Secondary cutaneous candidiasis with eosinophilia

Cutaneous candidiasis is a common skin infection caused by the Candida species, especially in intertriginous areas, and neutrophils usually infiltrate histopathologically. We describe a case of secondary cutaneous candidiasis which spread extensively to the trunk and extremities and showed marked dermal eosinophilia. This case and a similar reported case suggest that Candida can sometimes cause cutaneous inflammation predominantly composed of eosinophils.     

Congenital cutaneous candidiasis: a rare and unpredictable disease

Congenital cutaneous candidiasis (CCC) is an extremely rare disorder that presents within the first 6 days of life. The manifestations ranges from diffuse skin eruption without any systemic symptoms to respiratory distress, hepatosplenomegaly, sepsis, and death. We report a neonate who presented with generalized skin eruptions at birth, characterized by erythematous macules and papules. The eruption involved head, face, neck, trunk, and extremities. Candida albicans was demonstrated on direct KOH smear, skin biopsy. The disease implies a congenital intrauterine infection and is different from neonatal candidiasis, which manifests as thrush or diaper dermatitis. The infection is acquired from the maternal genital tract in an ascending fashion. Clinical features, direct smear examination of specimen, and appropriate cultures are useful in differentiating the lesions from other more common dermatoses of the neonatal period. Topical antifungal therapy is sufficient unless systemic candidiasis is present. Prognosis for congenital cutaneous candidiasis is good.     

Diagnostic and prognostic significance of various changes in the skin and mucous membranes in HIV infection

The prognostic and diagnostic importance of certain cutaneous lesions in HIV infection is discussed. In own patients of interest was the frequency of oral candidiasis (30%) and extensive seborrhoeic changes and persistent eruptions of the type of molluscum contagiosum in a patient with the AIDS-dementia complex which were associated with oropharyngeal candidiasis.     

Extensive cutaneous candidiasis revealing cutaneous T-cell lymphoma: 2 cases

BACKGROUND: During the course of immunodeficiency diseases, severe candidiasis can occur with extensive cutaneous and mucous membrane lesions. However, blood dyscrasias are very rarely revealed by diffuse candidiasis. We report two case of cutaneous T-cell lymphoma revealed by extensive and atypical cutaneous candidiasis. PATIENTS AND METHODS: Case No. 1:A 72-year-old woman presented a pruritic rash of circinate, serpiginous patches on glabrous skin and skinfolds with multiple intertrigo and rapidly worsening palmoplantar keratoderma. All mycological skin specimens tested positive for Candida albicans. Histological examination of a biopsy sample from a serpiginous patch revealed the presence of fungal elements while palmoplantar keratoderma biopsy showed an epidermotropic lymphocytic infiltrate in the superficial dermis evocative of mycosis fungoides. Blood tests showed a white cell count of 28 600/mm3 with 14% circulating Sezary cells and a T-cell clone. The T-cell lymphoma was treated with methotrexate, but the disease worsened a few months later, progressing to CD30- large T-cell pleomorphic lymphoma. The patient died of severe sepsis. Case No 2:A 60-year-old man presented a macular rash over the face, trunk and skinfolds as well as erythematous scaly annular plaques of the glabrous skin with lymphadenopathy. Cultures of skin scrapings were all positive for Candida albicans. Blood tests showed a white cell count of 15 000/mm3 with 30% circulating Sezary cells. A trunk patch biopsy revealed the histological appearance of mycosis fungoides. There was a T-cell clone in the peripheral blood and skin. DISCUSSION: In both cases, the patients presented with widespread annular and erythematous scaly lesions of the glabrous skin and skinfolds with evidence of Candida albicans on fungal tests of all skin scrapings. The discovery of circulating Sezary cells on a systematic smear for hyperleukocytosis led us to suspect underlying cutaneous T-cell lymphoma, which was confirmed by biopsy of the skin lesions accompanying the mycoses. Widespread cutaneous candidiasis can occur in patients with cell-mediated immunodepression. Cutaneous T-cell lymphoma can enhance such candidiasis through interference with skin integrity and impairment of cell-mediated immunity, with large amounts of IL10 and TGF-B, increased secretion of soluble interleukin-2 receptors (CD25) and impaired CD8 suppressor cell function.     

Congenital cutaneous candidiasis: a case with review of the literature

The clinical features of CCC are stereotyped. Twenty-two cases have been found in the literature. Skin lesions are present at birth (12/22) or within the first twelve hours of life (7/22) and sometimes later, up to the sixth day of life. Maculopapular lesions are the first to appear, followed by the more typical vesiculopustular rash and secondary desquamation. Involvement of the upper half of the body is frequent. Interestingly, palm and sole pustules are almost constant. Oral, periungueal and conjunctival lesions are rare. In most cases, healing occurs within ten days of topical treatment using either nystatin or imidazole derivatives. Rarely (2/22), systemic candidiasis may be associated and may progress to death because of lung or meningeal involvement. Differential diagnosis includes post-natal acquired candidiasis, infectious pustulosis-impetigo, herpes, varicella-, and syphilis. In the authors' experience, pustular erythema toxicum is the most difficult diagnosis to rule out and the value of the direct smear must be emphasized. The clinical picture of CCC correspond to intrauterine infection due to a specific chorioamnionitis, for the following reasons: the rash may occur at birth; experimental cutaneous candidiasis required from 2 to 7 days of incubation; C. albicans has already been demonstrated in the adnexae, even in cases with late onset; culture of C. albicans in multiple sites favours intrauterine infection. Ascending infection of the fetal skin by C. albicans via the birth canal occurs probably through intact membranes, but fissures or late amniocentesis may create a portal of entry. CCC is rare as compared with the frequent maternal carriage of C. albicans.(ABSTRACT TRUNCATED AT 250 WORDS)     

白念珠菌抗体疫苗研究进展

白念珠菌是免疫力低下患者黏膜和系统的真菌致病源,侵袭性念珠菌感染有很强的致死性.即使是健康的个体,也容易感染阴道念珠菌病和其他皮肤黏膜念珠菌病.传统抗真菌药的疗效有一定的局限性和毒副作用,并且容易产生耐药.近年来,一些新型抗体疫苗已经研发并应用于动物模型和临床,表现出很好的对抗白念珠菌和协同传统抗真菌药物的作用.尽管其疗效和安全性还需要进一步验证,念珠菌抗体疫苗仍具有较好的临床应用前景,有望成为念珠菌病的辅助治疗手段.     

Effect of hair growth cycles on experimental cutaneous candidiasis in mice

Experimental cutaneous Candida albicans infections were produced in mice by inoculating the organisms onto areas of shaved flank skin where the hair follicles were in either the anagen (growing) or telogen (resting) phase of the growth cycle. Infection with Candida occurred in a majority of animals inoculated on either anagen or telogen skin, and the rate of clearance of the organisms was equivalent for infections on the 2 types of skin. Some of the animals inoculated on anagen skin developed foci of Candida infection in the well-developed hair follicles, below the skin surface. Deep foci of infection were not found after inoculation of the telogen areas. The infections resulted in increases in epidermal thickness and sensitization of the animals to Candida antigens, but these responses were not different between animals inoculated on the 2 types of skin. The results of these experiments indicate that although Candida albicans can infect skin containing either active or resting hair follicles, foci of infection below the skin surface occur only when well-developed hair follicles are present. These findings may have relevance to the consequences of human cutaneous candidiasis.     

Epidemiological study of Candida species in cutaneous candidiasis based on PCR using a primer mix specific for the DNA topoisomerase II gene

BACKGROUND: We have previously reported a PCR-based identification system for pathogenic fungi by targeting the DNA topoisomerase II gene, in which primer mixes specific for this gene were used for the PCR amplifications. OBJECTIVE: To test the potential of the PCR using primer mix that is specific for the DNA topoisomerase II gene and are designated as PsVIc, for rapid identification of Candida species involved in cutaneous candidiasis, and to define the relation between Candida species and the infection lesion. METHODS: Scales from 48 patients with cutaneous candidiasis were cultured on GYEP agar plates, and the genomic DNAs were purified from the colonies and used as DNA templates for PCR amplifications. Candida was identified as individual species based on the sizes of the PCR products generated in the PCR amplifications using PsVlc. RESULTS: Four Candida species (five genotypes; Candida albicans, Candida glabrata, Candida parapsilosis I, Candida parapsilosis II and Candida tropicalis II) were identified in the patients' scales. In 19 of the patients (39.6%), multiple PCR products (two or three bands) were amplified in a DNA sample, especially derived from scales at the groin of bed-ridden older patients using napkins. CONCLUSION: The PCR-based identification using the primer mix was useful for an epidemiological study of Candida species in cutaneous candidiasis.     

A Clinician’s Guide to the Diagnosis and Treatment of Candidiasis in Patients with Psoriasis

Many of the molecular pathways associated with psoriasis pathogenesis are also involved in host defense mechanisms that protect against common pathogens. Candida can stimulate the production of cytokines that trigger or exacerbate psoriasis, and many systemic psoriasis treatments may put patients at increased risk for developing oral, cutaneous, and genitourinary candidiasis. Therefore, dermatologists should regularly screen patients with psoriasis for signs of Candida infection, and take steps to effectively treat these infections to prevent worsening of psoriasis symptoms. This review provides an overview of candidiasis epidemiology in patients with psoriasis, followed by a primer on the diagnosis and treatment of superficial Candida infections, with specific guidance for patients with psoriasis. Candidiasis in patients with psoriasis typically responds to topical or oral antifungal therapy. While biologic agents used to treat moderate-to-severe psoriasis, such as tumor necrosis factor-α inhibitors and interleukin-17 inhibitors, are known to increase patients’ risk of developing localized candidiasis, the overall risk of infection is low, and candidiasis can be effectively managed in most patients while receiving systemic psoriasis therapies. Thus, the development of candidiasis does not usually necessitate changes to psoriasis treatment regimens.     

Malassezia folliculitis in immunocompromised patients

Four cases of Malassezia folliculitis in immuno-compromised patients with leukemia, papillary adenocarcinoma of the lung, and chronic renal failure are reported. This condition manifests with multiple bland asymptomatic follicular papules of the trunk and arms. Biopsy specimens show dilated follicles containing unipolar budding yeast forms. Malassezia is a common infection that must be differentiated from the cutaneous manifestations of systemic candidiasis.     

Ciclopirox for the treatment of superficial fungal infections: a review

Ciclopirox is a broad-spectrum antifungal agent that also exhibits anti-inflammatory and antibacterial activity. The lotion and cream formulations of ciclopirox are effective in many types of infection, including tinea corporis/cruris, tinea pedis, cutaneous candidiasis, pityriasis (tinea) versicolor, and seborrheic dermatitis. The new ciclopirox gel 0.77% formulation is also indicated for the treatment of seborrheic dermatitis of the scalp, interdigital tinea pedis and tinea corporis.     

Adherence of Candida species to human epidermal corneocytes and buccal mucosal cells: correlation with cutaneous pathogenicity

Adherence of microorganisms to epidermal corneocytes may be a prerequisite for cutaneous colonization and infection. Six species of Candida were assayed in vitro for adherence to human epidermal corneocytes and buccal mucosal cells, and compared to previous studies of pathogenicity in a rodent model of cutaneous candidiasis. C. albicans and C. stellatoidea exhibited marked adherence to both epithelial cell types over time, and were cutaneous pathogens in the rodent model. The remaining species showed little or no adherence, and were nonpathogenic to skin. Adherence to corneocytes was not inhibited by ethylenediamine tetraacetic acid, mannan polysaccharide, or concanavalin A lectin. Fresh human serum, but not heat-inactivated serum, inhibited C. albicans adherence by 50%, and was associated with the deposition of complement components, C3 and factor B on blastospores. Adherence to epithelial corneocytes and mucosal cells is a property of pathogenic species of Candida, and may participate in cutaneous colonization and infection mechanisms. Adherence was time-dependent, and did not require divalent cations. Cell wall mannan may participate in the "adhesin" complex. Mannan activation of serum complement and deposition of C3 and factor B on blastospores may provide a protective action by inhibiting Candida adherence to corneocytes.     

皮肤念珠菌病患者多部位分离菌株DNA分型研究

目的 比较皮肤念珠菌病患者不同部位分离菌株基因相似性,推测皮肤念珠菌病多部位感染的可能途径。方法 采用PCR扩增引物P-Ⅰ和P-Ⅱ扩增出白念珠菌染色体25SrDNA片段和特征性的基因片段重复序列片段,结合两种扩增结果进行分型,并将870bp大小的特征性的基因片段重复序列片段用限制性内切酶EcoRⅠ和ClaⅠ消化。结果 来自19例皮肤念珠菌病患者的41株白念珠菌被分为6型,同一患者不同部位分离菌株基因型相似,不同个体间基因型有差异。结论 分离自皮肤念珠菌病患者不同部位的致病菌株基因型相同,提示其发病可能与外源性再发感染无关。     

Cutaneous candidiasis – an evidence‐based review of topical and systemic treatments to inform clinical practice

Cutaneous candidiasis is a common skin disease, and several treatments have been investigated within the last fifty years. Yet, systematic reviews are lacking, and evidence‐based topical and systemic treatment strategies remain unclear. Thus, the aim of this review was to summarize efficacy and adverse effects of topical and oral therapies for cutaneous candidiasis in all age groups. Two individual researchers searched PubMed and EMBASE for ‘cutaneous candidiasis’ and ‘cutaneous candidiasis treatment’, ‘intertrigo’, ‘diaper dermatitis’ and ‘cheilitis’. Searches were limited to ‘English language’, ‘clinical trials’ and ‘human subjects’, and prospective clinical trials published in abstracts or articles were included. In total, 149 studies were identified, of which 44 were eligible, comprising 41 studies of 19 topical therapies and four studies of three systemic therapies for cutaneous candidiasis. Topical therapies were investigated in infants, children, adolescents, adults and elderly, while studies of systemic therapies were limited to adolescents and adults. Clotrimazole, nystatin and miconazole were the most studied topical drugs and demonstrated similar efficacy with complete cure rates of 73%–100%. Single‐drug therapy was as effective as combinations of antifungal, antibacterial and topical corticosteroid. Four studies investigated systemic therapy, and oral fluconazole demonstrated similar efficacy to oral ketoconazole and topical clotrimazole. Limitations to this review were mainly that heterogeneity of studies hindered meta‐analyses. In conclusions, clotrimazole, nystatin and miconazole were the most studied topical drugs and demonstrated equal good efficacy and mild adverse effects similar to combinations of antifungal, antibacterial and topical corticosteroids. Oral fluconazole was as effective as topical clotrimazole and is the only commercially available evidence‐based option for systemic treatment of cutaneous candidiasis.     

Skin Reactions to Inhaled Corticosteroids

Inhaled corticosteroids are considered by many to be the therapy of choice in the treatment of asthma and allergic rhinitis. Systemic adverse effects are well known and are mainly dose dependent. Adverse cutaneous effects have also been characterized. Some of them are frequent and dose dependent, for example thinning of the skin and easy bruising. These adverse effects are probably present in about half of the patients treated with inhaled corticosteroids. The risk of these adverse effects is more important among elderly people and increases with the duration of the treatment and the daily dosage. Thinning of the skin and easy bruising are probably dependent on collagen synthesis modifications. Among rare or underestimated reactions, several adverse effects have been described such as angina bullosa hemorrhagica, acne and allergy. In this latter case, the attention should be paid to relevant clinical signs such as eczematous lesions of the face and aggravation of the nasal symptoms. Mucocutaneous infections related to inhaled coricosteroid use have also been reported, the most frequent being candidiasis. However, the frequency of symptomatic clinical infection is very rare. The risk of viral infection, especially with a herpes virus, has never been described. As cutaneous complications of corticosteroids are mainly dose dependent, these adverse effects could be prevented by attention to the daily dosage. Infection could be prevented by rinsing the mouth after inhalation and the use of a spacer device. If cutaneous adverse effects occur despite proper use of the inhaled corticosteroids and became unpleasant for the patient, discussion with a pneumologist or otorhinolaryngologist may be required but temporary halting therapy is rarely useful.     

Autoinoculated Palmar Pustules in Neonatal Candidiasis

A 2-week-old infant had grouped pustules on the right hand, wrist, and antecubital flexure that appeared after the first week of life. The infant was seen repeatedly to suck the involved areas of the hand and wrist. Clinically typical candidiasis was noted in the oral cavity and the diaper area. Wright's-stained smears of pustular contents, potassium hydroxide preparations of pustular material, and scale from the diaper dermatitis confirmed the presence of pseudohyphae and budding yeasts in all the involved sites. This case demonstrates fairly typical manifestations of neonatal-onset candidiasis, with the unusual feature of unilateral upper extremity pustules that appeared to represent an autoinoculated cutaneous infection.     

Congenital Candidiasis Limited to the Nail Plates

Numerous case reports have been published of patients with cutaneous congenital candidiasis and neonatal candidiasis; however, this is the first reported case of congenital candidiasis confined to the nail plates. A subplacental candidal abscess, funisitis, and demonstration of hyphal invasion of fetal nail plates supported the diagnosis.     

Cutaneous Fungal Infections in the Oncology Patient

There are two main types of fungal infections in the oncology patient: primary cutaneous fungal infections and cutaneous manifestations of fungemia. The main risk factor for all types of fungal infections in the oncology patient is prolonged and severe neutropenia; this is especially true for disseminated fungal infections. Severe neutropenia occurs most often in leukemia and lymphoma patients exposed to high-dose chemotherapy. Fungal infections in cancer patients can be further divided into five groups: (i) superficial dermatophyte infections with little potential for dissemination; (ii) superficial candidiasis; (iii) opportunistic fungal skin infections with distinct potential for dissemination; (iv) fungal sinusitis with cutaneous extension; and (v) cutaneous manifestations of disseminated fungal infections. In the oncology population, dermatophyte infections (i) and superficial candidiasis (ii) have similar presentations to those seen in the immunocompetent host. Primary cutaneous mold infections (iii) are especially caused by Aspergillus, Fusarium, Mucor, and Rhizopus spp. These infections may invade deeper tissues and cause disseminated fungal infections in the neutropenic host. Primary cutaneous mold infections are treated with systemic antifungal therapy and sometimes with debridement. The role of debridement in the severely neutropenic patient is unclear. In some patients with an invasive fungal sinusitis (iv) there may be direct extension to the overlying skin, causing a fungal cellulitis of the face. Aspergillus, Rhizopus, and Mucor spp. are the most common causes. We also describe the cutaneous manifestations of disseminated fungal infections (v). These infections usually occur in the setting of prolonged neutropenia. The most common causes are Candida, Aspergillus, and Fusarium spp. Therapy is with systemic antifungal therapy. The relative efficacies of amphotericin B, fluconazole, itraconazole, voriconazole, and caspofungin are discussed. Recovery from disseminated fungal infections is unlikely, however, unless the patient's neutropenia resolves.     

Disseminated candidiasis in a patient with acute myelogenous leukemia

Disseminated candidiasis is a frequently fatal condition that is rising steadily in immunocompromised patients. We present the case of a 62-year-old African American woman with acute myelogenous leukemia who developed characteristic cutaneous signs of systemic candidiasis. Early cultures and biopsies resulted in early diagnosis, which prompted proper antifungal therapy and a positive outcome.