Elisa Margherita Difonzo

Application of PCR to Distinguish Common Species of Dermatophytes

ABSTRACT This report describes the application of PCR fingerprinting for the identification of species and varieties of common dermatophytes and related fungi utilizing as a single primer the simple repetitive oligonucleotide (GACA)4. The primer was able to amplify all the strains, producing species-specific profiles for Microsporum canis, Microsporum gypseum, Trichophyton rubrum, Trichophyton ajelloi, andEpidermophyton floccosum. Intraspecific variability was not observed for these species. Instead, three different profiles were observed in the Trichophyton mentagrophytes group.

Retrospective study of onychomycosis in Italy: 1985–2000

Cases of onychomycosis diagnosed by mycological examination in three mycology units (Florence, Siena and Milan) of central and northern Italy over the 15‐year period, 1985–2000, were studied retrospectively. The number of cases was 4046 (1952 women, 2094 men). Dermatophytes were isolated in 2859, yeasts in 655 and moulds in 532 cases. The most frequent dermatophyte was Trichophyton rubrum (87%), followed by T. mentagrophytes var. interdigitale (10%). Candida albicans (93.2%) was the prevalent yeast. Moulds were mainly Scopulariopsis brevicaulis (48.6%) and Aspergillus spp. (25.2%). Dermatophytes and moulds most commonly infected the toenails, yeasts the fingernails.

Skin and nail infections due to Fusarium oxysporum in Tuscany, Italy

Summary. Nine cases of skin and nail infection due to Fusarium oxysporum, diagnosed in Tuscany in the period 1985‐97, are described. Two manifested as interdigital intertrigo of the feet and seven as onychomycosis. All were diagnosed on the basis of repeated mycological examination, direct microscope observation and culture, as well as histological examination of biopsy specimens in two cases of intertrigo. Fragments of the fungal colonies were examined by scanning electron microscopy (SEM) for more detailed observation of fungal morphology. All patients had normal immune status and a history of the infection extending several years. Four of the patients with onychomycosis were treated with oral itraconazole, and clinical and mycological recovery was achieved in three cases. Two others were treated with cyclopyrox nail lacquer, successfully in one case. One patient with intertrigo was treated with oral itraconazole and one with oral terbinafine; both were also treated and with topical drugs, however clinical recovery was not confirmed by the mycological results.

Epidemiology of the dermatophytoses in the Florence area of Italy : 1985-1990 : Trichophyton mentagrophytes, Epidermophyton floccosum and Microsporum gypseum infections

Between 1985 and 1990 we observed 2085 cases of dermatophytoses in the Florence area of Italy.Trichophyton rubrum andMicrosporum canis were the major etiological agents. 126 cases of dermatophytoses observed during this period were caused byTrichophyton mentagrophytes. Most of the patients came from rural areas or they kept pets.Epidermophyton floccosum ranked fourth in frequency (95 cases). The patients were adults and mainly males, most of whom engaged in sports or lived in group environments.Microsporum gypseum was isolated in 31 cases. Infections occurred directly from contact with soil or domestic animals. We report the principal clinical data concerning these last three dermatophyte infections.

Two cases of cutaneous phaeohyphomycosis by Alternaria alternata and Alternaria tenuissima

Two cases of cutaneous phaeohyphomycosis, one with a nodular appearance and the other with an erythematous infiltrating patch, are reported in immunocompromised patients. Diagnosis was based on histological examination, which revealed hyphae and round-shaped fungal cells in a granulomatous dermal infiltrate, and on identification of the moulds when biopsy fragments were cultured on Sabouraud-dextrose agar without cycloheximide. The pathogens were Alternaria tenuissima in the first case and A. alternata in the second. The fungi were examined by scanning electron microscopy. The patients were checked for bone and lung involvement and were then treated with surgical excision and itraconazole, and itraconazole only, respectively, with clinical and mycological resolution.

Tinea capitis in the Florence area between 1985 and 1993

Summary. This paper describes the main epidemiological findings in 203 patients with tinea capitis and in seven other patients with dermato‐phytosis that had also extended to the scalp. The patients were observed over a 9–year period (from 1985 to 1993) at the Department of Dermatology of the University of Florence. Tinea capitis was the fourth most frequent dermatophytosis. Most of the patients were children, although 23 were adults. The most frequent aetiological agent was Microsporum canis. It is interesting to note that there were 12 cases of tinea capitis due to Trichophyton violaceum in African immigrants. This dermatophyte was believed to have disappeared from Italy. One case was due to Epidermophyton floccosum.

Onychomycosis caused by Alternaria spp. in Tuscany, Italy from 1985 to 1999

Summary. Cutaneous phaeohyphomycosis due to Alternaria spp. is reported with increasing frequency, especially in patients with immune deficiency. Onychomycosis caused by this mould is still rarely observed. Here we report nine cases observed in Tuscany in the period 1985–99; the agent was Alternaria alternata in eight cases and Alternaria chlamidospora in one. Diagnosis was made on the basis of repeated direct microscopic mycological examination and culture, confirmed by scanning electron microscope observation of fragments of colonies. In most cases, the clinical manifestations were dystropy and distal subungual hyperkeratosis of one or two nails of the feet or hands. Seven cases were treated with oral itraconazole, successfully in six cases, as clinical and mycological recovery was confirmed at follow‐up 1 year later.

Detection of Candida dubliniensis in oropharyngeal samples from human immunodeficiency virus infected and non-infected patients and in a yeast culture collection

The incidence of Candida dubliniensis in oropharyngeal swabs of 132 human immunodeficiency virus (HIV)‐positive and 89 HIV‐negative patients was determined. The samples were plated onto CHROMagar Candida medium and 82 strains, presumptively identified as C. albicans or C. dubliniensis, were further investigated (temperature test, chlamydoconidia production, specific primer PCR). In addition, 487 collection strains (isolated from clinical samples and previously identified as C. albicans on the basis of a positive germ tube test) were screened in order to identify C. dubliniensis isolates. Two C. dubliniensis strains were isolated from two HIV‐positive patients without oral candidiasis. Candida dubliniensis was not isolated from 89 HIV‐negative patients nor was it identified among the collection strains.

The treatment of basal cell carcinomas in a patient with xeroderma pigmentosum with a combination of imiquimod 5% cream and oral acitretin

Summary Xeroderma pigmentosum (XP) is a rare autosomal recessive photosensitive disorder, which results in multiple face, neck and head basal cell carcinomas (BCCs), squamous cell carcinomas and melanomas. A 15‐year‐old boy with XP presented with multiple facial BCCs previously treated by surgical excision. Standard BCC treatments such as surgery are not ideal for patients with several facial BCCs because of the risk of scarring, and the patient refused further surgery. As an alternative, three times weekly application of imiquimod 5% cream in combination with oral acitretin (20 mg daily) was prescribed for 4–6 weeks. No adverse events were reported during treatment and all tumours had resolved at the 6‐month follow up visit, highlighting the therapeutic potential of imiquimod 5% cream.

Tinea capitis in the adult: Two case studies

The authors describe two cases of tinea capitis in adults, one due to Microsporum canis and the other to Trichophyton rubrum. The atypical clinical presentation of the dermatophytosis in these two cases is stressed. It is hypothesized that in both cases the disease spread from primary lesions on the face.