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Induction of antigen-specific suppression by circulating Cryptococcus neoformans antigen.

Immunoaffinity chromatography of sera from mice infected with Cryptococcus neoformans (Inf-MS) on a column with rabbit anti-cryptococcal antibody as the ligand resulted in the adsorption of the component(s) that induce suppression of the cryptococcal delayed-type hypersensitivity (DTH) response. In contrast, immunoaffinity chromatography of Inf-MS on columns coupled with cryptococcal antigen or goat anti-mouse IgM, IgG, and IgA did not adsorb the suppressive component(s). Quantification of cryptococcal antigen and anti-cryptococcal antibody in Inf-MS and column fractions established a direct correlation between cryptococcal antigen levels and suppressive activity; no correlation was observed between anti-cryptococcal antibody levels and suppressive activity. The suppression induced by Inf-MS was shown to be specific in that suppressive sera did not affect the induction of DTH responses to Listeria monocytogenes or dinitrofluorobenzene. These collective results provide evidence that cryptococcal antigen is the component in Inf-MS that induces antigen-specific suppression of the cell-mediated immune response to C. neoformans.

Animals↗

In-vitro activity of dicationic aromatic compounds and fluconazole against Cryptococcus neoformans and Candida spp.

We investigated the in-vitro activity of three selected dicationic aromatic compounds for nine clinical isolates of Cryptococcus neoformans and 93 clinical isolates of Candida spp., representing 12 different species, using a broth macrodilution method following NCCLS recommendations. All the clinical isolates were also tested for fluconazole susceptibility. The in-vitro data demonstrate that compounds 39 and 57 have excellent in-vitro activity for all tested strains (MIC 0.19-1.56 mg/L) except Candida pelliculosa. Moreover, compound 39 showed excellent in-vitro fungicidal activity against Candida krusei, Candida glabrata, Candida lusitaniae and Cryptococcus neoformans with MFCs in the range 0.39-6.25 mg/L. Both compounds 39 and 57 showed excellent in-vitro activity against fluconazole-resistant Candida albicans isolates, including a C. albicans strain that contains all known fluconazole-resistant mechanisms. Comparing MIC data from compounds 21, 39 and 57 with fluconazole, we found a statistically significant difference only with compound 39 (P = 0.043). However, comparing MFC data from compounds 21, 39 and 57 with fluconazole, we found statistically significant differences with all three compounds (P < 0.00001). These data indicate the potential antifungal breadth of two bis-benzimidazoles (compounds 39 and 57) as antifungal agents against yeasts. If it can be determined that compounds 39 and 57 are effective and non-toxic in vivo, the prospect of these compounds as clinically useful antifungal agents will be enhanced.

Antifungal Agents↗

Growth of Cryptococcus neoformans in a thiamine-free medium.

The growth of Cryptococcus neoformans in a minimal liquid synthetic medium with or without thiamine (10 micrograms/ml) was investigated. In these media the presence or absence of thiamine had no effect on the development of C. neoformans. To check these results, we performed a series of experiments on a solid form of the minimal synthetic medium. In this study a series of six serial transfers were carried out to starve the cells of nutrients that may have been carried over from their growth on rich media. In each of the transfers on the solid synthetic medium, C. neoformans showed a similar and scarce growth. This finding indicates that C. neoformans could be autotrophic in respect to thiamine.

Cryptococcus neoformans↗

Regulatory role of exogenous IL-10 in the development of immune response versus Cryptococcus neoformans.

The most important event involved in host defence against Cryptococcus neoformans is the development of an adequate cell-mediated immune response. IL-10, abundantly produced during AIDS progression, could be a negative factor that affects the T cell response through its own immunosuppressive action on antigen-presenting cells. To determine whether this cytokine affects the course of immune response against C. neoformans, we added exogenous IL-10 to cultured Cryptococcus-laden monocytes plus T lymphocytes. The data from this study confirmed the down-regulatory effect of exogenous IL-10 on monocytes and expanded the known inhibitory role to include an increase of the deleterious effect due to capsular material of C. neoformans on (i) lymphoproliferation, (ii) down-regulation of MHC class II molecules, (iii) inhibition of IL-2 mRNA expression and protein secretion by T lymphocytes. These results indicate that the presence of IL-10 in AIDS patients, due to the progression of disease, could represent a pivotal problem contributing to augment the pathogenic effect of C. neoformans.

Antibodies, Fungal↗

Effect of a tetracycline antibiotic on the experimental pathogenicity of Cryptococcus neoformans.

The pathogenicity of three stains of Cryptococcus neoformans was experimentally tested by intradermal inoculations into albino rabbits and intraperitoneally into mice. A relationship was found between the number of inoculated cells and the diameter of dermal lesion; moreover, a typical kinetics of lesion evolution and healing has been shown. Treatment of rabbits with deoxytetracycline did not dramatically influence the behavior of dermal lesions. However, in experiments dealing with strain Vi selected for its enhanced dermotropism, the antibiotic did significantly provoke a diminition of the inflammatory area. In mice, the antibiotic caused a marked increase in mortality (as evaluated by both LD50 values and rate of mortality). Neither in rabbits nor in mice, however, were we able to detect a significant effect of the drug on the dissemination of C. neoformans cells in internal organs. There is no simple explanation for the reported observations but it is possible that local factors in the derma or an aspecific antiinflammatory action of deoxytetracycline are responsible for the unusual response of dermal experimental infection to antibiotic treatment.

Animals↗

Culture of Cryptococcus neoformans in the nonencapsulated state.

Forty-one strains of Cryptococcus neoformans were examined after 3 days growth on a fresh and aged medium at pH 5 & pH 7 for comparison of capsule formation. Over one-half of the strains did not form visible capsules on aged medium at pH 5. Serotypes and source of isolation did not correlate with ability or inability to form capsules. Growth of C. neoformans in the nonencapsulated state makes it possible to culture many strains of C. neoformans in the form that more closely simulates the true infectious particles.

Cryptococcus↗

Two rapid pigmentation tests for identification of Cryptococcus neoformans.

Two tests were developed for the rapid identification of Cryptococcus neoformans based on pigment produced by the organism's phenoloxidase activity. Caffeic acid was incorporated into cornmeal agar, a medium used routinely for yeast identification. When tested on this medium, only C. neoformans isolates produced brown pigment. All other yeasts maintained their normal morphology and did not produce the reaction product. A non-medium-based test was developed for same-day identification of C. neoformans isolates. Paper strips saturated with a buffered L-beta-3,4-dihydroxyphenylalanine-ferric citrate solution were inoculated with isolates and incubated at 37 degrees C. Pigment production occurred only with C. neoformans isolates, many within 60 to 90 min. All other yeasts remained negative.

Cryptococcus↗

Epidemiological evidence for dormant Cryptococcus neoformans infection.

To date, the time of acquisition of a Cryptococcus neoformans infectious strain has never been studied. We selected a primer, (GACA)(4), and a probe, CNRE-1, that by randomly amplified polymorphic DNA (RAPD) analysis and restriction fragment length polymorphism (RFLP), respectively, regrouped strains from control samples of C. neoformans var. grubii environmental isolates according to their geographical origins. The two typing techniques were then used to analyze 103 isolates from 29 patients diagnosed with cryptococcosis in France. Nine of the 29 patients lived in Africa a median of 110 months prior to moving to France; 17 of the patients originated from Europe. Results showed a statistically significant clustering of isolate subtypes from patients originating from Africa compared to those from Europe. We conclude that the patients had acquired the C. neoformans infectious strain long before their clinical diagnoses were made.

Cryptococcosis↗

Occurrence and significance of Cryptococcus neoformans in the respiratory tract of patients with bronchopulmonary disorders.

Cryptococcus neoformans was cultured from 13 (3%) of 469 clinical specimens examined from the respiratory tract of patients with bronchopulmonary diseases. These isolations came from 5 (2%) of 207 patients; 11 isolates were from sputum and 1 each were from bronchoscopic aspirate and empyema pus. The fungus was not cultured from the oropharyngeal washings of 101 apparently healthy volunteers. Of the 5 patients, 3 had pulmonary tuberculosis, including one with pyopneumothorax and 2 with allergic bronchopulmonary aspergillosis as the underlying disease. In the tuberculosis patient with pyopneumothorax and C. neoformans in empyema pus, the fungus was presumably a tissue invader, whereas its role could not be unequivocally ascertained in the remaining 4 patients from whom it was isolated from sputum or bronchial aspirate on at least two consecutive occasions. The question of C. neoformans being a transient resident, commensal, or incitant of benign minimal lesions in the tracheobronchial tree is discussed. A comprehensive laboratory and clinical follow-up is warranted in patients from whose sputum or bronchial aspirate C. neoformans may be cultured even though definitive signs of cryptococcosis may be lacking.

Clostridium↗

In vivo interaction between alveolar macrophages and Cryptococcus neoformans.

In vivo interactions of rabbit alveolar macrophages (AM) and Cryptococcus neoformans, a yeast pathogenic for humans, were studied. As a control, inert silica particles of a similar diameter (5-6 microns) were used. Of 16 rabbits, 6 were instilled intratracheally with fluorescein-labelled heat-killed C. neoformans, 6 with fluorescein-labelled silica particles and 4 with saline only. After 24 h, the AM were collected by lung lavage, and phagocytosis, oxidative metabolism, phagolysosomal pH and morphology were studied. The accumulated number of yeasts attached to the AM was almost the same for C. neoformans as for the silica particles. The ingested fraction of C. neoformans was even higher than that of the silica particles. Quantitative NBT reduction by the AM, reflecting their oxidative metabolism, was markedly increased by exposure to C. neoformans for 24 h. The phagolysosomal pH was on the average lower in phagolysosomes with C. neoformans than with the silica particles, although approximately 2% of the phagolysosomes with C. neoformans had neutral pH. Phagolysosomes with neutral pH was not observed for silica particles. Electron microscopy showed presence of C. neoformans in phagolysosomes of AM. The conclusion of this study is that the phagocytic activity, oxidative metabolism and phagolysosomal pH AM against C. neoformans are significant 24 h after the exposure.

Animals↗

Cryptococcus neoformans in the crops of pigeons following its experimental administration.

Cryptococcus neoformans (5 X 10(6) yeast cells) was given per os to 10 pigeons (Columba livia) proved to be free (crops and excreta) of C. neoformans prior to experimentation. The yeast was recovered from the droppings of 9 pigeons the day after ingestion but was still present in the droppings of 1 pigeon on the 22nd day after ingestion. The crop was much more constantly positive than the droppings and for a much longer time since positive in 9 pigeons on the first day it was still positive in 2 pigeons on the 86th day at the end of the observation period. The results of the experiment presented here and the results of previous work, indicate that C. neoformans can survive and could so be carried in the crop of pigeons.

Animals↗

INFECTION OF WHITE SWISS MICE WITH AIRBORNE CRYPTOCOCCUS NEOFORMANS.

Smith, C. D. (Communicable Disease Center, Kansas City, Kansas), R. Ritter, H. W. Larsh, and M. L. Furcolow. Infection of white Swiss mice with airborne Cryptococcus neoformans. J. Bacteriol. 87:1364-1368. 1964.-A group of 39 white Swiss male mice were allowed to run 3 days on previously sterilized soil that had been seeded with Cryptococcus neoformans 1 year previously. It was determined that the soil contained an average of 1.6 x 10(6) viable yeast cells per ml. The mice were observed for 24 weeks, at which time the survivors were necropsied. The total mortality rate during this period was 44%; 67% of the mice had positive cultures, including all who had a fatal infection. Two additional experiments were done with the same strain with the use of aerosols produced by a Henderson apparatus. In experiment 1, 39 mice received 11,000 viable cells each; in experiment 2, 40 mice received 14,622 viable cells. Both groups of mice showed similar mortality rates, with a total of 77% dead after 20 weeks in experiment 1, and 80% in experiment 2. All of the mice in experiment 1 had positive cultures, as did 95% of the mice in experiment 2.

Aerosols↗

In-vitro interactions of itraconazole with flucytosine against clinical isolates of Cryptococcus neoformans.

Treatment failures can occur in AIDS patients infected with Cryptococcus neoformans, despite aggressive antifungal therapy. Combination regimens with additive or synergic drugs could provide additional options for treating cryptococcosis. We studied the effects of itraconazole combined with flucytosine against 16 strains of C. neoformans var. neoformans. Combination therapy revealed different results for the various strains, including synergy (fractional inhibitory concentration (FIC) index 0.5, 63% of the interactions), addition (FIC >0.5 to 1.0, 31% of the interactions) and indifference (FIC >1.0 to <2.0, 6% of the interactions). Antagonism (FIC >2.0) was not observed. The efficacy of combination therapy was confirmed by quantitative cfu and killing curve assays. In particular, killing curves conducted in replicating cells showed that the addition of itraconazole prevented the development of flucytosine-resistant mutants of C. neoformans. These data show that the combination of itraconazole and flucytosine is significantly more active than either drug alone against C. neoformans in vitro.

Antifungal Agents↗

Cryptococcus neoformans var. gattii among patients with cryptococcal meningitis in Mexico. First observations.

A retrospective study of 20 patients with cryptococcal meningitis and their isolated strains was performed. Cryptococcus neoformans var. neoformans was recovered from 14 (70%) cases, and var. gattii was recovered from six (30%) patients. Twelve patients had AIDS (all carrying var. neoformans), two had other diseases (one with var. neoformans and one var. gattii) and there was no identifiable underlying disease in six (one var. neoformans and five var. gattii). Fourteen patients (11 var. neoformans and three var. gattii) resided in the Mexico City area, where a temperate climate is prevalent, and there were six cases (three var. neoformans and three var. gattii) from states with a tropical/subtropical climate. Although there was no significant statistical difference between the two varieties, the fatal outcome was higher in patients with var. neoformans. The disease caused by var. gattii strains was characterized by a higher opening pressure, more inflamatory changes of CSF and a longer clinical course (delayed clinical and mycological cure). Cryptococcus neoformans var. gattii is a significant cause of cryptococcal meningitis in patients without underlying diseases in Mexico.

AIDS-Related Opportunistic Infections↗

Cutting edge: Role of C-C chemokine receptor 5 in organ-specific and innate immunity to Cryptococcus neoformans.

After intratracheal inoculation of the AIDS-associated pathogen Cryptococcus neoformans, 12-wk survival was >90% for CCR5+/+ mice but <25% for CCR5-/- mice. There were no defects in lung leukocyte recruitment (wk 5), pulmonary clearance, or delayed-type hypersensitivity in CCR5-/- mice. However, CCR5-/- mice had defects in leukocyte recruitment into the brain and, strikingly, in elimination of cryptococcal polysaccharide from the brain. In nonimmune CCR5-/- mice, there was a significant defect in macrophage recruitment after challenge with shed cryptococcal products (C. neoformans filtrate Ag) but not other nonspecific stimuli. Thus, CCR5 plays specific roles in innate immunity and organ-specific leukocyte trafficking during host defense against C. neoformans.

Animals↗

3-Hydroxyanthranilate in Cryptococcus neoformans: a secreted reductant that does not enable wood rot.

Cryptococcus neoformans secretes 3-hydroxyanthranilate (3HAA), but the utility is unknown. Exogenous 3HAA promoted growth of cultures starved for iron with transferrin, presumably by releasing Fe(III) reductively. Exogenous 3HAA protected C. neoformans from strong oxidants, suggesting a role in resistance to killing by immune cells. 3HAA represents an endogenous laccase substrate, in that crude laccase preparations convert 3HAA to cinnabarinic acid, whereas 3HAA concentrations are higher in Lac- mutants. We isolated hypersecreting mutants as highly fluorescent clones. Because C. neoformans has been isolated from rotting wood, we looked for a role in degradation of lignin. Using cyclic voltammetry, we found no electrochemical evidence that organic oxidation products of 3HAA are capable of oxidizing lignin. We found neither cellulose dehydrogenase nor lignin peroxidase enzymic activity, nor did C. neoformans grow on cellulose as carbon source. We found no evidence for production of Fenton reagent by cultures, even in the presence of transition metal ions or of those and 3HAA. The biological utility of 3HAA may be related to its functions as reducing agent and, conceivably, as laccase substrate. It does not appear to attack wood, nor does C. neoformans appear to have a mechanism to rot wood.

3-Hydroxyanthranilic Acid↗