Mycoses
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Case Reports
Tinea faciei incognito due to Trichophyton rubrum as a result of autoinoculation from onychomycosis.
The localisation of a dermatophytosis on the face is rare. Differential diagnoses include a broad range of dermatological disorders, e. g. contact dermatitis, psoriasis vulgaris, seborrhoeic dermatitis, demodicosis, and polymorphic photo eruptions. ⋯ Both patients were suffering from tinea pedis and tinea unguium caused by the same dermatophyte species. An infection caused by Trichophyton rubrum of the face always occurs following autoinoculation from a pre-existing tinea pedis and tinea unguium of feet and toenails, sometimes of the fingernails.
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A reliable diagnosis of invasive aspergillosis in patients with haematological malignancies is seldom achieved antemortem. Conventional laboratory diagnostic methods are insensitive and time-consuming, resulting in late diagnosis and treatment and contributing to unacceptably high mortality. As a result, routine antifungal prophylaxis and early empirical treatment have been recommended. ⋯ The excellent negative predictive value of these assays should convince clinicians to withhold antifungal therapy in persistently febrile neutropenic patients with no other signs of fungal infection. On the other hand, consecutive positive results in a high-risk population should at least trigger a complete diagnostic work-up. This review will focus on the diagnostic utility as well as on the pitfalls of serial screening for the presence of circulating fungal antigens in haematology patients.
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In diabetic patients, mycotic infections may increase the risk of developing diabetic foot syndrome. However, little data are available on the prevalence of fungal foot infections in patients with diabetes. In a first study published using data obtained during a conference attended by patients with long-term diabetes mellitus type 1 (DM1), 78/95 patients (82.1%) showed probable pedal fungal infections, of which 84.6% (66/78) were mycologically confirmed by direct microscopy and/or culture. ⋯ The sudomotoric activity was impaired in a very high number of participants [107/171 (61.5%)], and was found positively correlated with the prevalence of fungal foot infection in DM2 but not in DM1 and HAP. The high prevalence of fungal infections detected in DM1 as well as in DM2 diabetics is remarkable, especially considering this highly motivated collective. Therefore, it appears that the feet of diabetics require more diagnostic, therapeutic and preventive care in terms of mycotic infections and sudomotoric dysfunction than previously thought.
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Pityriasis versicolor (PV) is a superficial fungal infection where Malassezia species play a definite causative role, but the clinical significance of each of these species is not fully understood. The aim of our study was to analyse the prevalence of Malassezia species in PV lesions and to examine if the range of species varies with patient sex, age, direct microscopy findings and some clinical data. Ninety patients with PV completed the study. ⋯ The most frequently isolated species from clinically healthy skin were M. globosa (49%), M. sympodialis (37%) and M. furfur (5%). We found significant difference in the distribution of Malassezia species between lesional and non-lesional skin and in the distribution of Malassezia species according to the direct microscopy findings. M. globosa in its mycelial phase is the predominant species involved in the aetiology of PV.