[Intestinal excretion of nystatin during and after oral administration to newborn infants at risk]

The concentrations of nystatin excreted with faeces during and after oral application of 3 x 150,000 IU/d, either continuously for 14-21 days or every second day were determined in 42 newborns at risk by means of a bioassay (agar diffusion test). Results indicate that nystatin is distributed heterogeneously in the gastrointestinal tract. The excretion occurs discontinuously. 24 to 48 h after beginning of therapy there were effective concentrations of nystatin in the faeces. The daily application of 3 x 150,000 IU nystatin is recommended.

[Practical treatments of suppurative skin mycoses and allergic skin mycoses due to Candida]

In the inflammatory mycoses the author recommends an oral treatment consisting in griseofulvin, and, in case of severe inflammation, prednisone per os at the same time with a local treatment (painting with alcohol iodate 1%, followed by the application of a cream with cortisone associated with an antimicrobial antibiotic and pincer epilation). This way the evaluation is 3-4 weeks shorter and the scars and alopecia are avoided. In the allergic manifestations due to Candida (urticaria, eczema, itching), after discussing their peculiarities the author recommends the desensitization with an extract of Candida cultivated right from patient's primitive focus. This type of desensitization is twice specific: specific anti-Candida and at the same time specific to patient's own strain, even in the case of saprophyte Candida. The very good results obtained after 2-3 months of treatment are presented.

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.

Candidiasis in the breastfeeding mother and infant

Candidiasis in a breastfeeding mother and infant is described. The mother's breasts were a continuous source of Candida albicans, resulting in persistent thrush in the infant. The infant and mother were successfully treated with clotrimazole in a gel form. This report emphasizes the importance of treating both the infected mother and infant to prevent reinfection and ensure successful breastfeeding.

Treatment of cutaneous candidosis in guinea pigs: effect of zinc oxide on the antifungal efficacy of nystatin

This article describes the in vivo evaluation of a new topical preparation (Zincostatin) indicated for Candida albicans infected diaper rash. In order to study the influence of the 20% zinc oxide (W/W) (a protectant) on the anti-candidal efficacy of the 100,000 U/g of nystatin found in the ointment, groups of guinea pigs received different treatments with or without local occlusion. Zinc oxide, nystatin, or the combination of both were applied, in the ointment base, on the backs of the animals inoculated with a fresh strain of Candida albicans. Macroscopic and microbiological evaluation of the skin lesions were assessed at regular intervals during 21 days. While the two treatments containing nystatin were more effective than zinc oxide alone, the latter agent did not decrease the efficacy of the antifungal drug in combination therapy. Also, zinc oxide seemed to afford some protection against local maceration induced by occlusion, which increased the severity of the infection.

Comparative study of miconazole and clotrimazole in superficial mycosis

Two hundred cases of superficial mycosis (100 dermatophytosis, 40 candidiasis and 60 pityriasis versicolor) were studied for the comparative effect of miconazole and clotrimazole. The patients were evaluated both clinically and mycologically every 2 weeks for a period of 12 weeks. In dermatophytosis, miconazole showed accelerated response (75% cleared in 6 weeks) than clotrimazole (56%). In candidiasis, both were found to be effective (80-85%) cure though clotrimazole showed slightly earlier response (40% cure in 6 weeks) against miconazole (30% cure). In pityriasis versicolor both were, effective (miconazole 99.6% and clotrimazole 86.7%).

Cutaneous ulcers due to Candida albicans in an immunocompromised patient--response to therapy with itraconazole

The patient, a 68-year-old female, with chronic anaemia and a previous history of carcinoma of the breast treated surgically, had been receiving therapy with methyl prednisone, in addition to gold, for pemphigus vulgaris. She developed deep cutaneous ulcers on the lower leg. All had well-defined edges and were covered with purulent and serosanguinous exudates. On histopathology the ulcers were deeply infiltrated with yeasts and mycelium and Candida albicans was isolated on culture. There was no evidence of systemic candidosis. Complete healing was obtained using itraconazole in a dose of 200 mg daily for 45 days: treatment with prednisone was continued throughout. The response to antifungal therapy alone suggests that Candida was largely, if not wholly responsible, for this unusual clinical condition.

Naftifine cream in the treatment of cutaneous candidiasis

Naftifine, a member of a new class of synthetic antifungal drugs, the allylamines, was evaluated for the treatment of cutaneous candidiasis. In a double-blind, parallel-group clinical trial, sixty patients with cutaneous candidiasis were randomly assigned to receive either naftifine cream 1 percent or its vehicle twice a day for three weeks. Two weeks after the end of therapy, 77 percent of the naftifine-treated patients were mycologically cured (negative results on potassium hydroxide preparations and culture) and had no clinically apparent disease, compared with 3 percent of the patients treated with vehicle (p less than 0.001). Side effects reported with naftifine cream were few and minor.

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.

A laboratory method to evaluate formulation effects on the in vitro antimicrobial activity of topical creams and ointments

A simple and reproducible method is described to assess the effect of formulation on the bactericidal and fungicidal activity of topical antimicrobial agents. The technique involves direct inoculation of test and control articles followed by aliquot sampling, neutralization of active antimicrobial ingredients and enumeration of viable microorganisms by standard methods. Two silver sulphadiazine cream formulations, differing in their aliphatic alcohol content, were evaluated as manufactured and in diluted forms in this manner using three bacterial and one fungal burn wound isolates. Results were analysed by a multivariate analysis of variance to test formulation effects, concentration effects and their interaction over time. The results demonstrate that the antimicrobial activity of both creams is equivalent.

Comparative and non-comparative studies of the efficacy and tolerance of tioconazole cream 1% versus another imidazole and/or placebo in neonates and infants with candidal diaper rash and/or impetigo

Eleven open multicentre studies were conducted to evaluate the efficacy of tioconazole cream 1% as a treatment for diaper rash with or without fungal (Candida) involvement, or impetigo in neonates and infants. In the dermal candidiasis/diaper rash group, 320 patients had either tioconazole (n = 220), a comparative imidazole (n = 43), or vehicle cream (n = 57) applied to the affected area twice daily. Twenty-one impetigo patients had only tioconazole cream 1% applied three times daily to lesions. The overall cure rate (patients with both clinical and mycological cure) at the end of treatment for tioconazole treated patients was 78%, for the comparative imidazole group it was 76% and for vehicle cream it was 39%. At the long-term follow-up evaluation approximately 6 weeks after treatment for patients with diaper rash, the overall cure rate was about the same in both tioconazole- and comparative imidazole-treated patients (87% and 90%, respectively), and 14% in patients using vehicle cream. Side-effects were coincident with disease symptoms and consisted primarily of erythema localized to the treatment area; they occurred in 5.4% (13/241) of the patients who received tioconazole and in 21% (9/43) of the patients who received comparative imidazole (econazole or miconazole). No side-effects were reported in this open study for the 57 patients who used vehicle cream. The results of these studies show that tioconazole cream 1% is safe and effective for the treatment of neonates and infants with dermal candidiasis, diaper rash and impetigo.

[Ulcero-vegetative candidiasis of the leg]

Os Autores apresentam caso de paciente portadora de lesão única, úlcero-vegetante, localizada no 1/3 inferior da perna direita, causada pela Candida albicans. Submetida à terapêutica com Ketoconazol na dose de 400 mg diários durante o primeiro mês de tratamento e 200 mg diários no segundo mês, evoluiu para cura, sem recidiva e com negativação do título de anticorpos anti Candida albicans (fixação do complemento).