Erosio interdigitalis blastomycetica: A review of interdigital candidiasis

Erosio interdigitalis blastomycetica (EIB) is a Candida infection affecting the third web space, between the third and fourth fingers. In 1915, Gougerot and Goncea first described saccharomycetic organisms isolated from the hands and feet. Johannes Fabry later named it in 1917, well before the genus Candida was introduced in 1923. EIB is most common among those who work with their hands frequently in water, such as dishwashers, launderers, bartenders, and homemakers. Clinical presentation most commonly consists of a central erythematous erosion surrounded by a rim of white macerated skin involving at least one interdigital web space. The differential diagnosis is narrow, consisting of irritant contact dermatitis (ICD), erythrasma, inverse psoriasis, and bacterial infection (i.e. impetigo). The diagnosis is made by clinical examination in addition to fungal culture and KOH testing. The prognosis is good and treatment options include avoidance of frequent water immersion and topical or oral antifungal agents. Suspicion for secondary infections such as erysipelas and cellulitis should remain high until lesions have resolved. This review aims to address the history, epidemiology, pathophysiology, histopathology, clinical presentation, differential diagnoses, diagnosis, prognosis, and management of EIB. It also suggests an alternative name in place of the current misnomer.

[Trichophyton tonsurans associated with non-albicans Candida species in hands onychomycosis about a Moroccan case]

INTRODUCTION

Trichophyton tonsurans is an anthropophilic dermatophyte, frequent in the USA and in Asia where it is responsible for causing tinea capitis. At present, we attend an emergence of this species in certain regions where it was not or little met. Here, we report a case of onychomycosis of the hand due to T. tonsurans associated with non-albicans Candida species at an adult woman.

OBSERVATION

The patient is a 62-year-old woman, with hypertension and diabetes. She reports the rather frequent use of chemical cleaners for the housework. She presented one year previously a distal onycholysis of the last four fingers of the left hand. The clinical examination objectified a presence of intertrigo in the second interdigital space. The mycological examination showed at the direct examination mycelial elements and the culture allowed the isolation of T. tonsurans associated with non-albicans Candida species.

DISCUSSION-CONCLUSION

Our observation highlights especially the identification of a species, which has been described only once in Morocco about a case with onychomycosis of the feet. A possible emergence of this species in our country is not far from being possible.

Mycological Considerations in the Topical Treatment of Superficial Fungal Infections

Trichophyton rubrum remains the most common pathogenic dermatophyte in the United States, Europe, and industrialized Asia, although other species are predminant elsewhere. Candida albicans is the most common pathogenic yeast, with other species occasionally encountered. Just a few of the 14 described species of Malassezia cause pityriasis versicolor worldwide. FDA approval does not always accurately reflect the potential utility of any given topical antifungal agent. Azole, hydroxypyridone, and allylamine agents are beneficial in the management of dermatophytosis; however, the allylamines may lead to faster symptom resolution and a higher degree of sustained response. Although in actual clinical use the allylamines have all shown some activity against superficial cutaneous candidiasis and pityriasis versicolor, the azole agents remain drugs of choice. Ciclopirox is an excellent broad-spectrum antifungal agent. Optimal topical therapy for superficial fungal infections cannot yet be reliably based upon in-vitro laboratory determination of sensitivity. Inherent antibacterial and anti-inflammatory properties possessed by some antifungal agents may be exploited for clinical purposes. Candida species may be azole-insensitive due to efflux pumps or an altered target enzyme. So-called "antifungal resistance" of dermatophyets is actually due to poor patient adherence (either in dosing or treatment duration), or to reinfection.

Disseminated Candida tropicalis presenting with Ecthyma-Gangrenosum-like Lesions

Disseminated candidiasis in immunosuppressed patients has been classically associated with an erythematous papular eruption, however more severe presentations are possible. We present a patient who developed disseminated Candida tropicalis that presented with hemorrhagic bullae that progressed to large necrotic ulcers.

Infections with Candidatus Neoehrlichia mikurensis and Cytokine Responses in 2 Persons Bitten by Ticks, Sweden

The prevalence of Candidatus Neoehrlichia mikurensis infection was determined in 102 persons bitten by ticks in Sweden. Two infected women had erythematous rashes; 1 was co-infected with a Borrelia sp., and the other showed seroconversion for Anaplasma phagocytophilum. Both patients had increased levels of Neoehrlichia DNA and serum cytokines for several months.

Case report: Diaper dermatitis presenting as pustules

Diaper dermatitis is the most common dermatologic disorder of infancy. Its cause can often be determined clinically based on the clinical presentation. Primary diaper dermatitis is associated with irritants and spares the deep skin folds. Secondary diaper dermatitis is most often caused by Candida yeast overgrowth and typically presents as a well-defined area of beefy red erythema covering the diaper area and including the deep folds of skin with hallmark satellite pustules. Other causes include seborrheic dermatitis, psoriasis, acrodermatitis enteropathica, allergic contact dermatitis, Langerhans cell histiocytosis, and, in the setting of a primarily pustular eruption, bacterial folliculitis. A simple potassium hydroxide preparation (KOH) can confirm the diagnosis of candida diaper dermatitis and guide proper treatment.

Congenital candidiasis: an uncommon skin eruption presenting at birth

We present the case of a preterm neonate who was born with respiratory distress and a papulovesicular rash that was diagnosed as congenital candidiasis (CC). The mother was asymptomatic. The cutaneous eruption and respiratory distress improved following treatment with systemic antifungals. Congenital candidiasis ranges in presentation from isolated cutaneous involvement to severe multisystem disease. Given its rarity among neonatal skin eruptions, heightened suspicion is required for prompt diagnosis and treatment.

Primary cutaneous Candida tropicalis infection in a patient with B-cell lymphoma

We report the case of a 61-year-old man with diffuse large B-cell lymphoma who presented with a tender skin lesion on the left side of the flank of 5 weeks' duration after undergoing myeloablative chemotherapy. Prior treatment with intravenous vancomycin showed minimal response. Clinical examination revealed a tender, indurated, erythematous plaque on the left side of the flank. A skin biopsy demonstrated a lymphohistiocytic and neutrophilic infiltrate with deep dermal necrosis and fungal forms in the dermis and subcutis. A tissue culture grew Candida tropicalis; however, blood cultures remained negative for yeast. A diagnosis of primary cutaneous candidiasis was made based on the lack of response to antibiotics, tissue evidence of C tropicalis, and negative blood cultures. Although rare, primary cutaneous candidiasis should be considered in immunocompromised patients presenting with cellulitis or an abscess that is unresponsive to treatment.

Histopathology of the nail unit

In this report, we review several inflammatory infectious and tumoral conditions of the nail unit. We emphasize the anatomic peculiarities of such pathologies of the nail unit and provide some required diagnostic criteria.

Concurrent subcutaneous candidal abscesses and pulmonary cryptococcosis in a patient with diabetes mellitus and a history of corticosteroid therapy

A 50-year-old man with a history of long-term corticosteroid treatment following adrenalectomy for Cushing's syndrome and uncontrolled diabetes mellitus was admitted for an examination of an abnormal thoracic shadow. Cryptococcal serum antigens were positive, and the histopathology of a lung biopsy showed encapsulated yeast resembling Cryptococcus neoformans. On admission, the serum β-D-glucan level was approximately twice the cutoff value, several nodules were observed on both legs and magnetic resonance imaging revealed subcutaneous abscesses. Candida albicans was identified from needle aspirates, and the patient was successfully treated with fluconazole and flucytosine. We herein report the first case of concurrent C. albicans skin abscesses and pulmonary cryptococcosis.

Perianal and periumbilical dermatitis: Report of a woman with group G streptococcal infection and review of perianal and periumbilical dermatoses

PURPOSE

We describe a woman with perianal and periumbilical dermatitis secondary to group G Streptococcus, summarize the salient features of this condition, and review other cutaneous conditions that clinically mimic streptococcal dermatitis of the umbilicus.

BACKGROUND

Periumbilical and perianal streptococcal dermatitis are conditions that commonly occur in children and usually result from beta-hemolytic group A Streptococcus. Rarely, non-group A streptococcal and staphylococcal infections have been reported in adults.

MATERIALS AND METHODS

A 31-year-old woman developed perianal and periumbilical group G streptococcal dermatitis. Symptoms were present for six months and were refractory to clotrimazole 1 percent and betamethasone dipropionate 0.05 percent cream.

RESULTS

The etiology of perianal and periumbilical dermatitis is unclear, but is perhaps explained by virulence of previously asymptomatic colonized bacteria. Perianal streptococcal dermatitis is more common in children. A number of adult infections have been reported, most of which were secondary to group A beta-hemolytic Streptococcus. Men are more often affected than women. Group G Streptococcus is rarely the infective etiology of perianal streptococcal dermatitis. This condition presents as a superficial well demarcated erythematous patch on clinical examination. Diagnosis is ascertained by diagnostic swabs and serological tests: antistreptolysin O (ASO) or anti-DNase titer. Treatments include oral amoxicillin, penicillin, erythromycin, and mupirocin ointment.

CONCLUSIONS

Our patient expands on the clinical presentation typical of streptococcal dermatitis. We describe a rare occurrence of an adult woman infected with non-group A Streptococcus. Several conditions can mimic the presentation of perianal streptococcal dermatitis. Although rare, group G Streptococcus should be considered in the setting of virulent infections usually attributed to group A species. Streptococcal dermatitis can be added to the list of conditions affecting the umbilicus.

A prospective study of fluconazole treatment for breast and nipple thrush

BACKGROUND

Breastfeeding women with continuous burning nipple pain, often associated with post-feed radiating breast pain, may be diagnosed with nipple and breast Candida (thrush) infection. This project examined the efficacy of the three fuconazole capsule regime (one 150 mg capsule alternate days) and explored factors associated with longer courses of fluconazole.

METHODS

Women diagnosed with nipple and breast Candida and treated with oral fuconazole at a tertiary hospital (n = 96) were followed up until pain resolution.

RESULTS

Women took between 1 and 29 fluconazole capsules, mean = 7.3, median = 6. The number of capsules was not related to socio-demographic or health characteristics of mothers or babies; women with more severe breast pain were more likely to take > 3 capsules than women with less severe breast pain. Only minor side-effects were reported.

DISCUSSION

Most women require more than three capsules of fluconazole, but two-thirds of women will require six or less.

[Pitted keratolysis--how to treat?]

Pitted keratolysis is a common and problematic skin condition affecting the feet caused by the keratolytic activity of Corynebacterium, Micrococcus, Dermatophilus. Skin lesions are characterized by crater-like pits of the epidermis accompanied by a burning sensation, itching, pain and malodor. The purpose of the present paper was to characterise the disease's clinical features and possibilities for the therapy. Due to its interdisciplinary nature, not only dermatologists ought to be familiar with the disease, but also physicians, pediatricians, surgeons, orthopedists, military doctors and occupational health doctors.

The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol

BACKGROUND

The CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study will investigate the micro-organisms involved in the development of mastitis and "breast thrush" among breastfeeding women. To date, the organism(s) associated with the development of breast thrush have not been identified. The CASTLE study will also investigate the impact of physical health problems and breastfeeding problems on maternal psychological health in the early postpartum period.

METHODS/DESIGN

The CASTLE study is a longitudinal descriptive study designed to investigate the role of Staphylococcus spp (species) and Candida spp in breast pain and infection among lactating women, and to describe the transmission dynamics of S. aureus and Candida spp between mother and infant. The relationship between breastfeeding and postpartum health problems as well as maternal psychological well-being is also being investigated. A prospective cohort of four hundred nulliparous women who are at least thirty six weeks gestation pregnant are being recruited from two hospitals in Melbourne, Australia (November 2009 to June 2011). At recruitment, nasal, nipple (both breasts) and vaginal swabs are taken and participants complete a questionnaire asking about previous known staphylococcal and candidal infections. Following the birth, participants are followed-up six times: in hospital and then at home weekly until four weeks postpartum. Participants complete a questionnaire at each time points to collect information about breastfeeding problems and postpartum health problems. Nasal and nipple swabs and breast milk samples are collected from the mother. Oral and nasal swabs are collected from the baby. A telephone interview is conducted at eight weeks postpartum to collect information about postpartum health problems and breastfeeding problems, such as mastitis and nipple and breast pain.

DISCUSSION

This study is the first longitudinal study of the role of both staphylococcal and candidal colonisation in breast infections and will help to resolve the current controversy about which is the primary organism in the condition known as breast thrush. This study will also document transmission dynamics of S. aureus and Candida spp between mother and infant. In addition, CASTLE will investigate the impact of common maternal physical health symptoms and the effect of breastfeeding problems on maternal psychological well-being.

[Posttraumatic primary cutaneous aspergillosis with Candida guilliermondii infection in a healthy host]

Opportunistic fungal infections are usually seen in immunocompromised patients. While Candida is the most prevalent agent in such infections, Aspergillus is at the second order. Primary cutaneous aspergillosis is most common in immunocompromised patients but can rarely be seen in healthy hosts as well. We report a case of posttraumatic primary cutaneous aspergillosis and Candida guilliermondii coinfection in a 70-years-old healthy man. The patient had an ulcerous lesion which developed in the site of a trauma on the middle finger of the right hand. Histopathological examination of the biopsy specimens revealed septate hyphae with dichotomous branching small circular blastospores. The cultures of the biopsy specimen yielded yellow-green colored, granular mold colonies and creamy white yeast colonies. Microscopic examination of the lactophenol cotton blue stained mold colonies indicated long conidiophores with vesicles surrounded by uniseriate phialides, compatible with Aspergillus flavus. Yeast colonies were identified as Candida guilliermondii by ID32C (BioMerieux, France) and by their microscopical morphology detected in corn meal-Tween 80 agar incubated at 25°C for 72 hours. The patient was treated properly with surgical debridement and itraconazole therapy. Since the immune system is compressed as a consequence of aging, cutaneous opportunistic fungal infections should be considered in the differential diagnosis of posttraumatic necrotic ulcers and black eschar in aged patients.

Ulcerated plaque under a ruby ring in an immunosuppressed patient

We report a primary inoculation fungal infection in a 76-year-old man with acute myeloid leukemia. The patient presented with a painful red plaque located where he routinely wore a ruby ring. Histopathology revealed multiple branching septate hyphae. Cultures confirmed Fusarium and Candida parapsilosis infection. A short discussion of these organisms follows.

Candida krusei fungemia in an immunocompromised patient

Candida krusei is an emerging fungal pathogen found primarily in immunocompromised patients. Intrinsic resistance to fluconazole and decreasing susceptibility to other anti-fungal agents are problematic. When colonization occurs, dissemination may follow rapidly. We present a case of a patient with acute lymphoblastic leukemia who, despite being treated prophylactically with fluconazole, developed disseminated C. krusei.

Candida glabrata infection in gastric carcinoma patient mimicking cutaneous histoplasmosis

Candida glabrata is the second most common Candida species detected among hospitalized patients in USA. In tissue C. glabrata present as yeasts, 3-5 microns in size, which are difficult to visualize on H&E stained slides but can be detected on Grocott methenamine silver (GMS) stained slides. The presence of yeasts only, without any hyphal elements, makes C. glabrata difficult to distinguish from Histoplasma capsulatum yeasts that are of similar size. Mycology culture is the method of choice for definitive identification of C. glabrata. Rapid identification is necessary, as mortality rate due to C. glabrata infection in immunocompromised patients is particularly high. We herein report a patient with inoperable gastric carcinoma, who developed cutaneous and septic form of C. glabrata infection.

Solitary ecthyma gangrenosum (EG)-like lesion consequent to Candida albicans in a neonate

Ecthyma gangrenosum (EG) is a well recognized cutaneous lesion most commonly associated with Pseudomonas aeruginosa bacteremia. It usually occurs in immunocompromized and critically ill patients. Uncommonly, EG like lesions have also been observed in patients with fungal infections, like Fusarium Candida, Mucor and Aspergillus. We present a case of EG- Like lesion due to Candida albicans, in a 12 day old neonate.

Prospective aetiological study of diaper dermatitis in the elderly

BACKGROUND

The different causes of diaper dermatitis (DD) in the elderly are not well known and the treatment is often empirical.

OBJECTIVES

To determine the causes of DD in the elderly and to evaluate the efficacy of antifungal treatments in this indication.

METHODS

Consecutive patients presenting with DD were included. Clinical evaluation, skin swabs for bacterial and mycological cultures, patch testing and skin biopsy were performed at inclusion. This was followed by 1 month of topical antifungal cream and, if needed, by oral fluconazole for the second month.

RESULTS

Forty-six patients were included (mean age 85 years). Causes of DD were established for 38 patients: 24 had candidiasis (63%), six irritant dermatitis (16%), four eczema (11%) and four psoriasis (11%). After 2 months of treatment, 27 of 37 (73%) patients were cured and five of 37 were improved.

CONCLUSIONS

Mycoses and irritant dermatitis are the main causes of DD in the elderly, and emollient skin care and topical antifungal treatment can be considered a first-line therapy for this indication.

Narrow-spectrum staining pattern of Pityrosporum

BACKGROUND

Broad-spectrum fungal stains are used to detect fungal organisms, but narrow-spectrum stains can assist in fungal differential diagnosis. These stains include mucicarmine and Fontana-Masson (FM) for Cryptococcus, Alcian Blue for Cryptococcus and Blastomyces, Congo Red for Blastomyces and Coccidioides, and Ziehl-Neelsen for some examples of Blastomyces and Histoplasma. Pityrosporum is increasingly being recognized as a pathogen capable of significant cutaneous and systemic infections, but the narrow-spectrum staining pattern of Pityrosporum has not yet been systematically studied and reported.

METHODS

Paraffin-embedded archival tissue from 10 skin biopsies containing Pityrosporum was stained with Alcian Blue, Congo Red, Ziehl-Neelsen acid-fast stain, and FM stain. In addition to the 60-min staining time, a modified FM stain with 15-, 30-, and 45-min staining times was also performed.

RESULTS

All cases stained positive with Alcian Blue, Congo Red, and FM stains and negative with the Ziehl-Neelsen stain. The modified FM stain with the 15-min staining time showed significant staining in more than 50% of the cases.

DISCUSSION

The narrow-spectrum staining pattern of Pityrosporum distinguishes it from Cryptococcus, Blastomyces, Candida, Histoplasma, and Coccidioides.

Etiologic and causative factors in perianal dermatitis: results of a prospective study in 126 patients

BACKGROUND

Perianal dermatitis is probably the most common cutaneous disorder of the genitoanal area. Studies on the epidemiology of causative factors are rare.

METHODS

Over a 4-year period we prospectively studied 126 patients with a presumptive diagnosis of anal eczema. The diagnostic algorithm comprised medical history, inspection, microbiology, laboratory chemistry, patch tests, proctoscopy, and biopsy if appropriate.

RESULTS

The age range was 7-82 years and the majority of patients were male (57.1%). Periods of anal symptomatology ranged from 6 days to 120 months and most of the patients (51.6%) had complaints for more than 12 months. The clinical diagnosis in 68 patients (54%) was: intertrigo/candidiasis (42.9%), atopic dermatitis (6.3%), pruritus ani (5.6%), psoriasis (3.2%), skin atrophy from steroid use (2.4%), lichen sclerosus et atrophicus (n = 2), herpes simplex (n = 1), and condylomata acuminata (n = 1). Contact eczema was suspected in 58 patients (46%), but 25 of these (43.1%) showed no contact sensitization.

CONCLUSION

The majority of patients with symptoms of anal eczema suffer from intertrigo/candidiasis, and relevant, causative contact sensitization may be found in only some of them. Patch-testing is a valuable investigative tool only when the patients' own products are included in the test series. Most patients suffer from their perianal complaints for more than 12 months, therefore diligent evaluation is warranted.

Cutaneous fungal infections in the oncology patient: recognition and management

There are two main types of fungal infections in the oncology patient: primary cutaneous fungal infections and cutaneous manifestations of fungemia. The main risk factor for all types of fungal infections in the oncology patient is prolonged and severe neutropenia; this is especially true for disseminated fungal infections. Severe neutropenia occurs most often in leukemia and lymphoma patients exposed to high-dose chemotherapy. Fungal infections in cancer patients can be further divided into five groups: (i) superficial dermatophyte infections with little potential for dissemination; (ii) superficial candidiasis; (iii) opportunistic fungal skin infections with distinct potential for dissemination; (iv) fungal sinusitis with cutaneous extension; and (v) cutaneous manifestations of disseminated fungal infections. In the oncology population, dermatophyte infections (i) and superficial candidiasis (ii) have similar presentations to those seen in the immunocompetent host. Primary cutaneous mold infections (iii) are especially caused by Aspergillus, Fusarium, Mucor, and Rhizopus spp. These infections may invade deeper tissues and cause disseminated fungal infections in the neutropenic host. Primary cutaneous mold infections are treated with systemic antifungal therapy and sometimes with debridement. The role of debridement in the severely neutropenic patient is unclear. In some patients with an invasive fungal sinusitis (iv) there may be direct extension to the overlying skin, causing a fungal cellulitis of the face. Aspergillus, Rhizopus, and Mucor spp. are the most common causes. We also describe the cutaneous manifestations of disseminated fungal infections (v). These infections usually occur in the setting of prolonged neutropenia. The most common causes are Candida, Aspergillus, and Fusarium spp. Therapy is with systemic antifungal therapy. The relative efficacies of amphotericin B, fluconazole, itraconazole, voriconazole, and caspofungin are discussed. Recovery from disseminated fungal infections is unlikely, however, unless the patient's neutropenia resolves.

Mykologisches Labor

The clinical presentation of fungal infections of the skin, hair, or nails may be varied and confusing. To avoid delays in treatment and early spread of the infection, adequate diagnostics are necessary. This requires both the clinical expertise of the physicians as well as the capability to perform various laboratory tests. Classical methods are based on microscopy, different culture procedures, and histological examination. Genotypic approaches for the detection and identification of fungal pathogens have improved the speed and accuracy of laboratory diagnosis in the last few years, although further evaluation using molecular biology-based methods should be routinely applied in practice.

Therapeutic approach to selected neonatal eruptions

Management of numerous neonatal eruptions has been modified over the past 10 years. In this article, traditional and developing therapeutic insights are applied to both common and uncommon neonatal conditions.

Diaper dermatitis: a review and brief survey of eruptions of the diaper area

Eruptions in the diaper area are the most common dermatologic problem in infancy. Such eruptions can be subdivided into primary diaper dermatitis, an acute inflammation of the skin in the diaper area with an ill-defined and multifactorial etiology, and secondary diaper dermatitis, a term which encompasses eruptions in the diaper area with defined etiologies. The most important factors in the development of primary diaper dermatitis are: (i) water/moisture, (ii) friction, (iii) urine, (iv) feces, and (v) microorganisms (sometimes). Possible treatments include minimizing diaper use and using disposable diapers, barrier creams, mild topical cortisones, and antifungal agents. A variety of other inflammatory and infectious processes can occur in the diaper area and an awareness of these secondary types of diaper dermatitis aids in the accurate diagnosis and treatment of patients.

Therapy of common superficial fungal infections

Superficial fungal infections are common, especially onychomycosis, dermatophytoses, and superficial Candida infections. Most superficial fungal infections are treated with topical antifungal agents unless the infection covers an extensive area or is resistant to initial therapy. Onychomycosis often requires systemic therapy with griseofulvin, itraconazole, or terbinafine. The objective of this review is to provide the practicing dermatologist with the recommended available therapy for the treatment of common superficial fungal infections.

Diffuse cutaneous candidiasis in a dog. Diagnosis by PCR-REA

The authors describe a clinical case of cutaneous candidiasis in a dog with dermatological lesions, characterized by persistent alopecia, crusts, ulcers and scales. Predisposing factors such as the use of corticosteroids, the concomitan presence of an autoimmune disease (pemphigus foliaceus) and an infection of ehrlichiosis caused by Ehrlichia canis were observed. Histopathological findings included signs of orthokeratotic hyperkeratosis, moderate follicular keratosis and light epidermic acanthosis. The reactive process included an infiltrative superficial dermatitis and a mural folliculitis with prevalent participation of macrophages and lymphocytes. The application of PCR-Restriction Enzyme Analysis (REA) method on cutaneous specimens in veterinary medicine is an extremely interesting diagnostic tool. Its use, together with other techniques, such as mycologic, cytologic and histological examinations, allowed us to identify Candida albicans as aetiological agent in this particular case.

Diagnostic value of signs and symptoms of mammary candidosis among lactating women

Mammary candidosis in lactating women is not well defined and is most often presumptively diagnosed by signs and symptoms. This study evaluates the sensitivity, specificity, positive predictive value, and likelihood ratios of signs and symptoms of mammary candidosis based on the presence of Candida species on the nipple/areola or in the milk. In this prospective cohort study, the nipple/areola skin and milk of 100 healthy breastfeeding mothers were cultured from each breast at 2 weeks postpartum, and mothers were interviewed regarding signs and symptoms associated with mammary candidosis between 2 and 9 weeks postpartum. Positive predictive value for Candida colonization was highest when there were 3 or more signs or symptoms simultaneously or when flaky or shiny skin of the nipple/areola was reported together or in combination with breast pain.

"White dots on the placenta and red dots on the baby": congential cutaneous candidiasis--a rare disease of the neonate

Cutaneous congenital candidiasis (CCC) is a very rare disease of the term or premature infant consisting of a generalized rash at or shortly after birth usually without other signs or symptoms. The presence of white microabscesses on the placenta and umbilical cord of an infant with such a rash must suggest the diagnosis of CCC, which is always secondary to Candida chorioamnionitis but may pass unrecognized. Despite the high prevalence of vulvo-vaginitis in pregnant women, Candida chorioamnionitis is rare and CCC remains apparently extremely rare with just some hundred cases described. However, as the condition is essentially benign and self-limited, underdiagnosis is likely. As occasional systemic spread of Candida infection is described and maternal complications may arise, diagnosis and a close follow-up or treatment is of importance. We present two cases of CCC, stressing the importance of sharing clinical findings between obstetrician and neonatologist for the diagnosis and subsequent management.

[Three cases of congenital cutaneous candidosis]

We report three cases of term newborns with Congenital Cutaneous Candidosis (CCC) occured in a ten months period. Two of these showed respiratory distress that require mechanical ventilation and the administration of exogenous surfactant in one case. All the three cases recovered after therapy with fluconazole. Early onset of severe respiratory distress may require intubation and mechanical ventilation, and systemic involvement requires systemic antimichotic therapy. We did not find any predisposing factors of such a rare disease, in spite of the occurrence of three cases in a short period of time.

The pustular disorders

The pustular disorders constitute a subgroup of the vesiculobullous disorders defined by the presence of eosinophils or neutrophils with prominent accompanying intercellular edema or a canthelysis involving various levels of the epithelium. Herein, we describe the clinical and pathologic attributes of the subcorneal, infectious, neonatal, papulosquamous, drug-induced and miscellaneous pustular conditions.

[Epidemiology of mycoses in submariners based on the Kola Peninsula]

Subject of the study was spreading of mycoses in the troops based on the Kola Peninsula. Examined were the military serving on atomic submarines, maintenance crews of deactivated atomic submarines awaiting disposal, and coastal units. Spreading of skin lesions among the submariners was not same as among the coastal military. Signs of clinical mycoses were observed in 41.2% of submariners of the active unit, in 66.9% of the maintenance crews, and in 38.1% of the coastal military. Infection agents were fungi g. Candida (albicans, guilliermondii, krusei, pseudotropicalis), Epidermophytia plicarum, Ptyriasis versicolor, Trichophyton interdigitale. Among the fighters on active submarines, 53.8% of the clinical observations were accounted for onychomycosis and foot skin lesions and 38.5%--for erythema, maceration and suppuration. Among the maintenance crews 51.8% of the observations were accounted for onychomycosis and foot skin lesions and maceration; hyperkeratosis and fissures prevailed in the coastal military (31.1%). For submariners most common were Candida albicans (80.7%) and guilliermondii (11.6%), and Trichophyton interdigitale (7.7%). In the maintenance crew those were Candida albicans (84.1%) and guilliermondii (11.6%) and in the coastal military, Candida albicans (70.6%), guilliermondii (11.8%) and krusei (14.7%).

Congenital cutaneous candidiasis: a case presentation

When an infant presents in the delivery room with macular and papular skin lesions covering the trunk, extremities, and/or skin folds, the neonatal nurse practitioner covering deliveries must be aware of possible skin lesion differential diagnoses. Among these is congenital cutaneous candidiasis, a rare, usually benign skin infection. If this condition is recognized early, unnecessary testing and treatment of newborns who present with these symptoms might be avoided.