Cryptococci

Lab Anim Sci, 1977 Oct, 27(5 Pt 1), 694 - 9
Disseminated cryptococcosis in a patas monkey (Erythrocebus patas); Sly DL et al.; Cryptococcosis was diagnosed in an adult male patas monkey (Erythrocebus patas) 9 months after importation . The disease was characterized by an open lesion on the buttock and epileptiform seizures . Diagnosis was confirmed through immunologic identification of the organism in serum and cerebrospinal fluid and by mycologic procedures performed on the cultured organism . The monkey was killed and cryptococcal organisms were found in the lung, brain, subcutaneous lesions, thyroid, pancreas, adrenals, and spinal cord . Retrospective analysis of stored serum indicated that the monkey was infected at the time of importation.

J Clin Microbiol, 1977 Oct, 6(4), 387 - 91
Diagnostic medium containing inositol, urea, and caffeic acid for selective growth of Cryptococcus neoformans; Healy ME et al.; An agar medium containing inositol and urea as sole carbon and nitrogen sources, caffeic acid and ferric citrate as agents for the selective pigmentation of Cryptococcus neoformans, gentamicin as a broad-spectrum bacterial antibiotic, and yeast nitrogen base without amino acids and ammonium sulfate (Difco) was tested against 137 clinical isolates, 4 survey specimens, and 11 ATCC yeast and yeast-like strains . All 28 strains of C . neoformans showed heavy growth and dark brown pigmentation after 36 h . All other tested species of Cryptococcus showed heavy growth after 36 h but only light brown pigmentation after 48 h . No growth was observed in any tested strains of Geotrichum, Pityrosporum, Rhodotorula, Saccharomyces, and Torulopsis . Only the Cryptococcus-like Candida humicola grew of the 8 species and 62 strains of Candida tested . Six of 15 strains of Trichosporon cutaneum and 1 of 2 strains of Trichosporon pullulans showed moderate growth after 48 h . Very different colonial and microscopic morphology and/or the absence of brown pigmentation easily differentiated these strains of T . cutaneum, T . pullulans, and C . humicola from C . neoformans . The growth- and pigmentation-providing characteristics of the medium were unaffected by 2 h of exposure to 254 nm of ultraviolet light.

J Clin Microbiol, 1977 Oct, 6(4), 325 - 7
Occurrence and significance of Cryptococcus neoformans in the oropharynx and on the skin of a healthy human population; Randhawa HS et al.; Cryptococcus neoformans was cultured on one occasion from the oropharyngeal washings in 1 of 820 and from the interdigital areas of the feet in 6 of 723 healthy persons . Among the positive persons were two school children, two laboratory workers, one gardener, one plumber, and one printing press worker . Repeat cultures were negative in all seven positive persons; serological tests for cryptococcal antigen/antibody were negative in three . The results demonstrate that C . neoformans may occur as a transient inhabitant of the oropharynx or skin of healthy people.

Lipids, 1977 Oct, 12(10), 809 - 13
The in vivo incorporation of {32P}-labeled orthophosphate into pyrophosphatidic acid and other phospholipids of Cryptococcus neoformans through cell growth; Itoh T et al.; Cryptococcus neoformans was cultured in a liquid medium containing {32P}-orthophosphate and harvested at various stages of cell growth . An aliquot of the {32P}-labeled cells was transferred to a nonradioactive medium, and the culture was continued again for some hours . The {32P}-radioactivity composition and the phosphorus composition of individual phospholipids relative to the total phospholipid through the incubation periods were estimated . Although levels of major phospholipids remained constant throughout the cell growth, the distribution pattern of the {32P}-radioactivity of individual phospholipids changed remarkably along with the progress of cell growth . The changing patterns of the specific radioactivities of individual phospholipids through the growth phase demonstrated that phosphatidic acid was one of the most active metabolites in phospholipids and that pyrophosphatidic acid was also metabolically active.

Mayo Clin Proc, 1977 Oct, 52(10), 603 - 10
General principles of antimicrobial therapy; Hermans PE; In the initial therapy of life-threatening infections in which a bacterial cause is suspected, the emphasis should be on broad antibiotic coverage in contrast to definitive therapy, which is dependent on microbial isolation and, when indicated, in vitro susceptibility tests . In severe infections, antimicrobial agents should be given parenterally, at least initially . The need for optimal dosage is emphasized . This is particularly important when aminoglycosides are administered, for there is a tendency to use inadequate dosage because of concern for potential side effects with these agents . The problems leading to recurrence and persistence of fever during antimicrobial therapy include failure to diagnose and drain abscesses, superinfection, drug fever, and clinical or microbiologic errors . Combinations of antibiotics are indicated in severe infections in severe infections due to Pseudomonas aeruginosa, enterococcal group D streptococci, Klebsiella pneumoniae, and Cryptococcus neoformans . Laboratory aid for the selection of antimicrobial therapy can be of great value but need not always be done, because certain microorganisms have stable, predictable susceptibilities, for example, Streptococcus pneumoniae and Streptococcus pyogenes . Cautious conservatism is advocated with regard to the use of new antimicrobial agents.

Doc Ophthalmol, 1977 Sep 30, 44(1), 49 - 56
Cryptococcal eye disease; Condon PI et al.; A survey is given of the clinical picture of an infection with Cryptococcus neoformans . The symptoms and therapy are reviewed and the case history of a 13 year old boy suffering from this fungus infection is discussed.

Arch Intern Med, 1977 Sep, 137(9), 1180 - 5
Treatment of fungal meningitis with miconazole; Deresinski SC et al.; Twelve patients with fungal meningitis (ten cases were due to Coccidioides immitis, two were from Cryptococcus neoformans) were treated with brief courses of intravenous (IV) miconazole . Eleven patients, including patients with severe, chronic disease, had been treated unsuccessfully with amphotericin B . Four patients also received miconazole injected directly into the CSF . The drug was well tolerated by any route, with mild reversible side effects . After IV administration the miconazole concentration in the CSF rarely exceeded the minimal inhibitory concentration (MIC) of the infecting organism . Intra-CSF administration of 20 mg generally produced levels above the MIC for 24 hours . Five of ten patients with coccidiodial meningitis responded clinically . Of these five, four received only IV miconazole; three relapsed after therapy was stopped . Miconazole appears promising as a treatment of fungal meningitis, but trials of longer duration might prevent relapse.

Jpn Circ J, 1977 Sep, 41(9), 1009 - 13
A case of renal transplant recipient complicated with cryptococcosis and amphotericin B induced acute tubular necrosis; Mishima T et al.; An adult renal transplant recipient was complicated with cryptococcal lung granuloma and meningitis . Treatment with the antifungal agents, 5-fluorocytocin and clotrimazole had to be discontinued due to side effects . Whereas, the intrathecal administration of amphotericin B proved effective for meningitis but intravenously it induced acute tubular necrosis to the transplanted kidney . In order to cure the persistant fungal lung granulomas in renal transplant patients early surgical excision seems to be essential.

Infect Immun, 1977 Sep, 17(3), 634 - 8
Cryptococcus neoformans: size range of infectious particles from aerosolized soil; Neilson JB et al.; Although cryptococcosis is characterized as a chronic central nervous system disease, it is generally accepted that the lungs are the primary portal of entry for the etiological agent . Despite this, there is a distinct lack of evidence that viable airborne particles of Cryptococcus neoformans are small enough to reach the alveoli . Two encapsulated strains and one nonencapsulated strain of C . neoformans were inoculated into 250-g quantities of sterile soil . Throughout the 0 to 12 weeks of incubation, this soil was aerosolized in a sealed chamber with a Waring blender . Samples of the resultant dust cloud were taken with an Anderson air sampler from which the numbers and sizes of viable airborne particles were determined . Of the viable organisms aspirated into the air sampler, 15% were 0.65 to 2 micron in diameter . As incubation time in soil increased, the size of the particles decreased, and increased numbers of C . neoformans cells 0.65 to 2 micron in diameter were isolated . The presence of viable cells less than 2 micron in soil aerosols indicated that, under certain conditions in nature, C . neoformans cells exist in sizes that are capable of deep lung deposition.

Br J Dermatol, 1977 Aug, 97(2), 221 - 3
Cutaneous infection by Cryptococcus laurentii; Kamalam A et al.; Cryptococcus laurentii was isolated twice from cutaneous granulomas in the leg and foot of a 40-year-old man . Histologically the cells of C . laurentii were found in groups in the dermis and also inside giant cells . There was epithelioid cell infiltration in the dermis and subcutis . An atypical mycobacterium was isolated in addition to C . laurentii . Therapy with anti-tuberculous drugs after an initial amphotericin B infusion was found to be satisfactory.

J Bacteriol, 1977 Aug, 131(2), 702 - 6
Survey for alpha-(1 leads to 3)-glucanase activity among yeasts; Meyer MT et al.; Activity of alpha-(1 leads to 3)-glucanase was found in species of Cryptococcus, Rhodotorula, and Endomyces . Observations on the expression and stability of this enzyme in Rhodotorula minuta var . texensis was presented.

Mycopathologia, 1977 Jul 29, 61(1), 55 - 60
Characterization of immunoglobulin classes of human antibodies to cryptococcus neoformans; Blumer SO et al.; Immunoglobulin G (IgG), immunoglobulin M (IgM) and immunoglobulin A (IgA) levels were determined by radial immunodiffusion techniques in sera from 11 patients with cryptococcosis . Most specimens showed increased levels of IgM . Studies with fluorescein-labeled monospecific antihuman IgG and IgM, however, indicated that IgG was the immunoglobulin reactive in the indirect fluorescent antibody (IFA) test . In addition, cross-reacting sera from mycotic infections other than cryptococcosis were also shown to contain IFA antibodies of the IgG class . Sera treated with 2-mercaptoethanol continued to react in both the IFA test and the tube agglutination test . No correlation could be established between IgG AND IgM concentrations and serological reactivity in the sera evaluated in this study.

J Clin Microbiol, 1977 Jul, 6(1), 27 - 32
Rapid diagnosis of lymphocytic meningitis by frequency-pulsed electron capture gas-liquid chromatography: differentiation of tuberculous, cryptococcal, and viral meningitis; Craven RB et al.; Cerebrospinal fluid specimens from patients with tuberculous (17 cases), cryptococcal (15 cases), and viral (14 cases) meningitis were analyzed by frequency-pulsed electron capture gas-liquid chromatography and mass spectrometry . Compounds that disappeared after therapy were found to be present in each of these specimens and were not detected in controls . They occurred in repetitive patterns such that these three types of meningitis could be rapidly distinguished . The compound associated with tuberculous meningitis has been tentatively identified . These finding have implications for rapid diagnosis, pathophysiological studies, and possible new therapeutic approaches.

Infect Immun, 1977 Jul, 17(1), 187 - 94
Effects of stimulation and suppression of cell-mediated immunity on experimental cryptococcosis; Diamond RD; A model of cryptococcosis was developed using intraperitoneal infections of guinea pigs . This model shared characteristics with cryptococcosis in humans and was used to study the effects of immunosuppression and immunostimulation on cryptococcosis . Female guniea pigs survived longer than males; perphaps this was related to a greater capacity of their monocytes to kill cryptococci . A brief course of cortisone shortened survival of females and resulted in depressed immune and inflammatory responses, which persisted long after cortisone was stopped . Stimulation of the immune response by treatment with cryptococci in Freund complete adjuvant improved survival in males . Preliminary studies indicated the usefulness of this model for the study of other potential immunostimulants, including immune lymphocytes, transfer factor prepared from immune lymphocytes, and levamisole . Overall, long-term survivors appeared to clear disseminated cryptococci from extraperitoneal sites including brain, rather than prevent dissemination of cryptococci from the peritoneal cavity . The quantity of the inflammatory response in infectious foci, rather than the ability of individual leukocytes to kill crytococci, may have determined the outcome of most infections.

Cancer, 1977 Jul, 40(1), 268 - 74
Central nervous system infections in patients with cancer . Changing patterns; Chernik NL et al.; Central nervous system infections in patients with cancer at Memorial Sloan-Kettering Cancer Center from 1971 to 1974 were surveyed and compared with a previous survey from 1955 to 1970 . The two periods were similar in that: 1) There was a high incidence of CNS infection in patients with lymphoma, leukemia, and head and spine tumors, 2) specific organisms tended to infect patients with certain primary neoplasms, and 3) fungal infections were common and difficult to diagnose . The two periods differed in that: 1) the overall incidence of CNS infection was lower in 1971 to 1974, 2) there was a decreased incidence of cryptococcal meningitis, and 3) there was an increase in Listeria monocytogenes meningitis . Early recognition of CNS infection and aggressive therapy appears to increase survival.

South Med J, 1977 Jul, 70(7), 865 - 6
Simultaneous infection of the central nervous system with Cryptococcus neoformans and Mycobacterium intracellulare; Gentry RH et al.; A 46-year-old woman with cryptococcal meningoencephalitis also had Mycobacterium intracellulare isolated from her cerebrospinal fluid . She was treated with amphotericin B,5-fluorocytosine, and antituberculous agents (isoniazid and rifampin) . She gradually improved and was well, except for residual neurologic damage, three years after discharge from the hospital . No evidence of significant underlying disease has been found.

Ann Sclavo, 1977 Jul-Aug, 19(4), 758 - 63
{Liquor-culture in central nervous system mycosis (author's transl)}; Gargani G; Several possibilities of fungous etiology for meningo-encephalitis are shortly exposed, with the literature data on the liquor characters . Methods for the identification of the most frequently met fungi in liquor are given, both on microscopical and cultural examinations . For cryptococcal meningo-encephalitis is suggested the research in liquor of the capsular polysaccharide, and a personal observation is reported.

Mikrobiyol Bul, 1977 Jul, 11(3), 431 - 9
{Fungal infections following renal transplantation}; Ata H; Following the immunosuppressive treatment, applied after renal transplantations, infectious diseases are seen more frequently . Inspite of more frequency of bacterial infections, they can usually be controlled because of their easier diagnosis and treatment . However the mycotic diseases are usually fatal because of their easier diagnosis and treatment . However the mycotic diseases are usually fatal because of the difficulty in their diagnosis and treatment . The immunosuppressive treatment agents are cytotoxic medicines, codticosteroids, antilymphocytic sera (or antithymocytic sera) and radiation . The mycotic infections, more often encountered are candidiasis, aspergillosis, nocardiosis, cryptococcosis and phycomycosis . There are certain medicines used today in the treatment of deep mycotic infections . These are amphotericine B, 5 fluorocytosine and imidazol derivatives.

J Infect Dis, 1977 Jul, 136(1), 96 - 9
Fungicidal components of mammalian granulocytes active against Cryptococcus neoformans; Lehrer RI et al.; Citric acid extracts of granule-rich fractions, prepared from rabbit and guinea pig heterophils or human neutrophis, killed Cryptococcus neoformans in vitro . These extracts sere fractionated by micropreparative electrophoresis on polyacrylamide gels . In preparation of rabbit and guinea pig heterophils, cryptococcidal activity was associated predominantely with lysosomal cationic protein complex . Human neutrophils lacked strictly comparable cationic proteins but contained other components that killed C . neoformans . These components appeared to be identical to previously described proteins of the human neutrophil active against Candida parapsilosis.

Chest, 1977 Jul, 72(1), 13 - 9
Cryptococcosis, with emphasis on the significance of isolation of Cryptococcus neoformans from the respiratory tract; Duperval R et al.; Cryptococcus neoformans was isolated from 65 patients: 11 had meningitis, 11 had disseminated cryptococcosis without meningitis, and 43 had C neoformans isolated from the respiratory tract . Predisposing conditions and the diagnostic value of cultures from various sites and of the latex agglutination test on cerebrospinal fluid and serum are analyzed for patients with extrapulmonary disease . Nine patients had pleural effusions; the effusion was cultured in six and yielded C neoformans in four . None of 11 deaths among 43 patients with respiratory tract isolates could be attributed to cryptococosis . The 32 survivors were nor treated with antifungal agents . Twenty-six of 43 patients with respiratory isolates had various bronchopulmonary disorders, with chronic obstructive pulmonary diseases and asthma the most common (28 percent) . Seven of 28 patients (25 percent) with roentgenographically detected lung lesions had carcinoma of the lung . Roentgenographic evidence of a lung lesion and C neoformans grown from the respiratory tract warrant a further search for carcinoma of the lung.

Am J Clin Pathol, 1977 Jul, 68(1), 39 - 44
Detection of cryptococcal polysaccharide using counterimmunoelectrophoresis; Maccani JE; Counterimmunoelectrophoresis was used to detect Cryptococcus neoformans capsular polysaccharide in the body fluids of infected patients . Using rabbit anti-C . neoformans A15 globulin, counterimmunoelectrophoresis detected 1.25 microgram of purified cryptococcal polysaccharide per ml of cerebrospinal fluid (CSF) or urine and 2.5 microgram per ml of serum . When the body fluids were subjected to a hundredfold concentration prior to testing, as little as 25 ng of purified cryptococcal polysaccharide/ml CSF or urine and 80 ng/ml serum was detected . Among patients with cryptococcal meningitis, counterimmunoelectrophoresis detected polysaccharide in the CSF when the India-ink examination was negative . Using counterimmunoelectrophoresis, the concentrations of polysaccharide antigen in the body fluids of these patients could be estimated . Specificity of the rabbit anti-C . neoformans A15 globulin was evaluated . There was no crossreaction that detracted from its diagnostic usefulness . Rheumatoid factor was not a source of false-positive tests . Counterimmunoelectrophoresis is a useful technic for establishing a rapid, specific serologic diagnosis of cryptococcosis.

Ann Sclavo, 1977 Jul-Aug, 19(4), 660 - 749
{Research of the soluble microbial substances in organic fluids for the rapid diagnosis of some infections and particularly of bacterial meningitis (author's transl)}; Visconti A; A number of immunological and non-immunological techniques have been recently used to detect soluble microbial substances in body fluids of patients with acute meningitis, bacteremia, and lobar pneumonia . By the immunological methods capsular highly polymerized polisaccharide group- or type-specific antigens of the most common C . N . S . pathogens (N . meningitidis A, B, and C; Str . pneumoniae, H . influenzae type b, E . coli K1, mucoid Pseudomonas, Cryptococcus neoformans) can be detected and quantitated in spinal fluids, sera, urine and other fluids specimens from meningitic patients . Capsular type-specific antigens from pneumococcus, and likely from H . influenzae as well, can be detected in sputum from patients with lower respiratory infection . Among the various techniques, the radioimmunoassay appears as the most sensitive one, but high diagnostic sensitivity can be also achieved by using the latex agglutination, haemoagglutination inhibition and coagglutination tests . Counterimmunoelectrophoresis, however, is still the far most used technique for determining soluble microbial antigens, albeit its sensitivity is significantly less than the one of the above mentioned methods . High specificity and some advantages in serotyping the causal organisms are probably the main reasons of such preferential employment . Among the non-immunological techniques the evaluation of lactate and lactic dehydrogenase has been used by some Author for differentiating between bacterial and non bacterial meningitis, and the limulus test for detecting Gram-negative bacterial endotoxins with a high degree of sensitivity and specificity . Finally, the liquid gas chromatography has been evaluated in detection of some organic products (microbial?), such as acids, amines, neutral compounds, in spinal fluid, allowing the differential diagnosis between bacterial, tuberculous, viral, and cryptococcal meningitis . In the present review sensitivity, specificity, and other properties of each test alone and in comparison with the conventional microbiological methods (Gram and culture) are evaluated and the biological and pathogenic role and significance of the soluble microbial antigens and endotoxin are discussed.

J Clin Microbiol, 1977 Jun, 5(6), 625 - 8
Electron capture gas chromatography detection and mass spectrum identification of 3-(2'-ketohexyl)indoline in spinal fluids of patients with tuberculous meningitis; Brooks JB et al.; A basic, extractable, indolic type of compound, which was derivatized with heptafluorobutyric anhydride and pyridine, was obtained from the cerebrospinal fluids of patients with acute tuberculous meningitis . The compound was detected by frequency-pulsed, modulated electron capture gas-liquid chromatography, and it was tentatively identified by mass spectrometry as 3-(2'-ketohexyl)indoline . The compound was found to be valuable for differentiating between tuberculous, cryptococcal, and aseptic meningitides.

Hautarzt, 1977 Jun, 28(6), 286 - 94
{Etiopathogenesis and epidemiology of candidiasis and related yeast mycoses}; Male O; The clinically and histologically well differentiated clinical picture of candidosis (CA) is heterogenous with regard to etiology: Only about 95 per cents of the cases are caused by candida species, the rest by other cryptococcaceae species . Formal pathogenetically the CA may be primary as well as secondary . Which kind of pathogenicity is predominating depends first of all on the momentary ecological, civilisational and medical conditions . At present in unselected dermatological cases at least 90 per cents are secondary; the severe systemic cases without exception . Primarily the pathogenesis of CA is determined by certain disposing factors, being partly exogenous, partly endogenous and/or constitutional, conditional or accidental, the knowledge and consideration of them representing the basis for an effective therapy . Particular CA-forms are largely characteristic for the kind of "underlying disease" . Beside the disposing factors in the pathogenesis of CA also the quantity of the germs is of great importance whereas their virulence has only a minor meaning.

Br J Ophthalmol, 1977 Jun, 61(6), 411 - 3
Cryptococcal chorioretinitis: a case report; Chapman-Smith JS; Chorioretinitis occurred in a young man whose long-standing cryptococcal meningitis had been identified and treated . In one eye spontaneous resolution had occurred . His case history and fluorescein angiograms are presented.

Am J Epidemiol, 1977 Jun, 105(6), 582 - 6
Epidemiologic differences among serotypes of Cryptococcus neoformans; Bennett JE et al.; In the USA, the most prevalent serotype of the fungus, Cryptococcus neoformans, was serotype A . The serotype constituted 203 of 272 isolates from infections and 85 of 89 isolates from the environment . Serotype B or C isolates were infrequent causes of infection, except in Southern California, and were infrequent causes of infecand were not isolated at all from environmental sources . In Southern California, the absence of serotypes B and C in 67 soil and pigeon dropping isolates was striking, considering that 25 of 49 isolates from infections were serotypes B or C . The site in nature where serotypes B and C exist is currently unknown but differs from that of serotypes A and D . Serotype D may be unusually prevalent in both environmental and patient isolates from Denmark and Italy . Of 24 isolates from those countries, 21 were serotype D.

J Infect Dis, 1977 Jun, 135(6), 970 - 4
Antifungal activity of 5-fluorocytosine as measured by disk diffusion susceptibility testing; Utz CJ et al.; The susceptibilities of 216 isolates of pathogenic and commensal yeasts to 5-fluorocytosine were tested by a disk diffusion technique with use of 1- and 10-microgram disks . Minimal inhibitory concentrations (MICs) were determined by an agar dilution procedure with yeast morphology agar, pH 5.0, supplemented with 0.25 mg of thiamine/dl . Zones of inhibition produced by the two disks were correlated with paired MIC values . An MIC of 16 micrograms/ml, the upper limit of probable clinical susceptibility, correlated with zones of 14 mm and 25 mm, respectively, for the 1- and 10-microgram disks . With these values as interpretative breakpoints, the 1-microgram disk would have failed to predict clinical susceptibility with 25% of the suceptible isolates of Candida species other than Candida albicans, with 14% of the susceptible isolates of Cryptococcus neoformans, with 7% of the susceptible isolates of C . albicans, and with one of the 25 susceptible isolates of Torulopsis glabrata . The 10-microgram disk would have failed to predict susceptibility with only two isolates of Candida species.

J Bone Joint Surg Am, 1977 Jun, 59(4), 509 - 14
Skeletal cryptococcosis; Chleboun J et al.; We reviewed the published reports of skeletal cryptococcosis and added three cases to the fifty-six in the literature . Eight of the patients in the reported cases probably did not have primary skeletal cryptococcosis . The potential toxicity of antifungal drugs in current use and the apparent effectiveness of surgical treatment for patients who only have a single focus of infection in bone, without involvement of other tissues, should be noted . The association of cryptococcosis with other diseases and the difficulty in differentiating purely skeletal involvement from more extensive disease are emphasized.

Am J Ophthalmol, 1977 Jun, 83(6), 777 - 88
Immunosuppression and eye disease . First Vail lecture; Cogan DG; Several viral, fungal, and protozoal diseases of the eye are significantly associated with immunologic deficiencies . Of the viral agents, cytomegaly and herpes simplex and zoster cause a discrete necrotizing retinopathy that has the characteristics of vascular occlusion . Measles may result in a delayed retinopathy that is predominantly macular and associated with subacute progressive encephalopathy . Of the fungal agents, Candida and Aspergillus are apt to involve the eye, beginning as choroidal lesions with extension forward to involve the pigment epithelium and retina secondarily . Mucor and Cryptococcus are less common . Toxoplasmosis is the one ocular protozoal disease whose incidence is increased by immunosuppression, and, like the viral diseases, is characterized by a discrete necrotizing retinopathy and probably results from activation of dormant organisms in the retina . Autoimmunity undoubtedly plays an important role in eye disease but its ocular pathogenesis is obscure.

Cancer, 1977 May, 39(5), 2265 - 74
Cryptococcosis in a cancer hospital: clinical and pathological correlates in forty-six patients; Kaplan MH et al.; The clinical and pathological findings in 46 patients with cryptococcosis at Memorial Sloan-Kettering Cancer Center from 1956 to 1972 are reported . The striking predilection for cryptococcal infection in patients with leukemias and lymphomas is again confirmed . Of 41 patients with neoplastic disease, those with chronic lymphatic leukemia (CLL), Hodgkin's Disease, chronic myelogenous leukemia (CML), myeloma and lymphosarcoma had the highest incidence of cryptococcosis . In all cases, neoplastic disease was widespread when infection occurred . All of these patients had leukopenia and absolute lymphopenia at the time of infection . Thirty-nine were on steroids . Thirty-one patients with neoplastic disease had disseminated infection . Review of pathology revealed a spectrum of inflammatory lesions . Histiocytic-lymphocytic infiltrates occurred in the central nervous system in 10 patients . In six cases, reaction was granulomatous . There were single instances of suppurative and fibrotic reactions . Mortality from infection was high in patients with neoplastic disease . Twenty-four of 28 deaths occurred within 60 days as a result of infection . Within one year, 10 more patients died, nine of cryptococcosis . Only three survived more than one year, and all patients died within 600 days . Twenty-nine patients with neoplastic disease received amphotericin B . Only nine survived more than 60 days.

Arch Intern Med, 1977 May, 137(5), 688 - 90
Demonstration of Cryptococcus neoformans in a stained bone marrow specimen; Robert F et al.; Disseminated cryptococcosis is seen with increased frequency in patients with malignant hematologic disease . Usually the diagnosis rests on spinal fluid studies, and little attention has been paid to the direct examination of a bone marrow specimen . A febrile woman with an advanced histiocytic lymphoma was intensively treated with antineoplastic agents; the antemortem diagnosis of cryptococcosis was suspected from direct examination of the bone marrow and was subsequently confirmed by culture . Visualization of fungi in special stained bone marrow specimens could be useful in the initial examination of febrile patients with neoplastic diseases and/or compromised host defenses, and would permit early institution of specific therapy.

Infect Immun, 1977 Apr, 16(1), 99 - 106
Non-encapsulated variant of Cryptococcus neoformans . II . Surface receptors for cryptococcal polysaccharide and their role in inhibition of phagocytosis by polysaccharide; Kozel TR; The binding of cryptococcal polysaccharide to a non-encapsulated strain of Cryptococcus neoformans was studied . Binding of purified polysaccharide to the yeast was determined by inhibition of phagocytosis and by indirect immunofluorescence techniques . The ability of cryptococcal polysaccharide to prevent phagocytosis of the non-encapsulated strain appears to be directly related to adherence of polysaccharide to the yeast via specific receptors on the cell surface . Addition of varying doses of cryptococcal polysaccharide to non-encapsulated yeast cells inhibited phagocytosis only at polysaccharide concentrations at which the polysaccharide could be demonstrated on the yeast surface by immunofluorescence . Macrophages treated with cryptococcal polysaccharide had no detectable amounts of cryptococcal polysaccharide adherent to their surface, and they had a normal ability to phagocytize the yeast . Kinetic studies showed that inhibition of phagocytosis is directly related to the presence of cryptococcal polysaccharide at the yeast surface rather than to some indirect effect by the polysaccharide on serum components necessary for phagocytosis . Purified polysaccharide from C . neoformans serotypes A, B, C, and D bound to the yeast, but type III pneumococcal polysaccharide did not inhibit phagocytosis of the nonencapsulated yeast . Cryptococcal polysaccharide did not bind to cells of Candida albicans, C . pseudotropicalis, Torulopsis sp., Rhodotorula sp., or Saccharomyces cerevisiae.

Infect Immun, 1977 Apr, 16(1), 129 - 35
Capsule size of Cryptococcus neoformans: control and relationship to virulence; Dykstra MA et al.; Capsule size of five isolates of Cryptococcus neoformans was controlled by cultivation in media containing varying amounts of sugar . High concentrations of sugar (e.g., 16%) suppressed encapsulation whereas low concentrations (e.g., 1%) allowed maximal encapsulation . Suppression of capsule size was attributed at least in part to the increased osmolarity of the medium because a medium with low sugar concentration but having high osmolarity (by virtue of added sodium chloride) also produced cells having small capsules . The extent of control was more marked with certain of the isolates than with others . Mice were intravenously inoculated with cells of a single isolate cultivated so as to have either small or large capsules, and virulence was measured by comparing death rates . Results indicate that virulence after such an inoculation is a constant characteristic of an isolate and is not affected by size of the capsule of the cells in the inoculum.

Ann Ophthalmol, 1977 Apr, 9(4), 467 - 70, 473
Ocular complications after renal transplantation; Pfefferman R et al.; The ocular complications in 78 renal transplant patients were evaluated . Fifty-eight (74%) showed some ocular abnormality . Forty-one patients (53%) were found to have various degrees of cataracts . The duration of hemodialysis, the age of the patients, and daily dosage of prednisone did not seem to influence the development of cataracts . Correlation was found between the total dosage of prednisone and the cataract formation . Mild and moderated hypertensive fundus changes were found in 15 patients . Severe progression of diabetic retinopathy was observed in 2 diabetic patients . For the first time focal hemorrhagic necrosis of the eyelid as a result of cryptococcus septicemia was noted . Other ocular complications include one case of ocular hypertension and one case of herpetic keratitis . Although the incidence of ocular complications was high, the severity of ocular pathology seemed to be relatively mild.

Am J Med Technol, 1977 Mar, 43(3), 226 - 8
Pathogenesis and epidemiology of opportunistic mycotic infections: a review; Rippon JW; The pathogenesis, epidemiology, and ecology of pathogenic and opportunistic systemic infecting fungi are reviewed . The pathogenic fungi including the etiologic agents of histoplasmosis, blastomycosis, coccidioidomycosis, and paracoccidioidomycosis are limited geographically, can establish an infection in a normal host, and exhibit thermal dimorphism . In contrast, the opportunist fungi (Asperigillus sp., Candida sp., Cryptococcus sp., Mucor sp., and Rhizopus sp.) are widely distributed in nature, require altered host defenses for infection, and do not exhibit thermal dimorphism . Mechanisms of pathogenesis are also discussed.

J Clin Pathol, 1977 Mar, 30(3), 254 - 61
Cryptococcal meningitis complicating systemic lupus erythematosus: two patients treated with flucytosine and amphotericin B; Speller DC et al.; Two fatal cases of cryptococcal meningitis complicating adrenocorticosteroid-treated systemic lupus erythermatosus are reported . In one patient who was treated with flucytosine alone, after an initial period of improvement cryptococci resistant to flucytosine were isolated, and subsequent amphotericine B treatment silated, and subsequent amphotericin B treatment did not alter the progress of the disease . In the second patient, who received both drugs concurrently, resistant cryptococci did not appear and the patient recovered sufficiently to return home . Flucytosine-resistant mutants could be demonstrated in vitro in the original cryptococcal isolated from both patients . The use of flucytosine and amphotericin B in combination is discussed.

Ann Appl Biol, 1977 Mar, 85(2), 301 - 4
The fungal flora of loganberries in relation to storage and spoilage; Davis RP et al.; Botrytis cinerea, Cladosporium spp., Penicillium spp., Aureobasidium pullulans, Mucor mucedo, Phoma state of Didymella applanata, Cryptococcus laurentii var . laurentii, C . albidus var . albidus, Candida sake and Sporobolomyces roseus were consistently present on freshly harvested loganberries . Botrytis cinerea was the main spoilage organism with Mucor mucedo of minor importance . The importance of benomyl-resistant strains of B . cinerea is discussed.

Ann Intern Med, 1977 Mar, 86(3), 319 - 21
Flucytosine; Bennet JE; Flucytosine is a systemic antifungal drug that is readily absorbed from the gastrointestinal tract . The most clearly documented therapeutic effect has been in cryptococcosis, candidiasis, and chromomycosis . An important limitation of the use of flucytosine in all three diseases has been drug resistance arising during therapy . The addition of low-dose, intravenous amphotericin B to flucytosine therapy of cryptococcosis has appeared to decrease the frequency of secondary flucytosine resistance . In addition, the two drugs have an additive or slightly synergistic effect against flucytosine susceptible isolates of Cryptococcus and Candida . The combination is probably the treatment of choice in cryptococcal meningitis and offers promise in the therapy of systemic candidiasis and nonmeningeal cryptococcosis.

Riv Patol Nerv Ment, 1977 Feb, 97(1), 35 - 47
{Clinical and pathological observations on a case of granulomatous encephalitis (probable criptococcal infection) (author's transl)}; Maleci O et al.; A case of granulomatous encephalitis in a 42 year old woman is reported . During the course of her illness, she showed over a short period of time a left hemiparesis, epileptic seizures and severe impairment of consciousness . Bilateral carotic angiography showed no evidence of an expansive lesion, while brain-scan presented an hyperactive area in the right parasagittal region . The cerebrospinal fluid examination demonstrated an increasing hyperproteinosis and death occurred 45 days after the first symptoms appeared . At post mortem in addition to brain edema, a soft, grey-brown discoloured area, of the size of hazel nut was found in the right limbic convolution . Histologically the abnormal tissue revealed a granulomatous structure formed by thick masses of lymphocytes, plasmacells and epithelioid cells among which vessel neoformation and hemorrhages were noted . Remarkable perivascular infiltrations were seen in the white matter, in the gray matter and in the leptomeninges also far away from the granulomatous focus . Many round yeast-like elements were observed free in the tissue as well as inglobated in large histiocytes . Although morphologically they resembled Cryptococcus neoformans organisms, the specific staining techniques for the mycoses were negative . The authors, after reviewing the various histopathological pictures of cryptococcosis in the nervous system and the modern diagnostic procedures for this mycotic infection during life, discuss the range of so-called primitive granulomatous encephalites.

J Clin Microbiol, 1977 Feb, 5(2), 236 - 43
New culture medium for the presumptive identificaion of Candida albicans and Cryptococcus neoformans; Fleming WH et al.; A new medium composed of Tween 80, oxgall, caffeic acid, and Davis agar (TOC) that provides for the rapid presumptive identification of Candida albicans and Cryptococcus neoformans is described herein . C . albicans is differentiated from other yeasts by the sequential production of germ tubes and chlamydospores . In a comparison with cormeal agar control plates, there was an increase of chlamydospore-forming strains of C . albicans (97.1% versus 87.2%) and a decrease in the time required for chlamydospore formation (24 h versus 48 h) . C . neoformans produced a brown pigment of TOC, which is specific for its identification, thus differentiating it from the other yeasts . A comparison of 24-h pigment production by C . neoformans on TOC with that of birdseed agar showed a dark, coffee brown color in the former cultures and a light brown color in the latter . The change in pigmentation of C . neoformans, as well as morphological changes in C . albicans, can be induced within 3 to 12 h and in not more than 24 h on the TOC medium.

Am J Clin Pathol, 1977 Feb, 67(2), 141 - 5
identification of Cryptococcus neoformans in cytologic preparations of cerebrospinal fluid; Saigo P et al.; Review of routine Papanicolaou-stained cerebrospinal fluid preparations from 13 patients who had meningeal cryptococcosis documented by other methods demonstrated the yeast in 11 cases . Special stains greatly facilitated the detection of the organisms in two samples and discriminated them from artifacts . An increased number of cells was present in nine cases . Correlation with the clinical data revealed that every patient but one had a malignant lymphoma, most commonly Hodgkin's disease . The exception was a patient who had disseminated carcinoma of the breast treated with adrenal corticosteroids . The clinical history and the cellularity of the smear should alert one to the possibility of cryptococcosis.

Zentralbl Bakteriol {Orig A}, 1977, 237(2-3), 378 - 94
Ocular cryptococcosis - experimental and clinical observations; Staib F et al.; During the previous studies, we could demonstrate that there are strains of Cryptococcus neoformans which after intraperitoneal inoculation, are capble of surviving only in the brain of mice without causing any apparent clinical symptom; only in about 4% of the animals the fatal involvement of the CNS occurred . The present investigations suggest that the selective involvement of eye, i.e., formation of intraocular cryptococcoma, with subsequent blindness is also possible under similar experimental conditions . It was observed that a short-lived uremia caused by intramuscular injection of 0.2 ml glycerine could enhance the rate of the selective involvement of the CNS including the eye . The uremia was controlled by the auxanographic method using STAIB's technique of serum-residual-nitrogen-auxanogram and employing the strain used for infecting the mice . These animal experiments are discussed in connection with a clinical case of intra-ocular cryptococcosis in which the only known basic disease was uremia of unknown orgin . The spontaneously healing cryptococcosis detected in this case after the treatment of uremia, has been discussed . Cases of ocular cryptococcosis described in the world literature have been also briefly discussed inconnection with our results . These microbiological observations will be supplemented by the histopathological findings to be published separately.

Am J Trop Med Hyg, 1977 Jan, 26(1), 140 - 7
Occurrence of Histoplasma capsulatum Darling, 1906 in Israel, with a review of the current status of histoplasmosis in the Middle East; Ajello L et al.; The isolation of Histoplasma capsulatum from a bat cave in the Galilee region of Israel is reported along with the discovery of a bat (Myotis myotis) infected by H . capsulatum . Soils collected in avian and chiropteran habitats throughout Israel also yielded the following fungi of medical interest: Arthroderma quadrifidum, A . tuberculatum, Candida parapsilosis, Chrysosporium indicum, C . keratinophilum, C . tropicum, Cryptococcus neoformans, Ctenomyces serratus, Microsporum gypseum, and Petriellidium boydii . All available reports concerning the occurrence of H . capsulatum and histoplasmosis in the Middle East are critically reviewed.

Bol Med Hosp Infant Mex, 1977 Jan-Feb, 34(1), 83 - 93
{Cryptococcosis of the central nervous system}; Calderon E et al.; The steps for diagnosis and treatment and the clinical course followed in three patients with Cryptococcus meningitidis are discussed . One of them was treated with 5-flurocytosine alone . Two consecutive patients were treated with a combination of 5-flurocytosine and amphotericin B . The objectives of the study were: a) to achieve a therapeutic response better than that which might be obtained with either drug alone, b) to use lower doses of 5-fluorocytosine and amphotericin B in order to reduce toxicity, c) to extend treatment only for a period of four weeks, thus decreasing the period of hospitalization . None of the patients has relapsed . A shorter time of hospitalization and reduction in toxicity, suggests that combined therapy is a safe and effective alternative to other regimens.

Mayo Clin Proc, 1977 Jan, 52(1), 42 - 5
Should yeasts in respiratory secretions be identified?
Murray PR, Van Scoy RE, Roberts GD.
Four hundred forty samples of sputa and bronchial washings were examined microscopically for evidence of pulmonary and oropharyngeal secretions . Most (88%) sputa showed definite evidence of oropharyngeal contamination, whereas bronchial washings showed much less frequent (21%) contamination . Culture results of the same specimens showed that yeasts (excluding dimorphic fungi) were recovered from 74% of the sputa and 25% of the bronchial washings . It seems that microscopic evidence of oropharyngeal contamination is a reliable index for predicting the presence of yeasts in respiratory secretions . Their presence in cultures of respiratory secretions probably represents "normal flora" except for Cryptococcus neoformans, and their routine identification is not warranted.

Contrib Microbiol Immunol, 1977, 4, 86 - 95
Cryptococcosis: a diagnostic challenge; Seeliger HP et al.; Human cryptococcosis is an exogenous human infection of increasing frequency and growing importance . Early diagnosis is essential for the clinical outcome, no matter whether the infection is primary or secondary to underlying disease . Reliable and quick diagnostic methods are outlined and some pitfalls are discussed . Direct microscopy is essential, followed by cultivation procedures and serologic tests.

Schweiz Arch Neurol Neurochir Psychiatr, 1977, 121(2), 207 - 11
Cerebral cryptococcosis . Report of an unusual case; Fabiani A et al.; A case of cerebral cryptococcosis associated with pulmonary and bone lesions is described . While discussing some general data of the literature, the authors outline the rarity of granulomatous CNS Cryptococcosis . From a clinical standpoint the similarity with tuberculous processes is emphasized . The methods of histopathologic diagnosis both intraoperatively and in permanent sections are discussed.

Chemotherapy, 1977, 23(4), 243 - 59
The influence of 5-fluorocytosine on nucleic acid synthesis in Candida albicans, Cryptococcus neoformans, and Aspergillus fumigatus; Polak A et al.; 5-Fluorocytosine (5-FC) has a rapid inhibitory effect on the synthesis of RNA and DNA in the yeast and hyphal form of Candida albicans . 5-FC has a less marked effect on the RNA and DNA content of sensitive strains of Cryptococcus neoformans and has no effect on the nucleic acid content of Aspergillus fumigatus nor of resistant strains of C . albicans and C . neoformans . 5-FC has a slower inhibitory effect on yeast cell number increase and no effect on hyphal length of hyphal phase C . albicans over a 7-h incubation period . Rapidly growing yeasts of C . albicans and C . neoformans decrease in volume and in dry weight per cell . 5-FC prevents this decrease in sensitive strains . These results have been discussed with respect to the known metabolic pathway of 5-FC, the fungistatic and fungicidal action of 5-FC and the development of resistance to 5-FC.

J Immunol Methods, 1977, 14(3-4), 231 - 41
A radioimmunoassay for human antibody specific for microbial antigens; Tew JG et al.; A simple and sensitive method for detecting and quantitating antibody specific for microbial antigens is described . Bacterial, fungal, parasitic or viral antigens attached to bromoacetyl cellulose or the intact cells themselves were added to a series of two-fold dilutions of human serum . After a short incubation period, which allowed human antibody to attach to the antigens, the complex was thoroughly washed and carbon-14 labeled anti-human light chain antibody was added to each dilution . The resulting complex was washed, collected on a filter pad, placed in a scintillation vial and radioassayed . The relationship between radioactivity bound and --log2 of the serum dilution was linear . The endpoint for each assay and a confidence interval was calculated by doing inverse prediction from simple linear regression . Results obtained using this assay indicated the presence of antibody in a pool of normal human sera specific for herpes virus and for both cell surface and intracellular antigens of Streptococcus mutans, Naegleria fowleri, and Cryptococcus neoformans . In general the dominant response was against the intracellular antigens rather than cell surface antigens.

J Clin Microbiol, 1977 Jan, 5(1), 5 - 8
Occurrence and significance of Cryptococcus neoformans in the respiratory tract of patients with bronchopulmonary disorders; Randhawa HS et al.; Cryptococcus neoformans was cultured from 13 (3%) of 469 clinical specimens examined from the respiratory tract of patients with bronchopulmonary diseases . These isolations came from 5 (2%) of 207 patients; 11 isolates were from sputum and 1 each were from bronchoscopic aspirate and empyema pus . The fungus was not cultured from the oropharyngeal washings of 101 apparently healthy volunteers . Of the 5 patients, 3 had pulmonary tuberculosis, including one with pyopneumothorax and 2 with allergic bronchopulmonary aspergillosis as the underlying disease . In the tuberculosis patient with pyopneumothorax and C . neoformans in empyema pus, the fungus was presumably a tissue invader, whereas its role could not be unequivocally ascertained in the remaining 4 patients from whom it was isolated from sputum or bronchial aspirate on at least two consecutive occasions . The question of C . neoformans being a transient resident, commensal, or incitant of benign minimal lesions in the tracheobronchial tree is discussed . A comprehensive laboratory and clinical follow-up is warranted in patients from whose sputum or bronchial aspirate C . neoformans may be cultured even though definitive signs of cryptococcosis may be lacking.

Proc R Soc Med, 1977, 70 Suppl 1, 4 - 8
Clinical and experimental evidence on miconazole for the treatment of systemic mycoses: a review; Symoens J; Intravenous treatment with miconazole brought about the recovery of 90% of patients with gastrointestinal or systemic candidosis . Miconazole given by the same route has also been found effective in the treatment of cryptococcosis, coccidioidomycosis, and paracoccidioidomycosis . Cryptococcal and coccidioidal meningitis have been cured by combined intravenous and intrathecal instillation, although treatment of aspergillosis has presented difficulty . Oral treatment was effective in curing dermatophyte skin infections and systemic mycoses caused by sensitive organisms such as paracoccidioides, blastomyces and histoplasma . The question of blood levels following oral and intravenous administration is discussed . Side effects of the drug were few, and included chills, dizziness, skin rash, itching and diarrhoea . Thus miconazole can safely be given to seriously ill patients . Its behaviour in the body is not influenced by renal insufficiency and no drug induced resistance has been reported.

Arch Dermatol, 1976 Dec, 112(12), 1734 - 40
Cutaneous manifestations of disseminated cryptococcosis; Schupbach CW et al.; Five patients with disseminated cryptococcosis had lesions on the extremities resembling cellulitis, which evolved into areas of blistering and ulceration in three patients . All had underlying disease and were medically immunosuppressed . Disseminated cryptococcosis appears to present with cellulitis or herpes-like vesiculation more commonly than is currently appreciated . India ink preparations of aspirates from areas of cellulitis or Tzanck preparations from blisters may show characteristic organisms, and make possible an immediate diagnosis of cutaneous cryptococcosis . If cutaneous infection is confirmed by performing biopsies and growing cultures, dissemination must be presumed and the patient treated with a full course of systemic antifungal therapy . With increasing awareness of cutaneous involvement, some cases of disseminated cryptococcosis will be diagnosed sooner, leading to earlier therapy and improved prognosis.

Farmaco {Sci}, 1976 Dec, 31(12), 891 - 900
Antimycotic activity in vitro and in vivo of a new hydrosoluble polyene antibiotic; Strippoli V et al.; The in vitro and in vivo activity of a new water soluble polyene antibiotic, anmed SPA-S-222, has been studied on numerous Candida and Cryptococcus species . The in vitro tests were carried out in comparison with nystatin and amphotericin B whose antimycotic properties are already well known . The inhibition of "germination" of various strains of Candida albicans was also investigated . The results show that SPA-S-222 has greater antimycotic activity than nystatin or amphotericin B . Tests on the protection afforded by SPA-S-222 in Swiss albino mice infected with C, albicans were satisfactory as regards both the total protective dose and the partial protective dose (P.D . 50%).

Surg Neurol, 1976 Dec, 6(6), 323 - 5
Post-meningitic hydrocephalus and syringomyelia treated with a ventriculoperitoneal shunt; McLone DG et al.; Following cryptococcal meningitis, symptoms of cervical syringomyelia developed in a young heroin addict . Myelography confirmed syringomyelia and angiography demonstrated severe hydrocephalus . Ventriculoperitoneal shunting resulted in complete resolution of signs and symptoms of both hydrocephalus and syringomyelia.

JAMA, 1976 Nov 29, 236(22), 2517 - 8
Diagnosis of cryptococcal meningitis; Berger MP et al.; In a patient with progressive neurological deterioration, multiple lumbar CSF studies and extensive serological testing failed to demonstrate cryptococcal infection, while a single cisternal puncture produced viable cryptococcal organisms.

Med J Aust . 1976 Nov 27;2(22):825,828.
Cryptococcosis in the Northern Territory; Lo D; This report represents a review of cryptococcosis in the Northern Territory from 1957 to 1975 . There were 26 cases over a 19-year period; 25 of these were in full-blooded Aborigines . The disease occurred throughout the rural areas of the Territory as isolated cases . There were 24 cases of cryptococcal meningitis and only two with solitary lung involvement . The overall mortality was 50% . In all five untreated cases the disease was fatal . There were eight deaths among the 20 patients receiving chemotherapy, a mortality of 40% . Lung resection was performed in six cases of localized pulmonary cryptococcosis . The outcome for these was excellent.

Proc Clin Dial Transplant Forum, 1976 Nov 19-22, 6, 13 - 9
Cryptococcosis in renal transplant patients; Tipple M et al.; First, cryptococcal infections in transplant patients can be readily diagnosed and successfully treated; aggressive, innovative uses of currently available drugs should accomplish this . Second, some drug related toxicity, mostly nephrotoxicity and hematologic, is inevitable, and patients must be carefully monitored so that these effects may be minimized . Third, anti-fungal drug assays are available and can be performed and drug levels should be monitored, with the object of obtaining levels which are both reasonably safe and maximally effective in terms of known in vitro susceptibilities of the offending pathogen.

Sabouraudia, 1976 Nov, 14(3), 313 - 7
Cryptococcus neoformans in the crops of pigeons following its experimental administration; Swinne-Desgain D; Cryptococcus neoformans (5 X 10(6) yeast cells) was given per os to 10 pigeons (Columba livia) proved to be free (crops and excreta) of C . neoformans prior to experimentation . The yeast was recovered from the droppings of 9 pigeons the day after ingestion but was still present in the droppings of 1 pigeon on the 22nd day after ingestion . The crop was much more constantly positive than the droppings and for a much longer time since positive in 9 pigeons on the first day it was still positive in 2 pigeons on the 86th day at the end of the observation period . The results of the experiment presented here and the results of previous work, indicate that C . neoformans can survive and could so be carried in the crop of pigeons.

Sabouraudia, 1976 Nov, 14(3), 261 - 3
Caprine mastitis due to Cryptococcus neoformans; Pal M et al.; The isolation of Cryptococcus neoformans from milk and its demonstration by direct microscopy has been reported in a case of caprine mastitis . This is believed to be the first instance of caprine mastitis in which C . neoformans has been implicated as the etiologic agent.

J Infect Dis, 1976 Nov, 134(5), 423 - 7
Amphotericin B and amphotericin B methyl ester ascorbate . I . Chemotherapeutic activity against Candida albicans, Cryptococcus neoformans, and Blastomyces dermatitidis in mice; Gadebusch HH et al.; Amphotericin B methyl ester (AME) has been reported to possess in vitro antifungal activity similar to that of amphotericin B and to have less intrinsic toxicity in mice and dogs . For these reasons AME has been porposed as an alternative to amphotericin B in the therapy of deep mycoses . For comparison of the therapeutic efficacy of the two polyenes in laboratory animals before initiation of studies in humans, groups of mice were infected with Candida albicans, Cryptococcus neoformans, and Blastomyces dermatitidis . Treatment consisted of two or more doses of each drug given by the intravenous route . Concurrently, studies of subacute toxicity were conducted in the same species to permit calculation of therapeutic indices . These studies have shown that AME, as the ascorbate salt, is substantially less efficacious than amphotericin B (in colloidal dispersion with sodium deoxycholate) for treatment of the fungal infections and that amphotericin B had a higher therapeutic ratio for all infections studied than did AME.

Pathology, 1976 Oct, 8(4), 293 - 7
Cerebrospinal fluid fructose-biphosphate aldolase (aldolase) activity in infectious diseases of the central nervous system; Jeffs GC et al.; Aldolase levels were estimated in the cerebrospinal fluid of patients with infectious diseases of the central nervous system . A significant rise was found in bacterial and cryptococcal meningitis but the investigation failed to elucidate the source and clinical significance of the elevated activity.

Cancer, 1976 Oct, 38(4), 1717 - 28
Bone marrow manifestations of Hodgkin's disease; O'Carroll DI et al.; Bone marrow trephine biopsies were performed on 107 previously untreated patients with Hodgkin's disease (HD) . Fifteen patients (14%) exhibited bone marrow involvement . These consisted of two of three patients (67%) with lymphocyte depletion, six of 27 patients (22%) with mixed cellularity, five of 64 patients (8%) with nodular sclerosis, and two who were unclassified . Twelve patients manifested a diffuse pattern of involvement; three, a focal pattern . In eight patients more than 70% of the marrow biopsy was replaced by Hodgkin's tissue, in one patient 50% of the marrow biopsy was replaced, and in six patients less than 30% of the marrow biopsy was replaced . Typical Reed-Sternberg (RS) cells were found in the trephine biopsies in 13 of the 15 patients and mononuclear RS variants in two . Bone marrow involvement was the only evidence of stage IV disease in 10 of the 15 patients . In addition to the 15 patients with initial involvement with HD, 11 patients without marrow involvement exhibited granulomas (six) and benign lymphocytic aggregates (five) in their trephine sections . Hematological parameters were studied in all pretreatment patients . Only in the nodular sclerosis group were these parameters useful in differentiating patients with and without Hodgkin's involvement of the marrow . Seventeen additional patients who had been previously treated at the time HD was demonstrated in their bone marrow were also studied . Large areas of necrosis were frequently seen in previously treated patients and one patient demonstrated cryptococcosis in the bone marrow.

Br J Dis Chest, 1976 Oct, 70(4), 269 - 72
Giant 'cryptococcoma' of the lung; Menon A et al.; A case is described of cryptococcosis presenting as a large round intrathoracic lesion with superior vena caval obstruction and clubbing of the fingers . The patient was satisfactorily treated by lobectomy under cover of amphotericin B therapy.

J Bacteriol, 1976 Oct, 128(1), 445 - 55
Light microscopy of basidia, basidiospores, and nuclei in spores and hyphae of Filobasidiella neoformans (Cryptococcus neoformans); Erke KH; Three hypha-forming strains of Cryptococcus neoformans were induced to form basidia and basidiospores . Light microscopy showed that basidia formed at the ends of terminal hyphal cells and were able to produce from a few to many basidiospores . The morphology of the sexual structures indicated that these strains belonged to the recently described perfect state of C . neoformans, Filobasidiella neoformans . The average dimensions of the basidiospores were 1.9 mum in width by 2.7 mum in length . Giemsa staining revealed that dikaryotic cells were formed in all three strains . Only one strain had both terminal and subterminal dikaryons, indicating functional clamp connections, whereas the two remaining strains had dikaryons restricted to the terminal cells . Basidiospores of two strains were mononucleate, and yeast cell clones derived from single basidiospores of these two strains were able to complete the sexual life cycle, thus indicating their primary homothallic nature.

Can J Microbiol, 1976 Oct, 22(10), 1518 - 21
An ultrastructural analysis of protoplast-spheroplast induction in Cryptococcus neoformans; Peterson EM et al.; Protoplasts-spheroplasts of a human isolate of Cryptococcus neoformans were prepared using the gut enzyme of Helix pomatia . The induction process, as studied by transmission electron microscopy, occurred in two stages . Early in the induction process, protoplasts-spheroplasts emerged from whole cells through a break in the cell wall-capsule envelope . Later, a gradual dissolution of the entire cell wall occurred releasing the intact protoplast-spheroplast . A comparison of protoplasts-spheroplasts with normal untreated cells revealed that the degree of cellular vacuolation as well as the resolution of cellular organelles was similar.

S Afr Med J, 1976 Sep 25, 50(41), 1604 - 6
Cryptococcal meningitis: our experience in 24 black patients; Pillay N et al.; The records of 24 patients with cryptococcal meningitis, admitted to King Edward VIII Hospital in Durban, were reviewed . There were 21 adults and 3 children over periods of 10 and 18 years, respectively . Slightly more males were affected . The age distribution was fairly even . The common clinical presentations were headache, neck stiffness, mental changes, cranial nerve palsies and papilloedema . The diagnosis was proved by the presense of Cryptococcus neoformans in the cerebrospinal fluid (CSF) in 21 of the patients, and in pathological tissue in the remaining 3 patients . A significant percentage of patients presented with an initial polymorphonuclear leucocyte predominance in the CSF . The other CSF findings were elevated protein and low sugar levels . Tuberculosis was the common coexisting disease . We found the mortality rate of 58% to be very high and a significant number of patients died even after adequate treatment with amphotericin B either singly or in combination with 5-fluorocytosine.

Can Med Assoc J, 1976 Sep 18, 115(6), 537 - 8
Occurrence of two cases of cryptococcosis within 3 months on the same general medical ward; Roberts SH et al.; Two cases of systemic cryptococcal infection occurred on the same general medical ward within 3 months . The patients had been on the same ward for 5 days . Both had other diseases associated with depression of cellular immune responses had received immunosuppressive drugs.

Schweiz Med Wochenschr, 1976 Sep 11, 106(37), 1238 - 42
{Clinical features of Cryptococcus neoformans infections}; Selz B et al.; Two cases of infection with Cryptococcus neoformans are presented . The first showed primary localization in the CNS, while the second occurred in connection with lymphoproliferative malignancy and cytotoxic chemotherapy, with the typical sequence of initial lung infection and secondary meningo-encepha-litis . The important clinical features, development and therapy of the disease are discussed in the light of this personal experience.

Infect Immun, 1976 Sep, 14(3), 716 - 20
Nature of the effector cells responsible for antibody-dependent cell-mediated killing of Cryptococcus neoformans; Diamond RD et al.; Studies were performed to identify the types of human peripheral blood leukocytes capable of killing Cryptococcus neoformans in the presence of anticryptococcal antibody in vitro . A total of 24.1 +/- 2.7% (mean +/- standard error of the mean of four experiments) of the original cryptococcal inoculum survived in a mixed mononuclear, cell preparation (approximately 30% monocytes) after 4 h of incubation at 37 degrees C with rabbit anticryptococcal antibody . When phagocytic cells were removed, there was 36.4 +/- 4.6% survival in six experiments, compared with 52.8% survival in the presence of purified granulocytes (mean of two experiments) and 96.9 +/- 1% survival in the presence of purified T cells . There was never any significant killing in control mixtures that contained leukocytes with normal rabbit serum nor in those that contained anticryptococcal antibody without effector leukocytes . Significant antibody-dependent fungicidal activity was seen with ratios of effector to target cells as low as 6.25:1 . These observations indicate that multiple types of peripheral blood leukocytes, excluding T cells, are capable of antibody-dependent fungicidal activity.

Hautarzt, 1976 Sep, 27(9), 422 - 5
{Trichosporon capitatum as pathogen of dermatomycoses}; Grunder K; Three cases of dermatomcycosis are reported, caused by Trichosporon capitatum, a yeast-like organism, belonging to genus Trichosporon of the Cryptococcaceae, which till now was isolated out of dermatological material only in a few cases . One of the lesions, characterized as "leuconychia mycotica", is a problematic task with regard to the treatment, for it is a professional infection in an offset-printer . A glycerol containing fluid for wiping his printing machine was detected as reservoir of yeastlike agents and continuously scattering infection cause . The pathogenic role of Trichosporon capitatum is discussed with regard to the present literature and to the three reported cases.

J Clin Microbiol, 1976 Aug, 4(2), 157 - 9
Evaluation of a new system for the rapid identification of clinically important yeasts; Segal E et al.; The rapid system developed by Huppert et al . (1975) for the identification of yeasts based on assimilation and fermentation patterns and on germ tube and pseudohyphal production was evaluated in a comparative study with conventional procedures . The 95 test cultures were members of the genera Candida, Cryptococcus, Rhodotorula, Saccharomyces, Torulopsis, and Trichosporon . The study revealed that approximately 94% of the isolates were correctly identified by the rapid method in comparison with the standard method . With the rapid method identification was accomplished in 72h, and with the conventional procedures identification was completed in 2 weeks . Although it was difficult with some isolates to obtain definitive speciation by the rapid method, this method promises to be especially useful in clinical laboratories for the identification of yeasts of medical importance . Modifications were made in the procedure of Huppert et al . (1975) to improve the reading of reactions . Commercial media and a disk dispenser to make the method more useful were also investigated.

Surg Neurol, 1976 Aug, 6(2), 123 - 8
Candidosis: the most common postmortem cerebral mycosis in an endemic fungal area; Parker JC Jr et al.; To determine the recent postmortem character of cerebral mycoses, 1,752 consecutive complete autopsies done in the endemic fungal area of central Kentucky from 1964 through 1973 were reviewed . Fourteen patients (0.8%) had histologically confirmed fungal infections in the brain . The most prevalent fungus was Candida spp . which was observed in six patients . Cryptococcosis was recognized in three patients; histoplasmosis in two; zygomycosis in two; and blastomycosis in one . In every patient these fungi were also seen in tissues outside the central nervous system and were identified microbiologically in nine . Unlike the pathogenic yeasts, Candida spp . and the zygomycetes produced intracerebral lesions without any significant meningeal reactions . Cerebral candidosis was recognized only at autopsy in patients compromised by previous multiple antibiotic therapy for gram-negative infections . On the other hand, immunosuppression was associated more commonly with the non-candidal fungal infections . An experimental model for systemic candidosis in adult Sprague-Dawley rats likewise demonstrated its difficult antemorten recognition even with cerebral lesions . Although clinical consequences from candidemia seem often inapparent, the associated intracerebral lesions may further compromise the altered host . Their frequency and significance remain to be elucidated.

J Clin Microbiol, 1976 Aug, 2(2), 96 - 8
Six-hour pigmentation test for the identification of Cryptococcus neoformans; Hopfer RL et al.; Cryptococcus neoformans colonies can be identified within 6 h using paper disks containing caffeic acid and ferric citrate . Indentification is based on the development of a dark brown pigment . Saprophytic Cryptococcus species and common clinically isolated yeasts do not develop the brown color . The concentration of the reagents and the method of storage of the impregnated paper disks are critical for the rapid and specific development of the pigment.

J Clin Microbiol, 1976 Aug, 2(2), 115 - 20
Caffeic acid-containing medium for identification of Cryptococcus neoformans; Hopfer RL et al.; A new growth medium containing caffeic acid and ferric citrate is described . The pigment produced on this medium is specific for the identification of Cryptococcus neoformans and differentiates it from other cryptococci . The medium is more easily compounded and requires less time for pigment formation than the conventional Guizotia extract media . The medium is stable in the dry form as well as in the prepared form.

Radiology . 1976 Aug;120(2):290.
Localized cryptococcal osteomyelitis; Woolfitt R et al.; Cryptococcal infection of the skeletal system alone is rare . The authors report a case of osteomyelitis caused by Cryptococcus neoformans involving the distal humerus and skull, with roentgenographic and scintigraphic findings and pathological confirmation.

Am J Med Sci, 1976 Jul-Aug, 272(1), 65 - 74
Infections or neoplasm as causes of prolonged fever in cancer patients; Luft FC et al.; Thirty-six consecutive patients with cancer who met the classical criteria for fever of unexplained origin (FUO) were identified . A total of 18 patients had infections including all 12 with leukemia, four of 12 with Hodgkin's disease, and two with solid tumors . Fungal infections were found in nine: histoplasmosis, three; candidiasis, three; and aspergillosis, systemic sporotrichosis, or cryptococcal meningitis, one each . Six patients had unresolved pyogenic infections and one had tuberculous pericarditis . Two others had viral etiologies . Granulocytopenia was significantly more common in the FUO patients with documented infections . Clinical or laboratory abnormalities suggesting involvement of a specific organ or organ system provided important clues indicating infections . Morphological examination of biopsy specimens, with cultures, was the best method for diagnosis . In 18 patients, 12 with lymphomas and 6 with solid tumors, only the neoplasm appeared responsible for the fever . In these patients there was a paucity of abnormalities indicating organ system involvement with infection . Regardless, physicians' diagnostic efforts should not be deterred in such patients . Repeated thorough evaluations for infection are warranted.

Mikrobiologiia, 1976 JUL-AUG, 45(4), 701 - 3
{Lipid metabolism of yeasts in relation to their ecology}; Zviagintseva IS et al.; Lipid metabolism of epiphyte and soil yeasts was found to be different depending on their ecology . The activity of lipase and lecithinase of epiphyte cultures is higher than that of soil cultures . The highest concentration of lipids was accumulated by soil yeasts, especially the Lipomyces genus . Lipids isolated from the yeast are hydrolysed by its lipase at a higher rate than olive oil, the common substrate for lipase . Lipid accumulation is detected during later stages of cultural growth when the activity of lipase decreases . No fatty acids with the number of carbon atoms below 14 and over 20 were found in cultures of the Candida genus . Fatty acids with a long chain (C22, C24, C26) are encountered more often in cultures belonging to the Rhodotorula genus cf . Lipomyces and Cryptococcus.

G Batteriol Virol Immunol, 1976 Jul-Dec, 69(7-12), 244 - 9
{Antimycotic activity in vitro and in vivo of 5-fluorocytosine on pathogenic strains of Candida albicans and Cryptococcus neoformans}; Costa AL et al.; The authors have analyzed the 5 Fluoro Cytosine (5FC) activity on strains of Candida albicans and Criptococcus neoformans, both in vitro and in vivo . In vitro the minimal inhibitory concentration (MIC) was determined; in vivo tests of pathogenicity on rabbit and mouse have been executed . The various findings obtained have shown a strong activity of the 5FC on strains of Candida and Criptococcus.

Sabouraudia, 1976 Jul, 14(2), 171 - 9
Vaccine and Mycostatin in treatment of cryptococcosis of the respiratory tract; Bemmer AM et al.; Three cases of respiratory crytococcosis are described, one diagnosed only after thoracotomy and two after cytology . All were confirmed by cultures, biological and biochemical tests . The patients are alive and well 14 years, 5 years, and 5 years after treatment with crytococcal vaccines and mycostatin . Vaccines proved very effective when given intradermally in small doses and no dangerous reactions were encountered . Cytology of the sputum appears to be a very useful tool in diagnosis of fungal infections of the respiratory tract, especially when supravital staining is used . Difficulties in diagnosis, treatment, and significance of positive sputum findings are discussed.

Infect Immun, 1976 Jul, 14(1), 62 - 7
Inhibition of phagocytosis by cryptococcal polysaccharide: dissociation of the attachment and ingestion phases of phagocytosis; Kozel TR et al.; The effects of cryptococcal polysaccharide and selected serum factors on (i) the attachment of Cryptococcus neoformans to macrophages and (ii) the subsequent ingestion of yeast cells by the macrophages were investigated . Percent attachment was measured after incubation of yeast cells with macrophages at 4 C . Percent engulfment was determined after incubation of yeast cells and macrophages at 37 C . Nonencapsulated yeast cells readily attached to macrophages at the low temperature and were engulfed at a high rate at 37 C, whereas encapsulated yeast cells attached to macrophages at low rates and were engulfed at low rates . Addition of varying doses of purified cryptococcal polysaccharide to nonencapsulated yeast cells inhibited attachment at approximately the same concentration of polysaccharide required for inhibition of engulfment . Nonencapsulated yeast cells that attached to macrophages at 4 C were eluted from the macrophages by addition of purified cryptococcal polysaccharide to the incubation medium . Heat-labile opsonins were not required for attachment of yeast cells to macrophages, but they were necessary for maximal initial rates of phagocytosis . Heat-stable components of serum facilitated attachment of cryptococci, but their most important function appeared to be triggering the ingestion of attached yeast . Specific antiserum had no effect on the attachment and engulfment of nonencapsulated cryptococci, and the antiserum produced only a small enhancement of the engulfment of encapsulated cryptococci.

Sabouraudia, 1976 Jul, 14(2), 129 - 48
A study of 3891 cases of mycoses in the tropics; Kamalam A et al.; 4103 cases suspected of mycoses were analysed as to sex, age and site of disease and 3891 were proved cases . This group formed 50% of total mycoses or 13-93% of all dermatoses recorded in the Government General Hospital, Madras, during the period of study . There were 66-26% adult female, 27-6% adult male and 6-14% were below 13 years . Dermatophytoses were found in 73-5%; the other common diseases were tinea versicolor (17-68%) and candidiasis (12-43%) . Multiple sites of involvement or more than 1 disease in the same individual were mostly observed . The incidence of piedra (0-1%) and deep mycoses (0-156%) was very low . Mycetoma was the common disease (5/6) in deep mycoses . In dermatophytoses, tinea corporis (49-71%) and tinea cruris (47-85%) commonest; tinea axillaris (3-42%), tinea capitis (1-72%) and tinea barbae (1-29%) were less common . The incidence of tinea manuum, tinea pedis and tinea unguium was similar (4-97%-6-38%) . High temperature and humidity were related to the higher incidence of tinea corporis, tinea cruris and tinea versicolor . Mainly children suffered from tinea capitis . All other mycoses were commonly found in adults between 2nd and 3rd decades . In all mycoses but candidiasis, female predominated . Cutaneous candidiasis was mainly a problem of housewives . Among the dermatophytes Trichophyton violaceum was predominant (33-7%) followed by T . rubrum (32-6%) . Trichophyton schoenleinii and M . gypseum were rarely isolated . From mycetoma, Madurella mycetomii, Nocardia braziliensis, N . asteroides and Actinomadura spp . were isolated . Demonstration of Cryptococcus laurentii in 1 case is reported in this area for the first time.

Acta Cytol, 1976 Jul-Aug, 20(4), 400 - 3
Sputum fixatives: how safe is 50% alcohol?
O'Hara CM, Birmingham SP.
It is believed that the following conclusions can be drawn from this study . 1) Fifty per cent ethyl alcohol fixative is bactericidal to 90 to 95% of the bacterial organisms present in the specimens submitted to cytology . 2) The fixative definitely appears to be selective against gram-negative organisms, both cocci and rods . 3) The fixative does not alter the ability of the organisms to take a characteristic stain . 4) The fixative does appear to alter the ability of the Histoplasma and the Cryptococcus to grow after a two-hour minimum fixation . No growth was noted after six weeks.

Arch Intern Med, 1976 Jun, 136(6), 670 - 7
Factors affecting the frequency infection in renal transplant recipients; Murphy JF et al.; A retrospective review of 149 patients receiving 162 renal transplants showed that 83% of these patients developed one or more infections during a follow-up period averaging one year . In 32 (73%) of 44 deaths, infection was an important contributing cause . In only four (9%) of the deaths were the patients free of infection at the time of death . The Klebsiella-Enterobacter group was the most common agent causing pneumonitis and sepsis . Cryptococcus neoformans caused seven of 11 cases of meningitis . Pseudomonas was the most frequent agent associated with infections documented during postmortem examinations . In a short-term controlled study comparing daily and alternate daily therapy with prednisone, the alternate daily group had significantly (P less than .05) more infections per patient, especially in patients who had no evidence of rejection (P less than .025).

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