11/112. Significant post-transplant hypogammaglobulinemia in six heart transplant recipients: an emerging clinical phenomenon?BACKGROUND: The recent development of powerful agents such as mycophenolate mofetil and tacrolimus has altered current regimens for the prevention and treatment of allograft rejection. Questions have been raised about these newer regimens in terms of susceptibility to opportunistic infections and effects on host defenses. Severe hypogammaglobulinemia has been infrequently described in solid organ transplant recipients, but has been recently noted in six heart transplant recipients at one center, of whom five were receiving a combination of tacrolimus, mycophenolate mofetil, and prednisone. methods: Case summaries of six recent heart transplant recipients with total immunoglobulin g (IgG) levels of less than 310 mg/dl, five of whom had cytomegalovirus (CMV) infection and three of whom had multiple infections including nocardia, invasive trichophyton, and acinetobacter bacteremia. Previous literature was reviewed with the aid of a medline search using the search terms hypogammaglobulinemia; kidney, liver, heart, lung, and organ transplantation; mycophenolate mofetil; tacrolimus; cyclosporine; azathioprine; and nocardiosis. RESULTS: We here report six cardiac transplant recipients seen over a period of one year who were found to have immunoglobulin g levels of 310 mg/dl or below (normal: 717-1400 mg/dl). The first five patients were diagnosed because of evaluation for infections; the sixth, who was asymptomatic with an IgG level of 175, was found during screening for hypogammaglobulinemia instituted as a result of these first five patients. All six patients had received steroid pulses for rejection; all received mycophenolate mofetil; and 5/6 had been switched from cyclosporine to tacrolimus because of steroid-resistant rejection. Transient neutropenia (absolute neutrophil count less than 1000) was observed in 2/6; 3/6 had received OKT3 therapy for refractory rejection. These six patients were treated with a combination of antimicrobials, immunoglobulin replacement, and decrease in immunosuppressive therapy. CONCLUSION: The finding of unexpected hypogammaglobulinemia and concomitant infectious complications in six heart transplant recipients highlights a possible complication in a subset of patients receiving newer immunosuppressive agents. A larger prospective study is underway to determine risk factors for development of post-transplant hypogammaglobulinemia and to assess pre-transplant immune status of these recipients. Monitoring of immunoglobulin levels in high-risk patients receiving intensified immunosuppressive therapy for rejection may help to prevent infectious complications.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
12/112. The definition of trichophyton rubrum syndrome.Although chronic widespread dermatophyte infection is reported widely in the literature, neither a uniform nomenclature, nor even a clear definition of this syndrome have been established so far. Thus, we suggest trichophyton rubrum syndrome (TRS) for denomination and define the following obligatory clinical and mycological criteria for TRS. (A) skin lesions at the following four sites: (1) feet, often involving soles; (2) hands, often involving palms; (3) nails; and (4) at least one lesion in another location than (1) (2) or (3), except for groins. (B) Positive microscopic analyses of potassium hydroxide preparations of skin scrapings in all four locations. (C) Identification of trichophyton rubrum by cell culture at three of the four locations at least. For diagnosis of TRS the criteria (A) and (B) and (C) have to be fulfilled. This standardization is a prerequisite for further investigations of underlying mechanisms of this disease. The typical clinical pattern of TRS is illustrated by the presentation of two paradigmatic cases.- - - - - - - - - - ranking = 0.25keywords = infection (Clic here for more details about this article) |
13/112. trichophyton rubrum showing deep dermal invasion directly from the epidermis in immunosuppressed patients.trichophyton rubrum is the most widely encountered dermatophyte infection, and is usually regarded as exclusively keratinophilic often leading to chronic cutaneous and nail infections, even in healthy individuals. We present three patients with acute leukaemias, with ill-defined pre-existent cutaneous eruptions that were treated with a potent topical corticosteroid. All three patients received aggressive marrow toxic chemotherapy. These patients had progression of their cutaneous disease, which showed deep dermal invasion of T. rubrum, invading directly from the epidermis with no evidence of systemic spread. We conclude that systemic pancytopenia, in association with prolonged local immunosuppression, may increase the risk of direct dermal invasion of dermatophyte infections. However, even in these patients, the risk of systemic spread still appears very low. amphotericin b did not appear effective in treating these dermatophyte infections.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
14/112. Tinea incognito due to Trichophytom rubrum after local steroid therapy.The term "tinea incognito" refers to dermatophyte infections with clinical presentations that have been modified by the administration of corticosteroids. We describe a patient who had pustular inflammatory skin lesions due to trichophyton rubrum after receiving treatment with potent topical corticosteroid creams.- - - - - - - - - - ranking = 0.25keywords = infection (Clic here for more details about this article) |
15/112. case reports. Six cases of infection due to trichophyton verrucosum.Dermatophyte infections due to Trichopkyton verrucosum are not frequent in europe. Six cases observed in italy in the period 1995-99 are reported. Two were cases of tinea barbae, two of tinea corporis and two of tinea capitis, one of which had been preceded by tinea faciei. In three cases the source of contagion was horses, in two it was cattle and in one case it was another person. The two cases of tinea barbae were initially interpreted and treated as bacterial infections, a diagnostic error reported with increasing frequency in the literature regarding dermatophytosis due to T. verrucosum.- - - - - - - - - - ranking = 1.5keywords = infection (Clic here for more details about this article) |
16/112. Majocchi's granuloma and posttransplant lymphoproliferative disease in a renal transplant recipient.Renal transplant recipients are predisposed to infection and malignancy because of underlying long-term immunosuppressive therapy. In this case report, a renal transplant patient with coexisting trichophyton rubrum granuloma (Majocchi's granuloma) and posttransplant lymphoproliferative disease (PTLD) is presented, showing the undesirable effects of heavy immunosuppression. Majocchi's granuloma was probably associated with PTLD as a reflection of overimmunosuppression.- - - - - - - - - - ranking = 0.25keywords = infection (Clic here for more details about this article) |
17/112. Preseptal cellulitis caused by trichophyton (ringworm).A 10-year-old boy with a past medical history significant for chicken pox at 7 years of age was referred to our eye center by an outside ophthalmologist for a 15-day history of worsening right-sided preseptal cellulitis. The patient reported photophobia, pruritus, and pain in the eyelid region. There appeared to be vesicular lesions on the eyelids. Empiric therapy with oral antibacterial and antiviral medications failed to resolve the preseptal cellulitis. Lid cultures revealed coagulase negative staphylococcus, Streptococcal viridans, and a trichophyton species of fungus. The infection was successfully treated with two courses of oral itraconazole. This is the first case of preseptal cellulitis caused by this dermatophyte that we could find in the literature.- - - - - - - - - - ranking = 0.25keywords = infection (Clic here for more details about this article) |
18/112. Case report. First report on human ringworm caused by Arthroderma benhamiae in japan transmitted from a rabbit.Two human cases of tinea corporis due to Arthroderma benhamiae (teleomorph of trichophyton mentagrophytes) were described. They acquired the infection from their cross-bred rabbit. The three clinical isolates from a human couple and a pet rabbit had been identified as A. benhamiae by chitin synthase 1 (CHS1) gene analysis as well as by mating experiments. There was no previous isolate of A. benhamiae from humans in japan, although we had reported the first isolate of A. benhamiae from a rabbit in 1998. Therefore, this is the first report on human ringworm cases caused by A. benhamiae in japan. It is anticipated that the human and animal cases of A. benhamiae infection could rise in number.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
19/112. 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.- - - - - - - - - - ranking = 0.25keywords = infection (Clic here for more details about this article) |
20/112. An isolate of Arthroderma benhamiae with trichophyton mentagrophytes var. erinacei anamorph isolated from a four-toed hedgehog (Atelerix albiventris) in japan.A female four-toed hedgehog probably imported from africa and kept as a pet by a family suffered from depilation and mite (Caparinia tripilis) infection. Depilated quills were inoculated on a commercially available medium and an isolate of the dermatophytes was obtained. A giant colony after 14 days incubation on yeast extract Sabourauds agar had a central umbo with white granular surface and a yellow pigment ring in the reverse. The hedgehog isolate produced numerous elongated microconidia singly attached along the sides of hyphae. Macroconidia were somewhat irregular in shape and size and 2-6 septa. Abundant intermediate sized spores between micro- and macro conidia and few spirals were observed. hair perforation and urease activity tests were positive. Maximum growth temperature was 40 C. In the mating tests using the tester strains of both African and Americano-European races of Arthroderma benhamiae, the strain produced numerous gymnothecia only when paired with the African race mating type minus(-). In addition, 591 bases of the internal transcribed spacer region of the ribosomal rna gene including the 5.8S region (ITS1-5.8S-ITS2) were sequenced and corresponded to those of T. mentagrophytes var. erinacei (DDBJ/EMBL/GenBank accession numbers Z97996 and Z97997) by more than 99.7%. Therefore, our case is the first isolation of A. benhamiae with T. mentagrophytes var. erinacei anamorph in japan.- - - - - - - - - - ranking = 0.25keywords = infection (Clic here for more details about this article) |
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