Photodynamic therapy, currently used as an alternative technique for the treatment of superficial non-melanoma skin cancers, has been employed in vitro to kill different species of microorganisms. Here the development of Candida albicans colonies has been measured after application of 5-aminolaevulinic acid (ALA) plus visible light (VIS) irradiation. C. albicans suspensions (10 colony forming units microl(-1)) have been prepared. For the experiment 30 microl of suspension have been incubated in the dark for 3 h, with increasing concentrations of ALA (125, 250, 300, 350, 400, 450, 500, 550, 600, 750, 1000 mg ml(-1)) and then irradiated with a fixed dose (40 J cm(-2)) of VIS. Immediately after the irradiative session, the C. albicans suspensions were disseminated on dishes containing a Sabouraud agar + CAF medium and cultured in the dark at 27 degree C; after 48 h colony development has been measured. In the same way four controls have been prepared: (i)C. albicans suspensions not treated with ALA-PDT; (ii)C. albicans suspensions incubated with increasing ALA concentrations without VIS; (iii)C. albicans suspensions irradiated with 40 J cm(-2) of VIS without ALA; (iv)C. albicans suspensions irradiated immediately after the addition of increasing concentrations of ALA without the 3 h incubation. Colonies treated with ALA-PDT have been studied with electron microscopy (E.M.). It was found that: (i) none of the controls prepared modified the development of C. albicans colonies; (ii) ALA plus VIS inhibited C. albicans growth in a concentration-dependent way: up to 250 mg ml of ALA concentrations did not affect C. albicans cells, 300 mg ml(-1) induced a 50% reduction in the number of colonies, a complete inhibition started from concentrations of 600 mg ml(-1); (iii) after ALA-PDT E.M. showed modifications of the cell membranes. From the results it is concluded ALA plus VIS light is able to kill C. albicans colonies, at least in vitro. Although other pharmacological approaches are available, further studies could show that PDT is a potential treatment for candidosis.
Phaeohyphomycoses are induced by dematiaceous or darkly pigmented fungi. Alternaria species are the most important causative agents. Factors such as immunosuppression, local wounds or systemic disease are generally present. We report a case of phaeohyphomycosis induced by Alternaria alternata in an immunocompromised patient. The main interest in this case is the rareness of the cutaneous alternariosis and of its clinical aspects and the good response to therapy. Recognition of Alternaria spp. as potential opportunistic pathogens is important for the differential diagnosis of dermatological lesions, such as granulomatous or ulcerative lesions in immunocompromised patients.
Superficial mycoses are estimated to affect more than 20-25% of the world's population with a consistent increase over the years. Most patients referred to our clinic for suspected dermatomycoses have already been treated with pharmacotherapy, without a previous mycological examination and many show changes in the clinical manifestations. Indeed, some medications, such as steroids, antiviral, antibiotics and antihistamines are not able to erase a fungal infection, but also they can cause atypical clinical manifestations. The consequences of inappropriate treatment include delayed diagnosis, prolonged healing time, and additional costs. The aims of this study were (1) to evaluate the incidence of increased costs attributable to inappropriate therapy sustained by the National Health Service and patients and (2) to highlight the importance of mycological evaluation before starting treatment, in order to improve diagnostic accuracy. An observational retrospective and prospective study was performed from September 2013 to February 2014, in 765 patients referred to our center (University Hospital " Federico II") in Naples, Italy, for suspected mycological infection. The following treatments (alone or in combination) were defined as inappropriate: (1) cortisone in a patient with at least one positive site; (2) antifungals in (a) patients with all negative sites or (b) ineffective antifungal treatment (in terms of drug chosen, dose or duration) in those with all positive sites; or (3) antibiotics; (4) antivirals or (5) antihistamines, in patients with ≥ 1 positive site. Five hundred and fifty patients were using medications before the assessment visit. The total amount of avoidable costs related to inappropriate previous treatments was € 121,417, representing 74% of the total treatment costs. 253/550 patients received drugs also after the visit. For these patients, the cost of treatment prescribed after mycological testing was € 42,952, with a decrease with respect to the total consumption of drugs at the time of access to the Mycology Laboratory of € 34,781. Thus, our cost analysis shows that it is important to obtain a reduction of costs for pathologies that need to be confirmed by examinations before starting treatment.
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