Disseminated cutaneous Pseudallescheria boydii

As increasingly aggressive chemotherapeutic regimens are used to treat malignancy, more patients will become susceptible to various opportunistic pathogens. Specifically, several fungal organisms previously viewed as relatively non-pathogenic are more frequently causing serious disease in these patients. Identification of these organisms is of paramount importance, as some are relatively resistant to standard antifungal therapies. We report a patient with disseminated cutaneous Pseudallescheria boydii, diagnosed from histopathological examination and culture of a skin biopsy specimen. Identification of the organism was achieved shortly before the patient died. Clinicians must be aware of the numerous emerging opportunistic pathogens, which may require special culture techniques for diagnosis and varied or combined modes of therapy.     

Mycetoma caused by Petriellidium boydii: treatment with ketoconazole

A case of mycetoma of the lower leg (Madura foot) with bone involvement caused by Petriellidium boydii is presented. After an initially favourable therapeutic response to ketoconazole (2 X 200 mg/die) the process recurred despite proven sensitivity of the fungus in vitro. It could not be controlled with conservative treatment and ultimately necessitated amputation of the lower leg. A striking, hitherto unreported feature of mycetoma was the episodic occurrence of circulating immune complexes with febrile monoarthritis of the adjacent ankle.     

Disseminated subcutaneous nodules caused by Pseudallescheria boydii in an atopic patient

We present a 40-year-old woman with atopic dermatitis and multiple purulent subcutaneous nodules of 20 years' evolution. The biopsy material was cultured and revealed Pseudallescheria boydii. The patient was treated with oral itraconazole for 4 months and incision and drainage of the lesions. Afterwards the patient remained asymptomatic and no new lesions were detected.     

波氏假阿利什菌和尖端赛多孢子菌随机扩增DNA多态性分析

目的 了解波氏假阿利什菌和尖端赛多孢子菌的基因学特征,研究DNA分型与菌种来源的关系.方法 采用随机扩增多态性DNA分析(RAPD)方法.结果 3种引物可将来自5个国家的13株波氏假阿利什菌和18株尖端赛多孢子菌分为31个基因型.多引物聚类分析所得树状图显示,除来自哥伦比亚土壤的3株波氏假阿利什菌外,其他受试菌株无地域性群集分布特点.但受试菌株中的多数波氏假阿利什菌和尖端赛多孢子菌株分别聚集成一群.结论 波氏假阿利什菌和尖端赛多孢子菌存在较大株间差异,致病菌没有明显的地域性分布趋势,RAPD分型聚类分析结果与形态学分类之间具有一定一致性.     

波氏假阿利什霉和尖端赛多孢子菌的孢子、菌丝对唑类抗真菌剂敏感性的比较

目的：观察波氏假阿利什霉和有性期尖端赛多孢子菌的不同菌体形态对唑类抗真菌剂敏感性的异同。方法：参考美国NCCLS M38-A试验方案，检测氟康唑、伊曲康唑及伏力康唑对9株波氏假阿利什霉、18株尖端赛多孢子菌的孢子、发芽孢子及菌丝的MIC，并分析比较相互间的异同。结果：大多数受试波氏假阿利什霉与尖端赛多孢子菌菌株以三种不同菌体形态接种时，对上述三种唑类抗真菌剂的敏感性无显著性差异；对同一种唑类药物，两菌的敏感性无显著性差异，但两菌均对伏力康唑较敏感，其敏感性高于对氟康唑和伊曲康唑者。结论：在波氏假阿利什霉及尖端赛多孢子菌的三种唑类药物敏感试验中，其接种易于获取并易于量化的未发芽孢子时的MIC，可反映此三种唑类药物体外对发芽孢子及菌丝的抗菌活性。在受试的三种唑类药物中，伏力康唑在治疗波氏假阿利什霉及尖端赛多孢子菌感染方面值得推荐。     

Mycetoma formation in Trichophyton rubrum infection

An adult male patient with a chronic Trichophyton rubrum infection of the feet, toe nails and groin, for 15 years, developed on the dorsum of the right foot a tumour with draining sinuses. Histological examination of tissue from the growth revealed granulomatous inflammation with abscesses containing granules characteristic of mycetoma. T. rubrum was cultured from skin scrapings and toe nails. The concurrent complete clearing of the superficial lesions and the mycetoma during treatment with griseofulvin, as well as the disappearance of complement fixing antibodies against T. rubrum antigen, indicate that this hitherto unreported complication of a dermatophyte infection may be related and may not be coincidental to the infection.     

Mycetoma in Yemen: clinicoepidemiologic and histopathologic study

BACKGROUND: Mycetoma is widespread in Yemen, but has not been fully documented. METHODS: A prospective study of 70 patients (53 male, 17 female; from different regions of Yemen) was performed. The clinical profile of the cases was recorded in a special protocol. The diagnosis was based on clinical features, examination of grains, roentgenographic studies, and histopathology (44 cases). RESULTS: Fifty cases were diagnosed as eumycetoma and 20 as actinomycetoma. The identification of the causative species was performed in 44 cases by histopathologic studies. Among the cases of eumycetoma, Madurella mycetomatis was recognized in 27 patients, Leptosphaeria senegalensis in two, and pale-grain fungi in two. Among the cases of actinomycetoma, Streptomyces somaliensis was seen in eight patients, Streptomyces madurae in one, and Nocardia species in four. The treatment of eumycetoma patients with ketoconazole and excision in selected cases controlled the disease activity in the majority. Most of the cases of actinomycetoma were better controlled with drug therapy alone, with a combination of penicillin and cotrimoxazole, or cotrimoxazole alone. CONCLUSIONS: Mycetoma is widespread in Yemen, with a higher incidence of eumycetoma and a maximum number of cases from the Hudaida region. A multicenter study is needed to evaluate the exact extent of disease.     

Mycetoma in Iran: Causative Agents and Geographic Distribution

Background:

Mycetoma is a chronic granulomatous disease caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). It usually involves the subcutaneous tissue after a traumatic inoculation of the causative organism. We reviewed retrospectively 13 patients with mycetoma.

Materials and Methods:

This study reports the etiologic agents and distribution of mycetoma in 35 cases from 1994 to2009 in Iran. The diagnostic of mycetoma were confirmed by histopathology and direct preparation, culture techniques, and histopathology of granules and surgical biopsies, radiological examination of the affected site.

Results:

Mycetoma was identified in 35 patients of 168 suspected patients (20.8%). They occurred in 22 male and 13 females. Their ages ranged from 14 to 80 years. The duration of the disease ranged from two months to 38 years. Sixteen patients had eumycetoma, and 19 patients had actinomycetoma, one of them had mix infections by eumycetoma and actinomycetoma. The majority of the patients were from central and states in south and north of Iran. The feet were most affected site (65.7%) of the cases, followed by hands (25.7%), face (2.8%), and trunk (2.8%), and buttock (2.8%). Most patients (68.5%) were more than 40 year-old. The male to female ratio was 5:3. The disease was abundant among housewife in urban and farmer in rural area of Iran. The most common prevalent mycetoma agents in this study were Actinomyces sp. There was a history of risk factors in 28.6% of patients in this study.

Conclusion:

Mycetoma occasionally occurs particularly in the South, Central, and North of Iran, and seen most often in persons, who live in hot, humid climates. If there are risk factors for invasive fungal infections traumatic inoculation with any fungus may result in rapid local spread and systemic disease, often with fatal outcome.     

Mycetoma: retrospective study of 13 cases in Tunisia

Mycetomas are inflammatory pseudotumors of chronic and progressive evolution, of fungal (Eumycetoma), or bacterial (Actinomycetoma) origin. We conducted a retrospective study of patients who have been consulted for mycetoma over a period of 28 years. Thirteen cases of mycetomas were collected during the 28-year period, 10 patients were of rural origin. The lesions were localized on the foot in all instances. There was no male predominance. Histopathological examination confirmed mycetoma in all 13 cases and the determination of the infectious agent in 9 cases: 4 actinomycotic and 5 fungal. Microbiological examination identified the species in 7 cases. Bone involvement was found in 10 cases. Eumycetomas were treated by ketoconazole. The other cases were treated as actinomycetomas by antibiotics. The antibiotic treatment was associated with surgical excision in 4 cases and with amputation in 1 case. Mycetomas are rare in Tunisia, and only observed sporadically, for this reason the diagnosis is usually late, with severe functional, psychological, and socioeconomic consequences.     

The value of in-patient dermatology: a survey of in-patients in Scotland and Northern England

Dermatology in-patient units are frequently threatened with reduction or closure, yet there are few objective data regarding the nature and use of in-patient management with which to assess their value. We have surveyed 300 patients admitted during March 1997 to dermatology units throughout Scotland and Northern England, to establish their clinical and social profile, and the outcome of admission. All departments provided phototherapy and out-patient treatment services, and 84% of those admitted lived within an hour's travel of one of these. Three diagnostic groups (psoriasis, eczema and leg ulcers) accounted for 83% of in-patient days. Patients were admitted principally because of disease severity but many, including half of those with psoriasis, had concurrent medical problems such as alcohol abuse, psychiatric disorder or arthropathy. Many patients with psoriasis and leg ulcers were from socially deprived areas, as defined by low Carstairs index scores, and a similar proportion received income support. Eighteen per cent of patients, mainly those with acute disorders, would have needed admission irrespective of dermatology bed availability. Out-patient management was considered the next best alternative for only 28% of patients, and many patients would have been expected to treat themselves. By contrast, 84% of patients admitted were cleared or substantially improved, or had procedures completed as planned, and another 12% were partially improved. Outcomes were particularly good in psoriasis, eczema and infection groups. We have demonstrated that in-patient management is highly effective in providing remission in chronic skin disease, and our survey also suggests that concomitant disability or social factors mean that for many such patients ambulatory care cannot replace this service.     

Mycetoma caused by Nocardia caviae in the first Brazilian patient

Background  Mycetoma is a chronic subcutaneous mycosis caused by exogenous fungi or actinomycetes. This infection has a progressive course and shows a typical clinical characteristic of tumefaction, draining sinuses, and grains. Infection initiation is related to local trauma and can spread to muscle, underlying bone, and adjacent organs. Nocardia brasiliensis is the most frequent actinomycete isolated, while N. caviae is a rare agent. Methods  We present a case of mycetoma in a 37‐year‐old African‐American man on the right hand. The infection had been apparent for four years prior to the consultation. When the infection did not respond to antibiotic therapy, the patient was referred to the Dermatology department. Routine laboratory studies were normal. X‐ray examination of the hand showed an osteolytic lesion on the hand bones. On skin biopsy culture, on Sabouraud Dextrose Agar at 28 °C, a colony was isolated which was further identified as N. caviae by biochemical and hydrolysis testing. Results The patient was treated with oral trimethoprim/sulfamethoxazole (TMP/SMZ) 160/800 mg twice a day for 10 months. Four months after the beginning of the therapy, the subject exhibited clinical improvement and functional recovery of the hand. Five‐year follow‐up X‐ray examination of the hand showed no osteolytic lesion on the hand bones. Conclusion We report the first mycetoma case caused by N. caviae in our country with an unusual location on the hand. The patient showed clinical improvement with oral TMP/SMZ.     

A sun protection survey of New England fishermen

Skin cancer is the most common form of cancer in the United States, with more than 1 million cases of nonmelanoma skin cancer diagnosed annually and an estimated 53,600 cases of melanoma and 7400 deaths expected during the year 2002. Excess exposure to UV radiation has long been linked to both melanoma and nonmelanoma skin cancers. Fishing is a popular sport in the United States, and one with excessive sun exposure. Results of a survey of recreational fishermen conducted at the 23rd Annual Eastern Fishing & Outdoor Exposition found that sun protection attitudes and practices were poor or inadequate. I recommend that a tailored sun protection intervention program should take into account age, gender, and skin type, as well as the unique obstacles faced by fishermen.