4244. Cryptoccus neoformans and Urban Asthma
Session: Symposium: Environmental Moulds and Human Disease: Is There a Connection?
Tuesday, October 28, 2008: 12:00 AM
Room: Room 151B
Background. C. neoformans is an encapsulated basidiomycete that is uniquely adapted to survive in pigeon droppings. Infection is acquired through the inhalation of aerosolized particles and sub-clinical pulmonary cryptococcosis in healthy individuals has long been hypothesized. The tendency of this pathogen to elicit allergic inflammation in animal models has alos been well documented. We hypothesized that subclinical cryptococcosis contributes to the epidemic of urban asthma. To test this hypothesis, we conducted a variety of studies that are outlined in this presentation.
Methods. An immunoblot assay was done to estimate the prevalence of subclinical cryptococcosis in otherwise healthy children from the Bronx and a suburban area of New York. A rat model of pulmonary cryptococcosis was used to explore the potential effects of pulmonary cryptococcosis on the response to a respiratory challenge with ovalbumin. Both the effects on allergic inflammation and airway hyper-responsiveness were studied. Using this model, chitinase induction was characterized using a flurogenic activity assay and acidic mammalian chitinase expression was demonstrated by immunoblot and immunohistochemistry. A similar approach was used to study chitinase activity and YKL-40 expression in the bronchoalveolar lavage fluid of asthmatic children from the Bronx.
Results. Serologic evidence of subclinical cryptococcosis was common among children from the Bronx, but not in children from suburban New York. Animal studies demonstrated that this type of infection was capable of exacerbating airway hyper-reactivity and allergic inflammation possibly through the induction of chitinase. Chitinases have recently been implicated as important mediator of allergic inflammation. Studies confirmed chitinase induction and increased YKL-40 in the bronchoalveolar lavage fluid of Bronx children with asthma.
Conclusions. The results from our studies support a possible association between subclinical cryptococcosis and urban asthma. Furthermore, our results highlight the unique characteristics of C. neoformans that make it particularly suited to exacerbate asthma, including the tendency of this organism to cause asymptomatic, persistent pulmonary infections that promote allergic inflammation and airway hyper-responsiveness. The ability of C. neoformans to elicit chitinase expression reveals a previously unrecognized mechanism by which fungal infections may potentiate asthma. Additional studies are warranted to study the association between pulmonary cryptococcosis and urban asthma.
David Goldman, MD, Albert Einstein Coll. of Med., Bronx, NY and  D. Goldman, None.

CURRICULUM VITAE
DAVID L. GOLDMAN
Date of Birth
August 24, 1961
Education
1979-83
BA
Brandeis University
Waltham, MA
1983-87
MD
Jefferson Medical College
Thomas Jefferson University
Philadelphia, PA
Postgraduate Training
1987-88
Transitional Internship
St.Vincent’s Hospital
Yale University/ NY Medical College
1988-1991
Residency in Pediatrics
Jacobi Medical Center/Montefiore Medical Center
Albert Einstein College of Medicine
1991-1992
Fellowship in Academic Pediatrics
Jacobi Medical Center/Montefiore Medical Center
Albert Einstein College of Medicine
1992-1996
Pediatric Infectious Diseases Fellowship
Jacobi Medical Center/ Montefiore Medical Center
Albert Einstein College of Medicine
Academic Appointments
Albert Einstein College of Medicine
1996-
2001
Assistant Professor of Pediatrics
2001 -
Associate Professor of Pediatrics
2006 -
Assistant Professor of Microbiology and Immunology
Hospital Appointments
Jacobi Medical Center
1996-1998
Attending Pediatrician
Montefiore Medical Center
1996 - present
Board Certification
1992
American Board of Pediatrics Certified
1994
Pediatric Infectious Diseases Subspecialty Certification
1999
Re-certification American Board of Pediatrics
2001
Re-certification Infectious Diseases Subspecialty
2005
Re-certification American Board of Pediatrics
Professional Society Membership
1994-
American Society of Microbiology
1999-
Infectious Diseases Society of America
2001-
Pediatric Infectious Diseases Society
Awards, Honors and Membership in Honorary Societies
1986
Hobart Amory Hare Medical Society, Jefferson Medical College,
1994
American Society of Microbiology, Sustaining Member Student Travel Award
1994
National Foundation of Infectious Diseases Travel Grant
Professional Experience
1996-1998
Jacobi Medical Center
Acting Medical Director of Pediatric AIDS Program
1996 -
Montefiore Medical Center
Attending Pediatric Infectious Disease
Other Professional Activities
2000
NIH Study Section Reviewer. Center of Scientific Research (BM-2 F-32)
2007
IDSA Committee, Clinical Guidelines for the Treatment of Cryptococcosis.



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