Chronic Recurrent Cutaneous Mucormycosis due to Rhizopus arrhizus / 대한의진균학회지

Mucormycosis occurs primarily in patients with severe underlying illness, especially leukemia, lymphoma, and uncontrolled diabetes mellitus. Cutaneous mucormycosis is somewhat less frequently associated with systemic illness than other forms of mucormycosis. It develops where a break in the integrity of the skin has occurred as a result of surgery, burn, or other forms of trauma. We report herein a case of primary cutaneous mucormycosis due to Rhizopus arrhizus in a 24-year-old healthy man without systemic illness, who developed recurrent, prograssively extending, weeping and tender swollen ulcerative patches at the artificial trauma site on the right side of his face since 9 years of age. It was successfully treated with amphotericin B ointment combined with oral itraconazole and ketoconazole.

A Case of Tinea Corporis Caused by Microsporum ferrugineum / 대한의진균학회지

Microsporum (M.) ferrugineum has almost disappeared in Korea after three cases of tinea capitis that were reported in Jeonbuk province in 1993. It was most common cause of tinea capitis in Korea until 1970s. M. ferrugineum produces abundant chlamydospores. Another characteristic of the species is the production of distorted faviform hyphae and long, straight hyphae with thick septa that resemble segments of bamboo. We report a case of 27-year-old female with tinea corporis caused by M. ferrugineum.

A Study on the 71 Cases of Sporotrichosis over 38 Recent Years (1968~2005) / 대한피부과학회지

BACKGROUND: Sporotrichosis is a subacute to chronic, deep fungal infection caused by Sporothrix schenckii and has a wide variety of clinical presentations. Although sporotrichosis is the most common deep fungal infection in Korea, few reports have included a long term investigation and survey of sporotrichosis. OBJECTIVE: We analyzed patients' records for 38 recent years to identify the incidence and changes in clinical findings on sporotrichosis. METHODS: We conducted a retrospective analysis of 71 patients with sporotrichosis for 38 recent years (1968~2005) by reviewing the medical records and making phone calls to patients if needed. RESULTS: The incidence of sporotrichosis is currently on a decreasing trend and incidents were more common for rural residents (43 cases, 60.6%) than urban residents (28 cases, 39.4%). The most frequent occupation of patients was 'farmer' (37 cases, 52%). Seasonally, twenty seven cases (38.0%) occurred in winter (December to February), showing higher incidence than any other season. Lympho-cutaneous type (53 cases, 74.6%) is more common than fixed cutaneous type (18 cases, 25.4%) and the most common site of the initial lesion was left upper extremity. Of 47 patients who had primary lesion on upper extremity, 39 (83%) were of the lympho-cutaneous type, and of 15 patients who had primary lesion on face, 9 (60%) were of the fixed cutaneous type. CONCLUSION: According to this study, some changes in clinical findings and prevalence of sporotrichosis over the study period were noted. Further observation and analysis are required to clarify the meaning of these changes.

A Case of Cutaneous alternariosis due to Alternaria alternata / 대한의진균학회지

Alternaria is a common saprophyte that is not usually pathogenic in humans. However, infections by the fungus have occasionally been documented, occurring mostly in immunocompromised patients. We report a case of cutaneous alternariosis caused by Alternaria alternata in a 64-year-old woman presenting with a coin-sized, slightly elevated, dark red plaque on the right wrist without systemic immunosuppression. Macroscopic and microscopic morphology of fungal culture and histopathological differentiation offered diagnostic possibility. Systemic roxithromycin and itraconazole were administered with a dramatic resolution of the lesion.

A Clinicomycologic Study of Dermatophytosis of the External Auditory Meatus / 대한피부과학회지

BACKGROUND: Otomycosis is a mycotic disease of the external auditory meatus. Aspergillus is the most common pathogen. Despite the fact that a great number of fungi are considered as the cause of otomycosis, otomycosis due to dermatophytes occurs with great rarity. OBJECTIVE: The purpose of this study was to investigate clinical and mycological features of dermatophytosis in the external auditory meatus. METHODS: We performed a clinical and mycologic analysis of 17 patients who had been clinically and mycologically diagnosed with dermatophytosis of the external auditory meatus. In addition, amplication of TRS-1 and TRS-2 of the ribosomal DNA nontranscribed spacer was performed on strains of Trichophyton (T.) rubrum and T. raubitshcekii which were isolated from skin lesions of the external ear and cerumen in 6 patients. RESULTS: The ratio of male to female patients was 1.4:1. The age of patients were 6 to 72 and mean age of onset is 36.4. Eleven patients had concomitant dermatophytosis of other sites. Tinea unguium was combined in 7 cases, tinea pedis in 4 cases, tinea corporis in 3 cases, tinea manus in 2 cases and tinea cruris in 1 case. The positive rate of KOH examination was 88.2% and the positive rate of fungal culture on PDAC media was 88.2%. The most common organism cultured was T. rubrum (80.0%), followed by T. raubitschekii (13.3%) and T. mentagrophytes (7.7%). Ten patients were treated with topical terbinafine and seven patients with oral itraconazole, so all patients were cleared of fungi from the external auditory meatus and inflammation was resolved. With TRS-1 and TRS-2 amplication, 4 of 5 pairs of T. rubrum and 3 strains of T. raubitshcekii showed the same types regardless of the site in each patient. CONCLUSION: Dermatophytosis occurs rarely in the external auditory meatus but we experienced 17 cases of dermatophytosis at this site. With suspected otomycosis, dermatophytosis of the external auditory meatus and concomitant dermatophytosis must be investigated and treated simultaneously to prevent any recurrence.

The Clinical Observation of Trichophyton verrucosum Infections During the Last 19 Years (1986~2004) / 대한의진균학회지

BACKGROUND: Trichophyton verrucosum (T. verrucosum) is a zoophilic dermatophyte distributed all around the world. In Korea, kerion celsi caused by T. verrucosum was first reported by Kim et al in the southeast province of Korea. Since then, many patients infected with T. verrucosum have been reported in Young-nam, Chungcheong province, and so on. OBJECTIVE: There have been few reports on the T. verrucosum in Korea, yet. Authors tried to offer the information on dermatophytosis due to T. verrucosum in the various aspects such as prevalence of each year, epidemiology, onset time of the year and season, distribution and characteristics of the regions, sex and age distribution, the clinical types, onset site of the body, and the relation between human beings and infected cattle and so on. METHOD: A total of 218 patients who visited Catholic Dermatologic Clinic in Daegu, Korea from 1986 to 2004, were finally diagnosed as T. verrucosum infection by KOH and fungal culture. The data were based on a retrospective survey of hospital records. However, whenever the information was lacking, we called patients to ask lists of questions for the investigation. RESULTS: The number of patients had increased every year since the first report in 1986. In 1988, the number was up to 44, which was the most. After the year 2000, the number of patients had been decreasing so continuously that there was no case in the year 2003 and 2004. As we see the distribution of province, 47 cases were from Daegu, 137 cases from Kyungsang bukdo, 29 cases from Kyungsang namdo, 5 cases from other provinces and cyties. In the distribution of season, 81 cases appeared in the spring, which was the most. Female to male ratio showed about a 1.2-fold predominance for male. And less than 15-year-old group was 41.3% of total patients. The most frequent onset site was face (36 cases, 16.5%), and the next were arm, trunk, head, leg, neck in the decreasing orders. Classifying the patients by the clinical type, 150 cases (68.8%) were in the tinea circinata type, and the next were kerion celsi type, tinea barbae type, agminated folliculitis type in the decreasing orders. Among 126 cases, 99 patients raised cattle with lesions caused by T. verrucosum, 8 patients raise cattle without lesions, 19 patients didn't breed cattle. CONCLUSION: This investigation is expected to help understand and obtain more information on T. verrucosum infection in Korea.

A Clinical, Mycological and Epidemiological Study on Tinea Barbae During the Last 24-Year-Period (1981~2004) / 대한의진균학회지

BACKGROUND: Tinea barbae(TB) is a rare dermatophytosis localized on the bearded areas of the face and neck. OBJECTIVE: The purpose of this study was to elucidate the epidemiological, clinical and mycological characteristics of TB. METHODS: During the 24-year-period from 1983 to 2004, 74 patients with TB were evaluated in regard to annual incidence, the distribution of the subjects according to age, season, involved site, occupation, a place of residence and concurrent fungal infection. Patients with TB were further assessed concerning causative agents by fungal culture and their association with clinical type and a place of residence. RESULTS: In epidemiologic aspect, annual incidence was increased until 1989, thereafter gradually decreased. TB showed peak incidence in April in monthly distribution. TB occurred predominantly in middle-aged adults, especially in fifties in age distribution and countryfolk in residential distribution. In clinical aspect, superficial type was the most common in clinical types, followed by follicular and kerion type. Upper lip was affected mostly. In mycologic aspect, fungal culture showed positive results in 57 patients. Trichophyton(T.) rubrum was the most common causative agents followed by T. mentagrophytes and T. verrucosum. Thirty six patients had concurrent fungal infection and tinea pedis was the most common. CONCLUSION: The result suggests that although the incidence of TB is decreasing, it is important not only to isolate cattle with dermatophytoses from people but also to treat concurrent dermatophytoses in order to decrease the incidence

Chromoblastomycosis Caused by Rhinocladiella aquaspersa / 대한의진균학회지

Chromoblastomycosis is a rare disease in Korea and a total of 7 cases have been reported until now. The causative agents were Fonsecaea pedrosi in 5 cases and Phialophora verrucosa in 1 case. Rhinocladiella (R.) aquaspersa is a very rare etiologic agent and only a few cases of chromoblastomycosis due to this fungus have been reported in the Central and South Americas. We report a case of chromoblastomycosis caused by R. aquaspersa in a 52-year-old woman. The lesion was an erythematous, verrucous plaque on the abdomen, 2x1.3 cm in size, and had developed for 6 months before presentation without a traumatic history. She was successfully treated with itraconazole 200 mg/day for 4 months together with surgical excision without recurrence.

The Mycological and Molecular Biological Studies on Arthroderma benhamiae Isolated for the First Time in Korea / 대한의진균학회지

BACKGROUND: Arthroderma (A.) benhamiae, one of three telemorphs of Trichophyton (T.) mentagrophytes, has not been isolated until recently in Korea, but in Japan the first report on it was made in 1998. OBJECTIVE: To identify A. benhamiae for the first time in Korea. METHODS: Twelve strains suggestive of A. benhamiae grossly and microscopically were detected among 1, 059 of T. mentagrophytes isolated at the Catholic Skin Clinic, Daegu, from 1998 to 2000. They were examined by mating tests and molecular methods. In mating tests, they were respectively crossed with "+" and "-" tester strains of A. vanbreuseghemii, A. benhamiae African race, A. benhamiae Americano-European race. Molecular methods included the sequence analysis of internal transcribed spacer 2 (ITS2) region of ribosomal DNA and chitin synthase 1 (CHS1) gene, and random amplified DNA polymorphism (RAPD) with random primer OPAO-15 (5'-GAA GGC TCC C-3'). RESULTS: Mating tests revealed that 12 strains of T. mentagrophytes consisted of 6 of A. benhamiae, 4 of A. vanbreuseghemii and 2 of indeterminate. Six strains of A. benhamiae, all isolated from the patients with a history of contact with rabbits, included 1 of Americano-European race and 5 of African race of Americano-European race and 5 of African race. One clinical isolate, a strain of A. benhamiae Americano-European race "-" in mating tests, was almost identical with the standard strains of A. benhamiae Americano-European race with molecular methods as 99.2% (351/354) similarity of ITS2 sequence, 99.1% (313/ 316) similarity of CHS1 sequence, and similar RAPD pattern. Five clinical strains of A. benhamiae African race were identical with standard strains in ITS2 and CHS1 gene and RAPD pattern. CONCLUSION: The first isolation of 6 strains of A. benhamiae in Korea was reported. Five were identified as A. benhamiae African race "+", and 1 as A. benhamiae Americano-European race "-".

The Mycological and Molecular Biological Studies on Arthroderma benhamiae Isolated for the First Time in Korea / 대한의진균학회지

BACKGROUND: Arthroderma (A.) benhamiae, one of three telemorphs of Trichophyton (T.) mentagrophytes, has not been isolated until recently in Korea, but in Japan the first report on it was made in 1998. OBJECTIVE: To identify A. benhamiae for the first time in Korea. METHODS: Twelve strains suggestive of A. benhamiae grossly and microscopically were detected among 1, 059 of T. mentagrophytes isolated at the Catholic Skin Clinic, Daegu, from 1998 to 2000. They were examined by mating tests and molecular methods. In mating tests, they were respectively crossed with "+" and "-" tester strains of A. vanbreuseghemii, A. benhamiae African race, A. benhamiae Americano-European race. Molecular methods included the sequence analysis of internal transcribed spacer 2 (ITS2) region of ribosomal DNA and chitin synthase 1 (CHS1) gene, and random amplified DNA polymorphism (RAPD) with random primer OPAO-15 (5'-GAA GGC TCC C-3'). RESULTS: Mating tests revealed that 12 strains of T. mentagrophytes consisted of 6 of A. benhamiae, 4 of A. vanbreuseghemii and 2 of indeterminate. Six strains of A. benhamiae, all isolated from the patients with a history of contact with rabbits, included 1 of Americano-European race and 5 of African race of Americano-European race and 5 of African race. One clinical isolate, a strain of A. benhamiae Americano-European race "-" in mating tests, was almost identical with the standard strains of A. benhamiae Americano-European race with molecular methods as 99.2% (351/354) similarity of ITS2 sequence, 99.1% (313/ 316) similarity of CHS1 sequence, and similar RAPD pattern. Five clinical strains of A. benhamiae African race were identical with standard strains in ITS2 and CHS1 gene and RAPD pattern. CONCLUSION: The first isolation of 6 strains of A. benhamiae in Korea was reported. Five were identified as A. benhamiae African race "+", and 1 as A. benhamiae Americano-European race "-".

Clinical and Epidermiologic Study of Trichophyton tonsurans Infections (1995~2003) / 대한의진균학회지

BACKGROUND: Trichophyton (T.) tonsurans infection has been increasing gradually in non-athletes, i.e. general population as well as athletes since it was first reported that athletes had been infected in Korea in 1995, whereas it is a common dermatophyte species in the United States and Europe. OBJECTIVE: We performed retrospective study to observe tinea infections caused by T. tonsurans. METHOD: The clinical and epidermiological study was made with 105 patients of T. tonsurans infection among out-patients in our skin clinic from March, 1995 to December, 2003. RESULT: In 105 cases of T. tonsurans infection 73 ones were athletes such as wrestlers and judo players, and 32 ones were non-athletes. The infected skin lesions of 114 cases showed mild to moderate inflammation, whereas 7 ones showed moderate to severe inflammation. The results of KOH wet mount were positive in 92 cases (87.6%). In fungal culture with Potato dextrose agar-corn meal-tween 80, the mahogany variety (53.3%) was more than the sulfreum one (22.8%), which was less significant because the percentage of unclassified cases (23.8%) influenced on variety distribution considerably (p> 0.05, chi-test). Microscopic findings of cultured fungus showed hyphae with match-box type microconidia. Preferred anatomical sites were scalp (35.2%), face (32.4%), upper extremities (16.2%), and neck (14.3%). The rate of sex was 89 cases in male and 16 ones in female. The mean age was 16.1+/-4.6, ranged from 3 to 44 years. There is no difference between athletes and non-athletes. Preferred seasons were winter (44.8%) and spring (33.3%). The occurrence of the cases in athletes, which reached the peak in 1997, has been maintained since 1995, while the number of the cases in non-athletes has minimally increased until 2003. Throughout this study it proves that the occurrence of the infection has been disseminating with athletes of a hand-to-hand fight through a lot of physical contact in the center because of frequent athletic meetings since T. tonsurans was introduced in Korea in 1995. Moreover, there is a increasing tendency toward T. tonsurans infection in non-athletes. Therefore, athletic and medical associations should make continual observations of T. tonsurans infection and take close consideration into systematic management and strategy against the infection in order to suppress probable prevalence of the contagion in our society.

Chromoblastomycosis Treated with Occlusive Dressing of Amphotericin B Cream / 대한의진균학회지

We report a case of chromoblastomycosis in a 65 year-old woman. She had a 3x4 cm sized, annular, erythematous, plaque with crusts and ulcers on the right lower arm. The lesion had grown slowly for 2 years. In fungal and histopathologic examinations, several muriform cells were found in dermis as well as in scales and crusts on the lesional skin surface. Isolated fungus was identified as Fonsecaea pedrosoi. We treated the patient occlusive dressing of amphotericin B (3%) ointment for 8 weeks and achieved a good response without any evidence of recurrence. We propose that the occlusive dressing therapy of amphotericin B cream is a good modality among the various treatments of small localized chromoblastomycosis.

Relapse in Two Couples Among Longterm Smear Negative Leprosy Patients / 나학회지

All registered inactive leprosy patients were treated with multidrug regimen since 1985. We experienced two couples of relapsed leprosy patients among them. Three were relapsed as multibacillary type and one paucibacillary type. They were given the regimen regularly but taken irregularly. The spouse cases were relapsed 6months and 4years after index cases relapsed. Three patients were elevated PGL1 ELISA titer after relapse

Partial Purification and Characterization of 41 kDa Serine Proteinase from Culture Filtrate of Trichophyton tonsurans

Dermatophytes infect the human hair, skin, nail and cause the dermatophytosis. The extracellular and intracellular proteinases of the dermatophytes commonly occur in the genus Trichophyton like T. rubrum, T. mentagrophytes, and T. granulosum. These enzymes play a prominent role in growth, multiplication and infection of the host tissue. Extracellular proteinases have been purified from the species of Trichophyton and Microsporum. We purified the proteinase partially from the culture filtrate of the Trichophyton tonsurans through Mono-Q and Superose 12 column and investigated its biochemical and enzymatic characters. The molecular size of the proteinase was estimated to be 41 kDa by SDS-PAGE. And pI was 3.2. The optimal temperature and pH for an enzymatic activity were 27C and 7.5, respectively. The purified porteinase degraded the keratin, bovine serum albumin, hemoglobin. The serine proteinase inhibitor like PMSF and DFP inhibited the proteolytic activity of the purified enzyme whereas the cysteinase inhibitor did not. These results demonstrated that the purified proteinase is a serine proteinase and can contribute the tissue invasion.

The Epidemiologic Study on Epidermophyton floccosum(1976-1997) / 대한의진균학회지

BACKGROUND: E. floccosum was known to be the frequent dermatophyte of tinea cruris and fourth causative agent of dermatophytosis in Korea. However, its incidence has been decreasing. OBJECTIVE: The purpose of this study was to investigate epidemiologic aspects of E. floccosum. METHOD: We performed the epidemiologic study on 900 patients with E. floccosum infections in from January 1976 to December 1997. RESULTS AND CONCLUSION: The incidence of dermatophytosis was 16.5% out of a total of 614,139 outpatients, and that of E. floccosum was 0.9% out of a total of 101, 314 dermatophytosis. Among the age groups, the incidence rate was high in the first decade (29.4%) and second decade (41.7%). The ratio of male to female patients was 6.6:1. The prevalence of the month was high in the August, September and October. Involved sites were groin (85.8%), foot (6.2%), trunk (3.7%), hand (1.3%), leg (1.0%), toenail (0.8%), face (0.7%) and arm (0.6%) in decreasing order of frequency. We found that the incidence of E. floccosum had been markedly decreasing since 1986.

Spontaneously Healed Primary Cutaneous Alternariosis: Reports of 2 Cases / 대한의진균학회지

No abstract available.

Three Cases of Kerion Celsi Caused by Trichophyton tonsurans / 대한의진균학회지

We report three cases of kerion celsi caused by Trichophyton tonsurans in 16-year-old students of one high school wrestling team. The first case presented a 10x5cm and several 3~4cm sized, markedly inflammatory, boggy lesions on the scalp for 5 months. Other cases showed several 2~4cm sized, erythematous, follicular pustules and nodules with partial alopecia on the scalp for 2 months. Histopathology and results of mycologic study were consistent with kerion celsi due to Trichophyton tonsurans. All lesions were successfully treated with griseofulvin 500mg daily for 7~15weeks and short term therapy of low dose of prednisolone and cephadroxil.

A Case of Block Dot Ringworm Caused by trichophyton tonsurans / 대한피부과학회지

Trichophyton tonsurans is a major causative agent of tinea capitis in the United States, Canada, Mezico and other Latin American countries, but the infection of T.tonsurans has not been reported in Korea. We report a case of tinea capitis caused by T. tonsurans in a 15-year-old student wrestler. He had a 3*3cm sized non-inflammatory alopecia with black dots on the right occipital area of the scalp. The diagnosis was established by a hght microscopic examination of the affected hairs and by mycological studies from cultures. To our knowledge, this is the first case in which T. tonsurans has been isolated in Korea, It is likely that the student acquired the infection through contact with a foreign wrestler during interaational games and practice. We should be concerned about the potential of spread of this infection in our country.

Prevalence of Tinea Pedis of College Students and Their Families in Taegu / 대한피부과학회지

BACKGROUND: Tinea pedis is one of the most comrnon dermatoses in the general population. But its prevalence in the general populat,ion was not yet reported in Korea. OBJECTIVE: Prevalence of tinea pedis and associated tinea unguium were checked in the general population. METHODS: Six hundred fifty eight persons from 179 families of the college students were evaluated. Clinical examinatior. for tinea pedis and onychomycosis and collecting scales from the suspicious lesions of the family members were perforrned by educated college students. Then dermatologists exarnined those specimens mycologically by KOH ~tnount and fungal culture. RESULTS: The results were as follows 1. The prevalence of tinea pedis was 41.2% in the studied 658 persons. 2. Among all 271 patients with tinea pedis, 201 strains of dermatophytes were isolated. They were 143 strains of Trichophyton(T) rubrum, 49 strains of T. mentagrophytes and 9 mixed infections of T. rubrum and T. mentagrophytes. In the co existence of i,inea pedis and tinea unguiurn, isolated species were corresponding. 3. Among 179 families, 143 families (79.9%) had at least one patient with tinea pedis. The isolated species of derrnatophytes in a farnily were one organism, 71.4% and two or more organisms, 28.6% of 77 familiys with more than one patient. CONCLUSION: In our study, the prevalence rate of tinea pedis was 41.2%. That suggests that tinea pedis is a wide spr .ad disease in healthy adult in Korea.

Tinea Barbae due to Trichophyton verrucosum: Report of 3 Cases / 대한의진균학회지

Although there has been recently noted a nation-wide spread of Trichophyton verrucosum infection in cattle associated with promoted stock raising and dairy farming, there were no case reports in Korean dermatologic literature describing the characteristic clinical features of tinea barbae caused by that particular fungus. We report 3 cases of tinea barbae due to T. verrucosum that developed in male stock farmers breeding cattle. One Patient acted 37, experienced acutely inflamed bo99y tumors on the chin and sub-mandible. The others aged 43 and 46 experienced inflammatory lesions with multiple follicular pustules, crusts and loss of hairs on their upper lips. They were successfully treated with oral griseofulvin and local antifungal ointment combined with short-term oral antibiotics or corticosteroid for about one month.