Intensive Antifungal Therapy Research Articles

Widespread cutaneous candidiasis and tinea infection masking mycosis fungoides

A 71-year-old female with a widespread double mycotic infection caused by C. Albicans and T. rubrum was discovered to be suffering from mycosis fungoides. Clinically she was found to have large, polycyclic erythematous plaques with scaly, slightly infiltrated borders, covering almost all areas of the glabrous skin, and also involving the scalp (with no hair penetration), the soles and palms, toe-webs, finger and toe nails; there was also perleche and oral thrush. Cultures yielded C. albicans from most of the skin lesions, from the scalp, mouth, finger nails and urine and stool specimens, and T. rubrum from intermingled skin specimens, from the palms and soles and toe-nails. Blood culture was negative as were intracutaneous tests with fungal antigens and tuberculin. Histological examination confirmed the fungal invasion of the horny layer and at the same time revealed an underlying pathologic picture of mycosis fungoides, the lesions having been masked by the mycotic eruption. Intensive cytostatic and antifungal therapy led to a transient improvement but shortly thereafter there was a relapse of the fungal and lymphoproliferative manifestations and the patient died in septic shock.

Invasive Fungal Infections in Patients With Chronic Mucocutaneous Candidiasis

Patients with chronic mucocutaneous candidiasis have persistent Candida infection of nails, skin, and mucous membranes, but rarely, if ever, does an invasive fungal infection develop. We describe two patients with chronic mucocutaneous candidiasis who died of fungal infection; one had C albicans meningitis and the second had Cryptococcus neoformans meningitis. The cases of four other patients with chronic mucocutaneous candidiasis and invasive fungal infection, three with crytococcosis and one with histoplasmosis, have been reported previously. Immunological profiles on these six patients revealed no differences from those of other patients with chronic mucocutaneous candidiasis without invasive fungal infection. Three of the four patients who received amphotericin B were cured of their infection; three patients died, including one patient with overwhelming cryptococcosis who had received intensive antifungal therapy and transfer factor.

The relationship between immunological parameters and response to therapy in resistant oral candidosis.

Eight patients with resistant oral candidal infection have undergone full immunological assessment. In four of these patients no significant abnormality of immune function was observed, and all responded to intensive antifungal therapy with nutritional supplements of iron and folic acids as required. The remaining four patients had abnormalities only of specific candida-related immune function and no detectable abnormality of general immune function. Surgical excision of affected areas of oral mucosa was found to be the most effective therapy in three of these four cases. The immunological findings in these cases are compared with those observed in five patients with chronic mucocutaneous candidosis in whom both specific candida-related and non-specific immune incompetence were present.