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1 Laboratory diagnosis of imported mycoses : how to safely execute laboratory examinations Hideyo YAMAGUCHI Teikyo University Institute of Medical Mycology (TIMM) (359 Otsuka, Hachioji, Tokyo)
2 coccidioidomycosis histoplasmosisparacoccidioidomycosisblastomycosis 4 penicillosis marneffei 5 endemic mycoses Endemic mycoses endemic mycoses 5 reservoir 1
3 Coccidioides spp. a Histoplasma capsulatum var. capsulatum b Histoplasma capsulatum var. duboisii c Histoplasma farciminosum d Paracoccidioides brasiliensis Penicillium marneffei Blastomyces dermatitidis a C. immitis C. posadasii b c dh. capsulatum var. farciminosum
4 , HIV AIDS Medline AIDS
5 H. capsulatum var. capsulatum00 H. capsulatum var. duboisii H. capsulatum var. farciminosum H. farciminosum 13 H. farciminosum H. capsulatum var. capsulatum 14 15,
6 dimorphism dimorphic fungus Coccidioides spp. 37 Coccidioides immitis Alejandro Posadas Coccidioides posadasii C. immitis Coccidioides spp. C. immitis C. posadasii PCR 19 1 PCR, 3 1 Coccidioides spp. H. capsulatum biohazard laboratory infection
7 biosafety biosafety level ; BSL BSL 1976 Pike C. immitis108 H. capsulatum81 Sporothrix schenckii13 B. dermatitidis1 P. marneffei 5, 6 S. schenckii 7 BSL 8 C. immitis 3b 3a BSL 3 C. immitis Coccidioides immitis 1 Blastomyces dermatitidis Histoplasma capsulatum Histoplasma farciminosum Paracoccidioides brasiliensis Penicillium marneffei Cryptococcus neoformans 3 Sporothrix schenckii Cladosporium carrionii 4 Cladosporium trichoides 4 C. bantianum Fonsecaea pedrosoi 4 Aspergillus fumigatus Candida albicans Exophiala dermatitidis 4 Microsporum canis 5 Trichophyton mentagrophytes 5 Trichophyton rubrum 5 3b 3a 3a c 3a 3a b b b b b a a a a a a BSL b a 1ab3a3b 5 bbsl BSL 3 c 1 Coccidioides posadasii H. capsulatum var. capsulatum H. capsulatum var. duboisii 3 C. neoformans var. neoformans C. neoformans var. gattii 4 5
8 C. immitis H. capsulatum 30 BSL BSL 3 ASM 5 1 BSL BSL 3 BSL C. immitis 34 David Stevens 35 X AIDS
9 BAL BAL BAL 3 1 DNA PCR PCR Coccidioides spp Coccidioides spp. H. capsulatum Coccidioides spp. H. capsulatum BSL AB BAL KOH
10 Y PAS Coccidioides spp. Coccidioides spp. Coccidioides spp AIDS Coccidioides spp. Coccidioides spp. PAS Gridley H. capsulatum P. brasiliensis 400 Gridley P. marneffei B. dermatitidis Brauer Dr. Scott Nelson, Department of Pamoxogy, UCLA, USA 400 BHI 1 SDAPDA Coccidioides spp. a 4mm 0 60m Candida spp. C. glabratacr. neoformans, Prototheca spp. Histoplasma capsulatum Paracoccidioides brasiliensis Penicillium marneffei Blastomyces dermatitidis ac. immitis C. posadasii 4m 15 30mm 10m pilot s wheel 3 6m 8m 8 15m Coccidioides spp. P. marneffei C. glabrata, Cr. neoformans, Toxoplasma gondii H. capsulatum
11 H. capsulatum P. brasiliensis P. marneffei PDA P. citrinum, P. purpurogenum, P. rubrum Penicillium spp. P. marneffei Coccidioides spp. 1 BHI BHI 37Coccidioides spp.p. marneffei 3 1Coccidioides spp. Histoplasma capsulatum SDA714 1Coccidioides spp. Histoplasma capsulatumsda71 3Paracoccidioides brasiliensis SDA718 4Paracoccidioides brasiliensis Paracoccidioides brasiliensissda Penicillium marneffei 6Blastomyces dermatitidis 5Penicillium marneffeipda74 6Blastomyces dermatitidissda71 PDA75 SDA718 4
12 P. brasiliensis DNA DNA Coccidioides spp. Converse YNB 37 CO Coccidioides spp m Histoplasma capsulatum Paracoccidioides brasiliensis Penicillium marneffei Blastomyces dermatitidis 5m 8 16m 3 10m PDA Penicillium 3m 10m 4m 3 10m 3m 5 30m
13 1 DNA RNA ITS DNA DNA PCR nested PCR PCR DNA DNA DNA DNA DNA DNA PCR DNA direct sequencing A Coccidioides spp. Coccidioides spp. H. capsulatum 1 1 Anaissie EJ, McGinnis MR, Pfaller MAed: Clinical Mycology, Churchill Livingstone, New YorkEdinburgh London Philadelphia, Murray PR, Baron EJ, Jorgensen JH, et aled: Manual of Clinical Microbiology, 9th ed, ASM Press, Washington, DC, : 1-16, p , Coccidioidomycosis 1. : , 1984.
14 10 1. : 111, Cuellar-Rodriguez J, Avery RK, Lard M, et al : Histoplasmosis in solid organ transplant recipients : 10 years of experience at a large transplant center in an endemic area. Clin Infect Dis, : , Stevens DA : The interface of mycology and endocrinology. J Med Vet Mycol, : , : 36-45, Manfredi R, Mazzoni A, Nanetti A, et al : Histoplasmosis capsulati and duboisii in Europe : The impact of the HIV pandemic, travel and immigration. Eur J Epidemiol, : , Symmers WC : Histoplasmosis contracted in Britain : a case of histoplasmic lymphadenitis following clinical recovery from sarcoidosis. Br Med J, : , Viviani MA, Vago G, Farina C, et al : ECMM Survey of histoplasmosis in Europe. Report from Italy. Rev Iberoamer Micol, : S143, Ashbee HR, Evans EGV, Viviani MA, et al : Histoplasmosis in Europe : report on an epidemiological survey from the European Confederation of Medical Mycology Working Group. Med Mycol, : 57-65, Fisher MC, Koenig GL, White TJ, et al : Molecular and phenotypic description of Coccidioides posadasii sp. nov., previously recognized as the non-california population of Coccidioides immitis. Mycologia, : 73-84, Bialek R, Kern J, Herrmann T, et al : PCR assays for identification of Coccidioides posadasii based on the nucleotide sequence of the antigen proline-rich antigen. J Clin Microbiol, : , Johnson SM, Simmons KA, Pappagianis D : Amplification of coccidioidal DNA in clinical specimens by PCR. J Clin Microbiol, : , Umeyama T, Sano A, Kamei K, et al : Novel approach to design primers for identification and distinction of the human pathogenic fungi Coccidioides immitis and Coccidioides posadasii by PCR amplification. J Clin Microbiol, : , 006. Binnicker MJ, Buckwalter SP, Eisberner JJ, et al : Detection of Coccidioides species in clinical specimens by realtime PCR. J Clin Microbiol, : , Sheff KW, York ER, Driebe EM, et al : Development of a rapid, cost-effective TaqMan real-time PCR assay for identification and differentiation of Coccidioides immitis and Coccidioides posadasii. Med Mycol, : , Pike RM : Laboratory-associated infections. Summary and analysis of 391 cases. Health Lab Sci, : , Collins CH : Laboratory Acquired Infections, 3rd edn, Butterworth-Heinemann Ltd, Oxford, UK, Sewell DL : Laboratory-associated infections and biosafety. Clin Microbiol Rev, : , : 0-9, Walsh TJ, Pizzo PA : Nosocomial fungal infections : a classification for hospital-acquired fungal infections and mycoses arising from endogenous flora or reactivation. Ann Rev Microbiol, : , Pike RM : Laboratory-associated infections : incidence, fatalities, cases, and prevention. Ann Rev Microbiol, : 41-66, p Warnock DW : Mycotic agents of human disease, p , Fleming DO, Hunt DLed, Biological Safety : Principles and Practices, ASM Press, Washington, DC, Padhye AA, Bennett JE, McGinnis MR, et al : Biosafety considerations in handling medically important fungi. Med Mycol, : 58-65, Galgiani JN, Ampel NM, Blair JE, et al : Coccidioidomycosis. Clin Infect Dis, : , Stevens DA, Clemons KV, Levine HB, et al : Expert opinion : what to do when there is Coccidioides exposure in a laboratory. Clin Infect Dis, : , Kamei K, Sano A, Kikuchi K, et al : The trend of imported mycoses in Japan. J Infect Chemother, : 16-0, : , 1993.
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