PubMed · 1501388
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M Ohkawa. 1992. [Urinary candidiasis].. https://doi.org/10.5980/jpnjurol.83.812
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A 63-year-old man who grows orchids as a hobby, fell ill with weakness and pain in his hips and legs 2 months after his latest trip to South America (Ecuador). The WBC count was 9900/microliters with unremarkable differential count while blood sedimentation rate was raised to 60/100 mm. The chest X-ray demonstrated in the right upper lobe a well-circumscribed coin lesion (3 cm diameter) of soft-tissue density, uncalcified and without cavitation. Computed tomography in addition revealed an enlarged lymph-node at the lower hilar pole, but no mediastinal lymphoma. Bronchoscopy demonstrated narrowing of a subsegmental ostium of the 6th segment on the right. An attempt at transbronchial biopsy failed. As a peripheral bronchial carcinoma was suspected, a posterolateral thoracotomy was performed (4 months after the trip to Ecuador). Rapid histological examination was negative for tumour and the lesion was therefore enucleated. Histologically (Grocott silver staining) a histoplasmoma was diagnosed. Several serum samples were positive for precipitating (M-band) and complement-binding antibodies (titre 12 days preoperatively was 1:16). The postoperative course was without complication. No anti-histoplasma antibodies were demonstrable 1 year postoperatively.
Fluorescent antibody, immunoperoxidase and gold-silver staining methods for the rapid and accurate diagnosis of systemic mycotic infections are currently performed in a few specialized laboratories. These methods have proved applicable to formalin-fixed, paraffin-embedded tissues, and are reliable for identifying therein antigens of infectious dimorphic, monomorphic filamentous, and yeast-like fungal pathogens, i.e., Aspergillus spp., Blastomyces dermatitidis, Candida spp., Coccidioides immitis, Cryptococcus neoformans, Fusarium spp., Histoplasma capsulatum, Paracoccidioides brasiliensis, Pseudallescheria boydii, and Sporothrix schenckii. Most of the available reagents are derived from multiple adsorbed polyclonal antisera. However, problems occur in the production of uniform and standardized species- or genus- specific antibodies. Monoclonal antibodies, although promising, have to date not eliminated these problems. Immunohistologic methods will become more routinely used in clinical laboratories as these problems are resolved and more sensitive and specific reagents become commercially available.