[A glance at the evolution of ideas in medical mycology].
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Biomedical subjects
Publications and source records attributed to R Vanbreuseghem.
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The prevalence of Candida albicans was quantitatively compared in 74 surgical patients during and after total parenteral nutrition (TPN). Suppression of oral food intake is probably responsible for the decrease of the C. albicans population in the mouth. On the contrary anal swabs were more often positive for C. albicans during TPN. This may be due to local conditions as was observed in a group of patients who were not given TPN but were also immobilized for a long period.
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The clinical manifestations of "opportunistic" fungal infections in compromised hosts, asthenomycoses, differ from those caused by the same fungus in otherwise normal people. Examples are given on the field of dermatophytoses, aspergillosis, candidiasis and cryptococcosis.
Dematophytes invade hosts when their state is suitable for the production of their pathogenicity. When the host's resistance is reduced, the prevalence of dermatophytoses can be extremely high or the symptomatology can be very unusual. It is suspected that the 'maladie dermatophytique' and pherhaps dermatophytic mycetoma develop in such situations. The fact is that the behaviour of dermatophytes does not differ from that of the so-called opportunistic fungi and in some cases it is possible to speak of dermatophytic asthenomycosis.
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In light of his experiences especially in tropical regions, the author makes some remarks about dermatophytes and dermatophytia, which they cause. The following main items are: 1. The dermatophytes lead a saprophytic life. 2. Exceptionally, they can invade nonkeratinized tissue and cause "dermatophytic disease", perhaps mycetomas. 3. 45 percent of the ringworm of the scalp heal before puberty. 4. In the tropical regions, trichophytosis caused by endothrix-species are often of inflammatory nature, the favus appears often without scutula formation (afavic). 5. One can heal a substantial percentage of the ringworm of the scalp with a single dosis of 12 tablets (125 mg each) of fine particle griseofulvin. 6. Athlete's foot has also other causes than only dermatophytes.
A classification of mycoses, depending upon the depth of penetration of the organism is discussed, as is the need to distinguish the true from the 'pseudo' mycoses. The development of antifungal agents is described from the first antibiotics to amphotericin B and 5-fluorocytosine. Attention is particularly focussed on the question of safety and effectiveness. Finally, it is stressed that successful antifungal treatment must depend upon determination of the exact pathological status of the patient and examples are given which relate to such clinical assessments.
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