J. Fungi2015, 1(1), 44-54; doi:10.3390/jof1010044 - published 3 April 2015 Show/Hide Abstract
Abstract: Onychomycosis is a common fungal infection, afflicting some 10% of the adult population in industrialized countries. Aside from cosmetic concerns, onychomycosis can be the cause of toe and foot pain, as well as the underlying etiology for serious secondary bacterial infections and traumatic ulcerations. In select populations, such as diabetics, the latter conditions may even result in loss of all or part of the lower extremity. Thus, a simple, cost-effective and safe treatment for onychomycosis is highly desirable. Although both topical and oral systemic antifungal agents are available for this purpose, they are not always effective, carry some medical risks, are associated with potentially significant drug-drug interactions, and may be unacceptable to patient and healthcare provider alike. Physical modalities, such as laser therapy, therefore appear appealing. The question is whether laser treatment is sufficiently efficacious and safe to warrant the current high cost per treatment. The readily available literature on this controversy will be reviewed herein.
J. Fungi2015, 1(1), 30-43; doi:10.3390/jof1010030 - published 27 March 2015 Show/Hide Abstract
Abstract: Onychomycosis is the most common nail infective disorder. It is caused mainly by anthropophilic dermatophytes, in particular by Trichophyton rubrum and T. mentagrophytesvar. interdigitale. Yeasts, like Candida albicans and C. parapsilosis, and molds, like Aspergillus spp., represent the second cause of onychomycosis. The clinical suspect of onychomycosis should be confirmed my mycology. Onychoscopy is a new method that can help the physician, as in onychomycosis, it shows a typical fringed proximal margin. Treatment is chosen depending on the modality of nail invasion, fungus species and the number of affected nails. Oral treatments are often limited by drug interactions, while topical antifungal lacquers have less efficacy. A combination of both oral and systemic treatment is often the best choice.
J. Fungi2015, 1(1), 13-29; doi:10.3390/jof1010013 - published 12 March 2015 Show/Hide Abstract
Abstract: Background: Pityriasis versicolor (PV), also known as tinea versicolor, is caused by Malassezia species. This condition is one of the most common superficial fungal infections worldwide, particularly in tropical climates. PV is difficult to cure and the chances for relapse or recurrent infections are high due to the presence of Malassezia in the normal skin flora. This review focuses on the clinical evidence supporting the efficacy of antifungal treatment for PV. Method: A systematic review of literature from the PubMed database was conducted up to 30 September 2014. The search criteria were “(pityriasis versicolor OR tinea versicolor) AND treatment”, with full text available and English language required. Conclusions: Topical antifungal medications are the first-line treatment for PV, including zinc pyrithione, ketoconazole, and terbinafine. In cases of severe or recalcitrant PV, the oral antifungal medications itraconazole and fluconazole may be more appropriate, with pramiconazole a possible future option. Oral terbinafine is not effective in treating PV and oral ketoconazole should no longer be prescribed. Maintenance, or prophylactic, therapy may be useful in preventing recurrent infection; however, at this time, there is limited research evaluating the efficacy of prophylactic antifungal treatment.
J. Fungi2015, 1(1), 4-12; doi:10.3390/jof1010004 - published 14 January 2015 Show/Hide Abstract
Abstract: Protothecosis is a rare infection, which has the potential to cause severe disease in patients with underlying immunosuppression. We describe a case of an elderly female with chronic lymphocytic leukemia (CLL), as well as other risk factors, who presented with pustular and erythematous plaques, initially presumed to be leukemia cutis. A biopsy with special stains revealed the lesions to be cutaneous protothecosis, thus presenting a most unusual concurrence of disease entities. The literature to date on this rare infection will be reviewed.
J. Fungi2015, 1(1), 1-3; doi:10.3390/jof1010001 - published 16 July 2014 Show/Hide Abstract
Abstract: Fungi are one of the most important and diverse groups of organisms on the planet, having a dual impact on humanity. They adversely impact human and animal health and can be a scourge to agriculture, while in turn serving as a beneficial source for foods and beverages, new medications, and biocontrol. There are approximately 1.5 million different species of fungi on Earth, which largely reside in soil and plant. They are also readily found on human skin and within the gastrointestinal and genitourinary tract, yet only about 300 species are known to make people sick [1,2]. Fungi are bountiful in the environment and we encounter them everyday, usually in the form of freely dispersed spores and hyphal fragments that we breath-in. Typically, encounters with fungi are harmless, as the human immune systems is well poised to handle such interactions. However, some fungal species pose significant health risks, such as endemic mycoses or those producing toxins like mycotoxins. Most importantly, immune dysfunction can lead to serious life-threatening diseases or severe fungal-induced allergic diseases such as asthma or other chronic conditions . In fact, most invasive fungal diseases are associated with changes in the host such as immunosuppression, antibiotic-mediated disruption of microflora, or other immunosuppressing conditions resulting from HIV/AIDS and hematologic malignancies [3,4]. Such diseases require therapy with antifungal agents. Yet, there are only limited classes available to treat invasive fungal infection, and emerging drug resistance further restricts treatment options. In some cases, agents used to control agriculturally important moulds are the same class as those used to treat humans, and de novo resistance can emerge from the environment . Fungi are not always easy to detect and cryptic chronic infections in the form of unculturable organisms can confound diagnosis . [...]