Multiple processes underlie benzodiazepine-mediated increases in the consumption of accepted and avoided stimuli.

Hyperphagia is a reported side effect of anxiolytic benzodiazepines such as chlordiazepoxide (CDP). Prior research has focused primarily on the ingestive responses to sweet or solid foods. We examined CDP effects on licking for normally accepted and avoided taste solutions across a range of concentrations. The effect of CDP (10 mg/kg) versus saline on the licking patterns of water-restricted rats for water and 3 concentrations of sucrose, saccharin, NaCl, monosodium glutamate (MSG), citric acid, and quinine (Q-HCl) solutions was evaluated during 1 h tests. CDP increased meal size for all tastants except citric acid. Analysis of licking microstructure revealed 3 dissociable effects of CDP. CDP affected oromotor coordination as indicated by a uniform increase in the modal interlick interval for all stimuli. CDP increased meal size as indicated by shorter pauses during consumption of water, MSG, and weaker saccharin concentrations, and by fewer long interlick intervals (250-2000 ms) for normally avoided tastants. CDP also increased meal size by increasing burst size, burst duration, and the initial rate of licking for most solutions, suggesting increased hedonic taste evaluation. CDP did not affect variables associated with postingestive feedback such as meal duration or number of bursts, and the results also suggest that CDP did not enhance the perceived taste intensity. We hypothesize that the reduction of pause duration is consistent with an increased motivation to sample the stimulus that synergizes with changes in taste-mediated responsiveness to some but not all stimuli to yield increases in the consumption of both normally accepted and avoided taste stimuli.

Cerebral aspergillosis diagnosed by detection of Aspergillus flavus-specific DNA, galactomannan and (1-->3)-beta-D-glucan in clinical specimens.

A case of cerebral aspergillosis was diagnosed by the detection of Aspergillus flavus-specific DNA in brain biopsy and serum specimens. The diagnosis was also supported by detection of elevated levels of galactomannan and (1-->3)-beta-d-glucan in serum specimens. Despite the presence of dichotomously branched septate hyphae in brain biopsy, the culture remained negative. The inability to isolate the organism in culture suggested that combined therapy of AmBisome and caspofungin was fungicidal for the fungus in the brain abscess.

Persistent neutrophilic meningitis. Report of four cases and review of the literature.

Persistent neutrophilic meningitis is a poorly described variant of chronic meningitis characterized by the persistence of neutrophils in the CSF over extended periods of time (greater than 1 wk) in association with ongoing signs of meningeal inflammation and negative CSF cultures for bacteria and other pathogens. Although the incidence of persistent neutrophilic meningitis is difficult to ascertain, a review of available literature on CNS infections suggests that this entity is not rare. Etiologies of this syndrome are both infectious and noninfectious. Among infectious causes, bacteria such as Nocardia and Actinomyces and systemic mycoses such as Aspergillus and the zygomycetes are the predominant pathogens. The pathogenesis of the persistent neutrophilic CSF response is unknown; with some infectious etiologies, there may be a correlation between neutrophil response and the morphology of the invading organism. Mycelial-like pathogens appear to be the primary stimulus for an ongoing neutrophilic inflammatory response. In cases of persistent neutrophilic meningitis, epidemiologic features and clinical setting frequently offer clues to the etiologic agent, especially in the immunocompromised host. Evaluation should include repetitive cultural and serologic studies of the CSF with special emphasis upon special cultural methods, antigen detection and detection of characteristic metabolic byproducts. Biopsy of extraneural sites of disease should be pursued whenever possible to provide data for an inferential diagnosis of CNS disease. CNS biopsies should be selectively performed in those patients undergoing craniotomy for evaluation of mass lesions. Therapy must be individualized. However, in the immunocompromised host, consideration should be given to the empiric use of amphotericin B with or without a sulfonamide in undiagnosed cases that manifest progressive clinical deterioration.

Detection of fungi in cerebrospinal fluid.

With the exception of Cryptococcus neoformans, fungi are rarely detected in cerebrospinal fluid obtained from patients having or suspected of having fungal meningitis. A review of the literature reveals that several fungi have been either isolated, observed, or both in cerebrospinal fluid specimens. These fungi include Acremonium species, Aspergillus amstelodami, A. flavus, A. fumigatus, A. oryzae, A. terreus, Blastomyces dermatitidis, Candida albicans, C. tropicalis, C. viswanathii, Coccidioides immitis, Cryptococcus albidus, C. neoformans, Histoplasma capsulatum, Paecilomyces variotii, Paracoccidioides brasiliensis, Pseudallescheria boydii, Schizophyllum species, and Sporothrix schenckii. Laboratory findings for cerebrospinal fluid specimens obtained from such patients and clinical presentations are summarized.

Dactylaria infection of a human being: pulmonary disease in a heart transplant recipient.

We describe a case of pulmonary abscess caused by Dactylaria constricta in a heart transplant recipient. A 30-year-old man with a 1-month history of fever and cough was found by computed tomographic scan to have a cavitary lesion in the lingular segment in the upper lobe of his left lung. Culture of a needle biopsy specimen yielded a pure culture of D. constricta. The patient was successfully treated with systemic amphotericin B therapy, which resulted in resolution of the clinical symptoms and of the cavitary lesion.

Fusarium infection in burned patients.

The incidence of fungal infections of burn wounds is increasing because of the dramatic improvement in antibacterial chemotherapy and burn wound care. Species of Fusarium, common soil fungi and plant pathogens, are rarely isolated from burn wounds, and invasive disease due to these organisms is also rare. Therefore, a case of burn wound infection with dissemination due to F. oxysporum is reported; three other cases of burn wound colonization by Fusarium sp. are also reported. The literature on fungal infections of burn wounds is reviewed, and the importance of combined histologic and mycologic studies in the evaluation of such wounds is discussed.

Zygomycosis. Report of four cases with formation of chlamydoconidia in tissue.

The authors describe spheric to ovoid chlamydoconidia and mucoraceous hyphae in tissues from four patients, two with cutaneous and two with pulmonary zygomycosis. The diagnosis in each case was confirmed by immunofluorescence staining and the presence of characteristic hyphae in tissue. It is important that these conidia be recognized, because they can easily be mistaken for other fungi, nematode ova, or other microorganisms in tissue sections, thereby resulting in the potential for misdiagnosis.

Disseminated infection by Aspergillus terreus.

A patient with acute nonlymphocytic leukemia who received chemotherapy developed lung nodules and later central nervous system symptoms consistent with disseminated aspergillosis. The diagnosis was made at open lung biopsy by culturing the organism and observing in tissue sections conidia borne laterally along the hyphae, a characteristic of the Aspergillus terreus-flavipes group. This is the first reported case of disseminated A. terreus infection in an immunocompromised host.

Infections caused by dematiaceous fungi: chromoblastomycosis and phaeohyphomycosis.

Because of the increased incidence of infections caused by dematiaceous fungi, it is important to clearly define the conceptual basis for the clinical nomenclature for infections caused by these fungi. When considering dematiaceous fungal infections, there is a continuum of diseases that can be separated into the three categories of chromoblastomycosis, phaeohyphomycosis, and mycetoma. The diseases chromoblastomycosis and phaeohyphomycosis are compared and contrasted in this chapter.

Mycetoma: a contemporary concept.

Mycetoma is a localized noncontagious infection that involves cutaneous and subcutaneous tissue, fascia, and bone. The disease is caused by either aerobic actinomycetes or fungi that are normally associated with soil and plant material. In the past, actinomycosis, botryomycosis, fungus balls, and some forms of Majocchi's granuloma trichophyticum have been confused with mycetoma. Antimicrobic chemotherapy and surgery are management approaches used to resolve this disease.

Mycetoma.

Mycetoma is a chronic infectious disease, most commonly caused by Madurella mycetomatis, that remains localized, involves cutaneous and subcutaneous tissue, fascia, and bone, and is noncontagious. The disease is characterized by tumefaction, draining sinuses, and the presence of sclerotia. The 31 fungi known to cause mycetoma are associated with soil and woody plants. A chronic, tumor-like deforming disease develops during subsequent years following the introduction of the etiologic agent via localized trauma. Combined surgical and medical management with ketoconazole results in the best outcome.

Pathology of Penicillium marneffei. An emerging acquired immunodeficiency syndrome-related pathogen.

OBJECTIVE: To summarize current knowledge regarding the opportunistic dimorphic fungal pathogen Penicillium marneffei. Clinical presentation, differential diagnosis, mycology, histopathology, diagnostic serology, in vitro antifungal agent susceptibility testing, and therapy are discussed for human immunodeficiency virus-infected individuals primarily living in Southeast Asia. DATA SOURCES: Critical evaluation of peer-reviewed publications located through an electronic literature database search, supplemented by unpublished observations, were used to prepare this report. STUDY SELECTION: Studies were selected based on either the fungal name Penicillium marneffei, penicilliosis, penicilliosis marneffei, or a combination of these. DATA EXTRACTION: Articles were reviewed with appropriate data being abstracted and then synthesized into the review. DATA SYNTHESIS: Differential diagnostic criteria for tissue diagnosis and laboratory identification of the fungus are detailed. The usefulness of mycoserology and antifungal therapy are evaluated. CONCLUSIONS: Penicillium marneffei is an emerging pathogen, primarily among patients with acquired immunodeficiency syndrome residing in Southeast Asia. Although infection caused by P marneffei is endemic to this portion of the world, cases are being diagnosed and treated involving individuals who have traveled to this region. Penicilliosis marneffei can clinically resemble tuberculosis, molluscum contagiosum, cryptococcosis, and histoplasmosis. The successful treatment of P marneffei infection is dependent on its rapid and accurate diagnosis.

Fontana-Masson--stained tissue from culture-proven mycoses.

BACKGROUND: The Fontana-Masson stain can be used to detect melanin of dematiaceous fungi such as Curvularia lunata and Bipolaris hawaiiensis in tissue. This stain is often used to identify fungi that may not have an evident brown color in hematoxylin-eosin-stained sections. However, it is not clear whether hyphae of nondematiaceous fungi can be stained with the Fontana-Masson procedure. METHODS: Paraffin sections from culture-proven mycoses caused by species of Aspergillus, Candida, Fusarium, Pseudallescheria, Trichosporon, zygomycetes, and dematiaceous fungi were stained by the Fontana-Masson procedure. Extent of stain intensity and its distribution in fungal elements in tissue were evaluated by means of an intensity scale based on Cryptococcus neoformans as a positive control. RESULTS: Many Aspergillus spp, some zygomycetes, and all of the dematiaceous fungi showed strong intensity, whereas other fungi showed either weak intensity or no staining. CONCLUSION: Fungal hyphae other than dematiaceous fungi occasionally can be stained with the Fontana-Masson procedure. The morphology of positively stained hyphae must be carefully evaluated, especially when they are hyaline in hematoxylin-eosin-stained tissue sections.

Chlamydoconidia formation in zygomycosis due to Rhizopus species.

An unusual case of endobronchial zygomycosis, which was caused by Rhizopus species and which disseminated to one kidney, occurred in a 36-year-old, diabetic man. The patient recovered fully following lobectomy, nephrectomy, amphotericin B therapy, and control of diabetes mellitus. An interesting histologic finding was the presence of chlamydoconidia formation within the resected lung lesion. To our knowledge, only one previous culture-proven case of zygomycosis has described chlamydoconidia formation in tissue.

Zygomycosis due to Apophysomyces elegans: report of 2 cases and review of the literature.

OBJECTIVE: The zygomycete Apophysomyces elegans is an unusual human pathogen that is being reported with increasing frequency as a cause of infection in previously healthy patients following trauma or after invasive procedures. We report 2 cases of infection caused by this emerging fungal pathogen. METHODS: Histologic sections of tissue removed from the infected patients and the isolates in culture were examined. Other infections caused by A. elegans that have been reported in the literature were reviewed. RESULTS: Both patients developed infection due to A. elegans after sustaining trauma that required tissue debridement because of tissue necrosis. Histologic examination showed broad, sparsely septate, thin-walled hyphae and angioinvasion with thrombosis. Extensive coagulation necrosis of surrounding tissue was seen. A rapidly growing mold with sporangiophores having funnel-shaped apophyses and pyriform sporangia, characteristic of A. elegans, was isolated from each case. CONCLUSION: Apophysomyces elegans is an opportunistic pathogen that can cause infection in previously healthy patients who suffer an injury to the cutaneous barrier, such as trauma or burns. Infection with this zygomycete should be considered when there is progressive necrosis of a wound in a previously healthy patient. Successful treatment requires tissue debridement and amphotericin B. Histologic examination for early diagnosis and frozen section evaluation of surgical margins are required for optimal therapy.

Zygomycosis caused by Cunninghamella bertholletiae: clinical and pathologic aspects.

Two cases of disseminated systemic zygomycosis caused by Cunninghamella bertholletiae in compromised persons were studied. The underlying disease in one patient was hematopoietic dysplasia (preleukemic syndrome) and in the other, postnecrotic hepatic cirrhosis. A definitive diagnosis of zygomycosis caused by C bertholletiae is achieved only by isolation and identification of the fungus and by demonstration of tissue invasion.

Hansenula polymorpha infection in a child with chronic granulomatous disease.

In a patient with chronic granulomatous disease of childhood documented by the nitroblue tetrazolium test, an infection of the mediastinal lymph nodes developed that was caused by Hansenula polymorpha, an ascomycetous yeast. To our knowledge, this yeast has not been previously shown to be an etiologic agent of disease in man. The diagnosis was made by growing the yeast from cultures of several biopsy specimens collected at the time of thoracotomy. Susceptibility testing showed that the yeast was sensitive to amphotericin B. Treatment with amphotericin B reversed this life-threatening episode.

Zygomycosis caused by Cunninghamella bertholletiae: mycologic aspects.

Two isolates of Cunninghamella bertholletiae from confirmed cases of human zygomycosis were studied, and their sexual, asexual, and physiologic characteristics described. Minimal inhibitory concentrations for these two isolates, as well as for six other clinical isolates of C bertholletiae, were determined for amphotericin B, flucytosine, and miconazole using a standardized agar dilution technique. All isolates were found to be susceptible to miconazole, but resistant to flucytosine and amphotericin B.

Disseminated Conidiobolus infection with endocarditis in a cocaine abuser.

A crack cocaine abuser developed disseminated infection caused by a species of Conidiobolus not known to cause disease in vertebrates. The fungus gained entry via skin abrasions on the lower extremities, spread through the hematogenous route, and caused endocarditis. There was evidence of fungal infection in the lungs, heart, kidneys, skeletal muscles, and brain. An additional complication was extensive rhabdomyolysis, with a marked elevation of creatine kinase of up to 1.2 million U/L.

High mortality in a large-scale zebrafish colony (Brachydanio rerio Hamilton & Buchanan, 1822) associated with Lecythophora mutabilis (van Beyma) W. Gams & McGinnis.

Zebrafish (Brachydanio rerio) have become an important model system for studying vertebrate embryonic development and gene function through manipulation of genotype and characterization of resultant phenotypes. An established research zebrafish colony without substantial disease problems for more than 7 years of operation began experiencing appreciable mortalities in November of 1997. Young fish (fry), from five to 24 days after hatching, spontaneously developed elongate strands of organic material protruding from the mouth, operculum, and anal pore, leading workers in the laboratory to describe the infected fish as "bearded." Unlike typical freshwater fish fungal infections, the skin surface did not have evidence of fungal colonization. The disease was associated with progressive lethargy, reduced feeding, and subsequent mortality. From 10 to 100% of the fry in a given tank were affected. Initial examination indicated that the biofilm around the head of affected fry consisted of bundles of septate fungal hyphae, large numbers of mixed bacterial populations, and protozoans. Environmental samples of air and water in the laboratory were obtained to ascertain the source of the infective agent and to isolate and identify the fungus. A fungus identified as Lecythophora mutabilis was isolated repeatedly from infected fish and water samples from infected fish tanks, and from the main laboratory water supply tanks, but not from laboratory air. Some biofilm beards on fish were found to consist of relatively pure bacterial populations, and beards on occasional fish examined in the later part of the study consisted of hyphae and spores of the oomycete genus Aphanomyces. Lecythophora mutabilis did not invade tissues; however, elimination of the epizootic correlated with reduction in the number of L. mutabilis conidia in the water following modification of the laboratory water system by use of new filtration and sterilization systems. We conclude that the dense hyphal strands of L. mutabilis composing the predominant biofilm type, along with mixed bacteria and protozoa, contributed to the die-off in young fry by occluding the oral cavity and/or gills, leading to starvation and/or asphyxiation.