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PubMed1990

Epidemiology of digestive tract mycoses in immunocompromised patients--a review.

Systemic fungal infections are diseases of increasing incidence in immunocompromised patients. They are an important cause of morbidity and mortality in patients with severe granulocytopenia caused by hematological malignancies or high-dose corticosteroid treatments. Systemic candidiasis is usually attributed to colonization of the patient's digestive mucosa or central venous/peritoneal catheters by endogenous Candida spp. Esophageal candidiasis can be a serious problem in predisposed individuals, and it can be the first opportunistic infection suggesting overt AIDS in HIV-seropositive patients. The aim of this review is to assess the epidemiology of alimentary tract mycoses in "at risk" groups because of iatrogenous or pathological reasons, such as in-patients undergoing solid organ and bone marrow transplantation, peritoneal dialysis and enteral/parenteral nutrition and in HIV infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Epidemiological and clinical aspects of mycoses in patients with AIDS-related pathologies.

Mycological, cultural and/or serological studies were performed on 98 patients hospitalized in the Department of Infectious Diseases of the Catholic University in Rome with diagnoses of acquired immune deficiency syndrome (AIDS) or AIDS-related complex (ARC) diseases. The incidence of mycoses was evaluated by retrospectively analyzing the results of mycological examinations and comparing them with clinical manifestations. The presence of concomitant bacterial, viral and parasitic infections was also examined. For epidemiological purposes, the study was extended to include the biotyping of all yeasts isolated from patients hospitalized between September 1988 and February 1989 in the same Department. Antimycotic susceptibility was also determined for the first yeast isolate obtained from each of these patients. Oral candidiasis (50 cases) caused by Candida albicans was the most frequent mycosis, followed by esophageal candidiasis (13 cases) and cryptococcosis (6 cases). Four out of the 6 cryptococcosis patients had meningeal involvement. Systemic candidiasis (2 cases) and aspergillosis (1 case) were less common. Biotyping of yeasts isolated between September 1988 and February 1989 with the killer system revealed type 377 to be the most common among the C. albicans isolates. It represented 70% of all the yeasts isolated.

AIDS-Related Complex↗
PubMed1980

A compilation of published reports of mycoses in animals in India.

The available published reports on animal mycoses in India and the fungal agents isolated from animal material are discussed. Among dermatophytes, the occurrence of Trichophyton verrucosum, T. mentagrophytes, T. rubrum, T. equimum, T. violaceum, T. simii, T. tonsurans, T. terrestre, T. ajelloi, Microsporum canis, M. gypseum and M. namum has been reported. Cases of aspergillosis, candidiasis, phycomycosis, rhinosporidiosis, epizootic lymphangitis, mycotic abortions and mycotic mastitis have been recorded in animals in this country. However, there is no report of histoplasmosis, sporotrichosis, blastomycosis and coccidioidomycosis among animals from India.

Abortion, Veterinary↗
PubMed2002

Causative agents of nosocomial mycoses.

In the last few years mycoses have been caused by fungi formerly considered to be harmless for humans. They cause diseases of plants and insects; some of them are also used in the industry. They are now usually called "emerging fungi". We investigated this flora with respect to their potential to cause infections in hospitals. These fungi are present in the air, on medical objects and instrumentation, in the respiratory tract and on the hands of hospital staff; other sources have been identified in the use of iatrogenic methods. Mycotic diseases, their risk factors, their clinical pictures, and spectra of agents were analyzed in 1990-2000; the results were compared with data in the literature. Transplantations were the most frequent risk factors, fungemia and abscess the most frequent clinical picture and filamentous fungi (genera Absidia, Acremonium, Alternaria, Apophysomyces, Aspergillus, Bipolaris, Cladophialophora, Cunninghamella, Exserohilum, Fusarium, Chaetomium, Chrysosporium, Lecythophora, Ochroconis, Paecilomyces, Pythium, Rhizopus, Scedosporium, Scopulariopsis) were the most frequent agents of nosocomial infections. These filamentous fungi and also some yeasts (genera Candida, Cryptococcus, Trichosporon) bring about different clinical syndromes in both immunocompromised and immunocompetent patients.

Aspergillosis↗
PubMed1977

Mycoses of the Sudan.

Mycoses in the Sudan are still significant and, as well as mycetoma, there are a number of fungal diseases: paranasal aspergillus granuloma, which came into eminence in 1966; actinomycosis; subcutaneous phycomycosis; systemic phycomycosis; post-operative opportunistic infection of the eye with Trichosporon cutaneum and rhinosporidiosis. Mycetoma and paranasal aspergillus granuloma are discussed in detail.

Aspergillosis↗
PubMed2005

Bloodstream infections and invasive mycoses in children undergoing acute leukaemia treatment: a 13-year experience at a single Italian institution.

The incidence rate (IR) of bloodstream infections (BI) and invasive mycoses (IM) during chemotherapy for paediatric acute lymphoblastic (ALL) or non-lymphoblastic leukaemias (AnLL) was evaluated for 153 BI and 22 IM diagnosed during 143,668 patient-days at risk from January 1988 to December 2000. IR, the number of episodes/100 days at risk, was 0.315 for AnLL and 0.092 for ALL (P < 0.001) with significant changes reflecting the intensity of anti-ALL chemotherapy. IR was 0.097 for first-line less intensive, 0.136 during first-line intensive, 0.261 during second-line therapy (P < 0.001), and 0.021 during maintenance. During intensive chemotherapy, the IR for BI was 0.134 in ALL with 0.087 for first-line less intensive therapy, 0.110 for first-line intensive, 0.230 for second-line intensive therapy (P < 0.001) and 0.274 in AnLL (P = 0.001). IR was 0.021 in ALL and 0.048 in AnLL (P = 0.034) for IM. In conclusion, there is a correlation between intensity of chemotherapy and rate of infections in paediatric acute leukaemias.

Adolescent↗
PubMed1982

The diagnosis of deep mycoses by morphologic methods.

The morphologic diagnosis of deep mycoses, although ideally accomplished by culture, often has to be made from tissue sections for smears, when cultures are not available. Especially on specimens containing necrotic foci, the use of special stains is absolutely necessary, since on hematoxylin and eosin sections many fungi cannot be seen in the necrotic debris. Stains are discussed and the results with different organisms are illustrated. Since recognition of fungi in tissues with granulomatous reaction often leads to specific and curative therapy, their identification is one of the most satisfying aspects of the surgical pathologist's work.

Aspergillosis↗
PubMed1989

The superficial mycoses and the dermatophytes.

More than 100,000 species of fungi have been identified worldwide, but only a few dozen are of medical significance. Because of the opportunistic nature of these organisms and the prevalence of immunodeficient conditions, the number of medically important fungi is increasing. Identification of the causative organism is of value in the choice of correct therapy. The development of new antifungal drugs has made it increasingly important to be able to distinguish one fungus from another. This article reviews the laboratory diagnosis of the fungi generally classified as the superficial mycoses and the dermatophytes.

Antifungal Agents↗
PubMed2003

Treatment of opportunistic mycoses: how long is long enough?

For most opportunistic mycoses no optimum duration of antifungal therapy has been defined. Although a long course of therapy is prudent, especially for mycelial fungal infections, excessively and unnecessarily extended courses of treatment incur a risk of toxicity and the expense of the therapeutic regimen. On the basis of existing reports on the pathogenesis and the effect of duration of therapy and other variables on outcome and response rate in fungal infections, this review proposes guidelines that may facilitate a rational approach to decision-making about the duration of antifungal therapy.

Animals↗
PubMed2000

Disseminated mycoses in a dog by Paecilomyces sp.

We describe a case of canine mycoses initially diagnosed by clinical signs and enzyme-linked immunosorbent assay anti-fungal test, and later confirmed by the isolation of Paecilomyces sp. during the post-mortem examination. The fungus was isolated from lesions in the kidneys, mitral valve, abdominal aorta and vertebral discs. In this kind of process, it is important to identify the responsible agent early in order to make a study of anti-fungal susceptibility and establish effective treatment.

Animals↗
PubMed2003

Systemic mycoses in the immunocompromised host: an update in antifungal therapy.

Despite significant advances in the management of immunosuppressed patients, invasive fungal infections remain an important life-threatening complication. In the last decade several new antifungal agents, including compounds in pre-existing classes (new generation of triazoles, polyenes in lipid formulations) and novel classes of antifungals with a unique mechanism of action (echinocandins), have been introduced in clinical practice. Ongoing and future studies will determine their exact role in the management of different mycoses. The acceleration of antifungal drug discovery offers promise for the management of these difficult to treat opportunistic infections.

Amphotericin B↗
PubMed1999

[Mycoses of the paranasal sinus system].

BACKGROUND: During the last few years, in increasing number of fungal infections in the paranasal sinus system has been observed. Aspergillus species as well as mucor and candida albicans are especially responsible for these mycoses. PATIENTS: Twenty-seven cases of a fungal infection of the paranasal sinuses were observed between 1986 and 1997. The majority of the patients showed a chronic noninvasive form with affection of the maxillary sinus. Other forms (fulminant invasive form, chronic invasive form, allergic fungal sinusitis) are described. Typical features for fungal infection do exist in MRI and CT. CONCLUSIONS: A flexible therapeutic strategy is required in which appropriate pharmacologic and surgical options are tailored to the respective clinical picture.

Adult↗
PubMed1979

Superficial mycoses in a southern New Zealand district.

A total of 2,709 pathogenic fungi were isolated from 8,762 patients suspected as having mycotic disease, over an 8 year period in Christchurch, New Zealand. The district is climatically designated as temperate with average mean temperatures of 17 degrees C in summer and 8 degrees C in winter. The predominant species of fungi were relatively small in number with Trichophyton mentagrophytes var. interdigitals as the major pathogen. Fungi other than true dermatophytes, particularly Candida spp. and Malassezia furfur, were included to demonstrate the full spectrum of superficial mycoses presenting for diagnosis at the mycology clinic.

Adolescent↗
PubMed1989

Immunofluorescence staining of hyphae in the histopathological diagnosis of mycoses in cattle.

An immunofluorescence staining system was developed for the identification of mycelial fungi causing systemic mycoses in cattle. Antisera to Absidia corymbifera, Aspergillus fumigatus, Aspergillus flavus, and Aspergillus niger were raised in rabbits. Tissue sections of experimentally infected mice were used to determine the specificity of immune staining with antisera that had been absorbed with heterologous antigens. When 46 lesions from 22 cattle with systemic mycosis were studied, the infecting agent could be classified as a zygomycete, possibly A. corymbifera, in 18 lesions (15 cattle), A. fumigatus in 10 lesions (7 cattle) and both a zygomycete and A. fumigatus in a single lesion from one animal. Diagnosis was established by light microscopy in 13 (72%) of the 18 lesions classified as zygomycosis. Conversely, a dual infection with both a zygomycete and an Aspergillus species was suspected on the basis of morphology in nine of the 10 lesions reacting exclusively and uniformly with anti-A. fumigatus antiserum. A. fumigatus may be a more frequent aetiological agent of systemic mycosis in cattle than hitherto recognized on the basis of light microscopy and mycological culture.

Animals↗
PubMed2000

Vital staining of fungal elements in deep-seated mycotic lesions during experimental murine mycoses using the parenterally applied optical brightener Blankophor.

Optical brighteners of the diaminostilbene type are fluorescent dyes which are popular diagnostic tools in the mycology laboratory. While these dyes are conventionally used for the in vitro diagnosis of mycoses, their low toxicity and chemical reactivity have led us to investigate their potential use for in vivo staining of fungal elements in mycotic tissue. In mice we have established deep-seated candidiasis, cryptococcosis, aspergillosis and zygomycosis, as well as coccidioidomycosis, histoplasmosis and blastomycosis. After establishment of infection, which mostly required immunosuppression, a single dose of 100 microl of an aqueous solution (2.2 x 10(-4) M) of the optical brightener Blankophor P fluessig (4,4'-Bis [(4-anilino-6-substituted-1,3,5-triazine-2-yl) amino] stilbene-2,2'-disulfonic acid) was injected by the tail vein and the animals were sacrificed 1 h later. Sections of freshly prepared target organs were directly subjected to epifluorescence microscopy using an appropriate filter kit. In most cases, fluorescent fungal elements could be detected in the murine tissue. There was little evidence for uptake of the dye by non-infected tissues. It is suggested that radioactive labeling may render parenteral Blankophor suitable for radiographic localization of deep-seated mycotic foci in the host.

Animals↗
PubMed2001

Need for alternative trial designs and evaluation strategies for therapeutic studies of invasive mycoses.

Studies of invasive fungal infections have been and remain difficult to implement. Randomized clinical trials of fungal infections are especially slow and expensive to perform because it is difficult to identify eligible patients in a timely fashion, to prove the presence of the fungal infection in an unequivocal fashion, and to evaluate outcome in a convincing fashion. Because of these challenges, licensing decisions for antifungal agents have to date depended heavily on historical control comparisons and secondary advantages of the new agent. Although the availability of newer and potentially more effective agents makes these approaches less desirable, the fundamental difficulties of trials of invasive fungal infections have not changed. Therefore, there is a need for alternative trial designs and evaluation strategies for therapeutic studies of invasive mycoses, and this article summarizes the possible strategies in this area.

Antifungal Agents↗
PubMed1994

Newer developments in therapy for endemic mycoses.

In the 1960s and 1970s, amphotericin B was the only effective therapy for serious systemic endemic fungal infections due to Histoplasma capsulatum, Blastomyces dermatitidis, and Sporothrix schenckii. In the 1980s, ketoconazole was introduced as therapy for endemic mycoses; after this antifungal agent was introduced, some of these infections could be treated orally in an outpatient setting rather than intravenously in an inpatient setting. The 1990s have become the triazole era. It is now standard practice to treat nonmeningeal, non-life-threatening histoplasmosis and blastomycosis orally on an outpatient basis; the drug of choice for this treatment is itraconazole. Itraconazole also has proved useful as treatment for histoplasmosis in patients infected with human immunodeficiency virus. Although itraconazole has not yet been approved for the treatment of sporotrichosis, in preliminary studies it has been shown to be effective therapy not only for cutaneous and lymphocutaneous sporotrichosis but also for disseminated infection with S. schenckii.

Antifungal Agents↗
PubMedDate not supplied

Chemotherapy for the systemic mycoses: the prelude to ketoconazole.

Successful chemotherapy of the systemic mycoses now covers a span of more than 75 years and dates to the first reported use of potassium iodide for treatment of sporotrichosis. The second drug with efficacy was stilbamidine, and its currently available successor, hydroxystilbamidine isethionate, still has a role in therapy of some patients with nonprogressive blastomycosis of the skin. The introduction in 1957 of amphotericin B marked the first time there was an effective agent for such diseases as cryptococcosis, histoplasmosis, candidosis, and with lesser success, for coccidioidomycosis, mucormycosis, and aspergillosis. However, amphotericin B is nephrotoxic, depresses bone marrow (especially erythropoeisis), and, if patients are not monitored and controlled closely, the drug produces hypokalemic muscle weakness and cardiotoxicity. Flucytosine has a narrower spectrum of activity (cryptococcosis, candidosis, cladosporiosis, and chromomycosis) but a preferable route of administration (oral). Newer agents presently available are miconazole and clotrimazole; the latter is for topical use only.

Amphotericin B↗