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In vitro antifungal activity of KP-103, a novel triazole derivative, and its therapeutic efficacy against experimental plantar tinea pedis and cutaneous candidiasis in guinea pigs.

The in vitro activity of KP-103, a novel triazole derivative, against pathogenic fungi that cause dermatomycoses and its therapeutic efficacy against plantar tinea pedis and cutaneous candidiasis in guinea pigs were investigated. MICs were determined by a broth microdilution method with morpholinepropanesulfonic acid-buffered RPMI 1640 medium for Candida species and with Sabouraud dextrose broth for dermatophytes and by an agar dilution method with medium C for Malassezia furfur. KP-103 was the most active of all the drugs tested against Candida albicans (geometric mean [GM] MIC, 0.002 microg/ml), other Candida species including Candida parapsilosis and Candida glabrata (GM MICs, 0.0039 to 0.0442 microg/ml), and M. furfur (GM MIC, 0.025 microg/ml). KP-103 (1% solution) was highly effective as a treatment for guinea pigs with cutaneous candidiasis and achieved mycological eradication in 8 of the 10 infected animals, whereas none of the imidazoles tested (1% solutions) was effective in even reducing the levels of the infecting fungi. KP-103 was as active as clotrimazole and neticonazole but was less active than lanoconazole and butenafine against Trichophyton rubrum (MIC at which 80% of isolates are inhibited [MIC(80)], 0.125 microg/ml) and Trichophyton mentagrophytes (MIC(80), 0.25 microg/ml). However, KP-103 (1% solution) exerted therapeutic efficacy superior to that of neticonazole and comparable to those of lanoconazole and butenafine, yielding negative cultures for all samples from guinea pigs with plantar tinea pedis tested. This suggests that KP-103 has better pharmacokinetic properties in skin tissue than the reference drugs. Because the in vitro activity of KP-103, unlike those of the reference drugs, against T. mentagrophytes was not affected by hair as a keratinic substance, its excellent therapeutic efficacy seems to be attributable to good retention of its antifungal activity in skin tissue, in addition to its potency.

Animals↗

Immunisation against ringworm in cattle.

Immunisation against dermatomycoses in cattle was introduced in Gausdal, Norway, in 1979. A programme was implemented in which a six-year period of mandatory vaccination of all cattle was followed by vaccination on a voluntary basis. The prevalence of infected herds fell from 70 per cent in 1979 to 0 per cent in 1987. During the last five years, no newly infected herds have been registered in Gausdal. Proper disinfection of premises, the isolation of infected animals and other hygienic measures contributed to the successful result.

Animals↗

Strain differentiation of Trichophyton rubrum by random amplification of polymorphic DNA (RAPD).

Trichophyton rubrum is an important cause of dermatomycoses. Molecular strain typing methods have recently been developed to address questions about epidemiology and source of relapse following treatment. This report describes the application of RAPD for molecular strain differentiation of this fungus utilizing the primers 1- (5'-d[GGTGCGGGAA]-3') and 6- (5'-d[CCCGTCAGCA]-3'). A total of five RAPD patterns were observed among 10 strains of T. rubrum, with each of the primers used. We conclude that RAPD analysis using primers 1 and 6 can be used in epidemiological studies.

DNA Primers↗

Occurrence and impact of zoonoses in pet dogs and cats at US Air Force bases.

A descriptive epidemiologic study was conducted to quantitate the occurrence of zoonoses in pet animals (almost exclusively dogs and cats) at 30 Air Force bases in nine regions of the United States during 1980 and 1981. Reviews of reported cases of pet-associated zoonoses in humans at these bases were included. Occurrence of a zoonotic disease in dogs and cats was expressed as a ratio of reported cases per 100 rabies vaccinations (cs/Crv). Overall, the four zoonoses reported most frequently from these pets were hookworms, roundworms, tapeworms, and fleas. Annual ratios revealed geographic variations: for example, hookworms in dogs and cats in the southeast ranged from 12.3 to 9.4 cs/Crv; in the northern Great Plains, hookworms ranged from 0.9 to 0.4 cs/Crv. Dermatomycoses in the southeast ranged from 1.3 to 1.1 cs/Crv, and in Alaska from 0.3 to 0.2 cs/Crv. Quarterly zoonoses occurrence revealed seasonal variations in several regions. Reports of zoonoses in people from these bases indicated that five less frequent zoonoses in dogs and cats (Microsporum canis dermatomycosis, fleas, Sarcoptes scabiei var canis, Gram-positive bacterial infections, and rabies) presented greater acute threats to humans than did the four most frequent zoonoses reported from their pets.

Adult↗

Itraconazole. A reappraisal of its pharmacological properties and therapeutic use in the management of superficial fungal infections.

Itraconazole is an orally administered triazole antifungal agent. Its spectrum of activity includes dermatophyte, dimorphic and dematiaceous fungi, yeasts, and some moulds. In clinical trials, mycological cure was attained in approximately 70 to 80, > or = 70 and > or = 80% of patients with, respectively, fingernail and toenail onychomycosis (200 mg/day for 3 months), dermatophytosis (100 mg/day for 2 to 4 weeks) and vaginal candidiasis (400 mg/day for 1 day or 200 mg/day for 3 days). Approximately 20 to 30% of patients with onychomycosis may relapse after completion of therapy; relapse rate data are limited for the other indications. Recently developed intermittent regimens of itraconazole (400 mg/day for 1 week per month for 3 to 4 months) appear to have similar efficacy to standard regimens in the treatment of onychomycosis. Shorter, higher dosage itraconazole treatment regimens (200 or 400 mg/day for 1 week) are also beneficial in dermatomycoses. Discrepancies and limitations of study design hamper conclusions about efficacy relative to other antifungal drugs. Newer intermittent and short course higher dosage itraconazole regimens have also not been evaluated in comparative studies. Available studies show that the efficacy of itraconazole appears to be greater than that of griseofulvin, but similar to or lower than that of terbinafine in patients with dermatophyte onychomycosis or cutaneous fungal infections. Moreover, the efficacy of itraconazole may be similar to or lower than that of fluconazole in the treatment of cutaneous mycoses. Comparative data from patients with acute vaginal candidiasis suggest that itraconazole is at least as effective as intravaginal clotrimazole and oral fluconazole, and superior to intravaginal econazole. These results require confirmation. Prescription-event monitoring data indicate that itraconazole is generally well tolerated. Gastrointestinal disturbances, dizziness and headache occur most commonly; liver toxicity has been rarely described. Its usefulness in some clinical situations may be limited because of its ability to interact with various therapeutic agents. In conclusion, itraconazole along with other established agents should be considered a first-line treatment for patients with extensive or recalcitrant cutaneous fungal infections, mixed dermatophyte and Candida onychomycosis or vaginal candidiasis. It is currently considered a second-line drug for dermatophyte onychomycosis; the use of newer intermittent itraconazole treatment regimens may, however, extend its role in the management of this condition. Although itraconazole offers greater benefit than conventional therapies (griseofulvin and ketoconazole) in terms of efficacy and tolerability, wider clinical experience is required to determine its merits relative to the newer agents, terbinafine and fluconazole.

Absorption↗

Levels of terbinafine in plasma, stratum corneum, dermis-epidermis (without stratum corneum), sebum, hair and nails during and after 250 mg terbinafine orally once per day for four weeks.

The distribution of terbinafine in stratum corneum dermis-epidermis (without stratum corneum), sebum, hair, nails and plasma was studied in human male volunteers during and after 250 mg orally once daily for 28 days. The highest concentration was seen in sebum, 56.07 micrograms/g, after 14 days of therapy. The concentration was still 1.0 microgram/g 44 days after stop of medication. In stratum corneum the highest concentration, 14.4 micrograms/g, was seen 1 day after the last day of therapy, and it was 2.1 micrograms/g 44 days after stop of medication. The concentrations in hair and nails were lower with a maximum of 2.36 and 0.39 micrograms/g respectively, 1 day after stop of therapy, and still 0.21 microgram/g in hair and 0.09 microgram/g in nails 55 days after the last day of medication. With the exception of nails, all other tissue levels were at all times above the plasma concentrations. For nails, tissue levels exceeded that of plasma as early as 1 day after stop of medication, and this difference continued to increase until the last day of tissue sampling, 55 days after the last tablet. These results indicate that terbinafine is delivered to the stratum corneum through sebum and to a minor extent by direct diffusion through dermis-epidermis. Probably short-term therapy with terbinafine may be effective in the treatment of several dermatomycoses, due to the strong binding of terbinafine to stratum corneum for a long time after stop of medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗

Toxic effects of griseofulvin: disease models, mechanisms, and risk assessment.

Griseofulvin (GF) has been in use for more than 30 years as a pharmaceutical drug in humans for the treatment of dermatomycoses. Animal studies give clear evidence that it causes a variety of acute and chronic toxic effects, including liver and thyroid cancer in rodents, abnormal germ cell maturation, teratogenicity, and embroyotoxicity in various species. No sufficient data from human studies are available at present to exclude a risk in humans: therefore, attempts were made to elucidate the mechanisms responsible for the toxic effects of GF and to address the question whether such effects might occur in humans undergoing GF therapy. It is well documented that GF acts as a spindle poison and its reproductive toxicity as well as the induction of numerical chromosome aberrations and of micronuclei in somatic cells possibly may result from disturbance of microtubuli formation. Likewise, a causal relationship between aneuploidy and cancer has been repeatedly postulated. However, a critical survey of the data available on aneuploidogenic chemicals revealed insufficient evidence for such an association. Conceivably, other mechanisms may be responsible for the carcinogenic effects of the drug. The induction of thyroid tumors in rats by GF is apparently a consequence of the decrease of thyroxin levels and it is unlikely that such effects occur in GF-exposed humans. The appearance of hepatocellular carcinomas (HCC) in mice on GF-supplemented diet is preceded by various biochemical and morphological changes in the liver. Among these, hepatic porphyria is prominent, it may result from inhibition of ferrochelatase and (compensatory) induction of ALA synthetase. GF-induced accumulation of porphyrins in mouse liver is followed by cell damage and necrotic and inflammatory processes. Similar changes are known from certain human porphyrias which are also associated with an increased risk for HCC. However, the porphyrogenic effect of GF therapy in humans is moderate compared with that in the mouse model, although more detailed studies should be performed in order to clarify this relationship on a quantitative basis. A further important effect of GF-feeding in mice is the formation of Mallory bodies (MBs) in hepatocytes. These cytoskeletal abnormalities occur also in humans, although under different conditions; their appearance is associated with the induction of liver disease and HCC. Chronic liver damage associated with porphyria and MB formation, enhanced cell proliferation, liver enlargement, and enzyme induction all may contribute to the hepatocarcinogenic effect of GF in mice. In conclusion, further investigation is required for adequate assessment of health risks to humans under GF therapy.

Aneuploidy↗

[Present state and future direction of topical antifungals].

Topical agents are generally better than oral medicine with respect to systemic side effects. Even if an antifungal drug causes severe systemic side effects, the drug, if it has excellent antifungal activity, can be used for topical treatment. In addition, because most causative fungi in dermatomycosis are usually located in the horny cell layers of the epidermis (superficial layers of the skin), topical antifungals are the first choice of treatment for most dermatomycoses. Many topical antifungals with excellent antifungal activity have recently been developed and once a day topical application is presently possible. In spite of these new agents, however, clinical efficacy and mycological eradication rates have not shown significant improvement and there are still many patients with tinea pedis. One reason that no significant improvement has been observed in the topical antifungal therapy may be due to poor compliance with the treatment. That is, because it is difficult for most patients to continue regular topical application for a long period, most usually stop treatment after clinical symptoms disappear, even though no mycological cure may yet have been achieved. In addition, topical antifungals are not effective for the treatment of hyperkeratotic skin lesions or nail and hair infection. Therefore, the goal of new topical antifungals should be good compliance, which means shortening of the treatment period, high penetration of the drug into horny cell layers, nails, and hair, and high affinity to horny cell layers in order to keep a high concentration of the drug within the lesions.

Administration, Topical↗

Activity of terbinafine against serious fungal pathogens.

Although primarily indicated for dermatophyte infections, the allylamine terbinafine is active in vitro against a broad spectrum of filamentous and dimorphic fungi, in most cases with a primary fungicidal action. Using the standard NCCLS M27-A assay, recent studies confirmed the high activity of terbinafine against dematiaceous fungi and other medically important moulds such as Aspergillus and Penicillium marneffei. Terbinafine displayed a geometric mean MIC of 1.4 micrograms/ml against Candida albicans (n = 259) and has significant in vitro activity against other species of Candida, Cryptococcus, Trichosporon and Blastoschizomyces. As an approach to treatment of refractory infections, interactions of terbinafine with azoles and other agents are being investigated. Terbinafine was synergistic with azoles (and in some cases amphotericin B) against Candida species, Trichosporon beigelii, Aspergillus species, Pseudallescheria boydii and Scopulariopsis brevicaulis, some of which were unresponsive to any drug used singly. Terbinafine combined with fluconazole showed potent synergy against fluconazole- and multidrug-resistant C. albicans isolates. In conclusion, recent in vitro data suggest that terbinafine, either alone or in combination with other antifungal drugs, has potential in the therapy of a range of more severe fungal infections, in addition to its current widespread use against dermatomycoses.

Antifungal Agents↗

[Analysis of the results of mycological examination of skin samples from 1997 to 1998].

Mycological findings of 2,447 skin specimens were analyzed. The aim of the study was to estimate the methodology for mycological examination, frequency of particular fungal species isolation and localization on the skin. Fungi were found in 591 specimens: 53.64% microscopically and isolated in cultures, 31.47% only microscopically and 14.89% only isolated in cultures. Total number of isolated strains was 405 (356 strains grew on Sabouraud agar with antibiotics and 272 on mycobiotic agar). The most frequently isolated species were: Trichophyton mentagrophytes (27.9%), Trichophyton rubrum (20%) and Candida albicans (9.14%). The most frequent localizations on skin where fungi had been found were foot (41.47%), toe-nail (22.06%) and finger-nail (10.88%). Sabouraud agar is more reliable for isolation of dermatophytes and mycobiotic agar for Candida species. Usage of both media for primoisolation provides better and faster identification of fungi causing dermatomycoses. Comparing our with other studies, the patterns of fungal appearance in our population had changed and the number of nail specimens, where fungi were found had increased.

Culture Media↗

[Newer antimycotics. I. Derivatives of phenyl-hydrazine (author's transl)].

The author produced a number of derivatives of phenyl-hydrazine and its analogues, investigated their antimicrobial efficiency in vitro, and discussed the association of chemical structure with the fungistatic effect in the series of phenyl-hydrazine-derivatives. From the author's results it can be concluded that the halogen-substituted phenyl-hydrazines and their N-(acetyl)-derivatives exert a moderate fungistatic effect (Tab. 1). In the series of N-aryl-sulphonyl-N'-phenyl-hydrazines only the compounds derived from 3,4-dichloro-phenyl-hydrazine proved to be effective; the other representatives of this type were fully ineffective (Tab. 1). The majority of the halogen-substituted N-aroyl-N'-phenyl-hydrazines exerted a relatively strong fungistatic activity with a broad spectrum of efficiency (Tab. 2). On the contrary, their analogues having a -CO-NH- group in place of the -CO-NH-NH-group, were fully inactive (Tab. 3). From the investigated derivatives of phenyl-hydrazine, the N-benzoyl-, N-(2-chloro-benzoyl)-, N-(4-chloro-benzoyl)- and N-furoyl-derivatives of 3- and 4-chloro-phenyl-hydrazine, furthermore the N-benzoyl- and N-furoyl-derivatives of 3,4-dichloro-phenyl-hydrazine were most effective (Tab. 2). The acute toxicity in the mouse of these effective compounds was relatively small; they were found to be significantly less toxic than tetramethyl-thiuramdisulfide (Tab. 4). On the basis of an intensive fungistatic efficiency and small toxicity of the halogen-substituted N-aroyl-N'-phenyl-hydrazines, it seems that a number of representatives of these types of chemical compounds could be given a role in the chemotherapy of superficial human and animal dermatomycoses, and also in the chemoprophylaxis of certain phytomycoses.

Alternaria↗

Hazardous hedgehogs.

The African pygmy hedgehog has recently become a fashionable exotic pet in the United States, particularly in the South. As illustrated by the three cases reported, this mammalian insectivore can be a carrier of fungi that cause human dermatomycoses. The African pygmy hedgehog has also been associated with contact urticaria and human salmonellosis.

Adult↗

[Newer antimycotics. II. Arylhydrazones of derivatives of mesoxalic acid (author's transl)].

The author produced a number of aryl-hydrazone-derivatives of the esters and amides of mesoxalic-acid-seminitril and of mesoxalic-acid-diethylester, investigated their fungistatic efficiency in vitro, and discussed the association of chemical structure with the fungistatic effect in the series of these compounds. From the author's results it can be concluded that some compounds from the series of the aryl-hydrazones of mesoxalic-acid-seminitril-esters exert a strong fungistatic effect on Trichophyton gyps. (Tabl. 1); namely those, whose ester-alkyl-group is relatively short and in that there are the substituents of benzolring Cl-atom, CH3- or NO2- groups. On the other hand the majority of the compounds of this series is totally ineffective (Tab. 2). Each aryl-hydrazones of the amides of mesoxalic-acid-seminitril ant that ones of the mesoxalic-acid-diethylester are ineffective on Trichophyton gyps. (Tab. 2, 4, 5). Not a compound of the investigated series exerts any fungistatic effect on fungi-strains other then Trichophyton gyps. Those aryl-hydrazones of the mesoxalic-acid-seminitrilesters, which proved to be most effective on Trichophyton gyps. are on the mouse only negligible toxic and they do not irritate the skin and mucous membranes of the experimental animals; their fungistatic effect is not influenced by cystein, cysteamin or thioglycolic-acid. On the basis of the intensive fungistatic efficiency and small toxicity of some aryl-hydrazones of the mesoxalic-acid-seminitril-esters, it seems that a number of representatives of these types of chemical compounds could be given a role in the chemotherapy of superficial human and animal dermatomycoses.

Animals↗

[The health impact of stray and wild cats in the human environment].

The population of stray cats in towns expands due to irresponsible behaviour of humans who allow them to enter cellars, hot water canals, store rooms etc. As a result of frequent feeding some specimens become tame, lose their shyness and on contact with humans and domestic animals they can become the source of some infectious agents. The most important of thus transmitted diseases is rabies. Cats become infected from foxes on rubbish heaps on the periphery of communities. More than 60% of cases of rabies of domestic animals are found in cats. Toxoplasmosis--cats excrete the infectious stage of the causal agent in their excreta. In the same manner also the agent causing intestinal salmonelloses is excreted. More than 5% cats are infected. Via excreta also the causal agents of toxocariasis are spread--the larvae of cat thread worms settle in the internal organs of humans (larva migrans). The assumed incidence in cats is as high as 50%, as suggested also by the high positivity of specimens from children playgrounds. Stray cats may be the source of agents causing various dermatomycoses and of ectoparasites.

Animals↗

[Antimicrobial activity of selected aqua-carboxyl-cupric complexes].

The activity of compounds of different structural types of aqua-complexes of the composition Cu(R-COO)2.nH2O-methoxybenzoatocupric complexes, R = 2-, 3- and 4-methoxyphenyl (n = 1, 1 and 3); aryloxyacetatocupric complexes, R = phenoxymethyl (n = 3), 2-, 3- and 4-chlorophenoxymethyl (n = 4, 2 and 2) and 1-naphthoxymethyl (n = 4), and furthermore isomeric furanecarboxylato-(R = 2- or 3-furyl, n = 3, or 1) and thiophencarboxylatocupric complexes (R = 2- or 3-thienyl, n = 1 and 1), was examined by the methods of the 1st screening on selected anthropo- and phytopathogenic microorganisms. The effects of all aqua-complexes (suspension dosage form) on the representatives of bacteria and yeasts are minimal. On the other hand, the effect of these substances on the causative agents of dermatomycoses (Trichophyton terrestre, Microsporum gypseum) in the case of methoxybenzoato- and furoatocupric complexes achieves a MIC value of 500 micrograms/cm3 and lower. The activity against phytopathogenic fungi (both in vitro and in vivo experiments) is generally relatively low at 0.05% concentration of active ingredients (dispersible powders). At the same time the antimicrobial activity of the pertinent free carboxylic acids was investigated in relation to the cupric salts being formed. They are able to form the required pharmacoactive form prevalently as late as they are in the form of aqua-carboxylatocupric complexes.

Anti-Bacterial Agents↗

Antifungal activity of drimane sesquiterpenes from Drimys brasiliensis using bioassay-guided fractionation.

PURPOSE: This study describes the antifungal effect of extracts and compounds isolated from Drimys brasiliensis acting against dermatophytes. METHODS: The activities were evaluated by using the microbroth dilution method. RESULTS: Bioassay-guided fractionation of the most active extract from the bark (CHCl3) led to the isolation of the sesquiterpene drimanes polygodial, 1-beta-(p-methoxycinnamoyl)-polygodial, drimanial and 1-beta-(p-cumaroyloxy)-polygodial, which were selectively active against Epidermophyton floccosum and Tricophyton rubrum. CONCLUSIONS: The selective antifungal activity reported in this paper for drimanes isolated from D. brasiliensis opens the possibility that they could be helpful for the developing of new antifungal agents for treating the difficult to eradicate dermatomycoses produced by E. floccosum.

Antifungal Agents↗

Antifungal activity of the new agent latoconazole in two tinea models.

In vitro and in vivo antifungal activities of the new imidazole derivative latoconazole ((+-)-(E)-[4-(2-chlorophenyl)-1,3-dithiolan-2-ylidene]-1- imidazolylacetonitrile, NND-318; CAS 101530-10-3) were studied in comparison with three major topical agents, clotrimazole, bifonazole and tolnaftate. The in vitro activity of latoconazole against dermatophytes was much stronger than that of any reference agent tested. Both the recently developed tinea pedis model and the conventional tinea model in guinea pigs were employed for evaluation of topical usefulness of latoconazole. The 1% solution or cream preparation of latoconazole was highly effective in both of the two tinea models and its 5 or more doses achieved almost complete mycological cure. However, both tinea models, especially the former, were considerably resistant to the therapeutic treatment of all of the reference drugs. These results suggest that latoconazole is a promising topical antifungal agent, probably applicable to the treatment of tinea pedis as well as other types of dermatomycoses.

Animals↗