[Yeast species identification in vulvovaginal candidiasis: susceptibility to nystatin]. / Diagnostyka gatunkowa w kandydozie sromu i pochwy--wrazliwosc na nystatyne.

OBJECTIVE: The rates of Candida species and susceptibility to nystatin were evaluated. MATERIALS AND METHODS: In the period from January 1, 1998 to December 31, 1998 mycological tests have been carried out for identification of yeast species in the group of pregnant and delivering women hospitalized in the Obstetrics-Gynecological Departments of the Municipal Hospital in Bydgoszcz. We used two commercial media: Albicans ID and CHROMagar Candida. Noted have been 389 positive inoculation results for Candida from vaginal secretions. RESULTS AND CONCLUSIONS: From the total number of 416 differentiated fungus strains decidedly dominant was the species Candida albicans--constituting 81.97% of all strains. The second frequently occurring fungus species was Candida glabrata--11.06%. Further species were C. krusei--2.16%, C. tropicalis--1.20% and C. guilliermondii--1.20%. In 10 cases (2.41%)--in spite of carrying out the laboratory activities that are necessary in such a situation--the species type of tested strains could not be determined. The simultaneous occurrence of two Candida species has been noted in material originating from 27 women (6.94% of cases). Defining the drug-resistance of 93 Candida species strains against nystatin by means of the disk-diffusion method--it has been started that this drug is highly effective--81.72% of sensitive strains.

[In vitro assessment of the sensitivity of Candida albicans strains isolated from the vagina on basis antimycotics]. / Ocena in vitro wrazliwosci szczepów Candida albicans izolowanych z pochwy na podstawowe antymikotyki.

OBJECTIVE: The purpose of the study was to analyses the sensitivity of 73 randomly selected Candida albicans strains isolated from the vagina of pregnant and delivering women against seven basic antimycotics. MATERIALS AND METHODS: The microtest FUNGITEST (Sanofi Diagnostics Pasteur) was applied in assessing the sensitivity of 5-fluorocytosin, amphotericin B, ketoconazol, fluconazol, itraconazol and miconazol and the disk-diffusion method with the use of a Casitone base for nystatin. RESULTS AND CONCLUSIONS: Variations in the sensitivity against drugs have been noted between individual strains of Candida albicans species. The largest number of strains was resistant against ketoconazol--56.16%, and only 10.96% was resistant against nystatin.

Short-term itraconazole versus terbinafine in the treatment of tinea pedis or manus.

A total of 304 patients with a clinical diagnosis of palmar-type tinea pedis or manus and a positive mycologic examination were recruited into this double-blind, randomized, multicenter, phase III study. Patients were randomized to receive either oral itraconazole 200 mg twice daily (in the morning and evening) for 7 days, followed by placebo for 7 days (n = 153), or placebo in the morning and oral terbinafine 250 mg in the evening for 14 days (n = 151). At the first visit and 1, 2, and 6 weeks after the start of the study, signs and symptoms were assessed clinically, and scales were taken for mycologic assessments (microscopy and culture). At weeks 1, 2, and 6, the effectiveness of therapy was evaluated globally and given a rating of healed (absence of signs and symptoms), marked improvement (> or = 50% clinical improvement), considerable residual lesions (< 50% clinical improvement), no change, or worsened. The primary efficacy parameter was the mycologic cure rate at the follow-up end-point (week 6). The tolerability of the study medications was assessed at weeks 1 and 2. Adverse events were recorded at weeks 1, 2, and 6. Routine hematologic and biochemical tests were performed at the start of the study and after 1 week of treatment. No significant differences were seen in the baseline patient characteristics between the two groups. The rate of mycologic cure (negative microscopy and culture test result) was 79% in the itraconazole group and 80% in the terbinafine group at the follow-up end-point. The analysis of the 90% confidence interval for the difference between the treatment groups (-7.1, 5.4) and the outcome of the Blackwelder test (for two one-sided tests, P = 0.013 and P = 0.029) showed the two treatments to be equivalent. The results of the global evaluations of the efficacy in the two treatment groups are shown in Table 1. The rate of clinical response (healed or markedly improved) was 93% in the itraconazole group and 91% in the terbinafine group at the follow-up end-point. The analysis of the 90% confidence interval for the difference between the two groups (-2.5, 5.7) and the outcome of the Blackwelder test (for two one-sided tests, P = 0.004 and P < 0.001) showed the two treatments to be equivalent. The severity of the clinical signs and symptoms decreased from the baseline to the treatment end-point and from the treatment end-point to the follow-up end-point in both groups. At the double-blind treatment period end-point (week 2), the tolerability of the study medication was rated as very good or good in more than 97% of patients. During treatment, 21 of 153 patients (14%) in the itraconazole group and 28 of 151 patients (19%) in the terbinafine group reported adverse events. During follow-up, one patient in the itraconazole group and two in the terbinafine group reported adverse events. The most frequent events were headache, abdominal pain, nausea, vomiting, and hypertriglyceridemia. Two patients in the itraconazole group and four in the terbinafine group withdrew because of adverse events. Severe adverse events were reported by one patient in the itraconazole group and five in the terbinafine group. Serious adverse events were reported by two patients in the terbinafine group, although these were probably not drug related. No clinically relevant changes in laboratory variables were observed.

The effect of topical 0.75% metronidazole gel on malodorous cutaneous ulcers.

The unpleasant smell of infected fungating tumors and benign cutaneous ulcers is a distressing clinical problem, known to be associated with anaerobic infection. Topical metronidazole 0.8% gel has been shown to decrease smell from fungating malodorous tumors. This study was conducted to assess prospectively the subjective and bacteriological response to 0.75% metronidazole gel to decrease smell from these lesions and to assess whether bacterial contamination of the tubes of gel occurs during use. Forty-seven patients with benign or malignant cutaneous lesions associated with a foul smell were assessed for smell, pain, appearance, and bacteriological profile before entry and at 7 and 14 days. Forty-one (95%) of the 43 patients assessed at 14 days reported decreased smell. Anaerobic infection was initially found in 25 (53%) of patients and was eliminated in 21 (84%) of these. At review after 7 days, patients reported less pain from the lesions. Discharge and associated cellulitis were also observed to decrease significantly.

[A case of Lyell's syndrome caused by carbamazepine]. / Przypadek zespolu Lyella wywolany karbamazepina.

A case is described of Lyell syndrome in a female patient with schizoaffective psychosis which developed several days after addition of carbamazepine to the psychotropic treatment used. After withdrawal of the drug and three weeks of treatment with prednisone in dose 60 mg daily, antibiotic therapy and intensive dermatological-nursing care, full remission of skin lesions and oral mucosa lesions was obtained.

[Phenomenon of increased resistance of yeast-like fungi to nystatin]. / Zjawisko narastania opornosci grzybów drozdzoidalnych na nystatyne.

The results are presented of in vitro investigations of the sensitivity of 225 strains of yeast-like fungi to nystatin. The strains were isolated from cutaneous and mucosal lesions. In the study nystatin concentration 10 micrograms/ml of the substrate was used and a two-grade scale of evaluation was applied: sensitive or resistant to the drug. It was found that 56.7% of the tested strains were resistant to this nystatin concentration. The obtained data were compared with those obtained in 1972 when all the tested strains were sensitive to nystatin in this concentration. The study showed that the resistance to nystatin has been rising in these organisms with years.

[Comparison of the susceptibility of Candida strains to ketoconazole and itraconazole in in vitro experiments]. / Porównanie wrazliwosci szczepów rodzaju Candida na ketokonazol i itrakonazol w badaniach in vitro.

The activity of ketoconazole and itraconazole against 102 strains of Candida sp. was compared in the investigation "in vitro". The investigational material was taken from patients with different types of mycosis. The values of MICs of ketoconazole and itraconazole were 0.04-100.0 micrograms/ml and 0.02-35.0 micrograms/ml, respectively. From the data obtained it is evident that the average efficacy of itraconazole is 3 to 10 times higher in comparison with ketoconazole though 8 strains (7, 8 percent) of investigated strains have shown greater sensitivity to ketoconazole.

[Antifungal activity of itraconazole and ketoconazole investigated in vitro, determined with minimal inhibitory concentrations and mycelial cell transformation in Candida albicans]. / Aktywnosc przeciwdrozdzakowa itrakonazolu i ketokonazolu w badaniach in vitro okreslana za pomoca minimalnych stezen hamujacych i mycelialnej transformacji komórek Candida albicans.

Results of studies "in vitro" of the susceptibility of 82 strains of Candida albicans for itraconazole and ketoconazole have been report. The strains were isolated from lesions of the mucous membranes and skin. The susceptibility of Candida albicans was tested to Minimal Inhibitory Concentration (MIC) and Total Inhibition Germination Tubes (TI100). The values of MICs and TI100 of itraconazole were 0.02-35.0 micrograms/ml and 0.02-18.0 micrograms/ml, respectively. The similar values of MICs and TI100 of ketoconazole were 0.04-80.0 micrograms/ml and 0.04-20.0 micrograms/ml. It has been showed that TI100 can be used as preliminary and rapid test of Candida albicans susceptibility for these drugs.

[In vitro investigations of Candida strains for itraconazole]. / Badania in vitro wrazliwosci szczepów rodzaju Candida na itrakonazol.

Results of studies in vitro of the susceptibility of 102 strains of Candida type (88--Candida albicans, 7--Candida intermedia, 3--Candida parapsilosis, 1--Candida stellatoidea, 3--Torulopsis candida), to itraconazole have been reported. The strains were isolated from lesions of the skin and mucous membranes. The strains tested showed no resistance to this drug. Itraconazole concentrations inhibiting completely the growth of the yeast-like fungi ranged from 0.02 to 35.0 micrograms/ml of a culture medium. Strains of Candida albicans have shown the least susceptibility, most Candida intermedia. Changes in sensitivity (MIC) of some strains of Candida type for itraconazole after 48 and 72-hrs periods of incubation were very little.

[Effect of itraconazole on the process of mycelial transformation of Candida albicans cells in human serum]. / Wplyw itrakonazolu na proces mycelialnej transformacji komórek Candida albicans w surowicy ludzkiej.

Results of in vitro studies on the influence of itraconazole on mycelial transformation of 88 Candida albicans strains are presented. The drug influenced a number of cells capable to produce filaments. The number of those cells diminished gradually together with the increase of the drug concentration. The range of TI100 values was between 0.02 and 18.0 micrograms ml of medium. Mycelial transformation phenomenon can be applied for preliminary and rapid evaluation of Candida albicans strains sensitivity to itraconazole.

[Griseofulvin in the treatment of herpes zoster]. / Gryzeofulwina w leczeniu pólpasca.

The authors applied griseofulvin in 46 patients (28 women and 18 men) aged from 21 to 82 years with various forms of zoster. The locations of lesions was different: concerned very often the face and the thorax, rarely the extremities and sometimes the lesions were generalized. The treatment was started in beginning stadium of disease. The total daily oral dose of Griseofulvin-Forte (Medexport/SU were 500 mg (taken in two doses with 2 tablets a 125 mg). A average time of therapy was 10 days. Subjective troubles, pain and burning regressed rapidly and the regression endured. In author's opinion treatment with griseofulvin is efficacious and secure. The time of therapy is very short. The above mentioned method can be recommended to wide, general use.