[Fungi of the Trichosporon genus. Identification, epidemiology and significance of dermatologic disease pictures]. / Hefen der Gattung Trichosporon. Identifizierung, Epidemiologie und Bedeutung der dermatologischen Krankheitsbilder.

Based on molecular data, the genus Trichosporon was recently reclassified. Six human pathogenic species, which are closely related to specific types of infections can be differentiated. By means of commercial test systems and simple key criteria according to Gueho et al. [15], 44 isolates that had been identified as Tr. cutaneum between 7/92 and 1/96, were reclassified. The evaluation of clinical data also included 66 isolates that had not been preserved, and 27 strains of Tr. inkin. Trichosporon species were found in 4.8% of all yeast isolates (3.8% Tr. cutaneum, 1% Tr. inkin). Nearly every other isolate of Tr. cutaneum was cultivated from nail material, while Tr. inkin was mainly isolated from skin in the anogenital region. In 38 cases, reclassification revealed Tr. mucoides; Tr. ovoides and Tr. asteroides were identified in 3 cases each, while Tr. asahii, an especially remarkable pathogen in systemic mycoses, was not found. Clinically, isolates of Tr. mucoides were predominant in toenail mycoses which might be considered in the therapy of onychomycosis. Furthermore, isolates from the skin should be evaluated with respect to the increasing incidence of systemic Trichopsoron mycoses.

[Diagnosis, clinical aspects and therapy of early chromoblastomycosis in a case example]. / Diagnostik, Klinik und Therapie der frühen Chromoblastomykose an einem Fallbeispiel.

Despite the availability of modern antimycotics, which produce high cure rates in early infections, the therapy of advanced chromoblastomycosis is still unsatisfactory. An initial chromoblastomycosis caused by a hitherto unidentified species of the genus Phialophora was diagnosed in a 46-year-old teacher. The organism was isolated twice at an interval of 6 weeks from a partly psoriasiform, partly verrucous lesion on the 4th toe. The infection was apparently acquired 4 years ago during a holiday at Cape Verde. Treatment with itraconazole (Sempera). 200 mg/day, and amphotericin B (Ampho-Moronal) cream for 6 weeks initially resulted in rapid regression. However, 4 weeks after cessation of therapy, the Phialophora species was cultured again from skin scrapings. Complete healing was achieved after re-treatment with itraconazole for 20 weeks at the same dosage in combination with topical amorolfine and local hyperthermia. Until now, no relapse has occurred. The present case demonstrates that this rare disease, which mainly occurs as a traumatic mycosis in the rural population of tropical regions, must be included in the differential diagnosis of psoriasiform or verrucous skin lesions and also included in the list of diseases which may be acquired while on vacation in exotic locations.

Hydrolase activity of 150 Malassezia furfur isolates of different clinical origin.

Apart from pityriasis versicolor, Malassezia furfur is thought to play a significant role in the pathogenesis of seborrhoic eczema and Malassezia folliculitis. However, it has not been clarified whether in addition to host factors (e.g. immune status, greasy skin), yeast-dependent activities are responsible for manifestation of the disease. In this context interstrain variability of hydrolase activity of Malassezia isolates might be significant. For determination of hydrolase activity, washed yeast suspension was applied to selective agar for pathogenic fungi containing 8% (v/v) Tween 80 or Tween 60 and was incubated at 37 degrees C for 10 days. Growth was accompanied by formation of a dense white zone around the colony, in which free fatty acids corresponding to Tween 80 (C18:1) or Tween 60 (16:0, 18:0) were demonstrated by means of thin layer and gas chromatography. Thus, this phenomenon is a parameter for yeast-dependent hydrolysis of Tween 80 and Tween 60. Considering different growth behaviour, a "hydrolase zone' (H2) was determined using the quotient colony diameter/(ring+colony) diameter in each of the 150 strains tested. Although no significant H2 variations were observed in strains of different clinical origin, the present study revealed that in addition to a known enzyme, which is located within the cell wall and/or membrane systems, these Malassezia isolates produce a very active hydrolase diffusing into the medium.

Detection of extracellular phospholipase activity in Candida albicans and Rhodotorula rubra.

Phospholipases are important pathogenicity determinants in Candida albicans. They play a significant role in damaging cell membranes and invading host cells. High phospholipase production is correlated with an increased ability of adherence and a higher mortality rate in animal models. By means of an egg yolk-containing agar and the Pz (= phospholipase activity zone) value according to Price, the present study investigated phospholipase production in 170 strains of C. albicans. At an incubation temperature of 37 degrees C, Pz values ranged from 0.395 to 1; no clear relationship was found between clinical origin of the isolates and severity of the disease. In addition to C. albicans, a total of 110 strains of 16 other yeast species were investigated for possible phospholipase production. Only yeasts of the species Rhodotorula rubra showed phospholipase activity, with mean values exceeding those observed in C. albicans. This result was confirmed by an assay using sterile culture filtrates and phosphatidyl-[3H-methyl]-choline-dipalmitoyl as a substrate. Since Rh. rubra has only rarely been demonstrated as a pathogen in humans, we believe that factors such as reduced growth at 37 degrees C, absence of dimorphism and low ability of adherence lessen the importance of high phospholipase activity in Rh. rubra as a pathogenicity determinant. Therefore, potential virulence factors should always be considered in the context of the whole spectrum of pathogenic determinants.

The yeast spectrum of the 'tea fungus Kombucha'.

The tea fungus 'Kombucha' is a symbiosis of Acetobacter, including Acetobacter xylinum as a characteristic species, and various yeasts. A characteristic yeast species or genus has not yet been identified. Kombucha is mainly cultivated in sugared black tea to produce a slightly acidulous effervescent beverage that is said to have several curative effects. In addition to sugar, the beverage contains small amounts of alcohol and various acids, including acetic acid, gluconic acid and lactic acid, as well as some antibiotic substances. To characterize the yeast spectrum with special consideration given to facultatively pathogenic yeasts, two commercially available specimens of tea fungus and 32 from private households in Germany were analysed by micromorphological and biochemical methods. Yeasts of the genera Brettanomyces, Zygosaccharomyces and Saccharomyces were identified in 56%, 29% and 26% respectively. The species Saccharomycodes ludwigii and Candida kefyr were only demonstrated in isolated cases. Furthermore, the tests revealed pellicle-forming yeasts such as Candida krusei or Issatchenkia orientalis/occidentalis as well as species of the apiculatus yeasts (Kloeckera, Hanseniaspora). Thus, the genus Brettanomyces may be a typical group of yeasts that are especially adapted to the environment of the tea fungus. However, to investigate further the beneficial effects of tea fungus, a spectrum of the other typical genera must be defined. Only three specimens showed definite contaminations. In one case, no yeasts could be isolated because of massive contamination with Penicillium spp. In the remaining two samples (from one household), Candida albicans was demonstrated. The low rate of contamination might be explained by protective mechanisms, such as formation of organic acids and antibiotic substances. Thus, subjects with a healthy metabolism do not need to be advised against cultivating Kombucha. However, those suffering from immunosuppression should preferably consume controlled commercial Kombucha beverages.

Hydrolysis of fatty acid esters by Malassezia furfur: different utilization depending on alcohol moiety.

The lipophilic yeast Malassezia furfur belongs to the resident skin flora but has been implicated in various skin diseases. While topical oily preparations may support its growth, their formulation may be altered by yeast-dependent enzymatic degradation. Different synthetic fatty acid (mono-)esters used as refatting agents were mixed with 10(4), 10(5) and 5 x 10(5) yeasts/microliters, respectively, and incubated at 35 degrees C for a maximum of 48 h on selective agar for pathogenic fungi (Merck). The amount and pattern of generated free acids were evaluated by densitometric and gas chromatographic analysis, while yeast density was determined in a Neubauer chamber. Depending on the inoculum, yeast-dependent hydrolysis occurred immediately and was best effected in ethyl esters, followed by isopropyl esters, whereas hydrolysis of decyl oleate was only limited. Of the fatty acids released, unsaturated fatty acids were more stimulative to growth than saturated fatty acids; no toxic effects were observed. In conclusion, yeast-dependent hydrolysis of these synthetic fatty acid (mono-)esters was critically dependent on alcohol moiety, while growth promotion was best effected by unsaturated fatty acids. These results may help to improve the compatibility of topical formulations, especially in seborrheic areas.

Growth inhibition of Malassezia species by pharmacological concentrations of polidocanol.

In vitro antifungal properties of polidocanol (Thesi), a hydroxypolyethoxydecan, were investigated against various yeasts at concentrations of 0.05-10% (w/w) by means of the agar diffusion test; in the case of lipophilic Malassezia furfur, polidocanol-containing olive oil was used additionally for sensitivity study. Six strains of M. furfur of different clinical origin were tested as well as strains of C. albicans (3), C. krusei (3), C. parapsilosis (2), C. robusta (2), Tr. cutaneum (2) and one strain each of C. guilliermondii, C. glabrata, C. tropicalis and M. pachydermatis. Both test systems revealed predominantly fungistatic activity against M. furfur, with a minimal inhibitory concentration (MIC) of 1% polidocanol (w/w), while yeasts of other genera (Candida species, Trichosporum species) showed no or only transitory (C. krusei) inhibition of growth. M. pachydermatis was also found to be sensitive with a MIC of 0.1%; this suggests a specific inhibitory effect against the genus Malassezia. Polidocanol, which has been used for decades as an antipruritic and analgesic in various topical preparations at concentrations between 3% and 5%, might therefore be suitable for prophylaxis of recurrent pityriasis versicolor or in veterinary medicine.

[Fox-Fordyce disease (apocrine miliaria)]. / Morbus Fox-Fordyce (Apokrine Miliaria).

A 1-year follow-up in a 12 year old girl suffering from Fox-Fordyce disease is reported. Reddish papules were found in the typical locations in the regions with a high density of apocrine glands. A biopsy specimen showed keratin plugs in the infundibula of apocrine glands. Since hormone therapy could not yet be given, external therapy only was performed, with good results.

[Cutis marmorata teleangiectatica congenita (Van Lohuizen syndrome)]. / Cutis marmorata teleangiectatica congenita (Van Lohuizen-Syndrom).

The 2-year spontaneous course of a case of cutis marmorata teleangiectatica congenita in a girl is reported. The child had typical cutis marmorata, with teleangiectasis, phlebectasias and ulceration particularly on parts of the left leg and in the anogenital region, with no further anomalies. During symptomatic therapy over 2 years the lesions faded spontaneously.

Cutaneous cryptococcosis as the first symptom of a disseminated cryptococcosis in a patient with lymphogranulomatosis X.

A 63-year-old patient, known to have suffered from lymphogranulomatosis X for 4 years is reported, in whom a cutaneous cryptococcosis appeared as first sign of a disseminated cryptococcosis. Despite systemic therapy with amphotericin B, the patient died after a period of 2 months. Differential diagnosis of skin tumours of immunosuppressed patients includes rare skin mycoses, and both histological and mycological examinations should be performed.

[DNA determination by cytophotometry in bowenoid papules in comparison with condylomata acuminata and Bowen's disease]. / Cytophotometrische DNS-Bestimmungen bei bowenoiden Papeln im Vergleich mit Condylomata acuminata und M. Bowen.

The relation between bowenoid papules and Bowen's disease is characterized by largely corresponding histological pictures and diverging clinical-epidemiological features. In bowenoid papules and Bowen's disease, 5 cases each, compared with 5 cases of common condylomata acuminata, we determined the DNA by means of Feulgen's cytophotometry in visible light after Feulgen's staining. The following results were obtained: The average DNA content in bowenoid papules equals that in Bowen's disease, but it is significantly higher than in condylomata acuminata. What is different between the two groups "bowenoid papules" and "Bowen's disease" is the distribution of DNA: In Bowen's disease, DNA spreads into higher ranges of polyploidy. If we take recent molecular biological/virological findings into account, this result can be interpreted as a transition towards carcinoma in situ.

[Pruritic urticarial papules and plaques in pregnancy]. / Die PUPPP-Dermatose.

PUPPP is a distinct kind of dermatosis that occurs in pregnancy and is characterized by pruritic, mostly urticarial papules. The lesions usually occur during the last trimenon and regress shortly after delivery. In contrast to other types of dermatosis in pregnancy (e.g., herpes gestationis), PUPPP is not associated with a higher incidence of fetal or maternal complications. It is relatively rare and has only occasionally been mentioned in the German literature. The clinical features and courses of eight patients are described, and the differential diagnosis is discussed with regard to other dermatoses of pregnancy.

[Etiology of pathogen-induced changes between the toes in patients working under moist conditions]. / Zur Atiologie der erregerbedingten Zehenzwischenraumveränderungen bei Arbeitern in Feuchtbetrieben.

Referring to recent studies, we discuss the epidemiology of tinea pedis and its position within the range of polyetiological foot infections caused by microbial agents. 201 industrial workers used to wear rubber boots because of moist working conditions were examined with regard to their feet. 107 of them showed clinically altered toe web; in 45 cases, we found ringworm infection (22.4%), in correlation to increased daily wearing time of rubber boots. 85 workers showed colonization of pathogenic bacteria (42.4%), especially gram-negative species (25.8%). Frequently, mixed infections were found. The clinical picture not always allows definite conclusions as to the causal agents. The symptom "maceration" is seen in each of the 3 pathogenic groups of germs (fungi, gram-positive pathogenic cocci, gram-negative bacteria), frequently in bacterial foot infections, especially gram-negative infections. Marked clinical symptoms involve increased infection rates. The predisposing factors to foot infection such as interdigital maceration and the promoting role of rubber boots have been confirmed. The final diagnosis is to be reassured by cultural investigations, in order to set up a specific treatment.

[Classification of Gonococcus: auxanologic and serologic aspects using monoclonal antibodies]. / Typisierung des Gonokokkus: Auxotypie und Serotypie mit monoklonalen Antikörpern.

500 N. gonorrhoeae strains from the area of Lübeck/West Germany, collected in 1976-84, were auxologically and serologically classified by means of monoclonal antibodies from the Genetic Systems Corporation, Seattle, Washington (USA), against gonococcal outer membrane protein I. During the first years, auxological classification showed high proportions of AHU-strains (40%), which amounted to 20% over the total observation period. PPNG and DGI strains have characteristic type patterns. Our synopsis of serovars corresponds with the results obtained in a recent world-wide study. Combined auxological and serological classification shows two N. gonorrhoeae pools, 18% each, which cannot be further distinguished: AHU/A1 and prototrophic/B3. The advantages of the system have been proved in answering plain epidemiological questions. For further discrimination, an additional independent classification method might be useful.

Sensitivity of Neisseria gonorrhoeae to spectinomycin and thiamphenicol.

Between 1966 and 1978 the sensitivities of strains of Neisseria gonorrhoeae (70-80 strains in each year) to penicillin, thiamphenicol, and spectinomycin were tested. For penicillin the proportion of less sensitive strains increased from 21% in 1976 to 41% in 1978 and for thiamphenicol from 10% to 18% over the same period. All the strains proved to be sensitive to spectinomycin. A significant correlation in the degree of sensitivity was observed between penicillin and thiamphenicol but not between penicillin and spectinomycin.

[Effect of a corticosteroid additive on the result of local therapy of bacterial superinfection in tinea pedis intertriginosa]. / Der Einfluss eines Kortikosteroidzusatzes auf das Ergebnis der Lokalbehandlung der bakteriell superinfizierten Tinea pedum intertriginosa.

Sixty cases of tinea pedum intertriginosa were topically treated in a double-blind trial. In 34 cases a cream was used, which contained 5-chloro-8-hydroxyquinoline, gentamycin and fluprednyliden-21-acetate. In 26 cases a cream was used, which contained 5-chloro-8-hydroxyquinoline and gentamycin alone. Treatment was continued over three weeks. In weekly intervalls mycological, bacteriological and clinical controls were performed, which showed that the steroid-component had no disadvantageous effect on the course of infection. In contrast the steroid containing preparation proved to be slightly superior.