Search

Four cases of hair invasion by Microsporum gypseum are reported. In three the scalp was involved and in one, the beard. All presented a kerion type of invasion. In 3 cases hair penetration was of the ectothrix type, while in one case the kerion of the scalp resembled the type of invasion seen in T. schönleini infection. None of the invaded hairs showed fluorescence in Wood's light. The soil was the source of infection in 3 patients, the fungus having been isolated from soil samples collected in the vicinity of the houses of these patients through the hair bait method. In one case the source of contamination was the family dog, in which scaly, alopecic, follicularlike lesions caused by the same agent were found.

A 71-year-old female with a widespread double mycotic infection caused byC. AlbicansandT. rubrumwas discovered to be suffering from mycosis fungoides. Clinically she was found to have large, polycyclic erythematous plaques with scaly, slightly infiltrated borders, covering almost all areas of the glabrous skin, and also involving the scalp (with no hair penetration), the soles and palms, toe-webs, finger and toe nails; there was also perleche and oral thrush. Cultures yieldedC. albicansfrom most of the skin lesions, from the scalp, mouth, finger nails and urine and stool specimens, andT. rubrumfrom intermingled skin specimens, from the palms and soles and toe-nails. Blood culture was negative as were intracutaneous tests with fungal antigens and tuberculin. Histological examination confirmed the fungal invasion of the horny layer and at the same time revealed an underlying pathologic picture of mycosis fungoides, the lesions having been masked by the mycotic eruption. Intensive cytostatic and antifungal therapy led to a transient improvement but shortly thereafter there was a relapse of the fungal and lymphoproliferative manifestations and the patient died in septic shock.

A 71-year-old female with a widespread double mycotic infection caused byC. Albicans andT. rubrum was discovered to be suffering from mycosis fungoides. Clinically she was found to have large, polycyclic erythematous plaques with scaly, slightly infiltrated borders, covering almost all areas of the glabrous skin, and also involving the scalp (with no hair penetration), the soles and palms, toe-webs, finger and toe nails; there was also perleche and oral thrush. Cultures yieldedC. albicans from most of the skin lesions, from the scalp, mouth, finger nails and urine and stool specimens, andT. rubrum from intermingled skin specimens, from the palms and soles and toe-nails. Blood culture was negative as were intracutaneous tests with fungal antigens and tuberculin. Histological examination confirmed the fungal invasion of the horny layer and at the same time revealed an underlying pathologic picture of mycosis fungoides, the lesions having been masked by the mycotic eruption. Intensive cytostatic and antifungal therapy led to a transient improvement but shortly thereafter there was a relapse of the fungal and lymphoproliferative manifestations and the patient died in septic shock.

Described are three male patients showing bizarre manifestations of granulomatous dermatophytosis, all in the hand region. One had a small infiltrated nodular lesion near the thumb which was mistaken for a common insect bite. The second had a violaceous-yellowish plaque, also on the thumb, composed of 2–3 small subcutaneous nodules. The third case had five reddish intracutaneous nodules on the dorsum of the hand. Puncture of these nodules revealed the presence of fungal elements and culture yielded T. rubrumin all cases. Each patient was also found to have a fingernail affected by the same agent. Histologic sections in each case showed granulation tissue in the dermis and hypodermis, mainly in the vicinity of hair fragments with spores. These lesions appeared to be variants of Majocchi's granuloma trichophyticum.

Eleven adult patients (7 males, 4 females) were found to be infected with Microsporum canis. There was involvement of the scalp in three patients: in one male and one female there were kerion-like lesions and in one male the lesions resembled seborrheic dermatitis. There were three cases of tinea barbae, males aged 28, 65 and 82 years, in the first resembling an infected single lesion of granuloma annulare, the second with a kerion-like lesion and the third with an abscess-like tumor. There were five patients with lesions in glabrous areas: one male with a lesion of the palm resembling erythema multiforme and one with an infection of the auricular lobe resembling a seborrheic dermatitis or otitis externa; of three females with tinea faciei one had a lesion simulating granuloma faciale, one simulating lymphocytic infiltration and one simulating discoid lupus erythematosus. A cat was the source of infection in three cases; in the remainder it could not be determined with certainty. It is of note that a continuous increase in infection with M. canis has been observed in Israel during the past five years.

Hereby described is a case of a young girl suffering from widespread dermatophytosis caused byTrichophyton violaceum which proved intractable to accepted methods of therapy throughout a number of years. The girl was also found to have a history or recurrent respiratory tract infection and pyoderma in addition to verrucae vulgares, and Giardia lamblia in the gastrointestinal tract. Investigation revealed a marked immunological deficit seen in both the cellular and humoral system. It is suggested that in similar cases resistant to therapy it may be helpful to carry out a comprehensive investigation of the immunological system.

One hundred and fourteen soil samples collected from various areas of Israel were screened for the presence of keratinophilic fungi. Five species were isolated from the 59 positive samples, viz.: C. keratinophilum — 22 strains, C. evolceanui — 18, C. serratus Eidam — 10, M. gypseum —T. terrestre — 4. Most of the geophilic organisms were recovered from garden soil, road-side and sandy-soil specimens. The importance of these findings is briefly discussed.

Of 9 adults, 5 males, 4 females, with wide dissemination of Candida albicans skin lesions, the eruption started in the groin, from which it spread to other areas in most cases. In 5 cases the disseminated lesions were papulo-pustular; the rest were erythematous-squamous. Hyphae and yeast cells of C. albicans were found on direct microscopy. Diabetes was present in 5 patients, lymphoma in 1, and bullous pemphigoid in another. Onychia and paronychia were found in 7 patients, intertriginous lesions of the fingers in 4 and oral thrush in 2. Intradermal skin tests were negative. The percentage and absolute numbers of T-lymphocytes were normal in 6 of 7 patients, whereas their functional activity was impaired in 4 of 6 patients, as evidenced by the negative Graft-versus host reaction. The role of concurrent disease in the pathogenesis of the candidosis is discussed.

Chronic generalized trichophytosis in a 44-year-old female is reported. The disease began when she was 15 and gradually spread from the scalp. Surviving hairs on the scalp and eye-brows showed an endothrix invasion. Enlargement and fistulization of the cervical and axillary lymph nodes were also present. Trichophyton schoenleinii was cultured from the scalp while Trichophyton violaceum was isolated from the body skin, the nails and lymph nodes. Griseofulvin produced significant improvement with occasional relapses. The possible role of the basic cell-mediated immune defect, as revealed by the decreased number of the T and B cells, is discussed.

A new case, the third in Israel, of subcutaneous sporotrichosis is presented. A pigmentary strain of Sporothrix schenckii was cultured from the unopened and necrotic nodules of the left hand and forearm of an 80-year-old male. Experimental inoculation of the isolated fungus into mice led to the dissemination of the organism in the liver, kidneys and lungs inoculated intraperitoneally, and the development of orchitis with abscess formation in those inoculated intratesticularly. In both groups of mice the causative agent was successfully recovered. Three months of treatment with oral potassium iodide led to the disappearance of the lesions. The source of contamination was found to be the soil adhering to fragments of wood. Two strains of a fungus, morphologically identical to the human S. schenckii, were isolated through the mouse procedure and agar-plating method from soil samples collected in the vicinity of the patient's residence. The soil isolates also proved to be pathogenic in animal inoculation. This is the first isolation of S. schenckii from soils in Israel. The possible relationships between the soil isolates and Ceratocystis stenoceras are discussed.

A case of papulosis atrophicans maligna Degos of four years' duration, in a 46-year-old man, with typical skin lesions but without any abdominal symptoms as yet, is described. The histological picture showed distinct thickening of the intima of arterioles of the lower dermis, occasionally leading to almost complete occlusion; in the upper- and mid-dermis a great amount of mucin was seen.Capillaroscopy revealed the singular finding of numerous microaneurysms in the blood vessels of bulbar conjunctiva of both eyes. The explanation given by Funahashi and Fink for the mechanism of development of these microaneurysms in diabetics may be given additional support by the findings in our case of papulosis atrophicans maligna.

A group of 199 healthy laboratory animals, comprising 63 guinea pigs, 58 white mice. 47 rats and 31 rabbits, was sampled for the presence of pathogenic dermatophytes. T. mentagrophytes, var. granulare, was isolated in 10% (5-guinea pigs, 6 mice, 6 rats and 2 rabbits) and M. gypseum was found in 7 animals (3 guinea pigs, 3 mice and one rat). No ringworm lesions were observed in the respective animals. This is the first report on such findings in Israel.

A second case of actinomycetoma due to Nocardia caviae contracted in Israel is reported. A 39-year-old female of Yemenite origin, resident in Israel for more than 15 years, presented with a sclerotic tumor mass on the dorsum of the right foot which discharged an oily purulent fluid containing minute yellowish granules. Seen in the microscopic examination of smears were thin Gram-positive filaments and bacillary elements. Culture of the crushed granules yielded small pale colonies identified as Nocardia caviae. In vitro testing of the isolate to various antibiotics, isoniaside and sulphonamides showed the organism to be more sensitive to isoniaside and tetracycline. Isoniaside was administered for one year with marked improvement and was then replaced by tetracycline due to side effects, this treatment still being continued.

Three cases of scalp involvement by M. canisin infants are briefly reported. The first was a 2-month-old female with a few erythematous spots on the scalp, the second an 8-month-old male with lesions resembling seborrhoeic dermatitis and the third an 11-month-old male having areas of folliculitis of a kerion type. The father of the second case was found to have a tinea barbae infection due to the same fungus. Stray kittens were the most probable source of infection in all these cases.

During a period of 8 years 300 cases of dermatophytoses involving both hairy areas and the glabrous skin were found to be caused by M. canis. There was scalp involvement in 60%, including 8 infants and 27 adults; most of the adults presented Kerion-like lesions and presented various clinical aspects such as seborrhea capitis, folliculitis and discois lupus erythematosus. In the 21 patients showing invasion of the beard the clinical manifestations included superficial erythematosquamous patches with hyperemic slightly elevated margins, folliculitis or abscess-like lesions and Kerion-like lesions. Among the lesions found on the glabrous skin there were unusual aspects of tinea faciei in 19 adults, mimicking lymphocytic infiltration, granuloma faciale or discoid lupus erythematosus. Some of the cases of tinea corporis found in 70 patients also had lesions simulating various other dermatological entities, including erythema multiforme, psoriasiform eruption, pityriasis rosea and seborrheic dermatitis. The hands were invaded in 5 adults patients, with involvement of the finger nails in one. Repeated mycologic examinations were necessary to establish the true etiology in many of these cases.

Forty patients suffering from Kaposi's sarcoma (31 males, 9 females aged from 18 to 80 years) were examined for the presence of mycotic invasion of the toe-webs, toe-nails and soles. Fungi were found without exception in all patients. In 35 patients all three sites were invaded; the remaining 5 showed no involvement of the toe-nails. The causative agent was T. rubrum in 31 patients, T. mentagrophytes in 7, E. floccosum in 2. Four subjects with T. rubrum infection also showed a super-imposed C. albicans infection in the toe-webs. The skin tests with Trichophytin and Candidin yielded a mildly positive response to the former antigen in 4 cases and to the latter in 8 cases. The strikingly high percentage of affected cases in this group of patients with Kaposi's sarcoma is discussed.

A group of 83 patients (45 females, 38 males) suffering from various cancerous diseases were investigated for the presence of fungi, specimens being obtained from the intertriginous areas of the body and toe and fingernails as well as areas of apparently healthy skin at sites less prone to fungal infection, including the abdomen, thorax and interscapular area. A group of 25 patients with non-cancerous disease served as controls Examination of the KOH-treated scrapings and cultures revealed that the nails were affected in 85 % of the neoplastic patients, the toe-webs and soles in 79 %, the groin in 72 % and the inframmammary fold in 33 %. T. rubrum was the predominant organism found in the nails and soles, C. albicans in the groin and breast T. mentagrophytes (interdigitale) was second in order of frequency and E. floccosum was found in only a few cases. Of note was the finding of these fungi in areas with no visible changes, particularly on the abdomen (in 23 patients), the back (in 17 cases) and thorax (in 11 cases). The latter areas also were found to harbour the blastospores of Pityrosporum spp. in 22 patients. There was a negative response to trichophytin and candidin antigens in all the patients. The tests for cell-mediated immunity performed in 22 patients provided no significant data. In the control group of non-cancerous patients there was no evidence for any of the above fungi on the back, abdomen or thorax area. The findings of this study indicate that the apparently healthy skin of cancerous patients shows a higher incidence of fungal invasion in both areas usually affected by fungi as well as those usually found not to be affected in non-cancerous individuals.

Among 250 patients with tinea cruris (160 males, 90 females) lesions of both tinea pedis and tinea unguium were found in 221 and lesions of only tinea pedis in another 25. The four children were free of associated dermatophytic lesions. The predominant causative agent was T. rubrum, which was also found to be responsible for the hairy area invasion of the beard and pubis in 12 patients and for the widespread lesions of tinea corporis in 10 patients with lymphoma. None of these patients had noticed the discrete nail and foot involvement. It is therefore recommended that all patients with tinea cruris be subjected to careful examination of all possible mycotic foci, particularly the feet and nails.