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Query: UMLS:C0011849 (diabetes)
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The authors observed 167 cases of E.N.T. mycoses over a 14-year period (1974-1988) in the E.N.T. Departments of the Abidjan University Hospitals in the Ivory Coast, and in two private health institutions in the city. The majority of cases involve candidiasis (91 cases, or 54.5%), followed by aspergillosis (72 cases, 43.1%) and rhinoentomophtorosis (4 cases, 2.4%). Men are more affected than women (125 as against 42). Men suffering from rhinoentomophtorosis are, for the most part, farmers. Among the contributory factors, we found respectively the abuse of antibiotics, either alone or in association with corticoids for general or local use (ear drops), bathing in lagoons, and diabetes. Bacterial infection is often associated with these mycoses--mainly streptococci and staphylococci aurei. Clinical signs are dominated by pruritus, dull pains, a feeling of fullness in the ear, or of burning in the pharynx. An association of systemic Miconazole and Amphotericin B (local use) has given the best results for candidiasis and aspergillosis. For rhinoentomophtorosis, treatment was long, and even disappointing, until the use of Ketoconazole which may without doubt be considered as the medicament of choice.
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PMID:[Mycoses in otorhinolaryngology. Apropos of 167 cases]. 255 Oct 27

Although several strains of Candida can infect the oral mucosa, the most commonly encountered oral fungal infection is Candida albicans, which may be highly infective because of its greater level of pathogenicity and adherence properties. C. albicans is an oral commensal in as many as 40% to 65% of healthy adult mouths. The papillated dorsal surface of the tongue and palatal mucosa beneath a maxillary denture are favored reservoir sites. Oral candidal infection almost always involves a compromised host. The compromise may be local or systemic. Local factors include decreased salivation and the weaning of dentures. Systemic factors include diabetes mellitus, pernicious anemia, and AIDS. Some have even implicated advanced age and the female gender as being mild predisposing factors. Furthermore, the C. albicans infection itself can depress a host's immune system. A patient with oral candidiasis can present with one or more of the following clinical forms: pseudomembranous, erythematous, hyperplastic, and denture erythematous. Many investigators accept median rhomboid glossitis as a form of chronic oral candidiasis. In some patients with angular cheilitis, genesis of the lesions is secondary to monilial infestation. Because C. albicans is a normal inhabitant in many mouths, diagnostic confirmation of infection often rests with successful response (i.e., resolution of lesions) to antifungal medications. This form of diagnostic confirmation can be further enhanced by culturing the offending microbe, preparing a fungal smear, or even incisional biopsy. The microscopic demonstration of fungal hyphae is highly diagnostic of the candidal infection, whether the hyphae are demonstrated on a PAS smear or on a biopsy within surface stratified squamous epithelium. Numerous medications exist for the treatment of oral candidiasis. They include the antibiotic nystatin as well as clotrimazole, ketoconazole, and fluconazole. Nystatin is safe and is used as a topical agent in rinse or pastille forms. Clotrimazole is used as a topical agent in lozenge form; it is highly effective but can cause liver enzyme changes. Ketoconazole, which is usually prescribed systemically, is highly effective but also capable of causing adverse liver changes. Chlorhexidine can be used as an oral rinse or as a disinfectant for dentures.
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PMID:Fungal infections of the oral cavity. 829 Feb 82

Some generalizations regarding fungal infections of the larynx can be made. The reader is cautioned to refer to discussions of the individual infections for exceptions to these generalizations. For the most part, the mycoses are organisms of low pathogenicity emerging as opportunistic organisms thriving in a compromised host. The isolated fungal infections of the larynx reported are exceptions to the rule. Involvement of the larynx and other body sites outside the lung generally indicates a widely disseminated form of the disease. Fungal infections most commonly occur in the immunocompromised patient, including those afflicted with AIDS, cancer, leukemia, and other lymphoreticular neoplasms, patients on long-term corticosteroid therapy, patients with chronic systemic diseases, including diabetes mellitus and severe pulmonary disease, and patients who have undergone successful organ transplantation, which depends on immunologic suppression. Although specific fungi are characteristically found in designated endemic areas, the diseases may surface in remote areas in persons who have recently traveled through the endemic sites. The pathologic picture can be confusing, and pseudoepitheliomatous changes at times resemble malignancy. When atypical features occur in a patient with a suspicious history, special stains and cultures as well as skin tests and serologic studies may be helpful in establishing the diagnosis. For the most part, amphotericin B has been the mainstay of therapy, although the introduction of the newer azole drugs (ketoconazole, itraconazole and fluconazole) may present a breakthrough in the future therapy of these lesions. Ketoconazole has been proven efficacious in certain fungal infections. Itraconazole has recently been released for clinical use. Because of its lower incidence of toxic side effects, it may replace ketoconazole in the therapy of these diseases. Finally, fluconazole, taken orally, effectively crosses the blood-brain barrier; appropriate clinical trials may prove it to be an acceptable agent for those fungi commonly affecting the central nervous system.
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PMID:Fungal infections of the larynx. 829 Feb 83

Geotrichosis affects mainly patients with systemic diseases like diabetes mellitus, leukoses, neoplasms etc. Clinically, it is similar to candidiasis and may occur as an oral, vaginal, skin, or systemic infection. Clinical specimens (98 sputa and 67 oral smears) were collected and studied using microscopic examination of Gram stained preparations and culture sampling between 1995 and 1997. Geotrichum candidum was isolated as a single pathogen in 8 sputum and 7 oral smear samples. Ten-day antifungal treatment with Nizoral was applied and resulted in relatively quick clinical improvement. The presented cases are the first cases of pulmonary and oral infections reported in our home practice in which Geotrichum candidum species was identified as a pathogen. The identification of Geotrichum candidum using combination of colonial and microscopic morphologic features increase the possibilities for diagnostic decision.
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PMID:Isolation and identification of Geotrichum candidum as an etiologic agent of geotrichosis in Bulgaria. 1037 98

Vulvovaginal candidiasis (VVC) is a cause of significant morbidity in many women of a childbearing age worldwide. There is a paucity of literature on the prevalence of this condition in postmenopausal women, although it is believed to be uncommon because of the estrogen dependence of VVC. Postmenopausal women who have underlying risk factors for VVC (e.g. hormone replacement therapy, uncontrolled diabetes mellitus, immunosuppression caused by medication or disease) may be at risk of chronic or recurrent VVC. However, as in younger women, it is likely that, even after exhaustive investigations, no cause will be found in a significant number of patients. The investigation and treatment of VVC in older women should be the same as that undertaken in younger women. Both topical and oral preparations are available, but oral regimens are perhaps more acceptable because of the ease of administration and avoidance of potentially messy creams and suppositories. Ketoconazole at a dosage of 400 mg daily for 14 days can be used to achieve clinical remission of symptoms and negative fungal cultures. Induction treatment should be followed by maintenance therapy for 6 months with ketoconazole 100 mg daily, itraconazole 50 to 100 mg daily or fluconazole 100 mg weekly or 150 mg monthly. Short courses of topical therapy, e.g. 500 mg clotrimazole pessaries as a single weekly dose for 6 months or 100mg miconazole pessaries twice weekly for 3 months, followed by once weekly for 3 months may also be used.
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PMID:Chronic vaginal candidiasis. Management in the postmenopausal patient. 1091 71

Ectopic ACTH secretion represents 8-18% of the cases of endogenous hypercortisolism. Pheochromocytomas correspond to 2-25% of the cases and surgery is the indicated treatment. We describe a case of ACTH-secreting pheochromocytoma treated with percutaneous ethanol injection (PEI) guided by computed tomography (CT). A 71-yr-old man presented with diabetes, severe hypokalemia, weight loss, muscle weakness, and hypertension. Hormonal evaluation revealed elevated levels of urinary cortisol, ACTH, catecholamines, and urinary metanephrines. There was no cortisol or ACTH response to desmopressin stimulation test. Magnetic resonance revealed bilateral adrenal nodules, larger on the left side. The suspected diagnosis was ectopic ACTH syndrome caused by pheochromocytoma. Ketoconazole treatment resulted in reduction of urinary cortisol levels but was followed by severe cholestasis and hepatic dysfunction, preventing surgery; it was substituted by octreotide with reduction of ACTH and cortisol levels, but without improvement of cholestasis. The patient presented cachexia and developed multiple pulmonary abscesses that also prevented surgical treatment, thus he was treated with percutaneous ethanol injection guided by CT of the left adrenal tumor. During the procedure, the patient had an increase in blood pressure controlled by the infusion of sodium nitroprusside followed by hypotension that required infusion of dopamine and volume expansion. Afterwards, he presented hormonal normalization, normal catecholamines levels, and clinical improvement. Histological tissue analysis confirmed pheochromocytoma. We concluded that CT-guided PEI represents an efficient alternative therapy to ectopic ACTH-secreting pheochromocytomas in patients without clinical conditions for surgery.
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PMID:Ectopic ACTH syndrome caused by pheochromocytoma: computed tomography-guided percutaneous ethanol injection as an alternative treatment. 1799 72