[A case of Folliculitis barbae Candidomycetica]

A 71-year-old man was referred to our department on January 30, 1998 with hard red papules that had developed on the philtrum in mid-January. On January 2, the patient had received high-dose steroid therapy (pulse therapy) for cluster asthma attacks and antibiotics at the Department of Internal Medicine of our hospital. Infiltrative, protruding reddish plaques were observed on the philtrum, which contained a number of small pustules at sites corresponding to hair follicles. There was partial opacity and slight irregularity of the nail plates on the first and second toes of the right foot. Fungal elements were detected from a lesion on the mustache and the nail. Histological examination of the lesion on the philtrum revealed infiltration of inflammatory cells comprising neutrophils, lymphocytes, and macrophages around the hair follicles. Beard hair and nail cultures revealed Candida albicans A, indicating that the patient had candidal sycosis and candidal onychia. He was treated with oral fluconazole (100 mg/day). The lesion was clinically improved within 50-days. Recently, extensive use of steroids and antibiotics has produced an increase in reports of patients with Folliculitis barbae Candidomycetica. We believe that the present case was also induced by high-dose steroid therapy and antibiotics.

Common viral and fungal skin infections

Skin infections account for a significant portion of dermatologic diseases, often resulting in, or as a consequence of a disruption in the skin's integrity. This paper covers the presentation, diagnosis, and treatment of the more common viral and fungal skin infections. The viral infections presented in this paper include herpes simplex virus, herpes zoster, condyloma acuminata, and molluscum contagiosum. The fungal infections presented include tinea pedis, tinea cruris, tinea capitis, tinea unguium, tinea versicolor, and candidiasis. Once a diagnosis is made, treatment with appropriate antifungal, antiviral, destructive, or immune modifying therapies can be instituted.

[New developments in medical mycology]

Not only have the systemic mycoses clearly increased in number but also mycoses of the skin are more common than presumed in the past. Today onychomycosis is found in up to 10% of human beings. Onychomycosis can compromise quality of life markedly. Common tinea pedis is one of the most important risk factors for erysipelas of the lower legs. The clinical presentation of oral candidosis in HIV-infected patients is changing; Candida dubliniensis has been identified as another important causative microorganism. Onychomycosis today in most cases can be cured using terbinafine or itraconazole. When choosing the ideal drug in a given case, both the benefit risk ratio and the benefit cost ratio have to be taken into account. Liposomally encapsulated amphotericin B represents a major breakthrough in the treatment of systemic mycoses or fever of unknown origin. The same applies to liposomally encapsulated econazole with respect to tinea pedis. In regard to the pathogenesis of Candida infections the family of secreted aspartic proteinases plays a major role as a virulence factor and possible future target for antimycotic treatment.

[Diagnostic image (6) (Pustulous skin lesions)]

During chemotherapy a 35-year-old woman developed pustulous skin lesions. Biopsies of these lesions showed Candida albicans. Blood cultures were positive for C. albicans. The patient died.

[The clinical characteristics, diagnosis and treatment of soft-tissue suppurative-inflammatory diseases in patients with narcotic dependence]

Comparative analysis of clinical course and the diagnostic methods of purulent-inflammatory disease of soft tissues was performed in 20 patients with drug abuse (the 1st group) and in 20 patients, who are keeping the normal way of living (2nd group). In 16 (80%) of patients of the 1st group the anaerobic non-clostridial infection (ANI) was diagnosed. The factors causing the ANI occurrence, were determined, the programme of treatment was introduced. In the 1st group 3 patients died. The duration of the stationary course in the 1st group was 18 days and in the 2nd one--3.8 days.

Case report. Folliculitis barbae caused by Candida albicans

Folliculitis barbae candidomycetica is a very rare disease and in the scientific literature this manifestation of candidosis is rarely described. In most cases, a connection with predisposing factors is suspected, although in the cases cited this connection was not frequently proved. Furthermore, in our patient who was suffering from a folliculitis candidomycetica no predisposing factors or illnesses were apparent. For this reason, the importance of such aetiological factors of Candida folliculitis must be critically discussed. Effective drugs for use in treatment are fluconazole, itraconazole and ketoconazole.

Congenital cutaneous candidiasis: clinical presentation, pathogenesis, and management guidelines

We describe a term infant with congenital cutaneous candidiasis (CCC), and review all cases in the English literature that reported birth weight and outcome. Presence of an intrauterine foreign body was a predisposing factor for development of CCC and subsequent preterm birth. The most common presentation of CCC in neonates weighing >1000 g was a generalized eruption of erythematous macules, papules, and/or pustules that sometimes evolved to include vesicles and bullae. Extremely low birth weight, premature neonates weighing <1000 g most often presented with a widespread desquamating and/or erosive dermatitis (10 of 15 [67%]), and were at greater risk for systemic infection with Candida spp (10 of 15 [67%]) and death (6 of 15 [40%] than those weighing >1000 g (5 of 48 [10%]; 4 of 48 [8%], respectively). Systemic antifungal therapy is recommended for neonates with burn-like dermatitis attributable to Candida spp, or positive blood, urine, and/or cerebrospinal fluid cultures. Systemic treatment also should be considered for all infants with CCC who have respiratory distress in the immediate neonatal period and/or laboratory signs of sepsis such as an elevated leukocyte count with an increase in immature forms or persistent hyperglycemia and glycosuria.

[Candida in dermatology]

Regarding Candida in dermatology, two pathogenetic pathways must be taken into account: 1. on infection of the skin 2. immunological reactions with skin alterations as a result of Candida infection or colonization in the mouth and/or intestine. Case reports describe typical situations of napkin dermatitis, intertriginous candidosis, the intrauterine Candida infection of the foetus, Candida granuloma, Candida folliculitis and Candida paronychia. In the second part results of investigations of patients suffering from psoriasis, atopic dermatitis and urticaria are presented. There were no differences in the colonization with Candida albicans and in the level of Candida antibody titres between patients and a healthy control group.

Mammary candidosis in lactating women

Though perceived to be a growing problem by lactation professionals, fungal infection of the breast (mammary candidosis) is largely unstudied. Candida albicans, a commensal organism encountered frequently in the vagina and gastrointestinal tract of humans, has been reported to be responsible for both superficial (cutaneous) and localized (ductal) infection of the mammary gland in lactating women, though the latter association is not universally accepted. Severe pain is considered to be characteristic of yeast infection of the breast and may be a cause of premature weaning among lactating mothers. Given that pain is often the complaint that prompts mothers to consult lactation professionals, it is important that healthcare providers working with lactating women be knowledgeable about this disease. In this article, current research regarding yeast infection of the breast is summarized, including morphology and pathology, diagnosis, risk factors, and common treatment options.

Debilitating folliculitis barbae candidomycetica in a trumpeter: successful treatment with fluconazole

A 29-year-old trumpeter, suffering from debilitating folliculitis barbae candidomycetica, was successfully treated with fluconazole 50 mg daily for a period of 4 weeks. Because of the strong local inflammation, oral treatment was initially combined with topical corticosteroid application.

Congenital candidiasis: varied presentations

Congenital candidiasis, especially the disseminated disease, is very uncommon but has been reported in very low birth weight infants. Five cases of congenital candidiasis, two with cutaneous type and three with systemic type, are described. All cases were symptomatic within the first 24 hours of life and none of them had significant risk factors such as the presence of foreign body in the maternal genital tract. Cutaneous candidiasis presented as extensive erythematous rash with infiltrative plaques in one and as bullous lesions in the other. Three infants who had disseminated candidiasis presented with extreme leukemoid reaction, severe hyperglycemia, and skin mottling with some patchy areas resembling first-degree burns, respectively. One infant had meningitis and the autopsy of another who died revealed several microabscesses containing Candida spores in the liver and lungs. The urine microscopy obtained by suprapubic bladder aspiration was found to be a good diagnostic marker of systemic invasion. The purpose of this report is to highlight the importance of recognizing candida as a possible pathogen in a critically ill neonate even though the clinical presentation may be nonspecific and varied. The presence of characteristic skin lesions of Candida species within 24 hours of life is an important clue to the possible diagnosis of congenital candidal infection. Even though very high mortality has been reported in congenital disseminated candidiasis, early recognition and treatment could give a favorable outcome.

[Diagnostic value of Gram staining of peri-catheter skin and the connection in the prediction of intravascular-catheter-related bacteremia]

BACKGROUND

To evaluate the diagnostic value of Gram stain of pericatheter skin swabs and the intravascular device hub in detecting catheter-related bacteremia (CRB) in critically-ill patients.

METHODS

Over a 12-month period, 170 intravascular catheters (> 7 days in place) suspected as being the primary source of CRB were prospectively examined in adult patients admitted to 10 intensive care units of different hospitals in Spain. Blood cultures, Gram staining and culture of swabs obtained from skin entry side and catheter hub were performed before catheter removal. A semiquantitative culture of the catheter tip was carried out. Catheter-associated bacteremia was considered to be present if the same organism was isolated from the catheter tip, skin and/or hub, and blood cultures.

RESULTS

The incidence rate of CRB was 15%. Staphylococcus epidermidis was the most frequently isolated microorganism. Considered together, the sensitivity, specificity, positive predictive value and negative predictive value for Gram staining of the skin and hub were 80, 81.9, 35.3 and 97.1%, respectively.

CONCLUSIONS

The Gram stain of skin and hub swabs has a great utility in predicting CRB, specially in the absence of microorganisms. Gram stains of the above mentioned sites could be recommended as an easy and fast method to rule out the presence of CRB.

Congenital cutaneous candidiasis associated with respiratory distress and elevation of liver function tests: a case report and review of the literature

We describe congenital cutaneous candidiasis (CCC) in a term newborn. The mother had candidal vaginitis 1 week before delivery. At birth, the infant had a generalized, intensely erythematous, papulovesicular eruption, respiratory distress and elevation of liver function tests. The child responded well to intravenous amphotericin B plus topical and oral nystatin. There have been 13 previously reported cases of CCC in infants weighing more than 1500 gm who had evidence of systemic infection. Two deaths were attributed to candidal pneumonia and sepsis. The majority of infants with CCC have infection localized to the skin, but if there is any evidence of respiratory distress or signs of sepsis the possibility of systemic candidiasis and the need for parenteral antifungal therapy must be considered.

Early onset systemic Candida infection in extremely preterm neonates

Classically, systemic Candida infections in preterm neonates occur at a mean age of 1 month. Over an 18-month period in a Regional Neonatal Intensive Care Unit we encountered seven cases of severe Candida infection, all in babies below 26 weeks gestation and weighing less than 0.75 kg. The median age of onset was 7 days (range 0-17), with thrombocytopenia, coagulopathy, hypotension, oedema, and skin breakdown being prominent features.

CONCLUSION

The thin cutaneous barrier may contribute to early onset of systemic Candida infection in preterm infants. The characteristic skin appearance may assist early diagnosis.

[Superficial mucocutaneous mycosis]

Superficial mycosis are very common. The frequency in France is 10 to 15% of the population. The reason for the high incidence of this disease is the change of the moral values, rise in promiscuity and increase sports activities. The agents responsible are divided in four groups. Dermatophytes involve keratin of the skin, hairs and nails but never the mucous membranes. They can cause glabrous skin lesion, tinea corporis, tinea capitis or onychomycosis. Yeast are divided in two groups: the candidiasis and Malassezia furfur, the etiologic agent of pityriasis versicolor. Oral mucosa candidiasis is very common in HIV infected patients.

Cutaneous congenital candidiasis: a case report

Candida albicans is a frequent pathogen of the female genital tract, especially during pregnancy. Congenital candidiasis can occur as cutaneous or disseminated infection. We report a case of congenital cutaneous candidiasis, which may occur more frequently than is indicated by the literature. This is followed by a discussion of the pathogenesis, clinical presentation, diagnosis, and treatment of this infection.

Candida parapsilosis infection in a rose thorn wound

Candida parapsilosis should be recognized by primary care physicians as an important nosocomial pathogen, which is also frequently associated with sporadic skin and appendage infections. Its association with environmentally acquired skin ulcers can mimic fixed cutaneous sporotrichosis.

Mycology of nail disorders

Cases of onychomycosis represent up to 30% of diagnosed superficial fungal infections and are caused by three groups of fungi: dermatophytes, yeasts, and nondermatophytic molds. The majority of toenail infections are caused by dermatophytes; Trichophyton rubrum is isolated with the greatest frequency. In infections of fingernails, Candida species can be isolated as frequently as the dermatophytes. Of the molds, Scytalidium species can infect both fingernails and toenails, as well as adjacent skin, and represent 3% of the nail infections in a temperate country such as the United Kingdom but a much higher proportion in tropical countries. Other molds such as Scopulariopsis, Acremonium, and Aspergillus species can infect damaged nails. The isolation of a dermatophyte is always considered indicative of infection, but the presence of other molds, which may be aerial contaminants, must be interpreted with care.

Congenital cutaneous candidiasis--report of two cases

Candida infection contracted in utero and manifested at birth is a rare event. Two newborn infants are presented with generalized maculopapular rashes at birth. The eruption soon became vesicles or pustules; no other manifestations were found. Candida albicans was isolated from the skin lesion. After topical antifungal application, the lesions became fine and desquamated in the recuperative period. No complication was noted during the course. The diagnosis of congenital cutaneous candidiasis relies on its clinical course and positive culture result of the skin lesion. No systemic antifungal therapy is recommended except for the high risk infants.

[Congenital candida infections]

Congenital candida infection is a rare disease, although the incidence of candida vaginitis during pregnancy is high. We report on five cases each showing patterns considered typical for candida infection. The infective agent can cause chorioamnionitis even in the presence of intact fetal membranes. An intrauterine device (IUD) has been proved to be a risk factor for a congenital candida infection. The pathogenetic significance of contamination with candida for the fetus appears to depend largely on gestational age. A premature infant with a birth-weight less than 1500 g presented with bilateral candida endophthalmitis which was cured by intravenous Fluconazole therapy. Another premature infant weighing 800 g at birth developed a systemic candida infection. The other three more mature infants had milder symptoms, two of them presented with cutaneous candidiasis.

Cutaneous candidiasis. A practical guide for primary care physicians

Cutaneous candidiasis is a common fungal infection that can affect intertriginous or occluded areas, mucous membranes, the glabrous skin, and the nails. The diagnosis is confirmed by microscopic examination of a potassium hydroxide preparation, by Gram's stain or Polysciences Multiple Stain, or by culture when appropriate. Safe, simple, and effective treatment is available. Physical measures that promote dryness are helpful.

Atypical auricular pyoderma gangrenosum simulating fungal infection

We describe a patient with a highly unusual appearance of pyoderma gangrenosum. The pyoderma was located on the auricular region and preceded other manifestations of inflammatory bowel disease by 11 years. There was no correlation between the course of the pyoderma and the clinical activity of the associated bowel disease. Mycotic superinfections masked and delayed the diagnosis in our patient for several years. Only when typical pyoderma gangrenosum lesions developed on the legs at the site of trauma and responded dramatically to systemic corticosteroids was the correct diagnosis established. Pyoderma gangrenosum with secondary fungal infection was thus distinguished from deep ulcerated skin fungal infection simulating pyoderma.

Systemic candidiasis: cutaneous manifestations in low birth weight infants

The cutaneous manifestations of 18 infants treated for systemic candidiasis during a 3 3/4-year period were examined. Eight infants, with a mean birth weight of 712 +/- 161 g, had a diffuse burn-like dermatitis, usually within the first three days of life. Candida pseudohyphae were identifiable on skin scrapings. A history of a maternal cerclage or intrauterine device complicated by chorioamnionitis was common. A delay in diagnosis or therapy resulted in mortality, whereas promptly treated infants survived. Nine additional infants had monilial diaper rashes, which spread to the trunk and extremities in four infants. These infants were older at the onset of the dermatitis, and all survived the systemic infection. Systemic candidiasis without any cutaneous involvement developed in only one infant. Candidiasis should be more frequently considered, and prompt systemic therapy should be instituted when cutaneous candidiasis occurs within the first few days of life in infants who weigh less than 1,500 g.

Cutaneous manifestations of candidiasis

Candida is identified microscopically by the observation of hyphae, linear chains of asexually budding yeast. Since these structures do not grow extensively through the stratum corneum, cutaneous samples may require Gram stain for identification. Since Candida can colonize normal tissue and also be a culture contaminant, clinicians should consider predisposing factors and clinical presentation when making a diagnosis of candidiasis. Predisposing cutaneous factors for candidiasis include occlusion, maceration, and altered barrier function. The hallmarks of Candida infection are bright erythema, fragile papulopustules, and satellite lesions. Cutaneous and mucous membrane candidiasis may differ in appearance, and sexual transmission should be considered. Treatment usually involves a topical or oral anticandidal agent, such as an imidazole. Although implicated as a predisposing factor to candidiasis, mild topical steroids can be used as short-term adjuvant treatment of these infections; when used responsibly, steroids provide antiinflammatory effects that speed relief of patient discomfort.

[Balanitis and differential diagnosis]

In this synopsis the most common balanitides are presented and illustrated in a plate. Special consideration is given the differentiation of the balanitides from each other as well as from malignant diseases. Some modern concepts in the etiopathogenetic development and treatment are mentioned.

Intrapleural inoculation of candida in an infant with congenital cutaneous candidiasis

Though several pathologic processes can produce large denuded skin lesions in very low birthweight infants, trauma is often diagnosed without further investigation. Failure to consider other causes may prevent institution of appropriate specific treatment and may contribute to the development of serious complications, as described in the present case report of a premature infant with congenital cutaneous candidiasis.

Diaper dermatitis

Diaper dermatitis is a term used to encompass a wide range of inflammatory processes that occur in the area covered by the diaper. The term "diaper dermatitis" is thus simply a description of the location of a rash. Numerous factors can be involved in the pathogenesis of dermatitis in the diaper area. These factors, including the role of the diaper, of friction and contact irritation, of urine and ammonia, of feces, of infection, and of underlying dermatologic conditions, are discussed with an emphasis on management of the rash.

Invasive gastric candidiasis

A case of invasive gastric candidiasis is reported. The frequency and importance of Candida sp. as a gastric pathogen is reviewed.