Coccidioidomycosis of the male reproductive tract

Coccidioides immitis infection of the male reproductive tract is a rare entity that can evade diagnosis and pose a dilemma in management. Initially, patients are often evaluated for malignancy or other infections such as tuberculosis. In the past, surgery was the only management option for C. immitis infection of the male reproductive tract, but azole therapy now provides an adjunct or an alternative. We describe two patients who received azole therapy for C. immitis infection of the male reproductive tract. One received fluconazole for prostatic disease, while one received surgery followed by itraconazole for testicular disease. After 12 months of therapy, both remain asymptomatic and have decreased antibody titers against C. immitis.Disclaimer: The Views expressed herein are those of the authors do not reflect the official policy or position of the Department of the Air Force, Department of the Army, Department of Defence, or the U.S. Government.     

Coccidioides immitis isolated from armadillos (Dasypus novemcinctus) in the state of Piauí, northeast Brazil

Natural infection of armadillos with Coccidioides immitis was studied in the state of Piauí, northeast of Brazil, endemic for coccidioidomycosis. In 1998, 26 nine-banded armadillos (Dasypus novemcinctus) were captured in 4 different counties. The animals were sacrificed under deep anesthesia with ether. At necropsy fragments of spleen, liver, lungs and heart were homogenized and seeded onto Sabouraud dextrose agar with and without cycloheximide (BBL, USA). Part of each organ was also processed for histological examination. Suspected colonies of filamentous fungi observed after the second week of incubation at room temperature, exhibiting barrel-shaped arthroconidia alternating with empty spaces, were inoculated intraperitoneally into mice. Three armadillos proved to be infected with C. immitis. Mice inoculated with suspected colonies obtained from homogenized spleen of three and liver of two armadillos developed disseminated coccidioidomycosis and immature and mature spherules of C. immitis were disclosed in several organs. For the first time armadillos (D. novemcinctus) were found naturally infected with C. immitis, adding new data on the ecology and on a possible role of these ancestral mammals in the evolutionary life cycle of this fungus. This revised version was published online in July 2006 with corrections to the Cover Date.     

Serum glycoproteins in rats with experimental coccidioidomycosis

Summary The changes in the serum glycoproteins and the development of specific antibodies were examined during the course of experimental coccidioidomycosis in rats. The total glycoprotein, seromucoid hexose, seromucoid protein, and haptoglobin levels were signigicantly higher in sera from infected animals compared with sera from non-infected controls. These changes were evident at three days but not at two weeks following inoculation withC. immitis. The non-seromucoid hexose and total protein concentrations were not significantly different between infected animals and controls. The highest percentages of animals exhibiting positive tests for complement fixing and precipitin antibodies and positive cultures forC. immitis in organs at autopsy were found one week after infection.This study was supported in part by USPHS Grants T1 A1 52-07, A106048-02 and the Dermatologic Research Foundation of California, Inc.     

Effect of cyclophosphamide on rats experimentally infected with Cryptococcus neoformans

This study was undertaken to establish the function of T-lymphocytes in protective immunity against a cryptococcal infection in animals treated with Cyclophosphamide (Cy) pre or post infection and to determine how they relate to the progression of the disease.Inbred Suquía rats were infected either intranasally (i.n.) or intraperitoneally (i.p.) with 10⁵ viable Cryptococcus neoformans cells. The infected rats were divided in three groups. One of the groups (group I) was utilized as a control. The second group (group II) was treated with Cy 3 days before the infection. The third group (group III) was treated with Cy 3 days after the infection.At approximately 22 days post infection, C. neoformans growth in selected organs of all animals were determined. In addition, humoral and delayed-type hypersensitivity (DTH) response were assayed in the rats.When the Cy was applied after the infection the DTH was significantly diminished and inverse to the colony forming unit (CFU) which increased leading to the animals death. On the other hand, injection of the drug 3 days before infection did not modify the response, that was comparable in both treated and the control animals.In this study it were found haemagglutinating antibodies in sera from i.n. and i.p. infected rats although at minimal levels and were not present in all animals.The results show that with a low T-cell function induced as a consequence of injecting Cy after the infection, rats did not develop a normal DTH response to cryptococcal infections and were not able to control a cryptococcal infection as well as animals with normal T-cell function.     

Molecular detection of Wolbachia pipientis in natural populations of mosquito vectors of Dirofilaria immitis from continental Portugal: first detection in Culex theileri

Wolbachia pipientis (Rickettsiales: Rickettsiaceae) protects mosquitoes from infections with arboviruses and parasites. However, the effect of its co‐infection on vector competence for Dirofilaria immitis (Spirurida: Onchocercidae) in the wild has not been investigated. This study aimed to screen vectors of D. immitis for wPip, to characterize these, and to investigate a possible association between the occurrence of W. pipientis and that of the nematode. The presence of W. pipientis was assessed in the five mosquito potential vectors of D. immitis in Portugal. Polymerase chain reaction (PCR) products were sequenced, and wPip haplotypes were determined by PCR–restricted fragment length polymorphism (RFLP). Results showed that wPip was detected in 61.5% of Culex pipiens (Diptera: Culicidae) pools and 6.3% of Culex theileri pools. wPip 16s rRNA sequences found in Cx. theileri exactly match those from Cx. pipiens, confirming a mosquito origin, rather than a nematode origin, as some specimens were infected with D. immitis. Only wPip haplotype I was found. No association was found between the presence of wPip and D. immitis in mosquitoes and hence a role for this endosymbiont in influencing vectorial competence is yet to be identified. This study contributes to understanding of wPip distribution in mosquito populations and, to the best of the authors' knowledge, is the first report of natural infections by wPip in Cx. theileri.     

Artificial Infections of Pneumocystis carinii in the SCID Mouse and their Use in the In Vivo Evaluation of Antipneumocystis Drugs

A model for the in vivo evaluation of antipneumocystis drugs has been developed in SCID mice infected intratracheally with cryopreserved mouse-derived Pneumocystis carinii. The development of a highly reproducible fatal P. carinii pneumonia occured within 10 weeks (mean survival time ± SEM = 72.2 ± 1.2 days). Continuous administration of dexamethasone (2 mg/liter in the drinking water) exacerbated the rate of onset of severe P. carinii pneumonia (mean survival time ± SEM = 63 ± 1.3 days) in SCID mice. The number of cysts per g of lung homogenate (homogenate counts) were maximal with an inoculum of 20,000 cysts at 6 weeks post infection. Homogenate counts correlated with infection scores (graded assessments of immunofluorescent cysts on lung impression smears) suggesting that infection scoring accurately and rapidly reflects the severity of P. carinii pneumonia in SCID mice. These studies led to the development of a drug screening protocol in which Pneumocystis-free female SCID mice (20–25 g) were started on dexamethasone 7 days prior to IT inoculation with a single dose of 20,000 cysts. Drugs were evaluated either for: a) prophylaxis (continuously from day 1 post infection) or b) treatment (from day 21 post infection) until day 42 post infection, when all mice were killed and infection scores determined. Co-trimoxazole (at 250 mg sulfamethoxazole + 50 mg trimethoprim/kg/day) given in the drinking water was found to be highly effective in both the prophylaxis and treatment of mouse P. carinii pneumonia. Co-trimoxazole remained very effective in the prophylaxis P. carinii pneumonia in the SCID mouse at 125 mg sulfamethoxazole + 25 mg trimethoprim/kg/day p.o. and showed some enhancement of efficacy over sulfamethoxazole alone at 125 mg/kg/day p.o., suggesting limited synergy between sulfamethoxazole and trimethoprim. The results presented provide confirmation of the usefulness and predictability of the model.     

Investigation of an outbreak of endemic coccidioidomycosis in Brazil's Northeastern State of Piauí with a review of the occurrence and distribution of Coccidioides immitis in three other Brazilian states

An outbreak of coccidioidomycosis is described that involved three individuals and eight of their dogs, who had engaged in a successful hunt for nine-banded armadillos (Dasypus novemcinctus) in the environs of Oeiras, a community in Brazil's north eastern state of Piauí.Diagnosis was based on clinical, serological and cultural findings. Four of 24 soil samples collected in and around the burrow of an armadillo yielded cultures of Coccidioides immitis, thus establishing the endemicity of that mould in the state of Piauí. A literature review revealed that C. immitis, aside from that state, is endemic in three other Brazilian states — Bahia, Ceará and Maranhão. These four contiguous states have semi-arid regions where climatic conditions and their flora are similar to those that exist in C. immitis's endemic regions in North, Central and South America.This revised version was published online in October 2005 with corrections to the Cover Date.     

Dirofilaria immitis: cell-mediated and humoral immune responses in experimentally-infected dogs.

Four dogs were experimentally infected with 30 Dirofilaria immitis infective larvae, four dogs received two such infections and four dogs served as uninfected controls. A partially-purified D. immitis antigen was used in an indirect hemagglutination assay to determine anti-D. immitis antibody titers. Anti-D. immitis antibody was first detected in infected dogs 4 weeks after infection. Titers were highest 2 weeks after the appearance of microfilariae and diminished to low levels thereafter in the single infection group. Antibody levels in the double infection group decreased similarly but were demonstrable throughout the study. Antibody titers were significantly higher in the infected dogs, but there were no differences in titers between single and double infection groups.The responses of peripheral lymphocytes to phytohemagglutinin P and pokeweed mitogen were significantly depressed in infected dogs. Peripheral blood lymphocyte transformation could not be induced with D. immitis antigens. Differences between groups in T-cell function were not demonstrated by total hemagglutinating antibody or 2-mercaptoethanol labile hemagglutinating antibody following immunization with sheep erythrocytes.     

Elastase activity of fungi with anamorphs similar to Coccidioides immitis

The elastin digestion assay was examined to determine if it would facilitate the identification of Coccidioides immitis when non-pathogenic fungi resembling C. immitis are encountered. Fungal isolants tested have anamorphs that closely resemble the macroscopic or microscopic morphology of C. immitis. Elastin hydrolysis was measured by elastin-agar plate assays. Approximately 80% of the isolants hydrolyzed elastin; thus, the elastin digestion assay as a differential test appears to have little value.     

Prevalence of Dirofilaria immitis Infection in Stray Cats by Nested PCR in Korea

The purpose of this study was to conduct a survey of Dirofilaria immitis infection among stray cats in Korea using nested PCR. We included 235 stray cats (121 females and 114 males) and evaluated each for the presence of feline heartworm infection. Blood samples were collected from 135 cats in Daejeon, 50 cats in Seoul, and 50 cats from Gyeonggi-do (Province). Of the 235 DNA samples, 14 (6.0%) were positive for D. immitis. The prevalence of infection in male cats (8/114, 7.0%) tended to be higher than that in female cats (6/121, 5.0%), but the difference was not statistically significant. In each location, 8, 2, and 4 cats were positive for infection, respectively, based on DNA testing. No significant differences in the prevalence were observed among the geographic regions, although the rate of infection was higher in Gyeonggi-do (8.0%) than Daejeon (5.9%) and Seoul (4.0%). We submitted 7 of the 14 D. immitis DNA-positive samples for sequencing analysis. All samples corresponded to partial D. immitis cytochrome c oxidase subunit I gene sequences with 99% homology to the D. immitis sequence deposited in GenBank (accession no. {"type":"entrez-nucleotide","attrs":{"text":"FN391553","term_id":"295980069","term_text":"FN391553"}}FN391553). To the best of our knowledge, this is the first survey using nested PCR to analyze the prevalence of D. immitis in stray cats in Korea.     

Environmental vVariability and coccidioidomycosis (valley fever)

Coccidioidomycosis (valley fever) is a disease endemic to arid regions in the western hemisphere, and is caused by the soil-dwellingfungus Coccidioides immitis (C. immitis). In this paper, we provide an overview of the current state of knowledge regarding valley fever and C. immitis as related to climatic conditions and habitat requirements. Previous research shows there is a relationship between temperature and precipitation, and outbreaks of coccidioidomycosis. Incidence of the disease varies seasonally as well as annually due to changing climatic conditions. However, the specific environmental conditions that may produce an outbreak of coccidioidomycosis are not well understood in space and time. Previous studies have attempted characterize C. immitis' habitat. Temperature, moisture, salinity, and pH of the soil have all been considered separately in the geographic distribution of the fungus. Medical and proactive intervention are served best, however, by an integrative strategy that folds climate and surface variables into spatially-explicit models. We conclude with recommendations for future research directions.     

Climate controls on valley fever incidence in Kern County, California

Coccidiodomycosis (valley fever) is a systemic infection caused by inhalation of airborne spores from Coccidioides immitis, a soil-dwelling fungus found in the southwestern United States, parts of Mexico, and Central and South America. Dust storms help disperse C. immitis so risk factors for valley fever include conditions favorable for fungal growth (moist, warm soil) and for aeolian soil erosion (dry soil and strong winds). Here, we analyze and inter-compare the seasonal and inter-annual behavior of valley fever incidence and climate risk factors for the period 1980–2002 in Kern County, California, the US county with highest reported incidence. We find weak but statistically significant links between disease incidence and antecedent climate conditions. Precipitation anomalies 8 and 20 months antecedent explain only up to 4% of monthly variability in subsequent valley fever incidence during the 23 year period tested. This is consistent with previous studies suggesting that C. immitis tolerates hot, dry periods better than competing soil organisms and, as a result, thrives during wet periods following droughts. Furthermore, the relatively small correlation with climate suggests that the causes of valley fever in Kern County could be largely anthropogenic. Seasonal climate predictors of valley fever in Kern County are similar to, but much weaker than, those in Arizona, where previous studies find precipitation explains up to 75% of incidence. Causes for this discrepancy are not yet understood. Higher resolution temporal and spatial monitoring of soil conditions could improve our understanding of climatic antecedents of severe epidemics.     

Vascular endothelial cell activation by adult Dirofilaria immitis antigens

Dirofilaria immitis is the causal agent of cardiopulmonary dirofilariosis (heartworm disease). Adult worms lodge in the pulmonary arteries and right ventricle, thus vascular endothelium is exposed to high concentrations of Dirofilaria antigenic products. Heartworm disease habitually develops as a chronic foreseeable pathology. Moreover, the simultaneous death of many adult worms, naturally or induced by a filaricide treatment, can cause acute thromboembolisms and endarteritis. To better understand the effects of the massive death of D. immitis adult worms on the blood vessel endothelium, we cultured vascular endothelial cells in the presence or absence of an antigenic extract of D. immitis adult worms (DiSA). The parasite products increased the expression of enzymes and the synthesis of eicosanoids related to inflammation, such as COX-2, 5-LO, PGE₂ and LTB₄. The expression of ICAM-1 and PECAM-1 adhesion molecules and endothelial and inducible Nitric Oxide Synthases (eNOS and iNOS) was also increased in cultures treated with DiSA. Nevertheless, DiSA decreased endothelial permeability and does not alter both proliferation and apoptosis. These results suggest that the somatic extract of D. immitis adult worms stimulate inflammatory mechanisms in endothelial cells, without altering their basic physiologic processes.     

Dirofilaria immitis: Parasite-specific humoral and cellular immune responses in experimentally infected dogs

Humoral and cellular immune responses to adult antigens of Dirofilaria immitis were evaluated in experimentally infected dogs during the chronic phase of infection. All infected dogs had significantly elevated IgG (enzyme-linked immunosorbent assay) and IgE (passive cutaneous anaphylaxis) titers against D. immitis adult antigens. However, there was little difference between infected dogs and uninfected controls in cellular-immune responses to D. immitis adult antigen or phytohemagglutinin as assessed by the lymphocyte transformation assay. Although neither cellular nor humoral responses correlated with worm burdens, cellular responses among infected dogs correlated inversely with IgG titers to D. immitis adult antigen. These results are consistent with observations in other nematode and trematode systems which suggest that in chronic tissue helminth infections there is suppression of cellular immune responses to parasite antigens while humoral responses to the same antigens remain relatively preserved.     

Infezione sperimentale daCoccidioides immitis e steroidi corticosurrenali

Riassunto Ratti iniettati sottocute con sospensioni diCoccidioides immitis Stiles hanno presentato localmente lo sviluppo di un granuloma fibroblastico gigantocellulare e nessuna tendenza alla generalizzazione dell'infezione. Il trattamento con DCA o Artisone non ha modificato sensibilmente il decorso e le caratteristiche istologiche dell'infezione. All'opposto il trattamento con Cortisone ha condizionato in un'alta percentuale dei casi una diffusione viscerale dell'infezione stessa; nella sede d'impianto del fungo la reazione dei tessuti, anzichè il tipo granulomatoso abituale, ha assunto un tipo necroticoessudativo, senza barriera demarcante fibroblastica e con intensa vegetazione fungina. Questi reperti vengono messi in rapporto con le proprietà antiallergiche ed antiimmunitarie generiche del Cortisone e con l'effetto catabolico sul ricambio proteico unitamente al noto effetto inibitore sui normali processi di granulazione dei tessuti esercitato da questo ormone.

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Summary After the subcutaneous injection ofCoccidioides immitis Stiles, twenty rats showed a giant cell, fibroblastic granuloma; no general infection was observed. Treatment with DCA or Artisone did not modify the course and the histological pattern of the infection. On the contrary, in rats treated with Cortisone the infection was more severe, the subcutaneous granuloma showed larger necrotic and essudative foci, no fibroblastic tissue was formed, the fungous growth was conspicuous and visceral lesions were observed. These results are in agreement with the inhibitory effect of Cortisone on the allergic and immune responses and with the catabolic effect of the hormone on protein metabolism.

     

Ubiquinone system,GC contents and cellular fatty acid composition of species of the form-genusMalbranchea andCoccidioides immitis for chemotaxonomic study

Ubiquinone system, GC contents and cellular fatty acid (CFA) composition were analyzed as criteria for chemotaxonomy ofMalbranchea species andCoccidioides immitis, which are suggested to be phylogenetically related. Based on the major ubiquinone,Malbranchea spp. were divided into two groups, of which one group possessed the same major ubiquinone asC. immitis. Similar GC contents and CFA profiles were obtained for the species ofMalbranchea andC. immitis. On the basis of these criteria the relationships between the fungi are discussed.     

Dirofilaria immitis: effect on the longevity of Aedes trivittatus

Laboratory studies on vector mortality as related to parasite burden revealed that the mosquito Aedes trivittatus showed considerable tolerance to infection with the filarial nematode Dirofilaria immitis. Although mosquitoes exposed to a dog with a high microfilaremia (347 microfilariae/20 mm³) had a significant increase in mortality during the first 16 days postexposure, 66% of the mosquitoes lived long enough for complete parasite development to occur. Those mosquitoes exposed to a dog with a low microfilaremia (62 microfilariae/20 mm³) had no significant increase in mortality. There was a strong negative correlation between parasite burden and mosquito survival, but only mosquitoes harboring more than 15 juveniles had an increased chance of dying before D. immitis could develop to the infective stage. The retention of microfilariae within the blood clot and peritrophic membrane of A. trivittatus seems beneficial to this vector-parasite system by reducing the parasite burden and increasing mosquito longevity.     

Spherules in the serology of Coccidioides immitis. II. Complement fixation tests with human sera

Soluble and particulate spherule antigens fixed complement in tests with anti—C. immitis sera. However, the soluble antigen proved more active than the particulate one. Cross reactions were noted between the spherule antigens and anti—H. capsulatum and anti—B. dermatitidis sera. Following enzymatic treatment of the particulate preparation a soluble antigen was obtained which formed two bands with anti—C. immitis serum and one band with anti-H. capsulatum serum in an agar gel double diffusion test.