Characterization and real-live results of nebulized voriconazole: A single-center observational study

OBJECTIVE

Pulmonary administration of voriconazole involves advantages, including optimization of lung penetration and reduction of adverse effects and interactions. However, there is scarce evidence about its use and there are no commercial presentations for nebulization. We aim to characterize a compounded voriconazole solution for nebulization and describe its use in our center.

METHOD

This is a retrospective observational study including patients who received nebulized voriconazole to treat fungal lung diseases (infection or colonization). Voriconazole solution was prepared from commercial vials for intravenous administration.

RESULTS

The pH and osmolarity of voriconazole solutions were adequate for nebulization. Ten patients were included, nine adults and a child. The dosage was 40 mg in adults and 10 mg in the pediatric patient, diluted to a final concentration of 10 mg/ml, administered every 12-24 hours. The median duration of treatment was 139 (range: 26-911) days. There were no reported adverse effects and the drug was not detected in plasma when nebulized only.

CONCLUSION

Voriconazole nebulization is well tolerated and it is not absorbed into the systemic circulation; further research is needed to assess its efficacy.

Pulmonary endemic mycoses

While rare, the likelihood of encountering a case of a pulmonary endemic mycosis (PEM) in the UK is increasing. Diagnosis may be challenging, often leading to considerable delay to appropriate treatment. Clinical suspicion must be present for respiratory disease, particularly in the immunocompromised or in those not responding to empiric treatment approaches, and an extended travel history should be obtained. This article summarises the epidemiology of PEM, key clinical features, diagnostic strategies and management.

Diagnosis of invasive pulmonary fungal infections by a real-time panfungal PCR assay in non-neutropenic patients

This study explored the utility of quantitative real-time panfungal PCR assay in diagnosing invasive pulmonary fungal diseases (IPFD) in non-neutropenic patients. Panfungal PCR assay was performed on respiratory tract specimens from patients whose clinical signs could not exclude fungal infection. At the same time, the samples were subjected to bacterial and fungal culture, microscopic examination and galactomannan antigen (GM) test in order to find the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the 4 diagnostic methods in proven and probable cases. 518 specimens were collected while 63 respiratory tract specimens tested by PCR had positive results. According to diagnostic criteria, 40 patients were diagnosed with IPFD, with 12 proven, 20 probable and 8 possible cases. Among these, 33 patients of PCR results were positive, most of which were from BALF samples (44.12%). 23 cases were caused by Aspergillus species, with Aspergillus fumigatus was the major cause. Other Aspergillus species, including Aspergillus flavus, Aspergillus terreus and Aspergillus nidulans were found in 1 sample respectively. Candida species were found in 5 samples, Pneumocystis jeroveci pneumonia (PJP) in 4 samples and Mucormycosis in 1 sample. An analysis of proven/probable diagnosis showed a sensitivity of 78.13%, specificity of 92.18%, PPV of 39.68% and NPV of 98.46% for PCR and 50%, 85.27%, 35.7%, 95.65% for GM test respectively. The Ct value difference between proven/probable and possible cases had no statistical significance (P = .824). Fungal culture showed a sensitivity of 17.5% while microscopic examination sensitivity of 32.5%. Through stratified analysis, no apparent correlation was found between the Ct value of the PCR assay and GM value (r: 0.223, P = .294). But a conjunction of the 2 tests raised the PPV of Aspergillus to 90%. As shown in this study, the panfungal RT-PCR assay has high sensitivity and consistency with serological test and culture. Its high PPV in the detection of Aspergillus and PJP were also evident.

The first suspected disseminated Hormographiella aspergillata infection in China, diagnosed using metagenomic next-generation sequencing: a case report and literature review

Hormographiella aspergillata is a rare and emerging cause of invasive mould infections in patients with haematological malignancies, with a mortality rate of approximately 70%. Here, we present the first reported case of suspected disseminated H. aspergillata infection in China. The patient experienced a second relapse of acute myeloid leukaemia and developed neutropenia, fever, discrepant blood pressure between limbs, and cutaneous lesions limited to the left upper extremity. Since lung tissue biopsy was not feasible, metagenomic next-generation sequencing (mNGS) and panfungal polymerase chain reaction (PCR) analysis of bronchoalveolar lavage fluid and blood samples were performed, which indicated probable H. aspergillata pulmonary infection. Histopathology of cutaneous lesions revealed numerous fungal hyphae within dermal blood vessels. mNGS of a skin biopsy sample identified H. aspergillata sequences, and the fungi was subsequently recovered from fungal culture, proving cutaneous H. aspergillata infection. Despite combined antifungal therapy, the patient died owing to disease progression. Additionally, 22 previously reported cases of invasive H. aspergillata infection were reviewed in patients with haematological malignancies. Thus, mNGS is a powerful diagnostic tool for the early and effective detection of invasive H. aspergillata infections, with the advantage of sequencing all potential pathogens, and providing results within 24 h.

Fungal-mediated lung allergic airway disease: The critical role of macrophages and dendritic cells

Fungi are abundant in the environment, causing our lungs to be constantly exposed to a diverse range of species. While the majority of these are cleared effectively in healthy individuals, constant exposure to spores (especially Aspergillus spp.) can lead to the development of allergic inflammation that underpins and worsen diseases such as asthma. Despite this, the precise mechanisms that underpin the development of fungal allergic disease are poorly understood. Innate immune cells, such as macrophages (MΦs) and dendritic cells (DCs), have been shown to be critical for mediating allergic inflammation to a range of different allergens. This review will focus on the crucial role of MΦ and DCs in mediating antifungal immunity, evaluating how these immune cells mediate allergic inflammation within the context of the lung environment. Ultimately, we aim to highlight important future research questions that will lead to novel therapeutic strategies for fungal allergic diseases.

Autochthonous Case of Pulmonary Histoplasmosis, Switzerland

In Europe, pulmonary histoplasmosis is rarely diagnosed except in travelers. We report a probable autochthonous case of severe chronic pulmonary histoplasmosis in an immunocompetent man in Switzerland without travel history outside of Europe. Diagnosis was achieved by histopathology, fungal culture, and serology, but the source of the infection remains speculative.

Cytological and Histopathological Spectrum of Histoplasmosis: 15 Years of Experience in French Guiana

Background

Disseminated histoplasmosis remains a major killer of immunocompromised patients in Latin America. Cytological and histological methods are usually present in most hospitals and may represent a precious diagnostic method. We report 15 years of experience of the department of pathology of the Centre Hospitalier de Cayenne Andrée Rosemon in French Guiana.

Methods

Specimens from live patients from January 2005 to June 2020 with the presence of H. capsulatum on cytological and/or histological analysis were analyzed. All specimens were examined by an experienced pathologist. The analysis was descriptive.

Results

Two hundred two cytological and histological samples were diagnosed with histoplasmosis between January 2005 and June 2020. The 202 samples included 153 (75.7%) histopathological formalin-fixed and paraffin-embedded tissues (biopsy or surgical specimens) and 49 (24.3%) cytological analysis from all organs. One hundred thirty-four patients (82.7%) were HIV-positive, 15 patients (9.3%) had immunosuppressant treatment, and 13 patients (8%) were immunocompetent. Seventy-eight of 202 (38.5%) were samples from the digestive tract, mostly the colon (53/78 cases, 70%) and small intestine (14/78 cases, 18%). Microorganisms were more numerous in digestive samples (notably the colon) than in other organs. Lymphocyte and histiocyte inflammation of moderate to marked intensity were observed in all positive specimens. Tuberculoid epithelioid granuloma were present in 16/78 (20,5%) specimens including 14 colon and 2 small intestine specimens. There were 11/202 cases of liver histoplasmosis, 26/202 (12,8%) cases of pulmonary histoplasmosis. Bone marrow involvement was diagnosed in 14 (2%) specimens (8 aspiration and 6 biopsies). Lymph nodes were positive in 42 specimens (31 histology and 11 cytology). Histopathological analysis of the 31 lymph nodes showed a variable histological appearance. Tuberculoid forms were most frequent (24/31, 77,4%).

Conclusions

From the pathologist perspective, this is the largest series to date showing that digestive involvement was the most frequent, usually with a tuberculoid form and a greater load of Histoplasma. With awareness and expertise, cytology and pathology are widely available methods that can give life-saving results in a short time to help orient clinicians facing a potentially fatal infection requiring prompt treatment.

Cannabis Use and Fungal Infections in a Commercially Insured Population, United States, 2016

Case reports have identified invasive fungal diseases in persons who use cannabis, and fungal contamination of cannabis has been described. In a large health insurance claims database, persons who used cannabis were 3.5 (95% CI 2.6–4.8) times more likely than persons who did not use cannabis to have a fungal infection in 2016.

[Pulmonary Mucormycosis with Reversed Halo Sign on Computed Tomography of Patient with Leukemia]

The patient was a male in his 60s, who had undergone bone marrow transplantation because of lymphoblastic leukemia. He suffered from chest pain two weeks after the transplantation. A chest computed tomography(CT) showed reversed halo sign( RHS) in the right upper lobe of the lung. A bronchoscopic lung biopsy revealed mycelia, and the patient was diagnosed with pulmonary mucormycosis. Although antifungal drugs were administered, no significant improvements were observed. A right upper lobectomy of the lung was successfully performed, and no postoperative complications occurred. Pathological examination found nodular lesions with extensive necrotic foci inside, and inflammatory granulation tissue and mucormycosis with hyphae (+) were found through Grocott staining. RHS in leukemia patients with neutropenia is specific to pulmonary mucormycosis. Pulmonary mucormycosis is a life-threatening disease, and urgent treatment intervention including surgical treatment is advisable.

[Clinical features of children with bronchial asthma complicated by pulmonary fungal infection and risk factors for pulmonary fungal infection]

OBJECTIVE

To study the clinical features of children with bronchial asthma complicated by pulmonary fungal infection and the risk factors for pulmonary fungal infection.

METHODS

A retrospective analysis was performed for the clinical data of 150 children with bronchial asthma who were admitted from January 2015 to June 2018. Among these children, 75 had pulmonary fungal infection (fungal infection group) and 75 did not have such infection (control group). The distribution of pathogenic fungi, clinical symptoms/signs and treatment outcome were recorded for the fungal infection group. The multivariate logistic regression analysis was used to investigate the risk factors for pulmonary fungal infection.

RESULTS

A total of 69 pathogenic fungi were detected in 75 children in the fungal infection group, among which Candida albicans had the highest detection rate of 61%. Major clinical symptoms were cough (93%), persistent high fever (56%), wheezing (49%) and dyspnea (48%). Major signs were dry and moist rales (43%) and moist rales (29%). Parts of children had hepatosplenomegaly. Among the 75 children in the fungal infection group, 39 were markedly improved, 26 were improved, 7 had no response, and 3 experienced aggravation and then died. Age <3 years, comorbidities of nasosinusitis and/or allergic rhinitis, asthma attacks of >3 times during hospitalization, intravenous administration of glucocorticoids, non-rational use of antibiotics, mechanical ventilation and prolonged hospital stay were independent risk factors for pulmonary fungal infection in children with asthma (OR=4.865, 3.241, 2.255, 3.725, 3.568, 1.549, 3.808; P<0.05).

CONCLUSIONS

Pulmonary fungal infection should be considered for asthmatic children with cough, persistent high fever, obvious dry and moist rales and hepatosplenomegaly. The asthmatic children with an age of <3 years, comorbidities of nasosinusitis and/or allergic rhinitis, asthma attacks of >3 times during hospitalization, intravenous administration of glucocorticoids, non-rational use of antibiotics, mechanical ventilation or prolonged hospital stay have a higher risk for secondary pulmonary fungal infection.

The impact of common tumor necrosis factor haplotypes on the development of asthma in children: an Egyptian model

Conflicting results have arisen among different ethnic populations with regard to the ability of tumor necrosis factor (TNF) to control the development of bronchial asthma. We examined common TNF polymorphisms (TNFA -1031C>T, TNFA -308G>A, and TNFB +252A>G) to develop a model of the associations between these genetic markers and the development of the disease in Egypt. Amplified DNA from buccal mucosa was genotyped for 240 children using polymerase chain reaction-restriction fragment length polymorphism. Skin prick test, total serum immunoglobulin E levels, and assessment of pulmonary functions were investigated. The onset age for one-third of the asthma patients in our study was between 7 and 10 years. The TNFA -1031C>T and TNFA -308G>A polymorphisms were strongly associated with the risk of asthma (p = 0.007, and p = 0.000, respectively), but the TNFB +252A>G polymorphism was not (p = 0.6). We detected a significant linkage between the +252A>G and -1031C>T, and another between the +252A>G and the -308G>A (p < 0.0001 for both). The -1031C>T and -308G>A polymorphisms were not linked (p = 0.14). The -308A/A genotype was absent, and the -308A allele was expressed only in patients with -308G/A heterozygosity (13%). All but the +252G/A genotype were also strongly associated with the severity of disease. Environmental factors, as genetic variations, clearly influence susceptibility, the onset, progression, and severity of bronchial asthma. More information is needed to develop genetic models of susceptibility for different ethnic populations.

Cryptococcosis: an emerging respiratory mycosis

Cryptococcosis occurs in immunocompromised and, in special cases, immunocompetent individuals. There have been a number of important advances in the field, but, despite current treatment, patients continue to die of the infection. This article reviews cryptococcosis epidemiology, clinical features, and management. Current knowledge is incomplete, however, so this article also discusses some of the gaps in the present understanding of cryptococcosis. The hope is that current research striving to understand the mechanisms of host evasion of Cryptococcus will result in improved treatment regimens that decrease both the mortality and morbidity of cryptococcosis.

[The clinical significance of Aspergillus isolation from airway samples in critically ill patients]

OBJECTIVE

To analyze the risk factors and clinical significance of Aspergillus isolation from airway samples of critically ill patients.

METHODS

The study was conducted in an ICU between January 2007 and December 2007. The data of patients receiving mechanical ventilation with suspected invasive pulmonary fungal infection were analyzed. Tracheal aspirates were collected and cultured 3 times weekly. The cases were classified into groups of Aspergillus spp, Candida spp, and non-fungus spp according to the microbiological results. Isolation of Aspergillus spp. was subgrouped to proved-IPA (invasive pulmonary aspergillosis), probable-IPA or colonization. The risk factors for airway isolation of Aspergillus and infection were assessed. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) for Windows (version 12.0) and quantitative variables were expressed as mean +/- standard deviation. The Student' s t-test or the Mann-Whitney U-test was used for the comparison of categorical and normally distributed and non normally distributed variables, respectively. The chi2 test or the Fisher's exact test was used in the comparison of categorical variables. Logistic regression analysis was conducted to evaluate risk factors for the isolation of Aspergillus spp.

RESULTS

The study population included 160 patients (82 men) with a mean age of (64.5 +/- 17.2) years. Aspergillus spp was isolated in 45, Candida spp in 63, and non-fungus spp in 52. The ICU mortality in the 3 groups was 48.9% (22/45 cases), 23.8% (15/63 cases), 7.7% (4/52 cases), respectively. The ICU mortality in patients with Aspergillus spp. isolation was higher than those with Candida spp and non-fungus spp. In 28 patients isolation of Aspergillus spp. was interpreted as invasive aspergillosis (2 patients were proven, 26 patients were probable). The predictive value of isolating Aspergillus from airway samples was 62% (28/45 cases). On multivariate analysis, the following factors were independently associated with Aspergillus spp. isolation: connective tissue diseases (OR 3.3, 95% CI 1.7 - 12.2, chi2 = 4.82, P<0.01), hepatic dysfunction (OR 8.1, 95% CI 1.7 - 15.2, chi2 = 19.2, P<0.01), corticosteroid use (OR 4.6, 95% CI 2.6 - 13.7, chi2 = 8.92, P<0.01) and continuous renal replacement therapy (CRRT) (OR 5.1, 95% CI 2.6 - 11.5, chi2 = 11.4, P<0.01). Higher APACHE II score (25 +/- 6, 14 +/- 8, t = 2.75, P<0.01), septic shock (57%, 27%, chi2 = 3.56, P<0.01), and prolonged use of broad-spectrum antibiotics (15.9 d, 9.2 d, t = 2.49, P<0.01) were significantly associated with Aspergillus infection as compared to colonization.

CONCLUSION

Critically ill patients with Aspergillus from airway samples had a higher mortality. Connective tissue diseases, hepatic dysfunction, corticosteroid use and CRRT were significantly associated with Aspergillus spp. isolation in critically ill patients. In severely ill patients, the isolation of Aspergillus is highly indicative of infection rather than colonization.

[Zygomycosis]

Zygomycosis is an invasive fungal infection with extremely high mortality caused by filamentous fungi which belong to Class Zygomycetes (Rhizopus spp., Mucor spp., Cunninghamella spp., etc). Despite of the similarities of the ecological characteristics and of the patients' backgrounds, zygomycosis is much rarer than invasive aspergillosis. In addition to well known immunosuppressive risk factors (hematological malignancy, hematopoietic stem cell or solid organ transplant, prolonged neutropenia, corticosteroid, etc), diabetic ketoacidosis, iron overload, and administration of deferoxamine are specific factors predisposing zygomycosis. Rhinocerebral, pulmonary and disseminated disease is characteristic forms. The mainstay of the treatment is surgical resection, reversal of immunosuppressive factors, and administration of high-dose amphotericin B or its liposomal formulation. Because of the difficulty of culture detection and the absence of reliable serological diagnostic methods, premortem diagnosis and no delaying of effective treatment remain a challenge to physicians.

[Case of an HTLV-1 carrier complicated with chronic pulmonary histoplasmosis]

A 58-year-old man was admitted with complaints of pain in the right upper right side of the chest. Chest radiography and computed tomography (CT) revealed a cavitary lesion in the right upper lobe. A CT-guided percutaneous lung biopsy and transbronchial lung biopsy of this lesion did not yield a definitive diagnosis; therefore, we performed video assisted thoracic surgery (VATS). We also investigated various types of mycosis because he had several records of overseas travel. At a later day, the histoplasma immunodiffusion test showed positive results. We finally diagnosed pulmonary histoplasmosis based on the clinical course, CT and radiographic images and serological tests. Voriconazole improved the patient's subjective symptoms and laboratory findings. A positive reaction was obtained for anti-human T-cell leukemia virus type 1 (HTLV-1) antibody and the HTLV-1 carrier, confirming his immunodeficiency disorder. We raised the possibility that the development of pulmonary histoplasmosis might be associated with the HTLV-1 carrier.

Isolation of Aspergillus in critically ill patients: a potential marker of poor outcome

OBJECTIVE

Recent reports have suggested a rising incidence of pulmonary aspergillosis in intensive care unit (ICU) patients. The aim of this study was to determine the clinical significance of isolating Aspergillus from respiratory samples of critically ill patients.

DESIGN

Retrospective review of medical records.

SETTING

Tertiary medical center that has a large cancer center.

PATIENTS

All patients admitted to the ICU between January 1998 and August 2004, in whom Aspergillus was isolated from respiratory samples or lung tissue.

INTERVENTION

None.

RESULTS

The charts of 104 patients were reviewed. Aspergillus was isolated for a mean of 6.6 days after ICU admission. Thirty-three percent of patients had hematological malignancy, 10% had absolute neutropenia, 14% had bone marrow transplant, 11% had HIV infection, and 22% had chronic obstructive pulmonary disease. Upon admission to ICU, 79%, 43%, and 19% were on antibiotics, corticosteroids, or immunosuppressive therapy, respectively. Ninety percent of patients required mechanical ventilation. The mean Acute Physiologic and Chronic Health Evaluation II score on ICU admission was 20.6, with predicted mortality of 35.5%. However, the actual ICU mortality rate for the cohort was 50%. Twenty-eight percent of patients were diagnosed with probable or definite invasive pulmonary aspergillosis, and 72% had Aspergillus colonization. On univariate analysis, the significant clinical differences between the 2 groups were the presence of neutropenia (P < .05), immunosuppressants (P < .05), antibiotics (P < .05), or bone marrow transplant (P < .05). The differences in Acute Physiologic and Chronic Health Evaluation II score, the need for mechanical ventilation, ICU length of stay, and ICU mortality were not statistically significant. On multivariate analysis, the following factors were independently associated with invasive diseases, bone marrow transplantation (P < .01), hematological malignancy (P = .02), and broad-spectrum antibiotics (P = .02).

CONCLUSION

Isolation of Aspergillus in critically ill patients is a poor prognostic marker and is associated with high mortality irrespective of invasion or colonization. Those who are neutropenic, on immunosuppressive therapy, on broad-spectrum antibiotics, or had bone marrow transplantation are more likely to have invasive pulmonary aspergillosis.

Canine sporotrichosis in Rio de Janeiro, Brazil: clinical presentation, laboratory diagnosis and therapeutic response in 44 cases (1998-2003)

A sporotichosis epidemic involving forty-four dogs in the Metropolitan area of Rio de Janeiro is described. Solitary skin lesions were noted in 18 dogs (40.9%), 2-4 such lesions were observed in 17 animals (38.6%), and nine (20.5%) animals had five or more lesions. Twenty-five (56.8%) animals had single ulcerated skin lesions on the nose and nine (20.5%) showed nasal mucosal involvement (three of which also has a skin lesion). Respiratory symptoms were observed in 17 (38.6%) dogs and were found to be the most common extracutaneous signs of infection. Anemia, leukocytosis with neutrophilia, hypoalbuminemia and hyperglobulinemia were the most frequent hematological abnormalities. Histopathological analysis of skin biopsies in most cases revealed granulomatous reactions characterized by histiocytic hyperplasia and neutrophil infiltration. Yeast-like cells were observed in seven (16.7%) of 42 dogs examined histologically. During the study, eight (18.2%) animals were lost to follow-up and three (6.8%) were submitted to euthanasia. Of the remaining 33 dogs, five (15.2%) presented spontaneous regression of the lesions, 26 (78.8%) were cured after treatment, and two (6%) continue to be treated. The present cases indicate that many dogs with sporotrichosis respond well to treatment and in a few dogs, the disease may be self-limiting.

[Clinical and mycological features of cryptococcosis]

Cryptococcosis is the third most common deep mycosis in Japan. Cryptococcus neoformans is known to grow in pyres of pigeon feces. Chicken feces in Thailand were tested for whether C. neoformans could be isolated, because there is considerable prevalence of cryptococcal meningitis in patients with HIV in that country. We isolated C. neoformans from chicken feces in as many as at 70 % of the villages tested. Chicken as well as pigeon feces were believed to be an origin of infection. We have studied the relation between in vitro virulence and thickness of polysaccharide capsules. Strains with thicker capsules such as YC-11 or YC-5 showed more resistance to macrophage phagocytosis than strains with thinner capsules like YC-27 or YC-13. This finding was consistent with the cytokine dynamic state in mice cryptococcosis. Th1 was dominant in infections with thinner capsule strains, although Th2 was relatively dominant in those with thick capsules. The clinical features of 104 cases with pulmonary cryptococcosis were summarized. Radiological findings of pulmonary cryptococcosis varied depending on the time course of the disease and on immunological status. There were no specific symptoms and signs except for positive glucronoxylomannan. Those in azole class were the most commonly prescribed antifungals. New generation antifungals voriconazole and intravenous itraconazole showed potent clinical efficacy in pulmonary cryptococcosis.

State-of-the-art review of pulmonary fungal infections

The endemic mycoses are restricted geographically based on environmental and other factors that favor the growth of these organisms in the soil. Histoplasmosis and blastomycosis mostly afflict patients in the Mississippi and Ohio River Valleys whereas coccidioidomycosis occurs primarily in the desert southwest United States. Cryptococcosis also may present as pulmonary disease, particularly in persons with cellular immune impairment. These mycoses are increasing in importance as causes for opportunistic disease in immunocompromised patients, especially those with acquired immune deficiency syndrome (AIDS). Aspergillus is a common cause of serious invasive fungal infection in granulocytopenic patients, and may cause lung infection in persons with preexisting pulmonary diseases or atopy. Infections with less virulent fungi, such as Trichosporon, Fusarium, Alternaria, Pseudallescheria, and dematiaceous fungi, are being recognized more frequently. The lung is the portal of entry for most of these pathogens, and often is prominently involved in the clinical syndrome. This article focuses on the recognition, diagnosis, and management of these important pulmonary mycoses.

[Spontaneous resolution of primary pulmonary cryptococcosis]

A 22-year-old man underwent chest roentgenography to obtain a health certificate, and the film showed a nodular lesion in the left lung. Computed tomography of the chest revealed a 25 x 20 mm nodular lesion in the S4 segment of the left lung. Fiberoptic bronchoscopy was done and transbronchial biopsy specimens showed fungal elements consistent with Cryptococcus. Further examinations, including cereberospinal fluid examination, were negative. This patient's pulmonary cryptococcal lesion resolved without treatment and without complications.

EXPERIMENTAL VIABLE VACCINE AGAINST PULMONARY COCCIDIOIDOMYCOSIS IN MONKEYS

Converse, John L. (U.S. Army Biological Laboratories, Fort Detrick, Frederick, Md.), Merida W. Castleberry, and Ernest M. Snyder. Experimental viable vaccine against pulmonary coccidioidomycosis in monkeys. J. Bacteriol. 86:1041-1051. 1963.-Monkeys (Macaca mulatta) vaccinated by subcutaneous injection in the forearm with from 10 to 10(8) viable Coccidioides immitis arthrospores were protected against respiratory challenge with approximately 7000 viable arthrospores administered 6 months after vaccination. Protection was evident from: the healthy appearance throughout 4 months after respiratory challenge; negative chest X rays at 15, 30, 60, and 120 days; and only very minor histopathological pulmonary changes on autopsy at 120 days, with negative lung cultures in 80% of the animals. This was in striking contrast to the outward clinical appearance of control monkeys that were unvaccinated or had received nonviable arthrospore vaccines. These monkeys showed severe disease (loss of weight, accelerated respiration, severe coughing, general debilitation), positive X rays, massive pulmonary destruction, positive lung cultures, and death of five of nine animals. The appearance of spherules (very few in number, accompanied by very minor pathological changes) in the lungs of some of the "dissemination controls" (subcutaneous viable vaccination without respiratory challenge) indicated possible dissemination from the primary cutaneous infection, although oral transmission from the cutaneous lesions could not be ruled out.