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PubMed1992

Epidemiology and pathogenesis of paranasal sinus mycoses.

In a prospective study, 50 cases of paranasal sinus mycoses were diagnosed in 2 years out of 119 clinically suspected patients from north India. Young men from rural areas were most commonly afflicted. Patients with paranasal sinus mycoses could be grouped in three clinical varieties: noninvasive, 31; invasive, 17; allergic, 2. Maxillary and ethmoid were the common sinuses concurrently involved in these patients, whereas sphenoid and frontal sinuses were also affected in invasive variety. Aspergillus flavus (80%) was the most common isolate, followed by A. fumigatus (6%). Alternaria species was identified in two patients with noninvasive granuloma. In invasive variety, Rhizopus arrhizus and Candida albicans were the causative agents in two patients and one patient, respectively. Regarding pathogenesis besides epidemiologic factors, the immunologic factors were also evaluated. It was found that presence or absence of precipitating antibody against antigens from the etiologic agents correlates well with disease progression. Allergic factor was found in all varieties, though presence of cell-mediated immunity was demonstrated in 29% patients with noninvasive granuloma only. The combination of skin test against aspergillin and precipitin demonstration at the outset will therefore help in preliminary screening.

Adolescent↗
PubMed2005

Prevention of systemic mycoses by reducing exposure to fungal pathogens in hospitalized and ambulatory neutropenic patients.

PURPOSE/OBJECTIVES: To describe sources of fungal contamination that can incite invasive mycoses in hospitalized and ambulatory neutropenic patients and to discuss approaches to reduce exposure to pathogens. DATA SOURCES: Published articles, books, and brochures. DATA SYNTHESIS: Modifications of patient environments and lifestyles include hand hygiene for patients and healthcare workers, air filtration in hospitals, and reduction in exposure to plants, soil, standing water, and dusty environments. The effectiveness of dietary restrictions is controversial, although avoidance of pepper is recommended. These restrictions should be implemented prior to, during, and following neutropenia. CONCLUSIONS: Mycoses can be hospital or community acquired; however, although guidelines for environmental and lifestyle modifications are well documented for the institutional setting, they are more limited for ambulatory patients. IMPLICATIONS FOR NURSING: Nurses have a key role in the early identification of outbreaks of fungal infections, evaluation of hospital and home environments for sources of pathogens, education of patients on preventive measures, and research on neutropenic diets and improved technology to reduce exposure to fungal pathogens.

Cross Infection↗
PubMed2001

Immunotherapy in patients with systemic mycoses: a promising adjunct.

Evidence from several in vitro and animal model studies suggests a modulatory role of haemopoietic, T(H)1 and T(H)2 cytokines in host defence against fungi, and highlights their potential utility as adjunctive therapy for management of systemic mycoses (SM). However, there are limited clinical data to support the use of cytokines in prevention and treatment of SM. Thus, at present no adjunctive treatment is justified for routine use in all patients. Potential application of these immunomodulatory agents include the use of granulocyte-macrophage colony-stimulating factor or macrophage colony-stimulating factor in the management of mycoses in neutropenic patients with myelogenous leukaemia or bone marrow transplantation. Interferon-gamma may have a useful role against aspergillosis in patients with chronic granulomatous disease. Granulocyte colony-stimulating factor-elicited white blood cell transfusions may be life saving to patients with refractory SM. Better understanding of synergy between cytokines and specific antifungals may provide powerful tools for managing these serious infections.

Animals↗
PubMed1979

Oral mycoses and their treatment.

Mycoses of the mouth and nearby areas can be caused by both yeasts and filamentous fungi. They may appear either independently or as part of a systemic infection. It is typical of many mycoses that they occur as a consequence of local factors operating in the mouth, or in patients debilitated by severe diseases. Yeasts that are part of the normal microbial flora of man, among them especially Candida species, are the most frequent causative agents. Some tropical or semitropical infections may occur in Scandinavia and Finland, but they are rare. Local therapy with antimycotics is often effective in acute infections, whereas some chronic ones may make systemic administration necessary. Some of these infections are treated surgically.

Acute Disease↗
PubMed1999

Epidemiological survey of the imported mycoses in Japan.

The authors surveyed the present situation for imported (introduced) mycoses from papers published in Japan as of the end of October, 1998. There were 16 cases of coccidioidomycosis, 22 of histoplasmosis, 13 of paracoccidioidomycosis and one of penicilliosis marneffei. In coccidioidomycosis the ages ranged from 17 to 55, for 14 males and two females. There were eight cases of primary pulmonary coccidioidomycosis and the remaining eight were of the disseminated type, of which two were fatal. For histoplasmosis, the ages ranged from 17 to 74 of which five cases were female and 17 male. They consisted of 13 pulmonary histoplasmosis, seven disseminated type and two cutaneous type. All cases of the disseminated type died. All of the patients with paracoccidioidomycosis were infected in Latin American countries. They consisted of 12 males and one female, and the ages ranged from 34 to 68. The clinical types were dominated by mucocutaneous-lymphangitic paracoccidioidomycoses (10 cases). A single case of penicilliosis marneffei (38 years old, male) was reported very recently. The case was complicated by AIDS and became critical. Blastomycosis has not yet been reported. This survey indicates that the number of the imported mycoses in Japan is increasing. It is necessary for the responsible authorities to take counter measures to cope with this situation.

Adolescent↗
PubMed2005

[Imported mycoses in Japan: their present status and problems].

Imported mycoses in Japan, particularly coccidioidomycosis and histoplasmosis, have been on the increase in the past 15 years, and more than 40 patients have been reported to suffer from each of these diseases. In spite of their high infectivity and virulence, imported mycoses have received little attention by physicians. Concerning coccidioidomycosis, in particular, physicians should keep abreast of updated and detailed information, and should maintain close contact with clinical microbiologists. In this review, the general profile of coccidioidomycosis, including its diagnosis and treatment, was described, and the importance of these diseases as well as their recent trends were discussed.

Coccidioides↗
PubMed1996

Outbreak of invasive mycoses caused by Paecilomyces lilacinus from a contaminated skin lotion.

BACKGROUND: Invasive mycoses are an important cause of illness and death in immunocompromised patients. Infections with molds other than aspergilli have been increasingly seen in patients with hematologic cancers, but epidemics of these infections have not yet been reported. OBJECTIVE: To describe an outbreak of invasive mycoses with Paecilomyces lilacinus in severely neutropenic patients. DESIGN: An outbreak investigation. SETTING: The hematology-oncology isolation and bone marrow transplantation unit of the University Hospital, Basel, Switzerland. PATIENTS: 25 consecutive patients admitted between 17 August 1993 (the date of the first manifestation of P. lilacinus infection) and 31 October 1993 (when the unit was closed). MEASUREMENTS: Clinical and microbiological data, including histologic findings; cultures from several patient sites; and environmental examinations of potential airborne, parenteral, enteric, and horizontal routes of transmission. Infections were defined by the isolation of P. lilacinus from clinically evident skin eruptions. RESULTS: 12 of the 25 patients (48%) were infected or colonized. Nine patients (36%), including all bone marrow transplant recipients, had documented invasive P. lilacinus infections. All 9 infected patients had papular, pustular, or necrotic skin eruptions. Two patients with severe graft-versus-host disease died with refractory fungal disease; 1 also had microbiologically documented endophthalmitis and kidney infiltrates. Seven affected patients no longer had P. lilacinus after recovery of bone marrow function. The organism was resistant in vitro to amphotericin B, itraconazole, and fluconazole. Patients did not respond clinically to these agents. The outbreak was ultimately traced to a contaminated, commercially available, pharmaceutically prepared skin lotion. The outbreak ended after the skin lotion was recalled and has not recurred after a follow-up period of 2 years. CONCLUSION: Contaminated skin lotion is a potential cause of opportunistic fungal infections in immunocompromised hosts. Paecilomyces lilacinus is a common saprophytic mold that can cause, by direct cutaneous inoculation, invasive infections associated with illness and death.

Adolescent↗
PubMed1983

Treatment of systemic mycoses with ketoconazole: emphasis on toxicity and clinical response in 52 patients. National Institute of Allergy and Infectious Diseases collaborative antifungal study.

The pharmacology, in vitro mycologic activity, toxicity, and efficacy of ketoconazole were studied in a Phase-II evaluation by the National Institutes of Health and National Institute of Allergy and Infectious Disease Mycoses Study Group. This report emphasizes the toxicity and clinical response data in 52 patients with the following systemic mycoses: blastomycosis in 16 patients; nonmeningeal coccidioidomycosis in 13; histoplasmosis in 8; nonmeningeal cryptococcosis in 7; sporotrichosis in 7; and both blastomycosis and nonmeningeal coccidioidomycosis in 1. Maximum daily doses of ketoconazole were 100 mg in 1 patient; 200 mg in 23; 400 mg in 12; and 600 mg in 16. In 52% of the patients, duration of therapy ranged from less than 1 to 6 months, whereas in 35%, duration ranged from 7 to 12 months, and in 13%, from 12 to 22 months. In 35 patients (67%), evidence of toxicity was not seen. Nausea, anorexia, or vomiting occurred in 21%. Cure or marked improvement was shown in 27 patients (52%), whereas failure of the primary course was seen in 14 (27%) and relapse after ketoconazole was discontinued in 11 (21%). Although this evaluation did not provide clear-cut clinical response data, our results indicate that ketoconazole, in the dosage regimens used, was more effective in patients with histoplasmosis and nonmeningeal cryptococcosis than in patients with blastomycosis and nonmeningeal coccidioidomycosis, and least effective in patients with sporotrichosis.

Adolescent↗
PubMed2001

[Recent progress in molecular diagnosis of deep-seated mycoses].

Diagnosing deep-seated mycoses continues to be a major challenge for the clinician. The non-culture-dependent laboratory assay with high sensitivity and specificity are needed for rapid diagnosis of deep-seated mycoses. Future clinical mycology laboratories will increasingly utilize DNA-based methods for the recognition of pathogenic fungi in patient specimens and for the identification of fungal isolates. Over the last ten years, increasing numbers of papers were published which document the molecular biological methods feasible to detect fungus-specific DNA sequence in clinical specimens. The polymerase chain reaction(PCR) and internal probes are central to these procedures. More recently, the non-isotopic in situ technique has been applied in the detection of pathogenic fungi. These methods have the potential to improve diagnostic accuracy and hasten the institution of specific antifungal therapy. This article will review some of the recent advances in molecular diagnosis of fungal infections.

DNA Probes↗
PubMedDate not supplied

[Immunodiffusion tests in gel media with the addition of polyethyleneglycol 6000 for the serodiagnosis of mycoses].

Different immunodiffusion techniques with and without the addition of polyetilenglycol 6000 (PEG), were studied to determine its effect on the sensitivity of these reactions. One hundred thirteen sera from patients who suffered or had suffered deep mycoses (paracoccidioidomycosis: 49, histoplasmosis: 25, aspergillosis: 25, candidiasis: 8 and coccidioidomycosis: 6) were examined by the quantitative Ouchterlony's immunodiffusion procedure. Regular medium and media with 2% and 4% PEG were used. Eighty two out of the one hundred thirteen sera were positive for the regular medium and 91 for the medium containing 2% of PEG; furthermore, an increase of 1 or 2 two fold dilutions in the titers was observed in 40% of the sera, for the later media. Twenty one sera from aspergillosis cases were examined by agarose gel immunoelectrophoresis, 80% had more precipitin bands in the medium with 2% of PEG. Thirty four serum samples of patients suffering aspergillosis, paracoccidioidomycosis and histoplasmosis were studied using the agarose electroosmophoresis with the secondary immunodiffusion test. An increase in the number of the anodic bands were observed in 55% while 64% presented more catodic bands, when the PEG medium was used. This results would indicate that the addition of 2% PEG 6000 to the regular medium improves the sensitivity of the immunodiffusion tests for mycoses.

Antigens↗
PubMed1977

Therapy for deep mycoses: an introduction.

A classification of mycoses, depending upon the depth of penetration of the organism is discussed, as is the need to distinguish the true from the 'pseudo' mycoses. The development of antifungal agents is described from the first antibiotics to amphotericin B and 5-fluorocytosine. Attention is particularly focussed on the question of safety and effectiveness. Finally, it is stressed that successful antifungal treatment must depend upon determination of the exact pathological status of the patient and examples are given which relate to such clinical assessments.

Antifungal Agents↗
PubMed2003

Mycoses--prophylaxis and treatment.

An increase in the mycotic infections has been observed in recent decades. It is the effect of the development of industry, large migrations, living in huge aglomerations, usage of the public swimming-pools, wearing impervious clothes and shoes. Systemic diseases: diabetes, obesity, hormonal disorders, immune and food deficiency, AIDS, neoplasms and prescription drugs: antibiotics, corticosteroids and immunosuppressants, cause mycoses. Mycoses belong to chronic diseases, they are difficult to treat and very often recur. A lot of antimycotic drugs are known, but the most effective are azoles and alliloamines. An intensive research is conducted on introduction of new and more effective and cheaper preparations.

Antibiotic Prophylaxis↗
PubMed2004

[Histopathological diagnosis of mycoses].

Infectious diseases emerge as a cause of pathology in our patients. Among the possible etiologies, mycoses have shown a considerable increase in the two last decades. In general, the clinical features of fungal diseases are not very distinctive. The morphology and the clinical aspects of the fungi serve as a protocol for their correct identification. Clinicians, microbiologists and pathologists are essential for the diagnosis. The pathologist using a simple and fast methodology can diagnose some types of mycosis, but they do not only identify the causal agent, but also the kind of injury that produces, the inflammatory response and the affected organ or organs. Moreover, they can classify the mycosis as superficial, cutaneous, subcutaneous, deep and systemic depending on the location. The present review paper describes study guidelines for the pathologist faced with a fungal infection and new technical advances that are established in pathology laboratories for a more precise identification of the mycoses.

Biopsy↗
PubMedDate not supplied

[Immunodiagnosis of endemic mycoses and bronchopulmonary aspergillosis: a multicenter study in Argentina].

In order to contribute to the knowledge of the relative frequency of chronic fungal diseases and assess the performance of diagnostic laboratories in Argentina, a multicenter study was performed with the participation of 25 medical centers located in 12 different provinces and Buenos Aires City. Between 04-01-2000 and 03-30-2001, 965 serum specimens from patients clinically suspected of having histoplasmosis (HP), paracoccidioidomycosis (PCM), coccidioidomycosis (CM) or aspergilosis were analyzed. Agar immunodiffusion tests (IDD) were done locally. All positive and 35% of negative sera were retested in the reference center. Results of laboratories of origin showed 98.8% concordance with those of reference center. Antibodies against any of the etiological agents were detected in 120 specimens from 98 patients. Endemic mycoses (HP, PCM and CM) were diagnosed in 70 patients (71.4%) and aspergilosis in 28 (28.6%). The frequencies of the different mycoses in decreasing order were PCM 47 patients (47.9%), aspergilosis 28 patients (28.6%), HP 13 patients (13.3%) and CM 10 patients (10.2%). The study was carried out on a voluntary basis and some areas of the country were not represented. However, the frequencies were in range with the expected rates in the population under study.

Argentina↗
PubMedDate not supplied

Antifungal agents and immunomodulators in systemic mycoses.

The rising incidence of fungal infections and the emergence of several fungi as opportunistic pathogens have reawakened interest in chemotherapeutic and prophylactic agents for mycoses. During the past decades significant advances have been made in the development of novel antifungal agents for treatment of systemic mycoses. This brief review presents an update of the available information on polyenes, imidazoles, triazoles, flucytosine, allylamines, echinocandins, nikkomycins, sordarins and immunomodulators. A reference has also been made to the work in antifungals done or in progress at the Central Drug Research Institute (CDRI), Lucknow. Currently, antifungals represent more than 6% of the total world market for anti-infective agents and with 20% annual expansion they are expected to cross the 15 billion US Dollars in value within a decade.

Antifungal Agents↗
PubMed1991

[Little known mycoses caused by dematiaceous opportunists].

The mycoses caused by melanized hyphomycetes are reviewed. Agents of superficial, (sub)cutaneous, paranasal, and systemic mycoses are listed, putting the emphasis on species isolated in Germany. Adaptations to survive in extreme environments may be considered as virulence factors of these fungi. Survival inside human tissue is more or less successful depending on the immune status of the host. Several neurotropic fungi are possibly real pathogens in that they are capable of invading immunocompetent individuals.

Brain Diseases↗
PubMedDate not supplied

[Diagnosis and treatment of mycoses based on the records of the ENT Clinic of the Smolensk Medical Institute].

During the last three years the ENT Department examined and followed up 87 patients with mycoses of ENT organs of different localization. This paper describes the diagnostic and therapeutic methods used. Special attention is given to the differential diagnosis of mycoses, tumors and bacterial infections. Therapeutic protocols based on antifungal drugs are presented.

Adolescent↗
PubMed1989

[Fluconazole treatment of systemic mycoses].

Efficacies of fluconazole, a new triazole antifungal agent, were evaluated in 11 cases of systemic mycoses (1 case each of candiduria, pulmonary cryptococcosis, pulmonary aspergillosis, pulmonary penicilliosis and suspected fungal pulmonary infection, and 3 cases each of candidemia and Candida endophthalmitis). The clinical efficacies were excellent or good in 8 out of 9 cases and poor in 1. Side effects observed were mild with 1 incident each of gastrointestinal symptom and reversible leukopenia. This drug appears to be promising in treatment of systemic mycoses.

Adolescent↗