By Pseudallescheria Boydii

Total Page:16

File Type:pdf, Size:1020Kb

By Pseudallescheria Boydii BritishJournalofOphthalmology, 1992,76,367-368 367 CASE REPORTS Br J Ophthalmol: first published as 10.1136/bjo.76.6.367 on 1 June 1992. Downloaded from Treatment failure in a case of fungal keratitis caused by Pseudallescheria boydii Philip A Bloom, D A H Laidlaw, D L Easty, D W Warnock Abstract Twelve hours postoperatively there was a A case is presented ofPseudallescheria boydii marked fibrinous anterior uveitis and the donor fungal keratitis in an agricultural welder. Treat- corneal button was thickened and hazy. Over the ment with azole antifungal drugs (miconazole next 2 days the graft cleared but the hypopyon and itraconazole) and with penetrating kerato- reformed, so 0-1% dexamethasone drops four plasty was unsuccessful in eradicating the times a day were added. The fibrinous reaction infection, and eventualiy the eye was evis- progressed with lifting of the graft, and the cerated. dexamethasone was increased to 2 hourly. This failed to halt the progression to endophthalmitis (Fig 2). Case report Serum concentrations ofitraconazole were low A 57-year-old man presented with a painful red (0 2 mg/l at 4-5 hours), so the dose was increased eye. Ten days previously he had been welding in to 200 mg twice a day. The results of sensitivity a pig slurry tank while wearing a face mask, but testing of the Bristol corneal isolate became recalled no injury. An ulcer noted on the right available 4 days postoperatively. These showed cornea initially was thought to be herpetic and that the organism was sensitive to miconazole treated with 3% acyclovir ointment. Three days (minimum inhibitory concentration [MIC]= later 0 1% dexamethasone drops four times a day 0.5 mg/l), but resistant to amphotericin B were added. One week later the ulcer had greatly (MIC= 5 mg/l) and itraconazole (MIC >50 mg/l). extended and topical steroids were stopped. Miconazole 600 mg intravenously three times Microscopy following extensive lamellar a day was therefore recommenced. This was later corneal debridement (biopsy) showed massive increased to 1200 mg three times daily in com- fungal infection. The organism was later identi- bination with hourly topical miconazole 1% http://bjo.bmj.com/ fied as Pseudallescheria. boydii, but sensitivity and two further subconjunctival injections of tests were not performed on this isolate. Treat- miconazole. ment was instituted with 1% miconazole drops The endophthalmitis did not respond, how- hourly and itraconazole 200 mg once a day orally, ever, and the patient became depressed and and a subconjunctival injection of miconazole nauseated from systemic treatment. Because 0 5 ml of 10 mg/ml was given. The ulcer did not clinical success was deemed unlikely, the patient improve, so 1 week later further corneal requested evisceration, which was performed on September 26, 2021 by guest. Protected copyright. debridement was performed and the subcon- 8 weeks after the original infection. Pseud- junctival miconazole was repeated. Systemic allescheria boydii was isolated from evisceration antifungal treatment was changed to miconazole specimens of cornea and anterior chamber fibrin 600 mg three times a day intravenously, but the but not from lens or vitreous. ulcer continued to enlarge. Ten days later the patient was transferred to Bristol Eye Hospital. On admission the cornea was hazy and Discussion thickened with a deep central ulcer and marked Fungal keratitis is most prevalent in agricultural stromal infiltrate (Fig 1). The anterior chamber workers in the rural populations of tropical was deep with an intense fibrinous exudate and a areas, following traumatic implantation offungal 2-5 mm hypopyon. Following deterioration, an spores from soil or plant matter into the corneal Bristol Eye Hospital, 8 mm eccentric right penetrating keratoplasty stroma. Lower Maudlin Street, and clearout of the anterior chamber exudate Pseudallescheria boydii (previously Petriel- PBAiBloom were performed 3 days after transfer (5 weeks lidium boydii, Allescheria boydii, Monosporium D A H Laidlaw after presentation). Pseudallescheria boydii was apiospermum) is a ubiquitous fungus that has D L Easty isolated from excised cornea and anterior been isolated from soil, polluted water, and Regional Mycology chamber fibrin, but there was no bacterial sewage. It has been reported to cause keratitis, Laboratory, Department growth from these specimens. Microscopy endophthalmitis, mycetoma, pneumonia, of Microbiology, Bristol showed fungus up to the corneal resection osteomyelitis, arthritis, sinusitis, endocarditis, Royal Infirmary, Maudlin meningitis, and brain abscess.' In immuno- Street, Bristol BS2 8HW margi. D W Warnock Because of the patient's clinical deterioration suppressed patients infection may result in fatal Correspondence to: before surgery, postoperative antifungal treat- disseminated pseudallescherosis. Philip A Bloom, FRCS Ed, ment was changed from miconazole to itra- There have been at least 14 reported cases of FCOphth. conazole, initially 200 mg once a day orally. P boydii keratitis2 but none treated with itra- Accepted for publication 14 November 1991 Topical 1% miconazole was continued. conazole, a recently introduced orally adminis- 368 Bloom, Laidlaw, Easty, Warnock Br J Ophthalmol: first published as 10.1136/bjo.76.6.367 on 1 June 1992. Downloaded from Figure I Corneal ulcer with hypopyon, due to Figure 2 Reformed hypopyon after penetrating keratoplasty Pseudallescheria boydii. for Pseudallescheria boydii keratitis. A stitch abscess can be seen superiorly. tered broad-spectrum triazole compound. In Suspected mycotic keratitis, or mycotic only five of these 14 cases was treatment success- keratitis in which the organism or its sensitivities ful, the remainder requiring evisceration. have not yet been identified, should be treated Although many isolates of P boydii are resistant empirically with a combination of antifungal to amphotericin B,3 several cases ofkeratitis have agents. The broadest such 'best guess' combina- been successfully treated with this drug alone, or tion treatment should probably include topical in combination with nystatin or natamycin. miconazole or econazole, subconjunctival Although many strains ofP boydii are sensitive miconazole, and either oral itraconazole or intra- to miconazole,37 there have been no published venous miconazole. reports of Pseudallescheria keratitis successfully In any case of atypical or indolent keratitis the treated with this drug. The reasons for the failure possibility of fungal infection should be borne in ofhigh dose miconazole treatment in this case are mind, and steroids should be used with great unclear, but the administration of topical corti- caution, if at all. costeroids and lack of drug penetration to the infection site may have contributed. We thank Mrs G Bennerson for the photographs. Only three cases of endophthalmitis due to P boydii have been previously reported, none 1 Warnock DW, Johnson EM. Clinical manifestations and associated with keratitis. In one case of endoph- management of hyalohyphomycosis, phaeohyphomycosis and other uncommon forms of fungal infection in the thalmitis following cataract extraction8 the compromised patient. In: Warnock DW, Richardson MD, patient recovered after 3 months of topical treat- eds. Fungal infection in the compromised patient. 2nd ed. http://bjo.bmj.com/ Chichester: Wiley, 1991: 247-310. ment with amphotericin B, 4 mg/ml 2 hourly. 2 Rippon JW. Medical mycology. The pathogenic fungi and the Treatment success may have been due to the pathogenic actinomycetes. 3rd ed. Philadelphia: Saunders, 1988. anterior location of this infection. In a second 3 Lutwick LI, Galgiani JN, Johnson RH, Stevens DA. Visceral case3 the infection was haematogenous in origin fungal infections due to Petriellidium boydii (Allescheria boydii). In vitro drug sensitivity studies. AmJf Med 1976; 61: in a woman receiving corticosteroid treatment 632-40. for lupus nephritis. Parenteral therapy with 4 Gordon MA, Vallotton WW, Groffead GS. Corneal sclerosis. A case of keratomycosis treated successfully with nystatin on September 26, 2021 by guest. Protected copyright. miconazole was unsuccessful despite the fact that and amphotericin B. Arch Ophthalmol 1959; 62: 758-63. the drug was detected in the vitreous. The third 5 Matsuzaki 0. Ocular infection with a fungus from rice leaf. JpnJr Med Mycol 1969; 10: 239. case9 occurred in a 15-year-old patient who 6 Zapater RC, Albesi EJ. Corneal monosporiosis. Ophthalmo- developed aspiration pneumonia and died logica 1979; 178: 142-7. 7 Galgiani JN, Stevens DA, Graybill JR, Stevens DL, Tillinghast despite niconazole therapy. AJ, Levin HB. Pseudallescheria boydii infections treated with The treatment of mycotic keratitis remains a ketoconazole: clinical evaluation of seven patients and in vitro susceptibility results. Chest 1984; 86: 219-24. difficult problem, because none of the available 8 Glassman MI, Henkind P, Alture-Werber E. Monosporium antifungal drugs is ideal. Natamycin has been apiospermum endophthalmitis. Am J Ophthalmol 1973; 76: 821-4. used successfully to treat filamentous fungal 9 Meadow WL, Tipple MA, Rippon JW. Endophthalmitis infections, but its tissue penetration is limited caused by Petriellidium boydii. Am j Dis Child 1981; 135: 378-80. and it is ineffective subconjunctivally.'°0" 10 Jones DB. Initial therapy of suspected microbial corneal Nystatin and amphotericin B have been even less ulcers. II. Specific antibiotic therapy based on corneal scrapings. Surv Ophthalmol 1979; 24: 97. successful than
Recommended publications
  • Central Nervous System Infections by Members of the Pseudallescheria
    Review article Central nervous system infections by members of the Pseudallescheria boydii species complex in healthy and immunocompromised hosts: epidemiology, clinical characteristics and outcome A. Serda Kantarcioglu,1 Josep Guarro2 and G. S. de Hoog3 1Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul, Turkey, 2Unitat de Microbiologia, Facultat de Medicina i Ciencies de la Salut, Universitat Rovira i Virgili, Reus, Spain and 3Centraalbureau voor Schimmelcultures, Utrecht, and Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands Summary Infections caused by members of the Pseudallescheria boydii species complex are currently among the most common mould infections. These fungi show a particular tropism for the central nervous system (CNS). We reviewed all the available reports on CNS infections, focusing on the geographical distribution, infection routes, immunity status of infected individuals, type and location of infections, clinical manifestations, treatment and outcome. A total of 99 case reports were identified, with similar percentage of healthy and immunocompromised patients (44% vs. 56%; P = 0.26). Main clinical types were brain abscess (69%), co-infection of brain tissue and ⁄ or spinal cord with meninges (10%) and meningitis (9%). The mortality rate was 74%, regardless of the patientÕs immune status, or the infection type and ⁄ or location. Cerebrospinal fluid culture was revealed as a not very important tool as the percentage of positive samples for P. boydii complex was not different from that of negative ones (67% vs. 33%; P = 0.10). In immunocompetent patients, CNS infection was preceded by near drowning or trauma. In these patients, the infection was characterised by localised involvement and a high fatality rate (76%).
    [Show full text]
  • Application of HPLC Method in Determination of Miconazole Nitrate in Environmental Samples from El-Gharbia Governorate in Egypt
    Journal of Analytical & Pharmaceutical Research Research Article Open Access Application of HPLC method in determination of miconazole nitrate in environmental samples from el-gharbia governorate in Egypt Abstract Volume 8 Issue 4 - 2019 This paper describes an enhanced High-performance liquid chromatography (HPLC) method for the analysis of miconazole in water samples. In this study, determination of Mohamed W Ibrahim,1 Ahmad A Mohamad,2 miconazole has been carried out according to standard method for water and wastewater Ahmed M Ahmed3 analysis. Samples of collected water were agriculture stream water, River Nile (Surface 1Department of Pharmaceutical Analytical Chemistry, Al-Azhar water samples) water and Hospital wastewater samples from El-gharbia governorate in University, Egypt Egypt. Miconazole was extracted by liquid-liquid extraction and analyzed by HPLC. The 2Department of Pharmaceutical Analytical Chemistry chromatographic separation was performed using a Phenomenex C8 column, flow rate of Department, Heliopolis University, Egypt 0.8mL/min, and UV detection at 220nm. The optimized HPLC system was achieved using 3Pharmacist Research Laboratories, Egypt mobile phase composition containing methanol: water (85:15v/v). The intra-day and inter- day precisions were lower than 0.58 while the accuracy ranged from 99.06% to 101.53%. Correspondence: Ahmed M Ahmed, Pharmacist Research Finally, liquid-liquid phase extraction in combination with HPLC is a sensitive and effective Laboratories, Ministry of health, Giza, Egypt, Tel +201119538119, method for the determination of Miconazole Nitrate in water samples. Miconazole was Email [email protected] observed in some agricultural streams and waste water samples of El-gharbia governorate Received: August 06, 2019 | Published: August 14, 2019 hospitals.
    [Show full text]
  • 4. Antibacterial/Steroid Combination Therapy in Infected Eczema
    Acta Derm Venereol 2008; Suppl 216: 28–34 4. Antibacterial/steroid combination therapy in infected eczema Anthony C. CHU Infection with Staphylococcus aureus is common in all present, the use of anti-staphylococcal agents with top- forms of eczema. Production of superantigens by S. aureus ical corticosteroids has been shown to produce greater increases skin inflammation in eczema; antibacterial clinical improvement than topical corticosteroids alone treatment is thus pivotal. Poor patient compliance is a (6, 7). These findings are in keeping with the demon- major cause of treatment failure; combination prepara- stration that S. aureus can be isolated from more than tions that contain an antibacterial and a topical steroid 90% of atopic eczema skin lesions (8); in one study, it and that work quickly can improve compliance and thus was isolated from 100% of lesional skin and 79% of treatment outcome. Fusidic acid has advantages over normal skin in patients with atopic eczema (9). other available topical antibacterial agents – neomycin, We observed similar rates of infection in a prospective gentamicin, clioquinol, chlortetracycline, and the anti- audit at the Hammersmith Hospital, in which all new fungal agent miconazole. The clinical efficacy, antibac- patients referred with atopic eczema were evaluated. In terial activity and cosmetic acceptability of fusidic acid/ a 2-month period, 30 patients were referred (22 children corticosteroid combinations are similar to or better than and 8 adults). The reason given by the primary health those of comparator combinations. Fusidic acid/steroid physician for referral in 29 was failure to respond to combinations work quickly with observable improvement prescribed treatment, and one patient was referred be- within the first week.
    [Show full text]
  • ANNOVERA™ (Segesterone Acetate and Ethinyl Estradiol Vaginal System) • Risk of Liver Enzyme Elevations with Concomitant Hepatitis C Initial U.S
    HIGHLIGHTS OF PRESCRIBING INFORMATION ANNOVERA™ no earlier than 4 weeks after delivery, in females who These highlights do not include all the information needed to use are not breastfeeding. Consider cardiovascular risk factors before ANNOVERA™ safely and effectively. initiating in all females, particularly those over 35 years. (5.1, 5.5) See Full Prescribing Information for ANNOVERA™. • Liver Disease: Discontinue if jaundice occurs. (5.2) ANNOVERA™ (segesterone acetate and ethinyl estradiol vaginal system) • Risk of Liver Enzyme Elevations with Concomitant Hepatitis C Initial U.S. Approval: 2018 Treatment: Stop ANNOVERA™ prior to starting therapy with the combination drug regimen ombitasvir/paritaprevir/ritonavir. ANNOVERA™ can be restarted 2 weeks following completion of this WARNING: CIGARETTE SMOKING AND regimen. (5.3) SERIOUS CARDIOVASCULAR EVENTS • Hypertension: Do not prescribe ANNOVERA™ for females with See full prescribing information for complete boxed warning. uncontrolled hypertension or hypertension with vascular disease. If • Females over 35 years old who smoke should not use used in females with well-controlled hypertension, monitor blood ANNOVERA™. (4) pressure and stop use if blood pressure rises significantly. (5.4) • Cigarette smoking increases the risk of serious cardiovascular • Carbohydrate and lipid metabolic effects: Monitor glucose in pre­ events from combination hormonal contraceptive (CHC) use. (4) diabetic and diabetic females taking ANNOVERA™. Consider an alternate contraceptive method for females with uncontrolled ----------------------------INDICATIONS AND USAGE-------------------------- dyslipidemias. (5.7) ANNOVERA™ is a progestin/estrogen CHC indicated for use by females of • Headache: Evaluate significant change in headaches and discontinue reproductive potential to prevent pregnancy. (1) ANNOVERA™ if indicated. (5.8) Limitation of use: Not adequately evaluated in females with a body mass index • Bleeding Irregularities and Amenorrhea: May cause irregular bleeding of >29 kg/m2.
    [Show full text]
  • Product Monograph Entocort®
    PRODUCT MONOGRAPH ENTOCORT® (budesonide) Controlled Ileal Release Capsules 3 mg Glucocorticosteroid for the Treatment of Crohn’s Disease Affecting the Ileum and/or Ascending Colon Tillotts Pharma GmbH Date of Preparation: Warmbacher Strasse 80 July 7, 2016 79618 Rheinfelden Date of Revision: Germany April 9, 2018 Importer/Distributor: C.R.I. 4 Innovation Drive Dundas, ON Canada, L9H 7P3 Control Number: 213259 PRODUCT MONOGRAPH NAME OF DRUG ENTOCORT® (budesonide) Controlled Ileal Release Capsules 3 mg THERAPEUTIC CLASSIFICATION Glucocorticosteroid for the Treatment of Crohn’s Disease Affecting the Ileum and/or Ascending Colon ACTIONS AND CLINICAL PHARMACOLOGY The active ingredient of ENTOCORT capsules, budesonide, is a potent non-halogenated synthetic glucocorticosteroid with high topical potency and weak systemic effects. The exact mechanism of action of glucocorticosteroids in the treatment of Crohn’s disease is not fully understood. Anti-inflammatory actions, such as the inhibition of inflammatory mediator release and inhibition of immunological cellular responses, are probably important. Data from clinical pharmacology studies and controlled clinical trials indicate that ENTOCORT capsules, at least partly, act topically. Budesonide undergoes an extensive degree (approximately 90%) of biotransformation in the liver to metabolites with low glucocorticosteroid activity. The glucocorticosteroid activity of the major metabolites, 6β- hydroxybudesonide and 16α-hydroxyprednisolone, is less than 1% of that of budesonide. The metabolism of budesonide is primarily mediated by CYP 3A4, an isozyme of cytochrome P450. The favourable separation between topical anti-inflammatory and systemic effect is due to strong glucocorticosteroid receptor affinity and an effective first pass metabolism by the liver with a short half-life. A glucocorticosteroid with such a profile is of particular importance for the local treatment of inflammatory bowel diseases such as Crohn’s disease.
    [Show full text]
  • Management of Otitis
    Chronic and recurrent otitis is Management of Otitis frustrating! • Otitis externa is the most common ear disease in the cat and dog • Reported incidence is 10-20% in the dog Lindsay McKay, DVM, DACVD and 2-10% in the cat [email protected] • It is a common reason for referral to VCA Arboretum View Animal Hospital dermatology specialists and very common clinical problem for general practitioners 1- Primary causes- directly Breaking down the problem induce otic inflammation • ALLERGIES (atopy and food allergies) • Step 1- Identify the primary cause of otitis • Parasites (Otodectes cyanotis, Demodicosis) • Step 2- Assess for predisposing factors of • Masses (tumors and polyps) otitis • Foreign bodies (ex plant awns, hair, • Step 3- Treat the secondary infections ceruminoliths, hardened medications) • Step 4- Identify the perpetuating factors of • Disorders of keratinization (hypothyroidism, otitis primary seborrhea, sebaceous adenitis) • Immune mediated disease (pemphigus, juvenile cellulitis, vasculitis) What are most common causes of 2- Predisposing factors of ear disease recurrent otitis…. • These factors facilitate inflammation by changing • Allergic disease in the dog- over 40% cases environment of the ear! in one study • Ear conformation- stenotic • Polyps and ear mites in the cat canals, hair in canals, pendulous ears • Excessive moisture or cerumen production • Treatment effects- irritation from meds/contact allergy or trauma from cleaning 1 3- Secondary bacterial and/or 4- Perpetuating factors- prevent yeast infections the resolution
    [Show full text]
  • Miconazole (Topical) | Memorial Sloan Kettering Cancer Center
    PATIENT & CAREGIVER EDUCATION Miconazole (Topical) This information from Lexicomp® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider. Brand Names: US Aloe Vesta Antifungal [OTC]; Aloe Vesta Clear Antifungal [OTC]; Antifungal [OTC]; Azolen Tincture [OTC]; Baza Antifungal [OTC] [DSC]; Carrington Antifungal [OTC] [DSC]; Cavilon [OTC]; Critic-Aid Clear AF [OTC] [DSC]; Cruex Prescription Strength [OTC]; DermaFungal [OTC] [DSC]; Desenex Jock Itch [OTC]; Desenex [OTC]; Fungoid Tincture [OTC]; GoodSense Miconazole 1 [OTC]; Lotrimin AF Deodorant Powder [OTC]; Lotrimin AF Jock Itch Powder [OTC]; Lotrimin AF Powder [OTC]; Lotrimin AF [OTC]; Micaderm [OTC]; Micatin [OTC]; Miconazole 3; Miconazole 3 Combo-Supp [OTC]; Miconazole 7 [OTC]; Miconazole Antifungal [OTC]; Micro Guard [OTC] [DSC]; Mycozyl AP [OTC]; Podactin [OTC]; Remedy Antifungal Clear [OTC] [DSC]; Remedy Antifungal [OTC] [DSC]; Remedy Phytoplex Antifungal [OTC] [DSC]; Secura Antifungal Extra Thick [OTC] [DSC]; Secura Antifungal [OTC] [DSC]; Soothe & Cool INZO Antifungal [OTC] [DSC]; Triple Paste AF [OTC] [DSC]; Zeasorb-AF [OTC] What is this drug used for? All skin products: It is used to treat fungal infections of the skin. All vaginal products: This drug is used to treat vaginal yeast infections. Miconazole (Topical) 1/8 What do I need to tell my doctor BEFORE I take this drug? All products: If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had. All skin products: If you have nail or scalp infections.
    [Show full text]
  • Therapeutic Drug Class
    BUREAU FOR MEDICAL SERVICES EFFECTIVE WEST VIRGINIA MEDICAID PREFERRED DRUG LIST WITH PRIOR AUTHORIZATION CRITERIA 07/01/2018 This is not an all-inclusive list of available covered drugs and includes only Version 2018.3e managed categories. Refer to cover page for complete list of rules governing this PDL. • Prior authorization for a non-preferred agent in any class will be given only if there has been a trial of the preferred brand/generic equivalent or preferred formulation of the active ingredient, at a therapeutic dose, that resulted in a partial response with a documented intolerance. • Prior authorization of a non-preferred isomer, pro-drug, or metabolite will be considered with a trial of a preferred parent drug of the same chemical entity, at a therapeutic dose, that resulted in a partial response with documented intolerance or a previous trial and therapy failure, at a therapeutic dose, with a preferred drug of a different chemical entity indicated to treat the submitted diagnosis. (The required trial may be overridden when documented evidence is provided that the use of these preferred agent(s) would be medically contraindicated.) • Unless otherwise specified, the listing of a particular brand or generic name includes all legend forms of that drug. OTC drugs are not covered unless specified. • PA criteria for non-preferred agents apply in addition to general Drug Utilization Review policy that is in effect for the entire pharmacy program, including, but not limited to, appropriate dosing, duplication of therapy, etc. • The use of pharmaceutical samples will not be considered when evaluating the members’ medical condition or prior prescription history for drugs that require prior authorization.
    [Show full text]
  • Miconazole Label Statements
    Miconazole Label Statements Consultation on need for a warning regarding interaction with warfarin and harmonisation with Australian required statements Medsafe February 2017 Medsafe consultation on LSD statements for miconazole Contents About Medsafe ....................................................................................................................................... 3 Background ............................................................................................................................................. 3 Introduction ............................................................................................................................................ 4 Interaction between warfarin and topical miconazole containing medicines ....................................... 5 Case reports ........................................................................................................................................ 5 Clinical studies .................................................................................................................................... 7 Cases reported to the Centre for Adverse Reactions Monitoring ...................................................... 7 Information published by other Regulators ....................................................................................... 8 MHRA .................................................................................................................................................. 8 Health Canada ...................................................................................................................................
    [Show full text]
  • New Species and Changes in Fungal Taxonomy and Nomenclature
    Journal of Fungi Review From the Clinical Mycology Laboratory: New Species and Changes in Fungal Taxonomy and Nomenclature Nathan P. Wiederhold * and Connie F. C. Gibas Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; [email protected] * Correspondence: [email protected] Received: 29 October 2018; Accepted: 13 December 2018; Published: 16 December 2018 Abstract: Fungal taxonomy is the branch of mycology by which we classify and group fungi based on similarities or differences. Historically, this was done by morphologic characteristics and other phenotypic traits. However, with the advent of the molecular age in mycology, phylogenetic analysis based on DNA sequences has replaced these classic means for grouping related species. This, along with the abandonment of the dual nomenclature system, has led to a marked increase in the number of new species and reclassification of known species. Although these evaluations and changes are necessary to move the field forward, there is concern among medical mycologists that the rapidity by which fungal nomenclature is changing could cause confusion in the clinical literature. Thus, there is a proposal to allow medical mycologists to adopt changes in taxonomy and nomenclature at a slower pace. In this review, changes in the taxonomy and nomenclature of medically relevant fungi will be discussed along with the impact this may have on clinicians and patient care. Specific examples of changes and current controversies will also be given. Keywords: taxonomy; fungal nomenclature; phylogenetics; species complex 1. Introduction Kingdom Fungi is a large and diverse group of organisms for which our knowledge is rapidly expanding.
    [Show full text]
  • Dr. Jack Newman's All Purpose Nipple Ointment
    Dr. Jack Newman’s All Purpose Nipple Ointment (APNO) We call our nipple ointment “all purpose” since it contains ingredients that help deal with multiple causes or aggravating factors of sore nipples. “Good medicine” calls for the single “right” treatment for the “right” problem, true enough, but mothers with sore nipples don’t have time to try out different treatments that may or may not work, so we have combined various treatments in one ointment. Of course, preventing sore nipples in the first place would be the best treatment and often adjusting how the baby takes the breast can do more than anything to decrease and eliminate the mother’s nipple soreness (See information sheets When Latching, Sore Nipples as well as the video clips at the website nbci.ca. The APNO contains: 1. Mupirocin 2% ointment. Mupirocin (Bactroban is the trade name) is an antibiotic that is effective against many bacteria, particularly Staphylococcus aureus including MRSA (methicillin resistantStaphylococcus aureus). Staphylococcus aureus is commonly found growing in abrasions or cracks in the nipples and probably makes worse whatever the initial cause of sore nipples is. Interestingly, mupirocin apparently has some effect against Candida albicans (commonly, but inaccurately called “thrush” or “yeast”). Treatment of sore nipples with an antibiotic alone sometimes seems to work, but we feel that the antibiotic works best in combination with the other ingredients discussed below. Although mupirocin is absorbed when taken by mouth, it is so quickly metabolized in the body that it is destroyed before blood levels can be measured. Moreover most of it gets stuck to the skin so that very little is taken in by the baby.
    [Show full text]
  • Topical Miconazole Nitrate Ointment in the Treatment of Diaper Dermatitis Complicated by Candidiasis
    THERAPEUTICS FOR THE CLINICIAN Topical Miconazole Nitrate Ointment in the Treatment of Diaper Dermatitis Complicated by Candidiasis Mary K. Spraker, MD; Elvira M. Gisoldi; Elaine C. Siegfried, MD; John A. Fling, MD; Zila D. de Espinosa, MD; John N. Quiring, PhD; and Stephanie G. Zangrilli, RPh Diaper dermatitis (DD) complicated by candidia- conducted at day 14. Among the patients com- sis is a common problem in diaper-wearing pleting the study, the overall rate of cure (clinical infants and children. We report a double-blind, cure plus microbiologic cure) was 23% for the vehicle-controlled, parallel-group study evaluat- miconazole nitrate group and 10% for the vehicle ing the efficacy and safety of a low concentration control group (P=.005); the rate of clinical cure of miconazole nitrate in a zinc oxide/petrolatum (complete rash clearance, DD severity score=0 ointment for the treatment of DD complicated by at day 14) was 38% for the miconazole nitrate candidiasis. Patients (N=330) who had DD with group and 11% for the vehicle control group a severity score of 3 or higher were enrolled. (PϽ.001); and the rate of microbiologic cure (no Those patients with a baseline potassium culture growth of Candida) was 50% for the hydroxide (KOH) preparation and a baseline cul- miconazole nitrate group and 23% for the vehicle ture specimen that both tested positive for control group. The vehicle control resulted in Candida were retained for efficacy analysis mild improvement at day 3 but little or no subse- (n=236). Miconazole nitrate 0.25% ointment or a quent improvement.
    [Show full text]