Taralakshmi V. Venugopal

TINEA CAPITIS IN SAUDI ARABIA

Background. Tinea capitis is a dermatophyte infection of the scalp, eyebrows, and eyelashes caused by species of Microsporum and Trichophyton. The purpose of this study was to discover the incidence and causal agents of tinea capitis in Saudi Arabia.

SUPERFICIAL MYCOSES IN SAUDI ARABIA

Between June 1988 and December 1990, 1018 cases of superficial mycoses were investigated. Diagnosis was confirmed by microscopic examination in 503 cases and the causal agent was isolated in 490 cases. Tinea capitis accounted for 47.7% (92.5% in children below 10 years of age). The frequency of other clinical types in descending order was pityriasis versicolor 25.8%, tinea corporis 9%, onychomycosis 5.8%, tinea pedis 4%, intertrigo 3.9% and tinea cruris 2.8%. Erythrasma was encountered three times and mixed piedra and trichomycosis axillaris once.

CEREBRAL ASPERGILLOSIS: REPORT OF TWO CASES

Two cases of cerebral aspergillosis in Tamilians presenting as intracranial space-occupying lesions are reported. The first patient had a left frontal lobe abscess and a specific diagnosis was made by histopathology and isolation of Aspergillus versicolor. He responded well to excision followed by anticonvulsant therapy. In the other, the diagnosis was based on histopathology alone and she died after surgery. These are the first cases reported from Tamil Nadu and probably only one similar case has been reported from India so far.

TREATMENT OF EUMYCETOMA WITH KETOCONAZOLE

Ten patients with eumycetoma were treated with oral ketoconazole in the dosage of 400mg/day for 8 to 24 months. In eight cases the foot was affected: four were due to Madurella mycetomatis and one each due to M grisea, Pyrenochaeta romeroi, Acremonium kiliense and A falciorme. One mycetoma which affected the back and perineum was due to A kiliense, and one case presented with multiple sebaceous cysts and the scalp and M mycetomatis was isolated from the lesion. Clinical and laboratory tests showed excellent tolerance to the drug, with no adverse reactions. Complete cure was obtained in six patients and two showed good responses. The cured patients were followed up for a period ranging from three months to two years without any evidence of recurrence.

Mycetomas in Madras

In 90 of 150 cases clinically diagnosed as mycetoma in the Department of Pathology, Madras Medical College, from January 1964 to June 1975, histopathological study revealed granules. Besides special staining procedures, cultural methods were undertaken in recent cases. The age and sex incidence, site of lesion and the species of fungi identified on the basis of histological morphology of the granules are analysed. The disease was predominatly seen in the age group 21-40. Men were more frequently affected than women and the commonest site of the lesion was foot. Actinomycotic mycetoma (68-9%) was more often found than the maduromycotic type. Madurella mycetomi (37-8%) and Actinomadura madurae (26-7%) were the commonest causal agents. Nocardia spp. were the next most common (21-1%) followed by A. pelletieri (15-5%), S. somaliensis (5-6%) and presumably Allescheria/Cephalosporium spp. from only 3 cases of white grain mycetoma.

Pale grain eumycetomas in Madras

Biopsy specimens from 211 cases of mycetoma were examined histologically. Pale grain eumycetoma was found in seven cases. Four of these were studied mycologically, Acremonium kiliense was isolated from two and Acremonium falciforme and Pseudallescheria boydii from one case each. The geographic distribution of these organisms, and their incidence and prevalence are discussed.

Antimycotic susceptibility testing of agents of black grain eumycetoma

Antimycotic susceptibility testing of 17 strains of eumycetes including Madurella mycetomatis, Madurella grisea, Pyrenochaeta romeroi, Exophiala jeanselmei and Leptosphaeria tompkinsii, isolated from cases of black grain mycetoma, was carried out against ketoconazole, itraconazole, miconazole and econazole by broth microdilution and agar dilution methods. Itraconazole and ketoconazole were more active inhibiting 50% of the strains (MIC 50) at 0.5 and 1 microgram ml-1 and 90% (MIC 90) at 2.5 and 5 micrograms ml-1, respectively. The MIC 50s of econazole and miconazole were 2.5 and 5 micrograms ml-1 and MIC 90s 10 micrograms ml-1 for both drugs.

NOCARDIA SPECIES FROM BRONCHOPULMONARY INFECTIONS AND MYCETOMAS

350 specimens comprising sputum, bronchial aspirate, pleural fluid, pus and biopsy material were investigated for the presence of Nocardia spp. by the paraffin bait technique. Nocardia spp. were isolated in 15 of them. The physiological and morphological characteristics of the organisms and the use of paraffin baiting, a selective technique for isolating Nocardia spp. from clinical specimens, are discussed.

Primary cutaneous aspergillosis from Tamilnadu diagnosed by fine needle aspiration cytology

Aspergillus are ubiquitous and more than 30 species have been reported to be involved in human infection. Most of the cases occur in immunocompromised patients and are disseminated in the blood. Primary cutaneous aspergillosis in immunocompetent hosts is rare. We report a unique case of primary cutaneous aspergillosis in an immunocompetent patient diagnosed by fine needle aspiration cytology. The characteristic ascocarp and ascospores of Aspergillus species were found in the aspirate and Aspergillus glaucus was isolated in pure culture. The case is presented to increase the awareness of the usefulness of fine needle aspiration cytology for diagnosing fungal infections.

ACTINOMADURA MADURAE MYCETOMAS

Actinomycetomas are localised, chronic, suppurative and progressive infections of the skin, subcutaneous tissues and bones caused by aerobic actinomycetes. They are characterised by subcutaneous granulomas and abscesses with in duration, formation of sinus tracts and production of granules which are the microcolonies of the causative agents.