Cryptococcosis is a major fungal disease caused by members of the Cryptococcus gattii and Cryptococcus neoformans species complexes. After more than 15 years of molecular genetic and phenotypic studies and much debate, a proposal for a taxonomic revision was made.
Diagnosis of fungal pneumonia (FP) in critically ill patients is challenging. Circulating biomarkers for the diagnosis of FP have limitations and the combination of different assays in serum samples and directly from the target organ may further improve the diagnosis of FP. We prospectively assessed the diagnostic utility of paired galactomannan (GM) in bronchoalveolar lavage fluid (BAL) and serum GM and (1→3)-β-D-glucan (BG) assays in critically ill patients at risk of FP. Patients with FP were classified according to European Organisation for Research and Treatment of Cancer-Mycoses Study Group criteria, with modifications. Out of 847 admissions, 51 patients were eligible. There were nine invasive aspergillosis (IA) cases (four proven, five probable), three proven Pneumocysitis jirovecii pneumonia (PJP) cases and one mixed FP case (probable IA and proven PJP). The diagnostic accuracy as given by the area under the receiver operating characteristic curve in IA cases (proven and probable) for GM in BAL was 0.98 (95% CI, 0.94-1.00), whilst for GM and BG in serum it was 0.85 (95% CI, 0.74-0.96) and 0.815 (95% CI, 0.66-0.96), respectively. For IA cases (proven and probable) AUC for GM in BAL was significantly higher than GM and BG in serum (p 0.025 and p 0.032, respectively). In one of four proven and one of six probable IA cases, GM in serum remained negative, whereas GM in BAL was positive. In patients with IA, GM (90%) and BG (80%) appeared a mean of 4.3 days (range, 1-10 days) before Aspergillus was cultured. GM detection in BAL appears to improve the diagnosis of IA in critical patients.
Itraconazole is the first azole derivate that matches griseofulvin for the treatment of tinea capitis in children. The drug also appears to be better tolerated than griseofulvin.
From October 1994 to November 1995, a prospective study aiming to detect dermatophytes on the scalp was undertaken in 5000 unselected school children aged between 3 and 16 years (mean age 8.34 years, SD +/- 3.83). Thirty-two (0.64%) had dermatophytes in the scalp, 22. (0.44%) had tinea capitis and 10 were asymptomatic scalp carriers. It is important to point out that 33% of the patients with tinea capitis and 60% of the asymptomatic scalp carriers also had ringworm in other body sites. There was a significantly higher proportion of cases of tinea capitis (P < 0.001)(particularly due to Trichophyton tonsurans, P < 0.001) and of cases of asymptomatic scalp carriers (P < 0.05) (particularly due to Trichophyton tonsurans, P < 0.001) in the immigrant population of African origin. In all the child index cases with positive scalp cultures (tinea capitis and carriers), the household members were studied clinically and mycologically. One child had a body ringworm caused by Microsporum canis. Twelve adults had positive cultures with dermatophytosis (one tinea capitis and eleven body ringworm). Three adult patients were also carriers of dermatophytes in other body sites. Our data indicate a change in the causative agents of tinea capitis seen in Madrid over a 12-month period, with cases due to antropophilic species (T. tonsurans, T. soudanense, M. audouinii and T. violaceum) occurring in the immigrant population from Africa; as a consequence, there is an emergence of T. tonsurans in the Spanish population.
We have been monitoring the antifungal resistance in
Candida parapsilosis
isolates collected from inpatients at Madrid metropolitan area hospitals for the last 3 years. The study aimed to elucidate the presence of fluconazole-resistant
C. parapsilosis
genotypes in Madrid.
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