THE DISTRIBUTION OF COCCIDIOIDOMYCOSIS IN SOUTHERN CALIFORNIA

In coccidioidin skin test surveys among persons of high school age in Saugus, Canoga Park, Banning and Palm Springs areas the average incidence of positive reaction was 15 per cent. Although considerably less than the 68 per cent incidence reported among high school students of Kern County, it is high enough to indicate pockets of relatively high endemicity in Southern California below the San Joaquin Valley.Histoplasmin tests were performed on most of the persons tested with coccidioidin in this survey. The over-all incidence of positive reaction in the group was 7.6 per cent. Most of the subjects with positive reaction to histoplasmin gave a history of having previously lived in some area in the central United States where histoplasmosis is known to be endemic.A few subjects who had positive reaction to coccidioidin tests and who had lived in areas known to be endemic for coccidioidomycosis but not for histoplasmosis, also had positive reaction to histoplasmin. However, the induration produced was always smaller than that caused by the coccidioidin reaction, and there was minimal confusion in interpreting the tests.     

Intradermal reactions with coccidioidins in different towns of San Luis Province

Intradermal tests were used to determine the extent of the endemic zone of coccidioidomycosis in Argentina. We performed our endemiological study among school-aged children and grown-ups in San Luis city and in the following towns: Nogoli, Villa de la Quebrada, Balde, Salinas del Bebedero, Beazley, Fraga and Eleodoro Lobos. We employed three coccidioidins for each person--Negroni's coccidioidin, coloured coccidioidin and uncoloured coccidioidin. Reactions were usually read 48 h after inoculation. After inoculating 1,262 individuals we could read only 1,069 results. Overall, the positive reactors to one, two or three coccidioidins were 14.8%. We found no relation between positive reactors and the sex of subjects, but every group showed a noticeable relation between age and positive reactions, especially in older people. The positive reactors for each of the coccidioidins were as follows: Negroni coccidioidin: 10.1%: coloured coccidioidin: 4.9% and uncoloured coccidioidin: 5.0%.     

An evaluation of reactivity to Coccidioides immitis skin tests in subjects with diabetes mellitus

Persons with diabetes mellitus have an increased incidence of progression and dissemination of infection with Coccidioides immitis. This increased incidence of infection suggests that diabetic subjects may have a defect in cell-mediated immunity (CMI) to coccidioidomycosis. Skin test response is also determined by CMI. A negative coccidioidin skin test is often seen with serious infections and is used as evidence that therapy should be initiated. To evaluate CMI in diabetic subjects we investigated the reactivity to coccidioidin and spherulin of 54 diabetic and 56 nondiabetic subjects. There was no difference between the two groups in the prevalence or size of positive reactions to coccidioidin. These results support the continued use of coccidioidin to evaluate the need for therapy in diabetic subjects who have coccidioidomycosis. Spherulin antigen, however, produced fewer positive reactions in the diabetic group. This decreased spherulin reactivity may be associated with the increased incidence of severe coccidioidal infection in diabetic subjects.     

Value of the Concomitant Use of Complement Fixation and Immunodiffusion Tests in the Diagnosis of Coccidioidomycosis

Complement fixation titers of 1:2 and 1:4 with coccidioidin are not always of diagnostic significance. The concurrent use of the complement fixation and immunodiffusion tests is an effective means for specific serologic diagnosis of coccidioidomycosis in patients with low levels of complement-fixing antibodies. In routine testing, it is recommended that only sera that are negative for complement-fixing antibodies at 1:8 but positive in the immunodiffusion test with coccidioidin be selected for titration at the 1:2 and 1:4 levels.     

DIAGNOSIS OF PULMONARY COCCIDIOIDAL INFECTIONS

A wide variety of pulmonary lesions may be caused by coccidioidomycosis. Suspicion of coccidioidomycosis may be substantiated by careful clinical-epidemiological histories. The first laboratory procedure should be a coccidioidin skin test. If the reaction to the test is positive, serological tests are next. Also, if there is no reaction to coccidioidin, serological tests are still indicated if dissemination is suspected. The more severe the infection, the greater the probability of establishing a diagnosis serologically. In only three-fifths of patients with coccidioidal cavities can the diagnosis be fixed serologically. In such patients if differential skin tests are not conclusive, attempt should be made to recover the fungus. However, this is accompanied by great risk of laboratory infection. Eosinophilia and accelerated erythrocyte sedimentation are only circumstantial items of evidence, as is the appearance of the pulmonary roentgenogram.     

Clinical Comparison of Two Mexican Coccidioidins

Coccidioidin, an extract from the saprophytic mycelial form of Coccidioides spp., has been a very useful antigen preparation both for skin and serological tests for coccidioidomycosis. Unfortunately, coccidioidin is not currently available for skin testing in the United States. Coccidioidin has been produced commercially in Mexico by a vaccine and reagents laboratory of the Mexican Federal Government. It also has been produced at the Microbiology Laboratory of the Faculty of Medicine, Universidad Nacional Autónoma de México exclusively as an antigen for research projects. The objective of the study was to compare both coccidioidins in their reactivity and safety when applied in humans. One hundred and eighty-four volunteers were tested; median age was 33 (range 14–82). When the cutoff point is set in 5 mm, 88 subjects (47.8%) had a positive test for the commercial coccidioidin and 76 (41.3%; CI_95% 0.50, 1.15; P = 0.20) were positive with the research antigen. Seventy-five subjects were positive for both antigens and 96 were negative for both. Fifty-nine subjects (31.3%) reported an adverse reaction after the application of the antigen; they were mostly very mild local reactions. Mexican research coccidioidin is a safe and reliable antigen that can be used for the detection of coccidioidomycosis infection in mammals.     

Coccidioidin Retest Reaction—Observations of Tests on a Coccidioidin-Sensitive Person

The retest coccidioidin reaction in an apparently healthy person known to be coccidioidin-positive developed more quickly and was of a greater magnitude than that of an equivalent test in a virginal site in the same person. In both reactions, erythema, induration and/or edema were evident. Although the peak of the retest reaction was at 12 hours, readings made at 24 and 48 hours were in a definitively positive category.     

COCCIDIOIDOMYCOSIS IN SAN FERNANDO VALLEY—Report of a Study Carried Out in 1951-1952

Four cases of benign pulmonary coccidioidomycosis occurred during May 1951 among some 35 teenage students at a boarding school and farm for boys that occupies 30 acres in the northwestern section of the San Fernando Valley within the City of Los Angeles.Epidemiological and serological study of the patients yielded evidence that exposure had occurred on the farm or nearby.Correlation of results of skin testing for sensitivity to coccidioidin among students over the subsequent months and of serologic studies in cases in which there was positive reaction to skin tests indicated exposure to coccidioides during the time the subjects were in residence at the school. In addition, two boys had conversion from negative to positive reaction to coccidioidin while they were in residence.     

Coccidioidomycosis in San Fernando Valley; report of a study carried out in 1951-1952

Four cases of benign pulmonary coccidioidomycosis occurred during May 1951 among some 35 teenage students at a boarding school and farm for boys that occupies 30 acres in the northwestern section of the San Fernando Valley within the City of Los Angeles. Epidemiological and serological study of the patients yielded evidence that exposure had occurred on the farm or nearby. Correlation of results of skin testing for sensitivity to coccidioidin among students over the subsequent months and of serologic studies in cases in which there was positive reaction to skin tests indicated exposure to coccidioides during the time the subjects were in residence at the school. In addition, two boys had conversion from negative to positive reaction to coccidioidin while they were in residence.     

Results of skin test surveys for systemic Mycoses in Iran

Several investigators had carried out histoplasmin skin test surveys in 3 different areas of Iran before 1960 (5). To detect skin sensitivity to both histoplasmin and coccidioidin a study was carried out by the Institute of Public Health Research in parts of 7 of the country's 13 provinces on both apparently healthy persons and on clinic patients from February 1962–September 1966. These studies uncovered a small focus with a rather high level of positive reaction to histoplasmin (about 17 %). Positive cultures ofHistoplasma capsulatum were not obtained from either sputum of the positive reactors or from collected soils. In spite of a previously reported case of coccidioidomycosis, very low percentages of positive reaction to coccidioidin were noted.These studies were supported in part by the Institute of Public Health Research Teheran University, and funds of the Ministry of Health and Plan Organization for Project No. 631101 and N.I.H. Grant No. TW00170.Paper read at the Eighth International Congresses for Tropical Medicine and Malaria, September 1968, Teheran (Iran).     

Problemas clínicos en micología médica: problema número 52

The case of a 60 year old woman with hemoptysis and a thin-walled cavitary lesion at the upper lobe of the right lung is presented. The woman presented at the Mycology Unit of the Muñiz Hospital in Buenos Aires City 3 months after the beginning of her clinical manifestations. A hyaline micelial fungus with chlamido-arthroconidias was isolated from the bronchoalveolar lavage. Immunodiffusion and counter-immnunoelectrophoresis with coccidioidin and histoplasmin rendered positive results against both antigents, and skin tests with coccidioidin and histoplasmin were also positive with strong reactions. The isolated fungus was identified as Coccidioides posadasii at the National Microbiology Institute Carlos Malbrán, by means of a molecular technique. The patient was treated with itraconazole by oral route at a daily dose of 200 mg with good clinical response, but due to the persistence of the lung cavity, a surgical removal of the upper lobe of the right lung had to be scheduled.     

Spectrum of in vivo and in vitro cell-mediated immune responses in coccidioidomycosis.

The cell-mediated immune responses of 12 healthy, coccidioidin skin-test positive subjects (Group I) were compared with those of 15 healthy, coccidioidin skin-test positive persons who had primary asymptomatic coccidiodomycosis, (Group II), 12 patients with active, pulmonary coccidioidomycosis (Group III), four patients with disseminated disease (Group IV), and five patients who had been in clinical remission for 1 year or longer (Group V). Lymphocytes from healthy subjects in Groups I and II responded in vitro to Coccidioides immitis antigen by undergoing an increased DNA synthesis (lymphocyte transformation) and/or by producing macrophage migration inhibitory factor (MIF). In contrast, patients in Groups III and IV failed to respond to Coccidioides antigens in vivo (skin tests) or in vitro (lymphocyte transformation and production of MIF). The responses of subjects in Group V with inactive disease fell in between those of healthy donors in Groups I and II and patients in Groups III and IV. The cellular immune defect, in terms of antigen recognition, appeared to be specific for C. immitis in all but one patient.     

Organizational life and political incorporation of two Asian immigrant groups: A case study

Civil society is the foundation of a healthy democracy but its immigrant element has received little attention. This paper is a case study of immigrant organizations of highly skilled Asian Indians and Chinese immigrants in a suburban town of Edison, New Jersey. I find that civic participation of Asian Indian immigrants spills over into political incorporation while Chinese immigrant organizations remain marginalized. I argue that local processes of racialization are central in explaining differences in political incorporation of immigrants. In the local context, the Chinese are seen as successful but conformist model minorities and Asian Indians as invaders and troublemakers. The racialization of Asian Indians has resulted in more political activity and higher levels of political visibility of their organizations. The results highlight shortcomings of current assimilation theories, which give little space to civic and political incorporation and view human capital in an unqualifiedly positive light.     

An Archived Lot of Coccidioidin Induces Specific Coccidioidal Delayed-type Hypersensitivity and Correlates with in vitro Assays of Coccidioidal Cellular Immune Response

No test for assessing cellular immune response in coccidioidomycosis is currently available in the United States. In the present study, we tested 49 healthy subjects living in the coccidioidal endemic region with a 1:55.8 dilution of a single lot of coccidioidin archived since the 1970s. In this group, 23 evaluable subjects demonstrated ≥5 mm of induration at 24, 48 or 72 h, with a mean±SEM maximum induration of 18.4±4.0 mm. The induration results among 14 subjects reactive at 24 h were compared to those from 179 individuals in an historical cohort studied in the 1980s using a reference lot of coccidioidin. Results were within 5% and not significantly different (P=0.924). The maximum induration response of all evaluable subjects correlated significantly with the results of in vitro tests of coccidioidal cellular immunity using supernatant interferon-gamma concentration and CD69 expression on T cells (Spearman rank correlation coefficients 0.69 and 0.68, respectively; P<0.01 for both). These data suggest that archived coccidioidin retains its potency and specificity and that in vitro test of coccidioidal immunity may have utility in the measurement of coccidioidal cellular immunity.     

Agar-Gel Precipitin-Inhibition Test for Coccidioidomycosis: I. Preliminary Evaluation of the Complement-Fixation and Agar-Gel Precipitin Tests in the Serodiagnosis of Human Coccidioidomycosis

The agar-gel precipitin-inhibition serological test for coccidioidomycosis was a more sensitive indicator of Coccidioides immitis antibodies than the tube precipitin, the agar-gel immunodiffusion, in the complement-fixation tests in assaying monkey sera, whether these sera were from prechallenge-vaccinated or postchallenged animals. When applying this technique to the assay of human sera, an analogous finding generally persisted. However, some human sera were positive by the complement-fixation test and negative by the agar-gel precipitin-inhibition test. These sera were diffused in agar-gel against various coccidioidin complement-fixation, tube precipitin, and agar-gel precipitin-inhibition test antigens with essentially negative results.     

Taste sensitivity to phenylthiocarbamide (PTC) and endemic goiter in the Indian natives of Peruvian highlands

In 263 Peruvian Indians, natives and residents of Andean villages in the Department of Pasco, where goiter is endemic, very low frequencies of PTC non-tasters were found in agreement with other data on South America Indians. The data suggest that in this population the risk of developing goiter either is not associated with the tasting non-tasting dimorphism, or is greater in the taster class.     

Coccidioidomycosis in South America. A review of its epidemiology and geographic distribution

Argentina. Twenty-seven human cases and coccidioidin skin-test surveys have located the endemic area of coccidioidomycosis between the 27th and 40th south parallels. Climate is of the arid steppe type in the southern zone, arid hill and prairie in the intermediate zone, and arid hill and prairie plus hot tropical in the northern zone. Temperature ranges from 5° C to 29° C, vegetation is xerophytic and annual rainfall is from 300 to 500 mm. Paraguay. On the basis of human cases and coccidioidin surveys, the endemic area has been delimited between the 19th and 24th south parallels. It was a hot, dry, windy climate with temperature reaching 45° C, an annual rainfall average of 500 mm and xerophytic vegetation. Colombia. On the basis of two human cases and coccidioidin test surveys, an endemic area of low prevalence was confirmed in the northeast between the 10th and 12th north parallels. Altitude in this region is from 2 to 300 meters above sea level, temperature averages about 29° C. Within this region two different areas can be differentiated — one in the north where vegetation is tropical desert brush type and rainfall ranges between 125 and 500 mm; the second in the south with grass and cotton culture and rainfall from 500 to 2000 mm. Venezuela. Thirty-five human cases and nearly 60,000 skin tests made from east to west in the northern part of the country, where the population is concentrated, showed that the endemic area is situated between the 9th and 12th north parallels. This is an arid region with desert soils. Altitude ranges from sea level to 800 meters, annual temperature averages 24° C and rainfall 500 mm in some places, and 29° C and less than 400 mm in others. More than 172 species of plants have been identified in the zone but cacti predominate.C. immitis was isolated from soil collected at a site where a patient had become infected. Bolivia, Peru and Ecuador.Mackinnon studied a patient coming from Bolivia, but he has expressed doubt about the Bolivian origin of the infection because the patient had lived in the Paraguayan Chaco the previous year. More information is necessary to evaluate the human case mentioned in Peru byBinder. Cases reported from Ecuador appear to have been paracoccidioidomycosis and leishmaniasis rather than coccidioidomycosis.Many species of rodents and other wild and domestic animals share with man the possibility of infection in the four countries where the endemic areas have been confirmed.Paper read at the Eighth International Congresses for Tropical Medicine and Malaria, September 1968, Teheran (Iran).     

Immunologic and clinical improvement of progressive coccidioidomycosis following administration of transfer factor

Three patients with progressive coccidioidomycosis were given preparations of transfer factor (TF). Adverse reactions to TF were minimal. Following TF administration two of these patients had prolonged clinical remissions in their coccidioidal disease. Cellular immune responses were sequentially evaluated by coccidioidininduced delayed-type skin tests, lymphocyte blast transformation and macrophage inhibition factor production (MIF). These three patients each exhibited different cellular immune patterns before and after TF administration. Two patients converted their coccidioidin skin tests, and one converted lymphocyte transformation response to coccidioidin. Also, TF apparently favorably affected the MIF response in all three patients.     

Polydactyly in the American Indian.

Polydactyly has an incidence in the American Indian twice that of Caucasians. A minimum estimate of this incidence is 2.40 per 1,000 live births. Preaxial type 1 has an incidence three to four times that reported for Caucasians or Negroes. The overall sex ratio in Indians is distorted with more males affected than females. The preaxial type 1 anomaly has a strong predilection for the hands and always is unilateral in contrast to postaxial type B where more than one-half are bilateral. The evidence to date, consisting of varying incidences of specific types of polydactyly among American whites, Negroes, and Indians in varying enviroments, suggests different gene-frequencies for polydactyly in each population. The incidence in Indians with 50% Caucasian admixture suggests that the factors controlling polydactyly are in large part genetically determined. Family studies and twin studies reported elsewhere offer no clear-cut genetic model which explains the highly variable gene frequencies.