Mouse model of X-linked chronic granulomatous disease, an inherited defect in phagocyte superoxide production

Chronic granulomatous disease (CGD) is a recessive disorder characterized by a defective phagocyte respiratory burst oxidase, life-threatening pyogenic infections and inflammatory granulomas. Gene targeting was used to generate mice with a null allele of the gene involved in X-linked CGD, which encodes the 91 kD subunit of the oxidase cytochrome b. Affected hemizygous male mice lacked phagocyte superoxide production, manifested an increased susceptibility to infection with Staphylococcus aureus and Aspergillus fumigatus and had an altered inflammatory response in thioglycollate peritonitis. This animal model should aid in developing new treatments for CGD and in evaluating the role of phagocyte-derived oxidants in inflammation.

Infectious disease rounds: pneumonia due to Aspergillus

Angioinvasive fungi, like Aspergillus, can cause invasive infections in patients immunosuppressed by steroid therapy. Pulmonary infarction, manifested as pleuritic chest pain, frequently results from in situ thrombosis and is characteristic of Aspergillus pneumonia.

Reactivation of coccidioidomycosis in pregnancy

A woman presented in the third trimester with a recurrence of coccidioidomycosis. She had been treated 5 years earlier for coccidioidal meningitis. We induced delivery, and both mother and infant had favorable outcomes. We believe that this case represents a reactivation of the previously treated disease.

[A case of lung cancer suspected to be pulmonary mycosis of the fungus ball type]

This paper reports a 73-year-old male case of lung cancer presenting as thin-walled cavity which was suspected to be pulmonary mycosis of the fungus ball type. Routine chest X-ray film showed a thin-walled cavity without a round shadow inside it. CR tomogram taken 2 months after the previous plain chest X-ray film showed an irregular thickening of the cavity wall and a round shadow inside it. Pulmonary mycosis of the fungus ball type was suspected based on the CR tomogram. But chest X-ray CT film taken 1 month after the previous CR tomogram revealed that the entire cavity wall was thickened with irregular convexity and no round shadow was seen in the cavity. Cavitary lung cancer was also suspected based on the findings of X-ray CT film. The surgical specimen, obtained by right upper lobectomy, revealed a moderately differentiated squamous cell carcinoma unaccompanied by pulmonary mycosis in the cavity space. Even in cases suggestive of mycosis, aggressive surgical intervention is recommended in those suspected of malignancy.

Blastomycosis in Namibia--report of a case successfully treated with itraconazole

The clinical, histological, mycological, radiological and scintigraphic features of a 42-year-old Namibian male with blastomycosis are described. This appears to be the first documented incidence of blastomycosis in Namibia. Leucocyte myeloperoxidase deficiency was evident. Treatment with itraconazole led to dramatic resolution of lesions. A reactive xanthogranulomatous response was present in a healed clavicular lesion.

[A case of primary pulmonary cryptococcosis]

A 53-year-old male was admitted because of an abnormal chest roentgenogram showing a solitary tumor shadow in the right upper lung field. Laboratory data was normal. Although examination with the bronchoscope and sputum cytology showed no abnormal findings, a partial resection of the right upper lobe was performed. Microscopic examination of the lesion was cryptococcosis. As another focus was not found by systemic examination, the lesion was disclosed primary pulmonary cryptococcosis. Cryptococcosis is rare but we must think of it when we meet a solitary tumor shadow on the chest roentgenogram.

[A case of primary pulmonary cryptococcosis showing spontaneous recovery]

A 37-year-old woman was admitted with fever and cough. The chest roentgenogram revealed a solitary large round mass in the right lower lung field. Diagnosis was made by transbronchial lung biopsy. There was no evidence of abnormal cell-mediated immunity. The patient made an uneventful recovery and the chest X-ray showed progressive clearing without specific therapy. After 6 months, the mass lesion disappeared. This case suggests that specific therapy may not be necessary for all cases of primary pulmonary cryptococcosis.

Aspergillosis

The wide spectrum of disease states caused by fungi of the genus Aspergillus is dependent in large measure on environmental conditions leading to exposure, and to local and systemic host defenses. Allergic aspergillosis occurs in individuals hypersensitive to the fungus and is treated by immunosuppression, whereas invasive aspergillosis predominates in the severely immunocompromised and is treated with antifungal therapy. Aspergillomas generally arise from saprophytic colonization of a pre-existing pulmonary cavity with Aspergillus, and may be complicated by life-threatening hemoptosis.

Self-limited blastomycosis: a report of 39 cases

We report 39 patients with pulmonary blastomycosis who were not treated with specific antifungal chemotherapy. Fourteen of these patients were recognized during an epidemic of blastomycosis in 1972 and did not have culturally proven disease. The remaining 25 patients were all proven instances of blastomycosis, 24 of whom had pulmonary disease only. Over a median observation period of 42 months (range: 12 to 168) one patient relapsed 52 months after the original diagnosis, while all of the others have remained clinically well. It is our belief that certain patients with blastomycosis limited to the lungs may safely be followed without specific antifungal chemotherapy until clearing occurs. These include patients with mild or no symptoms and those who have been more symptomatic but are already improving when the diagnosis is established. Worsening of the clinical picture, or evidence of extrapulmonary disease requires immediate antifungal chemotherapy.

Pulmonary phycomycosis without obvious predisposing factors. A case report

A previously healthy infant developed congestive cardiac failure and an acute respiratory tract infection and died 4 days after the onset of illness. Autopsy showed pulmonary phycomycosis. Published reports on cases of pulmonary phycomycosis in which no predisposing factor was known are reviewed.

Allergic bronchopulmonary stemphyliosis

A patient is described in whom a clinical picture resembling allergic bronchopulmonary aspergillosis was found to be caused by hypersensitivity to the fungus Stemphylium lanuginosum. Bronchopulmonary reactions to antigens other than Aspergillus may be more frequent than is currently believed.

Mouse model of pulmonary blastomycosis: utility, simplicity, and quantitative parameters

A murine model of pulmonary mycotic disease using Blastomyces dermatitidis is defined quantitatively. Intranasal inoculation with yeasts avoids delays in growing microconidia and can be performed with routine precautions without sophisticated biohazard facilities. The particles rapidly reach the bronchioles and alveoli, producing a progressive focal pneumonia, studied histologically. In vitro growth conditions are defined to titer inocula reproducibly with visual methods. Median survival can be titrated with the challenge inocula. Although initial postchallenge lung cultures are not always positive, replication eventually proceeds, at a rate defined for various challenge sizes, to a ceiling of 10(7) to 10(8) colony-forming units per g of tissue incompatible with life. Lung weight correlates closely with colony-forming units per g above a threshold. Lethality correlates with initial body weight and with age. During the course of infection, weight is an accurate predictor of mortality. Extrapulmonary dissemination occurs as a premortem event in protracted infections. A wide variation in fungal strain virulence is documented. Quantification of these features of the model makes it useful for study of host response or therapeutic intervention, because efficacy can be related to stage of disease and parasitic burden.

Sporotrichosis: an unusual disseminated cutaneous case and a fatal pulmonary case

Two unusual cases of sporotrichosis are presented. One patient had disseminated vesicular skin lesions which yielded Sporothrix schenckii on culture. The other, with extensive pulmonary sporotrichosis, continued to have sputum cultures positive for S schenckii during three years of intensive chemotherapy.

[Physiopathology and clinical aspects of respiratory tract infections. Review]

A topographical account is given of the (mostly viral) infections that strike the upper airways and the lung parenchyma sites caused by bacteria, Mycoplasma, Rickettsiae and fungi. The different features of the three main syndromes that ensue: obstructive and restrictive ventilatory insufficiency, and alveolo-capillary block, are examined. The need for care in the administration of antibiotics is stressed, since germ resistance must be restricted as far as possible. In the case of chronic forms of lung disease, careful clinical surveillance and active therapeutic management are mandatory to prevent the establishment of irreversible, incapacitating consequences.