Common Fungal Infection Research Articles

Comparative Study of Topical 1% Terbinafine Cream Versus 1% Clotrimazole Cream in The Treatment of Tineapedis

Background:Tinea pedis (athletic foot) is the most common dermatophytic fungal infection of the body. It may last for a short or long time and may recur after treatment. Objective: To assessed and compared the effectiveness and safety of 1% terbinafine cream and 1% clotrimazole cream for the treatment of tinea pedis. Patients and Methods: Randomized control trial was done in the outpatient clinic of dermatology department in Rizgary Teaching Hospital in Erbil. From March, 2019 to January, 2020. Sixty patients with tinea pedis diag-nosed clinically were included in this study. Thirty patients applied 1% terbinafine cream topically twice daily for one week and thirty patients applied 1% clotrimazole cream topically twice daily for four weeks. Scraping for fungi was performed before and after therapy. Efficacy was assessed by clini-cal cure and mycological cure. Clinical and mycological cure measured at weeks one, four and six. Results: Mycological cure rates were 86.7% for terbinafine and 80% for clotrimazole at 4 weeks, 86.7% for terbinafine and 90% for clotrimazole at 6 weeks. At 4 weeks, terbinafine had an 83.3 percent clinical treatment rate and clotrimazole had a 76.67 percent clinical treatment rate; at 6 weeks, terbinafine had an 83.3 percent clinical treatment rate and clotrimazole had an 83.3 percent clinical treatment rate. Conclusion: The study showed that one week terbinafine two times a day is as effective as four weeks clotrimazole two times a day as well as in terms of mycological treatments and efficient therapies.

Comparative Study of Topical 1% Terbinafine Cream Versus 1% Clotrimazole Cream in The Treatment of Tineapedis

Background:Tinea pedis (athletic foot) is the most common dermatophytic fungal infection of the body. It may last for a short or long time and may recur after treatment.
 Objective: To assessed and compared the effectiveness and safety of 1% terbinafine cream and 1% clotrimazole cream for the treatment of tinea pedis.
 Patients and Methods: Randomized control trial was done in the outpatient clinic of dermatology department in Rizgary Teaching Hospital in Erbil. From March, 2019 to January, 2020. Sixty patients with tinea pedis diag-nosed clinically were included in this study. Thirty patients applied 1% terbinafine cream topically twice daily for one week and thirty patients applied 1% clotrimazole cream topically twice daily for four weeks. Scraping for fungi was performed before and after therapy. Efficacy was assessed by clini-cal cure and mycological cure. Clinical and mycological cure measured at weeks one, four and six.
 Results: Mycological cure rates were 86.7% for terbinafine and 80% for clotrimazole at 4 weeks, 86.7% for terbinafine and 90% for clotrimazole at 6 weeks. At 4 weeks, terbinafine had an 83.3 percent clinical treatment rate and clotrimazole had a 76.67 percent clinical treatment rate; at 6 weeks, terbinafine had an 83.3 percent clinical treatment rate and clotrimazole had an 83.3 percent clinical treatment rate.
 Conclusion: The study showed that one week terbinafine two times a day is as effective as four weeks clotrimazole two times a day as well as in terms of mycological treatments and efficient therapies.

In vitro outcomes of quercetin on Candida albicans planktonic and biofilm cells and in vivo effects on vulvovaginal candidiasis. Evidences of its mechanisms of action

Background and purposeCandida albicans is a fungus that produces common fungal infection in humans, including vulvovaginal candidiasis (VVC). While quercetin (QC) has potential antifungal activities against C. albicans, studies on the in vivo anti-VVC activity of QC are limited. This study evaluated the antifungal capacity of QC against cultured C. albicans strain SC5314 or in C. albicans-infected mice. MethodsMicrodilution and XTT reduction assay were used to determine the minimum inhibitory concentration (MIC) and biofilm formation of QC on C. albicans, respectively. Immunofluorescence was performed to detect the anti-invasive capacity of QC upon co-culturing C. albicans with VK2/E6E7 cells. The potential anti-VVC effects of QC were assessed in C. albicans-infected mice with VVC. Further, inflammatory cytokine levels were determined using ELISA. PAS and Papanicolaou staining were used to detect C. albicans cells and polymorphonuclear leukocytes (PMNs) in vaginal tissues. Western blotting and immunohistochemistry were performed to measure the expression of MAPK, ERK, JUN, and P38. ResultsMIC and minimal fungicidal concentration (MFC) of QC for C. albicans were 128 μM and > 512 μM, respectively. QC concentration lower than 128 μM (32–128 μM) could not inhibit C. albicans. QC (16 μM) notably inhibited C. albicans biofilm formation and suppressed the adhesion and invasion of C. albicans to VK2/E6E7 cells. In addition, the pharmacokinetic parameters of orally administered QC in mice showed rapid absorption (approximately 1 h) and slow elimination (approximately 6 h). Oral QC showed an effective protective function against C. albicans infection with no toxic effects a in mouse VVC model. QC significantly reduced IL-1α, TNF-α, IL-22 and IL-23 levels in vaginal lavage solution, inhibited invasive C. albicans and PMN infiltration in vaginal tissue, and effectively protected the integrity of vaginal mucosa. ConclusionsThe present study showed that QC has rapid oral absorption, slow elimination, good viral distribution, and a lack of toxicity. QC not only inhibited biofilm formation, adhesion, and invasion of C. albicans in vitro, but also ameliorated C. albicans-induced inflammation and protected the integrity of the vaginal mucosa in vivo, suggesting that QC has the potential for the treatment of candidiasis.

Comparison of the Efficacy of Honey and Clotrimazole Cream in the Vulvovaginal Candidiasis Treatment: A Systematic Review and Metaanalysis

Background: Vulvovaginal candidiasis (VVC) is a common fungal infection of the vaginal area affecting 75% of women at least once in their lifetime. However, there is no clear evidence helping to choose the most effective treatment method to improve the symptoms of VVC. Objective: The objective of this study was to compare the effect of using honey with clotrimazole on the treatment of symptoms of VVC. Methods: All databases in English (Embase, MEDLINE, ProQuest, Google Scholar, Scopus, Cochrane Library, and Web of Science) and Persian (Irandoc, SID, and Magiran) were searched without time limitation. Evaluation of studies in terms of bias was performed using the Cochrane handbook. Four clinical trials were included in the present systematic review; however, only three of them were included in the meta-analysis. Results: The results of the meta-analysis demonstrated that the rate of positive culture after treatment (RR: 2.35; 95%CI: 1.45 to 3.82) was significantly higher in the honey group than in the clotrimazole one. The frequency of itching after treatment (RR: 0.25, 95%CI: 0.12 to 0.49) was significantly lower in the honey-receiving group than in the clotrimazole one. However, there was no statistically significant difference in the incidence of other symptoms of VVC, including vaginal discharge (RR: 0.26, 95%CI: 0.02 to 2.75), vaginal burning (RR: 0.35, 95%CI: 0.03 to 3.80) and dyspareunia (RR: 0.64, 95%CI: 0.27 to 1.50) between groups. Conclusion: Due to the low quality of the studies, more clinical trial studies with stronger designs in this field are needed to clearly identify the therapeutic effects of honey on improving the symptoms of VVC.

A Case of Oral Candidiasis Treated with Fluconazole (Diflucan®) Mouthrinse

Oral candidiasis, a common fungal infection in humans, is characterized by the overgrowth of Candida species in the superficial oral epithelial mucosa. The condition is associated with multiple risk factors, including impaired salivary gland function, oral mucosal damage, and long-term antibiotic or corticosteroid use. Several treatment options are available; nystatin and amphotericin B are the most widely used local medications. Recently, fluconazole has emerged as the preferred systemic treatment. We report a case of oral candidiasis in an 83-year-old male diagnosed with bullous pemphigoid in 2017 and previously administered methylprednisolone. He developed oral candidiasis a few months before presentation and was treated with 10 mL nystatin suspension three times daily; unfortunately, the disease was recalcitrant to this treatment and his symptoms showed no improvement over two months. We discontinued nystatin in favor of fluconazole syrup (Diflucan®) administered by rinsing, then swallowing, 5 mL syrup once daily. The lesion improved after one month of treatment. This case demonstrates the efficacy of fluconazole as a primary treatment for oral candidiasis. The act of rinsing the mouth with syrup exposes the oral mucosa to drug, potentially producing a better treatment response than taking the syrup orally without rinsing.

Biofilm Formation and Phospholipase and Proteinase Production in Cryptococcus neoformans Clinical Isolates and Susceptibility towards Some Bioactive Natural Products.

Cryptococcosis is one of the most common fungal infections in immunocompromised patients, which is caused by Cryptococcus neoformans. However, relatively little is known about the virulence factors of C. neoformans and the incidence of antifungal drug resistance in C. neoformans is rapidly increasing. This study was undertaken to investigate the virulence factors in C. neoformans, thymol, curcumin, piperine, gallic acid, eugenol, and plumbagin for their potential antimicrobial activity against C. neoformans. The production of phospholipase and proteinase was detected using standard methods. Biofilm formation was determined using the microtiter plate method. The broth microdilution method was used to determine the antifungal activity. The antibiofilm activity was assessed using the safranin staining method. All isolates of C. neoformans produced biofilms with optical density values ranging from 0.16 to 0.89. A majority of C. neoformans isolates that were tested exhibited strong phospholipase (7/8) and proteinase (5/8) production. Plumbagin (with minimum inhibitory concentration values ranging from 4 to 16 μg/mL) showed the highest antifungal activity followed by thymol (with minimum biofilm inhibitory concentration values ranging from 8 to 64 μg/mL). In addition, plumbagin showed the highest antibiofilm activity with minimum biofilm inhibitory concentration and minimum biofilm eradication concentration values ranging from 4 to 16 μg/mL and 32 to 256 μg/mL, respectively. Plumbagin, compared to other natural products studied, was the most efficient in terms of antifungal and antibiofilm activities. Hence, plumbagin could be used in combination with antifungals for the development of new anticryptococcal drugs.

Common Invasive Fungal Infection in Bangladesh and Available Management

Invasive fungal diseases are an important cause of mortality in immunocompromised patients and in patients with chronic illnesses. Multiple studies in Bangladesh have documented the frequency of fungal infections in our country and results varied. However, better understanding of the invasive fungal infection includes learning about the epidemiology, clinical features, and diagnostic method which is integral part of improving outcomes. In this review, we discuss the common invasive fungal infection that are prevalent in our country along with the clinical pictures, diagnosis, and treatment. It is hoped that this article will highlight the burden of fungal infections on public health and promote effective diagnosis and therapy. J Bangladesh Coll Phys Surg 2023; 41: 164-169

The need for fast and accurate detection of dermatomycosis.

Dermatomycosis of the hair, skin or nails are one of the most common fungal infection worldwide. Beyond permanent damage to the affected area, the risk of severe dermatomycosis in immunocompromised people can be life-threatening. The potential risk of delayed or improper treatment highlights the need for a rapid and accurate diagnosis. However, with traditional methods of fungal diagnostics such as culture, a diagnosis can take several weeks. Alternative diagnostic technologies have been developed which allow for an appropriate and timely selection of an antifungal treatment, preventing nonspecific over-the-counter self-medication. Such techniques include molecular methods such as PCR, real-time PCR, DNA microarray, next-generation sequencing, in addition to matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. Molecular methods can help close the 'diagnostic gap' observed with traditional cultures and microscopy and allow for a rapid detection of dermatomycosis with increased sensitivity and specificity.

Molecular docking studies of different phytochemicals obtained from medicinal Plants of Uttarakhand region for identification of potential inhibitors against mucormycosis causing fungal species

Mucormycosis is an insidious fungal infection caused by members of Mucorales and zygomycotic species. During the last few years, mucormycosis has become the third most common invasive fungal infection in patients with haematological malignancies and organ transplantations. The incidence of mucormycosis is particularly high in patients with immunocompromised health. It has been reported that CotH receptor proteins have a potential role in binding Rhizopus species with the host cells. Further, CotH1, CotH2, and CotH3 are the spore-coating protein of mucormycosis, which are mostly responsible for the invasion of host cells and causing diseases. The present study aimed to predict the structure of CotH1, CotH2, and CotH3 receptors in Rhizpous delemar using homology modelling on SWISS Server and validated the model based on GMQE and QMEAN scores followed by analysis of the predicted model on Ramachandran plot. Further, molecular docking studies of the predominant 46 phytochemicals found in the medicinal plants of Uttarakhand region, India were done against these three receptors. Autodock vina results have shown that the binding energy value of Curcumin was -8.5 Kcal/mol against CotH1, and the binding energy value of Allosecurinin was -7.6 Kcal/mol against CotH2 and binding energy value of Isoquercetin was -7.7 Kcal/mol against CotH3. Evaluation of the ADMET parameters has shown the high efficacy of these compounds. The present Insilico study suggests that Curcumin, Allosecurinine, and Isoquercetin are effective lead molecules against the receptors CotH1, CotH2, and CotH3 in the mucormycosis caused by fungal species R. delemar.

Mucormycosis—A significant hazard in the COVID-19 pandemic?

Mucormycosis was the third most common angio-invasive fungal infection after candidiasis and aspergillosis. However, the frequency of this disease seems to be increasing with the arrival of COVID-19 infection. Despite efforts to better understand the pathophysiology of mucormycosis, its fatality rate remains high. Therefore, this review article aims to accomplish an evidence-based review answering whether mucormycosis is a significant hazard in the era of COVID-19 infection. It contains a wealth of information about the infection's aggressive and deadly characteristics in diabetic and immunocompromised individuals, as well as its pathogenesis, clinical aspects, and management, along with its link to COVID-19, which is the need of the hour.The method used to assemble all the information was a review of the literature, along with multiple case reports supporting the occurrence of COVID-19 linked mucormycosis. This article concludes that uncontrolled diabetes mellitus in COVID-19 patients makes them more vulnerable to secondary infections, primarily mucormycosis, due to the over-zealous use of corticosteroids for its treatment, resulting in immunosuppression. The diagnosis and treatment of this black fungus have also been established to be quite challenging. The effective management of mucormycosis in immunocompromised individuals is centered on a multimodal approach that includes early diagnosis, or cessation of the primary prompting factors, administration of antifungal agents at ideal doses, and comprehensive amputation of all devitalized tissues, along with several adjunctive remedies.

Fungal infection in nail psoriasis

Introduction: Onychomycosis is a common superficial fungal infection of nail in both developed and developing countries. It may involve any component of the nail unit, including the nail matrix, the nail bed, or the nail plate. It represents up to 20.0% of all nail disorders. Its prevalence is estimated at 2 to 18 percentage worldwide and up to 48-percentage incidence by age 70. Onychomycosis can be caused by dermatophyte mold, yeasts and non dermatophyte mold. We planned this study to determine the frequency of onychomycosis in psoriatic nails to establish the local perspective as the international studies shows wide variation. Objective: To find the presence of fungal elements in nails of patients affected by psoriasis. Setting: Dermatology (OPD), Baqai Medical University. Duration: 06 months from 15th July 2022 - 15th Dec 2022. Design: Descriptive Cross-sectional study. Results: In this study, out of 96 cases, 32.29% (n=31) of patients were between 18-40 years and 67.71% (n=65) were between 41-70 years of age, mean+SD: 47.32+11.94 years.

Surge of mucormycosis during the COVID-19 pandemic.

Patients with respiratory viral infections are more likely to develop co-infections leading to increased fatality. Mucormycosis is an epidemic amidst the COVID-19 pandemic that conveys a 'double threat' to the global health fraternity. Mucormycosis is caused by the Mucorales group of fungi and exhibits acute angioinvasion generally in immunocompromised patients. The most familiar foci of infections are sinuses (39%), lungs (24%), and skin tissues (19%) where the overall dissemination occurs in 23% of cases. The mortality rate in the case of disseminated mucormycosis is found to be 96%. Symptoms are mostly nonspecific and often resemble other common bacterial or fungal infections. Currently, COVID-19-associated mucormycosis (CAM) is being reported from a number of countries such as the USA, Turkey, France, Mexico, Iran, Austria, UK, Brazil, and Italy, while India is the hotspot for this deadly co-infection, accounting for approximately 28,252 cases up to June 8, 2021. It strikes patients within 12-18 days after COVID-19 recovery, and nearly 80% require surgery. Nevertheless, the mortality rate can reach 94% if the diagnosis is delayed or remains untreated. Sometimes COVID-19 is the sole predisposing factor for CAM. Therefore, this study may provide a comprehensive resource for clinicians and researchers dealing with fungal infections, intending to link the potential translational knowledge and prospective therapeutic challenges to counter this opportunistic pathogen.

Nanocrystalline Silver for the Treatment of Otomycosis: A Retrospective Study.

Otomycosis is a common fungal ear infection usually found in tropical and subtropical countries where infections arise due to hot and humid conditions. Also, these infections have a high recurrence rate with limited therapeutic options, which makes their management difficult. There is a long history of applying various antiseptic agents consisting of silver specifically for these broad-spectrum infections. Silver nanoparticles (AgNPs) are futuristic nano-size products for controlling the microbial infection. The study aimed to determine the antifungal properties of nanocrystalline silver in patients with otomycosis. The study was conducted in Pune (India) in the department of Ear Nose Throat & Head at the Dr. D.Y. Patil Medical College, Hospital and research center, Pune (India) for a period of one year (2019 -2020). Our study included 100 patients (58 male and 42 female) with clinically diagnosed otomycosis, which was treated by applying nanocrystalline silver gel-soaked Gelfoam. Our study had patients of 18 to 60 years, with the highest prevalence in males (58%) aged 30 to 45 years. A large number of infection cases were reported at the hospital, i.e., 62 cases during the wet season as compared to 38 cases during the dry season. Commonly found fungi belonging to the genus Aspergillus (55%), followed by Candida (45%). Improvements in symptoms were observed in 89% of the patients (70% within 5 to 6 days and 19% from 7 to 14 days). Applying nanocrystalline silver cured most of the patients (89%) within 14 days. Treating otomycosis patients with nanocrystalline silver demonstrated beneficial results. Further studies with larger samples should be conducted to validate the benefits of nanocrystalline silver.

“A CROSS-SECTIONAL STUDY OF CLINICO-MYCOLOGICAL PROFILE OF DERMATOPHYTES AND ANTIFUNGAL SUSCEPTIBILITY AMONG PATIENTS ATTENDING DERMATOLOGY OPD AT A TERTIARY CARE HOSPITAL IN TELANGANA”

Background: Dermatophytosis is the most common supercial fungal infection worldwide, caused by dermatophytes that cause infections of the skin, hair, and nails due to their ability to invade keratin. Belong to three closely related genera: Trichophyton, Microsporum, and Epidermophyton. It is common in the tropics & subtropical regions and in areas of high humidity. Recent years have seen an alarming increase in chronic, recurrent, and recalcitrant dermatophytosis in India. Despite the availability of a wide range of antifungals, treatment failure is often observed. This is often attributed to the probable emergence of drug-resistant strains. To identify t Objectives: he dermatophyte species causing Dermatophytosis and to determine antifungal susceptibility patterns to Fluconazole and Griseofulvin by Broth microdilution. A cross-sectional study was conducte Method: d over a period of 18 months duration i.e., from June 2021 to November 2022. Skin scrapings, hair plucking, and nail clippings were collected from 200 clinically diagnosed cases of dermatophytosis who attended the outpatient department of Dermatology (DVL) and samples were processed at the upgraded Department of Microbiology at Osmania General Hospital, Afzalgunj, Hyderabad. A total of 2 Results: 00 clinically diagnosed dermatophytosis patients were included in our study following inclusion and exclusion criteria. Their demographic details and clinical examination of cutaneous lesions were recorded. In our study, most patients affected were males 57% and the most common age group was 21-30 years seen in 25.5% of patients. Tinea corporis (40%) was the most common dermatophyte lesion followed by Tinea cruris (19.5%) seen in our study. KOH positivity was seen in 42% and culture was positive in 69.5% of cases. Dermatophytes isolated are 42% and non-dermatophytes isolated are 27.5% of cases in our study. The most common dermatophyte isolated in culture was Trichophyton rubrum (45%), followed by Trichophyton mentagrophytes 28 (33.3%). Among isolates of dermatophytes, Fluconazole is sensitive to 33.3% of isolates, whereas Griseofulvin is sensitive to 52.3% of isolates. Therapeutic failure is alarmingly common in t Conclusion: he current scenario of dermatophytosis in India. Failure is probably seen with all common isolates, younger patients, high contagious nature. This study will help to standardize care, provide guidance on management, and assist in clinical decision-making for healthcare professionals

Review on host-pathogen interaction in dermatophyte infections.

Dermatophytosis is a common superficial fungal infection of the skin and its appendages caused by dermatophytes. Recent times have witnessed a dynamic evolution of dermatophytes driven by their ecology, reproduction, pathogenicity and host immune response, influenced by population migration and socioeconomic status. Dermatophytes establish infection following successful adherence of arthroconidia to the surface of keratinized tissues. The proteolytic enzymes released during adherence and invasion not only ascertain their survival but also allow the persistence of infection in the host. While the cutaneous immune surveillance mechanism, after antigen exposure and presentation, leads to activation of T lymphocytes and subsequent clonal expansion generating effector T cells that differentially polarize to a predominant Th17 response, the response fails to eliminate the pathogen despite the presence of high levels of IFN-γ. In chronic dermatophytosis, antigens are a constant source of stimulus promoting a dysregulated Th17 response causing inflammation. The host-derived iTreg response fails to counterbalance the inflammation and instead polarizes to Th17 lineage, aggravating the chronicity of the infection. Increasing antifungal resistance and recalcitrant dermatophytosis has impeded the overall clinical remission. Human genetic research has the potential to generate knowledge to explore new therapeutic targets. The review focuses on understanding specific virulence factors involved in pathogenesis and defining the role of dysregulated host immune response against chronic dermatophytic infections for future management strategies.

The estimated burden of fungal diseases in Mali.

Mali is a developing country facing several health challenges with a high rate of tuberculosis (TB) and a moderate HIV infection burden. Little is known or done about fungal diseases, yet they represent a significant public health problem in certain populations. The aim of this study was to estimate the national burden of fungal disease, and summarize data, diagnostic and treatment gaps. We used national demographics and PubMed searches to retrieve articles on published data on these infections and at-risk populations (pulmonary TB, HIV/AIDS patients, patients receiving critical care etc.) in Mali. The estimated Malian population was 21,251,000 in 2020 (UN), of which 45% were children <14 years. Among HIV patients, we estimate an annual incidence of 611 cryptococcosis, 1393 Pneumocystis pneumonia, 180 histoplasmosis and >5,700 esophageal candidiasis and some microsporidiosis cases. Our prevalence estimates for tinea capitis are 2.3 million, for recurrent vulvovaginal candidiasis 272,460, ∼60,000 fungal asthma and 7,290 cases of chronic pulmonary aspergillosis (often mistaken for TB). Less common acute fungal infections are probably invasive aspergillosis (n=1230), fungal keratitis (n=2820), candidaemia (>1,060) and mucormycosis (n=43). Histoplasmin was found in 6% in general population. A few cases of mycetoma are described in Mali. Many WHO Essential medicines and Diagnostics are not available in Mali. This shows a marked disparity in documented and estimated cases of fungal diseases in Mali. These infections are underestimated due to the lack of accurate diagnosis tools and lack of support for fungal diseases diagnosis and management.

Prevalence of neuroinfectious diseases and outcomes in Africa

Prevalence of neuroinfectious diseases and outcomes in Africa

PRESENCE OF PERIPHERAL EOSINOPHILIA IN CUTANEOUS DERMATOPHYTOSES IN WESTERN MAHARASHTRA- AN OBSERVATIONAL STUDY

Introduction: Dermatophytosis is a supercial fungal infection of the skin, hair and nails. The clinical and pathological features of dermatophytosis have been extensively reported in literature but its association with peripheral eosinophilia has not received any attention. Aim: The aim of the study is to report peripheral eosinophilia in patients with supercial cutaneous fungal infections. Materials and methods : Total 305 patients attending a Dermatology OPD suffering from cutaneous fungal infection were included in this study. Peripheral blood sample was collected in all patients to estimate absolute eosinophil count. Patients with eosinophil count more than 500 cells/μL were considered as having eosinophilia. Results : In a study of 305 cases of cutaneous fungal infections, dermatophytosis was found to be the most common fungal infection accounting for 282 (92.45%) cases. Absolute eosinophil count (AEC) more than 500 cells/μLwas observed in 76 (26.95%) cases, out of which Six (2.12%) patients had marked eosinophilia (AEC &gt;1500 cells/μL). No peripheral eosinophilia was observed in remaining 23 (08.15%) cases of other cutaneous fungal infections. Conclusion : The presence of peripheral blood eosinophilia is a signicant nding in dermatophytosis particularly in chronic, long standing cases. One should be aware of this nding so as to avoid over investigating eosinophilia

Corticosteroids Increase the Risk of Invasive Fungal Infections More Than Tumor Necrosis Factor-Alpha Inhibitors in Patients With Inflammatory Bowel Disease.

Invasive fungal infections are a devastating complication of inflammatory bowel disease (IBD) treatment. We aimed to determine the incidence of fungal infections in IBD patients and examine the risk with tumor necrosis factor-alpha inhibitors (anti-TNF) compared with corticosteroids. In a retrospective cohort study using the IBM MarketScan Commercial Database we identified US patients with IBD and at least 6 months enrollment from 2006 to 2018. The primary outcome was a composite of invasive fungal infections, identified by ICD-9/10-CM codes plus antifungal treatment. Tuberculosis (TB) infections were a secondary outcome, with infections presented as cases/100 000 person-years (PY). A proportional hazards model was used to determine the association of IBD medications (as time-dependent variables) and invasive fungal infections, controlling for comorbidities and IBD severity. Among 652 920 patients with IBD, the rate of invasive fungal infections was 47.9 cases per 100 000 PY (95% CI 44.7-51.4), which was more than double the TB rate (22 cases [CI 20-24], per 100 000 PY). Histoplasmosis was the most common invasive fungal infection (12.0 cases [CI 10.4-13.8] per 100 000 PY). After controlling for comorbidities and IBD severity, corticosteroids (hazard ratio [HR] 5.4; CI 4.6-6.2) and anti-TNFs (HR 1.6; CI 1.3-2.1) were associated with invasive fungal infections. Invasive fungal infections are more common than TB in patients with IBD. The risk of invasive fungal infections with corticosteroids is more than double that of anti-TNFs. Minimizing corticosteroid use in IBD patients may decrease the risk of fungal infections.

Development of a Clioquinol Nanocarrier as a New, Promising Option for the Treatment of Dermatomycosis

Dermatomycosis is a common fungal infection, and its treatment is limited by few antifungal agents. Clioquinol (CQ) is an antiparasitic agent that has been studied for new uses, such as antifungal and antiviral applications. CQ was incorporated into a lipid-based nanocarrier as a new, promising option for dermatomycosis. This study aimed to develop a CQ-loaded lipid-based nanocarrier for cutaneous application and to evaluate its antifungal activity. CQ-loaded nanoformulation (LBN-CQ) was developed using the ultrasonication method, and the particle size, polydispersity index (PDI), pH, zeta potential, and drug content were monitored for 45 days. To evaluate antifungal activity, broth microdilution and a time-kill assay were performed. LBN-CQ presented a particle size of 91 ± 3 nm and PDI of 0.102 ± 0.009. The zeta potential and pH values were -9.7 ± 2.0 mV and 6.0 ± 0.1, respectively. The drug content was 96.4 ± 2.3%, and the encapsulation efficiency was 98.4%. LBN-CQ was able to reduce the minimum inhibitory concentration (MIC) in a 2-fold or 4-fold manner in most of the tested strains. Additionally, LBN-CQ presented stable fungistatic action that was not concentration- or time-dependent. In conclusion, the developed CQ-loaded nanocarrier is a promising treatment for skin fungal infections and a promising candidate for future randomized clinical trials.