Deep Mycoses Research Articles

Primary Cutaneous Histoplasmosis in an Immunocompetent Host from a Nonendemic Area.

A 32-year-old male presented to Dermatology outpatient Department with complaints of a single nonhealing ulcer on his right thigh. This lesion was there for the last 1΍ months. It had begun as a small nodule and increased up to the present size of 3 cm with an oozing and ulcerated surface and thickened everted margins. The systemic investigations were normal which included hemogram, biochemistry, including liver and renal function tests, chest X-ray, ultrasonography of abdomen, computed tomography of the thorax, and abdomen. Skin biopsy revealed multiple rounds to oval spores with surrounding halo intracellularly as well as extracellularly. A diagnosis of deep fungal infection as histoplasmosis was made and confirmed on culture.

Causative Agents of Aspergillosis Including Cryptic Aspergillus Species and A. fumigatus.

Aspergillosis is an important deep mycosis. The causative agents are Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger, and Aspergillus terreus, of which A. fumigatus is the most prevalent. Cryptic Aspergillus spp., which morphologically resemble representative species of each Aspergillus section, also cause aspergillosis. Most of the cryptic species reveal different susceptibility patterns and/or different secondary metabolite profiles, also called exometabolome in this manuscript, from those representative species. On the other hand, azole-resistant A. fumigatus strains in clinical specimens and in the environment have been reported. Therefore, it is imperative to precisely identify the species, including cryptic Aspergillus spp., and evaluate the susceptibility of isolates.In this manuscript, some of the causative cryptic Aspergillus spp. are briefly reviewed. In addition, the exometabolome of Aspergillus section Fumigati is described. Finally, azole resistance of A. fumigatus is also discussed, in reference to several studies from Japan.

Clinical and epidemiological features of leishmaniasis in northwestern-Argentina through a retrospective analysis of recent cases

Leishmaniasis is a parasitic disease caused by hemoflagellates of the genus Leishmania and is transmitted to humans by the bite of infected phlebotomine sandflies. Depending on the Leishmania species, the disease has different clinical forms including cutaneous, mucocutaneous, and visceral manifestations. Previous studies performed in endemic zones of northwestern-Argentina, during epidemic outbreaks, have been important for detecting patients suffering from the acute phase of the disease, but have not given a complete representation of the clinical and epidemiological features in the region. Furthermore, due to the resurgence of leishmaniasis worldwide and in particular the large increase of international tourism to the region, it seems pertinent to update the current epidemiological and clinical profile of leishmaniasis in northwestern-Argentina. Here we present a retrospective analysis of 95 Leishmania positive cases, presenting between 2000 and 2014. Patients were derived from hospitals and diagnosed in our lab at the University of Salta, located in a non-endemic area in Salta, Argentina. We detected numerous extensive mucocutaneous cases (34/95, 35.8%) distinct from mucosal affected patients, some instances originating in locations with no previously reported human cases. Additionally patients suffering from concomitant diseases, besides leishmaniasis, were assessed. These included Chagas disease, syphilis, deep mycoses, tuberculosis, toxoplasmosis and intestinal parasitosis. This study updates the clinical and epidemiological features of leishmaniasis in northwestern-Argentina, and discusses the implications and management strategy for patients who acquire the disease in this region.

The diagnostic challenge of mapping elephantiasis in the Tigray region of northern Ethiopia.

In Ethiopia, lymphatic filariasis and podoconiosis are the two neglected tropical diseases planned to be mapped together within the recently launched Ethiopian neglected tropical diseases master plan (2013-2015). However, other disorders cause tropical lymphedema, and this report aims to identify clinical epidemiological aspects of limb swelling in northern Ethiopia and to provide an algorithm orienting the clinical diagnosis. Medical records of patients with lower limb elephantiasis attending the Italian Dermatological Centre of Mekele, Tigray capital city, over a 4-year period (2005-2009) were retrospectively analyzed. Nine variables were collected from the charts comprising demographic data, job, origin, literacy, clinical, histopathologic, microscopic, and cultural findings. Over a total of 511 patients, lymphedema resulted from trauma (40.7%), chronic venous insufficiency (12.5%), deep mycoses (10.8%), lymphatic filariasis (9.2%), elephantiasis nostras verrucosa (7.0%), tropical ulcer (6.3%), leprosy (4.9%), recurrent infections (3.1%), podoconiosis (1.8%), tuberculosis (1.0%), malignancy (1.3%), Kaposi's sarcoma (1.0%), leishmaniasis (0.2%), and neurofibromatosis (0.2%). Advanced-stage elephantiasis, chronic osteomyelitis, and podoconiosis not previously reported in Tigray were observed. Further epidemiological investigation and training programs addressed to healthcare providers at the peripheral level are needed to detect elephantiasis early, prevent disabilities, and improve patients' quality of life.

TLR 9 involvement in early protection induced by immunization with rPb27 against Paracoccidioidomycosis

Paracoccidioidomycosis is caused by fungi of the Paracoccidioides genus and constitutes the most prevalent deep mycosis in Latin America. Toll-like receptors promote immune response against infectious agents. Recently, it was reported that TLR9 is crucial for mice survival during the first 48 h of P. brasiliensis infection. In this study, we used CPG oligodeoxynucleotide motif as an adjuvant with and without rPb27 to immunize mice against Paracoccidioidomycosis. CPG adjuvant induced differential recruitment of lymphocytes in the inflammatory process and a lower recruitment of neutrophils. In addition, CPG induced the production of pro-inflammatory cytokines such as IL-1β, TNF-α, IL-6 and IL-12; increased phagocytic ability and microbicidal activity by macrophages; and induced differential production of lgG2a and lgG2b, subtypes of Ig. Knockout mice for TLR9 and IL-12 showed higher fungal loads and rates of mortality compared to control mice after 30 days of infection. The association between CPG and rPb27 induced a high level of protection against Paracoccidioidomycosis after the first 30 days of infection but not at 60 days. Our findings demonstrate that TLR 9 plays a role in the protection induced by immunization with rPb27 and confirms the importance of TLR9 in the initial protection against Paracoccidioidomycosis.

The detection value of (1, 3)-β-D-glucan in clinical deep fungal infection

Objective To discuss the detection value of(1, 3)-β-D-glucan in the early diagnosis of fungal infection in clinic. Methods 86 patients with deep fungal infection were selected as the study group, and 24 cases of healthy volunteers were selected as the control group, all groups took plasma G test, while cultivating specimens suspected infection and deep fungal infections in patients were divided according to culture-negative group and positive group, plasma G test results were compared. Results In the control group, G test was (6.12±2.87)×10-3ng/mL in plasma, deep fungal infection negative, positive test results were (32.58±24.12)×10-3ng/mL and (101.28±36.04)×10-3ng/ mL in plasma G respectively, positive group G results in plasma were significantly increased, the differences were statistically significant(t=18.28, 7.92, P=0.036, 0.042); both positive plasma G test results were significantly higher than that of the negative group, the difference was statistically significant(t=12.16, P=0.038). Plasma G test positive diagnosis of deep fungal infection was 79.1%, significantly better than the fungal culture 50.0%, the difference was statistically significant(χ2=31.26, P=0.002). Conclusion In early clinical diagnosis of deep true infection, plasma G test positive rate is higher than fungal culture, and is worthy of wider application. Key words: Dextran; Fungal infections; Laboratory diagnosis

Subcutaneous mycoses in coastal Karnataka in south India.

Subcutaneous mycoses are chronic, localized infections of the skin and subcutaneous tissue which occur following traumatic implantation of the etiological agent. The causative organisms are soil saprophytes of regional epidemiology with varying ability to adapt to the tissue environment and elicit disease. This study was conducted to evaluate the various types of subcutaneous mycoses, including actinomycotic mycetomas, in south coastal Karnataka, India. Between January 2005 and January 2013, a total of 25 patients were diagnosed with subcutaneous mycoses based on a detailed clinical history and presentation, histopathology, and culture of organisms. Chromoblastomycosis was the infection most commonly seen (n=16 patients, 64%), followed by mycetoma (n=4, 16%), sporotrichosis (n=4, 16%), and rhinoentomophthoromycosis (n=1, 4%). The extremities were the most common site of involvement, with the lower limb being most affected (64%). Males were more commonly afflicted (64%) than females (36%). Most patients were agricultural workers, although preceding trauma was noted in only three patients. The majority of patients responded well to therapy and were disease-free on follow-up. Subcutaneous mycoses are a rare group of disorders. Chromoblastomycosis is the most frequent subcutaneous fungal infection in south India. Morphologically, chromomoblastomycoses present as verrucous, ulcerative, nodular, or eczematous lesions. Clinical diagnosis is important as culture is often negative. The incidence of infection is higher among rubber tappers. It is important to clinically differentiate chromoblastomycosis from tuberculosis verrucosa cutis. Most of the subcutaneous mycoses respond well to treatment, with the exception of rhinoentomophthoromycosis, which is a rare form of deep mycosis with associated mutilation. Eumycetomas are not observed in this part of India.

Use of an Artificial Neural Network to Construct a Model of Predicting Deep Fungal Infection in Lung Cancer Patients.

The statistical methods to analyze and predict the related dangerous factors of deep fungal infection in lung cancer patients were several, such as logic regression analysis, meta-analysis, multivariate Cox proportional hazards model analysis, retrospective analysis, and so on, but the results are inconsistent. A total of 696 patients with lung cancer were enrolled. The factors were compared employing Student's t-test or the Mann-Whitney test or the Chi-square test and variables that were significantly related to the presence of deep fungal infection selected as candidates for input into the final artificial neural network analysis (ANN) model. The receiver operating characteristic (ROC) and area under curve (AUC) were used to evaluate the performance of the artificial neural network (ANN) model and logistic regression (LR) model. The prevalence of deep fungal infection from lung cancer in this entire study population was 32.04%(223/696), deep fungal infections occur in sputum specimens 44.05% (200/454). The ratio of candida albicans was 86.99% (194/223) in the total fungi. It was demonstrated that older (≥65 years), use of antibiotics, low serum albumin concentrations (≤37.18 g /L), radiotherapy, surgery, low hemoglobin hyperlipidemia (≤93.67 g /L), long time of hospitalization (≥14 days) were apt to deep fungal infection and the ANN model consisted of the seven factors. The AUC of ANN model (0.829±0.019) was higher than that of LR model (0.756±0.021). The artificial neural network model with variables consisting of age, use of antibiotics, serum albumin concentrations, received radiotherapy, received surgery, hemoglobin, time of hospitalization should be useful for predicting the deep fungal infection in lung cancer.

Mucormycose rhinosinusienne révélée par une ulcération nécrotique vélopalatine

Mucormycosis is a deep mycosis which has been spreading out in recent years. It is still poorly understood and poorly described in sub-Saharan Africa. The authors report a case of sinonasal localization, of fatal evolution and late diagnosis in a young child. It is about a 13-year-old child suffering from chronic rhinosinus syndrome for two years. He was observed in stomatology for a necrotic velar ulceration that have occurred for three months. The clinical, radiological and histological explorations were in favor of a sinonasal mucormycosis. The administration of amphotericin B and the surgical treatment did not slow down the fatal evolution. Mucormycosis should not be dealt with any diagnostic error and no therapeutic improvisation. It has to be thought about when dealing with a rhinosinusal syndrome with cleft ulceration.

Deep Fungal Infections, Blastomycosis-Like Pyoderma, and Granulomatous Sexually Transmitted Infections.

Granulomatous diseases are caused by multiple infectious and noninfectious causes. Deep fungal infections can present in the skin or extracutaneously, most commonly with lung manifestations. An Azole or amphotericin B is the universal treatment. Blastomycosis-like pyoderma is a clinically similar condition, which is caused by a combination of hypersensitivity and immunosuppression. Successful treatment has been reported with antibiotics and, more recently, the vitamin A analog, acitretin. Granuloma inguinale and lymphogranuloma venereum cause ulcerative genital lesions with a granulomatous appearance on histology. The Centers for Disease Control and Prevention recommens treatment of these genital infections with doxycycline.

Epidemiology of deep cutaneous fungal infections in Korea (2006-2010).

Deep cutaneous fungal infections (DCFI) occur worldwide and their prevalence is influenced by personal factors of the affected patients and the geographic and cultural features. Surveillance studies of DCFI with respect to the various clinical backgrounds of affected patients can ultimately help to improve their outcome. Expanding on our previous study, we performed a retrospective analysis of patients with DCFI who were treated in a group of university teaching hospitals in Korea to determine the trends within a 5-year period. A retrospective medical record review of patients with DCFI treated between 2006 and 2010 at 16 university teaching hospitals located throughout Korea was performed. Among the 51 cases of DCFI (median patient age, 47.0years), opportunistic infections in immunocompromised hosts accounted for half. Patients in this group included 11 who were transplant recipients and 12 with malignancies. Overall, Candida (13/51) was the most common causative organism, followed by Sporothrix (12) and Aspergillus (6). Papuloplaques and nodular lesions were the typical presentation, with maculopatches and ulcers also occurring in considerable numbers. Ten patients had systemic involvement. Eight immunocompromised patients did not recover from the disease despite systemic antifungal treatment. Our results highlight the equal involvement of opportunistic and primary pathogens in DCFI, as determined in cases from a 5-year period. Especially in immunocompromised hosts with non-specific skin findings, clinical suspicion is important because failure to diagnose a DCFI causes significant morbidity and possibly even death.

Identification and characterization of expressed retrotransposons in the genome of the Paracoccidioides species complex

BackgroundSpecies from the Paracoccidioides complex are thermally dimorphic fungi and the causative agents of paracoccidioidomycosis, a deep fungal infection that is the most prevalent systemic mycosis in Latin America and represents the most important cause of death in immunocompetent individuals with systemic mycosis in Brazil. We previously described the identification of eight new families of DNA transposons in Paracoccidioides genomes. In this work, we aimed to identify potentially active retrotransposons in Paracoccidioides genomes.ResultsWe identified five different retrotransposon families (four LTR-like and one LINE-like element) in the genomes of three Paracoccidioides isolates. Retrotransposons were present in all of the genomes analyzed. P. brasiliensis and P. lutzii species harbored the same retrotransposon lineages but differed in their copy numbers. In the Pb01, Pb03 and Pb18 genomes, the number of LTR retrotransposons was higher than the number of LINE-like elements, and the LINE-like element RtPc5 was transcribed in Paracoccidioides lutzii (Pb01) but could not be detected in P. brasiliensis (Pb03 and Pb18) by semi-quantitative RT-PCR.ConclusionFive new potentially active retrotransposons have been identified in the genomic assemblies of the Paracoccidioides species complex using a combined computational and experimental approach. The distribution across the two known species, P. brasiliensis and P. lutzii, and phylogenetics analysis indicate that these elements could have been acquired before speciation occurred. The presence of active retrotransposons in the genome may have implications regarding the evolution and genetic diversification of the Paracoccidioides genus.Electronic supplementary materialThe online version of this article (doi:10.1186/s12864-015-1564-7) contains supplementary material, which is available to authorized users.

Field validation of a Leishmania (Leishmania) mexicana exo-antigens ELISA for diagnosing tegumentary leishmaniasis in regions of Leishmania (Viannia) predominance

BackgroundSeveral tests are performed to obtain better accuracy when diagnosing American tegumentary leishmaniasis (ATL). It is believed that antigens released via secretion, excretion and metabolism are more specific than are antigens released by the lysis of Leishmania parasites. Such antigens are known as exo-antigens (exo-Ag) and are formed from products released by cultured parasites in a way that is similar to that in which they cause infections in hosts. ObjectiveWe attempted to validate a Leishmania mexicana ELISA exo-Ag for ATL diagnosis in Midwestern Brazil. MethodsA total of 281 patients were included in the study. We analysed pre-treatment blood from 98 ATL patients; out of those, 85.7% and 14.3% had cutaneous and mucosal forms, respectively. ResultsThe exo-Ag accuracy was 83.99% (95% CI=79.24–87.81) with a sensitivity value of 90.82% (95% CI=83.46–95.09) and an overall specificity value of 80.33% (95% CI=73.97–85.44). The positive predictive value and negative predictive value were 71.20% (95% CI=62.72–78.41) and 94.23% (95% CI=89.40–96.94), respectively. Among healthy controls, exo-Ag had a specificity of 91.25% (95% CI=83.02–95.70); additionally, the test had specificity rates of 66.67% (95% CI=46.71–82.03) in Chagas disease patients, 60.61% (95% CI=43.68–75.32) in patients with rheumatic diseases, 76.92% (95% CI=49.74–91.82) in pemphigus foliaceus patients, 87.50% (95% CI=52.91–97.76) in leprosy patients, 87.50% (95% CI=63.98–96.50) in VRDL-positive patients, and 77.78 (95% CI=45.26–93.68) in deep mycosis patients. ConclusionBased on the indicators of validity, we conclude that the results obtained in this study enable the recommendation of the exo-Ag ELISA for ATL diagnosis once it presented a reasonable accuracy compared to classical methods. Cost evaluations are necessary to completely define the role of this technique in large scale.

Diagnostic challenges of oral and cutaneous Kaposi's sarcoma in resource-constrained settings.

Kaposi's sarcoma (KS), caused by HHV-8, is the most frequent HIV-associated malignancy worldwide and remains a major scourge in Sub-Saharan Africa. KS is also endemic in much of Africa. There is a risk of misdiagnosis based solely on clinical appearance and haematoxylin and eosin (H&E) staining, especially with other reactive and neoplastic vascular proliferations which occur in the mouth. This study examined oral and cutaneous biopsies from clinically diagnosed lesions of KS in Kenya, using histopathology supplemented with immunohistochemistry (IHC) and polymerase chain reaction (PCR) for HHV-8 as confirmation of diagnosis. Biopsies of 49 lesions (28 oral, 21 cutaneous) previously diagnosed as 'KS' were re-examined by H&E staining and IHC targeting HHV-8 LANA-1. Positive controls were sections from embedded BCBL-1 cell lines. Negative controls were from three different HHV-8-negative biopsies. Confirmation of HHV-8 immunohistochemistry was sought by PCR and by determining the HHV-8 ORFK1 subtype. Whilst most cases were confirmed, 12 oral and 4 cutaneous lesions displayed clinical and histological features of KS but were negative to HHV-8 IHC. These oral lesions were re-diagnosed as pyogenic granulomata (n = 6), deep mycosis (n = 1), inflamed mucosa (n = 2) or 'uncertain but not KS' (n = 3). Whilst PCR is usually helpful in differentiating HHV-8 disease, all samples were HHV-8 PCR positive, with identical sequences, suggesting cross-contamination of samples in the original pathology laboratories. HHV-8 IHC is essential for the correct diagnosis of KS, but due to the high level of contamination in resource-poor settings, PCR is inadvisable.

English

An ethnopharmacological survey concerning medicinal properties of Baillonella toxisperma (Pierre) was carried out by interview with the indigenous population of Dimako village situated in the East region of Cameroon. The result showed that the plant is implicated in the treatment of many infections among which is fungal infections. To confirm the antifungal property of B. toxisperma (Pierre), the barks and leaves of the plant were collected and serial extractions in water, hydro-ethanol mixture (3:7), ethanol, methanol and ethyl acetate were performed in vitro. One part of the hydro-ethanol (3:7) extract was degreased by mixing in water-hexane mixture (1:1). The extracts were then tested in vitro against Candida albicans, Candida parasilopsis, Candida sp. responsible for superficial, deep or systemic mycosis and against Cryptococcus neoformans responsible for sub-acute meningitis in immunodeficient individuals. The susceptibility of yeasts to plant extracts was evaluated using the wells diffusion method and yeasts growth inhibition parameters were evaluated according to the proposed National Committee for Clinical Laboratory Standards (NCCLS) M27-A2 standard guidelines (2002). The minimal inhibitory concentrations (MIC) and minimal fungicidal concentrations (MFC) determined were between 0.93 and 30.0 mg/ml. The extracts were fungicidal on clinical yeasts tested with MFC/MIC ratio of 1 or 2. The hexane phase HT2 from the hydro-ethanol crude extract of the barks gave the best antifungal activity on C. neoformans, with a MIC of 0.93 mg/ml and a MFC of 1.87 mg/ml. This activity was similar to the one obtained with fluconazole. Phytochemical screening revealed the presence of polyphenols, phenols, tannins, flavonoids, steroids, alkaloids, saponins, phlobatannins, triterpenes, anthocyanins, cardiac glycosides, leucoanthocyanins and fats, which are bioactive substances. The results could explain scientific validation to the traditional medical uses of B. toxisperma (Pierre) to treat fungal infections. Key words: Cameroon, Baillonella toxisperma (Pierre), ethnopharmacology survey, fungal infections, bioactive compounds.

Validation of a New (1 → 3)-β-D-Glucan Test Kit, Fungitec G Test MKⅡ " Nissui "

Using 415 residual blood samples subjected to (1→3) -β-D-glucan assay, we studied the correlation of measurement results between Fungitec G Test MKII "Nissui" (Nissui Pharmaceutical Co., Ltd., Tokyo) and its predecessor, Fungitec G Test MK (Seikagaku Corporation, Tokyo), which is now out of production. Their major difference is that MK II uses reagents derived from blood cells of Limulus polyphemus, the American horseshoe crab, whereas MK used those of Tachypleus tridentatus, an Asian horseshoe crab. Passing-Bablok analysis showed a linear regression with nearly one-to-one correspondence (slope=1.065, intercept=-0.287) between the two test kits over the regular range of measurements (4.0 pg/ml -500 pg/ml ). This was also true when data were subdivided and analyzed in the low to medium (≦150 pg/ml ) and in the low range (≦50 pg/ml ). There were several cases, however, that showed a wide discrepancy between the pair of measurements. This discrepancy is believed to be due in part to the difference between Limulus and Tachypleus in their reactivity to β-glucans with diverse side chains. Despite of this, the even distribution on either side of the regression line of those samples that are associated with deep fungal infection and the abrupt disappearance of such samples below 20 pg/ml attest that MK II "Nissui" is an acceptable successor of MK.

サルコイドーシスとの鑑別が困難であった口腔パラコクシジオイデス症の1例

We report a case of paracoccidioidomycosis that was difficult to differentiate from sarcoidosis. Paracoccidioidomycosis is a deep fungal infection caused by Paracoccidioides brasiliensis. It causes a granulomatous systemic mycosis and is endemic to rural areas of Latin America. A 57-year-old man visited our clinic because of swelling and slight pain in the lower lip. He had been previously been given a diagnosis of sarcoidosis after a histological examination of the tongue and pulmonary lesions, and had received steroid therapy at the respiratory department of a general hospital. We perform biopsy which specimens were taken from the lower lip and tongue. The initial pathological diagnosis was sarcoidosis, based on the presence of granulomas without caseous necrosis. Several months later, when the pain and swelling of lower lip and tongue had worsened, it was found that the patient had grown up in a rural area in Paraguay and that his relatives had suggested the possibility of fungal disease. This led us to suspect endemic fungal disease and additional pathological examination of the same specimen was performed. Giemsa staining and periodic acid-Schiff staining were negative, but Grocott-Gomori’s methenamine silver staining was positive and showed the characteristic features of paracoccidioidomycosis, associated with a so-called Mickey Mouse ears appearance.

What is deep tropical mycosis? An underestimated entity with serious problems

There are many fungal infections which have been described in the literature but only a small number of them causes diseases in human being. The clinical manifestation is diverse and the spectrum of severity ranges from simple localized infections to severe systemic disease. Some of these fungal infections characteristically occur more frequently in tropical countries and hence they are called tropical mycosis; however even these kinds of mycotic infections may be seen outside the tropical countries due to migration and travel. In this article we try to review the deep tropical mycosis and highlight the important aspects of diseases classified under this entity, we also try to address some of the issues related to these illnesses and demonstrating their management in summary.

DA 5505: A Novel Topical Formulation of Terbinafine That Enhances Skin Penetration and Retention

Topical fungal infections can become severe if left untreated. Efficient treatment modalities for topical fungal infections aid the penetration of antifungal agents deep into viable skin layers. Terbinafine is a fungicidal agent that inhibits ergosterol, an essential fungal component. The main objective of this study was to evaluate skin permeation and retention of a terbinafine-loaded solution containing chitosan as a film former. Comparative assessment of skin permeation and retention was performed using a prepared formulation (DA 5505) and marketed formulations of terbinafine in murine and porcine skin. To mimic fungal infection of skin, keratinized skin was induced in NC/Nga mice. In comparison with the marketed formulations, DA 5505 exhibited significantly better skin permeation. The flux, permeation coefficient, and enhancement ratio of terbinafine were remarkably increased by DA 5505 in comparison with the marketed formulations, and lag time was dramatically reduced. DA 5505 significantly increased cumulative terbinafine retention in viable skin layers in comparison with the marketed solution, suggesting enhanced efficacy. Furthermore, DA 5505 exhibited superior skin permeation in normal skin and keratinized skin. Thus, the DA 5505 formulation has the potential to effectively deliver terbinafine to superficial and deep cutaneous fungal infections.

Development of a loop-mediated isothermal amplification assay for rapid detection of Trichosporon asahii in experimental and clinical samples.

Invasive trichosporonosis is a deep mycosis found mainly in immunocompromised hosts, and the major pathogen is Trichosporon asahii. We detected the species-specific intergenic spacers (IGS) of rRNA gene of T. asahii using a loop-mediated isothermal amplification (LAMP) assay in 15 isolates with 3 different visualization methods, including SYBR green detection, gel electrophoresis, and turbidimetric methods. The LAMP assay displayed superior rapidity to other traditional methods in the detection time; that is, only 1 h was needed for detection and identification of the pathogen DNA. Furthermore, the detection limit of the LAMP assay was more sensitive than the PCR assay. We also successfully detect the presence of T. asahii in samples from experimentally infected mice and samples from patients with invasive trichosporonosis caused by T. asahii, suggesting that this method may become useful in clinical applications in the near future.