We conducted a retrospective cohort study on clinical and mycological features of tinea pedis and tinea unguium in psychiatric inpatients in Japan. Of the 317 inpatients (152 with schizophrenia and 165 with depression), 46.1% had tinea pedis and 23.7% had tinea unguium. Of those with tinea pedis, 48.6% also had tinea unguium. The most common clinical type of tinea pedis was the combination of interdigital type and hyperkeratotic type. The mean clinical score of tinea pedis was 5.9, and that of tinea unguium based on the Scoring Clinical Index for Onychomycosis (SCIO) was 15.8. The main causative species of tinea pedis were Trichophyton rubrum (68.4%) and T. mentagrophytes (26.3%). No statistically significant differences were observed in incidence rates of tinea pedis or tinea unguium between men and women or between patients with schizophrenia and those with depression. As for incidence rates by age, patients with depression showed a single peak for tinea pedis and / or tinea unguium in their 50's, while patients with schizophrenia exhibited twin peaks for tinea pedis and / or tinea unguium in their 50's and 70's. Both tinea pedis and tinea unguium tended to become more severe in patients with chronic schizophrenia. Our study suggests that schizophrenia and depression, like diabetes mellitus and HIV infections, should be regarded as risk factors for tinea pedis and tinea unguium.

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Filamentous fungi were detected in the blood culture of a one-year-old boy after autologous peripheral blood stem cell transplantation. The patient was suspected to have aspergillosis and received micafungin. Fungi were isolated on potato dextrose agar medium and incubated at 37℃ for 2-5 days. Grayish, cottony colonies formed. A slide culture showed a spherical sporangium at the tips of the sporangiophores. The fungus could have been a zygomycete. The zygomycete was isolated from three blood cultures. The antifungal drug was changed from micafungin to liposomal amphotericin B, which resulted in an improvement in the patient's symptoms. Growth was observed at 37℃, but not 42℃ in a growth temperature test. Gene sequence analysis identified the fungus as Mucor velutinosus. To the best of our knowledge, this is the first time M. velutinosus has been detected in Japan, and this case is very rare. Zygomycetes are known to be pathogens that cause fungal infections in immunodeficient patients such as those with leukemia. They are difficult to identify by culture and are identified at autopsy in many cases. Therefore, culture examinations should be performed for immunodeficient patients with the consideration of zygomycetes.

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In vitro antifungal susceptibility of pathogenic fungi is important information for physicians when selecting an appropriate antifungal drug, deciding the route of drug administration, surveying resistant strains, and so on. Although both the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) are well known endpoints of antifungal susceptibility, the MIC is by far the more highly referred in clinical laboratories. In fact, while methods for determining the MIC have been standardized in Japan and the West to ensure accuracy and reproducibility of the results, by contrast, scant attention has been paid to standardizing methods for determining the MFC. The same preference for MIC topical antifungal drugs for dermatophytes are concerned. In 1999, the Japanese Society of Medical Mycology published a new, standardized method of testing the MIC for dermatophytes and this has since been widely adopted. Nonetheless, the fact remains that the MFC is still determined using methods derived from antifungal pharmacology. Recently in Japan, however, the MFC of topical antifungal drugs has begun attracting more attention due to the development of new antifungal agents with fungicidal activity. These new developments call for improving our understanding of both the MIC and MFC as endpoints of antifungal susceptibility, and for standardizing methods for determining the MFC.
The present paper has two objectives : first, to overview the MIC and MFC for topical drugs as endpoints of antifungal susceptibility; and second, to describe a novel test based on the standardized broth microdilution method combined with the trans-well system and neutral red, which we recently developed in our laboratory for directly measuring the MFC.

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Onychomycosis is a common disease seen in dermatology practice. Most patients with onychomycosis opt for treatment due to the social stigma attached to the unsightly appearance, as well as the pain that can at times make walking difficult. However, in many cases, onychomycosis is resistant to oral antifungal medication, which is the first-line therapy for this disease. In recent years, we have attempted a new treatment method using a long-pulsed 1,064nm Nd :YAG laser (Cutera Inc., Brisbane, CA, USA) in refractory cases with onychomycosis. Using 1) a laser beam with a spot size of 5.0 mm and 2) sequential irradiation at low fluence, we 3) applied the laser to the infected lesions in a motion similar to showering, while maintaining a distance of several centimeters from the skin (Laser Genesis^TM). Treatment efficacy was assessed using nail turbidity scores on a five-point scale. Improvement in onychomycosis was noted in more than 68.8% of all cases, thus demonstrating the high efficacy of this method. No major adverse reactions were observed during the treatment period. Since its mechanism of action clearly differs from that of antifungal agents, it can be considered a useful treatment option for cases with onychomycosis resistant to antifungal therapy. Future studies should examine “combined therapy” with oral / topical antifungal agents and this laser treatment, which may provide a significant improvement in the level of satisfaction among patients with onychomycosis.

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D. Gruby (1842-1844) detected the fungus in tinea as a causative agent and C.P. Robin (1853) described Microsporum mentagrophytes that was transferred to Trichophyton by Blanchard (1896). Sabouraud (1910) established a group of ectothrix microïde which was divided into gypseum type (6 species: T. asteroids, T. granulosum, T. lacticolor and 3 species) and niveum type (T. radians and T. denticulatum). Thereafter, Epidermophyton simii Pinoy, 1912 and T. interdigitale Priestly, 1917 were reported. These species were classified as T. mentagrophytes by C.W. Emmons (1934 and 1940). Arthroderma simii Stockdale et al., 1965, A. benhamiae, Ajello and Cheng, 1967 and A. vanbreuseghemii Takashio, 1973 were discovered as teleomorphs of T. simii, T. mentagrophytes var. granulosum and T. mentagrophytes (mainly granulosum-asteroides form), respectively. Makimura et al., (1998) reported phylogenetic classification of T. mentagrophytes complex strains based on DNA sequences of nuclear ribosomal internal transcribed spacer 1 (ITS1) regions, indicating that A. vanbreuseghemii and T. interdigitale belong to the same clade that was later named T. interdigatale by Gräser et al.(1999). This naming has confused medical and veterinary doctors since anthropophilic isolates (T. interdigitale) and zoophilic isolates (A. vanbreuseghemii) were included as the same species.

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We report two cases of dermatophytosis caused by Microsporum (M.) gypseum. One case was a 59-year-old healthy woman who complained of itchy annular erythema on her right forearm. We isolated M. gypseum from scales on the forearm. The other case was a 73-year-old midwife who had developed infiltrated erythema on her face for 6 months. M. gypseum was isolated from scales of the nose. Both women liked gardening and M. gypseum was isolated from the garden soil of these women by a hair-baiting technique. The first case had a cat, a mouse and an owl, and the second had a dog. Hairbrush culture of these pets, however, was negative. So we concluded both cases were infected with M. gypseum from garden soil. We isolated M. gypseum from soil collected in Chigasaki city. Of the 7 fungal cultures from 10 samples, 2 cultures were identified as M. gypseum.

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