A Mother Speaks

Eosinophilic pneumonia was confirmed by bronchoalveolar lavage fluid examination and transbronchial lung biopsy. Aspergillus niger was cultured from the patient's pharyngeal swab and bronchoalveolar lavage fluid. Inhalation bronchoprovocation test with A. niger antigen was positive. Although the patient's condition improved promptly with 10 mg/day prednisolone administration, dry cough recurred approximately 2 months after completion of this therapy. Severe coughing disappeared on oral cleansing with 300 mg/day amphotericin B, and he recovered completely on 100 mg/day amphotericin B administration. Oral cleansing with amphotericin B may be efficacious in preventing relapses of eosinophilic pneumonia caused by allergic reaction to fungal antigen.     

Opportunistic Aspergillus pathogens measured in home and hospital tap water by quantitative PCR (QPCR)

Opportunistic fungal pathogens are a concern because of the increasing number of immunocompromised patients. The goal of this research was to test a simple extraction method and rapid quantitative PCR (QPCR) measurement of the occurrence of potential pathogens, Aspergillus fumigatus, A. flavus, A. terreus and A. niger, in home tap water and a hospital water supply.     

Effect of different sample volumes on the DNA extraction of Aspergillus fumigatus from whole blood

Five methods were compared, using conventional PCR, for the isolation of DNA from Aspergillus fumigatus conidia from 1–3-mL samples of whole blood. A lower detection threshold of Aspergillus conidia was achieved using 3-mL rather than 1-mL samples with three of five methods tested.     

Experimental aspergillosis in guinea pigs: influence of itraconazole on fungaemia and invasive fungal growth

Summary. The guinea pig model of experimental aspergillosis was used to evaluate the efficacy of itraconazole 2.5 and 5 mg kg^-1 in preventing the invasive phase of the disease when animals were already loaded with Aspergillus conidia. Evaluations were made by recording the survival rates, culturing fragments of nine organs, examining seven organs by means of histochemistry and immunohistochemistry (mAb EB-Al to Aspergillus galactomannan) and by serological titration of galactomannan. The data indicate that itraconazole is highly effective in preventing true invasive aspergillosis. Serological evaluations of antigenaemia suggest that low titres may only reflect fungaemia, while titres of 1:8 and above are suggestive of invasive disease.
Zusammenfassung. Das Meerschweinchen-Modell der experimentellen Aspergillose wurde eingesetzt, um die Wirkung von 2,5 mg und 5 mg kg^-1 Itraconazol zur Prävention der invasiven Krankheitsphase zu bewerten, wenn die Versuchstiere bereits mit Aspergillus -Konidien beladen sind. Die Bewertung stützt sich auf die Überlebensrate, auf Pilzkulturen aus neun verschiedenen Organen, auf histochemische und immunhistochemische Untersuchungen von sieben Organen mittels MOB EB-Al-Antikörpern gegen Aspergillus -Galactomannan sowie auf die Serotitration dieses Antigens. Die Ergebnisse belegen die hohe Wirksamkeit des Itraconazols in der Prävention der echt invasiven Aspergillose. Antigen-Titrationen im Serum sprechen dafür, daß geringe Titer lediglich das Fungämie-Stadium widerspiegeln, während Antigentiter ≥ 1:8 eine invasive Aspergillose belegen.     

Demolition of a hospital building by controlled explosion: the impact on filamentous fungal load in internal and external air

The demolition of a maternity building at our institution provided us with the opportunity to study the load of filamentous fungi in the air. External (nearby streets) and internal (within the hospital buildings) air was sampled with an automatic volumetric machine (MAS-100 Air Samplair) at least daily during the week before the demolition, at 10, 30, 60, 90,120, 180, 240, 420, 540 and 660 min post-demolition, daily during the week after the demolition and weekly during weeks 2, 3 and 4 after demolition. Samples were duplicated to analyse reproducibility. Three hundred and forty samples were obtained: 115 external air, 69 'non-protected' internal air and 156 protected internal air [high efficiency particulate air (HEPA) filtered air under positive pressure]. A significant increase in the colony count of filamentous fungi occurred after the demolition. Median colony counts of external air on demolition day were significantly higher than from internal air (70.2 cfu/m(3) vs 35.8 cfu/m(3)) (P < 0.001). Mechanical demolition on day +4 also produced a significant difference between external and internal air (74.5 cfu/m(3) vs 41.7 cfu/m(3)). The counts returned to baseline levels on day +11. Most areas with a protected air supply yielded no colonies before demolition day and remained negative on demolition day. The reproducibility of the count method was good (intra-assay variance: 2.4 cfu/m(3)). No episodes of invasive filamentous mycosis were detected during the three months following the demolition. Demolition work was associated with a significant increase in the fungal colony counts of hospital external and non-protected internal air. Effective protective measures may be taken to avoid the emergence of clinical infections.     

Animal models of aspergillosis - also useful for vaccination strategies?

The attempt to establish vaccination strategies against infections caused by Aspergillus fumigatus seems to be questionable. Invasive aspergilloses are opportunistic diseases of the immunocompromised host and only a passive immunization with immunoglobulins could be taken into consideration. Until now there have been no preclinical and/or clinical data available concerning the efficacy of specific immunoglobulins; animal experiments could offer an approach for the preclinical assessment of this topic. Generally, A. fumigatus is an opportunistic pathogen. Birds show a relatively high susceptibility to infections caused by A. fumigatus. In laboratory animal species, rabbits seem to have the highest susceptibility followed by mice, rats and guinea-pigs. Mice are easy to handle in all-day laboratory use, and infections are mostly established by the intravenous, intranasal or intraperitoneal route. The main target organs of infection are the kidneys by all three infection routes. Forty clinical isolates of A. fumigatus tested showed a comparable virulence in systemic infections in the intravenously infected mouse model. By using histopathological techniques, we also observed infectious lesions within the central nervous system in all cases. Only A. fumigatus strains lacking green pigmentation showed a significantly lower virulence. Histopathological examinations are of great benefit in the study of these animal models as they give detailed information about the infectious process. Measuring colony-forming units in tissues is only of minor use in prediction as it cannot discriminate between infective tissue lesions and cavity-infections/persistence, e.g. in the kidney pelvis. Quantitative methods for measuring fungal organ burdens, e.g. by chitin-enzyme-linked immunosorbent assays, have also been described and offer an alternative towards solely measuring colony-forming units in tissues.     

海洋真菌Aspergillus sp.的二肽类代谢产物的研究

目的对海洋真菌Aspergillussp.发酵液的乙酸乙酯萃取物进行化学成分的研究。方法采用硅胶柱色谱、凝胶柱色谱、高效液相色谱等手段,利用理化和波谱分析方法,对海洋真菌Aspergillussp.发酵液的乙酸乙酯萃取物的化学成分进行分离鉴定。结果与结论从该真菌发酵液的乙酸乙酯萃取物中分离得到8个二肽类化合物,经光谱数据分析,鉴定它们的结构分别为3-苯甲基-6-异丙基哌嗪-2,5-二酮(1)、3-苯甲基-6-异丁基哌嗪-2,5-二酮(2)、3-苯甲基-6-另丁基哌嗪-2,5-二酮(3)、3,6-二苯甲基哌嗪-2,5-二酮(4)、3-异丁基-6-异丙基哌嗪-2,5-二酮(5)、3-另丁基-6-异丁基哌嗪-2,5-二酮(6)、3-另丁基-6-异丙基哌嗪-2,5-二酮(7)、3-异丁基-吡咯并哌嗪-1,4-二酮(8)。这些化合物均是首次从该真菌代谢物中分离得到。     

Medical management of Aspergillus flavus endocarditis

An 11-year-old boy underwent a matched unrelated bone marrow transplant for refractory acute myeloid leukemia. He developed invasive aspergillus pneumonia and endocarditis post-transplant. The fungal endocarditis was successfully eradicated with liposomal amphotericin at the dose of 10 mg/kg/day. Surgical intervention was not required and no serious side effects of liposomal amphotericin were observed at this dose.     

Aspergillus endocarditis in chronic granulomatous disease

We report the first case, to our knowledge, of Aspergillus endocarditis in chronic granulomatous disease in a patient who also had an atrial septal defect. A diagnosis was made on culture of the organism from the mass despite extensive prior investigation. The presence of distinctive skin lesions as a diagnostic clue of fungaemia is highlighted. Possible advances in diagnosis by detection of fungal cell wall components and in prophylaxis by use of itraconazole are referred to. We conclude that fungal endocarditis should be considered in this condition, especially in the presence of a structural heart defect.     

Aspergillus Fumigatus Infection of an Automatic Internal Cardiac Defibrillator

We report a patient without immune compromise with infection of an automatic internal cardiac defibrilla- tor patch due to Aspergillus fumigatus presenting 8 years after implantation. The mechanism of infection was unknown, but symptoms began 1 month after laser uvulopalatopharyngoplasty was performed for sleep apnea. The patches were surgically removed and the patient was treated sequentially with amphotericin B and itraconazole. He remains without evidence of infection 12 months after the completion of therapy.