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PubMed1999

[Scytalidium dimidiatum pseudodermatophyte, agent of superficial mycoses and phaehyphomycosis].

Scytalidium dimidiatum is a fungus found mainly in tropical and subtropical zones. Infection can cause a benign disease closely resembling dermatophytosis. In immunocompromised hosts, Scytalidium dimidiatum can also lead to phaehyphomycosis. Although awareness of these hyphae remains limited in developed countries, their incidence is growing due to increasing immigration and tourism. The rising incidence is well illustrated by three patients who presented onyxis and squamous-like manifestations on the arch of the foot upon returning from trips overseas and in whom various treatments were unsuccessful. In all three cases, culture in non-selective Sabouraud medium identified Scytalidium dimidiatum. These findings underline the need for laboratory testing before undertaking local or systemic treatment of onyxis especially since this pathogen can cause systemic disease. Study of ribosome genes showed that Scytalidium hyalinum is an homologous unpigmented mutant form of Scytalidium dimidatum. No antifungal agent has been effective for management of superficial manifestations and prevention depends mainly on the use of appropriate footwear in endemic areas.

Adult↗
PubMed2000

Prevention of systemic mycoses in patients who are not neutropenic: should we do it? Can we do it?

It has been well documented that serious fungal infections may cause death in 5% to 10% of patients in certain high risk groups, such as those undergoing lung, pancreas, or liver transplantation. Patients in intensive care units, such as those with underlying severe disease, multi-organ fungal infection, those with catheters, those on broad spectrum antibacterial agents, and those in renal failure are also at risk and may be candidates for antifungal prophylaxis. However, recommendations regarding the use of antifungal drugs for prophylaxis in non-neutropenic patients are unclear. Several clinical trials in transplant recipients have supported the use of fluconazole for prophylaxis, particularly in liver transplantation, though the data are too few to permit generalized conclusions for all organ transplant recipients. There is also a trial in which antifungal prophylaxis has been successful after gut perforation. However, there are also reports in which high doses of fluconazole have not reduced fungal infection. The appropriate circumstances for prophylaxis are still undergoing definition. It is the author's opinion that effective prophylaxis will become more problematic in the future. In a year or two, once the drug becomes generic, the price of fluconazole will fall dramatically. A sharp increase in use is likely to occur, and is likely to be followed by increasing fluconazole resistance in both Candida albicans and non-albicans colonization and infections. The situation is similar to the consequences of widespread fluconazole use in AIDS patients. The best methods to delay resistance include strict handwashing, careful control of antibacterials, restricting fluconazole use to those situations where it has been most clearly shown to be beneficial, and carefully monitoring patients in intensive care units.

Antifungal Agents↗
PubMed2000

[Mycoses].

Explore the source record for details and available documents.

Aspergillosis↗
PubMed2000

New aspects of some endemic mycoses.

The treatment of mycetomas varies according to their etiological agents and the clinical state of the patient. For the treatment of eumycetomas, the azole derivatives are the drugs of choice, with itraconazole rendering better results than ketoconazole and presenting better tolerance. Actinomycetomas are treated according to different therapeutic schemes: dapsone plus sulfamethoxazol-trimethoprim (SMT), and streptomycin or amikacin or amoxicillin plus clavulanic acid. The first therapeutic scheme is very useful in the treatment of Nocardia mycetoma, while the association of amikacin plus SMT is the best treatment for those cases produced by Actinomadura madurae. Ciprofloxacin is a very useful drug for the treatment of actinomycotic mycetomas with bone lesions. Although there are several criteria for evaluating clinical outcome there is no accepted criterion of cure. During the 1990s, there was a remarkable increase in the incidence of coccidioidomycosis in California, USA. An almost ten-fold increase in the number of cases was registered during 1992 and 1993 over the usual incidence. A gradual reduction in coccidioidomycosis cases was observed in the late 1990s. This particular coccidioidomycosis outbreak took place in areas of low endemicity, as well as in those of usual high endemicity. Among the factors believed to have influenced this phenomenon were a drought followed by abundant winter/spring rainfall, increased immigration of susceptible individuals, increase in excavation/construction work and a better diagnosis of the infection, particularly in the last part of the decade. The majority of patients presented the usual clinical manifestations of symptomatic primary infection but an unusual number of cases with acute respiratory failure were observed.

Antifungal Agents↗
PubMed2001

[Ocular parasitoses and mycoses: cases diagnosed in the Central University Hospital of Sfax between 1996 and 1999].

Parasitical and fungal ophthalmic infections are polymorphic and variably severe. They are rarely reported in publications. The aim of our study has been to specify the parasitic and fungal agents isolated from the ocular samples in our district (Sfax-Tunisia). We surveyed retrospectively the different ocular parasitosis and mycosis diagnosed in our laboratory (Sfax hospital) over a 4 year-period (1996-1999). Fungal ophthalmic infections were dominated by corneal localisations: 20 cases of keratomycosis secondary to: Fusarium solani (8 cases), Aspergillus fumigatus (3 cases); Aspergillus flavus (2 cases); Alternaria sp (2 cases), Candida albicans (2 cases); Fusarium dimerium (1 case); Fusarium oxysporum (1 case) and Scedosporium sp (1 case). A prolonged treatment by ketoconazole had a successful resolution in 70% of cases; 1 case of ciliar tinea caused by Trichophyton violaceum. Parasitic agents were dominated by Demodex folliculorum (32 cases), Phthirius inguinalis (6 cases) and Oestrus ovis (2 cases). Two cases of orbital hydatidosis and 2 cases of palpebral cutaneous leishmania were noted; 21 cases of ocular toxoplasmosis were treated by clindamycine. Our survey concerned not only cosmopolite parasitosis and fungi, but also some affections endemic to our district (hydatidosis and leishmaniasis) with manifestations in isolated ophthalmic localisation. Our research has underscored the need to specify types of infection by way of adequate sampling so as to treat early and then improve prognosis.

Adolescent↗