Bacteria that masquerade as fungi: actinomycosis/nocardia.

The order Actinomycetales includes phylogenetically diverse but morphologically similar aerobic and anaerobic bacteria that exhibit filamentous branching structures which fragment into bacillary or coccoid forms. The aerobic actinomyces are a large, diverse group of gram-positive bacteria including Nocardia, Gordona, Tsukamurella, Streptomyces, Rhodococcus, Streptomycetes, Mycobacteria, and Corynebacteria. The anaerobic genera of medical importance include Actinomyces, Arachnia, Rothia, and Bifidobacterium.

The interaction of mannose binding lectin (MBL) with mannose containing glycopeptides and the resultant potential impact on invasive fungal infection.

Mannnose-binding lectin (MBL) binds oligosaccharides on the surface of microorganisms to form complexes that activate the complement cascade and facilitate phagocytosis. Teicoplanin and dalbavancin glycopeptide antibiotics possess N-acetyl glucosamine and mannose oligosaccharides that may bind MBL. Pharmaceuticals capable of binding to MBL may decrease clearance of significant pathogens such as yeast.

Association between Histoplasma exposure and stroke.

Background And Purpose: The rate of cerebrovascular events within the stroke belt, a geographic area defined in the Southeastern United States, exceeds that of the rest of the nation. Despite evaluation of multiple risk factors for this disparity, specific causes for the stroke belt have not been elucidated. More than 45 years ago, the US Public Health Service and US Navy cooperative skin-testing program (1958-1965) documented adolescent exposure to Histoplasma capsulatum.

In search of the holy grail of antifungal therapy.

The ideal antifungal agent remains an elusive goal for treatment of life-threatening systemic fungal infections. Such an agent would have broad antifungal activity, low rates of resistance, flexible routes of administration, few associated adverse events, and limited drug-drug interactions. Only three of the seven classes of antifungal agents currently available are suitable for treatment of systemic infection: the polyenes, the azoles, and the echinocandins.

Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America.

Evidence-based guidelines for the management of patients with blastomycosis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous management guidelines published in the April 2000 issue of Clinical Infectious Diseases. The guidelines are intended for use by health care providers who care for patients who have blastomycosis.

Reduced Candida glabrata susceptibility secondary to an FKS1 mutation developed during candidemia treatment.

We describe a case of recurring Candida glabrata infection in a 68-year-old African-American female on caspofungin therapy. The initial isolate was susceptible, but isolates recovered during following relapses were not. All isolates were clonal, and high-MIC strains contained a mutation in the highly conserved hot spot 1 region of Fks1p.

Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America.

Guidelines for the management of patients with sporotrichosis were prepared by an Expert Panel of the Infectious Diseases Society of America and replace the guidelines published in 2000. The guidelines are intended for use by internists, pediatricians, family practitioners, and dermatologists. They include evidence-based recommendations for the management of patients with lymphocutaneous, cutaneous, pulmonary, osteoarticular, meningeal, and disseminated sporotrichosis.

High purity amphotericin B.

Objectives: Amphotericin B (AmB) is a drug of choice for treatment of disseminated fungal infections, but its use is often associated with severe adverse effects. Our observation that generic formulations of AmB contain multiple polyene components led us to propose that removal of other polyenes would yield a high purity AmB (AmBHP) with an improved therapeutic index.

Methods: To test that premise, AmBHP was first isolated from generic AmB by semi-preparative reverse phase high-pressure liquid chromatography and then its effects were compared in vitro and in vivo with those of commercial AmB formulations.

Single low-dose mebendazole administered quarterly for ascaris treatment.

Background: Intestinal parasites are difficult to eradicate in tropical climates where poor sanitation exists. In addition, pharmaceutical stability is poor making traditional three day dosing for the treatment of A. lumricoides challenging.

Anidulafungin versus fluconazole for invasive candidiasis.

Background: Anidulafungin, a new echinocandin, has potent activity against candida species. We compared anidulafungin with fluconazole in a randomized, double-blind, noninferiority trial of treatment for invasive candidiasis.

Methods: Adults with invasive candidiasis were randomly assigned to receive either intravenous anidulafungin or intravenous fluconazole.

Thrombocytosis during antifungal therapy of candidemia.

Background: Secondary, "reactive," thrombocytosis has been attributed to bacterial infection and treatment with multiple pharmaceuticals and may be associated with an increase in the incidence of gastrointestinal tract bleeding and thrombotic events (eg, stroke).

Objective: To characterize the dynamics of thrombocytosis in patients with candidemia receiving antifungal therapy.

Methods: We initiated a retrospective observational description of patients with candidemia who were treated with antifungal agents.

Effects of amphotericin B and caspofungin on histamine expression.

Study Objective: To determine the effects of amphotericin B deoxycholate and caspofungin on the release of histamine from human peripheral blood cells, mononuclear cells, and mast cells.

Design: In vitro cell culture experiments.

Setting: University medical center.

Blastomycosis.

Blastomycosis is an endemic mycoses in the central United States caused by a dimorphic fungus, Blastomyces dermatitidis, that exists in nature in mycelial phase and converts to yeast phase at body temperature. The organism may produce epidemics of infection following a point source of infection or sporadic endemic infection. Blastomycosis can be a subclinical illness with subsequent protection against progressive infection afforded by cellular immune mechanisms, but it may present with progressive disease with either pulmonary or extrapulmonary disease or both.

A randomized and blinded multicenter trial of high-dose fluconazole plus placebo versus fluconazole plus amphotericin B as therapy for candidemia and its consequences in nonneutropenic subjects.

A randomized, blinded, multicenter trial was conducted to compare fluconazole (800 mg per day) plus placebo with fluconazole plus amphotericin B (AmB) deoxycholate (0.7 mg/kg per day, with the placebo/AmB component given only for the first 5-6 days) as therapy for candidemia due to species other than Candida krusei in adults without neutropenia. A total of 219 patients met criteria for a modified intent-to-treat analysis.

Variability in polyene content and cellular toxicity among deoxycholate amphotericin B formulations.

Study Objective: To evaluate the toxicity of amphotericin B deoxycholate formulations.

Design: In vitro experiment.

Setting: University research center.

Voriconazole: a new triazole antifungal agent.

Objective: To review the pharmacology, in vitro susceptibility, pharmacokinetics, clinical efficacy, and adverse effects of voriconazole, a triazole antifungal agent.

Data Sources: A MEDLINE search, restricted to English language, was conducted from 1990 to June 2002. Supplementary sources included program abstracts from the Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America from 1996 to 2001 and manufacturer information available through the Food and Drug Administration's Web site.

Differential expression of genes encoding immunomodulatory proteins in response to amphotericin B in human mononuclear cells identified by cDNA microarray analysis.

Amphotericin B (AMB) is an antifungal agent that possesses immunomodulatory properties that may contribute to its infusion-related toxicity and activity. It has previously been shown to induce the expression of genes encoding the cytokines interleukin (IL)-1 beta and tumour necrosis factor (TNF)-alpha and the chemokines IL-8 and macrophage inflammatory protein (MIP)-1 beta in the human monocytic cell line THP-1. In an effort to identify additional AMB-responsive genes, the gene expression profiles of both THP-1 cells and human peripheral blood mononuclear cells (hPBMCs) on exposure to AMB were assessed using cDNA microarray analysis.

Necrotizing fasciitis of the upper extremity resulting from a water moccasin bite.

Aeromonas hydrophila infection has been described as the cause of necrotizing fasciitis in patients with suppressed immune systems, burns, or trauma in an aquatic setting. We report a case in which severe necrotizing fasciitis involving hand, arm, chest, and lateral side of trunk, along with toxic shock, developed after the patient was bitten by a venomous snake. Mixed aerobic and anaerobic bacteria, including A hydrophila, were isolated from the wound culture.