Antigenic relationship of Penicillium marneffei to P. primulinum

Penicillium marneffei (ATCC 24100) was first isolated from a naturally acquired human infection in the U.S.A. by DiSalvo et al. in 1973. In 1979, this isolate was studied by Pitt who reidentified it as Penicillium primulinum. This prompted us to examine the antigenic relationship between P. marneffei and P. primulinum by comparing their exoantigens. The antigenic relationships of 11 isolates, including the type strains of P. marneffei and P. primulinum, were examined. Each exoantigen extract was tested simultaneously against rabbit anti-P. marneffei and P. primulinum antisera in the presence of the appropriate reference antigens. All eight isolates of P. marneffei, including ATCC 24100, produced two to four specific precipitin lines against their homologous antiserum. However, four of the eight extracts cross-reacted with unabsorbed antiserum to P. primulinum. The P. primulinum extracts contained specific exoantigens which only reacted with the anti-P. primulinum antiserum. Non-specific cross-reactions were eliminated by absorption procedures. On the basis of the specific exoantigens produced by both species, P. marneffei and P. primulinum were found to be antigenically distinct. Isolate ATCC 24100 was shown to be closely related to the other P. marneffei isolates and distinct from P. primulinum. Our results confirm the original identification of ATCC 24100 as P. marneffei and not P. primulinum as Pitt had concluded.

Monitoring of bone mineral content in patients on regular hemodialysis

Bone mineral content (BMC) was measured at the lumbar spine region by means of dual photon absorptiometry over a 3-year period in 20 patients on regular hemodialysis (RHD). Baseline mean BMC at the start of the monitoring was significantly decreased to 82.64% of predicted value (p less than 0.05). During a 3-year follow-up mean BMC rose significantly to 90.61% (p less than 0.05). Six patients received vitamin D supplements. Analysis of the data showed that rise of BMC was similar whether vitamin D was given or not. Our data suggest that (1) RHD inhibits bone loss at the lumbar spine level that occurred mainly before active uremia treatment and (2) the increment of BMC observed in this study can be attributed to the different site of measurement, the inaccuracy of the measurements by interference with soft tissue calcifications and the dialysis conditions.

Magnetic localization of neuronal activity in the human brain

The performance of a cryogenic system that monitors the extracranial magnetic field simultaneously at 14 positions over the scalp has been evaluated to determine the accuracy with which neuronal activity can be located within the human brain. Initially, measurements were implemented on two model systems, a lucite sphere filled with saline and a model skull. With a magnetic field strength similar to that of a human brain, the measurement and analysis procedures demonstrated a position accuracy better than 3 mm, for a current dipole 3 cm beneath the surface. Subsequently, measurements of the magnetic field pattern appearing 100 ms after the onset of an auditory tone-burst stimulus were obtained in three human subjects. The location of the current dipole representing intracellular ionic current in active neurons of the brain was determined, with 3-mm accuracy, to be within the cortex forming the floor of the Sylvian fissure of the individual subjects, corresponding closely to the Heschl gyrus as determined from magnetic resonance images. With the sensors placed at appropriate positions, the locations of neuronal sources for different tone frequencies could be obtained without moving the recording instrument. Adaptation of activity in human auditory cortex was shown to reveal long-term features with a paradigm that compared response amplitudes for three tones randomly presented.

Epidemiology of inflammatory bowel disease in a defined northern California population

The epidemiology of inflammatory bowel disease is described among the more than 1.5 million members of the Kaiser Permanente Medical Care Program (KPMCP) in northern California. We reviewed a 20% random sample of the medical records of 2,067 persons first admitted to hospital in the period 1971 through 1982 with codes indicating inflammatory bowel disease. We also examined all new outpatient cases for a 1-year period from records at the Oakland KPMCP facility. Criteria used to establish valid cases adhered to standards used in previous studies but were revised to reflect current diagnostic methods. The disadvantages of using hospital discharge data have been identified and quantified. In this population, only 21% of ambulatory patients with inflammatory bowel disease were admitted to hospital in a 3 1/2-year period. There was no difference in the incidence of the disorder by sex or between whites and blacks, but it was rare in Asians. A bimodal age distribution was suggested for Crohn's disease but not for ulcerative colitis. During the 12 years of this study, rates of hospital admissions for ulcerative colitis decreased and for Crohn's disease were slightly increased.

Localization of human breast tumors grafted in nude mice with a monoclonal antibody directed against a defined cell surface antigen of human mammary epithelial cells

A mouse monoclonal antibody (BLMRL-HMFG-Mc5) prepared against a defined cell surface antigen of human mammary epithelial cells, non-penetrating glycoprotein (NPGP), was used in imaging and distribution studies in athymic nude mice grafted with human breast tumors. For in vivo tissue distribution studies, 125I-labeled monoclonal antibody was injected into nude mice carrying simulated metastases of human tumors (breast and colon carcinomas). After 22-24 hr the amount of radioactivity per gram of tissue was 3-4 times higher in the breast tumor than in liver, brain, lung, muscle, or spleen. In contrast, colon carcinoma tissue, grafted and treated likewise, did not show higher accumulation of radioactivity relative to other tissues. At 4 days, the incorporation in breast tumors remained almost as high, while the circulating radioactive tracer and the incorporation in tissues other than breast had fallen significantly. In tumor imaging studies, breast tumor masses as small as 4 mm in diameter were clearly localized on a whole body scan using 131I-labeled BLMRL-HMFG-Mc5 antibodies with a High-Purity germanium gamma camera. Normalization of 131I-distribution to that of 99mTc-pertechnetate increased the specificity of this imaging methodology. The quantitative density of 131I-label was 2-3 fold higher over the breast tumor than over comparable areas of the mouse. No positive localization images were obtained for similar implants of colon and lung carcinomas or melanomas after injections of 131I-labeled BLMRL-HMFG-Mc5. Localization of human breast tumors in this model can be achieved with 131I-labeled anti-breast epithelial monoclonal antibodies.

Characterization of MR spectroscopic imaging of the human head and limb at 2.0 T

Using section-select and phase-encoding gradients, the authors obtained phosphorus chemical shift images of the human head and limb. Phosphorus spectra were acquired from planar sections divided into voxels as small as 7 cm3 in calf muscle and 27 cm3 in brain, with total examination times, including setup and proton locator imaging, of roughly 1 hour. Both spin-echo and free induction decay (FID) methods were employed; the FID gave superior results. Signal-to-noise ratios for the beta-adenosine triphosphate and phosphocreatine resonances were as high as 10:1 and 13:1 from volumes of 27 cm3 in brain.

Echo-planar pediatric imager

Practical constraints make it difficult to build large-aperture echo-planar magnetic resonance (MR) imagers. The implementation of a pediatric imager and its performance are described. Spatial resolution and signal-to-noise levels comparable to those of 1982 state-of-the-art MR imagers have been achieved in imaging times of 0.05-0.15 seconds. T1 and T2 information are obtainable in the echo-planar mode. A major issue is that of chemical-shift displacements.

Epidemiologic and immunologic evaluation of an outbreak of canine blastomycosis

Five confirmed cases of canine blastomycosis occurred over the 10-month period of December 1983 to September 1984 in a south-eastern Wisconsin colony of 30 dogs maintained for sled competition. Contrary to other published reports of canine blastomycosis, the sex-specific attack rates were higher among females than males. Four of the five confirmed cases and all four deaths occurred among young female dogs. Differences in the age distribution and/or the micro-environment of the females may have contributed at least in part to the difference in sex-specific attack rates. The serologic response and leukocyte function of the clinically affected and apparently healthy dogs from this colony were assessed during the outbreak. A survey of the adult dogs in the colony suggested that the mitogen-induced lymphocyte blastogenesis of dogs with clinical signs of blastomycosis was suppressed compared with that of dogs that remained free of clinical signs. In contrast to previous reports that autologous sera from dogs and humans with clinical blastomycosis inhibited mitogen-induced lymphocyte blastogenesis, lymphocyte responsiveness was similar to, or greater in the presence of autologous canine serum than it was in the presence of fetal bovine serum.

Signal-to-noise ratio and section thickness in two-dimensional versus three-dimensional Fourier transform MR imaging

The efficiency and quality of three-dimensional Fourier transform (3DFT) magnetic resonance imaging were evaluated and compared with those of 2DFT imaging. For a fixed imaging time and number of sections, 3DFT imaging with conventional spin echoes always had a worse signal-to-noise ratio (S/N) than did 2DFT imaging, when both were optimized with respect to choice of repetition time (TR). With partial-flip magnetic resonance (MR) imaging, S/N was nearly equal for 2DFT and 3DFT imaging when both were optimized with respect to TR and flip angle. 3DFT imaging can have cross-section artifacts that exceed those of 2DFT imaging. For very thin sections these artifacts may be lessened, and 3DFT imaging can achieve this with smaller gradient pulses. Over-all, 3DFT imaging was found to be advantageous only for the very-thin-section imaging and in combination with partial-flip MR imaging.

Evaluation of Leathers-Awasthi medium for identifying Coccidioides immitis isolates

Leathers-Awasthi medium (LAM) has been recommended for the definitive identification of Coccidioides immitis isolates recovered from clinical specimens. Studies were undertaken to determine the diagnostic reliability of this medium for identifying fungal cultures. A total of 62 fungi, representing 13 C. immitis isolates and 49 similar pathogenic and saprophytic fungi, were tested in parallel by the LAM and exoantigen tests. All of the 13 C. immitis isolates were positive by the exoantigen test, whereas only 11 were positive on LAM. Of the 49 other fungal isolates, 29 were positive on LAM whereas none was positive by the exoantigen test. LAM does not permit the unequivocal identification of C. immitis isolates.

Two outbreaks of blastomycosis along rivers in Wisconsin. Isolation of Blastomyces dermatitidis from riverbank soil and evidence of its transmission along waterways

Blastomycosis cannot yet be prevented or controlled, in part because the natural habitat of the causative fungus, Blastomyces dermatitidis, remains ill defined. In investigating 2 outbreaks of blastomycosis that occurred in the summer of 1985 among persons engaged in activities along rivers in contiguous central Wisconsin counties, we isolated B. dermatitidis from soil at one of the riverbanks. Blastomycosis developed in 7 (58%) of 12 residents and guests who had gathered at a pheasant farm on the Tomorrow River in early May, and in 7 (88%) of 8 boys and 1 adult who had visited a site on the Crystal River in early June. Of the 14 patients, 13 (93%) were symptomatic. Two patients visiting the sites only once became ill 23 and 78 days after exposure, respectively. We traced one outbreak to fishing from the bank of the Tomorrow River, and the other to climbing into an underground timber fort along the Crystal River. A culture of soil and organic debris from the fishing site yielded B. dermatitidis. From these and other outbreaks, and studies of endemic disease, we conclude that riverbanks can be a natural habitat of B. dermatitidis, and that the environment around waterways represents the most important site yet identified for transmission of B. dermatitidis.

Evaluation of commercial serologic test reagents for immunoidentification of medically important aspergilli

We evaluated commercial serodiagnostic test reagents from Greer Laboratories (GL), Lenoir, NC; Immuno-mycologics, Inc. (IMI), Norman, OK; and Scott Laboratories (SL), Fiskville, RI; for their ability to detect Aspergillus spp. exoantigens and group them in their proper series. We detected 87 culture extracts from coded cultures of Aspergillus groups and heterologous fungi against anti-A. fumigatus, A. flavus, A. nidulans, A. niger, and A. terreus sera in the presence of their corresponding antigens. Parallel control studies were performed using serological reagents from both laboratories. The IMI reagents accurately grouped all the isolates. The A. nidulans and A. terreus reactions, however, were significantly weaker than those noted with the control reagents. GL and SL do not supply A. nidulans and A. terreus reagents. Their available reagents correctly grouped the A. fumigatus, A. flavus, and A. niger isolates. Our results indicate that the commercial serodiagnostic reagents for aspergillosis can be effectively used to accurately immunoidentify the medically important Aspergillus spp.

Antigenic relationship between the animal and human pathogen Pythium insidiosum and nonpathogenic Pythium species

Identification of the newly named pathogenic oomycete Pythium insidiosum and its differentiation from other Pythium species by morphologic criteria alone can be difficult and time-consuming. Antigenic analysis by fluorescent-antibody and immunodiffusion precipitin techniques demonstrated that the P. insidiosum isolates that cause pythiosis in dogs, horses, and humans are identical and that they were distinguishable from other Pythium species by these means. The immunologic data agreed with the morphologic data. This indicated that the animal and human isolates belonged to a single species, P. insidiosum. Fluorescent-antibody and immunodiffusion reagents were developed for the specific identification of P. insidiosum.

Serologic studies in the diagnosis and management of meningitis due to Sporothrix schenckii

Eight patients have previously been reported to have central nervous system infections caused by Sporothrix schenckii. In those patients the fungus proved quite difficult to culture, delaying correct diagnosis and treatment. We describe seven additional patients with sporotrichosis meningitis, all of whom had antibody to this fungus in cerebrospinal fluid and serum. The antibody in the cerebrospinal fluid was most likely produced locally, as evidenced by its oligoclonality and the relatively high ratio of immunoglobulin to albumin in the cerebrospinal fluid as compared with the serum. Only one of these seven patients, who had active sporotrichosis of the knee joint, had obvious extrameningeal infection. None of 130 patients with meningitis known to be caused by other agents and none of 170 patients with other neurologic disorders had antibody to S. schenckii in their cerebrospinal fluid. We suggest that cerebrospinal fluid should be tested for S. schenckii antibody (in addition to other fungal agents) in any patient with chronic meningitis for which no cause is discovered by the usual diagnostic tests.

Depth-focused radio frequency coils for MR imaging

Surface coils improve signal-to-noise ratios by the simple expedient of reducing field of view. The uniformity of response of these coils is poor, since signal reception is weighted toward the surface of the object, which generally is of least interest. Furthermore, whole-section transmitter coils excite the subject uniformly, so that weak signals are detected from far regions. A dual-coil arrangement permits avoidance of these problems by combining the nonuniform excitation and reception characteristics of two surface coils.

Specific and rapid identification of medically important fungi by exoantigen detection

Within a decade of its introduction, the exoantigen technique has won general acceptance for accurate and rapid identification of fungal pathogens. This acceptance is emphasized by the fact that positive exoantigen results obtained with the dimorphic pathogenic fungi B. dermatitidis, C. immitis, H. capsulatum varieties capsulatum, duboisii, and farciminosum, and P. brasiliensis are no longer considered presumptive evidence but are considered definitive data for species identification. Technical problems associated with poor sensitivity and false-positives in some of the early tests have been resolved. The test expands the diagnostic capabilities of the laboratory. We encourage the establishment of libraries of antisera for species identification and, where appropriate, for serotyping. Since the test is simple and reagents for many of the pathogens are commercially available, the test can be performed in most laboratories. As highly defined antigens are produced, more standardized and specific tests will be developed. Hybridoma technology may provide the means for producing specific antibodies without the need for highly purified antigens, which have been difficult to produce. The identification of numerous fungi could be facilitated by application of exoantigen techniques. Specific antisera should be developed to achieve this goal and to obtain antigenic data useful for elucidating taxonomic relationships. Some fungi cannot be classified on the basis of morphologic and biochemical qualities alone. Supplementary data obtained with exoantigen analyses could undoubtedly aid in resolving such problems.

Hemorrhagic and nonhemorrhagic brain lesions: evaluation with 0.35-T fast MR imaging

Two fast magnetic resonance (MR) imaging techniques, advanced Fourier and partial-flip imaging, were used at 0.35 T to examine 21 patients with suspected intracranial lesions; the results were quantitatively compared with a conventional spin-echo study. Both of the fast MR techniques yielded a fourfold reduction in imaging time per section. The advanced Fourier sequence showed contrast that was identical to the conventional spin-echo study with signal-to-noise ratios of 58% and 57% for the first and second echoes, respectively. The partial-flip sequence showed a contrast of 109% and 57% for lesions versus substantia alba, and 107% and 78% for substantia grisea versus substantia alba relative to the first and second echoes of the conventional spin-echo study. The partial-flip sequence was particularly sensitive to magnetic susceptibility; this produced artifacts that may undermine the usefulness of partial flip for routine screening in certain parts of the brain. However, this susceptibility significantly improved the detection of intracranial hemorrhage when compared with the spin-echo sequence, particularly when combined with phase mapping of the partial-flip study.