This study reveals that German H1-antihistamine-refractory CSU patients have high rates of uncontrolled disease, angioedema, and comorbid CIndU, are undertreated, have impaired QoL, and rely heavily on healthcare resources.

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Trichophyton rubrum has led to unprecedented worldwide suppression of other dermatophytes which had been predominant earlier as a causative agent of superficial dermatomycoses. In tinea capitis on the other hand, several other species of Trichophyton or Microsporum are dominant depending on the region or continent. Tinea capitis caused by T. rubrum is a rare event worldwide. Occasional concentrations may be explained by several cases occurring by chance in one family or community. The relative frequency of this causative agent in tinea capitis in children is under 1%. In adults, however, where tinea capitis occurs very infrequently indeed, the incidence of T. rubrum appears to exceed 10%. Apart from two studies from India, one from Iran, two from Portugal and observations from Germany, which in the first country report of around 30% of all cases published, while the others document some 10% each, there are not only any conspicuous, unequivocal concentrations at all. Increased frequency of T. rubrum in this clinical picture has not been easily recognizable over the last decades due to low absolute case numbers.

Thirty-five patients with mycologically proven scalp infections were enrolled in a randomized, double-blind clinical trial with oral terbinafine (dose adjusted according to patient weight) for either 1 or 2 weeks. Patients were observed for 12 weeks; after 4 weeks, non-responders were offered an additional 4 weeks of treatment followed by a second observation period. The causative organisms were Microsporum canis (n = 12), Trichophyton tonsurans (n = 12) and other Trichophyton spp. (n = 11). The Trichophyton infections were treated effectively in five of nine (56%) patients treated for 1 week and 12 of 14 (86%) patients treated for 2 weeks. Three of the non-responders were treated for an additional 4 weeks, and one responded. In the Microsporum group only one of seven patients treated for 1 week and none of five treated for 2 weeks responded. However, treatment was effective in four of six (66%) patients treated for an additional 4 weeks. Mild to moderate adverse events believed to be drug related occurred in four patients in each of the two groups. Terbinafine is well tolerated, and requires 2 weeks of treatment in most patients with Trichophyton scalp infections and 4 weeks or more in Microsporum scalp infections, to achieve a successful clinical and mycological response.

The phylogenetic relationship of representative members of the genera Trichophyton, Microsporum and Epidermophyton was studied. 844 base pairs were compared after sequencing the nuclear 18S ribosomal RNA gene spanning the most variable area within the central 600 bases of this gene. The dermatophytes, which are monophyletic in origin, could be classified most effectively when placed as a subgroup in the Onygenales, Ascomycotina. The calculated radiation time was about 50 million years ago. The early cenozoic adaptive explosion of mammals, which can serve as a host for the keratinophilic fungi, provides corroboration for proximate co-evolution.

Our previous studies of the ribosomal DNA variation in dermatophytes have shown that these fungi are monophyletic in origin. However, this approach did not allow us to differentiate all the species defined by classical means. Therefore, we studied the internal transcribed spacer 1 (ITS 1) region of 17 species of the fungal order Onygenales, comprising the pathogenic keratinophilic fungi. Interspecific nucleotide composition and sequence length variation of the ITS 1 region was high, mean identities were as low as 40% and sequence lengths varied from 169 to 293 basepairs. Each established dermatophyte species could be identified. In contrast, the flanking sequences at the 3' end of 18S and the 5.8S rDNA were conserved. Although the value of the ITS 1 region as a phylogenetic tool may be limited because of its high variability, it provides the information necessary to design species-specific probes, or polymerase chain reaction restriction fragment polymorphism systems useful for taxonomic or rapid diagnostic tests.

In acquired immunodeficiency syndrome, the lesions of the central nervous system in association with the human immunodeficiency virus are thought to be related to an infection of microglia, although no studies are available in which cultured and physiological characteristics of microglia cells infected in vivo have been examined. In this report, we used brain tissue from a child dying of human immunodeficiency virus infection and show that microglia cells were the main cell population being infected. Moreover, isolated macrophage-like cells from fresh brain material revealed a close resemblance to peripheral blood macrophages in their content of surface and intracellular antigens. No virus particles or viral antigens were produced by these cells during the first week of cultivation. Productive infection was readily apparent, however, by day 30. This finding illustrates the slow nature of the virus life cycle in these cells and the minimal cytopathology that accompanied the infection.