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Biomedical subjects

B E Elewski

Publications and source records attributed to B E Elewski.

72 records · Page 4Linked to original sources
PubMed1994

Tinea capitis: itraconazole in Trichophyton tonsurans infection.

BACKGROUND: Although griseofulvin is considered the standard treatment of tinea capitis, alternatives are being investigated in hopes of identifying more rapid and better cure rates. OBJECTIVE: Our purpose was to determine the efficacy of itraconazole as therapy for tinea capitis. METHODS: An open label study was performed on three patients who did not respond to or could not tolerate griseofulvin therapy. RESULTS: A 30-day course of 100 mg of itraconazole daily resulted in clinical and mycologic cure in all three patients; no side effects were reported. CONCLUSION: Although these results need to be confirmed by larger, controlled trials, it appears that itraconazole offers a viable alternative to griseofulvin for the treatment of children with tinea capitis.

Child↗
PubMed1993

Malignant fibrous histiocytoma resembling mycetoma.

A case of malignant fibrous histiocytoma resembling mycetoma is reported. We describe a patient with a draining purulent mass and localized swelling of the left ankle. The lesion's ulcerated surface produced purulent material that contained black "granules" resembling those seen in mycetoma. Cultures revealed a heavy growth of Staphylococcus aureus and no growth of fungi. Treatment with oral antibiotics resulted in resolution of the infection with persistence of the mass. Histopathologic examination of the mass was consistent with malignant fibrous histiocytoma. This case represents an example of a malignant lesion whose initial presentation was complicated by a bacterial infection resembling a mycetoma.

Adult↗
PubMed1993

Mechanisms of action of systemic antifungal agents.

An understanding of the mechanisms of action and in vitro profiles of antifungal agents is pivotal to selecting effective treatments for dermatophytoses. The principal mechanisms of action of antifungal drugs include disruption of spindle and cytoplasmic microtubule function (e.g., griseofulvin), depletion of or binding to ergosterol (e.g., terbinafine, ketoconazole, and amphotericin B), and accumulation of squalene (terbinafine). It is likely that antifungal agents that deplete or bind to ergosterol have fungistatic activity only; agents that produce a concomitant accumulation of intracellular squalene have fungicidal activity. Although the mechanism of action markedly influences the clinical efficacy of an antifungal agents, in vitro and in vivo antimycotic profiles and bioavailability factors such as drug access to the stratum corneum also contribute to the effectiveness of antifungal agents.

Antifungal Agents↗
PubMed1993

Therapy of sporotrichosis.

Sporotrichosis is a fungal infection caused by the dimorphic organism, Sporothrix schenkii. This etiologic agent typically gains entrance into the skin by traumatic implantation of infected soil or plant materials. The majority of cases are of the fixed cutaneous or lymphangitic cutaneous varieties, and less commonly, hematogenous dissemination to skin or viscera occurs. Untreated, the disease may spontaneously resolve or persist and gradually progress over time, its virulence being less than that of other dimorphic fungi. Potassium iodide remains a favored treatment for uncomplicated cutaneous disease. Amphotericin B, with its high toxicity, has historically been reserved for recalcitrant cutaneous or disseminated disease. Itraconazole, the newest triazole antifungal to become available in the United States, seems to be highly effective against Sporothrix schenkii without significant adverse effects and will likely become the first line therapy for all forms of this disease in the future.

AIDS-Related Opportunistic Infections↗
PubMed1992

Pyostomatitis vegetans and primary sclerosing cholangitis: markers of inflammatory bowel disease.

The case of a 34-year-old woman with both pyostomatitis vegetans and primary sclerosing cholangitis is reported and the literature reviewed. Pyostomatitis vegetans is a rare disorder characterized by friable pustules on the buccal mucosa and often peripheral blood eosinophilia. In this review, the frequent association of pyostomatitis vegetans with inflammatory bowel disease as well as the potential for pyostomatitis vegetans to present with sclerosing cholangitis and liver disease before any other manifestations of inflammatory bowel disease is discussed. Patients with pyostomatitis vegetans may need long-term care for gastroenterological disease in addition to treatment for oral lesions.

Adult↗
PubMed1992

Cutaneous blastomycosis.

We report on a patient with cutaneous blastomycosis and no evidence of systemic involvement. This diagnosis was made on the basis of clinical findings and confirmed by histologic examination and results of culture. The primary lesion in blastomycosis is almost always pulmonary. However, occasionally, as in our patient, the pulmonic focus resolves spontaneously before the patient presents. Disseminated lesions occur most often in the skin, followed by bone, genitourinary tract, and central nervous system. Our patient had an excellent response to ketoconazole without adverse effects.

Arm↗
PubMed1991

Childhood epidermolysis bullosa acquisita. Report of three cases and review of literature.

Epidermolysis bullosa acquisita is an acquired subepidermal blistering disease with variable clinical, pathologic, and immunologic features. The disease has been reported infrequently in adults and only rarely in children. We describe three new cases of childhood epidermolysis bullosa acquisita, review three previously reported cases, and contrast the features of the disease in children with those in adults. The results suggest that both children and adults with epidermolysis bullosa acquisita have variable clinical and pathologic features that may mimic other bullous diseases. Epidermolysis bullosa acquisita is characterized by a chronic course, poor response to therapy, and occasional clinical remissions.

Adolescent↗
PubMed1991

Hendersonula toruloidea and Scytalidium hyalinum. Review and update.

Hendersonula toruloidea and Scytalidium hyalinum are opportunistic organisms that can produce tinea pedis, tinea manuum, and tinea unguium. These infections, which clinically mimic those caused by dermatophytes but are caused by nondermatophyte agents, are correctly called dermatomycoses. When examined microscopically with potassium hydroxide, the agents of these disorders resemble those of dermatophytosis, showing narrow, septate, branching hyphae. It, therefore, becomes important to culture samples taken from sites with these tineas on cycloheximide-free agars even if they are potassium hydroxide-positive to rule out nondermatophyte mycoses. Correct identification becomes imperative since neither H toruloidea nor S hyalinum responds to conventional therapy. We review these diseases with emphasis on clinical appearance and differentiation from dermatophytosis. We also report four cases of S hyalinum infection of the nail or feet.

Dermatomycoses↗
PubMed1989

The superficial mycoses and the dermatophytes.

More than 100,000 species of fungi have been identified worldwide, but only a few dozen are of medical significance. Because of the opportunistic nature of these organisms and the prevalence of immunodeficient conditions, the number of medically important fungi is increasing. Identification of the causative organism is of value in the choice of correct therapy. The development of new antifungal drugs has made it increasingly important to be able to distinguish one fungus from another. This article reviews the laboratory diagnosis of the fungi generally classified as the superficial mycoses and the dermatophytes.

Antifungal Agents↗
PubMed1983

In vivo suppression of neutrophil chemotaxis by systemically and topically administered tetracycline.

In vivo suppression of neutrophil chemotaxis in humans by orally and topically administered tetracycline (TCN) was examined using both modified Boyden chamber and skin chamber assays. Chemoattractants were derived from serum complement and bacterial culture supernates. The results showed that oral TCN caused significant suppression of neutrophil chemotaxis when measured by both assays and both sources of chemoattractant. Furthermore, application of a commercially available topical preparation containing TCN caused local suppression of chemotaxis as measured by the skin chamber assay. These results show that TCN does suppress neutrophil migration in vivo, and they provide support for an anti-inflammatory effect of TCN mediated in part by suppression of neutrophil chemotaxis.

Administration, Oral↗
PubMedDate not supplied

Tinea capitis: fluconazole in Trichophyton tonsurans infection.

Tinea capitis is the most common dermatophyte infection in children. Trichophyton tonsurans is the most common etiologic agent in the United States, and for more than four decades the standard therapy has been griseofulvin. The availability of newer, and often more effective, antifungal drugs creates the opportunity for choice and the ability to optimally tailor treatment for a particular patient. Fluconazole is an azole antifungal drug available in a pleasant, well-tolerated, liquid formulation ideal for the pediatric population. It has a good safety profile and is approved in the United States for use in children, although not for tinea capitis. We present five patients with tinea capitis successfully treated with fluconazole.

Adolescent↗
PubMedDate not supplied

Onychomycosis. Treatment, quality of life, and economic issues.

Onychomycosis is a public health concern because of its high worldwide incidence and prevalence, and its potential for spread of fungal elements to others, as well as complications such as cellulitis, bacterial infection, pain, and extensive dermatophytic infections. The incidence of onychomycosis has been increasing, particularly in individuals over 60 years of age, patients with HIV infection, and patients with diabetes mellitus. Onychomycosis may impact upon physical, functional, psychosocial, and emotional aspects of life. Difficulty walking, wearing shoes, and embarrassment are common complaints. Quantification of such quality-of-life changes are significant to clinical practice in that many factors can affect overall patient health. In light of the potential clinical implications on physical and mental health, onychomycosis should be considered a medical condition that deserves rigorous clinical management. Onychomycosis can be treated effectively and with comparative safety with the new generation of oral antifungal agents (itraconazole, fluconazole and terbinafine). Significantly improved pharmacokinetic and pharmacodynamic profiles permit markedly reduced duration of administration, individual drug exposure, and ultimately enhanced patient compliance and satisfaction with therapy. In addition, a number of pharmacoeconomic studies have documented the cost effectiveness of these newer agents compared with both traditional pharmacologic treatment and topical therapies. The currency figures quoted are 1997 values. With regard to continuous oral antifungal regimens, terbinafine therapy has been found to be most cost effective in the treatment of toenail onychomycosis, with a drug acquisition cost of $US522.50. However, improved safety, tolerability, efficacy and cost effectiveness have been documented with itraconazole intermittent, pulse regimens. With itraconazole pulse therapy, the drug acquisition cost decreases to $US488.90. Additionally, the total cost of medical management is less for itraconazole therapy compared with that of terbinafine ($US261.00 vs $US306.00). Because sensitivity analyses for itraconazole and terbinafine have been found to be somewhat comparable in terms of mycological cure, clinical response, and relapse rates, other variables such as safety and efficacy profiles, and patient attitudes and expectations toward therapy need to be considered when formulating an onychomycosis pharmacologic treatment plan. The drug aquisition cost of fluconazole given as a 300 mg dose once weekly for 6 months is $US562.76 and given as a 150 mg dose once weekly (for 6 months) $US281.38.

Humans↗