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This study comprised 100 healthy dentate adults and 53 patients with either chronic erythematous oral candidosis or oral leukoplakic lesions. The presence of yeasts was determined by microscopical examination of PAS-stained smears and by culture. Biopsy material was obtained from all lesions. The isolated yeasts were identified to species level. Strain phenotypes of 147 Candida albicans isolates were determined on the basis of the ODDS & ABBOTT procedure (25, 26). Yeasts were found in the mouth of healthy dentate individuals both by culture and by smears. The identification of hyphae in healthy mucosa indicates that the presence of these structures is not an unequivocal sign of candidal infection. The results support the view that tobacco smoking may be a predisposing factor for candidal infection. Also, the results have shown an association between the occurrence of yeasts and the type of leukoplakic lesions. Finally, the strain differentiation has indicated an oral mycoflora in patients with candidal lesions disappearing after antimycotic treatment which was more homogeneous in composition than in patients with irreversible lesions; furthermore, certain strains may possess properties which may be important in the development of pathological conditions and premalignant changes.

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Most women with group B streptococcus cervical colonization have uncomplicated pregnancies, but about 1% experience preterm premature rupture of membranes (PROM) followed by neonatal group B streptococcal sepsis. In such cases, streptococcal adherence to and penetration of the membranes may be an important step in the pathogenesis. In the present study, chorionic epithelial cells were incubated with group B streptococci isolated from either children developing sepsis after preterm PROM (complicated pregnancies) or from uncomplicated pregnancies. Incubation periods varied. The numbers of adherent bacteria per chorionic epithelial cell were counted by microscopic examination. After 70 minutes' incubation, the number of adherent group B streptococci in complicated pregnancies was 38, compared with 14 in uncomplicated pregnancies (P less than .001). This difference in vitro might reflect the virulence of group B streptococci.

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Conventional oral specimens for recovery of yeasts are swabs and smears. Oral rinses and imprint/impression cultures can also be used. Yeasts grow well at room temperature and may multiply in specimens under transport. Direct smears examined for blastospores, hyphae, and inflammatory cells ensure rapid presumptive diagnosis. Fungal identification requires culture, preferably on different media and at different temperatures to ensure recognition of all species present. YM agar supplemented with 0.01% aniline enables detection of Candida albicans and C. parapsilosis on primary plates through fluorescence. Microstix-Candida or Oricult-N slides can be read after culture at room temperature. Histologic sections for demonstration of yeasts require periodic acid-Schiff, Gridley, or Gomori's methenamine silver staining. Fungiqual staining enables non-specific diagnosis, also of rare oral mycoses, within 30 min, through fluorescence. Calcofluor white is even faster (less than 30 sec). Specific antibodies labeled with fluorescent stain enable more precise mycologic diagnosis. Mycologic findings should be interpreted together with clinical findings.

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Yeasts occur commonly in the oral cavity in healthy individuals. The prevalent species is Candida albicans (about 60-70% of all isolates). C. glabrata and C. tropicalis come next, followed by other Candida species and genera (Rhodotorula, Saccharomyces, etc.) which are all of rare occurrence and transient. The yeast flora increases in many patient groups, especially those who are immunocompromised. C. albicans is the most important species, being the cause of almost all cases of yeast infections in the region, often in association with other species. The number isolated from the oral cavity depends on testing site and methods used. C. albicans can be typed by means of serology (types A and B), by biotyping, by morphology, by means of sensitivity to killer factors, by electrophoretic karyotyping, DNA fragments, and immunoblotting. Such methods may be of value epidemiologically. Switching in Candida morphology is associated with changes in micromorphology and physiology. Several non-yeast fungi may affect the oral cavity, most frequently in association with lung or disseminated infections.

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Esophageal mucosal brushings from 51 consecutive patients with progressive systemic sclerosis (PSS) (group I), 18 PSS patients continuously treated with high-dose ranitidine or omeprazole (group II), 34 controls referred to the outpatient clinic for endoscopy (group III), and 10 patients receiving long-term potent antireflux therapy for idiopathic gastroesophageal reflux (group IV) were cultured for Candida albicans. There were 44%, 89%, 9%, and 0% Candida albicans culture-positive patients in groups I through IV, respectively. Fifteen patients with candida esophagitis from group II were treated with fluconazole systemically. Eleven and 14 patients became culture-negative after 2 and 4 weeks' treatment, respectively. Three months after fluconazole withdrawal the recurrence rate was 100%. It is concluded that esophageal dysmotility predisposes for candidosis. Adding gastric acid inhibitory treatment to dysmotility enhances the risk significantly (p less than 0.01). The efficiency of fluconazole treatment was close to 100%, but so was the recurrence rate within a short period.

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A case of cutaneous alternariosis is reported in the wife of a 73-year-old farmer. The diagnosis was verified culturally and histologically. The skin lesions were localized to legs, arms and face and were characterized by alternating spontaneous healing and formation of new lesions possibly due to autoinoculation from the lesions or re-exposure to the environment. The patient had a decreased resistance to infections owing to cancer - for which she had received X-ray treatment, chemotherapy and cortisone. This is the first reported Danish case.

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Trichosporon beigelii was isolated from the anal region in 45 (13%) of 343 Danish homosexual men. T. beigelii was also present on the scrotal skin of six anal carriers who were accessible for re-examination, and white piedra of the genital hair was observed in two cases. Because T. beigelii may cause systemic infections in compromised hosts it may pose a threat to homosexuals infected by HTLVIII/LAV virus.

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Calcium-dependent binding of C-reactive protein (CRP) to Aspergillus fumigatus was determined by enzyme-linked immunosorbent assay. A homogenate of young hyphae was fractionated by hydrophobic interaction chromatography followed by gel filtration. High CRP-binding activity was found in a fraction of mol. wt c. 500,000 which was characterised by strong binding to the hydrophobic column. Three fractions of less conspicuous CRP-binding activity were identified (c. 500 000, 150 000 and 150 000-50 000 mol. wt respectively). In these four fractions, phosphorylcholine was detected by an anti-phosphorylcholine mouse hybridoma antibody. Some CRP-binding activity in fractions with low affinity for the hydrophobic column did not correspond closely with the presence of phosphorylcholine. It is suggested that C-reactive substance in A. fumigatus is heterogeneous. The C-reactive substances did not correspond with fractions containing major antigens (470 000 and 250 000 mol. wt respectively) which elicit a strong immune response in man.

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Antibodies to Aspergillus umbrosus were investigated in 181 Danish farmers, 137 farmers' spouses and a control group of 104 male blood donors with no relation to farming. By enzyme-linked immunosorbent assay (ELISA) higher levels of IgG antibodies were found in farmers than in their spouses and in non-farming controls (P less than 0.0001). By double immunodiffusion precipitating antibodies occurred in 11 farmers, in none of farmers' spouses and in one control subject. Farmers and farmers' spouses who were non-smokers had higher IgG antibody levels than smokers in the same groups (P less than 0.04). Farmers more than 30 years of age had higher IgG antibody levels than younger farmers (P less than 0.04). Farmers rearing cattle tended to have higher IgG antibody levels than farmers without cattle. No correlation between antibody levels and respiratory symptoms or lung function parameters (FEV1 or FVC) could be demonstrated.

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In the normal human flora yeasts occur regularly and most of them are potential pathogens. Apart from C. albicans, C. glabrata and P. orbiculare they originate mainly from sources outside man. Thus Cryptococcus neoformans has its main reservoir in pidgeon manure. The epidemiology of yeast infections and more particularly those caused by C. albicans has not been well understood until recently when 3 different methods have been developed that allow for differentiation of strains of C. albicans. These methods are based on sensitivity to various chemicals, results of various biochemical tests and the sensitivity to various killer toxins. The methods have made it possible to trace the source and spreading of C. albicans, and may prove useful also in the differentiation of other yeast species.

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182 Danish farmers and 105 city-dwelling control subjects were investigated for serum IgG antibodies to three purified Aspergillus fumigatus antigen fractions and unfractionated culture filtrate by enzyme-linked immunosorbent assay (ELISA). Farmers had higher levels of antibodies to all four ELISA antigens than non-farming controls. In farmers and controls high antibody activity was recorded with an antigen fraction of approximate molecular weight 470 000 daltons. Antibody levels to this fraction were higher in non-smokers than smokers in both study groups. Cattle farmers had higher antibody levels to the 470 000 daltons fraction than farmers with no animals on the farm. Farmers with higher antibody activity to any of the three fractionated ELISA antigens tended to have fewer respiratory symptoms than farmers with lower antibody activity. It was concluded that occupational exposure and smoking habits are the main determinants of the immune response to A. fumigatus in man.

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162 women were investigated. Group I consisted of 85 women, who were partners to men with non-gonococcal urethritis (NGU) or presented macroscopic signs of cervicitis; patients who had harbored Neisseria gonorrhoeae were excluded from the study. Group II was a control group of 77 women without any complaints from the urogenital tract and with normal findings at pelvic examination. All the women were tested for infection with Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, and Candida albicans. In group I, chlamydiae and mycoplasmas were recovered in 44% and 36%, respectively, the corresponding figures for the control group (group II) being 5% and 19%. The difference is highly significant. No such difference between the two groups was found for ureaplasmas. Sixteen percent of the patients in group I were positive for C. albicans; 12% were positive in group II. Fifty per cent of asymptomatic NGU-partners were chlamydia-positive, and about one-third of patients with either dysuria or vaginal discharge harbored the organism. No difference in the isolation frequency of mycoplasmas was observed between asymptomatic partners to male NGU carriers and women with increased vaginal discharge, whereas the organism was isolated more frequently from patients with dysuria. Fifty-nine per cent of patients with cervicitis were chlamydia-positive, compared with 30% of patients with normal cervical appearance and normal vaginal discharge. Samples obtained from the cervix were more often positive than samples from the urethra. In conclusion, if samples can be taken from only one of the two sites in patients with lower genital tract infection, the cervix is the optimal sampling site.

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The influence of long-term treatment with a low dose of pivmecillinam on the fecal flora was investigated. Before treatment Escherichia coli was detected in about 88% of 30 outpatients with chronic recurrent urinary tract infections, but after 1-2 months only about 55% had detectable E. coli in the intestinal flora. E. coli resistant to mecillinam were not selected during the therapy. A similar group of patients treated with nitrofurantoin showed neither changes in the E. coli flora nor in the resistance pattern.

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IgA and IgG antibodies against Candida albicans culture filtrate were determined by enzyme-linked immunosorbent assay (ELISA) in sera from 84 pregnant and 21 non-pregnant women. IgA Candida antibody levels were found not to change significantly with age, whereas IgG Candida antibody levels were significantly higher in women aged 27 to 35 years than in women less than 24 years of age. Neither IgA nor IgG Candida antibody levels were related to the number of pregnancies. In a subgroup of 45 pregnant women examined for yeasts in the oral, anal and vaginal flora IgA Candida antibody levels were significantly higher in 13 women with negative cultures than in 19 women with recovery of C. albicans on plates. Intermediate levels of IgA Candida antibodies were found in 9 women with negative plate cultures, but positive enrichment broth cultures of C. albicans. All of 15 women with IgA ELISA values less than or equal to 0.51 had yeast-positive cultures compared with 17 of 30 women with IgA ELISA values greater than 0.51. This may suggest a role of IgA antibodies in the clearance of C. albicans from mucosal surfaces in healthy individuals.

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