Search

We present a case of black grain mycetoma caused by Madurella mycetomatis. The diagnosis was made on the basis of conventional light microscopy and mycological studies. After 12 months of oral therapy with ketoconazole, the patient showed partial response. This is the first native Israeli case of black grain mycetoma.

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.

The incidence, clinical appearance and causative agent of tinea capitis among children of Ethiopian immigrants, was studied. Out of 124 children examined, 36 had scalp lesions and 32 cases were confirmed as scalp-ringworm on direct microscopy. Culture showed the dermatophyte to be Trichophyton violaceum. The clinical presentation, resembling seborrheic dermatitis, without clinically apparent hair invasion, was atypical.

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.

103 pregnant women, at the onset of labor, and their newborn infants, up to the forth neonatal day, were investigated for the presence of Candida albicans in their vaginal discharge stool and oral exudate. Direct microscopic examination showed the presence of pseudomycelium and budding cells in only 7 of the respective mothers (2 in vagina, 4 in the mouth and one in the stool). Culture of the vaginal discharge yielded a significant number of C. albicans colonies in 2 women, a noticeable growth in 3 and a less significant in 9. Only 17% of the mouth specimens showed a considerable quantity of the same fungus and in 7 C. albicans was detected in significant amounts in stool specimens. In the newborns C. albicans, found only by culture, was present in a small numbers (14), starting from the first neonatal day. It was found primarily in the mouth. The data obtained showed a lower incidence, than expected, of C. albicans in the vagina of pregnant women, a few hours before delivery. This suggests transmission of the organism to the newborn earlier than generally accepted.

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 case of mycetoma, with abscess-like lesions which appeared on the right forearm of a 43-year-old male, is briefly reported. A few whitish granules were detected in the oily-like discharge, the same as in the histologic examination. No bone involvement was discovered in X-ray examination. Actinomadura was identified in the culture. A daily dose of 4 g bactrin brought significant improvement to the patients continuing the treatment.

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. schonleini 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 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.

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 imparied 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.

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.