Habilitationsschrift--Jena. / Cover-title. "Literaturverzeichnis": p. 34-41.

Thesis (Ph. D.)--University of Chicago. / "Reprinted from the Journal of infectious diseases, Vol. 8, No. 2 (March 1911, pp. 190-240)." Includes bibliographical references (p. 240). Also available on the Internet.

No description available.

Most cases of blastomycosis are sporadic and only nine outbreaks representing a total of 112 cases have previously been reported. Less than half of these have been culture proven cases. Outbreaks have previously occurred in North Carolina, Minnesota, Illinois, Wisconsin and Virginia. We report three culturally confirmed cases of blastomycosis from Elizabethton, Tennessee, who had onset of illness within a one-week span of time. The patients presented with fever, chest pain, weight loss, poor appetite and myalgia. Each initially had a dry cough which became productive of purulent sputum as the illness progressed. Mild hemoptysis occurred during each patient's course. Serologic testing by immunodiffusion and enzyme immunoassay were positive and testing by complement fixation was negative in each case. The diagnosis was made by histopathology on transbronchial biopsy or transthoracic needle aspiration material. Each patient improved on ketoconazole therapy.

No description available.

Background: In the United States, cases of human blastomycosis are largely described in defined geographic areas, with Mississippi reporting the highest prevalence of disease in the southeast region. The infection is uncommonly recognized in mountainous areas, and our previous report of blastomycosis in the southern Appalachian mountains of northeast Tennessee appeared to be an exception to the usual disease distribution. Methods: Our current retrospective study was undertaken to determine whether blastomycosis has persisted as an endemic fungal infection in our northeast Tennessee geographic area and whether epidemiologic features have changed over a 25-year time period. Results: Results show that clinical aspects of the disease have remained fairly constant with few exceptions; mass-type pulmonary lesions have become more common, and itraconazole has emerged as the therapy of choice. Most notably, however, are the observations that blastomycosis persists as a major endemic fungal infection in our mountain region, more than half of all cases occurring during the period from 1996 to 2005 were found in a core area centered on two counties, Washington and Unicoi; three of five counties surrounding the core counties experienced rate increases compared to our previous study. Conclusions: These findings suggest a further expansion of this endemic fungal disease beyond the core region.

Made available in DSpace on 2015-12-10T14:23:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-06-30. Added 1 bitstream(s) on 2015-12-10T14:29:39Z : No. of bitstreams: 1 000853880.pdf: 1851862 bytes, checksum: 828711480dc6e6cc9c37d4388711ad29 (MD5) / A doença de Jorge Lobo é uma infecção crônica, que afeta a pele e tecidos subcutâneos, cujo agente etiológico é o fungo Lacazia loboi. Dependendo da localização das lesões, pode ser classificada como localizada, multifocal ou disseminada e no que diz respeito aos aspectos imunológicos, estudos relatam predominância do perfil Th2 nos pacientes, além de maior frequência de células positivas para TGF-β e IL-10 no infiltrado inflamatório presente nas lesões. Porém, com a descoberta de outros perfis como Treg e Th17, outras subpopulações podem estar envolvidas na imunopatogênese da doença. Diante disso, com o intuito de explicar a imunorregulação entre estas subpopulações, este estudo teve por objetivo avaliar o papel das células Treg, Th1, Th2 e Th17, por meio da expressão de mRNA. No total, 114 amostras [pacientes portadores de lesão única (55), pacientes portadores de lesões múltiplas (47) e controles saudáveis (12)] foram avaliadas quanto a expressão gênica de alvos relacionados aos perfis Th1 (T-bet, IFN-γ), Th2 (GATA3, IL-5, IL-4, IL-13, IL-33), Th17 (IL-17F) e T regulatório (TGF-β1, FoxP3, CTLA4, IL-10). Os resultados obtidos neste estudo demonstraram expressão significativamente maior de TGF-β1, IL-10, CTLA4, FoxP3, T-bet e IL-17F, e significativamente menor de GATA3 e IL-4 em todos os portadores da doença avaliados. Adicionalmente, ao avaliar a expressão entre os grupos de lesão única (forma localizada) e lesões múltiplas (formas multifocais e disseminadas), TGF-β1 e IL-5 apresentaram expressão significativamente maior nos pacientes com lesão única e múltiplas, respectivamente. Em resumo, constatamos que a ação desta população está relacionada à capacidade de inibir a resposta antifúngica modulando principalmente a expressão de citocinas envolvidas na proteção, tais como, IFN-γ e IL-17F / Jorge Lobo's disease is a chronic disease that affect the skin and subcutaneous tissues, whose etiologic agent is the fungi Lacazia loboi. Depending on localization of lesions, it can be classified as localized, multifocal or disseminated. In respect to immunologic aspects, previous studies show the predominance of Th2 profile in patients, in addition to more frequent TGF-β and IL-10 positive cells in the inflammatory infiltrate present in lesions. However, the increased understanding about T regulatory (Treg) and Th17profiles suggest that other subpopulation of cells can be involved in the immunopathogenesis of Jorge Lobo's disease. Aiming at explaining the immunoregulation caused by these subpopulations, this study had as objective to evaluate the role of Treg, Th1, Th2 and Th17, through mRNA expression. A total of 114 samples [single lesion patients (55), multiple lesion patients (47) and healthy controls (12)] were evaluated by gene expression of targets associated to Th1 (T-bet, IFN-γ), Th2 (GATA3, IL-5, IL-4, IL-13, IL-33), Th17 (IL-17F) and T regulatory (TGF-β1, FoxP3, CTLA4, IKZF2, IL-10) profiles. The results obtained in this study demonstrated significant higher expression of TGF-β1, IL-10, CTLA4, FoxP3, T-bet and IL-17F, and significant lower expression of GATA3 and IL-4 in all patients. Additionally, the expression comparing single lesions (localized form) and multiple lesions (multifocal and disseminated forms) patients showed significant higher levels of TGF-β1 and IL-5, respectively, in single and multiple lesions patients. In summary, the role of the Treg population is associated with inhibition of the antifungal activity, thus modulating mainly the expression of cytokines associated protection against fungal infection, such as IFN-γ and IL-17F

Orientador: Ida Maria Foschiani Dias Batista / Coorientador: Andrea de faria FernandesBelone / Coorientador: Ana Paula Fávaro Trombone Garlet / Banca: Luciane Dias-Melicio / Resumo: A doença de Jorge Lobo é uma infecção crônica, que afeta a pele e tecidos subcutâneos, cujo agente etiológico é o fungo Lacazia loboi. Dependendo da localização das lesões, pode ser classificada como localizada, multifocal ou disseminada e no que diz respeito aos aspectos imunológicos, estudos relatam predominância do perfil Th2 nos pacientes, além de maior frequência de células positivas para TGF-β e IL-10 no infiltrado inflamatório presente nas lesões. Porém, com a descoberta de outros perfis como Treg e Th17, outras subpopulações podem estar envolvidas na imunopatogênese da doença. Diante disso, com o intuito de explicar a imunorregulação entre estas subpopulações, este estudo teve por objetivo avaliar o papel das células Treg, Th1, Th2 e Th17, por meio da expressão de mRNA. No total, 114 amostras [pacientes portadores de lesão única (55), pacientes portadores de lesões múltiplas (47) e controles saudáveis (12)] foram avaliadas quanto a expressão gênica de alvos relacionados aos perfis Th1 (T-bet, IFN-γ), Th2 (GATA3, IL-5, IL-4, IL-13, IL-33), Th17 (IL-17F) e T regulatório (TGF-β1, FoxP3, CTLA4, IL-10). Os resultados obtidos neste estudo demonstraram expressão significativamente maior de TGF-β1, IL-10, CTLA4, FoxP3, T-bet e IL-17F, e significativamente menor de GATA3 e IL-4 em todos os portadores da doença avaliados. Adicionalmente, ao avaliar a expressão entre os grupos de lesão única (forma localizada) e lesões múltiplas (formas multifocais e disseminadas), TGF-β1 e IL-5 apresentaram expressão significativamente maior nos pacientes com lesão única e múltiplas, respectivamente. Em resumo, constatamos que a ação desta população está relacionada à capacidade de inibir a resposta antifúngica modulando principalmente a expressão de citocinas envolvidas na proteção, tais como, IFN-γ e IL-17F / Abstract: Jorge Lobo's disease is a chronic disease that affect the skin and subcutaneous tissues, whose etiologic agent is the fungi Lacazia loboi. Depending on localization of lesions, it can be classified as localized, multifocal or disseminated. In respect to immunologic aspects, previous studies show the predominance of Th2 profile in patients, in addition to more frequent TGF-β and IL-10 positive cells in the inflammatory infiltrate present in lesions. However, the increased understanding about T regulatory (Treg) and Th17profiles suggest that other subpopulation of cells can be involved in the immunopathogenesis of Jorge Lobo's disease. Aiming at explaining the immunoregulation caused by these subpopulations, this study had as objective to evaluate the role of Treg, Th1, Th2 and Th17, through mRNA expression. A total of 114 samples [single lesion patients (55), multiple lesion patients (47) and healthy controls (12)] were evaluated by gene expression of targets associated to Th1 (T-bet, IFN-γ), Th2 (GATA3, IL-5, IL-4, IL-13, IL-33), Th17 (IL-17F) and T regulatory (TGF-β1, FoxP3, CTLA4, IKZF2, IL-10) profiles. The results obtained in this study demonstrated significant higher expression of TGF-β1, IL-10, CTLA4, FoxP3, T-bet and IL-17F, and significant lower expression of GATA3 and IL-4 in all patients. Additionally, the expression comparing single lesions (localized form) and multiple lesions (multifocal and disseminated forms) patients showed significant higher levels of TGF-β1 and IL-5, respectively, in single and multiple lesions patients. In summary, the role of the Treg population is associated with inhibition of the antifungal activity, thus modulating mainly the expression of cytokines associated protection against fungal infection, such as IFN-γ and IL-17F / Mestre

Background: Blastomycosis is caused by a dimorphic fungus that can be difficult to diagnose in certain situations. The disease is sometimes serious and can be deadly. Diagnosis by fungal serology and urinary antigens is not easy to establish and unreliable. Culture is also time-consuming and is not easy to perform. Thus, documentation of such an organism on cytology offers a quick and cost-effective alternative. This report describes for the first time identification of the 'negative image' of Blastomyces budding yeast. Case: A 79-year-old man presented with a left lung nodule associated with mediastinal and hilar lymphadenopathy. Fine needle aspiration was performed, and a 'negative image' of a yeast with wide base budding was noted on Diff-Quik (DQ)-stained smears. Blastomyces species were confirmed with periodic acid-Schiff fungal stain. Additionally, the fungal capsule contained focally polarizable material on Congo red stain and lacked mucin with mucicarmine stain. Conclusion: Blastomyces yeast forms can be easily identified with DQ staining by their 'negative image'. This feature can be utilized as a quick and cost-effective cytological characteristic to further triage these specimens for confirmation. The information can be of great value to clinicians in making appropriate clinical decisions.

Study objectives: To study the epidemiologic and clinical features of blastomycosis in northeast Tennessee. Design: Retrospective review of blastomycosis cases in the region from 1980 through 1995. Setting: Hospitals located in the Tri-Cities region of northeast Tennessee. Patients: Seventy- two patients with confirmed blastomycosis infection. Interventions: None. Results: During the 1980 to 1995 study period, we documented 72 cases of blastomycosis. The mean age was 52 years (range, 13 to 86 years), most were male (69.4%), and nine were immunocompromised. A possible environmental exposure was noted for 28 patients. Pulmonary involvement represented the most common site of infection (61 cases), but multiorgan involvement was common (17 cases). Most patients with pulmonary blastomycosis (66%) presented with a chronic illness, and radiologic findings usually revealed local consolidation or a mass-like lesion. Nine patients developed ARDS with an associated mortality rate of 89%, compared with a 10% mortality for non-ARDS pulmonary cases. Antifungal treatment regimens varied widely, with amphotericin B often used for sicker patients. An epidemiologic evaluation revealed that the mean yearly incidence rate for blastomycosis quadrupled between 1980 and 1987 (0.31 cases/100,000 population) and 1988 to 1995 (1.23 cases/100,000 population) (p=0.00001). Most new blastomycosis cases in the 1988 to 1995 period occurred in three counties in the region where significant new construction projects have been underway. Conclusion: Blastomycosis is endemic in northeast Tennessee and the number of eases is increasing, coinciding with major new construction in the region. Clinicians in the area must be alert to this condition.