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[Disorders of phagocytic and fungicide function of granulocytes in chronic muco-cutaneous candidiasis].

The granulocytes which are distributed by blood circulation close to the extern and intern body surfaces as well as in all organs protect the organism from microbial perils by phagocytosis and intracellular killing of bacteria and fungi so constituting a very important component of the granulocytic functions seriously impairs the host resistance and may entail a state of persisting infectious disease. As chronic mucocutaneous candidosis (CMCC) represents such a persistent generalized infection, we studied in vitro several functional activities of the granulocytes of 5 patients suffering from CMCC. 2 of them presented a non-familiar type of CMCC, the remaining 3 patients (father and 2 daughters) were subject to the hereditary type of CMCC. For comparison, by the same way we investigated the granulocytic functions of 51 clinically and immunologically healthy adult persons. Each of our 5 patients exhibited a reduced ability of the granulocytes to phagocytize and kill Candida albicans. In the CMCC family, the father had a marked deficiency of the oxidase activity of the granulocytes whereas in his daughters, the oxidase deficiency proved to be of a minor grade. In the sera of both daughters a phagocytosis inhibiting factor could be assumed to exist in addition to the granulocytic abnormalities. When heat-inactivated Candida albicans cells, however, were used for experiments, the granulocytes of each patient were able to phagocytize the germs at the same rate as did the granulocytes taken from the controls. With regard to alterations of the T cell function previously reported in CMCC, in all patients we also could demonstrate various symptoms of a T cell-dependent immunodeficiency. The results of the present in vitro-experiments furnish good evidence of a state of fundamental deficiency of the microphages in patients with CMCC, which may be the dominating cellular factor in the aetiopathogenesis of CMCC.

Adult

Evaluation of a topical steroid antibiotic combination (halcinonide-neomycin-amphotericin) in the treatment of cutaneous candidiasis and inflammatory dermatoses.

Halcinonide-neomycin-amphotericin (HNA) cream was evaluated in the treatment of cutaneous candidiasis and inflammatory dermatoses. The anti-candidal properties of HNA were assessed in a parallel comparison with iodochlorhydroxyquin-hydrocortisone (I-HC) as the control drug. The overall therapeutic response with HNA was excellent in 38 (95%) of 40 patients as compared to 17 (43%) of 40 treated with I-HC. In 50 patients treated for psoriasis, eczematous dermatitis, or neurodermatitis, HNA was evaluated in a paired comparison with hydrocortisone (HC). The overall therapeutic response with HNA was excellent in 36 (72%) patients as compared to 18 (36%) with HC. There were no adverse reactions with HNA or the control drugs.

Administration, Topical

Cutaneous candidiasis: treatment with miconazole nitrate.

In a well-controlled, double-blind, randomized study, 30 patients with cutaneous candidiasis were treated with a 2% miconazole nitrate lotion or its placebo control. By the 14th day, 13 of the 15 patients [87%] treated with miconazole nitrate achieved clinical and mycologic cures. Only a single patient treated with the placebo lotion would be classified as a therapeutic cure. In a second portion of the study those patients judged to be therapeutic failures were treated with the lotion containing 2% miconazole nitrate. By combining the results of both portions of the study we find that miconazole nitrate lotion produced both a clinical and mycologic cure in all patients receiving the active lotion. The miconazole lotion formula was well tolerated by all patients and no side effects were noted. The fact that miconazole nitrate acts rapidly in relieving symptoms, is well tolerated, and is highly effective against dermatophytes, yeasts and gram-positive bacteria, makes it a welcome addition to available topical therapy of skin infections.

Candida albicans

Superficial mycoses: treatment with a new, broad-spectrum antifungal agent: 1% clotrimazole solution.

A 1% clotrimazole solution was used as an antifungal for Tinea versicolor, Cutaneous Candidiasis and Dermatophytosis. All studies were double-blind and controlled, active vs vehicle. The final evaluation was made at a two-week follow-up after the treatment was stopped, which for most of the clinical conditions studied, was 28 days. The 1% clotrimazole solution was found to be effective with no local irritation noted.

Candidiasis, Cutaneous

A study of 3891 cases of mycoses in the tropics.

4103 cases suspected of mycoses were analysed as to sex, age and site of disease and 3891 were proved cases. This group formed 50% of total mycoses or 13-93% of all dermatoses recorded in the Government General Hospital, Madras, during the period of study. There were 66-26% adult female, 27-6% adult male and 6-14% were below 13 years. Dermatophytoses were found in 73-5%; the other common diseases were tinea versicolor (17-68%) and candidiasis (12-43%). Multiple sites of involvement or more than 1 disease in the same individual were mostly observed. The incidence of piedra (0-1%) and deep mycoses (0-156%) was very low. Mycetoma was the common disease (5/6) in deep mycoses. In dermatophytoses, tinea corporis (49-71%) and tinea cruris (47-85%) commonest; tinea axillaris (3-42%), tinea capitis (1-72%) and tinea barbae (1-29%) were less common. The incidence of tinea manuum, tinea pedis and tinea unguium was similar (4-97%-6-38%). High temperature and humidity were related to the higher incidence of tinea corporis, tinea cruris and tinea versicolor. Mainly children suffered from tinea capitis. All other mycoses were commonly found in adults between 2nd and 3rd decades. In all mycoses but candidiasis, female predominated. Cutaneous candidiasis was mainly a problem of housewives. Among the dermatophytes Trichophyton violaceum was predominant (33-7%) followed by T. rubrum (32-6%). Trichophyton schoenleinii and M. gypseum were rarely isolated. From mycetoma, Madurella mycetomii, Nocardia braziliensis, N. asteroides and Actinomadura spp. were isolated. Demonstration of Cryptococcus laurentii in 1 case is reported in this area for the first time.

Adolescent

Topical clotrimazole in tinea pedis.

Clotrimazole is a new antifungal agent which is effective topically in dermatophytosis, cutaneous candidiasis, and tinea vesicolor. The authors performed a controlled double-blind clinical trial comparing topical clotrimazole with its vehicle in the treatment of 66 patients with dermatophytic infections of the skin of the feet. Clotrimazole proved to be effective in the treatment of tinea pedis of both the interdigital and the plantar hyperkeratotic types.

Administration, Topical

Fungal diseases in Shiraz.

In 122 patients with fungal diseases studied over a six month period, sixty were seen with dermatophyte infections. Tinea pedis, cruris and ungruium occurred mainly in adult males attending the private hospital and tinea corporis and capitis children attending the University Hospital. The organisms found were Trichophyton rubrum, T. mentagrophytes, T. schonleinii, T. tonsurans, Epidermophyton floccosum and Microsporum canis. Infections with Candida albicans occurred both in the urban and rural population and included case of familial chronic muco-cutaneous candidiasis. Pityriasis versicolor was the commonest fungal disease seen.

Adolescent

Transfer factor therapy: clinical experience and the role of the E rosette assay.

Transfer factor has been administered to 17 patients, most with infectious diseases of various kinds. In 12 patients the therapy was followed by a definite clinical improvement although in most cases conventional chemotherapy was given concomitantly. In all cases where clinical improvement followed the sheep red cell or E rosette assay showed low values initially, with an improvement following therapy. This test of T lymphocyte function may be useful both in predicting patients likely to respond to transfer factor, and in monitoring response to treatment. As no specific assay of transfer factor activity is available, an in vivo rise in E rosette formation following transfer factor administration serves as a crude indicator that the injected material has some biological activity.

Abscess

Candidiasis seminar.

This is a review of candidiasis from its historical, epidemiologic aspect through the laboratory diagnoses, precipitating factors and the more common diseases caused by Candida. Therapeutic modalities available are listed and specific guidelines for therapy are demonstrated.

Adult