amphotericin-b and Hand-Dermatoses

Fungal infections of the upper extremity are of four main types: cutaneous, subcutaneous, deep, and systemic. Cutaneous infections are caused by organisms capable of utilizing keratin. They involve skin and nails. Most respond to local therapy. Subcutaneous infections are caused most typically by Sporothrix. Diagnosis is often delayed as associated bacterial colonization may be mistaken for the primary infectious agent. Treatment with systemic antibiotics is usually successful. Deep infections are usually caused by direct inoculation of fungus into deep soft tissues. Systemic fungal infections are of two types--those that occur in normal hosts and those that occur primarily in immunosuppressed patients. For both deep and systemic fungal infections, permanent impairment is common. Diagnosis is often delayed for many months. Treatment usually requires a combination of surgical excision and systemic antifungal therapy with Amphotericin B.

Topics: Amphotericin B; Hand Dermatoses; Humans; Mycoses

Topics: Adolescent; Adult; Amphotericin B; Animals; Autoantibodies; Blood Transfusion; Candidiasis; Candidiasis, Cutaneous; Child; Endocrine System Diseases; Female; Foot Dermatoses; Hand Dermatoses; Humans; Immunity; Immunity, Cellular; Lymphocyte Activation; Macrophages; Male; Mucous Membrane; Nails; Skin

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

Primary cutaneous mucormycosis is a very uncommon manifestation occurring most often in diabetics or following trauma.. We herein present a case of primary cutaneous mucormycosis of the hand caused by Rhizopus microsporus in an immunocompetent patient.. This is the second such reported case in the literature.

Topics: Adult; Amphotericin B; Antifungal Agents; Hand Dermatoses; Humans; Immunocompetence; Male; Mucormycosis; Rhizopus; Skin Ulcer

Chromomycosis is a chronic fungal skin infection that generally presents in the form of verrucous or vegetative lesions on uncovered areas of skin. We report an unusual case of generalised chromomycosis due to Phialophora verrucosa.. A 42-year-old town-dwelling housewife was hospitalised for erythematous keratotic nodules on the arm showing sporotrichoid distribution, associated with a crusted ulcerative lesion on the homolateral index finger, as well as subcutaneous papulonodular lesions. In places, the lesions on the patient's back presented an umbilical and molluscoid appearance. The patient had suffered no previous injuries and had not visited any areas in which leishmaniasis is endemic. Her history included insulin-dependent diabetes. Screening for Leishman bodies was negative. Histopathological analysis of the skin biopsy revealed an epithelioid giant-cell granuloma with no caseous necrosis. The mycological study demonstrated the presence of fumagoid bodies and P. verrucosa was isolated. Treatment with terbinafine was initially given, followed by clarithromycin, but in the absence of any improvement, the patient was readmitted to hospital and is currently on itraconazole and amphotericin B.. The novel features of our case comprise the clinical aspect of chromomycosis, the extent of the lesions, their unusual site on the back and upper limbs, and the isolation of a rare species, P. verrucosa (only the second observation in Morocco). It also highlights the therapeutic difficulties posed by this type of chromomycosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Arm; Chromoblastomycosis; Clarithromycin; Diabetes Complications; Diagnosis, Differential; Female; Hand Dermatoses; Humans; Itraconazole; Leishmaniasis, Cutaneous; Morocco; Naphthalenes; Phialophora; Terbinafine; Tuberculosis, Cutaneous

Topics: Amphotericin B; Antifungal Agents; Cellulitis; Diabetes Mellitus, Type 2; Female; Hand Dermatoses; Histoplasma; Histoplasmosis; Humans; Hypothyroidism; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Middle Aged; Panniculitis; Pemphigus

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

Dermatophytes are the main cause of onychomycosis, but various non-dermatophyte moulds (NDMs) are often the infectious agents in abnormal nails. In particular, Fusarium spp. and other NDMs are mostly insensitive to standard onychomycosis treatment with topical agents as well as with oral terbinafine and itraconazole.. The aim of this work is to report the efficacy of a topical amphotericin B solution on NDM onychomycosis in a series of 8 patients resistant to multiple conventional topical and systemic treatments.. Treatment consisted in the application of an optimized amphotericin B solution once daily to the affected nails and surrounding tissue. No mechanical debridement or medications were allowed except for trimming excessively long nails or in some cases occasionally applying urea-based cream to soften thickened nail plates.. Onychomycosis was clinically cured in all patients after a 12-month treatment. Mycological cure was obtained in all but 1 patient.. Topical amphotericin B is an efficacious, safe, cheap and easy-to-apply treatment which should be considered as first-line therapy for NDM onychomycosis.

Topics: Acremonium; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Female; Fusariosis; Hand Dermatoses; Humans; Middle Aged; Onychomycosis; Treatment Outcome

Blastomycosis is an uncommon cause of infection in the hand. Fungal infection should be suspected in any case when expected improvement does not occur with appropriate antibiotic therapy and wound care. We describe a rare case of primary blastomycosis of the hand that progressed to severe soft tissue destruction and significant loss of hand function.

Topics: Aged; Amphotericin B; Blastomyces; Blastomycosis; Female; Hand Dermatoses; Humans

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

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

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: 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