and a spectrum of radiographic manifestations can be seen . The most common finding is a poorly marginated nodule or mass . Lobar or segmental parenchymal opacities and, less commonly, a diffuse scattered nodular or reticulonodular pattern have also been observed . Associated adenopathy, pleural effusions, and cavitation are uncommon; when present, these are more common in immunocompromised patients . Establishing the diagnosis can be difficult, but pulmonary cryptococcosis should be considered in the differential diagnosis of patients in the proper clinical setting and with compatible radiographic findings. J Thorac Imaging, 1992 Sep, 7(4), 12 - 22 Clinical manifestations of pulmonary fungal infections; Boyars MC et al.; Coccidioidomycosis, histoplasmosis, cryptococcosis, and blastomycosis are the most common deep pulmonary fungal infections encountered by the clinician . Each has a particular environmental habitat . As world travel increases, exposure to these infections becomes increasingly more common . The article reviews the microbiology, natural history, and clinical and laboratory findings of these diseases . Treatment options for these infections also are discussed. Carbohydr Res, 1992 Sep 2, 233, 205 - 18 Structural variability in the glucuronoxylomannan of Cryptococcus neoformans serotype A isolates determined by 13C NMR spectroscopy; Turner SH et al.; Cryptococcus neoformans, the etiologic agent of cryptococcal meningoencephalitis, produces glucuronoxylomannan (GXM) as the major capsule component . Purified GXMs obtained from eight serotype A isolates of C . neoformans were treated by ultrasonic irradiation and then O-deacetylated prior to their comprehensive chemical analysis by GLC, GLC-MS, and 13C NMR spectroscopy . The average xylose: mannose: glucuronic acid molar ratio of the eight isolates is 1.96 +/- 0.25: 3.00: 0.58 +/- 0.10 . Methylation analyses and 13C NMR spectroscopy show a general structure for GXM that is comprised of a linear (1----3)-alpha-D-mannopyranan substituted with beta-D-GlcpA and with beta-D-Xylp at O-2 . Variable quantities of unsubstituted (1----3)-alpha-D-Manp were observed between the eight isolates studied . In several isolates some of the (1----3)-alpha-D-Manp residues are disubstituted with beta-D-GlcpA at O-2 and with beta-D-Xylp at O-4; this type of substitution was not previously thought to occur in serotype A isolates . Heterogeneity, between isolates, in the disposition of the substituents along the mannopyranan backbone was revealed by 13C NMR spectroscopy . The eight isolates, and three isolates previously studied, were each assigned to one of four distinct groups based on the 13C NMR chemical shifts of the anomeric carbons . Six of the eleven isolates gave identical spectra (Group I) . The six major anomeric resonances from Group I were assigned to specific glycosidic linkages present in GXM . The remaining five isolates gave more complex spectra that are indicative of additional linkages and comprise the remaining three groups . Three of these five isolates contain substantial amounts of linkages previously thought to be distinctive of serotypes B and C, i.e., Manp residues that are 4-O-glycosylated with beta-D-Xylp . Methylation analyses only predicted an average repeating unit, whereas 13C NMR spectroscopy demonstrated that GXM from each isolate may be categorized into four groups by the occurrence of distinct sequences of carbohydrate residues. Vet Clin North Am Small Anim Pract, 1992 Sep, 22(5), 1119 - 32 Fungal diseases of the nasal cavity of the dog and cat; Wolf AM; Fungal infections of the nasal cavity are a common cause of nasal disease in the dog and cat . Aspergillus fumigatus most commonly affects the dog; Cryptococcus neoformans is the most common fungus isolated from the cat . Rhinosporidium infection causes obstructive nasal polyps in the dog but has not been reported in the cat . Several other miscellaneous fungi, including Exophiala, Alternaria, Trichosporon, Blastomyces, and Histoplasma, and the alga Prototheca occasionally cause nasal disease in dogs and cats. J Urol, 1992 Sep, 148(3), 889 - 90 Cryptococcal prostatic abscess associated with the acquired immunodeficiency syndrome; Mamo GJ et al.; A case of cryptococcal prostatic abscess in a 28-year old man with the acquired immunodeficiency syndrome is presented . This is a unique presentation of a cryptococcal prostatic infection and of a prostatic abscess . The diagnosis and management are discussed, and the literature is reviewed. Infect Immun, 1992 Sep, 60(9), 3937 - 9 In vivo complement activation and binding of C3 to encapsulated Cryptococcus neoformans; Truelsen K et al.; Tissues from mice infected with Cryptococcus neoformans were examined by immunofluorescence to determine the extent of deposition of complement component C3 on encapsulated cryptococci . The relative percentages of cryptococci in each tissue having readily visible C3 were greatest for liver and lung tissues, with the kidney tissue having the next highest percentage and the spleen having the lowest percentage . Binding of C3 fragments to cryptococci in brain tissue was essentially absent. Infect Immun, 1992 Sep, 60(9), 3682 - 8 Experimental model of intracerebral infection with Cryptococcus neoformans: roles of phagocytes and opsonization; Blasi E et al.; A murine model of intracerebral (i.c.) infection with Cryptococcus