["Professional" blood donors].
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Biomedical subjects
Publications and source records attributed to F Staib.
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In connection with a case report, the mycological diagnosis and treatment of orbital aspergillosis are reviewed. In a 59-year-old male patient an exophthalmus on the right side could be diagnosed as aspergillosis spreading from the corresponding sinus maxillaris into retro- and peri-orbicular regions, after other causes had been excluded by differential diagnosis. In a biopsy specimen from the retrobulbar tumor, a fungal granuloma was found which, histologically and by isolation of the fungus, could be identified as an infection by A. fumigatus. Because of the good visus of the right eye, no exenteratio orbitae but an enoral revision of the sinus maxillaris, ethmoidal bone, and bottom of orbita was performed.--By infusions of amphotericin B and local washings with pimaricin (natamycin) in the sinus maxillaris and the region of the operation, a complete healing of the mycotic process was achieved.--Since 1 1/2 years, the patient has not had a relaps. This success of therapy was possible by exemplary cooperation of otorhinolaryngologists, ophthalmologists, pathologists and microbiologists.--In view of the prophylaxis of such infections, recent contributions to the epidemiology of aspergillosis are discussed.
The presence and growth of Aspergillus fumigatus and Aspergillus niger in the soil of ornamental plants have been demonstrated. The ecological conditions in the soil of such plants as influenced by temperature, humidity, desiccation, fertilization and ventilation obviously influence such fungal growth. The epidemiological significance of these findings is of interest with a view to the present efforts to control aspergillosis in the environment of susceptible persons. Observations of a preferential growth of certain Aspergillus species in the soil of defined plants under defined conditions raise problems of soil microbiology.
The concept of the epidemiology of Cryptococcus neoformans as the causative agent of cryptococcosis and as a basidiomycetous yeast is based on the fact that bird manure has been until now its only known habitat but not plant material which likewise harbours various nonpathogenic Cryptococcus species. It could be shown that the possible influence of nutritional factors on the morphology and morphogenesis earns attention not only in view of the epidemiology of C. neoformans but of its perfect states, too.
Trichophyton rubrum strains freshly isolated from clinical material exhibited red pigment formation within 7 days at 26 degrees C on slant serum-albumin agar, initial pH 7.0. In Trichophyton mentagrophytes strains this phenomenon could not be observed. Since in the case of T. rubrum, yellow pigmentation will appear at an initial pH of 5.0, the use of initial pH values of 7.0 and 5.0 is recommended for diagnostic application of slant serum-albumin agar.
The increasing incidence of human A. fumigatus infections particularly such of the respiratory tract has led to this study of the epidemiological situation. During the period between October 1968 and December 1977, A. fumigatus was isolated from clinical material in 425 cases. These findings which were established at the Mycology Unit, Robert Koch Institute, Federal Health Office, exhibited the following distribution by regions of the body or type of specimen: respiratory tract 277 (65.1(); venous blood 58 (13.6%); urine 3 (0.7%); stools 9 (2.1%) and others 78 (18.3%). Approximately two thirds of these findings were made during the period from October to March and about one third between April and September. The presence of A. fumigatus in the air both indoors and outdoors and also in the environment of patients suffering from aspergillosis was studied with the aid of the sedimentation-method. This method was chosen because the occurrence of A. fumigatus conidia in the air is of epidemiological interest. The number of isolations of A. fumigatus from outdoors samples was low, so the search for inhalative conidia concentrated upon sites near A. fumigatus habitats. These studies revealed that aspergillosis patients, clinical material sampled from them, decaying plant material (agriculture, horticulture), and used clothes and linen may form foci for the spread of A. fumigatus conidia. The control of aspergillosis in the hospital environment involves in particular a control of aspergillosis patients by means of culture and serology (preferably by ghe immunodiffusion test). Numerous recommendations are made on how to prevent A. fumigatus infections in hospitals, at the working site, and in the laboratory.
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The strikingly frequent and constant presence of Aspergillus fimigatus in the soil of potted ornamental plants kept in private houses and hospitals has been the reason for studying the antigens of the strains found from the diagnostic and epidemiological angles. Culture-filtrate antigens of A. fumigatus strains isolated from the soil of 4 different ornamental plants, epiphyllum (Epiphyllum truncatum), orange tree (Citrus sinensis), Alpine rose (Azalea indica) and Christmas flower (Euphorbia pulcherrima), were compared, in the immunodiffusion test, with antigens of A. fumigatus strains from aspergillosis patients prepared in an identical way. When tested against 8 different sera from different aspergillosis patients there was a good coincidence of results. Control sera from patients suffering from diseases other than aspergillosis, no false-positive reactions could be observed. The findings are discussed in respect of diagnosis and epidemiology.
On serum albumin agar (bovine albumin) with initial pH-values of 5.0-6.0, Trichophyton rubrum showed a yellow pigmentation, and on the same medium with an initial pH-value of 7.0, a red pigmentation. Strains of Trichophyton mentagrophytes have never shown pigmentation until now, The scarce growth (submerged) of T. rubrum on serum albumin agar is associated with a pigment formation that may be used for diagnostic purposes. It could be read within 3-7 days. Serum albumin agar with the initial pH-value of 5.0 was introduced in 1964 for the detection of the strain-specific proteolytic activity of Candida albicans.
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Cell-free, dialysed and concentrated culture filtrate of a Candida albicans strain, after proteolysis in serum-protein medium (bovine albumine), and after growth in Sabouraud glucose broth (for comparison) were used as antigens for the detection of precipitating antibodies in 558 samples of serum originating from defined groups of patients and healthy persons serving as controls. The differing distribution of antibodies against these two antigens as observed in the various groups of our patients calls for further studies of such antigens on the basis of proteolysis within the serodiagnostics of Candida albicans-mycoses.
During the previous studies, we could demonstrate that there are strains of Cryptococcus neoformans which after intraperitoneal inoculation, are capble of surviving only in the brain of mice without causing any apparent clinical symptom; only in about 4% of the animals the fatal involvement of the CNS occurred. The present investigations suggest that the selective involvement of eye, i.e., formation of intraocular cryptococcoma, with subsequent blindness is also possible under similar experimental conditions. It was observed that a short-lived uremia caused by intramuscular injection of 0.2 ml glycerine could enhance the rate of the selective involvement of the CNS including the eye. The uremia was controlled by the auxanographic method using STAIB's technique of serum-residual-nitrogen-auxanogram and employing the strain used for infecting the mice. These animal experiments are discussed in connection with a clinical case of intra-ocular cryptococcosis in which the only known basic disease was uremia of unknown orgin. The spontaneously healing cryptococcosis detected in this case after the treatment of uremia, has been discussed. Cases of ocular cryptococcosis described in the world literature have been also briefly discussed inconnection with our results. These microbiological observations will be supplemented by the histopathological findings to be published separately.
In connection with microbiological findings in two patients, a report on septicemia caused by C. tropicalis is given. C. tropicalis is second in frequency to C. albicans in man. Because for the different biological properties of Candida species in each case of isolation of such fungi from clinical specimens an identification of the species is obligatory, because the generalizing diagnosis of "Candida mycosis" may be insufficient for the detection of epidemiological and pathogenetic associations. The possible primary resistance of C. tropicalis against the antimycotic 5-Fluorocytosine (Ancotil) is discussed. It is shown that the antigen similarity within the most important Candida species as e.g. between C. albicans and C. tropicalis may cause a false interpretation of serological results concerning the causative agent of the infection. For a safe inactivation of C. tropicalis on human skin, cleaning with 70% isopropyl alcohol for ten seconds is proposed. Because C. tropicalis is entering the human body preferably through food it is discussed whether a microbiological control of food for patients predisposed for such infections should be performed.
The incidence and distribution of aspergillosis among patients of a lung clinic in West Berlin were recorded. The immunodiffusion test (IDT) was used on sera of 228 patients seen during one day to test for precipitins against A. fumigatus, A. flavus, and A. niger. Precipitating antibodies specific against A. fumigatus were found in five patients, in two of them A. fumigatus was isolated simultaneously from sputum. In order to obtain a clear view of the clinical occurrence of asperigillosis and its course one requires not only serological tests but also the isolation of Aspergillus in culture from sputum or bronchial secretion. IDT is useful for detecting aspergillosis and for screening persons harbouring Aspergillus in their respiratory tract.
Effect of certain low molecular nitrogen substances, namely uric acid, eura and creatinine as sole source of nitrogen was studied on 31 strains of Cryptococcus neoformans as well as on a rough looking isolate recovered from the brain of a mouse inoculated with a mucoid strain of C. neoformans. Uric acid as a nitrogen source caused striking alterations in the morphology of C. neoformans. In view of the facts that uric acid is a common end-product of human and animal metabolism, it is abundantly present in the avian faecal matter and is capable of inducing mucoid growth and capsule formation in dry growing non-encapsulated strains or in an otherwise rough looking hypha forming isolate, its role in studying the phylogenesis of C. neoformans and its pathogenicity seems to be an important proposition.
During a certain period of the course of infection in white mice inoculated intraperitoneally with the pure culture of a proteolysing strain of Candida albicans, Staphylococcus aureus and C. albicans both, were isolated simultaneously from the peritoneal abscesses, especially those adhering to the stomach, duodenum, pancreas and the upper part of small intestine. This concommitant occurrence of the two pathogens was further corroborated by histopathological examination which revealed large number of staphylococci present in the close neighbourhood of Candida cells, usually in the center of the granulomata caused by the fungus. In view of the facts that the proteolytic end-products of C. albicans can offer a good substratum for the growth of S. aureus and the latter may be isolated from the intestinal tract of apparently healthy mice, possibly as a constituent of the transient microflora, the co-existence of these two important aetiologic agents of endogenous infections as encountered during this study appears to be of great clinical interest. Furthermore, these observations also demonstrate the importance of controlling the bacterial flora of mice for pure mycological studies.