F. Staib

Fungal infections following heart transplantation

Summary. Following heart transplantation (HTx), patients often suffer from mycoses due to the necessary immunosuppressive treatment to prevent rejection episodes. Oropharyngeal Candida infections which mostly occur after HTx under high‐dose immunosuppressive therapy can be avoided and treated successfully by prophylactic medication to be started immediately after transplantation, either by using azoles (e.g. fluconazole) or amphotericin B suspension. Contrary to this, invasive aspergillosis, beginning in the upper respiratory tract and the lung and mostly followed by hematogenous dissemination into various organs, is always a serious disease with high mortality. To avoid this infection, specimens from the respiratory tract, serum and urine should be examined mycologically prior to HTx. After HTx, apart from prophylactic avoidance of exposure to airborne fungal spores, close mycological control is mandatory to detect colonizations by aspergilli early. Timely administration of amphotericin B and 5‐flucytosine, i.e. as soon as invasive growth is suspected, enables curative treatment of the often lethal course of this disease, even under immunosuppressive therapy.

Aspergillus Findings in AIDS Patients Suffering from Cryptococcosis Aspergillus‐Befunde während des Cryptococcose‐Verlaufs bei AIDS‐Patienten

Summary: Because of the known pathoge‐nicity of Cryptococcus neoformans and of aspergilli depending on defined but different immunodeficiencies of the host, the evaluation of their simultaneous cultural detection in specimens of the respiratory tract of AIDS patients is of epidemiological, diagnostic, pathogenetic and therapeutic interest. In 10 out of 15 AIDS patients the following species of the genus Aspergillus could be isolated either once or repeatedly during the course of Cr. neoformans infections in specimens from the respiratory tract: A.fumigatus, A.flavus, A. nidulans, A. niger and A. glaucus.

Amphotericin B und Flucytosin-Therapie beiAspergillus-Pneumonie und akutem Nierenversagen

SummaryKidney failure and pneumonia byAspergillus flavus andA. fumigatus were found in a 56-year-old woman who had received antibiotic and corticoid treatment to control high fever. Her bloody tracheal secretion was a suspension of granule-like spore-free colonies of bothAspergillus species. Hemorrhages in mucous membranes and skin suggested a hematogenous dissemination of the fungi. Aspergillus spores in the soil of ornamental plants were assumed to be responsible for the inhalatory infection. The kidney function normalized rapidly under treatment by amphotericin B plus flucytosine and hemodialysis performed eight times. After 29 days of antimycotic treatment (amphotericin B 463 mg, flucytosine 150 g), besides normalization of the kidney function, healing of the penumonia and bleeding from skin and mucal membranes took place. One and a half years later kidney function and blood parameters were found to be normal. In cases ofAspergillus pneumonia and kidney failure, a combined treatment by hemodialysis and amphotericin B plus flucytosine is recommended. In addition, there is discussion of the general importance of uremia and its influence on the mycotic infection.

Persistence of Cryptococcus neoformans in seminal fluid and urine under itraconazole treatment. The urogenital tract (prostate) as a niche for Cryptococcus neoformans.

The open questions of the persistence of Cryptococcus neoformans in the urogenital tract under antimycotic treatment can be examined under optimal mycological‐diagnostic conditions only. The example of a case of cryptococcosis in an AIDS patient diagnosed and treated with itraconazole in the early secondary stage of cryptococcosis is used to discuss the problems of the persistence of Cr. neoformans involvement in the urogenital tract (prostate). Data from a ten‐week follow‐up study are presented and discussed. The observations made have shown that itraconazole is effective in all regions of the body, with the exception of the urogenital tract. In addition to clinical examinations, cases treated with itraconazole should be finally subjected to cultural examination of prostatic secretion and/or seminal fluid, to exclude the possible presence of a symptomfree involvement of the prostate by Cr. neoformans.

[Peracute disseminated course of fatal Aspergillus fumigatus infection in liver failure and corticoid therapy. A case report on the epidemiology, pathogenesis and diagnosis of the systemic course of Aspergillus infections].

SummaryCytostatic-treated persons and cases of severe hepatic failure under corticoid therapy are predisposed to disseminating Aspergillus infections. Constant exposure to Aspergillus spores may result in a fatal Aspergillus infection. The triad of hepatic failure, corticoid therapy and constant exposure to Aspergillus spores is described in a 70-year-old female patient. A painless icterus was clinically diagnosed as non-A non-B hepatitis, with a protracted cholestatic course. She had been treated with an oral corticoid preparation. After leaving the hospital at her own insistance when still in the icteric stage, severe pneumonia due to Aspergillus developed within 14 days; this was confirmed radiologically. The autopsy results showed unexpected infarction, similar to pneumonic foci, in all lobes and dissemination in the myocardium, stomach, kidneys and brain. The liver showed subacute dystrophy. Constant exposure to the conidia of A fumigatus came about as a result of the soil of potted ornamental plants in the patients living room. The fungus could only be successfully cultured by putting infected tissue particles on Sabouraud dextrose agar; it was not possible by the common method of fractionated streaking.Cytostatic-treated persons and cases of severe hepatic failure under corticoid therapy are predisposed to disseminating Aspergillus infections. Constant exposure to Aspergillus spores may result in a fatal Aspergillus infection. The triad of hepatic failure, corticoid therapy and constant exposure to Aspergillus spores is described in a 70-year-old female patient. A painless icterus was clinically diagnosed as non-A non-B hepatitis, with a protracted cholestatic course. She had been treated with an oral corticoid preparation. After leaving the hospital at her own insistance when still in the icteric stage, severe pneumonia due to Aspergillus developed within 14 days; this was confirmed radiologically. The autopsy results showed unexpected infarction, similar to pneumonic foci, in all lobes and dissemination in the myocardium, stomach, kidneys and brain. The liver showed subacute dystrophy. Constant exposure to the conidia of A fumigatus came about as a result of the soil of potted ornamental plants in the patients living room. The fungus could only be successfully cultured by putting infected tissue particles on Sabouraud dextrose agar; it was not possible by the common method of fractionated streaking.

Pathogenic fungi in human dwellings

Zusammenfassung. Aerogene invasive Pilzinfektionen bei verschiedenen Risikogruppen abwehrgeschwächter Personen sind für die moderne Medizin (z.B. durch Therapieverfahren wie Immunsuppression und Chemotherapie) ein zunehmendes Problem. Wegen des akuten und schnellen Verlaufs solcher Infektionen ist entsprechende Vorsorge von erstrangiger Bedeutung. Diese Vorsorge sollte vor allem in der Überwachung der Raumluft auf Pilzsporen bestehen.

Cryptococcus neoformans-Meningoencephalitis und Mehrfachinfektionen bei AIDS

SummaryA 40-year old homosexual AIDS patient recovering from a Pneumocystis carinii pneumonia developed a Cryptococcus neoformans infection with involvement of the central nervous system (CNS) which could be treated successfully with amphotericin B and flucytosine. After a symptomfree interval of 4 1/2 months, a new acute fatal disease of the CNS did not reveal a cryptococcosis relapse but a necrotizing Toxoplasma encephalitis, a cytomegalovirus infection and striking cultural findings of Staphylococcus aureus in all organs examined. Neither by culture nor by histology Cr. neoformans could be detected in the CNS or in the other organs examined. The temporal course of the Cr. neoformans infection and its specific diagnosis are commented. It is demonstrated that (during or after successful therapy of Pneumocystis carinii pneumonia) a specific cultural examination of specimens from the respiratory tract for Cr. neoformans is needed, in order to recognize a Cr. neoformans infection in its primary stage, i. e. before hematogenous dissemination of Cr. neoformans leading to the secondary stage of the infection.

Detection of Cryptococcus neoformans in Biopsy Specimens from the Spleen and the Liver of AIDS Patients: Critical Comments: Nachweis von Cryptococcus neoformans in Biopsiematerial von Milz und Leber AIDS-Kranker: Eine kritische Stellungnahme

Summary:  This article was prompted by a publication describing the use of fluorochrome for rapid detection of Cryptococcus neoformans in the spleen of an AIDS patient