SummaryExophiala spinifera is a dematiaceous fungus responsible for rare skin infections presenting as phaeohyphomycosis or chromoblastomycosis which has been primarily reported in tropical and subtropical areas (Asia, South and North America). We report the first case of E. spinifera phaeohyphomycosis in a European patient. The phaeohyphomycosis was limited to the skin, involving the finger of an immunocompromised patient presenting with a large B‐cell lymphoma treated by R‐mini‐CHOP regimen. Remission was initially achieved by surgical excision; however, a local subcutaneous relapse required treatment with itraconazole. We performed a literature review of the 32 previously published cases of E. spinifera phaeohyphomycosis highlighting its clinical phenotype: disseminated infection with extracutaneous involvement and poor prognosis were reported in young patients, of whom some were recently associated with CARD9 mutations, whereas cases in older immunocompromised patients were limited to the skin and showed better prognosis. There is currently no standard treatment for E. spinifera phaeohyphomycosis; however, itraconazole, alone or in combination, allowed partial or complete response in 16 out of 20 cases.

Les dermatophyties représentent un des motifs fréquents de consultation en dermatologie. Leur traitement fait appel à des molécules actives, par voie générale, sur les espèces de dermatophytes, dont l’utilisation varie en fonction de la localisation, du nombre d’atteintes et de l’étendue des lésions. La terbinafine est la molécule de choix avec les topiques antifongiques locaux. Elle s’impose notamment dans les onycho-mycoses, les dermatophyties cutanées étendues et désormais pour les teignes du cuir chevelu chez l’enfant, la griséofulvine n’étant plus commercialisée.Le biologiste médical, qui a un rôle prépondérant dans le diagnostic biologique, doit apporter au médecin prescripteur, mais aussi au patient, voire à son entourage, toutes les informations utiles sur l’origine de la contamination, le suivi du traitement et la prévention des rechutes ou des récidives.Dermatophytosis represent a frequent reason for consultation in dermatology. Their treatment involve active antifungal molecules active on dermatophyte species, mainly using a systemic route. The choice of the treatment varies with the location of the infection, the number of attacks and the extent of the lesions. Terbinafine is the molecule of choice with either topical and systemic formulation. Terbinafine is the pivotal drug in particular for the treatment of onychomycosis, extensive skin dermatophytosis and more recently for tinea capitis in children, as griseofulvin is no longer marketed in France. The medical microbiologist, who has a predominant role in the biological diagnosis, must provide the prescribing physician, but also the patient, or even his entourage, with all useful informations regarding the origin of the contamination, the monitoring of the treatment and the prevention of relapses.

The aims of this network group were to collect epidemiological data of PcP cases in 14 hospitals in the Paris area and to determine the Di-Hydro Pteroate Synthase (DHPS) genotypes, genetic markers for possible sulfamide resistance. From January 1, 2003 to December 31, 2008, 993 (mean 166/year) PcP cases have been reported. Sixty-five percent of patients were HIV-positive. The median count of CD4 lymphocytes was 32/mm(3) (30 in HIV-positive patients, 152 in HIV-negative patients). In HIV-positive patients, PcP revealed the HIV infection in 39%. Among 304 PcP occurring in HIV known infected patients, no prophylaxis was prescribed for 64%; cotrimoxazole prophylaxis had been prescribed to 47 patients but only one of them had the right compliance. In HIV-negative patients (264), corticosteroids were prescribed in 59% and cytotoxic chemotherapies in 34%; 78% did not receive prophylaxis. One hundred sixty nine tumoral pathologies and 116 transplantations were notified. The mortality rate was 16% at day 14 (13% in HIV-positive patients, 26% in HIV-negative patients). Mutations in DHPS genes were detected in 18.5% of samples; 12.5% of patients were infected with several strains. The total annual number of cases has been stable for five years but the proportion of HIV-negative patients increased from 25% to 43%.

Head lice are endemic worldwide. Resistance to permethrin and doubts about the safety of pesticides promoted the use of physical therapies (wet-combing, dry-on suffocation). The aim of our study was to test the pediculicidal and ovicidal effects of one application of a silicon-oil complex composed of dimethiconol and castor oil. The study was a prospective cohort of 108 infested patients (11 males, 97 females; 58 children, 50 adults), in Sri-Lanka. Pediculicidal efficacy was evaluated as the percentage of patients free of live lice one hour after the application of the treatment and at day 1 (wet combing). Ovicidal efficacy was calculated as the proportion of subjects without larval stages at days 1 and 7 among subjects followed up all over the study. In normal conditions of use, in this open cohort, a pediculicidal effect of a dimethiconol-castor-oil lotion was shown one hour after application in 99/108 (91.7%) treated subjects and at day 1 in 86/99 (87 %) subjects and an ovicidal effect at day 7 in 79/108 (73.2 %) treated subjects. A second application of the same product was necessary to increase the cure rate to 79.6% (86/108) at day 8. In our study, the second application of the same product was performed seven days later, but the best time for additional applications should be defined in further studies. However, the efficacy of this safe physical treatment was similar to that of chemical pediculicides (malathion, permethrin).

In routine laboratory practice, the determination of MICs of antifungals for yeasts often relies on the Etest, because of a good correlation with reference methods. However, this correlation was established through predesigned studies, rather than prospective testing. The surveillance programme of fungaemia (YEASTS programme), implemented since 2003, facilitated our comparison of the Etest and the EUCAST results, obtained on a routine basis in nine different hospitals and in a reference laboratory, respectively. The analysis included 690 isolates recovered from blood culture (362 Candida albicans, 113 Candida glabrata, 69 Candida parapsilosis, 55 Candida tropicalis, 31 Cryptococcus neoformans, and 60 other yeast species) that were tested for their susceptibility to amphotericin B (n = 655), fluconazole (n = 669), itraconazole (n = 198), voriconazole (n = 588), flucytosine (n = 314), and caspofungin (n = 244). Agreement between the Etest and EUCAST datasets was calculated and categorized on the basis of previously published breakpoints. The level of agreement at ±2 dilutions was 75% for amphotericin B and 90% for flucytosine; for the azoles, it ranged from 71% for itraconazole to 87% for voriconazole. No significant difference was observed among the yeast species, except for Cryptococcus neoformans and flucytosine, with an agreement <40%. Categorical agreement ranged from 60% for itraconazole to 90% for flucytosine. Major and very major discrepancies occurred in <12% and 6%, respectively. The Etest, even when performed on a routine basis, shows a ≥71% agreement with the EUCAST reference method.

Introduction. - Human pneumocystosis (PCP) remains one of the most important fungal opportunistic pneumonia, in AIDS and in other immunocompromised patients. Genetic markers for possible sulfamide (the most frequently used chemoprophylaxis) resistance have been reported: two point mutations on dihydropteroate synthetase (DHPS) gene.Method. - The aims of this network are to study the cases of PCP in Ile-de-France area and to determine the DHPS genotypes.Results. - From 1 January 2003 to 12 December 2007, 805 (161 per year) clinically and biologically proved PCP cases have been reported by 14 laboratories. Sixty-one percent of patients were HIV-positive. Sex ratio was 2.2 and median age was 47 years. The median count of CD4 lymphocytes was 32 per millimeter cube (30 in HIV-positive patients, 158 in HIV-negative patients). In HIV-positive patients, PCP revealed the HIV infection in 39% and was a second episode in 8.5%. Among 211 PCP occurring in HIV known infected patients, no prophylaxis was prescribed for 72% (151); cotrimoxazole prophylaxis had been prescribed to 39 patients but only one of them had a right compliance. In HIV-negative patients (264), corticosteroids were prescribed in 54% and chemotherapy in 36%; 93% did not receive prophylaxis. One hundred and twenty-eight tumoral pathologies (54 leukemias, 44 lymphomas) and 86 transplantations (37: kidney, 21: bone marrow) were notified. The mortality rate was 16% at day 14 (13% in HIV-positive patients, 26% in HIV-negative patients). Mutations in DHPS genes were detected in 51 samples (17.5%); 33 patients were coinfected (several strains).Conclusion. - Total annual number of cases has been stable for 5 years but the proportion of HIV-negative patients has arisen (from 25 to 41%). Cotrimoxazole remains an efficient prophylaxis when correctly used. (C) 2009 Elsevier Masson SAS. All rights reserved.

L’histoplasmose à Histoplasma capsulatum var. capsulatum est une infection opportuniste grave au cours de l’infection par le VIH. Elle touche des patients profondément immunodéprimés. Cette mycose, endémique en Amérique et en Afrique, peut être diagnostiquée en France métropolitaine.Revue de la littérature.L’épidémiologie de la co-infection histoplasmose-VIH en France métropolitaine a évolué au cours des 20 dernières années, avec désormais une prédominance des patientes originaires d’Afrique. Les principales manifestations sont peu spécifiques (fièvre, hépatosplénomégalie, adénopathies…) et le diagnostic généralement tardif (deux mois). Les atteintes respiratoires et cutanées sont fréquentes et évocatrices. Le pronostic demeure sévère à l’ère des antirétroviraux (mortalité 15 %). Les antifongiques de référence sont l’amphotéricine B liposomale en induction lors des formes sévères et l’itraconazole. Le traitement doit être prolongé et une prophylaxie secondaire est nécessaire. Des syndromes inflammatoires de restauration immune ont été décrits chez 10 % des patients traités par antirétroviraux en France.L’histoplasmose reste méconnue et de diagnostic tardif en France métropolitaine. Touchant des patients profondément immunodéprimés, elle conserve un pronostic sombre malgré l’existence d’antifongiques efficaces (amphotéricine B liposomale, itraconazole) et l’impact positif des antirétroviraux.Histoplasma capsulatum var. capsulatum histoplasmosis is a life-threatening AIDS-related opportunistic infection. Only deeply immuno-compromised patients are involved. This mycosis is endemic in America and Africa but may also be diagnosed in France.Review of the medical literature.The epidemiology of AIDS-related histoplasmosis evolved significantly in France during the past two decades. Nowadays, most of the patients are African women. The more current signs are not specific (fever, hepatomegaly, splenomegaly, adenopathy) and diagnosis is usually late (2 months). Respiratory and cutaneous signs are frequent and more suggestive of histoplasmosis. Prognosis remains poor even at the antiretroviral era (mortality rate 15 %). The recommended antifungal treatments are liposomal amphotericin B as induction therapy of severe cases and itraconazole. Treatment must be prolonged and secondary prophylaxis is required. Immune restoration inflammatory syndrome has been described in 10 % of the French patients receiving antiretroviral therapy.Histoplasmosis is still unrecognized and its diagnosis is late in metropolitan France. Prognosis remains poor in spite of the availability of active antifungal agents (liposomal amphotericin and itraconazole) and of antiretroviral therapy.

The case is reported of a patient with cavitary sarcoidosis complicated by an aspergilloma caused by an itraconazole-resistant strain of Aspergillus fumigatus, who was treated with voriconazole. The authors suggest that susceptibility testing of A. fumigatus strains is of value during long-term therapy with itraconazole, and that voriconazole may be a good option for treatment of patients infected with itraconazole-resistant strains of A. fumigatus.

The authors report the results of a survey on the efficacy against mosquito bites of a repellent, Mousticologne Spécial Zones Infestées (DEET 20%, EHD 15%). Two forms of the product, spray and gel, were tested in Senegal. Repellent efficacy was evaluated by exposing volunteers, both repellent-treated and untreated, to mosquito bites. The number of mosquito bites per person and per night was 0.63 in the spray treated group (group 1), 6.03 in the gel treated group (group 2) and 94.17 in the untreated group (group 3). The analysis of these results showed a significant difference between treated and untreated persons. Untreated persons were not protected against mosquito bites, persons treated with the spray were protected for 12 hours and those treated with the gel had over 8 hours' protection. We concluded that a single application of the repellent Mousticologne in the field is capable of ensuring all-night protection against mosquito bites.

The authors report the results of a survey on the efficacy against mosquito bites of a repellent Mousticologne((R)) Special Zones Infestees (DEET 20%, EHD 15%). Two forms of the product, spray and gel, were tested in Senegal. Repellent efficacy was evaluated by exposing volunteers, both repellent-treated and untreated, to mosquito bites. The number of mosquito bites per person and per night was 0.63 in the spray treated group (group 1), 6.03 in the gel treated group (group 2) and 94.17 in the untreated group (group 3), The analysis of these results showed a significant difference between treated and untreated persons. Untreated persons were not protected against mosquito bites, persons treated with the spray were protected for 12 hours and those treated with the gel had over 8 hours' protection. We concluded that a single application of the repellent Mousticologne((R)) in the field is capable of ensuring all-night protection against mosquito bites.

We retrospectively analyzed 13 episodes of candidemia observed between July 1990 and July 1995 in human immunodeficiency virus (HIV)-infected adults. Candidemia was nosocomially acquired by 11 patients, among whom nine had a central venous catheter (CVC). Twelve cases were of stage C2/C3 according to the 1993 classification of the Centers for Disease Control and Prevention. The median CD4+ cell count was 10/mm3 (range, 3-400/mm3). Causative species were Candida albicans in nine episodes and Candida glabrata and Candida krusei in two episodes each. Eleven episodes occurred in 11 patients who had previously received fluconazole (mean total dose, 7.4 g), including the four episodes caused by non-albicans species. Outcome did not differ according to the administered antifungal therapy. CVCs were removed from seven patients (78%). The overall mortality was 38%. Candidemia is a potentially lethal nosocomial complication during late-stage AIDS and can be due to C. albicans and non-albicans strains.

We analyzed the data collected during a nationwide survey of cryptococcosis (1985-1993). We first checked the quality of the survey. The stability of its completeness (approximately 50%) and its representativity were assessed by the capture-recapture method after we cross-checked our data on cryptococcosis (as a presenting manifestation of AIDS) against those of the national registry of AIDS. Of the 1,057 cases of cryptococcosis (1,013 patients), 827 (86%) involved patients with AIDS. The increasing number of cases of human immunodeficiency virus (HIV)-related cryptococcosis over time paralleled the AIDS epidemic except for a higher male-to-female ratio. Malignancies (32%), organ transplantation (19%), and corticosteroid therapy (33%) were the main predisposing conditions in 163 patients without AIDS. Cryptococcal meningitis more frequently occurred in patients with AIDS than in HIV-negative patients (P < 10(-6)). Among the 413 isolates available for serotyping, 410 were Cryptococcus neoformans variety neoformans (including 20.5% of serotype D). Three isolates of the variety gattii (serotype B) were recovered from patients without AIDS.