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Mycology Mailer
February 2002
Dear XXXXXXXXX:

Fungi and People. You just never know.

A brief look at Scopulariopsis brevicaulis Species.

One of the most striking features of Scopulariopsis brevicaulis is its association with human deaths by producing arsine gas from arsenate dyes found in wallpapers. Arsenic is a minor constituent of soil. Volatilization and methylation of dimethylarsinic acid and methylation of arsenate and arsenite naturally occur in soil. These bicohemical reactions end up with production of trimethylarsine and dimethylarsine. Arsenic is found in pesticides as well; the currently used ones are methylarsonic acid and dimethylarsinic (cacodylic) acid pesticides. Arsine is the most toxic form of arsenic. At concentrations above 0.5 ppm, it has a garlic-like odor. However, it is toxic at concentrations much lower than this.

The whole story started when arsenate dyes were formulated to be used in wallpapers. The most famous of these dyes was Schweinfurter green, one of several green copper-arsenic dyes that were manufactured and incorporated into wallpapers in 1810s. Following the widespread use of these green wallpapers in Germany, France, and other countries, two things drew attention: A garlic odor in some rooms with these wallpapers and the death of people who slept in these rooms. These people got sick and died secondary to tubular necrosis and renal failure. In 1897, the Italian chemist B. Gosio showed that the deaths were due to the production of a gas which could not then be identified. This gas was thus called Gosio gas.

This gas was produced by Penicillium brevicaulum, the mould fungus today known as Scopulariopsis brevicaulis. The whole story was clarified by Frederick Challenger in 1945 when he identified the gas as trimethylarsine. We today know the whole mechanism of the production of this gas. Scopulariopsis brevicaulis consumes the starch found in the wallpaper paste. Meanwhile, the fungus converts the arsenate found in the paper to trimethylarsine oxide. Finally, the oxide is reduced to trimethylarsine and the gas, which is toxic and causes human deaths is released. Although the phenomenon was initially related only to Scopulariopsis brevicaulis, other moulds found in the environment may also theoretically be able to liberate volatile arsenic compounds by using the same mechanism.

Hats off to B. Gosio & Frederick Challenger!

John Rex, Mike McGinnis &
the entire doctorfungus team


September 11, 2001
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Mycology in the News
Voriconazole: a new alternative for the treatment of Invasive aspergillosis.

       The results of an important open multicenter study on the use of Voriconazole have been recently published at the last CID issue. Under the leadership of David Denning, a group of investigators from United Kingdom, France, and Germany evaluated the efficacy and safety of this novel azole on the treatment of Invasive Aspergillosis (IA).

       One hundred sixteen patients were enrolled either with proven (41%) or probable IA. Voriconazole was the primary therapy in half of these cases while the rest of them had previously failed either to Amphotericin B deoxycholate, lipid formulations of amphotericin B and/or itraconazole. Overall, 48% of patients responded to therapy and 31% failed. A detailed description of types of response is given in the following table:

•  Response
Criteria
Clinical
Radiographic
Evolution of clinical signs/symptoms
Evolution of initial
Patients
%
    Complete
Complete Resolution
Complete o nearly resolution
16
14
    Partial
Some improvement
Improvement > 50%
40
34
    Stable
a) Some
      improvement
and/or

b) Short Course of
      therapy
a) < 50% resolution
24
21
    Failure
Progression and death due to IA
36
31


When compare with the classic alternatives, Amphotericin B deoxycholate and even with the new Amphotericin lipidic formulations, for which response rates are around 35%, Voriconazole efficacy seems certainly promising. Nevertheless, randomized trials are necessary to establish with certainty the role of Voriconazole this modern triazole on the treatment of this and other conditions.




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