Primary invasive aspergillosis with disseminated intravascular coagulation as a presenting feature of non-Hodgkin's lymphoma.

Invasive aspergillosis (IA) is a life-threatening infection. IA is usually seen in severely immunocompromised patients. However, IA as a presenting feature of non-Hodgkin's lymphoma is rare.

Antifungal step-down therapy based on hospital intravenous to oral switch policy and susceptibility testing in adult patients with candidaemia: a single centre experience.

Aims: Echinocandins are recommended for the treatment of candidaemia in moderately severe to severely ill patients. Step-down or de-escalation from echinocandin to fluconazole is advised in patients who are clinically stable but data in relation to step-down therapy are sparse. Using our hospital intravenous to oral switch therapy (IVOST) policy to guide antifungal de-escalation in patients with candidaemia, we aimed to determine what proportion of patients are de-escalated to fluconazole, the timescale to step-down, associated reduction in consumption of echinocandins and antifungal cost savings.

Echinocandin resistance due to simultaneous FKS mutation and increased cell wall chitin in a Candida albicans bloodstream isolate following brief exposure to caspofungin.

Echinocandins are first-line agents for treating severe invasive candidiasis. Glucan synthase gene (FKS1) mutations lead to echinocandin resistance but the role of enhanced chitin expression is not well recognized in clinical isolates. We report a case of bloodstream Candida albicans infection with both Fks1 hotspot mutation and elevated cell wall chitin.

Penicillium marneffei infection presenting as an immune reconstitution inflammatory syndrome in an HIV patient.

We describe a case of Penicillium marneffei infection acquired in Thailand, manifesting as an immune reconstitution inflammatory syndrome (IRIS) in a Caucasian man with advanced HIV-related immunosuppression (CD4 72 cells/mm³). Initial presentation was consistent with Pneumocystis jirovecii pneumonia, and empirical co-trimoxazole resulted in clinical improvement. One month after initiating antiretroviral therapy (ART), an enlarging scaly lesion on his forehead and erythematous nodules on his face, trunk and limbs developed.

Introduction of a dermatophyte polymerase chain reaction assay to the diagnostic mycology service in Scotland.

Background: Dermatophytes are the major cause of superficial mycoses in samples submitted to Clinical Mycology, Glasgow. The most prevalent species is Trichophyton rubrum as identified classically by microscopy and culture. Recent advances in polymerase chain reaction (PCR) technology were examined for the feasibility of introducing a T.

Epidemiology of fungal scalp infections in the West of Scotland 2000-2006.

Background: Fungal infections of the scalp commonly affect the paediatric population and are caused by dermatophytes which have the ability to invade the keratinised structures of skin, hair and nails. This study analyses the changes in the epidemiology of fungal scalp infections in the West of Scotland during the period 2000-2006.

Methods: Skin and hair from scalp specimens sent by General Practitioners and Dermatologists throughout the West of Scotland were examined microscopically for the presence of fungal hyphae and/or spores and cultured to determine the identity of the fungi.

Successful treatment of Candida krusei fungemia with amphotericin B and caspofungin.

We report a leukemic patient with C. krusei fungemia who failed to respond to liposomal amphotericin B therapy alone. The addition of caspofungin eradicated infection and was well tolerated.

Fluconazole and itraconazole susceptibilities of Candida spp. isolated from oropharyngeal specimens and blood cultures of paediatric haematology/oncology patients.

This study examined the in vitro susceptibilities to fluconazole and itraconazole of isolates of Candida spp. from surveillance oropharyngeal specimens and blood cultures from paediatric patients with malignancy. The species distribution of 100 isolates from oropharyngeal specimens was C.

Cryptococcus neoformans var. gattii meningitis in an HIV-positive patient: first observation in the United Kingdom.

We present a case of meningitis due to Cryptococcus neoformans var. gattii in an HIV-infected man recently returned from South Africa. We believe this is the first imported case of meningitis secondary to Cryptococcus neoformans var.

Development of an indirect ELISA for the detection of serum antibodies to Aspergillus fumigatus in captive penguins.

Aspergillosis is a significant cause of mortality in captive penguins (Sphenisciformes). An indirect ELISA for the detection of Aspergillus fumigatus-specific immunoglobulin in penguins was developed and standardised by making use of a family-specific antiserum (anti-Aptenodyptes patagonica patagonicus). The results were calculated quantitatively as ELISA units, derived by polynomial regression analysis, and semi-quantitatively as end titres.

Fungal surveillance of an open haematology ward.

Air sampling and surveillance cultures for fungi were performed in a Scottish general haematology ward over a five-month period in 1997. The mean total fungal count from the air sampling appeared to be correlated with the number of patients colonized by Aspergillus. The most commonly isolated species were Aspergillus versicolor, A.

Cerebral candidiasis in a child 1 year after leukaemia.

We describe an unusual case of a late presentation of a fungal brain abscess in a non-neutropenic child 1 year after completing chemotherapy for M5 acute myeloid leukaemia (AML). Biopsy of the mass identified candidal hyphae and the patient was treated with 5 mg/kg of liposomal amphotericin B for 6 weeks. The lesion resolved completely and the child remains well 2 years later.

Multicenter evaluation of proposed standardized procedure for antifungal susceptibility testing of filamentous fungi.

A multicenter study was conducted to expand the generation and analysis of data that supports the proposal of a reference method for the antifungal susceptibility testing of filamentous fungi. Broth microdilution MICs of amphotericin B and itraconazole were determined in 11 centers against 30 coded duplicate pairs of Aspergillus spp., Fusarium spp.

DNA typing of epidemiologically-related isolates of Aspergillus fumigatus.

Invasive aspergillosis is often nosocomially acquired and carries a high mortality. Molecular typing methods to discriminate isolates have now been developed. Using simple restriction endonuclease (Sal1 and Xho1) digestion of total genomic DNA, we have typed 25 epidemiologically-related isolates of A.

Adherence of arthroconidia and germlings of anthropophilic and zoophilic varieties of Trichophyton mentagrophytes to human corneocytes as an early event in the pathogenesis of dermatophytosis.

The association (adherence) between human corneocytes and arthroconidia of Trichophyton mentagrophytes strains 121 and 126, and T. interdigitale strain 4 was studied in vitro. Adherence of arthroconidia to corneocytes from either the palm and sole occurred and increased with time up to 6 h, by which time germination of arthroconidia had started.

Differential binding of acapsulate and encapsulated strains of Cryptococcus neoformans to human neutrophils.

Investigations into mechanisms of binding of encapsulated and acapsulate strains of Cryptococcus neoformans by human neutrophils were performed, using a monolayer assay. The two strains bound to neutrophils by different mechanisms although both had an absolute requirement for opsonization with complement components in normal human serum for binding to occur. Neutrophil binding of encapsulated yeasts required conformational changes in actin yet did not appear to lead to phagocytosis of the organism.

Activity of topically applied leukotriene B4 in experimental dermatophytosis.

In a pilot study to assess the antimycotic potential of the chemoattractant leukotriene B4 (LTB4), guinea pigs were infected with Trichophyton mentagrophytes var. mentagrophytes and divided into groups of untreated control animals or treated daily with LTB4, isoconazole nitrate or vehicle alone. The animals were assessed clinically, mycologically and histopathologically.

Germination of Trichophyton mentagrophytes on human stratum corneum in vitro.

The emergence of germ tubes from arthroconidia of Trichophyton mentagrophytes on stripped sheets of stratum corneum from different body areas was measured. Arthroconidia increased in size and started germination by 4 h at 37 degrees C. Germ tubes originated from a point on the arthroconidium surface mid-way between the points of attachment to adjacent conidia.

Effect of cilofungin on phagocytosis and intracellular killing of Candida albicans by human neutrophils.

The effect of a beta glucan synthase inhibitor, cilofungin, amphotericin B and 5-fluorocytosine on opsonization, phagocytosis and intracellular killing of Candida albicans blastospores by glass-adherent human neutrophils was determined by microscopy and dye exclusion staining. Pretreatment of blastospores for 2, 4, 6 and 18 h with 1.25 mg/l cilofungin resulted in 24-28% of neutrophils ingesting compared to 24% with no drug present.