Fungal Infections

Causes and Symptoms of Ringworm

patoconnor — Fri, 25 Sep 2009 10:56:39 +0000

Ringworm

Causes and Symptoms of Ringworm
Posted by Bin Du | 16 September 2009, 7:29 am

Ringworm is a skin condition that is far more common than many understand. Luckily, because of its common occurrence, ringworm can be quite easy to identify and treat if one knows what to look for.

The condition’s name, “Ringworm”, is quite misleading. The tell-tale rings of red or flaking patches of skin are actually not caused by a worm at all. Ringworm, formally known as Tinea, is actually caused by a microscopic skin fungus that is related very closely to the fungi that cause athlete’s foot and jock itch. These fungi feed off of skin cells and as they multiply and move on to new skin they produce an itchy and sometimes painful series of rings on the skin.

Identifying ringworm can be quite easy. When looking closely at ringworms, you will notice that the affected area will have a circular or oblong shape. The innermost section of the skin infection will have normal color and texture while the outer “ring” will appear to be red, dry or flakey. The irritated outer edge may appear as a thin line of peeling dead skin, or may look like a thick band of red rash.

The cause of the uniquely round shape of a ringworm infection is the way that the ringworm fungus grows. It begins in a tiny centralized point on the skin, and as the fungus feeds on skin cells it moves outwards towards new territory. The origination point eventually heals itself, and the fungi continue on their outward direction leaving a normal patch of skin in the center of a ring of irritated skin.

As with both jock itch and athlete’s foot, ringworm is contagious. The ringworm infection can be spread through both person to person and person to animal contact. It is most commonly contracted through the sharing of personal items (combs, clothing, etc.) or through direct skin to skin contact (i.e. petting a dog or cat). Fortunately, once ringworms receive treatment and the rash begins to fade they are no longer contagious.

Once you have identified ringworm, begin treating with an over-the-counter antifungal cream. Although there are ringworm-specific ointments, athlete’s foot and jock-itch creams and sprays are also effective at treating ringworm as they are all a member of the same fungi family. With treatment ringworm will fade and clear up within two to four weeks. However, if after administering treatment for two weeks, there is no relief from symptoms or symptoms appear to be worsening you should notify your doctor as the infection may need more aggressive care.

To prevent yourself and others from contracting ringworm, follow the same steps that you would to avoid jock itch and athlete’s foot skin infections. Thorough washing and drying of the skin, nails and scalp are essential for preventing skin infections. Avoid sharing personal items with others and always wear shower shoes and use your own towel when using public showers. Change promptly out of damp or dirty clothing and do not re-wear clothing items until they have been thoroughly washed and dried.

Contact your doctor if you are unsure if your skin infection or rash is ringworm, or if you appear to have numerous skin infections on multiple parts of the body. If proper treatment for skin infection is not received they may worsen and spread, causing great discomfort.

More information on ringworm and other fungal infections can be found at any healthcare website. Two that are easy to use are www.medicinenet.com and www.webmd.com, although additional information can also be found through your medical insurance carrier site or local health department.

- By Denise Kawaii | AC

zikkar

The role of neutrophils in the development and outcome of zygomycosis in haematological patients.

patoconnor — Fri, 25 Sep 2009 10:29:42 +0000

The role of neutrophils in the development and outcome of zygomycosis in haematological patients.

Pagano L, Valentini CG, Fianchi L, Caira M.
Istituto di Ematologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, I-00168 Rome, Italy. lpagano@rm.unicatt.it

Zygomycosis constitutes the third leading cause of invasive fungal infections following aspergillosis and candidosis. Patients with haematologic malignancies or haematopoietic stem cell transplantation are particularly susceptible to zygomycosis. Neutropenia represents the most important pathogenic mechanism influencing the onset and outcome of zygomycosis. Neutrophils cause a lesion of the fungal wall with subsequent destruction by macrophages. They also enhance the activity of antifungal drugs against Zygomycetes. Strategies that aim to increase neutrophil count and function, such as granulocyte colony stimulating factor and granulocyte transfusion, could play an important role in the management of this life-threatening infectious complication.

PMID: 19754754 [PubMed - in process]

Zygomycosis and diabetes mellitus.

patoconnor — Fri, 25 Sep 2009 10:24:17 +0000

Zygomycosis and diabetes mellitus.

Clin Microbiol Infect. 2009 Oct;15

Lanternier F, Lortholary O.

Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Paris, France.

Zygomycoses are severe angio-invasive fungal infections that develop in immunocompromised and diabetic patients. Any episode of sinusitis not responding to short-term antibacterial therapy should evoke the diagnosis of zygomycosis in the latter population, especially in cases of a surrounding necrotic area. Appropriate diagnosis is obtained after careful direct examination of the sample and culture. Current therapy underscores the need to control glycaemia and acidosis in addition for urgent administration of high-dose liposomal amphotericin B in combination with extensive surgery.

PubMed

Incidence of zygomycosis in transplant recipients.

patoconnor — Fri, 25 Sep 2009 10:13:33 +0000

Incidence of zygomycosis in transplant recipients.

Clin Microbiol Infect. 2009 Oct

Cuenca-Estrella M, Bernal-Martinez L, Isla G, Gomez-Lopez A, Alcazar-Fuoli L, Buitrago MJ.
Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain. mcuenca-estrella@isciii.es

Recently, a remarkable increase in the incidence of zygomycosis has been reported from institutions in the USA and Europe. The use of voriconazole for the treatment of aspergillosis and, less frequently, the use of echinocandins as empirical treatment for invasive fungal infections are thought to be responsible for the increase. In addition, an increased incidence of this infection has been observed in transplant recipients, including both haematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) patients. There are no global surveys on the prevalence or incidence of zygomycosis, but data from individual institutions and countries show that zygomycosis is an emerging infection. The increased incidence of zygomycosis most probably reflects a greater frequency of predisposing factors, such as higher numbers of patients undergoing HSCT and immunosuppressive chemotherapy. In addition, the emergence of rare pathogens as a result of the rise in the use of antifungal therapy against common species can be postulated. Further, the availability of antifungal agents with activity profiles that are more specific for selected fungi increases the necessity of identifying pathogenic fungi; the frequency of Zygomycetes infections may have been underestimated until now because therapeutic decisions did not depend on the precise identification of pathogenic fungi.

PubMed

Outbreaks of zygomycosis in hospitals.

patoconnor — Fri, 25 Sep 2009 09:51:49 +0000

Outbreaks of zygomycosis in hospitals.

Clin Microbiol Infect. 2009 Oct

Antoniadou A.
4th Department of Internal Medicine, Athens University Medical School, University General Hospital ATTIKON, Athens, Greece. ananto@med.uoa.gr

Zygomycosis refers to a group of uncommon and frequently fatal mycoses caused by fungi of the class Zygomycetes, the organisms of which are usually found in decaying organic matter. Disease can be transmitted by the inhalation of spores or by direct inoculation on disrupted skin or mucosa. For rare diseases such as zygomycosis, two or more cases occurring in a short time should be investigated as a probable epidemic. Twelve hospital outbreaks and two pseudoepidemics caused by Zygomycetes have been cited in the English literature. The first epidemic was recorded in 1977 and the last in 2008. Outbreaks have been reported in the USA, the UK and elsewhere in Europe. Cases have included cutaneous, disseminated, pulmonary and rhinocerebral disease. Species identified have included Rhizopus arrhizus, Rhizopus rhizopodiformis, Rhizopus microsporus, Rhizopus spp., Absidia corymbifera and Rhizomucor pusillius. Sources of infection have included Elastoplast adhesive bandage rolls, ventilation systems, wooden tongue depressors, karaya (plant-derived adhesive) ostomy bags, and water damage to a linen store and patient shower room. Patients have included cardiosurgery patients, renal transplant recipients, orthopaedic patients, adult leukaemia patients, intensive care unit neonates, immunocompromised haematology patients, and burn unit patients. Although zygomycosis outbreaks in the hospital environment are infrequent, a high index of suspicion should exist if necrotic lesions appear in proximity to a postoperative wound. Direct tissue examination and tissue culture and histopathology must be routinely performed.

PubMed

Hyperbaric oxygen therapy and other adjunctive treatments for zygomycosis.

patoconnor — Fri, 25 Sep 2009 09:46:17 +0000

Hyperbaric oxygen therapy and other adjunctive treatments for zygomycosis.

Clin Microbiol Infect. 2009 Oct.

Tragiannidis A, Groll AH.
Second Department of Paediatrics, Aristotle University, AHEPA Hospital, Thessaloniki, Greece. atriagia@auth.gr.

Zygomycetes are increasingly reported as a cause of life-threatening invasive fungal infections in profoundly immunocompromised patients and in those with diabetic ketoacidosis. Zygomycosis, typically presents as soft tissue, rhino-orbitocerebral, pulmonary or disseminated disease and is characterized by rapid clinical progression and high mortality rates. Treatment with amphotericin B lipid formulations in combination with surgery and, perhaps, the addition of caspofungin offers the best chance for survival; posaconazole, a new antifungal triazole, is increasingly used for consolidation or maintenance therapy. Because of the poor prognosis of zygomycosis, particularly in immunocompromised cancer patients, adjunctive treatments such as hyperbaric oxygen therapy, use of immunomodulatory cytokines, and in vivo iron starvation continue to be explored. However, although each of these modalities is based on a plausible scientific rationale and has been helpful in the management of individual patients, there is no clinical evidence for their general effectiveness as adjunctive treatments in patients with zygomycosis. Further experimental and clinical investigations are necessary to determine whether and how these treatments can impact on outcome and to determine which patients and which types of infection may benefit from them.

PubMed

Clinical presentation of zygomycosis.

patoconnor — Thu, 17 Sep 2009 08:16:43 +0000

Clinical presentation of zygomycosis.

Clin Microbiol Infect. 2009 Oct

Mantadakis E, Samonis G.

Department of Paediatrics, Democritus University of Thrace and General District Hospital of Alexandroupolis, Thrace, Greece.

Zygomycetes are filamentous fungi with a worldwide distribution. This class of fungi encompasses two orders, i.e. the Mucorales and the Entomophthorales. Members of the latter are associated with chronic cutaneous and subcutaneous infections that are limited to the tropics and rarely disseminate to internal organs. The order Mucorales includes several species involved in rhinocerebral, pulmonary, cutaneous, gastrointestinal and other less frequent infections in immunocompetent and immunocompromised individuals, and is characterized by a tendency to disseminate. Portals of entry of zygomycetes are usually the lungs, skin, and gastrointestinal tract. A characteristic property of zygomycetes is their tendency to invade blood vessels and to cause thrombosis-processes that result in subsequent necrosis of involved tissues. Risk factors associated with zygomycosis include prolonged neutropenia and use of corticosteroids, solid organ or haematopoietic stem cell transplantation, AIDS, poorly controlled diabetes mellitus, iron chelation with deferoxamine, burns, wounds, malnutrition, extremes of age, and intravenous drug abuse. Recently, the widespread use of voriconazole for prophylaxis or treatment of aspergillosis in patients with haematological malignancies has been linked with a rise in the numbers of cases of invasive zygomycosis. As the symptoms, clinical signs and imaging findings of these infections are non-specific, a high index of suspicion is required for timely diagnosis. Early diagnosis, correction of the underlying predisposing factors, aggressive surgical debridement of all infected tissues and lengthy administration of antifungals are the only potentially curative options for this rare but emerging invasive fungal infection.

PubMed

Allicin enhances the oxidative damage effect of amphotericin B against Candida albicans.

patoconnor — Sun, 04 Jan 2009 18:01:04 +0000

Allicin enhances the oxidative damage effect of amphotericin B against Candida albicans.

An M, Shen H, Cao Y, Zhang J, Cai Y, Wang R, Jiang Y.
Department of Clinical Pharmacology, Chinese People’s Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, PR China.

Amphotericin B (AmB) is the gold standard of antifungal treatment for the most severe invasive mycoses. In addition to the interaction of AmB with ergosterol in the fungi cell membrane, several studies have demonstrated oxidative damage involved in the fungicidal activity of AmB. In this study, allicin, an allyl sulphur compound from garlic, was shown to enhance significantly the effect of AmB against Candida albicans in vitro and in vivo, although allicin did not exert a fungicidal effect.

Further study first demonstrated that allicin-mediated oxidative damage, such as phospholipid peroxidation in the plasma membrane, via influencing the defence of C. albicans against oxidative damage may be the cause of the synergistic interaction between allicin and AmB.

We envision that a combination of AmB with allicin may prove to be a promising strategy for the therapy of disseminated candidiasis.

Elsevier/ScienceDirect

Strong drug to treat fungal infections

patoconnor — Sun, 04 Jan 2009 17:42:23 +0000

Found: strong drug to treat fungal infections

London, Dec 18 (IANS) Researchers have found that the drug Voriconazole to be highly effective against fungal infections caused by AIDS, cancer treatment or organ replacement, according to a new study.

Voriconazole is an antifungal agent approved for treatment of a broad range of fungal infections, including those caused by Candida species.

Fungal infections can kill people with weakened immune systems, which can be caused by AIDS, cancer treatment or organ replacement.

The research reinforces earlier findings that this drug is a potent treatment for a wide range of these infections.

The study authors, from Britain, the US and New Zealand, analysed susceptibility data for the yeasts isolated from patients taking part in the Voriconazole phase III clinical trials.

The aim was to compare the effectiveness of Voriconazole with other agents, by studying the yeasts’ response to these antifungal agents in vitro, and also to check for resistance to Voriconazole.

The researchers analysed the effect of Itraconazole, Fluconazole, Amphotericin B and Voriconazole versus 1,763 yeasts isolated from samples obtained from 472 patients, according to an Elsevier release.

The authors conclude that “Voriconazole exhibits high potency against a wide range of yeast species. It is notably more active than Fluconazole in terms of both potency and spectrum, but shows similar activity to Itraconazole against most yeasts.”

They also note that the activity of the agent in vitro (test tube) may help predict the response of patients to treatment.

These findings are scheduled for publication in the International Journal of Antimicrobial Agents, published by Elsevier.

Mangalorean News

Sporotrichosis

patoconnor — Tue, 02 Dec 2008 17:09:07 +0000

Sporotrichosis is a fungal infection that frequently occurs following a minor injury while gardening or farming. Spores, which live in vegetation, enter the skin and begin to grow. The fungus follows the lymph channels up the extremity. Granulomatous lesions develop along the lymph channel, ulcerate, and drain. If left untreated, this condition can persist for years.

What is sporotrichosis?

Sporotrichosis is a fungal infection caused by a fungus called Sporothrix schenckii. It usually infects the skin.

Who gets sporotrichosis?

Persons handling thorny plants, sphagnum moss, or baled hay are at increased risk of getting sporotrichosis. Outbreaks have occurred among nursery workers handling sphagnum moss, rose gardeners, children playing on baled hay, and greenhouse workers handling bayberry thorns contaminated by the fungus. A number of cases have occurred among nursery workers, especially workers handling sphagnum moss topiaries.

How is the fungus spread?

The fungus can be found in sphagnum moss, in hay, in other plant materials, and in the soil. It enters the skin through small cuts or punctures from thorns, barbs, pine needles, or wires. It can also be inhaled and cause pulmonary infection or disseminated infection. It is not spread from person to person.

What are the symptoms of sporotrichosis?

The first symptom is usually a small painless bump resembling an insect bite. It can be red, pink, or purple in color. The bump (nodule) usually appears on the finger, hand, or arm where the fungus first enters through a break on the skin. This is followed by one or more additional bumps or nodules which open and may resemble boils. Eventually lesions look like open sores (ulcerations) and are very slow to heal. Pneumonia rarely occurs as a result of inhalation of fungal spores, and can cause symptoms such as shortness of breath, cough and fever. The infection can spread to other parts of the body, including bones and joints and the central nervous system.

Does sporotrichosis involve any other organs besides the skin?

The majority of infections are limited to the skin. Cases of joint, lung, and central nervous system infection have occurred but are very rare. Usually they occur only in persons with weakened immune system.

How soon do symptoms appear?

The first nodule may appear any time from 1 to 12 weeks after exposure to the fungus. Usually the nodules are visible within 3 weeks after the fungus enters the skin.

How is sporotrichosis diagnosed?

Sporotrichosis can be confirmed when a doctor obtains a swab or a biopsy of a freshly opened skin nodule and submits it to a laboratory for fungal culture.

If I have symptoms should I see my doctor?

Yes. It is important for the diagnosis to be confirmed by a doctor so that proper treatment can be provided.

How is sporotrichosis treated?

Itraconazole is the preferred treatment for cutaneous and lymphocutaneous sporotrichosis. It may also be used to treat bone and joint infections. For patients with severe disease, and/or pulmonary, central nervous system or disseminated infection, a lipid formulation of amphotericin B should be used initially. Itraconazole can be used for step-down therapy once the patient has stabilized. Potassium iodide (SSKI) is another option for cutaneous or lymphocutaneous disease that does not respond to itraconazole. SSKI and azole drugs like itraconazole should be avoided during pregnancy. Treatment recommendations may differ for children. Consult your doctor for more information.

Fluconazole is used in patients who do not respond to itraconazole. Systemic or disseminated infection is often treated with Amphotericin B, or sometimes itraconazole. Therapy for systemic disease can last up to 12 months.

How can sporotrichosis be prevented?

Control measures include wearing gloves and long sleeves when handling wires, rose bushes, hay bales, conifer (pine) seedlings, or other materials that may cause minor skin breaks. It is also advisable to avoid skin contact with sphagnum moss. Moss has been implicated as a source of the fungus in a number of outbreaks.

Centers for Disease Control and Prevention

Outlook (Prognosis)(1)

With treatment, full recovery can be expected. Disseminated sporotrichosis is more difficult to treat and requires chemotherapeutic agents. Disseminated sporotrichosis can be life-threatening for immunocompromised people.

Possible Complications (1)

In people with a normal immune system:

Secondary skin infections
Discomfort
In people who are immunosuppressed:
Disseminated disease
Lung and breathing problems (such as pneumonia)
Bone infection
Arthritis
Meningitis
Complications from medications — amphotericin B can have serious side effects

References:

(1) Medline Plus