Onychomycosis Caused by Neoscytalidium Dimidiatum: An Emerging Disease

Onychomycosis is one of the most common nail disorders. Neoscytalidium dimidiatum has been recognized among the common cause of onychomycosis that clinically similar to dermatophyte molds. To our knowledge, there are no reports of onychomycosis due to N. dimidiatum from Indonesia. Here, we describe two cases of onychomycosis, affecting females, 70 and 12 years of age. We discuss macroscopic and microscopic identification as well as the choices of antifungal therapy. The presented cases highlight that N. dimidiatum cannot be underestimated as the cause of onychomycosis in tropical and subtropical countries, especially if there were characteristic clinical conditions of dark-pigmented discolorization of the affected nails. Bangladesh Journal of Medical Science Vol. 24 No. 01 January’25 Page : 309-316

A comparative study on population development patterns of Sogatella furcifera between tropical and subtropical areas

Two cases of onychomycosis in green tea leaf pluckers caused by Scytalidium dimidiatum, a dematiaceous non-dermatophytic mold has been described. Onychomycosis caused by Scytalidium dimidiatum is clinically indistinguishable from that caused by dermatophytes and responds poorly to antifungals. The clinical presentations in the cases were of distal subungual type with associated melanonychia involving thumbnails. These cases have unique importance, because besides disfigurement, this has adversely affected the livelihood of the patient and poor response to antifungal dissuaded them from treatment compliance. To the best of our knowledge, this is the first report of onychomycosis caused by Scytalidium dimidiatum in green tea leaf pluckers.

Méthodes de diagnostic d’une onychomycose

Phaeohyphomycose cutanée à Scytalidiumdimidiatum chez une transplantée rénale

Temporal and spatial variations in IAQ and its association with building characteristics and human activities in tropical and subtropical areas

Soil degradation is a crucial problem, particularly in tropical and subtropical areas. Prevention or reduction of soil erosion requires strategies based on thorough rapid vegetation cover (VC) and favorable soil quality in subtropical and tropical areas. This study applied wood biochar (WB) and rice husk biochar (RHB) in a mudstone soil, which is widely distributed in Southern Taiwan, to investigate the effects of biochar application on soil erosion and vegetation restoration. The standard erosion unit plots (22.13 m in length and 9% in slope gradient) were set up to determine the relationship among soil losses, VC, and natural rainfall characteristics with and without biochar application. The results indicated that biochar application increased the growth rate (identified by cover ratio) of Bahia grass (Paspalum notatum Flüggé) by 2–2.6 times within 40 days compared with control (without biochar application) and increased VC by 20% after 120 days of treatment. The biochar application could effectively reduce soil losses by 60% at least in the mudstone soil. A well-predicted regression function of soil loss with VC and rainfall kinetic energy was established (amount of soil lost = −0.435 × ln VC + 0.54 × RKE, r = 0.89, p < 0.01).

Brazil has reported more than 1,600 cases of hantavirus cardiopulmonary syndrome (HPS) since 1993, with a 39% rate of reported fatalities. Using a recombinant nucleocapsid protein of Araraquara virus, we performed ELISA to detect IgG antibodies against hantavirus in human sera. The aim of this study was to analyze hantavirus antibody levels in inhabitants from a tropical area (Amazon region) in Rondônia state and a subtropical (Atlantic Rain Forest) region in São Paulo state, Brazil. A total of 1,310 serum samples were obtained between 2003 and 2008 and tested by IgG-ELISA, and 82 samples (6.2%), of which 62 were from the tropical area (5.8%) and 20 from the subtropical area (8.3%), tested positive. Higher levels of hantavirus antibody were observed in inhabitants of the populous subtropical areas compared with those from the tropical areas in Brazil.

Primary isolates from 128 cases of superficial Hendersonula toruloidea infection were invariably of the hyphomycete Scytalidium synanamorph of the fungus, characterized by the formation of dematiaceous fission arthroconidia. Three distinct colonial forms were recognized which were stable on repeated sub-culture. The growth rates of four isolates of each colonial form were determined at 25 degrees C, 30 degrees C, 37 degrees C and 40 degrees C. The production of the coelomycete synanamorph was investigated on a range of agar and natural media. Pycnidial or stromatal conidiomata were observed in representatives of two of the three colonial forms. All the infections were diagnosed in patients who had originated from, or resided in tropical, subtropical or warm temperate areas and the distribution of the different colonial forms was significantly related to the geographical/racial origins of the patients.

Mango (Mangifera indica L.) is an economically important fruit crop in the tropical and subtropical areas of the world. In southern Taiwan, mango is grown on 18,000 ha of hilly land mainly located in Tainan, Kaohsiung, and Pingtung. Tons (180,000) of mango with a value of NT$6.6 billion (US$206 million) are produced annually. In 2008, mango fruit rot disease was observed 1 week after harvest on 30 to 72% of stored mangoes collected from seven orchards in southern Taiwan. The initial symptom was a small, brown lesion and rot symptoms advanced progressively. Two predominant fungi were isolated from the margin of lesions on acidified potato dextrose agar (PDA with lactic acid, pH 3.8). Isolates of each fungal type were transferred to 2% water agar containing sterilized pine needles and exposed to near UV light to induce sporulation. For the first fungus, conidia obtained from pycnidia were ovate, one-celled, and hyaline, with an average length and width of 12.93 ± 0.93 × 6.98 ± 0.40 μm and an average length/width ratio of 1.85. To confirm the identity of the fungus, PCR amplification by universal primers, ITS1/ITS4, and DNA sequencing of the internal transcribed spacer (ITS1-5.8S-ITS2 rRNA gene cluster) were conducted. The internal transcribed spacer (ITS) sequence of ribosomal DNA of this fungus was analyzed and submitted to GenBank (Accession No. GQ421486). It showed a sequence identity of 100% with Neofusicoccum mangiferae (Syd. & P. Syd.) Crous, Slippers & A. J. L. Phillips) (GenBank Accession No. AY615185). For the second fungus, conidia obtained from pycnidia were fusiform, one-celled, and hyaline, with an average length and width of 22.87 ± 1.32 × 6.42 ± 0.46 μm and a length/width ratio of 3.53. The ITS sequence of ribosomal DNA of this fungus was analyzed and submitted to GenBank (Accession No. GQ421485). It showed a sequence identity of 100% with Botryosphaeria dothidea (Moug.: Fr.) Ces & De Not.) (GenBank Accession No. AY 786321). To test pathogenicity, four mango fruits were wounded with a sterile needle, inoculated with mycelium agar plugs (0.5 mm in diameter) excised from separate monoconidial cultures, and incubated in a plastic box with a 100% relative humidity for 2 days at room temperature. Brown lesions appeared on all wounded sites of each fungus 2 days postinoculation. In control experiments, sterile agar plugs were placed on the wounded mango fruits. These fruits remained completely free from symptoms throughout the experiment. The pathogen was reisolated from the lesions of inoculated fruits and identified as N. mangiferae and B. dothidea, thus fulfilling Koch's postulates. N. mangiferae and B. dothidea have been reported on mango trees in Australia and South Africa (1). To our knowledge, this is the first report of these fungi causing fruit rot of mango in Taiwan.

Problem statement: The experiment was carried out to determine whether the dietary Dried Fermented Ginger (DFG) has no affecting damage on broiler growth performance and can also be applicable in tropical and subtropical area using basal diets without antibiotics. Approach: Three hundred and fifty 7-d-old Arbor Acres broiler chicks were divided into one basal diet group (control) and 6 experimental groups. The basal diets were adequately formulated, but not added with antibiotics. Among the 6 DFG groups, 3 groups were fed each basal diet supplemented with DFG at 0.25 (0.25 S), 0.5 (0.5 S) and 1% (1 S) levels from 7-42 days of age (starter groups). The remaining 3 DFG groups were fed the starter basal diet until 21 days of age. At 22 days of age, they were switched to finisher diet supplemented with DFG at 0.25 (0.25 F), 0.5 (0.5 F) and 1% (1 F), from 22-42 days of age (finisher groups). Results: Feed intake, body weight gain and feed efficiency were not significantly different among the groups (p>0.05). However, when the body weight gain of the control was expressed as an index of 100, the body weight gain index of the DFG groups was better than the control except the 0.25 S groups. Compared to the body weight gain index of the starter groups, they showed the better index. The values of feed efficiency were also better in all the experimental groups than in the control. Conclusion: The present results suggest that DFG can apply to tropical and subtropical area as a natural supplementation without antibiotics and it is better to supplement to basal diet during finisher stage (from 22 days old).

Cardiovascular magnetic resonance in Myocarditis: Insights into Diverse clinical presentations.

Background: The associations between ambient temperatures and stroke are still uncertain, although they have been widely studied. Furthermore, the impact of latitudes or climate zones on these associations is still controversial. The Tropic of Cancer passes through the middle of Taiwan and divides it into subtropical and tropical areas. Therefore, the Taiwan National Health Insurance Database can be used to study the influence of latitudes on the association between ambient temperature and stroke events. Methods: In this study, we retrieved daily stroke events from 2010 to 2015 in the New Taipei and Taipei Cities (the subtropical areas) and Kaohsiung City (the tropical area) from the National Health Insurance Research Database. Overall, 70,338 and 125,163 stroke events, including ischemic stroke and intracerebral hemorrhage, in Kaohsiung City and the Taipei Area were retrieved from the database, respectively. We also collected daily mean temperatures from the Taipei and Kaohsiung weather stations during the same period. The data were decomposed by ensemble empirical mode decomposition (EEMD) into several intrinsic mode functions (IMFs). There were consistent 6-period IMFs with intervals around 360 days in most decomposed data. Spearman’s rank correlation test showed moderate-to-strong correlations between the relevant IMFs of daily temperatures and events of stroke in both areas, which were higher in the northern area compared with those in the southern area. Conclusions: EEMD is a useful tool to demonstrate the regularity of stroke events and their associations with dynamic changes of the ambient temperature. Our results clearly demonstrate the temporal association between the ambient temperature and daily events of ischemic stroke and intracranial hemorrhage. It will contribute to planning a healthcare system for stroke seasonally. Further well-designed prospective studies are needed to elucidate the meaning of these associations.

Objective: To assess the pattern of clinical presentation and management outcome of snake bite victims treated in a comprehensive health centre in a rural setting in North-Central zone of Nigeria where snake bite morbidity and mortality are known to be unacceptably high. Methods: All records of admission in the Comprehensive Health Centre from Jan to December 2001 were examined and all those admission due to snake bites were retrieved and carefully studied. Information on biodata, clinical presentation, clinical assessment, key investigations, type of treatment given and duration of admission were extracted, examined, computerized and analysed using the EPI info version 3.22 (CDC Atlanta). Differences among variables were subjected to statistical analysis and all P-values less than 5% were considered significant. Findings: 103 of 620 admissions, constituting 16.6% were due to snake bites. Majority of patients were farmers (48.5%) and students (22.3%). Farming and walking along the bush-path carry equal risk of exposure and accounted for 70% of bites. In 96% (99) of cases the snake was identified as carpet viper (Echis carinatus). 87 patients (84.5%) had envenomation defined as whole blood clotting time of 20 minutes or more. There was no significant difference in the proportion of envenoming between those bitten on the leg (83.9%) and those bitten on the hand (16.1%). About eight out of every ten patients (81.6%) use a first aid measure and nine out of every ten patients that used a first aid measure used a tourniquet either alone or combined with other measures such as traditional medicine, incision of site. About 13% of those that employed first aid measures used the black stone. The common presenting features on the site of bite were oedema (38.8%), oedema and bleeding (26.2%), fang marks and bleeding (16.5%) and tissue necrosis (3.9%). More than half of the patient with envenoming (52%) presented to health facility within 3 hours and 94% within 48 hours. All patients with envenoming had antivenom with the majority (69.7%) receiving between 20-30 mls. All patients did well on treatment and there were no deaths and no patient had permanent disability. Conclusion: Snake bite is a common cause of preventable morbidity and mortality and the carpet viper is the most common specie responsible in Langtang and its environs. Farming and walking bare foot along the bush-paths carry equal level of risk of exposure to snake bite in these communities and people should be educated on the need to use protective clothing. Effective anti snake venom exist but its effectiveness in reducing the menace of snake bite could be greatly enhanced by education on the need to avoid the use of popular first aid measures of doubtful benefit. Key words: Snake bite, pattern of clinical presentation; treatment outcome, Langtang. Highland Medical Research Journal Vol.2(2) 2004: 61-68

BACKGROUND: Onychomycosis is common infection in adults and account for 20% of all nail diseases.The clinical presentation is often confused with other conditions, making laboratory diagnosis and confirmation necessary.Accurate identification of etiological agent is important, as the treatment is different for dermatophytes and non dermatophytes.AIMS AND OBJECTIVES: 1.To isolate and identify the etiological agents of onychomycosis.2. To study the occupational status of the study group.3. Correlation between nail involvement and sex.METHODOLOGY: To identify the aetiological agents of onychomycosis, the present study was carried out in the department of Microbiology, S. S. Institute of medical sciences and research centre.Nail clippings were collected from a total of 120 clinically suspected patients of onychomycosis attending the outpatient department of Dermatology and Venereology and were processed and identified by standard laboratory techniques.RESULTS: Fungi was demonstrated in 66 (55%) either by KOH preparation and/or culture.Sixty (50%) were positive by direct microscopy and 54 (45%) were culture positive.Out of the 54 culture isolates,32 (59.26%)were dermatophytes followed by yeasts 13 (24.07%)and non dermatophytemoulds 9 (16.67%).Among the dermatophytes,T.rubrum18(33.33%) was the most common followed by T.mentagrophyte 8 (14.81%) and T.tonsurans 4 (7.41%).Among the yeasts, C.albicans11 (20.37%) was predominate followed by C.tropicalis 2 (3.7%).Among the non dermatophytemoulds,Aspergillusflavus3 (5.55%) was the commonest followed by Fusarium spp 2 (3.7%).The finger nails were more commonly involved 66 (55%) than toe nails 54 (45%).Most of the patients were farmers 38 (31.67%) followed by housewives 32(26.67%).CONCLUSION: Dermatophytes remain the predominant cause of onychomycosis, with T.rubrum as the most common aetiological agent, but less commonly yeasts like C.albicans and non dermatophytic moulds like Aspergillus spp can also cause nail infection and hence accurate diagnosis is needed ,since the treatment is different for each group.