Cases reported "Mycoses"

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1/14. hyalohyphomycosis caused by paecilomyces variotii: a case report, animal pathogenicity and 'in vitro' sensitivity.

    A case of cutaneous infection in a 25-year-old male caused by paecilomyces variotii is described. Animal pathogenicity studies with normal and cortisone-treated mice revealed the predeliction of P. variotii for skin and liver in both normal and cortisone-treated mice and for lungs and heart only in immunosuppressed mice. 5-fluorocytosine gave the best MIC value for P. variotii in vitro. This report documents for the first time that P. variotii causes cutaneous infection.
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2/14. Case of keratitis caused by an uncommon fusarium species.

    fusarium polyphialidicum caused a corneal ulcer in a Spanish man. diagnosis was established by a histopathological study and repeated cultures. The isolate was clearly resistant in vitro to the antifungal agents tested. This is the first case of human or animal mycosis by this rare fungus.
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3/14. Severe osteomyelitis caused by Myceliophthora thermophila after a pitchfork injury.

    BACKGROUND: Traumatic injuries occurring in agricultural settings are often associated with infections caused by unusual organisms. Such agents may be difficult to isolate, identify, and treat effectively. CASE REPORT: A 4-year-old boy developed an extensive infection of his knee and distal femur following a barnyard pitchfork injury. Ultimately the primary infecting agent was determined to be Myceliophthora thermophila, a thermophilic melanized hyphomycete, rarely associated with human infection, found in animal excreta. Because of resistance to standard antifungal agents including amphotericin b and caspofungin, therapy was instituted with a prolonged course of terbinafine and voriconazole. Voriconazole blood levels demonstrated that the patient required a drug dosage (13.4 mg/kg) several fold greater than that recommended for adults in order to attain therapeutic blood levels. CONCLUSION: Unusual pathogens should be sought following traumatic farm injuries. Pharmacokinetic studies may be of critical importance when utilizing antifungal therapy with agents for which little information exists regarding drug metabolism in children.
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4/14. Tropical disease in the immunocompromised host: melioidosis and pythiosis.

    melioidosis is an infection of humans and animals caused by a gram-negative motile bacillus, pseudomonas pseudomallei. Forty-nine patients with melioidosis complicating diabetes mellitus, collagen vascular disorders, leukemia/lymphoma, and other hematologic malignancies are described. Twenty-nine of these patients had disseminated/septicemic infection, two developed toxic shock syndrome, and one with AIDS experienced recrudescent melioidosis. patients with disseminated melioidosis often have a variety of defects in cellular immunity both in vitro and in vivo. In humans with recrudescent melioidosis, cellular immunity can be transferred by a transfer factor and by levamisole, a cellular immunopotentiating agent. The results of the treatment of our patients with disseminated/septicemic melioidosis with antimicrobial agents in combination have been successful. In recent years, four cases of fungal arteritis due to pythium species and one case of keratitis due to pythium were seen. Almost all patients with fungal arteritis had thalassemia; all presented with pain in the lower extremities and gangrenous lesions of the toes. pythium species, an aquatic Phycomycetes, was identified in these cases as a human pathogen on the basis of clinical features, pathologic findings, and--of greatest importance--the isolation of the etiologic fungi. These five cases with remarkably similar presentations exhibited certain similarities with and differences from cases of mucormycosis, entomophthoromycosis, and peniciliosis.
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5/14. Human pythiosis associated with thalassemia hemoglobinopathy syndrome.

    pythium infection (pythiosis) in humans has not previously been described, even in areas endemic for animal pythiosis. We report five patients with a unique presentation of fungal arteritis. The medium- to large-sized arteries were involved, and in some cases this involvement led to gangrene of the limbs, aneurysm formation, and ultimately fatal arterial leakage. All five patients were farmers. All patients, with the possible exception of one who had hemoglobin typing performed after receiving a blood transfusion, had thalassemia hemoglobinopathy syndrome. Fungal isolation was difficult. amphotericin b treatment seemed to be ineffective. Radical surgical removal of infected tissues and oral administration of a saturated solution of potassium iodide are proposed therapy. In the tropics, where pythium is ubiquitous, one should actively look for this fungal infection in patients with unexplained arterial occlusion, especially in the case of patients with thalassemia hemoglobinopathy syndrome.
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6/14. ketoconazole, an oral antifungal: laboratory and clinical assessment of imidazole drugs.

    miconazole, a parenterally administered imidazole antifungal agent has been shown to produce responses in systemic fungal infections in man. ketoconazole, an analogue, can be given by mouth. It is inhibitory in vitro at low concentrations to most fungi. Blood levels after oral administration to animals and man greatly exceed these inhibitory concentrations for several hours. The efficacy of this drug has been demonstrated in animal models. Initial clinical evaluation has produced responses to therapy with 200-400 mg/day in 13 of 16 evaluable patients with systemic and superficial fungal infections, involving 10 fungal pathogens. No toxicity has been noted to date in these human studies. ketoconazole is a promising agent needing further extensive evaluation.
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7/14. phaeohyphomycosis caused by cladosporium bantianum in Kerala (india).

    A case of phaeohyphomycosis caused by cladosporium bantianum is reported from india for the first time. It is also the first known case of infection involving the foot caused by this fungus. The cultural characteristics and animal pathogenicity of the isolate are described.
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8/14. phaeohyphomycosis of brain: granulomatous encephalitis caused by Drechslera spicifera.

    Drechslera spicifera is a dematiaceous fungus which occurs widely in nature but only rarely has been implicated in animal and human infections. Previous infections have occurred in superficial and subcutaneous sites or were encountered in immunologically compromised hosts. This report documents a case of granulomatous encephalitis due to Drechslera spicifera in an immunologically competent woman with no known underlying disease, from whom the fungus was isolated. Animal pathogenicity studies in mice reproduced the histopathologic features, and the fungus was reisolated from the animals.
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9/14. Fungal infection of the ear. Etiology and therapy with bifonazole cream or solution.

    Fungal infections of the auditory canal and middle ear are usually left unnoticed and regarded as a harmless saprophytic growth. However, these infections may become clinically significant in immunocompromised patients or patients undergoing long-term antibiotic treatment. This is demonstrated by characteristic case reports and confirmed by light and electron microscopic findings. Moreover, studies on animals with experimentally induced fungal infections have furnished evidence for the risk of the infection's spreading to the inner ear and causing serious damage to the organ of corti; indirect damage to these structures by mycotoxins cannot be ruled out. To avoid complications of such severity of an allegedly harmless otomycosis we consider a quick and clinically easy to perform local treatment of high-risk patients as absolutely necessary. Such a treatment using bifonazole solution or cream was carried out on a number of patients and proved to be effective and free from side effects.
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10/14. Clinical and experimental keratitis caused by the colletotrichum state of Glomerella cingulata and Acrophialophora fusispora.

    Two cases of mycotic keratitis caused by the colletotrichum state of Glomerella cingulata and Acrophialophora fusispora are reported for the first time. Both the isolates produced experimental corneal lesions in rabbit eyes but A. fusispora was more pathogenic. The experimental infection was more severe, with both the fungi, in rabbits pretreated with cortisone as compared with untreated animals. in vitro A. fusispora was most sensitive to miconazole and tolciclate followed by clotrimazole, amphotericin b and lactones while clotrimazole exerted maximum inhibitory effect on colletotrichum followed by miconazole, lactones, amphotericin b and arnebins. Arnebins and tolciclate were inactive respectively against A. fusispora and colletotrichum. Of the 3 drugs tested in vivo, against A. fusispora keratitis in rabbit, amphotericin b showed better results than tolciclate and miconazole.
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