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The Earliest Account of Human Cryptococcosis (Busse–Buschke Disease) in a Woman with Chronic Osteomyelitis of the Tibia

2015; Lippincott Williams & Wilkins; Volume: 34; Issue: 11 Linguagem: Inglês

10.1097/inf.0000000000000865

1532-0987

Joudeh B. Freij, Bishara J. Freij,

Antifungal resistance and susceptibility

To the Editors: Oh et al1 are to be commended on their expert review of isolated cryptococcal osteomyelitis in children. To their list of 15 children who have been described in the literature, we would add the report by McGuire et al2 of a 10-year-old immunocompetent girl with cryptococcal osteomyelitis in the left ilium. Not generally known is the fact that the first human isolate of Cryptococcus was from bone. The term Cryptococcus was originally used in 1833, but many of the organisms described were later shown to be algae. Otto Busse (1867–1922), a pathologist, and Abraham Buschke (1868–1943), a surgical assistant and later a renowned dermatologist, were the first to recover what is now known as Cryptococcus neoformans from a bone specimen of a 31-year-old woman with chronic tibial subperiosteal inflammation, thought to be a "softened" sarcoma, in June 1894 at Greifswald University, Germany. Busse believed it to be a Saccharomyces-like organism and called the disease saccharomycosis hominis. Buschke independently described the organism as a coccidium. Busse yeast was eventually renamed C. neoformans. He described the yeast as "clear, bright, circular or oval corpuscles," found within or outside giant cells. Busse inoculated a rabbit and a dog and found the same organism in pus after 3 days. Buschke also recovered the organism from eruptions on her skin and later inoculated her and some animals with material from secretions and pure culture. Busse and Buschke presented their findings in consecutive lectures at the Greifswald Medical Society in July 1894, a mere 3 weeks after the initial tibial debridement. Busse did not mention Buschke's contribution. Buschke, however, recognized Busse's work and gave him credit for the discovery. The patient's illness progressed, and she developed facial ulcers, knee and rib swelling, hematemesis but no neurologic symptoms. The organism was repeatedly recovered from multiple sites. She died in November 1894; 2 days later, Busse performed her autopsy at her apartment. She had disease affecting the right ulna, left tibia and left rib, in addition to the lungs, kidneys and spleen.3 Busse went on to become the head of Anatomic Pathology at the Institute of Hygiene in Posen and in 1911 became a professor in Zurich, until his death.3 Buschke was better known and in 1906 became the Head of Dermatology at the 2000-bed Rudolf Virchow Hospital, Berlin, with 400 beds allocated to skin diseases. He published widely and has several eponymous diseases such as Buschke–Löwenstein giant condyloma among others. He recovered the etiologic agent of syphilis (Spirochaeta pallida) from tissues of infants with congenital syphilis. In 1933, he was dismissed by the Nazis because he was Jewish. In 1937, he visited his 3 sons in the US but returned to Germany. He and his wife, Erna, were interned at the Theresienstadt concentration camp (Czech Republic) in 1942, where less than 4 months later he died of enteritis in 1943.4,5 Joudeh B. Freij, BS W. Harry Feinstone Department of Molecular Microbiology and Immunology Bloomberg School of Public Health Johns Hopkins University Baltimore, Maryland Bishara J. Freij, MD Beaumont Children's Hospital Royal Oak, Michigan Oakland University William Beaumont School of Medicine Rochester, Michigan