Small Epidemics Research Articles

Drivers of the dynamics of the spread of cholera in the Democratic Republic of the Congo, 2000-2018: An eco-epidemiological study.

The dynamics of the spread of cholera epidemics in the Democratic Republic of the Congo (DRC), from east to west and within western DRC, have been extensively studied. However, the drivers of these spread processes remain unclear. We therefore sought to better understand the factors associated with these spread dynamics and their potential underlying mechanisms. In this eco-epidemiological study, we focused on the spread processes of cholera epidemics originating from the shores of Lake Kivu, involving the areas bordering Lake Kivu, the areas surrounding the lake areas, and the areas out of endemic eastern DRC (eastern and western non-endemic provinces). Over the period 2000-2018, we collected data on suspected cholera cases, and a set of several variables including types of conflicts, the number of internally displaced persons (IDPs), population density, transportation network density, and accessibility indicators. Using multivariate ordinal logistic regression models, we identified factors associated with the spread of cholera outside the endemic eastern DRC. We performed multivariate Vector Auto Regressive models to analyze potential underlying mechanisms involving the factors associated with these spread dynamics. Finally, we classified the affected health zones using hierarchical ascendant classification based on principal component analysis (PCA). The increase in the number of suspected cholera cases, the exacerbation of conflict events, and the number of IDPs in eastern endemic areas were associated with an increased risk of cholera spreading outside the endemic eastern provinces. We found that the increase in suspected cholera cases was influenced by the increase in battles at lag of 4 weeks, which were influenced by the violence against civilians with a 1-week lag. The violent conflict events influenced the increase in the number of IDPs 4 to 6 weeks later. Other influences and uni- or bidirectional causal links were observed between violent and non-violent conflicts, and between conflicts and IDPs. Hierarchical clustering on PCA identified three categories of affected health zones: densely populated urban areas with few but large and longer epidemics; moderately and accessible areas with more but small epidemics; less populated and less accessible areas with more and larger epidemics. Our findings argue for monitoring conflict dynamics to predict the risk of geographic expansion of cholera in the DRC. They also suggest areas where interventions should be appropriately focused to build their resilience to the disease.

Historical epidemics of scrub typhus in Queensland and Papua New Guinea.

Undifferentiated febrile diseases (e.g., Mossman fever) from northern Queensland were eventually partially attributed to mite-transmitted rickettsial infections known as scrub typhus or tsutsugamushi fever. Scrub typhus became a major medical threat to military operations in Papua New Guinea during the Second World War and killed more Australian soldiers than malaria in the pre-antibiotic era. Further investigations showed scrub typhus to be an occupational disease of rural workers in north Queensland especially around Cairns and Innisfail. Occasional small epidemics of scrub typhus still occur during military exercises in Queensland, but as scrub typhus is not a reportable disease, its presence in the civilian community is largely unknown. Increased use of serological testing in patients with fever and rash illnesses after exposure in northern Queensland is likely to show that scrub typhus is a modern infection that remains treatable with antibiotics once it is identified.

An overview of the monkeypox

Smallpox-like symptoms are caused by the human monkeypox orthopoxvirus, a zoonotic orthopoxvirus. The zoonotic human monkeypox was detected in 1970, twelve years after the monkeypox virus was found in a Danish lab in 1958. It has lately been documented in cases outside of Africa, and it has spread to other regions of Africa. (mainly West and Central Africa). The genesis, epidemiology, and ecology of the disease are still largely unknown, which has caused a rise in the frequency and geographic dispersion of human monkeypox cases in recent years. 8 days on average were needed for incubation. (range 4–14 days). A multi-nation outbreak of human monkeypox infections, involving transmission from person to person, was documented in Europe and North America in May 2022. Monitoring and epidemiological analysis need to be more precise in order to calculate the effect on public health and develop policies to reduce the risk of a larger spread of disease. Small viral epidemics with mortality rates around 10% and rates of secondary human-to-human transmission around the same percentage are frequent in tropical Central and West Africa. On July 31, 2022, the first case of monkeypox mortality was reported in India; the victim was a 22-year-old man who had recently returned from the United Arab Emirates. In light of the continuous outbreaks throughout the world, we provide current information on monkeypox for medical professionals in this overview. There is a zoonotic orthopoxvirus that produces human monkeypox. However, ST 246 has been found to be effective in vivo and in vitro in infected animals, and experiments were safely carried out on non-infected humans. ST 246 has not been tested for its effectiveness on monkey pox or orthopox-infected individuals.

Sports et spores

AbstractSports practice, in general, promotes the occurrence of mycosis which usually remains superficial. Swimming, gymnastics, marathon, judo and wrestling are the most affected sports. Many epidemiological studies carried out on sports sites reveal that visitors who attend them have a higher risk of fungal infections, mainly Tinea pedis or athlete’s feet, than the rest of the general population. The species encountered are practically all dermatophytes of anthropophilic origin, Trichophyton rubrum and T. interdigitale and more rarely Epidermophyton floccosum. These same species are found on the floor and tiles of these sport establishments as well as on the judoka dojos. Among wrestlers and judokas who are involved in contact sports, there are small epidemics of “Tinea gladiatorum” due to Trichophyton tonsurans causing damage to the skin (Tinea corporis) and sometimes to the scalp (Tinea capitis). For other sports requiring the prolonged wearing of closed shoes (sneakers) and or close-fitting skin clothing that promotes perspiration, dermatophyte or yeast intertrigos predominate. More rarely, the practice of horse riding, through contact with an infected animal, can be exposed to the risk of zoophilic dermatophytosis.

What’s scabies?

Scabies is a contagious skin infestation caused by a parasite. In its usual, common form scabies is passed on through long-time close physical contact. Though rarely so, infestation, of the profuse and hyperkeratotic form, can also be caused by shared clothes, shared bed or bathroom linen. Scabies causative agent is the female mite sarcoptes scabiei , also called scab mites, a small-size skin parasite, less than half a millimeter in length, of the larger family of mites. It burrows into the host’s upper skin layer to lay its eggs there. Scabies is a common skin disorder throughout the world. Anyone can get infested whatever their age, sex, social background, or personal body care. Regular episodes of scabies flare up as small scales epidemics in communities like schools, nurseries, retirement homes, inpatient services, &.

Umrli od tifusa 1915. godine u parohijama crkava u Dračiću i Kkosjeriću - prilog demografskoj analizi ratnih žrtava

Although more than a century has passed, many questions have been unanswered, and the most important of them are related to a total number of war victims, as well as the shares of the murdered on the battlefield and dead from the consequences of various, big and small epidemics, including large typhus epidemic in 1915. In this paper, a general synthesis of epidemic situation during the war in Serbia has been presented, as well as the results of the specific research related to mortality changing according to years in various villages of the Valjevo and Užice area done by analysis of records in registry books and church death registry books. This research has shown that mortality was much bigger (about three times) than average mortality in previous years, approximately depending on village, 75%-85% of the dead passed away during the first half of the year, during the typhus epidemic. In addition, profound research of the mortality in the parishes of the churches in Dračić and Kosjerić showed that 5760 inhabitants lived in 12 villages according to the census from 1910. During the four-year period, from 1912 to 1915 (those were the years of the Balkan wars and the first two years of the World War I ending in the year when great typhus epidemic developed) deaths of 1090 parishioners were registered and that was 18.92% of the population registered in 1910. The main cause of the deaths was various diseases, although in 1914 there were many war actions, and in the death records only 11 direct war victims were registered. The greatest mortality rate was noted in the "typhus year", in 1915, when the informal armistice lasted most of the year. Out of 600 deceased, 477 died during the first half of the year. Typhus was noted as a cause of the death for 338 of the deceased, and it presented 31% of all the records during those four years, and 5.87% out of the inhabitants recorded in 1910. Regarding sex and age structure of the typhus victims during the epidemics, out of 338 deceased a bigger mortality rate of men was noted (185-54.73%) than women, and a much bigger mortality rate of the persons over 40 (219-4.79%) than younger persons. deaths of 1090 parishioners were registered and that was 18.92% of the population registered in 1910. The main cause of the deaths was various diseases, although in 1914 there were many war actions, and in the death records only 11 direct war victims were registered. The greatest mortality rate was noted in the "typhus year", in 1915, when the informal armistice lasted most of the year. Out of 600 deceased, 477 died during the first half of the year. Typhus was noted as a cause of the death for 338 of the deceased, and it presented 31% of all the records during those four years, and 5.87% out of the inhabitants recorded in 1910. Regarding sex and age structure of the typhus victims during the epidemics, out of 338 deceased a bigger mortality rate of men was noted (185-54.73%) than women, and a much bigger mortality rate of the persons over 40 (219-4.79%) than younger persons. deaths of 1090 parishioners were registered and that was 18.92% of the population registered in 1910. The main cause of the deaths was various diseases, although in 1914 there were many war actions, and in the death records only 11 direct war victims were registered. The greatest mortality rate was noted in the "typhus year", in 1915, when the informal armistice lasted most of the year. Out of 600 deceased, 477 died during the first half of the year. Typhus was noted as a cause of the death for 338 of the deceased, and it presented 31% of all the records during those four years, and 5.87% out of the inhabitants recorded in 1910. Regarding sex and age structure of the typhus victims during the epidemics, out of 338 deceased a bigger mortality rate of men was noted (185-54.73%) than women, and a much bigger mortality rate of the persons over 40 (219-4.79%) than younger persons.

HAND, FOOT AND MOUTH DISEASE –MANAGEMENT THROUGH AYURVEDA -A SHORT CASE REPORT

Hand, foot and mouth disease usually affect infants and children. It is viral disease characterised by a brief febrile illness and typical vesicular rash. In rare cases, patients may also develop neurological complications. It is moderately contagious and is spread through direct contact with the mucus, saliva, or feces of an infected person.
 It typically occurs in small epidemics, usually during the summer and autumn months. The incidence of hand, foot and mouth disease has recently been on the rise in India due to the probable mass immunization programs. The disease affects more than one family member and often takes a toll of epidemic situation.
 The modern management offers only symptomatic relief along with antiviral medicines whose indications are limited to severe cases. This report describes a prolonged case of hand foot and mouth disease from Kolhapur,central India, managed through ayurvedic remedies like Paripathadi kadha, Shatdhout ghrut and Kumari .ayurvedic remedies.Where it shows better improvement in healing of lesions in short duration.
 Keywords- Hand foot mouth disease, vesicular rash, Paripathadi kadha, Shatdhout ghrut

Measles Outbreak in a Rural Population in Bahar District, Hamadan Province, West of Iran in 2018.

Background: Measles is in elimination phase in Iran. Following occurrence of two cases of measles in two children under six years old with the history of measles immunization in one of the villages affiliated to Bahar District, west of Hamadan Province, northwest of Iran, this study was conducted to determine the immunity status of people living in the village affected by the measles outbreak in spring of 2018. Study design: A cross-sectional (descriptive-analytical) study. Methods: Overall, 272 populations of 0-40 yr old in the village affected by outbreak were enrolled. Multistage sampling was used for choosing participants. The data collection tool was a researcher-made checklist used to collect epidemiological data including demographic characteristics and vaccination status. Blood samples were taken from them and sent to the measles reference laboratory for IgG testing. The amount of optical density (OD) greater than 0.2 was considered as positive and less than 0.1 negative, respectively. Results: The mean age of the study population was 17.4 ±11.8 yr and the sex ratio was almost the same. Levels of antibodies against measles were positive in 63.24%, intermediate in 12.5% and negative in 24.26%. There was no significant difference between the immunity status of the subjects with gender (P=0.236) and age group (P=0.113). Pearson correlation results showed that in males there was a significant positive correlation between the age of the participants and the serum IgG level (r = 0.26, P=0.003). Conclusion: Measles immunity in communities is not sufficient to prevent outbreaks and small epidemics, and it is recommended that periodically, serological assessments carried out at community level and especially at high-risk groups.

Hand, foot and mouth disease

Hand, foot and mouth disease usually affect infants and children. It is moderately contagious and is spread through direct contact with the mucus, saliva, or feces of an infected person. It typically occurs in small epidemics, usually during the summer and autumn months. The incidence of hand, foot and mouth disease has recently been on the rise in India due to the probable mass immunization programs.

Simulation Based Evaluation of Time Series for Syndromic Surveillance of Cattle in Switzerland.

Choosing the syndrome time series to monitor in a syndromic surveillance system is not a straight forward process. Defining which syndromes to monitor in order to maximize detection performance has been recently identified as one of the research priorities in Syndromic surveillance. Estimating the minimum size of an epidemic that could potentially be detected in a specific syndrome could be used as a criteria for comparing the performance of different syndrome time series, and could provide some guidance for syndrome selection. The aim of our study was to estimate the potential value of different time series for building a national syndromic surveillance system for cattle in Switzerland. Simulations were used to produce outbreaks of different size and shape and to estimate the ability of each time series and aberration detection algorithm to detect them with high sensitivity, specificity and timeliness. Two temporal aberration detection algorithms were also compared: Holt–Winters generalized exponential smoothing (HW) and Exponential Weighted Moving Average (EWMA). Our results indicated that a specific aberration detection algorithm should be used for each time series. In addition, time series with high counts per unit of time had good overall detection performance, but poor detection performance for small epidemics making them of limited use for an early detection system. Estimating the minimum size of simulated epidemics that could potentially be detected in syndrome TS-event detection pairs can help surveillance system designers choosing the most appropriate syndrome TS to include in their early epidemic surveillance system.

Finite Symmetries in Agent-Based Epidemic Models

Predictive analysis of epidemics often depends on the initial conditions of the outbreak, the structure of the afflicted population, and population size. However, disease outbreaks are subjected to fluctuations that may shape the spreading process. Agent-based epidemic models mitigate the issue by using a transition matrix which replicates stochastic effects observed in real epidemics. They have met considerable numerical success to simulate small scale epidemics. The problem grows exponentially with population size, reducing the usability of agent-based models for large scale epidemics. Here, we present an algorithm that explores permutation symmetries to enhance the computational performance of agent-based epidemic models. Our findings bound the stochastic process to a single eigenvalue sector, scaling down the dimension of the transition matrix to o ( N 2 ) .

Meningococcal strain evolution, dusty dry air and respiratory tract infections: An explosive relationship.

Meningococcal strain evolution, dusty dry air and respiratory tract infections: An explosive relationship.

Mayaro virus: the jungle flu

Mayaro virus: the jungle flu Ricardo O Izurieta,1 David A DeLacure,1 Andres Izurieta,2 Ismael A Hoare,1 Miguel Reina Ortiz,1,3 1Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA; 2Department of Computer Science and Engineering, College of Engineering, University of South Florida, Tampa, FL, USA; 3Fundación Raíces, Esmeraldas, Ecuador Abstract: Mayaro fever is an emerging acute viral disease endemic in Central and South America. Mayaro virus (MAYV) is classified in the Semliki Forest virus antigenic complex and shares similarities with the alphavirus Chikungunya virus and the flavivirus Dengue virus. MAYV is an arbovirus transmitted by Haemagogus janthinomys, with competence also demonstrated in Aedes aegypti, Aedes scapularis, and Anopheles quadrimaculatus. Outbreaks and small epidemics of Mayaro fever have occurred in several countries in northern South America and the Caribbean. In addition, travel-associated cases have been reported in European nationals returning from endemic areas. Clinical features of Mayaro fever include fever, chills, persistent arthralgia, retro-orbital pain, maculopapular rash, itching, dizziness, and, rarely, lymphadenopathy. Methods of control for MAYV are similar to those used for other sylvatic arboviruses. Although MAYV was discovered as long ago as the 1950s and continues to be prevalent in the tropical areas of the Americas, it remains neglected and under-studied. This paper provides a thorough and current review of the published MAYV literature ranging from its original description to modern outbreaks, and from the basic virus characteristics to the clinical and epidemiological aspects of this disease. Keywords: Mayaro virus, emerging arbovirus, dengue-like virus, arthrogenic virus

Update of knowledge onNeglected Diseases in Haiti: Mansonelliasis, Tungiasis, Leprosy, andAnthrax

Haiti, like most limited-resources countries in the world, faces numerous neglected infectious diseases. They represent a real public health issue with lethal consequences especially in children. We are reviewing here the available literature on four neglected infectious diseases, mansonelliasis, tungiasis, leprosy and anthrax. Filariasis, due to Mansonella ozzardi, has been totally neglected since its discovery in 1920 in Haiti; it persists in coastal homes with a high prevalence in adults when an effective treatment is available. The skin lesions caused by Tunga penetrans have existed since the pre-Columbian period in Haiti. They persist in the most retreated and hard-to-reach areas where the population lives in precarious conditions and in extreme poverty. New available research data show the importance of the problem with very high prevalence rates in some rural communities far away from any healthcare center. Cases of leprosy are recently reemerging as no monitoring program has been in place since 2004. Finally, anthrax is still endemic; small epidemics resurfacing periodically in families in rural areas. Screening of people for these diseases and managing the cases are necessary to improve health and reduce morbidity and mortality in Haiti.

Seroprevalence of Rift Valley fever virus in livestock during inter-epidemic period in Egypt, 2014/15

BackgroundRift Valley fever virus (RVFV) caused several outbreaks throughout the African continent and the Arabian Peninsula posing significant threat to human and animal health. In Egypt the first and most important Rift Valley fever epidemic occurred during 1977/78 with a multitude of infected humans and huge economic losses in livestock. After this major outbreak, RVF epidemics re-occurred in irregular intervals between 1993 and 2003. Seroprevalence of anti-RVFV antibodies in livestock during inter-epidemic periods can be used for supporting the evaluation of the present risk exposure for animal and public health. A serosurvey was conducted during 2014/2015 in non-vaccinated livestock including camels, sheep, goats and buffalos in different areas of the Nile River Delta as well as the furthermost southeast of Egypt to investigate the presence of anti-RVFV antibodies for further evaluating of the risk exposure for animal and human health. All animals integrated in this study were born after the last Egyptian RVF epidemic in 2003 and sampled buffalos and small ruminants were not imported from other endemic countries.ResultsA total of 873 serum samples from apparently healthy animals from different host species (camels: n = 221; sheep: n = 438; goats: n = 26; buffalo: n = 188) were tested serologically using RVFV competition ELISA, virus neutralization test and/or an indirect immunofluorescence assay, depending on available serum volume. Sera were assessed positive when virus neutralization test alone or least two assays produced consistent positive results. The overall seroprevalence was 2.29% (95%CI: 1.51–3.07) ranging from 0% in goats, 0.46% in sheep (95%CI: 0.41–0.5), and 3.17% in camels (95%CI: 0.86–5.48) up to 5.85% in buffalos (95%CI: 2.75–8.95).ConclusionOur findings assume currently low level of circulating virus in the investigated areas and suggest minor indication for a new RVF epidemic. Further the results may indicate that during long inter-epidemic periods, maintenance of the virus occur in vectors and also most probably in buffaloes within cryptic cycle where sporadic, small and local epidemics may occur. Therefore, comprehensive and well-designed surveillance activities are urgently needed to detect first evidence for transition from endemic to epidemic cycle.

Data-Driven Risk Assessment from Small Scale Epidemics: Estimation and Model Choice for Spatio-Temporal Data with Application to a Classical Swine Fever Outbreak.

Livestock epidemics have the potential to give rise to significant economic, welfare, and social costs. Incursions of emerging and re-emerging pathogens may lead to small and repeated outbreaks. Analysis of the resulting data is statistically challenging but can inform disease preparedness reducing potential future losses. We present a framework for spatial risk assessment of disease incursions based on data from small localized historic outbreaks. We focus on between-farm spread of livestock pathogens and illustrate our methods by application to data on the small outbreak of Classical Swine Fever (CSF) that occurred in 2000 in East Anglia, UK. We apply models based on continuous time semi-Markov processes, using data-augmentation Markov Chain Monte Carlo techniques within a Bayesian framework to infer disease dynamics and detection from incompletely observed outbreaks. The spatial transmission kernel describing pathogen spread between farms, and the distribution of times between infection and detection, is estimated alongside unobserved exposure times. Our results demonstrate inference is reliable even for relatively small outbreaks when the data-generating model is known. However, associated risk assessments depend strongly on the form of the fitted transmission kernel. Therefore, for real applications, methods are needed to select the most appropriate model in light of the data. We assess standard Deviance Information Criteria (DIC) model selection tools and recently introduced latent residual methods of model assessment, in selecting the functional form of the spatial transmission kernel. These methods are applied to the CSF data, and tested in simulated scenarios which represent field data, but assume the data generation mechanism is known. Analysis of simulated scenarios shows that latent residual methods enable reliable selection of the transmission kernel even for small outbreaks whereas the DIC is less reliable. Moreover, compared with DIC, model choice based on latent residual assessment correlated better with predicted risk.

Hand, Foot and Mouth Disease (HFMD): An Update

Hand, foot, and mouth disease (HFMD) also known as vesicular stomatitis with exanthema, first reported in New Zealand in 1957 is caused by Coxsackie virus A16 (CVA16), human enterovirus 71 (HEV71) and occasionally by other HEV-A serotypes, such as Coxsackie virus A6 and Coxsackie virus A10, are also associated with HFMD and herpangina. While all these viruses can cause mild disease in children, EV71 has been associated with neurological disease and mortality in large outbreaks in the Asia Pacific region over the last decade. It is highly contagious and is spread through direct contact with the mucus, saliva, or feces of an infected person. This is characterized by erythrematous papulo vesicular eruptions over hand, feet, perioral area, knee, buttocks and also intra-orally mostly in children, typically occurs in small epidemics usually during the summer and autumn months. HFMD symptoms are usually mild and resolve on their own in 7 to 10 days. Treatment is symptomatic but good hygiene during and after infection is very important in preventing the spread of the disease. Though only small scale outbreaks have been reported from United States, Europe, Australia Japan and Brazil for the first few decade, since 1997 the disease has conspicuously changed its behavior as noted in different Southeast Asian countries. There was sharp rise in incidence, severity, complications and even fatal outcomes that were almost unseen before that period. There are reports of disease activity in different corners of India since 2004, and the largest outbreak of HFMD occurred in eastern part of India in and around Kolkata in 2007and Bhubaneswar, Odisha in 2009. In recent years there are cases of HFMD have been seen in Bangladesh also. Although of milder degree, continuous progress to affect larger parts of the neighboring may indicate vulnerability of Bangladesh from possible future outbreaks.Bangladesh J Child Health 2016; VOL 40 (2) :115-119

Sports-associated dermatophytoses : An overview

Because of high exposure (e. g. swimmers and athletes competing on mats) and disposition (e. g. microtraumata of the skin in runners) athletes are prone to ahigher risk for mycotic infections by dermatophytes. In disciplines with close contact during competition-especially wrestlers and judoists-infections by the anthropophilic Trichophyton (T.) tonsurans are most important (tinea gladiatorum). These infections are highly contagious and often cause small epidemics especially if the primary source of infection is not promptly recognized. The environment of the athletes (e. g. mats) and asymptomatic carriers may be sources of further spread. Tinea pedis with its clinical manifestations seems to be often underdiagnosed and insufficiently treated. Environmental contamination by fungal spores may be responsible for the significantly higher level of mycotic infections of the feet in children and adolescents active in sports. There is ahigher risk for spread of the infection to the toe nails (onychomycosis) and for consecutive infections by bacteria (e. g. erysipelas). More rarely infections by zoophilic or geophilic dermatophytes are seen in athletes (e.g. equestrians). Education and more intensive measures of prevention and environmental decontamination are essential for all dermatophytoses associated with sports.

Mycology – an update. Part 1: Dermatomycoses: Causative agents, epidemiology and pathogenesis

Dermatomycoses are caused most commonly by dermatophytes. The anthropophilic dermatophyte Trichophyton rubrum is still the most frequent causative agent worldwide. Keratinolytic enzymes, e.g. hydrolases and keratinases, are important virulence factors of T.rubrum. Recently, the cysteine dioxygenase was found as new virulence factor. Predisposing host factors play a similarly important role for the development of dermatophytosis of the skin and nails. Chronic venous insufficiency, diabetes mellitus, disorders of cellular immunity, and genetic predisposition should be considered as risk factors for onychomycosis. A new alarming trend is the increasing number of cases of onychomycosis - mostly due to T.rubrum - in infancy. In Germany, tinea capitis is mostly caused by zoophilic dermatophytes, in particular Microsporum canis. New zoophilic fungi, primarily Trichophyton species of Arthroderma benhamiae, should be taken into differential diagnostic considerations of tinea capitis, tinea faciei, and tinea corporis. Source of infection are small household pets, particularly rodents, like guinea pigs. Anthropophilic dermatophytes may be introduced by families which immigrate from Africa or Asia to Europe. The anthropophilic dermatophytes T.violaceum, T.tonsurans (infections occurring in fighting sports clubs as "tinea gladiatorum capitis et corporis") and M.audouinii are causing outbreaks of small epidemics of tinea corporis and tinea capitis in kindergartens and schools. Superficial infections of the skin and mucous membranes due to yeasts are caused by Candida species. Also common are infections due to the lipophilic yeast fungus Malassezia. Today, within the genus Malassezia more than 10 different species are known. Malassezia globosa seems to play the crucial role in pityriasis versicolor. Molds (also designated non-dermatophyte molds, NDM) are increasingly found as causative agents in onychomycosis. Besides Scopulariopsis brevicaulis, several species of Fusarium and Aspergillus are found.

A Clinical Study of Nail Changes Occurring Secondary to Hand-Foot-Mouth Disease: Onychomadesis and Beau's Lines.

A Clinical Study of Nail Changes Occurring Secondary to Hand-Foot-Mouth Disease: Onychomadesis and Beau's Lines.