Human pathogenic fungi in China--emerging trends from ongoing national survey for 1986, 1996, and 2006.

This epidemiological survey was a retrospective study on three nodes during the past three decades on fungal infections representing the China, including Taiwan. Owing to rare publications reporting on dynamic epidemiological trends in the pathogen epidemiology in China, we surveyed the isolation rates and pathogenic fungi from 8 representative districts in China using uniform identification with uniform methodology. The pathogenic fungi isolation rates and species obtained from 1986 (n=9,096), 1996 (n=19,009), and 2006 (n=33,022) suggested that Trichophyton rubrum was the commonest organism cultured in 1980s (45.4%) and 1990s (34.5%), but Candida albicans increased significantly and reaching to its peak (26.9%) in 2006s' survey, and has become the most common isolate of fungal infections in China currently. In addition, Candida glabrata became the most common non-albicans species of Candida in 2006s' survey. At the same time, the incidence of molds also gradually increased. According to comparative analysis of the results of these three surveys, we found apparent differences in the isolation rates of different pathogenic fungi and the forefront 10 species in China varied significantly, and the dermatophytes decreased markedly, while yeasts, especially the Candida species and the molds, increased gradually during the past three decades. Less dermatophytic infections may suggest better access to healthcare or increase in Candida species indicated higher incidence of hospital acquired infections.

Relationships between obesity and the clinical severity of psoriasis in Taiwan.

BACKGROUND: Obesity has been found to be associated with an increased risk of psoriasis in general population. However, studies addressing the relationship between obesity and clinical severity of psoriasis are still scarce, especially in Asian people. OBJECTIVES: In this study, we investigated the relationship between levels of obesity and the clinical severity of psoriasis in Taiwanese psoriasis patients. METHODS: This was a hospital-based cross-sectional study. A total of 399 patients with chronic plaque psoriasis were recruited. Their body mass index (BMI) was calculated as weight in kilograms divided by height in metres squared and was categorized into four groups (BMI < 24, normal; 24 or= 30, moderate-to-severe obesity). Disease severity was assessed by Psoriasis Area and Severity Index. Cumulative logistic regression models were used to estimate the association between BMI and Psoriasis Area and Severity Index. RESULTS: After adjusting for potential confounders (age, gender, cigarette smoking and duration of disease), moderate-to-severe obesity was significantly associated with an increased risk of clinically more severe psoriasis when compared with normal BMI [odds ratio, 2.70; 95% confidence interval,1.42-5.11]. There is a significant linear trend for clinically more severe psoriasis across increasing of BMI categories (P for trend = 0.004). The effect of obesity on the severity of psoriasis was greater in men than in women (test for interaction, P = 0.03). CONCLUSIONS: In psoriasis patients, obesity is associated with a more severe disease, especially in men. Bodyweight control may be important for the management of psoriasis.

Atrophie blanche. A clinicopathological study of 27 patients.

Twenty seven patients (8 males and 19 females) with atrophie blanche were observed in the past 7-years. The mean age at onset was 32 years (ranging from 23 years to 57 years) and 19 years (ranging from 11 years to 36 years) for male and female patient, respectively. The mean disease duration was 2.5 years (ranging from 2 months to 16 years) prior to their consultation. Sixty-three percent of them had summer exacerbation. Four patients had essential cryoglobulinemia, one of whom also developed bilateral iliofemoral artery stenosis one year later. Twelve patients also manifested concurrent purpura pigmentosa chronica (PPC)-like lesions. The observation of the natural course and clinical morphology, being divided into white atrophy-predominant and ulcer-predominant type, led to the impression that atrophie blanche and livedo vasculitis are synonyms with the same disease spectrum. Furthermore, white atrophy is not ulcer scars but lesions de novo suggesting dermal vasculopathy. An attempt was made to explain the uniqueness of clinical morphology. First line treatment included local wound care, bed rest and low-dose aspirin plus dipyridamole. Thirteen patients responded to these treatment either at the first attack or the recurrent episodes. Heparin (5000 units subcutaneous injection once daily) was effective for control of intractable painful ulceration in active stage in 70% of the remaining patients.

Assignment of a Chinese xeroderma pigmentosum patient from Taiwan to complementation group C.

A 2 years and 7 months-old Chinese boy with severe skin symptoms was diagnosed as xeroderma pigmentosum (XP) at Chang Gung Memorial Hospital in Taipei, Taiwan. Skin fibroblasts derived from the patient (patient identification number, XP1CTA) were used for genetic complementation analysis by the conventional cell-fusion technique followed by measurement of ultraviolet light (UV)-induced unscheduled DNA synthesis (UDS). The level of UDS in XP1CTA cells measured by autoradiography was about 20% of that in normal cells. When XP1CTA cells were fused with cells of a representative strain from each of the complementation groups A, D, E, F, G, and H, binuclear cells showed UDS levels in the range of normal cells, demonstrating a clear complementation between XP1CTA strain and either one of these strains. XP1CTA cells failed to complement with all the five reference strains belonging to group C. From these results, the XP1CTA was unambiguously assigned to complementation group C. Sensitivity of XP1CTA cells to UV, as measured by colony-forming ability, also fell within a range of variation in UV sensitivities of these group C XP cell strains.

[Nevus sebaceus--a clinicopathological study of 104 cases].

We studied the clinical and histopathologic features of 104 cases of nevus sebaceus observed between January 1983 and December 1988 in the department of Dermatology of Chang Gung Memorial Hospital. There were 48 males and 56 females, the ages ranged from 3 to 60 years, the mean age was 23.5 years old. Among them, most nevus sebaceus developed before age 10 (83%); the most common site of nevus sebaceus was the scalp (70%), followed by the face (26%) and only a few lesions were situated away from the head. Twenty-one cases were associated with secondary tumors in a portion of the lesions were found. In nineteen of the twenty-one patients, the secondary tumors occurred after age 10, their mean age was 30 years old. Of the 25 tumors developed in the 21 patients, 8 were syringocystadenoma papilliferum, 6 were basal cell epithelioma, 4 were trichilemmoma, 3 were sebaceous epithelioma. Multiple tumors were developed in 3 cases of nevus sebaceus. Since a variety of tumors may develop in the nevus sebaceus after puberty, prophylactic removal of nevus sebaceus and close follow-up are suggested.

Safety and efficacy of 2% topical minoxidil in the management of male pattern baldness in Chinese.

Topic 2% minoxidil solution has been proved to be effective for hair regrowth in 30-40% of male pattern baldness in the United States and Europe. There was no report concerning topical minoxidil in Chinese patients, therefore, we selected 40 patients to investigate the efficacy and safety from December 1988 to January 1989. Those selected patients were consistent with male pattern baldness without systemic disease, and had never used topical hair regrowth agents. Patients applied topical medication 1 ml twice daily and were examined at 1 month intervals. Thirty two patients completed 6 to 12 months (average 9.6 months) of the study, moderate hair growth was found in 22% while minimal growth in 59% of the studied patients. All patients noted their shedding decrease after the application of drugs for 1 to 3 months. Scalp dryness and mild scaling appeared in 2 patients, but were tolerable. Before and after the trial, all patients had a chest roentgenogram, EKG, complete blood counts, urinalysis and blood chemistry studies, and no apparent abnormality was found. The efficacy of 2% minoxidil solution application in our study was less than that in the United States. which might be because some patients did not follow the application order regularly and a more strict evaluation standard was adopted in our series. However, the safety of no systemic adverse effect and the potential of inhibiting progressive shedding of hair were valuable as a topical drug.

Intraepidermal neutrophilic IgA dermatosis.

We report a patient with a vesiculopustular eruption with features distinct from typical subcorneal pustular dermatosis. Clinically, well-formed pustular lesions, which were flowerlike in appearance, were present. Histopathologically, early vesicular lesions showed intraepidermal bullae containing numerous neutrophils, a few eosinophils, and acantholytic cells. Direct immunofluorescence study revealed IgA deposits in the intercellular space of the epidermis. The patient's serum, however, did not contain circulating antibodies reactive with the epidermis. We consider this eruption an immunologically mediated, intraepidermal blistering disease, similar to intraepidermal neutrophilic IgA dermatosis.

[Cutaneous protothecosis: first case in Taiwan].

In November 1985, a 5-year-old Chinese girl presented to the Dermatological Department of Chang Gung Memorial Hospital, Taipei, having scaly erythematous plaque with mild itching on her right upper eyelid. Skin biopsy and fungal cultures were performed after failure of initial topical steroid therapy. The histopathology revealed many acute and chronic inflammatory cells infiltrating the dermis and H & E stain revealed some foamy vacuolated spores; P.A.S. and Gomori's methenamine stain also showed many spores and sporangia containing endospores. Lactophenol cotton blue and methylene blue wet mount preparations were made from the colony growing on Sabouraud's agar. Microscopically, these showed many round or oval spores and endospore-containing sporangia, corresponding with the histopathology. This microorganism grew as a milky white yeast-like colony on Sabouraud's dextrose agar, blood agar, EMB, Tween 80 cornmeal agar, chocolate agar, MacConkey agar and brain heart infusion with sheep RBC agar. On Pagano-Levin medium, the colony became deep red in color and in the thioglycollate broth tube culture, it was suspended on the upper layer as a whitish ring-form of granules. The microorganism showed no urease activity. In the assimilation tests, there were positive reactions to glucose, galactose, trehalose, fructose, mannose and glycerol, and negative reactions to maltose, xylose, raffinose, sucrose, lactose, cellabiose, n-propanol, etc. The electronmicroscopic examination of the colony revealed sporangium containing spores and characteristic dense body and plastids in the spores.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult T-cell leukemia/lymphoma in Taiwan. A clinicopathologic observation.

The retrovirus-associated adult T-cell leukemia/lymphoma (ATL) has not been previously documented in Taiwan. Five cases identified recently by the authors are reported. Three of the patients were women, and their ages ranged from 36 to 60 years. The most important diagnostic clue was the observation of polylobated lymphoid cells in the peripheral blood. Other variably observed significant features included hypercalcemia, cutaneous eruptions, osteolytic bone lesion, hepatomegaly, and lymphadenopathy. Surface marker studies revealed that the leukemic or lymphoma cells were T-helper cells. Histopathologic examination revealed one case of pleomorphic type and three cases of medium-sized cell type. No tissue was available for study in one case. The diagnosis of ATL was confirmed by the indirect immunofluorescence test on MT-1 cell for antibodies to adult T-cell leukemia virus-associated antigen (ATLA). Three patients were dead within 6 months, and two patients had been in clinical remission for 7 and 10 months, respectively. These two latter cases were similar to the so-called smoldering type of ATL. Two descendents among nine relatives of the patients were also positive for anti-ATLA (22%). Two husbands were negative. Four of the five patients lived in the same county in northeastern coastal Taiwan, which suggested a possible clustering of ATL in that region.

Serological survey of antibodies to the adult T-cell leukemia virus-associated antigen (HTLV-A) in Taiwan.

A serological survey of antibodies to the adult T-cell leukemia virus-associated antigen (HTLV-A) conducted in Taiwan revealed II seropositive individuals among 2,565 serum donors tested, which included 1,187 hospital or free clinic patients, 1,065 blood donors and 313 aborigines. The overall prevalence rate was 0.43% and was 0.90% (9/995) for adults aged 40 years or over, which was similar to the rates observed in the non-endemic areas in Japan. No highly prevalent area was demonstrated. The II seropositive individuals identified were 8 hospital or clinic patients, 1 blood donor and 2 aborigines. Among 108 various leukemia/lymphoma patients also studied, 7 were positive. These 7 anti-HTLV-A-positive patients also had clinicopathologic features of adult T-cell leukemia/lymphoma (ATL). Among 21 relatives of 3 seropositive individuals in the epidemiologic study, 2 were positive; and among 25 relatives of 5 ATL patients, 6 were positive. Our data support the contention that horizontal familial transmission of human T-cell leukemia virus (HTLV-I) is an important route and HTLV-I infection can occur on a different genetic background. Furthermore, the antibody titer did not correlate with the manifestation or the state of the disease.

Cutaneous manifestations of adult T cell leukemia/lymphoma. Report of three different forms.

The clinical and pathologic features of cutaneous lesions observed in three adult T cell leukemia/lymphoma (ATL) patients identified in Taiwan are described. They represent one classical case of ATL and two "smoldering" variants. The classical ATL patient when first seen had numerous erythematous or purpuric papules, nodules, and plaques with or without ulceration. The two "smoldering" cases developed encrusted purpuric plaques with subcutaneous erythematous nodules in one patient and pompholyx-like vesicular eruptions with tumor masses in another patient. The pompholyx-like eruptions have not been described before. Pruritus was the major complaint in two patients. Histopathologic studies revealed pleomorphic infiltration in the classical case and monomorphic infiltration with medium-sized cells in the two "smoldering" variants. Therefore, the cutaneous lesions of ATL are diverse and not pathognomonic. The diagnosis requires a high index of suspicion, detection of circulating characteristic multilobated lymphoid cells with T helper/inducer cell marker, and demonstration of serum antibody against the adult T cell leukemia virus-associated antigen.