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Jochen Brasch - One of the best experts on this subject based on the ideXlab platform.
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guideline vulvovaginal candidosis 2010 of the german society for gynecology and obstetrics the working group for infections and infectimmunology in gynecology and obstetrics the german society of dermatology the board of german dermatologists and the german speaking mycological society
Mycoses, 2012Co-Authors: W Mendling, Jochen BraschAbstract:Candida (C.) species colonize the estrogenized vagina in at least 20% of all women. This statistic rises to 30% in late pregnancy and in immunosuppressed patients. The most often occurring species is Candida albicans. Host factors, especially local defense deficiencies, gene polymorphisms, allergic factors, serum glucose levels, antibiotics, psychosocial stress and estrogens influence the risk for a Candida vulvovaginitis. In less than 10% of all cases, non-albicans species, especially C. glabrata, but in rare cases also Saccharomyces cerevisiae, cause a vulvovaginitis, often with fewer clinical signs and symptoms. Typical symptoms include premenstrual itching, burning, redness and non-odorous discharge. Although pruritus and inflammation of the vaginal introitus are typical symptoms, only less than 50% of women with genital pruritus suffer from a Candida vulvovaginitis. Diagnostic tools are anamnesis, evaluation of clinical signs, the microscopic investigation of the vaginal fluid by phase contrast (400 x), vaginal pH-value and, in clinically and microscopically uncertain or in recurrent cases, yeast culture with species determination. The success rate for treatment of acute vaginal candidosis is approximately 80%. Vaginal preparations containing polyenes, imidazoles and Ciclopiroxolamine or oral triazoles, which are not allowed during pregnancy, are all equally effective. C. glabrata is resistant to the usual dosages of all local antimycotics. Therefore, vaginal boric acid suppositories or vaginal flucytosine are recommended, but not allowed or available in all countries. Therefore, high doses of 800 mg fluconazole/day for 2–3 weeks are recommended in Germany. Due to increasing resistence, oral posaconazole 2 × 400 mg/day plus local Ciclopiroxolamine or nystatin for 15 days was discussed. C. krusei is resistant to triazoles. Side effects, toxicity, embryotoxicity and allergy are not clinically important. A vaginal clotrimazole treatment in the first trimester of pregnancy has shown to reduce the rate of preterm births in two studies. Resistance of C. albicans does not play a clinically important role in vulvovaginal candidosis. Although it is not necessary to treat vaginal candida colonization in healthy women, it is recommended in the third trimester of pregnancy in Germany, because the rate of oral thrush and diaper dermatitis in mature healthy newborns, induced by the colonization during vaginal delivery, is significantly reduced through prophylaxis. Chronic recurrent vulvovaginal candidosis requires a “chronic recurrent” suppression therapy, until immunological treatment becomes available. Weekly to monthly oral fluconazole regimes suppress relapses well, but cessation of therapy after 6 or 12 months leads to relapses in 50% of cases. Decreasing-dose maintenance regime of 200 mg fluconazole from an initial 3 times a week to once monthly (Donders 2008) leads to more acceptable results. Future studies should include candida autovaccination, antibodies against candida virulence factors and other immunological trials. Probiotics should also be considered in further studies. Over the counter (OTC) treatment must be reduced.
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toenail infection by cladophialophora boppii
Medical Mycology, 2011Co-Authors: Jochen Brasch, S Dressel, K Mullerwening, R Hugel, D Von Bremen, G. S. De HoogAbstract:Cladophialophora boppii is a black yeast-like fungus that up to now has been only rarely described as a cause of human infection and whose role as a pathogen was not established despite its repeated isolation and genetic identification in these reports. Here we report the first case of a verified toenail infection caused by this fungus in a woman without any systemic disease or evidence of immunodeficiency. Identical dark molds were isolated from the same toenail at three points of time. Species identification was performed by scrutinizing the isolates morphologic, physiologic and genetic characteristics which resulted in their identification as Cladophialophora boppii. Oral treatment with terbinafin plus topical Ciclopiroxolamine was effective.
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nail infection by aspergillus ochraceopetaliformis
Medical Mycology, 2009Co-Authors: Jochen Brasch, Janos Varga, Jensmichael Jensen, Friederike Egberts, Kathrin TintelnotAbstract:Aspergillus ochraceopetaliformis is a rare fungal species that has not yet been identified as a proven human pathogen. Here we report a case of a toenail infection in a healthy woman caused by this fungus. Species identification was performed by scrutinizing the phenotypic and genetic characteristics of distinct isolates obtained at different times during the course of the infection. Treatment with terbinafine plus Ciclopiroxolamine was effective.
Martin Schaller - One of the best experts on this subject based on the ideXlab platform.
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guideline vulvovaginal candidosis awmf 015 072 level s2k
Mycoses, 2021Co-Authors: Alex Farr, Peter Mayser, Isaak Effendy, Brigitte Frey Tirri, Herbert Hof, Ljubomir Petricevic, Markus Ruhnke, Martin Schaller, Axel P A Schaefer, Valentina SustrAbstract:Approximately 70-75% of women will have vulvovaginal candidosis (VVC) at least once in their lifetime. In premenopausal, pregnant, asymptomatic, and healthy women and women with acute VVC, Candida albicans is the predominant species. The diagnosis of VVC should be based on clinical symptoms and microscopic detection of pseudohyphae. Symptoms alone do not allow reliable differentiation of the causes of vaginitis. In recurrent or complicated cases, diagnostics should involve fungal culture with species identification. Serological determination of antibody titers has no role in VVC. Before the induction of therapy, VVC should always be medically confirmed. Acute VVC can be treated with local imidazoles, polyenes, or Ciclopiroxolamine, using vaginal tablets, ovules, or creams. Triazoles can also be prescribed orally, together with antifungal creams, for the treatment of the vulva. Commonly available antimycotics are generally well tolerated, and the different regimens show similarly good results. Antiseptics are potentially effective but act against the physiological vaginal flora. Neither a woman with asymptomatic colonization nor an asymptomatic sexual partner should be treated. Women with chronic recurrent Candida albicans vulvovaginitis should undergo dose-reducing maintenance therapy with oral triazoles. Unnecessary antimycotic therapies should always be avoided, and non-albicans vaginitis should be treated with alternative antifungal agents. In the last 6 weeks of pregnancy, women should receive antifungal treatment to reduce the risk of vertical transmission, oral thrush, and diaper dermatitis of the newborn. Local treatment is preferred during pregnancy.
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susceptibility testing of amorolfine bifonazole and Ciclopiroxolamine against trichophyton rubrum in an in vitro model of dermatophyte nail infection
Medical Mycology, 2009Co-Authors: Martin Schaller, Claudia Borelli, Ursula Berger, Birgit Walker, Sybille Schmidt, Gunther Weindl, Andreas JackelAbstract:Antimycotic nail lacquers are effective and safe for the treatment of onychomycosis. To assess the effi cacy of three topical agents we studied the minimum inhibitory and fungicidal concentration of amorolfi ne, bifonazole and Ciclopiroxolamine. Amorolfi ne showed the most effective fungistatic and fungicidal activity in vitro against seven clinical Trichophyton rubrum nail isolates, followed in descending order by Ciclopiroxolamine and bifonazole. To mimic a nail infection more appropriately, the nail minimum fungicidal concentration (Nail-MFC) was determined in an onychomycosis model. Amorolfine and Ciclopiroxolamine had Nail-MFCs ranging from 2–32 μg/ml and 16–32 μg/ml, respectively. In contrast, bifonazole was unable to kill T. rubrum in this model. Statistical analyses of the results show a signifi cant difference between the two treatments with amorolfi ne and Ciclopiroxolamine ( P � 0.001). For amorolfi ne a mean concentration of 12.28 μg/ml (95%-CI � [8.66, 17.41]) was suffi cient to kill all strains, while for Ciclopiroxolamine about twice that concentration was needed, i.e., 24.13 μg/ml (95%-CI = [17.06, 34.13]). The individual sensitivity of six of the seven T. rubrum strains was higher for amorolfi ne. These data demonstrate that both amorolfi ne and Ciclopiroxolamine effectively kill T. rubrum growing on nail powder and suggest a better cidal action for amorolfi ne. Further investigation would be required to determine if these in vitro data can partially explain the clinical observation of signifi cantly higher cure rates in onychomycosis following a therapy with an amorolfi ne-containing nail lacquer formulation.
Peter Mayser - One of the best experts on this subject based on the ideXlab platform.
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guideline vulvovaginal candidosis awmf 015 072 level s2k
Mycoses, 2021Co-Authors: Alex Farr, Peter Mayser, Isaak Effendy, Brigitte Frey Tirri, Herbert Hof, Ljubomir Petricevic, Markus Ruhnke, Martin Schaller, Axel P A Schaefer, Valentina SustrAbstract:Approximately 70-75% of women will have vulvovaginal candidosis (VVC) at least once in their lifetime. In premenopausal, pregnant, asymptomatic, and healthy women and women with acute VVC, Candida albicans is the predominant species. The diagnosis of VVC should be based on clinical symptoms and microscopic detection of pseudohyphae. Symptoms alone do not allow reliable differentiation of the causes of vaginitis. In recurrent or complicated cases, diagnostics should involve fungal culture with species identification. Serological determination of antibody titers has no role in VVC. Before the induction of therapy, VVC should always be medically confirmed. Acute VVC can be treated with local imidazoles, polyenes, or Ciclopiroxolamine, using vaginal tablets, ovules, or creams. Triazoles can also be prescribed orally, together with antifungal creams, for the treatment of the vulva. Commonly available antimycotics are generally well tolerated, and the different regimens show similarly good results. Antiseptics are potentially effective but act against the physiological vaginal flora. Neither a woman with asymptomatic colonization nor an asymptomatic sexual partner should be treated. Women with chronic recurrent Candida albicans vulvovaginitis should undergo dose-reducing maintenance therapy with oral triazoles. Unnecessary antimycotic therapies should always be avoided, and non-albicans vaginitis should be treated with alternative antifungal agents. In the last 6 weeks of pregnancy, women should receive antifungal treatment to reduce the risk of vertical transmission, oral thrush, and diaper dermatitis of the newborn. Local treatment is preferred during pregnancy.
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widespread erosive tinea corporis by arthroderma benhamiae in a renal transplant recipient case report
Mycoses, 2010Co-Authors: Debby Budihardja, Viviane Freund, Peter MayserAbstract:Summary Superficial fungal infections are expected to be more prevalent in renal transplant recipients because of graft-preserving immunosuppressive therapy. Here we report the case of a 45-year-old patient with widespread erosive tinea corporis transmitted by domestic animals. Sequencing of the internal transcribed spacer region identified Arthroderma benhamiae (teleomorph of Trichophyton mentagrophytes) in the patient, her husband and her domestic animals. A combination therapy with systemic terbinafine hydrochloride and topically applied Ciclopiroxolamine was successful.
Andreas Jackel - One of the best experts on this subject based on the ideXlab platform.
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susceptibility testing of amorolfine bifonazole and Ciclopiroxolamine against trichophyton rubrum in an in vitro model of dermatophyte nail infection
Medical Mycology, 2009Co-Authors: Martin Schaller, Claudia Borelli, Ursula Berger, Birgit Walker, Sybille Schmidt, Gunther Weindl, Andreas JackelAbstract:Antimycotic nail lacquers are effective and safe for the treatment of onychomycosis. To assess the effi cacy of three topical agents we studied the minimum inhibitory and fungicidal concentration of amorolfi ne, bifonazole and Ciclopiroxolamine. Amorolfi ne showed the most effective fungistatic and fungicidal activity in vitro against seven clinical Trichophyton rubrum nail isolates, followed in descending order by Ciclopiroxolamine and bifonazole. To mimic a nail infection more appropriately, the nail minimum fungicidal concentration (Nail-MFC) was determined in an onychomycosis model. Amorolfine and Ciclopiroxolamine had Nail-MFCs ranging from 2–32 μg/ml and 16–32 μg/ml, respectively. In contrast, bifonazole was unable to kill T. rubrum in this model. Statistical analyses of the results show a signifi cant difference between the two treatments with amorolfi ne and Ciclopiroxolamine ( P � 0.001). For amorolfi ne a mean concentration of 12.28 μg/ml (95%-CI � [8.66, 17.41]) was suffi cient to kill all strains, while for Ciclopiroxolamine about twice that concentration was needed, i.e., 24.13 μg/ml (95%-CI = [17.06, 34.13]). The individual sensitivity of six of the seven T. rubrum strains was higher for amorolfi ne. These data demonstrate that both amorolfi ne and Ciclopiroxolamine effectively kill T. rubrum growing on nail powder and suggest a better cidal action for amorolfi ne. Further investigation would be required to determine if these in vitro data can partially explain the clinical observation of signifi cantly higher cure rates in onychomycosis following a therapy with an amorolfi ne-containing nail lacquer formulation.
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© 2009 ISHAM DOI: 10.3109/13693780802577892 Medical Mycology
2009Co-Authors: Gunther Weindl, Andreas JackelAbstract:Susceptibility testing of amorolfi ne, bifonazole and Ciclopiroxolamine against Trichophyton rubrum in an in vitro model of dermatophyte nail infectio
Nuriye Karaca - One of the best experts on this subject based on the ideXlab platform.
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in vitro susceptibility testing of dermatophytes comparison of disk diffusion and reference broth dilution methods
Diagnostic Microbiology and Infectious Disease, 2004Co-Authors: Nuriye KaracaAbstract:A total of 56 strains belonging to 4 species of dermatophytes were tested against 10 antifungal drugs by using a modification of the NCCLS (M38-P) standard for filamentous fungi. The minimum inhibitory concentration (MIC) values obtained using the dilution method were compared with the diameters of growth inhibition zones using the disk diffusion method. The antifungals used were itraconazole, fluconazole, ketoconazole, miconazole, sulconazole, oxiconazole, bifonazole, griseofulvin, Ciclopiroxolamine, and terbinafine. Relative to the other agents tested, terbinafine possessed the highest antifungal activity against all of the dermatophytes. In contrast, fluconazole was the least active drug. An increase of MIC values was accompanied by a decrease of growth inhibition zone diameter. The disk diffusion method of fungal susceptibility assessment yields data consistent with results obtained from the dilution method. The study suggests the potential value of the disk diffusion method as a convenient alternative method for testing the susceptibilities of dermatophytes.