Experimental Orbital Phycomycosis in Rabbits

Summary: Spores of Rhizopus oryzae when inoculated into the orbit of healthy rabbits failed to survive for 60 days. Systemic steroids helped establishing an infection as evidenced by proliferating fungi in the retro-orbital tissue, which however remained sub-clinical. There developed a mass in diabetic rabbits showing proliferating fungus, areas of necrosis and a granulomatous reaction. Fungus was more invasive in acidotic animals as it involved sclera, choroid and episclera. In both cases, the infection remained clinically unmanifested.
Zusammenfassung: Sporen von Rhiszopus oryzae überlebten nicht einen Zeitraum von 60 Tagen nach Inokulation in die Orbita von gesunden Kaninchen. Unter systemischer Corticoid-Behandlung konnte eine Infektion etabliert werden. Dies ließ sich durch Proliferation der Pilze im retroorbitalen Gewebe nachweisen. Klinische Erscheinungen traten jedoch nicht auf. Bei diabetischen Kaninchen entwickelte sich in der Orbita ein Prozeß mit proliferierenden Pilzelementen, nekrotischen Bezirken und einer granulomatösen Reaktion. Bei azidotischen Tieren zeigte der Pilz stärkere Invasion unter Beteiligung der Skleren, der Chorioidea und der Epissklera. Auch in der letztgenannten Fällen zeigten sich keine klinischen Manifestationen.     

Rhizopus oligosporus as a Cause of Mucormycosis in Man: Rhizopus oligospovus als Mucormykose-Erreger beim Menschen

After a fracture of the spinal column a 49-year-old male developed a mucormycosis due to Rhizopus oligosporus. This appears to be the first report of a disease caused by this thermotolerant Rhizopus species in a human being.     

Aspergillus-Antigen-Nachweis: Vergleich eines neuen Sandwich-ELISA mit dem Latex-Agglutinationstest bei Patienten mit histologisch gesicherter invasiver Aspergillose

Zusammenfassung. Ein neuer Sandwich-Antigen-ELISA zum Nachweis von Aspergillus-Galactomannan im Blutplasma wurde mit dem Latex-Agglutinations-Test anhand von sechs Patienten mit histologisch gesicherter invasiver Aspergillose verglichen. Der Antigen-ELISA zeigte sich dem Latex-Test in zweierlei Hinsicht überlegen: Alle sechs Patienten wurden vom Antigen-ELISA richtig als positiv erkannt, während dies beim Latex-Test nur in 5/6 der Fall war. Außerdem lieferte der Antigen-ELISA im Mittel 19 Tage früher als der Latex-Test ein positives Testergebnis. Summary. A new sandwich antigen enzyme-linked immunosorbent assay (ELISA) for the detection of Aspergillus galactomannan in blood plasma was compared with the latex-agglutination test by investigation of six patients with histologically proven invasive aspergillosis. The ELISA gave positive results in all six patients while the latex test recognized 5/6 as positive. On an average the antigen ELISA gave positive results 19 days earlier than the latex test.     

A case of cutaneous mucormycosis in Shanghai, China

A 34-year-old female farmer suffered from localized cutaneous mucormycosis for 17 years. At the first admission, the lesion was a dull red plaque, about 7 x 9 cm in size with ulcerations, surrounded by some nodules on the dorsum of her right hand. General examination did not reveal abnormal findings except the skin lesion. Direct examination of skin scrapings in 10% KOH revealed broad, sparsely septate, branching hyphae. Histopathology showed many intradermal granulomata and microabscesses as well as mycelial elements comprising broad, distorted, ribbon-like strands. Some of them were phagocytized by multi-nucleated giant cells. Cultures revealed rapidly growing yellow colonies on Sabouraud dextrose agar medium at 25 degrees C. Sporangiophores branched in sympodia and the sporangia were globose, 35-60 microns in diameter. Their walls were deliquescent, but some of them were rather persistent. Columellae were mostly globose, 12-17 microns in diameter, up to 35 microns with collars. Sporangiospores were mainly ellipsoidal, 1.5-2.5 x 3-5 microns in size, but sometimes highly variable in size and shape. The maximum growth temperature of the isolate was 37 degrees C. The pathogenic organism isolated was tentatively identified as Mucor lusitanicus, which, as far as we know, has not been reported as a causative agent of cutaneous mucormycosis.     

Total Skin Electron Irradiation: Efficacy in Early Mycosis Fungoides

The rare, indolent, but lethal malignancy, mycosis fungoides (MF), is amenable to durable remissions if treated topically at an early stage with nitrogen mustard, PUVA, or radiotherapy. A modification of conventional therapeutic irradiation which utilizes electron beams rather than photons, has been in use since 1951. This method, termed total skin electron irradiation (TSEI), has achieved consistently good CR rates (95-100%) at a variety of centres in the U.S.A., England, France, and Italy, despite troublesome differences in staging systems. In northern Israel we have treated 37 MF patients with TSEI during the past 13 years. All 21 of our early stage patients achieved CR, which is no longer regarded as an unusual result. However, most workers in the field acknowledge that issues of optimal dosing and curative potency remain unresolved.     

Necrotizing Pulmonary Aspergillosis with Oxalosis: Nekrotisierende pulmonale Aspergillose mit Oxalose

Summary: Aspergillus niger has the unique ability to produce oxalic acid. We describe a patient with chronic necrotizing pulmonary aspergillosis due to A. niger who had calcium oxalate crystals demonstrated in sputum, bronchial washings, and lung tissue obtained by transbronchial biopsy. Necrotizing pulmonary infection due to A. niger is uncommon; the presence of calcium oxalate crystals can prove helpful in establishing the diagnosis of serious infection due to A. niger.
Zusammenfassung: Aspergillus niger hat die einzigartige Fähigkeit, Oxalsäure zu produzieren. Wir beschreiben einen Patienten mit einer chronischen nekrotisierenden pulmonalen Aspergillose durch Aspergillus niger. Der Patient hatte Kalziumoxalat-Kristalle im Sputum, in Bronchialabsaugungen und im Lungengewebe, das durch transbronchiale Biopsie gewonnen wurde. Nekrotisierende pulmonale Infektionen durch Aspergillus niger sind selten. Der Nachweis von Kalziumoxalat-Kristallen kann bei der Stellung der Diagnose einer ernsten Infektion durch Aspergillus niger hilfreich sein.     

Mycosis fungoides involving the oral cavity

Mycosis fungoides is a malignant T‐cell lymphoproliferative disease with a predilection for cutaneous involvement. Extracutaneous disease is uncommon and oral mucosal involvement is rare. We describe a case of mycosis fungoides involving the hard palate treated with radiotherapy. The relevant literature on this topic is reviewed.     

Fungal nucleic acid detection for invasive aspergillosis

A universal PCR-assay for the detection of fungal DNA was compared with microscopy and culture for the diagnosis of invasive aspergillosis using 78 samples from 42 patients. Eighteen patients were suffering from invasive aspergillosis, 5 patients were colonized with Aspergillus in the respiratory tract, 19 patients did not show any sign of aspergillosis. Samples from 6 of the 18 patients with invasive aspergillosis were microscopically positive with true mycelia, 15 of 18 grew Aspergillus in culture, 16 of 18 were PCR-positive. The combination of microscopy and culture led to the diagnosis in 17 of 18 patients, the combination of microscopy and PCR in 16 of 18 and the combination of culture and PCR in all the 18 patients. For 3 of 18 patients, PCR was the diagnostic key: in 2 biopsies the histologically detected fungal elements were identified as Aspergillus, in 3 bronchial lavages from 1 patients nothing but PCR was positive for Aspergillus. Four out of 5 culture positive patients with Aspergillus colonization were also PCR positive; one out of 19 patients without aspergillosis was culture positive, 3 out of 19 were falsely PCR positive. Candida colonization in the upper respiratory tract or Pneumocystis carinii pneumonia did not lead to false positive Aspergillus-PCR results. In conclusion, the evaluated fungal PCR-assay can supplement conventional methods for the diagnosis of invasive aspergillosis.     

Orbital apex syndrome in a child

A 8-year-old male presented with visual loss, diplopia, ptosis, pain behind the left eye, facial numbness and vomiting of one week duration. The ophthalmological, neurological and radiological examination showed a lesion of the left orbital apex with extension into the cavernous sinus. Examination of the nose and paranasal sinuses did not reveal any abnormality. Transnasal Endoscopic orbital decompression was performed and inflamed granulation tissue found in the orbital apex was removed. Microbiology showed fungal elements which on culture grew Aspergillosis flavus. Antifungal therapy with new generation oral drug (voriconazole) resulted in complete resolution of symptoms. Relevant literature is reviewed and discussed.     

Isolierte Cerebrale Mucormykose bei Leukämie: Isolated Cerebral Mucormycosis in a Patient with Leukemia

Zusammenfassung: Mucormykosen stellen seltene Infektionen dar. Bei Diabetikern findet man vor allem die rhinocerebrale, bei immungeschwächten Patienten dagegen die pulmonale und disseminierte Form. Wir berichten über eine Patientin im Stadium der Vollremission einer akuten lymphatischen Leukämie, die klinisch an einer Meningo-Encephalitis mit Hirnnervenbeteiligung ohne bekannte Ätiologie verstarb. Bei der Obduktion zeigte sich eine Thrombosierung der Arteria vertebralis links, die durch eine Mucorinfiltration bedingt war und zu einer hämorrhagischen Erweichung im Kleinhirn und in der Medulla oblongata führte. Außer dieser cerebralen Mucormykose wurden keine weiteren Infektionsherde gefunden.
Summary: Mucormycosis is a rare infection. In patients with diabetes mellitus a rhinocerebral form predominates, while in the immunocompromised host mucormycosis is mostly pulmonary or disseminated. We report on a patient in remission of an acute leukemia, who died clinically of a meningo-encephalitis with involvement of cranial nerves of unknown etiology. At autopsy a thrombosis of the left arteria vertebralis caused by mucor was found with hemorrhagic necrosis of the cerebellum and the medulla oblongata. Except of this cerebral mucormycosis no further foci of infection were detected.     

Primary Pulmonary Aspergillosis. A Case Study: Primäre pulmonale Aspergillose. Ein Fallbericht

Summary: A case of chronic necrotizing pulmonary aspergillosis CNPA in a 47-year-old man is described. The disease was considered primary as the lesion arose in a previously normal lung lobe. The diagnosis was supported by a significant increase in Aspergillus fumigatus precipitin and catalase antibody titres in the beginning of disease. A percutaneous aspiration biopsy from the lung infiltrate revealed anucleate aspergillus-like hyphae. The patient died after 2 years of disease.
Zusammenfassung: Beridit über eine chronische nekrotisierende pulmonale Aspergillose CNPA bei einem 47 Jahre alten Mann. Die Erkrankung wurde als primär angesehen, da die Aspergillose sich in einem vorber normalem Lungenlappen entwickelte. Zur Diagnose trug ein signifikanter Anstieg der prezipitierenden Antikörpertiter gegen Aspergillus fumigatus und insbesondere der Katalase-Antiköpertiter bei. Eine perkütane Aspirationsbiopsie aus dem Lungeninfiltrat zeigte Aspergillus-artige Hyphen ohne Zellkerne. Der Patient verstarb nach einem Krankheitsverlauf von 2 Jahren.     

Sino-Orbital and Cerebral Aspergillosis: Cure with Medical Therapy/Sino-Orbital- und Zerebralaspergillose: Ausheilung durch medikamentöse Therapie

Summary: A patient with sino-orbital and cerebral aspergillosis was successfully treated medically without surgical debridement. Anti-fungal agents, including amphotericin B and flucytosine were given over a fifteen month period with improvement in symptoms, resolution of cerebral abscesses by CT scan, and disappearance of serum precipitins to Aspergillus fumigatus. Success was attributed to the long duration of therapy (received in part as an outpatient), the use of agents to which the organism was known to be susceptible, and the maintenance of therapeutic drug levels. Although surgery is important in the management of chronic sino-orbital and cerebral aspergillosis, in patients unable to undergo extensive debridement medical therapy given for extended periods of time may be successful in eradicating the infection.
Zusammenfassung: Eine Patientin mit einer Aspergillose der Nebenhöhlen, der Orbita und des Gehirns wurde erfolgreich medikamentös ohne chirurgisches Debridement behandelt. Antimykotika einschließlich Amphotericin B und Flucytosin wurden über einen Zeitraum von 15 Monaten verabreicht und führten zu einer Besserung der Symptomatik zu einer Rückbildung der computertomographisch erfaßbaren zerebralen Abszesse und zu einem Verschwinden der Serumpräzipitine gegen Aspergillus fumigatus. Der Erfolg wird der langen Dauer der antimykotischen Chemotherapie zugeschrieben (teilweise ambulant verabreicht), ferner der Anwendung von Präparaten mit ausgetesteter Suszeptibilität des Erregers und der Erzielung und Erhaltung therapeutisch wirksamer Antimykotika-Konzentrationen. Obgleich die Chirurgie in der Behandlung der Aspergillose der Nebenhöhlen, der Orbita und des Gehirns das Vorgehen der ersten Wahl ist, kann die medikamentöse Therapie bei Patienten, an denen ein extensives chirurgisches Debridement nicht möglich ist, bei Langzeitanwendung die Infektion zum Erlöschen bringen.     

The Treatment of Aspergillosis and Aspergilloma with Itraconazole, Clinical Results of an Open International Study (1982 - 1987)/Die Behandlung der Aspergillose und des Aspergilloms mit Itraconazol, Klinische Ergebnisse einer offenen internationalen Studie (1982 - 1987)

Summary: A total of 137 patients with aspergillosis or aspergilloma has been treated with 50 to 400 mg itraconazole daily during 11 to 780 days. The global assessments »markedly improved« and »cured« were given to 60% of the treatments in invasive aspergillosis (n = 35) and reached 66% in chronic necrotising pulmonary aspergillosis (n = 44). These response rates are sufficiently high regarding the limited number of antifungal agents useful in aspergillosis. Sixty-two percent of the chronic pulmonary aspergilloma cases (n = 42) showed symptomatic improvement and the radiological picture had improved in 30%. In one patient, the fungus ball disappeared during long-term treatment. The results in five allergic bronchopulmonary aspergillosis (ABPA) patients indicate a possible role for itraconazole as complementary treatment to corticosteroids. All seven patients with cutaneous aspergillosis were mycologically and clinically cured after a maximum of 158 days of treatment. Two out of three biopsy proven cases of bone aspergillosis responded to itraconazole therapy. These long-term treatments with itraconazole were well tolerated. The reported side effects were merely of gastro-intestinal origin and there was no effect on the most important biochemical and haematological parameters. Itraconazole appears to be a valuable new tool in the treatment of aspergillosis. Zusammenfassung: Eine Gesamtzahl von 137 Aspergillose- und Aspergillom-Patienten wurde mit 50–400 mg Itraconazol täglich über Perioden zwischen 11 und 780 Tagen behandelt. Das Globalurteil »wesentlich gebessert« oder »geheilt« erhielten 60% der Behandelten mit invasiver Aspergillose (n = 35) und 66% der Patienten mit chronisch nekrotisierender Lungenaspergillose (n = 44). Diese Ansprechquoten sind recht hoch, wenn man die beschränkte Anzahl der bei Aspergillose wirksamen Antimykotika berücksichtigt. Bei 62% der Fälle mit chronischem Lungenaspergillom (n = 42) wurde eine symptomatische Besserung erzielt, bei 30% besserte sich das radiologische Bild. Bei einem Patienten verschwand der Fungusball während Langzeitbehandlung. Die Ergebnisse von 5 Patienten mit allergischer bronchopulmonaler Aspergilose (ABPA) deuten auf die mögliche Rolle von Itraconazol bei einer Kombinationsbehandlung mit Kortikosteroiden. Alle 7 Patienten mit kutaner Aspergillose waren nach einer maximalen Behandlungsdauer von 158 Tagen mykologisch und klinisch geheilt. Zwei von 3 bioptisch nachgewiesenen Fällen mit Knochenaspergillose sprachen auf Itraconazol-Behandlung an. Die Langzeitbehandlung mit Itraconazol war gut verträglich. Die angegebenen Nebenwirkungen waren meist gastrointestinalen Ursprunges, die wesentlichsten biochemischen und hämatologischen Parameter blieben unbeeinflußt. Damit erweist sich Itraconazol als ein wertvolles neues Medikament bei der Behandlung der Aspergillose.     

Primäre Magenmykose,durch Trichosporon cutaneum verursacht: Primary Gastric Mycosis,Caused by Trichosporon cutaneum

Zusammenfassung: Eine durch gastroskopische, histologische und mykologische Untersuchung bewiesene, von Trichosporon cutaneum verursachte isolierte primäre Mykose kommt zur Demonstration. Im Einklang mit literarischen Angaben betonen die Verfasser die Wichtigkeit der komplexen Behandlung und der planmäßigen Nachprüfung. Summary: A case of primary gastric mycosis caused by Trichosporon cutaneum is demonstrated. It was verified by gastroscopic, histologic and mycologic examinations. In accordance with data from the literature, the authors point to the importance of complex treatment and systemic follow-up investigations.     

Orbital rhabdomyosarcoma: Multidisciplinary treatment experience

Orbital rhabdomyosarcoma (RMS) accounts for 10% of childhood RMS and has a relatively good prognosis of up to 85% 5‐year survival. Improved survival has led to increased interest in late effects of treatment. The objective of this study was to review the results of treating orbital RMS with multidisciplinary treatment at Women's and Children's Hospital and Royal Adelaide Hospital with emphasis on late effects of treatment. A retrospective review was carried out of all patients with orbital RMS treated with multidisciplinary treatment including radiation therapy and chemotherapy in the two institutions between 1982 and 2002. A total of five patients (age range 5.5‐12 years) satisfied the eligibility requirements. Late effects were significant and included facial bone hypoplasia, cataract formation and growth hormone deficiency. Overall survival was 80% (4/5) with mean follow up of 8 years (range 3‐13 years). Given the high cure rates achieved, future treatments must aim to maintain the good results but to reduce the high incidence of late effects of treatment. Standardised rating of late toxicity, long‐term follow‐up clinics, and implementation of modern radiation techniques (3‐D conformal radiotherapy, intensity modulated radiotherapy, proton therapy) for patients with orbital RMS are important to improving outcome.     

Epidemiologie der Aspergillose und Cryptococcose in Deutschland

Zusammenfassung. Umfrageergebnisse zur Aspergillose und Cryptococcose in Deutschland für den Zeitraum 1992–1997 werden mitgeteilt und analysiert. The results of an enquiry concerning aspergillosis and cryptococcosis for the period 1992–1997 in Germany are reported and analysed.     

Total Skin Electron Irradiation and Sequential Malignancies in Mycosis Fungoides Patients: Longitudinal Study

Aims

To determine the role of total skin electron irradiation (TSEI) as a cause of second malignancies in mycosis fungoides patients.

Mycosis on mycosis fungoides: zoophilic dermatophytosis selectively superimposed on pre-existing cutaneous T-cell lymphoma (mycosis fungoides) plaques

We report a case of tinea corporis caused by a cattle-derived strain of Trichophyton mentagrophytes in a 44-year-old male affected by cutaneous T-cell lymphoma (CTCL, so-called mycosis fungoides). Fungal colonization of glabrous skin was strictly confined within pre-existing lymphomatous plaques. Either oral itraconazole or griseofulvin, or topical terbinafine were ineffective until the patient, who was treated with systemic retinoids and interferon-alpha for his CTCL, was shifted from leucocyte to lymphoblastoid interferon. The hypothesis that a local immunodisturbance could be responsible for the selective superimposition of tinea on CTCL lesions ('mycosis on mycosis'), and that such an immunodisturbance could be partially corrected by the interferon switch is discussed.