Microscopic fungi in dwellings and their health implications in humans.

The article reviews the quantitative and qualitative incidence of microscopic filamentous fungi in dwellings, methods for their detection, mycotoxins, glucans and volatile organic compounds produced by microscopic fungi in the indoor air of homes. Characteristics and properties of the most important species of fungi in dwellings (Alternaria spp., Aspergillus spp., Cladosporium spp., Fusarium spp., Penicillium spp., Stachybotrys spp., and Wallemia spp.) and the health problems of occupants of the "moldy homes are also discussed.

Occurrence of itraconazole-tolerant micromycetes in the soil and food products.

Unexpected pathogens from the environment represent considerable risk for humans with impaired health. We examined the occurrence of itraconazole tolerant micromycetes in soil and in maize products. Five concentrations of itraconazole (2.5-12.5 micrograms/mL) selected according to known treatment schedules for human patients were incorporated into Sabouraud agar with chloramphenicol and Rose Bengal and diluted samples were inoculated onto the agar surface. After 7-d growth at 22 degrees C colonies of Alternaria sp., Aspergillus clavatus, A. glaucus group, A. flavus, A. fumigatus, A. niger group, A. ochraceus group, A. ochraceus, Chaetomium sp., Cladosporium cladosporioides, Cylindrocarpon sp., Doratomyces sp., Fusarium sp., F. moniliforme, F. oxysporum, F. solani, F. subglutinans, Marianaea elegans, Mortierella sp., Mucor sp., Myrothecium sp., Penicillium sp., Rhizopus sp., Scopulariopsis brevicaulis, Sepedonium sp., Stachybotrys chartarum, Stemphylium sp., Torula humicola and Trichoderma viride were isolated.

[Sensitivity to disinfectants in certain rare micromycetes]. / Citlivost' niektorých vzácnejsích mikromycét na dezinfekcné prostriedky.

The authors investigated the effectiveness of 6 different disinfectants at recommended concentrations on strains of rare types of filamentous micromycetes: Scedosporium apiospermum and Exophiala dermatitidis (isolated from ophthalmomycoses), Fusarium dimerum (isolates from nosocomial fungaemia) and strains of Fusarium moniliforme and Stachybotrys alternans (isolates from the environment and potential producers of mycotoxins). The tested strains were mostly sensitive also to an alcoholic solution, to a preparation containing glutaraldehyde, with inorganic peroxocompounds, with peroxoacetic acid; the lowest effectiveness was found in the preparation containing active chlorine and the most resistant strain was Scedosporium apiospermum.

Molds on house walls and the effect of their chloroform-extractable metabolites on the respiratory cilia movement of one-day-old chicks in vitro.

The ciliostatic activity of the chloroform-extractable endo- and exometabolites of 5 strains of filamentous fungi--Alternaria sp., Aspergillus glaucus group, Aspergillus versicolor, Cladosporium sphoerospermum, Penicillium sp. and Ulocladium sp.--isolated from molded walls of a dwelling--on tracheal cilia from 1-d-old chicks in vitro was evaluated. Endometabolites of Alternaria sp. and A. versicolor and exometabolites of Ulocladium sp. were the most active, these extracts stopped the ciliary movement within 1 d. The results are discussed in relation to the health status of people living in "moldy" dwellings.

Eight-year surveillance of non-albicans Candida spp. in an oncology department prior to and after fluconazole had been introduced into antifungal prophylaxis.

From 1989 until 1996, during the last 8 years, the proportion of Candida (C.) krusei, and other non-albicans Candida spp. isolated from surveillance cultures and from sterile body sites, was analyzed among 13,758 admissions in a National Cancer Institute. During these admissions a total of 9,042 isolates were prospectively collected from surveillance cultures, and 126 from blood cultures. The proportion of C. krusei among all organisms was 12.7% to 16.5% in 1989 through 1991, i.e., before fluconazole was introduced into prophylactic protocols. After the introduction of fluconazole into prophylaxis in acute leukemia in 1992 the incidence of C. krusei was 7.9% to 8.6% during 1994 to 1996. After 5 years of using this drug for prophylaxis, the incidence of C. krusei was lower than before this drug was introduced in our institute. Among yeasts, the most frequently isolated pathogen was still Candida albicans (72.2% of all isolated fungal organisms). Among molds, Aspergillus spp. was the most frequently isolated agent. Analyzing the etiology of proven fungal infections (fungemias) confirmed by positive blood cultures, C. albicans was the most common causative organism in 53.8% of cases. The incidence of fungemia due to Torulopsis (C.) glabrata and C. krusei before and after fluconazole introduction did not change. Of 126 organisms isolated from blood cultures, there was no increase in T. (C.) glabrata or C. krusei after introduction of fluconazole for prophylaxis and therapy, and the quoted 6.4% of fungemic episodes remained stable with an incidence of 1 fungemia/year since 1991. The proportion of C. krusei and C. glabrata among Candida spp. was decreasing in our center between 1989 and 1996. Also, the proportion of non-albicans Candida spp. among isolates decreased from 25.7% in 1990 to 11.9% in 1996.

[Mycotic keratitis with uveitis cause by Scedosporium apiospermum]. / Mykotická keratitída s indukovanou uveitídou spôsobená kmenom Scedosporium apiospermum.

Mycotic Keratitis with Induced Uveitis Caused by Scedosporium Apiospermum. In the work the case of mycotic keratitis with induced uveitis is descriped. Affected is young healthy woman working in a fruit and vegetable store. Affection arised on cornea in the area of previous erosion. Current antibiotics did not have any effect on the affection after repeated negative cultivative examinations. The culture of fibrous mikromycete was gained out of cultivation done on Sabouraud's glucose agar and was identified as Scedosporium apiospermum. This is the first case of mycotic eye infection of this etiology in our conditions. The patient reacted successfully on miconazol treatment. The finding on cornea equals vascularized leucoma, visual acuity is 5/50. In the future perforative keratoplastic is planned.

Fungaemia due to Fusarium spp. in cancer patients.

Five cases of fungaemia due to Fusarium spp. in cancer patients are described. Two were breakthrough cases, despite ongoing therapy with amphotericin B. Three were caused by Fusarium solani, one by F. oxysporum and one by F. dimerum. Four patients died, three of them despite therapy with amphotericin B for between 5-37 days. We describe only the second reported case of F. dimerum fungaemia. Since 1972, 93 cases of systemic infection with Fusarium spp. have been described: 43 had positive blood cultures and the overall mortality was 72%.

Toxinogenicity of heat-resistant fungi detected by a bio-assay.

The ciliostatic activity of exo- and endometabolites of 125 (100%) heat-resistant fungal isolates was evaluated in vitro by a bioassay on tracheal tissue cultures of 1 day old chicks. For 11 (9%) of the isolates investigated chloroform-extractable secondary metabolites were detected in the medium. For 29 (23%) they were detected in mycelium and spores and for 25 (20%) they were detected in the medium, mycelium and spores at the same time. Especially Dichotomomyces cejpii and Eupenicillium baarnense strains displayed ciliostatic activity. Extracts of Gilmaniella humicola, Talaromyces avellaneus and Talaromyces bacillisporus isolates were not found ciliostatic in our experiment. The chloroform-extractable metabolites of Neosartorya fischeri ATCC 96469 and T. avellaneus ATCC 96465 strains had no ciliostatic activity, either, but G. humicola ATCC 96467 produced ciliostatic metabolites detected in the medium, the mycelia and the spores.

[Today's tasks in medical mycology]. / Dnesné úlohy lekárskej mykológie.

The author analyzes contemporary tasks of mycology. Problems comprise clinical as well as environmental mycology which possesses a large amount of new findings and thus offers many research opportunities for young microbiologists.

Phaeohyphomycosis due to Alternaria spp. and Phaeosclera dematioides: a histopathological study.

A case of phaeohyphomycosis caused by strains of both Alternaria spp. and Phaeosclera dematioides is presented. The biopsy material was studied using histological, immunohistochemical and transmission electron microscopy techniques. The agent's dematiaceous mycelia are composed of thick-walled hyphae, branched and unbranched, with terminal vesicular formations. All the described structures occur alone or in chains within multinuclear giant foreign body-type cells or invading an abscess. Also present are budding forms. Immunostaining of histiocytic inflammatory cells in either. diffuse or granulomatous infiltrates revealed cytoplasmic positivity for lysozyme and Ki-MIP antibody. The lymphocytic infiltrates of the upper corium show predominantly small T lymphocytes (CD3 and CD45RO positive) and absence of CD20-positive B cells. Plasma cells occurring within the infiltrates of the deeper parts show polyclonal expression of both Ig light chains.

Invasive mold infections in cancer patients: 5 years' experience with Aspergillus, Mucor, Fusarium and Acremonium infections.

Twenty systemic mold infections due to hyphic fungi (molds) arising within the last 5 years in a 60-bed cancer department are analyzed. The most frequent risk factors were plants in ward (75%), prior therapy with broad spectrum antibiotics (70%), catheter insertion (70%), acute leukemia (65%) and neutropenia (60%). Before death, a definitive diagnosis was made in 40%, and a presumptive diagnosis in 60% of patients: post mortem the presumptive antemortem diagnosis was confirmed in all cases (100% of patients). Aspergillosis was the most common invasive fungal disease (55%), followed by mucormycosis (15%), fusariosis (15%), and acremoniosis (10%). Of 20 patients, 8 (40%) were cured or improved after antifungal therapy with amphotericin B, ambisome and/or itraconazole; 8/20 (40%) died of fungal infection and 4/20 (20%) of underlying disease with fungal infection. Even though the diagnosis was made and antifungal therapy started before death in 15/ 20 (75%), invasive mold infection had a 60% overall mortality in patients with malignant disease.

Filamentous microfungi in raw flax and cotton for textile industry and their ciliostatic activity on tracheal organ cultures in vitro.

In a three-year experiment we studied mycobiota of 24 samples of flax and 45 samples of cotton processed in Slovak textile factories. We isolated 12.2 x 10(6) (on average) cfu of microfungi per 1 g of flax samples and 3.3 x 10(5) (on average) cfu of micromycetes per 1 g of cotton samples. We also studied the ciliostatic activity of metabolites of isolated filamentous fungi on tracheal cultures of 1-day-old chicks in vitro. Twenty-nine percent of 116 investigated chloroform extracts of metabolites of microfungi isolated from flax samples stopped the cilia movement and 25% of 195 had ciliostatic activity during 72 h of experiment.

Ciliostatic effect of fungi on the respiratory tract ciliary movement of one-day-old chickens in vitro.

The ciliostatic activity of exo- and endometabolites of 243 filamentous fungal strains was evaluated by in vitro bioassay using tracheal organ cultures of 1-d-old chicks. Chloroform-extractable metabolites produced in the cultivation medium (25 degrees C/10 d) by 30 out of 72 (41%) investigated strains displayed the ciliostatic activity as did metabolites from the biomass of the spores and the mycelium of 46 other strains (26%). This result could contribute to the clarification of the correlation between fungi and respiratory disorders in some working places and in damp dwellings.

Phaeohyphomycosis caused by Alternaria species and Phaeosclera dematioides Sigler, Tsuneda and Carmichael.

A case of phaeohyphomycosis caused by strains of both Alternaria spp. and Phaeosclera dematioides is presented. First clinical signs of mycosis appeared on the patient's face, after an injury with a straw stalk during the wheat harvest in Germany in 1942. Further signs developed in 1955 at one forearm, and again in 1968 in the mouth, leading to perforation of the palate. After treatment with amphotericin B (1973-75) she went into a 13-year-long, clinically asymptomatic remission. She relapsed in 1988, when eight foci of the disease developed, mostly on both forearms. Diabetes mellitus and asthma developed at this time. After pulse therapy with itraconazole the patient remains in a good clinical condition.

The effect of chloroform-extractable secondary metabolites of filamentous fungi on the movement of respiratory tract cilia of one-day-old chicks in vitro.

The ciliostatic activity of the chloroform-extractable metabolites of 72 strains of filamentous fungi growing in a liquid medium, on tracheal cilia from 1-d-old chicks in vitro was evaluated. Forty-eight of the investigated strains produced ciliostatic metabolites; 13, 11, 16, and 25% of the strains stopped the movement of cilia after 1, 2, 3, 6 d, respectively. The results are discussed in relationship with chronic bronchitis of people working with mouldy materials, living in mouldy dwellings and with the "sick-building syndrome".

[Fusarium and fusariosis]. / Fuzáriá a fuzáriózy.

The submitted review deals with the problem of hyalohyphomycoses caused by the genus Fusarium. Attention is drawn to the fact that members of this genus cannot be considered any longer in medical microbiology as mere saprophytes but that they are able to cause superficial, organ and disseminated infections. The number of patients infected with these fungi is increasing.

Heat resistant fungi isolated from soil.

The Thermal death time values (TDT) were estimated for Dichotomomyces cejpii, Gilmaniella humicola, Talaromyces avellaneus and Talaromyces bacillisporus isolated from soil. TDT values were compared with the TDT values of the known heat-resistant species, Byssochlamys nivea, Neosartorya fischeri and Talaromyces flavus. All species studied showed considerable heat resistance. The most resistant species Talaromyces avellaneus (172 cfu, initial concentration) of the isolates with unknown heat resistance withstood 90 degrees C for 10 min. Byssochlamys nivea appeared to be the most sensitive species under our experimental conditions.

[New species of micromycetes infecting man]. / Dalsie druhy mikromycét infikujúce cloveka.

The author gives an account of another 77 species of micromycetes and some varieties of micromycetes which supplement the alphabetical list of 163 fungi which infect man, prepared by Otcenásek and Dvorák in 1985. Problems of medical mycology are discussed.

Effect of mycotoxins on in vitro movement of tracheal cilia from one-day-old chicks.

The effect of 11 mycotoxins on the ciliary movement of tracheal epithelium from one-day-old chicks in vitro was examined. Sterigmatocystin and diacetoxyscirpenol were most ciliostatically active in vitro; the ciliostatic effect was observed after 2 d if the amount concentration was 30 micrograms/L. In contrast, patulin stopped the movement of cilia after 2 d only if its concentration was 20 mg/L.

Aureobasidium mansoni meningitis in a leukemia patient successfully treated with amphotericin B.

Aureobasidium mansoni fungal meningitis in a 30-year-old leukemic patient is reported. This is the first reported case of Aureobasidium spp. central nervous system infection. The patient was successfully treated with systemic antifungal chemotherapy with a total dose of 2.2 g of amphotericin B.