Cutaneous Pseudallescheria boydii/Scedosporium apiospermum Complex (Molecular type: Scedosporium apiospermum [Clade 4]) Infection: A Case Report and Literature Review of Cases from Japan.

We report a case of subcutaneous Pseudallescheria boydii/Scedosporium apiospermum complex infection occurring in a 77-year-old Japanese female farmer suffering from interstitial pneumonia. Seven months prior to the current presentation, she noticed nodes on her right forearm after pulling up weeds, and the nodes grew larger. Two soft dome-shaped, protruded nodes ( 15 mm and 30 mm in size ) had fused together on the extensor surface of the right forearm. Yellowish-white, rice-grain-sized pustules clustered on the surface. Histopathological examination of the skin specimen showed large and small abscesses surrounded by epithelioid granuloma; separate branching hyphae within the granulation tissue were stained with PAS. No grains were observed. Fungal culture yielded fast-growing, grayish-white, fluffy colonies which were identified as Scedosporium apiospermum (Clade 4) using sequence analysis of the ß-tubulin gene. We also reviewed 28 previously reported Japanese cases of P. boydii or S. apiospermum infection presenting with skin manifestations.

Isolation of dermatophytes and related species from domestic fowl (Gallus gallus domesticus).

We investigated 793 bird combs [645 chickens and 148 fighting cocks (Shamo)] to determine the prevalence of dermatophytes and their related fungal species. The targeted fungal species were recovered from 195 of the 793 examined birds (24.6 %). Prevalence ratios were compared in temperate (the mainland) and subtropical (Nansei Islands) areas, genders, strains, breeding scale (individual and farm), and housing system (in cage and free ranging). The frequency of the fungal species in the mainland, males, fighting cocks, breeding scale by individual nursing, and free-range housing system exhibited significantly higher positive ratios than that in the other groups. A total of 224 dermatophytes and related species were isolated, including 101 Arthroderma (Ar.) multifidum, 83 Aphanoascus (Ap.) terreus, five Uncinocarpus queenslandicus, two U. reesii, two Ap. pinarensis, one Amauroascus kuehnii, one Ar. simii, one Gymnoascus petalosporus, one Microsporum gallinae, and 28 Chrysosporium-like (Chrysosporium spp.) isolates, which were identified using internal transcribed spacer regions of ribosomal RNA gene sequences. The predominant fungal species in the mainland was Ap. terreus and that in the Nansei Islands was Ar. multifidum. Pathogenic fungal species to humans and animals were limited to M. gallinae and Ar. simii, which corresponded to 0.025 % of the isolates in this study.

Genotype analyses of human commensal scalp fungi, Malassezia globosa, and Malassezia restricta on the scalps of patients with dandruff and healthy subjects.

Dandruff and seborrheic dermatitis are common afflictions of the human scalp caused by commensal scalp fungi belonging to the genus Malassezia. Malassezia globosa and Malassezia restricta are the predominant species found on the scalp. The intergenic spacer regions of these species' rRNA genes contain short sequence repeats (SSR): (GT)n and (CT)n in M. globosa and (CT)n and (AT)n in M. restricta. In the present study, we compared the genotypes (SSR) of M. globosa and M. restricta colonizing the scalps of patients with dandruff and healthy individuals. For M. globosa, the genotype (GT)10:(CT)8 (40.3 %, 25/62) was predominant followed by (GT)9:(CT)8 (14.5 %, 9/62) and (GT)11:(CT)8 (14.5 %, 9/62) in patients with dandruff, whereas the genotypes in healthy subjects were diverse. For M. restricta, the genotype (CT)6:(AT)6 (59.7 %, 37/62) was predominant followed by (CT)6:(AT)8 (24.2 %, 15/62) in patients with dandruff, while four genotypes, (CT)6:(AT)6 (10.5 %, 6/57), (CT)6:(AT)7 (22.8 %, 13/57), (CT)6:(AT)8 (17.5 %, 10/57), and (CT)6:(AT)10 (21.1 %, 12/57), accounted for 71.9 % of all combinations in healthy subjects. The results of this study suggest that the M. globosa genotype (GT)10:(CT)8 and the M. restricta genotype (CT)6:(AT)6 may be involved in the development of dandruff.

Treatment of onychomycosis using a 1064nm Nd:YAG laser.

We investigated the efficacy of 1064nm Nd:YAG laser for the treatment of onychomycosis caused by dermatophytes. The study population consisted of 12 patients (6 male, 6 female ; average age 53.5 years), with onychomycosis confirmed by fungal culture and/or real-time PCR identification of the pathogen. The causative agent was identified as Trichophyton rubrum in 11 cases and a mixture of T. rubrum and T. mentagrophytes in 1 case. For each patient, laser treatment was given to a single hallux nail, with turbidity at baseline affecting <75% of the nail surface and thickness at baseline <3mm. Treatment was given in 3 sessions at 4-week intervals, and nail turbidity was evaluated 3 and 6 months after the first laser treatment. After 6 months the efficacy results were as follows: 3 cases, turbidity significantly improved ( >70%) ; 2 cases, turbidity improved (50-70%), 1 case, turbidity slightly improved (30-50%) ; 5 cases, no change in turbidity (<30% improvement) ; and 1 case, turbidity worsened. Overall, the total lesion area with turbidity in 12 patients decreased from 664.4mm(2) to 481.0mm(2), corresponding to a 27.6% improvement after treatment. Pain during laser treatment was well tolerated, and all patients underwent all 3 treatments. These results suggest that the 1064nm Nd:YAG laser could be a useful treatment alternative for patients with mild onychomycosis.

Retrospective cohort study on combination therapy with the histamine H2-receptor antagonist lafutidine for antihistamine-resistant chronic urticaria.

We conducted a retrospective cohort study evaluating the efficacy and usefulness of the addition of lafutidine, a novel histamine H2-receptor antagonist, in treatment of patients with idiopathic chronic urticaria whose disease was not well controlled with histamine H1-receptor antagonists. Based on the assessment of global improvement, moderate or better improvement was achieved in 39 of 46 patients (85%) after 1-3 weeks of additional administration of lafutidine and 35 patients (76%) after 3 months. No incidence of drug-related adverse reactions was reported in any patient. Lafutidine was rated as useful or better in 34 patients (74%) after 3 months of treatment. The usefulness of the drug was not affected by differences in background factors, such as disease duration, previous treatment duration and the number of concomitant H1-receptor antagonists. Lafutidine appears to be a promising addition to histamine H1-receptor antagonist therapy for the treatment of chronic urticaria resistant to treatment with H1-receptor antagonists alone.

Urease gene of Trichophyton rubrum var. raubitschekii.

The recent description (in GenBank) of a urease-encoding gene from Trichophyton rubrum provides an opportunity to compare this species to the highly similar T. rubrum var. raubitschekii. Therefore, the corresponding genomic DNA was recovered from T. rubrum var. raubitschekii, and the sequence and expression were compared for this urease gene in urease-positive and -negative isolates of T. rubrum and T. rubrum var. raubitschekii. The sequence (2371 bp) of the T. rubrum var. raubitschekii urease gene revealed the presence of three exons. Except for a three-amino acid insertion, the predicted proteins were identical, but demonstrated protein identity of approximately 70% compared to an Arthroderma gypseum homolog. Reverse transcription polymerase chain reaction analysis revealed the presence of a corresponding transcript in both urease-positive T. rubrum var. raubitschekii isolates examined; the same analysis did not detect this transcript in urease-negative isolates of T. rubrum.

[A case of onychomycosis caused by Aspergillus sydowii].

Onychomyosis caused by Aspergillus sydowii is rare and difficult to diagnose. We report a case in which this disease was diagnosed by molecular-biological methods. The patient was a 53-year-old woman without any notable past history. She visited our hospital complaining of itching around the right first toenail in June 2010, although she had noticed nail opacification for 4 years. Opaque thickening of the nail, covering 57.3% of the normal nail area, was observed. Direct microscopic examination revealed thick mycelia with septa and black spores. While colonies with a red brown center and a grayish blue-green margin were observed in culture on Sabouraud ' s glucose agar at 25℃, radially arranged conidia in the conidial head were observed in slide culture. Thus, onychomycosis caused by Aspergillus was suspected. There were no blood or biochemical test abnormalities. We directly extracted deoxyribonucleic acid from the nail and analyzed the base sequences of the internal transcribed spacer 1 and 2 regions of the ribosomal ribonucleic acid gene, and identified Aspergillus sydowii. Because the minimal inhibitory concentration of itraconazole (ITCZ) is 0.25 µg/ml, we administered pulse therapy with monthly 1-week cycles of oral ITCZ 400 mg / day for 3 consecutive months. The opaque area subsided to 17. 9% of the normal nail by 6 months after treatment completion. However, 3 months later, the opaque area increased again to 22. 3%, and the same fungus was isolated and identified. The 3-month ITCZ pulse therapy was repeated and the symptoms disappeared, with complete cure achieved by 3 months after the second therapy.

Epidemiological aspects of Trichophyton rubrum var. raubitschekii in Japan.

Trichophyton rubrum var. raubitschekii is a rare anthropophilic dermatophyte isolated around the world from tinea corporis, tinea cruris, tinea pedis and tinea unguium. In this study, the isolation rate of T. rubrum var. raubitschekii was studied in 200 cases of tinea pedis and tinea unguium in Japan. The 200 clinical isolates were shown to be of downy type as their colonies on Sabouraud's dextrose agar were white to cream, suede-like to downy, with a yellow-brown to wine-red reverse, and they produced few macroconidia. The type strain of T. rubrum var. raubitschekii (CBS 100084) and one clinical isolate (KMU 8337; isolated at Kanazawa) of downy type tested positive for urease, but the reference strain of T. rubrum (CBS 392.58) and the remaining 199 clinical isolates tested negative. Further epidemiological investigations are required to study human cases of infection with the granular type of T. rubrum and T. rubrum var. raubitschekii in Japan.