Scedosporium prolificans is one of the most life-threatening fungal opportunistic pathogens due to its high resistance to common systemic antifungal agents. While a close relative of Pseudallescheria boydii, S. prolificans has a more limited geographic range being primarily found in Australia, USA and Spain. Infections have also been reported from several other European countries and from Chile. Twenty patients with Scedosporium prolificans infection or colonization from August 1993 to May 2007 were retrospectively reviewed in Germany. They had all been identified at or reported to the Reference Laboratory for Pseudallescheria/Scedosporium spp. in Berlin. Twelve of 13 patients with haematological disorders and/or on immunosuppressive therapy developed a fatal invasive scedosporiosis. Colonization of the respiratory tract was reported for one patient after heart-lung-transplantation, all six patients with cystic fibrosis and one with chronic sinusitis. Molecular studies of the S. prolificans isolates confirmed that parts of the 18S, the Internal Transcribed Spacer (ITS) regions and the D1/D2 domain of the 28S region of rDNA are monomorphic. However, sequencing of parts of the translation elongation factor EF1-alpha (EF-1alpha) and the chitin synthase (CHS-1) genes revealed the presence of three and two distinct genotypes, respectively. Two informative mutations were found in EF-1alpha and a single nucleotide exchange in the CHS-1 gene.

The aim of the present study was to investigate the incidence of Candida stomatitis and resulting interruptions in radiation and radiochemotherapy in 50 patients suffering from squamous cell carcinomas of the head and neck region receiving fluconazole (100 mg d-1) in comparison with a historical control group (n = 50) without specific prophylaxis. Twenty of the control patients (40%) demonstrated Candida stomatitis, with seven of them (14%) requiring interruptions in anticancer therapy. In contrast, none of the patients with fluconazole had evidence of Candida stomatitis (P = 0.0000051) and subsequent interruption of anti-cancer therapy (P = 0.0061). Laboratory monitoring for the presence of Candida species was performed in 30 patients before and after therapy with fluconazole. Candida albicans was identified less frequently after therapy when compared with the pretreatment status. However, C. glabrata and C. krusei were isolated in some of the patients, probably because of drug resistance of these subspecies. The results demonstrate the clinical usefulness of prophylactic fluconazole applications in patients suffering from head and neck tumours with the aim of reducing Candida stomatitis and the resulting interruptions in radiation and radiochemotherapy.

Antimycotic treatment of advancing histoplasmosis seems appropriate also in immunocompetent patients. The high number of patients within this group suggests high numbers of Histoplasma capsulatum in the caves. Wearing breathing masks throughout the work in the caves may prevent histoplasmosis even in case of high infectious doses. Pre-travel recommendations for cave researchers have to emphasize the continuous use of breathing masks and vaccination against tetanus and rabies.

Zusammenfassung Es werden erste Erfahrungen zur Herstellung von Zellwandantigen aus Candida albicans1) mit Hilfe einer modifizierten β‐Naphthol‐Methode beschrieben, bei dem sich der Einsatz von etwa 18 Tagen alten, auf synthetischen Nährböden gewachsenen Zellen von Candida albicans als besonders günstig erwies. Das Endprodukt — Candidin — ist eine weiße, wasserlösliche, amorphe, mit organischen Lösungsmitteln präzipitierbare Substanz, die mit Erfolg in verschiedenen immunologischen Methoden (Lymphozytentransformationstest, Makrophagen‐Elektrophorese‐Mobilitätstest, Präzipitation, passive Hämagglutination) sowie im Intracutantest und zur spezifischen Desensibilisierung eingesetzt wurde. Summary The paper describes initial experience in producing of cell wall antigen from Candida albicans1) using a modified β‐naphthol method in which it has been found particularly suitable to use Candida albicans cells which have been cultured on a synthetic substrate for about 18 days. The end product, candidin, is a white, amorphous substance which is soluble in water and can be precipitated by organic solvents. It can be used successfully in various immunological methods (lymphocyte transformation test, macrophage electrophoretic mobility test, precipitation, passive haemagglutination) as well as in the intracutaneous test and for specific desensitisation.