Program and Abstracts of Annual Meeting of the Japanese Society for Medical Mycology

Background : Although tinea pedis is one of the most prevalent diseases caused by dermatophytes, there have been few studies about distribution of dermatophytes on infected soles for this disease in Korea.
Objective : The purpose of the study was to investigate the distribution of dermatophytes on infected sole using the new direct culture method(Foot-press method).
Methods : The infected soles of 39 patients were directly pressed onto Sabouraud's dextrose agar with cycloheximide prepared in a large culture dish for a few seconds. The culture media were then incubated at 25C for 1-4 weeks.
Results and Conclusion :
1. Dermatophyte colonies were isolated from twenty-eight patients (71.8%).
2. Twenty-four of the isolated dermatophytes were Trichophyton (T.) rubrum (85.7%), and the rest were T. mentagraphytes (14.3%).
3. The number of isolated colonies from each patient range from 1 to 102 (Mean +- SD, 12.8 +- 20.7). Three isolated colonies were most common.
4. The isolation frequencies were higher in the patients of keratotic type and in those with tinea unguium (p < 0.05).
5. Positive rate was highest in patients with widely-spread lesion (p < 0.05).

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The micafungin and caspofungin susceptibilities of Saccharomyces cerevisiae strains stably hyper-expressing fungal ATP-binding cassette (ABC) or major facilitator super-family (MFS) transporters were determined using three separate methods: agar plate drug resistance, liquid microdilution susceptibility, and agar diffusion assays. Strains hyper-expressing individual alleles of ABC transporters or an MFS transporter gave the expected resistance profiles for the azoles fluconazole, itraconazole and voriconazole. The strains hyper-expressing CDR2 showed a slightly decreased susceptibility to caspofungin in agar plate drug resistance assays, as previously reported, but increased susceptibility to micafungin compared with either the strains hyper-expressing CDR1 or the null parent deleted of seven ABC transporters. The strains hyper-expressing CDR1 showed slightly decreased susceptibility to micafungin in these assays. These effects occurred within narrow ranges of candin concentration but they did not translate to other assays. None of the strains showed significant resistance to micafungin or caspofungin in liquid microdilution susceptibility assays. The strains hyper-expressing transporters and the null parent had micafungin MICs of 0.125 -0.25 μg/ml, and caspofungin MICs of 1.0-2.0 μg/ml. The antifungal activity of micafungin and caspofungin were similar in agarose diffusion assays, although the shape and size of the caspofungin inhibitory zones were affected by medium composition. The potency of micafungin and caspofungin are assay dependent but neither candin appears to be a substrate of fungal ABC or MFS transporters.

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Pulse therapy of itraconazole at a daily dose of 400 mg consisting of a 1-week administration and 3-week withdrawal was carried out for 3 cycle in patient of tinea unguium, and its efficacy and safety were evaluated. "Cure"and"Effective" were recorded by 63% and 10% of the patient respectively. Regarding side effects, one case each of itching and eczema were rocognized, however, these symptoms improved after drug administration was discontinved. No abnormalities in the laboratory data were observed. Based on these result, the pulse therapy of itoraconazole in treating tinea unguium was thus concluded to be safe and useful.

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Tinea capitis is mainly a fungal infection of children. Adult cases are uncommon. In the last two decades, some adult cases were reported in Taiwan. In 1991, Lee et al. has reported 17 adults' cases in Tainan county (southern Taiwan). Trichophyton violaceum was found to be the most prevalent etiologic agent. In 1994, Chao et al. reported 5 adult tinea capitis due to Trichophyton tonsurans in the same locale. Recently in 2002, Kuo et al. reported another 17 adults cases of tinea capitis caused also mainly by Trichophyton violaceum in Hualien county (eastern Taiwan). To investigate their claims, we have retrospectively reviewed our tinea capitis cases.
Between July 1994 and June 1995, there were 5 adult cases and 2 pediatric cases diagnosed in Mackay Memorial Hospital, Taitung Branch. All the adults' cases were females ranging in age from 62 to 84 years old without history of immunosuppression. Case 1 and 2 were black dot types. Case 3 and 4 were inflammatory types. Case 5 was gray patch type. Examination with 20% potassium hydroxide (KOH) on mounted specimens showed round spores within the hair shafts for the first 4 cases and septate hyaline hyphae on scales for case 5. Cultures from infected hair and scales grew Trichophyton violaceum (case 1 to 4) and Trichophyton rubrum (case 5) respectively.
Our observation agreed with other studies in Taiwan with similar (1) bimodal age distribution; (2) adult predominance; (3) female predominance; and (4) Trichophyton violaceum being the most common etiologic agent in adult cases.

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