Radiological manifestations of madura foot in the Eastern Province of Saudi Arabia.

A total of 29 patients with mycologically and histopathologically proven mycetomas were examined for radiological manifestations from April 1984 to March 1996. Twenty cases were actinomycotic mycetomas, while nine were maduromycotic mycetomas. Plain x-rays of the regions of interest were taken in all the cases and CT scan was performed on five selected cases to compare the findings. Soft tissue changes were observed in all the examined cases, while bony changes were observed in 16 (55.7%). CT scan is useful for showing soft tissue changes, erosion and destruction of bone in cases with an early infection only, which cannot be demonstrated in plain radiographs.

Fungal infection as a cause of skin disease in the eastern province of Saudi Arabia: cutaneous candidosis.

In the period between April 1984 and April 1988 a total of 4,294 clinically suspected cases of dermatomycoses were examined for causative fungi. Of these cases 174 (4.1%) were suspected as cutaneous candidosis. These cases belonged to 15 different nationalities. Both sexes were involved (122 males and 52 females). Thirty four cases were prepubertal children while 140 were adults. Of these cases 163 had their clinical diagnosis confirmed by direct microscopy and on culture yielded 164 isolates (Candida albicans 161, C. stellatoidea 1 and Trichophyton rubrum 1).

Fungal infection as a cause of skin disease in the eastern province of Saudi Arabia: tinea corporis and tinea cruris.

In the period between April 1984 and April 1988 a total of 4,294 clinically suspected cases of dermatomycoses were examined for causative fungi. Of these cases 768 (17.9%) were suspected as tinea corporis (427 cases) and tinea cruris (341 cases). Twenty two different nationalities were represented. Both sexes were involved and the age range was 19 days to 70 years. Of the 768 patients examined, 738 (96.1%) had their diagnosis confirmed by direct microscopy and in 631 of these positive cases the etiology was determined. Of the 408 patients who had suffered from tinea corporis, 323 isolates were obtained from 313 culturally positive cases. Microsporum canis was the main etiologic agent followed by Trichophyton violaceum, T. mentagrophytes, T. rubrum and Epidermophyton floccosum. Of the 330 patients who had suffered from tinea cruris, 388 isolates were obtained from 318 culturally positive cases and E. floccosum was the main etiologic agent. Next in frequencies were T. rubrum and T. mentagrophytes while Candida albicans was isolated from 45 of 70 patients with mixed isolates. Treatment with topical antifungal agents was effective in most of the cases. Oral griseofulvin in addition to the topical application was found necessary in extensive widespread cases.

Fungal infection as a cause of skin disease in the eastern province of Saudi Arabia: tinea pedis and tinea manuum.

In the period between April 1984 and April 1988 a total of 4294 clinically suspected cases of dermatomycoses were examined for causative fungi. Of these cases 680 were suspected as tinea pedis and tinea manuum. These cases belonged to 21 different nationalities. Both sexes were represented and 649 cases (95.4%) were adults while 31 (4.6%) were prepubertals. Clinical diagnosis was confirmed by direct microscopy in 505 cases or 74.4% (485 adults and 20 prepubertal children). Out of these, 504 cases were positive on culture and yielded 516 isolates. Candida species and other yeasts were responsible for 88.9% and dermatophytes for 11.1% of these infections. The interdigital type of lesions was the most common type (91.9% of all infections) followed by the hyperkeratotic scaling type (6.9%) while the acute inflammatory type was only 1.2% of infections. Treatment showed satisfactory results in most of the cases.

Fungal infection as a cause of skin disease in the eastern province of Saudi Arabia: prevailing fungi and pattern of infection.

A total of 4,294 clinically suspected cases of dermatomycoses belonging to 26 different nationalities were examined between April 1984 and April 1988. Fungi were demonstrated in routine potassium hydroxide/dimethyl sulfoxide mount in 3,814 cases (88.8%) and the etiology was determined by culture in 2,458 cases (57.2%). Tinea versicolor was the predominant fungal infection (30.9% of all infections). Onychomycosis and paronychia ranked second in prevalence (16.8%). Candidal onychomycosis was the most common type of infection. Scalp ringworm among children ranked third (15.3%), Microsporum canis was the main etiologic agent. Tinea pedis and tinea manuum ranked fourth in prevalence (13.2%). Tinea corporis represented 10.7% of infections and M. canis was the main agent. Tinea cruris accounted for 8.7% of infections and Epidermophyton floccosum was the most common agent. Cutaneous candidosis constituted 4.3% of infections. White piedra was seen in 6 cases (0.16%). Yeasts were proved not to be unimportant as a cause of disease of skin and nail in our study.

Broad spectrum antifungal agents in otomycosis.

The in vitro inhibitory activities of four currently used antimycotic agents (clotrimazole, econazole, miconazole and cyclopirox-olamine) against 304 fungal isolates comprising 51 species from 14 genera of moulds and yeasts, using a serial dilution procedure, were studied. Clotrimazole and econazole were found to have a grossly similar broad-spectrum antifungal activity, inhibiting all the tested yeasts and moulds at a concentration ranging from 0.1-4 micrograms/ml. At this range miconazole inhibited 90 per cent of the strains and cyclopirox-olamine inhibited 57 per cent only and thus they were less effective. Econazole 1 per cent solution was very effective in vivo in the treatment of otomycosis within 1-3 weeks. The drug was well tolerated, with no side-effects. Owing to the high broad-spectrum antifungal activity of clotrimazole and econazole, they should be the treatment of choice in otomycosis and can be used safely as otic drops.

Non-invasive antromycosis: (diagnosis and treatment).

Increasing numbers of cases of chronic maxillary sinusitis are encountered which resist frequent sinus irrigation and treatment of predisposing factors. The antral washouts are of unusual consistencies and colours. The antral washouts of six cases were investigated by culture and microscopic examination and proved to contain fungal colonies. Antroscopy was a valuable asset in diagnosis. One patient had a Caldwell-Luc operation and daily irrigation through an indwelling polythene tube followed by daily instillation of clotrimazole (Canesten). The five patients who refused operation were treated by repeated bi-weekly antral washouts followed by instillation of clotrimazole. Weekly samples of antral secretions were examined by culture and microscopic examination until they were free for four consecutive weeks. We believe that frequent antral irrigation and local instillation of a broad-spectrum antimycotic drug--preferably after debridement--is the treatment of choice for antromycosis.

Otomycosis: an experimental evaluation of six antimycotic agents.

One hundred-and eight-six fungi were isolated from one hundred-and-eighty cases clinically diagnosed as otomycosis. They comprise 59 species of 26 genera of moulds, and 2 genera of yeasts. This large variety of mould isolates provided ample material for in vitro experiments, to evaluate the anti-fungal activity of six antimycotic substances found in the preparations currently used for the treatment of otomycosis. The antifungal activity of clotrimazole and tolnaftate in vitro was evident. For over 94 per cent of the 59 fungus species tested, the MIC was less than 0.1 micrograms/ml, and for 6 per cent it was between 0.4 and 1 microgram/ml. Concerning the other 4 antimycotic substances (iodochlorhydroxyquin, fluonilid, natamycine and polymyxin B sulphate) the MIC ranged from greater than 100 micrograms/ml to 1 microgram/ml for the majority of tested fungi. The clinical observations were mostly in accordance with these findings.

Tonsillomycosis: a myco-histopathological study.

Tissues from 227 tonsillectomies, mainly in adults, were examined culturally and histopathologically for the presence of fungus. Actinomyces was demonstrated in 69 cases (30.40 per cent) by both methods. Yeasts and moulds were each isolated from 21 cases (9.25 per cent) and mixed isolates were obtained from 7 cases (3.08 per cent). There was no histopathological evidence of these organisms. Negative cultural and histopathological results were obtained in 53 cases (23.35 per cent). Chloramphenicol-resistant bacteria were cultured in 56 cases (25.11 per cent) but were seen histopathologically in only 25 cases (11.01 per cent). In all cases in which Actinomyces or bacteria were present histopathologically, a minimal tissue response indicated that these organisms were saprophytes and not primary pathogens.

Otomycosis: a survey in the eastern province of Saudi Arabia.

The Eastern Province of Saudi Arabia is characterized by a high perennial relative humidity and atmospheric pressure. One hundred and forty-eight cases clinically suspected of being otomycotic were examined by culture over a period of 13 months; 120 gave positive results and yielded 131 fungal isolates, of which 110 were single infections and 10 mixed infections of two or more fungi. A. niger was the most common (51.15%), then A. flavus (18.32%) Penicillium notatum (5.34%), C. albicans and A. terreus (each 4.58%) A. candidus (3.82%), Mucor spo (2.29%), Alternaria spo and A. clavatus (each 1.53%) and A. versicolor (0.76%). The patients were of 13 different nationalities, mostly labourers and people of low socio-economic standard. Males were affected more than females and ages ranged from 2 to 58 years. Thus racial factors, sex and age have no bearing on otomycosis. Only 8 of the 120 positive cases were affected bilaterally. The role of relative humidity and high atmospheric pressure was briefly discussed.