RESUMEN
Scedosporium prolificans is one of the most life-threatening fungal opportunistic pathogens due to its high resistance to common systemic antifungal agents. While a close relative of Pseudallescheria boydii, S. prolificans has a more limited geographic range being primarily found in Australia, USA and Spain. Infections have also been reported from several other European countries and from Chile. Twenty patients with Scedosporium prolificans infection or colonization from August 1993 to May 2007 were retrospectively reviewed in Germany. They had all been identified at or reported to the Reference Laboratory for Pseudallescheria/Scedosporium spp. in Berlin. Twelve of 13 patients with haematological disorders and/or on immunosuppressive therapy developed a fatal invasive scedosporiosis. Colonization of the respiratory tract was reported for one patient after heart-lung-transplantation, all six patients with cystic fibrosis and one with chronic sinusitis. Molecular studies of the S. prolificans isolates confirmed that parts of the 18S, the Internal Transcribed Spacer (ITS) regions and the D1/D2 domain of the 28S region of rDNA are monomorphic. However, sequencing of parts of the translation elongation factor EF1-alpha (EF-1alpha) and the chitin synthase (CHS-1) genes revealed the presence of three and two distinct genotypes, respectively. Two informative mutations were found in EF-1alpha and a single nucleotide exchange in the CHS-1 gene.
Asunto(s)
Micosis/epidemiología , Micosis/microbiología , Scedosporium/aislamiento & purificación , Adolescente , Adulto , Niño , Quitina Sintasa/genética , ADN de Hongos/química , ADN de Hongos/genética , ADN Ribosómico/química , ADN Ribosómico/genética , ADN Espaciador Ribosómico/química , ADN Espaciador Ribosómico/genética , Femenino , Proteínas Fúngicas/genética , Alemania/epidemiología , Neoplasias Hematológicas/complicaciones , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Factor 1 de Elongación Peptídica/genética , Filogenia , Polimorfismo Genético , ARN Ribosómico 28S/genética , Análisis de Secuencia de ADN , Adulto JovenRESUMEN
CASE HISTORY: Four males (age 25 to 40 years) and one female (age 25) were admitted to our hospital almost simultaneously with symptoms of fever up to 38 degrees C, dry cough, thoracodynia, dyspnoea, myalgia and arthralgia. All patients belonged to a team of eight German bat researchers who had returned from Cuba 10 days before, where they had investigated bats in caves. Another member of the team had only mild histoplasmosis and was followed in our outpatient clinic. Two scientists who wore their breathing masks continuously during their work in the caves did not fall ill. EXAMINATIONS: Chest X-rays of all in-patients showed pulmonary infiltrates correlating with the severity of their illness. In all patients specific IgG antibodies against Histoplasma capsulatum-antigen were found in the Western Blot assay, confirming the diagnosis of histoplasmosis. TREATMENT: Treatment with oral itraconazole 200 mg b.d was given to four inpatients for 6 weeks, in the fifth patient itraconazole was discontinued because of an increase of liver transaminases. CONCLUSION: Antimycotic treatment of advancing histoplasmosis seems appropriate also in immunocompetent patients. The high number of patients within this group suggests high numbers of Histoplasma capsulatum in the caves. Wearing breathing masks throughout the work in the caves may prevent histoplasmosis even in case of high infectious doses. Pre-travel recommendations for cave researchers have to emphasize the continuous use of breathing masks and vaccination against tetanus and rabies.
Asunto(s)
Quirópteros/microbiología , Histoplasmosis/transmisión , Enfermedades Pulmonares Fúngicas/transmisión , Viaje , Adulto , Animales , Cuba , Diagnóstico Diferencial , Femenino , Histoplasmosis/diagnóstico , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Masculino , InvestigaciónRESUMEN
In this double-blind clinical trial 429 patients (217 terbinafine and 212 clotrimazole) were randomized to receive twice daily terbinafine 1% topical solution for 1 week followed by a vehicle application for 3 weeks, or 1% clotrimazole solution for 4 weeks. Patients were evaluated clinically and mycologically at baseline and then at weeks one, two, four (end of treatment), and eight (end of follow-up). To be evaluable the patient needed to have a positive culture for a dermatophyte and positive KOH microscopy and a clinical diagnosis of tinea pedis (interdigital type) at baseline. Effective treatment of tinea pedis was recorded in 181 of 217 (83%) of patients treated for 1 week with terbinafine 1% solution and 174 of 212 (82%) of patients treated for 4 weeks with clotrimazole 1% solution. Mycological cure and disappearance of signs and symptoms were similar at each assessment visit in the two groups. In the subgroup of patients without any protocol violation the mycological cure rate was 95% (164 of 173) with terbinafine solution and 91% (159 of 174) with clotrimazole solution (P = 0.05). Adverse events believed to be drug-related occurred in 13 patients in the terbinafine group and 11 in the clotrimazole group (4 to 5% in each group). The events were primarily local skin reactions of mild to moderate intensity. It can be concluded that terbinafine 1% solution used for 1 week to treat tinea pedis is well tolerated and at least as effective as clotrimazole 1% solution used for 4 weeks.
Asunto(s)
Antifúngicos/administración & dosificación , Clotrimazol/administración & dosificación , Naftalenos/administración & dosificación , Tiña del Pie/tratamiento farmacológico , Administración Tópica , Adulto , Método Doble Ciego , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Polonia , Soluciones , TerbinafinaRESUMEN
The decline of STD in the region of Rostock, Germany, since 1945 is explained by a decreasing incidence of gonorrhoea and trichomoniasis. On the other hand chlamydial and candidal infections have increased. The rate of chlamydia infections was about 45% in our venerological patients, as common as gonorrhea used to be. Genital candidal infections were to be found in 23%. Mycoplasmas were identified in 15%, usually combined with other pathogens except in some cases of vaginitis.
Asunto(s)
Enfermedades de Transmisión Sexual/epidemiología , Áreas de Influencia de Salud/estadística & datos numéricos , Estudios Transversales , Femenino , Alemania/epidemiología , Hospitales Universitarios/estadística & datos numéricos , Humanos , Incidencia , Masculino , Servicio Ambulatorio en Hospital/estadística & datos numéricosRESUMEN
Untreated dermatological mycoses are easy to diagnose. Once treatment with corticosteroids has been initiated the diagnosis of a mycosis can be difficult. In the immunosuppressed patient (AIDS patients) typical dermatological manifestations can be lacking. Systemic antimycotic therapy requires precise detection of the pathogen concerned. Mistakes still made in surgical practice are incision of a tumour in the case of tinea profunda and the extraction of nails affected by fungi. In the healthy person yeasts are transient organisms present in the mouth and intestinal tract in contrast, the mouth and intestinal tract of patients in risk make up a reservoir of candida infection that can affect the internal organs. Cryptococcosis and aspergillosis are inhaled mycoses. Factors predisposing to mycoses influence the duration and the outcome of the course of illness. The most important of these factors in surgical practice is the immunosuppression. Systemic mycoses are difficult to recognize. In many cases organ mycoses can be diagnosed by CT. Continuous investigations of diagnostic cultures and serological tests can contribute to the diagnosis. Only cryptococcosis can be ascertained early by specific antigen demonstration in the serum. For this reason continuous serological testing for cryptococci is essential in AIDS patients.
Asunto(s)
Micosis/cirugía , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/cirugía , Anticuerpos Antifúngicos/sangre , Antígenos Fúngicos/sangre , Candidiasis/diagnóstico , Candidiasis/inmunología , Candidiasis/cirugía , Criptococosis/diagnóstico , Criptococosis/inmunología , Criptococosis/cirugía , Diagnóstico Diferencial , Humanos , Micosis/diagnóstico , Micosis/inmunología , Pronóstico , Factores de RiesgoRESUMEN
An invasive mycosis may cause death in high-risk patients. An early systemic antimycotic therapy can save life. Therefore, a continuous mycological monitoring in one week intervals is necessary in high-risk patients beginning with the day of admission. This monitoring should be done three to five times a week when an organ manifestation is suspected. Due to the continuous monitoring, the assignment of the results is much easier for the clinician. The goal of the mycological monitoring is to obtain an early hint of a fungus infection. The results of the culture as well as serum titers of antigen and antibodies have to be interpreted in connection with the clinical picture of the underlying disease and the actual risk of infection. Negative results do not rule out a mycosis! Positive results do not always proof an invasive mycosis. Only by interpreting the time course of the mycological findings and the patient's clinical status, an invasive mycosis may be diagnosed with some certainty. In any case, additional procedures like radiological techniques (i.e. CT-scan), histology etc. should be used.
Asunto(s)
Infección Hospitalaria/diagnóstico , Micosis/diagnóstico , Infecciones Oportunistas/diagnóstico , Antifúngicos/efectos adversos , Antifúngicos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/transmisión , Humanos , Micosis/tratamiento farmacológico , Micosis/transmisión , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/transmisión , Factores de RiesgoRESUMEN
The aim of the present study was to investigate the incidence of Candida stomatitis and resulting interruptions in radiation and radiochemotherapy in 50 patients suffering from squamous cell carcinomas of the head and neck region receiving fluconazole (100 mg d-1) in comparison with a historical control group (n = 50) without specific prophylaxis. Twenty of the control patients (40%) demonstrated Candida stomatitis, with seven of them (14%) requiring interruptions in anticancer therapy. In contrast, none of the patients with fluconazole had evidence of Candida stomatitis (P = 0.0000051) and subsequent interruption of anti-cancer therapy (P = 0.0061). Laboratory monitoring for the presence of Candida species was performed in 30 patients before and after therapy with fluconazole. Candida albicans was identified less frequently after therapy when compared with the pretreatment status. However, C. glabrata and C. krusei were isolated in some of the patients, probably because of drug resistance of these subspecies. The results demonstrate the clinical usefulness of prophylactic fluconazole applications in patients suffering from head and neck tumours with the aim of reducing Candida stomatitis and the resulting interruptions in radiation and radiochemotherapy.
Asunto(s)
Antifúngicos/uso terapéutico , Candidiasis Bucal/etiología , Candidiasis Bucal/prevención & control , Fluconazol/uso terapéutico , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Adulto , Anciano , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Humanos , Persona de Mediana EdadRESUMEN
The aim of the present study was to investigate the incidence of Candida stomatitis and resulting interruptions in radiation therapy in 50 patients suffering from squamous cell carcinomas of head and neck region receiving fluconazole (100 mg/d) in comparison to a historical control group without specific prophylaxis. 20 of the control patients (40%) demonstrated Candida stomatitis with 7 of them (14%) requiring interruptions of radiation therapy. In contrast, none of the patients with fluconazole had evidence of Candida stomatitis and subsequent interruption of anticancer therapy. Laboratory monitoring for the presence of Candida species was performed in 15 other patients before and after therapy with fluconazole. Candida albicans was identified less frequently after therapy when compared to the pretreatment status. However, C. glabrata and C. krusei were isolated in some of the patients probably due to decreased drug susceptibility of these species. The results demonstrate the clinical usefulness of prophylactic fluconazole applications in patients suffering from head and neck tumors with the aim to reduce Candida stomatitis and resulting interruptions in radiation therapy.
Asunto(s)
Antifúngicos/uso terapéutico , Candidiasis Bucal/prevención & control , Carcinoma de Células Escamosas/radioterapia , Fluconazol/uso terapéutico , Neoplasias de Cabeza y Cuello/radioterapia , Candida/aislamiento & purificación , Candida albicans/aislamiento & purificación , Candidiasis Bucal/epidemiología , Humanos , Incidencia , Radioterapia/efectos adversosRESUMEN
We investigated the yeast colonizations of hospitalized patients at time of the admission to hospital (< or = 3d; 1161 patients) and during stay in hospital (> 3d-several months; 568 patients). At admission to hospital 58% of patients had yeasts in one of the investigated specimens. During stay in hospital the part of patients with yeasts increased up to 81.7%. We established remarkable differences in proof of yeasts in patients of different area of risk. The spectrum of yeasts of the patients in Rostock and Dresden shows a similar shift in frequency of the different Candida species. C. albicans was the predominant yeast. But during hospitalization we saw an elevation of patients with C. glabrata infection from 7.4 to 22.5% and C. krusei infection from 2.8% to 11.8%. There were a remarkable correlation to the area of risk. In 30.8% of the patients we observed a change in yeast spectrum: from negative cultures to positive specimens or from one Candida species to another one.
Asunto(s)
Candida/aislamiento & purificación , Candidiasis/epidemiología , Pacientes Internos , Candida/clasificación , Candida albicans/aislamiento & purificación , Alemania , Humanos , Factores de RiesgoRESUMEN
We developed an enzyme immunoassay for the estimation of candida-specific IgA antibodies in saliva. In patients with stomatitis prothetica (n = 46) we found a higher concentration (p < 0.05) before therapy in comparison to normal controls.
Asunto(s)
Anticuerpos Antifúngicos/análisis , Candida albicans/inmunología , Saliva/inmunología , Estomatitis/inmunología , Humanos , Inmunoglobulina A/análisisRESUMEN
A male infant with obstructive uropathy developed yeast cell agglomerations which were detectable macroscopically and by image-generating techniques within both renal pelvises after Candida albicans infection of the urinary tract. Therapy with flucytosine induced excretion of 'fungal balls' via the urethra. Continuation of therapy with liposomal amphotericin B (AmBisome) prevented a relapse after development of fungal resistance against flucytosine. Sonographically or radiographically detectable formation of 'concrements' within the urinary tract of patients with an immature or compromised immune system and additional features such as obstructive urinary tract should suggest a localized or systemic mycosis, particularly in the context of long-term antibiotic treatment.
Asunto(s)
Candidiasis/complicaciones , Obstrucción Uretral/complicaciones , Enfermedades Urológicas/complicaciones , Anfotericina B/administración & dosificación , Candidiasis/diagnóstico , Candidiasis/tratamiento farmacológico , Flucitosina/uso terapéutico , Humanos , Lactante , Liposomas , Masculino , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/tratamiento farmacológicoRESUMEN
We studied the influence of human recombinant granulocyte-macrophage colony-stimulating factor (rhGM-CSF) and Candida albicans (CA) components, either alone or in combination, on the proliferation of human bone marrow cells in vitro (colony-forming assay). The number of colonies per 10(5) bone marrow cells after cultivation with rhGM-CSF [maximal (plateau) colony formation] was: 46.2 +/- 9.1 (n = 6); after cultivation with rhGM-CSF in combination with CA components the numbers of colonies were as follows: 0.05 mg protein/ml, 33.4 +/- 4.6 (n = 3); 0.10 mg protein/ml, 20.8 +/- 3.6 (n = 3). The mechanisms responsible for this inhibition of colony formation are still unknown. They may be of pathogenetic significance in CA infection.
Asunto(s)
Células de la Médula Ósea , Candida albicans/fisiología , Factor Estimulante de Colonias de Granulocitos y Macrófagos/farmacología , Médula Ósea/efectos de los fármacos , Médula Ósea/microbiología , División Celular/efectos de los fármacos , Ensayo de Unidades Formadoras de Colonias , Humanos , Proteínas Recombinantes/farmacologíaRESUMEN
Candida albicans (CA) components influence the proliferation of human bone marrow cells in vitro (colony-forming assay). Number of colonies per 10(5) bone marrow cells after cultivation with rHuGM-CSF (maximal plateau colony formation): 46.2 +/- 9.1 (n = 6); after cultivation with rHuGM-CSF in combination with CA proteins: 0.05 mg protein/ml: 33.4 +/- 4.6 (n = 3); 0.10 mg protein/ml: 20.8 +/- 3.6 (n = 3).
Asunto(s)
Células de la Médula Ósea , Candida albicans , Hematopoyesis/efectos de los fármacos , División Celular/efectos de los fármacos , Células Cultivadas , Factor Estimulante de Colonias de Granulocitos y Macrófagos/farmacología , Humanos , Técnicas In Vitro , Leucocitos Mononucleares/citología , Proteínas Recombinantes/farmacologíaRESUMEN
A microprecipitation method was used to test sera of psoriasis patients and control persons for precipitating keratin interfilament antibody (KIF-Ab). Precipitating KIF-Ab were detected in 83% of the psoriasis patients. The sera of only 20.5% of controls without dermatological diseases and 40% of nonpsoriatic patients contained KIF-Ab. The mean KIF-Ab titer of the control and psoriasis group did not differ significantly. The different therapy had different effects on the detectability of precipitating KIF-Ab. Upon completion of dithranol treatment and clinical healing, all sera reacted with KIF from psoriasis scales (pso-sc). PUVA treatment lowered the Ab-titer as well as the number of seropositive sera. These results were confirmed by means of immunoblot and immunodot techniques. Sera from psoriasis patients contained Ab of the IgG and IgM-types against 65, 55 and 45 kD proteins. KIF-IgA-Ab were found frequently in the cases of severe forms of psoriasis.
Asunto(s)
Autoanticuerpos/análisis , Queratinas/inmunología , Psoriasis/inmunología , Adolescente , Adulto , Anciano , Precipitación Química , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
In a woman patient who had received a kidney transplant 9 years previously, we diagnosed a cryptococcosis of the skin on the right arm. The results of clinical and mycological investigations and the forms of treatment applied are discussed.
Asunto(s)
Criptococosis/patología , Dermatomicosis/patología , Trasplante de Riñón , Infecciones Oportunistas/patología , Criptococosis/tratamiento farmacológico , Cryptococcus neoformans/aislamiento & purificación , Dermatomicosis/tratamiento farmacológico , Femenino , Humanos , Itraconazol , Cetoconazol/análogos & derivados , Cetoconazol/uso terapéutico , Persona de Mediana Edad , Infecciones Oportunistas/tratamiento farmacológico , Piel/patologíaRESUMEN
For prevention of infection we used an SD design including antibacterial (trimethoprim 480 mg/daily, sulfamerazine 720 mg/daily, and polymyxin 0.25 mg/daily) and antifungal (4-6 million IU nystatin/daily) components. We analyzed retrospectively 138 treatment periods in 108 patients. The intensified chemotherapy resulted in severe granulocytopenia below 0.1 x 10(9)/liter over 25.2 days. In 19 patients there was suspicion of major fungal infection; therefore they were given amphotericin B and 5-fluocytosine. Fourteen of them died; major fungal infections were documented in 5 cases. In 18% of all the deceased we found major fungal infections. There was a correlation between fungal infection, the late stages of the hematological malignancy, and the lesions on the oropharyngeal mucosa. However, in terms of the serological and culture findings no correlation appeared to exist between the group with and the group without fungal infection. The SD regime is meant to suppress the Candida cell concentration in the digestive tract but has no influence on Aspergillus in the respiratory tract.