Comparative efficacies of terbinafine and fluconazole in treatment of experimental coccidioidal meningitis in a rabbit model.

A rabbit model of coccidioidal meningitis was used to compare the therapeutic efficacies of terbinafine (TBF) and fluconazole (FCZ). Hydrocortisone acetate-treated New Zealand White male rabbits were infected intracisternally with either 2.2 x 10(4) or 6.4 x 10(4) Coccidioides immitis arthroconidia. Oral treatment with polyethylene glycol 200 (PEG) twice daily (n = 8), TBF twice daily (n = 9; 200 mg/kg of body weight/day), or FCZ once daily (n = 8; 80 mg/kg/day) began on day 5 and continued for 21 days. Mean survival times were 20, 24, and 32 days for rabbits treated with PEG, TBF, and FCZ, respectively. All of the FCZ-treated animals (100%; P = 0.003), 56% of the TBF-treated animals (P = 0.4), and 25% of the PEG-treated animals survived the length of the study. Both FCZ and TBF were effective at reducing the incidence of paresis. Only FCZ was effective at reducing most neurological and systemic signs. FCZ treatments resulted in lower cerebrospinal fluid (CSF) protein concentrations and leukocyte counts and faster clearing of CSF fungal cultures compared with those for PEG-treated controls, but TBF treatments had no significant effect on these parameters. Neither drug affected CSF glucose levels. Mean serum TBF levels by bioassay were within the range of 3.5 to 6.2 microgram/ml at 1, 2, and 4 h postdosing and 0.35 to 7.0 microgram/ml at 14 h postdosing. No TBF was detected in CSF. Mean FCZ levels (24 to 25.5 h postdosing) by bioassay were 16.4 to 19.2 and 13.5 to 19.2 microgram/ml in serum and CSF, respectively. The reduction in the numbers of CFU in the spinal cord and brain was over 100-fold (P = 0.0005) in FCZ-treated animals and 2-fold (P

Comparison of fluconazole and itraconazole in a rabbit model of coccidioidal meningitis.

Coccidioidal meningitis is a devastating disease that requires long-term therapy with little hope of cure. A rabbit model of coccidioidal meningitis was used to compare the therapeutic efficacies of fluconazole (FCZ) and itraconazole (ITZ). Hydrocortisone-treated male New Zealand white rabbits were infected intracisternally with 5.0x10(4) to 5.4x10(4) arthroconidia of Coccidioides immitis. Oral treatment with polyethylene glycol 200 (PEG) (n = 9), FCZ (n = 8; 80 mg/kg of body weight/day), or ITZ (n = 8; 80 mg/kg/day) began 5 days after infection and continued for 28 consecutive days. Both FCZ and ITZ reduced the number of CFU of C. immitis organisms in the spinal cord and brain compared with the number in PEG-treated animals (P< or =0.003), but the results for FCZ and ITZ were not different from each other. Histopathologic severity (semiquantitative scoring system by an observer blinded to treatment) was equally reduced in both FCZ and ITZ treatment groups compared with that in controls (P< or =0.0004). Both treatments resulted in lower cerebrospinal fluid (CSF) protein concentrations and leukocyte counts and faster clearing of C. immitis from CSF compared with the results for PEG-treated controls. Neither drug affected CSF glucose levels. Both compounds were effective at reducing neurological and systemic signs and extending survival (P< or =0.014). FCZ was more effective at reducing head and body shakes, posture changes, and incontinence; ITZ was more effective at reducing continuous fever. Mean levels of FCZ and ITZ in the serum and CSF were determined by bioassay; at 17 to 26 h postdosing, levels were 28.1 to 40.0 and 22.4 to 29.9 microg/ml, respectively, for FCZ and 0.77 to 2.51 and 0 microg/ml, respectively, for ITZ. The sera of most animals developed antibody to C. immitis, but azole treatment attenuated antibody development in CSF and its titer. In conclusion, both FCZ and ITZ were efficacious, but neither was curative in a rabbit model of coccidioidal meningitis.

Murine models of blastomycosis, coccidioidomycosis, and histoplasmosis.

Animal models have contributed much to the knowledge of fungal infections and their corresponding therapeutic treatments. This is true for animal models of the primary fungal pathogens, Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma capsulatum. This review gives a brief background of human diseases associated with these organisms and describes the development, details, and utility of murine models of blastomycosis, as well as coccidioidomycosis and histoplasmosis.

A model of coccidioidal meningoencephalitis and cerebrospinal vasculitis in the rabbit.

Coccidiodal meningitis is a devastating complication of disseminated coccidioidomycosis. An animal model of this infection could enhance understanding of the pathogenesis of the disease and lead to improvements in therapy. A rabbit model of central nervous system infection simulating human disease was established using a blind cisternal tap technique to inoculate 4 x 10(3)-1 x 10(6) arthroconidia of Coccidioides immitis into the cisterna magna. Systemic, neurologic, and histopathologic findings of meningitis were observed in all rabbits, but an inoculum of 2 x 10(4) arthroconidia produced a chronic illness in which meningeal endarteritis obliterans was consistently observed. Serial sampling of cerebrospinal fluid demonstrated an inflammatory response. Growth of C. immitis was demonstrated by quantitative fungal culture from brains and proximal spinal cords.

Efficacy of syringomycin E in a murine model of vaginal candidiasis.

Syringomycin E (SR-E), a new antifungal produced by the bacterium Pseudomonas syringae pv. syringae, was evaluated in a murine vaginal candidiasis model. In one study, mice were treated intravaginally b.i.d. for 4 days with drug carrier, SR-E 2% in either PEG-400 or PEG-ointment, or 1% clotrimazole as a positive control. Quantitative vaginal cultures were taken prior to treatment on day 1 and on days 5, 6, and 7. Both formulations showed a reduction of yeast colonization in the vaginas on day 5 (P< or =0.06 and P< or =0.03 for SR-E/PEG-400 and SR-E/PEG ointment, respectively) and SR-E/PEG ointment reduced the colonization on day 7 (P< or =0.06) when compared to carrier treated controls. In a second study, SR-E was formulated in Aquaphor at three higher concentrations of SR-E [3%, 6%, or 12% (w/v)]. SR-E showed dose-dependent efficacy. The 3% dose showed no effect while the 6% and 12% doses reduced the number of yeasts. The 12% dose showed a significant reduction on days 5 (P< or =0.01), 6 (P< or =0.06), and 7 (P< or =0.03) when compared with the drug carrier controls and on day 5 was more effective than clotrimazole (P< or =0.03). Clotrimazole did not significantly reduce the yeasts in the vagina until days 6 (P< or =0.01) and 7 (P< or =0.01) when compared to the drug carrier controls. No vaginal inflammatory response was evident by histological examination in uninfected animals treated with SR-E. No SR-E could be detected in plasma, kidney, or liver. SR-E (12%) was an effective treatment when compared to 1% clotrimazole.

PCR Detection of Cyclic Lipodepsinonapeptide-Producing Pseudomonas syringae pv. syringae and Similarity of Strains.

Many strains of Pseudomonas syringae pv. syringae produce one of four classes of small cyclic lipodepsinonapeptides: syringomycins, syringostatins, syringotoxins, or pseudomycins. These metabolites are phytotoxic and growth inhibitory against a broad spectrum of fungi. Their production is dependent upon the expression of conserved biosynthesis and export genes syrB and syrD, respectively. PCR and oligonucleotide primers specific for a 752-bp fragment of syrB were used to identify cyclic lipodepsinonapeptide-producing strains of P. syringae pv. syringae. In contrast, PCR amplification with primers based on syrD did not always correlate with possession of the syrD gene, as indicated by Southern blot analysis, or with cyclic lipodepsinonapeptide production. Sequence comparisons of 400 nucleotides from the syrB PCR-amplified fragments showed 94% plot similarity among 27 strains. In a sequence phenogram, syringostatin and syringotoxin producers were grouped apart from syringomycin-producing strain B301D, with sequences that differed by eight and nine conserved base substitutions, respectively. PCR amplification of the 752-bp syrB fragment offers rapid and accurate detection of cyclic lipodepsinonapeptide-producing strains, and its sequence provides some predictive capabilities for identifying syringotoxin and syringostatin producers.

In vitro antifungal and fungicidal activities and erythrocyte toxicities of cyclic lipodepsinonapeptides produced by Pseudomonas syringae pv. syringae.

Recent increases in fungal infections, the few available antifungal drugs, and increasing fungal resistance to the available antifungal drugs have resulted in a broadening of the search for new antifungal agents. Strains of Pseudomonas syringae pv. syringae produce cyclic lipodepsinonapeptides with antifungal activity. The in vitro antifungal and fungicidal activities of three cyclic lipodepsinonapeptides (syringomycin E, syringotoxin B, and syringostatin A) against medically important isolates were evaluated by a standard broth microdilution susceptibility method. Erythrocyte toxicities were also evaluated. All three compounds showed broad antifungal activities and fungicidal actions against most of the fungi tested. Overall, the cyclic lipodepsinonapeptides were more effective against yeasts than against the filamentous fungi. Syringomycin E and syringostatin A had very similar antifungal activities (2.5 to > 40 micrograms/ml) and erythrocyte toxicities. Syringotoxin B was generally less active (0.8 to 200 micrograms/ml) than syringomycin E and syringostatin A against most fungi and was less toxic to erythrocytes. With opportunities for modification, these compounds are potential lead compounds for improved antifungal agents.

Prophylactic efficacy of aerosolized liposomal (AmBisome) and non-liposomal (Fungizone) amphotericin B in murine pulmonary aspergillosis.

Pulmonary aspergillosis is a serious opportunistic disease in patients with immune suppression. Prophylactic measures would be highly beneficial because treatment often fails after infection occurs. The principle objective of this study was to evaluate the prophylactic efficacy of aerosolized liposomal (AmBisome) and non-liposomal (Fungizone) amphotericin B in a murine model. Immunocompromised mice were treated prophylactically for 3 days with AmBisome or Fungizone using a small particle aerosol generator. Intranasal challenge was with a high (10(8)), medium (10(7)), or low (10(6)) level of Aspergillus fumigatus spores. AmBisome nebulized more uniformly, resulting in very consistent chamber air concentrations. Total dose, however, was nearly the same for each formulation. Survival was prolonged in animals treated with both formulations at the 10(8) and 10(7) challenge levels. Quantitative lung cultures showed that organisms were completely cleared from the lungs in the low challenged group, with both formulations, whereas the high challenge proved overwhelming for both formulations. With the middle challenge, however, AmBisome cleared 80% of the lungs, whereas Fungizone cleared none. Lung drug retention of AmBisome treated animals was more than eight times higher than Fungizone at the time of challenge. BUN and creatinine values in animals treated with both formulations were not elevated. These results suggest that AmBisome is more effective than Fungizone when given as a prophylactic aerosol in this model.