This study prospectively evaluated the prevalence and risk factors of tinea unguium and tinea pedis in the general adult population in Madrid, Spain. One thousand subjects were clinically examined, and samples of nails and scales from the interdigital spaces of the feet were taken from those patients presenting with signs or symptoms of onychomycosis and/or tinea pedis, respectively. In addition, a sample from the fourth interdigital space of both feet was collected from all individuals with a piece of sterilized wool carpet. Tinea unguium was defined as a positive direct examination with potassium hydroxide and culture of the etiological agent from subjects with clinically abnormal nails. Patients with positive dermatophyte cultures of foot specimens were considered to have tinea pedis. The prevalence of tinea unguium was 2.8% (4.0% for men and 1.7% for women), and the prevalence of tinea pedis was 2.9% (4.2% for men and 1.7% for women). The etiological agents of tinea unguium were identified asTrichopyton rubrum (82.1%), followed by Trichopyton mentagrophytes var. interdigitale (14.3%) andTrichopyton tonsurans (3.5%). Trichophyton rubrum (44.8%) and Trichophyton mentagrophytes(44.8%), followed by Epidermophyton floccosum (7%) andT. tonsurans (3.4%), were the organisms isolated from patients with tinea pedis. The percentage of subjects who suffered simultaneously from both diseases was 1.1% (1.7% for men and 0.6% for women). In a multivariate logistic regression analysis, age (relative risk [RR], 1.03) and gender (RR, 2.50) were independent risk factors for tinea unguium, while only gender (RR, 2.65) was predictive for the occurrence of tinea pedis. In both analyses, the presence of one of the two conditions was associated with a higher risk for the appearance of the other disease (RR, >25).

We describe an unusual cluster of Corynebacterium striatum infections in 21 patients with chronic obstructive pulmonary disease (COPD) admitted to a medium-size respiratory unit. Eleven isolates from eight patients occurred simultaneously within a month. C. striatum is a potentially pathogenic microorganism with the ability to produce nosocomial infectious outbreaks and respiratory colonization in patients with advanced COPD.

The increasing prevalence of advanced chronic respiratory disease, with frequent exposure to broad-spectrum antibiotics for repeated and prolonged hospitalizations, favours the emergence of nosocomial respiratory infection by Gram-positive bacteria, such as outbreaks of Corynebacterium striatum. There is little evidence about patterns of respiratory infection, transmission and adaptive ability of this pathogen. Seventy-two C. striatum isolates from 51 advanced respiratory patients, mainly chronic obstructive pulmonary disease, were studied during 38 months. Patients were 74.8 ± 8.6 years old and 81.9% were men, who had required an average of 2.2 hospitalizations and 63.5 days in the hospital in the previous year. Of 49 isolates from 42 patients we were able to identify 12 clones by multilocus sequence analysis (MLSA), nine phenotypic variants and 22 antibiotic susceptibility patterns, and we determined their clinical and epidemiological determinants. MLSA allows identification of the existence of nosocomial outbreaks by transmission of the same or different clones, the persistence of the same clone in the environment or in patient airways for months. The study showed the high variability and adaptive capacity of the isolates, the antibiotic multidrug-resistance in all of them, and their contribution to a high morbidity and mortality (41%) during the study period.

The in vitro activity of the new triazole albaconazole (UR-9825) in comparison with those of flucytosine, fluconazole, ketoconazole, itraconazole, and voriconazole against 70 strains of Malassezia spp. was determined by a microdilution method using a colorimetric indicator for metabolic activity. Albaconazole showed an in vitro profile similar to those of the different antifungals tested (MIC < 0.06 g/ml for all the strains).Yeasts of the genus Malassezia are part of the normal mycota of the skin of humans and other warm-blooded animals, particularly in areas rich in sebaceous glands (19). Malassezia species may also be etiological agents of skin disorders and, uncommonly, systemic infections (3, 6, 16, 24, 30).In 1997, the National Committee for Clinical Laboratory Standards approved a broth micro-and macrodilution method for susceptibility testing of yeasts with RPMI 1640 medium (NCCLS-M27A) (21). However, this document is not applicable to Malassezia species other than Malassezia pachydermatis, because these organisms do not grow without lipidic substances in the medium. Only a few systems for in vitro susceptibility testing of Malassezia species have been described. In addition to present measurements in solid media, several microdilution methods have been used, but the different liquid media used, such as modified Dixon (19,27) and LeemingNotman (15), are turbid; consequently, the visual and turbidimetric results are difficult to interpret. A liquid medium method has been observed to overcome the difficulties in growth reading if one uses a colorimetric indicator for metabolic activity (Alamar blue) (25). Recently, Nakamura et al. (20) described a new microdilution method based on the urease activity of Malassezia spp.Albaconazole (ABC) is a new systemic triazole under development by J. Uriach & Cia S.A. (Barcelona, Spain) with both potent and broad-spectrum antifungal activity, good pharmacokinetics, and excellent bioavailability. It has demonstrated good in vitro activities against pathogenic yeasts (23), dermatophytes (10), and some filamentous fungi (4), including Scedosporium prolificans (5). It has also been shown to be active in the treatment of systemic aspergillosis and candidiasis in experimental animal models (2).The aim of this study was to compare the in vitro activity of ABC with those of five antifungal drugs, namely, flucytosine (5FC), fluconazole (FLC), ketoconazole (KTC), itraconazole (ITC), and voriconazole (VRC), against 70 isolates of Malassezia, namely, M. furfur (n ϭ 24), M. pachydermatis (n ϭ 10), M. sympodialis (n ϭ 21), and M. slooffiae (n ϭ 15). M. furfur was obtained from human skin, that of neonates with long stays in intensive care units. M. pachydermatis and M. slooffiae were obtained from healthy and diseased ears of dogs and pigs, respectively. M. sympodialis was isolated from normal human skin. Susceptibility testing of the drugs was initially performed with M. restricta (n ϭ 1), M. obtusa (n ϭ 1), and M. globosa (n ϭ 24). However, we were unable to obtain MICs due to the ...

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