Hautarzt, 1984 Dec, 35(12), 653 - 5 {Cryptococcosis and torulopsidosis of the skin and lung and epidermodysplasia verruciformis in AIDS (acquired immune deficiency syndrome)}; Grimm I; In a 47-year-old male patient with epidermodysplasia verruciformis, pulmonary cryptococcosis and torulopsidosis of at least 7 years' duration were detected, after mycotic ulcerous cutaneous lesions had appeared . The immunological findings are in accordance with those of AIDS. Am J Med Sci, 1984 Dec, 288(5), 221 - 2 Cryptococcal pneumonia: a fulminant presentation; Henson DJ et al.; A 32-year-old presented with fulminant, bilateral airspace pneumonia due to Cryptococcus neoformans while under cytotoxic therapy for advanced Hodgkin's disease . We alert physicians to this rapidly progressive form of cryptococcosis which has been poorly described previously and which may closely mimic bacterial pneumonia. Int J Dermatol, 1984 Dec, 23(10), 673 - 5 Localized cutaneous cryptococcosis in an immunosuppressed man; Geyer SJ et al.; Isolated cutaneous cryptococcosis developed in a 62-year-old white man with an idiopathic deficiency of T-lymphocytes . The patient was healthy, except for the cutaneous infection, and displayed no other evidence of an immunodeficiency disorder . An immunologic workup should be conducted in all patients with cryptococcal infection, regardless of their apparent health status. Jpn J Clin Oncol, 1984 Dec, 14(4), 601 - 12 Adult T-cell leukemia-lymphoma in the Hokuriku District and presentation of a case in hematological remission after cryptococcus infection; Hirose Y et al.; Ten cases of adult T-cell leukemia-lymphoma (ATL/L) in the Hokuriku district were studied . Five patients were born in endemic areas and later moved to Hokuriku . Five patients were from nonendemic areas, and have not lived in endemic areas . All of the five patients from nonendemic areas had antibody to the adult T-cell leukemia cell-associated antigen (anti-ATLA), and they had anti-ATLA-positive members in their families . Four of the six patients examined had ATL virus (ATLV) proviral DNA in their leukemic cells and type C virus particles were found in the cultured cell line from one of them (case S.D.) . The incidence of anti-ATLA in the control population was 0.93% in Ishikawa Prefecture, 0.39% in Toyama Prefecture and 0% in Fukui Prefecture . The overall positive rate in the controls in Hokuriku was 0.49% . The rate of positive anti-ATLA among family members of seven ATL patients (patients are excluded) was 43.5% (17/39) . The pedigree study of ATL patients very strongly suggested transmission of ATLV between spouses and transmission from mother to children . We also report a case of ATL from an endemic area, who has been in remission without antileukemic therapy for about one year . He is on 5 FC (5-fluorocytosine), Minomycin (minocycline hydrochloride), and Baktar (trimethoprim-sulfamethoxazole) . Possibility that the therapeutic effect of 5 FC on ATL or the remission is due to enhanced cellular immunity after cryptococcus infection is discussed. Acta Pathol Jpn, 1984 Nov, 34(6), 1201 - 8 Disseminated fungal infection . A review of 20 autopsy cases; Abe F et al.; In the study of disseminated fungal infection, in consecutive autopsy cases between 1974 and 1982, we have found this infection in 20 cases (2.55% in all autopsy cases and 16.8% of deep-seated fungal infection) . Candidiasis was present in 11 cases, aspergillosis in 8 cases, and mucormycosis and cryptococcosis in 1 case each . One case showed the disseminated infection by both Candida and Aspergillus . All of the 20 cases had underlying disorders . Hematologic disorders were most frequent and were present in 15 cases . In contrast to the small yellow disseminated foci of candidiasis, the lesion by Aspergillus and Mucor were relatively larger, hemorrhagic, and necrotic . Cryptococcal lesion showed a small gelatinous appearance . All of the fungal lesion were devoid of significant inflammatory reaction . Lymphocytopenia (less than 500/mm3) was present in 13 cases out of 16 cases (not examined in the remaining 4 cases) . Eight cases had long-standing indwelling intravenous catheters, including two cases in which the catheters apparently played an important role in the development of disseminated candidiasis . Ante-mortem diagnosis was established or suspected in only seven cases . Possible means of the prevention of fungal infection is also discussed. J Infect, 1984 Nov, 9(3), 301 - 6 Infection with Cryptococcus neoformans var . gattii leading to a pulmonary cryptococcoma and meningitis; Lehmann PF et al.; A patient who lived in Ohio, U.S.A., developed a large pulmonary cryptococcoma and meningitis as the result of infection with Cryptococcus neoformans var . gattii, an organism of subtropical and tropical distribution . He had no obvious predisposing illness or condition associated with increased susceptibility to cryptococcosis . Although he was found to have cutaneous anergy, his lymphocytes showed significant transformation responses in vitro when cultured both with mitogens and with killed cryptococci . The meningitis responded to intrathecal amphotericin B . The cryptococcoma, however, did not resolve in response to vigorous antifungal therapy during a period of more than 4 months . Eventually, the cryptococcoma was surgically removed . This case is unusual both for the finding of C . neoformans var . gattii outside its apparent endemic area as well as for the clinical features of the disease. Infect Immun, 1984 Nov, 46(2), 552 - 8 In vitro effects of natural killer cells against Paracoccidioides brasiliensis yeast phase; Jimenez BE et al.; Recently, data have been reported suggesting natural killer (NK) cells may function in natural resistance against a fungus, Cryptococcus neoformans . The primary objective of this study was to examine the reactivity of murine splenic cells against another fungus, Paracoccidioides brasiliensis . Levels of NK activity in effector cell pools were varied by: (i) removing nylon wool-adherent cells, (ii) fractionating splenic cells on Percoll discontinuous gradients, (iii) using old and young effector cell donor mice, (iv) using donors from different strains, and (v) pretreating donors with NK-augmenting and -depressing agents . The various effector cell pools were simultaneously used in the 4-h 51Cr release assay with YAC-1 targets to determine the NK reactivity and in the in vitro growth inhibition assay against P . brasiliensis yeast phase targets . In each case, the level of NK reactivity correlated with the ability of the effector cells to inhibit the in vitro growth of P . brasiliensis . NK activity and P . brasiliensis growth-inhibiting ability could be augmented by fractionation of splenic cells through nylon wool or Percoll gradients . The effector cells responsible for the NK activity and P . brasiliensis growth inhibition were characterized as being nylon wool nonadherent, being found in the low-density fractions from Percoll discontinuous gradients, and having no detectable Thy-1 antigen or immunoglobulin but having asialo GM1 on their surface . These data support the contention that NK or NK-like cells are responsible for limiting the in vitro growth of P . brasiliensis. Am J Psychiatry, 1984 Nov, 141(11), 1459 - 60 Meningeal cryptococcosis misdiagnosed as a manic episode; Thienhaus OJ et al.; A 63-year-old man had symptoms and a history suggestive of a manic episode . Meningeal cryptococcosis with normal pressure hydrocephalus was later found to be the underlying cause . Antifungal treatment resulted in sustained improvement of all mental functions. Cardiol Clin, 1984 Nov, 2(4), 671 - 86 Cardiac infections in the immunocompromised host; Atkinson JB et al.; Bacterial infections of the heart in compromised patients are uncommon but may be increasing in relative frequency . They are associated with near-equal frequencies in patients who have pre-existing or simultaneous infections at other sites, patients with neoplasms (usually solid tumors), those who have undergone cardiac surgery, and intravenous drug or ethanol abusers . Staphylococcus aureus is the bacteria most often identified, in contrast to a preponderance of Streptococcus isolated in the pre- and early antibiotic era . Gram-negative bacilli are the causative organisms in a significant number of cases . The endocardium remains the most common site of infection, and left-sided valves are most commonly involved, especially the mitral valve, often in the absence of pre-existing valvular damage . The majority of cases are associated with involvement at other sites, and premortem blood cultures are positive in approximately two thirds of patients who undergo autopsy . Fungal infections involving the heart do not occur as often as bacterial infections . The frequency, however, is increasing . Fungal infections usually occur in patients who have received treatment with antineoplastic agents, antibiotics, or corticosteroids, alone or in combination, or who have had abdominal or cardiac surgery . Candida is the organism found most frequently and usually causes myocarditis or endocarditis, whereas Aspergillus involves the myocardium but may be invasive to the endocardium or pericardium . Other fungi that occasionally infect the heart include Phycomycetes and Cryptococcus . Dissemination is usually present and involves the lungs, kidneys, brain, or gastrointestinal tract . The diagnosis may be difficult prior to death, because blood cultures are positive in only one third of patients who come to autopsy . Precipitin tests and antibody titers for specific organisms may be helpful in providing early diagnosis . Survival rates can be improved by early diagnosis and the institution of aggressive antifungal treatment. Cell Immunol, 1984 Oct 15, 88(2), 489 - 500 Growth inhibition of Cryptococcus neoformans by cloned cultured murine macrophages; Kitz DJ et al.; Cloned and unselected bone marrow-derived macrophage cell lines were obtained from A/J, AKR/J, BIO.A(5R), CBA/J, DBA/2, HPC, NZW, and {NZB X NZW}F1 mice, and their interactions were studied in vitro with a lightly encapsulated natural serotype A isolate of Cryptococcus neoformans . Growth inhibition of C . neoformans was seen with all of the cell lines, as determined by enumeration of colony-forming units . Inhibition was enhanced by a high concentration (8%) of fresh mouse serum and was the same for serum obtained from AKR/J (C5 deficient) and BIO.A (C5 normal) mice . Macrophage incubation with fresh AKR/J serum which had been absorbed with heat-killed Cryptococcus cells also inhibited C . neoformans growth . Heat-inactivation, EDTA addition or anti-C3 antibody treatment of fresh serum abolished the opsonic activity for C . neoformans, while EGTA addition to fresh serum was without effect on opsonization . In addition, neither IgM nor IgG1 murine monoclonal antibodies specific for C . neoformans enhanced phagocytosis or killing of the yeast by macrophages . These findings are consistent with the interpretation that C3b is an important modulator of interactions between macrophages and C . neoformans. South Med J, 1984 Oct, 77(10), 1341 - 2 Hairy cell leukemia: a case of cryptococcosis appearing as hairy cell meningitis; Gualtieri RJ et al.; Hairy cell leukemia has rarely been shown to involve the central nervous system . We have reported a case of hairy cell leukemia with apparent hairy cell meningitis, later found to be cryptococcal meningitis . Spinal fluid abnormalities, including the hairy cell pleocytosis, resolved with treatment of the cryptococcal infection. J Bacteriol, 1984 Oct, 160(1), 408 - 12 Novel inducers of the xylan-degrading enzyme system of Cryptococcus albidus; Biely P et al.; A series of compounds structurally related to xylan and 1,4-beta-xylobiose were tested as inducers of the xylan-degrading enzyme system of Cryptococcus albidus . Washed, glucose-grown cells were incubated with alpha- and beta-linked xylobioses, 4-O-beta-D-xylopyranosyl-L-arabinopyranose, 3-O-beta-D-xylopyranosyl-xylobiose, 6-O-beta-D-xylopyranosyl-cellobiose, cellobiose, and methyl beta-D-xylopyranoside . All alpha-xylobioses and cellobiose were inactive as inducers of the xylan-degrading enzyme system . Other compounds served as inducers of varying efficiency, depending on their concentration in the induction medium and the time of incubation of cells . The most rapid response of the cells, i.e., the shortest induction period of beta-xyloside permease, beta-xylosidase (EC 3.2.1.37), and beta-xylanase (EC 3.2.1.8), was observed with 1,4-beta-xylobiose, which was the most efficient inducer at low concentrations (0.1 to 0.2 mM) . At higher concentrations (2 to 10 mM) and after long incubations, the highest enzyme yields were obtained with 1,2-beta-xylobiose . The results represent a new example of efficient induction of polysaccharide-degrading enzyme systems by positional isomers of dimers derived from the polysaccharide. Microbiologica, 1984 Oct, 7(4), 371 - 4 Virulence, capsule size and lipid composition interrelation of Cryptococcus neoformans; Upreti HB et al.; Virulence and lipid composition were studied in three isolates of Cryptococcus neoformans . Virulence was evaluated by injecting mice intraperitoneally with 10(7) cells and recording organ involvement and spontaneous death over a 25 day period . Though the least virulent strain contained the least amount of total lipid and phospholipids, none of the lipids showed any quantitative relation to virulence . There was no major difference in the phospholipid composition among the three strains . Fungal cells with bigger capsules had a lower lipid content . The role of lipid in the defence mechanism of pathogenic fungi during the host invasion process is discussed. Microbiologica, 1984 Oct, 7(4), 299 - 307 Lipid composition of Cryptococcus neoformans; Rawat DS et al.; The lipid composition of Cryptococcus neoformans grown in Sabouraud's dextrose broth (shake culture) was analysed . The organism contained extremely low amounts of lipid (0.96% dry weight basis) of which 86.1% were nonpolaris lipids, 3.4% phospholipids and the rest were glycolipids and pigments . Alkoxylipids (41%), tryglicerides (18%), diglycerides (7.4%), free fatty acids (5.4%), sterols (4.7%), sterol ester (3.9%) and monoglycerides (2.2%) were found in the nonpolar lipid fraction of C . neoformans . The phospholipid composition (expressed as relative abundance) was: phosphatidylinositol (11.5%), lysophosphatidyl ethanolamine (10.9%), cardiolipin (10.1%), a glycophospholipid (9.5%), lysophosphatidyl choline (4.7%), phosphatidic acid (4.1%), phosphatidyl choline (28.1%), phosphatidyl ethanolamine (14.5%) and an unidentified lipid (6.5%) . Phosphatidyl serine, sphingolipids and cerebrosides, generally found in yeast-like fungi, were absent . Probable reasons for the abnormally low lipid content are discussed. Clin Haematol, 1984 Oct, 13(3), 599 - 630 Fungal infections in the immunocompromised host; Hawkins C et al.; Invasive fungal infections cause significant morbidity and mortality in patients with impaired immune defences . Defects in neutrophil function and neutropenia predispose to disseminated Candida, Aspergillus and Mucoraceae infections while altered T-lymphocyte mononuclear phagocyte function predisposes to infection with C . neoformans, Histoplasma and Coccidioides . Fungal infections in the immunocompromised host are difficult to diagnose and difficult to treat successfully . The diagnosis is often missed or delayed because of the non-specific clinical features, the failure to isolate or difficulty in interpreting the presence of the fungus from routine microbiological cultures, and the limited usefulness of available serological tests . The assay for cryptococcal antigen is the only currently available reliable serological test used to diagnose an invasive fungal infection . Definitive diagnosis is made by histopathological demonstration of the fungus in tissue or a positive culture from a sterile body site . Invasive procedures are often necessary to obtain adequate tissue for histology and culture . The treatment of invasive fungal infection in the immunocompromised host is amphotericin B with or without 5FC . The usual recommended dose is 1.5 to 3 g total amphotericin B over 6 to 12 weeks . The optimal dose and duration of therapy for each infection is not known . Treatment failures and relapses are common in patients who do not achieve remission of their underlying disease . Ketoconazole, a new broad-spectrum oral antifungal medication, does not appear to be effective therapy for invasive fungal infection in the immunocompromised patient based on results of small clinical trials . New diagnostic methods and therapeutic approaches are necessary to improve the outcome of these infections . Areas of current research include serological assays for fungal antigens and metabolites which may allow earlier diagnosis, treatment with combinations of antifungal agents, and the development of new antifungal agents. J Clin Microbiol, 1984 Oct, 20(4), 649 - 52 Update and evaluation of the AutoMicrobic yeast identification system; Land G et al.; The AutoMicrobic system (AMS) Yeast Biochemical Card (Vitek Systems Inc., Hazelwood, Mo.) is a system which has been designed for rapid and automated reporting of yeast identification in the clinical laboratory . Recent improvements have been implemented in the AMS data base to expand and enhance its yeast identification capabilities . These improvements include the addition of seven biotypes, changes in data analysis scheme, and construction of the taxonomic keys . The updated system was compared with the API 20C (Analytab Products, Plainview, N.Y.) yeast identification system and a rapid conventional method, using 1,106 clinical and stock yeast isolates . With these improvements, the AMS Yeast Biochemical Card had a correlation of 98.8% with the API 20C system and 93.4% with the rapid conventional method and significantly increased its capability of identifying Cryptococcus neoformans (98%) . The most difficult organisms for the system to identify in 22 to 24 h were Cryptococcus terreus (58%) and Cryptococcus uniguttulatus (73%) . The updated AMS not only provided more rapid results which were comparable to the other two systems but gave a substantial savings in set-up and reporting time as well. Cutis, 1984 Oct, 34(4), 359 - 61 Cryptococcal cellulitis; Bernhardt MJ et al.; Immunocompromised patients are more susceptible to unusual pathogens . The case of an immunocompromised patient who presented with cellulitis as the only manifestation of disseminated cryptococcosis is reported . The literature on cryptococcal cellulitis is reviewed. J Immunol, 1984 Oct, 133(4), 1920 - 4 Dissociation in the production of B cell-stimulating factors (BCGF and BCDF) and interleukin 2 by T cells from a common variable immunodeficient patient; Saiki O et al.; In the course of an analysis of lymphocyte functions of common variable immunodeficiency patients, we found one patient whose T lymphocytes released B cell differentiation factor (BCDF) and B cell growth factor (BCGF) without IL 2 production upon stimulation with Con A . The patient was a 68-yr-old woman with hypo-gamma-globulinemia (IgM: 31 mg/dl, IgG: 223 mg/dl, IgA: 23 mg/dl); she suffered from cryptococcal meningitis and pulmonary tuberculosis with a negative result of skin tests to PPD and cryptococcal antigen . The number of T cells and the ratio of T cell subsets (Leu-2a and Leu-3a) was normal . T cells showed no proliferative response to Con A and a low response to PHA (one-tenth of normal response) . The addition of patient T cells to normal T cells did not inhibit the proliferation of normal T cells when stimulated by Con A . The culture supernatant of Con A-stimulated T cells contained no IL 2 activity when assayed by an IL 2-dependent T cell line . Expression of Tac antigen was not impaired by Con A stimulation and the addition of partially purified IL 2 from the supernatant of Jurkat T cell line-induced proliferation of Con A-stimulated T cells, indicating that the defect observed was not in IL 2-responding cells but in IL 2-producing cells . In contrast, the culture supernatant of the T cells stimulated by Con A or PHA contained BCDF activity as much as that of normal T cells when assayed by Cowan I-stimulated normal B cells or the B lymphoblastoid cell line SKW6-CL4 . The supernatant also contained BCGF activity . These results suggest that B cell-stimulating factor (BCGF, BCDF) and IL 2 may be synthesized by different subsets of T cells or that the synthesis of those lymphokines are independently regulated in the same cells. Comput Radiol, 1984 Sep-Oct, 8(5), 309 - 17 Granulomatous diseases of the CNS as demonstrated by computerized tomography; Weisberg LA; The CT findings in 32 patients with pathological conditions characterized by granulomatous disorders are reviewed . The characteristic CT finding in caseating granuloma due to tuberculous disease is a nodular enhancing lesion with a central hypodense region . The granulomas representing sarcoidosis show homogeneous enhancing nodular lesions . The granulomas due to cryptococcal fungal disease showed ring pattern with large central hypodense region which represented cyst formation . In certain vasculitides which affected the CNS and had pathological evidence of granuloma formation, CT showed nodular enhancing lesions . Based upon the CT findings, it was not possible to differentiate these nodular enhancing lesions which represented granulomatous disease from other intracranial diseases, i.e . abscesses, neoplasms, multiple sclerosis, gliosis. Am Rev Respir Dis, 1984 Sep, 130(3), 407 - 11 Hypersensitivity pneumonitis induced by Trichosporon cutaneum; Shimazu K et al.; We isolated Trichosporon cutaneum from the houses of patients with hypersensitivity pneumonitis and investigated its possible role as an etiologic agent in 21 cases of the disease . A high titer of anti-T . cutaneum antibody was observed in serum samples from 20 (95.2%) of the 21 patients, but only a low titer was found in less than 9% of the control serum samples . Anti-Cryptococcus neoformans antibody was also observed in the patients' serum samples, but it appeared, in most samples, to be a cross-reaction to T . cutaneum antigen . This was because the anti-C . neoformans antibody was completely absorbed with T . cutaneum, but the anti-T . cutaneum antibody was only partly absorbed with C . neoformans . Besides, no C . neoformans was isolated from the patients' environment . A bronchoprovocation test with T . cutaneum was done on one patient, with a positive result . We also found T . cutaneum in bird droppings containing nutrients for this organism . To our knowledge, this is the first report on hypersensitivity pneumonitis induced by T . cutaneum. Arch Intern Med, 1984 Sep, 144(9), 1877 - 8 Cure of cryptococcemia and preservation of graft function in a renal transplant recipient; Watson AJ et al.; Disseminated cryptococcosis with cryptococcemia occurred in a renal transplant patient in whom immunosuppression was continued throughout antifungal therapy in an effort to ensure graft viability . Despite the initial presence of positive fungal cultures of blood, urine, and CSF, infection cleared rapidly, and there has been no evidence of recurrence . Throughout this period, renal function remained unaltered . This favorable outcome suggests that the prognosis for the renal transplant recipient with disseminated cryptococcosis may be improved. Ann Intern Med, 1984 Sep, 101(3), 334 - 8 Opportunistic infections in endogenous Cushing's syndrome; Graham BS et al.; The cases of 6 patients with endogenous Cushing's syndrome and opportunistic infections were studied, and compared with those of 17 similar patients reported in the literature . Cushing's syndrome was caused by ectopic adrenocorticotrophic hormone production or adrenal tumors in most patients, and hypercortisolism was extreme . Four infectious processes were preponderant: Cryptococcosis, aspergillosis, nocardiosis, or Pneumocystis carinii pneumonia occurred in 21 patients . Signs and symptoms of infection were often masked by the hypercortisolism . Morning plasma cortisol levels correlated with the infection type (rank-order Spearman correlation coefficient = 0.78, p less than 0.01): Levels of less than 70 micrograms/dL or greater than 121 micrograms/dL were associated with cryptococcosis or pneumocystis, respectively, by discriminant analysis . Of the 9 patients who survived their infection, 8 had evidence that cortisol production was reduced to near normal . In contrast, all 14 patients died in whom cortisol production went uncontrolled . In patients with hypercortisolism from endogenous Cushing's syndrome (especially of nonpituitary origin), opportunistic infections should be anticipated and prompt control of cortisol overproduction should be initiated. Rev Infect Dis, 1984 Sep-Oct, 6(5), 619 - 24 Capsular polysaccharides of Cryptococcus neoformans; Bhattacharjee AK et al.; Polysaccharides of Cryptococcus neoformans are considered to have a role in the virulence of this encapsulated fungus . The structure has been determined for the most abundant polysaccharide, a glucuronoxylomannan of varying xylose and ester content . The structural complexity of the capsular material increases from serotype D to A to B to C, but even for the simplest capsule (type D), the immunodeterminants seem to occur only on the side chains . The interactions of some of these groups with antibodies is discussed. J Am Acad Dermatol, 1984 Aug, 11(2 Pt 2), 371 - 4 Cutaneous cryptococcosis without evidence of systemic involvement; Sussman EJ et al.; As many as 15% of cases of systemic infection with Cryptococcus neoformans have cutaneous involvement . The existence of primary cutaneous disease is controversial . We report a patient with cutaneous cryptococcosis without evidence of visceral involvement at the time of diagnosis . She has been followed up for 5 years and remains free of systemic involvement . Cutaneous cryptococcosis does not always signify systemic disease. J Clin Microbiol, 1984 Jul, 20(1), 103 - 8 Immunoenzymatic absorption test for serodiagnosis of paracoccidioidomycosis; Mendes-Giannini MJ et al.; A sensitive enzyme-linked immunosorbent assay is described for paracoccidioidomycosis serodiagnosis, with antigen represented by filtrates from Paracoccidioides brasiliensis cultures . Cross-reactivities were, however, observed with sera from patients with other mycoses such as histoplasmosis, lobomycosis, cryptococcosis, candidiasis, and sporotrichosis . These cross-reactions did not occur when we used as antigen Yarzabal E2 component prepared by affinity fractionation of the culture filtrates . Specific results could also be obtained with the whole filtrate antigen when sera were absorbed with Histoplasma capsulatum yeast and mycelial components . Besides a very high sensitivity (100% of the 69 cases of paracoccidioidomycosis tested), this assay showed no false-positive results for the 206 non-paracoccidioidomycosis sera studied, including those from patients with other mycotic diseases. J Neurosurg, 1984 Jul, 61(1), 9 - 16 Central nervous system mass lesions in the acquired immunodeficiency syndrome (AIDS); Levy RM et al.; The authors present the cases of nine patients with acquired immunodeficiency syndrome (AIDS) and intracerebral mass lesions, who were evaluated at the University of California, San Francisco, between April, 1979, and July, 1983 . Eight patients were confirmed homosexual males, and none was Haitian . Their average age was 38.8 years . Tissue diagnosis was made in all patients from brain biopsy or autopsy material . Three patients initially presented for evaluation of their neurological deficits, while the other six already carried the diagnosis of AIDS at admission . Seven patients presented with multiple intracranial lesions and two had polymicrobial infection . In this series, three patients had Toxoplasma gondii brain abscesses, two had primary lymphoma, two had metastatic Kaposi's sarcoma of the central nervous system (CNS), two had focal cytomegalovirus encephalitis and one each had cryptococcal and Candida albicans brain abscesses . The clinical presentation, radiological evaluation, and serodiagnostic study of these patients were not helpful in establishing the nature of the CNS lesions . Brain biopsy is considered by the authors to be critical for the evaluation and appropriate treatment of mass lesions in patients with AIDS. Pathol Res Pract, 1984 Jul, 178(6), 617 - 34 What's new in mycotic bone and joint diseases? Schwarz J. Deep fungi exhibit different degrees of aggressiveness toward joints and bone, most likely depending on the individual make-up of the respective organism . Immunodepressed patients have a propensity to bone and joint involvement by sporotrichosis, cryptococcosis and candidiasis . African histoplasmosis, blastomycosis and coccidioidomycosis are the main mycoses to produce osteoarthritic complications . Arthralgias as part of primary mycotic infection are seen in histoplasmosis capsulati and in coccidioidomycosis . The recognition of the specific agent by morphologic, cultural and serologic methods changes potentially the prognosis and treatment of patients. Am J Epidemiol, 1984 Jul, 120(1), 123 - 30 Epidemiologic differences between the two varieties of Cryptococcus neoformans; Kwon-Chung KJ et al.; This report of the worldwide distribution of two varieties of Cryptococcus neoformans was drawn from data on 628 clinical isolates and from data on 97 additional isolates from other laboratories . Tests showed that 100% of the cultures from Austria, Belgium, Denmark, France, Germany, Holland, Italy, Switzerland, and Japan belonged to C . neoformans var . neoformans . More than 85% of the isolates from Argentina, Canada, the United Kingdom, and the United States (except southern California) were of C . neoformans var . neoformans, the remainder being of C . neoformans var . gattii . There was an unusually high prevalence (35-100%) of C . neoformans var . gattii in Australia, Brazil, Cambodia, Hawaii, southern California, Mexico, Paraguay, Thailand, Vietnam, Nepal, and countries in central Africa . These findings indicated that C . neoformans var . gattii is prevalent only in tropical and subtropical regions . Seventy per cent of the total isolates studied were of serotype A of C . neoformans var . neoformans . Serotype D (9% of the total) was common in Europe, but was found infrequently in other regions . Among the two serotypes of C . neoformans var . gattii , serotype B was 4.5 times more prevalent than serotype C . The majority (88%) of type C isolates in our collection were from southern California. J Immunol, 1984 Jul, 133(1), 166 - 72 In vitro human lymphocyte responses to Cryptococcus neoformans . Evidence for primary and secondary responses in normals and infected subjects; Miller GP et al.; Cryptococcus neoformans causes meningitis and disseminated infection in healthy individuals, but more commonly in hosts with defective immune responses . To study the role of immune lymphocytes in protection and recovery from this infection, in vitro lymphocyte proliferative responses to whole killed organisms were characterized in normal controls and in patients with cryptococcosis . Several differences were found between these two groups . All normal individuals were found to have significant proliferative responses to cryptococci in vitro; however, patients recovering from infection had accelerated and augmented responses . Patients' T cells, but not control T cells, were found to produce interleukin 2 (IL 2) during initial stimulation in vitro . After in vitro priming, mononuclear cells from normal controls rechallenged with cryptococci in vitro demonstrated accelerated kinetics and IL 2 production similar to that of cells from recovering patients . Proliferative responses in normals required T cells and antigen-presenting cells, and resulted in an increase in the proportion of T8+ and Tac+ cells in the responding population by the ninth day of primary stimulation . An increase in Tac+ cells, but not T8+ cells, was found by the fourth day of secondary stimulation . These results demonstrate in vivo acquisition of T cell responsiveness to the organism in this small group of recovering patients, and in vitro acquisition of T cell recognition of this antigen by normal T cells during primary stimulation . The data suggest that these responses represent in vitro priming to cryptococci and indicate a role for the T8+ lymphocyte subpopulation, both unusual findings for previously described in vitro responses to soluble antigens. Gastroenterology, 1984 Jul, 87(1), 201 - 3 Esophageal cryptococcosis in a patient with the hyperimmunoglobulin E-recurrent infection (Job's) syndrome; Jacobs DH et al.; Patients with the hyperimmunoglobulin E-recurrent infection (Job's) syndrome, which is characterized by an elevated immunoglobulin E level, recurrent staphylococcal infections, and an abnormality of neutrophil chemotaxis, have been reported to have visceral Candida infections in addition to their more frequent pyogenic infections . We report a patient with Job's syndrome who presented with massive hematemesis secondary to esophageal cryptococcosis . A thorough evaluation for an occult neoplasm or extraesophageal cryptococcosis was negative . The patient received a 6-wk course of amphotericin B (970 mg) and 5-fluorocytosine with complete radiographic and endoscopic resolution of the lesion . He is doing well 18 mo after therapy . The patient was not anergic, and his response to T-cell mitogens, helper-to-suppressor T-cell ratio, total number of T cells, and immunoglobulin-producing capability were all normal . This case is unusual in that it is the first documentation of a cryptococcoma of the esophagus and underscores the importance of culturing abnormal specimens for unsuspected pathogens in unusual clinical circumstances. Zentralbl Bakteriol Mikrobiol Hyg {A}, 1984 Jul, 257(2), 213 - 8 High prevalence of Cryptococcus neoformans var . gattii in tropical and subtropical regions; Kwon-Chung KJ et al.; The global distribution of 96 clinical isolates of Cryptococcus neoformans var . gattii among a total of 725 C . neoformans isolates was investigated . While C . neoformans var . gattii was not found among isolates obtained from Europe (excluding the United Kingdom) and Japan; and it was found only infrequently in North America (excluding Southern California), the United Kingdom, New Zealand, and Argentina; the variety was prevalent in regions with tropical to subtropical climates such as South East Asia, Southern California, Brazil, Mid to South Pacific, and the central part of Africa . Among the isolates of C . neoformans var . gattii in our collection, serotype B predominanted (77 of 96), and the serotype C isolates were almost exclusively from North America. Antimicrob Agents Chemother, 1984 Jul, 26(1), 5 - 9 In vitro studies with R 51,211 (itraconazole); Espinel-Ingroff A et al.; The in vitro activity of R 51,211 (itraconazole, accepted generic name; Janssen Pharmaceutica, Beerse, Belgium), a new orally active triazole, was compared with those of two existing orally active azoles, ketoconazole and BAY n 7133, and a topical agent, Ro 14-4767/002 . An agar dilution procedure (Kimmig agar) was performed with 148 isolates of pathogenic fungi . Incubation was at 30 degrees C from 48 h to 7 days . R 51,211 was dissolved in 0.2 N HCl in absolute ethanol, ketoconazole was dissolved in 0.2 N HCl alone, BAY n 7133 was dissolved in absolute ethanol, and Ro 14-4767/002 was dissolved in dimethyl sulfoxide . R 51,211 and Ro 14-4767/002 were the most active drugs against isolates of Histoplasma capsulatum, and R 51,211 showed the greatest activity in vitro against isolates of Blastomyces dermatitidis and Cryptococcus neoformans . Ro 14-4767/002 was the most active drug against 30 isolates of dermatophytes, followed by R 51,211, ketoconazole, and BAY n 7133 . R 51,211 showed the best activity in vitro against 19 isolates of Aspergillus fumigatus and Aspergillus flavus, as well as 19 isolates of dematiaceous fungi . All four drugs had 90% MICs of greater than or equal to 16 micrograms/ml when tested with isolates of zygomycetous fungi. Mycopathologia, 1984 Jun 30, 86(3), 179 - 84 Pulmonary cell response in mice following intranasal instillation with Cryptococcus neoformans; Anderson DM et al.; Cryptococcus neoformans was instilled intranasally into mice which were sacrificed to determine the fate of instilled cryptococci and the pulmonary cellular response . During the first 12 h, instilled cryptococci decreased significantly in numbers and did not disseminate to extrapulmonary sites . There was a transient increase in neutrophils which may have been due to an influx of bacteria which accompanied the process of intranasal instillation. Mycopathologia, 1984 Jun 30, 86(3), 169 - 77 Resistance to challenge and macrophage activity in mice previously vaccinated with formalin-killed Cryptococcus neoformans; Anderson DM et al.; Mice were vaccinated with formalin-killed Cryptococcus neoformans either intranasally, intravenously, or intraperitoneally . Resistance to lethal challenge and in vitro phagocytic activity of alveolar and peritoneal macrophages was studied . Increased resistance to lethal challenge was seen following vaccination by each of the three routes but increased phagocytic activity was seen only in alveolar macrophages from mice vaccinated intranasally. Ann Rheum Dis, 1984 Jun, 43(3), 508 - 10 Cryptococcal arthritis and cellulitis; Bunning RD et al.; A middle-aged man with diabetes mellitus and cardiomyopathy developed both cryptococcal arthritis and cellulitis . Unusual aspects included the benign nature of the joint effusion and lack of contiguous osteomyelitis. Mycopathologia, 1984 May 30, 86(2), 113 - 20 Studies on relationship between cysts and granulomas in murine cryptococcosis; Watabe T et al.; The histopathology of murine cryptococcosis was observed until the 55th day and particular attention was paid to whether or not cysts, which had been formed in the brain, could change to granulomas . Cryptococcus neoformans RIB-12M was used in this experiment . As experimental animals, five-week-old male BALB/c mice, weighing 20-22 g, were used . An infective inoculum was prepared by adjusting the number of cryptococci to 10(6) or 5 X 10(6)/0.2 ml . Each mouse was inoculated intravenously with 0.2 ml of the cell suspension, and the colony forming unit of the brain and liver, and the histopathological findings in various visceral organs were investigated . 40 X 10(4) colonies grew from 100 mg of the brain tissue of the eighth day . Thereafter, the number increased gradually . It reached 500 X 10(4) on the 20th day . The colony forming unit from the liver reached a peak on the 12th day (250 X 10(4} and thereafter the number decreased gradually . Histopathologically, the brain and liver were severely affected with the fungus . In the brain cysts with cryptococci continued to increase until the end of the experiment . On the other hand, in the liver several purulent foci appeared on the second day . On the eighth day numerous mononuclear cells accumulated at the foci and their lesions changed to granulomatous ones with cryptococci . The number of granulomatous lesions reached a peak on the 16th day in the mice inoculated with 5 X 10(6) cryptococci, and thereafter showed a tendency to decrease gradually. Int J Dermatol, 1984 May, 23(4), 273 - 4 Dermatomycoses in Indonesia; Harahap M et al.; A review of mycologic surveys and case reports indicates the unique occurrence of deep and superficial fungus infections of the skin as encountered in Indonesia, confirming that each country has its own pathogenic mycologic flora . Such diseases as phycomycosis, histoplasmosis, mycetoma, chromomycosis, cryptococcosis, and dermatophytosis are common. AJR Am J Roentgenol, 1984 May, 142(5), 893 - 6 Thoracic cryptococcosis: immunologic competence and radiologic appearance; Khoury MB et al.; Cryptococcosis, a potentially fatal pulmonary infection, is being recognized with increased frequency in both immunologically compromised patients and those without obvious predisposing factors . This review of 24 cases of proven pulmonary cryptococcosis includes 15 immunologically compromised patients and nine noncompromised hosts . The noncompromised hosts tended to have a radiographic pattern of a peripheral nodule or nodules . The compromised hosts demonstrated a wider variety of radiographic abnormalities including single nodules, multiple nodules that progressed to confluence and/or cavitation, segmental consolidation, bilateral bronchopneumonia, or mixed patterns . Adenopathy, cavitation, and pleural effusions were limited to the compromised hosts. No Shinkei Geka, 1984 May, 12(6), 725 - 9 {A case of cerebral cryptococcosis, with special reference to computerized tomography findings}; Yamagami T et al.; A case of cryptococcosis simulating brain tumor was reviewed . A 66-year-old female was admitted to our hospital with chief complaint of vertigo, gait disturbance and dysarthria . These symptoms started about one year before admission and worsened . Vomiting and urinary incontinence appeared . Neurological examination revealed left cerebellar ataxia and dysarthria . In plain CT (computerized tomography) irregular ill-defined low density area was noted in the cerebellar vermis and bilateral cerebellar hemispheres . And slight ventricular dilatation was found . Irregular shape of ring-like enhancement corresponding to capsule and patchy or mottled enhancement inside the tumor were seen . Suboccipital craniectomy was performed and yellowish necrotic tumor with hard capsule was removed . Histological diagnosis was not neoplasm or tuberculoma . Postoperatively liver function progressively worsened . She died due to disseminated intravascular coagulation . Autopsy revealed typical liver cirrhosis without malignant change . 3.0 X 2.5 cm sized, slightly hard, yellowish lesion was found on upper part of cerebellar hemispheres . This had extremely necrotic tissue and a great number of cryptococcus neoformans were found . And other intracranial lesion was not confirmed . Finding of pulmonary cryptococcosis was not gained . Our case is very rare because of solitary cerebellar abscess and absence of meningitic episode or pulmonary cryptococcosis . There are three types of inflammation in cerebral cryptococcosis . The commonest manifestation is the meningitic type, the second mode is granulomatous lesion and the third and the least presentation is intracranial abscess formation . CT reveals various findings according to clinical stage . CT findings are those of meningitis, meningoencephalitis, granuloma and abscess . Cryptococcal granuloma or abscess often simulates brain abscess, glioma and metastatic brain tumor.(ABSTRACT TRUNCATED AT 250 WORDS) J Antimicrob Chemother, 1984 May, 13(5), 447 - 63 Antimycotic activity of BAY N 7133 in animal experiments; Plempel M; The triazole derivative BAY N 7133 has been tested for its antimycotic efficacy on oral administration in vivo and compared with ketoconazole in mice infected with Candida albicans, Aspergillus fumigatus and Cryptococcus neoformans and in guinea pig trichophytosis . On starting administration at the same time as infection and using daily doses between 25 and 100 mg/kg, the agent protected the mice in all experimental models, even mouse aspergillosis for which ketoconazole was not adequately effective . BAY N 7133 was also effective for mouse candidosis by parenteral administration and was effective for guinea pig trichophytosis on topical application. Medicine (Baltimore), 1984 May, 63(3), 155 - 64 Opportunistic infection complicating acquired immune deficiency syndrome . Clinical features of 25 cases; Lerner CW et al.; Twenty-five cases of acquired immune deficiency syndrome (AIDS) complicated by opportunistic infections were diagnosed at Lenox Hill Hospital during an 18 month period and followed for at least 1 year or until the patients' deaths . Twenty-three patients were homosexual men, including 1 i.v . drug user, and 2 were heterosexual i.v . drug users, including the sole woman . Seventy infections were diagnosed . The commonest etiologic agents included Candida albicans, Pneumocystis carinii, cytomegalovirus, and Mycobacterium avium-intracellulare . Less frequent pathogens included Cryptococcus neoformans, Toxoplasma gondii, Cryptosporidium, JC virus, Mycobacterium xenopi, and Mycobacterium tuberculosis . Seven men also had Kaposi's sarcoma . Prodromal symptoms lasted up to 8 months before the diagnosis of AIDS . Immunologic and serologic evaluation demonstrated lymphopenia, polyclonal hypergammaglobulinemia, cutaneous anergy, reversal of the T-cell helper/suppressor ratio, and serologic evidence of previous exposure to CMV, EBV, and HBV . Pneumocystis pneumonia was diagnosed during life in 17 patients, by transbronchial biopsy and bronchoscopic washings, and all 17 cases were successfully treated . However, pneumocystis was more refractory to treatment than previously described and required an average of 29 days of antimicrobial therapy . Disseminated infections with atypical mycobacteria and cytomegalovirus were the leading causes of death . Bone marrow aspirates and biopsies often revealed a cellular abnormality (82%) but only occasionally yielded an infectious diagnosis (32%) . However, bone marrow examinations were the major means of detecting atypical mycobacteriosis . Colonoscopic biopsies were most useful for establishing the presence of cytomegalovirus colitis . Transbronchial biopsies and bronchial washings gave a high yield of opportunistic pathogens including 34 infectious diagnoses confirmed by 31 procedures . Multiple site biopsies and close communication between the clinician and the pathologist were needed for early diagnosis of opportunistic infections . Twenty-two patients (88%) died, and the few survivors remain debilitated. Mycopathologia, 1984 Apr 30, 86(1), 45 - 50 In vitro antifungal activities of Bay n 7133 and Bay L 9139, two new orally absorbed antifungal imidazole derivatives, against pathogenic yeasts; Fromtling RA et al.; Bay n 7133 and Bay L 9139 (Bayer AG, Wuppertal, Fed . Rep . Germany) are new, orally absorbable, antifungal imidazole derivatives . In vitro, Bay n 7133 was comparable to ketoconazole and miconazole when tested against isolates of Candida albicans and Cryptococcus neoformans . Bay L 9139 also was active against these organisms but to a lesser degree than the other imidazoles . LY 121019, an analog of echinocandin B, was also tested . It proved to be the most active antimycotic against C . albicans but the least active against C . neoformans . Optimal results were obtained in tests employing Kimmig's agar, a medium previously described for use in susceptibility tests with antifungal agents. Mycopathologia, 1984 Apr 30, 86(1), 35 - 43 Non-specific immunosuppression by Cryptococcus neoformans infection; Blackstock R et al.; Cryptococcus neoformans-infected animals were found to be immunosuppressed when tested by a variety of assays for immune competence . Primary humoral immune responses and delayed-type hypersensitivity reactions to sheep erythrocytes were suppressed in animals which had been infected for two weeks . Lymphocyte proliferation (LP) assays to sRBC stroma were also significantly diminished at two weeks of infection . Spleen cells of infected mice suppressed the LP response of sRBC immunized, normal mice in vitro . At least a part of the suppression could be attributed to a nylon wool non-adherent cell . Suppressor cells continued to be present in spleen cell suspensions following treatment with anti-T cell serum or anti-immunoglobulin and complement . When infected spleen cells were separated by adherence to plastic, both the adherent and non-adherent fractions exhibited suppressive activity . Incubation of infected spleen cells in tissue culture for 48 hr resulted in the elaboration of soluble immunosuppressive factors into the tissue culture medium . These data indicated that immune suppression in cryptococcosis can occur as a result of infection with Cryptococcus neoformans, and that at least one mechanism involved is the induction of adherent and non-adherent suppressor cells in the spleens of infected mice. Clin Nephrol, 1984 Apr, 21(4), 197 - 204 Renal disease in patients with AIDS: a clinicopathologic study; Gardenswartz MH et al.; To determine the nature and frequency of renal disorders in AIDS we reviewed the records of thirty-two patients hospitalized over a twenty-two month period . Group I, including all patients with AIDS who demonstrated proteinuria and/or renal insufficiency, numbered thirteen patients, in ten of whom renal tissue was available . Renal abnormalities included proteinuria in twelve patients, which exceeded two grams per day in seven . The glomerular histologic lesions included focal glomerulosclerosis, diffuse mesangial hypercellularity, diffuse proliferative glomerulonephritis, and membranoproliferative glomerulonephritis . The nonglomerular histologic lesions included acute tubular necrosis, nephrocalcinosis, focal interstitial nephritis, and one case each of intrarenal cryptococcal infection and renal cell carcinoma . Nine of these thirteen patients developed renal insufficiency, and four of them required dialysis . Their mortality by the end of the study period was eleven of thirteen patients (85 percent), significantly worse in the short term than AIDS patients without renal problems . The patients in Group I were compared to the nineteen AIDS patients without renal abnormalities in Group II . The Group I patients had a higher incidence of oral and esophageal candidiasis, other fungal infections, and infections with Mycobacterium avium-intracellulare . They also had a higher incidence of exposure to aminoglycoside antibiotics and amphotericin B, and experienced more clinical shock than their Group II counterparts . It is concluded that patients with AIDS may demonstrate renal abnormalities on the basis of immune, hemodynamic, infectious, and neoplastic derangements. Chemioterapia, 1984 Apr, 3(2), 119 - 25 In vitro and in vivo antifungal activity of the combination methylpartricin-5-fluorocytosine; Strippoli V et al.; In vitro studies on the antifungal activity exerted by the combinations SPA-S-222 (a hydrosoluble derivative of the polyene antibiotic methylpartricin) and 5-fluorocytosine evidence a favourable interaction against the formation of germ-tube in Candida albicans; against Cryptococcus neoformans and 5FC induced-resistant strains of Candida albicans . In the experimental infections with Candida albicans and Cryptococcus neoformans a significantly favourable interaction was exerted by polyene-5FC combinations. J Infect Dis, 1984 Apr, 149(4), 584 - 90 Combination of oral flucytosine and ketoconazole as therapy for experimental cryptococcal meningitis; Craven PC et al.; Current therapy for cryptococcal meningitis often is ineffective, toxic, and inconvenient . Ketoconazole has been shown to penetrate into brain tissue of mice and cerebrospinal fluid of humans and to improve the course of human coccidioidal meningitis . Ketoconazole, flucytosine, and amphotericin B, alone and in two-drug combinations, were used to treat cryptococcal meningitis in mice injected intracranially with Cryptococcus neoformans . Mortality was assessed, and numbers of cryptococci in brain and liver were counted . By both of these parameters, the combination of flucytosine and ketoconazole produced results superior to those of either agent used alone . The standard combination of amphotericin B and flucytosine also showed an additive effect in this model . However, the combination of amphotericin B and ketoconazole consistently showed no additive effect . None of the combinations of drugs was antagonistic . Our results indicate a possible role for therapy with a combination of oral flucytosine and ketoconazole as part of the treatment for cryptococcal meningitis. Mycopathologia, 1984 Mar 15, 85(1-2), 3 - 7 Cryptococcus neoformans: in vivo protection of mice by pretreatment with pyran copolymer; Fromtling RA et al.; Synthetic polyanions have been shown to alter host resistance to infection . The anticryptococcal effect of pyran copolymer was assessed in vivo and in vitro . Pretreatment with pyran copolymer significantly extended mean survival in mice lethally infected with Cryptococcus neoformans when compared to untreated animals (p less than 0.01) . The anticryptococcal effect of peritoneal exudate cells (PEC) elicited by 10% thioglycollate or pyran copolymer (25 mg/kg) was assessed in vitro . Initial percent phagocytosis of both encapsulated and non-encapsulated isolates of C . neoformans was greatest in the pyran elicited PEC . Significant killing of C . neoformans in vitro was observed only in pyran-activated PEC cultures combined with non-encapsulated cells of C . neoformans, although pyran PEC did inhibit initial growth of phagocytized encapsulated yeast cells . The protection of pyran copolymer pretreated mice from infection with C . neoformans, but the absence of significant killing of encapsulated yeast in vitro suggest a complex mechanism of host defense which may involve an activation of the reticuloendothelial system by pyran copolymer. Antimicrob Agents Chemother, 1984 Mar, 25(3), 339 - 41 In vitro activities of two new antifungal azoles; Hoeprich PD et al.; The antifungal activities of equimolar quantities of three azole compounds, Bay n 7133 {1-(4-chlorophenoxy)-3,3-dimethyl-2-(1,2,4-triazole-1-yl)methylbutan-2-O1}, Bay 1 19139 {1-(4-chlorophenoxy)-1-(1-imidazolyl)-3,3-dimethyl-2-butanol hydrochloride}, and ketoconazole, were compared by testing the susceptibility in vitro of 10 clinical isolates each of Candida albicans, Candida parapsilosis, Torulopsis glabrata, Cryptococcus neoformans, Aspergillus fumigatus, Aspergillus niger, Aspergillus flavus, Rhizopus spp., Mucor spp., and Coccidioides immitis . Molecule for molecule, ketoconazole was consistently the most active drug . All three azoles were primarily fungistatic, although they were fungicidal at clinically relevant concentrations against some strains of A . niger. J Infect, 1984 Mar, 8(2), 168 - 9 Benign cryptococcaemia; Cohen J; The most familiar clinical presentation of cryptococcal disease is subacute lymphocytic meningitis, generally in immunocompromised patients . Isolation of Cryptococcus neoformans from the bloodstream has been regarded as a grave prognostic sign, but we have recently seen a patient with cryptococcaemia which had an unusually benign course. Am J Med, 1984 Mar, 76(3), 458 - 63 Opportunistic fungal infections in patients with neoplastic disease; Gold JW; Opportunistic infections with yeast and molds are increasingly common in patients with neoplastic diseases . Candida species, Aspergillus species, Phycomyces, and Cryptococcus neoformans remain most common, but other organisms are being encountered as pathogens . With the exception of Cryptococcus, most opportunistic fungal infections are difficult to diagnose . New diagnostic tests for these diseases are being evaluated . Amphotericin B remains the antifungal agent of choice . In certain patients, the addition of 5-fluorocytosine may improve the outcome . Experience with cryptococcosis in severely immunocompromised cancer patients at Memorial Sloan-Kettering Cancer Center suggests that those who are treated with amphotericin B intravenously and intraventricularly via an Ommaya reservoir along with 5-fluorocytosine do better than those treated with amphotericin B alone. Medicine (Baltimore), 1984 Mar, 63(2), 108 - 32 Fungal and yeast infections of the central nervous system . A clinical review; Salaki JS et al.; In the past 20 years, there has been a marked increase in the number of reported cases of meningitis and brain abscess due to fungi and yeasts . This increase is due in part to better diagnostic techniques and greater awareness of the possibility of fungal invasion of the nervous system; but the increase can also be attributed to a growing pool of severely compromised hosts, many of whom are undergoing treatment with adrenal glucocorticoids or immunosuppressive agents . The diagnosis and treatment of aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, infections caused by dematiaceous fungi, histoplasmosis, paracoccidioidomycosis, petriellidosis, and sporotrichosis, as well as relatively rare infections of the central nervous system caused by other fungi, are discussed . The efficacy of amphotericin B and 5-fluorocytosine in the treatment of CNS fungal and yeast infections is also evaluated. Infect Immun, 1984 Mar, 43(3), 879 - 86 Binding of cryptococcal polysaccharide to Cryptococcus neoformans; Kozel TR et al.; Radioiodinated cryptococcal polysaccharide was used to study binding of the soluble polysaccharide to encapsulated and non-encapsulated cryptoccoci . Binding of polysaccharide to non-encapsulated cryptococci occurred rapidly over a 30-min period and was largely complete after 2 h . Bound, labeled polysaccharide was slowly eluted from Cryptococcus neoformans after the addition of unlabeled polysaccharide, indicating reversibility of binding . Non-encapsulated cryptococci bound polysaccharide in two ways . Specific binding to the yeast was saturable by ca . 82 ng of polysaccharide per 10(6) yeast cells . Nonspecific binding also occurred which was not saturable under the conditions used in our experiments . Phagocytosis of the non-encapsulated yeast strain was inhibited when the specific binding was ca . 50% saturated . Binding of polysaccharide to an encapsulated strain showed nonspecific, nonsaturable binding, but little specific binding occurred . Presumably the specific binding sites were saturated in the encapsulated strain . Polysaccharides obtained from a hypocapsular mutant (A61) and a normally encapsulated strain competed effectively with labeled serotype D polysaccharide for binding sites on non-encapsulated cryptococci and had identical phagocytosis-inhibiting properties . Similarly, polysaccharides from all four cryptococcal serotypes competed effectively with labeled serotype D polysaccharide for binding sites on the non-encapsulated strain, and all four polysaccharides inhibited phagocytosis of non-encapsulated Cryptococcus neoformans . Unmodified, de-O-acetylated, carboxyl-reduced, periodate-oxidized and reduced (polyalcohol), and Smith-degraded polysaccharides competed with labeled polysaccharide for binding sites on the cell . The unmodified, de-O-acetylated and carboxyl-reduced polysaccharides inhibited phagocytosis of non-encapsulated cells, but the polyalcohol and Smith product were unable to inhibit phagocytosis. J Leukoc Biol, 1984 Mar, 35(3), 329 - 41 Immunotoxic effects of diethylstilbestrol on host resistance: comparison with cyclophosphamide; Morahan PS et al.; To evaluate the usefulness of host resistance assays for measurement of immunotoxicologic effects of chemicals, the immunosuppressive effects of exposure to diethylstilbestrol (DES) were compared with the effects of treatment with the known immunosuppressive drug cyclophosphamide (CPS) . A panel of six host resistance models was evaluated, including infection with the bacterium Listeria monocytogenes, herpes simplex virus type 2 (HSV-2), and encephalomyocarditis virus (EMC), the yeast Cryptococcus neoformans, the parasite Naegleria fowleri, and transplantation of the B16F10 melanoma tumor . The results demonstrate a general correlation between the effects of CPS and DES on host resistance . Acute treatment with CPS (200 mg/kg) markedly depressed resistance to the microbial infections with L . monocytogenes and HSV, and exposure to DES usually also decreased resistance in a dose dependent manner . Moreover, CPS had no marked effect on resistance to N . fowleri and EMC virus, and exposure to DES also had a neglible or slight effect . There were, however, two model systems in which the effects of CPS and DES diverged . Whereas treatment with DES produced no significant effect on resistance to C . neoformans, acute treatment with CPS prior to the fungal infection produced a marked increase in resistance . Also, while treatment with CPS markedly increased B16F10 lung metastases, treatment with DES significantly decreased the incidence and number of lung metastases . The data support the general validity of host resistance assays, particularly with models of short disease course, for measuring immunosuppression . However, the results also emphasize the complexity of interpreting effects of environmental chemicals on host resistance, because of the interplay of such factors as relative times of exposure to the chemical in relation to pathogenesis of infection, the length of the disease course, the nature of the operative host defense mechanisms, and the compensatory recovery of these mechanisms. J Clin Pathol, 1984 Mar, 37(3), 332 - 4 Comparison of the sensitivity of three methods for the rapid identification of Cryptococcus neoformans; Cohen J; The sensitivity of three methods for the rapid identification of Cryptococcus neoformans was compared . These were: direct microscopy of india ink preparations, acridine orange staining followed by fluorescence microscopy and detection of cryptococcal capsular polysaccharide antigen by latex agglutination . The overall limit of detection was 3.5 +/- 5.4 X 10(3) CFU/ml (mean +/- SD, n = 27) . When different strains were studied, no single method was consistently superior . False positive results were rare (two of 162 observations, 1.2%) but there were eight false negatives (4.9%), five of which were with acridine orange . Tests such as these are an invaluable aid in the rapid diagnosis of cryptococcal meningitis but they cannot be relied upon to detect low grade infections. Boll Soc Ital Biol Sper, 1984 Feb 28, 60(2), 355 - 61 {Experimental pathogenicity of Cryptococcus cereanus in mice}; Tuttobello L et al.; Pathogenicity studies in mice with Cryptococcus cereanus . Cr.cereanus, a yeast which showing a characteristic ability to grow above 40 degrees C, was found to induce pathogenicity when i.p . inoculated into mice after 6-7 repeated inoculations . Infected mice were sacrificed after 4, 8, 24 h and 3, 7, 14, 21 days following i.v . inoculation (5 X 10(7) cells); and microbiological, histopathological and blood-clinical tests were performed . The time course of C.F.U . in kidneys and brains (Fig.1) the yeasts colonization in heart and kidney tissues (Fig.5-3) and the characteristic "soap's balls" in brains (Fig.4) were confirmed by the modified serum levels of CPK, LDH, GOT, urea and creatinine . For the first time experimental pathogenicity of Cr . cereanus has been demonstrated. N Engl J Med, 1984 Feb 23, 310(8), 492 - 7 Acquired immunodeficiency syndrome in African patients; Clumeck N et al.; Between May 1979 and April 1983, 18 previously healthy African patients were hospitalized in Belgium with opportunistic infections (cryptococcosis, Pneumocystis carinii pneumonia, central-nervous-system toxoplasmosis, progressive cutaneous herpes simplex virus infection, disseminated cytomegalovirus infection, candidiasis, or cryptosporidiosis) or Kaposi's sarcoma, or with both . Ten of them died . During the same period five other patients were hospitalized with an illness consistent with a prodrome of the acquired immunodeficiency syndrome (chronic lymphadenopathy, fever, weight loss, and diarrhea) . All patients tested had a marked decrease in helper T cells; an inversion of the normal ratio of helper to suppressor T cells, and a decreased or absent blastogenic response of lymphocytes to mitogens . Twenty patients had anergy . There was no evidence of an underlying immunosuppressive disease and no history of blood-product transfusion, homosexuality, or intravenous-drug abuse . This syndrome in patients originating in Central Africa is similar to the acquired immunodeficiency syndrome reported in American patients. Mycopathologia, 1984 Feb 15, 84(2-3), 81 - 5 Strain differentiation of pathogenic yeasts by the killer system; Morace G et al.; High sensitivity rates to the activity of killer toxins produced by 25 species of yeasts belonging to the genera Candida, Hansenula, Pichia, Rhodotorula, Saccharomyces and Trichosporon have been observed among 112 yeast isolates (25 Cryptococcus neoformans, 29 C . glabrata 16 C . parapsilosis, 20 C . pseudotropicalis and 22 C . tropicalis) . The highest sensitivity has been observed among the C . parapsilosis isolates, the lowest in C . glabrata strains . Genera Pichia and Hansenula proved to have the greatest killer activity . A killer system, formerly used for differentiating C . albicans isolates within the species, proved to be valid as epidemiological marker when applied to 112 strains of pathogenic yeasts. Mycopathologia, 1984 Feb 15, 84(2-3), 121 - 31 Biochemical variation of Cryptococcus neoformans; Schmeding KA et al.; Ninety-seven strains of Cryptococcus neoformans and C . bacillisporus were examined for 44 biochemical characters and the results were analyzed numerically . One phenon emerged at the 86% level of similarity when strains were clustered according to their M-similarity values . All strains grew in ten carbon sources (D-glucose, D-galactose, arbutin, maltose, sucrose, D-melezitose, D-xylose, D-mannitol, D-glucitol, and meso-inositol), and also grew at 37 degrees C and produced urease and phenoloxidase . None of them grew in melibiose, lactose, nor valine, and none reduced nitrate to nitrite . Comparison of selected biochemical characters, creatinine utilization, and serotypes of 49 aberrant strains is presented . Forty-eight of the 97 strains produced the Filobasidiella state either alone or when paired with a strain of compatible mating-type . Filobasidiella neoformans serotypes A and D were interfertile with compatible mating-types of F . bacillispora serotypes B and C . The 44 biochemical characters and 4 serotypes did not predict barriers to mating competence . The present study further substantiates that Filobasidiella neoformans and F . bacillispora are one species. J Am Acad Dermatol, 1984 Feb, 10(2 Pt 2), 387 - 90 Disseminated cryptococcosis presenting as herpetiform lesions in a homosexual man with acquired immunodeficiency syndrome; Borton LK et al.; A 31-year-old homosexual man with acquired immunodeficiency syndrome (AIDS) had cutaneous herpetiform lesions that showed numerous encapsulated organisms on Tzanck preparation . Subsequent cultures of cerebrospinal fluid and skin biopsy specimens substantiated a diagnosis of disseminated cryptococcosis . Cutaneous cryptococcosis should be considered in the differential diagnosis for skin lesions in the population with AIDS. Arch Neurol, 1984 Feb, 41(2), 216 - 7 Dementia and myoclonus in a case of cryptococcal encephalitis; Steiner I et al.; Dementia and generalized myoclonic jerks were the only neurologic features in a patient with cryptococcal encephalitis . Despite the presence of numerous budding yeasts identified as Cryptococcus neoformans in the CSF, there was no inflammatory reaction . Protein and glucose levels were normal, with no pleocytosis. Onkologie, 1984 Feb, 7 Suppl 1, 37 - 45 {Diagnosis, prevention and treatment of infections of bacterial, fungal and viral origin in immunocompromised patients}; Kurrle E et al.; Infections in immunocompromised patients are mostly caused by potentially pathogenic bacteria, yeasts, fungi and viruses . The predominant agents of bacterial infections are Enterobacteriaceae, Pseudomonas aeruginosa and staphylococci . Several randomized studies have shown that the incidence of infections caused by these bacteria can significantly be reduced by means of antimicrobial decontamination . In case of suspected or proven bacterial infections immediate empirical antibiotic therapy is mandatory . For this therapy a two drug combination of bactericidal broadspectrum antibiotics is recommended, generally a combination of an aminoglycoside and a betalactam antibiotic . The causative agents of fungal infections are mostly species of Candida and Aspergillus, less frequently zygomycetes and Cryptococcus neoformans . For the prophylaxis of fungal infections nystatin, amphotericin B and ketoconazole have been applied . The efficiency of these methods is still controversial . The drug of choice for the treatment of fungal infections is amphotericin B which can be combined with 5- fluorocytosin in case of infections with Candida, Aspergillus and Cryptococcus . Infections with herpes viruses mostly occur in patients with an impaired cellular immunity . As antiviral prophylaxis with CMV-hyperimmune serum and acyclovir for HSV- and VZV-infections should be considered in transplantation of bone marrow and other organs . Acyclovir is also very active in the treatment of manifest infections with HSV and VZV. Infect Immun, 1984 Feb, 43(2), 574 - 9 Localization on encapsulated Cryptococcus neoformans of serum components opsonic for phagocytosis by macrophages and neutrophils; Kozel TR et al.; Previous studies have shown that the cryptococcal capsule inhibits phagocytosis of Cryptococcus neoformans by macrophages and neutrophils . In this study, the binding sites of potential serum opsonins in immune and nonimmune sera were determined by immunoelectron microscopy, and the results were compared with the results of phagocytosis of the yeasts by mouse peritoneal macrophages and human neutrophils . Immunoglobulin G (IgG) from normal human serum showed low-density binding at the capsular surface and at sites throughout the capsule . Complement component C3 from normal serum bound heavily at the capsular surface . IgG from rabbit capsular antiserum showed relatively dense deposition at the capsular surface and at sites throughout the capsule . Cells opsonized with heat-inactivated human serum were engulfed poorly by both macrophages and neutrophils, indicating that the low-density deposition of IgG produced by normal serum was not adequate for opsonization . Yeasts opsonized with normal human serum were engulfed in large numbers by neutrophils and to a lesser extent by macrophages, indicating that neutrophils in particular were able to effectively utilize the opsonically active C3 which normal human serum deposited at the capsular surface . Yeasts opsonized with rabbit anticapsular serum were engulfed by both macrophages and neutrophils, indicating that the high density of surface IgG produced by capsular antiserum is an effective opsonin for both cells . These results suggest that the complement-neutrophil system is a possible defense mechanism in the nonimmune host. J Fr Ophtalmol, 1984, 7(12), 813 - 7 {Acquired ocular toxoplasmosis and immunosuppression of tumoral thymic origin}; Figuier P et al.; A rare case of acute bilateral unifocal chorioretinitis in a 24 years old man is described . The patient had been followed for more than 3 years for a benign thymoma, detected by systematic radiography, that was initially operated on with success . Later, after recurrence of clinical signs a second operation was performed that revealed local invasion of the tumor which was histologically identified as a benign, lymphoid thymoma . Serological data permitted us to attribute the lesions to a sub-acute ganglionary toxoplasmosis, contracted five months before any ocular localization . A treatment including local corticotherapy and oral pyrimethamine and sulfonamide was undertaken . Healing of the retinal lesions occurred slowly . A complete study of the patient's immunity revealed an important deficiency of cell-mediated functions . The problem of diagnosis of opportunistic chorioretinitis is discussed . In patients with impairment of cellular-type immunity, the following are commonly observed: herpes group viral diseases (including cytomegalic inclusion disease), fungus diseases (candida, aspergillus, mucormycosis, cryptococcus), and, rarely, toxoplasmosis . The presence of specific serum antibodies is the most important element in making a diagnosis, considering that the ophthalmoscopic appearance and clinical course may vary. Trans R Soc Trop Med Hyg, 1984, 78(6), 827 - 8 Chronic pulmonary cryptococcosis in a Rattus rattus from Rabaul, Papua New Guinea; Scrimgeour EM et al.; A wild Rattus rattus trapped in Rabaul, East New Britain Province, Papua New Guinea, was noted to have chronic, cystic pulmonary cryptococcosis . R . rattus is common in settlements in Papua New Guinea whereas pigeons, which have been suspected as a possible source of human cryptococcosis, rarely nest in villages in this country . If R . rattus was susceptible to chronic pulmonary cryptococcosis, because of its habit of nesting in roofs, it could serve as a possible vector of human cryptococcosis in Papua New Guinea and perhaps in other countries as well. J Neurol, 1984, 231(3), 109 - 11 Treatment of cryptococcal meningitis with pulmonary granuloma; Inoue N et al.; Two patients with co-existing meningeal and pulmonary cryptococcosis were successfully treated by pulmonary resection and chemotherapy . Under cover of miconazole and 5-fluorocytosine, pulmonary mass lesions were successfully removed despite the fact that the patients had meningitis . The patients recovered from meningitis immediately after the surgical procedures and show no recurrence of meningeal symptoms more than 2 years after the operation . It appears that early removal of a pulmonary cryptococcal focus combined with antifungal agents may give a quite favourable outcome for meningitis. Gerontology, 1984, 30(6), 393 - 6 Fungal serology in the elderly; Rudensky B et al.; 90 geriatric patients without any clinical signs of systemic fungal infection had their sera tested for the presence of candida and aspergillus precipitins and cryptococcal antigens . None of the patients had positive aspergillus or cryptococcal serology . 13% of patients were found to have candida precipitins, but these cases were not significantly correlated with candida colonisation, length of hospitalisation, prior antibiotic therapy, steroid therapy or diabetes . Allowing for 13% false positives, serological testing might be helpful in identifying systemic candidiasis . It is probably highly specific for parenchymal involvement by aspergillus or cryptococcus. Sabouraudia, 1984, 22(5), 439 - 42 Functional testing and chemical composition of cryptococcal extracts; Hall NK et al.; Three antigens were compared for their ability to detect immune responses in C57Bl/6 mice sensitized to Cryptococcus neoformans . Elicitation of responses in vitro was greatest with a urea extract antigen, followed in efficiency by an alkali extract and a soluble capsular polysaccharide preparation . The reactivity paralleled the protein content of the preparation. Sabouraudia, 1984, 22(4), 345 - 6 An improved medium for the isolation of Cryptococcus neoformans from pigeon droppings; Rubio M et al.; Isolation of Cryptococcus neoformans is enhanced when methyl violet at 2 mg l-1 is added to the usual Guizotia abyssinica medium . In preliminary tests the medium has also proved useful for isolating C . neoformans from other sources. Diagn Immunol, 1984, 2(2), 109 - 15 Enzyme immunoassay detection of IgM to galactoxylomannan of Cryptococcus neoformans; Reiss E et al.; Antibodies against the major capsular polysaccharide of Cryptococcus neoformans, glucuronoxylomannan (GXM), and a minor secreted polysaccharide, galactoxylomannan (GalXM), were surveyed by indirect enzyme immunoassay (EIA) in patients with cryptococcosis, with other mycoses, and in normal controls . Measurement of IgG levels against GalXM revealed cross reactions in candidiasis patients that were reduced by adsorption with Candida albicans cell walls . Measurement of IgM levels were subject to fewer cross reactions . The combination of adsorption with C albicans cell walls and measurement of IgM detected antibodies in 12 of 55 cryptococcosis patients . An end point equal to or greater than a titer of 1/16 excluded reactions in normals and limited cross reactivity in candidiasis patients to below 7% . This test has potential diagnostic significance in cryptococcosis patients who show no evidence of cryptococcal antigen circulating in the cerebrospinal fluid or serum . Reactions in this IgM assay were not spuriously due to rheumatoid factor . The major capsular GXM was much less serologically active and was subject to cross reactions with agents of bacterial sepsis . The specificity of the GalXM is directed mainly by the mannose and to a lesser extent by galactosyl residues. Sabouraudia, 1984, 22(2), 125 - 35 Effects of diethylstilbestrol and cyclophosphamide on the pathogenesis of experimental Cryptococcus neoformans infections; Duke SS et al.; Treatment of mice with a single dose of cyclophosphamide 24 h before challenge with Cryptococcus neoformans increased host survival, whereas treatment with 10 daily exposures of cyclophosphamide, starting 2 days before challenge, markedly reduced survival in mice challenged on the second day of drug treatment . Treatment with 14 daily exposures of diethylstilbestrol before challenge with C . neoformans did not markedly affect host survival . A correlation was sought between the distribution of radiolabeled C . neoformans and host survival . Radiolabeled C . neoformans administered intravenously was cleared rapidly from the blood of naive mice and accumulated in the lungs, liver and kidney within 1 h . The radiolabeled yeasts were subsequently cleared from the lungs . The distribution of radiolabeled C . neoformans among organs was generally the same in control mice and mice treated with diethylstilbestrol of various cyclophosphamide regimens after 3 or 24 h . The distribution of C . neoformans measured as colony forming units was generally in agreement with results from radioactivity measurements for animals sacrificed 3 or 24 h after challenge . One week after challenge, C . neoformans colonies were grown from the brain, liver and kidneys . C . neoformans was found in the brain within 1 h after i.v . challenge, suggesting that the central nervous system disease in mice challenged i.v . resulted from a primary infection of the brain. Microbiol Immunol, 1984, 28(1), 51 - 61 Role of serum factors in the phagocytosis of weakly or heavily encapsulated Cryptococcus neoformans strains by guinea pig peripheral blood leukocytes; Ikeda R et al.; We investigated the opsonic activity of the serum factors affecting phagocytosis of Cryptococcus neoformans in vitro to elucidate the role of humoral factors in the host defense mechanisms against cryptococcosis . Two strains of C . neoformans, one heavily and one weakly encapsulated, were used . Guinea pig peripheral blood leukocytes (PBLs) were used for phagocytosis . The viable weakly encapsulated cells were ingested effectively by PBLs, in the presence of guinea pig normal fresh serum, while the heavily encapsulated cells were not ingested . Neither immune serum, its IgG fraction alone, nor heated serum promoted the phagocytosis of either the weakly or heavily encapsulated strain . On the other hand, immune serum promoted adherence of PBLs to viable cells of the heavily encapsulated strain, forming rosettes in the presence of fresh serum . A substantial amount of C3b component was detected on yeast cells when weakly encapsulated cells were incubated with human fresh serum, or heavily encapsulated cells were incubated with rabbit immune serum together with human fresh serum . Serum chelation experiments also indicated that the factors involved in the alternative complement pathway are opsonins for the weakly encapsulated strain . These results suggest that the alternative pathway plays an important normal opsonic role for weakly encapsulated strains and that specific antibody plays an immune opsonic role for heavily encapsulated strains of C . neoformans via the classical pathway of complement activation. Ophthalmology, 1984 Jan, 91(1 Suppl), 1577 - 82 Unilateral cytomegalovirus retinochoroiditis and bilateral cytoid bodies in a bisexual man with the acquired immunodeficiency syndrome; Rodrigues MM et al.; A 42-year-old bisexual man with the acquired immunodeficiency syndrome, cryptococcal meningitis, disseminated Mycobacterium avium-intracellulare with mycobacteremia, and oropharyngeal candidiasis developed unilateral retinitis and bilateral cotton wool patches . Histopathologic examination revealed unilateral necrotizing retinochoroiditis with virions in retinal and choroidal tissues . Postmortem cultures of retina and choroid were positive for cytomegalovirus. Sabouraudia, 1984, 22(5), 381 - 94 Specificity of antigens from pathogenic Aspergillus species . I . Studies with ELISA and immunofluorescence; De Magaldi SW et al.; Studies were made by enzyme linked immunosorbent assay (ELISA) and indirect fluorescent antibody (IFA) tests on the reactivities and specificities of 13 antigens prepared from four species of Aspergillus against antisera from immunized rabbits and 64 sera from patients with aspergillosis, other systemic mycoses and nocardiosis . Although reactions in both serological tests were invariably strongest with homologous antigen: antibody systems, antisera from rabbits immunized with A . fumigatus, Blastomyces dermatitidis, Candida albicans and Paracoccidioides brasiliensis reacted in the ELISA test with all of the Aspergillus antigens . In contrast, cross-reactivity was virtually non-existent with antiserum to Histoplasma capsulatum . Of five antigens prepared from A fumigatus tested by ELISA against human sera from patients with aspergillosis and other nocardial and systemic fungal infections, sensitivities varied from 81 to 100% for sera from 32 patients with aspergillosis, and specificities from 20 to 97% for sera from 30 patients with nocardiosis and other systemic mycoses . Purified A . fumigatus C antigen reacted weakly with sera from eight of these 30 patients, but the reactions were readily distinguishable from those obtained with sera from patients with aspergillosis . At optimal serum dilutions, cross-reactivities of A . fumigatus in the IFA studies were non-existent in the sera from 28 patients with candidosis, coccidioidomycosis, cryptococcosis, histoplasmosis, paracoccidioidomycosis and nocardiosis . Sensitivities of IFA were 94% for patients with aspergilloma and 83% for patients with allergic bronchopulmonary aspergillosis. Nephron, 1984, 37(4), 264 - 9 Morphologic and immunohistologic study of pyelonephritis in rats by various bacteria and fungi . Special reference to inflammatory changes and localization of antigen; Nagai T; Experimental pyelonephritis induced in rats by a single intrarenal injection of Pseudomonas aeruginosa, Serratia marcescens, Candida albicans, and Cryptococcus neoformans was studied pathologically and immunohistologically . The lesions which develop following intrarenal inoculation were similar to those seen during the course of pyelonephritis in man . Localization of the whole bacteria and the amorphous bacterial antigens and the whole fungi and the amorphous fungal antigens in the inflammatory lesions persisted up to 10-12 and 6-8 weeks, respectively . After that, continued inflammatory changes in progressive scarring can evolve in the absence of persistent bacterial or fungal antigens . Rat gamma globulin was localized in the plasma cells of the renal inflammatory infiltrates from 5-6 days to the end of the experiment (14th week) . The incidence of progressive renal sclerosis was high in case of Candida pyelonephritis . The possible roles of progressive renal scarring by C . albicans are discussed. Sabouraudia, 1984, 22(6), 445 - 53 R 51211 (itraconazole) therapy of murine cryptococcosis; Graybill JR et al.; A new antifungal triazole, itraconazole (R51211), was compared with ketoconazole in treatment of murine cryptococcosis . Itraconazole is sparingly soluble in water, and must be administered orally in solvents such as polyethylene glycol . Serum concentrations are lower than those achieved with ketoconazole, but sustained for longer periods . Itraconazole was more effective than ketoconazole by MIC, but was similar to ketoconazole by minimum fungicidal concentration . Both drugs prolonged equally survival after intraperitoneal or intracerebral challenge with Cryptococcus neoformans . Tissue counts of C . neoformans were similar in mice treated with either drug . Neither drug sterilized brains of mice challenged intracerebrally . Itraconazole appears equally potent as ketoconazole, but in this model does not appear to offer any therapeutic advantage over ketoconazole. South Med J, 1983 Dec, 76(12), 1567 - 9 Cryptococcal meningitis: resolution eight months after antifungal therapy; Jones JM et al.; A patient with meningitis due to Cryptococcus neoformans had high titers of cryptococcal antigen in her lumbar cerebrospinal fluid after six months of antimicrobial therapy . Antifungal therapy was discontinued after improvement in immunologic parameters occurred . Cryptococcal antigen was no longer detectable in lumbar cerebrospinal fluid eight months after stopping all therapy . Because the course of cryptococcal meningitis is quite variable and cryptococcal polysaccharide is immunosuppressive, recovery of immunologic function may have been coincidental with resolution of the infection rather than due to treatment with transfer factor . However, confirmation of improved immunologic function was helpful in deciding to stop antifungal therapy. J Clin Microbiol, 1983 Dec, 18(6), 1419 - 21 Utilization of indole compounds by Cryptococcus neoformans to produce a melanin-like pigment; Kwon-Chung KJ et al.; Several indoles served as substrates for the phenoloxidase of Cryptococcus neoformans and resulted in the production of a melanin-like pigment . In general, a higher percentage of C . neoformans var . neoformans (A and D serotypes) isolates could produce pigment from indoles than could those of var . gattii (B and C serotypes) . Only compounds with a hydroxyl or an amino group on the phenyl ring produced pigment; methoxy, nitro, methyl, and fluorine substituents on the phenyl ring were inactive, as was a hydroxyl group at the 2 position on the indole ring . The phenoloxidase of C . neoformans thus appears to differ from that found in Mycobacterium leprae, which cannot use a hydroxyindole, desoxyfructo-5-hydroxytryptamine, as a substrate . In addition, C . neoformans differs from M . leprae in that desoxyfructo-5-hydroxytryptamine does not inhibit the uptake of dihydroxyphenylalanine into the cell. AJR Am J Roentgenol, 1983 Dec, 141(6), 1262 - 72 Pulmonary cryptococcosis: radiologic-pathologic correlates of its three forms; Feigin DS; To better understand the radiographic appearance of pulmonary cryptococcosis, 23 human cases and three cases in zoo animals were studied in which both radiographic and pathologic material was available for correlation . Radiographs in 44 additional cases were studied in which documentation was microbiologic but not pathologic . Three forms of pulmonary cryptococcal disease are recognized: (1) air-space collections of fungus with minimal or no inflammatory reaction, causing well defined masses both radiographically and pathologically, as documented by five cases in this series; (2)granulomatous infection, demonstrated here by 21 cases, producing segmental consolidation, poorly defined masses, or "infiltrative masses," often accompanied by lymph node enlargement; and (3) airway colonization without parenchymal infiltration resulting in no significant or specific radiographic findings and no specific pathology . The most specific and distinctive radiographic finding in pulmonary cryptococcosis is the "infiltrative mass," which resembles a mass in one view and an infiltrate in the 90 degree different view . A review of cryptococcosis shows the value of pathologic correlation of the form of the disease in understanding the radiographic abnormalities. Ophthalmology, 1983 Dec, 90(12), 1577 - 82 Unilateral cytomegalovirus retinochoroiditis and bilateral cytoid bodies in a bisexual man with the acquired immunodeficiency syndrome; Rodrigues MM et al.; A 42-year-old bisexual man with the acquired immunodeficiency syndrome, cryptococcal meningitis, disseminated Mycobacterium avium-intracellulare with mycobacteremia, and oropharyngeal candidiasis developed unilateral retinitis and bilateral cotton wool patches . Histopathologic examination revealed unilateral necrotizing retinochoroiditis with virions in retinal and choroidal tissues . Postmortem cultures of retina and choroid were positive for cytomegalovirus. Antimicrob Agents Chemother, 1983 Dec, 24(6), 851 - 5 Effect of ketoconazole and amphotericin B on encapsulated and non-encapsulated strains of Cryptococcus neoformans; Smith D et al.; Growth inhibition studies were done on an encapsulated and non-encapsulated strain of Cryptococcus neoformans at the minimal inhibitory concentration and one-half the minimal inhibitory concentration of ketoconazole and amphotericin B alone and in combination . Growth of both strains was significantly inhibited by ketoconazole, amphotericin B, and the combined drugs at the minimal inhibitory concentration of each drug over a 5-day period . Calculation of the expected inhibition of growth for both strains with both drugs showed antagonism at 24 h followed by an additive effect and synergy for the remaining 4 days of the assay . Although similar results were obtained for both strains with one-half the minimal inhibitory concentration, an additive effect was observed with the drug combination at 24 h for the encapsulated strain, and an antagonistic effect was observed with the non-encapsulated strain. Antimicrob Agents Chemother, 1983 Dec, 24(6), 829 - 34 Comparative activities of Bay n7133, ICI 153,066, and ketoconazole in murine cryptococcosis; Graybill JR et al.; Two new antifungal triazoles, BAY n7133 and ICI 153,066, were compared with ketoconazole in treatment of mice challenged intraperitoneally with Cryptococcus neoformans . At high challenge doses, thymus-containing normal mice had prolonged survival after treatment with BAY n7133 . Athymic mice, which have severely deficient cell-mediated immunity, were not protected . At low challenge doses, athymic mice also had prolonged survival . Although BAY n7133 was protective, it was less effective than either ketoconazole or ICI 153,066 . BAY n7133 was also less effective in mice challenged intracerebrally than in those challenged intraperitoneally . Both ketoconazole and ICI 153,066 prolonged survival and lowered cryptococcal spleen counts to a greater extent than did BAY n7133. Prikl Biokhim Mikrobiol, 1983 Nov-Dec, 19(6), 728 - 32 {Effect of carbon and nitrogen sources on exopolysaccharide synthesis by Cryptococcus laurentii}; Vitovskaia GA et al.; The effect of various carbon and nitrogen sources on the synthesis of the branched exopolysaccharide produced by Cryptococcus laurentii st 1803-K . was studied . The conditions favourable for a higher yield of the polymer were found . The carbon and nitrogen sources used do not affect the qualitative monosaccharide composition of the polysaccharide, however, the introduction of ammonium salts in the medium can cause a change in the monosaccharide ratio in the side chains of the polymer. J Clin Microbiol, 1983 Nov, 18(5), 1127 - 30 Comparison of three commercial cryptococcal latex kits for detection of cryptococcal antigen; Wu TC et al.; Three commercial latex kits, IBL, MYCO-Immune, and IMMY, for the detection of cryptococcal antigen were compared in regard to sensitivity, specificity, and height of antigen titers . A total of 218 cerebrospinal fluid and 79 serum specimens from 239 patients were included . Twenty-two patients had culture-proven disseminated cryptococcosis . Both the IBL and MYCO-Immune kits had sensitivities of 100%, and the IMMY kit had sensitivities of 82.6 and 45.4% in CSF and serum specimens, respectively . There was one false-positive reaction in serum with the MYCO-Immune kit and one false-negative reaction on screen only with all three kits . Rheumatoid factor-containing sera were used to check the agglutination titers between matching anti-cryptococcal globulin reagents and normal globulin reagents . The finding that agglutination titer with anti-cryptococcal globulin reagents was fourfold higher than with normal globulin reagents in the MYCO-Immune kit is considered to be a cause for a false-positive reaction in serum. Arch Intern Med, 1983 Nov, 143(11), 2179 - 80 Pulmonary cryptococcosis and Cushing's syndrome; Kramer M et al.; Pulmonary cryptococcosis occurred in two patients with Cushing's syndrome, both of whom were successfully treated with amphotericin B and flucytosine . Excessive endogenous production of corticosteroids may have predisposed these patients to the development of opportunistic infection . Persons with Cushing's syndrome and a pulmonary infiltrate should be examined for infection with Cryptococcus neoformans in addition to an examination for ectopic adrenocorticotropic hormone production. Radiology, 1983 Nov, 149(2), 485 - 91 Acquired immunodeficiency syndrome: neuroradiologic findings; Kelly WM et al.; Central nervous system complications depicted by CT in ten patients with acquired immunodeficiency syndrome are described . Three patients had multifocal intra-axial enhancing lesions representing atypical brain abscesses (two with toxoplasmosis, one with candidiasis) . A fourth patient with multifocal "ring" lesions whose biopsy was interpreted as suggestive of toxoplasmosis responded poorly to treatment . Following his death three months later of Pneumocystis carinii pneumonia, autopsy revealed primary intracerebral immunoblastic lymphoma . One patient had Kaposi sarcoma involving the right frontal lobe (seen as an enhancing mass on the CT scan) . CT findings in the remaining five patients revealed mild to moderate enlargement of cerebrospinal fluid spaces (including ventricles and basal cisternae) as a result of cryptococcal meningitis in three patients and "aseptic" meningitis in two . The two patients in whom early biopsy confirmed toxoplasmosis responded well to anti-infective therapy, resulting in dramatic clinical recoveries. Radiology, 1983 Nov, 149(2), 477 - 84 Acquired immunodeficiency syndrome: cerebral computed tomographic manifestations; Whelan MA et al.; CT examination of the central nervous system was performed in 19 patients with acquired immunodeficiency syndrome (AIDS) . Eighteen patients were homosexuals, and five drug abusers . Parenchymal and meningeal inflammations were seen in patients with intracranial manifestations of the disease . The most common demonstrable lesion in the parenchyma was toxoplasmosis, which produced ring enhancement, solid enhancement, and nonenhancing focal edema . The most common meningeal inflammation was cryptococcosis, which was diagnosed by examination of the cerebrospinal fluid and did not show specific CT changes . It is concluded that toxoplasmosis and cryptococcosis should be the first diagnostic consideration in patients with neurologic findings who have a history of homosexuality and/or intravenous drug abuse and previous unusual infections or anergy . A delayed contrast scan, single or double dose, appears to be the most accurate method of outlining the total extent of disease thereby helping to locate the best biopsy site for pretreatment diagnosis . Empirical institution of toxoplasmosis therapy is recommended in those cases in which CT findings are consistent with toxoplasmosis and the biopsy shows only nonspecific encephalitis . A biopsy of every parenchymal lesion is not considered necessary. Prikl Biokhim Mikrobiol, 1983 Nov-Dec, 19(6), 832 - 9 {Determination of lysine amidase and alpha-aminocaprolactam hydrolase activities in cell-free extracts of Cryptococcus sp.}; Galaev IIu et al.; he methods for detecting two activities, i . e . lysine amidase and alpha-aminocaprolactam hydrolase ones, in crude extracts of Cryptococcus sp . are described . The method for registering lysine amidase activity is based on the ability of Cu(II) complex to absorb at 230 nm . The products of lysine and alpha-aminocaprolactam interactions with o-phthalaldehyde in the presence of mercaptoethanol possess different molar absorption at 340 nm . This fact was used for detecting alpha-aminocaprolactam hydrolase activity . The main merit of the methods is the possibility to register the data on the course of the reaction without preliminary chromatographic separation of the reaction products and reactants . The methods proposed do not require expensive enzymes, such as lysine decarboxylase and lysine-alpha-ketoglutarate-epsilon-aminotransferase, which are used for the quantitative estimation of lysine. Boll Soc Ital Biol Sper, 1983 Oct 30, 59(10), 1509 - 12 Preliminary study of the pectolytic activity of Cryptococcus albidus var . albidus; Federici F; A preliminary study was done on the pectolytic activity of Cryptococcus albidus var . albidus . Cell-free culture broths of six strains of this yeast species were shown to degrade pectin hydrolytically by means of a polygalacturonase-pectinmethylesterase system . Neither pectin nor pectate lyase activities were detected. J Bacteriol, 1983 Oct, 156(1), 460 - 2 Recombinational mapping of capsule mutations in Cryptococcus neoformans; Still CN et al.; Seven capsule-negative mutants of Cryptococcus neoformans were isolated . All mutations were linked (maximum map distance, 38 U); two mutations were found to be allelic. Ann Neurol, 1983 Oct, 14(4), 403 - 18 Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients; Snider WD et al.; Fifty patients with acquired immune deficiency syndrome had complications affecting the central or peripheral nervous systems or both . The patients were either male homosexuals, intravenous drug abusers, or recently arrived Haitian refugees . They ranged in age from 25 to 56 . Central nervous system complications were of four kinds: (1) Infections included Toxoplasma gondii abscesses in 5 patients, progressive multifocal leukoencephalopathy in 2, cryptococcal meningitis in 2, Candida albicans in 1, and possible Mycobacterium avium intracellulare in 3 . Eighteen patients suffered a subacute encephalitis possibly attributable to cytomegalovirus infection . (2) Tumors consisted of primary lymphoma of the brain in 3 patients and meningeal invasion by systemic lymphoma in 4 . (3) Vascular complications included nonbacterial thrombotic endocarditis in 2 patients and cerebral hemorrhages in the setting of thrombocytopenia in 3 . (4) Undiagnosed central nervous system problems were evidenced as focal brain lesions in 3 patients and self-limiting aseptic meningitis in 4 . Peripheral neuropathy occurred in 8 patients. Blood, 1983 Oct, 62(4), 758 - 66 A proposal for smoldering adult T-cell leukemia: a clinicopathologic study of five cases; Yamaguchi K et al.; We have observed five patients with smoldering adult T-cell leukemia (ATL) who had skin lesions as premonitory symptoms . The illness developed slowly, but flared up after several years . Skin lesions appeared in the form of erythema, papules, or nodules . Infiltration of the skin by ATL cells was slight, and the proportion of ATL cells in the peripheral blood was 0%-2% . The serum lactate dehydrogenase (LDH) value was within normal range and was not associated with hypercalcemia; lymphadenopathy, hepatosplenomegaly, and bone marrow infiltration were very slight . In most cases, hypergammaglobulinemia was seen, and in one case, monoclonal hypergammaglobulinemia was observed . All five patients had lived in an area in which ATL was endemic, and their anti-ATLA antibodies were positive; none had ever received a blood transfusion . One patient developed typical ATL after more than 13 yr of illness and died of renal insufficiency . Another patient developed typical ATL after 5 yr of illness and died of cryptococcus meningitis . Based on clinical and pathologic differences, we believe that these cases should be distinguished from typical ATL cases for the purposes of prognosis and treatment. JAMA, 1983 Sep 2, 250(9), 1187 - 91 Unusual causes of death in Haitians residing in Miami . High prevalence of opportunistic infections; Moskowitz LB et al.; Twenty-one (100%) Haitians and 42 (21.5%) of 192 native black Americans autopsied in a 33-month period at Jackson Memorial Hospital, Miami, were included in this review . All autopsied materials were examined . Among the Haitians autopsied, infectious diseases accounted for 11 (52%) of 21 deaths . Toxoplasma encephalitis was the leading cause of death (five cases) . Other infectious causes of death included disseminated cryptococcosis (one), disseminated cytomegalovirus diseases (one), Pneumocystis carinii pneumonia (one), chronic active hepatitis B (two), and bacterial pneumonia (one) . Malignant neoplasms were also found to be causes of death and these included a single cases of each of the following: adenocarcinoma of the lung, multiple myeloma, diffuse histiocytic lymphoma, hepatoma, and Kaposi's sarcoma . Deaths of the remaining cases were due to hypertensive cardiovascular diseases (two), rheumatic heart disease (one), glomerulonephritis (one), and intimal fibroplasia of coronary arteries (one) . Seven Haitian cases fulfilled the Centers for Disease Control case definition for the acquired immune deficiency syndrome (AIDS) . For comparison, autopsies of black Americans were chosen from conditions that would most likely predispose them to opportunistic infections . Among the autopsies on black Americans there were no cases of opportunistic infections or Kaposi's sarcoma that were considered to be consistent with the AIDS. Obstet Gynecol, 1983 Sep, 62(3 Suppl), 35s - 37s Cryptococcal meningitis in pregnancy; Stafford CR et al.; Cryptococcal meningitis was diagnosed in a pregnant woman at 21 weeks' gestation . The availability of fetal tissues, blood, and amniotic fluid in such a patient receiving therapy with amphotericin B plus flucytosine afforded the opportunity to study the effects of the disease and therapeutic agents on the developing fetus . The amphotericin B concentration in amniotic fluid was 0.25 micrograms/ml and that of flucytosine was 168 micrograms/ml . The concentrations in cord blood were 0.3 micrograms/ml and 64.7 micrograms/ml, respectively . No evidence was found of amphotericin B or flucytosine toxicity in fetal tissues, although exposure of the fetus to these compounds was of brief duration. Sabouraudia, 1983 Sep, 21(3), 205 - 13 Antifungal activity in vitro of Ro 14-4767/002, a phenylpropyl-morpholine; Polak A; Minimal inhibitory concentrations (MICs) of Ro 14-4767/002 for pathogenic yeasts, Aspergillus spp., dermatophytes and other filamentous fungi were determined in dilution tests under a variety of experimental conditions and, for the most of the species and a number of different isolates . Ro 14-4767/002 showed the highest effect against dermatophytes and Cryptococcus neoformans, followed by Candida spp., whereas its activity against Aspergillus spp . was weak . Its activity against most pathogens compared favourably with antifungals of the imidazole class . The activity of Ro 14-4767/002 not only differed between the species but there was also a significant intra-species variation . The MICs were influenced by the inoculum size, the incubation time, and by the composition of the medium . The activity of the compound was significantly higher on Casitone agar than on a chemically defined medium (Yeast Nitrogen Base + glucose) . Ro 14-4767/002 was also found to exert fungicidal activity which was time- and concentration-dependent. Diagn Microbiol Infect Dis, 1983 Sep, 1(3), 257 - 60 Cryptococcal infection of the temporal bone; Cash JB et al.; Cryptococcus neoformans is a yeast-like organism which, after inhalation, may cause pulmonary disease or a systemic fungemia associated with numerous extrapulmonary sites of infection, but most notably affecting the central nervous system . Despite this frequent involvement of the leptomeninges, only three cases of infection of the temporal bones have been previously described . We describe an additional case with comments on the possible significance of infection of this site. J Immunol, 1983 Sep, 131(3), 1455 - 9 Antibody-dependent leukocyte killing of Cryptococcus neoformans; Miller GP et al.; Cryptococcus neoformans is an encapsulated, yeast-like fungus which is pathogenic for man . The role of various facets of the immune response which prevent disseminated disease in most normal hosts is unclear . A chromium-release assay was developed using radiolabeled cryptococci to reexamine antibody-dependent cell-mediated killing of this fungus . For a small capsule strain this assay served as a qualitative measure of effector cell function and was correlated with an assay of lethal injury to the organism . Polymorphonuclear leukocytes rather than mononuclear cells were the most active effector cells, causing significant chromium release from the fungus at effector-to-target ratios as low as 3:1 . Polymorphonuclear leukocytes and mononuclear cells from a patient with chronic granulomatous disease showed minimal antibody-dependent cell-mediated chromium release suggesting that the final fungicidal pathway may be similar in antibody-dependent and antibody-independent leukocyte killing of this organism. J Virol Methods, 1983 Sep, 7(3), 117 - 25 ELISA for the detection of herpes simplex virus antigens in the cerebrospinal fluid of patients with encephalitis; Coleman RM et al.; An inhibition enzyme-linked immunosorbent assay (ELISA) for the detection of herpes simplex virus antigens in cerebrospinal fluid (CSF) has been developed . A Triton X-100 extract of herpes simplex virus type 1 (HSV-1) infected HEp-2 cells was used to coat wells of polyvinyl chloride plates . Rabbit anti-HSV-1 globulin served as the reference antibody and the CSF specimens were tested at a final dilution of 1:4 . Positive results were obtained in CSF specimens from 11/18 (61%) neonates with HSV infection, 15/23 (65%) older individuals with HSV culture positive brain biopsies, and in 4/29 (14%) patients with culture negative brain biopsies . The assay was negative with CSF from 14 infants without HSV infections, from 30 patients with bacterial meningitis and 10 with cryptococcal meningitis . The test was positive in 10/21 patients within 10 days of onset, 11/14 within 11-20 days, and in 5/6 more than 20 days after onset of the herpetic infection . The overall sensitivity of the assay was 63% and the specificity was 95%. Bull Soc Pathol Exot Filiales, 1983 Aug-Oct, 76(4), 346 - 50 {Peritoneal cryptococcosis: discussion of clinical facts}; Masure O et al.; The isolation of Cryptococcus neoformans from peritoneal fluid is a rare event . The authors present the case of a patient with a post-hepatitis cirrhosis and from whom C . neoformans was isolated from the ascitic fluid . The pathogenicity, the origin, the portal of entry of the yeast are discussed. Am J Med, 1983 Jul 28, 75(1B), 129 - 38 Detection of fungi in cerebrospinal fluid; McGinnis MR; With the exception of Cryptococcus neoformans, fungi are rarely detected in cerebrospinal fluid obtained from patients having or suspected of having fungal meningitis . A review of the literature reveals that several fungi have been either isolated, observed, or both in cerebrospinal fluid specimens . These fungi include Acremonium species, Aspergillus amstelodami, A . flavus, A . fumigatus, A . oryzae, A . terreus, Blastomyces dermatitidis, Candida albicans, C . tropicalis, C . viswanathii, Coccidioides immitis, Cryptococcus albidus, C . neoformans, Histoplasma capsulatum, Paecilomyces variotii, Paracoccidioides brasiliensis, Pseudallescheria boydii, Schizophyllum species, and Sporothrix schenckii . Laboratory findings for cerebrospinal fluid specimens obtained from such patients and clinical presentations are summarized. J Antimicrob Chemother, 1983 Jul, 12(1), 97 - 9 Parkinsonism associated with intraventricular amphotericin B; Fisher JF et al.; Little information is available regarding the in-vivo effects of amphotericin B on organs other than the kidney . The increasing use of intrathecal amphotericin B has resulted in several reports of neurotoxicity associated with the drug . Development of parkinsonism following intraventricular treatment with amphotericin B for cryptococcal meningitis in a young woman suggested a direct toxic effect on nervous tissue by amphotericin B . Although transient signs of parkinsonism have been described in a patient receiving intraventricular amphotericin B, persistent parkinsonism is an unprecedented occurrence. Mycopathologia, 1983 Jun 20, 82(3), 179 - 84 Experimental cryptococcosis in guinea pigs; Riera CM et al.; A guinea pig model was used to evaluate immune response to Cryptococcus neoformans . This model shared characteristics with cryptococcosis in humans . Twenty five guinea pigs injected intraperitoneally with 10(7) viable C . neoformans cells developed disseminated disease . Forty days after infection all guinea pigs were killed and autopsy performed . C . neoformans growth in the lungs, brains, livers and spleen of the infected animals were determined . Furthermore, the immune response was characterized by moderate degree of delayed-type hypersensitivity and humoral response . In some organs was observed neutrophil and lymphocyte infiltration with presence of cryptococci cells . The infiltration observed in the organs was probably a consequence of an immune reaction. Mycopathologia, 1983 Jun 20, 82(3), 175 - 8 Effect of formalin on the survival of systemic fungi in tissue; Fahmy A et al.; Stock cultures of Blastomyces dermatitidis, Candida albicans, Cryptococcus neoformans, Histoplasma capsulatum and Sporothrix schenckii were grown in yeast phase on Sabouraud dextrose agar . Standardized suspensions (10(8) colony forming units/ml) were made and 1 . the organisms treated for various times with 10% formalin/acetate buffer; 2 . aliquots injected into the tail veins of Swiss-Webster mice . Minimal fungistatic and fungicidal concentrations of formalin were also determined . Five minutes or more of formalin treatment killed all organisms, in vitro, except C . albicans which withstood the 5-minute but not the 30-minute treatment . All fungi, except H . capsulatum which was not recovered, were cultured from mouse heart, kidneys, spleen, lungs and liver prior to but not after 5-minute formalin treatment . All yeasts were susceptible to concentrations of less than 1% formalin . These results emphasize the extreme fungicidal activity of 10% formalin and the uselessness of culturing even very briefly-fixed tissue. Infect Immun, 1983 Jun, 40(3), 912 - 6 Inbred mouse strains differ in resistance to lethal Coccidioides immitis infection; Kirkland TN et al.; Inbred strains of mice were infected intraperitoneally with Coccidioides immitis, and the mean lethal dose was determined after 28 days . DBA/2N mice had a mean lethal dose of greater than 10(5) arthroconidia, whereas BALB/cAnN, C57BL/6N, and C57L/J mice had a mean lethal dose of less than or equal to 10(3) . Since both BALB/c and DBA/2 mice are the H-2d haplotype, resistance is not primarily determined by the major histocompatibility locus . Re