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PubMed1991

Hendersonula toruloidea and Scytalidium hyalinum. Review and update.

Hendersonula toruloidea and Scytalidium hyalinum are opportunistic organisms that can produce tinea pedis, tinea manuum, and tinea unguium. These infections, which clinically mimic those caused by dermatophytes but are caused by nondermatophyte agents, are correctly called dermatomycoses. When examined microscopically with potassium hydroxide, the agents of these disorders resemble those of dermatophytosis, showing narrow, septate, branching hyphae. It, therefore, becomes important to culture samples taken from sites with these tineas on cycloheximide-free agars even if they are potassium hydroxide-positive to rule out nondermatophyte mycoses. Correct identification becomes imperative since neither H toruloidea nor S hyalinum responds to conventional therapy. We review these diseases with emphasis on clinical appearance and differentiation from dermatophytosis. We also report four cases of S hyalinum infection of the nail or feet.

Dermatomycoses↗
PubMed1990

[Obytin in the treatment of superficial skin mycoses].

Obytin (1% Cyclopyroxolamine) in the form of cream, a preparation of the firm Jugoremedija/Hoechst, was applied in the treatment of 33 patients with dermatophytic skin infections. The diseases were most frequently located in the intertriginous areas 19 (57%), somewhat less frequently on nude places of the skin 9 (27%), and on the hands and feet 5 (16%). The cream was applied twice daily for 28 days. Acute clinical symptoms of the disease disappeared rapidly under the influence of the preparation and disappeared completely after three weeks of treatment in 32 patients (97%); and four weeks after start of therapy mycology tests were negative in the same number of cases. Only 3% of patients had no evident changes during therapy. Obytin is one of the new topical antifungal agents with a wide spectrum of action and it can be used in all types of superficial dermatomycoses as well as in some bacterial infections. It is characterized by rapid onset of action. Side effects of local or systemic nature (irritative, alergic or toxic) had not been registered.

Adolescent↗
PubMedDate not supplied

[Multicentric clinical trial of a new combination of a broad spectrum antimycotic and a dermocorticoid (author's transl)].

After having reviewed the conditions of use of an antimycotic-corticoid combination, the authors are reporting their clinical results on 183 patients of a new drug combining econazole and triamcinolon. This clinical trial demonstrates that the own activity of each component of the combination is entirely maintained, and that the new combination shows an original interest in the treatment of all inflammatory dermatomycoses, as well as inflammatory supra-infected dermatoses.

Administration, Topical↗
PubMedDate not supplied

[A controlled double-blind clinical trial of a new association of a wide-spectrum antifungal preparation and a corticoid (author's transl)].

In a controlled double-blind study, the author has comparatively studied the effectiveness and the safety of econazole and of a combination econazole-triamcinolon topically applied, on inflammatory dermatomycoses. Results on 58 patients are reported. The respective well-known properties of econazole and of triamcinolon are maintained in the combination. Clinical symptoms statistically faster disappear with the combined preparation, during the first days of treatment. In addition, the average treatment duration is shortened when econazole-triamcinolon is applied. The new preparation allows security to the physician as well it makes the patient more comfortable.

Administration, Topical↗
PubMed1989

[In vitro susceptibility of dermatophyte strains to imidazole derivatives].

Recently, imidazole derivatives are being successfully used for the dermatomycoses. These drugs have the strongest antimycotic activity. 44 dermatophyte strains were isolated from our out-patient with dermatomycosis. Imidazole derivatives such as isoconazole, oxiconazole, bifonazole and tioconazole were studied their efficacy on these fungal agents in vitro. 4 imidazole derivatives were effective on all of the dermatophyte strains in less than or equal to 5 micrograms/ml concentration. Whereas, there were differences in Minimal Inhibition Concentration (MIC) and MIC50 values.

Antifungal Agents↗
PubMed1981

[Mycosis of the foot in people over 40].

Some aspects of the ecology of the human foot in the stage of senescence have been studied. Systematically 200 hospitalized patients, chosen at random, between the ages of 40 and 96 years were examined. The following was observed: 1.) 133 patients (66,5%) presented lesions suspected as dermatomycoses. 2.) 67 patients (33,5%) were free from clinical lesions. 42 (31,5%) positive direct examinations were obtained from the first group and 8 (11,8%) from the second one. In culture were isolated different strains of Dermatophytes obtained from 50 patients as follows: a) From digital fold scales: Trichophyton mentagrophytes: 26 (v. granulosa: 9. v. gypsea: 16, v nivea: 1). Trichophyton rubrum: 18, Epidermophyton floccosum: 1. b) From toe nails: Trichophyton mentagrophytes v. granulosa: 3, Trichophyton rubrum: 7. c) From the sole: Trichophyton rubrum: 1. A series of fungi supposed contaminants were isolated among which because of frequency the following are specified: Aspergillus sp., Penicillium sp., Cephalosporium sp., Fusarium sp., some yeast and some Demataceae.

Adult↗
PubMed1982

A clinical study of econazole cream in the treatment of fungal skin infections.

An open assessment of the efficacy of econazole nitrate (Pevaryl) cream in the treatment of 140 patients with proven dermatomycoses was conducted at five university health centres. Specimens were obtained from 129 patients at the end of treatment and 121 (93.8 per cent) showed no evidence of fungi. After a further month without treatment 108 patients reattended and, of these, 98 (90.9 per cent) remained clinically and mycologically free from infection. Trichophyton rubrum and Epidermophyton floccosum were the fungi most frequently isolated, and the distribution of species and areas of the body affected were similar for all five centres.

Dermatomycoses↗
PubMedDate not supplied

[Incidence of various etiologic agents of superficial mycosis].

In a retrospective review of laboratory records at the Department of Mycology, National Institute of Microbiology "Dr. Carlos G. Malbrán", during the period June 1989-July 1991, 1225 putatively immunocompetent cases of superficial mycoses were identified. Ninety five percent of these patients were adults and 5% children. Among the total cases, dermatomycoses were caused, 67.6% by dermatophytes, 25.9% by yeasts, 5.9% by Malassezia furfur. and 0.5% by other fungi, as proven by the isolation of the etiological agents. (Figure 1, Table 2). Among the dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes greatly predominated accounting for 66.6% and 20.0% of the isolates, respectively, whereas Microsporum canis (8.0%). Epidermophyton floccosum (5.1%) and Microsporum gypseum (0.3%) were found with less frequency (Figure 2). Nails (47%) were the most common source of isolates in adults, followed by feet (28%), smooth skin (15%), groin (5%) and hands (2%) (Table 1). Regarding the relative efficiency of the diagnostic methods, the analyses of laboratory results evidenced that, 98% of the cases with clinical findings compatible with mycoses and 76% of the cases with positive cultures (Table 1) were identified by microscopic observation.

Adult↗
PubMed1993

[Naftifin--laboratory and clinical experience with a new antimycotic from the allylamine group].

The authors evaluated the effectiveness of naftifin on a broad spectrum of 42 types of agents causing mycoses. Using the microdilution method, the authors assessed minimal inhibiting concentrations (MIC) of this antimycotic agent in 107 clinical isolates. Naftifin displayed a selective antifungal activity: excellent sensitivity was found in dermatophytes (MIC 90% = 0.39 mg.l-1), Aspergillae were medium sensitive (MIC = 0.09-12.5 mg.l-1). The majority of yeasts and filamentous fungi from the group of Zygomycetes was resistant to naftifin. The therapeutic results in 57 subjects with dermatomycoses corresponded to the results of in vitro tests of the antimycotic agent. Most successful as treatment of dermatophytoses at extra-intertriginous sites and treatment of pityriasis versicolor; manifestation of candidoses were not affected. The commercial preparation used--Fetimin cream--is considered by the authors a suitable alternative of hitherto used local antimycotics, in particular preparations from the azole series.

Allylamine↗
PubMed1976

Absolute concentrations of an antimycotic agent, econazole, in the human skin after local application.

The absolute concentrations of an antimycotic drug, econazole, 1-[2,4-dichloro-beta-(p-chlorobenzyloxy)-phenethyl]-imidazole nitrate, in the different layers of the skin are reported when the agent is applied to human skin in vitro and in vivo. The drug was tritium-labelled and incorporated into an ointment to give a 1% concentration as it is used in the therapy of dermatomycoses. This ointment was applied to the skin surface. After fixed time intervals, the skin was sliced parallel to the surface and the amount in each layer determined by liquid scintillation counting. In the in vivo investigations, the excretion of the drug in the urine was also determined. The results reveal that though up to 90% of the drug remain on the surface, about 20 mug/ml epidermal tissue and 1.5 mug/ml dermal tissue can be achieved. The amount which is excreted in the urine is equivalent to the quantity which enters the skin, i.e., the penetrating drug is absorbed by the circulatory system.

Administration, Topical↗
PubMed1976

Tolciclate against dermatophytes.

0-(1,2,3,4-Tetrahydro-1,4-methanonaphthalen-6-yl)-m-N-dimethylthiocarbanilate (toliciclate; KC 9147) is a new topical antimycotic having an in vitro activity on dermatophytes between 0.1 and 0.01 mug/ml. It is fungicidal after some day's contact. It has the advantage over dyes used in the past for topical treatment of dermatomycoses in that it is colourless and is soluble in well tolerated excipients. It is more liposoluble than tolnaftate. In the guineapig skin infections with Trichophyton asteroides and Microsporum canis, it is usually 3 times more active than tolnaftate and, in some tests, up to 10 times.

Animals↗
PubMed2003

Antifungal therapy--state of the art at the beginning of the 21st century.

The most relevant information on the present state of the art of antifungal chemotherapy is reviewed in this chapter. For dermatomycoses a variety of topical antifungals are available, and safe and efficacious systemic treatment, especially with the fungicidal drug terbinafine, is possible. The duration of treatment can be drastically reduced. Substantial progress in the armamentarium of drugs for invasive fungal infections has been made, and a new class of antifungals, echinocandins, is now in clinical use. The following drugs in oral and/or intravenous formulations are available: the broad spectrum polyene amphotericin B with its new "clothes"; the sterol biosynthesis inhibitors fluconazole, itraconazole, and voriconazole; the glucan synthase inhibitor caspofungin; and the combination partner flucytosine. New therapy schedules have been studied; combination therapy has found a significant place in the treatment of severely compromised patients, and the field of prevention and empiric therapy is fast moving. Guidelines exist nowadays for the treatment of various fungal diseases and maintenance therapy. New approaches interfering with host defenses or pathogenicity of fungal cells are being investigated, and molecular biologists are looking for new targets studying the genomics of pathogenic fungi.

Animals↗
PubMed1993

Disseminating infection with Scytalidium dimidiatum in a granulocytopenic child.

A 13-year-old Moroccan boy in The Netherlands developed fever and a lesion resembling ecthyma gangrenosum on the abdomen during cytostatic drug treatment for a lymphoblastic B-cell lymphoma. Scytalidium dimidiatum was cultured from blood and the abdominal skin lesion. The patient was successfully treated with amphotericin B. The fungus Scytalidium dimidiatum is a fairly common plant pathogen in tropical and subtropical countries and is known to cause dermatomycoses in humans in these areas. This case demonstrates that it is necessary to be aware that immigrants from these areas can import their own fungal flora, some members of which may cause life-threatening disease in the case of patients with immune suppression.

Adolescent↗
PubMed1994

Induction of kinetochore-positive micronuclei in human lymphocytes by the anti-fungal drug griseofulvin.

Griseofulvin (GF) is a widely used antifungal drug for the treatment of superficial dermatomycoses. However, because GF is carcinogenic and teratogenic in animal models there is considerable concern regarding its clinical application. Further, it produces numerical chromosome aberrations in human lymphocytes and cell lines. There are conflicting reports on the ability of GF to induce structural chromosomal aberrations. Here, we show GF induces micronucleus formation both in isolated peripheral lymphocytes and lymphocytes from whole blood cultures. An antikinetochore antibody was used to distinguish micronuclei with acentric chromosome fragments (kinetochore-negative) and from those containing whole chromosomes (kinetochore-positive). The micronuclei formed were 99% kinetochore-positive in isolated lymphocytes. In addition, GF was able to alter the cell cycle kinetics of lymphocytes, thereby increasing the percentage of triploid cells. We conclude that GF is a strong aneuploidy-inducing agent in peripheral human lymphocytes and produces effects at concentrations which should be detectable in the blood of persons undergoing therapy.

Aneuploidy↗
PubMed2006

Preventing reactivation of ocular histoplasmosis: guidance for patients at risk.

BACKGROUND: Ocular histoplasmosis syndrome (OHS), a significant cause of vision loss in young and middle-aged adults, is associated with the fungus Histoplasma capsulatum (Hc). There is considerable evidence that recurrent reactivation of perimacular ocular histoplasmosis lesions is an important cause of disease progression and that vision loss is at least, in part, a consequence of host sensitivity to fungal antigen. METHODS: The etiology and pathogenesis of OHS is reviewed and specific recommendations are made for patients with OHS that may decrease the risk of reactivation of ocular histoplasmosis lesions and slow disease progression. CONCLUSION: Patients with perimacular chorioretinal scars secondary to OHS should be informed by the clinician that they are at risk for vision loss; they should be told the symptoms of choroidal neovascularization and how to self-monitor their vision with an Amsler grid. We recommend they also be instructed on how to decrease their risk of reinfection by Hc. Aggressive treatment of dermatomycoses, onychomycosis, vaginal candidiasis, and other chronic fungal infections may decrease the risk of reactivation of ocular lesions. Patients with OHS who are considering LASIK surgery should be informed that the procedure may trigger choroidal neovascularization.

Animals↗
PubMed1982

Oral ketoconazole for dermatophyte infections.

Nineteen patients with chronic dermatophyte infections were treated with 200 to 400 mg per day of ketoconazole orally. Sixteen had had their disease for 2 years or more. Sixty-three per cent achieved cure, and an additional 26% showed clinical improvement. Clearing of lesions occurred in 10 weeks (mean). The dose was increased to 600 mg per day in four patients. Of these, two achieved cure, for an overall cure rate of 74%. Seventy-five percent of patients who previously failed to respond to griseofulvin were cured or improved by ketoconazole. Four of eight patients with onychomycosis were cured, and the rest improved on therapy. One patient developed a generalized drug eruption after the first dose of ketoconazole, and possible minor side effects were noted in five. Three of eight patients followed off therapy after apparent cure subsequently showed relapse. The drug appears to have great potential value for the therapy of dermatomycoses.

Administration, Oral↗
PubMed1997

Oral antifungal drug interactions.

The recent approval of itraconazole and terbafine for the treatment of onychomycosis has launched a new era in the therapeutic management of this previously resistant form of dermatomycoses. These agents represent safe and effective treatments. The clinician should, however, become knowledgeable with the potential drug interactions that are discussed in this article.

Administration, Oral↗
PubMed1999

In vitro evaluation of antifungal properties of phenylpropanoids and related compounds acting against dermatophytes.

Thirty-four arylpropanoids and related compounds were evaluated in vitro for antifungal properties. Among them, 22 phenyl-, 4 naphthyl-, and 4 phenanthrylpropanoids; naphthalene; phenanthrene; and 2-chloro-1-hexyl-1-propanone were tested against dermatophytes by the agar dilution method. alpha-Halopropiophenones exhibited a broad spectrum of activities against Microsporum canis, Microsporum gypseum, Trichophyton mentagrophytes, Trichophyton rubrum, and Epidermophyton floccosum, with MIC values between 0.5 and >50 microg/mL. Keto, alcohol, and alpha-haloketo propyl derivatives of naphthalene and phenanthrene also showed very good activity against all dermatophytes tested, clearly showing that in these series, a halogen atom is not necessary for activity. Phenanthryl derivatives were more active (MICs, 3-20 microg/mL) than naphthyl ones (MICs, 3-50 microg/mL). A structure-activity relationship study was carried out and aided in establishing the structural requirements of arylpropanoids for antifungal activities. Because dermatophytes are a group of fungi that characteristically infect the keratinized areas of the body, these new series of antifungal compounds open the possibility of discovering new topical antifungal drugs for the treatment of dermatomycoses, which are frequently very difficult to eradicate.

Antifungal Agents↗