Bacterial and fungal flora of seagull droppingsd in Jersey.

In Jersey 166 fresh and 122 dried seagull droppings were obtained and studied locally and in London for the presence of bacteria and fungi of potentially pathogenic nature. There were no salmonella or shigella bacteria isolated from the two groups but there was a high proportion of Candida albicans obtained from the fresh material (21.7%) and only 1.6% from the dry faeces. Cryptococcus neoformans and Histoplasma capsulatum were not found in either the dry or fresh droppings. The normal bacterial and fungal flora of the seagull was established and it is considered that the C. albicans in fresh gull droppings would not materially increase albicans infections in man.

Observations on the epidemiology of Candida albicans.

The carriage rates for C. albicans were found to vary for different groups of people but hospital patients appeared to have higher rates than the non-hospital population. Candida albicans was recovered more frequently from the bedding of patients than from that of school children. The variable concentration of this fungus in the air and on the bedding suggested that its presence might be related to the presence of individual patients.

Environmental sampling for aspergilli during building construction on a hospital site.

During the course of extensive building activity at Guy's Hospital, London, air sampling was carried out weekly, for one year, to monitor the frequency of spores of Aspergillus spp. in both the hospital grounds and a number of defined ward areas. Nasal swabs were taken from patients on a selected ward to assess the nasal carriage of Aspergillus. The weather conditions were monitored at the time of sampling. The predominant species was Aspergillus fumigatus which occurred at a low frequency throughout the year, with little evidence of seasonal variation bar a peak in March. Few differences were found between internal and external spore counts. Localized building activity in a ward area and a laboratory area did not result in higher internal levels. Six percent of the nasal swabs were positive for A. fumigatus, though none of these patients became infected.

Fungal aerobiology: how, when and where?

While there is undoubted risk of infection in certain hospitalized patients following exposure to inhaled spores of fungi such as Aspergillus, the actual risk appears to vary with the underlying condition. Secondly, the degree of exposure assessed by colony forming units (cfu) per unit of ambient air is not predictable. Thirdly, severely immunocompromised patients, mainly the severely neutropenic group, are at risk from infection at very low levels of ambient Aspergillus spores. From this it can be argued that the latter group requires some form of environmental protection or prophylaxis whatever the circumstances. At present the best approach is the use of highly filtered ward areas e.g. laminar air flow rooms. Monitoring spore loads is unlikely to affect management per se provided that the ventilation systems are regularly and effectively serviced. In non-neutropenic patients the risk of infection due to colonization, for instance of the paranasal sinuses, prior to hospital admission may be as great as that occurring due to exposure within hospital and filtration of air has a lesser value. The situation may alter, though, even in these patients if the risk level is increased by a building programme in the vicinity of ward areas.

Sphaeropsis subglobosa keratomycosis--first reported case.

Recurrent keratomycosis is reported due to the coelomycete Sphaeropsis subglobosa, which has not been recognised previously as a human pathogen. Infection followed corneal injury by a frayed bamboo cane with implantation of its splinters. Initial successful therapy with 2% clotrimazole topically, to which it was sensitive, was followed by recurrent infection after 39 months, initially a keratitis but progressing to an endophthalmitis. Penetrating keratoplasty was necessary to eradicate the infection. Further isolation of the fungus showed that it had not developed resistance to clotrimazole but had survived dormant, deep in the corneal stroma. S. subglobosa should be considered in bamboo-associated and horticultural injuries.

Oral yeast flora of a population in an area of Tanzania bordering an AIDS endemic zone.

Mouth swabs from 1,288 individuals in the North Mara region of Tanzania were cultured for yeasts. Subjects were randomly selected from rural and urban areas, and a group of food handlers were also studied. Yeasts were cultured from 407 (31.6%) and Candida albicans from 141 (10.9%) subjects. A wide variety of other yeast species were also identified.

PIP: Between May-October 1989, health personnel took mouth swabs from 875 15-55 year old male and female adults from rural Luo Imbo division of Tarime district, 145 similar individuals from the town of Tarime, and 268 food handlers from Tarime and other neighboring towns in the North Mara region of Tanzania to determine the prevalence of oral yeast flora in areas near an AIDS endemic zone. Laboratory personnel at the Shirati Hospital in Shirati isolated yeasts in 31.6% of the cases with most cases having Candida albicans (10.9%) followed by Saccharomyces cerevisiae (7.4%) and Trichosporon capitatum (6.5%). They were able to identify at least 23 other yeasts among the study group. Food handlers had the highest carriage rate (36.4%) then rural dwellers (32.5%) and urban dwellers (24.8%). C. albicans was present more often in the food handlers (17.5%) than either the rural or urban dwellers (9.5%) and 6.9% respectively). Thus the researchers suggested that the already occurring medical surveillance activities of food handlers should also monitor Candida infection. S. cerevisiae (used in food and drink fermentation processes) was also more prevalent in food handlers (10.8%) than the other 2 groups (6.3% and 7.6% respectively). On the other hand, laboratory staff isolated T. capitatum more often from rural dwellers (8.6%) than urban dwellers (2.1%) and food handlers (2.6%). In a study in Zaire, S. cerevisiae was the predominant oral yeast in AIDS patients. 9 (0.7%) subjects had T. beigelii, 1 of whom carried HIV-1. which has been associated with invasive infections in immunocompromised patients. Ongoing seroepidemiological studies in Tanzania are looking at any associations between subclinical C. albicans and other yeast infections, HIV-1 infection, and the development of AIDS.

Relevance of broad-spectrum and fungicidal activity of antifungals in the treatment of dermatomycoses.

The in vitro fungistatic and fungicidal activities of terbinafine, amorolfine and itraconazole against dermatophytes were compared. All three compounds showed very good activity against all dermatophyte species tested, but only terbinafine and amorolfine exhibited primary fungicidal activity. These two compounds were also active in vitro against other filamentous fungi which cause onychomycoses, such as Scytalidium and Scopulariopsis species.

Dermatophyte infections.

The newer antifungal agents, clotrimazole, miconazole and haloprogin are considered for their efficacy and acceptability, and are compared with other topical agents used for the treatment of dermatophyte infections of the skin.

Humoral antibodies in dermatophytosis--factors affecting the antibody response in Trichophyton rubrum infections.

This investigation demonstrates the presence of specific antibodies to human infection by the dermatophyte Trichophyton rubrum. Out of 152 patients investigated, precipitating and complement fixing antibodies were demonstrated in 54%. Complement fixing titres of 8 and over and one or more precipitin bands were considered of diagnostic significance. The anatomical site, extent, nature and duration of the infection all played a part in determining the presence of detectable circulating antibodies. Precipitating antibodies appeared early in the course of the infective process and complement fixing antibodies were detected later on.

[Tinea capitis in school children in London]. / Tinea capitis bei Schulkindern in London

An account is given of the increase in incidence of scalp ringworm seen in London school children over a twelve year period. The increase was accompanied by the isolation of a greater variety of species of dermatophytes some of which are not indigenous to Britain, such as Trichophyton soudanense. Four main radical groups of children were investigated and the distribution of the fungi causing scalp infections among them determined.

Treatment of chronic dermatophytosis and chronic oral candidosis with itraconazole.

Itraconazole was evaluated in patients with forms of superficial fungal infection that were previously unresponsive to treatment. Two groups of patients were treated, those with chronic dermatophytosis caused by Trichophyton rubrum affecting the body (10) or palm (five) and those with chronic oral candidosis (eight). All of the patients with dermatophytosis achieved complete remission in a mean period of 9.1 weeks, with three subsequent relapses. Seven patients with oral candidosis had originally presented with chronic mucocutaneous candidosis; recurrent or persistent oral candidosis had developed after initially successful treatment with ketoconazole. All of the patients with chronic oral candidal infections responded to itraconazole after a mean treatment period of 5.4 weeks, with two subsequent relapses. These results indicate that itraconazole is effective in treating these recalcitrant superficial mycoses and should be assessed in a larger unselected group of patients and compared with alternative drugs.

Dermatophyte fungi in the Guinea Savannah region of Nigeria and the changing phase of dermatophytosis in Nigeria.

Approximately 8,000 patients with various skin diseases were seen at the Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria between January 1983 and December 1986. 174 (2.2%) presented with features in which a clinical diagnosis of superficial fungal infection was made or suspected. 69 out of 190 (36.3%) of specimens taken from skin lesions or nails from these patients were mycologically positive. The fungi isolated were Trichophyton rubrum (24.6%), Tr. soudanense (13.0%), Candida albicans (5.8%) Hendersonula toruloidea (2.9%), Microsporum audouinii (1.5%) and Epidermophyton floccosum (1.5%); 34.8% of the specimens were positive on microscopy but failed to grow. Malassezia furfur was demonstrated in 15.9% of the 69 positive specimens.

Oral carriage of yeasts in two villages in Papua New Guinea.

Oral swabs were taken from 194 subjects in two villages in Papua New Guinea. Yeasts were isolated from 103 (53.1%) individuals of which 41 (21.1%) were Candida albicans. A wide variety of other yeasts were also identified.

A comparative study of terbinafine versus griseofulvin in 'dry-type' dermatophyte infections.

We conducted a double-blind comparative study of terbinafine, 250 mg twice daily, versus griseofulvin, 500 mg twice daily, for 6 weeks in chronic dermatophyte infections of the feet or hands. All but three patients (total 31) had Trichophyton rubrum infection. At 12-week follow-up, 100% of the terbinafine-treated group were free from infection compared with 45% of those treated with griseofulvin. Therapy in 75% of the terbinafine-treated group and in 35% of those given griseofulvin was rated as effective overall at long-term follow-up, although these differences were not statistically significant. Six months after treatment all nine patients whose skin had cleared with terbinafine therapy remained in remission versus only one of seven patients treated with griseofulvin. None of the patients in either group experienced serious adverse effects.

Bacteria and fungi in severe foot infection.

In a study of severe foot infection in 21 miners, an attempt was made to match nine clinical parameters with both bacteriological and mycological findings. Erythema was significantly more pronounced in the presence of dermatophytes but less pronounced in the presence of Gram-negative bacilli. No other clinical parameter differed in relation to the presence of particular microorganisms.

Mycotic keratitis: susceptibility to antiseptic agents.

Oculomycosis is a severe problem in most developing countries. Specific antifungal agents are often unavailable, and are expensive. The use of antiseptic agents was therefore explored. Fungal isolates from patients in India and Ghana were tested against chlorhexidine, povidone iodine, propamidine, and polyhexamethylenebiguanide, and compared with econazole by placing the drugs in wells made in Sabouraud's agar plates seeded with the test organism. Fungal sensitivity testing is a contentious area but this method is simple and cheap. Chlorhexidine showed a good dose related response, povidone iodine showed a good response at all concentrations and econazole was the most effective in vitro. A small pilot study was conducted in India to assess clinical efficacy for fungal corneal ulcers. Both chlorhexidine and econazole proved effective but povidone iodine was ineffective. We suggest that chlorhexidine may be a useful first line agent for fungal keratitis when other antifungals are not available.