Chronic mucocutaneous candidiasis and rheumatoid arthritis in autoimmune polyendocrinopathy

Chronic mucocutaneous candidiasis is a heterogeneous group of disorders characterized by early-onset chronic recurrent mucocutaneous infections with Candida albicans. It is associated with several endocrinopathies such as hypoparathyroidism, hypoadrenalism, and hypogonadism with or without other autoimmune diseases such as vitiligo, alopecia areata, pernicious anemia, and hepatitis. Here, we describe a case of chronic mucocutaneous candidiasis with polyendocrinopathy with unusual presentations and rheumatoid arthritis.

Candida famata Infection Presenting as an Erosive Patch on the Sole of an Immunocompetent Patient / 대한피부과학회지

Candida famata previously called Torulopsis famata or Debaryomyces hansenii, is usually found in natural substrates. It was earlier considered nonpathogenic in humans; however, a number of clinical cases of human infection have been reported showing isolation of this yeast. Dermatologic literature contains only a few reports regarding cutaneous infection caused by Candida famata. An 18-year old woman presented with a 4-month history of a 4.0×3.0 cm sized erythematous erosive patch on her left sole. A skin biopsy revealed numerous spores and hyphae in the epidermis. Histopathological specimens showed positive findings using the Periodic acid-Schiff and Gomori methenamine silver stains but negative findings using acid-fast bacilli stain. Cultures from skin scrapings yielded numerous colonies. Identification of the fungus was processed up to species level using VITEK 2 (bioMérieux, Inc. Hazelwood, MO, USA), and Candida famata was isolated. She was administered itraconazole at a dose of 200 mg once daily, and following 5 weeks of therapy, the erosive lesion was noted to have completely healed with postinflammatory hyperpigmentation.

Etiologia dos casos de candidíase cutânea atendidos no serviço de micologia da Universidade Federal Fluminense, Brasil / Etiología de casos de candidiasis cutánea atendidos en el servicio de micología de la Universidad Federal Fluminense, Brasil / Etiology of cutaneous candidiasis cases seen at the mycology service of the Universidade Federal Fluminense, Brazil

Neste trabalho foram estudadas 64 amostras oriundas de 56 pacientes com suspeita clínica de candidíase cutânea, coletadas de novembro de 2008 a agosto de 2009, no serviço de Diagnóstico Micológico Humano e Veterinário do Departamento de Microbiologia e Parasitologia, Instituto Biomédico da Universidade Federal Fluminense. Foram isoladas espécies de Candida em 58 amostras de 51 pacientes, trinta e oito mulheres e treze homens, com a seguinte distribuição: 15 C. parapsilosis, 11 C. famata, 9 C. albicans, 7 C. haemulonii, 5 C. ciferrii, 4 C. guilliermondii, 4 C. lipolytica e 3 C . tropicalis. As onicomicoses representaram mais de 75% das manifestações clínicas. Nos casos em que não foi Candida isolada como o agente etiológico, foram identificados dois Cryptococcus laurentii, um Trichosporon mucoides e um Trichosporon asahii. Este trabalho é uma contribuição para o entendimento da etiologia de candidíase cutânea no serviço de Micologia da Universidade Federal Fluminense.

En este trabajo se estudiaron 64 muestras procedentes de 56 pacientes con sospecha clínica de candidiasis cutánea, recolectadas entre noviembre de 2008 a agosto de 2009 en el servicio de Diagnóstico Micológico Humano y Veterinario del Departamento de Microbiología y Parasitología, Instituto Biomédico de la Universidad Federal Fluminense. Se aislaron especies del género Candida en 58 muestras de 51 pacientes, treinta y ocho mujeres y trece hombres, con la siguiente distribución: 15 C. parapsilosis, 11 C. famata, 9 C. albicans, 7 C. haemulonii, 5 C. ciferrii, 4 C. guilliermondii, 4 C. lipolytica y 3 C . tropicalis. Las onicomicosis representaron más del 75% de las manifestaciones clínicas. En los casos donde no se aisló Candida como agente etiológico se identificaron dos Cryptococcus laurentii, un Trichosporon mucoides y un Trichosporon asahii. Este trabajo es una contribución al conocimiento de la etiología de la candidiasis cutánea en el Servicio de Micología de la Universidad Federal Fluminense.

This work corresponds to the study of 64 samples from 56 patients with clinical suspicion of cutaneous candidiasis, collected between November 2008 and August 2009 at the Human and Veterinarian Diagnostic Service of the Department of Microbiology and Parasitology of the Instituto Biomédico of the Universidad Federal Fluminense, Brazil. Candida genus species were isolated in 58 samples from 51 patients (38 women and 13 men), with the following distribution: C. parapsilosis 15, C. famata 11, C. albicans 9, C. haemulonii 7, C. guilliermondii 4, C. ciferrii 5, C. lipolytica 4, and C. tropicalis 3. Onicomycoses represented over 75% of the clinical manifestations. In cases where Candida was not isolated as etiologic agent, two Cryptococcus laurentii, one Trichosporum mucoides, and one Trichosporum asahii were identified. This work is a contribution to the knowledge of the etiology of cutaneous candidiasis at the Mycology Service of the Universidade Federal Fluminense.

A Case of Congenital Cutaneous Candidiasis in a Premature Baby / 대한피부과학회지

Although candidal infections are common in the neonatal period, less than 100 cases of Congenital Cutaneous Candidiais (CCC) have been reported in the English literature. CCC appears to be acquired in the uterus by the ascension of organisms from an infected vagina into the uterine cavity. In this report, we describe a premature baby with CCC. At 6 months, his mother had a vaginal candidial infection which was treated. Her pregnancy terminated in preterm labor at 32 weeks. Desquamated patches that involved the trunk and extremities were noted at birth. The possibility of CCC was considered and numerous psedohyphae and spores were seen in the lesions by KOH microscopic examination. The skin lesions cleared completely after 2 weeks of topical clotrimazole cream.

Pancreatic Exocrine and Endocrine Cell Differentiation during Pancreatic Regeneration / 한양의대학술지

Pancreatic tissue is maintained by a simple proliferation of the preexisting cells in adulthood, whereas, they are dynamically derived from precursor/ stem cells from ductal epithelia during prenatal life. It has been known that tissue regeneration rarely occurs in the normal adult pancreas, particularly in the human pancreas. However, regeneration can be experimentally induced in the adult pancreas in response to various tissue injuries such as partial resection, pancreatitis by obstruction of the duct, and chemical insults. Regenerating pancreatic tissue shares a common morphogenic feature of "neogenic regeneration" in all regenerating animal models. Neogenic regeneration occurs at the site of tissue injury by forming small tubular structures with elongated epithelial cells (ductules) which grow to form pancreatic ducts and acini. The endocrine cells, including insulin secreting beta cells, are also derived from these ductules. As a sequential process of neogenesis, the regenerating tissue becomes heterogeneous in composition. Some areas were composed by tubules and ductules in surrounding loose connective tissue while others were denser with differentiating acini derived from tubules or ductules. Such neogenic regeneration mimics tissue development during fetal pancreatic organogenesis. In the process of pancreatic neogenesis, we found unique expressions of bioactive proteins such as nestin and clusterin as morphogenic factors. It is likely that the stem/precursor cells could be recapitulated and regenerated to functional cells, including endocrine and exocrine pancreatic cells with acinar and ductal cells during neogenic regeneration of the pancreas.

Superficial Cutaneous Mycoses in Korea / 한양의대학술지

Superficial cutaneous mycosis is mycotic infection of the epidermis of the skin, and one of common dermatoses in Korea. They have close relationship between host (human) and fungi. Their clinical patterns and incidence, and their causative fungi may change with social environments and life patterns. Since 1945, GNP has been increased explosively, more than 243 folds, and economic developments brought abrupt changes of social environments and life patterns in Korea. Furthermore, there had been great social events during this period; Korean War in 1950-1953, the Asian Game in 1986, the Olympic Game in 1988 and the World Cup in 2002. Those events gave much chances for dermatophytes to move and change. Tinea pedis is the most common dermatophytosis and has been increased from 26% of all dermatophytosis in late 1950s to 40.9-42.2%. And tinea unguium(onychomycosis) has been increased as tinea pedis does; Its proportion was 2.8% in late 1950s, and 17% in 1990s. The patients with tinea pedis have high family infection rate and also have high coexisting dermatophytosis. The most common isolate was Trichophyton(T.) rubrum, followed by T. mentagrophytes and Epidermophyton floccosum. Tinea capitis showed the most dramatic changes; its incidence was the highest just after Korean war and decreased abruptly since 1970s. Microsporum(M.) ferrugineum was the most common isolates till 1970s, and abruptly decreased and now nearly disappeared. Trichophyton(T.) violaceum was isolated in Cheju island. After Korean war, T. schoenleinii was isolated from favus and is disappeared. M. canis was isolated for the first time in 1959 and has been the most common isolates since late 1970s. T. verrucosum was isolated in 1986, and T. tonsurans was isolated for the first time in 1995 and spread among wrestlers, Judo players and Korean wrestlers. It might be imported by wrestlers with sport exchanging program. In cidence of tinea cruris was dramatically changed and was 5% of all dermatophytosis in 1940s, and 26.6-39.1% in 1990s. Those changes might be related to change of life patterns. Proportion of cutaneous candidiasis among superficial cutaneous mycosis was 1.9% in 1960s, 6.7% in 1973, 14.6% in 1976-1985, and 7.4% in 1989-1992. Proportion of pityriasis versicolor among superficial cutaneous mycosis was 12.1% in 1973, 7.7% in 1976-1985, and 7.7% in 1989-1992. Research for Malassezia have been increasing since late 1990s and that will bring us many new informations.

A Case of Neonatal Cutaneous Candidiasis on the Forearm / 대한의진균학회지

We report a case of neonatal cutaneous candidiasis on the right forearm in a 24-day-old infant. She showed well-defined 1.0 x 0.8 cm & 0.5 x 0.4 cm-sized erythematous patches with pustules and vesicles on the right forearm. The diagnosis was confirmed by 15% KOH preparation of the lesion, fungal culture and germ tube test. The 15% KOH preparation of the lesion showed numerous pseudohyphae and blastospores and fungal culture from the lesions on Sabouraud's dextrose agar containing antibacterial antibiotics showed white creamy colonies. The germ tube test revealed germ tube formation of Candida albicans. Skin biopsy was not available because of parents were not wanted. She had been treated with topical lanoconazole and lesions were improved, and recurrence is not observed.

Identification of Candida Species Using CHROMagar Candida in Superficial Cutaneous Candidiasis / 대한피부과학회지

BACKGOUND: CHROMagar Candida is a new differential culture medium that allows selective isolation and identification of clinically important Candida species. However, no study of CHROMagar Candida in superficial cutaneous candidiasis has been reported in Korea. OBJECTIVE: The purpose of this study was to evaluate the use of CHROMagar Candida to identify Candida species isolated from patients with cutaneous candidiasis. METHOD: A total of 95 strains isolated from 92 patients with candidiasis (70 Candida albicans, 9 Candida parapsilosis, 7 Candida guilliermondii, 1 Candida krusei, 1 Candida glabrata, 1 Candida tropicalis, 2 C. albicans plus C. parapsilosis, 1 C. albicans plus C. krusei) were subcultured to CHROMagar Candida (KOMED, Korea) and incubated for 48 hours. Colony appearance on CHROMagar Candida was assessed by two observers. RESULTS: Expected colony appearance on CHROMagar Candida was 100% for C. albicans, C. krusei, C. glabrata and C. tropicalis, respectively but 85.7% for C. guilliermondii and 77.8% for C. parapsilosis. Three mixed cultures of Candida species, not detected by conventional methods, were detected by CHROMagar Candida. CONCLUSION: CHROMagar Candida is a useful isolation medium capable of a rapid presumptive identification of Candida species and more reliable detection of mixed cultures in clinical specimens.

A Case of Leukemia Cutis at the site of Invasive Cutaneous Candidiasis: Wolfs Isotopic Response / 대한피부과학회지

The isotopic response defined by Wolf et al. describes the occurrence of a new skin disorder at the site of another, unrelated and already healed skin disease. In most of the reported cases, the first diseases were herpes zoster. We report a case of leukemia cutis developed on the exact same site of previous invasive cutaneous candidiasis, regarded as Wolfs isotopic response.

Isolation and Identification of Candida Species in Superficial Cutaneous Candidiasis / 대한피부과학회지

BACKGROUND: There have been few clinical and mycological studies of superficial cutaneous candidiasis in Korea. OBJECTIVE: The purpose of the study was to investigate the recent clinical and mycological features of superficial cutaneous candidiasis and correlation between underlying diseases and candidiasis. METHODS: Among 233 patients, 233 strains of Candida(C.) species were isolated and identified by Sabouraud's dextrose agar culture, germ tube test and sugar assimilation test using API 20C kit. RESULTS AND CONCLUSION: 1. The incidence of superficial cutaneous candidiasis was 4.0% out of a total of 5,809 out-patients. 2. The ratio of male to female patients was 1.1:1. 3. Among the age groups, the incidence rate was high in the first decade and above sixth decade. 4. Candidal intertrigo was the most common type of infection(56.7%). 5. Among 233 Candida species C. albicans(90.6%), C. parapsilosis(4.7%), C. guilliermondii(2.1%), C. tropicalis(1.7%), C. glabrata(0.9%) were identified. 6. Neurological disease was the most common underlying disease(56.4%).

Superficial Cutaneous Candidiasis / 대한의진균학회지

Candidiasis is an acute or chronic infection caused most commonly by Candida albicans and occasionally by other species of the genus Candida. The superficial cutaneous candidiasis is varied; oral Candidiasis, perieche, candidal vulvovaginitis, candidal balanitis, candidal intertrigo, erosio interdigitalis blastomycetica, perianal candidiasis, candidal paronychia, candidal onychia, chronic mucocutaneous candidiasis, congenital cutaneous candidiasis, and candidid. Diagnosis can be made by typical appearance of the clinical lesions and the presence of satellite vesicopustules. This can be confirmed by KOH examination and culture of skin scrapings. Treatment is the correction of predisposing factors, topical therapy of imidazoles and/or systemic administration of itraconazole or fluconazole.

A Case of Congenital Cutaneous Candidiasis with Nail Involvement in A Premature Baby

No abstract available.