Newsletter of the
Medical Mycology Society of New York

Volume 37, No. 1                                                                 September 2000
Published at NYU Medical Center                                                 S.A. Rosenthal, Editor

President: Arturo Casadevall, M.D. (718) 430-4259
Secretary-Treasurer: Jean Pollack M.S. (212) 263-5902

Thursday, September 28th, 2000 at 6:00 PM
NYU Medical Center
Orentreich Conference Room
First Floor, Tisch Hospital
560 First Avenue
(From main lobby follow signs to "C" elevator on first floor. Conference room is across from elevator)


Elusive Cases of Actinomycetoma

Dr. Julius Kane
Toronto, Canada

Abstract: Achieving the correct diagnosis of actinomycetoma is often difficult and the time course may be protracted, leading to incorrect treatment. Two cases were studied to assess the problems and solutions involved. Reports from various physicians as well as laboratory examinations were reviewed in both cases. The contributions to early diagnosis by the selective isolation medium Pyruvate Yeast Extract Agar (PYA) were assessed.

Case# 1: A Toronto woman was followed for three years as she searched for treatment for a lesion on her foot. An initial diagnosis of cellulitis and several swab and biopsy examinations growing non specific bacteria resulted in several ineffective therapies. Ultimately, Actinomadura madurae was cultured on a newly devised medium. PYA. Appropriate therapy was then initiated. Case#2: A 20-year 014 woman developed an erythematous nodular lesion below her right eye. It was diagnosed as a hemanioma and over a four-year period, several biopsies and surgical excisions were performed. At one point t patient was referred to a cancer treatment center. The patient was ultimately referred to the Dermatology Department of Sunny brook and Women's College Health Sciences Center. A biopsy specimen was sent to the mycology laboratory where an organism consistent with an aerobic actinomycete was observed. It was identified as Nocardia transvalensis. Fatty acid analysis was consistent with the pattern for this organism. Appropriate treatment was initiated and at a 4-month follow-up there was no histological indication of inflammation.

Patients infected subcutaneously by Nocardia-like organisms may experience extended periods of incorrect diagnosis. Astute microscopic examination and use of PYA as a primary isolation medium in suspect cases can facilitate a correct diagnosis.

The Society is pleased to offer members who attend this meeting a light, buffet-type dinner after the lecture. It will be held just outside the conference room. It is important that we know if you are coming to dinner so that we can order the appropriate amount. Please call Jean Pollack if you are coming at (212) 263-5902. If you do not call by September 25, 2000 do not plan on having dinner with us.

The MMSNY gratefully acknowledges the support of our


bioMerieux Vitek, Inc.
Merck Inc.
Novartis Pharmaceuticals Corp.
Pfizer Inc., Roerig Medical Division

President's Message: It is a great honor to serve as the president of the MMSNY. Our society has provided a venue for the dissemination of mycology-related knowledge in the region for more than four decades. It is currently one of the most active groups involved with infectious diseases in New York City. In the year 2000, the single most important issue facing our society is finding a means to grow and to remain relevant to our members. Our society continues to exist and function largely as a result of the tireless efforts of two individuals: Stan Rosenthal and Jean Pollack. Stan and Jean have done, and continue to do, most of the organizational work needed to maintain the MMSNY. I feel fortunate to follow Vince La Bombard] who did an outstanding job during his tenure as president. Vince organized two superb symposia and provided important links to other scientific groups in New York City that has greatly benefited the MMSNY.

Today, the society faces significant challenges. In recent years it has been difficult to recruit individuals to serve the MMSNY in leadership positions. For example, there is currently no elected vice-president to step into the presidency at the expiration of my term in 2002. Hence, my major goals are to maintain the standards of excellence that have characterized MMSNY-sponsored events and to recruit new members to maintain the vitality of our society. I ask all members of MMSNY to be proactive in identifying individuals who are interested in mycology and who are potential members for our society. We will maintain our fall and spring evening lectures and hopefully also host another symposium in the spring. I look forward to serving as your president and I hope to see you at our evening lectures and symposia. Please do not hesitate to tell me what you think and/or provide advice so that I can do this job in the best way I can.

Arturo Casadevall, M.D., PhD

Travel Grant Report: I want to thank the society for the generous stipend that allowed me to travel to my first national ASM meeting this past May. I attended several very good lectures, but space limits me to a brief summary of only some of those meetings:

At one lecture I learned of a case of an aortic graft becoming infected with Candida kefyr after a part of the patient's duodenum had attached itself to the graft. This is a rare pathogen in mucous membranes, but this yeast has the ability to grow on vascular endothelia and biofilms. Another case study involved a brain abscess caused by Acrophialophora fusispora, a mold originally classified within the genus Paecilomyces. On potato dextrose agar the colonies of this fungus appear buff to tan, becoming grayish-brown with age. Phialides are swollen and are borne singly or in whorls from thick-walled echinulate conidiophores. The phialides do not bend away from the main axis. Conidia can be smooth or rough Its optimum growth temperature is 35-40C. 'File organism is susceptible to Arriphotericin B and Itraconazole. This case appeared in the Journal of Clinical Microbiology,1999 vol. 37 pps. 2102-2103.

Dr. Kevin Hazen presented a very good lecture on the relationship between virulence and the hydrophobicity of fungi. In molds, small proteins called hydrophobias, which are apparently involved in the formation of emerging hyphal structures cause hydrophobicity. Hydrophobicity of yeasts does not involve hydrophobins. This phenomenon appears to be triggered by short, externalized hydrophobic peptide regions on the organism. Hydrophobic cells in C. albicans are more virulent and arc less sensitive to polymorphonuclear leukocytes. There is also a correlation between hydrophobicity and temperature. C. albicans are hydrophobic at 23C and hydrophilic at 230C. C. dubliniensis, C. glabrata C. ketvr, C. krusei, C. parapsilosis and C. iropicalis are hydrophobic at 23C and at 3 7C. Other proteins, such as mannoproteins and surface fibrils also contribute to this process.

In another lecture I learned that, although the cause and effect has not yet been elucidated. Candida species that exhibit greater pathogenicity are less proficient sexually. And at a meeting chaired by Dr. Demo Papagannis it was announced that he and his colleagues are involved in the development of a vaccine for Coccidiodes immitis.

Other meetings I attended were occasionally beyond my field of interest or understanding. but over-all I was greatly impressed with the scholarship of the meetings I attended. Finally, the scope of work presented at the poster sessions gave me encouragement that, although presently most research in mycology is carried out at the molecular level. there is still much interest in clinical mycology among young, bright doctorate and post-doe medical researchers.

Submitted by
Jean Pollack

News of Members: After 47 years at NYU Medical Center, Dr. Stanlev A. Rosenthal has moved to the Mycology Laboratory at New York Presbyterian Hospital. His new address is Columbia-Presbyterian 'Medical Center. Mycology Lab, Dept. of Microbiology, BHS-T14. 622 W. 168"' St. New York. NY l()0 )?: Phone: (1' 1?) 305- 9:77. fax: (212) 305-8971. He will continue as newsletter editor.

Dr Irene Weitzman is writing on the diagnosis of several fungal infections for a web site called UPCMD Disease Diagnosis. Medical information is provided on a current basis for 3 major product groups (UPC Medical Diagnosis Ser1ies. I 'PC transfusion Medicine and UPC Academic Series). It is intended for Health Care Professionals and students in the medical and associated professions. Dr. Weitzman is writing under the section called Disease-Oriented Testing, which includes bacterial, fungal parasitic infections etc. It is due to go online September 1, 2000. Information can be accessed on http://www/

Note: Some of you may remember that Irene said she would never use a computer!

New Members: Ms. Carmen Yarnpierre, Mr. Ariel Rodreiguez. Mr. Subhas Patel, Dr Stephanie Tucker and Dr. Martha Feldmesser.

Any items for the newsletter?' If so send to Jean Pollack, Mycology Lab., H-378, NYU Medical Center. 560 First Avenue, NYC 10016. Fax (212) 263-7022 Deadline for the November 2000 Newsletter is October 15th 2000.

Next Meeting: November 2000 at NYU Medical Center.