Although onychomycoses are caused by dermatophytes, yeasts or non-dermatophyte molds, tinea unguium describes chronic fungal infections by dermatophytes only. Tinea unguium is a common fungal infection of the nail plate or nail bed with increasing prevalence worldwide. It is not self-limited and shows a higher frequency among the elderly population. In Japan, approximately 10% of the entire population is estimated to have tinea unguium. During the period when only griseofulvin was available for treatment, it was a very difficult disease to treat. Since in the 1990's, however, the introduction of new oral antifungals, itraconazole and terbinafine, initiated a new era in the treatment of tinea unguium. Many excellent textbooks, review articles, and original articles have already been published. This paper considers the circumstances in Japan, epidemiology, causative agents including non-dermatophyte molds, differential diagnosis, diagnostic techniques, the quality of life of the patients with tinea unguium, and then the treatment options are reviewed again.
BACKGROUND:Tinea incognito is a dermatophytic infection in which topical or systemic steroids have modified the clinical appearance of the mycosis and mimicking other skin diseases.OBJECTIVES:A large retrospective study was carried out to identify the clinical aspects and type of dermatophytes involved in tinea incognito cases in Iran during 1993-2008.PATIENTS:Out of 6325 subjects suspected to have dermatophytoses, 56 patients (29 males, 27 females, mean age 32.6 years) were affected with tinea incognito.METHODS:The causative agents were identified macroscopically and microscopically after the clinical samples were subjected to potassium hydroxide examination and culture isolation.RESULTS:The most common type of infection was tinea corporis (32.1%), which significantly affected male patients. The prevalence of the other tineas in decreasing order was as follows: tinea faciei (26.8%), tinea cruris (14.3%), tinea manuum (12.5%), tinea pedis (8.9%), and tinea capitis (5.4%). The clinical features were to some extent diverse, ranging from eczema-like, seborrhoeic dermatitis-like, pyoderma-like and folliculitis to alopecia on scalp, trunk and limbs. Trichophyton verrucosum was the most frequently isolated species representing 33.9% of isolates, followed by T.mentagrophytes (28.6%), T. rubrum (12.5%), Epidermophyton floccosum (10.7%), Microsporum canis (8.9%), T. violaceum (3.6%), and T. schoenleinii (1.8%).CONCLUSION:To the best of our knowledge, this is the first broad investigation dealing with tinea incognito in Iran. The etiological agents of tinea incognito in Iran are consistent with those of the general population.
We examined the therapeutic effects of cinnamaldehyde and the potentiation of those effects with cassia and cinnamaldehyde when combined with the food additive methylcellulose against murine oral candidiasis. When 19.5mg/ml of cinnamaldehyde was administered in the oral cavity of Candida infected mice, the oral symptoms were improved. Furthermore, when either a cassia or a cinnamaldehyde preparation in combination with methylcellulose was administered to oral candidiasis-inflicted mice, the therapeutic effects of cassia or cinnamaldehyde potentiated. Methylcellulose itself did not affect the oral symptoms or the viable number of C. albicans cells. GC/MS analysis showed that the dose of cinnamaldehyde remaining in the tongue tissue of mice treated with the cinnamaldehyde-methylcellulose mixture was higher than that in mice administered cinnamaldehyde alone, and also showed that cinnamaldehyde was not detected in the blood of any of the tested mice. These findings suggested that the combination of cassia or cinnamaldehyde and methylcellulose may be a useful prophylactic or therapeutic tool against oral candidiasis.
This study aimed to examine the genotype distribution of Candida albicans and the major genotypes involved in superficial candidiasis. The genotypes of C. albicans isolated from the infection sites of patients with superficial candidiasis (referred to as infection isolates) were analyzed by fragment analysis using 4 microsatellite markers (HIS3, CDC3, CAI and CAIII). Genotypes of the infection isolates were compared with those of C. albicans isolated from oral mucosa of non-candidiasis patients (referred to as oral isolates). Isolates of C. albicans showed 4 major genotypes for HIS3/CAI (" a " for 148 : 148 / 23 : 23," b " for 148 : 160 / 33 : 41," c " for 148 : 164 / 32 : 41 and " d " for 152 : 152 / 18 : 27). The genotypes " a "," b " and " d " were commonly found in oral (4.7, 8.8 and 7.6%, respectively) and infection (6.6, 9.2 and 15.4%, respectively) isolates. No isolates of genotype " c " were isolated from infection sites. The genotype " a " was found in the isolates from patients with genitalia candidiasis. Genotyping of multiple isolates from an individual patient showed that C. albicans from infection sites was genetically homogenous as compared with that of oral isolates, even in the same patient with candidiasis.
Antithrombotic activity of a protease purified from a medicinal mushroom, Ganoderma lucidum, has been evaluated platelet aggregation in vitro and pulmonary thrombosis in vivo. The purified protease exhibited concentration dependent inhibitory effects on platelet aggregation induced by ADP (adenosine diphosphate), with an IC(50) value of 2.4 mg/mL. The purified protease protected mice against thrombotic death or paralysis induced by collagen and epinephrine in a dose dependent manner when administered orally. It produced a significant inhibition of thrombotic death or paralysis at 60 µg/kg body weight, while aspirin produced a significant inhibition of thrombosis at 10-20 mg/kg body weight. The purified protease also has showed fibrinolytic activity and alters coagulation parameters such as activated partial thromboplastin time (APTT), and thrombin time (TT) in rat platelet. These results suggested that the antithrombotic activity of Ganoderma lucidum protease might be due to antiplatelet activity rather than anticoagulation activity.
Twenty-five cases of dermatophytoses caused by Microsporum canis were encountered during a 3-year period (January 2008-December 2010). Their diagnosis was based on detection of fungal elements by direct microscopy and identification of M. canis by fungal culture. There were 17 women and 8 men ; they ranged in age from 4 to 85 years (mean, 34.6). The affected site was the head (n=5), face (n=8), neck (n=5), arm (n=8), leg (n=5), and trunk (n=5) ; exposed sites were those most often affected. A lone eruption was seen in 13 and multiple eruptions in 12 patients. The disease type was tinea corporis in 21 patients, tinea capitis in 5, and a combination of tinea corporis and tinea capitis in one. The disease showed familial onset in 10 patients (5 pairs), including 2 sibling pairs, 2 mother-child pairs, and 1 grandmother-granddaughter pair. Twenty-four patients had a history of contact with animals, and animals kept at home may have served as the infection source (cats in 23 patients and a dog in one). Hairbrush culture of the pets was positive in 9 patients. The patients with a lone eruption were treated with topical antifungal agents, while those with multiple eruptions of tinea capitis and tinea corporis were treated with oral itraconazole or terbinafine hydrochloride for 2-14 weeks, combined with topical antifungal therapy. Although reports of dermatophytoses caused by M. canis have been decreasing, our experience indicates the necessity of considering possible transmission of this disease from pets such as cats.
We herein describe five various cases of human infections by Nocardia cyriacigeorgica. The identification included conventional and molecular sequencing tests.The current study provides further evidences that N. cyriacigeorgica species is a ubiquitous organism capable of establishing long-term infection in healthy and immunocompromised patients.
Breakthrough non- Aspergillus mold infections among patients receiving the anti-mold azole antifungal agents like voriconazole or posaconazole have been increasingly reported. We report a case of lung Scedosporium prolificans infection with multiple cavities in a 58-year-old man with monoclonal gammopathy of undetermined significance (MGUS) during voriconazole treatment for probable invasive aspergillosis. Cultures of repeated sputum specimens yielded the same fungus until his death 83 days after diagnosis. S. prolificans should be considered in patients with breakthrough infections receiving voriconazole.
To evaluate the anti-inflammatory activity of the thiocarbamate antifungal agent liranaftate, the edema and the neutrophil accumulation detected by the activity of neutrophil marker enzyme, myeloperoxidase (MPO), were examined following application of liranaftate to mouse ears with inflammation induced by phorbol 12-myristate 13-acetate (PMA). Topical 20 microl administration of liranaftate in a dose-range between 1-4% suppressed the increase in ear thickness 6 hr after PMA application dose-dependently. Similarly, it decreased the weight increase of an ear section after 24 hr dose-dependently. More than 1% of liranaftate also suppressed augmentation of MPO activity of the ear section. This and histological observation indicate that liranaftate treatment suppressed neutrophil accumulation in PMA-applied ear lesion. From these results, we discussed that liranaftate might suppress inflammatory symptoms caused by trychophytosis in a clinical condition.
Aspergillosis is an important mycosis caused primarily by Aspergillus fumigatus and its relatives. The genus Emericella is a teleomorph related to the Aspergillus section Nidulantes. The typical anamorphic stage species in this genus is Aspergillus nidulans, which is sometimes a significant agent in chronic granulomatous disease (CGD) patients. The mortality rate of osteomyelitis in CGD patients due to A. nidulans ( E. nidulans ) is very high compared to that due to A. fumigatus. Moreover, two Emericella species ( E. nidulans and E. quadrilineata ) from clinical specimens exhibit different sensitivities against several antifungal drugs. In aspergillosis, correct species identification is important for antifungal therapy. We attempted to develop rapid and specific molecular discrimination by polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP) methods in the principal pathogenic Emericella species, and succeeded in establishing species-specific primers corresponding to the hydrophobin gene. These primers discriminate E. nidulans and E. quadrilineata rapidly and specifically. These methods and primers make it possible to diagnose etiological agents in aspergillosis quickly and easily.
Antifungal susceptibility tests were performed for 38 Candida albicans strains isolated from oral cavities of 43 Uighurian AIDS patients. Results showed that six isolates were resistant to fluconazole; one showed low susceptibility. We attempted to examine these strains molecular-epidemiologically, but 25S rDNA genotyping was insufficient for their discrimination. To estimate whether the origins of resistant strains were identical, we developed a new combination method of C. albicans tandem repeating units (ALTS)/RFLP and micro-temperature gradient gel electrophoresis (micro-TGGE). This new method was able to distinguish all seven strains. A suspected nosocomial infection was ruled out.
Morphology and dynamics of the spindle pole bodies (SPBs) in Exophiala dermatitidis and Cryptococcus neoformans were examined by freeze-substitution and serial ultrathin sectioning electron microscopy. The SPBs showed double forms and were located on the nuclear envelope in G1 phase, entered the nuclear membrane or the periphery of nucleus in M phase, and appeared to duplicate in early G1 phase in these yeasts. Thus, the SPBs in these yeasts are clearly different from those of Saccharomyces cerevisiae.
年５月 25 日(月)17：00-18：00 開会式においては，小川秀興会頭より Congratulatory Remarks on the Opening of the Congress and JSMM Award Ceremony が執り行われ，歴代の ISHAM Presidents と ISHAM Congress Presidents へ，世界の医真菌学および日本の医真菌学の発展に貢献して頂いたことへの感謝が述べられ，JSMM Award として記念メダルが手渡された．満員の会場より大きな拍手喝采が送られた． 引き続き，現 ISHAM President の DE HOOG, Sybren 教授からのご挨拶と，会長講演：Dangerous black fungi are all around us -How come we are still alive?
Molecular biological approaches have recently begun to be applied to molecular genetics studies of dermatophytes. High-throughput gene analysis methodologies, such as EST sequencing, differential cDNA screening, and cDNA-based microarray analysis have been used to obtain information on many dermatophyte genes and their expression profiles under different experimental conditions. In addition, whole genome sequencing projects are underway for several important dermatophytes, such as Trichophyton rubrum and Microsporum canis. These studies will provide large amounts of valuable information for elucidating the molecular basis of host invasion by dermatophytes and their virulence. Targeted gene disruption by homologous recombination is one of the most common approaches for determining the functions and roles of numerous genes isolated from pathogenic fungi. However, the difficulty of genetic manipulation due to low transformation frequency of dermatophytes may limit the successful production of null mutants by targeted gene disruption via homologous recombination. To overcome these problems, our group has developed useful genetic manipulation systems for dermatophytes using the clinically important dermatophyte, T. mentagrophytes.
Systemic fungal infections, caused by a wide variety of fungi, contribute to high mortality in humans with immunocompromised conditions. However, there are few classes of antifungal drugs available, limiting therapeutic options. Azoles are the most commonly used class of antifungals to treat many fungal infections, but resistance to azoles can be induced or, for some fungi, is an inherent property. One of major mechanisms of azole resistance is overexpression of drug efflux pumps in fungal cell membranes, such as the energy-dependent ATP-binding cassette (ABC) transporters. We have developed a protein hyperexpression system to facilitate functional analysis of efflux pumps using a Saccharomyces cerevisiae strain as the host for heterologous expression. The system is well suited for the hyperexpression of individual fungal ABC transporters for structural and functional studies. Furthermore, the recombinant yeast strains expressing heterologous membrane proteins can be used to screen for compounds that overcome fungal drug resistance. Also in this review, the mechanisms of azole resistance in Candida glabrata and C. krusei will be considered in relation to the recent increase in the incidence of Candida infections caused by non-albicans Candida. The development of possible novel antifungal agents will also be discussed.
