1974 survey. Obviously, a low response rate limits generalizability of these data. Why should participa¬ tion in response to respected colleagues established in the area have been so low? It is true that each of us is bombarded with unsolicited mail and that a fully committed physician must leave something else undone if such a questionnaire achieves a higher priority. The answer could be as simple as a relative lack of interest now that methotrexate seems to have achieved a rather stable niche after a roller-coaster ride over the last 30 years. I suspect that other trends in our specialty account for less general interest in management of severe psoriasis, despite the substan¬ tial increase in effective available therapies. Empha¬ sis on the technical and surgical aspects of our specialty makes psoriasis management seem very cumbersome by comparison. The priorities of our academy, reflected in budgets and assessments, indi¬ cate the membership's increasing concern with prac¬ tice building and direct-to-consumer "information." The basis for truly accurate professional and con¬ sumer information lies in studies of medical prac¬ tices and treatment outcome; participation by der-matologic practitioners is especially vital in this regard.The strength of our specialty will be enhanced by meeting the needs of a whole range of patients with skin diseases, especially those with chronic severe disabling inflammatory processes such as psoriasis. For planning, teaching, research, and legislative activities, we must continue to collect the kind of information that this study has tried to provide.There has been much confusion regarding the terminology for infections caused by the black (dematiaceous) fungi. The clinical nomenclature for infections caused by these microorganisms should be clear and concise so that, even with the recognition of new agents of disease and new methods of diagnosis and therapy, the terms still apply. There are three kinds of diseases caused by black fungi: mycetoma, chromoblastomycosis, and phaeohyphomycosis. Mycetoma is a clinical entity recognized by tumefaction, draining sinuses, and granules. These are serious infections that always require treatment by surgical and medical means. Madurella mycetomatis is one of the most common worldwide agents of this disease. Granules should not be confused with fungus balls, which consist of a mass of hyphae, usually colonizing a small cavity, such as a sinus, or an old lung cavity. A granule differs from a fungus ball by being an organized, compact mass of hyphae with or without a crystalline matrix. A fungus ball has the potential for invading surrounding tissue from the site of colonization, often making rigorous treatment necessary. Dematiaceous fungi, like Cladosporium cladosporioides, have been reported to produce pulmonary fungus balls.1
Iodide fixation by murine polymorphonuclear leukocytes (PMN) incubated with viable Candida albicans blastoconidia increases directly with yeast cell concentration up to about 3 x 106 cells per ml, but above this concentration bound activity declines dramatically. To understand the basis for this decline, we examined the oxidative metabolism offungi and stimulated PMN and found some remarkable similarities between these cell types. Both produced 14C02 when incubated with [1-14C]glucose, both reduced cytochrome c, and both fixed radiolabeled iodide, although the fungi required exogenous lactoperoxidase. In dose-response experiments, iodination by fungi with lactoperoxidase was identical to that with PMN, i.e., the maximum bound activity occurred in cultures with 106 to 3 x 106 blastoconidia per ml. lodination by fungi with lactoperoxidase was reduced when blastoconidia were incubated at 25°C or in the presence of catalase and the metabolic inhibitors rotenone, antimycin A, and 2-deoxyglucose. Results from assays for oxidation of scopoletin and o-dianisidine showed that 106 blastoconidia in 1.0 ml of medium released 0.5 to 0.7 nmol of I 202 after 1 h, but 3x 106 and 107 cells released significantly less H202. These results suggest that iodide fixation by PMN and low numbers of fungal cells may reflect a cooperative effort, with fungi generating some H202 that reacts with the myeloperoxidase released from the PMN. With high concentrations of blastoconidia, H202 activity appeared to be specifically inhibited, possibly to protect fungal cells from damage. Candida albicans and some related species are part of the normal flora of the upper respiratory, alimentary, and urogenital tracts of most humans. However, in a small percentage of the
The response of human polymorphonuclear leukocytes (PMN) to blastospores and pseudo-hyphae of the opportunistic fungus Candida albicans has been studied in vitro and in vivo. Of the fungicidal mechanisms elucidated thus far, the myeloperoxidase-hydrogen peroxide-halide system appears to be most effective against cells of this fungus. In our studies on the interaction between murine PMN and blastospores, we assayed the release of H2O2 by PMN incubated with viable or killed, unopsonized or opsonized blastospores by using two assay systems, lysis of murine erythrocytes and oxidation of scopoletin. Our results showed that PMN released increasing amounts of H2O2 when incubated with increasing numbers of opsonized or unopsonized killed blastospores, but released decreasing amounts of H2O2 when incubated with increasing numbers of opsonized or unopsonized viable blastospores. The oxidative metabolic burst by PMN in the presence of viable or killed blastospores was also measured by using reduction of nitroblue tetrazolium and chemiluminescence. Viable blastospores stimulated a stronger metabolic burst than killed blastospores, suggesting that PMN respond to live blastospores more vigorously than killed blastospores; however, live blastospores appear to alter or inhibit the release of H2O2 by PMN.
A qualitative and quantitative study of the mycotic flora of the interdigital spaces of 27 male volunteers yielded 1,291 moulds and 598 yeasts. Concurrently, a study of garden soil was conducted in order to obtain data concerning the transient-resident status of the fungi recovered from the feet. Of the 120 genera and species of fungi isolated, 51 were recovered from the volunteers, 53 from the soil, and 16 from both categories. The most commonly recovered fungi from the toewebs, in order to occurrence, were Torulopsis candida, Mycelia Sterilia, T. maris, Rhodotorula rubra, Cryptococcus albidus, and species of Aspergillus and Penicillium. Without sign of infection, Cryptococcus neoformans was isolated from 5 volunteers. Candida albicans was not recovered from any subject. Trichophyton mentagraphytes was recovered from 7 volunteers and T. rubrum from one.
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