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Livedo revealing an infectious mononucleosis
S152
Free cornawnication
FC14.
FC14-4 In vitro antifungal susceptibility of Malassezia species against terbinafine, ketoconazole and itraconazole A.K. Gupta’, A. Li’, J. Faergemam?, R.C. Summerb&. t University of Toronto, Canada; 2University of G6teborg, Sweden; 3Ministty of Health Mycology Laboratory, Catlada The current project was initiated to investigate the interspecial variations in in vitra antifungal susceptibility of the seven Malassezia species to terbinafine, ketoconazole, and itraconazole. Agar-based macro dilution method was used to prepare drug dilutions at concentrations ranging from 0.03 to 64 pg/mL. A growth scale of 0 to 4+ was applied to determine the growth of Malassezia yeasts on the agar media and the minimum inhibitory concentrations (MIC) of the drugs. The optimal incubation time was determined to be 96 hours post-inoculation. The MICs of terbinafine were determined to be ~0.3 PglmL for strains of M. sloofiae, 0.03 pg/mL for M. sytnpodialis and M. pachydermatis, 0.13 ,ug/mL for M. obtusa, 4.0 pg/mL for M. globosa, 80. @mL for M. restricta and M. furfur: MICs of all strains against ketoconazole and itraconazole were determined to be less than 0.03 /&mL, except for one M. fut$ur isolate whose MIC against ketoconazole was 0.13 hg/mL. In conclusions, all of the Malassezia strains tested were more sensitive to the azole drugs (ketoconazole and itraconazole) than to terbinafine.
FC14-5 Therapy of the nail mould infections T. Gregurek-Novak. A. Vnuk. Clinical Hospital “Sisters of charity”, Zagreb; General Hospital, Zabok, Croatia The mould infections of the nails are increasing in number. Because of resistance to therapy they are a great problem for dermatologists. We have chosen 20 patients with infection of the toenail with the Scopulariopsis brevicaulis. Ten patients received 3 pulses of itraconazole (2 x 200 mg daily for one week) and another 10 patients were treated with terbinafine tablets 250 mg once daily for 12 weeks. In the group treated with itraconazole mycological healing was complete after first pulse in all ten patients and in patients treated with terbinafine two were mycologically positive after ending the therapy. Clinical healing in the itraconazole group was complete in 8 patients and in the terbinafine group clinical healing was complete in 7 patients. We also used cultures (Sabouraud agar) in which we added itraconazole or terbinafine. Pure colonies of S. brevicaulis were inoculated in the culture medium. In the cultures with the itraconazole only in one case we have a new colonies of the mould and in the cultures with terbinafine in four. After our in vivo and in vitro studies we can conclude that itraconazole achieved better results against mould infections of the nail.
FC14-6 Orofacial gumma: A diagnostic dilemma S. Punjabi, R. Cerio. Royal London Hospital, Whitechapel, London, UK A52 year old Asian widow, presented to the oral surgeons in 1987 with spongy and swollen gums and palate. Palatal granuloma was excised. %o years ago, she developed a small
blSectiorls/irlfestatio,u
2
granulomatous plaque over her right upper lip. Sarcoidosis was considered on oral histology. No improvement occurred following systemic steroid 20 mg/day. Referred to dermatology; a biopsy was taken and she was empirically started on rifampicin as tuberculosis was thought to be the most likely diagnosis. Histology showed loose granulomatous inflammation which was plasma cell rich. Warthin Starry was unhelpful. Investigations: FTA ABS positive. TPHA positive. VDRL negative. Mycobacteria culture: no growth HIV no risk factors. CSF: normal. Treatment: Injection (inj) Benzyl Penicillin 300 mg 4 times a day followed by inj Procaine Penicillin 1.8 mega units once a day for 13 days, with Probenicid 500 mg 4 times a day. Comment: Gumma of the skin and palate is very rare, most often the presentation is late and the diagnosis delayed.
1FCI 4-7 1 Fluconasole versus intravaginal clotrimasole in the treatment of vulvovaginal candidiasis in women V. Markeviciene. University clinic of dertnatovenereology, Vilnius,
Lithuania
The efficacy and safety of fluconasole in comparison with intravaginal clotrimazol suppository in the treatment of vulvovaginal candidiasis. Analysis carried out for 80 females from 18 years old and older. The Clinical Symptoms: redden of vulva, itch, white discharges from vagina, mycological tests was evaluated. Patients were divided into two groups. Fluconasole was administered in a single oral 150 mg dose in 35 patients in a first group. The clotrimasole suppository was given one suppository one time a day six days in 45 patients in the second group. Control laboratory and clinical examination was performed in all patients after ten days and one month after first examination. The patients sexual partners was examination. Balanoposthitis and candida urethritis was diagnosed for 36 (45 percent) sexual partners of patients. After ten days was evaluated treatment results. The three patients repeatedly was detected candida in the first group, in the second five. After one month candida was detected only two patients who treated by clotrimasole suppository. In Conclusion: a single oral 150 mg dose of fluconasole is as effective and well tolerated as clotrimasole suppository for six days in the treatment of vulvovaginal candidiasis in women. In cases of candidiasis must treated all sexual partners.
FC14-6 Livedo revealing an infectious mononucleosis J. Martel, 0. Rogeaux, C. Peyre-Lavigne. Centre hospitalier; Chamb&y, France Livedo of the buttocks and thighs appeared in a 18 year-oldwoman with sore throat, lymphadenopathy, fever. IgM and IgG antibodies to Epstein-Barr virus were positive. Cold agglutinins and cryoglobulinemia were found. The infectious mononucieosis recovers in a few weeks. The livedo disappeared. Dermatologists have not to be surprised when a livedo occurs during an infectious mononucleosis. If a livedo occurs in a young patient with fever, practitioners must think about the infectious mononucleosis and ask for Epstein Barr serology.
Free cornawnication
FC14.
FC14-4 In vitro antifungal susceptibility of Malassezia species against terbinafine, ketoconazole and itraconazole A.K. Gupta’, A. Li’, J. Faergemam?, R.C. Summerb&. t University of Toronto, Canada; 2University of G6teborg, Sweden; 3Ministty of Health Mycology Laboratory, Catlada The current project was initiated to investigate the interspecial variations in in vitra antifungal susceptibility of the seven Malassezia species to terbinafine, ketoconazole, and itraconazole. Agar-based macro dilution method was used to prepare drug dilutions at concentrations ranging from 0.03 to 64 pg/mL. A growth scale of 0 to 4+ was applied to determine the growth of Malassezia yeasts on the agar media and the minimum inhibitory concentrations (MIC) of the drugs. The optimal incubation time was determined to be 96 hours post-inoculation. The MICs of terbinafine were determined to be ~0.3 PglmL for strains of M. sloofiae, 0.03 pg/mL for M. sytnpodialis and M. pachydermatis, 0.13 ,ug/mL for M. obtusa, 4.0 pg/mL for M. globosa, 80. @mL for M. restricta and M. furfur: MICs of all strains against ketoconazole and itraconazole were determined to be less than 0.03 /&mL, except for one M. fut$ur isolate whose MIC against ketoconazole was 0.13 hg/mL. In conclusions, all of the Malassezia strains tested were more sensitive to the azole drugs (ketoconazole and itraconazole) than to terbinafine.
FC14-5 Therapy of the nail mould infections T. Gregurek-Novak. A. Vnuk. Clinical Hospital “Sisters of charity”, Zagreb; General Hospital, Zabok, Croatia The mould infections of the nails are increasing in number. Because of resistance to therapy they are a great problem for dermatologists. We have chosen 20 patients with infection of the toenail with the Scopulariopsis brevicaulis. Ten patients received 3 pulses of itraconazole (2 x 200 mg daily for one week) and another 10 patients were treated with terbinafine tablets 250 mg once daily for 12 weeks. In the group treated with itraconazole mycological healing was complete after first pulse in all ten patients and in patients treated with terbinafine two were mycologically positive after ending the therapy. Clinical healing in the itraconazole group was complete in 8 patients and in the terbinafine group clinical healing was complete in 7 patients. We also used cultures (Sabouraud agar) in which we added itraconazole or terbinafine. Pure colonies of S. brevicaulis were inoculated in the culture medium. In the cultures with the itraconazole only in one case we have a new colonies of the mould and in the cultures with terbinafine in four. After our in vivo and in vitro studies we can conclude that itraconazole achieved better results against mould infections of the nail.
FC14-6 Orofacial gumma: A diagnostic dilemma S. Punjabi, R. Cerio. Royal London Hospital, Whitechapel, London, UK A52 year old Asian widow, presented to the oral surgeons in 1987 with spongy and swollen gums and palate. Palatal granuloma was excised. %o years ago, she developed a small
blSectiorls/irlfestatio,u
2
granulomatous plaque over her right upper lip. Sarcoidosis was considered on oral histology. No improvement occurred following systemic steroid 20 mg/day. Referred to dermatology; a biopsy was taken and she was empirically started on rifampicin as tuberculosis was thought to be the most likely diagnosis. Histology showed loose granulomatous inflammation which was plasma cell rich. Warthin Starry was unhelpful. Investigations: FTA ABS positive. TPHA positive. VDRL negative. Mycobacteria culture: no growth HIV no risk factors. CSF: normal. Treatment: Injection (inj) Benzyl Penicillin 300 mg 4 times a day followed by inj Procaine Penicillin 1.8 mega units once a day for 13 days, with Probenicid 500 mg 4 times a day. Comment: Gumma of the skin and palate is very rare, most often the presentation is late and the diagnosis delayed.
1FCI 4-7 1 Fluconasole versus intravaginal clotrimasole in the treatment of vulvovaginal candidiasis in women V. Markeviciene. University clinic of dertnatovenereology, Vilnius,
Lithuania
The efficacy and safety of fluconasole in comparison with intravaginal clotrimazol suppository in the treatment of vulvovaginal candidiasis. Analysis carried out for 80 females from 18 years old and older. The Clinical Symptoms: redden of vulva, itch, white discharges from vagina, mycological tests was evaluated. Patients were divided into two groups. Fluconasole was administered in a single oral 150 mg dose in 35 patients in a first group. The clotrimasole suppository was given one suppository one time a day six days in 45 patients in the second group. Control laboratory and clinical examination was performed in all patients after ten days and one month after first examination. The patients sexual partners was examination. Balanoposthitis and candida urethritis was diagnosed for 36 (45 percent) sexual partners of patients. After ten days was evaluated treatment results. The three patients repeatedly was detected candida in the first group, in the second five. After one month candida was detected only two patients who treated by clotrimasole suppository. In Conclusion: a single oral 150 mg dose of fluconasole is as effective and well tolerated as clotrimasole suppository for six days in the treatment of vulvovaginal candidiasis in women. In cases of candidiasis must treated all sexual partners.
FC14-6 Livedo revealing an infectious mononucleosis J. Martel, 0. Rogeaux, C. Peyre-Lavigne. Centre hospitalier; Chamb&y, France Livedo of the buttocks and thighs appeared in a 18 year-oldwoman with sore throat, lymphadenopathy, fever. IgM and IgG antibodies to Epstein-Barr virus were positive. Cold agglutinins and cryoglobulinemia were found. The infectious mononucieosis recovers in a few weeks. The livedo disappeared. Dermatologists have not to be surprised when a livedo occurs during an infectious mononucleosis. If a livedo occurs in a young patient with fever, practitioners must think about the infectious mononucleosis and ask for Epstein Barr serology.