Atypical and Unpredictable Superficial Mycosis Presentations: A Narrative Review.

While typically exhibiting characteristic features, fungal infections can sometimes present in an unusual context, having improbable localization (eyelid, face, or joint); mimicking other skin diseases such as eczema, psoriasis, or mycosis fungoides; and appearing with unexpected color, shape, or distribution. The emergence of such a challenging clinical picture is attributed to the complex interplay of host characteristics (hygiene and aging population), environment (climate change), advances in medical procedures, and agent factors (fungal resistance and species emergence). We aim to provide a better understanding of unusual epidemiological contexts and atypical manifestations of fungal superficial diseases, knowing that there is no pre-established clinical guide for these conditions. Thus, a literature examination was performed to provide a comprehensive analysis on rare and atypical superficial mycosis as well as an update on certain fungal clinical manifestations and their significance. The research and standard data extraction were performed using PubMed, Medline, Scopus, and EMBASE databases, and a total of 222 articles were identified. This review covers published research findings for the past six months.

Oleaster oil (Olea europaea sylvestris) effects on the efficiency of the reproductive system of diet-induced obese male Wistar rats.

OBJECTIVES: Obesity is the result of oxidative stress (OS), which appears to be linked to male infertility. Oleaster oil has multiple therapeutic virtues due to its richness in natural bioactive compounds. This study aimed to evaluate the effect of Algerian oleaster oil on the reproductive system effectiveness of diet-induced obese male Wistar rats. METHODS: The oil was extracted with an oleodoseur from the oleaster fruits. Rats were fed for 28 weeks two diets: a normal diet (NC group, n=8) and a high-fat, high-sucrose diet (HFHS group, n=32). The obese rats in the HFHS group were then split into three groups at random: the HFHS group, which continued to receive the HFHS diet; the HFHS L-OO group; and the HFHS H-OO group, which received for 6 weeks, respectively, in combination with the HFHS diet, oleaster oil at 1.5 and 3 mL/100 g body weight (BW). Then, the animals were sacrificed. Semen and testes were removed for semen analysis, OS, and histopathological evaluation. RESULTS: The oleaster oil diet induces an improvement in sperm count and viability and a decrease in the percentage of fragmented sperm DNA compared to the group fed the HFHS diet, preserving the testes against OS with a highly significant decrease in testicular MDA. This beneficial effect of oleaster oil on the reproductive efficiency of rats fed the HFHS diet was dose-dependent. CONCLUSIONS: The results showed that the oil decreased body weight, prevented OS and improved male reproductive indicators in HFHS-fed animals. The potential positive effects of oleaster oil on fertility biomarkers may be attributed to its ability to mitigate OS.

Fungal contamination of medical masks among forensic healthcare workers in the COVID19 era.

Background: Medical masks are widely used in health care settings to protect healthcare workers from respiratory infections, particularly in the context of the recent Covid-19 disease. Methods: A cross-sectional study of 52 used masks collected from 52 forensic healthcare practitioners was conducted to culture for fungal isolation and identification. A study of fungal contamination was conducted by making an impression of the mouth mask cut piece on Sabouraud agar for selective isolation; each health worker completed a questionnaire, which included age, sex, type of mask, and duration of mask use. Results: Twenty five of the 52 used masks tested positive for fungal contamination (48,08%). A total of 44% of the contaminated masks belong to health workers between the ages of 21-30 years. Surgical masks (80%), KN95 (8%), and N95 (4%) were the most contaminated protective devices. Usage duration of 1-2 h was associated with 4% of fungal contamination, while a usage duration of 5-6 h was associated with 36% of fungal contamination. Alternaria sp (32%), Penicillium sp (20%), Aspergillus sp (16%) were the most predominant isolated fungi discovered on the inside areas of the masks. Conclusion: Because fungi are known to cause allergies and serious adverse health effects following recommendations to properly wear a medical mask is critical to preventing fungal contamination, especially among health care workers who are wearing the same mask for a long period during the pandemic.

Fungal carriage of hospital trapped cockroaches: A prospective study.

Cockroaches are considered parasite carriers, and their nocturnal habits and regular contact with various environments make them ideal carriers of diverse fungal species. The aim of this study was to isolate superficial fungi carried by cockroaches trapped at our health care institution. A total of 100 cockroaches were captured from 6 wards of the hospital and were investigated for the presence of fungi on their external surface by using SDA medium. In this survey, 78% of the sampled cockroaches were contaminated with 96 fungi of medical importance, and the fungal prevalence was linked to some hospital areas, such as nephroplogy-haemodialysis p = 0,013 OR = 1367 IC95% (1199-1558), which could be explained by the presence of dialysis devices in which cockroaches can hide. Correlations were found between cockroach fungal contamination and the following variables: kitchen p = 0,026, OR = 1,349, IC95% (1190-1530); toilets p = 0,011, OR = 2,813, IC95% (0,868-9112); and patient rooms p = 0,01, OR = 3,621, IC95% (1322-9920), probably due to cockroaches searching for food among waste, garbage, skin flakes, and hair. The main fungi isolated were Rhizopus sp (21,9%), Candida non candida (16,7%), Aspergillus niger (15,6%), and Lichtheimia sp (12,5%). These results suggest that cockroaches act as carriers of several medically important fungi and could be involved in their transfer to hospital settings. There is a need for better control of these insects, especially in kitchens, bathrooms, and patient rooms.

Évaluation de la prescription et de l'utilisation des benzodiazépines dans la ville de Sidi Bel-Abbès / Evaluation of the prescription and use of benzodiazepines in Sidi Bel-Abbes city

Introduction :Une forte consommation des benzodiazépines (BZDs) a été remarquée en dehors parfois des règles de recommandations de prescription, ce qui rend leur consommation un problème majeur de santé publique. La présente étude a eu pour objectif d'évaluer la prescription et l'usage des BZDs dans la ville de Sidi Bel-Abbès. Méthodes-Il s'agissait d'une étude descriptive transversale réalisée du 01 Février 2018 au 30 Juin 2018 évaluant la prescription et l'usage des BZDs dans la ville de Sidi Bel-Abbès au moyen d'un questionnaire distribué aux patients de l'hôpital psychiatrique, du service de psychiatrie du CHU et aux pharmaciens d'officine.Le critère de jugement principal était l'évaluation de la prescription et de l'utilisation des BZDs dans cette ville. La saisie et l'analyse des données ont été réalisées par le logiciel SPSS. Résultats-Au total, 353 patients traités au moins par une BZD ont été inclus dont 178 hommes. Le taux de prescription des BZDs était de 1.10, des jeunes (59,77 %) et des personnes mariées (60,34%) constituaient les consommateurs privilégiés. La prescription était l'apanage des psychiatres, en monothérapie (07,42%), la molé cule la plus fréquemment prescrite était le Bromazépam (31,07%) et la prise noc turne était la plus importante (49,01%). Les BZDs étaient utilisées pour combattre l'insomnie (25,21%), l'anxiété (16,43%), pour une durée de plus d'une année (57,79 %). Conclusion-La prescription et l'utilisation des BZDs dans la ville de Sidi Bel-Abbès s'est avérée importante. L'insomnie et l'anxiété constituaient les principales raisons de leur utilisation, et le Bromazépam était la molécule la plus fréquemment utilisée .

Introduction-A high consumption of benzodiazepines (BZDs) has been noticed so metimes outside the rules of prescription recommendations, which makes their consumption a major public health problem. The present study aimed to evaluate the prescription and use of BZDs in Sidi Bel-Abbès city. Methods-: This was a descriptive cross-sectional study carried out from February 01st, 2018 to June 30th, 2018 evaluating the prescription and use of BZDs in of Sidi Bel-Abbès by means of a questionnaire distributed to patients from the psychiatric hospital, the CHU psychiatry department and community pharmacists. The primary endpoint was the assessment of the prescription and use of BZDs in this city. Data entry and analysis were performed using SPSS software. Results-A total of 353 patients treated with at least one BZD were included, including 178 men. The prescription rate of BZDs was 1.10, young people (59.77%) and married people (60.34%) were the privileged consumers. The prescription was the prerogative of psychiatrists, in monotherapy (07.42%), the molecule most frequent ly prescribed was Bromazepam (31.07%) and night intake was the most important (49.01%). BZDs were used to combat insomnia (25.21%), anxiety (16.43%), for a period of more than a year (57.79%). Conclusion-The prescription and use of BZDs in Sidi Bel-Abbès has proven to be important. Insomnia and anxiety were the main reasons for their use, and Bromazepam was the most molecule frequently used.

Cutaneous sporotrichoid leishmaniasis: An atypical case caused by Leishmania major.

A 32 year-old male was referred in our institution for painless erythematous papules on the back of the right hand, treated by various local therapies with no noticeable benefits. On examination multiples inconspicuous nodules were identified 10 days after the onset of the primary lesion. Mycological examination was done to rule out sporotrichosis, then cutaneous leishmaniasis was retained by finding amastigotes forms, and Leishmania major agent was confirmed after culture on NNN medium followed by isoenzyme electrophoresis. Sporortrichoid leishmaniasis is a rare condition and usually due to extension of local leishmaniasis into the subcutaneous tissue via direct extension, bloodstream or lymphatics. The patient responded favorably to Meglumine antimoniate treatment. To our knowledge, sporotrichoid cutaneous leishmaniasis after an erythematous-papular onset has never been reported in Algeria, this clinical entity should be considered for an earlier diagnosis and specific therapy.

Delusional Parasitosis in a School Teacher Living in a Rural Area: Parasitological Approach.

Delusional parasitosis is a psychotic illness. Patients often present to dermatologists with scars that are self-inflicted because they attempt to extract the "parasites". We report a 58 -year-old female with an eight-month history of a crawling sensation on her skin and constant generalized itching, which she believed to be caused by insects and worms crawling across her skin. Examination revealed self-inflicted scratches at various stages of healing, which were limited to body parts within easy reach. The patient visited many physicians; it seems that she mutilated in an attempt to remove the offending organisms. She also presented skin scrapings and debris to her doctors, claiming that they contained worms and insects. Light pressure on the lesions did not produce any extrusion of macroparasites, and no parasites such as helminths and insect larvae (myiasis), were observed during microscopy. Thin smear scrapings were stained and examined to rule out parasitic diseases such as leishmaniasis and mycosis; however, no evidence of parasites was found. Our patient was administered with amisulpride 100 mg twice a day, which resulted in the complete remission of delusions after five weeks. The skin lesions were managed with clobetasol propionate ointment. A careful clinical examination combined with parasitological tests can be decisive in diagnosing delusional parasitosis, especially for patients from rural areas.

Candida guilliermondii Onychomycosis Involving Fingernails in a Breast Cancer Patient under Docetaxel Chemotherapy.

Onychomycosis has been shown to have a higher incidence in cancer patients. Nail toxicity is a quite common side effect of anticancer agents. Taxotere© is a chemotherapeutic known to cause great incidence of nail change and has a role in subungual suppuration. We report on a 52-year-old woman with breast cancer admitted in our institution for onycholysis. Because of the stage and histology of breast cancer, neoadjuvant chemotherapy was initiated. The patient received 8 cycles of Taxotere and Adriamycin (AT), and she underwent a modified radical mastectomy. Three months later, the patient developed evidence of onycholysis, involving all the fingernails. We observed the following changes in nails of all the digits in both hands: onycholysis, dystrophy, oedema, and exudate. Nail scraping and purulent discharge were collected and cultured on Sabouraud medium. Physical features of the colonies and biochemical tests (Auxacolor©) revealed Candida guilliermondii as the sole etiologic agent of onychomycosis. This case details an onycholysis in a breast cancer case successfully managed solely with amorolfine lacquer. This clinical and mycological presentation should alert the clinician to the possibility of onychomycosis induced by docetaxel chemotherapy.

Variables that Influence Platelet Function Analyzer-100™ Closure Times in Healthy Algerian Adults.

CONTEXT: The Platelet Function Analyzer (PFA-100™) assesses primary hemostasis in vitro under high shear stress to simulate the conditions to which platelets are exposed at the site of an injured blood vessel wall. AIMS: We investigated preanalytical variables in healthy Algerian adults, and we also assess the performance of the test. SUBJECTS AND METHODS: Closure time (CT) was measured in 302 well-characterized healthy Algerian adults with the collagen/epinephrine (CEPI) and the collagen/adenosine diphosphate (CADP) cartridges. RESULTS: Age and sex did not affect CT values. Blood group O was associated significantly with longer CEPI CT and CADP CT than non-O groups (P ≤ 0.0001 for both). CTs were shorter in samples collected in the morning vs the afternoon (P < 0.0001 for both). We found a strong positive correlation between CT CEPI and CT CADP with r = 0.72 and P < 0.001 and an inverse mean correlation between von Willebrand factor level and CT with r = -0.56, r = -0.45 for CT CEPI and CT CADP, respectively P < 0.001. Duplicate analysis of PFA-100™ CT revealed a mean difference of 3.6% ±19.1% for the CEPI cartridge and 1.5% ±10% for the CADP cartridge. The mean coefficient of variation was 7.4% for the CADP CT and 7.6% for the CEPI CT. No marked difference between test positions. CONCLUSIONS: The PFA-100™ showed good reproducibility. The variables influencing the test in healthy Algerian adults are similar to Western and Asian populations. Standardization of preanalytical and analytical conditions is essential for obtaining reliable PFA-100™ results.

Netherton syndrome associated to Candida parapsilosis otomycosis.

A 7-year-old girl born to consanguineous parents, had recurrent erythroderma since birth; she presented with intractable pruritus, scaling, dry skin and eczematous lesions, associated to fingers and toes onychogryphosis, along with refractory otitis. The hair was sparse and brittle, the simple light microscopic examination of hair shaft revealed a pathognomonic Bamboo aspect (trichorrehxis invaginata) and ear swab culture revealed Candida parapsilosis as otitis agent. Due to the lack of genetic routine testing, children with recalcitrant erythroderma and otitis, along with hair shaft abnormalities, need to be evaluated for Netherton syndrome.

Aspergillus Genus and Its Various Human Superficial and Cutaneous Features.

Superficial and cutaneous aspergillosis is a rare fungal disease that is restricted to the outer layers of the skin, nails, and the outer auditory canal, infrequently invading the deeper tissue and viscera, particularly in immunocompromised patients. These mycoses are acquired through two main routes: direct traumatic inoculation or inhalation of airborne fungal spores into paranasal sinuses and lungs. Lesions are classified into three categories: otomycosis, onychomycosis, and cutaneous aspergillosis. Superficial and cutaneous aspergillosis occurs less frequently and therefore remains poorly characterized; it usually involves sites of superficial trauma-namely, at or near intravenous entry catheter site, at the point of traumatic inoculation (orthopaedic inoculation, ear-self-cleaning, schizophrenic ear self-injuries), at surgery incision, and at the site of contact with occlusive dressings, especially in burn patients. Onychomycosis and otomycosis are more seen in immunocompetent patients, while cutaneous aspergillosis is widely described among the immunocompromised individuals. This paper is a review of related literature.

Primary splenic hydatid cyst an unexpected diagnosis: Case report.

INTRODUCTION: Hydatid disease is endemic in farming areas but occurs worldwide. The most common site of disease is liver. Hydatid disease of the spleen is a rare condition. Worldwide incidence of splenic hydatid is 0.5-4%. Surgery is the mainstay of treatment. The standard treatment is open total or partial splenectomy. PRESENTATION OF CASE: A 28 year-old female patient was referred to our institution, after coincidental sonography finding. On abdominal examination, there was no sensitization, and there was no resistance or rebound.Ultrasound showed an enlarge spleen; an abdominal CT confirmed the presence of a splenic cyst at the lower pole of the spleen of 7 cm in diameter, no other organ involvement. The biological confirmation was made by indirect hemagglutination. Spleen-sparing surgery was performed. Macroscopic and microscopic examination of the specimen confirmed Hydatid cyst. The patient was discharged from hospital on the seventh postoperative day with a prescription for albendazole (2 × 400 mg/day) for three months. DISCUSSION AND CONCLUSION: The rarity of primary splenic hydatid disease poses a diagnostic challenge for clinicians, the disease should be considered in differential in every patient in endemic areas with cystic lesion of spleen until proved otherwise, it may be detected incidentally or present with non-specific complaints, preservation surgery should always be tried to avoid post splenectomy infection, especially in young patients.

Establishment of reference intervals for Platelet Function Analyzer -100 closure time in Algerian adults.

INTRODUCTION: The Platelet Function Analyzer-100 (PFA-100) is a point of care instrument that simulates plug formation under high shear flow. The PFA-100 measures the time required to occlude the aperture in a biochemically active cartridge and is expressed in a term of closure time (CT). In Algeria, the reference values used in clinical laboratories are of Western origin. However, ethnic, genetic, dietary environmental, and diet differences between populations may affect reference intervals. We established the reference intervals of PFA-100 closure times in healthy Algerian adults according to the International Federation of Clinical Chemistry method, and we compared them with those of Western and Asian countries. MATERIAL AND METHODS: We enrolled 303 healthy blood donors in the study. 218 subjects met inclusion criteria. We analyzed the blood sample on the PFA-100 for CT with both the collagen epinephrine and collagen ADP cartridges. RESULTS: The reference intervals of PFA-100 collagen epinephrine CT and PFA-100 collagen ADP CT were 91-207 seconds and 71-144 seconds, respectively. Compared to Western and Asian populations, there were significant differences. The upper limits of CTs were higher for Algerians in this study. Our findings show that many healthy Algerians would be incorrectly identified as having a primary hemostasis abnormality according to the reference intervals of the manufacturer and scientific literature. CONCLUSION: This report provides the first reference intervals for PFA-100 CTs in healthy Algerian adults. These results improve the accuracy of diagnosis and patient care in Algeria.

Trichophyton rubrum Skin Folliculitis in Behçet's Disease.

A 29-year-old patient with Behçet's disease based on three major criteria (i.e., oral ulceration, genital ulceration, and eye lesion) presented with intractable pruritus associated with pinpoint red nodules involving the hair follicles of the back along with steroid-refractory local treatment. Simple light microscopic examination of a skin scraping revealed fungal contamination, and culture on Sabouraud's medium confirmed Trichophyton rubrum as the agent of folliculitis. Behçet's disease is characterized by recurrent attacks of acute inflammation. Although the diagnosis of sterile folliculitis-like disorder is currently retained among patients with Behçet's disease, especially in the lower part of the body, it resembles dermatophytic folliculitis, which can be related to immunosuppressive therapy. Hence, patients with recalcitrant folliculitis predominating on the back who are receiving immunosuppressive treatment should be evaluated for fungal infection, as recognition of this disease may enable earlier diagnosis and treatment.

A rare primary hydatid cyst of the psoas muscle in a rural setting: A case presentation.

Hydatid cyst is a zoonosis caused mainly by the larval stage of the cestode worm Echinococcus granulosus, hydatidosis is frequently found in sheep-raising countries such as the Mediterranean countries. The disease usually involves the liver (75%) and lung (15%). We describe a case of hydatid cyst of the psoas muscle; we are reporting this case because of its rarity and its difficulty to diagnose clinically. A 16 -year-old female from rural setting, presented to the department of surgery of our institution, with complaints of right flank pain. On abdominal examination, there was sensitization in the right lower quadrant, and there was no resistance or rebound. On abdominal ultrasonography, a 6 × 6 cm hydatid cyst was detected within the psoas muscle, which was confirmed by positive indirect hemagglutination, no other organ involvement has been detected by CT scan. A pericystectomy was performed; the intact intramuscular cyst was completely excised, Macroscopic and microscopic examination of the specimen confirmed Hydatid cyst. The patient was discharged from hospital on the fifth postoperative day. No local recurrence was detected during postoperative follow up. Hydatidosis should be considered in cases of a symptomatic swelling in musculoskeletal system without history of trauma and irradiation when patients belong to endemic area. Cyst or complex retroperitoneal tumors, cold or pyogenic abscess of psoas muscle are considered in differential diagnosis. In the light of this case and the literature data, we discuss the diagnosis and the therapeutic problems raised by hydatid cyst of the psoas muscle.

Candida albicans Mastitis in Breastfeeding Woman: An Under Recognized Diagnosis.

Breastfeeding has been demonstrated to have many benefits for both mother and child. The diagnosis and management of Candida in the breastfeeding dyad are difficult because diagnosis is most often based on subjective signs and symptoms. Few studies have attempted to confirm the diagnosis with biological tests. A 26-year-old breastfeeding mother presented with stabbing breast pain, accompanied by erythematous, hyperkeratotic areola, and nipples. Histopathological results and direct mycological examination, followed by culture and auxanogram, revealed Candida albicans as an etiological agent of mastitis; the case was managed successfully by antifungal medication. Candida mastitis in lactating women is an under-recognized and under-treated cause of breast pain, hyperkeratosis over areola, and discharge of nipple should be assessed by biological tests. The hope is that with an increased awareness of this infection, more mothers will be appropriately treated and will thus be more likely to continue breastfeeding.