1/80. Congenital cutaneous candidiasis: clinical presentation, pathogenesis, and management guidelines. We describe a term infant with congenital cutaneous candidiasis (CCC), and review all cases in the English literature that reported birth weight and outcome. Presence of an intrauterine foreign body was a predisposing factor for development of CCC and subsequent preterm birth. The most common presentation of CCC in neonates weighing >1000 g was a generalized eruption of erythematous macules, papules, and/or pustules that sometimes evolved to include vesicles and bullae. Extremely low birth weight, premature neonates weighing <1000 g most often presented with a widespread desquamating and/or erosive dermatitis (10 of 15 [67%]), and were at greater risk for systemic infection with Candida spp (10 of 15 [67%]) and death (6 of 15 [40%] than those weighing >1000 g (5 of 48 [10%]; 4 of 48 [8%], respectively). Systemic antifungal therapy is recommended for neonates with burn-like dermatitis attributable to Candida spp, or positive blood, urine, and/or cerebrospinal fluid cultures. Systemic treatment also should be considered for all infants with CCC who have respiratory distress in the immediate neonatal period and/or laboratory signs of sepsis such as an elevated leukocyte count with an increase in immature forms or persistent hyperglycemia and glycosuria. ( info) |
| folliculitis barbae candidomycetica is a very rare disease and in the scientific literature this manifestation of candidosis is rarely described. In most cases, a connection with predisposing factors is suspected, although in the cases cited this connection was not frequently proved. Furthermore, in our patient who was suffering from a folliculitis candidomycetica no predisposing factors or illnesses were apparent. For this reason, the importance of such aetiological factors of Candida folliculitis must be critically discussed. Effective drugs for use in treatment are fluconazole, itraconazole and ketoconazole. ( info) |
3/80. Atrichia, ichthyosis, follicular hyperkeratosis, chronic candidiasis, keratitis, seizures, mental retardation and inguinal hernia: a severe manifestation of IFAP syndrome? A boy with congenital atrichia, ichthyosis follicular, keratitis, cutaneous infections and a huge inguinal hernia, but without deafness is reported. We believe it represents a new case of a rare X-linked recessive syndrome known as ichthyosis follicularis, alopecia, photophobia syndrome (IFAP). The differential diagnosis from keratitis ichthyosis deafness is discussed. The cutaneous infections seen in our case suggest the possibility of considering a genetic link between these syndromes. ( info) |
4/80. The effect of transfer factor on neutrophil function in chronic mucocutaneous candidiasis. Chronic mucocutaneous candidiasis with hypoparathyroidism in a 6-year-old-boy is described. In addition to defects of in vivo and in vitro correlates of delayed-type hypersensitivity to candida albicans the child also had abnormalities of neutrophil function in terms of their capacity to respond by chemotaxis to a known attractant and to kill suspensions of C. albicans. Dialysable transfer factor was given on six occasions at intervals of between 26 and 45 days. Neutrophil chemotaxis (optimal conditions) was restored following each of the six injections, neutrophil chemotaxis (sub-optimal conditions) following five of the six injections and candidicidal capacity following four of the six injections. The effects of transfer factor were transient requiring repeated injections. The Candida delayed-type hypersensitivity skin test was restored to normal but lymphocyte transformation to Candida extract was not consistently positive following treatment. There was a slight clinical improvement following therapy. These abnormalities of neutrophil and lymphocyte function point to the complexity of chronic mucocutaneous candidiasis. The improvement in neutrophil chemotaxis and candidicidal capacity following treatment suggests that transfer factor may be a heterogeneous group of molecules, some of which affect granulocytes and restore defects in their function. ( info) |
5/80. Clinical and immunological improvement in a patient with chronic mucocutaneous candidiasis treated with transfer factor. In a 19 year old patient suffering from CMC since the first months of life, clinical improvement accompanied by correction of the immunologic defect was achieved by transfer factor therapy. After 12 months from the last administration of transfer factor the improvement persisted. The positive outcome of the treatment in this disease is not constant. Possibly only patients with cellular immunologic defects are susceptible of a favourable response, moreover it is thinkable that the quality of transfer factor and the dosage administered must play a role. ( info) |
6/80. Congenital cutaneous candidiasis. Two cases of congenital cutaneous candidiasis are presented in order to call attention to this rarely recognized and infrequently reported condition. Clinical features and appropriate cultures are useful in differentiating the lesions from other more common dermatoses of the neonatal period. Microscopic examination of the placenta may disclose fungal funisitis or chorioamnionitis, thus defining the congenital nature of the disease. Topical antifungal therapy is sufficient unless systemic candidiasis is present. No evidence of impaired immunological responsiveness was found in the two infants. ( info) |
7/80. Congenital cutaneous candidiasis: a case presentation. When an infant presents in the delivery room with macular and papular skin lesions covering the trunk, extremities, and/or skin folds, the neonatal nurse practitioner covering deliveries must be aware of possible skin lesion differential diagnoses. Among these is congenital cutaneous candidiasis, a rare, usually benign skin infection. If this condition is recognized early, unnecessary testing and treatment of newborns who present with these symptoms might be avoided. ( info) |
8/80. Atopic dermatitis with mononuclear phagocytic activity deficiency. Five patients with atopic dermatitis, three males and two females, aged 2 to 17 years, had positive reactions to air allergens (dermatophagoides pteronyssinus and/or farinae). All the patients suffered from severe recurrent dermatophytosis that responded poorly to antifungal treatment. The results of immunologic evaluation by laboratory tests were normal, except for a decrease in the ingestion phase by mononuclear phagocytes.After diagnosis of immunodeficiency, ketoconazole shampoo was used prophylactically and at the very first signs of recurrence of dermatophytosis, systemic antifungal treatment was started, without concurrent use of macrolides and with monitoring of hepatic function. The fungal infections responded well to this treatment and the patients' quality of life markedly improved. ( info) |
9/80. Diffuse chronic granulomatous mucocutaneous candidiasis. A 3-year-old Thai boy with diffuse chronic granulomatous mucocutaneous candidiasis, recurrent bacterial skin infection and adrenal insufficiency is reported. candida albicans was demonstrated in the dermal granuloma. He had a defect in cell-mediated immunity and was anemic. Although therapy with topical clotrimazole, oral iron, systemic antibiotic and low-dose of prednisone gave a dramatic result, he died of disseminated cryptococcosis. ( info) |
| This report describes a case of chronic mucocutaneous candidiasis with associated hypoparathyroidism and acutely developed adrenocortical insufficiency. The latter was heralded by hypercalcemia. Upon the institution of cortisol therapy, while still under the effects of a vitamin d analog dihydrotachysterol (DHT), the patient exhibited severe hypocalcemia and tetany. Since calcium intake was minimal during this period of presumed corticosteroid-DHT antagonism, it is suggested that the cortisol disturbed calcium homeostasis by in inhibiting bone calcium resorption. ( info) |