[Dermatophytes transmitted by pets and cattle]. / Dermatophytes transmis par les animaux domestiques.

Most inflammatory skin and hair dermatophytoses are caused by one of four zoophilic dermatophyte species: Microsporum canis (from cats and dogs), Trichophyton verrucosum (from cattle), Arthroderma benhamiae (from Guinea-pigs) and Arthrodermna vanbreuseghemii (generally from cats and dogs). In cases of highly inflammatory tinea corporis, tinea faciae and tinea capitis in humans, it is important to identify with certainty the precise etiologic agent and to examine pets as the possible source of infection. The recurrence of infections or new infections can be prevented by adequately treating incriminated domestic animals and their environments. Cooperation between the medical and veterinary professions is required in this situation.

[Diagnosis and treatment of onychomycosis]. / Diagnostic et traitement des onychomycoses.

Onychomycosis are the more prevalent nail infections. They may be caused by dermatophytes (Tricophyton rubrum and T. mentagrophytes) as well as by Candida species and a number of other moulds. Laboratory confirmation of a clinical diagnosis of onychomycosis should be obtained before the beginning of oral treatment, because of the long periods of treatment that are usually required, the high costs of such treatments, and the potential side effects of the drugs. However, terbinafine, itraconazole and fluconazole are effective against the dermatophytes in nail. Moulds infections of nails more seldom respond to antifungal therapy.

Onychomycosis due to Trichophyton soudanense in Switzerland.

We report 2 cases of onychomycosis of the finger- and toenails due to Trichophyton soudanense with a typical clinical picture different from the hyperkeratosis of T. rubrum subungual onychomycosis.

Tinea capitis dermatophytes: susceptibility to antifungal drugs tested in vitro and in vivo.

BACKGROUND: Tinea capitis is a worldwide-spread infection of the scalp caused by dermatophytes and is predominantly seen in children. The clinical manifestations range from mild scaling lesions to widespread alopecia or highly inflammatory suppurating lesions. Terbinafine and itraconazole seem to be promising therapies with shorter treatment durations than griseofulvin. OBJECTIVE: The objective of the present study was to test the sensitivity of different species of dermatophytes towards terbinafine and itraconazole, and to compare the results with a retrospective study on 35 immunocompetent patients with tinea capitis who were treated with terbinafine (Lamisil(R)). METHODS: Minimal inhibitory concentrations (MIC) were measured with an agar dilution method. RESULTS: Each tested species of dermatophyte was sensitive to terbinafine and itraconazole at different concentration ranges. The MIC for terbinafine ranged from 0.005 to 0.5 microg/ml and for itraconazole from 40 to 80 microg/ml. Microsporum canis was the dermatophyte least sensitive to terbinafine. Our retrospective study showed that the cure rate was excellent for Trichophyton violaceum and T. soudanense, variable for T. mentagrophytes and poor for M. canis and M. langeronii. CONCLUSIONS: (i) Regarding the results of susceptibility tests obtained with species involved in tinea capitis, clinical efficacy is not related to MIC measured in vitro; (ii) identification of the isolated dermatophyte from tinea capitis seems to be important for choosing the appropriate treatment.

Treatment of onychomycosis with terbinafine.

An open multicentre trial was conducted by 40 dermatologists in Switzerland involving 188 patients with onychomycosis of either the toenails or fingernails. Of these patients, 145 who had positive microscopy and culture of dermatophyte infection were evaluable: of the dermatophytes identified at the initial visit, 80% were Trichophyton rubrum and 12.4% were T. mentagrophytes. Only the most affected nail was evaluated during the observation period. Daily dosage was 250 mg of terbinafine (Lamisil) orally for up to 6 months. The cure rate (negative microscopy and culture) at the end of treatment was 77% for toenails and 100% for fingernails. A follow-up investigation was made 6 months after the end of treatment: of the 88 patients examined with onychomycosis of the toenail and the 14 with fingernail onychomycosis, 90.9% and 85.7%, respectively, remained free of recurrence. Of the 26 patients who had shown improvement, but not cure, by the end of the treatment period, 15 were clinically and mycologically cured at the time of the follow-up investigation. Terbinafine was generally well tolerated; the most frequent drug-related adverse events were mild-to-moderate gastrointestinal disturbances. Changes in liver or renal biochemical tests were not considered clinically relevant.

Mycetoma of the foot due to Fusarium sp. treated with oral ketoconazole.

We report the case of a 30-year-old Nigerian patient with mycetoma of the foot without bone involvement caused by Fusarium sp..Long-term administration of ketoconazole produced a significant improvement with good clinical and biological tolerance.

[Mycobacterium marinum granuloma in a fish fancier. Apropos of a case with sporotrichoid lesions]. / Granulomes à mycobacterium marinum chez un aquariophile. A propos d'un cas avec atteinte sporotrichoïde.

A 43-year-old fish fancier with fish tank granuloma presented with a sporotrichoid-like skin infection of the right arm with multiple papulo-nodular lesions along the lymphatic drainage. Acid fast bacilli were found in skin biopsy specimens and Mycobacterium marinum grew in cultures. The clinical and histopathological findings in M. marinum infection are reviewed and the differential diagnosis, laboratory findings with this atypical mycobacterium, and therapeutic modalities are discussed. Finally, the importance of an adequate and pertinent patient's history for a correct and timely diagnosis is stressed.

In vitro nail invasion by pathogenic and non-pathogenic fungi under different culture conditions.

Data from the literature suggest that the nutritional environment can modify major metabolic functions of fungi and possibly their aggressivity towards keratinous structures. Trichophyton rubrum (TR), Microsporum canis (MC), Scopulariopsis brevicaulis (SB), Aspergillus fumigatus (AF) and Penicillium spec. (P) were inoculated on media of different nutritional value, in presence of nail fragments. The activity of the fungi was evaluated at two and four weeks for intensity and depth of invasion of nail samples. Nail invasion was most pronounced by MC, especially when grown on rice agar or peptone agar. Nail invasion by the other fungi tested was less important, Sabourand glucose and rice agar were most favorable. Our results indicate that nutritional factors can, at least in some fungus species, alter their rate of nail invasion.

The identification of pathogenic yeast strains by electrophoretic analysis of their chromosomes.

Epidemiological studies require characterisation of pathogenic yeasts at and below the species level. The chromosomes of 130 strains of four pathogenic species of the genus Candida, isolated from clinical material, were separated by pulsed field electrophoresis with the clamped homogeneous electric field (CHEF) technique. Each species was characterised by a distinct electrophoretic karyotype (EK). Furthermore, smaller variations of the EK amongst strains belonging to the same species appeared to offer a useful means of strain differentiation. A karyotyping system is proposed for C. albicans. The EKs were assigned to a code of four numbers which designated the number of bands that could be resolved in each of four sets of chromosomes. Morphotypes of the colonies of C. albicans on malt agar plates, which did not correlate with the EK, could provide a complementary means of strain characterisation in epidemiological studies.

Direct mycological examination in dermatology: a comparison of different methods.

Direct examination for fungi in skin and nail scrapings can be done by light microscopy with or without staining, or by fluorescence microscopy using specific fluorochromes for the fungal cell wall constituents. The principal techniques described in the literature and two new methods (Congo red and Na2S-Blankophor P flüssig) were compared for their efficiency and rapidity.

Disseminated candidiasis with extensive folliculitis in abusers of brown Iranian heroin.

Two cases of heroin abusers who developed disseminated candidiasis are reported. Cultures of skin lesions revealed Candida albicans, which on histology were shown to be located in and around hair shafts. Both patients recovered after treatment with amphotericin B combined with 5-fluorocytosine and either ketoconazole or dexamethasone. This unusual cutaneous syndrome of candidal infection associated with extensive folliculitis seems to be related to the use of a particular type of heroin, the so-called brown Iranian heroin.