Four methods for the accurate delineation of epidemiologically related and unrelated strains of Candida lusitaniae were compared. Three pulsed-field electrophoretic methods, including two contour-clamped homogeneous field gel electrophoresis methods (EKP-1 and EKP-2) yielding electrophoretic karyotype patterns of intact chromosomal DNA and a method in which the chromosomal DNA was macrodigested with the endonuclease SfiI prior to pulsed-field electrophoresis (MDP), and a random amplified polymorphic DNA (RAPD) assay were evaluated. A selected panel of 21 well-characterized isolates representing 13 strains of C. lusitaniae, including 7 epidemiologically related isolates of one strain (group I-A), 3 epidemiologically related isolates of another strain (group I-B), and 11 epidemiologically unrelated isolates (group II), were tested. All isolates were coded and tested in a blinded manner. All seven group I-A isolates were confirmed to be a single strain by the EKP-1 and MDP methods, and the three group I-B isolates were shown to be a single strain by the EKP-1, EKP-2, MDP, and RAPD methods. Subtle differences were noted with two of the group I-A isolates by the EKP-2 method, whereas three of these isolates were different by the RAPD method. Each group II isolate had distinct patterns by all four methods. These data support the fact that the three pulsed-field electrophoretic methods and the RAPD method can be used to delineate strains of C. lusitaniae. The EKP-1, EKP-2, and MDP gave results that correlated with the epidemiologic characteristics of the isolates tested in the study, whereas the RAPD method was perhaps too sensitive in detecting DNA changes for epidemiologic studies.
Fatal locally invasive pulmonary aspergillosis occurred in a previously fit young patient who had no predisposing factors other than exposure to fungal spores in his occupation as a gardener.Invasive pulmonary aspergillosis is uncommon, usually occurring in immunocompromised patients or in those with abnormal lungs. We describe a fatal case occurring in a previously fit young man.Case report A 34 year old man was admitted as an emergency with a five day history of dyspnoea, unproductive cough, fever, and anorexia. He had worked as a gardener for 14 years and had never left Britain. He was heterosexual and denied intravenous drug abuse. Five months previously he had had an episode of salmonella gastroenteritis, when a routine chest radiograph was normal. On examination he had central cyanosis and pyrexia (38°C). His respiratory rate was 40/min and heart rate 120/min. Chest ausculation indicated fine inspiratory crackles and bronchial breath sounds at both bases. A chest radiograph showed bilateral basal alveolar shadowing. Initial blood gas measurements when he was breathing air were: arterial oxygen tension (Pao2) 8-4 kPa, arterial carbon dioxide tension (Paco2) 4 9 kPa, pH 7-43. There was a neutrophil leucocytosis (16 x 109/l). He was treated with intravenous fluids, erythromycin 1 g four times daily, physiotherapy, and continuous 75% inspired oxygen. After 48 hours he remained febrile and gentamicin 80 mg thrice daily and co-trimoxazole 960 mg twice daily were added.After seven days the basal shadowing on his chest radiograph had become more extensive and fibreoptic bronchoscopy and bronchial biopsy were carried out. Histological examination showed extensive replacement of the bronchial wall by epithelioid granulomas showing small central foci of necrosis and surrounded by neutrophils, plasma cells, and lymphocytes. Neither fungi nor acid fast bacilli were seen. Prednisolone 40 mg/day and antituberculous treatment (rifampicin, isoniazid, ethambutol, and pyrazinamide) were started. The Mantoux test and blood and sputum cultures gave negative results. Paired titres of antibodies to Mycoplasma pneumoniae, Legionella pneumophila, and a range of pulmonary viral pathogens showed no appreciable rise, and screening for human immunodeficiency virus gave a negative result. On the 19th day his condition deteriorated; radiograAddress for reprint requests:
Two cases of human fungal infections caused by members of the genus Phialemonium, a genus proposed by Gams and McGinnis (1983) for fungi intermediate between the genera Acremonium and Phialophora, are presented. The first case was a phaeohyphomycotic cyst on the foot of a renal transplant recipient. The fungus was detected by direct examination and histopathology and was recovered by several procedures over 4 months. It was flat, glabrous, and white becoming yellow with the production of a diffusible yellow pigment; it had conidiophores that were mostly solitary and lateral and terminal phialides and adelophialides with distinct collarettes producing cylindrical to curved conidia. The isolate resembled both Phialemonium dimorphosporum and Phiakmonium curvatum, although its characteristics were more consistent with those of the latter. The second case was peritonitis in a renal transplant recipient. The fungus was white-to-cream colored and yeast like, but later became black with a green diffusible pigment, and produced obovoid conidia;
Two cases of primary invasive cutaneous infections caused by the zoophilic dermatophytic species Microsporum canis are presented. The first case occurred in a liver transplant recipient who was receiving immunosuppressive therapy. Multiple erythematous papules were seen on both legs, and a biopsy revealed invasive fungal hyphae. The second case was diagnosed in a human immunodeficiency virus-positive individual with a CD4 lymphocyte count of 81 mm 3. Raised red nodules were seen on her scalp and face. Histopathology was consistent with bacillary angiomatosis, and in addition, invasive septate hyphae were observed. The two strains recovered from the biopsy specimens from both individuals had colony morphologies consistent with that of M. canis, but it was difficult to induce production of macroconidia. These cases serve to increase the awareness of this unusual infection, reinforce the need for cultures, and raise some interesting questions about the potential virulence of this dermatophyte species.
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