Case reports: tinea corporis in a 13-year-old German girl due to Trichophyton schoenleinii. Fallbericht. Tinea corporis in einem 13jahrigen Madchen verursacht durch Trichophyton schoenleinii

We report the first case of a tinea corporis with partly profound lesions in a 13-year-old girl on her arms, legs and trunk due to Trichophyton schoenleinii but without any lesion on scalp and hair. Moreover, this is the first case of an infection with Trichophyton schoenleinii in Germany since more than 40 years. The diagnosis was confirmed by microscopy of mycological specimens. Other causes of the skin symptoms could be excluded (atopic dermatitis, bacterial or other fungal infection). Clinical and epidemiological aspects of this anthropophile dermatophyte are briefly reviewed.

[Therapy problems in chronic recurrent vaginal mycosis]

Vulvovaginal candidiasis is one of the most frequent infectious diseases. The mainly acute forms occur sporadically, have an uncomplicated course and can mostly be treated effectively with topical antimycotics. However, chronic infections are almost always a therapeutic problem. In most cases, systemic therapy is indicated. Since some mycoses cannot be treated effectively with fluconazole and itraconazole, prior identification of the causative agent is obligatory. Treatment of chronic vulvovaginal candidiasis also comprises identification and clearance of existing endogenous (oral cavity, intestine) and exogenous (sex partner) sources of reinfection. The following three-ponged treatment is suggested: (1) depending on the colonization status, selective orointestinal fungal decontamination with a polyene antimycotic, (2) depending on the kind of fungal pathogen systemic treatment with fluconazole or itraconazole, (3) topical treatment using ciclopiroxolamine as a synergistic combination partner.

Candida africana sp. nov., a new human pathogen or a variant of Candida albicans?

Atypical Candida strains were isolated from patients in Madagascar, Angola and Germany. These isolates were slow growing and were unable to produce chlamydospores. They had atypical carbohydrate assimilation profiles. All strains were unable to assimilate the amino sugars N-acteylglucosamine and glucosamine as well as the disaccharide trehalose and the organic acid DL-lactate. They were germ-tube-positive in serum, but only some of these organisms produced pseudohyphae after a long incubation. As shown by Fourier transform infrared spectroscopy the atypical Candida isolates clustered as a monophyletic group different from C. albicans and C. dubliniensis. All strains belonged to C. albicans serotype B. Considering all data presented here, this group of Candida strains differs from any other known member of the genus Candida. Therefore, it is suggested to represent a new species within the genus Candida for which the name Candida africana is proposed.

Incidence of endomycoses in autopsy material

From 1970 to 1993, 93 endomycoses confirmed by postmortem examination were diagnosed in the autopsy material of the Berlin Charité, a large hospital with an average of 1,500 Hospital beds and maximum medical care. These comprised 51 candidoses (54.8%), 24 aspergilloses (36.5%), five cryptococcoses (5.4%), one zygomycosis, one trichosporosis and one coccidioidomycosis. This corresponded to 0.7% of the 13,275 deceased persons autopsied during this period. The frequency of autopsy was 85.3%. In 3,770 cases (2,418 adults and 1,352 children), brain dissection was performed. An adequate clinical putative diagnosis was made in only six out of 28 patients (18 adults, 10 children) with histologically confirmed cerebral mycosis: 11 candidoses (39.3%), 10 aspergilloses (35.7%) five cryptococcosis (17.8%), one trichosporosis and one coccidioidomycosis. About 80% of the mycoses of the CNS thus remained undetected while the patients were alive. The observations made in the present paper underscore the importance of clinical autopsy in endomycoses.

One week terbinafine 1% cream (Lamisil) once daily is effective in the treatment of interdigital tinea pedis: a vehicle controlled study. LAS-INT-06 Study Group

Duration of therapy is an important factor determining patients' compliance in dermatomycosis clinical practice. We undertook a prospective, randomised, double-blind, parallel group study to investigate the efficacy and tolerability of once daily treatment with terbinafine 1% cream for 1 week, compared to its vehicle, in adult patients with interdigital tinea pedis. Efficacy was assessed in terms of mycological cure, total clinical signs and symptoms scores, and clinical response, 1 day and 1, 5 and 7 weeks after end of treatment. Terbinafine 1% cream was significantly more effective than its vehicle in achieving and maintaining mycological cure for 7 weeks: 91.4% vs. 37.1%, P < 0.001. Terbinafine was also significantly more effective than its vehicle in reducing total clinical signs and symptoms scores, and in achieving clinical response. We conclude that terbinafine 1% cream, applied once daily for 7 days, is an effective and well-tolerated treatment for interdigital tinea pedis in nonimmunocompromised patients. The short duration of treatment needed to achieve mycological cure has important implications for patient compliance and for control of infection within the community.

[Results of the first dermatomycoses quality control study in Germany]

For the first time in the history of German mycology, a multicenter study for identification of dermatophytes, yeasts and molds was conducted under the auspices of the German Speaking Mycological Society and the German Dermatological Society. A total of 1,008 dermatological offices and dermatology hospitals as well as 106 institutes of microbiology participated in this voluntary quality control trial. They were requested to identify four pathogens: Trichophyton tonsurans, Trichophyton mentagrophytes, Aspergillus niger, and Candida glabrata. T. tonsurans was correctly determined by 749 participants (67.2%), T. mentagrophytes by 974 (87.4%), A. niger by 922 (82.8%) and C. glabrata by 973 (87.3%). Four pathogens were identified at the species level by 591 investigators (53.1%). Three species were correctly identified by 310 investigators (27.8%), two by 143 (12.8%) and 0-1 by 70 (6.3%). The first dermatomycological quality control study in Germany may therefore be considered a success. Further trials will be carried out, initially at intervals of one year.

[Genetic structure of geographically different populations of candida albicans]

Codominant single-locus markers were developed by amplifying genomic DNA of C. albicans with pairs of random primers. Monomorphic PCR products were screened for polymorphisms by the SSCP technique. Sequencing confirmed that SSCP's were mostly due to single nucleotide substitutions in the polymorphic fragments. A total of 85 polymorphic loci were observed within 13 PCR fragments. Populations from Africa displayed less genotype variation than the populations from Europe and USA. Two genetically similar African C. albicans populations exhibiting an atypical biotype were strictly clonal and perhaps represent a geographically distributed clone. Analyses of "typical" C. albicans populations of different geographical origin provided however evidence for both clonality and recombination. Evidence for clonality was supported by the absence of segregation genotypes, and by deviation of genotypic frequencies from Hardy-Weinberg expectations. Tests for nonrandom association of alleles across loci revealed less evidence for linkage disequilibrium than expected for strictly clonal populations. Although all C. albicans populations tested were primarily clonal, evidence for recombination suggests that sexual reproduction or some other form of genetic exchange occurs in this species.

[Antifungal susceptibility testing in chronically recurrent vaginal candidosis as basis for effective therapy]

The chronically recidivist vulvo-vaginal candidiasis is one of the most stubborn problematic diagnosis in the dermatology and gynaecology ward. Prognosis and therapy are primarily determined by the causative micro-organism and the interaction of the fungal species with the currently available antifungal agents. Objective of the study was the investigation of vaginal yeast isolates from patients with chronically recidivist vaginal candidiasis against 8 antifungal agents with the aim of optimising the standard therapy with azole antifungal agents and assessment of alternative therapy schemes. 55 clinical isolates (Dermatology, Charité) of 40 patients were tested by microdilution according to DIN 58940-84. Species differentiation and identification was performed by Fourier-Transform Infrared Spectroscopy (FTIR). In the result Candida glabrata was the predominant causative agent for the recidivist vaginal candidiasis. MIC-mode values for C. glabrata were: fluconacole 32 micrograms/ml, itraconacole 1 microgram/ml, ketoconacole 1 microgram/ml, amphotericine B, voriconacole 0.03 microgram/ml, amphotericin B 0.5 microgram/ml, terbinafine 128 micrograms/ml, cicloproxolamine 4 micrograms/ml, 5-fluorocytosine 0.03 microgram/ml. Some strains of Patients with suboptimal introductory low doses of fluconacole showed increasing of MIC in course of therapy. Parallel resistance with itraconacole was observed in all these cases. Consecutively isolated strains could be clearly and reliably identified by FTIR. In conclusion of most importance is the initial dose adapatation of the drug used, e.g. for fluconacole 800/d p.o., when C. glabrata is the causative agent. Low dose fluconacole therapy is always unsuccessful in recurrent vaginal candidiasis and induces secondary resistance. Demonstrated high susceptibility of voriconacole, amphotericine B an 5-fluorocytosine particularly for C. glabrata may indicate of an anitmycotic therapy potential unconsidered regarding to dermatological indication up to now.

[Candida antigen and antibody kinetics during antifungal therapy in non-neutropenic intensive care patients]

The present study aimed at determining Candida antigen and antibody kinetics during antifungal therapy. 115 non-neutropenic patients with a stay of more than 5 days in an interdisciplinary intensive care unit during a period of 2 years were reviewed. Routinely measured Candida antigen and antibody titers were evaluated at the beginning and during antifungal therapy. In 67 patients serological data were evaluable in defined time slots. Under fluconazole therapy (FT) the median of Candida antigen (Ramco) was 1:4 and did not change significantly. Candida antibody level increased from 1:80 to 1:320. Initial titers between FT and amphotericin B/5-fluorocytosine therapy (AT) showed a significant difference. During AT antigen titers decreased from 1:8 to 1:4 while antibody titers kept constant at a level of 1:160.

Isolation of both Sporothrix schenckii and Nocardia asteroides from a mycetoma of the forefoot

Mycetoma is a localized primary subcutaneous infection due to fungi (eumycetoma) or aerobic actinomycetes (actinomycetoma). We report a patient who acquired an implantation infection on the forefoot following a motorcycle accident in Crete. Both Sporothrix schenckii and Nocardia asteroides were isolated simultaneously from the lesion. Under combined therapy with itraconazole and trimethoprim-sulphamethoxazole for 7 months the lesion healed completely. A combination of causative organisms in mycetomas is rare, and the combination of S. schenckii and N. asteroides together has not been reported from one lesion.

An epidemic of tinea corporis caused by Trichophyton tonsurans among children (wrestlers) in Germany

An outbreak of tinea corporis due to Trichophyton tonsurans among 46 children (aged 7-17 years) was investigated. Most of them were wrestlers. Thirty-one strains were identified by conventional methods, but proved to be problematic in 15 isolates due to colony variation and reduced sporulation. They were identified as Trichophyton tonsurans by the use of molecular methods, for example, sequence comparison of the ribosomal internal transcribed spacer (ITS) region and polymerase chain reaction fingerprinting. No DNA polymorphisms were detected with any of the techniques used, suggesting clonal reproduction of the populations of the species and providing evidence for spatial and temporal stability of the lineage.

Tinea capitis in Germany. A survey in 1998

Under the assignment of the ECMM (European Confederation of Medical Mycology) a survey regarding frequency, infectious spectrum and therapy of tinea capitis was conducted in Germany in 1998. In this survey 154 dermatology practitioners and 19 hospitals throughout Germany participated. There were 394 conditions reported, 377 with and 17 without identification of the infectious agent. The most frequent infectious agent was M. canis (n = 216; 54.8%) before T. mentagrophytes (n = 58; 14.7%), T. verrucosum (n = 32; 8.1%), T. violaceum (n = 24; 6.1%) and T. tonsurans (n = 15; 3.8%). Zoophilic dermatophytes (n = 306; 81.2%) predominated over anthropophilic species (n = 71; 18.8%) in the ratio of 4:1. Tinea capitis microsporica showed to be a more frequent infectious disease again which due to its high virulence and contagiosity of the infectious agent represents a therapeutical problem. Tinea capitis occurred in an average age of 17.3 years. The preferred therapeutical regimen was a combination of systemic and topical antimycotics in 61.5% (n = 176) of the reported cases (n = 286). A solely topical or systemical monotherapy was reported in 25.2% (n = 72) respectively 13.3% (n = 38) of the patients. In case of systemic antimycotics the most frequent used drugs were griseofulvin (43.0%, n = 101), fluconazole (25.1%, n = 59) or itraconazole (18.7%; n = 44), in topical preparations ciclopiroxolamine dominated (53.3%, n = 121) prior to clotrimazole (13.2%, n = 30) and terbinafine (7.1%, n = 16). Different from the situation in Germany and in Southern Europe some of the western European countries show a tendency of an increase of anthropophilic agents in tinea capitis.

Assessment of genetic relatedness of vaginal isolates of Candida albicans from different geographical origins

PCR fingerprinting with single non-specific primers was used to type vaginal isolates of C. albicans from Portugal, Angola, Madagascar, and two regions of Germany (Berlin and Munich). In addition to analysing isolates that exhibited the normal biotype of C. albicans, the study included atypical strains that failed to assimilate glucosamine and N-acetylglucosamine, which were isolated from women in Angola and Madagascar. A total of 212 strains of C. albicans were studied, representing 87 different multi-locus genotypes. The genotypes of strains from each geographical population were highly similar but not identical. There was one exception: a strain from Portugal grouped with the typical strains from Angola. The typical and especially the atypical populations from Africa displayed less genotype variation than the populations from Europe. The Portuguese samples exhibited the greatest genotypic heterogeneity. Distance analysis (UPGMA) revealed a statistically weak correlation between genotype and geographical origin of the C. albicans isolates.

Case report. Osteomyelitis caused by high resistant Candida guilliermondii

We describe a case of a 57-year-old patient with osteomyelitis at a finger of his right hand caused by Candida guilliermondii. The strains isolated were highly resistant to fluconazole and itraconazole. Using the three methods, microdilution, agardilation and E-test, the highest minimum inhibitory concentrations (MICs) amounted to > 256 micrograms ml-1 for fluconazole and > 32 micrograms ml-1 for itraconazole. To our knowledge, this is the first time such high values have been described for C. guilliermondii. They correlated with the therapeutic non-response to a triazole therapy in our patient. The patient was cured by partial amputation of the affected finger.

Development of an oligonucleotide probe specific for Trichophyton rubrum

A species-specific DNA probe was developed to detect the dermatophyte species Trichophyton rubrum. The selected oligonucleotide sequence is derived from the highly variable internal transcribed spacer 2 region of the ribosomal DNA operon. The specificity of the non-radioactive labelled oligonucleotide probe was tested against related dermatophytes, other eukaryotic microorganisms and against human DNA. No cross-hybridization was found, and hybridization signals were invariably detected in all T. rubrum strains investigated. In addition, no homologous sequences were found searching the EMBL database. Experiments to establish a method for isolating DNA directly from clinical specimens gave successful amplification and hybridization products in about 30% of the samples.

[Incidence of endomycoses in the autopsy material of the Berlin Charité Hospital]

From 1970 to 1993, a total of 93 endomf1p4es confirmed by post-mortem examination was diagnosed in the autopsy material of the Berlin Charité, a large hospital with an average of 1,500 hospital beds and maximum medical care. These comprised 51 candidoses (54.8%), 24 aspergilloses (36.6%), five cryptococcoses (5.4%), one zygomycosis, 1 trichosporosis and one coccidioidomycoses. This corresponded to 0.7% of the 13,375 decreased persons autopsied during this period. The frequency of autopsy was 85.3%. In 3,770 cases (2,418 adults and 1,352 children), brain dissection was performed. An adequate clinical putative diagnosis was made in only six out of 28 patients (18 adults, 10 children) with histologically confirmed cerebral mycosis [11 candidoses (39.3%), 10 aspergilloses (35.7%), five cryptococcoses (17.9%), one trichosporosis and one coccidioidomycosis]. About 80% of the mycoses of the CNS thus remained undetected while the patients were alive. Against the background of the continuing reduction in the frequency of autopsy in the Federal Republic of Germany, the observations made in the present paper underscore the demand for improved efficiency of mycological in-vivo diagnoses in the hospital and laboratory.

[Dermatomycosis caused by Trichophyton verrucosum in mother and child]

In recent years, there has been an epidemiological renaissance of zoophilic dermatophytoses caused by a variety of factors. At present, the most important causative organisms are Microsporum canis, Trichophyton mentagrophytes var. granulosum and, as in the present case, Trichophyton verrucosum. These are formerly notifiable pathogens which are highly virulent and contagious. The example of an extensive, originally unrecognized tinea corporis et faciei in mother and child presented here shows the current importance of Trichophyton verrucosum, but also the diagnostic difficulties in dealing with a formerly rare infection disease. The inflammatory symptoms of deep trichophytosis with imminent danger of scar formation was the basis of synergistic combination therapy in the two patients. The source of infection for zoophilic dermatomycosis at the beginning of the epidemiological increase were looked for almost exclusively in Mediterranean countries. However, there are now increased indications of indigenous pools. In view of the neglect of consistent immunization of livestock and the lack of a requirement to notify the disease, a further rise in the number of cases in humans is to be expected.

Stimulation of human immunodeficiency virus expression in permanent monocytic cells by Sarcocystis gigantea extract

As recently reported, a strong stimulation of noninfected CD4+ H9- cells by Sarcocystis gigantea (syn. S. ovifelis) extract (SGE) was observed using the lymphocyte proliferation assay. After SGE prestimulation, human immunodeficiency virus (HIV)-infected H9+ cells showed an exacerbation of viral replication. In the present study we investigated the reactivity of HIV-infected human monocytes using SGE. The highly sensitive p24 core-profile enzyme-linked immunosorbent assay (ELISA) was used to examine directly the amount of HIV produced. Experiments were performed using U937 permanent monocytic cells. Permanent incubation as well as preincubation with SGE before virus infection stimulated HIV expression in all the cells. In U937 cells the viral release per cell was 64 times higher on permanent stimulation with 320 microg SGE relative to controls and 9 times higher following prestimulation.

Identification of common dermatophytes (Trichophyton, Microsporum, Epidermophyton) using polymerase chain reactions

Polymerase chain reaction (PCR) fingerprinting detected DNA polymorphisms among frequently isolated species and strains of the genera Trichophyton, Microsporum and Epidermophyton. The patterns generated by this DNA-based method permitted species and strains to be identified. The conventional methods to identify dermatophytes rely on the expression of characteristic morphological features, as well as several physiological properties. Identification is often delayed or problematic because isolates may be slow to form conidia or produce atypical microscopic structures or colony appearances. Using non-specific primers such as (AC)10, (GTG)5, M13 core sequence and AP3, characteristic PCR profiles were generated for 17 species. Intraspecies variables were also observed for four of six varieties of T. mentagrophytes, whereas no detectable DNA variability was found within the three varieties of T. tonsurans. Comparing species-specific PCR fingerprints of clinical isolates with those of type strains, species could be identified by their PCR fingerprints, even if they could not be identified by the accepted phenotypic characteristics.

[Prerequisites for effective therapy of chronic recurrent vaginal candidiasis]

67 women with chronic recurrent or persistent vaginal candidosis between 5-79 years of age were seen in our outdoor department. In 34 cases, yeasts could be isolated in a vaginal swab taken at the first consultation. On average the patients reported 5 episodes per year during the last years. Typical symptoms consisted of pruritus vulvae, local inflammation and a curdy vaginal discharge. Nearly all of the women had received local or systemic antimycotic treatment for several times. In 53% (18 patients), C. albicans had been isolated, in 29% (10 patients) C. glabrata and in 9% (3 patients) C. krusei. While candidosis due to C. albicans and C. krusei was frequently associated with distressing complaints, infections with C. glabrata caused only very few symptoms. Independent of the species, severe and persistent infections were characterized by long term persisting specific IgM-antibody-titers and remarkable lack of IgG-antibodies. The laboratory parameters of WBC, CRP and immunelectrophoresis were normal. The minimum inhibitory concentrations (MIC) of 60 Candida strains against fluconacole were determined by microdilution assay. The MIC for C. albicans (n = 35) were between 0.78 and 3.125 micrograms/ml, for C. glabrata (n = 20) between 8 and 32 micrograms/ml and for C. krusei (n = 5) between 25 and 128 micrograms/ml. In 7 cases, local antimycotic treatment was sufficient. Correlating to the sensitivity, 18 women were treated with 100-800 mg fluconacole/d for 10-20 days. In 13 of them, clearance of symptoms and yeasts was achieved. The treatment of fluconacole-resistant strains with itraconazole (100-200 ml/d for 10-20 days) together with local application of nystatin (2 x 1 Mio. IE for 10 days) was without any effect. Three women with C. albicans, C. glabrata and C. krusei infection received a candidin-vaccination (0.005 BE/ml-500 BE/ml). In all of these cases, production of IgM-antibodies was induced. However, the clinical symptoms could not be influenced. Only in two cases it was not possible to reach a clearance of symptoms and yeasts. The results show the benefit of a precise differentiation before therapy. Serologic controls of antibody titers seem to be useful tools to control the efficacy of treatment.

[Application of molecular biological methods for diagnosis and epidemiology of human fungal infections]

For mycological diagnosis molecular methods can be applied to detect the pathogen directly without prior cultivation and to identify species and subspecies. For the detection of infecting agents specific DNA probes and/or the polymerase chain reaction (PCR) are widely used, whereas normally only PCR can provide sufficient sensitivity for the direct detection of pathogens in clinical material. Prospects and limitations of PCR approaches for the detection of pathogenic fungi reported in the literature will be discussed. DNA polymorphisms which are useful for species identification and epidemiological strain typing of medically relevant fungi can be detected by such methods as the analysis of restriction fragment length polymorphisms (RFLP), and Southern hybridization with appropriate DNA probes, and as karyotyping by pulsed field gel electrophoresis (PFGE). These techniques which could be applied successfully to different epidemiological studies are, however, laborious and time consuming. By using a PCR-fingerprinting method which can be performed much simpler polymorphic DNA regions are amplified with different non-specific primers. Distinctive and reproducible sets of amplification products were observed for 26 different Candida and 8 other fungal species. The number and size of the amplification products obtained were characteristic for each species. By comparing species-specific PCR-fingerprints of clinical isolates with those of reference strains, clinical isolates could be identified to the species level even if they could not be identified by conventional typing methods. With all primers, PCR-fingerprints also displayed intraspecies variability. Therefore, PCR-fingerprinting can also be applied for epidemiological strain characterization among medically relevant fungi.

Rapid identification of Candida species by DNA fingerprinting with PCR

DNA polymorphisms in different species and strains of the genus Candida were assessed by amplifying genomic DNA with single nonspecific primers. This PCR method employed an arbitrary primer (the 10-mer AP3), a primer derived from the intergenic spacer regions (T3B), and the microsatellite primers (GTG)5 and (AC)10. Distinctive and reproducible sets of amplification products were observed for 26 different Candida and 8 other fungal species. The numbers and sizes of the amplification products were characteristic for each species. All yeast species tested could be clearly distinguished by their amplification patterns. With all primers, PCR fingerprints also displayed intraspecies variability. However, PCR profiles obtained from different strains of the same species were far more similar than those derived from different Candida species. By comparing species-specific PCR fingerprints of clinical isolates with those of reference strains, clinical isolates could be identified to the species level even if they could not be identified by routine biochemical methods.

[Effect of Sarcocystis gigantea extract (SGE) on the replication of human immunodeficiency virus (HIV)]

Basis of this study were the previous findings regarding isolation and characterization of a Sarcocystis gigantea lectin (SGL) especially the activation of human mononuclear cells (CD3+, CD4+, CD8+, Mø, B-lymphocytes). HIV-susceptible, immortaliced cell lines (H9-, MT-4) should be investigated to examine their reactivity against SGE which contains this strong mitogen. Using lymphocyte proliferation assay a strong stimulation of noninfected CD(4+)-positive H9-cell by SGE was observed. HIV-infected H(9+)-cells showed after SGE stimulation (20-160 micrograms) an exacerbation with an optimum at day 4. The virus replication in the H(9+)-hostcells was 13 times stronger. This result could also be detected indirectly because of the higher cytotoxicity in the MT-4 cell system. Cytopathogeny was measured by MTT cellvitality assay. In parallel, the high sensitive p24 core Profile-ELISA was used to directly examine the amount of produced HIV. In case of the H(9+)-cells the virus release per cell was 5 times higher after SGE stimulation compared with control.

Phenotypic and genotypic characterization of unusual vaginal isolates of Candida albicans from Africa

As expected by its global prevalence, the most frequently isolated species of yeast from vaginal swabs obtained from patients in Africa was Candida albicans, which accounted for 53 of 85 (62.4%) of the isolates from women in Madagascar and 35 of 54 (64.8%) of the culture-positive women in Angola. However, 40% of the Madagascan and 23% of the isolates from Angola, as well as two isolates obtained from one German patient, were not able to utilize the amino sugars glucosamine and N-acetylglucosamine as the sole carbon source. These isolates were able to form germ tubes but did not form chlamydospores. The correct identification as C. albicans was made possible only by using a PCR-based method of DNA fingerprinting. Only minor phenotypic and genotypic variation was observed among these strains. Whether they represent a distinct clone that is found mainly in Africa is not clear. The relevance of the amino sugar catabolic pathway in C. albicans is discussed in view of these results.

[Changes in the fungal spectrum of dermatomycoses]

The spectrum of aetiologic agents isolated from 3607 patients suspicious for dermatomycosis being in the care of the Berlin Charité Clinics was analysed. Identification of dermatophytes and moulds were performed conventionally. For the identification of yeasts biochemical and genetic methods were used. Among the dermatophytes in comparison of present with previous incidence rates changes can be observed. Opportunistic yeasts are recognized in increasing importance. Five fungal species are forming a stable base of aetiologic agents of dermatomycoses, i.e. Trichophyton rubrum, T. mentagrophytes, Candida albicans, C. parapsilosis and Trichosporon cutaneum, completed by increasing incidence of Microsporum canis, T. mentagrophytes var. granulosum and T. tonsurans.

Persistent pulmonary lesion in a patient with rheumatoid arthritis

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Invasive metastasing pulmonary aspergillosis under polychemotherapy

We report on a female patient who received a polychemotherapy because of an extensive pemphigus vulgaris. Under this therapy, the general condition of the patient worsened. Noncharacteristic symptoms, such as dyspnoea and tachycardia occurred. In spite of comprehensive, also invasive diagnostics, pulmonary foci demonstrable by X-ray morphology and computer tomography could not be specified. In the course of treatment, a cerebral compression symptomatology developed. Post mortem, a pulmonary aspergillosis with abscess-formation in the brain was found. The antigen identification completed the diagnosis. The increasing significance of Aspergillus infections is pointed out. The results of clinical examination and the differential diagnosis as well as the possibility of the diagnosis of pulmonary aspergillosis are demonstrated.

Identification of clinical strains of Candida albicans by DNA fingerprinting with the polymerase chain reaction

DNA polymorphisms generated by the polymerase chain reaction (PCR) were used to differentiate clinical isolates of Candida. This PCR method employed single primers that were originally designed as hybridization probes for DNA fingerprinting experiments to probe minisatellite and microsatellite DNA sequences. To evaluate this procedure, 35 isolates from 20 patients in several intensive care units and 12 isolates obtained from the oral cavities of healthy dental patients were fingerprinted. The PCR-fingerprint patterns of isolates of Candida albicans from the immunocompromised patients revealed fewer differences than isolates from the dental service. Multiple isolates from different body sites of the same patients revealed that patients may harbour isolates of Candida with the same or different PCR-fingerprints. Since this method is generally simpler and faster than established methods of biotyping medically important yeasts, PCR-fingerprinting may prove useful for the surveying of large numbers of pathogens for epidemiological studies.

Induction of human cord blood lymphocyte proliferation by type III group B streptococci

In a preceding communication, the authors have described the selective adherence of group B streptococci (S. agalactiae) to human neonatal lymphocytes. In the present one, it has been shown that cord blood lymphocytes obtained from healthy newborns possess the ability to develop proliferative responses in the presence of type III group B streptococci. When investigating the influence of these bacteria on both adult and neonatal mononuclear cells (MNC), the following patterns of adherence and lymphocyte reactivity could be observed: (1) Type III group B streptococci adhered spontaneously to lymphocytes (11.4 +/- 5.7%, n = 14) of healthy newborns but not to those from adults, (2) The capacity to proliferate was restricted to cord blood lymphocytes giving a mean peak response at day five of culture in the presence of the bacteria (6.8 +/- 2.8 times over the background, n = 15), (3) The correlation between streptococcal adherence and cord blood lymphocyte proliferation was statistically significant for 10 independent experiments (r = 0.75, p = 5%), and (4) Type III group B streptococci inhibited the Pokeweed mitogen (PWM)-induced lymphocyte proliferation in adult but not in neonatal MNC cultures. The different pattern of reactivity between adult and cord blood MNC towards group B streptococci will be discussed.

Activation of human CD4+ and CD8+ cells by Sarcocystis gigantea lectin

As recently reported, Sarcocystis gigantea lectin (SGL) is a powerful mitogen and a polyclonal activator (Syn. S. ovifelis) of human peripheral B-cells. In the present study we investigated the reactivity of human T-helper (CD4) and T-suppressor (CD8) cells to SGL. Mononuclear cells (MNCs) from five newborns and six adults were examined cytofluorometrically for the expression of cell-surface differentiation and activation antigens using a set of seven monoclonal antibodies. In all, 96% of cord-blood and 81% of adult CD4 cells expressed receptors for interleukin-2 (Tac+) after 64 and 164 h microgram/ml). The percentages of neonatal and adult Tac+ CD8 cells amounted to 67% and 59%, respectively. Major histocompatibility complex (MHC) class II antigens identified using the monoclonal anti-human leukocyte antigen (HLA)-DR antibody L243 were expressed on 30% (CD4) and 44% (CD8) of adult T-cells. Neonatal HLA-DR+ T-lymphocytes were not detectable. In parallel, functional tests were performed to examine cell proliferation and MNC antibody production.

Sarcocystis gigantea lectin--mitogen and polyclonal B-cell activator

The present study further examined the in vitro response of human mononuclear cells (MNC) to the Sarcocystis gigantea lectin (SGL). The results confirm our previous report that SGL is mitogenic for human MNC. We now report that SGL is not only a potent mitogen but also a polyclonal activator for human peripheral B cells. As was true for pokeweed mitogen (PWM, 2 micrograms/ml), the addition of SGL (25 micrograms protein/ml) to cultures of MNC caused lymphocyte proliferation and B-cell maturation, indicated by a marked increase in IgG and IgM production. As measured by the [3H]-thymidine incorporation assay, SGL induced significantly higher proliferative responses than PWM (P less than 0.01, n = 24). The values obtained by SGL and PWM for IgG and IgM synthesis were essentially identical. As opposed to SGL, the sarcotoxin-containing fraction (SGTF) did not induce antibody formation or proliferative responses in human MNC.

Interactions between Sarcocystis gigantea lectin and toxin-containing fractions in human lymphocyte cultures

Sarcocystis gigantea extract (SGE) was separated by affinity chromatography into one lectin-containing fraction (SGL) that was mitogenic to mononuclear cells (MNC) and another that lacked this lectin activity. The SGL-depleted Sarcocystis extract (SGTF) contained the so-called Sarcotoxin, inducing only a slight increase in MNC proliferation. Furthermore, preincubation of MNC with SGTF for 60 min suppressed the mitogenic capacity of SGL by 60%-90%. The results presented indicate that SGTF interacts with human MNC differently than SGL, particularly by interfering with the mitogenic lectin. These findings suggest that SGL and SGTF may be involved in different immunomechanisms induced by the parasite.

The mitogenicity of extracts from Sarcocystis gigantea macrocysts is due to lectin(s)

As recently reported, extracts from macrocysts of Sarcocystis gigantea obtained by sonication show mitogenic activity towards lymphocytes. By affinity chromatography using a galactose gel, a lectin fraction which contained the entire mitogenic activity was obtained from these extracts.

Extracts from Sarcocystis gigantea macrocysts are mitogenic for human blood lymphocytes

Extracts were prepared from macrocysts of Sarcocystis gigantea, an animal parasite, by sonication and high speed centrifugation. Mononuclear cells were obtained from the blood of 14 adults and 5 newborns and used for transformation assays. Addition of Sarcocystis extracts (equivalent to 400 micrograms protein/ml) to these cells increased the lymphocyte proliferation approximately 71 fold over the background. The control with Pokeweed mitogen (5 micrograms/ml) gave a stimulation index of 58. There was no difference in the response to the Sarcocystis extract between the lymphocytes of adults and those of newborns. This findings show that the effect of the extract is mitogenic and not due an anamnestic reaction.