Pityriasis versicolor—Epidemiological and Therapeutical Study

Seventy-six patients with extensive pityriasis versicolor were divided into 3 groups and treated orally with ketoconazole, 200 mg daily, for 10, 20 or 30 days respectively. 50 patients out of this number completed the study. After 6 months, 46 patients were checked up. Eight of them developed relapses effectively treated with ketoconazole for another 15 days. Six out of these 8 patients belonged to the first group using ketoconazole for 20 days only. On the basis of this observation, we do not consider a 10 days' treatment to be sufficient and recommend that the patient should be treated for at least 20 days. As a preventive measure we recommend a daily bath with salicylic acid and sulphur soap. The frequency of the infection was higher in males (71.4%) than in females (28.6%). The youngest of the male patients was 4 months of age and the oldest 70 years. The youngest female was 4 months old and the oldest 50 years. Pityriasis versicolor was found to be predominant in the age group of 21--30 years. The sites most commonly involved were back, chest and the upper extremities.     

Comparison of Ketoconazole Suspension and Nystatin in the Treatment of Newborns and Infants with Oral Candidosis: Vergleich von Ketoconazol-Suspension und Nystatin in der Behandlung der oralen Candidose bei Neugeborenen und Kleinkindern

Ketoconazole suspension (20 mg per ml) was compared with nystatin (100,000 units per ml) in the treatment of oral candidosis in newborns and infants. In all patients Candida infection was proven by culture. Twenty patients were treated with ketoconazole and 15 patients with nystatin. Treatment was discontinued 2 days after clinical cure, or after 3 weeks. The investigator assessed the severity of the thrush and accompanying symptoms at the start of the study and at weekly controls. After one week all 20 patients on ketoconazole (100%) and 8 (53%) patients on nystatin were cured clinically. At the end of the treatment 12 patients on nystatin (80%) were cured. Clinical cure was confirmed by negative culture in 94% of the patients on ketoconazole and in 73% of the patients on nystatin. No side-effects were observed in the patients on ketoconazole. Only in the case of one patient on nystatin, was vomiting observed. This study shows that ketoconazole cures thrush faster and more effectively than nystatin.     

Treatment of vaginal candidiasis with ketoconazole, a new, orally active, antimycotic.

The efficacy of a new, orally active antimycotic, ketoconazole, in the treatment of vaginal candidiasis was studied at different doses involving 63 patients. All patients had subjective complaints and were mycologically positive. There was no significant difference in the cure rates of the different doses. The oral treatment was successful in 55 out of 63 patients (87.3%). No correlation was found between the relapse rate of vaginal candidiasis and the dose regimen. There were no serious side-effects, and no significant changes were reported in hematological and biochemical parameters.     

Prevention of Mycosis in Granulocytopenic Patients with Prophylactic Ketoconazole Treatment/Prophylaktische Mykose-Behandlung mit Ketoconazol bei granulozytopenischen Patienten

Summary: 38 patients with acute leukemia were randomly allocated to receive ketoconazole 400 mg daily p. o. or placebo in a double-blind fashion. Ketoconazole did neither prevent the patients from being colonized with Candida species, nor eradicate the fungi in patients already colonized, but only 2 ketoconazole patients developed clinical mycosis against 9 placebo patients (p = 0.03). The cumulative risk of developing clinical mycosis was significantly different in the two treatment groups (p = 0.003 at day 14). Prophylactic treatment with ketoconazole prevents or postpones the develepment of clinical mycosis in highly predisposed patients and has very few side effects.
Zusammenfassung: 38 Patienten mit akuter Leukämie wurden in einer randomisierten Doppelblindstudie mit Ketoconazol 400 mg pro die gegen Placebo untersucht. Ketoconazol vermochte weder die Kolonisierung von Candida-Spezies zu verhindern, noch beim Patienten bereits kolonisierte Pilze zu vernichten. Klinische Mykosen entwickelten sich bei 2 Ketoconazol-Patienten, gegenüber 9 Placebo-Patienten (p = 0,03). Das kumulative Risiko, eine Mykose zu entwickeln, war deshalb signifikant verschieden in den beiden Behandlungsgruppen (p = 0,003 am 14. Tag). Die prophylaktische Behandlung mit Ketoconazol verhindert oder verzögert die Entwicklung von Mykosen bei hochdisponierten Patienten und weist wenige Nebenwirkungen auf.     

The Role of Candida Infections as an Adverse Effect upon Head and Neck Cancer Patients Undergoing Therapeutic Radiation and the Effect of Antimycotic Treatment

Summary: Oral, pharyngeal and esoph-ageal infections caused by Candida species occur very frequently when it comes to radiation therapy for head and neck cancer. In clinical terms oral candidosis is most often characterized by pseudomembranes or erythema. The erythematous form of oral candidosis has in particular to be distinguished from radiation mucositis. Candidosis of the oral and gastrointestinal tract often causes interruption of therapeutic radiation. Ketoconazole treatment is able to reduce the period of time during which the patient cannot be treated by radiation. Oral ketoconazole given at a daily dose of 200 mg is moreover superior to topical nystatin. To date, however, it is not yet clear if patients who have head and neck cancer in whom radiation therapy has to be started would profit from the prophylactic application of ketoconazole from start on.     

Treatment with Itraconazole of Experimental Coccidioidomycosis in the Wistar Rat/Itraconazol-Behandlung der experimentellen Coccidioidomykose an Wistar-Ratten

Summary: The results obtained in a comparative study between ketoconazole and itraconazole in the treatment of the experimental coccidioidomycosis of the Wistar rat are presented. Animals weighing 250 g were inoculated intracardiacally with 200 arthrospores of Coccidioides immitis. Both drugs were administered once a day by gavage 16 mg/kg for itraconazole and 80 mg/kg for ketoconazole. Two therapeutic schedules of 14 days were used. The first one was set up 3 d before the infecting inoculation (earlier treatment) and the second one 7 d after it (later treatment). The control group of animals received only the solvent of both drugs (PEG 200). 98 animals which received the earlier treatment were evaluated. Only 3/30 rats that received itraconazole showed lung granulomas without spherules and the cultures were negative in all cases. From the 31 animals belonging to the ketoconazole group, 15 showed granulomas, 11 showed spherules and in 10 C. immitis developed in cultures. From the 37 rats used as controls, 35 had lung granulomas, 34 of them with spherules, and the cultures were positive in 35 cases. The later starting scheme was used on 30 rats, 8/10 of the animals treated with ketoconazole showed granulomas with spherules and the cultures were positive in 3 rats with 256 C.F.U./g of the lung; 9/10 of the itraconazole treated rats showed pulmonary granulomas with sporangia, with positive cultures in 2 cases and an average of 231 CF.U./g of the lung. The whole population of the control animals showed granulomas with sporangia and positive cultures, with an average of 18.247 C.F.U./g of the lung. All the treated animals exhibited very small sporangia without endospores. It was concluded that itraconazole was better in the treatment of the earlier schedule and showed similar efficacy to ketoconazole in the later schedule with doses 5 times lower. Zusammenfassung: Die Resultate einer Vergleichsstudie zwischen Ketoconazol and Itraconazol in der Behandlung der experimentellen Coccidioidomykose der Wistar-Ratte werden dargestellt. Es wurden Tiere mit einem Gewicht von 250 g verwendet und 200 Arthrosporen von Coccidioides immitis intrakardial inokuliert. Die Verabreichung beider Medikamente erfolgte 1 x/d in einer Dosierung von 16 mg/kg Itraconazol sowie 80 mg/kg Ketoconazol. Es kamen zwei therapeutische Schemata von 14-tägiger Dauer zur Anwendung, das erste begann 3 d vor der Infektion (Frühtherapie), das zweite 7 d danach (Spättherapie). Die Kontroll-gruppe erhielt ausschlißlich das Lösungsmittel beider Medikamente (PEG 200): 98 Versuchstiere mit Frühtherapie wurden ausgewertet. Nur 3/30 Ratten, denen Itraconazol appliziert wurde, zeigten pulmonale Granulome ohne Spherulen, und die Kulturen waren in allen Fällen negativ. Von 31 mit Ketoconazol behandelten Tieren wiesen 15 Granulome, 11 Spherulen auf, und bei 10 wuchs C. Immitis in Kulturen. Von den 37 Ratten der Kontrollgruppe zeigten 35 Lungengranulome, 34 davon mit Spherulen, und in 35 Fällen waren die Kulturen positiv. Die Spättherapie wurde bei 30 Ratten ange-wandt; 8/10 dieser Tiere, behandelt mit Ketoconazol, zeigten Granulome mit Spherulen, und bei drei Ratten waren die Kulturen positiv mit 256 KfE/g Lunge. 9/10 der mit Itraconazol therapierten Ratten wiesen pulmonale Granulome mit Spherulen auf mit positiven Kulturen in zwei Fällen und einem Durchschnitt von 231 KfE/g Lunge. Die gesamte Kontrollgruppe zeigte Granulome mit Spherulen und positive Kulturen mit einem Durchschnitt von 18.247 KfE/g Lunge. Alle behandelten Tiere wiesen sehr kleine Spherulen ohne Endosporen auf, die Kontrollgruppe hingegen reife Spherulen mit Endosporen. Daraus wird geschlossen, daß Itraconazol in der Friihtherapie besser wirkt und in der Spättherapie dem Ketoconazol vergleichbare Wirksamkeit mit einer fünffach niedrigeren Dosis erzielt     

Visceral paracoccidioidomycosis in a gold miner from Brazil

Zusammenfassung: Es wird über einen 49-jährigen Deutschen berichtet, der nach 15-jährigem Aufenthalt in Südameri-ka an einer Paracoccidioidomykose er-krankte. Er litt an einer Cheilitis, einer erosiven Stomatitis, einer Laryngitis und einer beidseitigen Pilzpneumonie; außer-dem bestand der Verdacht auf ein Pilzgra-nulom des Gehirns. Die Diagnose wurde kulturell und serologisch gesichert. Die Ausbildung typischer Hefeformen mit mul-tiplen Sprossungen (“Steuerradformen”) benötigt oft länger als einen Monat (in die-sem Fall 6 Wochen), was die Diagnostik bei unklaren Krankheitsbildern erschwert. Der Patient wurde zunächst mit Amphotericin B und Sulfamethoxazol/Trimethoprim behandelt. Beide Medikamente muß-ten wegen Nebenwirkungen abgesetzt wer-den, obwohl Amphotericin B gut wirksam war. Ketoconazol war bei unserem Patien-ten weniger gut wirksam, während unter Itraconazol eine weitere deutliche Besse-rung eintrat. Nebenwirkungen wurden unter den beiden letztgenannten Medika-menten nicht beobachtet. Summary: We report on a 49 years old patient who developed paracoccidioidomycosis after working in a gold mine in South America. The patient suffered from cheilitis, stomatitis, laryngitis, and bilateral pneumonia. Additionally, there was evidence for cerebral granuloma. The diagnosis was confirmed by culture and serologic methods. Paracoccidioides brasilien-sis grows slowly and more than a month may elapse (in this case 6 weeks) before typical yeast-like forms with multiple buds (steering-wheel fungus cells) appear in culture, which often complicates the diagnosis if there is no typical clinical picture. The patient was treated with amphotericin B and sulfamethoxazole/trimethoprim, and a clinical response to therapy was observed. However, therapy had to be stopped because of severe side effects. Ketoconazole was less effective, but further clinical improvement was achieved under itraconazole without untoward side effects.     

Epidemic postsurgical Candida parapsilosis endophthalmitis. Clinical findings and management of 15 consecutive cases

Fifteen cases of postoperative Candida parapsilosis endophthalmitis occurring secondary to a contaminated lot of an irrigating solution were studied. All patients underwent a vitreous tap or diagnostic and therapeutic vitrectomy. Eleven of the 15 specimens were positive for the organism. Fourteen patients were treated with pars plana vitrectomy surgery. All patients were treated with intravitreal amphotericin B and systemic amphotericin B and 5-fluorocytosine. Two clinical recurrences were successfully treated with intravitreal amphotericin B, removal of the pseudophakos, and oral ketoconazole. The intraocular lens was retained in 11 of the 14 pseudophakic patients. Final visual acuities ranged from 20/25 to no light perception with eight of 15 patients having 20/60 or better visual acuities. Measurable levels of intraocular amphotericin B were found after systemic amphotericin B administration. Two patients with totals of 20 and 30 micrograms of intravitreal amphotericin B over 48 and 96 hours, respectively, had near normal ERGs one year later. Posterior capsulotomy and vitrectomy appear to decrease amphotericin B toxicity and allow sequential intraocular injection of this drug within a short time period.     

Comparative efficacy and tolerability of Ketomousse (ketoconazole foam 1%) and ketoconazole cream 2% in the treatment of pityriasis versicolor: results of a prospective, multicentre, randomised study

Ketomousse (K), a new thermophobic formulation (ketoconazole 1%), has proven its efficacy in the treatment of dandruff, caused by the same agent as pityriasis versicolor (PV). The objective of this study was to compare the efficacy and tolerability of K thermophobic foam vs. ketoconazole cream 2% (N) in the treatment of PV. Forty-six patients (22 in K and 24 in N group) with PV involving no more than 15% of the total trunk surface were randomly assigned for treatment either with K or N once daily for 14 days. Three weeks after the completion of treatment, improvement rate and side-effects were evaluated by clinical and mycological examination (Wood's light). Follow-up was available for 81% of subjects. Complete resolution was observed in five patients (29%) in K group and in nine (47%) in N group (P = 0.291). One patient in the N group reported urticaria while no adverse events were reported for K. Both products were cosmetically acceptable with respect to feasibility of application and formulation with a preference for K. Ketomousse (1% ketoconazole) provides an equal efficacy and tolerability compared to ketoconazole cream 2%. Therefore, Ketomousse could be considered an excellent therapeutic option in the treatment of PV.