Aspergillus fumigatus peritonitis in ambulatory peritoneal dialysis: a case report and notes on the therapeutic approach

Aspergillus peritonitis is a rare disease in continuous peritoneal dialysis. It is a severe form of peritonitis, which is frequently lethal. We report a case of Aspergillus fumigatus peritonitis in a female patient on automated peritoneal dialysis (APD), who was successfully treated with intravenous amphotericin B and the removal of the peritoneal catheter. As delayed treatment has an increased mortality rate, it is mandatory to remove the catheter and to start intravenous treatment with amphotericin B empirically.     

A Comparison of Surface and Cytoplasmic Antigens of Aspergillus fumigatus in an Enzyme-Linked Immunosorbent Assay (ELISA)

Summary: Cytoplasmic antigens of Aspergillus fumigatus were prepared by exposing the mycelium to a lytic enzyme system from Trichodenna hanianum to yield protoplasts. Following physical rupture, the watersoluble constituents gave multiple peaks with homologous antiserum on 2-dimensional immunoelectrophoresis. The same system was used to identify reactive terminal sugar residues on antigen molecules by the incorporation of lectins of appropriate specificities in an intermediate gel. On affinity chromatography on Conmnavalin A (ConA) - linked Sepharose, the bulk of the applied cytoplasmic material eluted in the void volume. The elution profile obtained on column chromatography of the extract on wheat germ agglutinin (WGA)-linked Sepharose showed two major components, one of which was elutable only with N-acetyl-D-glucosamine. Cytoplasmic antigens and antigens derived from the mycelial wall by detergent extraction showed comparable reactivity towards homologous antisera when tested in an en-zymelinked immunosorbent assay (ELISA). In the same system, the wallassociated antigens proved far superior in the detection of specific IgG in sera from patients with aspergillus-related diseases. Zusammenfassung: Die zytoplasmatischen Antigene von Aspergillus fumigatus wurden gewonnen, in dem das Myzel einem lytischen Enzymsystem von Trichoderma harzianum ausgesetzt wurde, um so Protoplasten zu gewinnen. Nach Aufbrechen der Protoplasten ergaben die wasser-1öslichen Bestandteile zahlreiche Peaks mit homologem Antiserum bei der 2-dimensionalen Immunelektrophorese. Das gleiche System wurde benutzt, um reaktive terminale Zuckerreste an Antigenmolekülen zu identifizieren, indem Lectine mit entsprechender Spezifität in ein intermediäres Gel eingebracht wnrden. Bei der Affinitätschromatographie über Conavalin A (ConA) beschickter Sepharose, wurde der Hauptteil des aufgetragenen zytoplasmatischen Materials ausgewaschen. Dagegen ergab das Elutionsprofil mit Säulenchromatographie bei der die Sepharose mit Weizenkeimagglutinim (WGA) beschickt war, zwei Hauptkomponenten von denen eine nur mit N-acetyl-D-glucosamin eluiert werden konnte. Zytoplasmatische Antigene und Antigene von der Zellwand der Hyphen, die durch Extraktion mit Detergentien gewonnen worden waren, zeigten eine vergleichbare Reaktivität gegenüber homologen Antisera, wenn sie mit einem Enzymimmunosorbenttest (ELISA) untersucht wurden. Mit dem gleichen System zeigte sich, daß die Zellwandantigene für die Entdeckung von spezifischem IgG von Patienten mit Krankheiten, bei denen Aspergillen eine Role spielen, welt überlegen waren.     

Cutaneous<Emphasis Type="Italic">aspergillus flavus</Emphasis> infection in a neonate

A premature newborn infant born at 30 weeks gestation developed erythematous papular skin lesions that coalesced to form a necrotic plaque with black eschar. Skin histopathology and culture demonstrated infection with Aspergillus flavus. There was no evidence of Aspergillus flavus infection elsewhere     

Aspergillus chest wall osteomyelitis: surgical and medical management

This case report details the case of a 62-year-old male diabetic patient with persistent chest wall osteomyelitis that developed after repeat coronary artery bypass grafting. The chronic infection was localized to the right anterior chest wall and was refractory to medical and surgical treatment which included long-term antibiotics, five separate intraoperative debridements and reconstruction with vascularized omentum over a 2 year period at outside institutions. Aggressive surgical debridement with flap reconstruction resulted in definitive management of the infected chest wall. The organism isolated from intraoperative cultures yielded Aspergillus fumigatus. The surgical management of osteomyelitis and costochondritis in this location is reviewed accompanied by a literature review on this rare cause of chronic chest wall infection.     

In vitro activity of terbinafine and itraconazole against Aspergillus species isolated from otomycosis

The minimum inhibitory concentrations (MIC, microg ml-1) of itraconazole and terbinafine against overall 34 Aspergillus isolates from the external ear canals with otomycosis have been determined with M38-P microdilution method suggested by National Committee for Clinical Laboratory Standards (NCCLS). MIC intervals in 48 h determined by taking MIC-2 value of itraconazole (the lowest drug concentration causing 50% inhibition of visible fungal growth) and MIC-0 value of terbinafine (the lowest drug concentration causing 100% inhibition of visible fungal growth) as a basis have been found as follows: 0.125-1 and 0.06-0.5 microg ml-1 for A. niger (22 strains), 0.06-0.25 and 0.06-0.125 microg ml-1 for A. flavus (10 strains), 0.125 and 0.125-0.5 microg ml-1 for A. terreus (two strains). It has been observed that both of the antifungal agents showed an in vitro activity against all Aspergillus species tested.     

Heat-Treated Fungizone Retains Amphotericin B Antifungal Activity Without Renal Toxicity in Rats Infected with Aspergillus Fumigatus

PURPOSE: The purpose of this study was to assess the antifungal activity and renal and hepatic toxicity of amphotericin B (AmpB) following administration of Fungizone (FZ) and a heat-treated form of FZ (HFZ) to rats infected with Aspergillus fumigatus. METHODS: Infected rats were administered FZ and HFZ at a dosing regimen of 1 mg/kg i.v. once daily for 4 consecutive days. Following administration the number of colony forming units (CFUs) of Aspergillus fumigatus in different organs and serum creatinine concentrations were determined. RESULTS: FZ and HFZ had similar overall effectiveness in decreasing the total number of Aspergillus fumigatus CFUs found in all organs analyzed compared to controls. Except for the serum creatinine concentrations reported in the nontreated infected control rats, none of the treatment groups tested displayed a greater than 50% increase in serum creatinine. CONCLUSIONS: Taken together, these findings suggest that HFZ at 1 mg/kg once daily x 4 days appears to be as effective as FZ as an antifungal agent without renal toxicity.     

Prevalence of Aspergillus fumigatus and other fungal species in the sputum of adult patients with cystic fibrosis

Aspergillus fumigatus is often found in the respiratory tract secretions of patients with cystic fibrosis (CF), although the role of the fungus for progression of pulmonary disease remains unclear. This study aimed to investigate the frequency of A. fumigatus and other fungi in sputum of adult CF patients using different methods for culture and microscopy. Results from the analysis of 369 samples from 94 patients showed that A. fumigatus could be isolated in 45.7% of patients. Other moulds were rare, but the yeast Candida albicans was another frequent isolate, detected in 75.5% of patients. A comparison of different culture media showed no difference between a selective medium developed to specifically inhibit Pseudomonas aeruginosa and a standard fungal culture medium for growth of A. fumigatus, although both were more efficient for detection of fungi than other bacterial culture media. Fluorescent microscopy with calcofluor white was more sensitive for detection of fungal hyphae in undiluted sputum than standard methylene blue staining. This study shows that A. fumigatus and C. albicans have a high frequency in adult CF patients. Microbiological analysis should routinely include methods for specific identification of fungi to monitor for potential complications arising from fungal disease in these patients.     

免疫抑制宿主和健康宿主在鼠肺部烟曲霉感染时基因表达的差异

目的 观察免疫抑制宿主和健康宿主在遭遇条件致病真菌初期时基因表达的差异,筛选新的真菌免疫相关基因,以便对条件致病真菌导致系统性真菌病的发病机制有更新的认识。方法 免疫抑制和健康小鼠各6只,经鼻内接种烟曲霉孢子3d后处死,取肺组织,抽提总RNA,进行基因表达谱芯片研究。结果 在4096条基因中共筛选出66条差异表达基因。其中,免疫抑制组编码CD22、CD53、24p3以及与单核巨噬细胞吞噬消化有关的基因表达上调。编码免疫球蛋白入链、肺泡表面蛋白C以及与肺组织代谢有关的基因表达下调。编码IL18、CD8、CD28等的基因无差异表达。结论 免疫抑制组CD22基因上调可能是宿主受到免疫抑制的途径之一,而CD8则未发现差异。CD53可能间接参与对单核巨噬细胞的调控。24p3蛋白作为应激蛋白,可能保护宿主免受过度炎症反应。     

A novel `two-component' protein containing histidine kinase and response regulator domains required for sporulation in Aspergillus nidulans

We have characterised a novel Aspergillus nidulans gene encoding a `two-component' signalling protein (tcsA). tcsA encodes both a histidine kinase domain and a response regulator domain similar to those found in bacterial, lower eukaryotic and plant members of the two-component family of proteins, while two PAS domains in the amino-terminal region of the predicted tcsA product may monitor the signal which regulates a tcsA histidine kinase-response regulator phosphorelay. While tcsA is nonessential for vegetative growth, cells lacking the gene are unable to produce conidia on standard Aspergillus growth media. However, tcsA is not absolutely required for production since this defect is suppressed by growth on 1 M sorbitol. Received: 23 December 1999 / 1 March 2000