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PubMed1992

[Systemic mycoses. Epidemiology, clinical aspects, diagnosis].

Systemic mycoses are serious, often life-threatening, infections that are encountered with increasing frequency in many countries. These infections are most often seen as a result of advanced medical treatment leading to profoundly immuno-suppressed patients. In Norway, most systemic mycoses are caused by Candida, followed by Aspergillus, Cryptococci and Mucorales. This paper deals with the pathogenetic and immunologic mechanisms underlying these infections. The different agents are described, and the various clinical manifestations. A discussion of the diagnosis of systemic mycoses is followed by some general considerations regarding treatment.

Aspergillosis↗
PubMed2002

[Clinical study of non-invasive nasal sinus mycoses].

OBJECTIVE: To explore the pathogeny, diagnosis and treatment of the noninvasive nasal sinus mycoses. METHOD: 11 cases with nasal sinus mycoses were analyzed retrospectively. All of them had undergone endoscopic operation. RESULT: After operation all cases got regular check up under endoscope. 9 cases recovered quickly. The other 2 had caseous matter in their maxillary sinus in the initial stage. After cleaning up the fungus ball and washing the maxillary sinus for several times, the surgical cavity became clear. 10 cases had been followed up for 6 months to 5 years and no recurrence occurred. The other one lost follow-up. CONCLUSION: Endoscopic operation is the basic surgical method to treat the non-invasive nasal sinus mycoses. Excising the focus thoroughly, correcting the abnormal nasal cavity structure and resuming the cleanout function of nasal sinus cilia are the principle of treatment.

Adult↗
PubMedDate not supplied

The spectrum of respiratory mycoses in a referral hospital in north-western India.

There has been an increasing recognition of respiratory mycoses in this country in the recent past. Candidiasis, aspergillosis and cryptococcosis have been reported from different centres. Occasional cases of histoplasmosis and sporotrichosis have also been reported. Infections with Pneumocystis carinii, which is now classified as a fungus, are being frequently diagnosed, especially in the immuno-compromised patients such as those on prolonged immunosuppressive therapy or with HIV infection. Although the clinical picture of respiratory mycoses resembles that of any other infection, the presentation in several cases is atypical and the diagnosis is delayed. In a review of our patients of respiratory fungal infections seen in the last few years, we found several interesting examples. We report here the general clinical spectrum of respiratory mycoses and some interesting cases seen at our Centre.

Hospitals↗
PubMed1991

[Tropical mycoses].

The most common tropical subcutaneous and deep mycoses include chromomycosis, sporotrichosis and mycetoma. All are commonly found in Natal and in other sub-tropical countries. Although blastomycosis is endemic in North America, only four cases have been identified in Natal during the last 25 years and all presented with atypical clinical features. African histoplasmosis caused by H. capsulatum var. duboisii and limited mainly to central and western Africa has been found in only one patient in Natal. Paracoccidioidomycosis, although the most common deep mycosis in Latin America, is limited to that area and we have no experience of this disease in South Africa. Over the past eight years itraconazole has been used in clinical trials for all these mycoses. The results in sporotrichosis, non-meningeal blastomycosis and paracoccidioidomycosis suggest that for these diseases itraconazole may be the drug of choice. The results in histoplasmosis are encouraging as are the results in chromomycosis particularly those cases associated with C. carrionii. However, where F. pedrosoi is the causal agent and in mycetomas, successful management still remains a therapeutic problem. In our own experience and that of other using itraconazole, even over prolonged periods, this drug has an impressive safety profile. In our present series of 42 patients, no side effects were observed, no adverse reactions occurred and serum chemistry values remained within normal limits. It appears, therefore, that itraconazole, although not the final answer to management of the deep mycoses, is certainly a major improvement on previous drugs.

Antifungal Agents↗
PubMed1991

[Deep mycoses in leukemia and malignant lymphoma].

1053 autopsies were performed from 1976 to 1990 in patients with leukemia and malignant lymphomas. At autopsy 184 of these (17.4%) presented with deep seated mycoses. There was an increasing percentage of mycoses per year with a maximum of 30% in 1990. Today deep seated mycoses are the most frequent letal complication in hematologic neoplasias. As expected their number was especially high in patients with acute leukemia but in recent years they were nearly just as numerous in myeloproliferative disorders. Among NHL they were twice as frequent in low grade cases as in high grade cases possibly due to a different extent of bone marrow infiltration. In contrast to former years more aspergilloses than candida infections are found, probably as a result of antimycotic therapy.

Acute Disease↗
PubMed1991

[Mycoses and adrenocortical function. New pathogenetic aspects of adrenal hypofunction].

Three aspects of the possible relationships between adrenocortical function and mycoses are considered: a) abnormal steroid hormone concentrations that may favour onset and/or clinical course of mycotic diseases; b) presence of granulomas in the adrenal glands during systemic mycoses; c) effects of antifungal drugs on steroidogenesis. Glucocorticoids are potent inhibitors of T-lymphocyte proliferation, in that they affect both the production of IL-1 from monocytes/macrophages and IL-2 from activated T-lymphocytes. Consequently opportunistic fungal infections are frequently observed in patients with chronic hypercortisolism (Cushing's syndrome) and in particular in those under chronic treatment with corticoids. On the other hand, mucocutaneous candidiasis is a prominent feature of the autoimmune polyglandular syndrome type I, characterized by adrenal insufficiency, hypoparathyroidism and mucocutaneous candidiasis. Its onset is usually at childhood, first with symptoms and signs of the fungal infection and then with those of endocrine failure. It is a complex disorder, familiar or sporadic, not linked to particular HLA haplotype, potentially associated with other autoimmune diseases (endocrine and not), thus forming the so called candidiasis endocrinopathy syndrome (CES). Adrenal involvement is very frequent in systemic mycoses, such as histoplasmosis (Histoplasma capsulatum), cryptococcosis (Cryptococcus neoformans), and paracoccidioidomycosis. From the pathogenetic view point, corticostatins-defensins may play a role. They are a family of recently discovered cationic peptides, that are able to inhibit adrenal steroidogenesis by interfering with ACTH at the specific receptor level. The pharmacological effects of ketoconazole on adrenal (and gonadal) steroidogenesis are a focus of great interest. This compound has been demonstrated to be a potent inhibitor of cytochrome P450-dependent enzymes.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Autopsy results of deep mycoses in hematologic neoplasms (1053 patients].

1053 autopsies were performed during the period from 1976 to 1990 in patients with leukaemia and malignant lymphomas. At autopsy 184 of these (17.4%) presented with deep-seated mycoses. There was an increasing percentage of mycoses per year with a maximum of 30% in 1990. Today deep-seated mycoses are the most frequent lethal complication in haematologic neoplasias. As expected their number was especially high in patients with acute leukaemia but in recent years they were nearly just as frequent in myeloproliferative disorders. Among Non-Hodgkin lymphomas (NHL) they were twice as frequent in low-grade cases as in high-grade cases possibly due to a different extent of bone marrow infiltration. In contrast to former years more aspergillosis than Candida infections are found, probably as a result of antimycotic therapy.

Autopsy↗
PubMed1989

[Treatment of mycoses and new antifungal agents].

The multiplication of iatrogenic factors, nosocomial diseases and acquired immunodeficiency syndrome is responsible for an ever increasing number of deep opportunistic mycoses, namely candidiasis, aspergillosis and cryptococcosis. The advent of a wide variety of rare opportunistic fungi is a fairly recent and worrying phenomenon. To combat these infections, often very serious, our therapeutic armentarium is rather scanty. Moreover, the prescription of the available drugs is limited by their toxicity, their spectrum and their route of administration or by the emergence under treatment of resistant mutants. Beside old products, such as amphotericin B and 5-fluorocytosine, miconazole and, mainly ketoconazole (both azole derivatives) were the first steps towards oral administration and low toxicity. Fluconazole is a triazole antifungal compound with a very original distribution to the meninges and urinary tract; it is mainly used in candidiasis and cryptococcosis. Another triazole compound, itraconazole, presents the particularity of being active against Aspergillus spp., Cryptococcus spp. and some agents of exotic mycoses. These two products are well tolerated and should soon be available for use in deep visceral mycoses. Other azole derivatives are under study. Among compounds issued from new chemical families, terbinafine (allylamine) is particularly active against dermatophytes, and cilofungine (a polypeptide) against fungi. These drugs are in the experimental stage. Research should be pursued aimed at developing, probably in new chemical families, and agent that is fungicidal in vivo.

Allylamine↗
PubMed1989

[Incidence of oro-gastrointestinal mycoses--results of an Ampho-Moronal study].

This report is a survey of epidemiological facts about oro-gastro-intestinal tract mycoses. It is documented that children and older people suffer more often from oro-gastro-intestinal tract mycoses than the rest of the average population. In addition older patients with oro-gastro-intestinal tract mycoses show predisposing factors more frequently than younger people.

Adolescent↗
PubMed1982

[Panorama of mycoses in otorhinolaryngology].

Three classes of important mycoses in O.R.L. field can be recognized according to the responsible fungi and to thier physiopathology: 1) mycoses due to cosmopolite, opportunistic fungi, yeast-like fungi (Candida albicans, Cryptococcus neoformans, Torulopsis glabrata) or filamentous fungi (Aspergillaceae, Mucoraceae, Penicillia, etc...) invading a compromised host by antibiotics, immunosuppressors, radiotherapy or by severe diseases (hemopathia, diabetes with acidosis). The oropharyngolaryngeal candidosis, the black tongue (a polyfungal syndrome), the sinusal aspergillosis, the otomycoses, the nasalorbital cerebral form of mucormycosis are reviewed and the allergic accompanying symptoms described. 2) deep, systemic mycoses of tropical origin with respiratory entry and oral pharyngeal laryngeal metastatic localizations (histoplasmosis, blastomycosis, paracoccidioidomycosis, coccidioimycosis); the histoplasmosis represent actually the principal imported systemic mycosis with O.R.L. localization. 3) tropical and african mycosis localized exclusively in O.R.L. area (rhino-enthomophtoromycosis and rhinosporidosis).

Diagnosis, Differential↗
PubMed2003

Prevalence and causative agents of superficial mycoses in a textile factory in Adana, Turkey.

This study was carried out in a textile factory settled in the city center of Adana, Turkey. The workers were evaluated for the presence of superficial mycoses and the interaction of their working environment or working condition. A total of 431 textile workers were included in the study, with a male to female ratio of 378 (87.7%) to 53 (12.3%) and an age range of 19-52 (mean: 33.7 +/- 6.8). Direct examination and/or culture revealed superficial mycoses in 73 (16.9%) workers, among them 56 (76.7%) were classified as dermatophytoses, 8 (11.0%) as Pityriasis versicolor while in nine (12.3%) of the cases, no causative agent could be determined. Trichophyton rubrum (57.1%) and T. mentagrophytes (42.9%) were the two species isolated on culture. This study emphasized that textile workers should be admitted as a risk group for superficial mycoses, especially tinea pedis.

Adult↗
PubMed1981

Epidemiologic risk factors associated with canine systemic mycoses.

A prevalence study was designed to evaluate host and seasonal risk factors associated with three systemic mycoses in dogs: blastomycosis, coccidioidomycosis, and histoplasmosis. Histoplasmosis was the most commonly diagnosed of the three diseases. All three of the mycoses occurred more frequently in male than female dogs. Compared to dogs less than 2 years of age, those 4--7 years of age were at increased risk of developing coccidioidomycosis whereas dogs 2--7 years of age were at increased risk of developing histoplasmosis. Three breeds, i.e., Pointer, Weimaraner and Brittany Spaniel, had increased risk of having histoplasmosis infections. Seasonal analysis with an epidemiologic trend model indicated that all three systemic mycoses have different but strong seasonal trends.

Age Factors↗
PubMed1992

[Clinical and pathological investigation of opportunistic pulmonary mycoses in autopsy cases].

Clinical and pathological investigations were performed in 58 cases of opportunistic pulmonary mycoses diagnosed at autopsy during the 10 years between 1979 and 1988 at Sasebo General City Hospital. The following findings were obtained. 1) The incidence of opportunistic pulmonary mycoses during the 10 years was 7.7%, with a significant increase in the incidence of fungal infections during the last 5 years of the study. The incidence of pulmonary mycoses was higher in patients with blood dyscrasia than in those with solid tumor or benign disease (p less than 0.001). 2) Administration of steroid hormone and anticancer drugs were suspected to be causative factors in the development of pulmonary aspergillosis and cryptococcosis, but not in candidiasis. 3) Characteristic radiographic patterns and clinical symptoms were absent in cases of pulmonary candidiasis due to the small size of the lesions and the high incidence of other complicating pulmonary infections and edema. 4) The most common initial roentgenographic pattern in opportunistic pulmonary aspergillosis was localized infiltrate, subsequently progressing to either multifocal infiltrates or cavitation. 5) The initial symptom in opportunistic pulmonary aspergillosis was usually high fever, and the radiographic abnormalities appeared later. The median duration between onset and death in 19 patients with pulmonary aspergillosis was 23.1 days. 6) Pulmonary aspergillosis should be suspected in the compromised host with high fever refractory to antibiotics and pulmonary infiltrates. Empiric antifungal therapy should be initiated at an early stage for the best chance for survival.

Aged↗
PubMed2005

[Superficial mycoses: comparative study between type 2 diabetic patients and a non-diabetic control group].

Superficial mycoses are considered to affect more frequently patients with type 2 diabetes mellitus (DM-2), specially onychomycosis and Tinea pedis. The purpose of this study was to compare the dermatophytoses, candidiasis and Pitiriasis versicolor frequency between 40 patients with DM-2 and 40 healthy persons of either sex, 40 years old or more. Clinical, metabolic, mycologic and inmunologic studies against Candida albicans, were carried out. Both diabetics 75% (30/40) and controls 65% (26/40) presented a high frequency of superficial mycoses (no significant difference p = 0.329). Pitiriasis versicolor was not detected in diabetic patients. They presented Tinea unguium, concomitant with Tinea pedis, with a higher frequency. The predominant dermatophyte was Trichophyton rubrum 18/23 (78%) in diabetics and 8/16 (50%) in non diabetics. Candida was isolated as commensal from oral mucous: 23/40 (58%) in diabetics and 21/40 (52%) in non diabetics (serotipo A was the more frequent), and from onychomycosis: 11/40 (28%) in diabetics and 12/40 (30%) in non diabetics. The immunological response was the same in both groups: celular 100%, humoral 20%. No statistical correlation among superficial mycoses, blood glucose level, glycosylated hemoglobin values or the time suffering the disease was observed. The high susceptibility to dermatophytes and Candida sp. infection showed to be associated with age and no with the diabetic type 2 condition in those patients.

Adult↗
PubMed1977

[Clinical aspects of lung mycoses].

The clinical picture of pulmonary mycoses is described and discussed. The diagnosis of tropical pulmonary mycoses is--in contrast to the native mycoses--relatively simple with respective serological tests and intracutaneous reactions. For the diagnosis the differentiation of fungi or molds is of utmost importance.

Aspergillosis↗
PubMed2007

Incidence of bacteremias and invasive mycoses in children with high risk neuroblastoma.

BACKGROUND: Information on the incidence of infectious complications during for treatment for high risk neuroblastoma (HR-NB) is limited. Bacteremias and invasive mycoses may be considered surrogate markers of the infection burden. PATIENTS AND METHODS: Data on bacteremias and invasive mycoses occurring during 3 consecutive protocols for front line (NB-89; NB-92; NB-97) or salvage therapy (TVD) for HR-NB were reviewed. The cumulative risk of developing a first episode and the rate of infections during the entire length of each protocol were evaluated. RESULTS: Front line protocols were given to 80 patients for a total of 22,070 days at risk; salvage treatment was given to 24 children for 2,909 days at risk. During front line therapy 41 infectious episodes were diagnosed in 29 (36%) patients, for a 45% cumulative risk and an infection rate (IR) of 0.19/100 patient-days-at risk. Salvage therapy determined five infectious episodes in four (17%) patients, with a 39% cumulative risk, and an IR of 0.17. The IR during the phase of high dose chemotherapy with hematopoietic stem cell rescue (megatherapy) included in the three front line protocols decreased over time (1.54 in NB-89; 0.52 in NB-92 and 0.0 in NB 97; P = 0.001), possibly because of the use of less aggressive conditioning regimens, without radiotherapy. CONCLUSIONS: The IRs of protocols for HR-NB did not change over time. The megatherapy-related phases are those at highest risk.

Adolescent↗
PubMed1994

Treatment of deep mycoses with liposomal amphotericin B.

Amphotericin B is the mainstay of therapy of many deep mycoses, but its use is seriously hampered by dose-limiting nephrotoxicity. In this study a liposomal formulation of amphotericin B was administered to ten patients with proven deep mycoses: invasive aspergillosis (n = 4), deep candidiasis (n = 4) and zygomycosis (n = 2). The mean daily dosage of liposomal amphotericin B was 3.0 mg/kg (range 2.5 to 4 mg/kg), the mean total dosage of liposomal amphotericin B 2,781 mg (range 87 to 5,220 mg) and the mean duration of treatment 17 days (range 3 to 33 days). Treatment with liposomal amphotericin B was associated with little nephrotoxicity and an overall survival rate of 50%. The median increase of serum creatinine from baseline levels was 0.38 mg/dl (-1.2 to 2.6 mg/dl).

Adult↗
PubMed1991

Fluconazole. Review and situation among antifungal drugs in the treatment of opportunistic mycoses of human immuno-deficiency virus infections.

Fluconazole is a novel triazole antifungal drug chiefly used in the treatment of opportunistic mycoses in immuno-compromised patients, particularly those with the acquired immuno-deficiency syndrome (AIDS). In comparison with other antifungal drugs, fluconazole has outstanding physical and pharmacokinetic properties, such as an excellent aqueous solubility allowing a parenteral formulation, high bioavailability by the oral route, even distribution throughout the tissues, including the central nervous system and the cerebro-spinal fluid, a long half-life (permitting once daily administration), and low binding to plasma proteins. It is excreted mainly as unchanged drug in the urine. Fluconazole is a broad-spectrum antifungal agent, especially effective against Candida spp., Cryptococcus neoformans and dermatophytes. Its antifungal efficacy was mainly proved by testing in animal models, since there is no relationship between in vitro and in vivo activities. It possesses a low toxicity and it is well-tolerated. Fluconazole is currently marketed for the treatment of oropharyngeal candidiasis in immuno-compromised patients and of atrophic oral candidiasis. Its place in the treatment of opportunistic mycoses in human immuno-deficiency virus-positive patients, in particular cryptococcal meningitis, is still under investigation but is promising.

Acquired Immunodeficiency Syndrome↗