[Sports-induced infections--an overview]

Sportive activities are playing an increasing role for the spare time in our society. Subsequently, practicing of various kinds of sport can lead to direct and indirect exposures to and transmission of microorganisms between athletes and also passive observers. As a result, different microbial pathogens can be transmitted and might lead predominantly to cutaneous or mucosal infections. These include both bacteria--Staphylococcus aureus, streptococci and gram-negative bacteria, like Pseudomonas, viruses--herpes simplex virus, human papilloma virus--and, last but not least, also dermatophytes--e.g. Trichophyton tonsurans as particular pathogenic agent of tinea gladiatorum. Beside single cases of infections outbreaks through various virus-, bacteria- and dermatophytes-induced infections might happen and have indeed been reported. Surprisingly, there is only limited knowledge among physicians concerning sport-induced infections. Therefore, sport-induced infections are reviewed giving details about their route of transmission. Awareness of these infections might facilitate implementation of early treatment and preventive measures.

Study of the dermatophytes in dogs and the risk of human infection

BACKGROUND

The infiltrative growth of fungi that multiplies in the tissues (dermatophytes, candida, agents of visceral mycoses) is the generally known proof of "active" functioning of these organisms. The relative importance of fungi as inducers of human and animal diseases grows constantly.

METHODS

The study was carried out on dogs that showed skin changes. The frequency of examinations was determined on the basis of anamneses. Skin scrapings and affected fragile or dull hair and skin swabs were subject to Laboratory diagnostic examinations based on cultivation and microscopical examination. Our evaluations were focused on the type of parasite--ecothrix, endothrix, neoendothrix, and the size of arthrospores.

RESULTS

The results of our study are presented as the incidence of dermatophytes and other micromycetes in 100 samples of skin scrapings and swabs from 100 dogs of both sexes, different breeds and age categories that had exhibited skin problems. We isolated 12 species. Malassezia pachydermatis was the most frequently detected species and was isolated from 31 cases. Trichophyton mentagrophytes was isolated from 2 samples, species Microsporum canis was isolated only from one case, Candida albicans was isolated from 3 samples. The agent Candida krusei was isolated from 5 samples, Candida pulcherrima a relatively rare candidal species, was isolated from skin of an 8-year old Dalmatian bitch, Candida sp. in 5 cases. Trichosporon cutaneum was isolated from a 3-year old Laika etc.

CONCLUSION

This study confirms the need of constant research in this area. This indicates that the incidence of mycoses in dogs and other pets is of importance in the exposure of people to the risk of acquiring mycotic infections. (Tab. 1, Fig. 5, Ref. 57).

[Epidemiology of dermatomycoses in Slovakia]

The authors analyze the incidence of dermatomycoses in the Slovak Republic in 1994-1999. They found an increase of these infections in particular epidermophytoses, trichophytoses and candidoses. From 25,762 examined subjects with suspicion of dermatomycosis they isolated in 1990 till 1999 8,237 cultures of dermatophytes. The most frequent causal agent was Trichophyton rubrum (81.61%). In the conclusion the authors draw attention to the inevitability of introduction of effective preventive measures.

Skin colonization by Malassezia species in neonates: a prospective study and relationship with neonatal cephalic pustulosis

OBJECTIVES

To assess skin colonization by Malassezia species in full-term healthy newborns, to investigate factors associated with colonization, and to look at acnelike cephalic pustulosis associated with this carriage.

DESIGN

Samples were obtained from neonates and their mothers 0 to 5 days after birth and again 3 weeks later. Clinical patterns of common acnelike pustulosis were reported as mild (<10 papulopustules), moderate (> or =10 papulopustules), or absent. Direct examination and culture of sample. Identification of yeasts was based on microscopic and physiologic criteria.

SETTING

A maternity hospital and the pediatric dermatology unit of a university hospital.

PARTICIPANTS

Consecutive series of 102 neonates and their mothers.

MAIN OUTCOME MEASURES

Incidence of skin colonization and type of Malassezia species found in neonates and correlation with neonatal cephalic pustulosis (neonatal acne).

RESULTS

At the first visit, 11 neonates and 36 mothers had cultures positive for Malassezia. Malassezia sympodialis and Malassezia globosa were preferentially cultured. At 3 weeks, 29 (52%) of 56 neonates and 18 (32%) of 56 mothers had cultures positive for only M sympodialis and M globosa. Breastfeeding was not associated with a higher prevalence of Malassezia carriage in neonates. Malassezia colonization was higher when pustulosis was more severe and M sympodialis was found in pustules.

CONCLUSIONS

Malassezia colonization begins at birth and increases in the first weeks of life. A high prevalence of M sympodialis in neonates is noted from birth. Its association with neonatal acne is confirmed. Further investigation is needed to study the role of sebum secretion rate and quality in the neonatal period.

Imported skin diseases in dermatology

Millions of afflicted people suffer from conditions which Japanese dermatologists may rarely encounter. Many of our patients travel extensively either as part of work-related business trips or during vacationing. From three to ten percent of travelers experience skin, hair or nail disorders. With worldwide travel heightening exposure to the causative agents, there is an increasing likelihood that a patient with leishmaniasis, Boutonneuse fever, onchocerciasis, loaiasis, dengue fever, cutaneous larva migrans or other recently acquired skin conditions from a far away land will visit your office for diagnosis and treatment. The clinical characteristics, diagnostic tests and therapeutic options for such imported tropical diseases will be discussed.

Scytalidium dimidiatum melanonychia and scaly plantar skin in four patients from the Maghreb: imported disease or outbreak in a Belgian mosque?

Scytalidium dimidiatum is a geophilic dematiaceous, non-dermatophyte mould that can become a pathogen for plants and humans particularly in tropical and subtropical regions. We report 4 cases of S. dimidiatum onychomycosis presenting clinically as thickened and dark toenails. The skin of the soles was scaly. The time and location of the contaminations were uncertain. Indeed, the patients were ancient immigrants from the Maghreb to Belgium. They were also regularly travelling to their countries of origin. They were also often barefoot in the same Belgian mosque. The disease was unresponsive to current oral antifungal treatments.

Effectiveness of terbinafine in the eradication of Microsporum canis from laboratory cats

In this study, the coats of 20 cats with no dermatophytosis lesions were sampled for colonization by Microsporum canis, which was isolated in 45% of cases. All cats were treated with oral terbinafine for 3 weeks. The drug was administered orally at a daily dosage 8.25 mg kg-1. Mycologic status was assessed at the end of the treatment; and after follow-up at 2 days, and 4 and 9 weeks. The final evaluation revealed a complete mycologic cure of all cats by obtaining negative cultures, thereby demonstrating that terbinafine is an effective method of eradication of dermatophyte colonization.

Two cases of tinea corporis by infection from a rabbit with Arthroderma benhamiae

The first cases of tinea corporis with Arthroderma benhamiae in Japan are reported. A 7-year-old girl and a 30-year-old mother in Shimane prefecture suffered from dermatophyte infections on the neck, shoulder, arms and leg. Three isolates from the two patients and a rabbit by which they supposedly were infected, were identified as Trichophyton mentagrophytes. On the bases of mating tests using the tester strains of both the African race and the Americano-European race of A. benhamiae, they were identified as A. benhamiae African race mating type (-). Our results are the first to indicate that both races of A. benhamiae exist in Japan.

Experimental transmission of cutaneous chytridiomycosis in dendrobatid frogs

In a series of three experiments during March-October, 1998, two species of captive-bred poison dart frogs (Dendrobates tinctorius and D. auratus) were exposed to Batrachochytrium dendrobatidis, a recently-described chytridiomycete fungus (chytrid) that was originally isolated from a blue poison dart frog (D. azureus). All frogs exposed to the chytrids developed a fatal skin disease, whereas none of the control frogs developed skin lesions. The most consistent clinical sign in chytrid-exposed frogs was excessive shedding of skin. Gross lesions were subtle, usually affected the legs and ventrum, and consisted of mild skin thickening and discoloration. Microscopic examination of shed skin pieces and/or skin imprints demonstrated the presence of chytrids and was used for ante mortem and post mortem confirmation of chytrid infection. Histologically, there was epidermal hyperkeratosis, hyperplasia, and hypertrophy associated with low to moderate numbers of chytrids in the keratinized layers. These experiments demonstrated that Batrachochytrium dendrobatidis can be a fatal pathogen in poison dart frogs. The experimentally-induced disease in these frogs resembled cases of cutaneous chytridiomycosis that have recently been described in several other species of captive and wild amphibians.

[Dermatophytoses due to domestic animals]

Dermatophytoses are superficial skin infections due to dermatophytes which are filamentous fungi. Some dermatophytes can be hosted by domestic animals. In Belgium, Microsporum canis, Trichophyton (T.) mentagrophytes variety mentagrophytes, T. verrucosum and T. equinum are zoophilic species capable of infecting humans. Animals, clinical aspects in humans and the investigations needed will be reviewed. Treatment should target animal and patient but also limit the spread of the infection. Topical therapy is sufficient in cases restricted to the skin. When hair is involved, systemic treatment becomes mandatory. The withdrawal of griseofulvin from the Belgian market more than two years ago has made it necessary to introduce the mode of use of the newer antifungals such as fluconazole, Itraconazole and terbinafine.

[Tropical cutaneous mycoses]

In the field of cutaneous mycoses, some are cosmopolitan and others keep a geographical territory of predilection. Such a fact is bound to the fungus identity and natural biotope, and to the overall quality of public health in the region under consideration. Some of the tropical mycoses of cutaneous origin remain superficial in extension. Others are semi invasive or are even at risk of systemic dissemination.

Presence of keratinophilic fungi with special reference to dermatophytes on the haircoat of dogs and cats in México and Nezahualcoyotl cities

In order to study the presence of keratinophilic fungi with special reference to dermatophytes on the coat of dogs and cats living in the cities of Mexico and Nezahualcoyotl in the Metropolitan area of Mexico City, two hundred samples were collected from dogs and one hundred from cats by using the MacKenzie's tooth brush technique, they were processed by routine mycological methods for dermatophyte fungi, results were analyzed by means of the statistical packages SAS. There were isolated 67 and 90 keratinophilic strains from cats and dogs samples, respectively. The most commonly fungi isolated in pure culture in this study were Chrysosporium spp (25%), followed by Trichophyton terrestre (22%), Microsporum gypseum (5%), M. canis (4%), as well as mixed cultures like Chrysosporium spp. & M. gypseum (2%) and T. terrestre & T. mentagrophytes (1%). Keratinophilic fungi were found in higher numbers in the cat haircoat (67%) than in the dog's (45%) and the same was true with regard to dermatophytes with 12 isolates out of a 100 samples in cats and 7 Isolates out of 200 samples from dogs. This may represent a health risk for humans in contact with a dermatophyte infected cat or dog.

[Farm animals as disease vectors of parasitic epizoonoses and zoophilic dermatophytes and their importance in dermatology]

Different pest arthropods and dermatophytes occurring primarily in farm animals may be transmissible to man and produce human dermatoses. The movement and cutaneous penetration habits of external parasites often cause crusted papules, severe itching and dermatitis or may damage their hosts by blood-sucking or by sensitizing them to their saliva. Furthermore different dermatophytes should be considered a possible cause of human skin lesions. Farm animals (cattle, pig, poultry, and rabbit) can transmit external parasites (ticks: Ixodes ricinus, Argas reflexus; fleas: Ceratophyllus gallinae, Spilopsyllus cuniculi, and mites: Sarcoptes scabiei var. bovis, Sarcoptes scabiei var. suis, Dermanyssus gallinae, Cheyletiella parasitovorax), and dermatophytes (Trichophyton sp., and Microsporum sp.). People who have close contact to infested farm animals are more often exposed to epizoonotic infections. Certain professions, such as farmers, and veterinarians, are especially vulnerable.

Parasitic relationship between Microsporum canis and the cat

Cats are often cited as reservoirs of M. canis but it is questionable whether M. canis is part of the resident flora of the cat's skin and hair or only a transient organism. Studies indicate that M. canis is most often isolated from cats at risk of infection or exposure from other infected cats or from a contaminated environment. Many more cats are culture-positive for M. canis than have dermatophytosis. Culture isolation alone is not an indication of dermatophytosis; the diagnosis of dermatophytosis requires microscopic evidence of infection as well as culture evidence of the presence of the dermatophyte. The cat's hair coat adopts the culture image of its surroundings. Diverse factors may influence the frequency of isolation of M. canis. Nevertheless, isolation of M. canis implies either active disease or fomite carriage and warrants aggressive investigation of the clinical situation.

[Dermatomycosis in human and animals]

Dermatomycosis including dermatophytosis, sporotrichosis and cryptococcosis commonly occurs in humans and animals all and are considered to be zoonotic diseases. Recently, human cases of dermatophytosis transmitted from animals are increasing in number due to changes in the environments of human and animal life. Three species of dermatophytes, Microsporum canis, Trichophyton mentagrophytes and T. verrucosum are the most important pathogens from animal to human, respectively. Therefore, it is necessary to understand their biological and ecological characteristics to correctly diagnose and treat the disease. Some human cases of sporotrichosis and cryptococcosis were reported to be transmitted from animals in Europe and America, suggesting that medical doctors should be careful in taking the history of human patients with reference to their contacts with animals. Close cooperation between medical and veterinary doctors is required in clinical studies on mycotic infection.

Experimental exposure of Canadian toads to Basidiobolus ranarum

Experimental transmission of the fungus Basidiobolus ranarum was induced in two treatment groups of Canadian toads (Bufo hemiophrys) and caused a fatal mycotic dermatitis. Seven of 10 (70%) toads that had their ventral skin mildly abraded and exposed to B. ranarum developed hyperemia, and sloughing of their ventral skin and died. Toads with abraded ventral skin or exposure to infected skin also were affected statistically at a higher rate than those with abraded skin and exposure to pure cultures of B. ranarum inoculated into their water source. Of toads showing clinical disease, B. ranarum was identified by both impression smears and histology in all cases, but not from toads that appeared clinically healthy. The organism was cultured from 5 of 7 (71%) toads with clinical disease but not from any toad that appeared clinically healthy (n = 28). This study documents methods of experimental transmission of B. ranarum, an organism responsible for causing a mycotic dermatitis that is fatal to toads.

Occurrence of dermatomycosis (ringworm) due to Trichophyton verrucosum in dairy calves and its spread to animal attendants

Persistent dermatomycosis (ringworm) caused by Trichophyton verrucosum affected 20 dairy calves aged between 3 months and 1 year and housed together. The infection also spread to 2 animal attendants working among the calves. The major clinical lesions observed on the affected calves were extensive alopecia and/or circumscribed thick hairless skin patches affecting the head, neck, flanks and limbs. The observed lesions persisted for more than 17 weeks and most of the calves did not respond to topical treatment with various anti-fungal drugs within the anticipated period of 9 weeks. Two animal attendants developed skin lesions that were circumscribed and itchy and there was good response to treatment following the application of anti-fungal skin ointment. Although ringworm in dairy animals in Kenya has not previously been associated with spread to humans, the potential is evident from this report.

[Cutaneous zoonoses transmitted by dogs and cats]

Pets like dogs and cats are responsible for a series of zoonotic disorders. Some of these diseases are inflicted by bites, scratches or licking. Others result from a close contact with fur, or are transmitted by ectoparasites or by the contaminated environment. Some systemic infectious and parasitic diseases are transmitted from animals to humans and vice versa. Such situation may lead to endemic problems in some communities.

Cutaneous manifestations of Paecilomyces lilacinus infection induced by a contaminated skin lotion in patients who are severely immunosuppressed

BACKGROUND

New opportunistic fungal infections cause significant morbidity and death in patients who are severely immunocompromised. Cutaneous lesions may be the first clinical manifestation and give the clue to early diagnosis.

OBJECTIVE

The purpose of this study was to describe the clinical and histologic manifestations of Paecilomyces lilacinus infection in patients who are severely immunosuppressed.

METHODS

Within a 3-month period, we observed 5 patients with allogenic bone marrow transplantation and 4 patients with aplasia after chemotherapy for hematologic malignancies who developed skin eruptions caused by invasive P lilacinus.

RESULTS

The skin lesions began in 7 cases during or shortly after recovery of pancytopenia. Most of the skin lesions were located on the lower extremities. The cutaneous manifestations were highly variable including erythematous macules, nodules, pustules, vesicular lesions, and necrotic crusts. In 3 biopsy specimens, histologic examination revealed hyphae in periodic acid-Schiff-stained sections. In all patients P lilacinus was isolated from skin tissue samples. P lilacinus was identified from all lesions either by skin biopsy or needle aspiration from clinically evident lesions. In 3 additional cases, the patient's hands were colonized without skin lesions. The source of the epidemic outbreak was finally traced down to several contaminated lots of a topical moisturizing agent. Two patients died; one patient had septic lesions in the eye and kidney as the result of P lilacinus.

CONCLUSION

Clinical and histologic findings of P lilacinus infection with cutaneous manifestations in patients who are severely immunosuppressed are summarized. P lilacinus is resistant to all systemic antimycotics available, and in general, recovery of immunosuppression is necessary to eradicate the mold. Contaminated topical dermatologic agents should be included in the differential diagnosis as a source for severe epidemic cutaneous manifestations of fungal infection in patients who are severely immunosuppressed. This fact implies that additional safety guidelines are necessary for topical dermatologic agents used for patients who are severely immunosuppressed.

[Zoophilic dermatophytes as epizoonoses pathogens and their significance to dermatology]

Different dermatophytes occurring primarily in animals may be transmissible to man and produce human disease; such zoophilic fungi should be considered a possible cause of skin lesions of unclear origin. Several species including Trichophyton verrucosum, Trichophyton mentagrophytes and Microsporum canis may infect human skin, causing a variety of signs and symptoms. People who have close contact to infested cattle or cats are more often exposed to fungal infections. Certain professions, such as farmers, and children are especially vulnerable. Finally, less common ways of transmission of dermatophytoses from other animal species to man are discussed.