Superficial and cutaneous aspergillosis is a rare fungal disease that is restricted to the outer layers of the skin, nails, and the outer auditory canal, infrequently invading the deeper tissue and viscera, particularly in immunocompromised patients. These mycoses are acquired through two main routes: direct traumatic inoculation or inhalation of airborne fungal spores into paranasal sinuses and lungs. Lesions are classified into three categories: otomycosis, onychomycosis, and cutaneous aspergillosis. Superficial and cutaneous aspergillosis occurs less frequently and therefore remains poorly characterized; it usually involves sites of superficial trauma—namely, at or near intravenous entry catheter site, at the point of traumatic inoculation (orthopaedic inoculation, ear-self-cleaning, schizophrenic ear self-injuries), at surgery incision, and at the site of contact with occlusive dressings, especially in burn patients. Onychomycosis and otomycosis are more seen in immunocompetent patients, while cutaneous aspergillosis is widely described among the immunocompromised individuals. This paper is a review of related literature.
A 29-year-old patient with Behçet's disease based on three major criteria (i.e., oral ulceration, genital ulceration, and eye lesion) presented with intractable pruritus associated with pinpoint red nodules involving the hair follicles of the back along with steroid-refractory local treatment. Simple light microscopic examination of a skin scraping revealed fungal contamination, and culture on Sabouraud's medium confirmed Trichophyton rubrum as the agent of folliculitis. Behçet's disease is characterized by recurrent attacks of acute inflammation. Although the diagnosis of sterile folliculitis-like disorder is currently retained among patients with Behçet's disease, especially in the lower part of the body, it resembles dermatophytic folliculitis, which can be related to immunosuppressive therapy. Hence, patients with recalcitrant folliculitis predominating on the back who are receiving immunosuppressive treatment should be evaluated for fungal infection, as recognition of this disease may enable earlier diagnosis and treatment.
A 7-year-old girl born to consanguineous parents, had recurrent erythroderma since birth; she presented with intractable pruritus, scaling, dry skin and eczematous lesions, associated to fingers and toes onychogryphosis, along with refractory otitis. The hair was sparse and brittle, the simple light microscopic examination of hair shaft revealed a pathognomonic Bamboo aspect (trichorrehxis invaginata) and ear swab culture revealed Candida parapsilosis as otitis agent. Due to the lack of genetic routine testing, children with recalcitrant erythroderma and otitis, along with hair shaft abnormalities, need to be evaluated for Netherton syndrome.
Orthodontic treatment makes necessary to use a longtime fixed-band appliance, it offers suitable conditions for fungal growth, dentures also allow fungal contamination on their surfaces. The aim of our study is the identification of the fungal species colonizing surfaces of dental appliances, the crosssectional study was carried out on 60 patients wearing dental appliances, during 5 months, and sterile swabs were used and inoculated into Sabouraud's dextrose agar tubes. Yeast identification has been based on germ tube test, chlamydoconidia production and biochimical tests (Auxacolor, Api 20 C). The overall prevalence of fungal contamination of dental orthodontic appliance was 35%. The prevalence rate was 40% among patients who had dental appliances for 1 to 2 months, and 45,5% fort patients brushing their teeth at least twice daily, but no statistical relation with mycosis was found. Pain, burning and discomfort were correlated to fungal carriage p=0,038; OR=4,867 IC 95% (1.09-21.74). The fungal species most recovered were Candida parapsilosis 21.47%, Candida Zeylanoides 21.47%, Candida albicans 17.38%, and Cryptococcus terreus 13.04%. Mycological monitoring of dental prosthesis is crucial to prevent possible fungal's adverse health effects.
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