Histoplasmosis in Europe: report on an epidemiological survey from the European Confederation of Medical Mycology Working Group.

The purpose of this survey was to systematically collect data on individuals with histoplasmosis in Europe over a 5-year period (from January 1995 to December 1999). This included information on where and how the infection was acquired, the patient's risk factors, the causative organism, how the infection was diagnosed and what therapy the patients received. Data were sent on a standardized survey form via a national convenor to the coordinator. During the survey, 118 cases were reported, with 62 patients having disseminated disease, 31 acute pulmonary infection, chronic pulmonary infection in 6 and localized disease in 2 patients. For 17 patients, the diagnosis of histoplasmosis was incidental, usually secondary to investigations for lung cancer. Most patients had travelled to known endemic areas, but 8 patients (from Italy, Germany and Turkey) indicated that they had not been outside their countries of origin and hence these cases appear to be autochthonous. Notable observations during the survey were the reactivation of the disease up to 50 years after the initial infection in some patients and transmission of the infection by a transplanted liver. Itraconazole was the most commonly used therapy in both pulmonary and disseminated disease. The observation of autochthonous cases of disease suggests that the endemic area of histoplasmosis is wider than classically reported and supports continued surveillance of the disease throughout Europe.

[Aspergillus, aspergillosis]. / Aspergillus, aspergilózy.

Aspergillus is a ubiquitous fungus which can penetrate into the human body in a natural way, by the respiratory tract or traumatically or iatrogenically. The presence of Aspergillus in the atmosphere is constant, in the environment, especially in moist places or in the neighbourhood of man, in dust. Aspergillus can colonise different substrates, the organic rests, soil, plants, cloting, climatisation, furniture. Aspergillus is in the first phase among the agents responsible for respiratory infections, for different physiopathological mechanisms and for some nosocomial infections. The author gives a review of sources of Aspergillus, especially for hospitalized patients, of mechanisms of the host's defence, of factors enabling the survival of Aspergillus in hosts and of clinical picture. The prevalence of deep forms: aspergillome, allergic bronchopulmonal aspergillosis remain constant. New clinical forms appear due to modern therapy (immunosuppression, organ transplantation). The author describes further laboratory diagnostics with the interpretation of results and epidemiological studies. The early diagnostics of different types of aspergillosis, preventive methods and actual antimycotic therapy can inhibit the progress and improve the prognosis of these infectious diseases.

[Septic conditions caused by yeasts and their diagnosis]. / Septické stavy vyvolané kvasinkami a jejich diagnostika.

The authors present a review of factors making possible the penetration of yeasts into the blood stream, development of Candinaemia and sepsis, and a group of tests which have been used for the diagnosis of sepsis evoked by Cryptococcus neoformans, Candida albicans, C. glabrata, C. melinii and C. krusei.

Causative agents of nosocomial mycoses.

In the last few years mycoses have been caused by fungi formerly considered to be harmless for humans. They cause diseases of plants and insects; some of them are also used in the industry. They are now usually called "emerging fungi". We investigated this flora with respect to their potential to cause infections in hospitals. These fungi are present in the air, on medical objects and instrumentation, in the respiratory tract and on the hands of hospital staff; other sources have been identified in the use of iatrogenic methods. Mycotic diseases, their risk factors, their clinical pictures, and spectra of agents were analyzed in 1990-2000; the results were compared with data in the literature. Transplantations were the most frequent risk factors, fungemia and abscess the most frequent clinical picture and filamentous fungi (genera Absidia, Acremonium, Alternaria, Apophysomyces, Aspergillus, Bipolaris, Cladophialophora, Cunninghamella, Exserohilum, Fusarium, Chaetomium, Chrysosporium, Lecythophora, Ochroconis, Paecilomyces, Pythium, Rhizopus, Scedosporium, Scopulariopsis) were the most frequent agents of nosocomial infections. These filamentous fungi and also some yeasts (genera Candida, Cryptococcus, Trichosporon) bring about different clinical syndromes in both immunocompromised and immunocompetent patients.

[Risk of fungal infection from foods, particularly in immunocompromised patients]. / Riziko houbové infekce z nekterých potravin, zvláste pro imunoalterované pacienty.

The aim of our study was the evaluation of fungal contamination of food distributed in hospitals to the immunocompromised patients. 97 samples of 10 sorts of fruit, 100 samples of 17 sorts of cheeses and 56 samples of 11 sorts of smoked meat products were investigated by cultivation on Sabourand's agar at 25 degrees C for 10 days. The yeasts (Candida, Trichosporon, Saccharomyces, Rhodotorula, Aureobasidium) were found in 82% of fruit, in 13% of cheeses and in 46% of smoked meat products. The filamentous fungi (Cladosporium, Alternaria, Penicillium, Aspergillus, Mucor and Helminthosporium) were found on all samples of fruit, in 44% of cheeses and in 3% of smoked foods. Our results show that the fungal contamination of the investigated food is not negligible. The isolated strains are agents of candidoses, phaeohyphomycoses, mucormycoses and aspergilloses and can kill immunocompromised patients.

[Filamentous fungal infections in man. Alphabetical overview of mycotic agents with data on their systematic classification and on the localization of individual diseases]. / Vláknité houby infikující cloveka. Abecední prehled puvodcu mykóz s údaji o jejich systematickém zarazení a o lokalizaci jednotlivých onemocnení.

The authors present a survey of filamentous microscopic fungi causing human mycoses. The outline is based on an alphabetical list of genera and their classification into higher taxonomic categories, i.e. orders, classes and divisions. The name of a relevant mycosis is followed by enumeration of the individual species and localizations of diseases produced by a given agent. To facilitate orientation in the system of myco-pathologically important agents, examples of classification of individual genera are presented in the text in a hierarchical arrangement of higher taxonomic categories.

Kaposi's sarcoma in dog with acquired immunodeficiency after phosphate poisoning.

We describe Kaposi's sarcoma accompanied by osteomyelitis of the gum, cystic degeneration of the kidneys and E. coli sepsis in an Alsatian with very severe acquired immunodeficiency stimulated by poisoning with organophosphates. This is the first case of Kaposi's sarcoma observed in animals.

Growing importance of non-Candida species as opportunistic pathogens.

A 40-year study of C. albicans, non-C. albicans species and non-Candida species in the excretions of patients with different diseases is described. An increase of non-C. albicans, and non-Candida species since 1980 has been determined. The study is completed by a review of new and emerging yeasts.

[Classification of microscopic fungi from the aspect of risk of infection in laboratory personnel]. / Klasifikácia mikroskopických húb z hl'adiska rizika infekcie laboratórnych pracovníkov.

The authors submit information on a new categorization of microscopic fungi causing human mycoses, as well as criteria of their classification in bio-risk groups (BioSafety Level-BSL) proposed by the European Confederation of Medical Mycology. According to the risk of infection of laboratory workers during handling of cultures isolated from biological specimens almost 400 species of fungi were divided into three groups (BSL 1 and BSL 2-fungi which can produce systemic infections in subjects with immunodeficiencies, or superficial infections in healthy subjects, BSL 3-fungi which can produce severe systemic infections also in healthy subjects). At the same time they express reservations to the classification of some species into groups.

[Newly emerging fungal pathogens]. / Nove se objevující houbové patogeny.

Candida albicans was once considered the only important fungus species associated with human infection. Modern medical therapy and improved methods for detection and differentiation of fungi have now shown that many other species are clinically important. During the past decade, is has become apparent that species once considered only of industrial importance or harmless, are capable to attack the human host. These organisms can vary greatly.

[Secretory proteases of pathogenic Candida]. / Sekrecní proteáza patogenních kandid.

The enzymic activity of secreted aspartic proteinase (SAP) in 117 clinical isolates of Candida albicans strains ranges from 0.0 do 0.12 mumol Tyr/min/ml of culture supernatants following 24 h incubation in a YCB-BSA-glucose medium. SAP was purified by the modification of a combined chromatographic method (Banerjee et al., 1991) and a final gel filtration. The diagnostic value of the SAP activity estimation and immunochemical use of purified enzyme are discussed.

[Unusual causes of chromomycosis]. / Neobvyklé prípady chromomykózy.

The typical clinical picture and mycological and histological basis of chromomycosis is compared with the clinical course, which is encountered more often nowadays. It refers also to the affection of the vascular, respiratory, lymphatic system, the brain and the dissemination in compromised patients. For this reason chromomycosis should rank among opportunistic mycoses. Chromohyphomycosis characterized by skin nodules occurs very rarely. Subcutaneous abscesses also called phaeomycotic cysts, are more frequent especially after corticoid and immunosuppressive therapy. Among three Czechoslovak cases of chromomycosis, the case in Pilsen can be evaluated as uncommon. It was caused by Phialophora pedrosoi and passed as a skin form of chromomycosis. The lesion developed on the right forefinger of a patient who never visited tropical countries. She never was seriously ill, never treated with antibiotics, chemotherapeutics, or corticosteroids. The histological examination of the excision revealed a granuloma with histiocytes and many giant cells phagocytizing typical spherical brown microorganisms. The patient was cured by KI, intraiodine and X-ray therapy.

[A case of coccidioidomycosis in Plzen]. / Plzenský prípad kokcidioidomykózy.

A case of the pulmonary form of coccidioidomycosis of a Czech patient infected in Arizona is described. The disease was diagnosed on the basis of serological tests. In addition to a review of the mycological, epidemiological and clinical picture of coccidioidomycosis criteria of laboratory mycological diagnostics are given. It is important to be aware of this mycosis in patients who have a history of recent visits to endemic areas in North, Central and South America.

[Mycotic diseases in patients with AIDS]. / Mykotická onemocnení u pacientu s AIDS.

The author analyzes factors influencing the occurrence of mycoses in AIDS-patients with different stages of the disease. The clinical picture, the diagnosis and sources of common as well as uncommon mycoses accompanying AIDS are given in detail. Candidosis, cryptococcosis, histoplasmosis and dermatomycosis complicate AIDS frequently most. The course of all mycoses in AIDS patients is quite different from the course of the same mycoses complicating other diseases.

Biotyping of Candida strains with regard to the epidemiology of candidosis. A practical approach.

In 62 strains of Candida albicans cultivated from specimens of patients with recurrent vaginal candidosis or with renal transplants, the biotypes were determined according to several characters: colony morphology, production of chlamydospores, auxanogram of C- and N-substances, zymogram, growth kinetics, adherence capability, proteolytic activity, sensitivity to 6 antimycotics, and serotypes. On the basis of this typing system the endogenous and exogenous sources of chronic vaginal candidosis as well as the sources of systemic candidosis in patients with renal transplants could be evaluated.

[Serological identification of medically significant yeasts]. / Moznosti sérologické identifikace lékarsky významných kvasinek.

The authors describe possibilities of serological identification of medically significant yeasts by means of agglutination with specific monofactorial sera. This method permits identification of different species within several minutes and has, as compared with laborious biochemical methods which take several days, considerable advantages. The authors examined 265 clinical isolates of yeasts by means of slide agglutination and 11 morphological and biochemical tests. Agreement between results of serological and conventional identifications was recorded in 98.5% of the tested strains. One of the advantages of serological assessment of yeasts is also the possibility of rapid differentation of serotypes of the very frequently occurring species Candida albicans.

[The importance of adhesion capacity in Candida to pathogenicity in mucosal and skin candidiasis]. / Význam adherencní schopnosti kandid pro patogenezi sliznicních a kozních kandidóz.

The authors describe the mechanism of adherence of Candida cells to biological and non-biological materials and the effect exerted on this property by various factors. They explain the importance of adherence capacity of Candida for the pathogenesis of mucosal, skin, disseminated, invasive infections, for Candida sepsis and Candida endocarditis. They describe methods which determine the adherence capacity of Candida and therapeutic and preventive possibilities of candidiasis by blocking adherence.