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M Feuilhade de Chauvin

Publications and source records attributed to M Feuilhade de Chauvin.

At least 19 recordsLinked to original sources
PubMed2005

Epidemiology and clinical classification of onychomycosis.

OBJECTIVES: To review recent data - what is new in the epidemiology of onychomycoses? To identify the most relevant diagnostic criteria for effective therapy. METHODS: The preliminary results of the European Onychomycosis Observatory (EUROO) study were analysed. In this international study, physicians completed questionnaires concerning patient profile and the disease. RESULTS: One of the most interesting novel findings was that sampling requests were often not made [only 3.4% of general physicians (GPs) and 39.6% of dermatologists]. This means that no information about causative agent(s) was available, hindering appropriate treatment choice. Furthermore, contrary to previous findings, 70.7% of participants did not practice sports. Lastly, these preliminary findings showed that treatment strategy depends largely on the type of treating physician, with GPs preferring monotherapy and dermatologists preferring combination therapy. CONCLUSIONS: A consensus was reached that treatment strategy should depend on the severity of nail involvement and the causative fungus. It is thus important to promote the importance of sampling. To simplify the choice of an appropriate treatment, onychomycosis may be divided into just two clinical groups: onychomycosis with and without nail matrix area involvement. However, the distinct clinical findings (number and type of affected nails, multimorbidity, drug interaction, etc.) in each individual case must be taken into account to ensure an appropriate treatment decision.

Antifungal Agents↗
PubMed2005

Treatment options--development of consensus guidelines.

BACKGROUND: There are currently three main treatment strategies for onychomycosis: topical, oral and combination. Amorolfine nail lacquer appears to be the most effective form of topical monotherapy. However, the best mycological and clinical cure rates are obtained with combination therapy. Combination therapy increases antifungal spectrum, fungicidal activity and safety. New antifungals (triazoles and echinocandins) were recently developed, enabling new protocols. OBJECTIVES: To review available therapies. To design an algorithm for the management of onychomycoses in daily practice. RESULTS: Therapeutic choice should be based on numerous factors including patient's age and health, aetiology, extent of involvement and clinical form. The consensus was that topical monotherapy is recommended when < 50% of the nail is affected without matrix area involvement. Oral monotherapy or combination therapy is indicated when > 50% of the nail, including the matrix area, is involved. Topical treatments should not be used alone when topical drug transport is suboptimal (i.e. when dermatophytoma, onycholysis or spikes are present). Chemical or mechanical removal should also be considered whenever applicable (interruption of drug transport). CONCLUSION: In conclusion, treatment decision-making tools (e.g. an illustrated booklet or CD-ROM presenting each type of onychomycosis and criteria to be considered before selecting treatment regimen) would be valuable supports for the successful treatment of onychomycoses.

Administration, Oral↗
PubMed2005

New diagnostic techniques.

OBJECTIVES: To review current diagnostic strategies. To review alternative diagnostic techniques. RESULTS: The pathogen(s) responsible for onychomycosis must be identified to optimize treatment. Mycological examination is currently the most common diagnostic technique. This typically involves clearing with potassium hydroxide followed by microscopy. This direct test rapidly differentiates between living and dead hyphae. Sensitivity can be enhanced by using dimethyl sulfoxide (DMSO) or stains such as Chlorazol Black E. However, microscopy must always be combined with culture, allowing correct species identification. Accurate diagnosis depends on the expertise of laboratory staff and biologists and on the quality of the nail sample: samples should always be taken from the most proximal infected area. In the absence of experienced mycological laboratories, new laboratory techniques have been developed. Histological analysis by nail plate clipping has been shown to be an easy and efficient method for diagnosis. However, nail clipping is not an optimal technique for fungal culture and a large proportion of nonpathogenic but contaminant moulds can grow on culture medium. Moreover, histological analysis provides no information about causal agent or vitality. In vivo confocal microscopy and flow cytometry are powerful but complicated and costly techniques, making them unsuitable for routine use. Finally, polymerase chain reaction (PCR) (low proportion of positive results) and PCR-restriction fragment length polymorphism (PCR-RFLP) (suitable even for patients receiving antifungals) techniques have been developed. These molecular methods are cost-intensive and require highly skilled staff, meaning they are reserved exclusively for laboratories that process numerous nail samples. CONCLUSION: In conclusion, mycological examination remains the gold standard technique; it provides the most information, at a reasonable cost with little inconvenience to the patient.

DNA, Fungal↗
PubMed2004

Polymorphisms and intronic structures in the 18S subunit ribosomal RNA gene of the fungi Scytalidium dimidiatum and Scytalidium hyalinum. Evidence of an IC1 intron with an His-Cys endonuclease gene.

The fungi Scytalidium dimidiatum (Nattrassia mangiferae synanamorph) and Scytalidium hyalinum are mainly encountered in (sub)tropical areas as plant pathogens and agents of human dermatomycosis. Because the classification and differentiation of these two species is unclear, we studied 22 S. dimidiatum and 15 S. hyalinum isolates in order to identify potential species-specific insertions and polymorphisms in the 18S subunit ribosomal gene. The presence of an IE intron in S. dimidiatum, together with a single polymorphism (A in S. dimidiatum, G in S. hyalinum) in the coding region, allowed us to differentiate these two species in most cases. Moreover, in one S. dimidiatum isolate we found a group IC1 intron containing a putative truncated His-Cys endonuclease gene. This enzyme shows strong similarity to the intronic homing endonuclease of Physarum polycephalum. Based on these results and our previous findings, we propose an evolutionary pathway for 18S rDNA S. dimidiatum insertions, implying independent events.

Ascomycota↗
PubMed2003

[Differential diagnosis of onychomycosis].

In order to give an effective treatment to a patient with nail disorders, a correct aetiological diagnosis is necessary. Distal and lateral thickening of nail bed and nail plate with onycholysis, deep or superficial leuconychia, melanonychia, paronychia, distal and lateral onycholysis, and total dystrophic onychomycosis are the common physical signs of onychomycosis which represent 50 per cent out of nails disorders. Nail disorders due to cutaneous or general diseases with similar alteration of nail configuration may be confused with onychomycosis. In many cases, an aetiological trend is given by a total body examination of the skin and the mucosa. To diagnose correctly a non fungal nail disorder from an onychomycosis sometimes is a real challenge. According non fungal nail disorder and fungal nail infection may be associated, so a mycological examination and sometimes histopathological examination are very helpful to establish a good diagnosis.

Diagnosis, Differential↗
PubMed2002

Tinea pedis in European marathon runners.

BACKGROUND: Epidemiological studies suggest that 15% of the population in industrial countries suffer from tinea pedis (athlete's foot) and that persons who do sports are a high-risk population. OBJECTIVE: To investigate the responsibility of dermatophytes in interdigital lesions of the feet in European marathon runners and to identify associated risk factors. SUBJECTS AND METHODS: Runners of the 14th Médoc Marathon (n = 147) were interviewed on risk factors for tinea pedis and underwent physical and mycological examinations. RESULTS: Interdigital lesions of the feet were found in 66 runners (45%). A dermatophyte was isolated in 45 runners (31%), 12 of whom were asymptomatic. Trichophyton interdigitale and T. rubrum accounted for 49% and 35.5%, respectively, of the cases of tinea pedis. Thirty-three (22%) of the 102 runners free of dermatophyte infection had lesions resembling those of tinea pedis. Increasing age and use of communal bathing facilities were predictive of T. rubrum culture. CONCLUSIONS: Marathon runners are at high risk for tinea pedis, but dermatophytes are responsible for only half of the foot lesions found in runners. The existence of asymptomatic carriers calls for prophylactic measures.

Adult↗
PubMed2000

[Fungal and bacterial nail infections].

Fungal and bacterial infections are very common causes of nail deformity. The majority of fungal nail infections are caused by dermatophytes. Dermatophytosis result from a human contamination. A dermatophyte is always a pathogenic agent. Very effective drugs are available to treat dermatophyte nail infections. Yeasts of the genus Candida, notably C. albicans are the second most common cause of nail infection. The infections of nails due to Candida and bacteria are related with Candida sp and bacteria which are common commensals of the gastrointestinal tract, vagina or skin. Except C. albicans which is always a pathogen of skin, the other species of Candida and the bacteria could be a commensal of the skin, a colonizer of a dermatological disease or a true pathogen of nail. It is important to consider these different situations. More rarely, environmental moulds, most often known as saprophytic agents, can affect nails. They do not respond to conventional antifungal drugs. So, their diagnosis do not suffer any error. In order to evaluate properly the patient with possible fungal or bacterial infection of nails and also to choice an accurate therapy, the laboratory confirmation is essential. Clinical diagnosis is not sufficient to distinguish an infection of nails from a dermatological disease (psoriasis, traumatism) and to identify the responsible agent.

Anti-Bacterial Agents↗
PubMed1996

Ivermectin-responsive crusted scabies in HTLV1 carrier.

We report a case of HTLV1 infection revealed by crusted scabies and widespread dermatophytosis in an African woman. HTLV1 infection was not complicated by adult T cell leukemia or myelopathy. Crusted scabies is a marker of HTLV1 infection. The importance of oral ivermectin therapy in crusted scabies is emphasized.

Aged↗
PubMed1994

Disseminated cutaneous botryomycosis--an unexpected diagnosis after 20-years' duration.

A 35-year-old man presented with nodular suppurative lesions of the buttocks and the neck evolving over 20 years. A diagnosis of botryomycosis was established. Staphylococcus aureus, Acinetobacter baumanii and coagulase negative Staphylococcus were isolated from the biopsy specimen. Surgical excision was performed with success on the buttock.

Acinetobacter Infections↗
PubMed1994

[Contamination by aspergillosis: evaluation of preventive measures and monitoring of the environment].

Aspergillosis has become a major fungal infection in hospitals since the advent of immunosuppressive therapy in the last fifteen years. Aspergilli are saprophytic and ubiquitous fungi and are associated with pulmonary and disseminated infections in immunodepressed patients with a mortality rate of about 85%. Aspergillosis is an air-borne infection, thus intensive care units should be conceived so as to decrease the outer risk of contamination. In the first part of this chapter the conception of such a unit is presented, taking the bone marrow transplantation unit of St-Louis Hospital as an example. A prospective study of the quality of the environment is a complementary and necessary information. In the second part of this chapter, the methods of airborn control of Aspergillus sp. are investigated. According to the literature, commun concepts can be drawn to evaluate nosocomial risks of aspergillosis. Nevertheless in the absence of a defined and accepted methodology, it is not possible up to that date to propose norms and acceptable norms of levels of contamination adapted to the degree of immunodepression of patients.

Air Microbiology↗
PubMed1993

Aspergillosis: advances in immunological diagnosis and therapeutic measures.

Invasive aspergillosis has become the most frequent cause of death due to opportunistic infections in hematological units where neutropenic patients and bone marrow transplant patients are treated. This is largely a consequence of the difficulty of establishing an early clinical or microbiological diagnosis, and the ensuing delay in starting antifungal therapy. Furthermore, the more effective treatment is not really codified. In this article, we make a review of advances in immunological diagnosis and in therapy against invasive aspergillosis for the last years.

Antifungal Agents↗
PubMed1990

Comparison of antibody, antigen, and metabolite assays for hospitalized patients with disseminated or peripheral candidiasis.

Repeat serum samples from 22 patients with proven disseminated candidiasis and 42 with simple peripheral colonization were assayed for Candida antibodies by coelectrosyneresis, immunoprecipitation, and A and B immunofluorescence, for metabolites by D-arabinitol measurement, and for antigens by the mannan immunoassay and Cand-tec latex agglutination (mean number of samples tested, 2.5 per patient). For the antibody and metabolite assays, the results showed no statistical difference between the two groups. By contrast, the results of both antigen assays were positive for a significantly larger number of patients with disseminated candidiasis than of those with simple peripheral colonization. Results were regardless of whether the patients were neutropenic. They were not predictive of death. We calculated that the mannan antigen assay had 29% sensitivity and 97% specificity for the diagnosis of disseminated candidiasis. Likelihood ratios of a positive and a negative result of this test were 9.2 and 0.7, respectively, for this diagnosis. In the latex agglutination test, likelihood ratios were 2.5, 1.5, 1.6, and 0.3 when the test was positive for dilutions of 1/8, 1/4, and 1/2 and was negative, respectively.

Adolescent↗
PubMed1987

[Severe nasosinus aspergillosis in immunosuppressed patients. Apropos of 3 cases].

Nasosinusal lesions due to Aspergillus rarely occur during immunosuppressive chemotherapy, but are extremely grave, and often fatal due to the extensive necrotizing mucoperiostitis of facial bones provoked under these conditions. Three cases are reported, with recovery in one case only, after exenteration of orbit and denudation of dura mater in orbital roof.

Adolescent↗