Invasive mycosis

Aureobasidium pullulans, a common dimorphic endophyte of grapevine [305] and saprophyte on plant leaves, occurs in addition as an allergenic fungus [297, 307] and as a rare opportunistic pathogen in humans, where it caused keratitis, pulmonary infection, systemic infections, cutaneous infection, peritonitis, and invasive mycosis in an AIDS patient [80]. Complete 18S as well as partial 26 S rDNA sequences corroborate a relationship of Aureobasidium species with Dothideales (fig. 3) [16, 89, 300]. 

However, a clinical study in severely ill patients with invasive mycosis briefly mentions that two patients receiving voriconazole developed high trough digoxin levels, which required the digoxin to be withdrawn. One patient was symptomatic with an arrhythmia and ECG changes. ... 

Cesaro S, Toffolutti T, Messina C, Galore E, Alaggio R, Cusinato R, PiUon M, Zanesco L. Safety and efficacy of caspofungin and liposomal amphotericin B, followed by voriconazole in young patients affected by refractory invasive mycosis. EurJHaematol (2004) 73,50-5. 

Since the invasive form of Candida in vaginal mycosis is the pseudo-mycelium, we also looked at this morphologically specialized material. We observed that bifonazole causes an accumulation of dihydrolanosterol exclusively, whereas clotrimazole causes the normal accumulation of 24-methylenedihydrolanosterol, dihydrolanosterol, and lanosterol (Figure 18). However, after bifonazole application, the rate of total sterol synthesis is lowered by a factor of two, a result which will be discussed later. 

Fungal infections superficial dermatophyte or Candida infections purely involving the skin can be treated with a topical imidazole (e.g. clotrimazole, miconazole). Pityriasis versicolor, a yeast infection, primarily involves the trunk m young adults it responds poorly to imidazoles but topical terbinafine or selenium sulphide preparations are effective severe infection may require systemic itraconazole. Invasion of hair or nails by a dermatophyte or a deep mycosis requires systemic therapy terbinafine is the most effective drug. Terbinafine and griseo-fulvin are ineffective against yeasts, for which itraconazole is an alternative. Itraconazole can be used in weekly pulses each month for 3-4 months it is less effective against dermatophytes than terbinafine. 

Obayashi T, Yoshida M., Takeshi M., Goto H Yasuoka A.. Iwasaki H.. Teshima H.. Kohno S., Horiuchi A.. Ito A,. Yamaguchi H.. Shimada K. and Kawai T. (1995) Plasma (l- 3)-P-D-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episodes. Lancet.. 145, 17-20. 

Obayashi T, Yoshida M, Mori T et al. Plasma (l->3)-beta-D- can measurement in diagnosis of invasive deep mycosis and fungal febrile episodes. Lancet 1995 345 17-20. 

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