Surv Ophthalmol, 1987 May-Jun, 31(6), 384 - 410 Acquired immunodeficiency syndrome (AIDS); Schuman JS et al.; The Acquired Immunodeficiency Syndrome (AIDS), caused by the human immunodeficiency virus (HIV), also called the human T-lymphotropic virus type III/lymphadenopathy-associated virus {HTLV-III/LAV}, has affected over 23,000 people; more than half of those with the disease have died . The actual case fatality rate approaches 100% . AIDS affects all groups and classes of people, although some are at special risk . Distribution of the disease is worldwide . The illness' effects on the body are widespread; of special interest are the ophthalmologic manifestations . The eye may be infected by various viruses (cytomegalovirus, varicella-zoster virus, herpes simplex virus or HIV itself), toxoplasma gondii, candida sp, cryptococcus neoformans, M . tuberculosis, or M . avium-intracellulare . Kaposi's sarcoma may affect the eye as well . Retinal vascular abnormalities (e.g., cotton-wool spots, vasculitis) are not uncommon in AIDS . The syndrome may present with neuro-ophthalmologic manifestations . No effective treatment for the illness is currently available, although several hold promise and there is hope for an AIDS vaccine . Prevention of infection through reduction of risks appears to be the only defense against AIDS at this time. Can J Microbiol, 1987 May, 33(5), 396 - 404 Urease testing and yeast taxonomy; Booth JL et al.; When urease production was assayed by the hydrolysis of {14C}urea, all basidiomycetous yeasts tested, including the Cryptococcus vishniacii complex (previously reported urease negative), produced significant amounts of 14CO2 . The Schizosaccharomycetaceae were the only urease-positive ascomycetous yeasts tested . Yarrowia lipolytica was urease negative . The stoichiometry of {14C}urea hydrolysis paralleled by Roberts' rapid urea hydrolysis (RUH) test indicated that causes of anomalous results in conventional urease testing include acidification and alkalinization of the test medium by products of endogenous metabolism and autolysis rather than urease activity . Anomalous results also occurred when cells were grown on media containing the chelating agent ethylenediaminetetraacetic acid (EDTA) prior to RUH . The addition of EDTA to a complex natural medium inhibited urease production in all yeasts reportedly growing at 35 degrees C (and all other yeasts tested), except Filobasidiella (Cr.) neoformans var . neoformans (NIH 12) . The RUH test could differentiate at the varietal level: Fil . (Cr.) neoformans var . neoformans was about 10 times more resistant to EDTA in media used for the growth of cells prior to RUH testing than was Fil . neoformans var . bacillispora (Cr . neoformans var . gattii) (NIH 191) . Urease production by Fil . neoformans var . bacillispora was specifically restored to half maximal activity by the addition of 22 microM Ni+2 (as NiCl2) to a growth medium containing 0.100 mM EDTA. Antimicrob Agents Chemother, 1987 May, 31(5), 834 - 6 Activity of phenothiazines against medically important yeasts; Eilam Y et al.; Two phenothiazine compounds, trifluoperazine and chlorpromazine, inhibited growth in vitro of the five most common pathogenic yeasts, with MICs ranging from 10 to 40 micrograms/ml . Daily intraperitoneal injections of trifluoperazine (4 to 7 mg/kg of body weight) increased the survival of mice experimentally infected with Candida albicans or Cryptococcus neoformans . The potential use of these drugs against fungal meningitis is discussed. J Antimicrob Chemother, 1987 May, 19(5), 663 - 70 Efficacy of fluconazole (UK-49,858) against experimental aspergillosis and cryptococcosis in mice; Troke PF et al.; The efficacy of fluconazole, a new bis-triazole antifungal agent, was compared with that of orally administered ketoconazole and parenterally administered amphotericin B against aspergillus and cryptococcus infections in mice . Fluconazole was 5-20-fold more active than ketoconazole against systemic aspergillosis and against systemic, intracranial and pulmonary cryptococcosis but was less active than amphotericin B. S Afr Med J, 1987 Apr 18, 71(8), 510 - 2 Sensitivity and specificity of a latex agglutination test for detection of cryptococcal antigen in meningitis; Coovadia YM et al.; A cryptococcal latex agglutination test (Crypto-La; International Biological Laboratories, Canbury, New Jersey, USA) was evaluated for its ability to detect cryptococcal antigen in cerebrospinal fluid (CSF) specimens obtained from black patients with a clinical diagnosis of meningitis . Of the 445 Gram-stained and bacterial culture-negative CSF specimens routinely tested for cryptococcal antigen, 34 (7,6%) were positive . With the exception of 1 false-positive result, the remaining 33 specimens were obtained from 12 patients in whom the diagnosis of cryptococcal meningitis was confirmed by the isolation of Cryptococcus neoformans . The Crypto-La test gave false-positive results on 1% (4/384) of control CSF specimens tested . Nonspecific agglutination reactions were observed with 1,6% (13/829) of all CSF specimens and 22% (10) of sera tested . The ethylenediaminetetra-acetic heat-extraction method proved reliable in eliminating false-positives and nonspecific agglutination reactions in CSF and serum specimens. Br Med J (Clin Res Ed), 1987 Apr 4, 294(6576), 868 - 9 From persistent generalised lymphadenopathy to AIDS: who will progress? Carne CA, Weller IV, Loveday C, Adler MW. PIP: The current rate of progression of persistent generalized lymphadenopathy to acquired immunodeficiency syndrome (AIDS) was tested in a cohort of 105 homosexual men in London, UK . 5 patients were lost to follow-up, and the remaining 100 were seen every 3 months . All tested positive for the human immunodeficiency virus antibody . Previous clinical observations had shown oral candida; anemia; leucopenia; thrombocytopenia; enthrocyte sedimentation rate 15 mm in the 1st hour to be possible predictors of AIDS . 5 of the 13 patients who developed AIDS during a mean follow-up period of 22 months (range 12-32) developed Pneumocystis carinii; 5 Karposi's sarcoma; 1 both; 1 P carinii and cryptosporidiosis; and 1 cryptococcal meningitis . A life table technic calculation showed that over 3 years the probability of patients with persistent generalized lymphadenopathy progressing to AIDS was 20.9% . Of the clinical features examined, those most likely to indicate progression to AIDS were Oral candida (relative risk (RR)=12); Lymphopenia (RR=7); Erythrocyte sedimentation rate 15mm (RR=7); and anemia (RR=6) . There were figures for median time before AIDS onset and the range of variation of these median times for these symptoms, e.g . oral candida, 8 months median; range of 1-24 months . Similar prospective studies performed in the US are reviewed . It is determined that a clinical examination and hematological measurements are useful in determining progression risk . Leukemia, 1987 Apr, 1(4), 288 - 93 Unusual presentations and complications of hairy cell leukemia; Bouroncle BA; In a series of 116 patients with hairy cell leukemia at the Ohio State University, followed for over 20 years, several unusual presentations and complications were encountered . The awareness of these unusual findings might be of help to investigators in the prompt diagnosis and treatment of this disease . The patients presented had, at the time of initial diagnosis, spontaneous rupture of spleen, cryptococcal meningitis, massive splenomegaly with hairy cell infiltration with normal peripheral blood and bone marrow examination, and marked leukocytosis . Some patients developed unusual complications during the course of their illness, such as gastric submucosal infiltration by hairy cells with secondary protein-losing enteropathy, spinal cord compression with paralysis, esophageal perforation with fistula tract, and massive ascites and pleural effusion with typical hairy cells present in the ascitic and pleural fluid. South Med J, 1987 Apr, 80(4), 511 - 3 Cryptococcemia due to Cryptococcus albidus; Gluck JL et al.; We have described a patient with cryptococcemia due to Cryptococcus albidus . Although usually nonpathogenic, C albidus and other non-neoformans cryptococcal species may occasionally be the causative agents in severe infections in man . The latex agglutination test for cryptococcal polysaccharide capsular antigen appears to be specific for C neoformans and thus may be falsely negative in serious infections caused by non-neoformans cryptococci, as seen in our patient with C albidus fungemia . Severe infections caused by C albidus appear to respond to treatment with amphotericin B with or without 5-fluorocytosine but so few cases are available for analysis that no firm conclusions can be made in this regard at present. Q J Med, 1987 Apr, 63(240), 283 - 95 Chronic meningitis without predisposing illness--a review of 83 cases; Anderson NE et al.; Eighty-three previously healthy patients with chronic meningitis presenting to a general hospital were reviewed . The single most common cause was tuberculosis (40 per cent) with cryptococcosis (7 per cent), malignancy (8 per cent) and other definable causes much less frequent . In one-third of patients (34 per cent) no cause was found although most appeared to respond to treatment either with anti-tuberculosis drugs or steroids . There were some differences in clinical presentation, the clinical picture being most characteristic in tuberculous meningitis and malignant meningitis . However, there were frequent exceptions to any general rule and, particularly in adults, the clinical features and changes in cell count, protein and glucose in the cerebrospinal fluid (CSF) did not reliably distinguish one form of chronic meningitis from another . Cerebral and meningeal biopsy produced disappointing results with respect to practical guidance in management . It is often necessary to begin treatment before a cause has been identified . Important points in management include the early use of anti-tuberculosis treatment and the difficulty in deciding on a trial of treatment with corticosteroids or amphotericin B . Not emphasised in previous reports is a subgroup of patients with idiopathic chronic meningitis who are responsive to treatment with steroids . Those patients tend to follow a more prolonged indolent course and often require long-term immunosuppression to control symptoms. Med Trop (Mars), 1987 Apr-Jun, 47(2), 185 - 8 {Salmonella bacteremia and generalized cryptococcosis, a double indicator of African AIDS}; Rogerie F et al.; PIP: This work argues that nontyphoidal Salmonella bacteremia should be included in the provisional World Health Organization case definition of adult AIDS for countries with limited diagnostic resources . The case is described of a 50-year-old-man from Rwanda with proven AIDS who died from generalized cryptococcosis 6 months after episodes of recurrent fever during which Salmonella enteritidis was isolated from blood cultures . 3 months after the initial hospitalization with Salmonella bacteremia a positive hemoculture for Cryptococcus neoformans was obtained, and subsequent ELISA and immunofluorescence tests for AIDS were positive . Adult nontyphoidal Salmonella septicemia affects weakened subjects suffering from deficits of cellular immunity: leukemia, lymphoma, malignant tumors, or treatment with corticoid or other immunosuppressive medications . Numerous publications have drawn attention to the association of Salmonellosis and AIDS . Most of the authors observed the salmonelloses in AIDS patients were recurrent, and some recommended uninterrupted antibacterial treatment for such cases . Several authors mentioned the early character of Salmonella, which often appeared before the 4 opportunistic infections recognized in the WHO definition of AIDS . J Med Vet Mycol, 1987 Apr, 25(2), 67 - 76 Immunosuppression in experimental cryptococcosis in rats . Induction of afferent T suppressor cells to a non-related antigen; Sotomayor CE et al.; To demonstrate the nature of the suppressor cells elicited in rats infected with Cryptococcus neoformans and immunized with human serum albumin (HSA), spleen mononuclear (SpM) cells were fractionated through a nylon wool column . The adherent and non-adherent populations were collected and transferred to syngeneic rats . In all cases, the non-adherent or T-enriched cells adoptively transferred suppression to HSA, however, the suppressive effects of the non-adherent cells were never as great as those of the unpassed population of SpM cells . The fractions adherent to nylon wool also diminished the delayed-type hypersensitivity response to HSA although this was not significant, but glass-adherent cells did exhibit significant suppressor activity . Immunized, non-infected rats were used as donor controls . Furthermore, we showed that the T-enriched-cells are sensitive to treatment with low doses of cyclophosphamide and that they bind HSA . These data indicate that immune suppression of the induction of the delayed-type hypersensitivity response to HSA in cryptococcosis can occur as a result of infection with C . neoformans, and that at least one mechanism involved is the induction of adherent and non-adherent suppressor cells . Characterization of the non-adherent cells indicates that they are Ts1 cells. Am J Med, 1987 Mar 23, 82(3 Spec No), 665 - 7 Cryptococcal peritonitis . Report of a case and review of the literature; Poblete RB et al.; Cryptococcus neoformans is a rare cause of peritonitis; only four cases have been reported in the literature . A 63-year-old man in whom isolation of C . neoformans from ascitic fluid provided the initial clue to disseminated cryptococcosis is described . Review of this case and those previously reported reveals striking association between cryptococcal peritonitis and hepatic disease. Chest, 1987 Mar, 91(3), 459 - 61 Pleural cryptococcosis in the acquired immune deficiency syndrome; Newman TG et al.; Pleural cryptococcosis is extremely rare . We report the first case of cryptococcal pleural effusion in association with the acquired immune deficiency syndrome . Pleural effusion without the evidence of pulmonary parenchymal involvement was the initial and only clinical finding leading to the diagnosis of disseminated cryptococcosis . The pleural effusion resolved spontaneously prior to amphotericin B therapy. Infection, 1987 Mar-Apr, 15(2), 87 - 92 Problems in antifungal chemotherapy; Stevens DA; The field of antifungal chemotherapy is undergoing rapid change at present, with an accelerating pace of introduction of new agents . The problems at present include the need for more effective agents, particularly with novel modes of action . Fungal infection must be considered more frequently in differential diagnosis, and methods developed for early diagnosis . The literature must be improved, with more precise terms . Trials comparing agents are needed, as are studies directed at determining the appropriate length of therapy . In vitro susceptibility testing must be standardized, and clinical correlations examined . Particular problem areas in current therapy are deep candida infections, zygomycotic infections, fungal endocarditis and meningitis, cryptococcosis in AIDS patients, and ocular infections with Fusarium species . Immunomodulating or "pro-host" drugs present an as yet unexplored avenue for clinical therapy . Regimes to prevent fungal infection need improvement . Until the needed advances occur, we must be resourceful in minimizing the toxicity of the agents presently available. Infect Immun, 1987 Mar, 55(3), 749 - 52 Protection of mice against experimental cryptococcosis by anti-Cryptococcus neoformans monoclonal antibody; Dromer F et al.; Humoral immunity does not play a prominent role during experimental cryptococcosis . However, previous studies have shown that immunoglobulin G (IgG) anti-Cryptococcus neoformans antibodies can mediate cell-dependent yeast killing in vitro . Therefore, the protective effect of a previously described monoclonal IgG1 anti-C . neoformans antibody (E1) administered intraperitoneally 24 h before intravenous infection with a C . neoformans serotype A strain was evaluated in mice . Heavily infected (3 X 10(6) cells) untreated mice died in 2.9 +/- 0.5 (standard deviation) days . Survival time was 17.9 +/- 1.6 days for mice treated with 100 micrograms of E1 and 3.0 +/- 0.7 days for mice treated with 100 micrograms of a monoclonal IgG1 anti-thyroglobulin antibody used as a control . Protection was dose dependent and required at least 10 micrograms of E1 (mean antibody concentration in serum +/- standard deviation, 6.6 +/- 2.3 micrograms/ml) . Insufficient concentrations of IgG anti-C . neoformans antibody could explain previous negative results obtained with polyclonal immune serum . After infection with a smaller inoculum (5 X 10(3) to 5 X 10(4)), the protective effect of E1 was confirmed by the presence of fewer CFUs in the spleens and brains of treated mice than in those of controls . CFU were still detected in the brains of protected mice 5 days after infection, although soluble antigen was negative in sera . These results suggest that passive serotherapy with monoclonal IgG antibodies could participate in the prevention or treatment of experimental cryptococcosis. Infect Immun, 1987 Mar, 55(3), 742 - 8 Production, characterization, and antibody specificity of a mouse monoclonal antibody reactive with Cryptococcus neoformans capsular polysaccharide; Dromer F et al.; Two monoclonal immunoglobulin G1 antibodies reacting with Cryptococcus neoformans capsular polysaccharide (CNPS) were produced in mice by using a carefully defined procedure for immunization with unmodified CNPS purified from C . neoformans serotype A . Since the antibodies were found to have the same pattern of specificity, only one of them (E1) is described . This anti-CNPS monoclonal antibody reacted with the glucuronoxylomannan component of CNPS but not with the constituent monosaccharides or with the mannose alpha(1----3)-linked oligosaccharide structures present on CNPS . E1 appeared to be specific for C . neoformans serotype A by agglutination of whole cells; it was specific for soluble CNPS A by gel immunoprecipitation . However, indirect immunofluorescence and competitive-binding enzyme-linked immunosorbent assay experiments showed low levels of cross-reactivity with serotypes B and D but not with serotype C . Concentrations 10,000 times higher for serotypes B and D cells than for serotype A cells were required for a 50% inhibition of E1 anti-CNPS A activity as measured by enzyme-linked immunosorbent assay . Among the other yeasts tested, a cross-reaction was only detected with Trichosporon beigelii . The four serotypes of C . neoformans could be distinguished based on intensities and patterns of fluorescence in an indirect immunofluorescence assay using the monoclonal anti-CNPS A antibody . Monoclonal anti-CNPS A antibodies could be useful for fundamental studies on the glucuronoxylomannan structure, as well as for clinical applications such as serotyping and possibly the serological diagnosis of cryptococcosis. J Clin Neuroophthalmol, 1987 Mar, 7(1), 45 - 8 Visual loss in cryptococcal meningitis; Ofner S et al.; Optic neuropathy with visual loss is a well-known complication of chronic elevated intracranial pressure . The association of visual loss with cryptococcal meningitis may reflect the intracranial hypertension often seen in this condition . However, the generally poor results of optic nerve sheath fenestration and analysis of autopsy cases have led to the suggestion that direct invasion of the visual system by organisms may be the more common mechanism of visual loss . We describe a patient with severe visual loss from cryptococcal meningitis in whom organisms were demonstrated in the optic nerve sheath obtained at the time of fenestration . This is the first report to demonstrate this finding in a living patient. Acta Chir Scand, 1987 Feb, 153(2), 133 - 5 Fungal mastitis . Case report; Walia HS et al.; Fungal (cryptococcal) mastitis in a young woman seemed to be a systemic manifestation of the infection, since it recurred contralaterally within 4 months . Diagnostic problems are discussed . Only two previous reports of deep mammary mycosis were found . In addition to excision, ketoconazole is recommended to prevent recurrence or serious complications. Mycopathologia, 1987 Feb, 97(2), 117 - 9 Aspergillus myositis in a patient with a myelodysplastic syndrome; Reboli AC et al.; We present the case of an elderly man who, while being treated with corticosteroids for a myelodysplastic syndrome, developed myositis of the calf due to Aspergillus fumigatus . Despite therapy with amphotericin B the myositis failed to resolve and he died . At autopsy, a localized necrotizing myositis of the right calf was found with no evidence of disseminated Aspergillus infection . Myositis in the setting of disseminated candidiasis or cryptococcosis has been previously reported . This case is unique in that it is the first reported case of localized fungal myositis and of myositis caused by Aspergillus. J Clin Microbiol, 1987 Feb, 25(2), 430 - 1 Cryptococcus neoformans var . gattii in Australia; Ellis DH; An examination of 45 clinical isolates of Cryptococcus neoformans revealed an unusually high incidence of C . neoformans var . gattii in South Australia (65%) and in the Northern Territory (95%) . In assessing all the available data from Australian isolates of C . neoformans, there appeared to be an endemic focus for the incidence of C . neoformans var . gattii in the rural aboriginal population of the Northern Territory. Diagn Microbiol Infect Dis, 1987 Feb, 6(2), 131 - 8 Biochemical serogrouping of clinical isolates of Cryptococcus neoformans; Shadomy HJ et al.; Three hundred twenty-three clinical isolates of Cryptococcus neoformans of diverse geographic origins were biochemically serogrouped using glycine-cycloheximide-phenol red agar (GCP), the same medium less cycloheximide (GOP), and glycine-L-canavanine bromothymol blue agar (CGB) . Twenty isolates gave positive reactions on all three media typical of the B and C serotypes . Three were from the Peoples' Republic of China; three each were from Michigan (two patients) and Louisiana; two each were from California, Georgia, and Virginia; and one each was from Alabama, Florida, North Carolina, Oklahoma, and Tennessee . Two hundred seventy-six isolates were identified as belonging to the A/D serogroup; 272 were of American origin and four were from China . Twenty-seven isolates were biochemically ungroupable . Evaluations of the reactions on all three media were open to subjective interpretations . Utilization of glycine was the most frequent atypical variable; 36 of 276 (13%) A/D isolates utilized glycine while being inhibited by either GCP or CGB or both . Significant differences between A/D and B/C serogroups in terms of susceptibility to 5-fluorocytosine but not to amphotericin B were observed; B/C serogroup isolates appeared to be less susceptible to 5-fluorocytosine in vitro than were the A/D serogroup isolates . These results provided new evidence on the distribution of B/C serogroup isolates of C . neoformans in America and demonstrate the difficulties of using biochemical tests for serotyping purposes . They also offer a possible explanation for the apparent more refractory therapeutic responses of infections caused by B and C serotypes to conventional antifungal chemotherapy. Lancet, 1987 Jan 3, 1(8523), 1 - 4 Laboratory testing on cerebrospinal fluid . A reappraisal; Hayward RA et al.; 555 consecutive cases in which cerebrospinal fluid (CSF) was sent for cell count were reviewed to determine which cerebrospinal-fluid tests affect diagnosis or therapy . Among 334 cases (60%) with a normal opening pressure, cell count, and protein, 1385 additional tests were done, but such tests were useful in only 3 patients (0.9%) with multiple sclerosis . Among 148 consecutive cases of bacterial, chronic infectious, and malignant meningitis the opening pressure, cell count, or protein was abnormal in all but 3 (2 childhood bacterial meningitis and 1 cryptococcal meningitis in a patient with the acquired immunodeficiency syndrome) . If the opening pressure, cell count, and protein are normal, no additional CSF tests are needed in most instances; however, in immunocompromised patients and in those with possible multiple sclerosis or childhood bacterial meningitis additional tests may be indicated. Neuroradiology, 1987, 29(1), 43 - 6 Cryptococcus meningitis, clinical--CT scan considerations; Tan CT et al.; Twenty adult cases of cryptococcus meningitis and their cranial CT scan findings were reviewed . Ten patients had abnormal CT scans . The findings were hydrocephalus, gyral enhancement, focal nodules, decreased attenuation in the white matter, and patchy increased uptake of contrast . The CT scan appearance often failed to correspond with symptoms . None of the appearances was specific to the cryptococcal infection . Fourteen patients developed papilloedema during the course of the illness . The majority of the patients who developed papilloedema did not have demonstrable hydrocephalus. Am J Med, 1987 Jan, 82(1), 149 - 50 Acquired immune deficiency syndrome presenting as bone marrow and mediastinal cryptococcosis; Witt D et al.; Disseminated cryptococcosis developed as the first manifestation of the acquired immune deficiency syndrome in a previously healthy Haitian man . Following presentation with a febrile illness that included massive mediastinal and peripheral lymphadenopathy, the patient died of overwhelming pulmonary, visceral, and meningeal cryptococcosis. Clin Exp Neurol, 1987, 23, 127 - 37 Cryptococcal infections of the central nervous system: a ten year experience; Waterston JA et al.; Twenty cases of cryptococcal CNS infection treated at the Alfred and Fairfield Infectious Diseases Hospitals from 1975 to 1985 were reviewed . A predisposing immunological deficit was present in 40% of the cases and nearly half had evidence of pulmonary involvement . Severe headache was an almost universal presenting feature but fever and meningismus were not . Measurement of CSF cryptococcal antigen and CSF culture were far more reliable diagnostic markers than Indian ink smears . Cerebral CT scanning identified abnormalities in nearly 30% of cases, including 2 with cystic lesions and 2 with mass lesions . Combination therapy with amphotericin B and 5-fluorocytosine was used as first line treatment . Ventricular shunts were required for 2 patients with hydrocephalus, and persistently raised intracranial pressure often required frequent lumbar punctures and corticosteroids for control . Mortality was 30% and correlated with the presence of impaired conscious state, hydrocephalus or other neurological deficit, underlying immunodeficiency and low CSF glucose levels. Rev Neurol (Paris), 1987, 143(4), 290 - 3 {Quasi-normal cerebrospinal fluid in patients with acquired immunodeficiency syndrome and cryptococcal meningitis}; Gudesblatt M et al.; We report eight patients with cryptococcal meningitis and a cerebrospinal fluid characterized by few or no white blood cells and chemistries that may be near normal . In four of these patients, only testing for cryptococcal antigen allowed the initial diagnosis . Seven of the patients had a certain diagnosis of AIDS . Six have died . Autopsies performed in two cases indicated a poor meningeal inflammatory response . Contrary to the findings in most immunodeficient patients, in AIDS cryptococcal meningitis may present with few cellular or biochemical abnormalities in the cerebrospinal fluid . In AIDS patients presenting with headache and fever or change in mental status, examination of the cerebrospinal fluid should not be limited to routine studies. Ann Pathol, 1987, 7(1), 15 - 24 Acquired immune deficiency syndrome (AIDS) in Brazil . Necropsy findings; Michalany J et al.; PIP: Clinical and autopsy findings obtained from 15 male patients treated for acquired immunodeficiency syndrome (AIDS) at 3 hospitals in Sao Paulo provided a clearer profile of AIDS cases in Brazil . Of the 12 patients whose sexual orientation was recorded, 9 were homosexual and 3 were bisexual . 75% were between the ages of 22-36 years; 14 were white . The duration of diseases ranged from 14 days-7 months in this series, confirming the rapid evolution of AIDS from 1st symptom to death . The most common clinical manifestations of disease were fever, cough, weight loss, diarrhea, and lymphadenopathy . Organs most frequently involved were the lungs (13 cases) and encephalum (9 cases) . Microscopic findings revealed 9 types of microorganisms, fungi, and protozoa, the most common of which was Cytomegalovirus (7 cases) . The cause of death was meningoencephalitis in 7 cases and panlobar pneumonia in 3 cases . The incidence of Kaposi's sarcoma (2 cases) was surprisingly low in this series . In addition to lesions produced by microorganisms, there were important associated lesions represented by lymphocytic depletion, acute myocarditis, brown atrophy of neuronia, acute pancreatitis, and liver cirrhosis . Several microorganisms and tumors in these AIDS patients were discovered only at autopsy, confirming the importance of necropsy to the study of the natural history of this disease . An unexpected pathological finding in this series was the absence of cellular reactions to microorganisms, particularly Pneumocystis carinii, Cryptococcus neoformans, and Mycobacterium tuberculosis . J Med Primatol, 1987, 16(1), 39 - 47 Spontaneous cryptococcosis of a squirrel monkey (Saimiri sciureus) in French Guyana; Roussilhon C et al.; An old female squirrel monkey (Saimiri sciureus) with a tumor-like growth of the lower jaw died in shock after 2 months of illness . Histological studies of different tissue samples demonstrated that the pathological agent was Cryptococcus . Multiple foci of fungus existed in the thoracic cavity with essentially pulmonary and glandular localizations. Mycopathologia, 1987 Jan, 97(1), 9 - 16 Description of a case of rhinosporidiosis in Spain; Alonso MJ et al.; Rhinosporidiosis is reviewed, and the first autochthonous case in Spain is presented (site: in the nasal cavity of a 19-year-old male from a rural background) . Diagnosis was established morphologically after eliminating the possibilities of Cryptococcus neoformans, Coccidioides immitis, and Chrysosporium crescens . Clinico-pathological features are described . Preparations were stained with hematoxylin-eosin, PAS, and methenamine silver, and studied for fluorescence . Certain aspects of the epidemiology and diagnosis are commented upon. Histopathology, 1987 Jan, 11(1), 9 - 20 Fungal and nocardial infections of the kidney; Raghavan R et al.; This report describes 16 cases of candidiasis, seven of aspergillosis, four of mucormycosis, two of cryptococcosis and one of nocardiosis in which the kidney was involved . Characteristic patterns of renal tissue injury were seen in each of these infections . Candida and nocardia caused microabscesses in the cortex and medulla . Tissue destruction was minimal with candidiasis and when present was confined to the papillary tips and produced only mild impairment of renal function . Aspergillus and mucor invaded blood vessels resulting in thrombosis and extensive necrosis of cortical and medullary tissue and most patients had clinical and biochemical evidence of renal disease . Cryptococcosis caused no tissue reaction or clinically evident renal disease in the two immunosuppressed patients studied. Mycopathologia, 1987 Jan, 97(1), 25 - 31 Evaluation of SOC for the presumptive identification of Candida albicans and Cryptococcus neoformans; Fleming WH 3rd et al.; SOC, a fungal growth medium composed of Solryth, oxgall, and caffeic acid, was evaluated as a medium to provide rapid, differential identification of Candida albicans and Cryptococcus neoformans . Using a variety of common isolation media to produce the yeast inocula, the germ tube methods tested ranked in the following order of decreasing sensitivity: SOC (97% +/- 1), serum (92% +/- 5), rabbit coagulase plasma with EDTA in combination with tryptic soy broth (89% +/- 5), TOC (89% +/- 6), and rabbit coagulase plasma with EDTA (83% +/- 4) . In chlamydospore production, SOC also proved to be the most sensitive after 24 h incubation: SOC (96% +/- 2), TOC (80% +/- 2), and cornmeal-Tween 80 agar (14% +/- 3) . Other medically important yeasts showed normal patterns of growth within 24 h on SOC, thus assisting in their identification . Eighty strains of Cryptococcus neoformans showed characteristic brown pigmentation on SOC and TOC within 18 h, while all other species of the genus Cryptococcus and 229 Candida isolates did not show a change in pigmentation. Crit Rev Microbiol, 1987, 14(2), 99 - 170 The genetics of medically important fungi; Whelan WL; The present review is concerned with recent progress in basic genetic investigations with a variety of fungi which are pathogenic for man and animals . The principles and strategies involved in undertaking genetic investigations of sexual species and of asexual species are discussed . Progress in genetic analysis of Cryptococcus neoformans made possible by the discovery of its sexual phase is described in detail, as is progress in development of parasexual methods of analysis in Candida albicans . The genetic bases of virulence and drug resistance are discussed for those few species in which these phenotypes have been investigated . Suggestions for future research, including the application of recent advances in molecular biology to the study of pathogenic fungi, are presented. J Am Acad Dermatol, 1987 Jan, 16(1 Pt 2), 243 - 9 Localized cutaneous cryptococcosis successfully treated with ketoconazole; Granier F et al.; A 27-year-old female recipient of a renal allograft, treated with systemic steroids and azathioprine, developed progressive cutaneous lesions (an ulcer, a nodule, and an abscess) . Histopathologic and tissue-culture examination of the skin lesions led to the diagnosis of cutaneous cryptococcosis . A description of the light and electron microscopic features of the cutaneous lesions is reported . A thorough visceral investigation failed to detect systemic involvement . The patient was treated with oral ketoconazole (400 mg daily) for 6 months . A gradual healing of the lesions was obtained, and cultures performed 3 months after the onset of treatment failed to show Cryptococcus neoformans . No relapse or dissemination has so far been observed. Rev Infect Dis, 1987 Jan-Feb, 9 Suppl 1, S4 - 14 Evolution of antifungal agents: past, present, and future; Drouhet E et al.; Important progress has been achieved in antifungal chemotherapy in recent years . Two groups of drugs are now used: those produced by various organisms and those made synthetically . In the first group, only amphotericin B (1956) administered systemically is active in numerous deep mycoses . Although toxicity limits the use of amphotericin B, it is still the drug of choice for systemic mycoses . Griseofulvin was the first agent used for oral treatment of dermatophytoses . The introduction of flucytosine began a new era in chemotherapy; however, although flucytosine is orally administered and rapidly distributed, its antifungal activity is limited to cryptococcosis and systemic candidosis . The rapid induction of flucytosine-resistant mutants led to the development of treatment regimens of amphotericin B plus flucytosine . With the development of imidazole derivatives in 1969, a new generation of azole antifungal agents has emerged . Of these, only ketoconazole was orally active . New azole derivatives and triazoles have been synthesized, but only itraconazole has been successful in the treatment of superficial and deep mycoses in humans . Future trends for the development of agents with fungicidal activity, wider spectra, and better distribution are proposed . The association of immunotherapy with antifungal chemotherapy may offer new treatments for fungal infections in immunocompromised patients. Arch Pathol Lab Med, 1987 Jan, 111(1), 53 - 7 Advantage of Fontana-Masson stain in capsule-deficient cryptococcal infection; Ro JY et al.; We describe light and electron microscopic findings in three cases of pulmonary infection caused by capsule-deficient Cryptococcus neoformans (CDCN) and emphasize the value of the Fontana-Masson silver (FMS) stain in diagnosing cryptococcosis . Capsule-deficient C neoformans infections, including coccidioidomycosis, histoplasmosis, typical cryptococcosis, blastomycosis, candidiasis, and pneumocystosis were used as controls . Several stains including mucicarmine, alcian blue, and FMS were done on tissue sections from all of the above mentioned infections . It was found that while the FMS stain was positive only in the organisms of CDCN and typical C neoformans, the mucicarmine was positive only in typical C neoformans . The negativity of the mucicarmine in the organisms of CDCN reflected the absence of capsular material as demonstrated by ultrastructural study . Therefore, when fungal cultures are not available or are negative, and tissue mucicarmine is negative, the FMS stain is a valuable alternative for use on tissue sections . It may be used, along with routine fungal stains, when a yeast-forming fungal infection is suspected. Retina, 1987 Summer, 7(2), 75 - 9 Cryptococcal chorioretinitis and endophthalmitis; Henderly DE et al.; The diagnosis of endogenous ophthalmic fungal infection may be difficult . A patient initially presented with hydrocephalus and later developed a progressive bilateral intraocular inflammation unresponsive to corticosteroids or antituberculous therapy . Further evaluation with vitreous biopsy study and lumbar puncture led to the diagnosis of cryptococcal chorioretinitis, endophthalmitis, and meningitis . Initial treatment with intravenous amphotericin failed to control the intraocular infections . Vitrectomy and intravitreal injections of amphotericin combined with the systemic intravenous amphotericin halted progression of the intraocular disease . This case demonstrates the difficulty in making the diagnosis of an endogenous fungal endophthalmitis and the value of diagnostic vitreous biopsy study in cases of increasing intraocular inflammation unresponsive to medical therapy . It also suggests the usefulness of vitrectomy combined with intravitreal amphotericin in cases of fungal endophthalmitis that are unresponsive to systemic antifungal agents. Am J Med, 1987 Jan, 82(1), 129 - 31 Disseminated cryptococcal infection in a patient with hypogammaglobulinemia and normal T cell functions; Gupta S et al.; The immunologic status of a patient with disseminated cryptococcosis and no underlying predisposing factor was evaluated . The proportions and numbers of T cells, T cell subsets, B cells and proliferative responses to mitogens and soluble antigens, including cryptococcal antigen, were comparable to those in healthy control subjects; however, the patient had moderately severe hypogammaglobulinemia . The patient continues to do well clinically with intravenous gammaglobulin and antifungal therapy . This study suggests that antibodies might also play a role in the defense against cryptococcal antigen. Ann Med Interne (Paris), 1987, 138(8), 607 - 9 {Adrenal lesions in AIDS: anatomopathological study}; Bricaire F et al.; Systematic autopsy studies of 100 patients with AIDS confirmed a high incidence of adrenal lesions . Eighty eight cases were analysed, 79 men and 9 women; 57 had opportunist infection alone, 6 had Kaposi sarcomas and 30 had an association of both pathologies . The adrenal glands were normal in 19 cases and abnormal in 64 cases . One case has non-specific spongiocytic depletion and 4 were uninterpretable because of necrosis . The main adrenocortical changes were inflammatory (N = 37) or necrotic (N = 22) . The commonest sites were in the adrenal medulla in the cortex or at the cortico-medullary junction . There was a high incidence of cytomegalic inclusion bodies (44 cases) . In 7 cases specific lesions were observed; cryptococcus (1), toxoplasmosis (1), tuberculosis (2), Kaposi (3) . Adrenal insufficiency was diagnosed before death in only 3 cases. Ann Biol Clin (Paris), 1987, 45(5), 588 - 90 {Significance of the presence of Candida sp . in bronchopulmonary secretions . Contribution of pulmonary biopsy}; Roux P et al.; Candida SP is often found in broncho-pulmonary secretions (expectorations, bronchial aspirations, bronchiolo-alveolar lavage...); however, its presence even in massive amounts, is difficult to interpret . Is it a sign of broncho-pulmonary candidosis or mouth-pharynx contamination? The different clinical and biological elements, in particular immunology in immunodepressed patients, bring little information . In this article, we present the retrospective study of 18 patients hospitalized in Pneumology Department of Tenon Hospital for severe extensive pneumopathy of unexplained origin . In these patients, for the most part immunodepressed, Candida sp was found in large amounts in at least a sample (expectorations {5} and/or bronchial aspirations {4} and/or bronchiolo-alveolar lavage {12} . No lesion suggestive of candidiasis was found during bronchial endoscopy carried out for these different samples . In pulmonary biopsy with diagnostic in view, these yeasts were found only in one patient . In this patient, as C . tropicalis was associated with Pneumocystis carinii and Cryptococcus neoformans, it was difficult to know the respective part of each of these agents in pulmonary symptomatology . In the other 17 cases, the direct examination and cultures were negative . The presence of Candida sp in the different broncho pulmonary secretions is not synonymous of bronchopulmonary candidiasis; likely it is, in most cases, a sign of contamination of mouth-pharynx origin. Rev Neurol (Paris), 1987, 143(10), 631 - 42 {Neuropathological study of 31 cases of acquired immunodeficiency syndrome}; Henin D et al.; Post-mortem study of every patient who died from AIDS in Pitie-Salpetrire Hospital from June 1984 to November 1985 was performed without regard to the presence of neurological signs and symptoms . Autopsy were performed in 31/48 cases . Patients had been hospitalized in the Departments of Parasitology-Infectious Disease (24 cases) Internal Medicine (4 cases) and Neurology (3 cases) . In every case, formalin-fixed material from the brain and the spinal cord were embedded in paraffin (20 samples), stained with hematoxylin-eosin, PAS, Alcian blue, Giemsa, Grocott and Ziehl techniques and Bodian's silver impregnation along with Luxol fast blue, and, in celloidin (8 samples), stained with hematoxylin-eosin and Loyez' impregnation . There were 30 men (27 caucasian, 1 egyptian, 1 haitian, 1 senegalese) and one woman (congolese) . Twenty eight (28) patients were homosexuals . AIDS was transfusion-associated in two cases . Neurologic complications revealed the disease in 2 cases . Eighteen (18) patients had neurological signs or symptoms before death . Age range at death was 22-58 (mean 38) . Brain weight in AIDS (from 1150 gms to 1750 gms-mean 1428 gms) was not statistically different from the mean weight of 100 male patients in the same age range autopsied in the same laboratory during the identical period (mean 1427 gms, standard deviation: 23) . Microscopic abnormalities were present in every brain examined . These included non-Hodgkin lymphoma (3 cases), opportunistic infections (21 cases: 13 toxoplasmosis, 4 cytomegalovirus encephalitis, 3 cryptococcal meningitis, 1 infection by mycobacterium avium-intracellulare), and subacute encephalitis (17 cases, 9 isolated, 8 associated with other disorders) . The characteristic changes consisted of lympho-monocytic focal infiltrates (so-called microglial nodules) and mild lympho-monocytic perivascular cuffs in 10 cases . Typical giant cells were seen only in one case . Mild demyelinating changes were also seen in only one case . No spinal cord spongiosis, nor Progressive Multifocal Leukoencephalopathy was found . HIV localization was performed on frozen sections utilizing in situ hybridization techniques (2 cases) and immunohistologic techniques (5 cases) . HIV, RNA and proteins, was detected in 2 cases with subacute encephalitis . Infected cells were labeled with macrophage markers, and rarely with T4 lymphocyte markers . Infected astrocytes (identified by anti-GFAP serum) or neurons (identified by anti-NSE serum) were never observed . No giant cells were seen in these two cases. Crit Rev Microbiol, 1987, 15(1), 45 - 56 The genetic basis of resistance to 5-fluorocytosine in Candida species and Cryptococcus neoformans; Whelan WL; In terms of genetically determined susceptibility to the clinical antifungal agent 5-fluorocytosine (5-FC), Candida albicans may be homozygous sensitive (FCY/FCY), homozygous resistant (fcy/fcy), or heterozygous (fcy/FCY) . Although heterozygotes are only slightly resistant, they occur at significant frequency among clinical strains and carry preexisting resistance determinants which may be responsible, following homozygosis, for treatment failures . There are two resistance genes (FCY1 and FCY2) known . Resistance in fcy1/fcy1 strains was associated with decreased UMP pyrophosphorylase activity, whereas resistance in fcy2/fcy2 strains was associated with decreased cytosine deaminase activity . These results were confirmed and extended in a 19F nuclear magnetic resonance study of 5-FC uptake and metabolism in genetically defined strains . By means of hybridization via spheroplast fusion, a complementation test was devised to test allelism of resistance determinants . Resistance to 5-FC was employed as a useful genetic marker in basic studies . In tetraploid hybrids which bore appropriate fcy markers, it was possible to select for reduction in ploidy by selecting for increased resistance to 5-FC; a novel parasexual system was thus generated (2n x 2n----4n----2n) . In linkage studies, the gene FCY1 was shown to be linked to the gene HIS . Reciprocal mitotic recombination was demonstrated repeatedly with fcy1 and his alleles in cis and in trans configurations and evidence for nonreciprocal recombination (mitotic gene conversion) was also obtained . In Cryptococcus neoformans, mutation in either of two genes (FCY1, FCY2) is sufficient to confer resistance . These genes behave as simple Mendelian determinants which recombine freely . Diploid C . neoformans heterozygous for resistance (FCY/fcy) provided useful strains in which to develop genetic mapping methodology based on mitotic recombination. Microbiol Immunol, 1987, 31(5), 449 - 60 Evaluation of the experimental pathogenicity of some Cryptococcus species in normal and cyclophosphamide-immunodepressed mice; De Bernardis F et al.; The pathogenic potential of distinct Cryptococcus species has been evaluated in mice rendered leukopenic by one or two injections of the potent immunosuppressive drug cyclophosphamide (Cy) . Pathogenicity assessment included enumeration of viable cryptococcal cells in animal organs and histopathological observations . It was found that putatively non-pathogenic species of Cryptococcus, in particular C . cereanus and C . albidus, showed significant lethality for Cy-treated mice . In Cy-immunodepressed mice, challenged with the infectious cryptococcal cells two days after pharmacological treatment, a significant decrease of LD50 (equivalent to at least one order of magnitude) was observed for all Cryptococcus species . However, the pathogenicity enhancement due to Cy immunodepression was greater with C . neoformans . In all cases, brain and kidney were the most invaded tissues as also evidenced by histopathological examination, which showed the typical cystic lesion . All the observations made point to the conclusion that the pathogenic potential, for the immunomodulated host, of Cryptococci other than C . neoformans is significant being quantitatively and not qualitatively different from that of C . neoformans, as evidenced by a similar organotropism and similar type of histological lesions in the target organs (brain and kidney). Trop Geogr Med, 1987 Jan, 39(1), 67 - 9 Recurrent meningitis of 5 years duration due to Cryptococcus neoformans; Woo E et al.; A patient with recurrent meningitis over five and a half years due to Cryptococcus neoformans is reported . The relapsing course and the unusual diagnostic features are emphasized. Am J Surg Pathol, 1987, 11 Suppl 1, 3 - 15 Tissue diagnosis of selected AIDS-related opportunistic infections; Rotterdam H; Opportunistic infections are the most common initial manifestations of AIDS and, in many instances, are first encountered in surgical specimens . Pneumocystis carinii pneumonitis is by far the most frequent infection seen in biopsy specimens of AIDS patients . Most pathologists are familiar with its histopathologic presentations from previous experience . By contrast, many other opportunistic infections are either new or present clinically and pathologically in unfamiliar ways . Cytomegalovirus affects primarily the alimentary tract and lung . Colitis is the most common presentation . Penetrating ulcers may perforate . Most often, mesenchymal cells, endothelium in particular, show the typical intranuclear and intracytoplasmic inclusion bodies . The greater the number of inclusion bodies in tissues the shorter is the survival of the patient . Mycobacterium avium-intracellulare affects mainly small intestine and lymph nodes and produces a clinical and histologic picture similar to that of Whipple's disease . Diffuse infiltrates of histiocytes stuffed with acid-fast bacilli are characteristic . Cryptosporidiosis is the most ominous enteric opportunistic infection . Protozoa attach themselves to the epithelial surface and produce severe profuse, watery diarrhea . Cryptococcosis is seen in lung, lymph node, and brain biopsy specimens . Large numbers of organisms, sometimes with deficient mucinous capsules, and little or no inflammatory reaction, are notable . Toxoplasmosis is the most common cause of neurological complications in AIDS . Brain biopsy specimens show necrosis, microglial nodules, perivascular lymphocytic infiltrates, and, in 50% of cases, trophozoites. Rev Infect Dis, 1987 Jan-Feb, 9 Suppl 1, S33 - 42 Degenerative changes in fungi after itraconazole treatment; Borgers M et al.; Changes in morphogenetic behavior and structural degeneration after exposure to itraconazole are illustrated in Candida albicans, Cryptococcus neoformans, Pityrosporum ovale, Paracoccidioides brasiliensis, Trichophyton rubrum, and Aspergillus fumigatus . With the exception of P . ovale, primary alterations are seen at the cell periphery and the cytoplasmic vacuoles in which lipid-like vesicles assemble . These changes are usually accompanied by a marked increase in cell volume, impaired cell division, or abortive hyphal outgrowth . The concentration of itraconazole necessary to induce irreversible structural degeneration (necrosis) depends greatly on the species used, the time of incubation, and the morphogenetic form in which the fungus is grown and varies from 10(-10) M (P . brasiliensis) to greater than 10(-6) M (C . albicans) . Itraconazole achieves these effects either at a concentration comparable to that required for ketoconazole (C . albicans and C . neoformans); at concentrations 10- to 100-fold lower (P . ovale, T . rubrum, P . brasiliensis), or at concentrations 100-fold lower (A . fumigatus). Rev Infect Dis, 1987 Jan-Feb, 9 Suppl 1, S15 - 32 Activity of orally, topically, and parenterally administered itraconazole in the treatment of superficial and deep mycoses: animal models; Van Cutsem J et al.; The activity of itraconazole in vitro was evaluated for 2,094 strains of 132 fungal species, one achloric alga, nine actinomycetes, and six bacterial species . Itraconazole was active against dermatophytes (271 strains), Candida species (1,303), Cryptococcus neoformans (27), Torulopsis species (170), Pityrosporum species (40), Aspergillus species (87), Sporothrix schenckii (12), dimorphic fungi, Dematiaceae, and various other organisms . This activity depended largely on the test conditions and the medium used . Ittraconazole was as active as ketoconazole in the treatment of dermatophytoses and of both superficial and deep candidosis at oral doses about eight and four times lower, respectively, than the doses of ketoconazole required . Disseminated dermatophytosis was cured more rapidly by itraconazole than by ketoconazole . Parenteral and oral itraconazole were of equal efficacy for the treatment of systemic candidosis . Itraconazole used topically was more active than reference compounds against microsporosis, trichophytosis, and superficial candidosis . Given orally, itraconazole was effective therapy for aspergillosis and meningo-cerebral cryptococcosis in mice and for generalized cryptococcosis, histoplasmosis, and sporotrichosis in guinea pigs . No drug-related adverse effects were observed. Am Fam Physician, 1987 Jan, 35(1), 109 - 18 Thoracic manifestations of AIDS; Hollerman JJ et al.; Of 67 hospitalized AIDS patients, 39 had pulmonary pathology . More than half of these patients died of pulmonary disease . Pneumocystis carinii, cytomegalovirus, Cryptococcus neoformans and Mycobacterium avium-intracellulare were the most common pulmonary pathogens, and Kaposi's sarcoma was the most common neoplasm . Infections and neoplasms frequently coexist in the thorax of an AIDS patient . The chest radiograph may be normal in an AIDS patient with active Pneumocystis pneumonia. Infect Immun, 1987 Jan, 55(1), 233 - 9 Induction of a macrophage-suppressive lymphokine by soluble cryptococcal antigens and its association with models of immunologic tolerance; Blackstock R et al.; Soluble extracts of Cryptococcus neoformans were examined for their ability to induce a macrophage-regulatory T-suppressor cell known to appear in the spleens of mice infected with cryptococci . Suppressor cells were induced by injection of extracts of encapsulated or thinly encapsulated strains of cryptococci . Dose-response analysis showed that as little as 25 micrograms of soluble capsular polysaccharide antigen could induce significant suppressor cell activity, with maximum suppression occurring at a dose of 100 micrograms . The suppressor cells appeared within 1 week of injection of antigen and persisted for at least 2 months . Suppressor cells were induced in animals given tolerogenic doses of levan, human gamma globulin, and soluble capsular polysaccharide antigen . When these same antigens were administered in immunogenic form, no suppressor cell activity was detected . Therefore, the suppressive mechanism was common to models of immunologic tolerance and was not unique to cryptococcal disease or cryptococcal capsular polysaccharide antigen . The phagocytosis-inhibiting lymphokine produced by the suppressor cell population completely inhibited the phagocytic activity of only a portion of peritoneal exudate cells . Other macrophages in the population were not totally inhibited but exhibited a reduction in the number of yeast cells engulfed. Chemotherapy, 1987, 33(5), 381 - 95 Combination therapy of experimental candidiasis, cryptococcosis, aspergillosis and wangiellosis in mice; Polak A; Combination pairs of 5-fluorocytosine (5-FC) + itraconazole (Itra), 5-FC + fluconazole (Fluc), and amphotericin B (Amph B) + Itra were administered to mice with experimental candidiasis, cryptococcosis, aspergillosis and wangiellosis with a variety of combination ratios . The life-prolonging effect of the combinations was compared with the effect of each partner administered alone and with a double dosage . Using the U test of Mann and Whitney, the effects of the concentration were classified as synergistic, additive, indifferent or antagonistic; the degree of the interaction was compared with the known effect of Amph B and 5-FC combinations . The combination 5-FC + Itra was definitely synergistic or additive in candidiasis and aspergillosis . The most pronounced synergism occurred in the infection with a 5-FC-resistant strain of Candida albicans . The degree of synergism was the same as with 5-FC + Amph B . In cryptococcosis this combination was indifferent . The combination of 5-FC + Itra merits clinical investigation, especially in candidiasis and aspergillosis . Amph B + Itra was mostly indifferent and weakly antagonistic; the degree of antagonism was significantly weaker than the one observed with Amph B + ketoconazole (Keto) . In candidiasis, 5-FC + Fluc was synergistic, but indifferent in cryptococcosis and aspergillosis. Blood Cells, 1987, 13(1-2), 171 - 84 Mechanisms of erythroid suppression in the anemia of chronic disease; Roodman GD; The mechanism underlying the hypoproliferative anemia in patients with chronic diseases has not been clearly defined . We have examined the effects of marrow macrophages from anemic patients with chronic diseases and normals to determine if they suppress erythroid progenitors in vitro . We found that marrow macrophages from patients with the anemia of chronic disease (ACD) significantly suppressed erythroid progenitor cell growth, whereas marrow macrophages from normals did not . Since ACD is seen in conditions that activate macrophages, we then determined if activated macrophages could suppress erythroid progenitor cell growth . Peritoneal macrophages activated by chronic Cryptococcus neoformans infection significantly suppressed erythroid progenitor cell growth, although resting macrophages did not . We then examined the effects of a product of activated macrophages, tumor necrosis factor (TNF), for its effects on CFU-E and BFU-E . TNF significantly suppressed CFU-E and BFU-E growth in concentrations as low as 10(-11)-10(-12) M . Preincubation of marrow samples with TNF for as little as 15 minutes was sufficient to suppress CFU-E and BFU-E growth . Addition of TNF, after the onset of culture could only suppress CFU-E and BFU-E if added within the first 48 hours . TNF (10(-10)-10(-11) M) also inhibited the growth of hematopoietic cell lines K562, HL60, and HEL cells . These cell lines expressed low numbers of high affinity TNF receptors, with 80%-90% of the cells expressing TNF receptors. Ophthalmology, 1987 Jan, 94(1), 23 - 6 The value of calcofluor white in the diagnosis of mycotic and Acanthamoeba infections of the eye and ocular adnexa; Marines HM et al.; In search of an easy and quick method for the diagnosis of fungal and Acanthamoeba infections of the eye, the authors have used calcofluor white (CFW), a fluorescent brightener with marked affinity for chitin and cellulose which are present in the cell walls of fungi and cysts of Acanthamoeba . Paraffin-embedded tissues containing mycotic organisms were stained with CFW and examined under a fluorescent microscope . Several fungi such as Candida sp, Aspergillus sp, Phycomycetes, Fusarium solani, Histoplasma capsulatum, Cryptococcus neoformans, Rhinosporidium seeberi, and others were studied . Trephine corneal biopsy specimens (2 mm) and methanol-fixed corneal scrapings containing Acanthamoeba sp were also examined . The walls of fungi and Acanthamoeba cysts stained bright greenish white in contrast to the reddish-orange background of the supporting tissues . The results demonstrate that the CFW method is a highly reliable and rapid technique for identification of mycotic organisms as well as cysts of Acanthamoeba . This method may also be applied in surgical pathology when performing frozen sections, as well as cytologic examination of corneal smears, vitrectomy specimens, and others. Arch Inst Pasteur Tunis, 1986 Dec, 63(4), 477 - 80 {2 cases of mycotic infection caused by Cryptococcus neoformans}; Ben Jilani S et al.; The authors present two cases of Cryptococcus neoformans disease in two young persons . Its appears, in the first case, a diffuse ganglionnary and cutaneous lesion with an evolutive meningo-encephalic localization, and in the second case it appears only a meningitic lesion . These two observations are characterized by the apparition of the infection in a immunodepression patient and by an unfavorable evolution in spite of the treatment. J Neurol Sci, 1986 Dec, 76(2-3), 187 - 98 Neuropathology of acquired immunodeficiency syndrome (AIDS) . Analysis of 22 Brazilian cases; Rosemberg S et al.; PIP: Involvement of the central nervous system is not uncommon in patients with acquired immunodeficiency syndrome (AIDS) . The neuropathologic aspects of 22 consecutive autopsies of Brazilian AIDS victims were investigated to gain more information on this manifestation . 13 (59%) of these cases exhibited neuropathologic changes, including infection by Toxoplasma (4 cases), Cryptococcus neoformans (3 cases), viral encephalitis (4 cases), primary lymphomas (2 cases), isolated cerebral infarct (1 case), and reactive gliosis (1 case) . In 2 cases, primary lymphoma and viral encephalitis were associated . 3 of the 4 cases of toxoplasmosis had macroscopical abscesses in the region of the internal capsule, basal ganglia, or thalamus . Axonal spheroids in the gracilis and cuneatus nuclei were present . All 3 cryptococcosis cases demonstrated a meningeal inflammatory process; in addition, multiple microcysts were found in the cortex of the cerebral hemispheres and in the basal ganglia in 2 of these cases . The 4 encephalitis cases showed multiple microglial nodules and occasional foci of perivascular lymphocytic cuffings, with dissemination of lesions throughout the grey structures of the central nervous system . All 22 patients autopsied in this series were male; 19 were homosexual . Previous studies of the incidence of neurologic complications in AIDS reported in the US and European literature have yielded rates between 23-73% . J Thorac Cardiovasc Surg, 1986 Dec, 92(6), 977 - 80 The thoracic surgical spectrum of acquired immune deficiency syndrome; Miller JI; The acquired immune deficiency syndrome has presented a complex and, as yet, unsolvable spectrum of pulmonary disease characterized by bizarre infections, pneumothoraces, respiratory distress, and death . Thirty-eight patients underwent 49 surgical procedures during 42 months . Ages of the patients ranged from 24 to 56 years . Surgical procedures included tracheostomy, closure of air leaks, mediastinoscopy, lobectomy, open lung biopsy, and esophagogastrectomy . Hospital mortality was 10 of 38 (24%); the 1 year survival rate was 13 of 38 (34%) . Pulmonary infections included Pneumocystis carinii, cytomegalovirus, Microbacterium avium, toxoplasmosis, candidiasis, and Cryptococcus neoformans . Open lung biopsy and surgical closure of air leaks can be accomplished safely with low morbidity . Tracheostomy and ventilatory support should be avoided at present in the majority of patients with this syndrome, as the mortality has been 100% when that stage of the disease is reached. Arq Neuropsiquiatr, 1986 Dec, 44(4), 351 - 8 {Cerebrospinal fluid signalization in chronic inflammatory diseases of the central nervous system}; Livramento JA et al.; Dynamics of cerebrospinal fluid (CSF) cyto-proteic dual obeys to different models when central nervous system (CNS) inflammatory diseases are considered . In order to evaluate these models data pertinent to multiple sclerosis (20 cases), neurosyphilis (20 cases), neurocysticercosis (20 cases), subacute sclerosing panencephalitis (20 cases), neuroschistosomiasis (18 cases) and neuro-cryptococcosis (20 cases) are compared in report to a control group: chronic vascular headache (50 cases) . CSF data on cytology and proteins were considered . Cytology was evaluated as to the total cell count (cumm); the cytomorphological profile (%) and as to lymphocytes subpopulations (B, T, T-active, T-sensitized, and T-avid for T-total and for T-active) . Proteins were evaluated as to the total content (mg/dl) and protein fractions (agar gel electrophoresis) . Antibodies determinations were studied for comparative purposes and diagnosis . Results were analyzed according to the groups considered and comparatively . Analyses support conclusions on cells and proteins dual interaction . This interaction is expressed by phenomena that obey similar parameters . These parameters permit to consider two models of chronic inflammatory signalization: the continuous model and the repetitive model . Neurosyphilis and subacute sclerosing panencephalitis obey the chronic continuous inflammatory model . Neurocysticercosis and multiple sclerosis obey the repetitive model. J Med Vet Mycol, 1986 Dec, 24(6), 433 - 6 Systemic mycoses in the United States, 1980-1982; Reingold AL et al.; To evaluate temporal trends in the incidence of systemic mycoses resulting in hospitalization, we reviewed hospital discharge data from the Professional Activity Study of the Commission on Professional and Hospital Activities for 1980-1982 . In comparison with results from similar studies in 1970 and 1976, the incidences of the mycoses that are more likely to be opportunistic and/or hospital-acquired infections (candidiasis, aspergillosis, cryptococcosis) increased in 1980-1982 as did the incidences of sporotrichosis and actinomycosis . At the same time the incidences of most community-acquired mycoses (histoplasmosis, coccidioidomycosis, and blastomycosis) remained stable or declined . These results are consistent with the increasing number of immunocompromised patients with severe underlying illnesses, who are at risk of developing opportunistic mycoses. J Infect Dis, 1986 Dec, 154(6), 944 - 51 Inhibition of complement by culture supernatants of Aspergillus fumigatus; Washburn RG et al.; Aspergillus fumigatus produced a water-soluble extracellular material that inhibited the opsonization of fungal cells by normal human serum . Blastospores of Cryptococcus neoformans and conidia from A . fumigatus or Aspergillus niger were used as fungal targets for ingestion by human monocytes . The opsonic inhibitor from A . fumigatus was found to decrease binding of complement component C3b to fungal surfaces by selectively interfering with activation of the alternative complement pathway . Inhibition of complement did not appear to result simply from proteolysis, as judged by the minimal degradation of casein and of purified C3 and C4 . The complement-inhibiting activity was partially labile to heating at 100 C and could be concentrated by using dialysis tubing with a 10,000-dalton exclusion limit . Aspergillus flavus, which is also a pathogen for humans, also produced this activity; A . niger did not . We speculate that this material may represent a pathogenesis factor for Aspergillus species. J Immunol, 1986 Dec 1, 137(11), 3624 - 31 Natural cellular resistance of beige mice against Cryptococcus neoformans; Hidore MR et al.; Previous reports have demonstrated that natural killer (NK) cells are capable of inhibiting the growth of Cryptococcus neoformans in vitro, and recent studies indicate that adoptively transferred NK cell-enriched spleen cell populations enhance clearance of cryptococci from the tissues of cyclophosphamide-pretreated recipients . The primary objective of these studies was to confirm that NK cells participate in early clearance of C . neoformans in vivo . Secondarily, the anti-cryptococcal activities of polymorphonuclear leukocytes and macrophages were examined . Seven-week-old C57BL/6 bg/+ mice, which have normal levels of NK cell activity, were compared with their bg/bg littermates, which have impaired NK cell function . One and 3 days after injecting both groups of mice i.v . with 2 X 10(4) cryptococci, we assessed the NK cell activities in spleens, lungs, and livers and clearance of the organism from corresponding tissues as determined by the mean log10 numbers of cryptococcal colony-forming units (CFU) per organ . Three days postinfection, the mean numbers of cryptococcal CFU in lungs and spleens of bg/+ mice were significantly lower than in the corresponding organs of bg/bg mice . NK cell activities in spleens and lungs of bg/+ mice were significantly higher than were the NK cell activities in similar cell populations from bg/bg mice . In contrast, the mean numbers of cryptococcal CFU in livers of the two groups of animals were nearly equivalent, a situation not unexpected, since liver NK cell activities were extremely low and similar in both groups of animals . Although these data indicated a correlation between early clearance of cryptococci from tissues and levels of NK cell activities in the corresponding tissues, it was also possible that differences in phagocytic cell function between the bg/+ and bg/bg animals could account for the observed differences in clearance of cryptococci from the tissues . Therefore, phagocytic cells from the two groups of animals were compared with respect to their abilities to phagocytize and inhibit the growth of cryptococci and to their abilities to respond to chemotactic stimuli in vivo . Peritoneal PMNL from bg/+ and bg/bg mice were similar in their abilities to phagocytize and inhibit the growth of cryptococci, as well as in their chemotactic responses to viable cryptococci or sodium caseinate . In addition, there were no differences in splenic macrophage functions between the two groups of mice.(ABSTRACT TRUNCATED AT 400 WORDS) Infect Immun, 1986 Dec, 54(3), 742 - 50 Binding of purified and radioiodinated capsular polysaccharides from Cryptococcus neoformans serotype A strains to capsule-free mutants; Small JM et al.; Strains 6, 15, 98, 110, and 145 of Cryptococcus neoformans serotype A vary in capsule size, animal virulence, and susceptibility to in vitro phagocytosis . The isolated capsular polysaccharides (CPSs) differ in monosaccharide composition ratios and molecular size, as determined by gel filtration . The purpose of this investigation was to characterize the binding of CPSs to capsule-free mutants of C . neoformans and to examine CPSs from these strains for differences in their ability to bind, to determine whether such differences might explain the variation in the pathobiology of these strains . CPSs were partially periodate oxidized, tyraminated, iodinated with 125I, and used in binding studies with two capsule-free mutants of C . neoformans, strain 602 and Cap59 . Binding was specific for yeast species and for polysaccharide and was saturable, which is consistent with a receptor-mediated mechanism of attachment . Binding occurred rapidly and was only slowly reversible . Binding was also independent of pH from pH 5.5 to 8, of cation concentrations, and of competition by sugars up to 1.0 M concentrations . Only a portion of CPS was capable of binding, and strains varied in the extent to which their CPS bound . CPS-15-IV (peak IV was the major polysaccharide peak on DEAE-cellulose chromatography of CPS from strain 15) had the highest proportion of binding (40%), followed by CPS from strains 98, 6, 145, 110, and 15-III (peak III was an earlier eluting fraction of CPS from strain 15) . The CPSs differed similarly in their ability to competitively inhibit binding . Treatment of CPS, but not yeast cells, with proteinase XIV abolished binding without altering the CPS gross structure . Treatment of yeast cells with proteases, heat, or formaldehyde did not alter binding, and both strain 602 and Cap59 bound CPS similarly . Binding to encapsulated yeast cells was minimal. Infect Immun, 1986 Dec, 54(3), 735 - 41 Strain variation in composition and molecular size of the capsular polysaccharide of Cryptococcus neoformans serotype A; Small JM et al.; The capsule of Cryptococcus neoformans is an important virulence factor . In this investigation capsular polysaccharides (CPSs) were isolated by ethanol precipitation from culture filtrates of C . neoformans serotype A strains 6, 15, 98, 110, and 145 . Capsule sizes on India ink examination ranged from barely perceptible (strain 15) to greater than the diameter of the yeast cell (strain 6); the others were intermediate in size . On ion-exchange chromatography on DEAE-cellulose each CPS eluted at 0.2 M NaCl; CPS of strain 15 had two major peaks, designated III and IV . On gel-permeation chromatography CPSs of strains 6, 98, 110, and 145 eluted at the void volume of Sepharose CL-2B in the presence or 0.1 M EDTA, while the CPS of strain 15 eluted in two peaks . Sephacryl S-1000 resolved CPSs of all five strains in the following order, from largest to smallest molecular size: 145 greater than 110 greater than 98 greater than 6 much greater than 15 . All five CPSs contained mannose, xylose, and glucuronic acid, while the carboxyl-reduced CPS of strain 110 also contained a large percentage of an inositol-like compound . The CPS of strain 110 contained approximately 30% uronic acid by weight, while the others had 15 to 20% . The composition of peak IV from the CPS of strain 15 resembled those of the other strains; peak III of strain 15 contained a substantial amount of galactose . Each CPS contained less than 0.2% protein by weight . The significant differences in molecular size and sugar composition among CPSs of these strains of C . neoformans serotype A may partially explain strain differences in virulence and biological properties of the organism. Acta Neurol Scand, 1986 Dec, 74(6), 467 - 74 Neurological complications and concomitants of AIDS; Helweg-Larsen S et al.; A survey of the literature of neurological manifestations associated with the acquired immune deficiency syndrome (AIDS) shows a broad disease spectrum affecting approximately one third of the patients in large hospital series . The complications include focal cerebral lesions caused by abscesses, lymphomas, leucoencephalopathy or infarcts as well as encephalitis, meningitis and myelitis . Most opportunistic infections of the central nervous system presumably are caused by toxoplasma gondii, cytomegalovirus and cryptococcus neoformans . One tenth of all patients have neurological disease as their initial symptom of AIDS . The diagnosis should always be considered in patients at risk and in males with an unusual neurological history or with a peculiar CT scan of the brain . Besides the opportunistic complications of AIDS, LAV/HTLV-III itself probably attacks the nervous system and gives rise to concomitant lesions of the long tracts of the spinal cord with ataxia, paresis and spasticity and to subacute encephalopathy and peripheral nerve abnormalities as well. Science, 1986 Nov 21, 234(4779), 955 - 63 AIDS in Africa: an epidemiologic paradigm; Quinn TC et al.; Cases of the acquired immune deficiency syndrome (AIDS) have been reported in countries throughout the world . Initial surveillance studies in Central Africa suggest an annual incidence of AIDS of 550 to 1000 cases per million adults . The male to female ratio of cases is 1:1, with age- and sex-specific rates greater in females less than 30 years of age and greater in males over age 40 . Clinically, AIDS in Africans is often characterized by a diarrhea-wasting syndrome, opportunistic infections, such as tuberculosis, cryptococcosis, and cryptosporidiosis, or disseminated Kaposi's sarcoma . From 1 to 18% of healthy blood donors and pregnant women and as many as 27 to 88% of female prostitutes have antibodies to human immunodeficiency virus (HIV) . The present annual incidence of infection is approximately 0.75% among the general population of Central and East Africa . The disease is transmitted predominantly by heterosexual activity, parenteral exposure to blood transfusions and unsterilized needles, and perinatally from infected mothers to their newborns, and will continue to spread rapidly where economic and cultural factors favor these modes of transmission . Prevention and control of HIV infection through educational programs and blood bank screening should be an immediate public health priority for all African countries. J Neurol, 1986 Nov, 233(6), 362 - 6 Cryptococcal meningoencephalitis: intrathecal immunological response; La Mantia L et al.; The intrathecal immune response is reported in a patient with cryptococcal meningoencephalitis . CSF IgM and IgG levels were significantly related to the favourable clinical evolution . IgM response was specifically directed against the pathological agent, while IgG were mostly non-specific . The data are discussed and compared with the other chronic infections of the central nervous system. Mycopathologia, 1986 Nov, 96(2), 91 - 6 Evaluation of a fluorescent method (fluorescein diacetate and ethidium bromide solution) in the study of the viability Cryptococcus neoformans strains; Correa B et al.; The effectiveness of the fluorescent viability test (fluorescein diacetate-FDA and ethidium bromide-EB-solution) compared to the plaque counting test (Miles & Misra M & M) was performed on 10 samples of Cryptococcus neoformans cultivated in Sabouraud dextrose agar at 25 degrees C . The optimum incubation period of 50 minutes was determined . Growth curves of the fungal strains studied based on the mean cell number were drawn for both the FDA & EB and M & M methods . The statistical evaluation (Student's T test) of the average sum of the viable cell counts showed that the FDA-EB method is more sensitive than the M & M test for the studied species . The growth curves of the samples usually followed a homogeneous pattern comparable to other non-dimorphic fungi. J Clin Microbiol, 1986 Nov, 24(5), 860 - 2 Disseminated cryptococcosis presenting as cellulitis with necrotizing vasculitis; Shrader SK et al.; Patients with disseminated cryptococcosis infrequently present with cutaneous involvement . Skin lesions, when present, are usually multiple and polymorphous in appearance . Cellulitis caused by Cryptococcus neoformans is rare, and necrotizing vasculitis associated with cryptococcal vascular invasion has not to our knowledge been reported . We report here a case of disseminated cryptococcosis in a renal transplant recipient who had cellulitis and necrotizing vasculitis and in whom a diagnostic skin biopsy allowed for early therapy with cure and salvage of the renal allograft. Vardfacket, 1986 Oct 23, 10(19), 28 - 30 {AIDS in Africa}; Neander L et al.; PIP: The main aspects of the acquired immunodeficiency syndrome (AIDS) epidemic in Africa as of mid-1986 are discussed . In certain parts of Africa the disease appears to be widespread and fairly evenly divided between the sexes . Most of the AIDS patients have traveled a great deal and been very active sexually, even while traveling . Prostitutes in such large cities as Nairobi are heavily infected with HIV . Recognized routes of infection are: sexual transmission, blood transfusion, contaminated injection equipment, and mother to child . The pathology of AIDS involves the death of the helper cell type of T-lymphocytes, which increases the patient's susceptibility to infections and tumors . There is some evidence that the HIV epidemic originated in central Africa, possibly as a mutant of the green monkey fever virus, and gradually spread to Europe and the USA . Clinically, AIDS should be suspected with such symptoms as persistent unexplained fever, chronic diarrhea, lymphadenopathy, severe wasting, and itching skin lesions, primarily on the extremities . Definitive symptoms include such opportunistic infections as candida esophagii, cryptococcus, severe varieties of herpes simplex, pneumocystis carinii pneumonii, disseminated strongyloids, cerebral toxoplasmosis and a typical mycobacteria . Serological diagnostic tests include enzyme linked immunosorbent assay (ELISA) and Western blot, both of which require advanced equipment . No treatment for AIDS is known; management should concentrate on preventing opportunistic infection . Arch Dermatol, 1986 Oct, 122(10), 1186 - 90 Disseminated Nocardia brasiliensis infection following cryptococcal disease; Schreiner DT et al.; Nocardiosis is an increasing clinical problem, especially in immunocompromised patients . The offending species is almost always Nocardia asteroides . Cryptococcosis is also an increasing problem in the immunosuppressed . We describe a patient with probable disseminated cryptococcosis followed by disseminated Nocardia brasiliensis infection . Only eight patients with disseminated N brasiliensis infection have been described, to our knowledge, in the United States. Urology, 1986 Oct, 28(4), 318 - 9 Prostatic cryptococcosis in acquired immune deficiency syndrome; Lief M et al.; A rare care is presented of recurrent dysuria and urinary obstruction due to cryptococcal prostatitis in a thirty-six-year-old male with acquired immune deficiency syndrome . Although there are a handful of reports in the world literature of patients with cryptococcal prostatitis, this appears to be the first case reported related to acquired immune deficiency syndrome. Mycopathologia, 1986 Oct, 96(1), 33 - 40 In vivo and in vitro studies with an atypical, rhinotropic isolate of Cryptococcus neoformans; Dixon DM et al.; An atypical isolate of Cryptococcus neoformans was investigated because of its consistent and reproducible production of gross nasal pathology following i.v . injection in Swiss albino mice . Dose response to graded concentrations ranging from 1 X 10(2)-1 X 10(7) cells/mouse yielded an LD50 of 1.4 X 10(3) cells/mouse for the atypical rhinotropic strain H140 which was significantly less virulent (p less than 0.01) than our reference strain of Cryptococcus neoformans . There was no significant difference in mortality following the injection of in vitro vs . in vivo passed inoculum . As early as two weeks after inoculation, this strain produced gross nasal enlargement to approximately 2-3 X normal dimensions with granulomatous and ulcerated lesions . The LD60 resulted in the greatest percentage of nasal involvement (85%) . C . neoformans was demonstrated by culture and histopathology in the noses, brains, lungs, livers and kidneys . A temperature selection was indicated by findings of a lower temperature minimum for subcultures isolated from the noses relative to those isolated from the brain, and by the fact that the most densely populated organs following intraperitoneal injection were the testes . This route of inoculation resulted in cutaneous nasal involvement in a manner analogous to that following i.v . injection . The atypical isolate was unable to assimilate trehalose or raffinose but otherwise was entirely consistent with identification as C . neoformans and produced characteristic CNS and general organ system disease in addition to the rhinotropic cutaneous manifestations . The model characterized here in normal mice may be of value in studies of fungal dermotropism. Mycopathologia, 1986 Oct, 96(1), 25 - 8 Primary cutaneous cryptococcosis; Moreno Castillo JL et al.; A 7-year-old boy, without apparent underlying disease, but with a non-specific failure in his cellular immunity, developed a cutaneous lesion on the left retroauricular area with spontaneous healing . Mycologic study revealed Cryptococcus neoformans, a capsule deficient strain, as the etiologic agent. Radiology, 1986 Oct, 161(1), 87 - 93 Pulmonary manifestations of AIDS: review of 106 episodes; Suster B et al.; We reviewed the clinical records and chest radiographs of all patients admitted to our institution between 1982 and 1984 who had pulmonary disease and who were later proved to have acquired immunodeficiency syndrome (AIDS) (95 patients) . Diffuse parenchymal lung disease was the most common finding . These infiltrates were usually interstitial and caused by Pneumocystis carinii pneumonia or P . carinii combined with cytomegalovirus infection . Focal, multilobar, interstitial infiltrates were also often seen and usually caused by P . carinii or P . carinii and cytomegalovirus infections . Rarely, well-defined, multiple, interstitial nodules less than 10 mm in diameter were the only or predominant characteristic and were seen only in association with Mycobacterium tuberculosis or Cryptococcus neoformans infections or Kaposi sarcoma . Hilar or mediastinal adenopathy occurred in 17 of the 21 patients with M . tuberculosis or C . neoformans infections . In contrast, only 4% of patients with P . carinii infections presented with these findings . We also found that hilar or mediastinal adenopathy was not significantly associated with peripheral adenopathy . Lung cavitation, pleural effusion, or a normal chest radiograph was uncommon. Mikrobiologiia, 1986 Sep-Oct, 55(5), 851 - 4 {Characteristics of free water distribution in the cytoplasm of cryotolerant cells of Cryptococcus laurentii}; Ratner EN et al.; The resistance to freezing-thawing was studied with Cryptococcus laurentii cultivated at a near-zero plus temperatures in a minimal or a rich medium . At the transition into the stationary phase, the resistance of the cells to freezing increased 20 times in the culture grown in the minimal medium and 8 times in the culture grown in the rich medium . Free water localization in the cell cytoplasm was determined by electron microscopy . In yeast cells with the maximal cryotolerance, free water was found mainly between glycogen granules . The authors discuss the role of glycogen as of a possible factor making the cells resistant to low temperatures. Can J Microbiol, 1986 Sep, 32(9), 756 - 8 Ascorbic acid specific utilization by some yeasts; Costamagna L et al.; One hundred and eighty strains of yeasts belonging to 17 genus and 53 species were screened for their ability to grow on ascorbic acid and iso-ascorbic acid as the sole carbon source . Most of the tested strains (157) were unable to grow on either compound . Strains of seven species of the genus Cryptococcus, of two Candida species, of Filobasidiella neoformans, Trichosporon cutaneum, Lipomyces starkeyi, Hansenula capsulata, and one strain of Aureobasidium pullulans were able to grow on ascorbic as well as on iso-ascorbic acid . Conversely, four strains of Aureobasidium pullulans, Candida blankii, and Cryptococcus dimennae could use only ascorbic acid for growth. Mycopathologia, 1986 Sep, 95(3), 183 - 7 Susceptibility of clinical isolates of yeasts to anti-fungal agents; Hussain Qadri SM et al.; The antimicrobial activity of amphotericin B, 5-fluorocytosine, nystatin, clotrimazole and miconazole were compared in vitro against 244 strains of yeasts that had been isolated from clinical specimens . The yeasts used in this study included 20 species of Candida, Cryptococcus, Saccharomyces Geotrichum, Rhodotorula, Torulopsis and Trichosporon . The majority of the strains (78%) had an MIC of less than or equal to 0.5 microgram/ml for amphotericin B, 81% an MIC of less than or equal to 1 microgram/ml for 5-fluorocytosine, 99% less than or equal to 8 micrograms/ml for nystatin, 91%, less than or equal to 8.0 micrograms/ml for clotrimazole and 98% had an MIC of less than or equal to 4.0 for miconazole . Of the anti-fungal agents tested, 5-fluorocytosine and nystatin were found to have the greatest antifungal activity. Clin Exp Immunol, 1986 Sep, 65(3), 639 - 46 Tolerance to cryptococcal polysaccharide in cured cryptococcosis patients: failure of antibody secretion in vitro; Henderson DK et al.; Ten patients cured of cryptococcosis and 14 normal volunteers were immunized with subcutaneous injections of cryptococcal polysaccharide (CPS) . Peripheral mononuclear cells cultured from the volunteers 7 days post-immunization secreted significant amounts of IgM, IgA and IgG antibody to CPS in vitro . In cell cultures obtained 7 days after immunization of patients, nine of 10 had neither IgM nor IgG antibody response to CPS, and eight lacked anti-CPS IgA . Depletion of T lymphocytes from patients' cell cultures did not promote specific antibody secretion to CPS by B cells . The intense, prolonged antigenaemia with CPS that accompanies cryptococcosis may be responsible for the failure of cured patients to have circulating anti-CPS-secreting cells after immunization. Yeast, 1986 Sep, 2(3), 193 - 204 Orthogonal-field-alternation gel electrophoresis banding patterns of DNA from yeasts; de Jonge P et al.; Chromosomal DNAs from various yeast species were separated by orthogonal-field-alternation gel electrophoresis (OFAGE) . To this end we developed a spheroplasting and lysis method to obtain intact DNA from both ascomycetous and basidiomycetous yeasts . The OFAGE banding patterns of 22 ascomycetous and four basidiomycetous yeast strains were compared . The strains represented species from the genera: Brettanomyces, Candida, Cryptococcus, Filobasidiella, Geotrichum, Hansenula, Kluyveromyces, Pachysolen, Pichia, Rhodosporidium, Rhodotorula, Saccharomyces, Saccharomycodes, Saccharomycopsis, Schizosaccharomyces and Zygosaccharomyces . Variations occurred in the number of bands and their positions in the gel, not only among strains of different genera but also among species from the same genus and even between varieties of the same species . The ascomycetous yeasts, with the exception of Saccharomyces cerevisiae, only showed one to five bands of DNA larger than 1000 kilobase pairs (kb) in general none smaller . The patterns of the four basidiomycetous yeasts revealed also a few large DNA bands but in addition one to six bands ranging in size from 500 to 1000 kb, with the exception of a single smaller chromosome in Rhodotorula mucilaginosa . From the OFAGE banding patterns of strains studied here it appears that in Sacch . cerevisiae the partitioning of DNA over chromosomes is unique . But rather than the large number of chromosomes, the presence of four chromosomes with less than 500 kb of DNA is characteristic for Sacch . cerevisiae. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Sep, 262(3), 417 - 24 Modulation of Bhanja virus infection in mice; Hubalek Z; Randombred (ICR) and inbred (C57B1/6) 4-wk-old SPF male mice were infected extraneurally with Bhanja virus (Bunyaviridae) and subjected to various treatments . Immunosuppression with cyclophosphamide (CPA) affected the course of the infection when a higher dose (10(6) suckling mouse intracerebral LD50) of the virus and 2 or 3 injections of CPA (150 mg/kg each) were given: then a part of the animals died due to viral encephalitis, whereas all the CPA-untreated infected mice survived . A dual peripheral infection with Bhanja and Lipovnik (Reoviridae) viruses did not cause any symptomatic response, and the host's humoral antibody was slightly stimulated . When Bhanja virus was given prior to, or simultaneously with, tick-borne encephalitis virus (Flaviviridae), a moderate decrease of the mortality (due to tick-borne encephalitis) occurred . A mixed peripheral infection of mouse with Bhanja virus and Cryptococcus neoformans, did not result in a fatal virus encephalitis of the host, nor was cryptococcosis affected substantially . However, formalin-killed cells of the fungus ("cryptococcin") administered before the extraneural inoculation of Bhanja virus caused an 8-fold increase of antibodies neutralizing the virus; a mild therapeutic or protective effect of cryptococcin on encephalitis after an intracerebral application of Bhanja virus was also observed. Diagn Cytopathol, 1986 Sep, 2(3), 181 - 6 Pulmonary cytology of the acquired immune deficiency syndrome: an analysis of 36 cases; Duggan MA et al.; The infectious pathogens and associated cellular reactions in 75 pulmonary cytological specimens obtained largely by fiberoptic bronchoscopy from 36 patients with the acquired immune deficiency syndrome are described and correlated with the biopsy specimens . An opportunistic pathogen was diagnosed in 33% of cytological preparations . Pneumocystis carinii was encountered most frequently; Cryptococcus neoformans and cytomegalovirus were also seen . The polymorphonuclear neutrophil was the predominant inflammatory cell . Cells of secondary import were bronchial cells and type II pneumocytes with atypia and hyperplasia . Bronchoalveolar lavage had the highest yield, positive predictive value, and sensitivity for all pathogens and for P . carinii . An opportunistic pathogen was diagnosed in 69% of patients utilizing histological material and in 33% using cytological samples; the rate of diagnosis increased to 72% when the samples were combined. Am J Pathol, 1986 Sep, 124(3), 537 - 58 The neuropathology of AIDS . UCLA experience and review; Anders KH et al.; The central nervous system (CNS) has been examined at autopsy in 89 patients who died of the acquired immune deficiency syndrome (AIDS), including 14 patients who died primarily of neurologic complications of the disease . A total of 66 brains (74%) showed significant pathologic abnormalities, with opportunistic infections including cytomegalovirus (14) and cryptococcal (11) infections, progressive multifocal leukoencephalopathy (6), toxoplasmosis (6), and histoplasma microabscesses (1) . Incidental Mycobacterium avium-intracellulare infection was found in 4 cases . Simultaneous CNS infection by more than one microorganism was encountered in 5 patients . Subacute (microglial nodule) encephalitis-related to cytomegalovirus infection or possibly brain infection by the causative agent of AIDS was present in 56 cases . Primary CNS lymphoma was noted in 3 patients . Secondary CNS deposits of lymphoma were found in 1 patient, and another patient had lymphomatoid granulomatosis . Vascular complications were not infrequently seen, and included infarcts secondary to vessel occlusion and disseminated intravascular coagulation in 4 patients and intracranial hemorrhage of variable severity in 13 . White matter changes included vacuolar myelopathy (3 cases), central pontine myelinolysis (1 case), and foci of calcified, necrotizing leukoencephalopathy in pontocerebellar fibers of the basis pontis (2 cases) . These findings highlight the variety of CNS complications in AIDS, some of which are not associated with clinical manifestations . Nevertheless, characterization of all lesions may be important in understanding the neurologic sequelae of AIDS. Eur J Clin Microbiol, 1986 Aug, 5(4), 379 - 88 New developments in the diagnosis of opportunistic fungal infection; Hopwood V et al.; This review considers recent developments in the diagnosis of aspergillosis, candidosis and cryptococcosis and discusses the prospects for routine application of a number of novel methods . The introduction of lysis-centrifugation and radiometric methods for blood culture has improved the diagnosis of deep candidosis, but the value of these methods for the diagnosis of aspergillosis has not yet been determined . Recent developments in serological diagnosis have included the evaluation of newly discovered antigens of Candida albicans in an attempt to distinguish colonization from significant infection . Antigen detection, an established method for the diagnosis of cryptococcosis, has also been evaluated and appears promising for the diagnosis of aspergillosis and candidosis . Another promising approach has been the use of gas-liquid chromatography to detect fungal metabolites in serum and other host fluids. J Clin Microbiol, 1986 Aug, 24(2), 269 - 71 Influence of culture medium on susceptibility testing with BAY n 7133 and ketoconazole; Hoeprich PD et al.; The effect of four culture media (two complex and undefined {Sabouraud glucose and Kimmig} and two synthetic and defined {synthetic amino acid medium, fungal, and modified yeast nitrogen base}) on the activity in vitro of two newer azole compounds (BAY n 7133 and ketoconazole) was assessed with five strains each of Candida albicans, Candida parapsilosis, and Cryptococcus neoformans . Also, the nutritional adequacy of the four media was evaluated with the same 15 strains of yeastlike fungi . While the MICs of BAY n 7133 were higher in the complex media, the activity of ketoconazole was little affected . The Candida spp . grew least well and the C . neoformans grew best in yeast nitrogen base. J Am Vet Med Assoc, 1986 Aug 1, 189(3), 302 - 4 Cryptococcosis involving the eye and central nervous system of a dog; Jergens AE et al.; Cryptococcus neoformans meningoencephalitis was diagnosed as the cause of stupor and generalized seizures in a 2-year-old Cocker Spaniel . Unilateral granulomatous chorioretinitis was observed ophthalmoscopically, and isolation of C neoformans from CSF confirmed the antemortem diagnosis . The dog was euthanatized and necropsied . Multifocal lesions were seen throughout the lungs, nasal turbinates, cerebral cortex, and the optic nerve of each eye . Microscopically, the multifocal lesions were granulomas consisting of lymphocytes, macrophages, plasma cells, and cryptococcal organisms . Infection may have originated in the nasal passages and extended directly through the ethmoid plate into the meninges of the CNS and optic nerves . Although the prognosis is poor in dogs with CNS involvement, various chemotherapeutic agents are available for use by clinicians. Am J Clin Pathol, 1986 Aug, 86(2), 204 - 8 Differentiation of Cryptococcus neoformans serotypes by isoenzyme electrophoresis; Safrin RE et al.; Cryptococcus neoformans has been divided into four serotypes by specific agglutination in immune rabbit sera . Based on mating characteristics of the perfect state and epidemiologic and biochemical differences, the serotypes have been divided into two major pairs . In an attempt to characterize the serotypes further, the authors studied 22 strains of C . neoformans by the technic of horizontal starch-gel isoenzyme electrophoresis . The glucose-phosphate isomerase and phosphoglucomutase of serotypes A, C, D, and a subset of the serotype B strains migrated to distinguishable locations in this system . The activities of the remainder of the serotype B strains co-migrated with the serotype C strains . Thus, this technic distinguishes all the serotypes of C . neoformans except for a subset of serotype B and should be a useful adjunct for further elucidation of the epidemiologic and biochemical differences among serotypes. J Antimicrob Chemother, 1986 Aug, 18(2), 261 - 70 Treatment of cryptococcal meningitis in mice with fluconazole; Palou de Fernandez E et al.; Fluconazole is a recently developed triazole with activity in vitro against Cryptococcus neoformans, water solubility, and excellent oral absorption . We compared fluconazole in murine cryptococcosis with ketoconazole and amphotericin B . Fluconazole was highly effective in suppressing cryptococcosis in mice challenged by the intravenous and intranasal routes, and was comparable with the other two drugs in its protective capacity . However, fluconazole was superior to ketoconazole and comparable with amphotericin B after intracerebral challenge . Fluconazole may warrant clinical evaluation in cryptococcosis. J Immunol, 1986 Jul 15, 137(2), 693 - 701 Macrophage-mediated fungistasis: requirement for a macromolecular component in serum; Granger DL et al.; Peritoneal macrophages from Mycobacterium bovis- or Toxoplasma gondii-infected mice cultured in vitro in Dulbecco's medium containing 10% fetal bovine serum (FBS) and endotoxin stopped replication of Cryptococcus neoformans for 30 hr, whereas yeast cells cultured alone reproduced with a 3.0-hr doubling time . Without at least 5% FBS, macrophage fungistasis was poor . FBS without macrophages enhanced the growth rate of cryptococci . Macrophages preincubated in vitro for 24 hr without serum became fungistatic when challenged with cryptococci in medium with FBS but were not fungistatic without FBS . Macrophages preincubated in medium with FBS were never subsequently fungistatic . Dialyzed, heated (56 degrees C, 30 min), or delipidated FBS supported macrophage fungistasis, whereas FBS heated at 70 degrees C for 30 min did not . FBS contained no measurable opsonic activity for C . neoformans . Inclusion of endotoxin and/or murine IFN-gamma over wide concentration ranges did not substitute for FBS . Ultrafiltration estimation of FBS activity localized to 50 to 150 Kd . By gel filtration chromatography, FBS activity ran in the 25 to 100 Kd range . Dye-ligand affinity chromatography on Cibacron blue agarose gel dissociated the FBS activity from the albumin and lipoprotein fractions . Anion-exchange chromatography on DEAE-Sephacel revealed activity in the first fraction eluting at low ionic strength, pointing to a protein(s) with an isoelectric point toward neutral . Activated macrophages can prevent microbial replication within host tissues; the local environment is critical for fulfillment of this important physiologic function . These results point to a macromolecular factor(s) present in serum that is essential for full fungistatic capability of activated macrophages. Dtsch Med Wochenschr, 1986 Jul 4, 111(27), 1061 - 5 {Disseminated cryptococcosis in 2 AIDS patients . A contribution to cryptococcosis diagnosis in AIDS}; Staib F et al.; In two AIDS patients (homosexual men) microscopical demonstration of Cryptococcus neoformans in samples obtained by puncture of the liver (n = 1) and additionally of the spleen (n = 1) led to the diagnosis of systemic cryptococcosis . Using the India ink method capsulated Cryptococcus neoformans cells could also be detected in cerebrospinal fluid (CSF) and urine . Concomitant culture of the fungus from tracheal secretion, CSF, urine and faeces confirmed the diagnosis of a disseminated infection; the identification and germ count of C . neoformans was achieved by means of the differential-selective medium Guizotia-abyssinica-creatinine agar . The C . neoformans antigen titres in serum and CSF corresponded to the stage of the mycosis as detected by microscopy and culture . After a six-week course of treatment with amphotericin B and flucytosine (Ancotil), the fungus could no longer be isolated from the materials examined in one patient . Mycological monitoring aiming at the detection of C . neoformans in the tracheal secretions by means of the mentioned differential-selective medium is therefore recommended as a prophylactic measure in AIDS patients and persons at risk. Med Trop (Mars), 1986 Jul-Sep, 46(3), 275 - 80 {Therapy of deep mycoses}; Aubry P et al.; In 1985, available drugs to cure deep mycosis are in fact limited to amphotericin B (Fungizone), 5-fluorocytosine (Ancotil) and ketoconazole (Nizoral) . Potassium iodide is not much utilized . In diffuse aspergillosis and meningitic cryptococcosis, Fungizone by I.V . injection remains the high-grade antifungal drug--Ancotil is not actually used anymore in mono-therapy, but associated either with Fungizone in cryptococcosis and diffuse aspergillosis, or with Nizoral in systemic candidosis--Nizoral, which does not diffuse in C.S.F . and has a limited efficiency in immunosuppressive patients, is recommended in systemic candidosis and tropical deep mycosis, particularly histoplasmosis, blastomycosis, entomophtoromycosis, as well as in candidosis and diffuse aspergillosis prophylaxis in people at high risk . New antimycosis drugs are under studies: itraconazole efficient against aspergillus and fluconazole, which diffuses in C.S.F . and has a long time action. Med Trop (Mars), 1986 Jul-Sep, 46(3), 263 - 7 {Deep mycoses rarely described}; Charles D; Beside deep mycoses very well known: histoplasmosis, candidosis, cryptococcosis, there are other mycoses less frequently described . Some of them are endemic in some countries: South American blastomycosis in Brazil, coccidioidomycosis in California; some others are cosmopolitan and may affect everyone: sporotrichosis, or may affect only immunodeficient persons: mucormycosis . They do not spare Africa, we may encounter basidiobolomycosis, rhinophycomycosis, dermatophytosis, sporotrichosis and, more recently reported, rhinosporidiosis . Important therapeutic progresses have been accomplished with amphotericin B and with antifungus imidazole compounds (miconazole and ketoconazole) . Surgical intervention is sometime recommended in chromomycosis and rhinosporidiosis. Med Trop (Mars), 1986 Jul-Sep, 46(3), 257 - 60 {Mycoses in AIDS in the Central African Republic}; Lesbordes JL et al.; Among the 155 cases of A.I.D.S . observed by the authors in Bangui (C.A.R.) from April 1985 to February 1986, 49 patients (31.6%) were carriers of mycosis . 42 candidosis, 5 cryptococcosis, 2 aspergillosis were found; the authors describe the clinical aspects, the localizations and the methods of diagnosis. Med Trop (Mars), 1986 Jul-Sep, 46(3), 249 - 56 {Cryptococcosis in Burundi in 1985 . Report of 30 cases}; Laroche R et al.; Over a period of 23 months, 30 cases of cryptococcosis have been studied in Bujumbura (Burundi) . Through them, epidemiological and clinical aspects have been underlined, and attempts have been made to establish links between cryptococcosis and A.I.D.S., which is significantly frequent in Central Africa . Cryptococcosis strikes young adults (40% between 30 and 35 years of age) . Its high frequency in Bujumbura among patients infested by A.I.D.S., suggest some thoughts . A.I.D.S . in Central Africa, and particularly in Burundi, presents some peculiarities linked to surrounding and possibilities of diagnosis: opportunistic diseases are of different frequency in temperate or tropical climates: pneumocystosis are more frequent in U.S.A . but cryptococcosis and candidosis are more frequent in Africa because their diagnosis is easier . lack of classical risk factors in African populations is known, but other risk factors have to be taken into consideration: tuberculosis, intestinal parasitosis, chronic virus B hepatitis, protein-caloric deficiency. Stroke, 1986 Jul-Aug, 17(4), 753 - 4 Sudden hemiparesis as the presenting sign in cryptococcal meningoencephalitis; Saul RF et al.; A previously healthy young man presented with an acute stroke syndrome and was found to have cryptococcal organisms in the CSF . Though an initial CSF examination for an infectious etiology was negative, a second lumbar puncture was performed because of hypoglycorrhachia, which established the diagnosis . An uneventful recovery followed the administration of Amphotericin B and 5-Flucytosine . A literature search revealed only one previously reported case of cryptococcal meningoencephalitis presenting as a stroke . The need for performing a CSF examination on young patients presenting with a cerebrovascular event, and the aggressive investigation of unexplained hypoglycorrhachia are emphasized. Am J Med, 1986 Jul, 81(1), 24 - 8 Intraventricular therapy of cryptococcal meningitis via a subcutaneous reservoir; Polsky B et al.; Intraventricular administration of amphotericin B for meningitis due to Cryptococcus neoformans is usually reserved for selected, seriously ill patients with recurrent disease . Between September 1973 and November 1983, 10 of 23 patients treated for cryptococcal meningitis at Memorial Sloan-Kettering Cancer Center received intraventricular amphotericin B through subcutaneous reservoirs, in addition to systemic therapy . The value of intraventricular amphotericin B was assessed in the 13 patients treated for first episodes of meningitis with systemic amphotericin B and flucytosine . Death during therapy occurred in one of six patients with intraventricular and systemic therapy compared with six of seven patients with systemic therapy alone (p = 0.025) . The cerebrospinal fluid was sterilized in six of six patients given systemic and intraventricular therapy compared with three of seven given systemic therapy alone (p = 0.049), and the cerebrospinal fluid cryptococcal antigen titer declined in six of six patients given systemic and intraventricular therapy compared with two of seven given systemic therapy alone (p = 0.016) . In the 10 patients who received intraventricular therapy, there were no complications related to reservoir insertion; however, complications related to reservoir use requiring replacement or revision occurred in two patients, and bacterial infection occurred in one but was treated successfully without removal of the reservoir . Although these data are retrospective, they suggest that early therapy with intraventricular amphotericin B in combination with systemic therapy may be beneficial and relatively safe in patients with cryptococcal meningitis and a poor prognosis. Am J Clin Pathol, 1986 Jul, 86(1), 105 - 7 Bacteremia and fungemia in patients with acquired immune deficiency syndrome; Eng RH et al.; Patients with acquired immune deficiency syndrome (AIDS) are known to have identifiable host defense deficiencies, especially deficiencies in cell-mediated immunity . They are at increased risk for developing infections of the bloodstream caused by Cryptococcus neoformans and Salmonella species . However, bacteremias caused by other enteric gram-negative rods and Pseudomonas aeruginosa are found less frequently in patients with AIDS than in patients without AIDS (P less than 0.001 and P less than 0.01, respectively) . The findings of specific organisms in blood is consistent with the known types of host defense deficiencies in these patients. J Allergy Clin Immunol, 1986 Jul, 78(1 Pt 1), 102 - 8 Microbiologic analyses of nasal polyp tissue; Dunnette SL et al.; Nasal polyps from 40 patients were cultured within 2 1/2 hours after surgical removal to determine whether microorganisms were present . The first 20 polyps were cultured for aerobic and anaerobic bacteria, viruses, fungi, mycoplasmas, and mycobacteria . Of these 20 polyps, eight were sterile by all tests, one grew Cryptococcus albidus, one grew Sporobolomyces, one had large numbers of Peptostreptococcus micros and Propionibacterium acnes, greater than 10(6) colony-forming units per gram (cfu/gm), and nine had aerobic bacteria including 10 different species at levels less than 10(5) cfu/gm . The second 20 polyps were cultured for aerobic bacteria only; 11 polyps were positive . Overall, 14 of 26 polyps from patients with asthma and two of 14 polyps from patients without asthma were positive for aerobic bacteria at levels greater than 10(3) cfu/gm (p less than 0.05) . Multiple aerobic bacterial species tended to occur in polyps from patients with asthma (11 of 26) more frequently than in those from patients without asthma (one of 14) (p less than 0.01) . There was a highly significant positive correlation between tissue neutrophilia and bacterial count (r = +0.9; p less than 0.001) . The results indicate that patients with asthma have a significantly higher number and a tendency to a greater variety of aerobic bacteria in nasal polyp tissue than patients without asthma and that the number of infiltrating neutrophils is directly related to the number of bacteria. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Jul, 261(4), 481 - 6 The susceptibility of Cryptococcus neoformans to an antimycotic agent (G2) from alfalfa; Polacheck I et al.; Compound G2, 2-beta-hydroxy-3-beta-O-(beta-D-glucopyranosyl)-delta 12-oleanene-23,28-dionic acid, isolated from alfalfa roots, demonstrated considerable activity against Cryptococcus neoformans (MIC value of 2 micrograms/ml) . Compound G2 exhibited rapid killing of this fungus (MFC value of 4 micrograms/ml) suggesting that it might be a useful active agent in the treatment of cryptococcosis. Am J Med, 1986 Jul, 81(1), 19 - 23 Cryptococcal infections in patients with acquired immune deficiency syndrome; Eng RH et al.; Cryptococcus neoformans is a major pathogen in patients with acquired immune deficiency syndrome and was found to infect 13.3 percent of such patients seen at two medical centers . Serum cryptococcal antigen levels were as high as 1:2,000,000 and, despite therapy, often remained elevated . Antigen titers in the cerebrospinal fluid generally declined at an expected rate in the survivors . The significance of high antigen titers in the blood after a prolonged course of therapy with amphotericin B and 5-flucytosine is unknown. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1986 Jul, 261(4), 471 - 80 The biochemical basis for the distinction between the two Cryptococcus neoformans varieties with CGB medium; Min KH et al.; The biochemical basis for the reaction to canavanine-glycine-bromthymol blue (CGB) agar by Cryptococcus neoformans var . gattii and C . neofo