Development of long-term specific cellular immunity after acute Blastomyces dermatitidis infection: assessments following a large point-source outbreak in Wisconsin

Article Abstract:

The true natural history and distribution of blastomycosis (BM), a rare fungal infection, is not readily discernible. One of the principal systemic mycoses affecting man, it is caused by the dimorphic fungus Blastomyces dermatitidis (Bd; which takes two forms). The saprophytic form resides in the soil. Primary infection occurs following the inhalation of conidia (asexual spores). At body temperature, the conidia convert to yeast, producing disease in the lungs and, occasionally, other organs. Skin test antigens of blastomycin, produced from mycelial (fungal) filtrates, proved to be unreliable and nonspecific, and are no longer readily available. A new antigen was developed, Blastomyces-alkali and water-soluble antigen (B-ASWS), which was more sensitive and specific than former products, but it has not been fully evaluated in humans. A point-source epidemic (all cases were exposed simultaneously) of BM occurred in Eagle River, Wisconsin in 1984, providing an opportunity to study the epidemic itself, the reliability of B-ASWS, and the development of specific cellular immunity, as measured by in vitro lymphocyte reactivity. Ninety-five persons from two elementary school groups were exposed to Blastomyces dermatitidis in an abandoned beaver lodge. Nine cases were confirmed positive for BM, and 39 were probable positives, having at least one of four markers of infection. Ninety-four children, including the confirmed non-cases, were skin tested and had blood samples taken at 3, 7 and 21 months after exposure. In vitro lymphocyte proliferation tests were conducted. The immune response, measured by tritiated thymidine uptake by lymphocytes proliferating in response to B-ASWS stimulation, demonstrated more specificity and sensitivity. (That is, B-ASWS was more reliable in identifying the individuals who did have the fungal infection and those who did not). The value of B-ASWS as a means of discriminating even asymptomatic cases of BM, and in addition, separating BM positive cases from other systemic mycoses was confirmed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Physiological aspects, Cellular immunity, Blastomycosis

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Bacterial pneumonia in HIV-infected patients: analysis of risk factors and prognostic indicators

Article Abstract:

There is a variety of risk factors and indicators for prognosis for bacterial pneumonia in HIV-infected patients. Intravenous drug abuse (IVDA), cigarette smoking, cirrhosis, and previous pneumonia were risks for generally-acquired bacterial pneumonia. Length of hospital stay was a risk factor for nosocomial bacterial pneumonia. Low T CD4 cell count was a risk for both types. Since the variables affect not only the level of risk but also the prognosis, physicians need to address them in developing therapeutic responses.

Health aspects, Risk factors, HIV patients, Pneumonia, Nosocomial infections, Cross infection, Bacterial pneumonia

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