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Endemic deep or systemic mycoses are common in specific geographical areas of the world. Coccidioidomycosis is present in semi-desert areas, histoplasmosis and paracoccidioidomycosis in tropical regions and blastomycosis belongs to temperate climates. The two former are widely distributed in the American continent and some tropical regions of the world; the third is limited to Central and South America, and the last to North America and Central and East Africa. These mycoses all have a similar pathogenesis, as the inoculum enters the host through the respiratory tract. Cutaneous manifestations are secondary to lymphatic and hematogenous dissemination. These deep mycoses are exceptional in Europe. Most cases are observed in returning travelers from endemic areas, aid workers, archaeologists, speleologist and immigrants. However, there have been some autochthonous cases of histoplasmosis due to Histoplasma capsulatum var. capsulatum reported in European countries such as Italy and Germany. In this article, we provide up-to-date epidemiological, clinical, diagnostic and therapeutic data on the four most important imported systemic mycoses in Europe., (© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.)

Recognition of and therapy for fungal infections of the lungs still presents problems even for the experienced clinician. The distinction between invasive mycoses of the lungs and fungal colonisations that do not require therapy is cinically difficult and can often not be made satisfactorily even with advanced microbiological diagnostics. One must differentiate between a primary, often locally limited, endemic pulmonary mycosis and a pulmonary mycosis against the background of a locally or systemically compromised immune system. Patients at risk include those with advanced HIV infections, patients under long-term antibiotic therapy as well as oncological and multimorbid patients. The pulmonary manifestation of a mycosis may not only be the starting point for a systemic dissemination but can also arise in the course of hematogenous spread of the infection. The latter can appear, for example, as an invasive pulmonary aspergillosis in immunesuppressed patients. Thus, early clinical, radiological and biological confirmation of the diagnosis is essential in order to avoid the possible complications of pulmonary mycosis.

Lobomycosis, caused by the fungal pathogen Lacazia loboi, is a chronic deep mycosis and is only found in Central and South America. Clinically the disease is characterized by shiny keloidal nodules appearing mainly on the exposed parts such as face and the upper and lower extremities. Therapeutically the surgical removal of the lesions is considered as the only successful treatment. We describe the therapeutic response of a patient with Lobo's disease treated for one year with a combination of clofazimine (100 mg/day) and itraconazole (100 mg/day). A complete clinical and histopathological remission of the disease was observed. The patient has been followed for three years.

Venereological patients (Group I, n = 210), intact women without any gynaecological disease (Group II, n = 125), pregnant women close to full term (Group III, n = 200), and women with vaginal fluor (Group IV, n = 380) were examined and compared for the occurrence of blastomyces, particularly Candida albicans (C. albicans), in the vagina, oral cavity, and rectum. The presence of C. albicans in vaginal secretion was established from 15.7 per cent of all probands in Group I, 12.0 per cent in Group II, 24.0 per cent in Group III, and 31.6 per cent in Group IV. The difference between Groups I and II was not significant. Promiscuity, consequently, did not seem to have major impact upon vaginal blastomyces infestation of young women. Probands with rectal infestation of C. albicans accounted for figures between 20.0 and 27.5 per cent in all four groups. Group I took first position in oral infestation of C. albicans, the figure being 64.8 per cent which was significantly above those recorded from all other groups, between 33.9 and 37.5 per cent. The correlations between rectal and vaginal occurrence of C. albicans are discussed.

The vaginal smear of 200 women treated with hormonal contraceptives (group A), of 45 women using an IUD (group B) and of 220 women representing an untreated control group (group C) was investigated on infection with vaginal yeasts and trichomonads. It was found, that infection with vaginal yeasts in women of group A was significantly higher (23,7%), than in women of group B (9,0%) and group C (9,5%). The occurance of trichomonads was also different between the groups. It was about 6,6% in group B and 6,8% in group C but only 2,1% in group A. From these results we concluded, that hormonal contraceptives on vaginal yeast infections act as a stimulating factor.

Vaginal and vulva smears and urine obtained by catheters from 232 pregnant and 251 non-pregnant women were examined for the growth of yeasts. These fungi could be grown from the vulvo-vaginal smears from 26,7% of the pregnant women. Yeasts were found in 6,4% of the urine samples. In the case of non-pregnant women, fungi were found in 19,9% of the vulvo-vaginal smears, whereas 3,2% of the urine samples contained yeasts. The growth of yeasts was encouraged by the addition of various urine dilutions using to a nutrient solution containing Candida albicans of Torulopsis glabrata the urine obtained via catheters from both pregnant and non-pregnant women. There was no difference in the intensity of the effect between the two urine charges. Due to the relatively rare occurrence of yeasts in the urine from pregnant and non-pregnant women it suspected that the increased frequency of vaginal mycoses during pregnancy is not caused by a general disposition, but that locally effective factors are responsible.

The clinical picture of pulmonary mycoses is described and discussed. The diagnosis of tropical pulmonary mycoses is--in contrast to the native mycoses--relatively simple with respective serological tests and intracutaneous reactions. For the diagnosis the differentiation of fungi or molds is of utmost importance.

Bismuth-containing Sabouraud's glucose agar was used as an indicator medium. Preliminary experience is reported in this paper. Blastomyces infection was properly identified in some 82 per cent of all cases checked, and falsely negative results cropped up in 18 per cent. The causes are discussed. The medium is considered by the authors are being suitable for the diagnosis of blastomyces infection in the genital region of women.