Preventive effects of topical washing with miconazole nitrate-containing soap to diaper candidiasis in hospitalized elderly patients: A prospective, double-blind, placebo-controlled study.

The objective of the present randomized, double-blind trial was to evaluate the efficacy and safety of daily washing with miconazole nitrate-containing soap for candidiasis at diaper-covered sites in elderly subjects under long-term inpatient care. To confirm the onset and disappearance of candidiasis, we microscopically evaluated the existence of the pseudohyphae and/or blastoconidia of Candida spp. We enrolled 75 elderly patients who wore diapers all day in the hospital or nursing home. Patients were randomly assigned to receive treatment with either miconazole soap or miconazole-free placebo soap, and 28 patients in the miconazole group and 27 patients in the placebo group were followed for 4 weeks. Although washing with miconazole soap did not affect the frequency of pseudohyphae/blastoconidia-positive patients, it significantly inhibited the positive conversion of pseudohyphae/blastoconidia compared with the placebo group. As a result, the frequency of patients positive for pseudohyphae/blastoconidia was significantly lower in the miconazole group than in the control group at 4 weeks (17.9% vs 44.4%). Clinically apparent diaper candidiasis did not develop in either group. Washing with miconazole soap was a significant independent factor for reducing the cases positive for pseudohyphae/blastoconidia, while diarrhea and heart failure were significant factors associated with an increase in the positive rate at the end-point. Severe adverse effects were not found in any patients. Thus, washing with miconazole soap is well-tolerated and can inhibit the positive conversion of Candida in patients wearing diapers. Therefore, maintenance of genital hygiene using this soap may prophylactically decrease the overall prevalence of patients with diaper candidiasis.

Blue dye and red light, a dynamic combination for prophylaxis and treatment of cutaneous Candida albicans infections in mice.

The objective of this study was to investigate photodynamic therapy (PDT), using blue dye and red light, for prophylaxis and treatment of cutaneous Candida albicans infections in mice. A mouse model of skin abrasion infected with C. albicans was developed by inoculating wounds measuring 1.2 cm by 1.2 cm with 10(6) or 10(7) CFU. The use of a luciferase-expressing strain of C. albicans allowed real-time monitoring of the extent of infection in mice noninvasively through bioluminescence imaging. The phenothiazinium salts toluidine blue O (TBO), methylene blue (MB), and new methylene blue (NMB) were compared as photosensitizers (PS) for the photodynamic inactivation of C. albicans in vitro. PDT in vivo was initiated either at 30 min or at 24 h after fungal inoculation to investigate the efficacies of PDT for both prophylaxis and treatment of infections. Light at 635 ± 15 nm or 660 ± 15 nm was delivered with a light dose of 78 J/cm(2) (for PDT at 30 min postinfection) or 120 J/cm(2) (for PDT at 24 h postinfection) in multiple exposures with bioluminescence imaging taking place after each exposure of light. In vitro studies showed that NMB was superior to TBO and MB as the PS in the photodynamic inactivation of C. albicans. The efficacy of PDT was related to the ratio of PS concentration to fungal cell density. PDT in vivo initiated either at 30 min or at 24 h postinfection significantly reduced C. albicans burden in the infected mouse skin abrasion wounds. These data suggest that PDT is a viable approach for prophylaxis and treatment of cutaneous C. albicans infections.

Candida krusei fungemia in an immunocompromised patient.

Candida krusei is an emerging fungal pathogen found primarily in immunocompromised patients. Intrinsic resistance to fluconazole and decreasing susceptibility to other anti-fungal agents are problematic. When colonization occurs, dissemination may follow rapidly. We present a case of a patient with acute lymphoblastic leukemia who, despite being treated prophylactically with fluconazole, developed disseminated C. krusei.

Use of chlorhexidine-impregnated patch at pin site to reduce local morbidity: the ChIPPS Pilot Trial.

Pin tract infection is one of the most common complications associated with the use of external fixation. While some studies have identified the potential benefit of chlorhexidine gluconate-impregnated polyurethane dressings to reduce the incidence of catheter-related bloodstream infections, we are unaware of any published studies that evaluate the effectiveness of similar technologies in reducing the risk for external-fixation-related pin tract infections. Therefore, the purpose of this study was to evaluate the effectiveness of chlorhexidine gluconate-impregnated polyurethane dressing in reducing percutaneous-device-related skin colonisation and local infections. In this initial retrospective cohort, data were abstracted for two groups of consecutive patients undergoing surgery involving external fixation at an interdisciplinary foot and ankle surgical unit. All patients received surgical treatment of their foot/ankle pathology along with application of a hybrid external fixator. Twenty patients (45% male, age 54.5 +/- 3.69 years) received chlorhexidine gluconate-impregnated polyurethane dressing and twenty (55% male, age 55.8 +/- 3.22 years) received standard pin care. There was a significantly higher rate of pin tract infection in patients who received standard pin care compared with those who received chlorhexidine gluconate-impregnated polyurethane dressings (25% versus 0%, P = 0.047). There was no significant difference in any of the descriptive study characteristics (age, gender, diabetes and presence of neuropathy). The results of this initial study suggest that chlorhexidine gluconate-impregnated polyurethane dressing may be effective to reduce the incidence of pin tract infections and help decrease morbidity associated with external fixation.

Candidiasis cutaneomucosas. Manifestaciones clínicas / Mucocutaneous candidiasis. Clinical manifestations

Resumen La candidiasis cutaneomucosa se presenta con una gran variedad de manifestaciones clínicas y con características especiales en las diversas etapas de la vida. En la infancia es característica la aparición del muguet o de la candidiasis del área del pañal; en la edad adulta muchas manifestaciones orales están asociadas al uso de prótesis dentales, y entre adultos jóvenes es muy frecuente la balanitis y la vulvovaginitis candidiásica. No hay que olvidar que entre los pacientes con sida genera una enfermedad frecuente y resistente. Durante muchos años, en España no fue raro encontrar, entre heroinómanos, una foliculitis producida por Candida; sin embargo, la manifestación cutánea más relevante es el intertrigo, relacionado con factores de humedad y a veces en relación con la diabetes. La perionixis y la onixis por Candida no son muy frecuentes y precisan un diagnóstico certero para su tratamiento. Controvertida es la alergia a Candida, no aceptada por todos, y que sin embargo es importante tener en cuenta en algunos procesos cutáneos (AU)

Mucocutaneous candidiasis presents a wide variety of clinical manifestations with special characteristics in the distinct stages of life. In childhood, candidal napkin dermatitis around the nappy area is common; in adults, many oral manifestations are associated with the use of dental prostheses, and among young adults candidal balanitis and vulvovaginitis are frequent. This infection is both frequent and often resistant among patients with AIDS. For many years, it was not uncommon to find candidiasis folliculitis among heroin addicts in Spain; however, the most important cutaneous manifestation is intertrigo, which is related to humidity and sometimes to diabetes. Candidal perionyxis and onyxis are not common and require an accurate diagnosis for treatment. Candida allergy is controversial and not universally accepted. However, it should be borne in mind in some cutaneous processes (AU)

Descriptive study of peristomal complications.

OBJECTIVE: The objective of this study was to assess new ostomy patients for the presence of peristomal complications when they returned for their 2-month postoperative follow-up at a major university hospital. DESIGN: A prospective descriptive design was used. SETTING AND SUBJECTS: For 1 year, new ostomy patients were seen at a 540-bed university-based hospital. Subjects included 220 patients with ostomies who underwent a fecal or urinary diversion at a university-based hospital. INSTRUMENTS AND METHODS: For 12 months, each patient who returned for a 2-month follow-up visit was assessed by 1 of 3 WOC nurses for the presence or absence of peristomal complications using a tool developed by the investigators. The study was conducted from August 2001 to August 2002. Descriptive statistics were used to summarize the data. RESULTS: A total of 220 new ostomy patients were examined, 35 of whom had peristomal complications for a frequency of 16%. Sixteen of the 35 patients had ileostomies, 10 patients had colostomies, and 9 patients had ileal conduits. Of the 35 patients with peristomal complications, 24 had irritant dermatitis, 7 had mechanical injury, and 3 had Candida infections. The WOC nurses determined the causes of the peristomal complications to be related to flush stomas, peristomal hernias, inappropriate opening in the skin barrier, and mechanical injury from the pouching systems. Nine of 35 patients had flush stomas; 5 patients developed peristomal hernias. For 7 patients, the skin barrier in the pouching system was larger than the stoma, allowing the effluent to contact the peristomal skin, resulting in denuded peristomal skin; and 7 patients had pressure areas on the peristomal skin and were wearing convex pouching systems. CONCLUSIONS: With more laparoscopic ostomy surgeries resulting in decreased hospital stays, there is less opportunity for the patient to learn pouching techniques and problem solving regarding peristomal complications. Patients require more education regarding peristomal issues and follow-up after discharge to ensure the maintenance of a secure pouching system. Decreased hospital stays and decreased reimbursement for outpatient and home health services will continue to be a challenge for the WOC nurse. There is also a need for universal definitions of complications and the need for continued studies examining the frequency of these complications, as well as the role of stoma site marking in reducing these complications.

Nasal vaccination induces the ability to eliminate Candida colonization without influencing the pre-existing antigen-specific IgE Abs: a possibility for the control of Candida-related atopic dermatitis.

In some cases of atopic dermatitis (AD), a possible pathological contribution to disease development by Candida albicans (C. albicans) has been suggested. AD patients with severe symptoms showing positive capsulated hydrolic carrier polymer radioallergosorbent test (CAP-RAST) against C. albicans demonstrated significantly higher levels of serum IgE Abs than did AD patients with mild symptoms. Based on the clinical facts, we have postulated that elimination of C. albicans by mucosal vaccination may lead to the restoration of severe symptoms in AD patients. For this purpose, we have developed an allergic murine model. Mice which were systemically challenged with C. albicans-associated antigen, manganese superoxide dismutase (MnSOD) or secreted aspartic proteases 2 (SAP2), together with alum, exhibited hyper IgE Abs. Systemically primed mice were then immunized with MnSOD or SAP2 plus cholera toxin (CT) as mucosal adjuvant through the nasal route. Interestingly, nasally immunized mice showed increased levels of Candida Ag-specific IgA Ab in fecal and nasal washes as well as in saliva samples but unchanged levels in Ag-specific IgE responses. Consistent with the Ab levels, high numbers of Candida Ag-specific IgA Ab-forming cells were induced in mononuclear cells isolated from intestinal lamina propria, nasal passages and salivary glands of nasally vaccinated mice with Ag plus CT. Furthermore, nasal immunization using MnSOD or SAP2 together with CT resulted in the elimination of colonized C. albicans from the intestinal tract. These results also suggest a potential role of mucosal vaccination in the control of C. albicans in patients with allergic diseases, including AD, although more research is needed to establish this therapeutic approach for mucosal vaccination.

Micosis superficiales: candidiasis y pitiriasis versicolor / Superficial mycosis: candidiasis and pityriasis versicolor

Se exponen las características clínicas de las lesiones cutáneas en las candidiasis y la pitiriasis versicolor. Se hace hincapié en las medidas de educación, prevención y control de estas afecciones a nivel primario de atención médica. Se exponen además las diferentes maniobras terapéuticas, tanto tópicas como sistémicas, con las que se cuenta para su tratamiento, y se hace referencia a las medidas terapéuticas alternativas que brinda la medicina natural y tradicional para estas afecciones(AU)

Micosis superficiales: candidiasis y pitiriasis versicolor / Superficial mycosis: candidiasis and pityriasis versicolor

Se exponen las características clínicas de las lesiones cutáneas en las candidiasis y la pitiriasis versicolor. Se hace hincapié en las medidas de educación, prevención y control de estas afecciones a nivel primario de atención médica. Se exponen además las diferentes maniobras terapéuticas, tanto tópicas como sistémicas, con las que se cuenta para su tratamiento, y se hace referencia a las medidas terapéuticas alternativas que brinda la medicina natural y tradicional para estas afecciones

There's a fungus among us!

Candida infections can be extremely persistent and often are a source of considerable frustration for parents and professionals. Appropriate management of the initial infection is critical. Too often the treatment is inadequate or carried out for too short a period. A fungus is an amazing organism, deceptive in its simplicity, tenacious in its adaptability. Management of candidiasis challenges the lactation consultant to provide not only assessment and intervention but reassurance and reassessment in order to preserve the breastfeeding relationship.

[Skin pathology in industrial microbiology workers]. / Patologiia kozhnykh pokrovov u rabotaiushchikh na predpriiatiiakh mikrobiologicheskoi promyshlennosti.

Skin examinations of the workers engaged in three microbiologic synthesis enterprises revealed changes produced as reactions to the influence of multicomponent industrial factors. The allergic dermatoses, superficial candidiasis and epidermitis occurrence depended on the duration and degree of the contact with industrial biologically active substances. The regularities underlying transformations of the diseases from one form to another were determined. The stage based approach to the treatment and prevention of dermatoses contributed significantly to lowering their prevalence.

[New possibilities of prevention of occupational Candida albicans infection]. / Nowe mozliwosci profilaktyki w grupach zawodowych narazonych na zakazenie Candida albicans.

The effects were studied in vitro of a score of various additives to toilet soaps on strains of Candida albicans isolated from patients. Their effect on the basic properties of toilet soaps was studied, determining foam production and the index of foam stability, and their resistance to high temperature was determined since in the process of production high temperature might reduce their effects on C. albicans. The strongest fungicidal effect was exerted in strongly alkaline soap solutions by Clotrimazole. Good effects were obtained also using Clioquinol, a derivative of 8-hydroxyquinoline. The results of these studies suggest that certain substances may be added for exerting a fungicidal effect in alkaline medium protecting thus against fungal infections.