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PubMed1990

Review of animal mycoses in Australia.

This review covers the available literature on the mycoses of animals in Australia since the last review published in 1967. Of the cutaneous infections, dermatophytoses have been recorded in a wide range of animals: cattle, horses, goats, pigs, sheep, cats, dogs, mice, guinea-pigs, rabbits, a lion, kangaroos, a camel, koalas and wallabies. These infections were caused by several species and varieties of the genera, Microsporum and Trichophyton. Eight agents of ringworms have been recorded in the horse. Two subcutaneous mycoses, phaeohyphomycosis and sporotrichosis have been reported. Phaeohyphomycosis is becoming more common but sporotrichosis is rare having been recorded only once in a cat. The following systemic mycoses have been recorded: adiaspiromycosis, aspergillosis, candidiasis, cryptococcosis, dactylariosis, fusariomycosis, histoplasmosis, miscellaneous mycoses, mycotic abortion and related conditions, zygomycosis, pythiosis, protothecosis and green algal infections. Cryptococcosis has affected 11 different animal species. Mycotic abortion is a serious disease in Victoria. Pythiosis of horses has been extensively studied in northern Australia.

Animals↗
PubMed2005

Serodiagnosis of mycoses using recombinant antigens.

The early diagnosis of mycoses is important for the institution of an effective antifungal therapy. Detection of antibodies against crude antigenic extracts is one of the standard techniques for the diagnosis of most mycoses. However, while these crude antigenic extracts are relatively easy to obtain, they usually show low reproducibility and are not very specific, since antibodies from patients with different mycoses may show cross-reactivity. The application of molecular biology techniques to the study of fungal antigens has allowed the production of recombinant antigens that may help to solve these problems. The purpose of this review is to discuss the use of recombinant fungal antigens in the diagnosis of mycoses.

Antigens, Fungal↗
PubMed2005

[Mycoses of the head and neck].

OBJECTIVES: The ever growing number of immunocompromized patients and increasing travel to areas where fungal diseases are endemic explain why in recent years mycoses have emerged as important infections in clinical practice. It is essential that pathologists and clinicians be knowledgeable about them. RESULTS: Head and neck infections are common in disseminated mycoses. The most frequent causative yeasts or yeast-like organisms include Candida albicans, Cryptococcus neoformans, Histoplasma capsulatum var capsulatum, Blastomyces dermatitidis, Paracoccidioides brasiliensis and Coccidioides immitis. Other causative fungal pathogens include Aspergillus fumigatus and less frequently, Rhizopus oryzae and Rhinosporidium seeberi. Since their pathophysiology is in most cases similar, those microorganisms share a common clinical pathological picture. Head and neck mycoses may simulate carcinoma or cause upper airway obstruction. Symptoms such as dysphonia or dysphagia associated with hyperplastic and ulcerative lesions on endoscopic examination should prompt biopsies. An inflammatory tissue reaction with pseudoepitheliomatous hyperplasia warrants caution since it may lead to a mistaken diagnosis of cancer. CONCLUSION: The pathologist must look carefully for microorganisms with special stains. Clinicians and pathologists must be aware of these mycoses to identify the causative agent, isolated it by culture, and prescribe adequate treatment for the patients.

Aspergillosis↗
PubMed2001

Emerging trends in the epidemiology of invasive mycoses in England and Wales (1990-9).

Invasive fungal infections are becoming an increasing public health problem owing to the growth in numbers of susceptible individuals. Despite this, the profile of mycoses remains low and there is no surveillance system specific to fungal infections currently existing in England and Wales. We analysed laboratory reports of deep-seated mycoses made to the Communicable Disease Surveillance Centre between 1990 and 1999 from England and Wales. A substantial rise in candidosis was seen during this period (6.76-13.70 reports per million population/year), particularly in the older age groups. Rates of cryptococcosis in males fluctuated over the decade but fell overall (1.05-0.66 per million population/year), whereas rates of female cases gradually rose up until 1998 (0.04-0.41 per million population/year). Reports of Pneumocystis carinii in men reduced substantially between 1990 and 1999 (2.77-0.42 per million population/year) but showed little change in women. Reports of aspergillosis fluctuated up until 1996, after which reports of male and female cases rose substantially (from 0.08 for both in 1996 to 1.92 and 1.69 per million population/year in 1999 for males and females respectively), largely accounted for by changes in reporting practice from one laboratory. Rates of invasive mycoses were generally higher in males than females, with overall male-to-female rate ratios of 1.32 (95% CI 1.25-1.40) for candidosis, 1.30 (95% CI 1.05-1.60) for aspergillosis, 3.99 (95% CI 2.93-5.53) for cryptococcosis and 4.36 (95% CI 3.47-5.53) for Pneumocystis carinii. The higher male than female rates of reports is likely to be a partial reflection of HIV epidemiology in England and Wales, although this does not fully explain the ratio in infants and older age groups. Lack of information on underlying predisposition prevents further identification of risk groups affected. Whilst substantial under-reporting of Pneumocystis carinii and Cryptococcus species was apparent, considerable numbers of superficial mycoses were misreported indicating a need for clarification of reporting guidelines. Efforts to enhance comprehensive laboratory reporting should be undertaken to maximize the utility of this approach for surveillance of deep-seated fungal infections.

Adolescent↗
PubMedDate not supplied

The growing problem of mycoses in patients infected with the human immunodeficiency virus.

With the rapid increase in cases of AIDS over the past 10 years, certain mycoses have dramatically risen in frequency, particularly those contained by T cell-mediated mechanisms of host defense. In this clinical setting mucocutaneous candidiasis as well as systemic cryptococcosis, histoplasmosis, and coccidioidomycosis pose special diagnostic and/or therapeutic challenges. Compared with fungal infections in general, AIDS-associated mycoses are more likely to have nonspecific clinical manifestations; moreover, treatments effective in other settings seldom are curative. These problems have led to new vigilance regarding mycoses in the differential diagnosis of complications of infection due to the human immunodeficiency virus (HIV) and have necessitated a redefinition of goals: the aim is now to suppress rather than cure infection in most cases. This change has stimulated trials of new antifungal agents and regimens particularly designed to facilitate long-term outpatient management of mycoses without interfering with treatment of either HIV infection itself or other concomitant complications.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Laboratory evaluation of new antifungal agents against rare and refractory mycoses.

PURPOSE OF REVIEW: An increase in refractory invasive fungal infections in the setting of marrow/solid organ transplantation and other immune-compromising clinical entities has provided the impetus for the development of new, more efficacious/less toxic antifungal agents. This review (1) examines currently available laboratory methods for the in-vitro evaluation of these new agents against both yeasts and filamentous fungi; (2) provides a summary of the most attractive investigational agents currently undergoing clinical trials/development; and (3) outlines the major refractory mycoses in contemporary medicine. RECENT FINDINGS: Fluconazole-resistant Candida spp., Trichosporon spp., zygomycetous genera, the endemic mycoses, Scedosporium, Aspergillus, and Fusarium spp., and an ever-expanding list of lesser-known hyaline and phaeoid genera inciting invasive fungal infections comprise the bulk of refractory mycoses in the immune-compromised host. In-vitro data generated from reference-based antifungal susceptibility testing methods indicate an increased armamentarium of potentially efficacious agents against most of these mycoses. SUMMARY: The newly approved antifungal agents caspofungin and voriconazole, used either as monotherapy or in combination regimens, have a significantly improved spectrum of activity over previously available therapeutic options. Correlation of clinical outcomes with investigational agents demonstrating in-vivo/in-vitro activity will provide critical information needed for the development of clinically significant minimum inhibitory concentration interpretative breakpoints.

Anti-Bacterial Agents↗
PubMed2003

Status of combination therapy for refractory mycoses.

PURPOSE OF REVIEW: Invasive fungal infections remain a leading cause of infectious morbidity and mortality in heavily immunosuppressed patients. As the efficacy of current antifungal agents is suboptimal, combinations of antifungal agents, administered concomitantly or sequentially, are increasingly used (mostly empirically) as a strategy to improve the treatment outcomes for refractory mycoses. Here we review recent developments in the area of antifungal combinations based on both laboratory (in vitro and in animal models) and clinical studies. RECENT FINDINGS: With the exception of cryptococcal meningitis, the benefits of combination antifungal therapy have been more difficult to prove for other life-threatening mycoses such as invasive candidiasis or invasive aspergillosis. The recent introduction of a new class of antifungal agents (the echinocandins) and of extended spectrum triazoles has renewed interest in studying antifungal combinations that may result in additive or synergistic effects in difficult-to-treat mycoses. The combination of an echinocandin plus amphotericin B or a newer triazole seems to be the most promising in vitro and in animal model studies, whereas reliable clinical information especially for invasive mould infections is still lacking. SUMMARY: Antifungal combinations are conceptually appealing as a strategy to overcome the frequent failures of antifungal monotherapy in immunosuppressed patients with invasive mycoses. Results of in-vitro studies cannot yet be translated into measurable clinical results because of methodological problems and the complexity of designing relevant prospective clinical trials, but important findings are expected in the near future in this rapidly expanding investigational area.

Animals↗
PubMed1992

Orofacial manifestations of the systemic mycoses.

Aspergillosis, cryptococcosis and zygomycosis (mucormycosis) are overall the most common systemic mycoses but histoplasmosis is particularly endemic in parts of central USA and other areas worldwide. Orofacial lesions caused by systemic mycoses have rarely been reported in the past though they have been recorded particularly in outdoor workers from geographic areas with a high prevalence of infection and occasionally in immunocompromised individuals. Increasing world-wide travel, and the dramatic increase in numbers of immunocompromised persons, especially those with human immunodeficiency virus (HIV) disease, have been responsible for an increase in reports and other studies of orofacial disease in systemic mycoses and new opportunists are now being recognized. Those in Oral Medicine and Pathology must now be aware of the possibility of a systemic mycosis as the cause of chronic oral ulceration, chronic maxillary sinus infection, or bizarre mouth lesions, especially in patients with HIV disease, lymphoproliferative disorders, or diabetes mellitus, or in those who have been in endemic areas. Diagnosis and management should be undertaken in consultation with a physician with appropriate expertise, as pulmonary and other systemic infection may well be present. This paper reviews the eight main systemic mycoses.

Aspergillosis↗
PubMed1999

Epidemiology of visceral mycoses: analysis of data in annual of the pathological autopsy cases in Japan.

The data on visceral mycoses that had been reported in the Annual of the Pathological Autopsy Cases in Japan from 1969 to 1994 by the Japanese Society of Pathology were analyzed epidemiologically. The frequency of visceral mycoses among the annual total number of pathological autopsy cases increased noticeably from 1.60% in 1969 to a peak of 4.66% in 1990. Among them, the incidences of candidiasis and aspergillosis increased the most. After 1990, however, the frequency of visceral mycoses decreased gradually. Until 1989, the predominant causative agent was Candida, followed in order by Aspergillus and Cryptococcus. Although the rate of candidiasis decreased by degrees from 1990, the rate of aspergillosis increased up to and then surpassed that of candidiasis in 1991. Leukemia was the major disease underlying the visceral mycoses, followed by solid cancers and other blood and hematopoietic system diseases. Severe mycotic infection has increased over the reported 25-year period, from 6.6% of the total visceral mycosis cases in 1969 to 71% in 1994. The reasons for this decrease of candidiasis combined with an increase of aspergillosis or of severe mycotic infection might be that (i) nonsevere (not disseminated) infections were excluded from the case totals, since they have become controllable by antifungal drugs such as fluconazole, but (ii) the available antifungal drugs were not efficacious against severe infections such as pulmonary aspergillosis, and (iii) the number of patients living longer in an immunocompromised state had increased because of developments in chemotherapy and progress in medical care.

AIDS-Related Opportunistic Infections↗
PubMed2006

[Epidemiology of visceral mycoses in patients with leukemia and MDS - Analysis of the data in annual of pathological autopsy cases in Japan in 1989, 1993, 1997 and 2001].

To study the changes of visceral mycoses in autopsy cases, data on visceral mycosis cases with leukemia and myelodysplastic syndrome (MDS) reported in the Annual of the Pathological Autopsy Cases in Japan in 1989, 1993, 1997 and 2001 were analyzed. The frequency rate of visceral mycoses with leukemia and MDS was 27.9% (435/1,557) in 1989, 23.0% (319/1,388) in 1993, 22.3% (246/1,105) in 1997 and 25.1% (260/ 1,037) in 2001, which was clearly higher than the rate of cases without leukemia and MDS: 3.4%, 2.7%, 3.5% and 3.7%, respectively. Furthermore, in comparing the rate of mycoses in recipients of stem cell transplantation with that of non-recipients, that of recipients was about 10% higher. The predominant causative agents were Candida and Aspergillus, at approximately the same rate (Candida 33.6%, Aspergillus 33.3%) as in 1989. However, Aspergillus increased conspicuously in 1993 (Candida 22.3% Aspergillus 44.5%), and continued to increase (Candida 22.8%, Aspergillus 50.8% in 1997; Candida 16.9%, Aspergillus 54.2% in 2001). In aspergillosis and zygomycosis, the lung and bronchi comprised the most commonly infected organs: 74.7% and 75.6% of the total cases, respectively. Among a total of 1,260 cases with mycotic infections in the four years studied, acute lymphatic leukemia and acute myeloid leukemia were the major diseases (35.5% and 33.5%, respectively) followed by MDS (29.0%). Given these facts, we emphasize that a greater interest in mycoses should be taken by clinicians, and immunocompromised patients should be protected from opportunistic invasive fungal infections, especially aspergillosis.

Adolescent↗
PubMed2000

[Systemic tropical mycoses].

Systemic tropical mycoses have been emerging since the beginning of the AIDS epidemic. The incidence of these infections is probably even underestimated since most cases occur in populations with poor access to medical care in regions where modern diagnostic methods are unavailable. In Europe, this pathology is sometimes observed in returning travelers, aid workers, and immigrants. Differential diagnosis of imported systemic tropical mycosis may be difficult for uniformed physicians. The purpose of this review of the literature is to provide up-to-date epidemiological, clinical, diagnostic, and therapeutic data on the six main systemic tropical mycoses with disseminated forms. The six mycoses described in this study are histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, and penicilliosis due to Penicillium marneffei. Strictly superficial and subcutaneous mycoses are not covered.

Blastomycosis↗
PubMed1975

[Current problems and new developments in therapy of mycoses (author's transl)].

Mycoses for most of them) represent a group of infectious diseases which seem to increase steadily although numerous fungicidal or fungistatic therapeutics are available. A severe problem is provided by the so-called opportunistic fungi which become parasitic only after the host's immunological protection has been impaired by predisposing factors. Therapy resistance and prevention of relapse are problems of a general nature in the therapy of mycoses. As special topics local treatment of dermatophytoses, of Candida mycoses, and new development in systemic treatment of deep mycoses are discussed.

Amphotericin B↗
PubMed1986

Systemic mycoses in the United States, 1980-1982.

To evaluate temporal trends in the incidence of systemic mycoses resulting in hospitalization, we reviewed hospital discharge data from the Professional Activity Study of the Commission on Professional and Hospital Activities for 1980-1982. In comparison with results from similar studies in 1970 and 1976, the incidences of the mycoses that are more likely to be opportunistic and/or hospital-acquired infections (candidiasis, aspergillosis, cryptococcosis) increased in 1980-1982 as did the incidences of sporotrichosis and actinomycosis. At the same time the incidences of most community-acquired mycoses (histoplasmosis, coccidioidomycosis, and blastomycosis) remained stable or declined. These results are consistent with the increasing number of immunocompromised patients with severe underlying illnesses, who are at risk of developing opportunistic mycoses.

Cross Infection↗
PubMed1995

Current drug therapy of systemic mycoses: a review.

The frequency of systemic fungal infections have increased significantly in the past decade. Opportunistic systemic fungal infections are increasingly posing difficult management challenges to the clinician. To the aid of the clinician, new systemic antifungal agents have also emerged in the last two decades. To effectively utilise the old and new antifungal agents, a clear understanding of their clinical pharmacology and therapeutic applications is needed. Amphotericin-B remains effective therapy in many severe disseminated mycoses including candidaemia and cryptococcosis but problems with toxicity (especially nephrotoxicity), resistances, and non-availability of oral form for long-term maintainance therapy in the immunocompromised patient create important drawbacks. Flucytosine is not effective when used alone and is only used in combination with amphotericin-B in cryptococcal and candidal meningitis. Ketoconazole is available in oral form for systemic antifungal use and is an effective therapy for endemic mycoses, dermatomycoses and oropharyngeal candidiasis. However, it is not satisfactory therapy for deep seated mycoses in the immunocompromised patient. Itraconazole is a new triazole antifungal with better pharmacokinetic profile than Ketoconazole and is currently the drug of choice in most non-life threatening endemic mycosis and is also useful in some deep opportunistic mycoses. Fluconazole is also new triazole antifungal which has the best pharmacokinetic profile and least incidence of adverse effects among all the systemic antifungal available today. It is a first-line therapy for deep candidal and cryptococcal infections in both the immunocompetent and immunocompromised. It is also a first-line maintainance therapy for these infections in the immunocompromised.

Antifungal Agents↗
PubMed1994

[Epidemiology of deep-seated, domestic mycoses].

The opportunistic character of deep-seated mycoses depends on granulocyte-based defense in candidosis and aspergillosis. Therefore, haematological, patients represent the group of highest risk. Mucocutaneous candidosis is controlled by macrophages. Cryptococcus neoformans forces its way into the human host via causing an imbalance in the CD8-T-cell suppressor system. An aggravating synergism exists between Cryptococcus invasion and HIV-infection which explains the severe course of cryptococcosis in AIDS patients. The following pathways of transmission are observed in opportunistic mycoses: In aspergillosis and cryptococcosis humans are infected by inhalation of fungal propagules and primary settlement of the pathogens in the lungs, a site from which dissemination may occur. Exposure to Aspergillus conidiospores is ubiquitous and can be remarkably intensified by construction activities. Exposure to Cr. neoformans is geographically highly variable; not all humans are exposed. Candidosis emerges from the commensal reservoir of the human gastrointestinal tract, caused by translocation of the pathogens from the GI tract into the blood-lymph circulation or by anal/oral or oral-oral infection respectively. The incidence of deep-seated mycoses in the northern hemisphere is estimated to be 600 mycosis situations per million population per year. The estimate for Germany amounts to 50,000 mycoses patients per year, i.e. 45,000 candidosis and 5,000 aspergillosis situations as well as 100 each of cryptococcal and other mycotic diseases. Beyond that the number of AIDS-patients with cryptococcosis in Germany amounts to about 200 cases.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Deep mycoses].

The problems of the diagnosis of deep mycoses such as candidiasis, aspergillosis and actinomycosis most frequent in this country are discussed. A classification system for deep mycoses based on the characteristics of the causative agents which is of practical value is presented. The microscopic and cultural diagnosticating of deep mycoses is described in detail. A brief information on the principles of the treatment of the mycoses is given.

Actinomycosis↗
PubMedDate not supplied

[Epidemiological and clinical profile of superficial mycoses in the Monastir region (Tunisia). Retrospective study (1991-1994) of 3578 cases].

Despite of socio-economical improvement in our population and the efficacy of available antifungal treatment, superficial mycoses remain a common condition in dermatologic practice. To determine the epidemio-clinical pattern of superficial mycoses in our region, a retrospective study of 3578 cases have been carried out in the Department of Dermatology of the University Hospital of Monastir during a 4 year-period. The mean age of patients was 33 years (range: 6 months-91 years). The male to female sex-ratio was 0.82. Rural origin, history of previous mycoses, diabetes, topic or systemic corticosteroids and the presence of animals in surroundings were the most predisposing factors. The most frequent clinical patterns were: tinea corcoris and pedis (40.3%), Tinea versicolor (21.6%), Tinea capitis (9.7%) dermatophytosis of hairless skin (9.6%) and onychomycosis (8.6%). Dermatophyte was the most frequent (55.5%). The occurrence of superficial mycose especially if it affects diffuse area of the body, or if it is relapsing and resistant to treatment, requires looking for predisposing factors.

Adolescent↗
PubMed1999

Therapeutic potential of terbinafine in subcutaneous and systemic mycoses.

Mycoses vary widely in severity, and may present as superficial, subcutaneous and/or systemic infection. Effective treatments for most superficial mycoses now exist, but new agents with convenient dosing regimens and a low level of adverse events are still needed to reduce morbidity and mortality from serious subcutaneous and systemic fungal infections. In vitro, terbinafine exhibits a broad spectrum of activity against the pathogenic fungi responsible for deep mycoses. Clinical data, while not abundant, suggest that this in vitro activity of terbinafine is reflected in its in vivo efficacy. The limited data show that terbinafine is a useful first-line treatment in chromoblastomycosis patients and has efficacy in pulmonary aspergillosis. There are also data to suggest that terbinafine may be effective in treating histoplasmosis, Pneumocystis carinii infection, fungal mycetoma, and cutaneous leishmaniasis. Moreover, there is some evidence of terbinafine having synergistic activity with amphotericin B, itraconazole, and fluconazole against clinical isolates of Candida species. Thus, the therapeutic potential of terbinafine extends well beyond its current use in acute and chronic dermatophytoses to include a wide range of subcutaneous and systemic mycoses. Studies are needed to determine the optimum dose in each disease, and whether combination therapy would have advantages in certain circumstances.

Antifungal Agents↗