Terapia fotodinámica con azul de metileno en úlceras cutáneas infectadas con Pseudomonas aeruginosa y Fusarium spp / Photodynamic Therapy With Methylene Blue for Skin Ulcers Infected With Pseudomonas aeruginosa and Fusarium spp

La terapia fotodinámica tiene una importante acción antimicrobiana. Se presentan 2 casos clínicos de úlceras crónicas en las extremidades inferiores sobreinfectadas por hongos y bacterias de difícil manejo, en los que el tratamiento fotodinámico con azul de metileno como fotosensibilizante resultó en la curación clínica y microbiológica. No se presentaron efectos adversos reseñables. La posibilidad de utilizar la terapia fotodinámica con azul de metileno en el manejo de las úlceras crónicas sobreinfectadas constituye una interesante alternativa para reducir el uso de antibióticos y disminuir la aparición de resistencias (AU)

Photodynamic therapy (PDT) is a therapeutic modality with significant antimicrobial activity. We present 2 cases of chronic lower limb ulcers in which fungal and bacterial superinfection complicated management. PDT with methylene blue as the photosensitizer led to clinical and microbiological cure with no significant adverse effects. PDT with methylene blue is a valid option for the management of superinfected chronic ulcers, reducing the use of antibiotics and the induction of resistance (AU)

Enhancement of the antidermatophytic activity of silver nanoparticles by Q-switched Nd:YAG laser and monoclonal antibody conjugation.

The objective of this research was to investigate the effect of silver nanoparticles (AgNPs), free or conjugated with monoclonal antibody and mediated by Q-switched Nd:YAG laser on five dermatophytes. The laser was applied for 45 s at 532 nm and 0.8 J/cm2. The application of AgNPs combined with laser caused an increase in fungal susceptibility compared to application of AgNPs alone. The MIC50 and MIC100 recorded 3 and 9 µg/ml in the case of E. floccosum (the most susceptible species), 10 and 19 µg/ml for T. rubrum (the most tolerant species), respectively. A decrease in keratinase activity reaching 76.1, 67.1, and 62.4% was attained in the case of M. gypseum, T. rubrum, and T. mentagrophyte, respectively, on application of 10 µg/ml AgNPs combined with Nd:YAG laser. Under the same conditions of application, a steady increase in leaked materials coupled with reduction in ergosterol synthesis was reached. The structural alterations occurred to the fungus were more observed on the application of AgNPs in combination with laser where the conidia and hyphae lost their cellular integrity, become flaccid, permanently destructed, and completely killed. The monoclonal antibody conjugated AgNPs did not result in significant variation in in vitro experiments compared with that produced by nonconjugated nanoparticles. However, the conjugates achieved significantly more curing of M. canis-inoculated guinea pigs compared with nonconjugated nanoparticles.

Surgical resection of a rare cutaneous manifestation of Scedosporium apiospermum in a patient who underwent renal transplant.

A man aged 47 years who was immunosuppressed following renal transplantation for focal segmental glomerulosclerosis was referred to the Plastic Surgery team for management of a painful, chronic, granulomatous lesion of the right forearm. Serial ultrasound scans and MRI scans were not diagnostic, but microbiological specimens tested positive for the fungus Scedosporium apiospermum The renal transplant graft-which was failing-was removed, allowing him to cease immunosuppression. He then underwent a resection of the lesion and reconstruction with a split thickness skin graft. Analysis of the specimen revealed fibrosis, granulomatosis and a collection of S. apiospermum He was started on voriconazole which, in conjunction with his surgical resection, appears to have kept the disease at bay. With increasing numbers of solid organ transplants and improved survival, this case highlights the growing burden of rare, opportunistic infections, the difficulty in diagnosis and the need for specialist intervention.

Terapia fotodinámica antimicrobiana in vitro aplicada sobre Trichophyton mentagrophytes con nuevo azul de metileno como fotosensibilizador / In vitro antimicrobial photodynamic therapy against Trichophyton mentagrophytes using new methylene blue as the photosensitizer

INTRODUCCIÓN Y OBJETIVOS: La terapia fotodinámica antimicrobiana combina el uso de un fármaco fotosensibilizante, la luz y el oxígeno para erradicar microorganismos patógenos. Trichophyton mentagrophytes es un hongo dermatofito capaz de invadir la piel y tejidos queratinizados. El objetivo de este trabajo es aplicar la terapia fotodinámica antimicrobiana para la inactivación in vitro de T. mentagrophytes utilizando el nuevo azul de metileno como agente fotosensibilizador. MATERIAL Y MÉTODOS: Se aplica un diseño factorial completo para optimizar los parámetros que permiten la fotoinactivación del dermatofito. Se tiene en cuenta la concentración del nuevo azul de metileno, el tiempo de contacto entre el fotosensibilizador y el hongo antes del tratamiento con luz y la fluencia de luz roja aplicada entre 620 y 645 nm. RESULTADOS: La mínima concentración de nuevo azul de metileno que produce una mortalidad de todas las células de T. mentagrophytes de la suspensión inicial (concentración∼106 ufc/ml) es 50 M para una fluencia de 81 J/cm-2 y un tiempo previo de contacto hongo-fotosensibilizador de 10 min. Si se aumenta la concentración a 100 M la fluencia que se necesita disminuye a 9 J/cm-2. CONCLUSIONES: La comparación de nuestros datos con otros publicados muestra que la susceptibilidad de T. mentagrophytes a la terapia fotodinámica antimicrobiana con nuevo azul de metileno es cepa-dependiente. El nuevo azul de metileno es un fotosensibilizador a tener en cuenta para el tratamiento de las micosis cutáneas causadas por este dermatofito

INTRODUCTION AND OBJECTIVES: Antimicrobial photodynamic therapy combines the use of a photosensitizing drug with light and oxygen to eradicate pathogens. Trichophyton mentagrophytes is a dermatophytic fungus able to invade the skin and keratinized tissues. We have investigated the use of new methylene blue as the photosensitizing agent for antimicrobial photodynamic therapy to produce the in vitro inactivation of T mentagrophytes. MATERIAL AND METHODS: A full factorial design was employed to optimize the parameters for photoinactivation of the dermatophyte. The parameters studied were new methylene blue concentration, contact time between the photosensitizing agent and the fungus prior to light treatment, and the fluence of red light (wavelength, 620---645 nm) applied. RESULTS: The minimum concentration of new methylene blue necessary to induce the death of all T. mentagrophytes cells in the initial suspension (approximate concentration, 106 colony forming units per milliliter) was 50 M for a fluence of 81 J/cm2 after a contact time of 10 minutes with the photosensitizing-agent. Increasing the concentration to 100 M allowed the fluence to be decreased to 9 J/cm2. CONCLUSIONS: Comparison of our data with other published data shows that the susceptibility of T. mentagrophytes to antimicrobial photodynamic therapy with new methylene blue is straindependent. New methylene blue is a photosensitizing agent that should be considered for the treatment of fungal skin infections caused by this dermatophyte

The antifungal effect of light emitting diode on Malassezia yeasts.

BACKGROUND: Malassezia (M.) species are members of the normal part of the skin flora, but they might induce or be involved with various cutaneous diseases. Although the role of Malassezia in the pathogenesis of cutaneous diseases is not fully understood, recent studies have shown that decreased density of Malassezia led to improvement of these diseases. OBJECTIVE: To identify the antifungal effect of light emitting diode (LED) against Malassezia, its antifungal mechanisms and the impact on the keratinocytes. METHODS: LED with various wavelengths (370-630nm) on Malassezia furfur, Malassezia sympodialis and Malassezia globosa was irradiated according to dose and then the antifungal effects were thereafter assessed. After irradiating LED with 392.5±1nm of wavelength according to dose on Malassezia species, reactive oxygen species (ROS) and lipid hydroperoxide production assay were measured. In addition, cell viability and inflammatory cytokines (IL-1α, IL-1ß, TNF-α, TGF-ß, TLR-2 and COX-2) expressions in normal human epidermal keratinocytes (NHEKs) by LED irradiation were evaluated. RESULTS: The growth of Malassezia species was dose-dependently suppressed by both LED with 380±2 and 392.5±1nm wavelengths. The increases of intracellular and extracellular ROS by LED irradiation with 392.5±1nm wavelengths were significantly observed compared to control group. The cell viability and cytokines in NHEKs were not significantly affected by LED irradiation under 5J/cm(2)in vitro. CONCLUSION: LED irradiation with 380±2 and 392.5±1nm wavelengths proved to have antifungal effect against Malassezia species and no impact on NHEKs under 5J/cm(2). The findings suggest that LED might be an adjunctive therapeutic light tool against Malassezia yeasts related cutaneous diseases.

[New apects in the diagnosis and therapy of dermatomycoses]. / Neues zu Diagnostik und Therapie bei Mykosen der Haut.

Recent observations indicate that Arthroderma benhamiae can cause bullous tinea, that onychomycosis increasingly occurs in children and that molds can cause tinea-like lesions. If a mycotic infection is suspected, the pathogen needs to be identified. The first genetic assays for the detection of dermatophytes have successfully been tested under routine conditions. Using appropriate techniques, genetic diagnosis is faster and more sensitive than a culture. Laboratory standards that would facilitate widespread implementation of genetic identification of dermatophytes have not yet been established. For the identification of yeasts, MALDI-TOF has already been established in many laboratories. This method is being refined for the diagnosis of hyphomycetes too. Newer antimycotics that are approved for certain systemic mycoses such as the triazoles voriconazole and posaconazole and the echinocandines caspofungin, micafungin und anidulafungin may be considered for dermatomycoses that cannot be treated by other therapies. Thermotherapy and photodynamic therapy are additional options in particularly difficult cases.

Thermotherapy in dermatologic infections.

The use of local induced hyperthermia or thermotherapy for dermatologic infections has not been fully explored in the more recent medical literature. Herein, we discuss the rationale behind the use of thermotherapy and review reported clinical experience with its use in the management of cutaneous infections.

Cutaneous mucormycosis: report of five cases and review of the literature.

Mucormycosis is a highly aggressive fungal infection caused by Zygomycetes, from the order of Mucorales. This infection commonly presents an aggressive and rapid course and typically affects immunocompromised patients. Mucormycosis can manifest in different clinical patterns and locations. Although the correct diagnosis is often difficult, an early identification is essential for patient survival. Several clinical forms of mucormycosis are recognised. Cutaneous mucormycosis is less common than other clinical forms, but potentially lethal if treatment is not rapid. Tissue examination by histopathology and culture confirms the fungal infection. Standard treatment includes antifungal therapies associated with surgical debridement. We report five different cases of cutaneous mucormycosis treated in our institution and the management carried out in each case.

Diagnosis and treatment of cutaneous zygomycosis.

Cutaneous zygomycosis is a rare but severe fungal infection with high risk of dissemination. Early recognition, deep surgical biopsy for diagnosis, aggressive treatment with repeated surgical debridement, and targeted pharmacotherapy are essential and can prevent dissemination and fatal outcome. We present case reports of 2 patients.

Deep cutaneous infection by Fusarium solani in a healthy child: successful treatment with local heat therapy.

We describe a 6-year-old boy with a granulomatous lesion on the upper aspect of his left arm. Fusarium solani infection was confirmed by biopsy studies and cultures. The biopsy specimen showed an unusually extensive dermal invasion with fungal hyphae. This is an uncommon clinical presentation for deep cutaneous infection caused by F solani in a healthy child. Local heat therapy with a chemical pocket warmer led to dramatic healing of the lesion.

Antifungal activity of Juniperus essential oils against dermatophyte, Aspergillus and Candida strains.

AIMS: The increasing resistance to antifungal compounds and the reduced number of available drugs led us to search therapeutic alternatives among aromatic plants and their essential oils, empirically used by antifungal proprieties. In this work the authors report on the antifungal activity of Juniperus essential oils (Juniperus communis ssp. alpina, J. oxycedrus ssp. oxycedrus and J. turbinata). METHODS AND RESULTS: Antifungal activity was evaluated by determination of MIC and MLC values, using a macrodilution method (NCCLS protocols), on clinical and type strains of Candida, Aspergillus and dermatophytes. The composition of the oils was ascertained by GC and GC/MS analysis. All essential oils inhibited test dermatophyte strains. The oil from leaves of J. oxycedrus ssp. oxycedrus is the most active, with MIC and MLC values ranging from 0.08-0.16 microl ml(-1) to 0.08-0.32 microl ml(-1), respectively. This oil is mainly composed of alpha-pinene (65.5%) and delta-3-carene (5.7%). CONCLUSIONS: J. oxycedrus ssp. oxycedrus leaf oil proved to be an emergent alternative as antifungal agent against dermatophyte strains. delta-3-Carene, was shown to be a fundamental compound for this activity. SIGNIFICANCE AND IMPACT OF THE STUDY: Results support that essential oils or some of their constituents may be useful in the clinical management of fungal infections, justifying future clinical trials to validate their use as therapeutic alternatives for dermatophytosis.

Micosis superficiales: dermatofitosis / Superficial mycosis: dermatophytosis

Se exponen las características clínicas de las lesiones cutáneas producidas por los dermatofitos u hongos filamentosos. Se hace hincapié en las medidas de educación, prevención y control de estas afecciones a nivel primario de atención médica, se exponen además las diferentes maniobras terapéuticas, tanto tópicas como sistémicas, con las que se cuenta para su tratamiento. Se hace referencia a las posibilidades terapéuticas que brinda la medicina natural y tradicional para estos pacientes(AU)

A case of cutaneous Exophiala spinifera infection.

A 66-year-old female had a solitary dark-red nodule measuring 1 cm in diameter on her left forearm. She often had trauma to her hands and arms. A histopathologic examination demonstrated granulomatous changes in the dermis. Under the high-power magnification yeast-like cells and short toruloid hyphal elements were observed in the granuloma. A few giant cells contained fungal elements. No sclerotic cells were found. On the basis of the histopathologic and mycologic findings, the lesion was diagnosed as a dematiaceous fungal infection caused by Exophiala spinifera. She was treated with oral itraconazole (200 mg/day) and topical heat therapy. The lesion was clinically improved within 58-days. However, E. spinifera was still isolated from the excisional specimen 92-days later. We believe that surgical excision is the choice of therapy if the lesion is small.

Limb-threatening necrotizing alternariosis salvaged by adjunctive hyperbaric oxygen therapy.

We describe, to our knowledge, the first case of limb-threatening necrotizing alternariosis whose limbs were successfully salvaged by adjunctive hyperbaric oxygen therapy (HBO2). This 58-y-old patient was immunocompromised with both diabetes and Cushing's syndrome. She suffered from necrotizing soft tissue infection of both legs caused by Alternaria. It was impossible to halt the progression of the invasive infection with standard anti-fungal treatment and aggressive surgical debridement. After the use of HBO2, the wound was stabilized and eventually healed. Adjunctive HBO2 in this case has demonstrated its role in the treatment of complicating necrotizing soft tissue infection caused by invasive fungal infection. The possible mechanisms may be the potentiation of immune responses and the enhancement of fibroblast proliferation.