Is itraconazole the treatment of choice in Microsporum canis tinea capitis?

Mycotic scalp infection caused by Microsporum canis is the most dominant cause of tinea capitis in Greece. Griseofulvin has been the gold standard for the treatment of tinea capitis, but it is unavailable in our country. In this study, we evaluated 111 children with M. canis tinea capitis that were treated with itraconazole. Eighty-one of them were treated with itraconazole capsule pulse therapy (group A) and 30 (group B) were treated with oral suspension administered in continuous regimen. Twenty-one patients, all from group A, were lost to follow-up, probably due to the length of this regimen. In all patients that made up the study protocol, complete cure was achieved within seven pulses for group A and 12 weeks for group B. No significant side effects to lead to the cessation of therapy were recorded. Laboratory investigations were performed in 32 randomly chosen patients and were within normal ranges. The response to therapy did not appear to depend upon the formulation administered (capsules versus suspension). Using the pulse regimen, we also believe that it is necessary to individualize the number of pulses administered according to the clinical response. In conclusion, itraconazole proved safe and effective in our study, providing an ideal alternative to griseofulvin.

Oral Candida isolates in patients undergoing radiotherapy for head and neck cancer: prevalence, azole susceptibility profiles and response to antifungal treatment.

Oral pseudomembranous candidiasis and mucositis were assessed in 39 patients receiving a total dose of 39-70 Gy radiotherapy for head and neck cancer. Mucositis was scored using the Radiation Therapy Oncology Group criteria, and oral candidiasis was diagnosed on the basis of clinical evaluation and quantitative laboratory findings. Radiation-induced mucositis was observed in 9/39 patients. Only 3/39 patients discontinued radiotherapy due to acute severe mucosal effects. Candidiasis (colony-forming units 35 to > or = 60/lesion) associated with mucositis was diagnosed in 30/39 patients: the most frequent aetiology of the infection was Candida albicans (n = 23), followed by Candida glabrata (n = 3), Candida krusei (n = 2), Candida tropicalis (n = 1) and Candida kefyr (n = 1). Patients with confirmed oral pseudomembranous candidiasis were treated with either fluconazole 200 mg/day or itraconazole 200 mg/day for 2 weeks. Clinical improvement and concomitant negative Candida cultures (mycologic cure) were the criteria determining a response to antifungal treatment. Etest revealed very low voriconazole MICs (0.004-0.125 microg/ml) for all isolates, and fluconazole resistance for eight C. albicans strains (MIC > 64 microg/ml) and for the C. krusei isolates (MIC > 32 microg/ml). The same strains showed itraconazole susceptibility dose dependence (MIC 0.5 microg/ml). Despite the itraconazole susceptible dose dependent MIC readings, all patients with oral pseudomembranous candidiasis caused by these strains responded to antifungal treatment with 200 mg/day itraconazole. Oral mycologic surveillance of patients undergoing radiotherapy for head and neck malignancies and susceptibility testing of isolates may be indicated in cases with mucositis-associated confirmed oral pseudomembranous candidiasis to ensure prompt administration of targeted antifungal treatment. On the basis of the low MIC values found, clinical evaluation of voriconazole is indicated for management of oral pseudomembranous candidiasis refractory to other azoles.

Efficacy and tolerability of 8 weeks' treatment with terbinafine in children with tinea capitis caused by Microsporum canis: a comparison of three doses.

BACKGROUND: Tinea capitis caused by Microsporum canis is the most common mycosis of the scalp in preschool and school-aged children in Greece. OBJECTIVE: To compare the efficacy, safety and tolerability of an 8-week course of oral terbinafine at different doses. METHODS: Patients received oral terbinafine at doses ranging from 3.3 to 12.5 mg/kg/day for 8 weeks, as follows: group A, terbinafine 3.3 to 6.0 to 7.0 mg/kg/day (23 patients); group C, terbinafine > 7.0 to 12.5 mg/kg/day (37 patients). Fungal microscopy and cultures were performed 4 weeks before the start of the treatment, at the end of the treatment (week 8) and at a follow-up visit at week 16. RESULTS: At week 8 mycological cure was achieved in one patient (2.7%) in group A, in 21 patients (91.3%) in group B and in 34 patients (97.1%) in group C. At week 16 mycological cure was achieved in one patient (2.7%) in group A, in 22 patients (95.7%) in group B and in 35 patients (100%) in group C. There was a statistically significant difference (P < 0.0005) between dose level and efficacy of terbinafine at the end of the treatment period and also at the follow-up visit at week 16. Five patients (three in group A and two in group C) discontinued treatment because of adverse events. CONCLUSIONS: The administration of terbinafine at a dose of either 6-7 or 7-12.5 mg/kg/day for 8 weeks is safe and effective for the treatment in children of tinea capitis caused by M. canis.

Tinea capitis in adults during 1981-95 in northern Greece.

The mycological laboratory of our Hospital examined 31,073 patients between 1981 and 1995. Sex, age, the residence of patients, the clinical type of tinea and contacts with other persons and animals were investigated. All the patients were also examined under Wood's light. Tinea capitis was diagnosed in 35 adults. Trichophyton violaceum was the commonest aetiological agent (54.5%), especially in elderly women. The other anthropophilic fungi were T. rubrum (8.5%), T. schoenleinii (5.7%) and T. tonsurans (2.8%). The zoophilic fungi Microsporum canis (14.3%), T. terrucosum (8.5%) and T. mentagrophytes (5.7%) were also isolated.

Tinea capitis in children in northern Greece during the period 1981-1995.

In our 15 years of investigation in northern Greece, the predominant organism producing tinea capitis in children was found to be the zoophilic Microsporum canis (494 strains) which is a common saprophyte of the hair of pets, especially cats. The high percentage of cases with M. canis (97%), in contrast to zoophilic fungi (3%), is probably due to the increased contact of children with pets. The small number of infections with anthropophilic fungi (41 strains) is attributed to good hygienic conditions. The fluorescence of infected hair under Wood's light seems to be a major diagnostic criterion in the hands of dermatologists who are not served by a mycological laboratory.

Dermatophytosis in northern Greece during the decade 1981-1990.

Dermatophytic infections are very common in Greece. In the Mycological Laboratory of the Venereal and Skin Diseases Hospital in Thessaloniki, 6572 isolates of different dermatophytes were obtained from 17,120 patients examined. It is suggested that 5% of the people who present with skin problems in Greece suffer from dermatophyte infections. They are frequent causative agents of tinea pedis, tinea cruris, tinea corporis, tinea capitis and tinea unguium. In this paper, the species, the number and the prevalence of the dermatophytes were studied according to location and sex of the patients. The contribution of dermatophyte infections to the overall incidence of superficial fungal infection over 10 years was also studied.

Dermatophytosis due to Trichophyton rubrum in northern Greece during the decade 1981-1990.

During the years 1981-1990 Trichophyton rubrum was the most frequent causative agent of dermatophytic infections in Northern Greece, especially in cases of tinea pedis, cruris, corporis, and unguium, as well as dermatophytosis of the hands. Between sexes there was a prevalence in women in tinea pedis and toenail infections. Men were particularly infected in the groin, the hands and the face. The chronic follicular dermatophytosis in the lower legs was also presented in women, but tinea corporis and fingernail infections showed no significant differences between the sexes. Also studied were the age of the patients, the inflammatory component of the lesions and the morphotypes of T. rubrum isolated.