Local Fungal Infection Research Articles

Mycological profile of subcutaneous skin biopsy samples in suspected subcutaneous mycosis, Are we missing some fungi? A tertiary care hospital based study

Subcutaneous mycosis includes a heterogeneous group of fungal infections that develop at the site of transcutaneous trauma. A rise in surviving population of individuals with co-morbidities together with lapses in infection control practices especially in rural India has led to emergence of myriad species of fungi causing such infections in recent years. This poses a diagnostic challenge to the clinicians. We therefore felt a need to study the mycological profile of subcutaneous tissue biopsies suspected of fungal etiology in our hospital setup. This was a Retrospective cross-sectional observational study conducted for a period of 4 years from Jan 2015 to Jan 2019 in the Department of microbiology, Government medical College Srinagar. A total of 148 specimens of subcutaneous tissue biopsies of patients suspected of localized fungal Infection were processed by microscopy and culture for fungi. Among a total of 148 subcutaneous tissue biopsy samples 76 (51%) were positive for fungi on KOH and culture. Mycological profile revealed that majority of fungi were Dermatophytes (n=22; 29%) and Yeasts (n=21; 28%). Third most common causative fungi isolated were Chromoblastomycetes (n=8; 11%), Phaeohyphomycetes (n=8;11%) and Aspergilli (n=8;11 %) comprising, A.fumigatus (n=11) and A.terreus (n=03), followed by Hyalohypomycetes (n=4;5%), sporotrichosis (n=3;4%) and Zygomycetes (n=4 ;5.3%). : Dermatophytes and yeasts are emerging subcutaneous fungal infections. Active surveillance for all types of fungal infections should be done at all levels to address knowledge gaps that exist in etiology, pathogenesis and manifestations of fungal diseases of skin and subcutaneous tissue.

Neuroendocrine carcinoma of the larynx: A case report

In the physical examination of a 65-year-old male patient who presented with hoarseness and dysphagia, an ulcerovegetative mass was observed in the medial wall of the right pyriform sinus, with subglottic extension involving the right hemilarynx. The right vocal cord was found to be paralyzed. The patient underwent neck magnetic resonance imaging and thorax computed tomography. The pathology report revealed findings consistent with a neuroendocrine neoplasm, Grade 1 (typical carcinoid) neuroendocrine carcinoma. The patient underwent total laryngectomy and bilateral functional neck dissection after the completion of treatment by the recommendations of infectious diseases, as the coronavirus disease 2019 polymerase chain reaction test performed one day before the operation was positive. The patient developed herpes zoster and a local fungal infection after the surgery, and the patient was discharged with a plan for adjuvant chemoradiotherapy after the completion of treatment. The patient’s follow-up is ongoing.

Physiological and transcriptome analysis of Candida albicans in response to X33 antimicrobial oligopeptide treatment.

Candida albicans is an opportunistic pathogenic fungus, which frequently causes systemic or local fungal infections in humans. The evolution of its drug-resistant mutants necessitate an urgent development of novel antimicrobial agents. Here, we explored the antimicrobial activity and inhibitory mechanisms of X33 antimicrobial oligopeptide (X33 AMOP) against C. albicans. The oxford cup test results showed that X33 AMOP had strong inhibitory activity against C. albicans, and its MIC and MFC were 0.625 g/L and 2.5 g/L, respectively. Moreover, SEM and TEM showed that X33 AMOP disrupted the integrity of cell membrane. The AKP, ROS, H2O2 and MDA contents increased, while the reducing sugar, soluble protein, and pyruvate contents decreased after the X33 AMOP treatment. This indicated that X33 AMOP could damage the mitochondrial integrity of the cells, thereby disrupting the energy metabolism by inducing oxidative stress in C. albicans. Furthermore, transcriptome analysis showed that X33 AMOP treatment resulted in the differential expression of 1140 genes, among which 532 were up-regulated, and 608 were down-regulated. These DEGs were related to protein, nucleic acid, and carbohydrate metabolism, and their expression changes were consistent with the changes in physiological characteristics. Moreover, we found that X33 AMOP could effectively inhibit the virulence attributes of C. albicans by reducing phospholipase activity and disrupting hypha formation. These findings provide the first-ever detailed reference for the inhibitory mechanisms of X33 AMOP against C. albicans and suggest that X33 AMOP is a potential drug candidate for treating C. albicans infections.

P496 Effect of fluconazole prophylaxis in prevention of local fungal infections in patients of head and neck cancers receiving chemo-radiotherapy

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectivesTo ascertain, in head and neck cancer patients receiving chemo-radiotherapy, the efficacy of fluconazole prophylaxis in1. Reducing the incidence of oropharyngeal fungal infections2. Reducing the incidence of severe i.e., grade 3 and 4 oropharyngeal mucositisMethodsA total of 66 cases of Stage III or IV squamous cell carcinoma of the oral cavity or oropharynx who were candidates for radical chemo-radiotherapy (CCRT) were randomly assigned between arm A (study arm) and arm B (control arm) using computer-generated algorithms. Both arms received conventionally fractionated radiation (66-70 Gy) with concurrent weekly intravenous cisplatin (40 mg/m2) along with standard measures of oropharyngeal hygiene. In addition, arm A received Tab Fluconazole 100 mg/d administered per oral after lunch from initiation to the completion of radiotherapy, while arm B received Tab Fluconazole 100 mg/d, if fungal infections appeared, for a period of 7-14 days.Weekly clinical examination for oro-pharyngeal candidiasis was done. Throat swabs for microbiological assessment of fungal colonization were done before treatment (zero week), during second and sixth week of CCRT, and 4 weeks after the completion of CCRT, and if any clinical suspicion of fungal infection was present.ResultsProportion of patients who developed fungal infection during treatment was significantly lower in group A—6/33 patients as compared with group B—27/33 patients (18.18% vs. 69.70% respectively, P-value < .0001). Candida albicans was detected in 7 patients (31.82%) while non-albicans Candida was detected in 15 patients (68.18%). Candida parapsilosis, C. tropicalis, C. krusei, and C. glabrata were detected. A total of 3 infected patients (75%) in group A were resistant to fluconazole but showed sensitivity to voriconazole, posaconazole, and caspofungin B. While in group B, 3/18 infected patients (16.66%) showed resistance to fluconazole and these were sensitive to voriconazole, amphotericin B, posaconazole, and caspofungin B. Mean week of onset of fungal infection in group A was 5.5 weeks which was significantly higher as compared with group B of 4.48 weeks (P-value = .029).Proportion of patients who developed grades 3/4 mucositis was significantly lower in group A as compared with group B of 54.55% vs. 81.82% respectively (P-value = .017). Median week of onset of grade 3/4 mucositis in group A was 5.5 weeks which was significantly higher as compared with group B of 5 weeks. (P-value = .029).Proportion of patients with treatment completion was significantly higher in group A as compared with group B—84.85% vs. 60.61% respectively (P-value = .027). Mean number of days needed for treatment completion in group B was 57.55 days which was significantly greater as compared with group A of 50.68 days (P-value =. 033). Median treatment gap in group B was 10 days which was significantly higher as compared with group A of 4 days (P-value = .003).See Figures below.ConclusionTab fluconazole 100 mg prophylaxis in head and neck cancer patients receiving chemo-radiation isAn effective way to reduce fungal infections, ideal prophylaxis beginning at the fourth week.An effective way to reduce the severity of radiation-induced oral mucositis—thereby translating into reduced morbidity, treatment interruptions, and overall treatment time, which have been shown to impact prognosis favorably.

Comparative Fungicidal Activities of N-Chlorotaurine and Conventional Antiseptics against Candida spp. Isolated from Vulvovaginal Candidiasis.

N-chlorotaurine (NCT), the N-chloro derivative of the amino acid taurine, is a long-lived oxidant produced by stimulated human leucocytes. NCT has antimicrobial activities which are generally enhanced in the presence of organic material. The aim of this study was to investigate fungicidal effects of NCT and conventional antiseptics against Candida isolated from vulvovaginal candidiasis (VVC). Chlorhexidine (CHX, 1.6%), octenidine dihydrochloride (OCT, 0.08%), povidone iodine (PVP-I, 8%), boric acid (8%), and NCT (0.1% (5.5 mM)) were evaluated against forty-four Candida isolates, according to European Standard methods, at 30, 60, 90, and 120 min and 24 h in the presence of skim milk as an organic material. CHX, OCT, and PVP-I showed rapid fungicidal activity against all Candida isolates with 5–6 log10 reduction of viable counts after 30 min, whereas boric acid and NCT needed 1 h against Candida albicans and 2 h against non-albicans Candida for a significant 3 log10 reduction. NCT showed fungicidal activity (defined as ≥4 log10 reduction) against C. albicans within 90 min and C. non–albicans within 24 h. Based upon all presently available data, including our results, NCT could be used as a new agent for treatment of local fungal infections such as VVC.

STATISTICAL OPTIMIZATION AND EVALUATION OF ETHOSOMAL MICONAZOLE NITRATE SUSPENSION

Objective: The objectives of the present study were to optimize and evaluate the ethosomal suspension of miconazole nitrate for the treatment of local and systemic fungal infections. Methods: Miconazole topical formulation is prepared for better patient compliance and to reduce the dose of a drug. Miconazole nitrate ethosomes were prepared by the cold method using factorial designing with Ethanol(X1), IPA(Isopropyl alcohol)(X2), and Lecithin(X3) as Independent variables and % EE(Entrapment efficiency)(Y1) and % DR(drug release at 8th h)(Y2) was selected as responses. Results: The results obtained in the design showed that there was no significant interaction among factors. The lecithin concentration had a positive response on % EE, while ethanol concentration and IPA had a positive effect. For % DR, Ethanol, and IPA showed a positive effect and Lecithin had a negative response. The formulation EM22 (3 ml X1,3 ml X2 and 300 mg of X3) characterized by high % EE(77.3 %) and optimum % DR(94.2%) and formulation EM6 (2 ml X1,2 ml X2 and 100 mg of X3) characterized by high % DR(97.32 %) and optimum % EE (74.8 %). EM22 was incorporated in the gel as it is showing more entrapment efficiency and compared with the marketed product for drug release. Conclusion: From the result, it was concluded that formulated ethosomal suspension and optimized gel have more drug release than marketed formulation so that formulated suspension can be used for the preparation of antifungal gels, creams, ointments for sustained release.

In Vivo Potentiation of Antimicrobial Photodynamic Therapy in a Mouse Model of Fungal Infection by Addition of Potassium Iodide.

Antimicrobial photodynamic inactivation (aPDI) involves the use of a nontoxic dye or photosensitizer excited with visible light to produce reactive oxygen species that can kill all classes of microorganisms. Antimicrobial photodynamic therapy (aPDT) can be used in vivo as an alternative therapeutic strategy to treat localized infections due to its ability to selectively kill microbes while preserving host mammalian cells. aPDI can be potentiated by the addition of the nontoxic inorganic salt potassium iodide (KI). KI is an approved drug for antifungal therapy. The mechanism of potentiation with iodide is likely to be singlet oxygen addition to iodide to form iodine radicals, hydrogen peroxide, and molecular iodine. A previous chapter in this volume described potentiation of aPDI in vitro by addition of KI, while in this chapter we address the ability of KI to potentiate aPDT in vivo using an animal model of localized fungal infection. We employed oral candidiasis in immunosuppressed mice caused by a bioluminescent strain of Candida albicans and monitored by bioluminescence imaging.

Development and Evaluation of Nanoparticles Based Topical Gel Containing Antifungal Drug Fluconazole

The objective of this work was to prepare Fluconazole nanoparticles, and then incorporated into the freshly prepared gel for transdermal delivery, reducing the oral side effects of the drug and forenhancing stability. Fluconazole is commonly used antifungal agents for the treatment of local and systemic fungal infections. In this study Fluconazole nanoparticles was prepared by using Eudragit RL 100 by nanoprecipitation method with different drugs to polymer (1:1, 1:2 and 1:3) and stabilizer (Poloxamer 188) ratios (0.5%, 0.75% and 1%) and evaluated for various parameters. Drug-excipients compatibility was performed by FTIR study. The particle size, polydispersity index, Zeta potential, % Entrapment efficiency and % drug content of all the formulations were found in the range of 16.8 to 48.9nm, 0.229 to 0.558, -11.6 to -26.6 mv, 28.41% to 95.78% and 59% to 97.38%. From SEM studies it was revealed that Fluconazole nanoparticles particles are spherical in shape and without any agglomeration. From the in-vitro drug release study, it was revealed that sustained release of same formulation last up to 12 hours. From the stability study, it was revealed that the F5 formulation was stable at 40°C ± 2°C /75% ± 5%RH and 4°C. The optimised formulation F5 was selected to prepare Fluconazole loaded nanoparticles based topical gels using different concentration of Carbopol 934 and 940 and characterized for pH, spreadability, drug content, viscosity and in-vitro drug diffusion. Among the five formulations, G5 was selected as the best formulation. The pH of all formulations was found near to the skin pH value. The in-vitrodiffusion study of Fluconazole gel (G5) showed 94.75%. The optimized formulation G5 was checked for mechanism and kinetics of drug release. It is found it following Zero order release and non-Fickian mechanism. The selected Gel formulation G5 was found to be stable at 40°C ± 2°C /75% ± 5%RH and 4°C, it is clear that the formulation did not undergo any chemical changes found more stable at room temperature

Design and in vitro antifungal activity of Nystatin loaded chitosan-coated magnetite nanoparticles for targeted therapy

Super-paramagnetic iron oxide nanoparticles were synthesized by a co-precipitation method, which was further functionalized with chitosan (CS). The composite was investigated for binding with Nystatin (Nyst), a polyene polyhydroxy antifungal widely used in management of mucocutaneous fungal infections. The structure of the Fe3O4/CS/Nyst composite was characterized by different physicochemical techniques. Transmission electron microscope analysis revealed the Fe3O4/CS/Nyst composite with a mean diameter of ∼10–20 nm in a monodispersed spherical form. Fourier-transform infrared spectroscopy analysis confirmed the binding of CS on Fe3O4 NPs and also the loading of Nyst on the nanostructure. The UV–Vis absorption spectroscopy demonstrated the Nyst drug loading by 22% capacity. The antifungal activity of the Fe3O4/CS/Nyst was evaluated against Candida species and Aspergillus fumigatus, which demonstrated excellent activity with a minimum inhibitory concentration ranging from 2 to 16 μg/mL. The MTT assay was used to evaluate the toxicity of compounds which did not reveal any toxic effect on the adipose derived mesenchymal stem cells. Regarding remarkable antifungal activities and low toxicity of this magnetic nano-compound, it could be a good candidate for target therapy of mucocutaneous and local fungal infections.

Drug prescribing pattern of antifungal drugs for local fungal infections in a tertiary care hospital: MAMC, Agroha

Background: Drug utilization research or studies are the powerful exploratory tools to ascertain the role of drugs in the society which refers to the marketing, distribution, prescription and use of drugs with special emphasis on the medical, social and economic consequences. Periodic prescription audit in form of drug utilization study is a way to improve the quality of prescription and promote rational prescribing.Methods: This was a prospective and an observational study. Prescriptions included all newly diagnosed patients with cutaneous fungal infection of both sexes who attended dermatology OPD. Factors considered were sociodemographic parameters and WHO prescribing indicators.Results: 1000 prescriptions were analysed of patients between 18 to 65 years of age with cutaneous fungal infections. The average number of drugs per encounter was 3.68. The percentage of drugs prescribed by generic name was 50.33% and the percentage of drugs prescribed from NLEM was 20.93%.Conclusions: This study indicates that prescribing practices of drugs in tertiary care hospital can be improved by promoting generic name drug prescribing, prescribing drugs from NLEM and by reducing polypharmacy.

Formulation and In-vitro Evaluation of Itraconazole Floating Microparticles

Itraconazole (ITZ) is an antifungal drug (BCSII) used for the treatment of local and systemic fungal infections. Furthermore, ITZ used as an antifungal prophylaxis for immunocompromised patients.&#x0D; The objective of the study is to overcome the two problems of low and pH dependent solubility of ITZ by its preparation as floating microparticles.&#x0D; Firstly, pH-dependent floating microparticles were prepared using oil in water solvent evaporation method, from which the best one (F7) selected as a best pH-dependent formula with composition of ITZ (200mg),EC (800mg), HPMC 15cps (200mg) and safflower oil (2ml) .Then, F7 was compared with the selected Relatively pH-independent ITZ floating microparticles formula with composition of ITZ(200mg), a first coat of HPMC15cps (200mg), a second coat of EC (800mg), HPMC 15cps (200mg) and safflower oil (2ml) which prepared by a dual coating solvent evaporation method using a first coat which provides relatively pH-independent solubility, while the second coat applied as a bouncy producing agents. Polyvinyl alcohol (PVA) was used as a surfactant in both cases.&#x0D; The prepared floating microparticles were subjected to various evaluation parameters such as yield percent, drug loading and drug entrapment efficiency (EE), particle size analysis, in- vitro bouncy, drug release, Fourier Transforms Infrared Spectroscopy (FTIR), Differential Scanning Calorimetry (DSC) and X-ray Diffractometry (XRD) studies.

A pharmacoepidemiology study of local fungal infections in skin and venereal diseases outpatient department of a rural tertiary care hospital

Background: Fungal infections of the skin were the 4th most common skin disease in 2010 affecting 984 million people. An estimated 20-25% of the world’s population has some form of fungal infection. Dermatophytes are fungi that cause superficial infections of the skin, commonly referred to as tinea infections.Methods: This was a prospective and an observational study conducted from February 2018 to January 2019 in Dermatology Department. Prescriptions included all newly diagnosed patients with cutaneous fungal infection of both sex who attended dermatology OPD. Factors considered were sociodemographic parameters, the disease encountered and number of patients in each group and number of patients who received antifungal therapy (oral and topical) etc.Results: 1000 prescriptions were analysed of patients between 18 to 65 years of age with cutaneous fungal infections. There were a greater number of males (57.4%) than females (42.6%). The average number of antifungal drugs prescribed per prescription was 2.33. Majority of the patients were prescribed itraconazole (82.30%) followed by terbinafine (9.70%) and fluconazole (8.0%).Conclusions: The most common oral antifungal drug used was itraconazole. Ketoconazole and Terbinafine were the most commonly used topical agents respectively.

Chromoblastomycosis: A rare fungal infection from a nonendemic region—Southern Odisha

Chromoblastomycosis, a slowly progressing localized fungal infection confined to the skin and subcutaneous tissue, is caused by dematiaceous fungi. Dermal lesions are pleomorphic and can range from small nodules to large papillary like eruptions. Herein, we report a case of chromoblastomycosis in a 26-year-old male caused by Fonsecaea pedrosoi. The patient was immunocompetent and had thorn injury 4 years back and developed a nonhealing ulcer on the medial aspect of his right leg, which was clinically suspected as tuberculous or carcinomatous lesion. Punch biopsy was done and sent in normal saline for the histopathological examination. Microscopically, sclerotic bodies, characteristic of chromoblastomycosis, were noticed on hematoxylin and eosin stained sections. Potassium hydroxide mount of the punch biopsy also revealed dematiaceous branching septate fungal hyphae. The fungal culture produced typical black colonies of Fonsecaea pedrosoi. The case is of interest because to the best of our knowledge it has so far not been reported from our region—southern part of Odisha.

Acetic acid treatment for toe web infection caused by Pseudomonas Aeruginosa combined with fungal infection: A case series of ten patients.

Gram-negative bacterial toe web infection (GNBTWI) caused by Pseudomonas Aeruginosa combined with fungal infection has variety of treatments. However, these treatments have been poorly described in the literature. Our retrospective study describes patients that had been treated in our medical center with acetic acid combined with local antifungal treatment, to evaluate evidences for the appropriateness of this treatment. Ten patients with evidence of GNBTWI caused by Pseudomonas Aeruginosa combined with local fungal infection which have been treated with acetic acid in Emek Medical Center were identified. Eight patients (80%) had a complete response while two patients (20%) showed only a partial response. Side effects were minimal and included temporary stinging sensation. Acetic acid is a relatively cheap ingredient with minimal side effect profile and highly effective outcomes as a treatment for GNBTWI caused by Pseudomonas Aeruginosa and should be considered as an adjuvant treatment.

Modeling of a three-dimensional dynamic thermal field under grid-based sensor networks in grain storage

Thermal management is a major task in granaries, due to the essential role of temperature in grain storage. The accurate acquisition and updating of thermal field information generates a meaningful index for grain quality surveillance and storage maintenance actions. However, given the unknown mechanisms of local uncertainties, including local grain degradation and fungal infections that may significantly vary the thermal field in granaries, the appropriate modeling of field dynamics remains a challenging task. To address this issue, this article combines a three-dimensional (3D) nonlinear dynamics model with a stochastic spatiotemporal model to capture a 3D dynamic thermal map. To best harness the temperature data from the grid-based sensor network, we integrate the Kriging model into the Gaussian Markov random field model by introducing an anisotropic covariance function. Both simulation and real case studies are conducted to validate our proposed approach, and the results show that our approach outperforms other alternative methods for field estimation.

Formulation and Evaluation of Topical Antifungal Gel Containing Itraconazole

The present research has been undertaken with the aim to develop a topical gel formulation of Itraconazole. Itraconazole is an imidazole derivative and used for the treatment of local and systemic fungal infection. The oral use of Itraconazole is not much recommended as it has many side effects. Commercially Itraconazole topical gel preparation are not available in the market, thus this formulation is made for better patient compliance and to reduce the dose of drug and to avoid the side effects like liver damage and kidney damage. The gel was formulated by changing the polymer ratio. Formulation were evaluated for % yield, spredability, extrudability, washability and viscosity in-vitro drug release study, skin irritation study, stability testing and finally it was concluded that formulation F3 was the best formulation among these formulation.

Cationic amphiphilic Zn-porphyrin with high antifungal photodynamic potency.

Photodynamic therapy (PDT) is a promising alternative approach particularly attractive for treatment of localized fungal infections. It is based on compounds, photosensitizers (PSs), which when excited with visible light, generate reactive species that ultimately cause cell death. Such species have short lifespans; as a consequence, efficiency and selectivity of the PDT treatment depend mainly on the properties of the PSs. This study is the first to explore the effect of cationic porphyrin-based photosensitizers on Saccharomyces cerevisiae, a member of the fungus kingdom. The study investigates which properties of the PS are essential for efficient antifungal PDT. Cationic Zn(ii) meso-tetrakis(N-alkylpyridinium-2-yl)porphyrins (ZnP) with identical tetrapyrrole core and photo-physical properties, but with different substituents at the meso positions of the porphyrin ring were studied. Attaching six-carbon aliphatic chains to the four pyridyl nitrogens at all meso positions to the porphyrin ring produced a highly photo-efficient amphiphilic, water soluble PS, with minimal dark toxicity. It was taken up by the yeast cells and upon illumination suppressed metabolism by inactivating cytoplasmic and mitochondrial enzymes, and compromising plasma membrane barrier function. At low concentrations (up to 5 μM) the tetrahexyl derivative was a much more powerful antifungal agent than the commercially available chlorin e6. The more lipophilic tetraoctyl analog was also highly photo-efficient but displayed strong dark toxicity, presumably due to higher lipophilicity which might affect the lipid bilayer of membranes. Results presented here can assist the design of antifungal agents whose biological action depends on efficient and rapid uptake by the cells.

The effects of photodynamic treatment with new methylene blue N on the Candida albicans proteome.

Candida albicans is a human pathogenic fungus mainly affecting immunocompromised patients. Resistance to the commonly used fungicides can lead to poor treatment of mucosal infections which, in turn, can result in life-threatening systemic candidiasis. In this scenario, antimicrobial photodynamic treatment (PDT) has emerged as an effective alternative to treat superficial and localized fungal infections. Microbial death in PDT is a consequence of the oxidation of many cellular biomolecules, including proteins. Here, we report a combination of two-dimensional electrophoresis and tandem mass spectrometry to study the protein damage resulting from treating C. albicans with PDT with new methylene blue N and red light. Two-dimensional gels of treated cells showed an increase in acidic spots in a fluence-dependent manner. Amino acid analysis revealed a decrease in the histidine content after PDT, which is one plausible explanation for the observed acidic shift. However, some protein spots remained unchanged. Protein identification by mass spectrometry revealed that both modified and unmodified proteins could be localized to the cytoplasm, ruling out subcellular location as the only explanation for damage selectivity. Therefore, we hypothesize that protein modification by PDT is a consequence of both photosensitizer binding affinity and the degree of exposure of the photooxidizable residues on the protein surface.

Rhinofacial Conidiobolomycosis in a 16-Year-Old Girl

Objectives : To present the case of a 16-year old girl with progressive facial disfigurement spanning 11 months due to Conidiobolomycosis.&#x0D; Methods: &#x0D; Design: Case Report&#x0D; Setting: Tertiary Government Hospital&#x0D; Patient: One&#x0D; Results: A 16-year-old girl presented with a severe facial deformity of 11 months duration. The lesion started as a swelling in the right nasal vestibule, which later involved the entire nose, forehead, cheeks, upper and lower lip. A series of tissue biopsies revealed varied results -- chronic inflammation, chronic granulomatous inflammation with foreign body type giant cells, and eosinophilic granuloma—resulting in delayed provision of appropriate treatment. On the fourth biopsy using Grocott methenamine silver staining technique, septate fungal hyphae were identified. With a diagnosis of rhinofacial conidiobolomycosis, she was started on Itraconazole 100mg three times daily for eight months. Her facial swelling subsided gradually during the course of treatment and no systemic drug-related complications were observed.&#x0D; Conclusion: Rhinofacial conidiobolomycosis is a rare chronic localized fungal infection that usually affects midline facial structures in immunocompetent hosts. Early detection and diagnosis, and appropriate medication can give rapid resolution. To the best of our knowledge, this may be the first documented case of rhinofacial conidiobolomycosis in the Philippines.&#x0D; &#x0D; Keywords: Conidiobolomycosis; Conidiobolus; fungal infection; Itraconazole, Therapeutic use

Systemic T Cells and Monocyte Characteristics in Patients with Denture Stomatitis.

Chronic inflammatory disorders of the oral cavity, such as periodontitis, were recently linked to systemic immune activation. Since fungal oral infections have not yet been studied in this respect, the aim of our study is to determine whether the local inflammation caused by oral fungal infection of the palatal tissue (denture stomatitis-DS) is associated with the systemic inflammatory response. This question is becoming essential as the population ages. Peripheral blood of DS patients (n = 20) and control patients (n = 24) was assessed with flow cytometry to determine lymphocyte and monocyte profiles. Intracellular cytometric analysis was carried out to establish cytokine production by T cells. DS was diagnosed based on clinical symptoms of DS such as swelling and redness of oral mucosa, confirmed by microbiological swabs for fungal colonization with Candida species. The control group was recruited from denture users without clinical and microbiological signs of oral infections. Percentages of peripheral lymphocytes, T cells, monocytes, and their subpopulations were similar in both studied groups. The exception was median percentages of CD25+ T cell subsets, which were significantly lower in DS patients than in control subjects. This reduction was observed in both CD4 T cell subset (16.7% and 28.1%; p = 0.0006) and CD8 T cell subset (4.6% and 7.0%; p = 0.007) CONCLUSIONS: While DS and associated local fungal infection do not overtly affect activation of monocytes or lymphocytes, the number of CD 25+ T cells is significantly lower in the DS patients, possibly indicating limited potential for the infection clearance in denture-using aging patients.