Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment

Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment.While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.

Purification of Cajanus cajan root lectin and its interaction with rhizobial lipopolysaccharide as studied by different spectroscopic techniques

A lectin present in roots of Cajanus cajan seedlings was isolated and purified by affinity chromatography. Sugar specificity assayed by hemagglutination-inhibition activity indicated that lectin belongs to glucose/mannose-specific group. The root lectin was found to be mannose-specific from the second day onwards as it was reconfirmed by specific elution of different days' sample from mannose agarose matrix. The maximum interaction of lectin with goat IgM was obtained in 10-day-old sample, indicating the highest crude lectin content. Lectin (total amount of eluted protein) from different days soil sample showed a maximum amount in 10-day-old sample. For further studies, the lectin has been isolated from the roots of 10-day C. cajan seedlings and purified on mannose-CL agarose column by affinity chromatography. Lectin was found to be a dimer of 18.5-kDa subunit as revealed by SDS-PAGE. Tryptophan quenching fluorescence was studied for C. cajan root lectin. Secondary structure of C. cajan root lectin as studied by circular dichroism was found to be a typical beta-pleated sheet structure. The interaction of purified root lectin with C. cajan-specific rhizobial lipopolysaccharide and its inhibition by specific and nonspecific sugars was demonstrated by fluorescence and circular dichroism. Results discussed in this paper were studied for the first time by different spectroscopic methods, suggesting that C. cajan root lectin-lipopolysaccharide interaction is specific.