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PubMed1993

[Testing the sensitivity of opportunistic agents of mycoses to antimycotic drugs in vitro].

The authors tried to standardize the method of assessment of the minimal inhibitory concentration (MIC) of antimycotics for the evaluation of the sensitivity of opportunistic causal agents of mycoses. They paid attention to factors which cause deterioration of the reproducibility of tests and lead to intra- and interlaboratory variability of results. In conjunction with this the authors drew attention to the lack of uniformity of views on the application of these tests in clinical practice. In the author's view the reservation pertaining in particular to an inadequate correlation of results in vitro and in vivo do not cast doubts on the expedience of laboratory assessment of sensitivity. Testing of systemic antimycotics with a low pharmacotherapeutic index and a relatively high frequency of secondary resistance is particularly justified. In those instances assessment of MIC values is a significant component of monitoring of adequate antifungal chemotherapy, in particular when antimycotics are administered for prolonged periods to patients with altered immunity.

Antifungal Agents↗
PubMed1993

[Mycoses of the heart].

There is an increasing frequency of heart mycoses. Authors identified 19 such cases between 1972 and 1991, 63% in the last 6 years (frequency was 0.1% in 17.661 autopsies of patients over 7 days of life). Males prevailed (17:2). Yeasts of genus Candida dominated, unusual etiology represented Candida parapsilosis, Torulopsis candida and Aspergillus restrictus. Sampling from vegetations or abscesses was a prerequisite for positive autoptic cultivation. Probable source of infection was found in 12 patients and 5 of them had an infected thrombosis of venous catheter. Mycosepsis comprised nearly equal number of endocarditides (mostly left sided) and myocarditides. Spread of endocardial infection into myocardium was rare, most myocarditides resulted from disseminated infection in immunocompromised patients. Endocarditides mainly complicated surgical interventions.

Adolescent↗
PubMedDate not supplied

Invasive Fusarium infections: a retrospective survey of 31 cases. The French 'Groupe d'Etudes des Mycoses Opportunistes' GEMO.

A retrospective study was conducted in France to investigate Fusarium infections which are now recognized as emerging opportunistic infections. The clinical and mycological findings for 31 cases diagnosed between 1984 and 1993 by members of the French Groupe d'Etudes des Mycoses Opportunistes were analysed. All suffered from haematological disease, most often acute leucaemia (n = 19). Twenty-two had received cytostatic chemotherapy and ten had undergone bone marrow transplantation. Prolonged aplasia and pancytopenia were present in 18 and 11 patients, respectively. Skin (61%) and blood (42%) were the sites most frequently involved. Fusarium solani (n = 7), Fusarium oxysporum (n = 7), Fusarium verticilloides (n = 7) were the species most frequently isolated. Nine antifungal treatments were used, associated with colony-stimulating factors in five cases. None was unambiguously superior to all the others. The overall mortality was 51.6% with a specific mortality > or = 25.8%. The disseminated form of the infection was associated with poor prognosis (P < 0.02) whereas improving granulocyte count improved prognosis (P < 0.001). More aggressive cytostatic regimens used for patients with haematological malignancies have favoured the emergence of Fusarium infections. As prognosis is closely correlated with neutrophil recovery, the promising results obtained with the use of colony-stimulating factors should be further evaluated.

Adolescent↗
PubMed1976

Granulomatous mycoses of the central nervous system.

A clinical and pathological description of five cases of granulomatous mycoses of the C.N.S. is reported. Four had an intracranial and one a spinal localization. In all patients the clinical pattern was of tumoral type, while the disease evolution was favourable only in one case. From a histipatholic point of view the preliminary diagnosis was of granulomatous process. The fungi organisms were identified only by means of combined stain methods. Beside the pathogenetic problems the Authors outline some histological methods useful for diagnostic purposes when a culture procedure for fungi is lacking.

Actinomycetaceae↗
PubMed1997

[Profound mycoses in AIDS in Abidjan (Côte d'Ivoire)].

During 1995, among 1105 HIV patients explored in our department, 64 presented a deep fungic infection (5.8%). The yeast was searched for in cerebrospinal fluid, blood, urine, and bronchoalveolar aspiration. Isolated germs were Cryptococcus neoformans (95%), Candida tropicalis (1 case), Saccharomyces cerevisiae (1 case) et Aspergillus fumigatus (1 case). Results of treatment with amphotericin B were: recovery (9%), clinical success (11%), out of sight (14%), letality (66%), relapse (23%) and side effects (19%). We emphasized diagnostical and therapeutical difficulties, and bad prognostic of mycoses in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Fontana-Masson--stained tissue from culture-proven mycoses.

BACKGROUND: The Fontana-Masson stain can be used to detect melanin of dematiaceous fungi such as Curvularia lunata and Bipolaris hawaiiensis in tissue. This stain is often used to identify fungi that may not have an evident brown color in hematoxylin-eosin-stained sections. However, it is not clear whether hyphae of nondematiaceous fungi can be stained with the Fontana-Masson procedure. METHODS: Paraffin sections from culture-proven mycoses caused by species of Aspergillus, Candida, Fusarium, Pseudallescheria, Trichosporon, zygomycetes, and dematiaceous fungi were stained by the Fontana-Masson procedure. Extent of stain intensity and its distribution in fungal elements in tissue were evaluated by means of an intensity scale based on Cryptococcus neoformans as a positive control. RESULTS: Many Aspergillus spp, some zygomycetes, and all of the dematiaceous fungi showed strong intensity, whereas other fungi showed either weak intensity or no staining. CONCLUSION: Fungal hyphae other than dematiaceous fungi occasionally can be stained with the Fontana-Masson procedure. The morphology of positively stained hyphae must be carefully evaluated, especially when they are hyaline in hematoxylin-eosin-stained tissue sections.

Aspergillus↗
PubMed1998

[AIDS and opportunistic visceral mycoses. A diagnostic and therapeutic update].

Candidiasis, cryptococcosis, aspergillosis, histoplasmosis, and coccidioidomycosis are the most commonly recognized visceral mycoses complicating the course of HIV infection and AIDS. Their current management issues are discussed on the ground of the personal experience, and the most recent literature evidences.

AIDS-Related Opportunistic Infections↗
PubMed1991

Treatment of deep mycoses with itraconazole.

Four patients with deep mycoses were treated with itraconazole. Two patients had chromoblastomycosis, one patient each had aspergillosis and Rhinofacial zygomycosis. These patients were either resistant to or showed poor response to Amphotericin B and/or ketoconazole. After the initial clinical and mycological evaluation, itraconazole was given in a daily dose of 200 mg orally. All patients responded to the drug very well. No adverse effects attributable to itraconazole were detected.

Adult↗
PubMed1976

Miconazole in the treatment of superficial mycoses.

Miconazole nitrate (2%) cream was evaluated in the treatment of superficial mycoses. Out of 116 patients having multiple clinical diagnoses, 66 cases were found to be positive by culture. Species of Trichophyton were the predominant etiological agents (in over 60%) followed by Candida species (20%) and Epidermophyton floccosum (15%). All the cases selected for study were followed up to a period of 4-18 months. A cure rate of 94.6 per cent was observed in all the cases where causal organisms were isolated. Significantly high cure rate (66%) was also seen in cases where causal organisms could not be isolated, including cases of tinea versicolor. Results of mycological examination were in confirmity with the clinical results.

Candidiasis↗
PubMed1981

Superficial mycoses in Italy.

A total of 1244 cases suspected of superficial mycoses were analysed in a period of 12 months in Italy. Dermatophytoses were found in 62.4%; the other common disease was Pityriasis versicolor (44.1%)., The predominant species Epidermophyton floccosum (34,2%) was strikingly high in relation to other statistics; this species was commonest in tinea cruris. Among the other dermatophytes M. canis was predominant (31.3%) commonest in tinea corporis, followed by T. mentagrophytes (17,8%) and T. rubrum (10,3%). A high rate of yeasts was found in tinea manum (81.6%) and tinea pedis (47.7%). ?

Adolescent↗
PubMed1994

Thoracotomy for pulmonary mycoses in non-HIV-immunosuppressed patients.

Pulmonary mycoses can be life threatening in patients who are in an immunocompromised state stemming from defective host defenses or the use of certain treatment regimens. In 36 immunosuppressed patients undergoing thoracotomy for the treatment of pulmonary fungal disease, the underlying cause of immunosuppression was malignancy (n = 9), Wegener's granulomatosis (n = 4), hematologic disorders (aplastic anemia, 5-Q minus syndrome, or myelofibrosis) (n = 6), or chronic granulomatous disease of childhood (n = 17). The mean age of the patients was 25 years, and 89% were symptomatic (fever, n = 27; cough, n = 20; chest pain, n = 14; and other, n = 13). Chest x-ray studies revealed the presence of cavitary disease (n = 7), a mass (n = 8), infiltrates (n = 20), or cavity and infiltrate (n = 1). A preoperative diagnosis was lacking in 23 of the 36 patients. Procedures included wedge biopsy (n = 13), segmentectomy with or without wedge or chest wall resection (n = 5), lobectomy with or without chest wall resection (n = 16), wedge resection plus completion pneumonectomy (n = 1), and segmentectomy plus completion pneumonectomy (n = 1). Fungi identified included Aspergillus (n = 23), Zygomycetes (n = 4), Cryptococcus (n = 3), and other (n = 6; 1 each), and specific antifungal treatment was instituted in 34 of the patients (94%). The 31% operative (ie, < 30-day or inhospital) mortality was chiefly due to multiorgan system failure (9/11).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Itraconazole in opportunistic mycoses: cryptococcosis and aspergillosis.

Striking results were obtained with oral itraconazole therapy in two opportunistic mycoses. Of 28 patients with cryptococcal meningitis, 18 achieved complete responses, including 16 of 24 patients with acquired immunodeficiency syndrome. Other manifestations of cryptococcosis were similarly responsive. In aspergillosis 12 of 15 patients responded, including 8 of 10 immunocompromised hosts. These patients included those with invasive pulmonary disease (4/5), skeletal disease (2/2), pleural disease (1/2), and pericardial, sinus, mastoid, hepatosplenic, or nail disease (1/1). These results with itraconazole compare favorably to conventional (parenteral) therapy, and toxicity was minimal. This suggests that comparative trials are now in order.

Acquired Immunodeficiency Syndrome↗
PubMed1998

National epidemiology of mycoses survey: a multicenter study of strain variation and antifungal susceptibility among isolates of Candida species.

The National Epidemiology of Mycoses Survey (NEMIS) involves six academic centers studying fungal infections in surgical and neonatal intensive care unit (ICU) patients. We studied variation in species and strain distribution and anti-fungal susceptibility of 408 isolates of Candida spp. Candida spp. were isolated from blood, other normally sterile site cultures, abscesses, wounds, catheters, and tissue biopsies of 141 patients hospitalized in the surgical (107 patients) and neonatal (34 patients) ICUs of medical centers located in Oregon, Iowa, California, Texas, Georgia, and New York. Isolates were also obtained from selected colonized patients (16 patients) and the hands of health care workers (27 individuals). DNA typing was performed using pulsed field gel electrophoresis, and antifungal susceptibility to amphotericin B, 5-fluorocytosine, fluconazole, and itraconazole was determined using National Committee for Clinical Laboratory Standards (NCCLS) methods. Important variation in susceptibility to itraconazole and fluconazole was noted: MICs of itraconazole ranged from 0.25 microgram/mL (MIC90) in Texas to 2.0 micrograms/mL (MIC90) in New York. Similarly, the MIC90 for fluconazole was higher for isolates from New York (64 micrograms/mL) compared to the other sites (8-16 micrograms/mL). In general, DNA typing revealed patient-unique strains; however, there were 13 instances of possible cross-infection noted in 5 of the medical centers. Notably, 9 of the 13 clusters involved species of Candida other than C. albicans. Potential transmission from patient-to-patient (C. albicans, C. glabrata, C. tropicalis, C. parapsilosis) and health care worker-to-patient (C. albicans, C. parapsilosis, C. krusei) was noted in both surgical ICU and neonatal ICU settings. These data provide further insight into the epidemiology of nosocomial candidiasis in the ICU setting.

Amphotericin B↗
PubMed2003

Antifungal drugs used for systemic mycoses.

Table 1 summarizes the antifungal agents commonly used for the treatment of systemic mycoses. The treatment of these conditions remains a challenge. This is particularly the case with infections in neutropenic patients where mortality rates remain high despite the development of new drugs and the evaluation of drug combinations. Much attention has been focused on the development of new antifungal drugs that can provide a solution to this problem without concurrent toxicity and without the risk of drug resistance.

Administration, Oral↗
PubMed2003

Subcutaneous mycoses.

Subcutaneous mycoses include a heterogeneous group of fungal infections that develop at the site of transcutaneous trauma. Infection slowly evolves as the etiologic agent survives and adapts to the adverse host tissue environment. Diagnosis rests on clinical presentation, histopathology, and culture of the etiologic agents. This article considers sporotrichosis, chromoblastomycosis, and mycetoma.

Antifungal Agents↗
PubMed2003

Characteristics of superficial mycoses in Malta.

BACKGROUND: A study was conducted to determine the chief agents of superficial mycoses in Malta. Data were collected over a 5-year period from mycologic investigations carried out on all dermatologic specimens sent to the Mycology Laboratory at St. Luke's Hospital in Malta. METHODS: In the period between January 1995 and December 1999, a total of 1271 specimens from skin, nails, or hair were collected from 1200 clinically suspected cases of dermatomycoses. RESULTS: The fungi cultivated included dermatophytes (n = 371), yeasts (n = 33), and nondermatophyte filamentous fungi (n = 12). Trichophyton rubrum (n = 121) was the most prevalent, followed by Microsporum canis (n = 109), T. mentagrophytes (n = 80), M. gypseum (n = 27), Epidermophyton floccosum (n = 17), T. soudanense (n = 10), T. tonsurans (n = 2), T. verrucosum (n = 2), M. persicolor (n = 1), and T. violaceum (n = 1). Candida species were also cultivated, with C. parapsilosis (n = 14) being the most common, followed by C. albicans (n = 12) and C. tropicalis (n = 6). Nondermatophyte filamentous fungi were isolated from nail specimens only. CONCLUSIONS: In this study, superficial fungal infections were reported more commonly in female (n = 207) than in male (n = 182) patients. M. canis was the chief agent of tinea capitis and tinea corporis, whilst T. rubrum was the main causative agent of tinea pedis, tinea manuum, and tinea unguium. Onychomycosis due to Candida species was more common in female than in male patients.

Adolescent↗
PubMed2000

The role of murine models in the development of antifungal therapy for systemic mycoses.

Animal testing is crucial to the development of new antifungal compounds. This review describes the role that murine and other animal models have played in the development of three classes of antifungal agents: the polyenes, the triazoles and the echinocandins and the ways in which these models have been either the positive link in the path from in vitro studies to the patient, or have foreclosed later clinical evaluation. Efficacy studies in particular mycoses are discussed, as well as studies designed to determine whether combinations of antifungal drugs may have value over single agents. Copyright 2000 Harcourt Publishers Ltd.

Journal Article↗
PubMed1988

Pulmonary mycoses. New concepts and new therapy.

The pathogenic and opportunistic fungi that commonly infect the human respiratory system cause diseases such as histoplasmosis, blastomycosis, aspergillosis, and invasive candidiasis. The increase in the incidence and severity of mycotic infections due to more aggressive immunosuppressive therapy and the spread of acquired immunodeficiency syndrome (AIDS) has had an impact on diagnosis and treatment of these conditions. Several therapeutic agents are currently available or undergoing clinical trials in the treatment of the pulmonary mycoses; among the agents with the greatest potential usefulness are the oral imidazoles, ketoconazole, itraconazole, and fluconazole.

Antifungal Agents↗