Successful treatment of disseminated Fusarium infection after autologous bone marrow transplantation for acute myeloid leukemia.

Disseminated Fusarium is a rare but life-threatening infection of severely immunocompromised patients. A fatal outcome has been described in all reported cases of Fusarium infection occurring after bone marrow transplantation. We describe a patient who developed disseminated Fusarium infection with a secondary fungal endophthalmitis after an autologous bone marrow transplant for acute myeloid leukemia. This infection was successfully eradicated after neutrophil recovery by prolonged systemic administration of amphotericin B as well as aggressive local therapy including enucleation of the affected eye. The patient remains free of both leukemia and fungal disease more than 4 years after transplant.

Disseminated visceral fusariosis treated with amphotericin B-phospholipid complex.

Fusariosis, a rare infectious disease of the immunocompromised host, is relatively resistant to amphotericin B (AmB) or other antifungal agents. We describe a 5-year follow-up of a 40 year old woman with T-type acute lymphoblastic leukemia who following chemotherapy developed prolonged high fever, chills, night sweats, and severe weakness. Liver function tests were impaired and abdominal computerized tomography (CT) showed multiple lesions in the liver and abnormal structure of the spleen. A laparotomy revealed multiple granulomas containing Fusarium sp. in the liver, and the spleen was heavily infiltrated by the same fungus. The patient failed to respond to the conventional AmB dosage form (Fungizone) even after a total dose of 3.0 g was given, and developed significant renal impairment. AmB was complexed (in a mole ratio of 1:16) with a mixture of the phospholipids dimyristoyl phosphatidylcholine and dimyristoyl phosphatidylglycerol (mixed in 7:3 mole ratio). The resulting drug complex, AmB-PLC, was then administered (1-4 mg/kg/day, total dose 4.2 g) and subsequently the patient was cured of all symptoms of fusariosis. There were only mild side effects and no nephrotoxicity was evident. On the contrary, marked improvement of the renal function tests occurred during AmB-PLC treatment. Eight months later, she developed a spinal lesion with dense consistency in L5 and S1, and after receiving another course of AmB-PLC (3.1 g) she recovered completely. In a 2 year follow-up period the patient had no further relapse of the fungal disease. Subsequent chemotherapy given for relapse of the leukemia was followed by a new fungal infection, which was treated with AmB-cholesteryl sulfate complex (Amphocil).(ABSTRACT TRUNCATED AT 250 WORDS)

Pathogenicity of Candida paratropicalis.

A new Candida species, Candida paratropicalis, was recently described. Four cases of infections due to C paratropicalis are reviewed in detail and an additional five cases are reviewed to establish the clinical relevance of this species of yeast. Candida paratropicalis was isolated from blood and several other body sites. Although the isolates tested were sensitive in vitro to amphotericin B and fluocytosine, significant morbidity and mortality were associated with the infections.

Dermatophilus dermatitis enzootic in deer in New York State and vicinity.

In a recent 2-year period Dermatophilus congolensis infection, ranging from mild to very severe, was found in 15 white-tailed deer (Odocoileus virginianus) taken in southeastern New York State (12) adjacent New Jersey (2) and central Vermont (1). The host range for Dermatophilus congolensis is given.

Association of Malassezia (Pityrosporum) pachydermatis with sarcoptic mange in New York State.

Malassezia (Pityrosporum) pachydermatis consistently accompanied sarcoptic mange in all red foxes (Vulpes fulva), porcupines (Erethizon dorsatum), and coyotes (Canis latrans) examined. This yeastlike microorganism has not heretofore been reported on any of these hosts. Its presence on the exoskeleton of Sarcoptes scabiei taken from these animals suggests a carrier role for the mite. The yeast may be saprophytic or a secondary pathogen.

Spontaneous dermatophilosis in twin white-tailed deer fawns.

Twin white-tailed deer (Odocoileus virginianus) fawns captured in Morris County, New Jersey, displayed papular, darkly pigmented scabs principally on the skin overlying the nasal bones, dentary, commissure of the lips and ears. Histopathological and bacterial examinations revealed Dermatophilus congolensis. The epidermitis caused by this bacterium apparently had developed within the first 12 to 14 days after birth and had begun to regress by one month of age. The location of the lesions suggested transmission during nursing from an infected doe. This is believed to be the first confirmed report of this zoonotic disease in white-tailed deer, with isolation of the etiologic agent, outside the State of New York. Epizootiological considerations are discussed.

Dermatophilosis among wild raccoons in New York State.

Dermatophilus congolensis was established as the cause of dermatitis in 8 raccoons, as determined from examination of carcasses and untreated hides. Encrusted lesions were restricted to or more pronounced in the areas around the eyes, along the snout, and on the skin in the tarsal and carpal regions. The causative agent was demonstrated through direct examination of stained paraffin sections, isolation in pure culture, or examination of stained smears from lesions induced experimentally in rabbits with material from the affected raccoons.

Dual infection of a white-tailed deer by Dermatophilus congolensis and Alternaria alternata.

Infection by both Dermatophilus congolensis and Alternaria alternata was found in a 5 1/2-year-old, female white-tailed deer (Odocoileus virginianus). Encrusted lesions characteristic of dermatophilosis were observed on the hocks, flanks, and back. Giemsa-staining of smears of material from beneath the crusts revealed branching filaments, transversely and longitudinally divided into packets of coccoid cells typical of D congolensis. Hyphae morphologically consistent with those of A alternata were found in methenamine-silver- and hematoxylin-and-eosin-stained sections of tissue from the ears, flanks, and back. Nutrient agar cultures inoculated with tissue from an ear and hindlimb of the deer yielded, respectively, A alternata and D congolensis.

New medium for differentiation of Candida albicans from Candida stellatoidea.

A simple medium effectively differentiated Candida stellatoidea from Candida albicans on the basis of a new criterion, relative sensitivity to cycloheximide.

Further simplification of the Guizotia abyssinica seed medium for identification of Cryptococcus neoformans and Cryptococcus bacillispora.

A simplified Guizotia abyssinica seed-based medium for presumptive diagnosis of Cryptococcus neoformans and C. bacillispora (Paliwal and Randhawa 1978) was further simplified by replacing seed extract with pulverized seeds. This medium gives unambiguous results, avoids false-positive reactions with 13 other yeastlike organisms, and is simple and relatively inexpensive to prepare.

Adaptation to cycloheximide: in vitro studies with filamentous fungi.

Adaptation of numerous strains of filamentous fungi to cycloheximide was noted upon first transfer during serial exposure to the antibiotic. The extent of this adaptation varied in part with the species and strain of the microorganism. Exposure on subsequent transfers caused no change in the growth of any of the strains used. These results suggest that nonzoopathogens may be differentiated from zoopathogens on the basis of adaptation to cycloheximide and that such adaptation might also be found in other eucaryotes.

Dermatrophye test medium: evaluation with nondermatophytic pathogens.

The growth and color change produced on dermatophyte test medium (DTM) by 25 strains of zoopathogenic fungi associated with human skin lesions were evaluated quantitatively. DTM only partially suppressed the development of nondermatophytes, with total growth in most instances comparable with that observed with dermatophytes. Whereas all dermatophytes induced a rapid color change on DTM, several nondermatophytic pathogens induced an equally intense and almost as rapid conversion. The rapidity of this color change and the colonial morphology of these forms on DTM could cause their misidentification as dermatophytes under clinical conditions.

Polymorphism of Malassezia furfur.

Alterations in the morphologic and physiologic characters of 11 isolates of Pityrosporum orbiculare were noted upon prolonged maintenance in pure culture. Successive subculturing of each isolate resulted in its progressive conversion from globose (P. orbiculare) through ovoid to cylindrical (P. ovale) form. Globose forms utilized neither olive oil nor Tween 20 as a sole carbon source, nor KNO3 as a sole source of nitrogen, while ovoid and cylindrical forms utilized both of these carbon sources, and one of four strains of the cylindrical form assimilated KNO3. These results suggest that P. orbiculare and P. ovale are stages in the complex developmental cycle of a single species (Malassezia furfur), but the three names should be preserved until the life cycle is more fully understood.

Uncommon yeastlike zoopathogens and commercial systems for their identification.

Opportunistic infections caused by yeasts or yeastlike fungi have increased in incidence in recent years as a result of clinical and therapeutic factors. Several formerly uncommon yeastlike zoopathogens--Candida lusitaniae, Candida paratropicalis (sucrose-negative variant of Candida tropicalis), Trichosporon beigelii, Blastoschizomyces capitatus, and Rhodotorula species--have been isolated from patients with invasive infections. The increased isolation of such opportunistic pathogens from a variety of clinical specimens has created a demand for simple, rapid, reliable, and accurate commercial systems to assist laboratorians in identification. Here we summarize the manual and automated systems currently available and present detailed descriptions of three representative commercial products, i.e., API 20C, Abbott Quantum II, and API Yeast-Ident.

Morphologic and physiologic studies of three dematiaceous pathogens.

Uncertainty in identifying a dematiaceous mold from a human bronchial washing precipitated a study of Dactylaria gallopava (Cooke) Bhatt et Kendrick and its relationship to Scolecobasidium constrictum Abbott. Morphologic and physiologic studies were conducted with representative isolates and subcultures derived from the isolates used to prepare the type specimens of these two fungi, as well as a third dark mold, Ochroconis constricta (Abbott) de Hoog et von Arx. All test isolates were morphologically similar in that two-celled, cylindrical blastoconidia with a rhexolytic mode of dehiscence were the predominant and most consistent anamorphic structures. Sympodial development of the conidiophore was too variable to distinguish the isolates. Based on their morphologic similarity, we propose a new combination within the genus Dactylaria as amended by Bhatt and Kendrick, D. constricta (Abbott) Dixon et Salkin. However, D. constricta could be differentiated into two groups on the basis of physiologic tests--a subgroup in which isolates grow at 37 and 45 degrees C, give a delayed positive gelatin reaction, and are inhibited on Mycosel agar; and a second subgroup in which isolates grow on Mycosel agar and give a rapid positive gelatin reaction, but do not grow at 37 or 45 degrees C. We recommend that D. constricta be viewed as a potential pathogen when isolated from clinical specimens.

Evaluation of Aspergillus differential medium.

The new Aspergillus differential medium distinguishes effectively between members of the Aspergillus flavus group and other Aspergillus species of interest in medical mycology.