amphotericin-b and Dermatomycoses

Topics: Amphotericin B; Anti-HIV Agents; Cesarean Section; Debridement; Dermatomycoses; Drug Therapy, Combination; Fungemia; Gestational Age; HIV Infections; Humans; Immunocompromised Host; Infant; Infant, Premature; Infant, Very Low Birth Weight; Infusions, Intravenous; Male; Necrosis; Prognosis; Risk Assessment; Treatment Outcome; Umbilical Veins; Umbilicus

Saksenaea vasiformis is one of the numerous fungi of the Order Mucorales. Rapid progression and invasion of neighboring tissues are the most characteristic features of S. vasiformis mucormycosis.. The objective of this review is the management of this type of infections.. Case report and literature review.. A 62-year old woman, without a history of immunocompromisation, developed a localized cutaneous infection at her right thigh. No trauma, skin laceration or insect bite was reported at the side of infection. The initial treatment was surgical debridements and intravenous administration of amphotericin B/posaconazole. In order to avoid the further rapid progression of the infection and save her life, it was decided to proceed to amputation of the patient's right leg. This is the first case of S. vasiformis cutaneous infection in an immunocompetent patient, in Greece.. Early diagnosis of S. vasiformis mucormycosis is of paramount importance. Clinical suspicion, based on the rapid progression of the infection and on the medical history of the patient, is sufficient to start antifungal treatment. Broad, aggressive, and repeated surgical debridement of the infection site together with systemic antifungal agents administration is the key point for successful treatment.

Topics: Administration, Intravenous; Amphotericin B; Amputation, Surgical; Antifungal Agents; Debridement; Dermatomycoses; Female; Greece; Humans; Middle Aged; Mucorales; Mucormycosis; Thigh; Triazoles

Primary cutaneous aspergillosis is a rare, life-threatening fungal infection in premature infants. We report a case of primary cutaneous aspergillosis caused by Aspergillus tamarii in an extremely low birthweight infant. The infant was delivered by cesarean section with complications from an intrauterine infection, brain intraventricular hemorrhage, tension pneumothorax and cardiac tamponade. On the 12th day of life, he developed erythematous maceration with erosion on his back. Septate hyphae were detected on two occasions from specimens of the skin lesion. The manifestations of the colony and slide culture showed the characteristics of A. tamarii. The nucleotide sequences of internal transcribed spacer regions of the ribosomal RNA gene, partial sequences of β-tubulin and calmodulin gene were compatible with those of A. tamarii. Of the known Aspergillus species, Aspergillus fumigatus and Aspergillus flavus have been reported in previous studies as the major causative agents in primary cutaneous aspergillosis, whereas human infection by A. tamarii is rare. We consider that A. tamarii is important as an unusual opportunistic human pathogen among premature infants.

Topics: Administration, Cutaneous; Administration, Intravenous; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Cesarean Section; Clotrimazole; Dermatomycoses; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Male; Ointments; Opportunistic Infections; Skin; Treatment Outcome

Cutaneous mucormycosis is a rare but often fatal invasive fungal infection that occurs most commonly in patients with diabetes, malignancy, and other immunocompromising conditions. We report an extremely preterm (<28 weeks) baby boy who developed polymicrobial sepsis and primary cutaneous mucormycosis within his first 10 days of life. He was successfully treated with medical management alone since he was not a candidate for surgery. Successful treatment of cutaneous mucormycosis without surgical debridement has been reported on only two other occasions. This case highlights the importance of rapid and thorough evaluation of skin lesions when evaluating preterm infants and other immunocompromised patients, even when other sources of infection have been identified.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Follow-Up Studies; Humans; Infant, Extremely Premature; Infant, Newborn; Male; Monitoring, Physiologic; Mucormycosis; Rhizopus; Risk Assessment; Treatment Outcome

Non-Candida opportunistic yeasts are emerging causes of bloodstream infection (BSI) in immunocompromised hosts. However, their clinical presentation, management, and outcomes in stem cell transplant (SCT) recipients are not well described. We report the first case to our knowledge of Pseudozyma BSI in a SCT recipient. He had evidence of cutaneous involvement, which has not been previously described in the literature. He became infected while neutropenic and receiving empiric micafungin, which is notable because Pseudozyma is reported to be resistant to echinocandins. He was successfully treated with the sequential use of liposomal amphotericin B and voriconazole. A review of the literature revealed nine reported instances of Pseudozyma fungemia. We performed a retrospective review of 3557 SCT recipients at our institution from January 2000 to June 2015 and identified four additional cases of non-Candida yeast BSIs. These include two with Cryptococcus, one with Trichosporon, and one with Saccharomyces. Pseudozyma and other non-Candida yeasts are emerging pathogens that can cause severe and disseminated infections in SCT recipients and other immunocompromised hosts. Clinicians should have a high degree of suspicion for echinocandin-resistant yeasts, if patients develop breakthrough yeast BSIs while receiving echinocandin therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cryptococcus; Cytarabine; Dermatomycoses; Echinocandins; Exanthema; Fever; Fungemia; Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cell Transplantation; Humans; Idarubicin; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Lipopeptides; Male; Micafungin; Opportunistic Infections; Retrospective Studies; Saccharomyces; Salvage Therapy; Trichosporon; Ustilaginales; Vidarabine; Voriconazole; Yeasts

Cryptococcus neoformans infection can occur in a wide range of hosts ranging from those who are severely immunosuppressed to those who are apparently immunocompetent. Two apparently immunocompetent HIV-seronegative patients with cryptococcal meningitis and multiple skin lesions, both due to C. neoformans var. grubii, are reported. Pregnancy was found as an associated factor in cryptococcal meningitis in a 20-year-old female patient from Arunachal Pradesh. Multiple skin lesions were the presenting feature of an 18-year-old male patient from Dibrugarh, eastern Assam. The organism was identified both phenotypically and by sequencing of ITS1 and ITS2 regions of rRNA gene. The cases are reported because of rarity of this infection in non-HIV-infected patients.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Base Sequence; Cryptococcus neoformans; Dermatomycoses; DNA, Intergenic; DNA, Ribosomal Spacer; Female; Fluconazole; HIV Seronegativity; Humans; India; Male; Meningitis, Cryptococcal; Sequence Analysis, DNA; Young Adult

Granulomatous diseases are caused by multiple infectious and noninfectious causes. Deep fungal infections can present in the skin or extracutaneously, most commonly with lung manifestations. An Azole or amphotericin B is the universal treatment. Blastomycosis-like pyoderma is a clinically similar condition, which is caused by a combination of hypersensitivity and immunosuppression. Successful treatment has been reported with antibiotics and, more recently, the vitamin A analog, acitretin. Granuloma inguinale and lymphogranuloma venereum cause ulcerative genital lesions with a granulomatous appearance on histology. The Centers for Disease Control and Prevention recommens treatment of these genital infections with doxycycline.

Topics: Acitretin; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Azoles; Blastomycosis; Coccidioidomycosis; Cryptococcosis; Dermatomycoses; Doxycycline; Granuloma Inguinale; Histoplasmosis; Humans; Keratolytic Agents; Lymphogranuloma Venereum; Mycoses; Pyoderma; Sexually Transmitted Diseases; Sporotrichosis

We report a case of primary cutaneous mucormycosis caused by Mucor irregularis. A 47-year-old farmer was presented to our clinic with the history of progressive red plaque around the inner canthus following dacryocystectomy about a year earlier. Linear, aseptate hyphae were seen by direct KOH examination and in biopsy. Fungal culture revealed light yellow filamentous colonies that were identified as Mucor irregularis by nucleotide sequencing of rRNA gene. Amphotericin B and dexamethasone were used in gradually increasing dosage. The treatment lasted 43 days, and the patient received 760 mg total amphotericin B. The patient was discharged after 2 months of treatment. The plaque became smooth, and fungal culture was negative. There was no recurrence for half a year through telephone follow-ups. A review of published studies revealed 23 cases of Mucor irregularis infection. Most cases resulted following injuries or surgical complications. Farmers and manual laborers were most at risk with males outnumbering females among patients. Amphotericin B and its liposomal preparations remain most effective treatment choices.

Topics: Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Biopsy; Dermatomycoses; Dexamethasone; Eye Diseases; Humans; Male; Microbiological Techniques; Microscopy; Middle Aged; Molecular Sequence Data; Mucor; Mucormycosis; Sequence Analysis, DNA; Treatment Outcome

Cutaneous mucormycosis is a rare opportunistic infection caused by zygomycetes that can be rapidly fatal if unrecognized. We describe the clinical, histopathological, fungal and molecular features of a case of gangrenous cutaneous mucormycosis. The patient presented with great necrosis on his right forearm at the site of detained intravenous cannula needle. He had type II diabetes and chronic renal insufficiency. KOH mount of black eschar showed many broad, aseptate fungal hyphae with right-angle branching. PAS staining of the tissue sample revealed similar broad hyphae in the dermis and cutis. Fungal culture and ITS sequence analysis identified this fungus as Rhizopus oryzae. As no organ involvement was detected, the patient was diagnosed with primary cutaneous mucormycosis. Considering the poor state of the patient, complete excision of the infectious tissue was performed without skin graft instead of amputation. At the same time, intravenous liposomal amphotericin B was given, starting from a small dosage and increased to a total dosage amount of 5.45 g. The wound recovered well with granulation. We emphasize that early recognition and prompt therapy including the control of the primary diseases were important. In this article, we also reviewed the features of primary cutaneous mucormycosis reported in China over the last 20 years.

Topics: Administration, Intravenous; Amphotericin B; Antifungal Agents; Catheter-Related Infections; China; Debridement; Dermatomycoses; Diabetes Complications; DNA, Fungal; DNA, Ribosomal Spacer; Forearm; Gangrene; Histocytochemistry; Humans; Male; Microbiological Techniques; Middle Aged; Molecular Sequence Data; Mucormycosis; Rhizopus; Sequence Analysis, DNA

Histoplasma capsulatum is a common endemic mycosis. Infection typically goes unnoticed by an individual, but in immunosuppressed patients, it may become disseminated. We report a case of disseminated histoplasmosis occurring 6 weeks after a kidney transplant. We discuss disseminated histoplasmosis and review its characteristic clinical, laboratory, and histologic manifestations, as well as current treatment modalities.

Topics: Amphotericin B; Antifungal Agents; Bone Marrow; Dermatomycoses; Histoplasmosis; Humans; Immunocompromised Host; Kidney Transplantation; Lung; Male; Middle Aged; Pyrimidines; Triazoles; Voriconazole

Primary cutaneous zygomycosis caused by Saksenaea vasiformis is rare. Such infections usually are not suspected, and delay in their diagnosis and treatment results in a poor outcome.. Case report and review of the relevant English-language literature.. A fulminant cutaneous infection developing after intramuscular injection in the gluteal region of a 60-year-old female patient is described. The hallmark of this uncommon infection was the rapidity with which the skin and subcutaneous tissues of the right gluteal and lower abdominal regions underwent necrosis. The infection remained undiagnosed for nearly two weeks, leading to a fatal outcome.. Awareness of the fact that fungi can also be the cause of cutaneous infections, as well as a high index of suspicion in patients who do not respond to conventional therapy, should help in the early diagnosis and management of such infections and may help in reducing the mortality rate.

Topics: Amphotericin B; Antifungal Agents; Debridement; Delayed Diagnosis; Dermatomycoses; Fatal Outcome; Female; Humans; Injections, Intramuscular; Middle Aged; Mucormycosis

Penicillium marneffei is an important opportunistic pathogen in Southeast Asia in HIV-positive individuals, but it rarely infects non-HIV ones. Four SLE patients with disseminated penicilliosis had been previously reported out of which 3 died. We describe a 46-year-old Chinese woman who had a 10 years history of SLE, associated with disseminated Penicillium marneffei infection, which presented as fever, subcutaneous masses, and fine nodular shadows disseminated over lung fields. She was initially misdiagnosed as miliary tuberculosis and panniculitis that did not respond to anti-tubercular drugs and prednisone. The correct diagnosis was finally made by histopathology and tissue culture and also culture from exudate. She responded well to antifungal therapy in the form of intravenous amphotericin B for 2 weeks followed by itraconazole plus fluconazole. The cutaneous lesions were cured leaving behind scars by secondary suture after times of epluchage, and the fine nodular shadows over lungs disappeared finally. She had no recurrence on 8 months of follow-up. We also review the literature on this topic.

Topics: Amphotericin B; Antifungal Agents; China; Dermatomycoses; Female; Fluconazole; Humans; Itraconazole; Lupus Erythematosus, Systemic; Middle Aged; Mycoses; Opportunistic Infections; Penicillium

Topics: Administration, Oral; Adolescent; Amphotericin B; Antifungal Agents; Cunninghamella; Dermatomycoses; Female; Humans; Injections, Intravenous; Mucormycosis; Transplants; Triazoles

We report a case of primary cutaneous zygomycosis caused by Rhizopus species in an infant with a hematological malignancy. Multiple surgical debridements, skin grafting, and intravenous antifungal therapy were necessary to ultimately eradicate the infection. Zygomycotic infections are an emerging concern in immunocompromised patients because of their increased incidence as well as their potential to cause substantial morbidity through both emotional distress and impaired functionality. Because resection is a cornerstone of treatment for zygomycosis, the authors anticipate a growing need for plastic surgery involvement for both surgical debridement with limb and tissue-sparing procedures, and for reconstructive options that effectively treat the disease while preserving both function and esthetics. The plastic surgery literature is reviewed regarding surgical and reconstructive options for this population of patients. This case demonstrates the important role plastic surgeons play in the multidisciplinary treatment of zygomycotic and other opportunistic cutaneous infections.

Topics: Amphotericin B; Antifungal Agents; Debridement; Dermatomycoses; Humans; Immunocompromised Host; Infant; Male; Risk Factors; Zygomycosis

Cutaneous fungal infections are not uncommon in newborns and are seen in premature or otherwise immunocompromised neonates as well as in healthy full-term neonates. Healthy newborns can develop clinical manifestations as a result of infection with Candida species or as a result of skin colonization with Malassezia species; cutaneous infection with other fungal pathogens is rare. Immunocompromised and premature neonates, however, are susceptible to infection with opportunistic pathogens and are also at higher risk for invasive infection with common pathogens such as Candida. This review discusses the fungal species associated with cutaneous fungal infection in neonates, emphasizes the relevant clinical features, and also reviews the use of newer antifungal agents, including lipid-associated amphotericin B, voriconazole, and caspofungin.. Neonatal cutaneous infections with opportunistic fungal pathogens, including Aspergillus and the Zygomycetes, have been reported with increasing frequency as advances in neonatal care have improved the survival rate in very low birthweight neonates. Although these infections are frequently fatal, survival in some neonates has been reported with the use of aggressive surgical debridement and systemic antifungal therapy. Newer antifungal agents, including voriconazole and caspofungin, show promise in the treatment of potentially fatal fungal infections in neonates.. Cutaneous fungal infections in neonates range from generally benign conditions such as congenital candidiasis and neonatal cephalic pustulosis to potentially fatal infections with opportunistic pathogens in very low birthweight or immunocompromised neonates. The prompt recognition and appropriate treatment of cutaneous fungal disease in neonates is critical to the prevention of adverse outcomes.

Topics: Amphotericin B; Antifungal Agents; Arthrodermataceae; Caspofungin; Dermatomycoses; Echinocandins; Fungi; Humans; Infant, Newborn; Infant, Premature; Lipopeptides; Mitosporic Fungi; Peptides, Cyclic

Aspergillus candidus, a common contaminant of grain dust, may represent an important respiratory hazard to grain workers, considering its immunomodulating capability by producing p-terphenyl metabolites and terprenins, potent cytotoxic substances. However, there are only three cases of A. candidus infection in the English literature, one fatal solitary brain mass and two onychomycosis. We describe the first case of invasive pulmonary infection and skin abscesses due to A. candidus, determination of minimal inhibitory concentration for anti-fungals, and the successful treatment with liposomal amphotericin B and itraconazole. Possible mechanisms involved in the dissemination of infection in an immunocompetent host are discussed.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Biopsy, Fine-Needle; Dermatomycoses; Female; Humans; Immunocompetence; Itraconazole; Liposomes; Lung Diseases, Fungal; Middle Aged; Radiography, Thoracic; Treatment Outcome

We describe three cases of subcutaneous phaeohyphomycosis developing in the lower limbs of renal transplant recipients shortly after transplantation. Each case presented with dark-colored nodules that subsequently ulcerated. Histopathologic examination revealed dematiaceous fungal hyphae with a surrounding granulomatous reaction. The fungi were subsequently identified as Alternaria alternatum in two cases and Phialophora richardsiae in one case. In one case, the lesions resolved during a prolonged (6-month) course of itraconazole without the requirement for surgical excision. In the other two cases, combined medical and surgical treatment resulted in cure. A review of the literature on phaeohyphomycosis is presented.

Topics: Aged; Alternaria; Amphotericin B; Antifungal Agents; Dermatomycoses; Drug Therapy, Combination; Female; Humans; Itraconazole; Kidney Transplantation; Male; Middle Aged; Phialophora

Mucormycosis (zygomycosis) normally occurs among individuals with predisposing factors such as prematurity, use of broad spectrum antibiotics, metabolic acidosis or advanced stages of immunosuppression. There have been reports of sporadic cases of cutaneous mucormycosis related to predisposing skin lesions and contact with contaminated material such as adhesive bandages and tongue depressors placed close to intravenous catheter insertion sites. We report successful treatment of a case of Absidia corymbifera infection with the combination of amphotericin B and surgical debridement of the affected area.

Topics: Absidia; Amphotericin B; Antifungal Agents; Debridement; Dermatomycoses; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Mucormycosis; Treatment Outcome

Amphotericin B reformulated into the liposomal formulation known as AmBisome (amphotericin B, hydrogenated soy phosphatidylcholine, cholesterol and dimyristoyl phosphatidylglycerol) can be safely administered at dosages 15 times higher than the conventional drug with the same broad spectrum of activity. Increased doses demonstrate non-linear clearance with saturation of the reticuloendothelial system (RES) and redistribution of the drug into non-RES tissues. The efficacy of this liposomal amphotericin B formulation appears to be related both to improved tissue penetration in the lungs, brain, kidneys, liver and spleen along with sustained bioactivity of therapeutic drug levels in these target tissues.

Topics: Amphotericin B; Animals; Antifungal Agents; Brain Diseases; Dermatomycoses; Humans; Liver Diseases; Lung Diseases, Fungal; Mycoses; Splenic Diseases

During the last decade the incidence of invasive aspergillosis has substantially grown due to the increasing use of powerful immunosupressive drugs in more patients. Unfortunately, the associated mortality with this infection is still very high and has not decreased in recent years. Pulmonary aspergillosis is by far the most frequent clinical picture of this infection, followed by sinus, tracheo-bronchial and central nervous system disease. The degree of immunosupression is the main factor influencing the evolution and dissemination of aspergillosis. Conventional amphotericin B has been the first-line therapy of invasive aspergillosis for the last 30 years, and most authors have long considered amphotericin B related toxicity as one of the main causes for the poor results obtained in the outcome of patients who developed this infection. Fortunately, in the last few years new safer and more effective drugs have been developed for the treatment of this entity. However, if we are really trying to substantially decrease invasive aspergillosis associated-mortality we should use these drugs earlier in the development of the infection, using new more sensitive diagnostic tests and/or a riskbase strategy which could identify patients at the highest risk to develop this infection.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Caspofungin; Dermatomycoses; Drug Therapy, Combination; Echinocandins; Humans; Immunocompromised Host; Immunologic Factors; Itraconazole; Lipopeptides; Neuroaspergillosis; Neutropenia; Peptides; Peptides, Cyclic; Pyrimidines; Respiratory Tract Infections; Triazoles; Voriconazole

Apophysomyces elegans is an environmental fungus related to other well-known agents of zygomycosis. We report a case of locally invasive A elegans soft tissue infection resulting from the application of a skin patch to test for snapdragon sensitivity. The infection was limited to skin and soft tissue, and treatment consisted of local debridement and liposomal amphotericin B. Outcome was successful.

Topics: Aged; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Dermatomycoses; Humans; Male; Mucormycosis; Patch Tests; Soft Tissue Infections

Transplantation is now currently and increasingly performed for the treatment of various acute and chronic diseases. Today the kidney, heart, lung, heart-lung, liver, pancreas, kidney-pancreas, small bowel and bone marrow are being transplanted. The immunological status of patients receiving such transplants exposes them to the risk of developing bacterial, viral and fungal infections. The etiological agents of mycotic diseases involving the skin of transplant recipients range from the common dermatophytes through yeasts such as Candida spp., Malassezia spp. and dimorphic fungi to the emerging molds Fusarium spp. and Pseudallescheria boydii. The very wide spectrum of fungi causing cutaneous disease produces equally varied clinical aspects. Lesions may be typical, but are very often aspecific or ambiguous. Cutaneous lesions may be the sign of a trivial mycotic disease or the marker of a disseminated, potentially lethal fungal illness, so great attention should be given to their early recognition. Cutaneous manifestations due to Candida spp., Aspergillus spp., dematiaceous fungi and Pityrosporum folliculitis are usually observed early after transplant, cryptococcosis more than 6 months later, while the frequency of dermatophytoses increases as time goes by. Coccidioides immitis, Histoplasma capsulatum and Blastomyces dermatitidis may appear any time after transplantation. The management of the more severe forms of cutaneous mycosis in transplant recipients is difficult. Besides the fact that early recognition is not easy, there are also problems regarding the effectiveness and the toxicity of the therapy and drug-drug interactions. Prophylactic measures to avoid fungal contamination must be performed during hospitalization; patients should be taught how to avoid contamination, not only during the first period after transplantation, when high dosage immunosuppressive drugs are given, but also later when a normal lifestyle is resumed.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Fluconazole; Humans; Incidence; Itraconazole; Organ Transplantation; Risk Factors

The management of superficial fungal infections differs significantly from the management of systemic fungal infections. Most superficial infections are treated with topical antifungal agents, the choice of agent being determined by the site and extent of the infection and by the causative organism, which is usually readily identifiable. One exception is onychomycosis, which usually requires treatment with systemically available antifungals; the accumulation of terbinafine and itraconazole in keratinous tissues makes them ideal agents for the treatment of onychomycosis. Oral candidiasis in immunocompromised patients also requires systemic treatment; oral fluconazole and itraconazole oral solution are highly effective in this setting. Systemic fungal infections are difficult to diagnose and are usually managed with prophylaxis or empirical therapy. Fluconazole and itraconazole are widely used in chemoprophylaxis because of their favourable oral bioavailability and safety profiles. In empirical therapy, lipid-associated formulations of amphotericin-B and intravenous itraconazole are safer than, and at least as effective as, conventional amphotericin-B (the former gold standard). The high acquisition costs of the lipid-associated formulations of amphotericin-B have limited their use.

Topics: Administration, Oral; Administration, Topical; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Chemistry, Pharmaceutical; Dermatomycoses; Fluconazole; Humans; Intestinal Absorption; Itraconazole; Onychomycosis

Not only have the systemic mycoses clearly increased in number but also mycoses of the skin are more common than presumed in the past. Today onychomycosis is found in up to 10% of human beings. Onychomycosis can compromise quality of life markedly. Common tinea pedis is one of the most important risk factors for erysipelas of the lower legs. The clinical presentation of oral candidosis in HIV-infected patients is changing; Candida dubliniensis has been identified as another important causative microorganism. Onychomycosis today in most cases can be cured using terbinafine or itraconazole. When choosing the ideal drug in a given case, both the benefit risk ratio and the benefit cost ratio have to be taken into account. Liposomally encapsulated amphotericin B represents a major breakthrough in the treatment of systemic mycoses or fever of unknown origin. The same applies to liposomally encapsulated econazole with respect to tinea pedis. In regard to the pathogenesis of Candida infections the family of secreted aspartic proteinases plays a major role as a virulence factor and possible future target for antimycotic treatment.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspartic Acid Endopeptidases; Axilla; Candida albicans; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Case-Control Studies; Child; Clinical Trials as Topic; Dermatomycoses; Female; Humans; Liposomes; Microscopy, Immunoelectron; Multicenter Studies as Topic; Multivariate Analysis; Naphthalenes; Onychomycosis; Practice Guidelines as Topic; Prospective Studies; Risk Factors; Terbinafine; Tinea; Tinea Pedis; Trichophyton

Systemic fungal infections are an increasing problem in older adults. For several of the endemic mycoses, this increase is the result of increased travel and leisure activities in areas endemic for these fungi. Immunosuppressive agents, care in an intensive care unit, and invasive devices all contribute to infection with opportunistic fungi. Treatment of systemic fungal infections is usually with an azole or amphotericin B. The preferred regimen depends on the specific fungal infection, the site and the severity of the infection, the state of immunosuppression of the patient and the possible toxicities of each drug for a specific patient. In older adults, drug-drug interactions between the azoles and drugs commonly prescribed for older persons may lead to serious toxicity, and absorption of itraconazole can be problematic. Amphotericin B is associated with significant nephrotoxicity, especially in older adults with pre-existing renal disease, and infusion-related adverse effects. Newer lipid formulations of amphotericin B can obviate some of these toxicities, but their role in the treatment of systemic fungal infections in older adults has not yet been clarified.

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Azoles; Dermatomycoses; Drug Interactions; Humans; Immunocompromised Host; Mycoses; Opportunistic Infections

Over recent years the clinical importance of mucormycosis has significantly increased. Most frequently mucormycosis occurs in neutropenic patients with haematological diseases. It is caused by fungi of the order Mucorales. The clinical patterns of the disease produced by different genera or species of Mucorales are virtually identical. Rhizopus, Absidia, Rhizomucor and Mucor are the organisms most commonly isolated from patients who suffer from mucormycosis. Diagnosis of mucormycosis is difficult as it is based on culture methods or microscopy of clinical specimens. The diagnosis is often only made after a delay or even post-mortem. Therapy includes surgical intervention if possible and is based on systemic amphotericin B (conventional or liposomal).

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Female; Humans; Male; Mucorales; Mucormycosis

Infection of subcutaneous tissue by black fungi (subcutaneous phaeohyphomycosis) has only been reported in six transplant patients, all of whom were solid organ recipients. These patients presented with indolent, localized infections at least 1 year after transplant, while on maintenance immunosuppressive regimens. They were cured by surgical resection, either alone or in conjunction with antifungal agents. We report a case of subcutaneous phaeohyphomycosis occurring in a bone marrow transplant recipient receiving high doses of immunosuppressive agents, in whom widespread subcutaneous infection due to Exophiala jeanselmei was not eradicated by repeated resections and therapy with amphotericin B and flucytosine. The infection was eventually cured after addition of itraconazole to the therapeutic regimen. Results of in vitro testing of the isolate for susceptibility to a combination of amphotericin B, flucytosine and itraconazole confirmed the potential role of combination antifungal therapy in the setting of refractory infection.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Bone Marrow Transplantation; Combined Modality Therapy; Dermatomycoses; Drug Resistance, Microbial; Drug Therapy, Combination; Flucytosine; Fungi; Humans; Itraconazole; Male; Middle Aged; Skin

Mucormycosis is an uncommon infection caused by fungi of the order Mucorales, family Mucoraceae, and almost always occurs in individuals with predisposing factors such as diabetes mellitus, metabolic acidosis, or immunodeficiency states. Although mucormycosis is a rare infection in childhood, sporadic cases of skin infections have been described in young infants and older children; primary skin infection has been associated with multiple nosocomial outbreaks caused by contaminated elastic bandages. In all reported cases involving premature infants, the elimination of the infection involved surgical debridement. We report for the first time successful conservative treatment with intravenous amphotericin B in a premature infant with primary cutaneous infection caused by Rhizopus oryzae.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Dermatomycoses; Dexamethasone; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Mucormycosis; Necrosis; Respiratory Distress Syndrome, Newborn; Rhizopus

We report a fatal case of invasive pulmonary aspergillosis in a severely ill neonate and review 43 additional cases of invasive aspergillosis reported from 1955 through 1996 that occurred during the first 3 months of life. Eleven of the 44 patients had primary cutaneous aspergillosis, 10 had invasive pulmonary aspergillosis, and 14 had disseminated disease. Most infections were nosocomial in origin. Prematurity (43%); proven chronic granulomatous disease (14%); and a complex of diarrhea, dehydration, malnutrition, and invasive bacterial infections (23%) accounted for the majority of underlying conditions. At least 41% of the patients had received corticosteroid therapy before diagnosis, but only one patient had been neutropenic. Among patients who received medical and/or surgical treatment, outcome was relatively favorable, with an overall survival rate of 73%. Invasive aspergillosis may occur in neonates and young infants and warrants consideration under certain circumstances. Current therapeutic approaches consist of high-dose amphotericin B and appropriate surgical interventions.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Central Nervous System Diseases; Critical Illness; Cross Infection; Dermatomycoses; Fatal Outcome; Gastrointestinal Diseases; Humans; Infant; Infant, Newborn; Lung Diseases; Male

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Dermatomycoses; Humans; Male; Middle Aged

We report on a case of subcutaneous infection of the arm caused by the coelomycetous fungus Nattrassia mangiferae (formerly Hendersonula toruloidea) in a steroid-dependent diabetic man with chronic obstructive lung disease. The man was a resident of Arizona, where the fungus is known to be endemic on Eucalyptus camaldulensis and on citrus trees. Diagnosis of fungal infection was made by observation of narrow hyphal filaments by histopathology of biopsy specimens and isolation of a fast-growing black mold which demonstrated hyphae and arthroconidia of varying widths typical of the Scytalidium synanamorph (S. dimidiatum). The formation of pycnidia, which at maturity expressed conidia with a central median dark band, allowed for the confirmation of the isolate as N. mangiferae. Remission of the lesions occurred following intravenous therapy with amphotericin B, followed by topical clotrimazole treatment. We use this patient's case report as an opportunity to review the literature on cases of deep infection caused by Scytalidium species, to evaluate the antifungal susceptibilities of a spectrum of Scytalidium isolates, and to review the taxonomy of Scytalidium species isolated from human infections.

Topics: Aged; Amphotericin B; Antifungal Agents; Arm; Dermatomycoses; Diabetes Mellitus, Type 1; Humans; Lung Diseases, Obstructive; Male; Microbial Sensitivity Tests; Mitosporic Fungi; Skin

Trichoderma longibrachiatum infection of the skin in an 11-year-old child with severe aplastic anemia and prolonged neutropenia is reported. The patient received systemic antifungal therapy and underwent bone marrow transplantation. To our knowledge, this is the first description of T. longibrachiatum infection in a pediatric patient. It also is the first case successfully treated with medical therapy. A review of the literature suggests that Trichoderma spp. are recognized as human pathogens with increasing frequency, particularly for immunocompromised patients, and should be considered in the differential diagnosis of fungal infections in the pediatric population.

Topics: Amphotericin B; Anemia, Aplastic; Antifungal Agents; Child; Dermatomycoses; Humans; Male; Skin; Trichoderma

A premature neonate (gestational age, 26 weeks) with multiple prematurity-related problems developed primary cutaneous aspergillosis due to Aspergillus fumigatus on the 30th day of life. The infection developed in an area that had been macerated by adhesive tape. During the infection, renovation of the hospital was in progress near the neonatal intensive care unit. The infection was cured with a short course of therapy with amphotericin B. Five cases of primary cutaneous aspergillosis in neonates have been previously reported in the English-language literature. We review these cases and discuss the risk factors and favorable outcome of the disease when treatment with amphotericin B is instituted.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Dermatomycoses; Humans; Infant, Newborn; Male

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Candidiasis, Oral; Clinical Trials as Topic; Dermatomycoses; Esophageal Diseases; Humans; Itraconazole; Meningitis, Cryptococcal; Mycoses; Pharyngeal Diseases; Tropical Medicine

Twenty-five patients with mucormycosis were seen at two university-affiliated hospitals from 1979 to 1993. These cases included 10 cutaneous, 9 rhinocerebral, and 3 disseminated infections, as well as one case each of pulmonary, renal, and peritoneal dialysis catheter-related infection. Eleven of the patients were diabetic and seven had ketoacidosis, including four who became acidotic after admission to the hospital. The mortality rates associated with rhinocerebral, disseminated, and pulmonary infections were 78%-100%, while those associated with cutaneous and miscellaneous forms were zero. In view of the prominence of cutaneous infections, the 10 cases of cutaneous mucormycosis (in addition to a case from a community hospital) are reported in detail. Systemic diseases were present in four of the 11 patients. Local factors leading to infection were identified in nine of the cases and included motor vehicle accident-related and other trauma, surgery, a spider bite, and an intravenous infusion catheter. The cases of cutaneous mucormycosis reported in the literature have been analyzed for identification of predisposing factors, treatment, and outcome. Aggressive surgical debridement is the most important component of therapy, and administration of amphotericin B is a useful adjunct. Skin grafting is useful as a method of repairing defects left by extensive debridement.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain; Dermatomycoses; Extremities; Female; Humans; Infant; Lung; Male; Middle Aged; Mucorales; Mucormycosis; Risk Factors; Tibia

Intraocular infection due to Blastomyces dermatitidis is rare, and only 10 cases have previously been reported. Manifestations of ocular blastomycosis can range from keratitis to panophthalmitis, and it is often difficult to diagnose ocular blastomycosis early. We report the case of a 45-year-old man who had disseminated blastomycosis that involved the lungs, skin, and ocular uvea and who was successfully treated with systemic and local antifungal therapy. We also review the literature describing the spectrum of clinical findings due to intraocular blastomycosis.

Topics: Amphotericin B; Betamethasone; Blastomycosis; Dermatomycoses; Drug Therapy, Combination; Humans; Iritis; Lung Diseases, Fungal; Male; Miconazole; Middle Aged

Coccidioidomycosis is usually acquired by inhalation of Coccidioides immitis in certain areas of the Western Hemisphere. However, the disease may occur far away in individuals who have visited or lived in, then departed from, the endemic areas. The disease which can affect normal and immunocompromised individuals, has many manifestations resembling those of many diseases. The diagnosis is usually not difficult and can be accomplished by histopathological, cultural, and serological methods. Therapy can be surgical and/or medical. The latter can make use of parenteral amphotericin B and its lipid-complex, or the azoles ketoconazole, fluconazole, and itraconazole. However coccidioidal meningitis, coccidioidal arthritis, and acute coccidioidal respiratory insufficiency pose significant challenges to the available therapy.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antifungal Agents; Coccidioidomycosis; Dermatomycoses; Drug Interactions; Drug Therapy, Combination; Humans; Surgical Procedures, Operative

Histoplasmosis is an infection caused by the dimorphic fungus, Histoplasma capsulatum. The initial site of entry is usually the lung, but dissemination to skin occurs in some patients, particularly those with human immunodeficiency virus (HIV) infection in whom it is part of a widespread infection. The organisms have to be distinguished from other yeasts in skin such as Cryptococcus neoformans and small forms of Blastomyces dermatitidis.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antifungal Agents; Dermatomycoses; Histoplasmosis; Humans; Lung Diseases, Fungal

Protothecosis is an emerging opportunistic infection caused by species belonging to the genus Prototheca. Two Japanese cases of protothecosis are documented with a critical review of the literature. A current perspective concerning the microbiology and disease entity of protothecosis is described in detail.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Arm; Child, Preschool; Dermatomycoses; Enteritis; Female; Humans; Intestinal Mucosa; Japan; Ketoconazole; Lymph Nodes; Male; Middle Aged; Prototheca

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Cryptococcosis; Dermatomycoses; Diagnosis, Differential; Fluconazole; Humans; Injections, Spinal; Meningitis; Molluscum Contagiosum; Opportunistic Infections; Prognosis

Erythematous macules, nonpalpable and palpable purpura, and flaccid pustules developed in a 59-year-old man with acute lymphocytic leukemia 8 days after reinduction chemotherapy with cytosine arabinoside and daunorubicin. Tissue and blood cultures grew Fusarium proliferatum, and a skin biopsy specimen revealed fungal vasculitis. Anemia and muscle weakness accompanied the disseminated infection, for which the patient received granulocyte transfusions and amphotericin B, ketoconazole, rifampin, and griseofulvin. Skin lesions and fungemia resolved with recovery of the bone marrow, and 51 days after the completion of his chemotherapy he returned home. If promptly recognized and aggressively treated, disseminated fusariosis is responsive to therapy. Infection with Fusarium species should be suspected in profoundly neutropenic patients in whom disseminated palpable purpura and myositis develop concomitantly.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Drug Therapy, Combination; Fusarium; Humans; Immune Tolerance; Male; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Fungal infections in immunocompromised hosts cause major morbidity and mortality. The Candida and Aspergillus species are the most common causes, but many rarer organisms, once considered "contaminants," are being reported. The number of patients who receive immunosuppressive agents for the treatment of malignancy or for organ transplantation is increasing as well as the potential for local or disseminated fungal infections. The diagnosis of these infections is often difficult and the existing methods for treatment are often ineffective. A high degree of suspicion to identify fungal infections and to prompt initiation of treatment must be maintained if the survival rate of these patients is expected to improve.

Topics: Amphotericin B; Dermatomycoses; Flucytosine; Humans; Immunosuppression Therapy; Ketoconazole; Opportunistic Infections

Although rapid population growth in the Southwestern United States and travel to and through the area are increasing the potential for exposure to Coccidioides immitis, prevalence rates have declined in some endemic areas, probably because of environmental factors. With the iatrogenic immunosuppression of organ transplantation and the immunosuppression inherent in AIDS, more opportunistic infections with this organism are to be expected. The variety of cutaneous manifestations continues to challenge the dermatologist's acumen. Spherule-derived coccidioidin is an improved epidemiologic tool, and serodiagnostic techniques are easier to perform and are useful in the management of dissemination. While amphotericin B remains the standard, ketoconazole has found a definite role in the treatment of this disease in many patients. Itraconazole, now under investigation, appears very promising. Morbidity and mortality from disseminated disease appear to be declining. With current diagnostic and therapeutic methods, the prognosis for survival in immunocompetent patients is excellent.

Topics: Adult; Age Factors; Amphotericin B; Arizona; Biopsy; Child; Child, Preschool; Coccidioidomycosis; Dermatomycoses; Female; Humans; Immune Tolerance; Ketoconazole; Male; Pregnancy; Serologic Tests; Sex Factors; Skin Tests

Cutaneous cryptococcosis occurs in 10 to 15% of patients with cryptococcosis. Because the cutaneous crytpococcosis may precede clinical signs of central nervous system disease, early recognition may lead to more successful outcomes. This article reviews the mycology, epidemiology, pathology, clinical manifestations, and treatment of this disease, focusing primarily on the cutaneous aspects.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Biopsy; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Drug Therapy, Combination; Flucytosine; Humans; Immune Tolerance

Superficial fungal infections are frequent and can cause considerable morbidity. Many topical agents are available that are effective against most of these infections. Systemic fungal infections are increasing in frequency, especially among immunocompromised hosts. Amphotericin B remains the most important therapeutic agents but is associated with significant acute and chronic toxicities.

Topics: Administration, Topical; Amphotericin B; Antifungal Agents; Dermatomycoses; Flucytosine; Humans; Ketoconazole; Miconazole; Mycoses

The deep mycoses are increasing in importance both as opportunistic infections and from exposure in geographically defined areas. Diagnosis may be difficult in both groups. Mucosal involvement may be non-specific (e.g., in disseminated candidiasis) or highly predictive of disseminated disease (e.g., histoplasmosis, blastomycosis and paracoccidioidomycosis). Skin involvement is generally uncommon in disseminated aspergillosis, mucormycosis and cryptococcosis but is more common in candidemia and coccidioidomycosis. Manifestations of mucosal and cutaneous lesions of the deep mycoses are reviewed and the need for an aggressive diagnostic approach stressed. Culture is more specific than histopathologic examination alone but the latter may have to suffice in some cases. Control of underlying disease and administration of amphotericin B remain the mainstays of therapy. Ketoconazole is being evaluated as an alternative in therapy of some deep mycoses.

Topics: Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis; Candidiasis, Cutaneous; Coccidioidomycosis; Cryptococcosis; Dermatomycoses; Flucytosine; Histoplasmosis; Humans; Immunosuppression Therapy; Ketoconazole; Miconazole; Mouth Diseases; Mouth Mucosa; Mucormycosis; Mycoses; Paracoccidioidomycosis; Sporotrichosis; Travel

Topics: Amphotericin B; Antifungal Agents; Chemical Phenomena; Chemistry; Dermatomycoses; Flucytosine; Griseofulvin; Humans; Imidazoles; Kidney Diseases; Mycoses

Blastomycosis is the infection caused by the dimorphic fungus Blastomyces dermatitidis. The fungus was believed to be limited in distribution to North America but is found in Africa and northern South America, too. The exact natural habitat of B. dermatitidis is still uncertain with only rare reported isolation of the fungus from the environment. The inability to recover the organism from nature along with the absence of both a reliable skin test antigen and a sensitive serological test have significantly restricted our understanding of the epidemiology and the full clinical spectrum of blastomycosis. An accidental laboratory infection and several common source epidemics have enabled us to recognize that blastomycosis may be a self-limited pulmonary infection. Endogenous reactivation and opportunistic infections have been newly appreciated as clinical presentations of blastomycosis. This report will review blastomycosis with particular emphasis on these recent developments.

Topics: Adult; Amphotericin B; Animals; Antibodies, Fungal; Arthritis, Infectious; Blastomyces; Blastomycosis; Bone Diseases; Central Nervous System Diseases; Child; Dermatomycoses; Disease Outbreaks; Female; Humans; Lung Diseases, Fungal; Male; United States; Urologic Diseases

The term mucormycosis encompasses a distinctive group of infections caused by fungi belonging to genera within the taxonomic order Mucorales, usually Rhizopus, Absidia, Mortierella, and Mucor. These fungi are widespread in nature, subsisting on decaying vegetation and diverse organic materials. Although the fungi and spores of Mucorales show minimal intrinsic pathogenicity toward normal persons, they can initiate aggressive and fulminant infections under certain clinical conditions. Ketoacidotic diabetics are predisposed to rhinocerebral mucormycosis, whereas patients with leukemia or lymphoma are susceptible to pulmonary or disseminated infections. These infections, which often result in devastating long-term sequelae for surviving patients, pose difficult diagnostic and therapeutic challenges.

Topics: Amphotericin B; Dermatomycoses; Diabetic Ketoacidosis; Facial Dermatoses; Female; Gastrointestinal Diseases; Humans; Leukemia; Lung Diseases, Fungal; Lymphoma; Male; Mucorales; Mucormycosis

Two patients with cutaneous alternaria infection are presented. In both patients the skin lesions were characterized by multiple non-healing ulcers covered with dry crusts. Although the skin changes were macroscopically alike in the two patients, differences in the histology were seen. Both patients had primary debilitating diseases. A review of the literature is presented and revealed an additional ten cases of cutaneous alternariosis. Methods for the isolation of Alternaria and the susceptibility of the fungus to antimycotic drugs are presented.

Topics: Adolescent; Adult; Alternaria; Amphotericin B; Child, Preschool; Chlorquinaldol; Dermatomycoses; Female; Flucytosine; Gentian Violet; Griseofulvin; Humans; Male; Middle Aged; Mitosporic Fungi; Nystatin; Potassium Permanganate; Skin Ulcer

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Blastomycosis; Candicidin; Candidiasis; Coccidioidomycosis; Colistin; Cryptococcosis; Dermatomycoses; Drug Resistance, Microbial; Emetine; Flucytosine; Griseofulvin; Histoplasmosis; Humans; Imidazoles; Minocycline; Natamycin; Nystatin; Polyenes; Tolnaftate

Topics: Alkenes; Amphotericin B; Animals; Antifungal Agents; Aspergillus; Benzene Derivatives; Candida; Dermatomycoses; Flucytosine; Griseofulvin; Humans; Imidazoles; Kinetics; Mice; Microsporum; Mycoses; Natamycin; Nystatin; Trichophyton

Topics: Adult; Amphotericin B; Animals; Cats; Clinical Trials as Topic; Coccidioidomycosis; Dermatomycoses; Dogs; Drug Evaluation; Drug Evaluation, Preclinical; Drug Resistance, Microbial; Humans; Imidazoles; Lung Diseases, Fungal; Male; Miconazole; Middle Aged; Mycoses

Herein, we report a case of otitis externa caused by Malassezia slooffiae complicated with mastoiditis. A 70-year-old male complained of fever and severe otorrhea from left external auditory canal 2 months after undergoing a craniotomy to remove a hematoma. He had right-sided paralysis and undertook bed rest. Brain computed tomography revealed continuous fluid accumulation in the left mastoid air cells and middle ear from left external auditory canal in addition to leukocytosis and increased C-reactive protein level. The tympanic membrane was severely swelling. These results indicated the presence of otitis media and mastoiditis. Otorrhea culture showed large amounts of M. slooffiae. The administration of liposomal amphotericin B (L-AMB), the irrigation of external auditory canal with normal saline, and the application of topical ketoconazole ointment were started. The administration of L-AMB for 8 weeks and voriconazole, which was switched from L-AMB, for 4 weeks ameliorated his infection and he was transferred to another hospital to receive rehabilitation. From these results and his clinical course, the diagnosis of otitis externa caused by Malassezia slooffiae complicated with mastoiditis was made. And the possibility of the contamination by M. slooffiae was very low. Clinicians should be aware that M.slooffiae can provoke otological infections since M. slooffiae is the most common Malassezia sp. in external auditory canal.

Topics: Aged; Dermatomycoses; Humans; Malassezia; Male; Mastoiditis; Otitis Externa

Cutaneous mucormycosis is a rare, often fatal fungal infection that most commonly affects patients with underlying immunosuppression but also can occur in premature neonates. We report the case of an extremely premature boy (<25 weeks) who developed primary cutaneous mucormycosis shortly after birth. Although surgical debridement has been a mainstay of treatment in combination with antifungal therapy, our patient was successfully treated with amphotericin B alone-the management only reported in three other cases to date. We present this case to highlight that prompt initiation of treatment with amphotericin B alone may be an appropriate alternative to surgical intervention, particularly in patients with non-angioinvasive disease who are poor surgical candidates.

Topics: Amphotericin B; Antifungal Agents; Debridement; Dermatomycoses; Humans; Infant, Newborn; Male; Mucormycosis

Cutaneous mucormycosis is an emerging opportunistic mycosis caused by Mucorales. It can be divided into primary caused by trauma and secondary by extension of rhino-cerebral and disseminated cases. The objective is to present a retrospective study of cases of mucormycosis with cutaneous involvement.. A retrospective and descriptive study was carried out. Mucormycosis patients were included and divided into two groups: a) Primary Cutaneous and b) Secondary Cutaneous. Mycological tests were performed; the agents were identified by morphology and molecular studies (PCR and sequencing); some cases underwent histopathology. Clinical data and response to treatment were collected.. 115 cases were included, 18 of primary, and 97 of secondary cutaneous mucormycosis. Primary cutaneous mucormycosis was most associated with adhesive bands (44.4%) and trauma from traffic accidents (33.3%). The principal clinical form was extensive and deep necrotic ulcers. Secondary cutaneous mucormycosis cases were rhino-cerebral with uncontrolled diabetes (81.4%) The most frequent clinical presentation was necrosis of the eyelid and the nose (65.9%). In both groups, the principal agent was Rhizopus arrhizus, 38.8% and 74.2% respectively. The most effective treatment was the combination of amphotericin B with surgical debridement. The clinical and mycological cure was achieved in 31.0% of primary cases, and 44.4% for secondary cases.. Primary cutaneous mucormycosis is caused by implantation of the Mucorales due to trauma or rupture of the cutaneous barrier-breach, and secondary cutaneous mucormycosis develops as part of the rhino-cerebral process. The response to treatment depends on the extension and depth, as well as the predisposing factors.

Topics: Adhesives; Adult; Amphotericin B; Antifungal Agents; Debridement; Dermatomycoses; Diabetes Complications; Female; Humans; Male; Mexico; Middle Aged; Mucormycosis; Opportunistic Infections; Retrospective Studies; Rhizopus oryzae; Tertiary Care Centers; Wounds and Injuries

Topics: Administration, Intravenous; Amphotericin B; Antifungal Agents; Conservative Treatment; Dermatomycoses; Duration of Therapy; Early Medical Intervention; Gestational Age; Humans; Infant, Extremely Premature; Infant, Low Birth Weight; Infant, Newborn; Rhizopus; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Dermatomycoses; Edema; Erythema; Humans; Infant, Extremely Premature; Infant, Newborn; Infant, Premature, Diseases; Male; Twins

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, with disseminated histoplasmosis (HD) being one of its clinical forms. As a consequence of the HIV-AIDS pandemic, HD has become prevalent not only in regions that are recognized as endemic but also in areas not considered endemic, such as Europe and Asia. Its clinical manifestations are varied and mimic several infectious diseases, mainly tuberculosis. In endemic areas, it is the first manifestation of AIDS in 50 to 70% of patients. The diagnosis of histoplasmosis is difficult and HD can lead to death if not diagnosed early and if proper treatment is not instituted. The present report presents a patient with a recent diagnosis of HIV-AIDS, in treatment for miliary tuberculosis, who was diagnosed with disseminated histoplasmosis because of his dermatological manifestations.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Antitubercular Agents; Critical Illness; Dermatomycoses; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Tuberculosis, Miliary; Young Adult

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Dermatomycoses; Diagnosis, Differential; Drug Therapy, Combination; Female; Fluconazole; Humans; Immunocompetence; Lung; Lung Diseases, Fungal; Tomography, X-Ray Computed; Young Adult

Combination therapy has become popular in clinical practice, but limited data on the effects of combinations of antifungal agents is still available for most fungal pathogens. We studied the in vitro response of 30 genetically diverse clinical strains of the basidiomycetous lipophilic yeast Malassezia pachydermatis obtained from cases of canine otitis to several amphotericin B (AMB)-azole combinations. Broth microdilution checkerboard tests revealed that AMB antagonized the effects of itraconazole (ITC) and voriconazole (VRC) in 50% and 6.7% of the strains, respectively, but did not interact with fluconazole or posaconazole (fractional inhibitory concentration index (FICI) values were <4 in all cases). Subsequent Etest-based assays performed for a subset of strains did not confirm the antagonism between AMB and ITC or AMB and VRC. In summary, the results of this study suggest that antagonistic combination effects between AMB and azoles might occur when tested against M. pachydermatis. Nevertheless, as observed for other fungi, different in vitro analyses yielded contrasting results, and the response to AMB-azole combinations was compound- and strain-dependant.

Topics: Amphotericin B; Animals; Antifungal Agents; Azoles; Dermatomycoses; Dog Diseases; Dogs; Malassezia; Microbial Sensitivity Tests; Microbial Viability; Otitis; Species Specificity

The Mucorales fungi-formerly classified as the zygomycetes-are environmentally ubiquitous fungi, but generally rare causes of clinical infections. In the immunocompromised host, however, they can cause invasive, rapidly spreading infections that confer a high risk of morbidity and mortality, often despite surgical and antifungal therapy. Patients with extensive burn injuries are particularly susceptible to skin and soft-tissue infections with these organisms. Here, we present a case of Lichtheimia infection in a patient with extensive full-thickness burns that required significant and repeated surgical debridement successfully treated with isavuconazole and adjunctive topical amphotericin B washes. We also review the available literature on contemporary antifungal treatment for Lichtheimia species and related Mucorales fungi.

Topics: Amphotericin B; Antifungal Agents; Burns; Debridement; Dermatomycoses; Humans; Male; Middle Aged; Mucorales; Mucormycosis; Nitriles; Pyridines; Treatment Outcome; Triazoles

Curvularia is a saprophytic dematiaceous mold and a rare human pathogen. Here, we report three severely immunocompromised pediatric patients who developed invasive Curvularia infection. Diagnosis was achieved or confirmed in all cases by fungal ribosome sequencing, which hastened species identification and targeted treatment for the patients reported. There are no treatment guidelines for invasive Curvularia infection, though we report three patients who were cured of their infection through a combination of surgical resection and various anti-fungal therapies, indicating a relatively low virulence and good prognosis in comparison to other angioinvasive molds.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Child; Dermatomycoses; Female; Humans; Immunocompromised Host; Male; Opportunistic Infections; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; RNA, Ribosomal, 28S; Sequence Analysis, DNA; Voriconazole

Phaeohyphomycosis is a term used to describe a heterogenous group of cutaneous and systemic mycotic infections caused by melanized fungi. Many fungi have been reported as pathogens of this disease. The disease spectrum ranges from superficial cutaneous infections, deep cutaneous infections, to systemic infections with internal organ involvement. We report two cases of deep cutaneous phaeohyphomycosis on the foot clinically presenting as cellulitis with abscess formation. The pathogens were isolated from the lesion and both were identified as Neoscytalidium dimidiatum by their colony morphology, microscopic features, and sequences of internal transcribed spacers of ribosomal DNA. Both patients did not respond to the therapy with voriconazole and itraconazole, but improved after intravenous amphotericin B.

Topics: Abscess; Aged, 80 and over; Amphotericin B; Antifungal Agents; Ascomycota; Cellulitis; Dermatomycoses; DNA, Fungal; DNA, Ribosomal Spacer; Female; Foot; Humans; Male; Microbiological Techniques; Middle Aged; Molecular Diagnostic Techniques; Phaeohyphomycosis; Sequence Analysis, DNA; Treatment Outcome

We report a case of eczema-like cutaneous mucormycosis caused by Rhizopus arrhizus. A 4-year-old child was presented to our hospital with a history of gradually enlarging papule and plaque in the periumbilical area for nearly 4 years since 2 weeks after his birth, and it has been misdiagnosed as eczema for nearly 3 years. Based on histopathology examination, the fungus culture test and DNA sequencing, it was revealed that R. arrhizus should be the responsible fungus for skin infection. The patient was successfully cured by combination of intravenous drip and percutaneous injection amphotericin B for nearly 3 months, and no recrudescence was seen during a follow-up of 6-month observation.

Topics: Amphotericin B; Antifungal Agents; Child, Preschool; Dermatomycoses; Eczema; Histocytochemistry; Humans; Infusions, Intravenous; Injections; Male; Microbiological Techniques; Mucormycosis; Rhizopus; Sequence Analysis, DNA; Treatment Outcome

A 66-year-old woman with diabetes who was treated with prednisolone (15 mg/day) for autoimmune hepatitis developed multiple erythematous nodules with retention of purulent fluid on her lower right limb. Candida albicans was cultured from the nodules. She was started on oral fluconazole, and the lesions subsided. However, multiple dark-red abscesses and indurations newly appeared on the left crus. Histopathological examination showed numerous branched hyphae, and tissue culture yielded a Rhizopus microsporus-related fungus. She was treated with liposomal amphotericin B combined with drainage and debridement. However, she died because of poor control of the infection and hepatic disorder.

Topics: Abscess; Aged; Amphotericin B; Antifungal Agents; Debridement; Dermatomycoses; Drainage; Fatal Outcome; Female; Hepatitis, Autoimmune; Humans; Immunocompromised Host; Mucormycosis; Prednisolone; Rhizopus

Endogenous fungal endophthalmitis (EFE) caused by disseminated fusariosis is a rare condition that generally has a poor outcome, even with intensive therapy. Here, we describe a case in which this type of EFE was diagnosed with vitreous sampling and was successfully treated with 25-gauge vitrectomy and antifungals, including liposomal amphotericin B and voriconazole. A 16-year-old male patient undergoing treatment for acute myeloid leukemia complained of eye pain and blurred vision in his right eye. Treatment was initiated for a vitreous opacity, possibly associated with herpetic retinitis, but the patient worsened and he was referred to us. Right-eye visual acuity was limited to light perception. We suspected endogenous endophthalmitis and performed 25-gauge vitrectomy with antibiotic perfusion of ceftazidime, vancomycin, and voriconazole. Vitreous culturing revealed the presence of Fusarium solani species complex, and enhanced computed tomography revealed disseminated fusariosis lesions in the lung, spleen, and the soft tissue of the left upper arm. The patient received antifungal treatment with liposomal amphotericin B and voriconazole, and these conditions were eliminated. Visual acuity recovered to 20/400 after additional vitrectomy for tractional retinal detachment and was maintained at this level during the 6-month follow-up period. The success of our treatment allowed the capture of optical coherence tomography images of the retina during fusarium-associated endogenous endophthalmitis and the follow-up period. Furthermore, this case showed that immediate vitrectomy for suspected EFE and intensive treatment can lead to a good clinical outcome.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Dermatomycoses; Endophthalmitis; Fusariosis; Fusarium; Humans; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Splenic Diseases; Treatment Outcome; Vitrectomy; Voriconazole

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Female; Fluconazole; Hand Dermatoses; Humans; Immunocompetence; Meningitis, Cryptococcal; Neck

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Coccidioidomycosis; Dermatomycoses; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Itraconazole; Lymphadenitis; Neck; Treatment Outcome; Young Adult

Topics: Aged; Amphotericin B; Antifungal Agents; Debridement; Dermatomycoses; Humans; Male; Mucormycosis; Triazoles

Primary cutaneous mucormycosis is an opportunistic fungal infection caused by the order Mucorales, most frequently by the Rhizopus species. Both systemic factors, such as diabetes mellitus or malignancies and local factors disrupting the skin barrier are implicated in development of this entity. The initial manifestation is a red-to-black papule rapidly progressing to a necrotic and painful ulcer. Diagnosis is obtained by identification of fungal forms in a skin biopsy, typically showing branching and non-septate hyphae. The clinical course is highly variable and depends mostly on the fungal invasion of deep tissues. However, an early diagnosis is essential for implementation of prompt and optimal treatment, based upon antifungal therapy and aggressive surgical debridement.

Topics: Adrenal Cortex Hormones; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cetuximab; Cross Infection; Debridement; Dermatomycoses; Equipment Contamination; Fluorouracil; Humans; Immunocompromised Host; Leg Ulcer; Leucovorin; Male; Mucormycosis; Organoplatinum Compounds; Rectal Neoplasms; Urinary Catheterization

Topics: Amphotericin B; Antifungal Agents; Cavernous Sinus Thrombosis; Cheek; Cranial Nerve Diseases; Dermatomycoses; Facial Dermatoses; Fatal Outcome; Humans; Male; Middle Aged; Mucormycosis

The present study was designed to develop a nanoemulsion formulation of Amphotericin B (AmB) for the treatment of skin candidiasis and aspergillosis. Several ingredients were selected on the basis of AmB solubility and compatibility with skin. The formulation that exhibited the best properties was selected from the pseudo-ternary phase diagram. After physicochemical characterization its stability was assessed. Drug release and skin permeation studies were also accomplished. The antifungal efficacy and skin tolerability of developed AmB nanoemulsion was demonstrated. Finally, our results showed that the developed AmB formulation could provide an effective local antifungal effect without theoretical systemic absorption, based on its skin retention capacity, which might avoid related side effect. These results suggested that the nanoemulsion may be an optimal therapeutic alternative for the treatment of skin fungal infections with AmB.

Topics: Administration, Topical; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Candida; Candidiasis; Dermatomycoses; Emulsions; Female; Humans; Pharmaceutical Vehicles; Skin; Skin Absorption

Topics: Administration, Cutaneous; Amphotericin B; Antifungal Agents; Dermatomycoses; Female; Humans; Immunocompetence; Middle Aged; Penicillium

Topics: Aged; Amphotericin B; Antifungal Agents; Cryptococcosis; Debridement; Dermatomycoses; Female; Flucytosine; Humans

We present the case of a 51-year-old man with acute myeloid leukemia who developed fevers with a skin lesion following the first cycle of induction chemotherapy. Skin biopsy showed evidence of invasive fungal infection. Cultures remained negative, but polymerase chain reaction on tissue detected Rhizopus oryzae complex. The patient was started on liposomal amphotericin B and underwent surgical debridement. He was switched to posaconazole, with plans for allogeneic hematopoetic stem cell transplant in the future.

Topics: Amphotericin B; Antibiotic Prophylaxis; Antifungal Agents; Biopsy; Debridement; Dermatomycoses; Febrile Neutropenia; Forearm; Humans; Immunocompromised Host; Induction Chemotherapy; Invasive Fungal Infections; Leukemia, Myeloid, Acute; Male; Middle Aged; Mucormycosis; Polymerase Chain Reaction; Rhizopus; RNA, Fungal; Triazoles

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Aspirin; Cellulitis; Dermatomycoses; Drug Combinations; Female; Flucytosine; Gastrostomy; Geotrichosis; Geotrichum; Humans; Magnesium Oxide; Microbial Sensitivity Tests; Surgical Wound Infection

Topics: Aged; Amphotericin B; Antifungal Agents; Dermatomycoses; Diagnosis, Differential; Fatal Outcome; Humans; Immunocompromised Host; Male; Microbial Sensitivity Tests; Myelodysplastic Syndromes; Phaeohyphomycosis

Phaeohyphomycosis is an infrequent infection in human beings. However, in recent years, its prevalence has augmented in immunosuppressed patients (mostly in solid organ transplanted patients). Infection can be mucocutaneous or disseminated. In the former, the fungus inoculation occurs mainly through traumatism. Lesions may be polymorphic and asymptomatic, isolated or multiple, and are usually localized in exposed areas of the limbs and head. Treatment is not standardized. When possible, surgical resection of the lesion is combined with systemic antifungals.. We communicate three phaeohyphomycosis cases with cutaneous compromise.. The cases we present show diverse clinical characteristics and varied severity and evolution.. It is important for dermatologists to recognize this cutaneous fungus infection because the diagnosis using microscopic examination and mycological culture depends on the clinical suspicion.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Fasciitis, Necrotizing; Fatal Outcome; Female; Humans; Immunocompromised Host; Itraconazole; Lung Diseases; Male; Middle Aged; Phaeohyphomycosis

Topics: Adolescent; Amphotericin B; Antifungal Agents; Deoxycholic Acid; Dermatomycoses; Drug Combinations; Fever; Histoplasmosis; Humans; Itraconazole; Lung Diseases, Fungal; Male; Nepal; Rural Population

Mucormycosis is most common in immunocompromised patients, but it can also occur in healthy hosts, most frequently as primary cutaneous mucormycosis (PCM) and predominantly as a result of skin trauma. We present an uncommon case of PCM in a healthy, young man with no previous history of local trauma. Despite rapid progression of the infection, the patient was successfully treated through surgical intervention and by administering liposomal amphotericin B and posaconazole. He made a full recovery without the need for skin grafting.

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Diagnosis, Differential; Humans; Immunocompetence; Male; Mucormycosis; Treatment Outcome

Entomophtoramycosis is a type of subcutaneous mycosis which includes both basidiobolomycosis and conidiobolomycosis; the latter is caused by Conidiobolus coronatus, a saprophytic fungus which lives in tropical soils. This mycosis characteristically affects the paranasal sinuses and oropharynx, with the potential to deform the face in patients without apparent immunodeficiency. It has a chronic course of infection with a tendency to form granulomas visible using histology. We present the case of a 28 year-old male agricultural worker, with a clinical profile of 6 months' evolution of rhinofacial tumefaction, nasal obstruction and post-nasal drip who was diagnosed with conidiobolomycosis by means of tissue culture after multiple biopsies of the facial area. The patient received antifungal treatment with amphotericin B and subsequently with itraconazol, resulting in a dramatic improvement without the need for surgical treatment; itraconazol was administered for one year and there was no evidence of relapse at the end of this period. Due to the low frequency of this disease there is no established treatment strategy; however, the use of azoles such as itraconazol with or without adjuvant surgical treatment is increasingly seen in case reports. The present report adds to the clinical experience in Colombia of this rare mycosis and also describes the long-term clinical and therapeutic response.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Conidiobolus; Dermatomycoses; Face; Granuloma; Humans; Itraconazole

Mucormycosis is an uncommon opportunistic fungal infection caused by Zygomycetes. It usually affects immunocompromised, diabetic and trauma patients with infected wounds. We report a case of disseminated infection secondary to facial cutaneous mucormycosis caused by Saksenaea vasiformis in a diabetic patient who had a farming accident causing him severe head injury. The patient was treated with a combination of surgical debridement and antifungal therapy with liposomal amphotericin B, but he had a slow and fatal outcome. In cases of tissue necrosis following trauma involving wound contact with soil (i.e., potential fungal contamination), testing for the presence of Zygomycetes fungi such as S. vasiformis in both immunocompetent and immunocompromised patients is crucial. The reason is that this infection usually has a rapid progression and may be fatal if appropriate treatment is not administered.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Craniocerebral Trauma; Dermatomycoses; Diabetes Complications; Diabetes Mellitus; Humans; Immunocompromised Host; Male; Middle Aged; Molecular Sequence Data; Mucorales; Mucormycosis; Sepsis

Opportunistic infections cause a significant morbidity and mortality in immunocompromised patients. We describe the case of a patient with skin fusariosis and a probable cerebral toxoplasmosis after UCB stem cell transplantation for B-cell acute lymphoblastic leukaemia. Fusarium species (spp) infections are difficult to treat. To date, there has been no consensus on the treatment of fusariosis and the management of its side effects. Given the negative pretransplant Toxoplasma serology in this case, identifying the origin of the Toxoplasma infection was challenging. All usual transmission routes were screened for and ruled out. The patient's positive outcome was not consistent with that of the literature reporting 60% mortality due to each infection.

Topics: Adolescent; Amphotericin B; Cord Blood Stem Cell Transplantation; Dermatomycoses; Diagnosis, Differential; Drug Therapy, Combination; Febrile Neutropenia; Female; Fusariosis; Gibberella; Humans; Mycophenolic Acid; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimethamine; Retreatment; Sulfadiazine; Toxoplasmosis, Cerebral

Mucormycosis are rare fungal infections occurring chiefly in the lung or the rhinocerebral compartment, particularly in patients with immunodeficiency or mellitus diabetes. We report the case of an elderly patient with cutaneous mucormycosis caused by Rhizopus microsporus.. An 89-year-old man presented a skin lesion of the forearm rapidly becoming inflammatory and necrotic. The patient had been treated for 2months with oral corticosteroids for idiopathic thrombocytopenia. Histological and mycological examination of the skin biopsy revealed the presence of a filamentous fungus, R. microsporus. The outcome was unfavorable, despite prescription of high-dose liposomal amphotericin B.. Mucormycosis are infrequent opportunistic infections caused by angio-invasive fungi belonging to the Mucorales order. Cutaneous presentations are rare, and in rare cases the species R. microsporus is isolated in clinical samples. Diagnosis is based on histological examination highlighting the characteristic mycelium within infected tissue, together with ex vivo mycological identification using morphological and molecular methods. Treatment consists of liposomal amphotericin B combined with debridement surgery.. R. microsporus is a marginal fungal species rarely isolated in clinical practice, and even less in dermatology departments. This clinical case report highlights the severity of infection with this fungus, particularly in the absence of early surgery.

Topics: Adrenal Cortex Hormones; Aged, 80 and over; Amphotericin B; Biopsy; Dermatomycoses; Dose-Response Relationship, Drug; Humans; Male; Mucormycosis; Necrosis; Opportunistic Infections; Palliative Care; Rhizopus; Skin; Thrombocytopenia

Chytridiomycosis, an amphibian skin disease caused by the emerging fungal pathogen Batrachochytrium dendrobatidis, has been implicated in catastrophic global amphibian declines. The result is an alarming decrease in amphibian diversity that is a great concern for the scientific community. Clinical trials testing potential antifungal drugs are needed to identify alternative treatments for amphibians infected with this pathogen. In this study, we quantified the MICs of chloramphenicol (800 μg/ml), amphotericin B (0.8 to 1.6 μg/ml), and itraconazole (Sporanox) (20 ng/ml) against B. dendrobatidis. Both chloramphenicol and amphotericin B significantly reduced B. dendrobatidis infection in naturally infected southern leopard frogs (Rana [Lithobates] sphenocephala), although neither drug was capable of complete fungal clearance. Long-term exposure of R. sphenocephala to these drugs did not inhibit antimicrobial peptide (AMP) synthesis, indicating that neither drug is detrimental to this important innate skin defense. However, we observed that chloramphenicol, but not amphotericin B or itraconazole, inhibited the growth of multiple R. sphenocephala skin bacterial isolates in vitro at concentrations below the MIC against B. dendrobatidis. These results indicate that treatment with chloramphenicol might dramatically alter the protective natural skin microbiome when used as an antifungal agent. This study represents the first examination of the effects of alternative antifungal drug treatments on amphibian innate skin defenses, a crucial step to validating these treatments for practical applications.

Topics: Amphibians; Amphotericin B; Animals; Anti-Infective Agents; Bacteria; Chloramphenicol; Chytridiomycota; Dermatomycoses; Immunity, Innate; Itraconazole; Microbial Sensitivity Tests; Skin

Invasive fungal infections are a major cause of morbidity and mortality among organ transplant recipients, despite many progresses concerning diagnosis, preventions and treatment. Risk factors for invasive fungal infections in transplanted recipients include type and severity of immunosuppression, especially in life-saving organs as lung or liver, older age at transplantation, and technical complexity of surgery, living in endemic areas or exposure to a contaminated environment. Superficial fungal infections are caused by Candida, Dermatophytes, and Malassezia. In invasive mycoses, skin lesions may occur as a consequence of the systemic dissemination of invasive mycoses, or after direct inoculation in the skin. Aspergillosis, cryptococcosis, Zygomycoses, dark mould infections, fusariosis and infections attributable to Scedosporium and Pseudallescheria species are the most common etiological agents. Cutaneous manifestations of fungal infection are not specific, and a high degree of suspicion is required, and prompt biopsy for histology and culture is needed. Therapy with lyposomal amphotericin B and new triazoles are effective.

Topics: Amphotericin B; Dermatologic Agents; Dermatomycoses; Humans; Immunocompromised Host; Italy; Organ Transplantation; Risk Factors; Transplant Recipients; Treatment Outcome; Triazoles

We studied the in vitro activity of fluconazole (FCZ), ketoconazole (KTZ), miconazole (MCZ), voriconazole (VCZ), itraconazole (ITZ) and amphotericin B (AMB) against the three major pathogenic Malassezia species, M. globosa, M. sympodialis, and M. furfur. Antifungal susceptibilities were determined using the broth microdilution method in accordance with Clinical and Laboratory Standards Institute reference document M27-A3. To support lipid-dependent yeast development, glucose, peptone, ox bile, malt extract, glycerol, and Tween supplements were added to Roswell Park Memorial Institute RPMI 1640 medium. The supplemented medium allowed good growth of all three species studied. The minimal inhibitory concentrations (MICs) were recorded after 72 h of incubation at 32ºC. The three species showed different susceptibility profiles for the drugs tested. Malassezia sympodialis was the most susceptible and M. furfur the least susceptible species. KTZ, ITZ, and VCZ were the most active drugs, showing low variability among isolates of the same species. FCZ, MCZ, and AMB showed high MICs and wide MIC ranges. Differences observed emphasize the need to accurately identify and evaluate antifungal susceptibility of Malassezia species. Further investigations and collaborative studies are essential for correlating in vitro results with clinical outcomes since the existing limited data do not allow definitive conclusions.

Topics: Amphotericin B; Antifungal Agents; Azoles; Culture Media; Dermatomycoses; Humans; Malassezia; Microbial Sensitivity Tests

Topics: Abdominal Wall; Acute Kidney Injury; Adult; Amphotericin B; Anti-Infective Agents; Antibiotic Prophylaxis; Antifungal Agents; Clostridium Infections; Cytomegalovirus Infections; Debridement; Dermatomycoses; Hepatitis; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Mucormycosis; Opportunistic Infections; Postoperative Complications; Primary Graft Dysfunction; Reoperation; Triazoles

The frequency of histoplasmosis among solid organ transplant (SOT) recipients appears to be low where there are only a few case series, mostly among renal and liver transplant recipients. Herein we report a case of a 44-year-old woman who underwent a living-related renal transplant 18 years prior to evaluation, developed a nodule after followed by ulceration upon her posterior right leg and a second one upon her left leg 3 months and 2 months before her hospitalisation, respectively. The biopsy of lesion revealed the presence of Histoplasma spp. Bone marrow aspiration was performed and also revealed the same organism. She had initially received itraconazole without improvement of lesions, while a new lesion appeared on her left arm. Healing of all lesions could be observed after 40 days of liposomal amphotericin B when she was submitted to skin grafts on the legs and a surgical treatment on the arms, and the myelosuppression improved simultaneously. Histoplasmosis seems to be very uncommon among patients who underwent to organ solid transplantation. Most cases occur within 12-18 months after transplantation, although unusual cases have been presented many years post-transplant. There are cases reported in the literature, occurring from 84 days to 18 years after organ transplantation, but without cutaneous involvement. Our patient developed lesions on limbs and myelosuppression after 18 years of chronic immunosuppression medication. This case suggests that besides cutaneous histoplasmosis is an uncommon infection following iatrogenic immunosuppression and even rarer over a long period after the transplantation. Clinicians who care SOT recipient patients must bear in mind histoplasmosis infection as differential diagnosis in any case of cutaneous injury with prolonged fever and try to use as many tools as possible to make the diagnosis, once this disease presents a good prognosis if it is diagnosed and treated promptly.

Topics: Adult; Allografts; Amphotericin B; Antifungal Agents; Bone Marrow; Bone Marrow Diseases; Dermatomycoses; Female; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Kidney Transplantation; Skin Transplantation; Skin Ulcer; Transplant Recipients; Treatment Outcome

Zygomycosis is an invasive disease that affects both immunocompetent and immunocompromised, depending on the type of strain. This disease diagnosis is clinical and histopathological, and its treatment is based on antifungal therapy and surgical cleaning. This paper reports a case of a boy with invasive zygomycosis rinofacial who final treatment was successful after underwent antifungal and surgical therapies.

Topics: Amphotericin B; Antifungal Agents; Child; Dermatomycoses; Facial Dermatoses; Humans; Immunocompetence; Male; Paranasal Sinus Diseases; Tomography, X-Ray Computed; Treatment Outcome; Zygomycosis

Mucormycosis is usually an invasive mycotic disease caused by fungi in the class mucormycetes. Here we report a case of cutaneous mucormycosis due to Lichtheimia ramosa in a 20-year-old female patient with burn injuries. She was admitted to the hospital with accidental flame burns covering 60 % total burn surface area. After 15 days of admission to hospital, the burn wound showed features of fungal infection. Culture showed white cottony growth belonging to the Mucorales order. Morphological identification confirmed it as L. ramosa. She was managed surgically and medically with the help of amphotericin B. Patient survived due to prompt diagnosis and appropriate medical and surgical treatment. Early diagnosis is critical in prevention of morbidity and mortality associated with the disease. Fungal infection in burn wounds can be difficult to diagnose and manage.

Topics: Amphotericin B; Antifungal Agents; Burns; Debridement; Dermatomycoses; Female; Humans; Microbiological Techniques; Mucorales; Mucormycosis; Treatment Outcome; Young Adult

Primary cutaneous aspergillosis (PCA) is a rare fungal infection in premature infants. Extreme prematurity, immature immune system, therapy with broad-spectrum antibiotics and systemic steroids, as well as hyperglycaemia and a vulnerable and very thin epidermal layer are considered risk factors in this patient population. We present a premature male infant born at 24(+3) weeks of gestation with PCA, successfully treated with amphotericin and surgical curettage of the ulcerating skin lesions. Complete resolution of the lesions was achieved and scarring was barely visible at later follow-up.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Biopsy; Dermatologic Surgical Procedures; Dermatomycoses; Diagnosis, Differential; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Skin

Chytridiomycosis, a skin disease caused by Batrachochytrium dendrobatidis, has caused amphibian declines worldwide. Amphibians can be treated by percutaneous application of antimicrobials, but knowledge of in vitro susceptibility is lacking. Using a modified broth microdilution method, we describe the in vitro sensitivity of two Australian isolates of B. dendrobatidis to six antimicrobial agents. Growth inhibition was observed, by measurement of optical density, with all agents. Minimum inhibitory concentrations (µg/ml; isolate 1/2) were - voriconazole 0.016/0.008; itraconazole 0.032/0.016; terbinafine 0.063/0.063; fluconazole 0.31/0.31; chloramphenicol 12.5/12.5; amphotericin B 12.5/6.25. Killing effects on zoospores were assessed by observing motility. Amphotericin B and terbinafine killed zoospores within 5 and 30 min depending on concentration, but other antimicrobials were not effective at the highest concentrations tested (100 µg/ml). This knowledge will help in drug selection and treatment optimization. As terbinafine was potent and has rapid effects, study of its pharmacokinetics, safety and efficacy is recommended.

Topics: Amphibians; Amphotericin B; Animals; Antifungal Agents; Australia; Chytridiomycota; Dermatomycoses; Dose-Response Relationship, Drug; In Vitro Techniques; Microbial Sensitivity Tests; Naphthalenes; Terbinafine

Topics: Amphotericin B; Antifungal Agents; Biopsy; Child; Cryptococcosis; Dermatomycoses; Drug Therapy, Combination; Fluconazole; Humans; Kidney Transplantation; Male; Skin; Time Factors; Transplant Recipients; Treatment Outcome

A population-based survey was conducted to investigate the epidemiology of and antifungal resistance in Spanish clinical strains of filamentous fungi isolated from deep tissue samples, blood cultures, and respiratory samples. The study was conducted in two different periods (October 2010 and May 2011) to analyze seasonal variations. A total of 325 strains were isolated in 29 different hospitals. The average prevalence was 0.016/1,000 inhabitants [corrected]. Strains were identified by sequencing of DNA targets and susceptibility testing by the European Committee for Antimicrobial Susceptibility Testing reference procedure. The most frequently isolated genus was Aspergillus, accounting for 86.3% of the isolates, followed by Scedosporium at 4.7%; the order Mucorales at 2.5%; Penicillium at 2.2%, and Fusarium at 1.2%. The most frequent species was Aspergillus fumigatus (48.5%), followed by A. flavus (8.4%), A. terreus (8.1%), A. tubingensis (6.8%), and A. niger (6.5%). Cryptic/sibling Aspergillus species accounted for 12% of the cases. Resistance to amphotericin B was found in 10.8% of the isolates tested, while extended-spectrum triazole resistance ranged from 10 to 12.7%, depending on the azole tested. Antifungal resistance was more common among emerging species such as those of Scedosporium and Mucorales and also among cryptic species of Aspergillus, with 40% of these isolates showing resistance to all of the antifungal compounds tested. Cryptic Aspergillus species seem to be underestimated, and their correct classification could be clinically relevant. The performance of antifungal susceptibility testing of the strains implicated in deep infections and multicentric studies is recommended to evaluate the incidence of these cryptic species in other geographic areas.

Topics: Amphotericin B; Antifungal Agents; Aspergillus; Base Sequence; Dermatomycoses; Drug Resistance, Fungal; Fungi; Fusarium; Humans; Microbial Sensitivity Tests; Penicillium; Scedosporium; Sequence Analysis, DNA; Spain; Triazoles

Mucormycosis is a rare opportunistic fungal infection with clinical polymorphism and is rapidly extensive and destructive. It is caused by fungi of the mucorales group in the environment and generally arises in the context of immunosuppression. Often difficult and late, diagnosis is based on mycological and histological examination. We report the case of a 10-year-old patient admitted for a pruritic erythematous scaly eruption located in the right inguinal area associated with satellite lymphadenopathy and lymphedema of the right lower limb. The histological study of the cutaneous biopsy revealed a granulomatous reaction with filaments. The mycological examination of the collection of the cutaneous lesion showed mucorales filaments and a stump of Absidia corymbifera was isolated. Abdomino-pelvic CT showed muscular extension with vascular and ureteral englobement. The diagnosis of cutaneous mucormycosis was made. Immunological investigations were normal. Treatment included itraconazole for 3months followed by IV amphotericin B for 1month, with favorable clinical and radiological progression. Mucormycosis is an uncommon fungal infection whose cutaneous localization is rare. It occurs exceptionally in immunocompetent patients and is clinically manifested by a vesicular and pustular rash progressing to ulceration. The diagnosis is confirmed by mycological and histological studies. Treatment consists of antifungal therapy associated with surgical excision of necrotic and infected tissue.

Topics: Amphotericin B; Antifungal Agents; Child; Dermatomycoses; Erythema; Granuloma; Groin; Humans; Immunocompetence; Itraconazole; Lymphedema; Male; Mucormycosis; Pruritus

Trichosporon (T.) asahii can cause superficial skin infections and can be an opportunistic pathogen that produces potentially fatal systemic infections in immunocompromised hosts. We report a case of lower limb infection due to T. asahii in an immunocompetent patient who displayed no evidence of underlying disease. There is a strong possibility that our patient had been colonized at the infection site as part of the normal skin flora. After one-month bed rest due to an accidental fall and fracture of the right shoulder blade, a 61-year-old woman experienced severe edema and redness in the right lower limb and received topical treatment with iodine solution and antibiotics without improvement. She presented at our Outpatient Clinic with cellulitis and lymphedema. Samples collected from the affected areas revealed T. asahii and the patient was referred to a hospital for infectious diseases for appropriate therapy. The patient was treated with wound dressings until she was admitted to our intensive care unit when her general condition abruptly deteriorated. Despite in vitro susceptibility results, therapy with liposomal amphotericin and voriconazole could not change the fatal outcome. Nowadays, physicians must suspect this emerging difficult-to-treat fungal pathogen and treatment must start promptly in these infections.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Edema; Fatal Outcome; Female; Humans; Immunocompetence; Leg; Middle Aged; Trichosporonosis; Voriconazole

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Biopsy; Dermatomycoses; Histoplasma; Histoplasmosis; HIV Infections; Humans; Male; Middle Aged; Skin Ulcer; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Fatal Outcome; Fever; Flucytosine; HIV Infections; Humans; Male; Multiple Organ Failure; Respiratory Distress Syndrome

Mucormycosis is a deadly invasive fungal infection whose characteristics are only partially understood.. Data on mucormycosis obtained in France between 2005 and 2007 from 2 notification systems were merged. The 2008 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definition criteria were applied and risk factors for death were analyzed by hazard ratios (HRs) calculated from the Cox proportional hazards regression model.. A total of 101 cases (60 proven, 41 probable), mostly in men (58%) >50 years (mean age, 50.7 ± 19.9) were recorded. Hematological malignancies represented 50% (median time for occurrence, 8.8 months after disease onset), diabetes 23%, and trauma 18% of cases. Sites of infection were lungs (28%; 79% in hematology patients), rhinocerebral (25%; 64% in diabetic patients), skin (20%), and disseminated (18%). Median time between first symptoms and diagnosis was 2 weeks. The main fungal species were Rhizopus oryzae (32%) and Lichtheimia species (29%). In cases where the causative species was identified, R. oryzae was present in 85% of rhinocerebral forms compared with only 17% of nonrhinocerebral forms (P < .001). Treatment consisted of surgery in 59% and antifungals in 87% of cases (liposomal amphotericin B in 61%). Ninety-day survival was 56%; it was reduced in cases of dissemination compared with rhinocerebral (HR, 5.38 [2.0-14.1]; P < .001), pulmonary (HR, 2.2 [1.0-4.7]; P = .04), or skin localization (HR, 5.73 [1.9-17.5]; P = .002); survival was reduced in cases of hematological malignancies compared with diabetes mellitus (HR, 2.3 [1.0-5.2]; P < .05) or trauma (HR, 6.9 [1.6-28.6], P = .008) and if ≥2 underlying conditions (HR, 5.9 [1.8-19.0]; P = .004). Mucormycosis localization remained the only independent factor associated with survival.. This 3-year study performed in one country shows the diverse clinical presentation of mucormycosis with a high prevalence of primary skin infection following trauma and a prognosis significantly influenced by localization.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Cerebellar Diseases; Child; Data Collection; Dermatomycoses; Diabetes Mellitus; Female; France; Hematologic Neoplasms; Humans; Lung; Male; Middle Aged; Mucormycosis; Prognosis; Proportional Hazards Models; Retrospective Studies; Rhizopus; Risk Factors; Survival Analysis; Treatment Outcome; Wounds and Injuries; Young Adult

Penicillium marneffei is an opportunistic fungal pathogen in HIV disease. We report the case of a patient with AIDS who presented with general weakness and generalized skin rashes. No specific allergic history or recent medication were reported. The skin lesions disappeared after adequate antifungal therapy. A blood culture obtained from the patient confirmed the presence of P. marneffei, infection which is characterized by cutaneous umbilicated lesions in AIDS patients. We report this case on account of the unusual skin presentation.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Dermatomycoses; Humans; Itraconazole; Male; Penicillium

S. dimidiatum (recently reclassified as N. dimidiatum) is a fungus that causes nail and/or superficial skin infection. It may also cause subcutaneous and deep infection, chiefly in immunocompromised patients.. An 87-year-old male treated with oral corticosteroids for sarcoidosis consulted for violaceous cutaneous nodules on the back of his hands. Histopathological examination revealed epithelioid cell granulomas with numerous mycelial filaments and multiple spores. Culture of a biopsy sample resulted in growth of numerous colonies of S. dimidiatum and the patient was treated with intravenous amphotericin B.. This organism is transmitted by direct or indirect contact with contaminated soil or plants. It mainly causes superficial skin and nail infections, and may result in deeper infections on rare occasions. We report a case of subcutaneous infection with S. dimidiatum in an immunocompromised patient (due to general steroid therapy) that was successfully treated using amphotericin B.

Topics: Adrenal Cortex Hormones; Aged, 80 and over; Amphotericin B; Antifungal Agents; Biopsy; Coelomomyces; Dermatomycoses; Diagnosis, Differential; Hand Dermatoses; Humans; Infusions, Intravenous; Male; Opportunistic Infections; Sarcoidosis; Skin

Invasive disseminated neonatal aspergillosis is an uncommon disease, with only scattered reports in literature in the last few years. Here we report on a 25-week gestational age, 730 g at birth preterm female infant who developed on day-of-life 10 multiple cutaneous exhulcerative lesions in her right arm, trunk and abdomen. Early recognition and diagnosis of these lesions as a due to cutaneous initial symptom of cutaneous disseminated aspergillosis, as well as prompt treatment with Liposomal amphotericin B + Itraconazole, secured successful recovery from the systemic infection. Skin lesions healed without any surgical treatment. The infant was discharged in good health. Long-term follow-up at three years of age revealed normality of all neurodevelopmental and cognitive parameters. To our knowledge, this is one of the very few cases of survival, free from sequelae, for a preterm infant affected by neonatal cutaneous disseminated aspergillosis.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Dermatomycoses; Female; Follow-Up Studies; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Itraconazole; Treatment Outcome

Penicillium marneffei may cause life-threatening systemic fungal infection in immune-compromised patients and it is endemic in Southeast Asia. A 39-yr-old HIV-infected male, living in Laos, presented with fever, cough, and facial vesiculopapular lesions, which had been apparent for two weeks. CT scans showed bilateral micronodules on both lungs; Pneumocystis jirovecii was identified by bronchoscopic biopsy. Despite trimethoprim-sulfamethoxazole and anti-tuberculosis medications, the lung lesions progressed and the facial lesions revealed central umbilications. Biopsy of the skin lesions confirmed disseminated penicilliosis, with the culture showing P. marneffei hyphae and spores. The P. marneffei was identified by rRNA PCR. A review of the bronchoscopic biopsy indicated penicilliosis. The patient completely recovered after being prescribed amphotericin-B and receiving antiretroviral therapy. This is the first case of penicilliosis in a Korean HIV-infected patient. It is necessary to consider P. marneffei when immunocompromised patients, with a history of visits to endemic areas, reveal respiratory disease.

Topics: Adult; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Bronchoscopy; Dermatomycoses; HIV Infections; Humans; Immunocompromised Host; Laos; Lung Diseases; Male; Penicillium; Pneumocystis carinii; Tomography, X-Ray Computed

Histoplasma capsulatum is an opportunistic dimorphic fungus responsible for most often self-limiting or flu-like infections but potentially lethal in immunocompromised hosts. Histoplasmosis is rare in Europe. We reported a case of disseminated histoplasmosis in an African HIV patient with a leprosy-like primary cutaneous presentation and involvement of lungs, brain, limphnodes and eye. The therapy with liposomial B amphotericin and itraconazole led to a prompt resolution of the symptoms.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antiretroviral Therapy, Highly Active; Dermatomycoses; Diagnosis, Differential; Drug Therapy, Combination; Ghana; Histoplasma; Histoplasmosis; HIV Seropositivity; Humans; Immunocompromised Host; Italy; Itraconazole; Leprosy; Male; Skin; Treatment Outcome

Invasive fungal infections are a major cause of morbidity and mortality in hematopoietic stem cell transplantation patients. In recent years, new resistant fungal strains have emerged, requiring physicians to use new generation antifungal drugs or drug combinations. We report a case of invasive Fusarium infection involving the nasopharynx, skin and lungs, following haploidentical hematopoietic stem cell transplantation in an 8-year old patient with recurrent leukemia. The patient was treated with combination antifungal treatment of amphotericin B and voriconazole, as well as supportive care, with the improvement of his symptoms and home discharge. We reviewed the history of combination antifungal therapy. Combination antifungal treatment has been used since 1979, especially in immunocompromised patients. Although randomized controlled trials are lacking, reports favoring combination, especially for invasive mold infections, are increasingly published.

Topics: Amphotericin B; Antifungal Agents; Child; Dermatomycoses; Drug Therapy, Combination; Fusariosis; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Leukemia; Lung Diseases, Fungal; Male; Nasopharyngeal Diseases; Pyrimidines; Treatment Outcome; Triazoles; Voriconazole

Topics: Aged; Amphotericin B; Anticoagulants; Antifungal Agents; Cellulitis; Cryptococcosis; Dermatomycoses; Fatal Outcome; Female; Fungemia; Heparin, Low-Molecular-Weight; Hepatitis, Autoimmune; Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Cirrhosis; Lung Diseases, Fungal; Necrosis; Prednisone; Radiography; Thrombophilia

A 35-year-old HIV seropositive male patient presented with fever, weight loss, papules, nodules and fungating masses all over the body. Histopathological and mycological study of the skin biopsy tissue confirmed the diagnosis of penicilliosis. Although penicilliosis is restricted to Southeast Asia, more cases are being recognized in nonendemic countries.

Topics: Adult; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Dermatomycoses; Diagnosis, Differential; HIV Seropositivity; Humans; India; Male; Penicillium; Skin; Skin Diseases

Zygomycosis is a relatively uncommon mycosis with a morbidity that is increasing worldwide. Cutaneous zygomycosis, one of the clinical manifestations of the disease, has also emerged in recent decades. The major reported etiologic agents in China include Rhizomucor spp., Rhizopus spp., Mucor spp., and Lichtheimia spp. (formerly Absidia spp.). This study examined 11 clinical isolates of Rhizomucor that belong to three species (R. variabilis, R. regularior, and R. chlamydosporus). They were identified by both morphological and molecular methods and were found to have a high degree of correlation. In vitro susceptibility of the Rhizomucor isolates to seven antifungal drugs (amphotericin B, itraconazole, terbinafine, voriconazole, fluconazole, flucytosine, and micafungin) were tested, which resulted in amphotericin B being found to be the most active agent against all species evaluated in this study. The investigation also reviewed case reports of cutaneous zygomycosis in China.

Topics: Amphotericin B; Antifungal Agents; Base Sequence; China; Dermatomycoses; DNA, Ribosomal; DNA, Ribosomal Spacer; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Mucormycosis; Phylogeny; Rhizomucor; RNA, Ribosomal, 5.8S; Sequence Analysis, DNA

Primary cutaneous mucormycosis is uncommon and is extremely rare in immunocompetent young individuals. Here we report a case of necrotising fasciitis due to mucormycosis in an immunocompetent young individual following minor trauma. Mucormycosis must be suspected in any wound that is worsening despite appropriate treatment even in immunocompetent individuals.

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Fasciitis, Necrotizing; Humans; Immunocompetence; Male; Mucormycosis; Rhizomucor; Treatment Outcome

Mucormycosis or zygomycosis is a rare opportunistic infection caused by aerobic saprophytic fungus that belongs to the class of Zygomycetes Mucorales family. These organisms live in the environment and enter the body by air, gastrointestinal or skin routes, through solutions of continuity of the skin. This microorganism is generally not pathogenic for immunocompetent hosts, being the development of the disease linked with the immune status of the subject. Its mortality is around 50-60%; sometimes in spite of early diagnosis and treatment initiation it has a fatal course. Six clinical forms of mucormycosis are described: rhinocerebral, cutaneous, pulmonary, disseminated, gastrointestinal and miscellaneous form. Two cases of patients with primary cutaneous mucormycosis diagnosed in the Pathology Unit of Hernan Henriquez Aravena Hospital of Temuco, Chile are presented here.

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Humans; Male; Middle Aged; Mucormycosis; Severity of Illness Index

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Histoplasma; Histoplasmosis; HIV Infections; Humans; Immunocompromised Host; Male; Shock, Septic; Silver Staining

To describe ocular involvement and response to treatment in a patient with human immunodeficiency virus (HIV) infection with severe progressive disseminated histoplasmosis (PDH).. We report a 35-year-old HIV-infected patient seen in our clinics over a period of 4 years. During antiretroviral treatment (ART), the HIV load became undetectable at 3 months; however, CD4 T-cell count increased slowly and rose to 100 cells/microl. Histoplasma capsulatum was cultured from skin pustules, cerebrospinal fluid (CF) and aqueous humour.. The patient developed central nervous system (CNS) involvement 2 months and panuveitis in both eyes 4 months after the initiation of ART. With intravenous liposomal amphotericin B followed by oral voricanozole, the chorioretinal lesions of the right eye (RE) became inactivated and magnetic resonance imaging (MRI) lesions of CNS disappeared. Relapse of the inflammation in the anterior segment of the left eye (LE) resulted in a total closure of the chamber angle and severe glaucoma. Despite medical therapy, two cyclophotocoagulations, total vitrectomy and repeated intravitreal amphotericin B injections, LE became blind. Histoplasma capsulatum was cultured from the aqueous humour after antifungal therapy of 16 months' duration.. PDH with intraocular and CNS manifestations was probably manifested by an enhanced immune response against a previous subclinical disseminated infection. It seems difficult to eradicate H. capsulatum from the anterior segment of the eye in an immunocompromised patient.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Retroviral Agents; Aqueous Humor; CD4 Lymphocyte Count; Central Nervous System Fungal Infections; Cerebrospinal Fluid; Dermatomycoses; Drug Therapy, Combination; Eye Infections, Fungal; Female; Glaucoma, Angle-Closure; Histoplasma; Histoplasmosis; HIV-1; Humans; Magnetic Resonance Imaging; Panuveitis; Skin; Viral Load

We describe a 69-year-old female farmer with diabetes mellitus who developed subcutaneous infection due to a plant pathogen, Corynespora cassiicola. The organism was identified based on characteristic morphotypes and confirmed by sequence analysis of the internal transcribed spacer (ITS) regions. The patient was treated successfully with amphotericin B therapy.

Topics: Aged; Amphotericin B; Antifungal Agents; Ascomycota; Dermatomycoses; Diabetes Complications; DNA, Fungal; DNA, Ribosomal Spacer; Female; Humans; Sequence Analysis, DNA; Soft Tissue Infections; Treatment Outcome

Cryptococcosis most commonly occurs in immunosuppressed patients. The pathogen is the yeast Cryptococcus neoformans. This article reports on the case of a 20-year-old female patient with acute myeloid leukemia who suddenly developed disseminated livid red papules and papulovesicles. The clinical picture and in particular the histopathology findings led to the diagnosis of cutaneous cryptococcosis, which was successfully treated with amphotericin B. For the differential diagnosis generalized herpes zoster, erythema exudativum multiforme and disseminated molluscum contagiosum must be considered. To confirm the diagnosis attempts can also be made to culture the pathogen from skin biopsy preparations. Furthermore, fungal spores can be rapidly and simply detected with the Tzanck test.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Cryptococcosis; Dermatomycoses; Female; Humans; Leukemia, Myeloid, Acute; Treatment Outcome

This study evaluated the in vivo activity of liposomal amphotericin B (L-AMB) and deoxycholate amphotericin B (D-AMB) in a murine model of disseminated infection caused by Exophiala dermatitidis. Cyclophosphamide-treated neutropenic ddY mice were inoculated intravenously with conidial suspensions of E. dermatitidis IFM 4827 or IFM 53409. The maximum tolerated doses of L-AMB and D-AMB were set at 10 mg/kg and 1 mg/kg, respectively. Four hours after infection, a single dose of L-AMB (0.3 to 10 mg/kg) or D-AMB (0.1 to 1 mg/kg) was administered intravenously. The efficacy of the antifungal treatment was assessed by the survival time over two weeks and the tissue fungal burdens 4 days after infection. L-AMB at a dose of > or =1 mg/kg significantly prolonged the survival time of mice infected with either strain compared with that of the control group. Percent survivals in the 10 mg/kg L-AMB-treated group (100% and 75%) were higher than those in the 1 mg/kg D-AMB-treated group (20% and 37.5%) in the IFM 4827 and IFM 53409 models, respectively. In the IFM 4827 model, 10 mg/kg L-AMB exhibited greater efficacy than 1 mg/kg D-AMB in terms of reducing the tissue fungal burdens (blood, lung, liver, spleen, and kidneys). These findings suggest that L-AMB was effective in the treatment of experimental disseminated E. dermatitidis infection, and the efficacy of L-AMB was superior to that of D-AMB.

Topics: Amphotericin B; Animals; Antifungal Agents; Deoxycholic Acid; Dermatitis; Dermatomycoses; Exophiala; Male; Mice

Histoplasmosis caused by Histoplasma capsulatum var. duboisii is an endemic mycosis of sub-Saharan Africa that usually affects the skin, subcutaneous tissue, lymph nodes and bones. We present a case of a 10-year-old immunocompetent girl with severe cutaneous and subcutaneous abscesses affecting the head and upper body. Microscopic examination showed polar budding yeasts and short mycelium compatible with H. capsulatum var. duboisii. Cultures were not possible but serology showed antibodies against both H. capsulatum var. duboisii and H. capsulatum var. capsulatum antigens. Presumptive diagnosis of histoplasmosis was done but treatment with itraconazole was inefficacious. After 15 days of treatment with Amphotericin B i/v, improvement was evident and, three months later, the patient was discharged with only residual lesions. Seven months later, no relapses were observed.

Topics: Abscess; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Chad; Child; Dermatomycoses; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole

Cutaneous zygomycosis is a rare but serious infection in trauma patients. We report two cases of cutaneous zygomycosis caused by Mycocladus corymbifer (formerly Absidia corymbifera) which were probably the result of soil contamination of wounds of the patient's lower extremities. Both patients received appropriate antifungal therapy in combination with aggressive surgical debridement. While a cure was achieved with amphotericin B in one, the other patient was intolerant to this antifungal and cure was achieved with a new drug, posaconazole. Twenty seven cases (including the two cases in this study) of cutaneous M. corymbifer zygomycosis reported in the literature were reviewed. The data showed an increase in infections with 16 cases (59.2%) reported since 2002.

Topics: Absidia; Adult; Amphotericin B; Antifungal Agents; Debridement; Dermatomycoses; Foot; Humans; Leg; Male; Triazoles; Zygomycosis

Zygomycosis is an opportunistic fungal infection with a fulminant course. Varying clinical forms have been described, including cutaneous zygomycosis, which is mainly observed in diabetic and burns patients. We report herein a case of cutaneous zygomycosis of the nose in a 26-year-old female patient with diabetic ketoacidosis, developing secondary to the application of non-elasticized adhesive tape probably contaminated with fungal spores.

Topics: Adult; Amphotericin B; Antifungal Agents; Bandages; Cross Infection; Debridement; Dermatomycoses; Diabetic Ketoacidosis; Female; Humans; Mucormycosis; Nose; Rhizopus; Treatment Outcome; Zygomycosis

Topics: Amphotericin B; Animals; Antifungal Agents; Cat Diseases; Cats; Dermatomycoses; Female; Injections, Intralesional; Male

We describe a case of cutaneous zygomycosis caused by Saksenaea vasiformis in an immunocompetent 24-year-old woman. Diagnosis was based on histological and microbiological examination. The patient made a complete recovery with surgical debridement and antifungal therapy (liposomal amphotericin and posaconazole).

Topics: Amphotericin B; Antifungal Agents; Debridement; Dermatomycoses; Female; Histocytochemistry; Humans; Mucorales; Skin; Triazoles; Wound Infection; Young Adult; Zygomycosis

Cutaneous cryptococcosis, caused by an encapsulated yeast, Cryptococcus neoformans, is generally associated with concomitant systemic infection. Here we report a case of primary cutaneous cryptococcosis with spread to central nervous system in an HIV seronegative young boy. In the present case, a 17-year-old boy who was suffering from a non-healing ulcer on his right great toe for 5 months, presented with the signs and symptoms of meningitis. Cryptococcus neoformans var. gattii was isolated from the CSF of the patient. Amphotericin B administration produced recovery from the meningitis as well as from the ulcer. This case study suggests that primary cutaneous cryptococcosis can be diagnosed provisionally by a simple Gram stained smear and India ink examination in order to avoid occurrence of disseminated cryptococcosis, including meningial involvement, which may have a fatal outcome.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Carbon; Coloring Agents; Cryptococcosis; Cryptococcus gattii; Dermatomycoses; Fluconazole; Foot Ulcer; Fungemia; Gentian Violet; HIV Seronegativity; Humans; Male; Meningitis, Cryptococcal; Phenazines; Staining and Labeling; Toes

Black yeasts are a rare cause of infections especially in Europe, yet their pathological significance is increasing, particularly in cases of immunosuppression. We report a 53-year-old immunocompetent woman with an extensive skin infection due to Aureobasidium pullulans, who responded well to treatment with liposomal amphotericin B.

Topics: Amphotericin B; Animals; Antifungal Agents; Ascomycota; Cats; Dermatomycoses; Female; Humans; Middle Aged

The main aim of this study was to verify the efficacy of subculture on potato dextrose agar (PDA) as a complement to the in vitro susceptibility test for Malassezia pachydermatis strains by a broth microdilution method, as well as to determine the MIC and MFC of azole derivatives, amphotericin B and caspofungin. The microdilution assay was performed in 96-well plates using a modified RPMI 1640 medium. The M. pachydermatis strains were resistant to caspofungin. All strains (n=50) had shown MIC values of <0.03, <0.03, 2.0, 4.0 and 4.0 microg/ml for itraconazole, ketoconazole, voriconazole, fluconazole and amphotericin B, respectively. Thus, the subculture on PDA improved the analysis of the in vitro antifungal susceptibility of M. pachydermatis.

Topics: Agar; Amphotericin B; Animals; Antifungal Agents; Azoles; Caspofungin; Culture Media; Dermatomycoses; Dog Diseases; Dogs; Echinocandins; Glucose; Lipopeptides; Malassezia; Microbial Sensitivity Tests; Microbiological Techniques; Solanum tuberosum

Disseminated cryptococcosis is a well-known opportunistic infection in AIDS patients. We report an unusual patient who demonstrated an isolated plaque of cryptococcosis on the penis. Resolution of this plaque was obtained after treatment with fluconazole, but subsequent cutaneous dissemination occurred that was responsive to amphotericin B.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Biopsy, Needle; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Follow-Up Studies; Humans; Immunohistochemistry; Infusions, Intravenous; Male; Penis; Risk Assessment; Severity of Illness Index; Treatment Outcome

In this study the molecular identification and susceptibility profile of 21 clinical isolates, from a Brazilian hospital, belongs to six different species of Trichosporon were described. Trichosporon asahii was the predominant species and corresponded to 43% of isolates. Eighty three percent of the strains isolated from deep sites were identified as T. asahii, while only 17% belong to a non-T. asahii species (Trichosporon inkin). In general, the MICs were high and independent of the species of Trichosporon as well as the clinical origin of strain. Amphotericin B and fluconazole were less effective against Trichosporon spp. and high MIC values of voriconazole, posaconazole and ravuconazole were observed. Fifty-six percent (5/9) of T. asahii strains were isolated from deep sites, whereas 8% (1/12) of non-T. asahii species were isolated from those sites. A total of 89% of T. asahii isolates exhibited resistance to amphotericin B in vitro.

Topics: Amphotericin B; Antifungal Agents; Brazil; Cross Infection; Dermatomycoses; Drug Resistance, Fungal; Echinocandins; Female; Flucytosine; Fungemia; Hospitals, University; Humans; Mycological Typing Techniques; Mycoses; Onychomycosis; Opportunistic Infections; Organ Specificity; Triazoles; Trichosporon; Urine; Vaginitis

Topics: Amphotericin B; Anemia, Neonatal; Anemia, Sideroblastic; Antifungal Agents; Catheters, Indwelling; Deferoxamine; Dermatomycoses; DNA, Mitochondrial; Female; Hemochromatosis Protein; Heterozygote; Histocompatibility Antigens Class I; Humans; Infant; Infant, Newborn; Membrane Proteins; Metabolic Diseases; Methylprednisolone; Mitochondrial Diseases; Siderophores; Zygomycosis

Fusarium infections are associated with high mortality after allogeneic stem cell transplantation. We report on successful treatment of a disseminated cutaneous Fusarium proliferatum infection using liposomal amphotericin B and terbinafine. In vitro susceptibility tests of antifungal drugs suggest that terbinafine is a potent additional antifungal drug for disseminated cutaneous fusariosis.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Drug Therapy, Combination; Female; Fusarium; Humans; Middle Aged; Naphthalenes; Neutropenia; Salvage Therapy; Stem Cell Transplantation; Terbinafine; Transplantation, Homologous; Treatment Outcome

Simultaneous mold infections in heart transplant recipients have not been previously reported. Here we describe early onset post-transplant pulmonary aspergillosis and cutaneous zygomycosis in a 46-year-old heart transplant recipient who was also treated with basiliximab. Along with surgical debridement, medical treatment of his cutaneous abdominal wall zygomycosis at the former left ventricular assist device driveline site with liposomal amphotericin B and voriconazole also led to cure of his pulmonary aspergillosis.

Topics: Amphotericin B; Antibodies, Monoclonal; Antifungal Agents; Aspergillus fumigatus; Basiliximab; Cardiomyopathy, Dilated; Debridement; Dermatomycoses; Heart Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Injections, Intravenous; Male; Middle Aged; Mucormycosis; Prosthesis-Related Infections; Pulmonary Aspergillosis; Pyrimidines; Recombinant Fusion Proteins; Rhizopus; Triazoles; Voriconazole

To describe the clinical presentation, management, and outcomes of patients with Penicillium marneffei infections in a regional hospital in Hong Kong.. Retrospective study.. A regional and tertiary human immunodeficiency virus-referral hospital in Hong Kong.. Those who had penicilliosis during the inclusive period January 1994 to February 2004.. Forty-seven immunocompromised patients (44 being human immunodeficiency virus-positive) with penicilliosis were retrospectively studied. Fever, malaise, and anaemia were the commonest presentations. Most diagnoses were obtained from blood cultures (83%) and lymph node biopsies (34%). Five (11%) died, death being attributable to penicilliosis; four (9%) of them had received no specific antifungal treatment due to late presentation and late diagnosis. The CD4 count of human immunodeficiency virus-infected patients upon diagnosis of penicilliosis was low (median, 20.0 cells/mm3). Most (70%) patients received amphotericin B as an induction treatment, followed by oral itraconazole, although a smaller proportion (21%) received oral itraconazole only. All surviving human immunodeficiency virus-infected patients took highly active antiretroviral treatment and oral itraconazole as secondary prophylaxis after treatment of penicilliosis. The prognosis appeared satisfactory with early diagnosis and administration of appropriate antifungal therapy. Relapse ensued in two (4%) of the patients only.. Penicillium marneffei infection in immunocompromised patients is a serious disease with significant mortality if not diagnosed early and treated with appropriate antifungal drugs. Simple investigations like blood culture enable the diagnosis in the majority of cases. Immunocompromised patients who have been successfully treated should receive oral itraconazole as a maintenance therapy to prevent relapse.

Topics: Administration, Oral; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antiretroviral Therapy, Highly Active; Dermatomycoses; Diagnosis, Differential; Drug Therapy, Combination; Fungemia; Hong Kong; Humans; Infusions, Intravenous; Itraconazole; Lung Diseases, Fungal; Opportunistic Infections; Penicillium; Retrospective Studies; Survival Rate

Treatment options for primary cutaneous aspergillosis in neonates are limited by the lack of pharmacokinetic and safety data of newer antifungal agents that are effective against Aspergillus spp. We report the successful treatment of cutaneous aspergillosis in an extremely low-birth-weight preterm infant with liposomal amphotericin B, voriconazole and micafungin, and provide pharmacokinetic profiles for voriconazole and micafungin.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Dermatomycoses; Echinocandins; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lipopeptides; Lipoproteins; Micafungin; Peptides, Cyclic; Pyrimidines; Treatment Outcome; Triazoles; Voriconazole

A 5-year-old boy had a 10-month remission of acute lymphocytic leukemia (ALL) after chemotherapy. Re-induction chemotherapy was performed for relapse of ALL. Thereafter, he suffered from an episode of neutropenic fever with pneumonia. One week following control of the condition with antibiotics, a 1 x 1-cm, red, painful nodule appeared on the left thigh, which was initially suspected to be Pseudomonas infection. Parenteral ceftazidime and amikacin were administered, but persistent high fever, mild cough, and a few painful erythematous papulonodules on the face and lower extremities appeared several days later (Fig. 1). These lesions increased insidiously in diameter up to 2-5 cm with central necrosis. Hemogram showed neutropenia with a shift to the left [white blood cell (WBC) count, 2.1 x 10(9)/L; neutrophil count, 0.21 x 10(9)/L]. A skin biopsy showed heavy growth of hyaline branching septate hyphae in the deep dermis and subcutis, together with fat necrosis (Fig. 2). Invasion of molds into vessels and sweat glands was also seen. A culture from a lesion yielded Fusarium moniliforme, but no fungi were isolated from blood specimens. Only mild infiltrations on bilateral lower lung fields were detected by chest roentgenography. The skin lesions gradually healed and the fever subsided 2 weeks after the initiation of therapy with amphotericin B 30 mg and itraconazole 200 mg daily. Meanwhile, relapse of leukemia was detected by hemogram showing atypical leukocytosis (WBC count of 24,400 x 10(9)/L, with blast cells representing 78%). A course of chemotherapy with cytarabine, mitoxantrone, and VP-16 was prescribed, subsequently resulting in neutropenia (WBC count, < 0.1 x 10(9)/L; neutrophil count, 0/L) and spiking fever. Although the aforementioned antifungal therapy was continued, the centers of the originally healed lesions turned dusky red, swollen, necrotic, and ulcerative. There were more than 10 such ecthymiform lesions. After administration for 22 days, itraconazole was discontinued because of no appreciable effects. Granulocyte colony-stimulating factor (G-CSF) salvage was used, and the neutropenia gradually subsided 20 days later. In addition, the ecthymiform lesions gradually resolved. Amphotericin B was discontinued 1 week following neutrophil recovery. The patient died of Acinetobacter baumannii and Stenotrophomonas maltophilia sepsis 8 months later.

Topics: Amphotericin B; Antifungal Agents; Child; Child, Preschool; Dermatomycoses; Fatal Outcome; Fusarium; Humans; Itraconazole; Male; Neoplasm Recurrence, Local; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Primary cutaneous aspergillosis is a rare cutaneous disease that usually affects immunodepressed patients of any age. The most common associated disorders in children are leukemias and lymphomas although it can also occur in neonates and preterms due to their intrinsic immunological immaturity. We report the case of a 4-year-old boy diagnosed of acute lymphoblastic leukemia that, during chemotherapy, developed an ulceronecrotic inflammatory cutaneous lesion in the venopuncture area of the left forearm, and whose microbiological culture was positive for Aspergillus flavus.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Aspergillus flavus; Child, Preschool; Dermatomycoses; Humans; Immunocompromised Host; Male; Neutropenia; Opportunistic Infections; Phlebotomy; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Skin Ulcer; Wound Infection

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Drug Combinations; Humans; Immunocompromised Host; Infant; Phosphatidylcholines; Phosphatidylglycerols; Zygomycosis

Cutaneous zygomycosis is a rare but severe fungal infection with high risk of dissemination. Early recognition, deep surgical biopsy for diagnosis, aggressive treatment with repeated surgical debridement, and targeted pharmacotherapy are essential and can prevent dissemination and fatal outcome. We present case reports of 2 patients.

Topics: Amphotericin B; Antifungal Agents; Child; Child, Preschool; Debridement; Dermatomycoses; Female; Humans; Hyperbaric Oxygenation; Immunocompromised Host; Male; Neutropenia; Treatment Outcome; Zygomycosis

Topics: Abscess; Amphotericin B; Antifungal Agents; Candidiasis; Dermatomycoses; Extremities; Face; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged

Topics: Amphotericin B; Antifungal Agents; Catheterization; Dermatomycoses; Equipment Contamination; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Necrosis; Zygomycosis

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus neoformans; Cytodiagnosis; Dermatomycoses; Diagnosis, Differential; Drug Therapy, Combination; Fluconazole; Humans; Male; Middle Aged; Skin

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Dermatomycoses; Diagnosis, Differential; Humans; Immunocompromised Host; Male; Middle Aged

Topics: Aged; Amphotericin B; Antifungal Agents; Cryptococcosis; Dermatomycoses; Female; Humans; Immunocompetence; Itraconazole

Although the dematiaceous fungus Veronaea botryosa is rarely encountered clinically, it can be pathogenic.. A patient with a history of diabetes mellitus, coronary artery disease, and Cushing's syndrome had recurrent multifocal, crusted, brownish-red noduloplaques on the right forearm, left upper limb, and right knee. A skin biopsy was obtained for histopathology and fungal cultures.. The histopathology showed brownish hyphae and yeast-like cells scattered in granulomatous infiltrates. Slide cultures revealed erect and straight conidiophores with two-celled cylindrical conidia, which have round tops and truncated bases. The fungus was identified as Veronaea botryosa. The disease slowly progressed despite a 6-month itraconazole regimen (200 mg daily). Subsequent use of Amphoterecin B produced only mild clinical improvements. Susceptibility tests showed resistance to both agents.. Cutaneous phaeohyphomycosis caused by V. botryosa is extremely rare. Antifungal susceptibility tests are important for choosing the appropriate drug and predicting the clinical outcome.

Topics: Aged; Amphotericin B; Antifungal Agents; Coronary Artery Disease; Cushing Syndrome; Dermatomycoses; Diabetes Complications; Drug Resistance, Multiple, Fungal; Humans; Itraconazole; Male; Mitosporic Fungi

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antiretroviral Therapy, Highly Active; Dermatomycoses; Histoplasmosis; HIV Seropositivity; Humans; Male

Invasive aspergillosis seems to be on the rise, especially in immunocompromised children. Historically, only systemic amphotericin B has been effective against Aspergillus. Development of newer antifungal agents, such as voriconazole and caspofungin, has improved the treatment options available for aspergillosis, although no definitive management strategy has been established. Here we describe the use of topical voriconazole combined with systemic antifungal agents for cutaneous aspergillosis in a pediatric patient after bone marrow transplant.

Topics: Administration, Cutaneous; Adult; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Aspergillus flavus; Bone Marrow Transplantation; Combined Modality Therapy; Debridement; Dermatomycoses; Disease Susceptibility; Female; Graft vs Host Disease; Humans; Immunocompromised Host; Injections, Subcutaneous; Nystatin; Postoperative Complications; Pyrimidines; Skin; Transplantation, Homologous; Triazoles; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Drug Resistance, Fungal; Endophthalmitis; Exophiala; Female; Fungemia; Humans; Itraconazole; Middle Aged; Mycoses; Opportunistic Infections; Osteolysis; Pregnancy; Pregnancy Complications, Infectious; Pyrimidines; Recurrence; Th2 Cells; Triazoles; Voriconazole

Primary cutaneous aspergillosis is a rare, life-threatening, infectious complication in premature infants that may result in fulminant sepsis and subsequent multi-organ failure. In the past decade, the incidence of primary aspergillosis has increased significantly, whereas the high morbidity and mortality of invasive aspergillosis remains unaltered. In vitro studies reveal that more and more Aspergillus species seem to be refractory to the classical treatment with fluconazole or amphotericin B. This case report presents two extremely low birth weight infants (ELBW) with primary cutaneous aspergillosis, which was refractory to amphotericin B. Both patients were successfully treated with systemic voriconazole, an extended-spectrum triazole antifungal, supported by topical care. This paper provides the clinical manifestation, diagnostics and pharmacotherapy of primary cutaneous aspergillosis, as well as pharmacokinetic aspects of voriconazole in ELBW infants.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Dermatomycoses; Drug Resistance, Fungal; Female; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Pyrimidines; Triazoles; Voriconazole

Cutaneous infections is observed in 15% of patients with disseminated cryptococcosis with AIDS. We present here a case of a 34 years old female with AIDS. She presented with multiple skin coloured umbilicated over face, neck, trunk and limbs, which mimicked molluscum contagiosum and kaposi sarcoma. The tissue from cutaneous lesions was collected by excision biopsy and processed by standard mycological methods. Cryptococcus neoformans was isolated and identified. Cerebrospinal fluid (CSF) also yielded the growth of C. neoformans . Cryptococcal antigen was detected with a titre of 1024 by Latex agglutination, is serum and CSF. Her serum was reactive for HIVI and 2 antibodies. The CD4 lymphocytes count was 80/cmm. The HIV viral load was 2,48,084 copies/mL. She was treated with amphotericin B injectable and oral fluconazole. She responded well and lesions regressed.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Biopsy; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Female; Fluconazole; Humans; Male

Topics: Alternaria; Amphotericin B; Dermatomycoses; Female; Fever; Hand; Humans; Middle Aged; Neutropenia

Since the first human infection by Saksenaea vasiformis in 1976 another 26 cases have been reported. Here is a report of a new case which involved an Ecuadorian adolescent who suffered serious burns after a car accident. It developed as a localized cutaneous infection which was successfully treated with surgical debridement and amphotericin B. This is the second report of this infection from South America and the third involving a burn patient. The previously reported 27 cases are reviewed.

Topics: Adolescent; Amphotericin B; Burns; Dermatomycoses; Humans; Male; Microscopy, Electron, Scanning; Microscopy, Polarization; Mucorales; Mucormycosis

A 49-year-old renally transplanted man, under a five-year course of immunosuppressive therapy with prednisone and cyclosporine A, experienced a subcutaneous phaeohyphomycosis caused by Phaeoacremonium parasiticum. The clinical presentation consisted of impressive, large, inflammatory and draining cystic tumors on the left foot that had been present for one year. A significant improvement was obtained with itraconazole plus intralesional injection with amphotericin B. Drug interaction was observed between itraconazole and cyclosporine A causing a severe hypertensive crisis and requiring a temporary sharp reduction in cyclosporine administration. Subcutaneous phaeohyphomycosis caused by P. parasiticum is uncommon among major organ transplant patients but several cases have previously been published and some patterns are emerging, e.g., limbs are generally involved but no known traumatic event has preceded lesion development. The identification of the case isolate was confirmed using a recently published online system based in part on beta-tubulin sequence comparison.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Dermatomycoses; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Skin

A 7-year-old castrated male Whippet developed deep ulcerative skin lesions whilst receiving immunosuppressive doses of prednisolone and cyclosporine for the treatment of immune-mediated haemolytic anaemia. The lesions were determined to be a phaeohyphomycosis, caused by Curvularia lunata. The dog was treated with a combination of systemic antifungals and weaning off immunosuppressants and made a complete recovery. To the authors' knowledge, this is the first case report of the successful treatment of disseminated cutaneous phaeohyphomycosis in a dog.

Topics: Amphotericin B; Animals; Antifungal Agents; Ascomycota; Cyclosporine; Dermatomycoses; Dog Diseases; Dogs; Immunocompromised Host; Immunosuppressive Agents; Male; Prednisolone; Treatment Outcome

Disseminated cryptococcal disease is typically seen in patients with HIV infection. We report here the evolution of a patient with disseminated cryptococcosis whose treatment failed after ten weeks of induction therapy with amphotericin B. This case illustrates the importance of careful initial evaluation, and close clinical follow-up of these patients who are at risk of developing other opportunistic infections and drug-related complications.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Biopsy; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Diagnosis, Differential; Female; Fluconazole; HIV Seropositivity; Humans; Skin

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Dermatomycoses; Fluconazole; Humans; Kidney Transplantation; Liver Transplantation; Male; Middle Aged; Time Factors; Treatment Outcome

Chromoblastomycosis is a cutaneous and subcutaneous mycotic disease caused by the dematiaceous (black) fungi. Five species of fungi are known generally to be the cause: Fonsecaea pedrosoi, Phialophora verrucosa, Cladosporium carrionii, F. compacta and Rhinocladiella cerphilum. In infected tissue they can appear as pigmented sclerotic bodies, commonly called 'copper pennies', which are pathognomonic of chromoblastomycosis. The infection usually occurs through traumatic skin inoculation, with the majority of lesions occurring on the feet and legs of outdoor workers. We report a patient in whom the lesions had begun on the right breast, which is an unexposed area, without a history of trauma. A uniform, reliable treatment does not exist but our patient was mycologically cured with the use of amphotericin B and the subsequent combination of 5-flucytosine and itraconazole.

Topics: Adult; Amphotericin B; Antifungal Agents; Breast Diseases; Chromoblastomycosis; Dermatomycoses; Drug Therapy, Combination; Female; Flucytosine; Humans; Phialophora

Topics: Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Dermatomycoses; Fatal Outcome; Female; Fluconazole; Humans; Leukemia; Thumb

Topics: Adult; Amphotericin B; Biopsy, Needle; Chronic Disease; Combined Modality Therapy; Debridement; Dermatomycoses; Follow-Up Studies; Fusarium; Hodgkin Disease; Humans; Immunocompromised Host; Immunohistochemistry; Male; Risk Assessment; Severity of Illness Index; Treatment Outcome

We report two cases of cutaneous cryptococcosis in male patients without underlying disease. Case 1 had a granulomatous mass on his right neck, gradually enlarging for 3 months. After the mass was debrided surgically in a hospital, the incision wound gradually developed into a severe ulceration. Mycological examination revealed Cryptococcus neoformans infection. It was significant that histopathology of both pre-surgery granuloma and post-surgery ulceration revealed thick-walled spores with thick capsule. Chest X-ray revealed a shadow in the left lower lung. After treatment with amphotec for 21 days, the lesion healed. Case 2 had an approximately 2 x 2 cm solitary dull nodule on his right thigh, which had been present for 8 months. Mycological examination confirmed that the lesion was caused by C. neoformans. The patient's ratio of peripheral blood CD4(+) cell was slightly reduced. After 14 days of treatment with oral fluconazole, followed by oral itraconazole for 2 months, mycological and clinical cure were achieved. The two isolates were identified as C. neoformans var. gattii serotype C and C. neoformans var. grubii serotype A.

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Fluconazole; Granuloma; Humans; Itraconazole; Male; Neck; Spores, Fungal; Thigh

A rapidly enlarging leg ulcer appeared in a 54-year-old woman with systemic lupus erythematosus receiving aggressive immunosuppressive therapy. Skin biopsy revealed proliferation of hyphae in the midst of a neutrophilic abscess. Culture yielded Rhizopus azygosporus. As no organ involvement was detected by thorough examination, the patient was diagnosed as having primary cutaneous mucormycosis. Although intravenous amphotericin B therapy seemed to be very effective, it had to be discontinued due to nephrotoxicity. She unfortunately died of subsequent disseminated fungal infection and cerebral infarction in which the primary cause could not be determined. Minimum inhibitory concentrations of several antifungal drugs to the isolate were examined and amphotericin B proved to be the only agent that may potentially reach the effective plasma concentration. This is the first case report of cutaneous mucormycosis caused by R. azygosporus.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Fatal Outcome; Female; Humans; Leg Ulcer; Lupus Erythematosus, Systemic; Middle Aged; Mucormycosis; Rhizopus

Primary cutaneous aspergillosis is a rare diagnosis. Predisposing factors are immunodeficiency and macerated skin. The mortality of infections with Aspergillus species is high, especially in neonatal intensive care units (NICUs). We present a premature (24 wk of gestation) infant with primary cutaneous aspergillosis appearing on the sixth day of life. Predisposing factors in this patient were prematurity, extremely vulnerable skin, treatment with antibiotics and renovation in the radiology department nearby. The patient was treated with amphotericin B intravenously for a total of 40 d. He did not have, nor develop, disseminated aspergillosis, and suffered no side effects from the treatment. The only remaining trace of his infection was scarring in the affected area.. After having treated this patient successfully and having gone through the available literature, we conclude that treating primary cutaneous aspergillosis with intravenous amphotericin B prevents disseminated aspergillosis and is the treatment of choice.

Topics: Amphotericin B; Aspergillosis; Dermatomycoses; Diseases in Twins; Humans; Infant, Newborn; Infant, Premature, Diseases; Male

Topics: Adult; Amphotericin B; Antifungal Agents; Brain; Child; Dermatomycoses; Diagnosis, Differential; Facial Dermatoses; Fatal Outcome; Humans; Itraconazole; Magnetic Resonance Imaging; Male; Paranasal Sinuses; Skin; Zygomycosis

Mucormycoses are seen with an increasing incidence in immunocompromised patients. Most common presentations are rhinocerebral and pulmonary. We here report the experience of a single center with mucormycoses in patients with hematologic malignancies.. Mucormycoses were diagnosed in six patients, (median age of 52 years; range, 26-74) treated between 2001-2004. Diagnoses included acute myeloid leukemia (AML) (n=3), acute lymphoblastic leukemia (n=1), chronic lymphocytic leukemia (n=1) and multiple myeloma (n=1). Mucormycosis was diagnosed in the neutropenic state following allogeneic hematopoietic cell transplantation (n=3) or intense chemotherapy (n=3). Sites of infections were rhinocerebral, facial and pulmonary involvement in one patient each and disseminated mucormycosis in three patients. The diagnosis was established by computed tomography followed by surgical interventions and histological diagnosis in 4 patients and post-mortem in two patients. Species identified were Rhizopus (n=3), Rhizomucor (n=2) and Absidia (n=1). Treatment responses were best if surgical resection was followed by aggressive antifungal chemotherapy. Five of six 6 patients died, all of complications of mucormycosis or their underlying disease. Only one patient with facial mucormycosis is still alive.. This experience demonstrates that patient with mucormycoses have a high mortality rate and early recognition followed by aggressive surgical debridement, high dose antifungal therapy and attempts to correct the underlying immunocompromised state are crucial in the treatment of this fatal infection.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Communicable Diseases, Emerging; Dermatomycoses; Disease Susceptibility; Female; Fluconazole; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Itraconazole; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Neutropenia; Pyrimidines; Sinusitis; Transplantation Conditioning; Triazoles; Viscera; Voriconazole

Paecilomyces variotii, an emerging hyalohyphomycetes, has been reported to be susceptible in vitro to voriconazole. We describe a case of disseminated P. variotii infection in a neutropenic child with relapsed leukaemia who was on voriconazole prophylaxis. The P. variotii isolate was resistant to voriconazole in vitro. The patient responded to liposomal amphotericin B.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Dermatomycoses; Drug Resistance, Fungal; Fungemia; Humans; Lung Diseases, Fungal; Male; Microbial Sensitivity Tests; Mycoses; Neutropenia; Paecilomyces; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Radiography; Treatment Outcome; Triazoles; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Diagnosis, Differential; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Liver Neoplasms; Male; Middle Aged; Thigh

Topics: Amphotericin B; Antifungal Agents; Biopsy, Needle; Coccidioidomycosis; Dermatomycoses; Diagnosis, Differential; Female; Follow-Up Studies; Fungemia; Humans; Immunohistochemistry; Middle Aged; Mycosis Fungoides; Risk Assessment; Severity of Illness Index; Skin Neoplasms; Treatment Outcome

A case of disseminated infection with Fusarium oxysporum following chemotherapy of acute myelogenous leukemia is reported. Antifungal treatment was successful with a 13-day course of oral terbinafine 250 mg t.i.d. in combination with amphotericin B deoxycholate 1.0-1.5 mg/kg qd and subsequently intravenous liposomal amphotericin B 5 mg/kg qd. Preceding monotherapy with amphotericin B deoxycholate 1.0-1.5 mg/kg qd had not stopped the progression of infection. The combination therapy described here represents a novel approach to the treatment of Fusarium spp. in the immunocompromised host in whom Fusarium spp. are known to cause disseminated infection with high mortality.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Drug Therapy, Combination; Fusarium; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Microbial Sensitivity Tests; Middle Aged; Naphthalenes; Neutropenia; Terbinafine; Treatment Outcome

Disseminated infection with the coelomycetous fungus Nattrassia mangiferae is a very rare disease affecting only the immunocompromised host. We report the first case of a disseminated infection with spondylodiscitis and granular skin lesions due to N. mangiferae in a renal transplant patient.

Topics: Amphotericin B; Dermatomycoses; Humans; Immunocompromised Host; Kidney Transplantation; Male; Middle Aged; Mitosporic Fungi

We report a 44-year-old patient with refractory acute myeloid leukemia who developed a rare form of disseminated cutaneous aspergillosis resulting from colonization in the deep reticular dermis of Aspergillus flavus. Diagnosis was based on cutaneous biopsy. Antifungal therapy was started with liposomal amphotericin B (L AmB). However, the lesions continued to spread and there was a marked decline in the patient's clinical condition. Consequently, L AmB was replaced with voriconazole. Response to voriconazole was excellent with regression of the skin lesions and a rapid improvement of the patient's general clinical condition.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Dermatomycoses; Female; Humans; Leukemia, Myeloid, Acute; Pyrimidines; Triazoles; Voriconazole

Systemic fungal infections are being recognized with increasing frequency in extremely premature neonates. We report two such infants with late-onset mixed infection with Staphylococcal species and unusual fungi. These cases are of interest in view of recent reports on the interaction of Staphylococcal cell wall components and neutrophils, as damaged skin sites could form a nidus and portal of entry for saprophytic fungal pathogens. It is also important to consider fungal infection as a possibility in sick premature infants with necrotic skin lesions even when the systemic signs have an alternative explanation with ongoing bacteremia.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Male; Staphylococcal Infections; Trichosporon

Pseudallescheria boydii is a ubiquitously occurring fungus. While rarely causing opportunistic infection in humans, it is the most common cause of fungal pneumonia in cases of near drowning, and is associated with high mortality. P. boydii typically causes cutaneous mycetomas but may invade the lungs or brain. P. boydii infections are difficult to treat due to amphotericin B resistance and frequent need for surgical resection. Zygomycetous infections, often referred to as "mucormycoses," usually occur in immunocompromised hosts, trauma or burn victims. Like P. boydii, these organisms are found on decaying vegetation and in soil. Zygomycetous infections generally require debridement and prolonged amphotericin B. We report a case of P. boydii pneumonia with a simultaneous brain lesion and cutaneous mucormycosis in a near drowning patient. The pneumonia responded to treatment with voriconazole and the brain lesion resolved without surgery. The cutaneous mucormycosis responded to surgery and amphotericin B. This is the first documented case of simultaneous invasive P. boydii and cutaneous mucormycosis successfully treated with dual systemic antifungal therapy and resection.

Topics: Accidents, Traffic; Adult; Amphotericin B; Anti-Infective Agents; Ciprofloxacin; Dermatomycoses; Humans; Lung Diseases, Fungal; Magnetic Resonance Imaging; Male; Near Drowning; Pseudallescheria; Tomography, X-Ray Computed; Zygomycosis

We report herein a case of primary cutaneous zygomycosis caused by Rhizopus oryzae in a 7-year-old girl with acute lymphoblastic leukemia (ALL) receiving intensive chemotherapy. The diagnosis was based on observation of hyphal elements in cutaneous biopsy and isolation of the fungus in culture. The patient responded to surgical intervention and treatment with amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Child; Dermatomycoses; Female; Humans; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rhizopus; Skin; Zygomycosis

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Dermatomycoses; Fusarium; Humans; Immunocompromised Host; Immunosuppressive Agents; Leukemia; Male; Middle Aged

An immunosuppressed patient who presented with unusual clinical signs of cutaneous alternariosis, including papular, nodular and verrucous lesions of the forearms, is reported. In spite of continuous treatment with oral itraconazole for 6 months, a large, progressive, necrotic ulcer appeared on the patient's left leg. Liposomal amphotericin B was then administered (total dose, 750 mg) with excellent clinical results.

Topics: Alternaria; Amphotericin B; Antifungal Agents; Biopsy, Needle; Dermatomycoses; Follow-Up Studies; Humans; Immunocompromised Host; Immunohistochemistry; Kidney Transplantation; Leg Ulcer; Liposomes; Male; Middle Aged; Opportunistic Infections; Recurrence; Risk Assessment; Severity of Illness Index; Treatment Outcome

We report the case of a patient suffering from subcutaneous phaeohyphomycosis caused by Cladophialophora bantiana. The face of the upper site was involved with small, stellate, pyogranulomatous foci and low inflammation. The patient was treated by topical and systemic corticosteriod and amphotericin B. After 3 months of treatment, the patient showed good response.

Topics: Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Cladosporium; Dermatomycoses; Drug Therapy, Combination; Face; Facial Dermatoses; Female; Humans; Middle Aged

Paecilomyces lilacinus was the causal agent of a case of subcutaneous infection in a patient with liver cirrhosis. Surgical treatment in combination with systemic amphotericin B therapy led to complete recovery. Retrospectively performed microdilution testing revealed dose dependent in vitro susceptibility of the isolate to voriconazole (MIC = 2 g/ml) and terbinafine (MIC = 1 microg/ml).

Topics: Abscess; Adult; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Dermatomycoses; Germany; Humans; Liver Cirrhosis; Male; Microbial Sensitivity Tests; Paecilomyces

A disseminated Fusarium oxysporum infection with skin localization was diagnosed in a woman with a relapse of B-acute leukemia during induction chemotherapy. The infection was refractory to amphotericin B-lipid complex alone but responded successfully when voriconazole was added.

Topics: Adult; Amphotericin B; Antifungal Agents; Burkitt Lymphoma; Dermatomycoses; Drug Therapy, Combination; Female; Fusarium; Humans; Pyrimidines; Treatment Outcome; Triazoles; Voriconazole

A 20-year-old female patient presented with erythematous plaques on the nose which were progressively spreading to the trunk and the extremities, sometimes with erosions and scars. The patient was misdiagnosed as having seborrhoeic dermatitis and subacute cutaneous lupus erythematosus. The histopathological biopsy revealed mycotic infectious granuloma. Samples taken from skin lesions and other locations grew Trichosporon asahii in cultures. The identification was confirmed by molecular biological methods. The patient was treated successfully with liposomal amphotericin B in combination with fluconazole orally.

Topics: Adult; Amphotericin B; Antifungal Agents; China; Dermatomycoses; DNA, Ribosomal; Drug Therapy, Combination; Female; Fluconazole; Humans; Mycological Typing Techniques; Mycoses; RNA, Ribosomal; Sequence Analysis, DNA; Trichosporon

A woman with a skin infection because of Scedosporium apiospermum, in the interdigital spaces of her feet is presented. The minimum inhibition concentration values (MIC, microg ml(-1)) of this isolated mould for itraconazole, amphotericin B and terbinafine after 48 h were determined as 1, 8 and 16, respectively. The patient was treated successfully with oral terbinafine and topical clotrimazole.

Topics: Adult; Amphotericin B; Antifungal Agents; Clotrimazole; Dermatomycoses; Drug Therapy, Combination; Female; Foot Dermatoses; Humans; Itraconazole; Microbial Sensitivity Tests; Naphthalenes; Scedosporium; Terbinafine

A case of disseminated Aspergillus terreus infection in a patient with prolonged neutropenia after stem cell transplant for myeloma is reported. The isolate was resistant to amphotericin B in vitro, and the patient was successfully managed with surgical debridement and the recently licensed antifungal agent caspofungin. There are many challenges associated with treating invasive aspergillosis, particularly that due to A. terreus, and the early use of caspofungin should be considered.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Caspofungin; Dermatomycoses; Drug Resistance, Fungal; Echinocandins; Humans; Immunocompromised Host; Itraconazole; Lipopeptides; Male; Middle Aged; Neutropenia; Peptides; Peptides, Cyclic; Stem Cell Transplantation

Topics: Acute Kidney Injury; Amphotericin B; Antifungal Agents; Blastomycosis; Dermatomycoses; Forearm; Humans; Itraconazole; Leg; Lung Diseases, Fungal; Lymphatic Diseases; Male; Middle Aged

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Child; Dermatomycoses; Humans; Leukemia, Myeloid, Acute; Male; Severity of Illness Index; Therapeutic Irrigation

A Cryptococcus neoformans strain from cutaneous lesions of a patient with thrombotic thrombocytopenia purpura was tested for in vitro susceptibility against seven conventional antifungal agents. The strain was susceptible to fluconazole, itraconazole, ketoconazole and miconazole but was resistant to 5-fluorocytosine (5-FC). Minimal inhibitory concentration (MIC) values obtained against amphotericin B and terbinafine were 1 and 4 microg ml(-1), respectively. The isolate belonged to serotype D. Few human cases of cryptococcosis have been reported over the last 50 years in Turkey. This is the first C. neoformans isolate in Turkey shown to have primary resistance to 5-FC. Primary resistance to flucytosine is rarely reported in C. neoformans and may be associated with treatment failure in some cases.

Topics: Adult; Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Drug Resistance, Fungal; Flucytosine; Humans; Male; Purpura, Thrombotic Thrombocytopenic; Skin

Mal de Meleda is a rare autosomal recessive form of palmoplantar keratoderma characterized by hyperkeratosis of the palms and soles. The presence of yeast and dermatophytes was investigated in 29 mal de Meleda patients from Koprucay canyon, Turkey, a newer geographical focus, and was found in 62.0% and 20.7% of cases, respectively. Antifungal resistance of isolates was not detected.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Biopsy, Needle; Comorbidity; Dermatomycoses; Female; Fluconazole; Follow-Up Studies; Humans; Itraconazole; Keratoderma, Palmoplantar; Male; Microbial Sensitivity Tests; Middle Aged; Prevalence; Prospective Studies; Risk Assessment; Sampling Studies; Skin; Treatment Outcome; Turkey

The mucormycosis is a rare opportunistic invasive infection caused by fungi of the order Mucorales and characterized by vascular invasion and tissue necrosis. It affects generally the subjects with altered natural resistances, particularly the diabetics patients. The cerebro-rhino-orbital region is the most common site. The clinical signs depend on the intra-tissular and intra-vascular evolution of the fungi. The diagnosis of this disease is asserted by the mycological and anatomo-pathological exams. The treatment is based on the antifungic and the surgical excision of necrotic tissues. We report three observations: one man (42 years) and two women (59 and 60 years). Diabetes was found in two cases. The diagnosis was in every case anatomo-pathologic. Our objective was to study the epidemiological and clinico-pathologic aspects of this serious affection and to discuss its prognosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Diabetes Complications; Face; Female; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Prognosis

Topics: Alternaria; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Dermatomycoses; Female; Foot Ulcer; Humans; Immunocompromised Host; Immunosuppression Therapy; Kidney Transplantation; Leg Ulcer; Middle Aged; Postoperative Complications

The Sensititre YeastOne antifungal panel was used to test 49 dermatophytes belonging to the species Epidermophyton floccosum, Microsporum gypseum, Microsporum canis, Trichophyton tonsurans, Trichophyton rubrum, and Trichophyton mentagrophytes. The MICs of four antifungals obtained with the Sensititre YeastOne antifungal panel were compared with those obtained by the reference NCCLS microdilution method. The levels of agreement between the two methods (

Topics: Amphotericin B; Antifungal Agents; Arthrodermataceae; Colorimetry; Coloring Agents; Dermatomycoses; Drug Resistance, Fungal; Epidermophyton; Fluconazole; Humans; Itraconazole; Ketoconazole; Microbial Sensitivity Tests; Microsporum; Oxazines; Sensitivity and Specificity; Trichophyton; Xanthenes

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Dermatomycoses; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Injections, Intravenous; Itraconazole; Male; Recurrence

Phaeohyphomycosis is a clinical entity caused by dematiaceous fungi. We describe a clinical case of phaeohyphomycosis due to Cladosporium cladosporioides in a 45-year-old white male, apparently healthy, human immunodeficiency virus-negative. The patient was treated with terbinafine for 9 months, with regression of a skin lesion. Three months after discontinuation of the therapy, there was a clinical and mycological relapse. After progression of the disease with inadequate treatment, there was no response to amphotericin B and flucytosine. Finally, we obtained a clinical response with itraconazole oral solution at 600 mg day(-1) for a 6-month period.

Topics: Adult; Amphotericin B; Antifungal Agents; Cladosporium; Dermatomycoses; Flucytosine; Humans; Itraconazole; Male

The emergence of new fungal pathogens such filamentous fungi (Scedosporium, Fusarium) or yeast (Trichosporon) is a real problem for doctors who treat immunocompromised patients. These fungi present in our environment (Scedosporium, Fusarium) can also be on the skin (Trichosporon). They are responsible for invasive infections cause of morbidity and mortality because patients are immunocompromised and the fungi are resistant to antifungal treatment. Clinical manifestations are seldom specific, but cutaneous localisations are frequent. They are either the portal of entry of the infection or a metastatic localisation. The role of laboratory for identification of the fungus is essential.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Ecology; Fusarium; Humans; Itraconazole; Mycetoma; Mycology; Mycoses; Pseudallescheria; Risk Factors; Scedosporium; Trichosporon

A case of lethal invasive mucormycosis (IM), a rare fungal infection which predominantly affects immunocompromised patients, is reported in a 73-year-old female patient who presented with a cervical abscess. The patient had asthma treated with steroids and had previously undiagnosed diabetes mellitus. Despite surgical treatment and parenteral antibiotic therapy, there was fatal progression of the condition. The pathogenesis, histological appearances and treatment of mucormycosis are discussed, particularly the importance of urgent histological examination of debrided tissue to distinguish this condition from necrotizing fasciitis (NF) earlier than microbiological culture alone would allow, thus permitting the early introduction of appropriate antifungal therapy.

Topics: Abscess; Absidia; Aged; Amphotericin B; Antifungal Agents; Asthma; Dermatomycoses; Diabetes Complications; Diagnosis, Differential; Drug Therapy, Combination; Fasciitis, Necrotizing; Fatal Outcome; Female; Humans; Immunocompromised Host; Mucormycosis; Neck

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Dermatomycoses; Drug Administration Schedule; Fluconazole; Humans; Infant, Newborn; Liposomes

Topics: Adult; Amphotericin B; Antifungal Agents; Cheek; Colony Count, Microbial; Dermatomycoses; Facial Injuries; Forehead; Humans; Male; Rhizopus; Spinal Injuries; Zygomycosis

We report a case of life-threatening nasal sinus zygomycosis that developed during remission induction therapy for a relapsed acute lymphoblastic leukaemia. The patient was successfully treated with liposomal amphotericin B and granulocyte-colony stimulating factor followed by surgical reconstruction of the resultant cutaneous defect.

Topics: Absidia; Amphotericin B; Antifungal Agents; Child; Dermatomycoses; Humans; Male; Mucormycosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis; Tomography, X-Ray Computed

A 33-year-old Hispanic woman with newly diagnosed human immunodeficiency virus (HIV) infection, a CD4 T-lymphocyte count of 2, viral load of 730,000 copies/mL, candidal esophagitis, seizure disorder, a history of bacterial pneumonia, and recent weight loss was admitted with tonic clonic seizure. On admission, her vital signs were: pulse of 88, respiration rate of 18, temperature of 37.7 degrees C, and blood pressure of 126/76. Her only medication was phenytoin. On examination, the patient was found to have multiple umbilicated papules on her face, as well as painful, erythematous, large, punched-out ulcers on the nose, face, trunk, and extremities of 3 months' duration (Fig. 1). The borders of the ulcers were irregular, raised, boggy, and undermined, while the base contained hemorrhagic exudate partially covered with necrotic eschar. The largest ulcer on the left mandible was 4 cm in diameter. The oral cavity was clear. Because of her subtherapeutic phenytoin level, the medication dose was adjusted, and she was empirically treated with Unasyn for presumptive bacterial infection. Chest radiograph and head computed tomography (CT) scan were within normal limits. Sputum for acid-fast bacilli (AFB) smear was negative. Serologic studies, including Histoplasma antibodies, toxoplasmosis immunoglobulin M (IgM), rapid plasma reagin (RPR), hepatitis C virus (HCV), and hepatitis B virus (HBV) antibodies were all negative. Examination of the cerebrospinal fluid was within normal limits without the presence of cryptococcal antigen. Blood and cerebrospinal cultures for bacteria, mycobacteria, and fungi were all negative. Viral culture from one of the lesions was also negative. The analysis of her complete blood count showed: white blood count, 2300/microl; hemoglobin, 8.5 g/dL; hematocrit, 25.7%; and platelets, 114,000/microl. Two days after admission, the dermatology service was asked to evaluate the patient. Although the umbilicated papules on the patient's face resembled lesions of molluscum contagiosum, other infectious processes considered in the differential diagnosis included histoplasmosis, cryptococcosis, and Penicillium marnefei. In addition, the morphology of the ulcers, particularly that on the left mandible, resembled lesions of pyoderma gangrenosum. A skin biopsy was performed on an ulcer on the chest. Histopathologic examination revealed granulomatous dermatitis with multiple budding yeast forms, predominantly within histiocytes, with few organisms resid

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Dermatomycoses; Female; Histoplasma; Histoplasmosis; HIV Infections; Humans; Pyoderma Gangrenosum

The first case of a cutaneous cryptococcosis associated with systemic erythematous lupus (SLE) diagnosed in our Mycology Reference Centre is presented: a 24-year-old female patient diagnosed with SLE, nephrotic syndrome, arterial hypertension, renal insufficiency due to glomerulonephritis type IV and cellulitis in the right thigh and gluteus. Cryptococcus neoformans was isolated by cutaneous biopsy and haemoculture. Cryptococcal antigen was detected in serum by the latex agglutination test. As the patient did not respond to fluconazol intravenous treatment, amphotericin B administration was performed. She died of acute renal insufficiency.

Topics: Adult; Agglutination Tests; Amphotericin B; Antifungal Agents; Antigens, Fungal; Cellulitis; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Fatal Outcome; Female; Fluconazole; Fungemia; Humans; Injections, Intravenous; Lupus Erythematosus, Systemic; Renal Insufficiency

Malignant otitis externa caused by fungal infections is rare. A review of the literature showed only 9 cases, and the causative fungus in all cases was Aspergillus. This article reports an unusual case caused by Malassezia sympodialis.. A 53-year-old man with non-insulin dependent diabetes presented with malignant otitis externa. He deteriorated despite treatment with intravenous antipseudomonal therapy and surgical debridement. Microbiologic tests revealed M. sympodialis. He responded rapidly to intravenous amphotericin.. Systemic human infections caused by M. sympodialis have not been reported. M. furfur systemic infection is rare and has been associated lipid hyperalimentation by means of a central catheter. Only 1 other case of M. fungemia without these associated risk factors has been reported.. The first case of malignant otitis externa caused by M. sympodialis is presented. It highlights the difficulty of initial biologic diagnosis and the need for lipid-enriched media to grow this fastidious organism.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Diabetes Mellitus, Type 2; Follow-Up Studies; Humans; Malassezia; Male; Middle Aged; Otitis Externa; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Dermatomycoses; Diagnosis, Differential; Facial Dermatoses; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male

Fusarium is a newly emerging fungal pathogen associated with significant morbidity and mortality in the immunocompromised host. We have reviewed our hospital's experience with Fusarium between 1985 and 1995. Fusarium species were isolated from 22 specimens, representing 11 patients. Cases were not clustered by time period. The median age of the patients was 36.5 years (range 17-69 years). The sources of the organism were 12 skin lesions from eight patients, seven blood cultures from two patients and one specimen each from a Hickman catheter tip, nail clippings and a bronchoalveolar lavage. Seven of the patients had chemotherapy-induced neutropenia when the Fusarium was isolated. Five of them developed invasive fusarosis during acute leukaemia induction treatment. They remained neutropenic, and none survived. The other two patients recovered from neutropenia and were treated successfully for this infection. The remaining four patients were not neutropenic or immunocompromised. Three grew Fusarium from skin or nail clippings and one from bronchial alveolar lavage (BAL). There was no evidence of invasive disease in any of the four. None of them received antifungal therapy, and they were all alive at last follow-up. We conclude that Fusarium is a newly emerging infection in neutropenic patients. A high index of suspicion, especially for skin lesions, will help in early diagnosis before systemic and visceral dissemination. Excision of the initial focus of infection and antifungal therapy, aided by speedy neutrophil recovery, are likely to protect patients threatened with these fatal infections. Fusarium isolated from non-neutropenic, non-immunosuppressed patients is not significant and does not merit systemic antifungal treatment.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Dermatomycoses; Female; Foot Dermatoses; Fusarium; Humans; Immunocompromised Host; Leukemia; Male; Middle Aged; Necrosis; Neutropenia; Retrospective Studies; Skin

Topics: Amphotericin B; Aspergillosis; Aspergillus flavus; Aspergillus niger; Bandages; Dermatomycoses; Fatal Outcome; Female; Humans; Infant, Newborn; Infant, Premature; Intubation, Intratracheal; Male; Respiratory Insufficiency; Sepsis

We describe a 68-year-old asthmatic female patient with multiple pulmonary cavities. A preexisting ecthyma on the left lower leg became erythematous and swollen during exacerbation of her asthma which was under treatment with high-dose steroids. Nonseptate broad hyphae were found in her sputum, pus from the wound, and debrided skin tissue. Hematogenous spread of septic emboli from indolent cutaneous mucormycosis to both lungs was the suspected mechanism of dissemination. High-dose steroid therapy may have been the major contributory factor. The patient was successfully treated with local surgical debridement of the wound and intravenous amphotericin B.

Topics: Aged; Amphotericin B; Antifungal Agents; Asthma; Debridement; Dermatomycoses; Female; Humans; Lung Diseases, Fungal; Mucormycosis

Topics: Amphotericin B; Child; Dermatomycoses; Ecthyma; Female; Foot Diseases; Fusarium; Humans; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence

Hamycin activity (in vitro) against Malassezia ovale was studied and compared with old and newly discovered polyene antifungal antibiotics. Hamycin showed a marked anti-M. ovale activity which was enhanced in the presence of divalent cations like Cu++ and Zn++. Furthermore, the absorption of hamycin onto the cell membrane or cell surface of M. ovale was also increased in the presence of divalent cations. It is suggested that hamycin alone or along with metal ions, specifically Cu++ may be useful clinically in the treatment of dandruff or seborrheic dermatitis.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Copper Sulfate; Dermatitis, Seborrheic; Dermatomycoses; Humans; Macrolides; Malassezia; Microbial Sensitivity Tests; Nystatin; Polyenes; Zinc Sulfate

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Dermatomycoses; Fusarium; Humans; Leukemia, Myeloid; Male; Ulcer

Topics: Adult; Alternaria; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Dermatomycoses; Humans; Male

Topics: Adult; Amphotericin B; Dermatomycoses; Diabetes Complications; Facial Dermatoses; Female; Humans; Mouth Diseases; Mucormycosis; Nose Diseases; Orbital Diseases; Oroantral Fistula; Osteonecrosis; Paranasal Sinus Diseases

To describe ocular findings in 2 patients with disseminated coccidioidomycosis diagnosed by skin biopsy.. The clinical and histopathologic findings of the 2 patients were reviewed retrospectively.. One patient had a unilateral, granulomatous iridocyclitis with multiple iris nodules and a large vascularized anterior chamber mass, in the setting of pulmonary, cutaneous, and skeletal infection by Coccidioides immitis. The second patient developed papilledema and multifocal chorioretinitis accompanied by pulmonary, cutaneous, and meningeal C immitis infection. In each case, examination of the skin biopsy specimen revealed C immitis spherules. Treatments included local and systemic amphotericin B and oral fluconazole.. Although rare, intraocular involvement can occur in the setting of disseminated coccidioidomycosis. A thorough systemic evaluation and biopsy of suspicious skin lesions can aid in the diagnosis.

Topics: Adult; Amphotericin B; Biopsy; Bone Diseases; Brain Diseases; Chorioretinitis; Coccidioidomycosis; Dermatomycoses; Eye Infections, Fungal; Female; Fluconazole; Humans; Iridocyclitis; Lung Diseases, Fungal; Male; Radiography; Radionuclide Imaging; Retrospective Studies; Skin; Technetium Tc 99m Pyrophosphate

Diagnosis and successful therapy for primary cutaneous zygomycosis (mucormycosis) that complicated the securing of an endotracheal tube with cloth tape. Primary cutaneous mucormycosis is a rare fungal infection noted most often in immunosuppressed individuals. Cloth tape, of the type commonly used to secure endotracheal tubes, often is contaminated with fungal spores. In the case reported here, cloth tape securing the endotracheal tube was the probable vector for transmission of zygomycosis to a moderately imunocompromised host. Rapid diagnosis and combined medical and surgical therapy resulted in a favorable outcome.

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Disease Reservoirs; Equipment Contamination; Facial Dermatoses; Female; Follow-Up Studies; Humans; Immunocompromised Host; Intubation, Intratracheal; Lupus Erythematosus, Systemic; Mucormycosis; Pneumonia, Pneumococcal; Rhizopus; Spores

The skin is frequently a site of extrapulmonary dissemination in patients with coccidioidomycosis. Clinical experience in an endemic area suggests an association between facial cutaneous coccidioidomycosis and meningitis. Awareness of this association is important because coccidioidal meningitis is the most ominous site of spread in coccidioidomycosis. In this study, we assess whether cutaneous dissemination involving the face is associated with meningitis to a greater degree than that limited to the body. We retrospectively reviewed the medical records of 201 patients from 1987 to 1996 with disseminated coccidioidomycosis and found 30 patients with cutaneous involvement. Their mean age was 29.5 +/- 11.6 years; 20 patients were male; 14 were African American, 12 were Hispanic, 3 were white, and 1 was Asian. Nineteen patients had facial involvement, and 11 had isolated body involvement. Meningitis developed in 11 patients, 10 with facial involvement and 1 with only body involvement. Patients with facial lesions were more likely to have meningitis (odds ratio, 11.1; 95% confidence interval, 1.1 to 529, P = .023). The identification of a subgroup of patients at significant risk of developing meningitis may allow earlier detection and perhaps improved management of patients with meningeal disease.

Topics: Adult; Amphotericin B; Antifungal Agents; Coccidioidomycosis; Confidence Intervals; Dermatomycoses; Facial Dermatoses; Female; Fluconazole; Humans; Male; Meningitis, Fungal; Odds Ratio; Retrospective Studies

Trichosporon beigelii, causal agent of white piedra can cause disseminated infection in immunodepressed subjects. Systemic infections due to this pathogen have been reported mainly in neutropenic patients and rarely in AIDS patients.. A 36-year-old HIV+ man from Senegal was hospitalized for fever and meningoencephalitis associated with skin lesions. T. beigelii was isolated from skin biopsies and cerebrospinal fluid cultures. The patients was treated with amphotericin B with regression of the skin lesions. The diagnosis of disseminated T. beigelii infection was retained.. Disseminated T. beigelii infections are known to occur in immunodepressed subjects, especially in case of neutropenia. In our patient, the presence of two proven localizations (meninges and skin) and the favorable outcome with amphotericin B favored disseminated infection. The good response to treatment can probably be explained by the absence of neutropenia. Skin lesions are frequent, usually occurring as disseminated papulae or purpural nodules. Pathology examination and skin biopsy culture can provide rapid diagnosis allowing appropriate treatment.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Biopsy; Dermatomycoses; Humans; Male; Trichosporon

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Dermatomycoses; Humans; Immunocompromised Host; Prognosis

Two imported cases of Penicillium marneffei infection in Belgium are reported. Both patients are Thai women co-infected with HIV. P. marneffei infection should be suspected in immunocompromised patients originating or travelling from South-East Asia with unexplained fever (> 38 degrees C), weight loss, a generalised lymphadenopathy, hepatomegaly, splenomegaly, skin lesions, cough and anaemia. Diagnosis is made by culture and/or histopathological examination. Mild to moderate infections are treated with itraconazole 400 mg/day as first choice. Amphotericin B parenteral therapy may be required for seriously ill patients. Maintenance therapy with itraconazole 200 mg/day is necessary to prevent relapses.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Belgium; Dermatomycoses; Fatal Outcome; Female; Fever; Humans; Immunocompromised Host; Itraconazole; Lymphatic Diseases; Mycoses; Penicillium; Sepsis; Thailand; Travel; Weight Loss

Topics: Amphotericin B; Animals; Antifungal Agents; Dermatomycoses; Female; Flucytosine; Fusarium; Guinea Pigs; Humans; Male; Middle Aged

Topics: Aged; Amphotericin B; Antifungal Agents; Cellulitis; Cryptococcosis; Dermatomycoses; Female; Fluconazole; Flucytosine; Humans; Immunocompetence; Itraconazole; Leg Dermatoses

Mucormycosis is an uncommon severe life-threatening fungal infection in the immunocompromised host caused by fungi belonging to the order Mucorales, most commonly Rhizopus arrhizus (R. oryzae). We report a patient who developed a severe right atrial catheter exit site infection with Absidia corymbifera. The catheter was removed and necrotic tissue debrided. With liposomal amphotericin B and G-CSF, the infection subsided. He remains well 8 months later.

Topics: Amphotericin B; Anemia, Aplastic; Antifungal Agents; Bone Marrow Transplantation; Catheterization, Central Venous; Child; Dermatomycoses; Humans; Immunocompromised Host; Male; Mucorales; Mucormycosis; Opportunistic Infections

The case of a 77-year-old man in whom a large digital ulcer with undermined edges was due to cutaneous infection by Cryptococcus neoformans variety neoformans serotype D, probably following direct inoculation, is reported. Long-term steroid treatment for chronic obstructive pulmonary disease may have been a risk factor. A 12-day course of intravenous amphotericin B at a cumulative dose of 750 mg, followed by oral fluconazole at a daily dose of 600 mg for six weeks, resulted in healing of the skin lesion. Manifestations of primary cutaneous cryptococcosis in immunocompetent or immunocompromised patients are reviewed.

Topics: Administration, Oral; Aged; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Fingers; Fluconazole; Humans; Immunocompromised Host; Lung Diseases, Obstructive; Male; Steroids

We report the occurrence of invasive Candida albicans infection with disseminated cutaneous Candida granulomas in a patient with aplastic anaemia after viral hepatitis. Fungal elements in a skin biopsy specimen were detected by PAS stain and identified as Candida sp. by immunohistochemistry directed against the C. albicans mannan surface antigen. Based on rapid diagnosis of Candida granuloma and by Candida-positive cultures of blood and swabs, systemic treatment with liposomal amphotericin B led to survival of the patient.

Topics: Adult; Amphotericin B; Anemia, Aplastic; Antibodies, Fungal; Antibodies, Monoclonal; Antifungal Agents; Antigens, Fungal; Antigens, Surface; Candida albicans; Candidiasis; Dermatomycoses; Granuloma; Hepatitis, Viral, Human; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunocompromised Host; Immunohistochemistry; Male; Mannans; Polysaccharides, Bacterial; Sepsis

Histoplasma capsulatum is a dimorphic pathogenic fungus endemic to the Mississippi and Ohio river valleys. In the immunocompetent it causes a self-limited disease, but in the immunocompromised may lead to disseminated disease (disseminated histoplasmosis (DH)). It is one of the opportunistic infections which defines the acquired immunodeficiency syndrome (AIDS) and is rarely encountered outside endemic regions.. Clinical, laboratory, and histologic information concerning seven patients with DH and AIDS in South Florida was recorded.. We report seven cases of DH with mucocutaneous lesions in patients infected with the human immunodeficiency virus (HIV). All patients had markedly depressed CD4 counts of less than 40 cells/mm3, and only two had traveled to endemic areas. Two out of the seven patients were diagnosed with HIV/AIDS at the time DH was identified. All of our patients had mucocutaneous lesions at the time of diagnosis, which clinically presented as a generalized papular eruption, ulcers, and erythematous scaly plaques.. Even in non-endemic regions, HIV-positive patients presenting with fever, chills, weight loss, hepatosplenomegaly, anemia, cough, lymphadenopathy, and mucocutaneous lesions should have an early skin biopsy specimen taken for mycologic tissue culture and histopathologic evaluation for disseminated fungal infections.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Biopsy; Dermatomycoses; Florida; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Skin

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Drug Therapy, Combination; Fluconazole; Humans; Male; Mucorales; Mucormycosis; Thigh

Multiple necrotizing skin lesions due to Fusarium solani in an elderly man with acute myelogenous leukemia is described.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Female; Fluconazole; Fusarium; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Necrosis; Skin

Topics: Abscess; Amphotericin B; Antifungal Agents; Aspergillosis; Dermatomycoses; Diagnosis, Differential; Female; Flucytosine; Humans; Infant, Newborn

The authors report three cases of fusarial infection in neutropenic patients with hematologic malignancies. The first patient was affected by a cutaneous extensive fusariosis. The second patient developed a fusarial lung infection during a multiple organ failure following allogenic bone marrow transplantation. The third patient who presented with refractory acute myelogenous leukemia, developed fusarial skin lesions, and died from pulmonary failure. The treatment of fusarial infection is disappointing and requires amphotericin B, in association with hematopoietic growth factors. The role of new agents, or combination chemotherapy remains to be determinated. The recovery of adequate neutrophil levels is the most important factor in the resolution of fusarial infection.

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Female; Fusarium; Humans; Lung Diseases, Fungal; Male; Middle Aged; Neutropenia

We report a case of Fusarium solani infection in a 2 1/2-year-old girl with acute lymphoblastic leukemia and severe neutropenia. The infection, initially limited to her sinuses, became disseminated, as evidenced by the development of a characteristic cutaneous lesion on her left leg after a cumulative dose of amphotericin B of 18.3 mg/kg. Amphotericin B lipid complex (ABLC), 5 mg/kg/day, in conjunction with repeated surgical debridement of the sinuses and correction of neutropenia with granulocyte colony stimulating factor (GCSF), led to clinical and mycologic cure.

Topics: Amphotericin B; Antifungal Agents; Child, Preschool; Dermatomycoses; Drug Combinations; Drug Resistance, Microbial; Female; Fusarium; Humans; Immunocompromised Host; Mycoses; Neutropenia; Paranasal Sinus Diseases; Phosphatidylcholines; Phosphatidylglycerols; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Cutaneous mucor infection developed in two children who had undergone bone marrow transplantation for treatment of leukemia. One infection occurred before transplantation, and the other occurred during the period of profound neutropenia after transplantation. Both children were treated with an extensive wide excision of the infected area, and there was no evidence of mucor along the resected edges of tissue. Both patients received extensive treatment with either amphotericin (case 1) or amphotericin and itraconazole (case 2). These two cases represent aggressive management of cutaneous mucor infections, which is believed to be required for the successful completion of a marrow transplantation procedure.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Child; Dermatomycoses; Female; Humans; Itraconazole; Leukemia, Myeloid, Acute; Male; Mucormycosis; Neutropenia; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rhizopus

Mucormycotic infections caused by fungi of the families Rhizopus, Mucor or Absidia are rare and usually associated with diabetes or immunosuppression. We describe a patient with invasive necrotizing cutaneous mucormycosis caused by Absidia corymbifera shortly after allogeneic BMT. The infection was successfully treated with surgical debridement and liposomal amphotericin B for 6 weeks. Recognition of these rare infections requires a high index of suspicion. These patients should be evaluated with tissue biopsy and cultures and treated without delay.

Topics: Adult; Amphotericin B; Anemia, Refractory; Antifungal Agents; Bone Marrow Transplantation; Combined Modality Therapy; Debridement; Dermatomycoses; Female; Humans; Immunocompromised Host; Mucorales; Mucormycosis

A 12-year-old girl had been presenting a woody infiltration and erythema in the frontal region and on the entire left half of the face, leading to deformity of the nose and buccal fissure, and adenomegaly in a posterior cervical chain, for the last 18 months. Sinusitis was diagnosed and treated with antibiotics, and submitted to ethmoid sinusotomy, with no improvement. Several laboratory tests were made to find the correct diagnosis. An intradermal test for delayed hypersensitivity showed a positive reaction (5 mm) with necrosis for metabolic antigens for Conidiobolus. An oral mucosa biopsy showed a dense lymphohistiocytic infiltrate and focal points of necrosis. Gomori staining for fungi revealed countless wide, nonseptate hyphae. Amphotericin B was prescribed during 35 days, with no improvement. Terbinafine given orally was started in association with amphotericin B. Reduction of the lesions was observed 2 months later. No side effects were seen during 4 months of treatment.

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Child; Dermatomycoses; Drug Combinations; Entomophthora; Erythema; Ethmoid Sinusitis; Facial Dermatoses; Female; Humans; Lymphatic Diseases; Mouth Diseases; Naphthalenes; Nose Diseases; Terbinafine

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antigens, Fungal; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Humans; Male

Topics: Adult; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Dermatomycoses; Fusarium; Humans; Immunocompromised Host; Male; Opportunistic Infections; Postoperative Complications

Topics: Amphotericin B; Antifungal Agents; Chemistry, Pharmaceutical; Dermatomycoses; Drug Costs; Drug Resistance, Microbial; Humans; Mycoses

Topics: Amphotericin B; Dermatomycoses; Female; Fusarium; Humans; Leukemia, Myeloid, Acute; Liposomes; Middle Aged; Neutropenia

To review the presentation and course of choroidal blastomycosis, a rare chorioretinal mycotic infection, which results from disseminated blastomycosis.. Two cases of disseminated blastomycosis with ocular infection limited to the choroid are presented. Each patient was diagnosed through biopsy of skin lesions demonstrating the characteristic histologic features and the budding yeast.. Systemic evaluation revealed extensive disseminated disease with involvement of the eye, lung, skin, bone and joint, central nervous system, and genitourinary system. Both patients were successfully treated with intravenous amphotericin B with elimination of ocular and systemic disease.. Although rare, blastomycosis can result in choroidal mycotic infection in immune competent individuals. Tissue biopsy to confirm the diagnosis and extensive systemic evaluation are required.

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Brain Diseases; Choroid; Choroid Diseases; Dermatomycoses; Eye Infections, Fungal; Female; Fundus Oculi; Hand; Humans; Infusions, Intravenous; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Skin; Tomography, X-Ray Computed

We describe a patient with chronic granulomatous disease who presented with erythematous papular skin lesions on the chest, back, and arm. Examination of biopsy specimens from the lesions on the arm and back showed suppurative granulomata in association with acute and chronic inflammation. Histopathologic examination of a specimen from the lesion on the arm revealed fungal elements, and cultures yielded Microascus cinereus. The patient was treated with 2.5 g of intravenous amphotericin B, and the lesions resolved. We report what is, to our knowledge, the first case of invasive disease due solely to M. cinereus.

Topics: Amphotericin B; Ascomycota; Child; Dermatomycoses; Female; Granuloma; Granulomatous Disease, Chronic; Humans; Opportunistic Infections

We describe a patient with zygomycosis that resembled herpes zoster infection. The diagnosis was readily made with a potassium hydroxide preparation that revealed sparsely to non-septate hyphae. The patient responded to combination antifungal therapy with amphotericin B and fluconazole. The clinical response correlated with antifungal susceptibility test results.

Topics: Adult; Amphotericin B; Dermatomycoses; Diagnosis, Differential; Female; Fluconazole; Herpes Zoster; Humans; Liver Transplantation; Mucormycosis; Rhizopus; Skin Diseases, Viral

Mucor circinelloides form circinelloides has rarely been associated with human disease, even in immunocompromised patients. We report a case of cutaneous zygomycosis caused by M. circinelloides in a 23-year-old neutropenic woman receiving consolidation chemotherapy for acute myelogenous leukemia. The organism was exquisitely susceptible to amphotericin B. Despite the fact that the patient was profoundly neutropenic for an additional 3 weeks, the lesions began to resolve during therapy, and no surgical debridement was required.

Topics: Adult; Amphotericin B; Antineoplastic Agents; Dermatomycoses; Drug Resistance, Microbial; Female; Humans; Leukemia, Myeloid, Acute; Mucor; Mucormycosis; Neutropenia; Opportunistic Infections

The usual management of opportunistic fusarium infection in the immunocompromized patient is with systemic antifungals, despite which little impact is made on the mortality which approaches 100%. We describe a case of fusarium infection of the foot in a bone marrow transplant recipient which was successfully managed with local wide excisional surgery and intravenous liposomal amphotericin B.

Topics: Adult; Amphotericin B; Bone Marrow Transplantation; Combined Modality Therapy; Dermatomycoses; Foot Dermatoses; Fusarium; Humans; Male; Opportunistic Infections

Cutaneous cryptococcosis usually is associated with concurrent systemic infection and actually may develop before clinical manifestations of cryptococcal meningitis become apparent. It is rare for a cryptococcal infection to be localized only to the skin. A case of cutaneous cryptococcosis is described in an immunocompromised patient who initially had a rash and a positive serum cryptococcal antigen titer, but no central nervous system involvement. The papular pustular skin lesions disappeared after 8 weeks of therapy with amphotericin B, which was stopped secondary to progressive azotemia. Less than 2 months after therapy, the skin lesions recurred, again without evidence of systemic disease. Treatment with oral fluconazole resulted in a gradual resolution of the cutaneous lesions. The pathogenesis of cryptococcosis is discussed, with emphasis on the management of cutaneous cryptococcosis.

Topics: Aged; Aged, 80 and over; Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Female; Fluconazole; Humans; Immunocompromised Host

A 55-year-old homosexual Indonesian (last stay in Indonesia 2 years previously), known to be HIV positive since 1986, developed desquamating, in part ulcerating, skin eruption over the face and shoulder region. On admission his temperature was 38.2 degrees C, erythrocyte sedimentation rate 72/95 mm, white cell count 3.100/microliters, and the CD4 cell count 30/microliters. Examination of lung, oesophagus, stomach, duodenum and colon for possible opportunistic infections was negative. Fundoscopy revealed an infiltrate in the right eye with destruction of the vitreous. Skin biopsy suggested histoplasmosis, confirmed by culturing H. capsulatum varietas capsulatum. It is likely that this was the reactivation of a latent, previously symptom-free infection, in this case the first opportunistic infection in the presence of AIDS. For 30 days he received infusions of amphotericin B (initially 0.1 mg/kg daily, after the 5th day 0.5 mg/kg), resulting in rapid healing of the skin lesions. Subsequently he has received (for 6 months so far) itraconazole, 400 mg daily, without further complications.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Biopsy; Dermatomycoses; Diagnosis, Differential; Drug Therapy, Combination; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Middle Aged; Skin

Photopheresis is being used with increasing frequency as therapy for patients with neoplastic and dermatologic diseases and is being evaluated as therapy for patients with AIDS. We describe a patient with advanced cutaneous T cell lymphoma who developed pulmonary and cutaneous cryptococcosis after receiving therapy with photopheresis and biweekly methotrexate. We consider the potential roles of cutaneous T cell lymphoma, methotrexate, and photopheresis as predisposing factors in the development of serious cryptococcal infections.

Topics: Aged; Amphotericin B; Chemotherapy, Adjuvant; Cryptococcosis; Dermatomycoses; Humans; Immunocompromised Host; Lymphoma, T-Cell, Cutaneous; Male; Methotrexate; Photopheresis

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Dermatomycoses; Female; Humans; Mucormycosis; Rhizopus; Sensation Disorders

We report the case of a 13-year-old boy who presented with multiple swellings all over the body. His condition remained undiagnosed for over 3 years. Exophiala spinifera was recovered from pus drained from the swellings. We discuss the difficulties in the initial diagnosis and the ease of correct diagnosis once we had used special fungal stains.

Topics: Adolescent; Amphotericin B; Dermatomycoses; Exophiala; Humans; Male; Suppuration

A case of primary cutaneous aspergillosis in a very low birthweight infant that responded to medical therapy is reported. Knowledge of the potential pathogenic role of this organism in neonatal skin lesions is important because of resistance to standard empirical antibacterial therapy and the potential for dissemination and deep parenchymal invasion. Surgical excision may be necessary if cutaneous aspergillosis progresses despite systemic antifungal therapy.

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Dermatomycoses; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care, Neonatal; Male

Mucor ramosissimus Samutsevitsch is presented for the first time as an etiologic agent of cutaneous zygomycosis in a patient with aplastic anemia on immunosuppressive therapy. This report also represents the third case caused by this species reported in the literature. A biopsy taken from a lesion on the patient's thigh revealed broad, nonseptate, nonbranching hyphae compatible in morphology with a Zygomycete; M. ramosissimus was cultured twice from the thigh lesion. The patient was treated successfully with amphotericin B. Identifying features of M. ramosissimus include the following: numerous sporangia lacking columellae and resembling those of Mortierella spp., short, erect sporangiophores repeatedly branching sympodially; tough, persistent, and diffluent sporangial walls; numerous oidia in chains; extremely low colonies; and restricted growth at 36 degrees C. This paper describes the isolate and strives to alert the clinical microbiologist to this rarely reported pathogen.

Topics: Adult; Amphotericin B; Anemia, Aplastic; Dermatomycoses; Female; Humans; Mucor; Mucormycosis; Thigh

Topics: Adolescent; Amphotericin B; Aspergillosis; Aspergillus; Child; Child, Preschool; Cross Infection; Dermatomycoses; Female; Hospitals, Pediatric; Hospitals, University; Humans; Immunocompromised Host; Infant, Newborn; Lung Diseases, Fungal; Male; Ontario; Opportunistic Infections; Retrospective Studies

This article, rather than presenting an overview of all available antifungal agents, has provided an update on new information about older agents, as well as evolving information about new agents, including those currently undergoing clinical trials. Among the azoles, ketoconazole will continue to be used as a major antifungal agent in dermatology, but one must keep up with its side effects and drug interactions. The place of the new triazole fluconazole in the treatment of cutaneous fungal infections needs to be clarified by additional controlled studies. Other agents on the horizon which are still undergoing investigation include itraconazole, which should be especially useful for dermatophyte (including tinea unguium) and candidal infections, sporotrichosis, and unusual infections such as aspergillosis and phaeohyphomycosis; and terbinafine, a member of the new class of antifungals called allylamines, which is an orally and topically active fungicidal agent that should be very useful for all types of dermatophyte infections. Research continues into the effectiveness of members of other classes of antifungals, including piritetrate, cilofungin, and amorolfine. In the 1990s, dermatologists should have safer, more effective antifungal agents for treating cutaneous fungal infections.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Fluconazole; Humans; Itraconazole; Ketoconazole; Naphthalenes; Terbinafine

The incidence and prevalence of histoplasmosis in Southeast Asia has not been extensively described. The first microbiologically documented case of disseminated histoplasmosis with cutaneous papulonodules in a 56-year-old woman from the Philippines is reported. She presented with fever and generalized papulonodular lesions in various stages, which evolved into vesicles with central necrosis that resembled molluscum contagiosum with an indurated erythematous halo. Biopsies revealed a granulomatous mass of lymphohistiocytic and epithelioid cells with intracellular budding yeast cells and dark nuclei. Cultures were positive for Histoplasma capsulatum. The patient was treated with amphotericin B (3 g) and 5-fluorocytosine (50 mg/kg/day), followed by ketoconazole (400 mg/day). Her clinical course was complicated by intractable hemolytic anemia that was initially treated with corticosteroids. A splenectomy was subsequently performed. Pneumonia and a brain abscess caused by Nocardia asteroides were secondary complications. Nine months after her admission, repeat testing was diagnostic for systemic lupus erythematosus. This patient serves to re-emphasize that cutaneous lesions in an immunocompromised patient must be evaluated by biopsy and culture analysis. Disseminated histoplasmosis in the immunocompromised host may present with unusual cutaneous lesions, and must be considered even in a nonendemic area.

Topics: Amphotericin B; Dermatomycoses; Female; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Ketoconazole; Lupus Erythematosus, Systemic; Middle Aged; Neutrophils; Philippines; Prednisone

Conidia and mycelial cells of Fonsecaea pedrosoi ATCC 46428 were obtained for analyses of lipid composition. Total lipids, phospholipids, sterols, and qualitative sterols and fatty acid composition were determined. A higher lipid content was detected in conidia than in mycelial cells of Fonsecaea pedrosoi, which could not be attributed to total sterols and phospholipids. In both forms of this fungus, ergosterol was the only sterol detected. The minimal inhibitory concentration of amphotericin B was lower for conidia than for mycelium.

Topics: Amphotericin B; Dermatomycoses; Drug Resistance, Microbial; Ergosterol; Humans; Lipids; Microbial Sensitivity Tests; Mitosporic Fungi

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Dermatomycoses; Fluconazole; Humans; Male; Meningitis, Fungal; Sporothrix; Sporotrichosis

A case of primary cutaneous zygomycosis due to Absidia corymbifera in a patient with AIDS is described. The lesions, which were located on the forehead, jaw and chest, were intradermal, extending into the subcutaneous fat and did not appear to be associated with any trauma. No deep-seated infection was evident suggesting that the superficial lesions were exogenous in origin. The possible aetiology of this infection is discussed.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Combined Modality Therapy; Dermatomycoses; Humans; Male; Mucorales; Mucormycosis

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Aspergillosis; Dermatomycoses; Graft Rejection; Humans; Immunosuppressive Agents; Liver Cirrhosis, Alcoholic; Liver Transplantation; Lung Diseases; Male; Middle Aged

In vitro antifungal activities of itraconazole (ITZ), a triazole antifungal agent, against clinical isolates obtained from patients with superficial and subcutaneous mycoses were examined using the agar dilution method on casitone agar. The clinical isolates tested were 7 species and 263 isolates including Trichophyton mentagrophytes (104 isolates), Trichophyton rubrum (103 isolates), Microsporum canis (3 isolates), Epidermophyton floccosum (2 isolates), Candida albicans (32 isolates), Malassezia furfur (7 isolates) and Sporothrix schenckii (12 isolates). The results are summarized as follows: 1. MIC values of ITZ for the isolates of dermatophytes and M. furfur distributed in a range of less than 0.0012-5 micrograms/ml indicating that ITZ had greater in vitro activities. These in vitro activities of ITZ were greater than those of clotrimazole or bifonazole. 2. C. albicans isolates were divided into 2 groups in terms of ITZ-susceptibilities, a high susceptibility group and low-susceptibility group with MIC values of 0.02-0.08 micrograms/ml and greater than 10 micrograms/ml, respectively. 3. The in vitro activities of ITZ against S. schenckii isolates with a geometric mean MIC of 0.119 micrograms/ml were greater than those of ketoconazole, miconazole or amphotericin B used as reference drugs.

Topics: Amphotericin B; Antifungal Agents; Clotrimazole; Dermatomycoses; Humans; Imidazoles; Itraconazole; Ketoconazole; Miconazole; Microbial Sensitivity Tests

A 60-year-old man receiving chemotherapy for an intermediate-grade non-Hodgkin's lymphoma developed multiple papuloerythematous cutaneous lesions. Alternaria alternata was cultured from the lesions, and hyphae were seen in biopsy specimens. This is an unusual infection, without a well-established treatment, in patients with lymphoma. The use of amphotericin B resulted in cure.

Topics: Alternaria; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Dermatomycoses; Humans; Lymphoma, Non-Hodgkin; Middle Aged; Opportunistic Infections

Through a retrospective review, we identified 77 previously unreported cases of coccidioidomycosis during HIV infection. Patients were classified into 1 of 6 categories based on their primary clinical presentation: 20 had focal pulmonary disease (Group 1), 31 had diffuse pulmonary disease (Group 2), 4 had cutaneous coccidioidomycosis (Group 3), 9 had meningitis (Group 4), 7 had extrathoracic lymph node or liver involvement (Group 5), and 6 has positive coccidioidal serology without a clinical focus of infection (Group 6). Coccidioidal serologies were positive on initial testing in 83% of the patients in whom such serologic testing was performed. Sera from 39% of patients were positive for TP antibodies while 74% had CF antibodies. Eleven of 12 seronegative patients had pulmonary disease (Group 1 or 2). Serologic results of other patients sent to a single reference laboratory were similar, with 26% positive for immunodiffusion TP antibodies and 79% positive for immunodiffusion CF antibodies. For the 77 patients in this study, the CD4-lymphocyte count was below 0.250 X 10(9) cells/L in 46 of the 55 patients who had this test performed, and a low CD4 count was significantly associated with mortality (p less than 0.01). At the time of follow-up, 32 of the 77 patients (42%) had died. There were significantly more deaths in those with diffuse pulmonary disease (Group 2) than in other groups (p less than 0.001). Amphotericin B, ketoconazole, fluconazole, and itraconazole were all used as antifungal therapies. Outcome could not be related to the therapy used. Of note, 3 patients developed coccidioidomycosis while receiving ketoconazole for other conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Amphotericin B; Arizona; California; Coccidioidomycosis; Dermatomycoses; Female; Follow-Up Studies; HIV Infections; Humans; Ketoconazole; Leukocyte Count; Liver Diseases; Lung Diseases, Fungal; Lymphatic Diseases; Male; Meningitis; Retrospective Studies; T-Lymphocytes, Helper-Inducer

A 74-year-old man who had a weight loss of 7 kg in three months, with fever up to 38 degrees C and anaemia (Hb 9.4 g/dl) began to have pain and blue discoloration of fingers II-V of the right hand. Echocardiography demonstrated vegetation on the aortic valve cusps and blood culture grew Aspergillus fumigatus, indicating Aspergillus endocarditis. There were no predisposing factors. Valve replacement was contraindicated because of the age of the patient, the presence of peripheral arterial disease, and previous myocardial infarction. Treatment was started with amphotericin B i.v. (dosage increasing to 50 mg daily) and 1.5 g daily of flucytosine by mouth, to a total of 1.1 g amphotericin B and 41.5 g flucytosine in five weeks. During this time there was a gradual decrease in symptoms and the valve vegetations. Nine months later there has been no recurrence.

Topics: Aged; Amphotericin B; Amputation, Surgical; Aortic Valve; Aspergillosis; Aspergillus fumigatus; Combined Modality Therapy; Dermatomycoses; Drug Therapy, Combination; Endocarditis; Fingers; Flucytosine; Hand Dermatoses; Heart Valve Diseases; Humans; Male

Systemic fungal infections with Fusarium occur predominantly in immunocompromised patients and are usually fatal. We report a patient with acute lymphocytic leukemia and fusariosis involving the skin and lungs. This patient underwent antifungal chemotherapy and bilateral pulmonary resections. She subsequently had successful bone marrow transplantation. The results of this treatment suggest that this aggressive management of pulmonary fusariosis offers the best chance of survival.

Topics: Adolescent; Amphotericin B; Bone Marrow Transplantation; Dermatomycoses; Female; Fusarium; Humans; Lung; Lung Diseases, Fungal; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Amphotericin B; Antifungal Agents; Arthrodermataceae; Candida; Dermatomycoses; Fungi; Humans; Microbial Sensitivity Tests; Mycoses

We recently reviewed a skin biopsy specimen obtained from a child with acute monocytic leukemia that demonstrated abundant mycelia present within a keratin plug of a hair follicle, a granulomatous dermal inflammatory infiltrate, and focal dermal invasion by fungi. These histologic findings were suggestive of an invasive dermatophyte infection; however, Aspergillus flavus was identified by culture. This case illustrates the need for care in interpreting biopsy specimens of cutaneous fungal infection in the immunocompromised host, since proper treatment is determined by the specific agent present. The morphological features of fungi in tissue sections and histopathologic patterns of host response in the immunocompromised patient may be misleading in trying to identify fungal pathogens. At present, culture is the most reliable method for identifying pathogenic fungi and should be utilized to confirm appropriate therapy.

Topics: Amphotericin B; Aspergillosis; Aspergillus flavus; Biopsy; Child, Preschool; Dermatomycoses; Diagnosis, Differential; Humans; Male; Skin

83 cases of mycotic otitis of external ear are reported during a period of 27 months from three departments of otorhinolaryngology in Libreville (Gabon, Central Africa) Prevalence is estimated at about 25% among all infectious otitis. The main functional signs are pruritus, otorrhea, pain and hypoacousia. The physical examination shows masse of white, grey, black or creamy caseous debris, invading the external auditory meatus (EAM) which is sometimes inflammatory. Fungal species responsible of otitis are Aspergillus (54%), yeasts (45%) mainly Candida, infrequently Fusarium (1%). A niger (26%), A. flavus (17%), Candida parapilosis (18%), Candida albicans (9%) are predominant species isolated (70%) among all the 21 species of identified fungi from otomycosis in Gabon. Therapy, done by thorough washing of the ear followed by insertion into the EAM of a wick soaked in Econazole or Amphotericin B, is quickly effective.

Topics: Administration, Topical; Adolescent; Adult; Amphotericin B; Child; Dermatomycoses; Econazole; Female; Gabon; Hearing Disorders; Humans; Male; Middle Aged; Otitis Externa

Three cases are reported of patients with the Acquired Immune Deficiency Syndrome (AIDS) and cutaneous histoplasmosis. Their initial presentation was that of a generalised maculopapular rash. Two patients were bisexual males and the third was an unmarried female. The range of opportunistic infections seen in AIDS patients in Trinidad is mentioned and clinicians are alerted to the fact that in areas endemic for Histoplasma capsulatum maculopapular rash in patients with AIDS may suggest disseminated histoplasmosis. The value of skin biopsy is mentioned.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Biopsy; Dermatomycoses; Enzyme-Linked Immunosorbent Assay; Female; Histoplasmosis; Humans; Ketoconazole; Male; Middle Aged; Staining and Labeling; Trinidad and Tobago

Mucormycosis is infrequently encountered in the pediatric population in any of its forms (nasopharyngeal, disseminated, pulmonary, or cutaneous) and generally is associated with the immunocompromised host. We present an adolescent with poorly controlled diabetes mellitus who developed a progressive skin lesion 3 weeks after a motor vehicle accident. Rhizopus species was isolated from the lesion, and the biopsy revealed a fungal vasculopathy. Control of her diabetes, aggressive surgical intervention and a 10-day course of antifungal therapy (amphotericin B) resulted in a favorable outcome. This article illustrates the importance of considering cutaneous fungal infections, especially those in the class zygomycetes, in the diabetic patient with unusual, severe or persistent skin lesions. Early recognition is essential in order to avoid morbidity and mortality from this unusual opportunistic infection.

Topics: Accidents, Traffic; Adolescent; Amphotericin B; Combined Modality Therapy; Dermatomycoses; Diabetes Mellitus, Type 1; Female; Humans; Mucormycosis; Rhizopus; Skin Transplantation; Wound Infection

A 77-year-old woman had had a slowly spreading lesion of five years' duration on her left cheek. The lesion consisted of sharply demarcated, dark-red plaques with infiltration. A biopsy specimen from the lesion showed mixed-cell granulomatous infiltration in the upper to middle dermis. Hyphae were observed in the granulomatous tissue. Alternaria tenuissima was isolated from a biopsy specimen. Antimycotic susceptibility test with amphotericin B, ketoconazole, and flucytosine revealed that the isolate was sensitive to the former two drugs. The lesion was treated with intralesional infiltration of amphotericin B.

Topics: Aged; Alternaria; Amphotericin B; Biopsy; Cheek; Dermatomycoses; Epidermis; Female; Humans

A widespread maculo-papular cutaneous rash appeared on a HIV-positive young bisexual Cambodian man. He was treated for Mycobacterium tuberculosis and Pneumocystis carinii infections. He had been residing in France for seven years. Histology showed, within the dermis, abundant extracellular and intramacrophagic yeast-like organisms suggestive of histoplasmosis. Cultured specimens produced a growth of colonies after three weeks on Sabouraud 4 p. 100 dextrose agar at 25 degrees C. Numerous macroconidia were found which made the species diagnosis of Histoplasma capsulatum possible. Despite initiation of therapy with amphotericin B the patient died. Cutaneous involvement with or without specific features is uncommon in disseminated histoplasmosis. The specific cutaneous lesions are protean. They rarely are the presenting sign of initial infection. Disseminated histoplasmosis has a poor prognosis in acquired immunodeficiency syndrome: amphotericin B is not curative. Maintenance suppressive therapy with ketoconazole has been recommended following amphotericin B completion, although break-through has been reported.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Biopsy; Dermatomycoses; Histoplasmosis; Humans; Male; Prognosis

The drugs used in the treatment of superficial mycoses include substances with an indirect affect on the organisms such as the keratolytics as well as antifungal compounds. The antifungals include specific inhibitory compounds such as the polyene or imidazole antibiotics and substances with a wider spectrum of antiseptic activity. High cure rates (80-90%) can be achieved by most specific antifungals although this can be affected by the host response and the location of the infection. The orally active antifungals used in superficial disease, ketoconazole and griseofulvin, can be used in conditions unresponsive or inaccessible to topical therapy, such as chronic superficial candidosis and tinea capitis. However, the treatment of onychomycosis, particularly affecting toe nails, is highly unsatisfactory. There is therefore an important place for new drugs and new methods of applying them in the treatment of superficial (local) mycoses.

Topics: Administration, Oral; Administration, Topical; Amphotericin B; Antifungal Agents; Benzoates; Dermatomycoses; Drug Combinations; Etretinate; Female; Griseofulvin; Humans; Imidazoles; Ketoconazole; Nystatin; Potassium Permanganate; Resorcinols; Salicylates; Salicylic Acid; Suppositories; Tretinoin; Vagina

We have described a patient with cavitary pulmonary fungal infection, probably blastomycosis, with necrotizing arteritis of the skin. The pulmonary and skin lesions resolved with amphotericin B therapy.

Topics: Adult; Amphotericin B; Arteritis; Blastomycosis; Dermatomycoses; Diagnosis, Differential; Female; Granulomatosis with Polyangiitis; Humans; Lung Diseases, Fungal; Necrosis

Cutaneous mucormycosis followed trivial injury to the leg of a 72-year-old man. The lesion progressed rapidly requiring above-knee amputation.

Topics: Aged; Amphotericin B; Ampicillin; Dermatomycoses; Drug Combinations; Floxacillin; Humans; Ketoconazole; Leg Ulcer; Male; Mucormycosis

Topics: Amphotericin B; Coccidioidomycosis; Dermatomycoses; Head; Humans; Lung Diseases, Fungal; Male; Middle Aged; Neck

The therapeutic potential of UK-49,858, a difluorophenyl bis-triazole derivative, has been assessed by evaluating its activity against systemic infections with Candida albicans in normal mice and rats and in mice with impaired defence mechanisms, against vaginal infections with C. albicans in mice, and against dermal infections with Trichophyton mentagrophytes in guinea pigs. Orally administered ketoconazole was used as a comparative agent throughout, and parenterally administered amphotericin B was included in the study of C. albicans systemic infection in normal mice. The activity of UK-49,858 given orally to mice or rats infected systemically with C. albicans was far superior to that of ketoconazole. In addition, UK-49,858 showed activity comparable to that of amphotericin B when given parenterally, although the latter gave more prolonged protection. UK-49,858 was also effective orally in curing experimental candidal vaginitis in mice and trichophytosis in guinea pigs, against which it was approximately 10 times more active than ketoconazole. These data suggest that UK-49,858 may be of value in the treatment of both C. albicans and dermatophyte fungal infections in man.

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Candidiasis, Vulvovaginal; Dermatomycoses; Female; Fluconazole; Guinea Pigs; Immunosuppression Therapy; Ketoconazole; Mice; Rats; Rats, Inbred Strains; Tinea; Triazoles

We report a cluster of primary cutaneous aspergillosis in six children with hematologic malignancy. When first seen, they had hemorrhagic bullae caused by Aspergillus flavus, Aspergillus fumigatus, and Aspergillus niger at the sites of insertion of intravenous cannulas or where arm boards had been taped to the extremities. Rapid diagnosis of cutaneous aspergillosis was made by direct examination of the blister roof with potassium hydroxide before it progressed to a necrotic ulcer. Intravenous amphotericin was instituted promptly in five of six patients, and none died of disseminated aspergillosis. Epidemiologic investigation tracked the source of aspergillus to a storeroom with a false ceiling that had recently been repaired for a water leak.

Topics: Amphotericin B; Aspergillosis; Aspergillus; Child; Child, Preschool; Cross Infection; Dermatomycoses; Equipment Contamination; Female; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Male; Materials Management, Hospital

Thirty-one immunocompromised patients (22 renal allograft recipients, 5 patients receiving chronic corticosteroid therapy, and 4 patients undergoing chemotherapy for acute leukemia) with significant dermatologic infection, excluding typical cellulitis and herpesvirus infections, were retrospectively identified over a 12-year period. Of these 31 patients, 15 (48%) had infection restricted to their skin, 6 (19%) appeared to have primary cutaneous infection that spread hematogenously to other parts of the body, 2 (6%) had infections of adjoining nasal tissue that spread to contiguous skin, and 8 (26%) appeared to have disseminated systemic infection that spread to the skin. In six of the eight patients with apparent secondary skin involvement, the development of the cutaneous lesion was the first clinical indication of disseminated infection. Eleven immunocompromised patients (35%) with bacterial infection of the skin or subcutaneous tissue were identified. These patients could be divided into three categories: leukemic patients with bacteremic gram-negative infection metastasizing to the skin (3 cases), renal transplant recipients with recurrent staphylococcal infection on and around the elbow ("transplant elbow") or streptococcal sepsis from a site of cellulitis (5 cases), and immunocompromised patients with opportunistic bacterial infection due to Nocardia asteroides or atypical mycobacteria (3 cases). Seventeen immunocompromised patients (55%) with fungal infection of the skin or subcutaneous tissue were identified. These included 12 patients with opportunistic fungal infection (Cryptococcus neoformans, 4 cases; Aspergillus species, 3 cases; Paecilomyces, 2 cases; Rhizopus species, 2 cases; and Candida tropicalis, 1 case) and 5 patients with extensive, confluent cutaneous dermatophyte infections. One patient with protothecosis and two patients with extensive papillomavirus infection were identified. Of these latter two cases, one had his immunosuppression discontinued, with clearing of his extensive warts; the other had confluent warts of the face and neck that subsequently underwent malignant degeneration to squamous cell carcinoma while chronic immunosuppressive therapy was continued.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adolescent; Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Connective Tissue Diseases; Debridement; Dermatomycoses; Female; Humans; Immunosuppression Therapy; Infections; Male; Middle Aged; Mycobacterium Infections; Prototheca; Skin Diseases, Infectious

We report a new case of cutaneous mucormycosis in a diabetic woman. The major favouring circumstances are found in this patient: ketoacidosis diabetes, use of bandages, local corticosteroid applications, renal insufficiency. The diagnosis, rarely made on the clinical aspect, is based on the histological and mycological data. A trial of treatment by ketoconazole has been carried out, but without success. The usual treatment by intravenous amphotericine B has been successful.

Topics: Amphotericin B; Bandages; Casts, Surgical; Dermatomycoses; Diabetes Mellitus, Type 1; Female; Humans; Ketoconazole; Middle Aged; Mucormycosis

Localized sporotrichosis can present a difficult diagnostic problem. It mimics many other skin diseases, some of which are far more common. Often the skin biopsy is not helpful. The disease tends to be chronic, requiring specific therapy with potassium iodide.

Topics: Administration, Oral; Adult; Amphotericin B; Chronic Disease; Dermatomycoses; Humans; Male; Potassium Iodide; Sporotrichosis

Topics: Amphotericin B; Cytosine; Dermatomycoses; Drug Interactions; Flucytosine; Humans; Imidazoles; Kidney

Topics: Adult; Amphotericin B; Antifungal Agents; Child; Dermatomycoses; Female; Griseofulvin; Humans; Male; Mycoses; Nystatin; Pyrrolidinones

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Candidiasis; Candidiasis, Oral; Dermatomycoses; Flucytosine; Griseofulvin; Humans; Imidazoles; Injections, Intravenous; Ketoconazole; Miconazole; Piperazines; Tinea; Tinea Versicolor

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Drug Resistance, Microbial; Female; Flucytosine; Foot Dermatoses; Humans; Imidazoles; Ketoconazole; Middle Aged; Mitosporic Fungi; Piperazines

A 49-year-old outdoor laborer had an endophthalmitis in one eye and small posterior segment lesions in the other, as well as raised lesions on his skin. The diagnosis of disseminated North American blastomycosis was established by the performance of a biopsy on one of the skin lesions. The ocular inflammation slowly improved with intravenous amphotericin B therapy, and the ocular lesions, presumably caused by Blastomyces dermatitidis, were followed clinically for six months. The patient died of a hospital-acquired pneumonia caused by Staphylococcus aureus.

Topics: Amphotericin B; Blastomycosis; Dermatomycoses; Endophthalmitis; Eye Diseases; Humans; Male; Middle Aged

Topics: Adult; Amphotericin B; Blastomycosis; Dermatomycoses; Diabetes Mellitus; Humans; Male

We present a patient with coccidioidal meningitis whose diagnosis was not confirmed until a skin biopsy was performed. Because he lived in an area where coccidioidomycosis is not endemic, his meningitis was at first attributed to tuberculosis or sarcoidosis. After a verrucous lesion from the face was biopsied and the diagnosis substantiated, the patient responded well to consolidation therapy consisting of intrathecal amphotericin B and oral ketoconazole.

Topics: Adult; Amphotericin B; Coccidioidomycosis; Dermatomycoses; Humans; Male; Meningitis

Blastomycosis is a fungal disease with an endemic area identical to that of histoplasmosis in the United States. Disease states range from a subclinical pulmonary illness to a rapidly progressive and fatal disease. Cutaneous lesions are common although the lung is the portal of entry for blastomyces. The organisms are easily demonstrated with potassium hydroxide preparations of fresh sputum, pus from skin lesions, or other biologic material. Skin and serologic tests are unreliable, largely because of cross-reactivity with antigens of histoplasmosis. Because of the ever present potential for milder forms of illness to progress to severe disease, it is recommended that all patients with symptomatic or culture proven disease be treated with amphotericin B.

Topics: Adult; Amphotericin B; Blastomycosis; Dermatomycoses; Humans; Male; Skin Diseases, Infectious

A seventy-six-year-old man from New Jersey developed multiple pustular lesions on his face, trunk, and extremities. These rapidly assumed a crusted appearance, and were proven, by culture and histopathology, to be North American blastomycosis. The patient was successfully treated with amphotericin B. Complement fixation studies paralleled clinical improvement and laboratory studies revealed impaired white cell function. It is postulated that the organism was first encountered fifty years earlier when the patient worked in an area in which blastomycosis was endemic.

Topics: Aged; Amphotericin B; Blastomyces; Blastomycosis; Dermatomycoses; Humans; Lung Diseases, Fungal; Male; Phagocytosis; Time Factors

The authors present one case of cutaneous cryptococcosis, which diagnosis was confirmed by histopathologic and mycologic procedures. As there has not been systemic dissemination, this case must be considered uncommon. The lesions healed completely after treatment by amphotericin-B.

Topics: Amphotericin B; Cryptococcosis; Dermatomycoses; Humans; Male; Middle Aged; Skin

Topics: Aged; Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Female; Flucytosine; Humans

Three cases of disseminated cutaneous sporotrichosis are reported, including a rare presentation of the disease as vesicular dermatitis. The diagnosis was confirmed by culture of a skin biopsy specimen, and all patients responded well to amphotericin B therapy. The sporotrichosis slide latex agglutination titer was used to determine the end point of therapy.

Topics: Adult; Amphotericin B; Dermatomycoses; Female; Humans; Middle Aged; Sporotrichosis

Topics: Adult; Amphotericin B; Blastomycosis; Dermatomycoses; Diagnosis, Differential; Humans; Male; Sporotrichosis

A 6-year-old boy with acute monocytic leukemia and therapy-induced leukopenia developed multiple necrotizing skin lesions where an intravenous administration unit had been secured to his arm and hand. Biopsy and cultures demonstrated Aspergillus flavus as the etiologic agent without evidence of systemic dissemination. Resolution of the infection occurred following systemic amphotericin B therapy and a granulocyte transfusion.

Topics: Amphotericin B; Aspergillosis; Aspergillus flavus; Blood Transfusion; Child; Dermatomycoses; Granulocytes; Humans; Leukemia, Myeloid; Leukopenia; Male

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Clotrimazole; Dermatomycoses; Griseofulvin; Humans; Miconazole; Nystatin; Phenyl Ethers; Tolnaftate

Cutaneous mucormycosis in a renal transplant recipient resulted in gangrenous cellulitis of the neck at an internal jugular cannula site. This nosocomial process was due to a histologically confirmed infection, and cultures revealed Mucor sp. The patient died despite surgical debridement and amphotericin B therapy. Cutaneous mucormycosis is a relatively rare entity with only 12 cases previously reported. In renal transplant patients only nine cases of renal transplant patients only nine cases of mucormycosis have been reported and only one was cutaneous. Also, this case reported is the second originating at an intravenous cannula site; the first recorded patient was diabetic.

Topics: Amphotericin B; Cellulitis; Debridement; Dermatomycoses; Gangrene; Humans; Kidney Transplantation; Male; Middle Aged; Mucormycosis; Neck; Postoperative Complications; Transplantation, Homologous

Two cases of cutaneous phycomycosis in the form of diabetic leg ulcers were diagnosed by culture and biopsy demonstration of invasive fungal infection. The first patient had an infected vesicular skin lesion. Systemic amphotericin B therapy and repeated debridement were curative. A posttraumatic leg ulcer developed in the second patient in the setting of hyperglycemia and renal insufficiency. Aggressive infection necessitated a curative amputation. Phycomycetes can cause or complicate diabetic leg ulcers and such infections may require biopsy for early recognition and subsequent successful therapy.

Topics: Aged; Amphotericin B; Debridement; Dermatomycoses; Diabetes Complications; Female; Humans; Leg Ulcer; Middle Aged; Mucormycosis

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Dermatomycoses; Humans; Immunity, Cellular; Lung Diseases, Fungal; Male; Middle Aged

An experimental dermatitis was established for the guinea pig and Swiss white mouse by topical application of cultures of Pityrosporum ovale, isolated from pityriasis capitis and from P. arbiculare isolated from pityriasis versicolor. Histology showed the development of the yeasts in the stratum corneum, with hyperkeratosis at the follicular ostium and in the pilous bulb: the clinical and histological appearances resembled human seborrheic dermatitis. The nude (nu/nu) mouse, the hair-less mouse and the nude rat were not susceptible to this experimental infection, probably because of the dystrophy of their pilous follicles and sebaceous glands. The experimental model permitted evaluation of antifungal agents. The Pityrosporum dermatitis disappeared rapidly after topical application of econazole or amphotericin B. No pathological differences were observed between the strains tested.

Topics: Administration, Topical; Amphotericin B; Animals; Dermatomycoses; Disease Models, Animal; Econazole; Female; Guinea Pigs; Malassezia; Male; Mice; Mice, Nude; Rats; Skin; Species Specificity

A 31-year-old woman with long-standing renal disease, treated with systemic steroids and azathioprine, developed progressive skin ulceration and subcutaneous nodules. A diagnosis of cryptococcosis was established after histological examination of a cutaneous lesion and confirmed by culture of the organism from the biopsy specimen. A detailed description of the histology and ultrastructure of the cutaneous lesion is presented. Treatment with parenteral amphotericin B and 5-fluorocytosine resulted in dramatic resolution of the skin lesions.

Topics: Adult; Amphotericin B; Cryptococcosis; Dermatomycoses; Drug Therapy, Combination; Female; Flucytosine; Humans; Skin

Topics: Administration, Oral; Adult; Amphotericin B; Cautery; Cryosurgery; Curettage; Cytosine; Dermatomycoses; Evaluation Studies as Topic; Flucytosine; Griseofulvin; Hand Dermatoses; Humans; Imidazoles; Male; Miconazole; Potassium Iodide; Sporotrichosis

The new therapeutic methods based on antibiotics, corticosteroids and immunosuppressors and the new medicosurgical techniques (catheters, monitoring in intensive-care units, open-heart surgery) modify the host, favorise the adaptation and introduction f endogenous and exogenous yeast-like fungi and thus create a new pathology characterized by deep visceral or septicemic infections due to yeasts belonging to the genera Candida, Torulopsis, Cryptococcus, Trichosporon, Rhodotorula, and Saccharomyces. The pathological aspects are analyzed and therapy is suggested in the light of new findings on polyenes (nystatine, amphotericine B), 5-fluorocytosine, imidazole, derivatives (miconazole, econazole) considering their association in function of synergy or antagonism possibilities.

Topics: Amphotericin B; Candida; Candidiasis; Cryptococcosis; Dermatomycoses; Endocarditis; Flucytosine; Humans; Iatrogenic Disease; Imidazoles; Lung Diseases, Fungal; Mycoses; Nystatin; Osteitis; Sepsis; Urinary Tract Infections

Topics: Adolescent; Adult; Amphotericin B; Blastomycosis; Bone Diseases; Child; Child, Preschool; Dermatomycoses; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; Lung Diseases, Fungal; Male; Stilbamidines; United States

Molds are vegetable microorganisms, which differ from dermatophytes sensitive to griseofulvin, and from yeasts, which do not form aerial mycelium. Most of the molds, phytopathogenic or which live from dead organic substances, are apathogenic to humans. Only a couple of dozen species can parasitize on the skin, usually together with dermatophytes or yeasts. Onychomycoses with molds appear mostly in elderly people, and fungus affections of external auditory passage in seborrheic eczema of the ear. The hair can be infected by Piedraia hortae, resulting in hard black nodules. After the identification of molds on the skin, criticism is necessary, since in more than 95% of the cases they are accidental germs. Several cultures and microscopic tests are necessary to assure the diagnosis. Broad-spectrum antimycotics is the predominant choice for treatment, but also amphotericin B, nystatin and pimaricin.

Topics: Amphotericin B; Dermatitis, Seborrheic; Dermatomycoses; Humans; Natamycin; Nystatin; Onychomycosis; Piedra

A verrucose dermatitis of the face, accompanied by onychomycosis was observed in a 30 years old male living in Algeria. He was born there and 15 years previously he had been treated successfully for "Dermatophytic disease" due to Trichophyton verrucosum. A deficiency in his cellular immune mechanism was noted at that time. On this occasion Hendersonula toruloidea was isolated from facial lesions and affected nails. The infection of the face, but not the nails, responded to treatment with amphotericin B. In the facial lesions, the fungus was present as single cell units sometimes with a false bud or a short hyphal extension. Cross walls were occasionally present but the cell walls were not pigmented. Intratesticular inoculation of the isolates to guinea pigs resulted in an infection in which the morphology of the fungus conformed to that found in the facial lesions. In cultures, the isolates of H. toruloidea conformed to the descriptions in literature, although pycnidia were not formed.

Topics: Adult; Amphotericin B; Dermatomycoses; Facial Dermatoses; Humans; Male; Mitosporic Fungi; Onychomycosis

The manifestation of a mycotic infection can be prevented by exposition prophylaxis, disposition prophylaxis or chemoprophylaxis. The main statements are discussed. Protective measurements are helpful provided the instructions are followed continually. One must pay attention to one's personal hygiene. The environmental sanitation can be also important.

Topics: Amphotericin B; Animals; Arthrodermataceae; Cattle; Dermatomycoses; Disinfectants; Dogs; Female; Humans; Hygiene; Infant, Newborn; Nystatin; Swimming Pools

A patient with disseminated coccidioidomycosis initially had pulmonary and skin manifestations and survived for 14 years before dying of meningitis due to Coccidioides immitis. In addition to several courses of amphotericin B therapy the patient received injections of transfer factor derived from appropriate donors and miconazole nitrate therapy. The immunologic defence mechanisms of the patient during the course of his disease were studied and the possibility of a cell-mediated immunologic defect, potentially reversible by transfer factor, was demonstrated.

Topics: Adult; Amphotericin B; Coccidioidomycosis; Dermatomycoses; Humans; Immunity, Cellular; Male; Meningitis; Miconazole; Prognosis; Transfer Factor

Histoplasmosis due to Histoplasma capsulatum var duboisii developed in a Canadian immigrant one year after his entry into Canada. He had lived in Guinea for two years prior to immigration. Lymphatic infection characterized the course of his illness. The clinical and pathologic features of this disease's distinctive skin and bone manifestations are outlined. The causal agent's mycologic features are compared with those of H capsulatum var capsulatum. Treatment with amphotericin B was successful.

Topics: Adult; Amphotericin B; Canada; Dermatomycoses; Emigration and Immigration; Guinea-Bissau; Histoplasma; Histoplasmosis; Humans; Male

Pityrosporum folliculitis occurs mainly among adult males on the back and may result from antibiotic and steroid administration. The lipophilic yeasts are numerous in the papulo-pustular lesions and can easily be demonstrated in the perifollicular inflammation on histological slides. 8 new cases with typical clinicopathological features are recorded by the authors. The best results are obtained with topically applied amphotericin B or econazol.

Topics: Adult; Amphotericin B; Dermatomycoses; Econazole; Female; Folliculitis; Humans; Malassezia; Male; Middle Aged; Sebum

Topics: Adult; Aged; Amphotericin B; Bandages; Cross Infection; Dermatomycoses; Humans; Male; Middle Aged; Mucormycosis; Rhizopus

Topics: Amphotericin B; Animals; Antifungal Agents; Arthrodermataceae; Dermatomycoses; Drug Resistance, Microbial; Flucytosine; Fungi; Humans; Miconazole; Mycoses

Described herein is a 15 year old girl with a generalized, possibly systemic Microsporum audouinni infectin associated with anergy and defective lymphocyte transformation as a consequence of a deficiency of an uncharacterized plasma factor. Intravenous administration of plasma, obtained from normal donors, has produced consistent although incomplete clinical improvement. Defective lymphocyte transformation to M. audiouinii antigen cultured in autologous plasma became normal after infusions of normal plasma were instituted. Systemic administrations of griseofulvin, clotrimazole and miconazole produced transient and incomplete clinical improvement. Clearing of the cutaneous infection and stabillization of the neurologic status was finally achieved with plasma infusions combined with parenterally administered amphotericin B.

Topics: Adolescent; Amphotericin B; Antigens, Fungal; Brain; Chemotaxis, Leukocyte; Dermatomycoses; Female; Humans; Immunity, Cellular; Lymphocyte Activation; Lymphokines; Microsporum; Radionuclide Imaging; Skin Tests; Transfer Factor

Two unusual cases of sporotrichosis are presented. One patient had disseminated vesicular skin lesions which yielded Sporothrix schenckii on culture. The other, with extensive pulmonary sporotrichosis, continued to have sputum cultures positive for S schenckii during three years of intensive chemotherapy.

Topics: Adult; Amphotericin B; Dermatomycoses; Female; Humans; Lung Diseases, Fungal; Male; Middle Aged; Potassium Iodide; Sporotrichosis

Cutaneous lesions as a manifestation of histoplasmosis, primarily a disease of the respiratory system, are rare and most commonly appear secondary to progressive dissemination. A patient with documented progressive, disseminated histoplasmosis, having been treated previously with amphotericin B, presented on a second occasion with cutaneous lesions as the chief complaint. Biopsy and cultures of these lesions were positive for Histoplasma capsulatum. A review of the English literature revealed only 7 reported cases of secondary skin histoplasmosis in the past 20 years. All patients, including the current one, either had diseases associated with depressed immunity or were receiving steroid therapy.

Topics: Adult; Amphotericin B; Dermatomycoses; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Recurrence

Topics: Actinomycosis; Amphotericin B; Blastomycosis; Candida albicans; Candidiasis, Cutaneous; Chromoblastomycosis; Coccidioidomycosis; Cryptococcosis; Dermatomycoses; Flucytosine; Griseofulvin; Histoplasmosis; Mucormycosis; Mycetoma; Sporotrichosis; Tinea Capitis; Tinea Pedis; Tinea Versicolor

Mycoses for most of them) represent a group of infectious diseases which seem to increase steadily although numerous fungicidal or fungistatic therapeutics are available. A severe problem is provided by the so-called opportunistic fungi which become parasitic only after the host's immunological protection has been impaired by predisposing factors. Therapy resistance and prevention of relapse are problems of a general nature in the therapy of mycoses. As special topics local treatment of dermatophytoses, of Candida mycoses, and new development in systemic treatment of deep mycoses are discussed.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Clotrimazole; Cryptococcosis; Dermatomycoses; Drug Resistance, Microbial; Flucytosine; Fungi; Griseofulvin; Humans; Miconazole; Mycoses

Topics: Acute Disease; Adult; Aged; Amphotericin B; Antibodies, Fungal; Antigens, Fungal; Arthrodermataceae; Candidiasis; Cell Adhesion; Cell Count; Chronic Disease; Dermatomycoses; Female; Hand Dermatoses; Humans; Immune Adherence Reaction; Immunity, Cellular; Inguinal Canal; Leukocytes; Male; Middle Aged; Onychomycosis; Prednisone; Scrotum; Tinea; Tinea Pedis

Topics: Abscess; Adult; Amphotericin B; Coccidioidomycosis; Dermatomycoses; Humans; Lung Diseases, Fungal; Male; Thoracic Diseases

Topics: Adult; Age Factors; Amphotericin B; Anti-Bacterial Agents; Candidiasis, Cutaneous; Child; Child, Preschool; Chronic Disease; Dermatomycoses; Female; Foot Dermatoses; Furunculosis; Hand Dermatoses; Herpes Zoster; Humans; Immunity, Cellular; Immunity, Maternally-Acquired; Immunotherapy; Infant; Male; Pneumonia; Pyelonephritis; Remission, Spontaneous; Skin Tests; Staphylococcal Infections

Topics: Adult; Amphotericin B; Biopsy; Cheek; Coccidioidomycosis; Dermatomycoses; Facial Dermatoses; Female; Granuloma; Humans; Nose Diseases; Pregnancy; Pregnancy Complications, Infectious

Topics: Amphotericin B; Burns; Dermatomycoses; Humans; Male; Middle Aged; Nystatin

Topics: Acute Disease; Adult; Aged; Amphotericin B; Arthritis, Infectious; Blastomyces; Blastomycosis; Dermatomycoses; Humans; Lung Diseases, Fungal; Male; Radiography; Sputum; Stilbamidines; Synovial Fluid

Topics: Amphotericin B; Animals; Antifungal Agents; Cycloheximide; Dermatomycoses; Female; Guinea Pigs; Male; Mice; Mitosporic Fungi; Natamycin; Nystatin; Rabbits

Topics: Adult; Aged; Amphotericin B; Blastomycosis; Bone Diseases; Dermatomycoses; Humans; Injections, Intravenous; Lung Diseases, Fungal; Male; Middle Aged; Stilbamidines; Urologic Diseases

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Griseofulvin; Humans; Mycoses; Nystatin; Penicillins; Potassium Iodide; Stilbamidines; Sulfonamides

Topics: Adult; Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Diagnosis, Differential; Face; Female; Humans; Japan; Lupus Erythematosus, Discoid

Topics: Accidents; Amphotericin B; Blastomyces; Blastomycosis; Dermatomycoses; Humans; Laboratory Infection; Male

Topics: Amphotericin B; Blastomyces; Blastomycosis; Dermatomycoses; Diagnosis, Differential; Humans; South America; Sputum; Sulfonamides

Topics: Adult; Aged; Amphotericin B; Arthritis, Infectious; Dermatomycoses; Humans; Hypersensitivity, Delayed; Iodides; Lung Diseases, Fungal; Male; Middle Aged; Skin Tests; Sporotrichosis

Topics: Amphotericin B; Dermatomycoses; Griseofulvin; Humans; Lung Diseases, Fungal; Potassium Iodide; Sporotrichosis

Topics: Adult; Amphotericin B; Back; Biopsy; Cerebral Ventricles; Cryptococcosis; Cryptococcus; Dermatomycoses; Diagnosis, Differential; Female; Humans; India; Lung; Lung Diseases, Fungal; Male; Meningitis; Middle Aged; Skin

Topics: Adult; Amphotericin B; Antifungal Agents; Child; Dermatomycoses; Griseofulvin; Humans; Nystatin; Tinea

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Dermatomycoses; Female; Humans; Injections, Intravenous; Lung Diseases, Fungal; Male; Middle Aged; Retrospective Studies; United States; United States Public Health Service

Topics: Amphotericin B; Anti-Bacterial Agents; Chemical Phenomena; Chemistry; Dermatomycoses; Humans; Nystatin; Phenols; Quaternary Ammonium Compounds; Quinolines; Salicylates; Sulfides; Sulfonamides; Sulfones; Thiocarbamates

Topics: Amphotericin B; Candidiasis; Child, Preschool; Dermatomycoses; Facial Dermatoses; Female; Humans; Male; Scalp Dermatoses; Stomatitis

Topics: Adult; Amphotericin B; Colombia; Dermatomycoses; Face; Female; Fungi; Humans

Topics: Actinomycosis; Adult; Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis, Vulvovaginal; Child; Cryptococcosis; Dermatomycoses; Female; Griseofulvin; Humans; Lung Diseases, Fungal; Mycetoma; Mycoses; Nails; Nocardia Infections; Nystatin; Skin Diseases; Sporotrichosis; Stilbamidines; Thallium; Tinea Pedis

Topics: Agricultural Workers' Diseases; Agriculture; Amphotericin B; Biopsy; Coccidioidomycosis; Dermatomycoses; Diagnosis; Drug Therapy; Humans; Lymph Nodes; Pathology

Topics: Amphotericin B; Coccidioidomycosis; Dermatomycoses; Diagnosis; Drug Therapy; Foot Diseases; Hand Injuries; Humans; Lymph Nodes; Sepsis; Skin Tests; Wound Infection

The data derived from these three young patients would indicate the need for: (1) Early recognition of the primary cutaneous skin infection as being due to Coccidioides immitis. (2) The prompt use of suppressive intravenous amphotericin B therapy until such time as local tissue resistance and systemic immunity become manifest and sufficient to contain the pathogenic fungus within the initial cutaneous site of infection as manifested by complete healing of this primary lesion and its associated lymphadenopathy. It is apparent that there is a need to reassess present concepts which have been based on insufficient data, and to revise conclusions derived from the study of the eight previously reported instances of primary cutaneous coccidioidomycosis. The traumatic cutaneous inoculation of C immitis into a previously uninfected person, contrary to earlier impressions, can result not only in prolonged illness but in serious dissemination of the disease, and in one reported instance has resulted in coccidioidal meningitis.

Topics: Adolescent; Amphotericin B; Child, Preschool; Coccidioidomycosis; Dermatomycoses; Female; Humans

Topics: Adult; Amphotericin B; Aspergillosis; Dermatomycoses; Ethmoid Bone; Humans; Male; Paranasal Sinuses

Topics: Adrenal Gland Diseases; Amphotericin B; Brain Diseases; Cerebrospinal Fluid; Cryptococcosis; Dermatomycoses; Diagnosis; Gastroenterology; Geriatrics; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Meningitis; Pathology

Topics: Amphotericin B; Blastomycosis; Blood Cell Count; Blood Chemical Analysis; Dermatomycoses; Dosage Forms; Humans; Lung Diseases; Lung Diseases, Fungal; North America; Nose; Toxicology

Topics: Amphotericin B; Blastomycosis; Candida; Candidiasis; Dermatomycoses; Humans; Mitosporic Fungi; Nylons; Plastics

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Dermatomycoses; Fungi; Griseofulvin; Humans; Mycoses

Topics: Amphotericin B; Antifungal Agents; Coccidioidomycosis; Dermatomycoses; Granuloma; Humans; Sepsis