الفهرس 
FUNGIOnly 14 pages are availabe for public view
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Abstract
Immunodeficiency disorders occur when the body’s immune response is reduced or absent. Different immunodeficiency diseases involve different components of the immune system. The defects can be inherited and/or present at birth (congenital) or acquired or as a result of immunosuppressive drugs.
The symptoms of immunosuppression vary with the specific disorder. The signs of immunosuppression include persistent recurrent infections or severe infection by microorganisms that do not usually cause severe infection, poor response to treatment, delayed or incomplete recovery from illness, and recurrent fungal yeast infections.
The basic tests performed when an immunodeficiency is suspected should include a full blood count (including accurate lymphocyte and granulocyte counts) and immuno-globulin levels (the three most important types of antibodies: IgG, IgA and IgM).
Fungi are native inhabitants of soil and water and some species behave as opportunistic pathogens in man. They are ubiquitous and no geographical area or any group of people is spared by these organisms.
Superficial fungal infections of the skin are among the most common diseases seen in our daily practice. These infections affect the outer layers of the skin, the nails and hairs.
Superficial fungal infections of the skin and its appendages can be caused by dermatophytes, yeasts and non-dermatophytes. The yeasts and moulds now rank amongst the 10 most frequently isolated pathogens among patients in Intensive Care Units.
Fungi, like all living things, are recognized and identified on the basis of their shapes, structures and their behavioral properties. Fungi that exist predominantly in the form of independent single cells are usually called yeasts while those based on hyphal threads are called moulds (i.e. hyphal fungi). Hyphae and yeast are nearly always microscopic cell forms. A complex of hyphal strands, hyphal branches and any associated spore-bearing structure is known as a mycelium.
Superficial candidaisis is defined as infection of cutaneous or mucosal epithelium by Candida species. Superficial candidiasis is one of the most common clinical forms of candidiasis. It is characteristically chronic and recurrent.
Definitive diagnosis of fungal skin infections requires confirmation of causative organisms by microscopic examination (a KOH preparation) and laboratory fungal culture methods.
The treatment of superficial fungal infections varies based on the type of infection and the suspected pathogen. For some infection types such as tinea corporis, tinea pedis and candidiasis, treatment with topical agents may be adequate, while for infections such as tinea unguium, tinea capitis, and other refractory or severe cutaneous fungal infections, use of systemic antifungal agents is the standard of care.
Fungal infections are more common in the immunocompromised patients suffering malnutrition, some infections (e.g. AIDS), diabetes mellitus, tumors of the immune system (e.g. leukemia, lymphoma), prolonged administration of corticosteroids, immunosuppressive therapy, splenectomy or autoimmune diseases.
There are two main types of fungal skin infection in cancer patients: primary cutaneous fungal infections and cutaneous manifestations of fungemia. Cancer patients at particular risk of these infections are those who are highly immunosuppressed. In general, these are leukemia and lymphoma patients who are neutropenic following high-dose chemotherapy or bone marrow transplantation (BMT).
Fungal infections in cancer patients can be further divided into five groups: (i) superficial dermatophyte infections with little potential for dissemination; (ii) superficial candidiasis; (iii) opportunistic fungal skin infections with distinct potential for dissemination; (iv) fungal sinusitis with cutaneous extension; and (v) cutaneous manifestations of disseminated fungal infections.
In dermatophyte infections; Microsporum, Epidermo-phyton and Trichophyton species may cause superficial infections of the nails, hair, and stratum corneum. The most common presentations are tinea pedis and onychomycosis.
In superficial candidiasis the infections include Candida intertrigo, vaginitis, balanitis, perlèche, and paronychia. In the oncology population, dermatophyte infections and superficial candidiasis have similar presen-tations to those seen in immunocompetent host.
Our work aimed to study the types of fungal skin infection in the patient with immunosuppression, as well as to determine the causative organisms of fungal skin infection in those patients.
This study included 100 patients 50 patients with immunosuppression and another 50 patients without immunosuppression.
For each patien full history taking, physical examination were done. Mycological examination followed by cultures on Sabouraud dextrose agar (SDA), with chloramphenicol and SDA with chloramphenicol and cycloheximide (Dermasil), was done.
Identification of dermatophytes was done by macroscopic examination for type of growth, surface and reverse color. Microscopic examination by identification of hyphae, macroconidia and microconidia then culture on differentiation media.
Identification was done for nondermatophyte moulds according to macro and micro-morphological characters.
Identification of the yeast was done by macro and micro morphological examination as well as culture on Chromogenic candida agar (Oxoid).
In the patients with immunosuppression, 39 samples were positive for presence of fungal elements after KOH mount while in patients without immunosuppression 35 samples were positive after KOH mount and direct microscopic examination.
Among the patients with immunosuppression the fungal isolates were identified in 16(32%) as dermatophytes, 13(26%) as yeasts and 8(16%) as non dermatophyte moulds. The dermatophytes were identified into 11(22%) as Microsporum canis and 5(10%) as Trichophyton violaceum. Identification of 13 yeasts isolated showed Candida species. Further identification of Candida species revealed 8(16%) Candida albicans and 5(10%) Candida glabrata.
Concerning the non demratophyte moulds, the identification revealed 8(16%) Aspergillus species including Aspergillus niger in 1(2%).
Among the patients without immunosuppression, the fungal isolates were identified in 25(50%) as dermatophytes, 7(14%) as yeasts, and 6(12%) as non dermatophytes moulds. The dermatophytes were identified into 15(30%) as Microsporum canis and 10(20%) as Trichophyton violaceum. Identification of 7 yeasts isolated showed Candida species. Further identification of Candida species revealed 6(12%) Candida albicans and 1(2%) Candida glabrata.
Concerning the non dermatophyte moulds, the identification revealed 4(8%) as Aspergllus niger and 2(4%) as other Aspergillus species.
There are no statistically significant difference between the patients with and without immunosuppression regarding the result of KOH mount, clinical types of fungal skin infection, and causative organisms of fungal skin infection.
Among the patients with immunosuppression, there were 32 females (64%) and 18 males (36%) while among the patients without immunosuppression there were 35 females (70%) and 15 males (30%). Both were well matched regarding gender and there was no statistically significant difference between the patients with and without immunosuppression regarding the age, while there was statistically significant longer fungal disease duration in patients with than in those without immunosuppression.
Among the patients with immunosuppression with fungal skin infection, there was high statistically significant difference between types of fungal skin infection regarding age and disease duration, but there was no statistically significant difference regarding number of chemotherapy or radiotherapy sessions. Also, there was statistically significant difference regarding immunosuppressive agent duration with the highest immunosuppressive agent duration in Tinea pedis.
No statistically significant difference was found between diabetic and non diabetic regarding different types of fungal skin infection, but statistically significant difference was found between them regarding causative organisms with diabetics showing Candida albicans as most common isolated fungus.
Among the patients with immunosuppression with fungal skin infection, there was high statistically significant difference between causative organisms regarding age with the highest mean age reported with isolated fungus Aspergillus species while the lowest with Microsporum canis, but there was no statistically significant difference regarding disease duration, number of chemotherapy or radiotherapy sessions. Also, there was statistically significant difference regarding immunosuppressive agent duration with the highest immuno-suppressive agent duration in isolated fungus Trichophyton violaceum.
Also, there was no statistically significant relation was found between different causes of immunosuppression and types of fungal skin infection, comparison between types of fungal skin infection and different types of cancer showing no statistically significant difference