Four strains of Candida albicans with different abilities in secreting proteinase in culture were inoculated into rabbit cornea and the severity of the infection was compared by histopathological examination. Generally, the Proteinase-secreting strains developed more severe and extensive infections in the cornea than the proteinase-deficient ones. Our results on the comparative studies of a proteinase-producing 961S with its variant 961VGR4, which had lost the ability of proteinase secretion, in the corneal tissue invasion suggested that proteinase worked to enhance or continue the corneal infection against the host defence mechanism.

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To establish a risk index to estimate the occurrence of visceral fungal infections in immunocompromised hosts, we performed a retrospective survey of various clinical data for 45 autopsy cases with carcinoma, malignant lymphoma or SLE and 15 clinical cases who received a renal transplant. Among the cases investigated, there were 31 cases with fungal infection of candidosis (18 cases), aspergillosis (9 cases), cryptococcosis (3 cases) and mixed fungal infection (one case). Peripheral leukocyte count, neutrophil count and lymphocyte count were markedly decreased in cases with fungal infection compared with cases without fungal infection. In addition, the number of consecutive clinical days in which the leukocyte count was below 3, 000/mm³ was greater in cases with fungal infection than in cases without.
Consequently, the above-mentioned four factors were selected as infectious risk factors for an appropriate estimation of the occurrence of visceral fungal infections in immunocompromised hosts. A risk index was calculated by various points given to each risk factor.
If a risk index was over 20 points, the occurrence of a visceral fungal infection was highly likely. Based on this assumption, the percentage of correctly predicted cases for visceral fungal infections using a risk index in carcinoma, malignant lymphoma, SLE and renal transplant cases was 80%, 83%, 57% and 75%, respectively. The percentage of falsely predicted cases was in 10%, 50%, 17% and 0%, respectively.
We recognized that the survival rate and survival period of mice in experimental candidosis were also influenced by the peripheral leukocytes count and lymphocytic function.
From these results, we conclude that a risk index will be very useful in the management of the clinical course in immunocompromised hosts and helpful in the diagnosis of fungal infection in the early clinical stage, except for cases with malignant lymphoma.

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Forty patients with pulmonary aspergilloma admitted to Juntendo University Hospital from 1960 to 1988 and 26 cases referred for serologic diangosis from other institutes were subjected to analysis of thier clinical features, treatment and prognosis.
The age at diagnosis ranged from 31 to 81 years (mean: 61 years). There were 55 men and 11 women. The most common preceding lung lesion was an open healed tuberculous cavity, which was present in 30 patients (45.5%). Other lesions included lung abscess in 5 patients (7.6%), lung cyst in 3 (4.5%) and unknown in 28 (42.4%). Aspergilloma occurred with equal frequency in each lung (right: 31; left: 31). In 63 cases aspergilloma was situated in an upper lobe, while one was in the left lower lobe and two were in the right upper and lower lobes. Sixty patients (90.9%) had one aspergilloma, 5 had two aspergillomas (7.6%) and 3 had three aspergillomas (4.5%).
Sputum samples were obtained from 40 patients, and Aspergillus fumigatus was cultured from 21 patients (52.5%). A. flavus and A. candidus were each cultured from one patient. In 7 cases, the culutred Aspergillus could not be completely identified, and the culture was negative for 10 patients.
Roentogenographically, the period of formation of the pulmonary aspergilloma ranged from 5.5 months to 12 years (mean: 4 years and 6 months).
The treatment of our 40 original patients varied, with only one patient undergoing surgery and 27 patients administered antifungal agents. Inhaled and systemic antifungal agents were ineffective even after several weeks of usage. Antifungal drugs were instilled directly into the cavity in 15 patients, . by either percutaneous puncture (1 patient) or endobronchial instillation using a flexible bronchocatheter (14 patients). The antifungal drugs used for endobronchial instillation were amphotericin B (8 patients), flucytosine (2 patients), miconazole (3 patietns), clotrimazole (1 patient) and fluconazole (1 patietn). In 4 patients, a single attempt at endobronchial instillation failed. Of 8 patients in whom instillation of antifungal drugs by the endobronchial route was repeated, four aspergillomas disappeared within a few months (2 patients received amphotericin B, 1 patient flucytosine and 1 patient miconazole). One patient expectorated fragments, and the fungus ball disappeared during the course of complicated pyogenic infection of the cavity. Spontaneous lysis of the aspergilloma occurred in three patients (7.5%).
Of our 40 cases, 13 patients died from respiratory diseases (6: pneumonia, probably bacterial pneumonia; 5: chronic respiratory failure; and 2: hemoptysis), while 5 patients died from other underlying diseases.
Hemoptysis occurred in over half the patients, but fatal hemoptysis occurred in two of our patients. This incidence is lower than in earlier reports.
In conclusion, endobronchial instillation of antifungal drugs was useful for the treatment of pulmonary aspergilloma in patients unfit for surgery.

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We attempted to make a medium which would induce teleomorph of Arthroderma vanbreuseghemii using Eagle's Minimum Essential Medium as a basal medium. A composition of 0.44g Minimum Essential Medium-Amino acids and Vitamins, 3.8g minerals modified from EARLE solution, 1g glucose and 15g purified agar in 1000ml water proved best to produce fertile gymnothecia. This medium seemed superior in gymnothecia production of A. vanbreuseghemii to Takashio's diluted Sabouraud dextrose agar with salts.

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Amino acid residues involved in the hemolytic active site of Asp-hemolysin from Aspergillus fumigatus were analyzed. The hemolytic activity of the toxin for human erythrocytes was found to be inactivated by the following modification procedures: arginine residue with 1, 2-cyclohexadione (CHD), arginine and tyrosine residues with 2, 3-butanedione (BDO), and reductive methylation (RM) of lysine residue with formalin. The results indicate that arginine and/or lysine residues in toxin play an important role as a binding site to erythrocyte ghost membranes. Based on these results, a possibility of amino acid residues involved in the binding and the hemolytic active sites of Asp-hemolysin molecule was therefore studied.

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We report a 68-year-old man with chromomycosis successfully treated with topical hyperthermia. He had been suffering for ten years from a skin lesion on his upper right arm. When he visited our clinic, the skin lesion was an annular erythematous plaque with scales, measuring 7×11cm². A potassium hydroxide preparation of the scales revealed several sclerotic cells. Fonecaea pedrosoi was isolated from both the scales and biopsy specimen. The patient was treated with topical hyperthermia using a pocket warmer for 12 hours a day. During the treatment, the temperature of the dermis was maintained at 39°C. The lesion healed in about five weeks. The ioslated fungus did not grow at either 39°C or 41°C. However, when cultured for 12 hours at 39°C and 12 hours at room temperature everyday, it grew to 80% of the size of a culture at room temperature. A histopathological study showed that the number of neutrophils in the dermis decreased immediately after the therapy. The lymphocytes, plasma cells, histiocytes, and foreign body giant cells gradually increased in number. These results suggest that the efficacy of hyperthermia in chromomycosis is not only its direct effect on fungi, but the activation of cell-mediated immunity, consequent enhancement of granulomatous reaction, and the activation of humoral immunity.

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In vitro antifungal and antibacterial activities of a combination of pyrrolnitrin (PY) with clotrimazole (CTZ) were studied under various assay conditions and the results are summarized as follows:
1) Combinations of PY and CTZ inhibited synergistically the growth of Candida albicans, Trichophyton rubrum, T. mentagrophytes and Staphylococcus spp.
2) The significant synergistic effect was obtained in about 60% of the 49 strains of T. rubrum isolated from clinical specimens. However, the synergistic action was exerted in only 20% of the 27 strains of T. mentagrophytes.
3) The combination of PY and CTZ exhibited the fungicidal activity against T. rubrum No. 68.
These data suggest an advantage of appropriate combinations of PY and CTZ in the topical treatment of dermatophytosis and other superficial mycosis.

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Development of a system for detecting cryptococcal antigen in clinical specimens using latex particles sensitized with anti-C. neoformans globulin was attempted. We examined the optimal condition of the sensitized latex particle using anti-C. neoformans globulin fractionated by 40% saturated ammonium sulfate. Latex particles, with a diameter of 0.81μm, were sensitized with 20μg of anti-C. neoformans globulin per 1mg of latex. We compared the minimal concentration of detectable polysaccharide antigen by the sensitized latex particles and the commercially available particles and obtained almost the same sensitivity, but the former was also capable of detecting the antigen forming soluble immune complex in a patient's serum. The latex agglutination test was performed using a mixture of 75μl of protease treated serum or cerebropsinal fluid (CSF) and 25μl of sensitized latex suspension. After 10 minutes reaction on a rotator, the agglutination was read. The sensitivity of the latex agglutination test using the sensitized latex particles was found to be 100% in cases of cryptococcal meningitis, 81.8% in pulmonary cryptococcosis and 75% in cutaneous cryptococcosis. The specificity of the test was 100% with sera and 95% with CSF. It was concluded that the sensitized latex particles could be very useful in antigen detection for rapid and accurate serological diagnosis of cryptococcosis.

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