South Med J, 1989 Mar, 82(3), 395 - 6 Cryptococcal meningoencephalitis presenting transient focal cerebral symptoms; Nowack WJ et al.; Cryptococcal meningoencephalitis (CM) is a fatal disease if untreated . We have presented an unusual case of CM clinically diagnosed as transient ischemic attacks . Therapy with amphotericin B and flucytosine cured the infection and the patient had no further episodes of transient focal cerebral dysfunction . In patients with transient focal cerebral symptoms, study of the cerebrospinal fluid may prove helpful. Radiology, 1989 Mar, 170(3 Pt 1), 629 - 35 Pulmonary parenchymal disease: evaluation with high-resolution CT; Murata K et al.; Usefulness of high-resolution computed tomography (HRCT) in locating pulmonary parenchymal disease in relation to the pulmonary lobule was evaluated in 71 patients, including 30 with normal pulmonary parenchyma and 41 with various pulmonary diseases . Both 10-mm-thick sections and 1.5- or 3.0-mm-thick HRCT scans were obtained . Distribution of pulmonary parenchymal disease was classified as centrilobular, panlobular, perilobular, bronchovascular, or nonlobular . Intralobular classification of disease distribution was more feasible in less severely diseased regions . HRCT revealed thickened intralobular bronchovascular bundles in patients with bronchiolitis obliterans, mycoplasma pneumonia, and pulmonary tuberculosis and thickening of both bronchovascular bundles and perilobular structures in patients with sarcoidosis, lymphangitis carcinomatosa, and malignant lymphoma . Centrilobular areas of increased attenuation were seen in patients with bronchopneumonia and pulmonary cryptococcosis . Centrilobular emphysema and bronchiolectasis were recognized only on HRCT images . The improved clarity and sharpness of parenchymal abnormalities on HRCT images, even in severely involved areas, provide additional information about disease distribution. Antonie Van Leeuwenhoek, 1989 Mar, 55(3), 221 - 36 A study of yeasts during the delignification and fungal transformation of wood into cattle feed in Chilean rain forest; Gonzalez AE et al.; In Chilean rain forest the presence and distribution of yeasts were studied during the fungal transformation of wood, producing a partially delignified material used as cattle feed ("huempe") . A total of 68 yeast species was reported, including a noticeable proportions of basidiomycetous and xylose-assimilating strains, the latter related to the increased availability of this sugar in the decayed wood . The results of the mathematic comparison of taxonomic data of 327 strains showed a delimitation of sharp clusters corresponding to different species, including several new species described from this substrate, and genera, as Rhodotorula and Cryptococcus . At the initial stages of wood decay, characterized by the presence of Candida species, yeast diversity was low . The highest values were found in the medium stage of decay, used as feed, with an important presence of the genera Apiotrichum, Rhodotorula, Cryptococcus and Schizoblastosporion . After establishing a non-linear ordination from Euclidean distances between samples, based on yeast abundances, a relationship was observed between the populations developing at the different stages of wood decay by Ganoderma applanatum . A succession of yeast species was demonstrated during wood degradation by this white-rot fungus. Mycoses, 1989 Mar, 32(3), 131 - 5 Incidence of yeasts in pregnant and non-pregnant women in Nigeria; Gugnani HC et al.; The yeast flora of vagina and associated sites (cervix, urethra, perineum and rectum) in 224 pregnant and 106 non-pregnant Nigerian women was investigated . A variety of yeasts represented by 12 species were isolated . Candida albicans was the most frequently isolated species in both groups, accounting for 63.6% of the isolates from pregnant women and 44.8% of the isolates from non-pregnant women . Other species of yeasts infrequently or occasionally encountered were Torulopsis glabrata, C . tropicalis, C . pseudotropicalis, C . parapsilosis, C . krusei, C . guilliermondii, C . stellatoidea, T . candida, T . etchellsii, Saccharomyces cerevisiae, Rhodotorula rubra and Cryptococcus uniguttulatus . C . albicans was also the principal species recovered from symptomatic cases in both groups, followed by T . glabrata in pregnant women and C . parapsilosis in non-pregnant women. Gaoxiong Yi Xue Ke Xue Za Zhi, 1989 Mar, 5(3), 132 - 45 Screening of isoquinoline alkaloids and their derivatives for antibacterial and antifungal activities; Tsai IL et al.; A screening test of antimicrobial activities for some of the isoquinoline alkaloids and their first and second Hofmann elimination products was conducted in this study . Results showed that (+)-actinodaphnine (1), (+)-N-Me-actinodaphnine (2), (+)-anonaine (17), (-)-xylopine (19) and (-)-N-Me-xylopine MeI (20), had the strongest inhibitory activities against three G(+) bacteria (Bacillus cereus, Micrococcus sp . and Staphylococcus aureus) MIC greater than or equal to 50 micrograms/ml) . Whereas anhydroushinsunine (34), anhydroushinsunine MeI (35), ushinsunine isomethine (38), dicentrine methine (23), roemerine methine (26), dicentrine bismethine (29) and O-Me-armepavine methine (48) also had antibacterial effects against these same three G(+) bacteria (MIC = 50-300 micrograms/ml) . However, only (+)-actinodaphnine (1) and roemerine methine (26) showed weak effects against two G(-) bacteria (Escherichia coli and Klebsiella pneumonia) (MIC = 300 micrograms/ml) . (+)-Actinodaphnine(1), (+)-N-Me-actinodaphnine (2), (+)-anonaine (17), anhydroushinsunine (34), anhydroushinsunine MeI (35), ushinsunine isomethine (38), O-Me-armepavine methine (48) and O,O-di-Et-N-Me-coclaurine methine (49) had potent antifungal activities against Candida albicans, Cryptococcus neoformans and other Candida species (MIC = 62.5-1000 micrograms/ml). Sarcoidosis, 1989 Mar, 6(1), 57 - 9 Sarcoidosis, cysticercosis and cryptococcosis: an unusual association; Ahmad I et al.; The association of sarcoidosis, cysticercosis, and cryptococcosis has not been reported before . We describe a 55-year old woman with this unusual association . The patient had a favorable outcome of cryptococcal meningitis. Antimicrob Agents Chemother, 1989 Mar, 33(3), 345 - 9 Study of the effects of liposomal amphotericin B on Candida albicans, Cryptococcus neoformans, and erythrocytes by using small unilamellar vesicles prepared from saturated phospholipids; Jullien S et al.; We compared the anticellular effects of liposomal amphotericin B (AmB) formed from AmB and small unilamellar vesicles . The small unilamellar vesicles with or without cholesterol were prepared from three L-alpha-phosphatidylcholines with saturated acyl chains of different lengths: distearoyl (C18), dipalmitoyl (C16), and dimyristoyl (C14) . We found that the anticellular potency of liposomal AmB, compared with that of free AmB, decreased with decreasing length of the acyl chain of the phospholipid and increased with the addition of cholesterol . In a parallel study (S . Jullien, A . Vertut-Croquin, J . Brajtburg, and J . Bolard, Anal . Biochem . 172:197-202, 1988), we found that binding of AmB to vesicles decreased with increasing length of the acyl chain of the phospholipid and decreased with the addition of cholesterol . We conclude that the anticellular effects of liposomal AmB preparations are due to the levels of AmB remaining free (unbound to the lipids) in these preparations. Semin Respir Infect, 1989 Mar, 4(1), 56 - 63 Community-acquired fungal pneumonias; Johnson PC et al.; Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, and Cryptococcus neoformans can cause acute community-acquired pneumonia . All are soil-dwelling fungi and disturbance of contaminated soil is necessary for infection in man . Each has particular epidemiologic considerations that may offer a clue to diagnosis, but the clinical presentation is not sufficiently characteristic to be of diagnostic help . Infection may produce variable symptoms, ranging from asymptomatic skin test conversion to fulminant respiratory failure . Chest roentgenograms are likewise nonspecific . Rapid microscopic diagnosis of Histoplasmosis in pulmonary secretions is seldom possible while blastomycosis and coccidioidomycosis may be seen in KOH digested sputum . Culture of H capsulatum and B dermatitidis usually takes several weeks, should not be attempted with C immitis, and is rapid with Cr neoformans . Serodiagnosis also takes several weeks and is usually not helpful while the patient is symptomatic . Treatment may not be necessary unless the patient is immunosuppressed, seriously ill, or has life threatening complications . The primary pulmonary infection may disseminate to extrapulmonary sites, which always requires treatment. Infect Dis Clin North Am, 1989 Mar, 3(1), 77 - 102 Cryptococcosis; Perfect JR; Cryptococcosis emphasizes the importance of the host-parasite interaction . C . neoformans has developed factors to invade the host but generally requires host immune dysfunction to establish infection . Cryptococcal infection has increased as our immunocompromised pool of patients enlarges . Although many questions regarding management of cryptococcosis remain, it is a well-studied infection with excellent guidelines for diagnosis, treatment, and prognosis. Drugs, 1989 Mar, 37(3), 310 - 44 Itraconazole . A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in superficial and systemic mycoses; Grant SM et al.; Itraconazole is an orally active triazole antifungal drug which has demonstrated a broad spectrum of activity and a favourable pharmacokinetic profile . It is a potent inhibitor of most human fungal pathogens including Aspergillus sp . In non-comparative clinical trials itraconazole was shown to be extremely effective in a wide range of superficial and more serious 'deep' fungal infections when administered once or twice daily . Generally, greater than 80% of patients with superficial dermatophyte or yeast infections are cured by itraconazole . Similarly, good to excellent response rates (clinical cure or marked improvement) are achieved in paracoccidioidomycosis, histoplasmosis, sporotrichosis, blastomycosis, systemic candidiasis, coccidioidomycosis, chromomycosis, aspergillosis and cryptococcosis . Understandably, given the rare nature of some of these diseases, clinical experience is relatively limited and further evaluation, preferably controlled trials with amphotericin B and ketoconazole, would help clarify the ultimate role itraconazole will have in their management . Preliminary findings also indicate that itraconazole may hold promise for the prophylaxis of opportunistic fungal infections in patients at risk, for example women with chronic recurrent vaginal candidiasis, immunodeficient patients with chronic mucocutaneous candidiasis, AIDS patients and patients receiving immunosuppressant drugs . In studies to date itraconazole has been very well tolerated . Transient changes in indices of liver function occurred in 1 to 2% of patients; however, symptomatic liver dysfunction (as occurs infrequently with ketoconazole) has not been reported . Wider clinical experience is needed to permit clear conclusions as to whether liver dysfunction can result from itraconazole administration . Thus, while several aspects of the drug's profile require further investigation, itraconazole is a promising new oral treatment of fungal disease . The extent to which itraconazole will be employed in preference to ketoconazole will be clarified by wider clinical experience. J Infect, 1989 Mar, 18(2), 151 - 65 Experience with itraconazole in cryptococcosis and aspergillosis; Viviani MA et al.; Cryptococcosis and aspergillosis in immunocompromised patients are extremely difficult clinical conditions to manage and treatment with available antifungal drugs often fails . Itraconazole, R-51211, Janssen Pharmaceutica, a new orally absorbed triazole, is a possible alternative drug which is potentially effective and nontoxic . Preliminary experience with 28 patients, eight with cryptococcosis and 20 with aspergillosis, is reported . Of these patients, 16 were immunocompromised (seven with the acquired immune-deficiency syndrome (AIDS), five heart transplant recipients and four with leukaemia or lymphoma) . Overall, results of treatment were good (18 in remission, four markedly improved, four moderately improved and two failed) . Prevention of relapses of cryptococcosis was obtained in all patients with AIDS on long-term itraconazole monotherapy (3 mg/kg) . Treatment of invasive aspergillosis required a higher dosage (about 5 mg/kg) and prolonged administration . Besides its efficacy this antifungal agent allowed outpatient management. Acta Cytol, 1989 Mar-Apr, 33(2), 233 - 44 Cerebrospinal fluid manifestations of the neurologic complications of human immunodeficiency virus infection; Katz RL et al.; Cerebrospinal fluid (CSF) cytology, white blood cell (WBC) count and protein were evaluated in 32 human immunodeficiency virus (HIV)-infected patients with the acquired immune deficiency syndrome (AIDS) or an AIDS-related complex who manifested a variety of neurologic symptoms . Of 17 patients with AIDS-related encephalitis (ARE), 13 had hypocellular CSFs; elevated WBCs and pleocytosis were noted in 4, multinucleated giant cells in 2 and elevated CSF protein was found in 4 of 8 specimens tested . Three patients with central nervous system (CNS) toxoplasmosis had unremarkable CSF cytology findings, but all had elevated CSF proteins . In five patients with cryptococcal meningitis, cytologic examinations demonstrated organisms in four and elevated proteins in three . Of five patients with primary CNS lymphomas, one had cytology positive for large cell lymphoma; two showed suspicious cells and two manifested "atypical lymphocytes." Elevated CSF protein was present in four . Other conditions observed included progressive multifocal leukoencephalopathy, tubercular meningitis and cytomegaloviral (CMV) meningitis or encephalitis . Twenty-five percent of patients with ARE manifested pleocytosis with multinucleated giant cells; pleocytosis with CMV inclusions was noted in a CMV viral radiculitis . The CSF cytologic examination in HIV-infected patients with neurologic complications seems helpful in diagnosing cryptococcal meningitis and lymphoma, but less so for diagnosing toxoplasmosis. In Vivo, 1989 Mar-Apr, 3(2), 61 - 78 Acquired immunodeficiency syndrome: molecular biology and its therapeutic intervention (review); Schulhafer EP et al.; AIDS is one of the most perplexing diseases to confront modern medicine today . AIDS will rank just behind accidents, heart disease and cancer as a major cause of potential life lost in the USA by 1991 . Over half million AIDS cases are predicted by 1993 in the United States alone . There has been a great improvement in the understanding and treatment of opportunistic infections in AIDS . The most important concept is prophylactic treatment of the most common infectious complications as the immune system deteriorates . The major advance has been the prophylactic treatment of Pneumocystic Carinii Pneumonia (PCP) with either aerosolized Pentamidine or low dose Bactrim . Some experts advocate a low dose antibiotic prophylaxis for latent toxoplasma and cryptococcal infection in those patients whose immune systems are deteriorating . Prophylaxis would be instituted as the T4 helper lymphocyte count decreases . Finally, any patient found to be lately infected with either tuberculosis or syphilis, while HIV positive, must be thoroughly treated for these infections prior to any immunocompromise . The minimum follow-up of HIV positive individuals should include T4 lymphocyte counts and perhaps P24 antigen levels as well as beta 2-microglobulin levels . As these parameters worsen, patients should be directed to explore safe available treatments such as Antabuse, Naltrexone and Dextran sulfate . Any healthy patient with T4 helper counts under 400 should be directed to AIDS treatment evaluation units for enrolment in research protocols . At present over 100 drugs are being tested for the treatment of AIDS . However, researchers predict that no more than one or two drugs will be discovered over the next three years that will be helpful in the treatment of AIDS . If ever there was a more powerful argument to institute a new way of evaluating research drugs, it is this prediction . Due to the epidemic proportions of this disease, it seems reasonable to test epidemic proportions of this disease, it seems reasonable to test drugs shown to have some effect in groups of three of four drugs per patient . It is well demonstrated that AZT (Zidovudine) loses its anti-retroviral effect at about twelve to eighteen months . Drug resistance is seen in the treatment of a similar infectious agent, M . tuberculosis . Acute infection of MTB necessitates the use of three antibacterial agents . In AIDS infection, it seems logical to test two or three anti-retrovirals combined with one immunostimulant.(ABSTRACT TRUNCATED AT 400 WORDS) Tubercle, 1989 Mar, 70(1), 37 - 43 Detection of mycobacterial antigens in cerebrospinal fluid by enzyme-linked immunosorbent assay; Wu CH et al.; By use of commonly available antibodies against Mycobacterium bovis BCG, Mycobacterium tuberculosis antigens can be detected by a rapid and sensitive double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) . The ELISA was dose-dependent and capable of detecting as little as 4 ng of antigens . Absorbance for 5 patients with confirmed tuberculous meningitis ranged from 0.150 to 0.600 with a mean value of 0.271 +/- 0.190 . For 134 non-meningitis control patients and 6 treated tuberculous meningitis patients, optical densities were 0.032 +/- 0.009 and 0.029 +/- 0.010, respectively . Specificity was demonstrated by the negative results (0.028 +/- 0.006) with bacterial and cryptococcal antigens . Maximum cross-reactivity with non-tuberculous mycobacterial antigens was less than 7%. Neurol Med Chir (Tokyo), 1989 Mar, 29(3), 251 - 4 Intraventricular cryptococcal granulomas--case report; Aoki N; A 54-year-old, previously healthy female with chronic meningocencephalitis is presented . Computed tomography (CT) revealed hydrocephalus and mass lesions in both the lateral and fourth ventricles . A culture of cerebrospinal fluid obtained from the lateral ventricle on admission was negative, but 2 years later, when the meningoencephalitis recurred, Cryptococcus neoformans was cultured . The diagnostic difficulties and CT features of intracranial cryptococcal granulomas are discussed. Arch Intern Med, 1989 Feb, 149(2), 302 - 4 Significance of Histoplasma antigen in the cerebrospinal fluid of patients with meningitis; Wheat LJ et al.; A radioimmunoassay was previously developed for detection of Histoplasma capsulatum antigen in the blood and urine of patients with disseminated histoplasmosis . In this investigation, cerebrospinal fluid (CSF) specimens from 14 episodes of Histoplasma meningitis occurring in 12 patients were tested by radioimmunoassay . Histoplasma capsulatum antigen was detected in the CSF of five patients . Cerebrospinal fluid cultures were positive for H capsulatum in three of these five patients . Antibodies to H capsulatum were found in nine of the 13 CSF specimens tested . The radioimmunoassay for Histoplasma antigen was also positive in the CSF in one of 11 patients with coccidioidal meningitis but not in 17 patients with cryptococcal meningitis . It was concluded that Histoplasma antigen is present in the CSF of some patients with histoplasmosis and chronic meningitis, but cross-reactions may occur in patients with coccidioidal meningitis. Gaoxiong Yi Xue Ke Xue Za Zhi, 1989 Feb, 5(2), 126 - 8 Isolation of Cryptococcus albidus var . albidus in patient with pemphigus foliaceus; Lin SR et al.; Cryptococcus albidus var . albidus was isolated from the blood of a patient with pemphigus foliaceus after steroid therapy . This organism was found in triple extract peptone medium which is used in our laboratory for blood culture to detect aerobic and anaerobic bacteria . Identification of Cryptococcus was made by the API 20C yeast carbohydrate assimilation test, together with conventional procedures . These include the demonstration of chlamydospore production, germ tube test, urease test, nitrate assimilation test and colony morphology . The patient infected with Cryptococcus albidus var albidus had a good response to oral ketoconazole therapy, then the recovered and was discharged . The isolate obtained from this case may be regarded as an etiologic agent in fungemia. Mycoses, 1989 Feb, 32(2), 63 - 72 Use of the membrane filtration technique and Staib agar for the detection of Cryptococcus neoformans in the urine of AIDS patients--a contribution to diagnosis, therapy and pathogenesis of cryptococcosis; Staib F et al.; For the cultural control of Cryptococcus neoformans (Cr.n.), among the routinely examined standard specimens like CSF, sputum, blood, etc., urine earns special attention . The combination of membrane filtration technique (MFT) and Staib agar for the detection of Cr.n . from body fluids as described by Staib in 1963 was used for the cultural isolation of Cr.n . from urine of AIDS patients . In 3 examplary cases the diagnostic significance of this method could be demonstrated: The brown colour effect (BCE) of Cr.n . of a single CFU, as well as in colonies growing with a high density, was produced on average within 3-5 d/26 degrees C . The method was found to be useful for the evaluation of antimycotic therapy . One example of the survival of a few CFUs of Cr.n . under treatment with fluconazole as compared to the efficacy of therapy with amphotericin B + flucytosine, and one example of a re-emergence of Cr.n . in the urogenital tract after a too short duration of treatment with amphotericin B + flucytosine are shown . For the exclusion of the survival of single CFUs of Cr.n . in the urogenital tract of males, quantities up to 1 l of urine for the combination of MFT and Staib agar are proposed . As a secondary observation, it was found that this diagnostic combination in addition to its primary purpose, can serve to detect the metabolic end products of the human body present in urine which may influence capsule formation of Cr.n . neoformans. J Laryngol Otol, 1989 Feb, 103(2), 214 - 5 Cryptococcosis of the larynx; Smallman LA et al.; An unusual case of cryptococcosis of the larynx is described in a non-immunocompromised patient . To our knowledge this is the second reported case in the literature. J Neurosurg, 1989 Feb, 70(2), 195 - 200 Stereotaxic suboccipital transcerebellar biopsy of pontine mass lesions; Abernathey CD et al.; Twenty-six patients (16 male and 10 female) ranging in age from 5 to 68 years underwent suboccipital transcerebellar stereotaxic biopsy of mass lesions situated in the pons . Stereotaxic computerized tomography, magnetic resonance imaging, and angiographic data were obtained while the patient was positioned in an inverted custom stereotaxic head frame . The patients were then placed under general endotracheal anesthesia and positioned prone . Optimal trajectory planning utilized a transcerebellar route directed through the middle cerebellar peduncle, with target and entry points calculated to avoid vascular structures . No complications were encountered in the perioperative period when this technique was used . Histological diagnosis of the lesions revealed: astrocytomas in 14 patients, oligodendroglioma in one, ependymoma in one, arteriovenous malformations in two, radionecrosis in one, cryptococcal abscess in one, demyelinating disease in three, and infarctions in three . No consistent correlation could be made between radiographic characteristics and histological diagnoses . Empiric treatment of brain-stem lesions without tissue diagnosis based upon the radiological and clinical findings may result in inappropriate therapy administration . Alternatively, open operative procedures to obtain tissue require a visible surface abnormality to guide biopsy, and carry the risks of a major surgical procedure in already compromised patients . For these reasons the authors consider a suboccipital transcerebellar stereotaxic biopsy to be the diagnostic procedure of choice in the assessment of pontine mass lesions. AIDS, 1989 Feb, 3(2), 77 - 8 The value of cryptococcal serum antigen screening among HIV-positive/AIDS patients in Kinshasa, Zaire; Desmet P et al.; Cryptococcal meningitis is a frequently observed opportunistic infection in AIDS patients in Zaire and other countries in Central Africa . The prognosis in those patients is very poor because of the advanced stage of their cryptococcal disease at presentation . To improve the prognosis of cryptococcal meningitis in HIV-infected patients through earlier diagnosis, a routine serum cryptococcal antigen screening was performed on 450 HIV-positive/AIDS patients seen at the Cliniques Universitaires de Kinshasa between 1 January 1988 and 31 August 1988 . Cryptococcal antigen was detected in the sera of 55 (12.2%) of them . Cerebrospinal fluid was obtained from 44 of these 55 patients and the presence of Cryptococcus neoformans was demonstrated by direct microscopy and culture in 29 (66%) of themPIP: A routine serum cryptococcal antigen screening of 450 human immunodeficiency virus (HIV)-positive/acquired immunodeficiency syndrome (AIDS) patients at the Cliniques Universitaires de Kinshasa, Zaire, revealed that cryptococcal antigen was present in the sera of 55 (12.2%) of them . Health professionals collected cerebrospinal fluid of 44 patients from the positive serum group . The fungus Cryptococcus neoformans was identified by direct microscopy and culture in 29 (66%) of them . 6.6% of the originally screened HIV-positive/AIDS patients, therefore, had cryptococcal meningitis which is an opportunistic infection in these individuals . Serum screening for cryptococcal antigens could improve the prognosis of cryptococcal meningitis in HIV-infected patients by introducing an appropriate antifungal treatment at an early stage . J Immunol, 1989 Jan 15, 142(2), 659 - 65 Paradoxical role of capsule in murine bronchoalveolar macrophage-mediated killing of Cryptococcus neoformans; Levitz SM et al.; Infections with the encapsulated fungus Cryptococcus neoformans are usually acquired via inhalation, and the presence of a capsule has been identified as a virulence factor . Therefore, we studied murine bronchoalveolar macrophage (BAM)-mediated killing and phagocytosis of encapsulated and acapsular strains of C . neoformans . After 2 h, BAM killed encapsulated strains CN52 and MP415 more readily than acapsular strains CN602 and CAP67 (54.9 and 36.2% vs 26.1 and 6.7%, respectively, p less than 0.001) . Pre-incubating CN602 with purified capsular polysaccharide increased killing to 42.7% (p = 0.04) . Significantly greater killing of the encapsulated strains also occurred in vivo . BAM-mediated killing of CN52 appeared to proceed by non-oxidative mechanisms, as BAM released minimal amounts of H2O2 after stimulation with CN52, and killing was not reduced by inhibitors or scavengers of the respiratory burst . The association between encapsulation and susceptibility to BAM fungicidal effects was not attributable to differences in yeast ingestion . Using the same low ratio of organisms to BAM as in the killing assay, greater than 95% of both CN52 and CN602 were phagocytosed . However, BAM phagocytosed significantly greater numbers of acapsular CN602 when incubated with a higher inoculum . Phagocytosis and killing of CN52 and CN602 required fresh serum as a source of C . Phagocytosis of CN52, but not CN602, was profoundly inhibited if BAM were plated on surfaces coated with mAb against the C3bR (CR1) . mAb against the iC3b receptor (CR3) did not affect phagocytosis of either strain . These data demonstrate the innate ability of BAM to preferentially kill, by apparently non-oxidative mechanisms, an encapsulated as opposed to acapsular organism . Inasmuch as different receptors appear involved in phagocytosis of encapsulated versus acapsular C . neoformans, the disparity in killing may result from the greater ability of receptors mediating uptake of encapsulated organisms to trigger the antimicrobial armamentarium of the BAM. Am J Vet Res, 1989 Jan, 50(1), 32 - 3 Seminal vesicle and coagulating gland growth induced by intraperitoneal inoculation of fungi in mice; Lyons HJ et al.; The effect of fungi on the growth of body organs in mice was investigated . Single, intraperitoneal injections of yeasts (Cryptococcus albidus, Saccharomyces cerevisiae, Schizosaccharomyces octosporus) or molds (Aspergillus niger, Geotrichum candidum, Mucor haemalis) induced an increase in the mass of seminal vesicles and coagulating glands independent of whole body weight changes in mice. J Neurol, 1989 Jan, 236(1), 38 - 42 Cryptococcosis in AIDS patients: observations concerning CNS involvement; Weinke T et al.; The clinical course and response to therapy of seven patients with cryptococcosis and AIDS were reviewed . One patient was still in the primary stage of cryptococcosis in AIDS, i.e . the stage that is characterized by the sole cultural detection of Cryptococcus neoformans in the respiratory tract . The other six patients were in the secondary stage, where C . neoformans can be detected from the cerebrospinal fluid (CSF), blood, urine, faeces and other body sites . The main presenting features (headache, fever, nausea) were due to central nervous system involvement, although meningism and mental changes were rarely present, and CSF changes were very subtle . Treatment with amphotericin B and flucytosine was very effective, there being no more growth of fungi in cultures in most cases . Adverse reactions to the drugs used occurred frequently and consisted mainly of anaemia, hepatosis and fever . Diagnosis in the primary stage of cryptococcosis may improve the prognosis. Plucne Bolesti, 1989 Jan-Jun, 41(1-2), 103 - 5 {Pulmonary manifestations in patients with AIDS}; Sunjara BM et al.; In acquired immunodeficiency syndrome (AIDS) the pulmonary opportunistic infections are due to the depression of cellular immunity and they are found in more than 50% of patients . Most frequently the infection is due to Pneumocystis carinii, Cytomegalovirus, Cryptococcus neoformans and Mycobacterium avium-intracellulare . Non-opportunistic infections in AIDS are mostly due to the Mycobacterium tuberculosis and Legionella pneumophila . In Kaposi sarcoma in AIDS the lungs may be involved into pulmonary manifestations of the syndrome . In this paper the diagnostics of pulmonary disturbances in AIDS is briefly evaluated together with the therapy of most frequent pulmonary infections. J Med Vet Mycol, 1989, 27(4), 253 - 6 Garlic (Allium sativum) in the treatment of experimental cryptococcosis; Louria DB et al.; An extract of garlic was studied for its efficacy in treatment experimental cryptococcosis in mice . The garlic, given by mouth, appeared to reduce brain cryptococcal populations, although the results obtained were generally inconsistent . Complete eradication of the cryptococci was not achieved and the early beneficial results observed diminished over time. Adv Exp Med Biol, 1989, 252, 181 - 8 Glomerular lesions and opportunistic infections of the kidney in AIDS: an autopsy study of 47 cases; van der Reijden HJ et al.; AIDS-associated nephropathy (AAN) causing acute renal failure has been described in patients with AIDS . It is characterized by massive proteinuria and focal segmental glomerulosclerosis . From 1982 until 1987, 177 patients with AIDS were seen in our center . Most of them were homosexual or bisexual men . One patient was also an intravenous drug addict . One patient was a black female . None suffered from a nephrotic syndrome or needed hemodialysis during their illness . In 47 of the 110 patients who died an autopsy was performed . On microscopical examination of kidney tissue obtained at autopsy, no abnormalities were seen in 12 patients and slight abnormalities were found in 35 patients . Glomerular changes, mostly fibrous caps in Bowman's space, were present in 22 patients . Mesangial and intracapillary lesions were seen in only 5 patients . Tubular atrophy was found in 14 patients and sparse interstitial inflammation in 15 patients . A renal localisation of disseminated opportunistic infections was found in 11 patients: CMV (n = 4), tuberculosis (n = 2), Mycobacterium avium intracellulare (n = 1) and Cryptococcal infection (n = 4) . In one patient a renal localisation of a Kaposi sarcoma and in another patient a renal localisation of a disseminated non-Hodgkin lymphoma was found . In conclusion the clinical picture of AAN with acute renal failure was not found in our center . As is the case with heroin associated nephropathy, AAN seems to be confined to certain areas in the USA, suggesting that racial or local co-factors, are important for the pathogenesis of AAN in AIDS. Bull Soc Pathol Exot Filiales, 1989, 82(3), 297 - 307 {Neurologic and psychiatric manifestations of AIDS in Central African Republic}; Belec PL et al.; To describe and evaluate the frequency of neurological and psychiatric manifestations in African patients with AIDS, 93 in patients at the National Hospital Center, Bangui, were chosen according to the WHO clinical definition of AIDS and were confirmed to be HIV-1 positive (92/93) or HIV-2 positive (1/93) by Western blot . Patients were given both neurologic and psychiatric examinations . Cortico-spinal fluid (CSF) analysis was performed in case of neuro-psychiatric signs . 11 patients presented neurologic symptoms: 5 had focal processes associated in 2 cases with deep coma, 4 had cryptococcal meningitidis, 1 demonstrated peripheral facial paralysis, and there was one case of abnormal movement, choreo-athetotic type . 4 patients presented frank psychiatric symptoms (3 dementia syndromes, one of whom was HIV-2 positive, and 1 case of hallucinatory psychosis) . CSF analysis was only helpful in the etiologic diagnosis of cryptococcal infection . The mortality rate in these 15 patients was 60% during the 2-month study . In this series, neurologic and/or psychiatric symptoms were detected in 16 (15/93)% of African patients with AIDS. Nihon Kyobu Shikkan Gakkai Zasshi, 1989 Jan, 27(1), 14 - 24 {Autopsy cases of terminal pulmonary infections}; Nagata N et al.; In order to clarify the present state of terminal pulmonary infections, all autopsy cases from 1976 to 1985 reported in the annual records of autopsy cases in Kyushu University Hospital were reviewed . Of the total of 2,238 autopsy cases, pulmonary infections were present in 1,042 (46.6%) and in 595 (26.6%) pulmonary infections were fatal . Among the primary diseases associated with pulmonary infections, hematologic diseases such as leukemia and malignant lymphoma, lung cancer, esophageal cancer and cerebrovascular disease were most frequent . The pathogens of fatal pulmonary infections occurring in autopsy cases were bacteria (26.6%), Aspergillus (3.2%), Candida (1.8%), cytomegalovirus (1.7%), Pneumocystis carinii (1.1%), Mycobacterium (0.9%), Cryptococcus (0.6%) and phycomycetes (0.1%) . The incidence of non-bacterial, especially fungal, pulmonary infections has increased during the recent five-year period . Among the pulmonary infections associated with lung cancer in autopsy cases, mycobacteriosis occurred more frequently than fungal infection . The incidence of fatal mycobacteriosis was more frequent in cases receiving steroids than in those not receiving steroids . Antemortem diagnosis of pulmonary infections was made in only 4.6% and 26.3% of cases of non-bacterial infection and mycobacteriosis, respectively . There was no autopsy case diagnosed before death as aspergillosis, which most frequently occurred among the fungal pulmonary infections in autopsy cases. Neuroradiology, 1989, 31(1), 33 - 9 Nervous system manifestations and neuroradiologic findings in acquired immunodeficiency syndrome (AIDS); Rodesch G et al.; We report a series of thirteen patients with nervous system complications out of a total of thirty AIDS patients admitted to our hospital over the last two years for which CT and/or MRI have been performed . Five were homosexual men and eight patients (5 men, 3 women) were of African origin (Zaire and Rwanda) (n = 5) or had had sexual intercourse with the local African population (n = 3) . The nervous system complications encountered included: toxoplasma gondii brain abscess (2 patients); cryptococcus neoformans meningitis + toxoplasmosis (1 patient); toxoplasmosis + lymphoma (2 patients); progressive multifocal leucoencephalopathy (1 patient); lymphocytic meningitis or encephalitis (3 patients); lymphoma (1 patient); polyradiculoneuritis (3 patients) . Three of thirteen patients had multiple intracranial abnormalities: one had concomitant intraparenchymal toxoplasma abscess and cryptococcal meningitis; in one patient a lymphoma developed after the successful medical treatment of a toxoplasma abscess; conversely, one patient developed a toxoplasma abscess two years after mediastinal radiotherapy for a systemic non-Hodgkin lymphoma . In conclusion, in our experience, nervous system toxoplasmosis is the most frequent AIDS related CNS complication . Our series demonstrates the high frequency of a second neurological disease occurring either concomitantly or separately . In these cases, while CT may readily identify the intracranial abnormalities, it contributes little towards an etiological diagnosis . Finally, our series illustrates the importance of a central African endemic focus for AIDS. Acta Cient Venez, 1989, 40(2), 151 - 4 {Serotyping of 27 Cryptococcus neoformans strains isolated in Venezuela}; Villanueva E et al.; Twenty seven autochtonous isolates of Cryptococcus neoformans from different parts of the country were studied . The analysis indicated the following serotype distribution: 63% Serotype A, 29.6% Serotype B, 3.7% Serotype D and 3.7% belonging to C . neoformans var gattii. Yao Xue Xue Bao, 1989, 24(12), 895 - 905 {Synthesis and antifungal activity of N-(6,6-dimethyl-2-hepten-4-ynyl)-N-methyl-alpha-substituted -1-(4-substi tuted) naphthalenemethanamines}; Chen WP et al.; Thirty (E)- or (Z)-N-(6,6-dimethyl-2-hepten-4-ynyl)-N-methyl-alpha-subst itu ted-1-(4-substituted)naphthalenemethanamines were synthesized for searching of more potent and less toxic antimycotic agents . All title compounds and most of the intermediates are new . Results of preliminary biological tests showed that most of the title compounds exhibited activity against the common pathogenic fungi such as Cryptococcus neoformnas, Candida albicans, Aspergillus fumigatus, Cladosporium carrionii, Sporothrix schenckii, Microsporum gypseum, Trichophyton rubrum and Epidermophyton floccosum . The antifungal activity of compound I1a was roughly comparable to clotrimazole, and was more active against Candida albicans than naftifine and terbinafine . Compound III1a was as active as terbinafine against all fungi tested . Some improvements for the synthesis of tert-butylacetylene and the alkylating method of 1H-1,2,4-triazole and 1H-imidazole were made . Synthesis of 6,6-dimethyl-1-hepten-4-yn-3-ol and 2-alken-4-ynylamines were modified. Arch Neurobiol (Madr), 1989, 52 Suppl 1, 23 - 9 {Neurologic complications of AIDS . Panoramic view based on a multicenter hospital study}; Martinez-Martin P et al.; Data concerning 292 neurologic complications of AIDS were supplied by ten Departments of Neurology of Spanish hospitals . The period of study was from june 1984 to june 1988 . The most frequent complications were: Toxoplasmosis of the CNS (28%), subacute encephalopathy (17%), distal polyneuropathy (8%), tuberculous meningitis (7.5%) and cryptococcal infection of the CNS (6.5%) . The most important risk factors for AIDS in this series were intravenous drug addiction (77%) and homosexuality in males (12%) . The overall mortality among the reported complications was 54.7% . The main causes of mortality were toxoplasmosis (32% of the fatalities), subacute encephalopathy (19%), and progressive multifocal leukoencephalopathy (8%) . These data are compared to those obtained from other European and American series. Rev Inst Med Trop Sao Paulo, 1989 Jan-Feb, 31(1), 1 - 6 Isolation of human fungi from soil and identification of two endemic areas of Cryptococcus neoformans and Coccidioides immitis; Rubinstein H et al.; The present study was carried out in two different areas of Province of Cordoba, Argentina, where there was a suspicious of endemic mycosis . The previous data were the presence of a clinical case of pulmonary cryptococcosis in one area (Alta Gracia) and the previous findings of a high incidence of coccidioidin and cryptococcin reactors in the population of the second one (Villa Dolores) . In both areas soil samples for fungi were studied and Cryptococcus neoformans was found in 2/25 samples from Alta Gracia . In Villa Dolores Coccidioides immitis was isolated in 2/40 samples, and C . neoformans in 1/40 samples . Delayed hypersensitivity test with cryptococcin was determined in the population from Alta Gracia and it was found to be 5.3% . Positive cutaneous tests with coccidioidin (33.8%) and cryptococcin (31.9%) in Villa Dolores were obtained . With these findings two endemic areas of systemic mycoses in Cordoba, Argentina were delimited. J Med Vet Mycol, 1989, 27(4), 219 - 28 Killing of Cryptococcus neoformans by rat alveolar macrophages; Bolanos B et al.; The addition of {51Cr}-labeled yeast cells of Cryptococcus neoformans to monolayers of Lewis rat alveolar macrophages (AM phi) provided a sensitive and reproducible in vitro assay of phagocytosis . AM phi and yeast cells were incubated in 10% (v:v) normal rat serum for 1 h, non-AM phi associated yeast cells were removed and the AM phi-associated radioactivity (phagocytosis) determined . Replicate wells were replenished with fresh medium and reincubated . At different times, yeast-AM phi monolayers were treated with a non-cryptococcocidal mixture of DNAse and sodium deoxycholate to release the yeast cells from the AM phi . The fate of the yeast cells was critically evaluated by {51Cr}-release and viable plate counts . Killing was detected by plate counts within an hour following phagocytosis and did not increase significantly during the next 5 h . Strains of C . neoformans with small, medium, or large capsules varied in their susceptibility to killing from 10% to 95% but susceptibility to killing was not directly related to capsule size and the extent of phagocytosis . Release of 51Cr did not correlate with viability as determined by culture . The 51Cr was associated with two pools in the yeast cells; one, representing 15-20% of the radiolabel, was easily released and was probably bound to low molecular weight compounds in the cytoplasm . The majority of label was tightly bound to the particulate alkali-soluble cell wall fraction. J Med Vet Mycol, 1989, 27(4), 203 - 17 Phagocytosis of Cryptococcus neoformans by rat alveolar macrophages; Bolanos B et al.; A radiolabeling method was developed to investigate the interaction in vitro between Cryptococcus neoformans and Lewis rat alveolar macrophages (AM phi) . AM phi were harvested by lung lavage, monolayers of adherent cells were established in wells of microtiter plates and {51Cr}-labeled yeast cells were added to the monolayers . After removal of extracellular yeasts, the adherent radioactivity associated with the AM phi was directly proportional both to the number of yeasts added and to the number of yeasts per AM phi as determined by microscopic examination of Giemsa-stained monolayers . Phagocytosis (attachment and/or ingestion) of radiolabeled C . neoformans by AM phi was a sensitive, quantitative and reproducible assay for the evaluation of the AM phi-C . neoformans interaction . AM phi were able to phagocytose encapsulated strains of C . neoformans . The extent of phagocytosis was inversely related to the capsule size . Normal rat serum (NRS) was an excellent source of opsonins for the ingestion . Inactivation of serum complement or depletion of C3 by affinity chromatography removed most of the opsonic activity of NRS . Specific antibodies against C . neoformans did not increase phagocytosis. J Gen Microbiol, 1989 Jan, 135 ( Pt 1), 65 - 71 Electrophoretic karyotype of the pathogenic yeast Cryptococcus neoformans; Polacheck I et al.; The electrokaryotype of the pathogenic yeast Cryptococcus neoformans is described for the first time . Three different patterns were seen: (a) serotypes B and C (variety gattii) are similar and consist of nine chromosome mobility groups of greater than 580 kb; (b) serotype A (variety neoformans) revealed eight chromosome-like groups greater than 700 kb; (c) serotype D (the second serotype of variety neoformans) not only differs from those described above, but each D isolate tested showed a different distribution of bands . The discrepancy, and the importance of electrokaryotyping as a taxonomic tool, are discussed. J Med Vet Mycol, 1989, 27(1), 17 - 25 Inhibitory effect of a new mycotic agent, piritetrate on ergosterol biosynthesis in pathogenic fungi; Morita T et al.; A new antimycotic agent piritetrate, a thiocarbamate derivative, was found to interfere with fungal sterol biosynthesis . Sterol biosynthesis was measured by means of incorporation of radioactivity from {14C}acetate into individual sterol fractions and their precursor compounds extracted from cells of Candida albicans, Cryptococcus neoformans, and Trichophyton mentagrophytes . Piritetrate was a much more potent inhibitor of fungal squalene epoxidation than a related drug, naphthiomate . The greater antifungal efficacy of the former was reflected in its greater inhibitory action on sterol biosynthesis than the latter . Such inhibitory effects were also demonstrated in in vitro labelling experiments with {14C}mevalonate on the S10 fraction (10,000 g supernatant of homogenate) of C . albicans cells . At 5 x 10(-7) M concentration, piritetrate gave almost 90% inhibition of ergosterol biosynthesis in the S10 fraction of C . albicans cells . Furthermore, this agent was highly specific for fungal enzymes involved in ergosterol biosynthesis, with no detectable effects on mammalian cholesterol biosynthesis in rat liver at the therapeutic concentration. Mycoses, 1989 Jan, 32(1), 7 - 13 Mitochondrial kinetics during mitosis in Cryptococcus neoformans--an ultrastructural study; Mochizuki T et al.; Mitochondrial kinetics during mitosis in Cryptococcus neoformans was examined with ultrathin serial sections using a computer-aided three-dimensional reconstruction technique . The number of mitochondria varied during mitosis: there was an increase in prophase to telophase cells and a decrease in interphase cells . No appreciable differences in the form and number of mitochondria were found between the cells in the logarithmic growth phase and stationary phase . Fluctuations in the ratio of mitochondrial volume/total cytoplasmic volume were minimum during mitosis . However, the ratio was affected by the growth condition of the cells; that is, the ratio in the logarithmic growth cells was significantly higher than that in stationary cells . A giant mitochondrion, which is composed of a coalescence of all the mitochondria in a cell, was not found in this study. Mycoses, 1989 Jan, 32(1), 14 - 23 Effect of hypertonic solutes upon the polysaccharide capsule in Cryptococcus neoformans; Jacobson ES et al.; The polysaccharide capsule is a characteristic virulence factor in the yeast-pathogen, Cryptococcus neoformans . Growth in hypertonic growth media results in yeast cells with visibly smaller capsules . We investigated this suppression quantitatively, using a chemical assay for cell-bound and dissolved capsular polysaccharide . Molar NaCl suppressed production of cell-bound polysaccharide by a factor of 2.5- to 5-fold . The possibility of salt-induced physico-chemical contraction of capsular gel was tested by dialysis of fixed cells from hypotonic medium against medium containing 1 M NaCl and against the original medium again, while capsular thickness, packed cell volume and cell-bound polysaccharide were followed . We detected a physical contraction of gel following dialysis against medium containing 1 M NaCl . Mutants which gave mucoid colonies on hypertonic agar were isolated . One of these gave twice as much polysaccharide as the wild type when cultivated in medium containing 1 M NaCl . The hypercapsular trait was passed through serial outcrosses to the wild type and segregated as a chromosomal gene . This mutant may represent a gene which regulates production of capsular polysaccharide. Ann Biol Clin (Paris), 1989, 47(2), 102 - 7 {Current aspects of medical mycology}; Dupouy-Camet J et al.; The authors tried in this article to review the principal aspects of deep mycoses . A special attention was paid to the clinical aspects of candidiasis, aspergillosis and cryptococcosis . The incidence of these diseases is now growing owing to the increasing use of immunosuppressives drugs and to AIDS . The difficulty of the biological diagnosis of these mycoses is discussed . Drugs currently used are amphotericin B, 5-fluoro-cytosine, ketoconazole and fluconazole . Prophylactic measures and the indications of the main drugs are considered. J Antimicrob Chemother, 1989 Jan, 23 Suppl A, 107 - 25 Fungal and mycobacterial infections in patients infected with the human immunodeficiency virus; Spencer PM et al.; Fungal and mycobacterial infections are among the most common opportunistic infections in patients infected with human immunodeficiency virus (HIV) . Candida infections are the bell-wether of progression to symptomatic HIV infection and candida oesophagitis often marks the onset of the acquired immunodeficiency syndrome (AIDS) . More than 80% of AIDS patients have candida disease . Candida infections remain local and respond to treatment but tend to recur . Cryptococcal infections initially affect few HIV positive patients but involve 10-30% with AIDS . Meningitis is the usual presentation and dissemination is common . Amphotericin usually produces improvement but cure is infrequent, and maintenance therapy is advisable . Mycobacteria cause intracellular infections increasing in parallel with immunodeficiency . Mycobacterium avium-intracellulare is predominant, occurring with other opportunistic pathogens causing systemic and local symptoms with high bacterial density in infected cells . Multidrug treatment is best, but the results are disappointing . Tuberculosis is prevalent in certain groups of patients . It often presents with atypical clinical and pathological features . Anti-tuberculous treatment is effective and prophylaxis should be considered . Endemic fungi with mycobacteria cause sporadic infections . Opportunistic infections are the lethal arm of HIV infection . Diligent diagnosis and persistent treatment offer benefit to HIV-infected patients. Neurosurgery, 1989 Jan, 24(1), 96 - 9 Stereotactic drainage of Aspergillus brain abscess with long-term survival: case report and review; Goodman ML et al.; Aspergillus species are second only to Cryptococcus neoformans as the most common cause of fungal infections of the central nervous system in immunocompromised patients . Survival following treatment of Aspergillus brain abscess has been reported only 4 times . In each case, craniotomy was performed for abscess drainage . We present a case of long-term survival following stereotactic drainage of a bilateral Aspergillus brain abscess . In all reported cases, including the present one, histological examination of the abscess contents established the correct diagnosis . Amphotericin B was used in combination with operation in 4 of the 5 cases of long-term survival. East Afr Med J, 1989 Jan, 66(1), 69 - 73 Cryptococcal hepatitis and meningitis in a patient with acquired immunodeficiency syndrome: a case report; Joshi MD et al.; A case of cryptococcal hepatitis is described in a patient with Human Immunodeficiency Virus (HIV) infection . There has been no previous reports of this in the East African literature . A review of world literature showed that the entity of cryptococcal hepatitis is very rare. Am Rev Respir Dis, 1989 Jan, 139(1), 8 - 13 Treatment of murine cryptococcosis with cyclosporin-A in normal and athymic mice; Mody CH et al.; We previously demonstrated that prophylactic Cyclosporin-A (Cs-A) treatment of mice enhanced survival after inoculation of Cryptococcus neoformans by both the intratracheal (IT) and intravenous (IV) routes . In the present studies, we determined whether an established infection due to C . neoformans could be treated with Cs-A . Mice inoculated IT develop a prominent pulmonary infection with late dissemination to distant organs . The survival of mice infected by the pulmonary route that received Cs-A subcutaneously was prolonged in both immunologically intact and congenitally T-cell-deficient mice (athymic nude mice) . In normal mice that received Cs-A, growth of C . neoformans was arrested in the lung, spleen, kidney, and liver, and the rapid rate of accumulation of organisms in the brain was slowed as compared to that of control mice . In nude mice, the organisms continued to increase in all organs although at a considerably slower rate than in untreated control nude mice . Mice given C . neoformans IV developed infection in the brain at the time of inoculation . When an inoculum was deposited in the brains of normal mice by giving the organism IV and Cs-A treatment initiated 3 days later, mice receiving Cs-A did not demonstrate a reduced number of C . neoformans in the brain as compared to untreated control mice . Thus, Cs-A was effective for treatment of extraneural cryptococcal infection in normal mice, but it was unable to reduce cryptococcal replication in the central nervous system.(ABSTRACT TRUNCATED AT 250 WORDS) Acta Derm Venereol, 1989, 69(4), 365 - 7 Cutaneous cryptococcosis resembling molluscum contagiosum: a first manifestation of AIDS; Picon L et al.; A 30-year-old homosexual man developed multiple skin umbilicated lesions resembling molluscum contagiosum . Initially the lesions were on his face but they rapidly spread . Histopathology and mycologic cultures of a skin biopsy revealed cryptococcus neoformans which was also identified in cerebrospinal fluid and in bronchoalveolar washings . The patient had fever, weight loss, generalized lymph node enlargement, depletion of the T helper subpopulation and positive HIV-1 serology . During treatment with flucytosine and amphotericin B, the skin lesions regressed in 3 months (cryptococcus neoformans disappeared in the cerebrospinal fluid and skin within one and five weeks, respectively) . Our case demonstrates that molluscum contagiosum-like skin manifestations may be caused by cryptococcal infections . So it is necessary to perform skin biopsy in HIV seropositive patients with skin lesions resembling molluscum contagiosum, to diagnose mycotic infections, and especially cryptococcosis . Cutaneous cryptococcosis was, in this case, the first symptom of AIDS. Clin Immunol Immunopathol, 1989 Jan, 50(1 Pt 2), S166 - 76 Clinical and immunological aspects of HIV infection in drug addicts; Galli M et al.; Intravenous drug users (IVDUs) account for more than 64% of the total AIDS cases in Italy . The IVDUs' seropositivity rate is greater than 70% in Milan and greater than 50% in the main cities of Italy . The first evidence of seropositivity in this population dates back to 1979 . In a cohort study performed in Milan the rate of progression to overt AIDS among IVDUs was 6% in 3 years (1984-1987) . At presentation, more than 75% of the subjects had CD4+ cell counts higher than 400/mm3 (mean 631, median 528, mode 465) . These values are significantly higher than those observed in the same population in New York, the only American city with HIV-infection spread comparable to that observed in Milan . The probability of having CD4+ cell counts lower than 400, 300, and 200/mm3 in relation to the length of follow-up was, respectively, 50, 40, and 2% after 36 months from presentation . At the same end point, subjects presenting less than 400 CD4+ cells at entry had 30% probability of falling under 200 cell/mm3 . The pattern of CD4+ cells, as much as the low percentage of yearly progression to overt AIDS, is probably related to the recent, even if rapid, spread of infection among IVDUs in Italy . The clinical features of overt AIDS present some differences between IVDUs and other at-risk groups . Among U.S . IVDUs with AIDS, Kaposi's sarcoma is infrequent (2.9% vs 27.7% in homosexual men) while mycotic infections such as deep candidiasis and cryptococcosis are significantly more frequent . The same pattern has been observed in our case file in Milan: esophageal candidiasis represents the most frequent cause of diagnosis of overt AIDS . Mycotic infections, overall, are more frequent than in U.S . IVDUs . The increased rate of mycotic infections among IVDUs might be justified by altered functions of nonspecific immunity, such as PMNL killing and phagocytosis of Candida albicans spores, impaired in HIV-infected IVDUs, but generally normal in infected subjects belonging to the other at-risk groups. G Ital Chemioter, 1989 Jan-Dec, 36(1-3), 95 - 9 {Clinical and therapeutic profile of 3 cases of cryptococcal meningitis in patients with AIDS}; Michelone G et al.; We report three cases of cryptococcal meningitis in patients with AIDS observed in our Institution . In addition, we discuss antifungal treatment during and after the acute phase of the disease and the use of fluconazole as a prophylactic treatment of disease relapse. Clin Exp Neurol, 1989, 26, 183 - 91 CNS cryptococcosis: unusual aspects; Cochius JI et al.; Eleven patients with CNS cryptococcal infection are reviewed . The most prominent symptom was headache, present in all patients . The clinical manifestations were the direct result of the meningitis itself or a consequence of intracranial cryptococcal granulomata or hydrocephalus, these latter 2 complications being demonstrable on CT head scan . In the 2 patients who also had MRI scans, additional parenchymal lesions were revealed which had not been detected by CT . Combined amphotericin B and 5-fluorocytosine therapy was the treatment of choice, but in 3 patients fluconazole was also used . Chronic oral therapy with this agent has maintained a good clinical response in one patient who failed to respond to traditional antifungal therapy. Arch Neurobiol (Madr), 1989, 52 Suppl 1, 108 - 20 {Opportunistic infections of the central nervous system in patients with AIDS}; Ricart C et al.; Between August 1985 and March 1989 we had evaluated 70 AIDS patients . We had identified 7 opportunistic Central Nervous System infections, others toxoplasmosis and tuberculosis: A case of progressive multifocal leukoencephalopathy presented with aphasia as their initial manifestation, a probable herpesvirus type 1 polyradiculoneuropathy, four cryptococcal meningitis and syphilitic neuroretinitis. Mycoses, 1989, 32 Suppl 1, 7 - 13 The in-vitro antifungal spectrum of itraconazole; Van Cutsem J; The activity of itraconazole on 6113 fungal strains belonging to 252 species was evaluated in fluid media . The test medium was brain heart infusion broth for all fungi, except for Pityrosporum ovale, for which it was Dixon broth . Most of the human and animal pathogens and a large number of saprophytes were highly sensitive: dermatophytes, Candida, Cryptococcus, Torulopsis, Pityrosporum, Aspergillus, Penicillium, Sporothrix, dimorphic fungi, phaeohyphomycetes, agents of eufungal mycetoma, Entomophtorales and various others . The majority of Fusarium species and the Zygomycetes were poorly sensitive . Itraconazole was not only fungistatic at low concentrations, but also fungicidal for the tested organisms, such as Microsporum canis, Trichophyton mentagrophytes, Candida albicans, C . tropicalis, Aspergillus fumigatus, P . ovale and Cryptococcus neoformans with or without replenishment . Itraconazole was able to block the morphogenetic transformation of C . albicans from the yeast phase into the (pseudo)-mycelium phase. Mycoses, 1989, 32 Suppl 1, 53 - 9 Mode of action of itraconazole: morphological aspects; Borgers M et al.; The broad spectrum of antifungal activity of itraconazole is verified by morphologic criteria at the light and electron microscopical level . Yeast and fungal species examined are Candida albicans, Cryptococcus neoformans, Paracoccidioides brasiliensis, Sporothrix schenckii, Pityrosporum ovale, Trichophyton rubrum and Aspergillus fumigatus . Exposures of cultures of these yeasts and fungi to itraconazole results in dose- and time-dependent alterations which vary in nature and intensity from one species to another . The most striking gross morphological change is seen in the biphasic species and consists of the abolishment of morphogenic development of the blastospore into the hyphal forms (C . albicans and P . ovale) and of the hyphal into the yeast forms (P . brasiliensis) . Furthermore, the outgrowth and development of inoculated A . fumigatus hyphae into sporulating vesicles is almost completely abolished . The above mentioned effects on morphogenesis are achieved in the 10(-10)-10(-7) M range . Except for P . ovale, the earliest ultrastructural changes after itraconazole consist of abnormalities at the plasma membrane, the cell wall and cytoplasmic vacuoles . They precede a marked increase in cell volume, defective cell division, abortive hyphal outgrowth and loss of cell viability . These changes are identical to those previously described after miconazole and ketoconazole treatment . However, when compared to the other available azole-derivatives sharing the same basic mechanisms of action, itraconazole displays an exceptionally strong activity against A . fumigatus which can be morphologically translated by a potent necrotizing action on hyphae and inhibition of vesicle formation and sporulation . The in vitro effects of itraconazole are supported by data obtained from microscopic examinations of samples derived from patients with experimental animals infected with various fungal organisms. Mycoses, 1989, 32 Suppl 1, 14 - 34 Oral, topical and parenteral antifungal treatment with itraconazole in normal and in immunocompromised animals; Van Cutsem J; Itraconazole was dissolved in polyethylene glycol for oral and topical treatment and in hydroxypropyl-beta-cyclodextrin for oral, topical or parenteral treatment . Topical and oral treatment was successful in microsporosis, trichophytosis, skin-and vaginal candidosis, pityrosporosis and eye mycosis by Candida, Fusarium and Aspergillus . Vaginal candidosis could be cured with a one-day topical or oral treatment . The same results could not be obtained with any of the reference compounds (griseofulvin, terbinafine, ketoconazole or fluconazole) on a mg per kg body weight base, nor on a % concentration base . Antifungal levels were determined by bioassay: biologically active antifungal levels were present in plasma and vaginal fluid of rats, after one oral dose of 10 mg.kg-1, for at least 72 and 96 hours respectively . This was in good correlation with findings on prophylaxis of vaginal candidosis . Itraconazole was also successfully used, in normal animals and animals immunodepressed with various agents, in disseminated and systemic diseases: trichophytosis, sporotrichosis, histoplasmosis, candidosis, aspergillosis and cryptococcosis . Oral and parenteral treatment with itraconazole was compared in various models to oral and parenteral fluconazole and to parenteral amphotericin B . The outcome with itraconazole was better than with the other antifungals . Meningeal cryptococcosis responded very well to itraconazole . Combination therapy of itraconazole and fluconazole was not superior to treatment with itraconazole alone . No side-effects were observed in relation to itraconazole treatment. FEMS Microbiol Lett, 1989 Jan 1, 48(1), 57 - 60 Stimulation of xylanase synthesis in Cryptococcus albidus by cyclic AMP; Morosoli R et al.; Cryptococcus albidus secretes a xylanase when induced by xylan or beta-methylxyloside, a non-metabolizable inducer, and production of the enzyme is repressed by xylose . The effect of exogenous cAMP on xylanase production was tested under different growth conditions . The cAMP elicited a 1.5 to 2 fold increase in xylanase production during the induction by xylan and B-methylxyloside but did not relieve the repression observed during growth on xylose . Cyclic AMP also affected the growth rate of the cells and did not modulate the activity of pure xylanase in vitro . A 15-nucleotide sequence located upstream from the xylanase gene could be part of a cAMP regulatory sequence. Acta Neuropathol (Berl), 1989, 77(4), 379 - 90 Neuropathology of the acquired immune deficiency syndrome (AIDS): a report of 135 consecutive autopsy cases from Switzerland; Lang W et al.; Neuropathological changes were studied in a consecutive autopsy series of 135 cases, comprising 73% of all patients who died of AIDS in Switzerland between April 1981 and December 1987 . Central nervous system involvement was found in 119 patients (88%), 19 of which had multiple concomitant intracerebral lesions . Among the non-viral opportunistic infections, encephalitis due to Toxoplasma gondii was most frequent and occurred in 35 patients (26%), followed by central nervous system infection with Cryptococcus neoformans, which was found in five patients (4%) . Cytomegalovirus (CMV) encephalitis was present in 14 patients (10%) . Disseminated microglial nodules without morphological or immunocytochemical evidence of CMV was encountered in 18 patients (13%) . However, in all but two of these patients there was evidence of extracerebral CMV infection, suggesting that CMV was responsible for these nodular encephalitides . Nine patients (7%) had progressive multifocal leukoencephalopathy (PML); in five of these, demyelination was associated with extensive tissue destruction and cyst formation . HIV-associated encephalopathy was observed in 21 patients (16%) and showed two characteristic morphological patterns: progressive diffuse leukoencephalopathy (PDL) and multifocal giant cell encephalitis (MGCE) . PDL was observed in 13 cases and characterized by diffuse pallor and gliosis of the cerebral and cerebellar white matter with scattered multinucleated giant cells, but without significant inflammatory response . MGCE was found in eight patients and characterized by clusters of numerous multinucleated giant cells, rod cells, macrophages, lymphocytic infiltrates and occasional necroses . In our view, PDL and MGCE represent the two opposite variants of HIV-induced encephalopathies, with overlapping intermediate manifestations. Jpn J Antibiot, 1989 Jan, 42(1), 63 - 116 {Clinical study of fluconazole on deep-seated fungal infections}; Ikemoto H et al.; Fluconazole is a novel antifungal agent, available in oral and intravenous forms, which was developed by Pfizer Central Research . It is characterized by its long serum half-life (approximately 30 hours) to allow once-a-day dosing and favorable safety profile . Fluconazole was administered orally or intravenously to 166 patients with deep-seated mycosis and it was possible to evaluate clinical efficacies in 99 patients . Clinical cures were obtained in 41 (87.2%) out of 47 cases of candidiasis, in 10 (66.7%) out of 15 cases of cryptococcosis, in 17 (48.6%) out of 35 cases of aspergillosis and in 1 case each (100%) of mucormycosis and mycosis due to an unspecified yeast . Side effects were observed in 10 cases (rash 2, fever 2, abdominal discomfort 1, nausea 1, edema 1, edema/pleural effusion/oliguria 1, finger stiffness 1, hiccup 1) with incidence rate of 6.0% . Drug administrations were discontinued in 4 cases . In general, however, fluconazole was well tolerated . Abnormal changes in laboratory test values due to the drug were observed in 32 cases and incidence rate was 19.3% . These were, however, slight and temporary changes and most of them were in parameters of liver function . It is not clear if these changes were related to the fluconazole administration, because other drugs were concomitantly administered to these cases . These results indicate that fluconazole is an agent with very good potential for the treatment of the systemic deep-seated mycoses. Jpn J Antibiot, 1989 Jan, 42(1), 55 - 62 {Fluconazole treatment of systemic mycoses}; Mori T et al.; Efficacies of fluconazole, a new triazole antifungal agent, were evaluated in 11 cases of systemic mycoses (1 case each of candiduria, pulmonary cryptococcosis, pulmonary aspergillosis, pulmonary penicilliosis and suspected fungal pulmonary infection, and 3 cases each of candidemia and Candida endophthalmitis) . The clinical efficacies were excellent or good in 8 out of 9 cases and poor in 1 . Side effects observed were mild with 1 incident each of gastrointestinal symptom and reversible leukopenia . This drug appears to be promising in treatment of systemic mycoses. Jpn J Antibiot, 1989 Jan, 42(1), 165 - 70 {Experience of fluconazole in pediatric patients}; Arai S et al.; Fluconazole is a triazole agent and possesses a potent antifungal activity against fungi such as Candida, Cryptococcus and Aspergillus . Fluconazole is well absorbed following oral administration and shows bioavailability almost comparable to that attained in intravenous administration . The serum half-life is as long as about 30 hours and distributed widely into organs and tissues . Because of these it is expected to exhibit good clinical efficacy in the deep-seated mycosis . We evaluated the efficacy of fluconazole given orally to 3 pediatric patients with deep mycosis and also with aim of evaluating its prophylactic effect, gave fluconazole to 4 patients who had high risks of mycotic infections . Pathogenic fungi isolated from the 3 patients with mycosis were all Candida albicans and diagnoses made were Candida pneumonia, oral candidiasis and gastrointestinal candidiasis . Clinical efficacies were judged to be good in all of the 3 patients and C . albicans were found eradicated following the treatment . In the 4 patients to whom fluconazole was given prophylactically, no mycosis developed . Fluconazole was well tolerated and no incidence of side effects or clinical laboratory parameter abnormalities were seen any of the patients involved in the study. Jpn J Antibiot, 1989 Jan, 42(1), 144 - 52 {A clinical evaluation of fluconazole in the treatment of deep mycosis}; Yagi S et al.; Fluconazole is a novel triazole antifungal agent developed by Pfizer Inc . and available in both oral and intravenous forms . It is characterized by a long serum half-life of 25 to 30 hours and good absorbability into tissues . In the present study, fluconazole was given to 12 patients with deep mycosis orally, intravenously or by local infusion . The patients included 4 cases of candidemia, 1 case each of candidemia and candiduria, candiduria, esophageal candidiasis, Candida hepatic abscess, pulmonary cryptococcosis and septicemia due to unspecified yeasts and 2 cases of pulmonary aspergillosis . Clinical efficacies of fluconazole against these infections were excellent in 2 cases, good in 8 and fair in 2 . None of the patients reported any side effects . From the results of the study, fluconazole appears to be a useful and safe drug for the treatment of deep seated mycosis. Jpn J Antibiot, 1989 Jan, 42(1), 138 - 43 {Clinical efficacy of fluconazole in the patient with pulmonary mycosis}; Lee Y et al.; Fluconazole, a novel triazole antifungal agent, was given orally or intravenously to 10 patients with pulmonary mycosis (7 patients with primary pulmonary cryptococcosis and 3 with pulmonary aspergillosis) . Routes of administration were changed in some patients depending on their condition . Two patients from whom foci was removed by surgical operations were excluded from the efficacy assessment . Clinical efficacies in the remaining 8 patients were good in 2 cases and fair in 3 cases of pulmonary cryptococcosis; excellent in 1 case of pneumonia due to Aspergillus; and fair in 1 case and poor in the other case of pulmonary aspergilloma . Side reactions developed in 9 patients who received intravenous drip infusion were nausea or loss of appetite in 3 patients, fever and/or feverish sensation in 3, vascular pain in 1 and diarrhea and eruption in 1 . In the patient who reported fever the drug was discontinued and in the patient who complained of pain at the site of injection, dosing was changed to the oral route but was discontinued due to elevated GOT, GPT, Al-P and gamma-GTP . Seven patients who received the drug orally did not report side effects except 2 patients . None of these side effects reported was serious and from the above results, fluconazole was considered to be a useful agent for the treatment of pulmonary mycosis. Jpn J Antibiot, 1989 Jan, 42(1), 127 - 37 {The clinical study of fluconazole against pulmonary mycosis . Effects of fluconazole on pulmonary cryptococcosis and aspergillosis, and its pharmacokinetics in patients}; Nakashima M; Effects on pulmonary cryptococcosis and aspergillosis and the pharmacokinetics of the new antimycotic agent, fluconazole, were examined . 1 . Cases Pulmonary cryptococcosis: Two cases, 30 and 29 year-old men who were suspected of pulmonary tuberculosis by routine health examinations . Pulmonary aspergillosis: A 65 year-old man with collagen disease and a 62 year-old man with bacilli free cavities of tuberculosis . 2 . Method Fluconazole was administered at a dose level of 400 mg/day per os for 2 to 4 weeks . One exception was the 65 year-old aspergillosis patient who was administered with fluconazole 50 mg/day for 4 weeks, 100 mg/day for 6 weeks then 400 mg/day for 4 weeks . Sera of the cases 1, 2 and 4 were harvested before, and 1/2, 1, 2, 4, 8 and 24 hours after administration of fluconazole on the 1st and the 7th day, and in every morning until the 9th day before administration and stored in a freezer . Serum fluconazole concentrations were determined at Pfizer Taito Laboratory . As pharmacodynamic parameters, T1/2, Tmax and Cmax were calculated . 3 . Result Effects of fluconazole on 2 of the 2 cases with cryptococcosis were excellent . On the other hand, the effects on the aspergillosis were poor . The average Tmax was 2-4 hours . The average C maxs were 10.3 micrograms/ml on the 1st day and 30.6 micrograms/ml on the 7th day . Serum concentrations reached the plateau on the 5th-7th day, and the average C min (concentration before administration) was 21-23 micrograms/ml . Average T1/2s were 34.4 hours on the 1st day and 37.2 hours on the last (32th) day . 4 . Conclusion Fluconazole may be regarded as the promising remedy for pulmonary cryptococcosis but not for pulmonary aspergillosis. Jpn J Antibiot, 1989 Jan, 42(1), 1 - 16 {In vitro activity of fluconazole, a novel bistriazole antifungal agent}; Yamaguchi H et al.; Fluconazole is a novel triazole antifungal agent with excellent activities against a broad range of medically important fungi . The in vitro antifungal activities of fluconazole especially against Candida albicans were examined and the results summarized as follows: 1 . Fluconazole was proved to exhibit the highest antifungal activity in synthetic amino-acid medium, fungal (SAAMF), well buffered in a physiologically neutral range . 2 . In a exposed time-killing test performed using SAAMF (pH 7.4), the growth inhibition by fluconazole was enhanced in proportion to an increase of fluconazole concentration and 99% inhibition was observed at a concentration of 1 microgram/ml though further increases of concentration up to 80 micrograms/ml failed to demonstrate complete inhibition . 3 . Activities of fluconazole against medically important various yeasts were determined by a broth dilution method in SAAMF using the viable counts technique . Among 9 species tested, C . albicans and Candida kefyr were the most sensitive to fluconazole with a IC99 range from 0.20 microgram/ml to 0.39 microgram/ml . On the contrary, Candida glabrata, Cryptococcus neoformans and Trichosporon cutaneum were the least sensitive with a IC99 range from 3.13 micrograms/ml to 12.5 micrograms/ml . 4 . Growth inhibition activities of fluconazole against 4 species of Aspergillus were measured on the basis of mycelial protein content . IC50 and IC90 of fluconazole against Aspergillus fumigatus were distributed in the range of 23.9-43.5 micrograms/ml and 50- greater than 100 micrograms/ml, respectively . 5 . The anti-Candida activity of fluconazole was little affected by serum concentrations . Fluconazole at a concentration of 0.20 microgram/ml inhibited significantly the mycelial-phase growth and germ tube elongation of C . albicans in a medium supplemented with serum . 6 . The germ tube formation and elongation of C . albicans cells engulfed by murine peritoneal exudative cells were significantly affected in a medium containing 1 microgram fluconazole per ml. Hautarzt, 1989 Jan, 40(1), 31 - 3 {Cryptococcosis of the skin}; Kaben U et al.; In a woman patient who had received a kidney transplant 9 years previously, we diagnosed a cryptococcosis of the skin on the right arm . The results of clinical and mycological investigations and the forms of treatment applied are discussed. Medicina (B Aires), 1989, 49(6), 600 - 2 {Cryptococcosis in acquired immunodeficiency syndrome (AIDS)}; Cotone C et al.; Cryptococcus neoformans is an infrequent but important cause of severe disease in immunodepressed patients, especially in those with AIDS . We refer the case of a 45 year old patient with clinical, epidemiological and serological patterns of HIV-induced infection in the course of which the patient suffered a subacute neurologic syndrome with fatal evolution . The diagnosis was made by isolation of Cryptococcus neoformans in CSF and in palpable lymph nodes by fine-needle aspiration biopsy . Cryptococcal antigen titer of CSF was 1:2560 . Treatment was standardized in the administration of amphotericin B (0.3 mg/kg/day) and 5-fluocytosine (150 mg/kg/day) for a period of six weeks . Factors that suggested poor prognosis were: a positive india ink preparation before treatment, a high initial CSF antigen titer, low CSF leukocyte count and the presence of Cryptococcus neoformans at an extraneural site . Since diagnosis of cryptococcosis was made when prominent localizing symptoms and signs were found, an intensive culture and serologic screening would be necessary in every patient with AIDS in order to establish an earlier diagnosis. Hansenol Int, 1988 Dec, 13(2), 47 - 56 {Virchowian Hansen's disease, Lucio's phenomenon, cryptococcosis}; Persistent diarrhoea in Zairian AIDS patients: an endoscopic and histological study; Projet SIDA, Department of Public Health, Kinshasa, ZaireTo determine the aetiology of persistent diarrhoea in African patients with acquired immunodeficiency syndrome (AIDS), 42 patients with human immunodeficiency virus (HIV) and persistent diarrhoea were enrolled in a microbiological, endoscopic, and histological study . Cryptosporidium was the intestinal parasite most often identified (30%); Isospora belli was found in 12% of the patients . Histological examination of the duodenal mucosa showed a non-specific inflammatory reaction in a significantly higher number of HIV-seropositive patients (82%) than HIV-seronegative controls without diarrhoea (52%) (p = 0.02) . Lymphocytes were more likely to be found in inflammatory reactions in HIV-seropositive patients than in controls (p less than 0.0001) . Pathogens were observed in histological sections of the duodenum of HIV-seropositive patients only (p = 0.002) and included cryptosporidia (four patients) Isospora belli (one), Strongyloides stercoralis (one), and Cryptococcus neoformans (one) . On histological examination the rectal mucosa of HIV-seropositive patients and controls was similar, except eosinophils were more likely to be present in inflammatory reaction in HIV-seropositive patients (p = 0.05) and enteric pathogens were observed only in HIV-seropositive patients (cytomegalovirus inclusion bodies (one) and Schistosoma mansoni (two) . The aetiology of persistent diarrhoea in most African AIDS patients remains unclear. Am J Clin Pathol, 1988 Dec, 90(6), 707 - 10 Cerebrospinal fluid (CSF) TRAP . A method to improve CSF laboratory efficiency; Albright RE Jr et al.; Establishment of a procedure termed cerebrospinal fluid (CSF) TRAP ("Transport and Rapid Accessioning for Additional Procedures") allows clinicians to appropriately store, at -75 degrees C, and rapidly access CSF specimens . The CSF TRAP enhances patient care by decreasing the need for repeat lumbar punctures and providing reserve fluid for the following: (1) further CSF testing; (2) repeating questionable test results; and (3) laboratory accidents . The CSF TRAP has been approved for third-party payment because it promotes efficient laboratory utilization by encouraging clinicians to review initial CSF findings before ordering low-yield CSF assays such as the venereal disease research laboratory (VDRL) and cryptococcal antigen latex agglutination tests . Currently, CSF TRAP samples are being obtained with 40% of all CSF acquisitions at the Duke University Medical Center . The availability of the CSF TRAP was associated with a significant decrease in the ordering of CSF VDRL and cryptococcal antigen assays (P less than 0.05); however, there was no significant change in the proportion of those studies being performed on normal CSF . The CSF TRAP procedure provides the framework for an overall restructuring of CSF testing that is being investigated. Mycopathologia, 1988 Dec, 104(3), 163 - 9 Persistence of infection in mice inoculated intranasally with Cryptococcus neoformans; Anderson DA et al.; Cryptococcus neoformans was instilled intranasally into mice which were periodically sacrificed to determine the course of infection . Cryptococci persisted within the nasal passages throughout the 90 day study . Extranasal dissemination began 14-28 days after instillation and was still demonstrable 90 days post-exposure . Ten percent mortality was observed in mice receiving 10(6) cryptococci, while no mortality was observed in mice exposed to 10(3) or 10(4) cryptococci . Our research suggests that nasal colonization with C . neoformans can precede pulmonary and systemic cryptococcosis by weeks or months. Acta Orthop Scand, 1988 Dec, 59(6), 720 - 2 Localized osseous cryptococcal infection . Report of 2 cases; Govender S et al.; Cryptococcal infection in man is widely disseminated and commonly involves the central nervous system . Primary bone involvement is rare . We report on 2 cases of localized cryptococcal osseous lesions treated successfully by surgery. J Cutan Pathol, 1988 Dec, 15(6), 385 - 92 Secondary cutaneous cryptococcosis: case report and review of 22 cases; Barfield L et al.; A 51-year-old immunosuppressed man presented with ulcerations of the abdominal wall . Biopsy of the ulcer margin was necessary for the diagnosis of cutaneous cryptococcosis . Since a variety of opportunistic organisms can present with non-specific cutaneous lesions, these infections must be ruled out by tissue diagnosis of all immunosuppressed patients . A review of 22 additional cases is included together with electron microscopic findings. Am J Gastroenterol, 1988 Nov, 83(11), 1306 - 8 Cryptococcal anal ulceration in a patient with AIDS; Van Calck M et al.; We report the case of an African patient with acquired immune deficiency syndrome (AIDS) who had a chronic cryptococcal rectal abscess with anal fistula and a disseminated neurologic and bony fungal disease, associated with pulmonary infiltration due to Pneumocystis carinii . The anal lesion was surgically excised because of failure of the medical treatment . Although clinical intestinal cryptococcal involvement is quite rare, the experience here recorded should draw physicians' attention to the possibility of an insidious disseminated disease in AIDS patients. J Clin Microbiol, 1988 Nov, 26(11), 2450 - 1 Experience with the use of pronase to eliminate interference factors in the latex agglutination test for cryptococcal antigen; Gray LD et al.; Cryptococcal antigen titers of 70 cerebrospinal fluid and 57 serum specimens from patients suspected of having cryptococcosis were determined both before and after treatment with pronase . Median titers of cerebrospinal fluid specimens before and after treatment were 128 and 128, respectively; mean geometric titers of these specimens before and after treatment were 102 and 204, respectively . Median titers of the serum specimens before and after treatment were 16 and 512, respectively; mean geometric titers of these specimens before and after treatment were 19 and 631, respectively . The modified latex agglutination test did not detect antigen in any of 50 cerebrospinal fluid and 51 serum specimens from patients not suspected of having cryptococcosis . These results suggest that the pronase modification increases the sensitivity of the latex agglutination test and that the modification be routinely incorporated into it. Carbohydr Res, 1988 Nov 1, 182(2), 227 - 39 Type-specific polysaccharides of Cryptococcus neoformans . n.m.r.-spectral study of a glucuronomannan chemically derived from a Tremella mesenterica exopolysaccharide; Cherniak R et al.; A glucuronomannan (GM) was derived by removal, through Smith degradation, of xylose from the native (3-O-acetylglucurono)xylomannan exopolysaccharide isolated from Tremella mesenterica . 13C-N.m.r . chemical shifts measured at various pD values were compared for p-nitrophenyl beta-D-glucopyranosiduronic acid (1) and two GMs (2 and 3) differing in GlcA content (Man:GlcA; 2, 10:1; and 3, 5:1) . Also measured and compared were pKa values for 1 and 2 . One-dimensional and two-dimensional (COSY and HETCOR) n.m.r . data allowed unambiguous assignments of pD-sensitive chemical shifts due to 2-O-beta-D-GlcpA substituents attached to a (1----3)-linked alpha-D-Manp backbone . The pKa and n.m.r . data indicated that the CO2H groups in either GM are independent of each other, and are similar in behavior to those of p-nitrophenyl beta-D-glucopyranosiduronic acid molecules . The n.m.r . data confirmed the previous, chemically deduced, structural role of GlcpA in the native polysaccharide from T . mesenterica, and indicated that significant pD-induced changes occur in the stabilities of the glycosidic orientations in the GM . Previous 13C-n.m.r . assignments for 2-O-beta-D-GlcpA in polysaccharides derived from Cryptococcus neoformans serotype A-variant were confirmed, except for the signal due to the anomeric carbon atom . This signal is now known to be pD-sensitive . In acidic solutions, it is coincident with the signal (104.5 p.p.m.) due to the anomeric carbon atoms of the unsubstituted alpha-D-Manp backbone residues . In basic solutions, the 2-O-beta-D-GlcpA anomeric carbon resonance is shifted upfield by approximately 0.2 p.p.m., and is observed as a separate signal. J Clin Microbiol, 1988 Nov, 26(11), 2262 - 5 Rapid detection of positive blood cultures with the BACTEC NR-660 does not require first-day subculturing; Levi MH et al.; An analysis of blood culture data was performed to determine whether subculturing within the first 24 h of incubation decreased the time to detection of positive blood cultures when compared with the routine use of the BACTEC NR-660 system (Johnston Laboratories, Inc., Towson, Md.) . During a 9-month period (June 1985 to February 1986), 17,913 blood cultures were received in our laboratory, of which 1,463 (8.2%) became positive . Of the positive cultures, 97% were detected with equal or greater rapidity by the NR-660 system than by visual inspection and first-day blind subculturing . There were 37 delayed positive cultures from which only one isolate (0.07%) was not eventually detected by the NR-660 system . Coagulase-negative staphylococcus was the most frequent isolate among the delayed positive cultures, but only 3 of 15 isolates were known to be clinically significant isolates . The longest delay in detection by the NR-660 system was 6 days for one isolate of Cryptococcus neoformans and one isolate of Klebsiella pneumoniae . Although subculturing may decrease the time to detection of a few cultures, the majority of positive blood cultures were detected faster or with equal speed by the NR-660 system . When the data were evaluated, routine use of the NR-660 system was sufficient for the detection of positive blood cultures and was cost-effective. J Infect Dis, 1988 Nov, 158(5), 1071 - 8 Functional versus phenotypic analysis of T cells in subjects seropositive for the human immunodeficiency virus: a prospective study of in vitro responses to Cryptococcus neoformans; Hoy JF et al.; We performed a prospective study of 50 subjects at high risk for human immunodeficiency virus (HIV) infection to determine if assays of antigen-specific T cell function provide an earlier indication of future progression to AIDS or a better assessment of immune function than do current methods of evaluation . We measured in vitro T cell responses to Cryptococcus neoformans and tetanus toxoid, response to mitogens, HIV p24 antigenemia, and clinical parameters . Progression to AIDS was significantly associated with loss of T cell response to cryptococci (P = .015), HIV antigenemia (P = .001), and low CD4+ cell numbers (P = .001) . Most importantly, we found that loss of antigen-specific responses to cryptococci and tetanus can occur before changes in CD4 cell number . Abnormal response to mitogens and marked depletion of CD4+ cells were late signs of progressive HIV infection . Measurement of antigen-specific T cell function may be useful for assessing the efficacy of antiviral therapy in HIV infection before onset of symptoms. Infect Immun, 1988 Nov, 56(11), 2794 - 800 Strain variation in phagocytosis of Cryptococcus neoformans: dissociation of susceptibility to phagocytosis from activation and binding of opsonic fragments of C3; Kozel TR et al.; Phagocytosis of Cryptococcus neoformans is markedly influenced by the presence of a polysaccharide capsule . We examined activation and binding of C3 fragments to eight isolates of C . neoformans . All isolates were shown to have capsules by light and electron microscopy . These strains differed in susceptibility to phagocytosis by neutrophils . Yeast cells were opsonized by incubation in normal human serum . Five strains were resistant to ingestion, two strains showed intermediate levels of resistance to ingestion, and one strain was quite sensitive to phagocytosis . Yeast cells opsonized with heat-inactivated serum (56 degrees C for 30 min) neither attached nor were ingested by neutrophils . A quantitative estimate of the amount of C3 bound to the yeast cells was determined by use of normal human serum containing 125I-labeled C3 . The results showed approximately 5 X 10(6) to 10 X 10(6) C3 molecules per yeast cell regardless of whether the yeast cells were sensitive or resistant to phagocytosis . Bound C3 was eluted from the yeast cells by treatment with 0.1 M NH2OH (pH 10), and the eluted fragments were examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis under reducing conditions . Results of this analysis showed that little of the C3 was in the form of C3b, and there was substantial decay to iC3b, the inactive decay product of C3b . This pattern of decay was similar with all strains . Immunoelectron microscopy was used to assess the ultrastructural location of the C3 fragments bound to the yeast cells . C3 fragments were bound to the perimeter of the capsule regardless of whether the isolate was sensitive or resistant to phagocytosis . Thus, phagocytosis-sensitive and phagocytosis-resistant isolates were similar with regard to the amount, molecular form, and ultrastructural location of C3 fragments bound to the cryptococcal capsule . These results further indicate that activation of the complement cascade is necessary but not sufficient for phagocytosis of the yeast cell. Wien Med Wochenschr, 1988 Oct 31, 138(19-20), 517 - 20 {Internal and neurologic manifestations of the acquired immunodeficiency syndrome}; Zielinski C; The acquired immune deficiency syndrome (AIDS) is characterized by a multitude of clinical complications consisting of mainly opportunistic infections and malignancies . Particularly often encountered and life-threatening conditions are therefore due to infections of the respiratory tract (pneumonias caused by pneumocystis carinii or cytomegalovirus) or the central nervous system (e.g . toxoplasmosis or cryptococcosis) and Kaposi sarcoma or highly malignant non-Hodgkin lymphomas . The course of the disease can become even more severe by additional neurologic complications . In patients with AIDS, the use of preparations with proven clinical effectivity for the treatment of opportunistic infections is often hampered by severe side effects. Wien Med Wochenschr, 1988 Oct 31, 138(19-20), 508 - 10, 514-6 {Skin manifestations in HIV infection}; Civatte J et al.; In HIV-infections, skin manifestations are manifold and are conditioned mainly by the immunodeficiency . Kaposi's sarcoma, oral hairy leucoplakia and candidiasis of the esophagus are of diagnostic significance as same as a severe course of opportunistic infections e.g . herpes simplex, herpes zooster, cryptococcosis, dermatomycoses, verrucae vulgares, condylomata acuminata and others . Sometimes skin manifestations are the first perceivable sign of an HIV-infection. J Gen Microbiol, 1988 Oct, 134 ( Pt 10), 2849 - 55 Taxonomic relationships of Cryptococcus and Tremella based on fatty acid composition and other phenotypic characters; Smit EJ et al.; The cellular long-chain fatty acids present in 33 strains, representing 15 species of Cryptococcus, and 4 species of Tremella, were determined by gas chromatography . According to the relative amounts of fatty acid methyl esters, the Cryptococcus species studied were divided into four main groups . Possible relationships between species representing the two genera are presented in a new model, where cellular long-chain fatty acid compositions and other phenotypic characteristics are included. Bioorg Khim, 1988 Oct, 14(10), 1405 - 12 {The structure of extracellular heteroglycans in various Cryptococcus species}; Vitovskaia G et al.; Extracellular polysaccharides produced by some Cryptococcus species have been structurally investigated . These polymers have identical core structure, which was found to be alpha-1,3-mannan and different degrees of substitution of mannose in the core by xylose and glucuronic acid residues of side chains and different composition of side chains . Heteropolysaccharide from Cr . humicolus, the simplest one, has the same structure as the Cr . neoformans serotype D capsular polysaccharide . The Cr . skinneri polymer proved to be the most branched among Cryptococcus polysaccharides. Med Trop (Mars), 1988 Oct-Dec, 48(4), 359 - 66 {Principle aspects of acquired immunodeficiency syndrome (AIDS) in adults in Burundi}; Laroche R et al.; The authors describe their experience of the infection by the virus of the human immunodeficiency HIV-1 in Burundi . The acquired immunodeficiency syndrome was brought to light in 1983 by the emergence of cryptococcal meningitis, Kaposi's sarcomas, disseminated candidiasis . 109 cases of infection by the virus of the human immunodeficiency (HIV) AIDS related complex, or acquired immunodeficiency syndromes, were observed in 8 months and are related in this paper . The authors elucidate the spread and amplify the role played by lorry drivers . The frequency of recent case history: tuberculosis, zona, sexually transmitted diseases (41%) . Clinical manifestations have been studied according to their clinical stage: 28 patients are AIDS related complex (25%), 81 are acquired immunodeficiency syndrome . One have to notice the frequency of tuberculosis at the stage of acquired immunodeficiency syndrome, of digestive parasitoses, not only coccidiosis, but also strongyloidiasis and colonic amoebiasis, cryptococcal meningitis, and encephalopathies caused by the virus of human immunodeficiency (HIV) at the period of AIDS . Lethal evolution is fast: 28 out of the 81 AIDS were observed up to their end, occurring in less than 60 days, as an average . Lastly, numerous opportunistic infections cannot be diagnosed because the lack of technical facilities. Med Trop (Mars), 1988 Oct-Dec, 48(4), 337 - 44 {Human immunodeficiency virus infections (HIV-1 and HIV-2) in Dakar . Epidemiologic and clinical aspects}; Barabe P et al.; The authors report on the results of an investigation carried out on 109 HIV seropositives ascertained by the Dakar Central Hospital between February 20, 1987 and May 31, 1988 . These seropositives affected 44 patients with AIDS (0.78% of admitted patients) and 65 seropositive people of which 43 blood donors (1.35% of donors) . Both viruses are present in about equal number: 50 HIV1 seropositives, 44 HIV2 seropositives, and 15 composite seropositives . Sex-ratio is 3,9 in favour of males; this figure is nearer to the one observed in Europe and North American than the one observed in Central Africa where there is equality between both sex . Clinical patterns are dominated by a bad general status: lost of weight, fever, diarrhea, polyadenopathiae, pneumopathiae, meningoencephalitis . Kaposi's sarcoma and cryptococcal meningitis have been observed only four times . Development of the infection lead to death for 12 patients during the 16 months of the investigation . Both viruses are responsible for an equal immunodepression, leading to the same potential severity . Immunodepression might be acquired more slowly with HIV2, so strongly suggesting an incubation apparently lasting morePIP: Between February 1987-May 1988, 109 patients at the Dakar Central Hospital were diagnosed by the ELISA method and confirmed by Western Blot as seropositive for HIV infections . 44 had AIDS, including 2 blood donors and 1 child . 39 asymptomatic but seropositive subjects included 15 blood donors, 7 spouses and 2 children of seropositive individuals, 2 subjects who had spent time in Central Africa where HIV is endemic, 2 patients receiving blood transfusions in Benin and the Ivory Coast, 2 patients with a positive treponemic serology, 4 pregnant women, and 5 patients with disorders unrelated to AIDS . The remaining 26 seropositive blood donors were not examined and their risk factors and health status were unknown . Among the 109 cases there were 50 seropositivities to HIV 1, 44 to HIV 2, and 15 for both HIV 1 and 2 . 83 men and 26 women were seropositive, for a sex ratio of 3.9 . The average ages of AIDS patients were 33.2 for HIV 1, 41.1 for HIV 2, and 42.3 for HIV 1 and 2 . Average ages of asymptomatic carriers were 30.1 for HIV 1, 29.5 for HIV 2, and 26.1 for HIV 1 and 2 . Risk factors were difficult to study, but 78 records including information indicated 3 open homosexuals, 4 drug users, 25 who frequented prostitutes, 11 patients who had received transfusions, and 30 who had received injections . 21 of 35 seropositive for HIV 1, 5 of 33 seropositive for HIV 2, and 5 of 10 seropositive for both HIV 1 and 2 had lived outside Senegal and its neighboring countries in the past 10 years . Clinical signs in the 44 AIDS patients were highly varied . The most frequently noted were poor general state with weight loss, fever, diarrhea, polyadenopathic syndrome, pneumopathy, and meningoencephalitis . 9 men and 3 women died during the study period . In all cases the clinical status at hospital admission was very poor . There has as yet been no epidemic of AIDS in Senegal following observation of the 1st case in 1987 . The 44 AIDS patients represented .78% of hospital admissions during the study period, while the 43 seropositive blood donors represented 1.35% of all donors . The HIV 1 and HIV 2 viruses both cause profound immunodepression . Some evidence suggests that the HIV 2 virus has a longer incubation period . The study indicates that the epidemiology of HIV is not the same in West Africa as in Central Africa . Med Trop (Mars), 1988 Oct-Dec, 48(4), 327 - 35 {Clinical manifestations of infection with (HIV) human immunodeficiency virus in Africans . Comparison of cases observed in Africa and Europe}; Coulaud JP; The AIDS case definition of Bangui WHO workshop is more convenient for Africa and increases the number of cases reported to WHO . Natural history of HIV infection is the same in Africa as in the developed countries of western world . The clinical pattern of African Aids is mainly the result of opportunistic infections and specially those involving the intestinal tract . Some of them are more frequent in tropical area as Candidiasis and Cryptococcosis . The follow up of seropositive patients is more difficult in Africa, due to technical problems of use and interpretation of some tools (antigenemia.. . lymphocytes CD4 count...). Med Trop (Mars), 1988 Oct-Dec, 48(4), 325 - 6 {Acquired immunodeficiency syndrome (AIDS) in tropical regions: African foci}; Aubry P; PIP: Most AIDS victims in Africa south of the Sahara are heterosexuals with multiple partners . The risk of infection appears to be somewhat greater among women . Seroprevalence is believed to be under 1% in rural zones but is about 7% in the large cities and is increasing rapidly along transportation routes . Condom use is the only measure capable of slowing the spread of AIDS in Africa at present, but condoms are not widely used . AIDS in Central Africa is distinguished also by its clinical manifestations . Esophageal candidiasis and cryptococcal meningoencephalitis by their rapid spread contributed to the growing awareness of AIDS in Africa . Kaposi's sarcoma, which already had an elevated incidence in Central Africa, became more aggressive in AIDS patients . Africa's precarious medical resources led the World Health Organization in 1985 to define criteria for a clinical diagnosis of AIDS in Africa . Despite the epidemiological and clinical differences between the American and African experience with AIDS, both are caused by the same virus, which was isolated in 1983 at the Institute Pasteur in Paris . The high number of false positives with the ELISA test means that positive cases must be confirmed by Western Blot . AIDS prevention efforts are based on educational measures . Efforts underway to develop vaccine will probably require several years . Trop Doct, 1988 Oct, 18(4), 147 - 50 Clinical manifestations of AIDS in tropical countries; Carswell JW; PIP: Diagnosis of clinical AIDS can be difficult for clinicians in Africa, where there is only limited access to the sophisticated bacteriological diagnostic facilities needed for diagnoses based on the criteria laid down by the Center for Disease Control in the US . The most common presentation of AIDS in Africa is as an enteropathic condition known as 'Slim.' Based on this and other common presentations of the disease in Africa, a group of clinicians in Bangui, Central African Republic, drew up a list of criteria for the diagnosis of AIDS in Africa which are based on patient history and examination and the exclusion of other conditions rather than on serological confirmation of HIV infection . The major criteria are 1) unexplained fever for longer than 1 month; 2) unexplained diarrhea for longer than 1 month; and 3) weight loss greater than 10% of previous weight . Minor symptoms are presence of a maculopapular rash, oral candidiasis or thrush, herpes zoster or shingles, aggressive or uncontrollable herpes simplex, unexplained cough for longer than 1 month, or enlarged lymph nodes in more than 1 extrainguinal site . The finding of 2 major symptoms and at least 1 minor one is enough for diagnosis . These criteria have been found to be useful . However, they do not cover all the presentations which have been associated with AIDS . Unusual presentations of HIV infected persons which have been seen in Africa include serially developing abscesses in pyomyositis, gall bladder diseases, pericarditis or myocarditis, diseases of the Central Nervous System (cryptococcal meningitis, toxoplasmosis, non-specific leuko-encephalitis, atraumatic paraplegia, acute psychosis or chronic deterioration in mental capacity, lymphoma of the brain), prodromal illnesses, swollen lymph nodes, herpes zoster or shingles in young adults, or tumours of the lymphatic system . Differential diagnosis is extremely important . J Clin Microbiol, 1988 Oct, 26(10), 2054 - 8 Comparison of the Quantum II, API Yeast Ident, and AutoMicrobic systems for identification of clinical yeast isolates; Pfaller MA et al.; The Quantum II Yeast Identification System (Abbott Laboratories) is a microprocessor-based spectrophotometric system for identification of clinical yeast isolates within 24 h . We compared the Quantum II system with the API Yeast Ident (Analytab Products) and the AutoMicrobic System Yeast Biochemical Card (AMS-YBC; Vitek Systems, Inc.) for the identification of 221 clinical yeast isolates, including 120 common clinical isolates (Candida albicans, C . tropicalis, C . parapsilosis, Torulopsis glabrata, and Cryptococcus neoformans) and 101 relatively uncommon clinical isolates . The API 20C (Analytab) was used as the reference system . The Quantum II and AMS-YBC systems correctly identified 181 (82%) and 184 (83%) isolates, respectively, whereas the Yeast Ident system correctly identified 132 (60%) isolates . Of the 120 common clinical isolates, 113 (94%) were correctly identified by Quantum II, 103 (86%) were correctly identified by AMS-YBC, and 83 (69%) were correctly identified by Yeast Ident . Of the 101 uncommon clinical isolates tested, 68 (67%) were correctly identified by Quantum II, 81 (80%) were correctly identified by AMS-YBC, and 49 (49%) were correctly identified by Yeast Ident . The overall accuracy of the Quantum II, AMS-YBC, and API Yeast Ident was not sufficient to recommend any of these systems for routine use in the clinical microbiology laboratory without substantial expansion of the respective data bases. Infect Immun, 1988 Oct, 56(10), 2544 - 51 Differential stimulation of murine resident peritoneal cells by selectively opsonized encapsulated and acapsular Cryptococcus neoformans; Levitz SM et al.; Stimulation of murine resident peritoneal cells (RPCs) by encapsulated strain 52 and acapsular strain 602 of Cryptococcus neoformans was compared . Fresh serum was required for fungistasis of both strains . Encapsulated organisms were killed only if the RPCs were activated with gamma interferon (IFN-gamma) or if the organisms were opsonized with anticapsular immunoglobulin G (IgG) . In contrast, acapsular organisms were killed by unactivated RPCs, with enhanced killing seen if the cells were activated with IFN-gamma . Except for unopsonized strain 52, all organisms of both strains were phagocytosed . The respiratory burst was stimulated in unactivated and IFN-gamma-activated RPCs by encapsulated strain 52 only if organisms were opsonized with both IgG and serum . In contrast, the burst was stimulated by acapsular strain 602, with or without opsonization . Only unopsonized strain 602 stimulated significant lysosomal enzyme release . Nitrite synthesis by unactivated RPCs was seen only if strain 52 was opsonized with anticapsular IgG or if strain 602 was opsonized with serum . If RPCs were activated with IFN-gamma, then serum-opsonized strain 52 was also able to stimulate nitrite synthesis . Thus, RPC killing, phagocytosis, respiratory burst, lysosomal enzyme release, and nitrite synthesis following challenge by both unopsonized and opsonized with serum or anticapsular IgG strains 52 and 602 varied according to the surface properties of the organisms, the state of activation of the RPCs, and the particular RPC event studied . However, stimulation of nitrite synthesis was the only RPC event which correlated with killing of both strains. Mycopathologia, 1988 Oct, 104(1), 37 - 46 Electron microscopic cytochemical analysis of hepatic granuloma induced by Cryptococcus neoformans; Baba T; The hepatic granulomas in experimental cryptococcosis were analyzed by peroxidase (PO) cytochemistry . Cryptococcus neoformans was inoculated intravenously into rats (group A), and some rats were administrated with dextran sulphate to suppress Kupffer cell functions before inoculation (group B) . All rats were sacrificed 7 days after inoculation . The livers were examined PO cytochemically . In addition, the liver, spleen, lungs, kidneys and brain were also examined histopathologically . The hepatic granulomas consisted of the following four type cells; exudate macrophages (type I), PO-negative macrophages (type II), Kupffer cells (type III), and other inflammatory cells (type IV) such as neutrophils and lymphocytes . The percentages of the granuloma-composing cells in group A were 10.3% (type I), 27.3% (type II), 52.9% (type III) and 9.5% (type IV), respectively . In contrast in group B, type II cells outnumbered type III cells by a ratio of 5:3 . In group B, necrosis and hemorrhage were observed in the granuloma . The lesions in the lungs changed from granulomatous to cystic ones after suppression of the Kupffer cell functions . These results suggest that resident macrophages such as Kupffer cells may play an important role in the formation of cryptococcal lesions. J Clin Microbiol, 1988 Oct, 26(10), 2224 - 5 Disseminated infection caused by urease-negative Cryptococcus neoformans; Ruane PJ et al.; We report a case of fungemia and disseminated disease caused by a urease-negative strain of Cryptococcus neoformans in a patient with the acquired immune deficiency syndrome . Except for failure to hydrolyze urea, the microbiological characteristics of the isolate were typical of C . neoformans . Laboratory specialists should be aware of the occurrence of atypical strains of C . neoformans, particularly those recovered from patients with the acquired immune deficiency syndrome. Blood, 1988 Oct, 72(4), 1310 - 5 Neutrophil migration is defective during recombinant human granulocyte-macrophage colony-stimulating factor infusion after autologous bone marrow transplantation in humans; Peters WP et al.; We have previously reported that continuous intravenous (IV) administration of recombinant granulocyte-macrophage colony-stimulating factor (rHuGM-CSF) to humans following high-dose alkylating agent chemotherapy and autologous bone marrow support (ABMS) results in myeloid bone marrow maturation, accelerated granulocyte recovery, and reduced treatment-related toxicity . However, we found that leukocyte counts declined rapidly after discontinuation of rHuGM-CSF therapy, which suggests possible growth factor effects on leukocyte margination and migration . For these reasons we studied granulocyte margination by using 111In-labeled autologous granulocytes and found similar granulocyte margination before (21.5% +/- 13.4%) and during continuous IV rHuGM-CSF infusion (23.3% +/- 9.6%) . Phagocytosis of Cryptococcus neoformans and granulocyte hydrogen peroxide production was similar before and during rHuGM-CSF infusion and similar to patients treated with the same high-dose chemotherapy and ABMS but not receiving growth factor . However, migration of granulocytes to a sterile inflammatory site was markedly reduced during continuous rHuGM-CSF infusion (1.2 +/- 0.9 WBCs/cm2, 24 hr) as compared with baseline (39.6 +/- 17.7 WBCs/cm2/24 hr; P less than .0008) . These findings may be of relevance when extravascular granulocytes are required for host defense. Am J Med, 1988 Oct, 85(4), 481 - 9 Oral fluconazole as suppressive therapy of disseminated cryptococcosis in patients with acquired immunodeficiency syndrome; Sugar AM et al.; PURPOSE: Because of the increasing numbers of patients with acquired immunodeficiency syndrome (AIDS) who will require treatment for cryptococcosis and because of the problems associated with long-term administration of intravenous amphotericin B, an alternative therapeutic approach in the form of an efficacious and easily administered oral antifungal drug would be of great benefit . Fluconazole, a new triazole antifungal agent, represents such an alternative . We therefore conducted an open, non-randomized trial of oral fluconazole as maintenance suppressive therapy of disseminated cryptococcosis in patients with AIDS . PATIENTS AND METHODS: Twenty patients with AIDS, 19 of whom had cryptococcal meningitis, were studied . Patients were followed for up to 21 months . All patients received amphotericin B as primary therapy, fro