Tinea capitis in an adult. Case report

A tinea capitis and tinea faciei case in an elderly female patient with diabetes mellitus type 2 is presented. Her dermatological illness began on her face and later disseminated to her scalp. She received multiple medications which aggravated her condition. The diagnosis was established by means of direct examination and the isolation of Trichophyton tonsurans in culture. Treatment with 200 mg daily dose of itraconazol for two months resulted in clinical and mycological cure.     

Comparison of the efficacy of 1% flutrimazole cream twice a day with 1% flutrimazole cream once a day for the treatment of superficial dermatophytoses

Different clinical studies have demonstrated flutrimazole's efficacy in the treatment of superficial dermatomycoses when administered either twice daily or once daily for four weeks. The aim of the present study was to compare both dosing schedules for the treatment of superficial dermatomycoses. In this randomized, controlled, double blind study, we included 84 patients suffering superficial dermatophytosis (confirmed by microscopic examination (KOH) and culture) susceptible for topical monotherapy. Forty-one patients received flutrimazole 1% twice daily (TD) and forty-three once daily (OD) for four weeks. The efficacy of treatment was evaluated by clinical and mycological criteria at the end of treatment (D28) and after four weeks without treatment (D58). Clinical and mycological cure rates on D28 were 50% with TD and 65% with OD treatment. Only considering clinical evaluation, clinical cure rates on D28 were 63% (TD) and 70% (OD). Also, clinical and mycological cure rates on D56 were 65% with TD and 72% with OD treatment. Only considering clinical evaluation, clinical cure rates on D56 were of 68% (TD) and 72% (OD). The overall tolerability was similar in both treatment groups. The efficacy assessment at the end of treatment (D28) and four weeks after treatment discontinuation (D56) showed that the OD treatment is not inferior to the TD treatment, with similar clinical and mycological cure rates and clinical cure rates in both cases. The OD administration of flutrimazole cream 1% is the most appropriate dosing schedule as it provides the same efficacy, it improves patient's compliance and the cost per day of treatment.     

Deep dermatophytosis caused by Trichophyton rubrum – A case report

A case of deep dermatophytosis in the gluteal region in a male patient successfully treated with terbinafine is described with its clinical, mycological and histopathological features. This revised version was published online in June 2006 with corrections to the Cover Date.     

Scedosporium apiospermum external otitis.

We report a case of Scedosporium apiospermum external otitis. The patient was topically treated with miconazole cream and achieved a clinical and mycological cure. The etiology, diagnosis and treatment of external fungal otitis are discussed.     

Five cases of zygomycosis.

Combined histological and mycological study of tissue specimens established a proven diagnosis of cutaneous zygomycosis in four patients. All patients had been treated with wide spectrum antibiotics and one patient (liver transplantation) was in addition also treated with cyclosporine. All had acidosis and cutaneous breaks and four had also been treated with systemic corticosteroids. The infecting organisms were Absidia corymbifera (n=2), Rhizopus stolonifer (n=1) and Mucor circinelloides (n=1). Combined treatment with i.v. conventional and liposomal formulations of amphotericin B and surgical treatment lead to a favourable clinical and mycological cure in three patients (A. corymbifera and R. stolonifer infections). One lymphoma patient with suspected Rhizopus pusillus infection of the lungs (presence of hyphae in sputum and positive culture) had an unfavourable outcome. The patient had been treated with wide spectrum antibiotics, corticosteroids and showed severe neutropenia and acidosis. The clinical presentations are outlined, including the outcomes and predisposing factors and focus on the diagnostic procedures, treatment and preventive measures.     

Cryptococcus neoformans: The Model Organism for Yeast Antifungal Drug Susceptibility Testing

We describe an approach to antifungal susceptibility testing of the yeast Cryptococcus neoformans that shows promise for predicting the mycological response in patients to treatment. Quantitative cultures of the cerebrospinal fluid provide a direct measure of the patient's mycological response to treatment and have been used in multiple studies to identify the most promising antifungal drugs for subsequent testing in larger clinical studies. Using these quantitative measures of response, a modified macrobroth dilution assay system shows the potential for predicting the response of an individual patient to treatment with amphotericin B, fluconazole, or the combination of amphotericin B plus flucytosine. We describe this modified macrobroth dilution assay method, the statistical approach for assessing susceptibility, and the clinical decisions that can be guided by this in vitro antifungal drug susceptibility testing.     

念珠菌性包皮龟头炎56例临床分析

目的 了解念珠菌性包皮龟头炎的临床特点、诱发因素、菌种分布及治疗.方法 对本院性病门诊中确诊的56例念珠菌性包皮龟头炎患者的临床和实验室资料进行回顾性分析,总结临床特征、诱发因素、菌种分布及治疗经验.结果 56例念珠菌性包皮龟头炎发病平均年龄(34.11±9.92)岁,25～ 40岁青年人占67.9％ (38/56);包皮过长者87.5％ (49/56),有糖尿病史14.29％ (8/56).56例患者念珠菌培养阳性48人(85.71％),共分离到49株念珠菌,其中白念珠菌44株(91.84％),近平滑念珠菌4例(8.16％).所有患者予舍他康唑乳膏外用,5例症状严重患者联合伊曲康唑口服,76.79％(43/56)的患者获得临床和真菌学治愈,1个月后随访无复发.结论 念珠菌性包皮龟头炎好发于青年人,白念珠菌仍是其最常见的病原菌,外用舍他康唑乳膏临床获得较好的疗效,为提高治愈率和避免再感染,治疗期间应避免性行为.     

Tinea Unguium: Diagnosis and Treatment in Practice

Onychomycosis is caused by dermatophytes, yeasts or non-dermatophyte molds; when caused by dermatophytes, it is called tinea unguium. The main etiological agents are Trichophyton rubrum and Trichophyton interdigitale. The most frequent types are distal and lateral subungual onychomycosis. Diagnosis usually requires mycological laboratory confirmation. Dermoscopy can be helpful and also biopsy is an excellent diagnostic method in uncommon cases or when mycological test is negative. Treatment must be chosen according to clinical type, number of affected nails and severity. The goal for antifungal therapy is the clearing of clinical signs or mycological cure.     

Problemas clínicos en micología médica: problema número 53

A 21 year-old man, HIV infected, and with poor adherence to antiretroviral treatment, consulted us due to a papular rash on trunk and extremities, showing simultaneously hypochromic stains on his back. He was afebrile and hemodynamically stable. In the mycological study of the clinical samples taken from different lesions, yeasts compatible with Malassezia were observed. Oral itraconazole was prescribed, with an excellent clinical response. Finding the same etiolologic agent in 2 different clinical pictures on a single patient is extremely rare.     

Short term treatment of dermatophyte onychomycosis with terbinafine.

OBJECTIVE--To evaluate the effect of short term treatment with terbinafine on dermatophytosis. DESIGN--Multicentre, randomised, double blind placebo controlled trial of 250 mg/day terbinafine for 12 weeks in dermatophyte onychomycosis. SETTING--Eight dermatology centres in the United Kingdom. PATIENTS--112 patients (mean age 44, range 19-78), 99 with mycologically proved toenail infections and 13 with fingernail infections, of whom eight were subsequently excluded and 19 failed to complete the study. INTERVENTION--Terbinafine 250 mg daily or placebo for 12 weeks. Follow up for 36 weeks after stopping treatment. MAIN OUTCOME MEASURES--Mycological cure (negative results on microscopy and culture) and clinical cure at the end of follow up, adverse events, and biochemical and haematological variables at monthly intervals during treatment. RESULTS--After follow up 82% (37/45) (95% confidence interval 68% to 92%) mycological cure and 69% clinical cure were recorded for evaluable patients treated with terbinafine for toenail infection and 71% (5/7) (30% to 96%) mycological cure and clinical cure for those treated for fingernail infection. The corresponding values for those treated with placebo were 12% (3% to 31%) mycological cure and no clinical cure for toenail infections and 33% (1% to 91%) mycological cure and no clinical cure for fingernail infections. On an intention to treat basis for toenail infections the figures were 73% (38/52) (58% to 85%) mycological cure for terbinafine compared with 6% (0% to 30%) for placebo (p less than 0.007). Two withdrawals were related to adverse events with terbinafine, and there were no significant abnormal laboratory test results. CONCLUSION--12 weeks'' terbinafine is effective and safe treatment for nail dermatophytosis.     

盐酸布替萘芬乳膏治疗体、股癣,手、足癣60例疗效观察

目的观察1%盐酸布替萘芬乳膏治疗60例浅部真菌病疗效。方法进行治疗前、后临床疗效和真菌疗效评价。结果临床疗效评价和真菌疗效评价,总有效率分别为96.67%和96.7%。结论1%盐酸布替萘芬乳膏治疗浅表真菌病疗效良好。     

Rhinosporidiosis in Delhi, North India: Case Series from a Non-endemic Area and Mini-review

We report three cases of rhinosporidiosis from migrant population of Delhi. Three male patients had sino-nasopharyngeal, nasopharyngeal and nasal rhinosporidiosis, respectively. One patient gave a history of bathing in stagnant water. The diagnosis was made by clinical presentation and microscopic observation of characteristic sporangia of Rhinosporidium seebri in mycological and histopathological investigations. All the patients were successfully treated with complete surgical excision of lesions and cauterization of base. There were no recurrences.     

5%阿莫罗芬搽剂治疗68例远端侧位甲下型甲真菌病的临床疗效观察

目的观察5%阿莫罗芬搽剂治疗远端侧位甲下型甲真菌病的疗效及安全性。方法招募具有远端侧位甲下型甲真菌病典型临床表现且真菌镜检阳性患者,应用5%阿莫罗芬搽剂治疗36周(每周1次)。计算临床有效率、真菌学清除率、治疗前后甲真菌病临床评分和甲真菌病严重程度指数及治疗前后生活质量评分,记录患者不良反应及满意度。收集病甲组织行真菌培养。结果共招募68例患者,总体临床有效率为66.1%;真菌学清除率为82.4%,第2~5趾甲受累患者临床有效及真菌学清除率较高,治疗过程中除轻微脱屑、灼热及红斑外,所有患者均耐受治疗。76.47%患者对治疗效果感到满意。治疗前后患者生活质量改善显著。结论5%阿莫罗芬搽剂是治疗远端侧位甲下型甲真菌病的一种安全有效的方法,可用于抗拒或不适合系统用药的患者。     

Screening the keratinolytic activity of dermatophytes in vitro

A case of rhinofacial zygomycosis with of years duration, caused by Conidiobolus coronatus is described. The patient, a 72-years-old woman, presented with a bilateral distortion of the subcutaneous tissue and disfigurement of the face. Treatment with ketoconazole and potasium iodide did not prevent several relapses. At present she is still under treatment with fluconazole with clinical healing. Histopathological and mycological examination confirmed the dermatological diagnosis. An increasing number of cases of zygomycosis caused by fungi of the order Entomophthorales have also been reported in the Northern and Northeastern States of Brazil.     

Problemas clínicos en Micología Médica: problema número 55

A 31-year-old woman, with signs of HIV infection (oral thrush, weight loss, asthenia) presented to our hospital with dyspnea and fever. A rapid HIV test yielded a positive result, and cryptococcal capsular antigen was detected in serum. In the mycological study of the clinical respiratory samples, yeasts compatible with Cryptococcus were observed under light microscope in a wet mount; structures compatible with Pneumocystis jirovecii were also observed in Giemsa stain. Treatment for both pathologies was prescribed but, unfortunately, the patient died 7 days after. The finding of two etiologic agents in the same clinical picture is rare but not exceptional, and it always must be considered in immunocompromised hosts.     

硝酸舍他康唑乳膏每日1次疗法治疗股癣疗效观察

目的 观察舍他康唑乳膏1次/d疗法治疗股癣的效果与安全性.方法 将参与试验的股癣患者随机分组,试验组每晚1次外用舍他康唑乳膏,对照组早晚各1次外用舍他康唑乳膏,连续用药4周,于治疗前、用药2周、4周及停药后2周分别进行症状和体征评分.结果 治疗结束和停药2周时,两组的临床疗效无显著差异(P＞0.05).治疗2周时试验组和对照组的真菌清除率分别为82.6％和92.5％,有显著差异(P＜0.05);治疗结束和停药2周时试验组的真菌清除率分别为95.9％和97.3％,对照组分别为96.4％和98.6％,均无显著差异(P＞0.05).结论 舍他康唑乳膏1次/d疗法治疗股癣疗效好,简便易行,安全性高.     

近平滑念珠菌引起真菌性膝关节炎：病例报告及文献回顾

报告1例由近平滑念珠菌引起的膝关节炎并进行相关骨关节真菌感染的文献回顾.患者,男,53岁,有糖尿病史及左侧腘窝皮肤浅表小肿瘤切除史,因左膝关节反复疼痛7 a,逐渐加重伴跛行6个月入院.临床表现为左膝关节明显红肿,影像学发现关节腔内滑膜增生,临近胫骨上端及股骨下端有灶性骨破坏、吸收,关节腔积液查见真菌,鉴定为近平滑念珠菌.经关节镜清理术及静脉用氟康唑治疗后症状改善,随访2 a无复发,已恢复日常活动.本文结合本例患者进行了骨关节真菌感染的相关文献复习,对骨关节感染的相关因素及治疗等内容进行了回顾,其结果对临床相关医生具有重要参考价值.     

萘替芬酮康唑乳膏每日1次治疗足癣疗效观察

目的观察萘替芬酮康唑乳膏1次/d治疗足癣的效果与安全性。方法将参与试验的足癣患者随机分组,试验组每晚1次外用萘替芬酮康唑乳膏,对照组早晚各1次外用萘替芬酮康唑乳膏。连续用药4周,于治疗前,用药2周、4周及停药2周后分别进行症状和体征评分。结果治疗结束和停药2周时,两组的临床疗效无显著差异(P>0.05)。治疗2周时试验组和对照组的真菌清除率分别为78.6%和90.3%,有显著差异(P<0.05);治疗结束和停药2周时试验组的真菌清除率分别为92.9%和97.6%,对照组分别为94.4%和98.6%,均无显著差异(P>0.05)。结论萘替芬酮康唑乳膏1次/d治疗足癣疗效好,简便易行,安全性高。     

Lobomicosis

The ninth Colombian case of Lobomycosis is presented, along with a review of the Colombian literature. The clinical, histopathological, and mycological aspects are summarized emphasizing the peculiar birefringent appearance of Lobomyces when examined under polarized light.     

Isolated Skull Cryptococcosis in an Immunocompetent Patient

A 62-year-old immunocompetent rural woman who represents an isolated cryptococcal skull infection without systematic involvement is described. Diagnosis was based on positive India ink staining, positive histopathologic examination, and positive culture. Species identification was performed by growth on Sabouraud dextrose agar and CHROMagar medium and by sequencing of the intergenic and internal transcribed spacer regions of the rRNA genes. This case describes a rare presentation of Cryptococcus neoformans infection in a human immunodeficiency virus-negative patient. The lesions were significantly improved with treatment of daily oral itraconazole 400 mg. A maintenance therapy with a low-dose itraconazole was prescribed to warrant a clinical and mycological eradication. A two-year follow-up did not show any recurrence of infection.