BackgroundNecrotizing fasciitis (NF) is a fatal aggressive infectious disease. We aimed to assess the major contributing factors of mortality in NF patients.MethodsA retrospective study was conducted at a single surgical intensive care unit between 2000 and 2013. Patients were categorized into 2 groups based on their in-hospital outcome (survivors versus non-survivors).ResultsDuring a14-year period, 331 NF patients were admitted with a mean age of 50.8 ± 15.4 years and 74 % of them were males Non-survivors (26 %) were 14.5 years older (p = 0.001) and had lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors (74 %) at hospital presentation. Diabetes mellitus, hypertension, and coronary artery disease were more prevalent among non-survivors (p = 0.001). The 2 groups were comparable for the site of infection; except for sacral region that was more involved in non-survivors (p = 0.005). On admission, non-survivors had lower hemoglobin levels (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.07) and had higher serum creatinine (p = 0.001). Non-survivors had greater median LRINEC (Laboratory Risk Indicator for NECrotizing fasciitis score) and Sequential Organ Failure Assessment (SOFA) scores (p = 0.001). Polybacterial and monobacterial gram negative infections were more evident in non-survivors group. Monobacterial pseudomonas (p = 0.01) and proteus infections (p = 0.005) were reported more among non-survivors. The overall mortality was 26 % and the major causes of death were bacteremia, septic shock and multiorgan failure. Multivariate analysis showed that age and SOFA score were independent predictors of mortality in the entire study population.ConclusionThe mortality rate is quite high as one quarter of NF patients died during hospitalization. The present study highlights the clinical and laboratory characteristics and predictors of mortality in NF patients.

Background: Our objective in this study was to obtain information on the prevalence of fungi responsible for superficial mycoses in the region of Tripoli, Libya. Patients and Methods: Skin scrapings collected from 2224 patients attending the Dermatology Clinic, at Tripoli Medical Center with suspected clinical symptoms of fungal involvement were investigated in a 28-month study period, from August 1997 to December 1999. Direct microscopy was carried out with a 20% KOH preparation, and cultures were performed in petri dishes on Sabouraud dextrose agar (SDA) with cycloheximide 0.5 mg/mL and chloramphenicol 0.05 mg/mL, and SDA with chloramphenicol 0.05 mg/mL. Olive oil (2%) was added to the SDA without cycloheximide when pityriasis versicolor was suspected. Results: Diagnosis was confirmed by microscopic examination in 1180 cases (53.1%), and the causal agents were isolated in 1160 cases (52.2%). Dermatophytes, Malassezia furfur (tinea versicolor) and Candida albicans were the major etiological agents isolated. Tinea corporis accounted for 45.9% (85% occurred in children below 15 years of age). The frequency of other clinical types in descending order was pityriasis versicolor 27.8% (322 cases), candidiosis 13.4% (156 cases), tinea pedis 8.1% (94 cases), tinea manuum 2.6% (30 cases), and tinea barbae 2.2% (26 cases). Trichophyton violaceum was the most common etiological agent, and was responsible for 44% (300 cases) of dermatophyte infections. Malassezia furfur was ranked second in frequency with 27.8% (322 cases), followed by Trichophyton rubrum 13.8% (160 cases), and Candida albicans 10% (116 cases). Other species found were Microsporum canis 8.1% (94 cases), Epidermophyton floccosum 6.6% (76 cases), and Trichophyton mentagrophytes 3.1% (36 cases). Conclusion: Dermatophytes, in particular Trichophyton violaceum, Trichophyton rubrum and Microsporum canis, are an important cause of tinea corporis in Libya. Malassezia furfur and Candida albicans are the most commonly encountered fungi in superficial mycoses.

Summary.  This study sought to determine the prevalence of skin infections and their causative agents in the Libyan population. Samples were collected from 2224 patients attending the Dermatology Clinics of the Tripoli Medical Centre (TMC) between August 1997 and December 1999 and were submitted to a mycology laboratory for analysis. Diagnosis was confirmed by microscopic examination in 1180 cases (53.1%) and the causative agent was isolated and cultured in 1160 cases (52.2%). Dermatophytes, Malassezia furfur and Candida albicans were the most common etiological agents isolated. Tinea corporis accounted for 45.9% of cases (85% of cases occurred in children below 15 years of age). The frequency of the other clinical types in descending order was pityriasis versicolor 27.8% (322 cases), candidiosis 13.4% (156 cases), tinea pedis 8.1% (94 cases), tinea manuum 2.6% (30 cases) and tinea barbae 2.2% (26 cases). Trichophyton violaceum was the most common etiological agent, responsible for 44% (300 cases) of dermatophyte infections. Malassezia furfur was ranked the second most frequent causative agent being found in 27.8% of cases, followed by Trichophyton rubrum 13.8% (160 cases) and Candida albicans 10% (116 cases). Other species isolated included Microsporum canis 8.1% (94 cases), Epidermophyton floccosum 6.6% (76 cases) and Trichophyton mentagrophytes 3.1% (36 cases).

This paper has been updated to correct a spelling error concerning an author name. It previously showed as Giuseppe Griseo, however the correct spelling is Giuseppe Criseo.

In order to elucidate the distribution of Cryptococcus neoformans and C. gattii in the Mediterranean basin, an extensive environmental survey was carried out during 2012-2015. A total of 302 sites located in 12 countries were sampled, 6436 samples from 3765 trees were collected and 5% of trees were found to be colonized by cryptococcal yeasts. Cryptococcus neoformans was isolated from 177 trees and C. gattii from 13. Cryptococcus neoformans colonized 27% of Ceratonia, 10% of Olea, Platanus and Prunus trees and a lower percentage of other tree genera. The 13 C. gattii isolates were collected from five Eucalyptus, four Ceratonia, two Pinus and two Olea trees. Cryptococcus neoformans was distributed all around the Mediterranean basin, whereas C. gattii was isolated in Greece, Southern Italy and Spain, in agreement with previous findings from both clinical and environmental sources. Among C. neoformans isolates, VNI was the prevalent molecular type but VNII, VNIV and VNIII hybrid strains were also isolated. With the exception of a single VGIV isolate, all C. gattii isolates were VGI. The results confirmed the presence of both Cryptococcus species in the Mediterranean environment, and showed that both carob and olive trees represent an important niche for these yeasts.