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Deep cutaneous fungal infections including deep dermatophytosis are responsible for significant morbidity and mortality, especially in immunocompromised patients. Variable and longer turnaround time on tissue culture results delay diagnosis. We sought to seek the fast bedside diagnosis for disseminated deep dermatophytosis by direct microscopy using a blunt scalpel or needle aspiration before biopsy. This is a 6-year retrospective review of patients with a diagnosis of disseminated deep dermatophytosis seen at a single tertiary care institution. Trichophyton rubrum was isolated in four patients, and T. mentagrophyte complex in one patient. All the dermatophyte isolates can grow at 37 °C. Microscopy of purulence sampling from intact nodules demonstrated abundant septate hyphae, and also isolation from purulence was concordance with skin tissue culture. Ultrasound-guided sampling from non-eroded can yield purulence, and direct microscopy of purulence may facilitate rapid diagnosis of deep dermatophytosis and serve to prevent disease progression and dissemination.

Introduction: Tinea capitis (TC) is a disease caused by dermatophytes on the scalp and hair. This disease mainly infects pre-school children, although there has been a gradual increase in the number of adults infected with TC over recent years. Here, we retrospectively analyzed epidemiological data relating to adult TC (ATC) in Hangzhou, eastern China, over the last decade.Materials and Methods: We analyzed all adult patients who were referred to the Mycology Laboratory of Hangzhou Third People's Hospital (Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine) between 2012 and 2021 and suspected of having TC. Mycological tests were used to confirm the diagnosis. We acquired arrange of epidemiological data for analysis, including age, gender, and the distribution of dermatophytes. We also collated data relating to risk factors, such as tinea with other sites, underlying diseases, and a history of animal contact. Results: A total of 165 patients were diagnosed with ATC, including 77 males (46.7%) and 88 females (53.3%). The gender ratio was 0.875 and the mean age was 49±23.1 years (range: 18-96 years). The most dominant dermatophytes were Trichophyton violaceum (25.6%) and Trichophyton rubrum (25.6%), followed by Microsporum canis (24.4%). Anthropophilic dermatophytes accounted for 63.3% of all cases. Interestingly, 63 patients (38.2%) with a confirmed diagnosis of ATC also presented tinea with other sites.Conclusion: This study indicated that ATC infection is more commonly found in women, especially in those aged >45 years. Anthropophilic dermatophytes, T. violaceum and T. rubrum, were found to be the most dominant dermatophytes, followed by M. canis. Dermatologists should consider that tinea with other sites may represent a risk factor for ATC.

Combination dermoscopy is a simple, noninvasive and accurate technique for the rapid diagnosis, initiation and monitoring of systemic antifungal therapy for tinea faciei caused by Microsporum canis, especially in settings where fungal testing is not available.

A 43-year-old male barber presented with 1 year history of a painful, itchy plaque on the dorsal hand. Microsporum canis was recovered from pus of the lesion. Serologic testing for human immunodeficiency virus (HIV) antibody was positive, with a CD4+ count of 81 cells per cubic millimeter. Invasive cutaneous Microsporum canis infection is uncommon and can be suggestive of HIV infection or other conditions of immunocompromise.

Ultraviolet dermoscopy is a rapid and noninvasive diagnosis tool for tinea auricularis caused by Microsporum canis, which facilitated early treatment with systemic antifungals.

In the present report, we describe an unusual case of mixed infection of Candida albicans and Talaromyces marneffei in the oral cavity and oropharynx with cutaneous involvement. On the CHROMagar Candida plate, green colonies (identified as C. albicans) and tiny violet colonies (identified as T. marneffei) grew from the throat swab after incubation for 96 hours. 10 clinical isolates of T. marneffei were used to verify their color production on CHROMagar Candida. All colonies were violet on the fourth, seventh and ninth day incubated at 37 °C. T. marneffei appears violet on the CHROMagar Candida plate, but it may be easily ignored because of its slow growth and small colony size, especially after incubation for 48 hours. Therefore, when using CHROMagar Candida plate to detect specimens in AIDS patients, special attention must be paid to detect non–yeasts such as T. marneffei for up to 96 hours.

To characterize the clinical and mycological features of favus of scrotum due to Trichophyton rubrum. A single-site prospective study was carried out in an outpatient dermatology clinic. Microscopic examination and fungal culture were done using skin scrapings. Scales on the scrotum were stained with PAS and visualized by microscopy, including in vivo reflectance confocal microscopy (RCM). Two strains were analyzed by RAPD typing. Scutular lesions were fixed for scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Cultures of the scale from the scrotum and/or groin in all patients showed a growth of T. rubrum. T. rubrum strains from scrotum and groins in one patient were demonstrated as the same strain by RAPD typing. The average age of patients was 34.1 ± 12.78 years. The mean course was 8.2 ± 5.07 days. All the patients received only topical treatment for 2 weeks without recurrence. Direct smear, calcofluor-white staining and in vivo RCM study of the scrotal favus in patients showed a massive number of septate branching hyphae, while fewer septate hyphae in scales in the groin. Abundant hyphae were found only in the outer layer of the stratum corneum of the scrotum under SEM and TEM with intact bilateral cell walls, and normal nucleus, liposomes and reticulum. Few distorted hyphae structures, cell wall degeneration, degenerated cytoplasm and the autophagy phenomenon could be seen in scales from groin under TEM. Scrotal favus due to T. rubrum is still a true infection, which most often occurred in immunocompetent patients.

Tinea capitis remains a common public health problem worldwide, especially in developing countries. OBJECTIVES To investigate the changes of the predominant dermatophytes of tinea capitis in children in Hangzhou in recent 9 years. METHODS The age, gender and pathogen spectrum of 650 children with tinea capitis at the Department of Dermatology, Affiliated Third People's Hospital of Hangzhou, Anhui Medical University from 2011 to 2019 were analysed, and the distribution of pathogens from 1998 to 2000 was compared. RESULTS Among the 650 cases, 340 cases (48.2%) were males and 310 cases (51.8%) were females. The main population infected with tinea capitis was children aged 0-10 years (620 cases, 95.4%). From 2011 to 2019, the predominant dermatophyte was changed from Trichophyton violaceum (2011) to Trichophyton mentagrophytes complex (2012-2015) and later to Microsporum canis (2016-2019). In the past 9 years, M. canis (250 cases, 38.5%) was the most common dermatophyte and followed by T mentagrophytes complex (209 cases, 32.2%). The dermatophyte spectrum was statistically different between the years 2011 and 2019 (Chi square: χ2 = 69.75, P

Linear IgA bullous dermatosis (LABD) is a rare acquired autoimmune chronic vesiculobullous dermatosis affecting primarily young children and older adults. We report a 17-year-old Chinese boy with a 2-month history of intense itching erythema or tense vesicles on healthy skin or on an erythematous base, with parts of lesions arising a characteristic "cluster of jewels" pattern. With the characteristics of vesicles or blisters on the skin, subepidermal blisters with neutrophilic infiltrate on histology, and linear IgA deposits on the basement membrane zone and absence of other immunoglobulins on direct immunofluorescence, LABD was dignosized. Sulfapyridine has also been reported as one of the best options of systemic therapy for LABD. Our patient successfully treated with only oral sulfasalazine (alternative medicine of sulfasalazine), which is safe and effective.

A 3 year old boy presented with one month of nail shedding affecting two right hand fingernails and three left hand fingernails (fig 1 …

Background Antimicrobial photodynamic therapy(aPDT) has been used to treat localized cutaneous fungal infections that have an enhanced antifungal susceptibility profile. The aim of this study was to evaluate the effect of ALA aPDT on both the growth and the antimicrobial and antifungal susceptibility of Prototheca wickerhamii. Methods Six isolates of P. wickerhamii were used in the present study. The inocula in sterile 6-well microtiter plates were irradiated with narrow band LED (633 ± 10 nm) at the light intensity of 100 mW/cm2 and at a distance of 1 cm for 900 s. The ALA was tested at concentrations of 1, 5, and 10 mmol/l, while 10-μl aliquots of suspensions from each group were inoculated on Sabouraud dextrose agar to test the photoinactivation. Antibiotic susceptibility was investigated by the disc-diffusion method. Results Our study shows ALA aPDT induced 46% ± 24.23% reduction of the growth of all tested P. wickerhamii strains in T1 group. ALA aPDT induced 50.39% ± 19.88% reduction of the growth of all tested P. wickerhamii strains in T2 group. ALA aPDT induced 52.68 ± 20.22% reduction of the growth of all tested P. wickerhamii strains inT3 group. Single ALA aPDT induced 32.97% ± 1.6% growith reduction of three tested strains(O23d, O23e and 62,207), while repeated ALA aPDT induced 51.65 ± 2.91% reduction of the growth(P value = 0.000). There were no significant difference of the inhibitory zone diameter of both antibacterial and antifungal agents before and after ALA aPDT. Conclusions ALA aPDT can inactivate the growth of P. wickerhamii, and repeated aPDT has more photoinactivation of P. wickerhamii. ALA aPDT does not change antibacterial agents and antifungal drugs susceptibility profile of P. wickerhamii.

Alternaria alternata is a rare etiology of phaeohyphomycosis in immunocompromised patients, which has never been reported to cause chromoblastomycosis. As far as we know, this is the first chromoblastomycosis case successfully treated with a short course of systemic antifungals and subsequent 5-aminolevulinic acid-photodynamic therapy.

The main causes of performance variation in tube bending process are variations in the mechanical properties of material, initial tube thickness, coefficient of friction and other forming process parameters. In order to control this performance variation and to optimize the tube bending process parameters, a robust design method is proposed in this paper for the tube bending process, based on the finite element method and the Taguchi method. During the robust design process, the finite element analysis is incorporated to simulate the tube bending process and calculate the objective function value, the orthogonal design method is selected to arrange the simulation experiments and calculate the S/N ratio. Finally, a case study for the tube bending process is implemented. With the objective to control tube crack (reduce the maximum thinning ratio) and its variation, the robust design mathematical model is established. The optimal design parameters are obtained and the maximum thinning ratio has been reduced and its variation has been controlled.