In vitro susceptibility testing of Candida and Aspergillus spp. to voriconazole and other antifungal agents using Etest®: results of a French multicentre study

Minimum inhibitory concentrations (MICs) of the antifungal agent voriconazole were determined using the Etest and compared with those of amphotericin B, itraconazole and fluconazole using 1986 clinical isolates of Candida spp. Voriconazole MICs were also compared with those of amphotericin B and itraconazole using 391 clinical isolates of Aspergillus spp. Voriconazole was found to have more potent activity and lower MIC values than amphotericin B, itraconazole and fluconazole against C. albicans, C. tropicalis, C. parapsilosis and C. kefyr. Against C. glabrata and C. krusei, voriconazole was more active than either of the other two azole antifungals but had similar activity to amphotericin B. For species of Aspergillus, MIC values of voriconazole were lower than those of amphotericin B and itraconazole against A. fumigatus and A. flavus, and were similar to those of amphotericin B against A. niger. Against A. terreus, MIC values for voriconazole and itraconazole were similar. A. terreus is known to be resistant to amphotericin B, and this was reflected in higher MIC values compared with those of voriconazole and itraconazole. Voriconazole therefore compares very favourably with other antifungal agents against a large number of clinical isolates of Candida and Aspergillus spp.

Lupus-erythematosus-like eruption induced by Trichophyton mentagrophytes infection

BACKGROUND

Several factors are known to trigger acute manifestations of lupus erythematosus (drugs, ultraviolet radiation, bacterial or viral infections, pregnancy), but fungal infections have never been reported to induce lupus-like lesions. We describe 2 children with tinea capitis caused by Trichophyton mentagrophytes(TM), who developed transient skin and serological manifestations of systemic lupus erythematosus.

PATIENTS

Case 1, a 3-year-old girl, had a kerion due to TM transmitted by an octodon, and a facial skin eruption suggestive of systemic lupus erythematosus. Antinuclear antibodies (ANA) were positive at 1:250. After griseofulvin treatment, the lupus-like rash completely regressed, and the ANA titre decreased. Case 2, a 4-year-old girl, had occipital kerion and an annular scaly erythema on the shoulder caused by TM. She also had a non-scaly rash on the face and a recent history of photosensitivity. The ANA titre was positive at 1:8,000. Cutaneous lesions disappeared after an 8-week griseofulvin therapy, and ANA titres decreased progressively.

CONCLUSIONS

'New pets' are usually the vectors of TM, especially familiar rodents like the degu of Chile (also named octodon). In our 2 cases, lupus-like rashes began before the onset of griseofulvin treatment, suggesting a pathogenic role of the dermatophyte. A wide variety of lesions named 'mycides' was described several decades ago associated with TM infections. We hypothesize that these mycides and the TM-induced lupus-like lesions reported in our 2 cases could represent the same entity.

Tinea pedis in European marathon runners

BACKGROUND

Epidemiological studies suggest that 15% of the population in industrial countries suffer from tinea pedis (athlete's foot) and that persons who do sports are a high-risk population.

OBJECTIVE

To investigate the responsibility of dermatophytes in interdigital lesions of the feet in European marathon runners and to identify associated risk factors.

SUBJECTS AND METHODS

Runners of the 14th Médoc Marathon (n = 147) were interviewed on risk factors for tinea pedis and underwent physical and mycological examinations.

RESULTS

Interdigital lesions of the feet were found in 66 runners (45%). A dermatophyte was isolated in 45 runners (31%), 12 of whom were asymptomatic. Trichophyton interdigitale and T. rubrum accounted for 49% and 35.5%, respectively, of the cases of tinea pedis. Thirty-three (22%) of the 102 runners free of dermatophyte infection had lesions resembling those of tinea pedis. Increasing age and use of communal bathing facilities were predictive of T. rubrum culture.

CONCLUSIONS

Marathon runners are at high risk for tinea pedis, but dermatophytes are responsible for only half of the foot lesions found in runners. The existence of asymptomatic carriers calls for prophylactic measures.

Is common neonatal cephalic pustulosis (neonatal acne) triggered by Malassezia sympodialis?

BACKGROUND

A type of neonatal cephalic pustulosis that is clinically similar to classic neonatal acne recently has been linked to Malassezia furfur infection. To correlate the mycological and clinical findings in neonates with cephalic pustulosis, we carried out a prospective case-control study in a neonatal unit from February to April 1997 using new techniques for classifying Malassezia species.

OBSERVATIONS

Nineteen patients with cephalic pustulosis and 19 controls younger than 45 days were studied among 161 consecutively hospitalized infants. Cultures from swabs and smears of pustules were obtained from patients, and swabs from healthy site-matched skin were obtained from controls. Three patients were excluded from the study because another cause of pustulosis was found. A blank sampling of pustules was obtained from 2 patients. Test results for 6 of 16 patients were positive for Malassezia sympodialis on contralateral nonpustular skin, and 4 of those patients also had positive cultures for M sympodialis. Cultures from 6 to 19 controls were positive (4 for M furfur and 2 for M sympodialis). The prevalence of Malassezia species increased with age, and the severity of the pustulosis was correlated with the isolation of M sympodialis.

CONCLUSION

Our data suggest that M sympodialis triggers the severe form of common cephalic pustulosis in infants with this benign disorder.

DNA typing suggests pigeon droppings as a source of pathogenic Cryptococcus neoformans serotype D

The unusual proportion of serotype D strains of Cryptococcus neoformans infecting patients diagnosed with cryptococcosis in some parts of France prompted the analysis of DNA fingerprints obtained with 26 clinical and 29 environmental isolates from the same area. Our results suggest that pigeon droppings are a potential source of pathogenic strains of C. neoformans serotype D, as previously demonstrated for serotype A.

Neonatal Malassezia furfur pustulosis

BACKGROUND

Papulopustular eruptions of the face in neonates are frequently referred to as neonatal acne or sebaceous miliaria. Our findings suggest that there is an association between this type of eruption and Malassezia furfur infection.

OBSERVATIONS

Direct examination of pustule smears showed M furfur yeasts in eight of 13 cases involving neonates with erythema and papulopustules of the face, neck, and scalp (mean age at onset, 22 days [range, 7 to 30 days]). The pustules were predominantly neutrophilic. Treatment with 2% ketoconazole cream applied topically twice daily was effective in 1 week.

CONCLUSION

Malassezia furfur is frequently associated with a common nonfollicular pustulosis of the newborn, probably improperly termed neonatal acne.

[Pneumocystis carinii pneumonia in AIDS: retrospective analysis of 80 documented cases (1985-1993)]

Eighty initial episodes of HIV-associated Pneumocystis carinii pneumonia (PCP) diagnosed at Bordeaux hospital between 1985 and 1993 are reported (57 were men and 23 women). PCP revealed HIV infection in 29 patients (36%). Others cases were patients with poor medical follow up (10%), with a CD4+ lymphocyte count above 200/mm3 at last follow-up (9%), non compliant with PCP prophylaxis (9%), or using aerolized pentamidine (AP+) (20%). The main clinical symptoms were fever (90%), dyspnea (68%), non productive (63%) and productive (17%) cough. Radiographic infiltrates were purely interstitial (59%), acinar and interstitial (25%), purely acinar (5%) and absent (11%). Thirty-eight percent of AP+ had upper lobe preferential involvement and 13% a pleural effusion. In all cases, Pneumocystis carinii was detected in bronchoalveolar lavage. Extrapulmonary localizations of pneumocystosis were noticed (eye, liver, spleen, ascitis) in two AP+. Mean CD4+ count was 54/mm3 in patients not having received aerolized pentamidine (AP-) and 22/mm3 in AP+. P24 antigenemia was positive in 53% (AP-) and 88% (AP+). PaO2 LDH and albuminemia were similar in both groups. Antimicrobial therapy (Cotrimoxazole in 91% of the cases) was combined with corticosteroids in 45% and mechanic ventilation in 19%. After 30 days of follow-up, 17 deaths were observed (21%) and 14 attributed to PCP: mortality was worse in AP+ (31%) than in AP- (19%). The main conclusions of our study are the followings: HIV related PCP is still in 1995 frequent and severe; atypical features should not rule out diagnosis; preventive measures are neither sufficient nor efficient. PCP remains in 1995 a priority in HIV related public health and therapeutical research.

[Mucorales infection in diabetics]

Naso-orbito-cerebral mucormycosis is a fungal infection reported to occur especially in association with diabetes mellitus. Mucorales germinate in the nasal cavities and then colonize sinuses and the orbit. The diagnosis must be made before meningeal and cerebral impairement. The diagnosis is based on histologic and mucologic examination. Once the diagnosis is confirmed, treatment required high and prolonged dose of intravenous Amphotericine B, otherwise the evolution is fatal.

[Apropos of 2 cases of Scedosporium apiospermum nasosinusal infection]

We report two cases of nasosinusal infection caused by Scedosporium apiospermum and involving the nasal fossa in one case and the maxillary sinus in the other. The course of the disease varied according to the patient's immune status. The otherwise healthy patient (case n. 1) was completely cured by surgery, whereas the immunosuppressed patient (case n. 2) had local extension with pseudotumoral symptoms and lysis of the inter-sinusonasal septum; an early surgical treatment combined with local administration of a specific antifungal agent resulted in an apparent cure, but the patient died a few months later. A review of the literature confirms the invasive potential of this fungus which in immunosuppressed patients (by therapeutic immunosuppressants or by a debilitating disease) becomes a dangerous opportunistic organism. Cultures on Sabouraud's medium provide an accurate diagnosis and enable antifungal drugs to be tested, miconazole being the most regularly effective of them. In healthy subjects surgery is the sole treatment of nasal or sinusal lesions, while in all immunocompromised patients it must be combined with an antifungal treatment.

[Epidemiology of dracunculosis in the Mandara Mountains (North Cameroon). Organization of a control campaign]

The map of the Mandara Mountains dracuntiasis focus showing the wells and water bodies, which are the transmission sites of the disease in the study area, shows that the focus is relatively well limited. The drilling of new wells, the protection of existing water bodies used for human consumption, the health education project and the treatment of water by temephos lead to ascertain that the number of Guinea worm cases seen is decreasing every year in the area where the project is meticulously performed. These encouraging results show that it is now possible to eliminate the Guinea worm from North Cameroon by extending the operations in progress to the comprehensive surface of the focus, including the remote areas in mountains and the satellite foci in the plain along the Nigerian border.

[Epidemiological aspects of malaria in 2 villages of the Manyemen forest region (Cameroon, southwest province)]

In terms of parasitaemia in blood, the prevalence was 18.7% for Plasmodium falciparum, 10.5% for P. ovale and 1% for P. malariae in the villages of Mungo Ndor and Kokobuma. The plasmodial index of children from 2 to 9 years of age was 38.2% and the spleen index 26.6%, with a mean HACKETT score of 1.56. Malaria is thus meso-endemic in the region. The immunofluorescent test performed with a P. falciparum antigen was positive in 66% of the children in the same age group. Parasites were seen in 15% of new-born children. The malaria infection indices were higher in Mungo Ndor, which is located on the main road in the vicinity of the Manyemen hospital, than in Kokobuma. Morbidity and mortality due to malaria remain major problems in this part of the South-West Province, in spite of improving primary health care facilities and free chloroquine distribution. Anopheles gambiae is the main vector of malaria in the area, and transmission is interrupted only during the short dry season.

[Epidemiologic study of intestinal and urinary bilharziasis in the Tala Mokolo region (Mandara Mountains, North Cameroon)]

In the Mandara Mountains, where small dams have been erected, people living in the Tala Mokolo district eliminate some S. haematobium eggs in 31,4% of urines samples, and some S. mansoni eggs in 38,1% of stools samples. Evaluated from hemagglutination test, bilharziosis prevalence reaches 55,7%. Male subjects are more frequently affected than female subjects, particularly as for as intestinal bilharziosis is concerned. Urinary bilharziosis prevalence or intestinal bilharziosis prevalence are subject to proximity of small water reservoirs mostly infested either by Bulinus globosus or Biomphalaria pfeifferi. These small water reservoirs are mainly "mayo" head-bays.

[Epidemiologic study of intestinal helminthiasis in the valley of the Guerléo River (North Cameroon)]

Prevalence of intestinal helminthiasis: 999 stool specimens are examined in 9 villages located in the valley of the Guerleo River. In this sample eggs of N. americanus are seen in 20.4% of the specimens, eggs of S. mansoni in 2.6%, T. trichiura in 2.0%, T. saginata in 1.4%, A. lumbricoides in 1.1% and H. nana in 0.6%. The prevalence of bilharziasis measured by means of the hemagglutination test using a S. mansoni antigen is 28.5% in the villages. It should be noticed that urinary bilharziasis too is frequently seen in the area. In the village of Madalam , where intestinal bilharziasis as the highest prevalence, B. pfeifferi are numerous in the Guerleo River close to the village.

[Evaluation of the larvicidal activity of Bacillus thuringiensis serotype H14 on mosquitoes in natural breeding places]

The experiments conducted with Bacillus thuringiensis var. israelensis, serotype H14, in nature, show that this Bacillus has a specific and extremely high larvicidal power against the larval population of Culicidae. It operates very quickly but its action seems relatively short-time lasting. Considering the increasing resistance of larvae to organophosphorus compounds, this new serotype presents a particular interest for the control of mosquitoes.

[Tinea capitis: 73 cases observed in Bordeaux (author's transl)]

73 cases of tinea capitis were observed in the "Hôpital des Enfants" in Bordeaux during these last five year. 71 children under 14 years of age and only 2 adults have seen. The dermatophytic spectrum transformation noticed in other parts of Western Europe is also encountered in Bordeaux. 83 p. 100 are affected by zoo-antropophilic dermatophytes, M. canis chiefly in town, T. mentagrophytes, T. verrucosum in rural aeras. The cases are often familial, from an infected animal, but without any interhuman transmission. Only 8 out of 73 cases are due to strict antropophilic dermatophytes and are found in newly arrived immigrants from North Africa (T. violaceum, T. schönleini) of from West Africa (M. langeroni, T. ferrugineum, T. soudanense). Not a single case of scholar transmission could be observed. Cure by micronised griseofulvine per os (15 mg/kg/day) associated with local care was effective in all cases.