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Superficial mycoses.

Twenty-five years ago many of the topical remedies for superficial mycoses were irritating, toxic, or allergenic. Total x-ray depilation of the scalp was the accepted mode of therapy for tinea capitis. The introduction of topical nystatin for candidiasis and tolnaftate for dermatophytosis were major advances, but tinea capitis, onychomycosis, and chronic tinea pedis still presented problems. Soon after its introduction in 1958, griseofulvin became the definitive form of therapy for all types of dermatophytosis and played a major role in abolishing large-scale epidemics of tinea capitis in some countries. Recently, haloprogin and the imidazole derivatives, miconazole and clotrimazole, which are topically active against dermatophytes and Candida albicans, have become available. Selective indicator media for isolating dermatophytes are useful diagnostic tools, but quicker methods of diagnosis which require little interpretation are still lacking. Epidemiologic studies in Vietnam again revealed the effects of climate and occlusion on the prevalence, incidence, and severity of superficial mycoses and led to renewed interest in host susceptibility, environment, and prevention of infections.

Administration, Topical

[Pulmonary mycoses; laboratory diagnosis, antimycotic therapy].

The microscopic, cultural and serological techniques for the diagnosis of European and non-European systemic mycoses involving the respiratory tract are reviewed. The antimicrobial, therapeutic and toxic properties of those antimycotic drugs are discussed, which can be used in the treatment of pulmonary mycoses. Data on biotransformation, kinetics and dosage are reported.

Administration, Topical

Intravenous and intrathecal miconazole therapy for systemic mycoses.

Ten patients with systemic mycoses, including five with fungal meningitis, were treated with intravenously or intrathecally administered miconazole, or both. Minimal inhibitory concentrations of miconazole for clinical isolates of Coccidioides immitis, Cryptococcus neoformans and Candida albicans were less than 0.6 microg per ml. Except for pruritus of variable degrees, the drug was well tolerated both intravenously and intrathecally by all patients. No measurable impairment of renal, hepatic or bone marrow function was observed in patients after 4(1/2) months of intravenous therapy. No hematological or biochemical abnormalities and no evidence of recurrent coccidioidal osteomyelitis were observed in 16 months of follow-up in our first patient treated with this drug. Miconazole is apparently an effective antifungal drug of low toxicity and is a potentially useful agent for treatment of human systemic mycoses.

Aged

Mycoses of the Sudan.

Mycoses in the Sudan are still significant and, as well as mycetoma, there are a number of fungal diseases: paranasal aspergillus granuloma, which came into eminence in 1966; actinomycosis; subcutaneous phycomycosis; systemic phycomycosis; post-operative opportunistic infection of the eye with Trichosporon cutaneum and rhinosporidiosis. Mycetoma and paranasal aspergillus granuloma are discussed in detail.

Aspergillosis

Superficial mycoses in a southern New Zealand district.

A total of 2,709 pathogenic fungi were isolated from 8,762 patients suspected as having mycotic disease, over an 8 year period in Christchurch, New Zealand. The district is climatically designated as temperate with average mean temperatures of 17 degrees C in summer and 8 degrees C in winter. The predominant species of fungi were relatively small in number with Trichophyton mentagrophytes var. interdigitals as the major pathogen. Fungi other than true dermatophytes, particularly Candida spp. and Malassezia furfur, were included to demonstrate the full spectrum of superficial mycoses presenting for diagnosis at the mycology clinic.

Adolescent

Deep mycoses prevalent in the Igbos of Nigeria.

During a 3-year period, 6 cases of Africal histoplasmosis, 6 of phycomycosis and 5 of mycetoma were recognized histologically in 0.4 per cent of 4,307 surgical specimens removed from Nigerian Igbos and examined at a central laboratory. Undoubtedly, these cases are but the representatives of the mycological iceberg existing in this part of the world. Our experience suggests that collaboration between physicians, pathologists and mycologists should bring about increased international awareness of the deep mycoses.

Adult

Mycoses imported from the West Indies. A report of three cases.

There have been isolated case reports of deep fungal infections from the Caribbean area but little is known about the distribution of mycoses there. Three cases, one of mycetoma, one of chromomycosis, one of histoplasmosis, are described. Their management and the advantages and disadvantages of treatment outside the area of origin are discussed.

Adult

Clinical and experimental evidence on miconazole for the treatment of systemic mycoses: a review.

Intravenous treatment with miconazole brought about the recovery of 90% of patients with gastrointestinal or systemic candidosis. Miconazole given by the same route has also been found effective in the treatment of cryptococcosis, coccidioidomycosis, and paracoccidioidomycosis. Cryptococcal and coccidioidal meningitis have been cured by combined intravenous and intrathecal instillation, although treatment of aspergillosis has presented difficulty. Oral treatment was effective in curing dermatophyte skin infections and systemic mycoses caused by sensitive organisms such as paracoccidioides, blastomyces and histoplasma. The question of blood levels following oral and intravenous administration is discussed. Side effects of the drug were few, and included chills, dizziness, skin rash, itching and diarrhoea. Thus miconazole can safely be given to seriously ill patients. Its behaviour in the body is not influenced by renal insufficiency and no drug induced resistance has been reported.

Animals

[Mycoses of genital organs of girls - therapeutic problems (author's transl)].

The therapeutic effectiveness of poliene antibiotics, such as nystatin, polyfungin, and pimafucin, was comparatively analysed in the context of mycoses of the genital organs of girls in various periods of development. Early detection of fungi in genital organs, the oral cavity, rectum, and urethra is of great importance to mycosis treatment of children. Whenever antimycotic treatment is followed by recurrent outbreaks, all persons in the child's closer environment have to be examined at any rate.

Adolescent

[Preventive drug therapy of mycoses in surgery].

In surgery there exist several groups of patients with significant risk of deep-seated mycoses, e.g., those undergoing cardiac surgery, renal transplantation, intravenous alimentation or suffering from grave burn injury. "Blind prophylaxis" which would be applied indiscriminately to all patients of the respective groups cannot be recommended with the presently available systemic (parenteral or orally absorbed) antimycotic drugs for reasons such as toxicity or risk of resistance. Less objections exist against the oral, not absorbed polyene antibiotics; however, prophylaxis with these drugs only covers candidiasis affecting, or originating from, the digestive tract and lacks statistical proof of efficacy. As an alternative to "blind prophylaxis", selective prophylaxis" is proposed which is consistent with close supervision of the patients and start of antimycotic treatment as soon as there are signs of a probable fungal infection. This is, more correctly, a sort of "early therapy".

Antifungal Agents

[Recent progress in immunologic technics for the diagnosis of systemic mycoses].

The new immunological techniques used for the diagnosis of systemic mycoses are very specific. Purified antigens are now available and new methods allow the detection of various classes of specific antibodies. Precipitation tests, such as bidimensional electrophoresis and electroimmunodiffusion, are compared with passive agglutination tests; radioimmunoassay and enzyme immunoassays are analyzed. The value and utilization of cellular immunity and various other tests are discussed.

Agglutination Tests

Aspergillosis and other systemic mycoses. The growing problem.

To measure the incidence in the United States of systemic mycoses necessitating hospitalization, we reviewed discharge records of 1,875 hospitals participating in the Professional Activity Study of the Commission on Professional and Hospital Activities. Projected incidence rates in 1976 ranged from 23.0 per million for histoplasmosis to 0.2 per million for blastomycosis. High prevalences of leukemia or lymphoma (5.9% to 10.2%) or of other malignancies (9.9% to 13.2%) were recorded in patients with aspergillosis, candidasis, or cryptococcosis. High prevalences of chronic obstructive lung disease (9.6% to 9.9%) were recorded in those with aspergillosis or histoplasmosis. Marked increases from 1970 to 1976 were found in the incidence of aspergillosis (158%), actinomycosis (92%), cryptococcosis (78%), and coccidioidomycosis (74%). Increasing numbers of persons with immunosuppressive conditions, migration of susceptible persons into hyperendemic areas, and aging of the population contributed to the increases.

Adolescent

Therapeutic possibilities in mucosal and organ mycoses.

From the practical experience and from own results of examinations in the therapy of mycoses of mucous membrane and organ resulted the following problems: It is necessary a sufficient concentration of the antimycotic remedy in the place of the growth of the fungus on and in the tissues. It depends on the kind of application, absorptive capacity and compatibility. When pre-disposing factors are present the gastrointestinal tract should be cleaned up as the most important reservoir. Repeated determinations of the causative organisms and tests of the resistance are necessary for therapy.

Antifungal Agents

Granulomatous mycoses of the central nervous system.

A clinical and pathological description of five cases of granulomatous mycoses of the C.N.S. is reported. Four had an intracranial and one a spinal localization. In all patients the clinical pattern was of tumoral type, while the disease evolution was favourable only in one case. From a histipatholic point of view the preliminary diagnosis was of granulomatous process. The fungi organisms were identified only by means of combined stain methods. Beside the pathogenetic problems the Authors outline some histological methods useful for diagnostic purposes when a culture procedure for fungi is lacking.

Actinomycetaceae

Miconazole in the treatment of superficial mycoses.

Miconazole nitrate (2%) cream was evaluated in the treatment of superficial mycoses. Out of 116 patients having multiple clinical diagnoses, 66 cases were found to be positive by culture. Species of Trichophyton were the predominant etiological agents (in over 60%) followed by Candida species (20%) and Epidermophyton floccosum (15%). All the cases selected for study were followed up to a period of 4-18 months. A cure rate of 94.6 per cent was observed in all the cases where causal organisms were isolated. Significantly high cure rate (66%) was also seen in cases where causal organisms could not be isolated, including cases of tinea versicolor. Results of mycological examination were in confirmity with the clinical results.

Candidiasis

Role of Aspergillus and Candida species in allergic bronchopulmonary mycoses. A comparative study.

Allergic bronchopulmonary aspergillosis (ABPA) and allergic bronchopulmonary candidiasis (ABPC) has been diagnosed in 20 and 13 cases respectively with one case in common, on the basis of laboratory and clinical findings. Most of the ABPA cases (60%) diagnosed had an early onset of respiratory symptoms, i.e. below the age of 30 years, while most of ABPC cases (69%) had a late onset of respiratory symptoms, i.e. after the age of 30 years. The precipitin bands in ABPA and ABPC were R-type and H-type, respectively. Apparently, ABPA and ABPC are independent of one another in origin as suggested by specific precipitins and dual skin reaction. In ABPA, A. fumigatus appears to be the primary causal organism although the contributory role of other species of Aspergillus, which include A. flavus, A. nidulans, A. terreus and A. niger, is evident from the present study. It is concluded that allergic bronchopulmonary mycoses (ABPM) could be caused by several fungal species independently or jointly belonging to the genera Asperigillus and Candida.

Antigens, Fungal

[Use of a new culture procedure in the diagnosis of vaginal mycoses--a contribution on the improvement of diagnosis].

On the basis of our good experiences with the application of the spoon culture procedure in the quantitative bacteriological urine diagnostics, we tested the applicability of the plastic spoon in the diagnostics of vaginal mycoses. Our investigations show that the spoon culture procedure means an optimization and rationalization in mycological diagnostics due to omission of several stages of work and of the risks of transport, and due to improvement of diagnostic reliability and acceleration of the transmission of findings.

Bacteriological Techniques