[Current problems in mycoses: opportunistic fungi and iatrogenic mycoses].
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Antifungal Agents↗
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[Mycoses and antimycotics. I. Mycoses of the skin, mucous membrane and inner organs].
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Antifungal Agents↗
A study of 3891 cases of mycoses in the tropics.
4103 cases suspected of mycoses were analysed as to sex, age and site of disease and 3891 were proved cases. This group formed 50% of total mycoses or 13-93% of all dermatoses recorded in the Government General Hospital, Madras, during the period of study. There were 66-26% adult female, 27-6% adult male and 6-14% were below 13 years. Dermatophytoses were found in 73-5%; the other common diseases were tinea versicolor (17-68%) and candidiasis (12-43%). Multiple sites of involvement or more than 1 disease in the same individual were mostly observed. The incidence of piedra (0-1%) and deep mycoses (0-156%) was very low. Mycetoma was the common disease (5/6) in deep mycoses. In dermatophytoses, tinea corporis (49-71%) and tinea cruris (47-85%) commonest; tinea axillaris (3-42%), tinea capitis (1-72%) and tinea barbae (1-29%) were less common. The incidence of tinea manuum, tinea pedis and tinea unguium was similar (4-97%-6-38%). High temperature and humidity were related to the higher incidence of tinea corporis, tinea cruris and tinea versicolor. Mainly children suffered from tinea capitis. All other mycoses were commonly found in adults between 2nd and 3rd decades. In all mycoses but candidiasis, female predominated. Cutaneous candidiasis was mainly a problem of housewives. Among the dermatophytes Trichophyton violaceum was predominant (33-7%) followed by T. rubrum (32-6%). Trichophyton schoenleinii and M. gypseum were rarely isolated. From mycetoma, Madurella mycetomii, Nocardia braziliensis, N. asteroides and Actinomadura spp. were isolated. Demonstration of Cryptococcus laurentii in 1 case is reported in this area for the first time.
Adolescent↗
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↗
[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↗
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↗
[Therapy of opportunistic mycoses].
The author presents the drugs that are available for the treatment of opportunistic mycoses: amphotericin B, nystatin, 5-fluorocytosine, miconazole and the newest imidazole derivative econazole. He presents his experience with econazole in 4 cases with deep mycoses. He speaks of the mode of application and the therapeutical limits of these products as well as of the favorable factors and the prophylactic measures to be taken.
Adult↗
[Pulmonary mycoses; laboratory diagnosis, antimycotic therapy].
The microscopic, cultural and serological techniques for the diagnosis of European and non-European systemic mycoses involving the respiratory tract are reviewed. The antimicrobial, therapeutic and toxic properties of those antimycotic drugs are discussed, which can be used in the treatment of pulmonary mycoses. Data on biotransformation, kinetics and dosage are reported.
Administration, Topical↗
Superficial mycoses in a southern New Zealand district.
A total of 2,709 pathogenic fungi were isolated from 8,762 patients suspected as having mycotic disease, over an 8 year period in Christchurch, New Zealand. The district is climatically designated as temperate with average mean temperatures of 17 degrees C in summer and 8 degrees C in winter. The predominant species of fungi were relatively small in number with Trichophyton mentagrophytes var. interdigitals as the major pathogen. Fungi other than true dermatophytes, particularly Candida spp. and Malassezia furfur, were included to demonstrate the full spectrum of superficial mycoses presenting for diagnosis at the mycology clinic.
Adolescent↗
Mycoses imported from the West Indies. A report of three cases.
There have been isolated case reports of deep fungal infections from the Caribbean area but little is known about the distribution of mycoses there. Three cases, one of mycetoma, one of chromomycosis, one of histoplasmosis, are described. Their management and the advantages and disadvantages of treatment outside the area of origin are discussed.
Adult↗
Clinical and experimental evidence on miconazole for the treatment of systemic mycoses: a review.
Intravenous treatment with miconazole brought about the recovery of 90% of patients with gastrointestinal or systemic candidosis. Miconazole given by the same route has also been found effective in the treatment of cryptococcosis, coccidioidomycosis, and paracoccidioidomycosis. Cryptococcal and coccidioidal meningitis have been cured by combined intravenous and intrathecal instillation, although treatment of aspergillosis has presented difficulty. Oral treatment was effective in curing dermatophyte skin infections and systemic mycoses caused by sensitive organisms such as paracoccidioides, blastomyces and histoplasma. The question of blood levels following oral and intravenous administration is discussed. Side effects of the drug were few, and included chills, dizziness, skin rash, itching and diarrhoea. Thus miconazole can safely be given to seriously ill patients. Its behaviour in the body is not influenced by renal insufficiency and no drug induced resistance has been reported.
Animals↗
[Mycoses of genital organs of girls - therapeutic problems (author's transl)].
The therapeutic effectiveness of poliene antibiotics, such as nystatin, polyfungin, and pimafucin, was comparatively analysed in the context of mycoses of the genital organs of girls in various periods of development. Early detection of fungi in genital organs, the oral cavity, rectum, and urethra is of great importance to mycosis treatment of children. Whenever antimycotic treatment is followed by recurrent outbreaks, all persons in the child's closer environment have to be examined at any rate.
Adolescent↗
[Preventive drug therapy of mycoses in surgery].
In surgery there exist several groups of patients with significant risk of deep-seated mycoses, e.g., those undergoing cardiac surgery, renal transplantation, intravenous alimentation or suffering from grave burn injury. "Blind prophylaxis" which would be applied indiscriminately to all patients of the respective groups cannot be recommended with the presently available systemic (parenteral or orally absorbed) antimycotic drugs for reasons such as toxicity or risk of resistance. Less objections exist against the oral, not absorbed polyene antibiotics; however, prophylaxis with these drugs only covers candidiasis affecting, or originating from, the digestive tract and lacks statistical proof of efficacy. As an alternative to "blind prophylaxis", selective prophylaxis" is proposed which is consistent with close supervision of the patients and start of antimycotic treatment as soon as there are signs of a probable fungal infection. This is, more correctly, a sort of "early therapy".
Antifungal Agents↗
[Recent progress in immunologic technics for the diagnosis of systemic mycoses].
The new immunological techniques used for the diagnosis of systemic mycoses are very specific. Purified antigens are now available and new methods allow the detection of various classes of specific antibodies. Precipitation tests, such as bidimensional electrophoresis and electroimmunodiffusion, are compared with passive agglutination tests; radioimmunoassay and enzyme immunoassays are analyzed. The value and utilization of cellular immunity and various other tests are discussed.
Agglutination Tests↗
Aspergillosis and other systemic mycoses. The growing problem.
To measure the incidence in the United States of systemic mycoses necessitating hospitalization, we reviewed discharge records of 1,875 hospitals participating in the Professional Activity Study of the Commission on Professional and Hospital Activities. Projected incidence rates in 1976 ranged from 23.0 per million for histoplasmosis to 0.2 per million for blastomycosis. High prevalences of leukemia or lymphoma (5.9% to 10.2%) or of other malignancies (9.9% to 13.2%) were recorded in patients with aspergillosis, candidasis, or cryptococcosis. High prevalences of chronic obstructive lung disease (9.6% to 9.9%) were recorded in those with aspergillosis or histoplasmosis. Marked increases from 1970 to 1976 were found in the incidence of aspergillosis (158%), actinomycosis (92%), cryptococcosis (78%), and coccidioidomycosis (74%). Increasing numbers of persons with immunosuppressive conditions, migration of susceptible persons into hyperendemic areas, and aging of the population contributed to the increases.
Adolescent↗
Role of Aspergillus and Candida species in allergic bronchopulmonary mycoses. A comparative study.
Allergic bronchopulmonary aspergillosis (ABPA) and allergic bronchopulmonary candidiasis (ABPC) has been diagnosed in 20 and 13 cases respectively with one case in common, on the basis of laboratory and clinical findings. Most of the ABPA cases (60%) diagnosed had an early onset of respiratory symptoms, i.e. below the age of 30 years, while most of ABPC cases (69%) had a late onset of respiratory symptoms, i.e. after the age of 30 years. The precipitin bands in ABPA and ABPC were R-type and H-type, respectively. Apparently, ABPA and ABPC are independent of one another in origin as suggested by specific precipitins and dual skin reaction. In ABPA, A. fumigatus appears to be the primary causal organism although the contributory role of other species of Aspergillus, which include A. flavus, A. nidulans, A. terreus and A. niger, is evident from the present study. It is concluded that allergic bronchopulmonary mycoses (ABPM) could be caused by several fungal species independently or jointly belonging to the genera Asperigillus and Candida.
Antigens, Fungal↗
Geographic distribution and epidemiology of mycoses.
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Cross-Sectional Studies↗
Imported mycoses: some diagnostic problems.
Infections by actinomycetes or by true fungi may cause diagnostic difficulties in countries where they are not familiar. Illustrative cases from a series of 353 instances are given together with rare indigenous examples of the same infections. Early, accurate diagnosis is essential for rational and effective treatment.
Adult↗