In the past two decades standardized in vitro antifungal susceptibility testing has been developed in responsive to increasing invasive fungal infections. Until now, antifungal susceptibility testing is not considered as a routine testing procedure in many laboratories. However, cumulative antifungal susceptibility data of fungi show that, because of the fungal organisms' different susceptibilities to antifungal agents, knowledge of the infecting fungal species is highly predictive of likely susceptibility and can be used as a guide to therapy. Recently, routine use of fluconazole susceptibility testing for Candida species is becoming recognized as a useful aid in optimizing treatment of candidiasis. This testing may be particularly useful in patients with recurrent mucosal candidiasis, and candidemia or invasive candidiasis who have been previously treated with azole antifungals, those whose infections are not responding to treatment, and those with infections caused by non-albicans species of Candida. As several new antifungal drugs have been or will be licensed in the next few years, it is very important for the clinicians to choose antifungal agents appropriately, while considering changing epidemiology and susceptibility trends.
Antifungal Agents ; Candida ; Candidemia ; Candidiasis ; Candidiasis, Invasive ; Danazol ; Epidemiology ; Fluconazole ; Fungi ; Humans

The development of selective and safe antifungal agents are relatively delayed, compared to that of other antibiotics. The reasons are the relatively lesser interest of pharmaceutical companies because of the fewer occurrence of fungal disease and the apparent lack of a highly selective fungal target, not present in other eukaryotic (including mammalian) cells. Until the 1940s, fungal skin infection was treated by keratinolytics, antiseptics, and antibacterial chemicals. The first selective antifungal agent was polylene compounds in the early 1950s, which were topical nystatin and fungizone (amphotericin-B). In 1958, the first oral fungal agents, 'griseofulvin', as developed and have been used effectively to tinea capitis and other dermatophytes. Between the late 1960s and early 1970s, the azole compound, 'the real broad spectrum antifungal agents' was introduced, and clotrimazole was the first topical azole compound followed, by miconazole and econazole. Ketoconazole was released in early 1980s and it was the first real oral antifungal agent for systemic and superficial fungal infections. However, because of serious side effects of symptomatic hepatic injury, its use was replaced by triazole antifungal agents such as itraconazole and fluconazole. Triazole was more safe and effective, and caused advancement in the treatment of onychomycosis. In addition, terbinafine 'belonging to the allylamine compounds and developed in 1984', has been approved as a very potent antifungal agent for dermatophytes and also is being used widely to cutaneous infection by candidia species and some molds.
Allylamine ; Amphotericin B ; Anti-Bacterial Agents ; Anti-Infective Agents, Local ; Antifungal Agents* ; Arthrodermataceae ; Clotrimazole ; Danazol ; Dermatomycoses* ; Econazole ; Fluconazole ; Fungi ; Itraconazole ; Ketoconazole ; Miconazole ; Nystatin ; Onychomycosis ; Skin ; Tinea Capitis

It is estimated that the number of fungal species is now in excess of 100,000, with approximately 1500 new species described each year. At present, more than 200 species of fungi have been demonstrated to cause in humans. Because the clinical symptoms and radiographic findings in fungal infections are not specific, diagnosis usually depends on three basic laboratory approaches: microbiologic, immunologic, and histopathologic. Recently, the application of nucleic acid-based detection and identification methods offers promise as rapid methods of diagnosis for fungal infections. Successful laboratory diagnosis of fungal infection is directly dependent on the proper collection of appropriate clinical specimens and the rapid transport of the specimens to the clinical laboratory. Microscopic examination of clinical specimens is perhaps the most rapid, useful, and cost-effective means of diagnosing fungal infections. The isolation of fungi on culture is the most sensitive means of diagnosing infections, and in most instances it is necessary to identify the etiologic agent.
Clinical Laboratory Techniques ; Dermatomycoses* ; Diagnosis ; Fungi* ; Humans ; Microscopy

In order to successfully determine the etiology of fungal disease, proper management in terms of the collection, transport, and processing of clinical specimens should be considered. Inappropriate collection and handling of specimens may induce confusing results and mislead to wrong diagnosis and subsequent failure in the management of the infection. All health care workers involved in obtaining the specimens, collection of them from appropriate sites, and proper labeling of specimen containers should follow appropriate instructions, usually in the form of a specimen collection procedure manual provided by the responsible laboratory. The best specimen for determining the etiologic agent is usually obtained from the active infection site, as with all disease processes. All specimens should be properly labeled with information of the collection, as well as the patient's clinical data. Appropriate transport and storage of specimens are necessary for fungal elements to remain viable for a successful culture. In the laboratory, all acceptable specimens could be processed appropriately before culturing for identification of the etiologic agents. They include direct microscopy, antigen detection procedures and/or direct molecular methods. This review article is devoted to standard recommendations in obtaining, transporting, and processing clinical specimens. In addition, some of the basic procedures of direct microscopy for the clinician is dealt for the clinician.
Delivery of Health C ; Microscopy ; Specimen Handling

Traditional identification of fungi is based on their gross morphology and microscopic findings. It takes a long time and needs experience and sometimes it is difficult because their morphology may change. Nucleic acid detection methods such as PCR have become a common tool for microbial identification and diagnosis. Molecular typing techniques provide information to detect their infection routes. They are fast, sensitive, and reproducible. Pure DNA, the targets, and methods are important for good results. There are lots of techniques like sequencing, RFLP, RAPD, and hybridization. Each method has its advantage and limitation, and proper selection is essential. In clinical application, careful consideration will reduce errors. There is a limited number of reports about cutaneous fungal infection. We review the molecular methods for fungal identification and typing, and discuss the advantages and limitations of the methods.
Diagnosis ; DNA ; DNA, Ribosomal ; Fungi ; Molecular Biology* ; Molecular Typing ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

Dermatomycoses are defined as the fungal infections of the skin including hair and nail. Generally, dermatomycoses are divided into superficial mycoses involving hair, nail and horny layer of the epidermis, and deep mycoses involving dermis and subcutis. Superficial mycoses described herein are dermatophytosis, candidiasis and Malassezia infection. Histopathologic findings of onychomycosis were a little more focused because of recently increased interest of its usefulness in making the diagnosis of onychomycosis and its causative fungi. Deep mycoses of the skin include primary or secondary dermal and/or subcutaneous fungal infections. Deep mycoses reported only in Korea were briefly described herein. Those are sporotrichosis, the most common primary cutaneous deep mycosis in Korea, and rare deep mycoses including chromoblastomycosis, phaeohyphomycosis, mycetoma, cutaneous paecillomycosis, aspergillosis, cryptococcosis, mucormycosis, systemic candidiasis, fusariomysosis, and trichophytic granuloma. Cutaneous protothecosis, a disease by achlorophilic algae, was also included because of its similarity of clinical and pathological findings with deep mycoses.
Aspergillosis ; Candidiasis ; Chromoblastomycosis ; Cryptococcosis ; Dermatomycoses* ; Dermis ; Diagnosis ; Epidermis ; Fungi ; Granuloma ; Hair ; Korea ; Malassezia ; Mucormycosis ; Mycetoma ; Mycoses ; Onychomycosis ; Phaeohyphomycosis ; Skin ; Sporotrichosis ; Tinea

Neurodevelopmental disorders are characterized by impaired development that causes adjustment problems. The spectrum of developmental impairment varies and includes intellectual disabilities, communication and social interaction challenges, and attention and executive function deficits. The neurodevelopmental disorders include intellectual disability, communication disorder, autism spectrum disorder, attention-deficit/hyperactivity disorder, neurodevelopmental motor disorders, and specific learning disorder. The differential diagnosis of neurodevelopmental disorders is important, comprehensive psychological assessmentsare required for individuals who may have a neurodevelopmental disorder. This paper focuses on intellectual, neuropsychological, adaptive behavior, and autism diagnostic assessments and psychiatric comorbidities. These assessments accurately screen for neurodevelopmental disorders and aid in differential diagnosis. The goals of psychological assessment include facilitating therapeutic planning, and suggesting prognosis. Further research is required to clarify each aspect of neurodevelopmental disorders and optimize psychological assessment tools accordingly.
Adaptation, Psychological ; Autistic Disorder ; Child ; Communication Disorders ; Comorbidity ; Diagnosis, Differential ; Executive Function ; Intellectual Disability ; Intelligence ; Interpersonal Relations ; Learning Disorders ; Prognosis ; Psychological Tests ; Symptom Assessment ; Autism Spectrum Disorder

Autism spectrum disorder (ASD) is characterized by a range of conditions including impairments in social interaction, communication, and restricted and repetitive behaviors. Pharmacological treatments can improve some symptoms of ASD, but the effect is limited and there is a huge unmet demand for successful interventions of ASD. Brain stimulation and modulation are emerging treatment options for ASD: electroconvulsive therapy for catatonia in ASD, vagal nerve stimulation for comorbid epilepsy and ASD, and deep brain stimulation for serious self-injurious behavior. Therapeutic tools are evolving to mechanism-driven treatment. Excitation/Inhibition (E/I) imbalance alters the brain mechanism of information processing and behavioral regulation. Repetitive transcranial magnetic stimulation can stabilize aberrant neuroplasticity by improving E/I balance. These brain stimulation and modulation methods are expected to be used for exploration of the pathophysiology and etiology of ASD and might facilitate the development of a mechanism-driven solution of core domains of ASD in the future.
Autistic Disorder* ; Automatic Data Processing ; Brain* ; Catatonia ; Child ; Autism Spectrum Disorder* ; Deep Brain Stimulation ; Electroconvulsive Therapy ; Epilepsy ; Interpersonal Relations ; Neuronal Plasticity ; Optogenetics ; Self-Injurious Behavior ; Transcranial Magnetic Stimulation ; Vagus Nerve Stimulation

Cerebral palsy (CP), known as "Little's disease" is the most common neurologic disorder in pediatric patients. The core problem of CP is the abnormal movement and posture which manifests very early in the development. The cornerstone to treat the children with CP is the conventional rehabilitation program based on neurodevelopmental approach that has been done for decades. Recently, various translational research has emerged, and focused on the changing therapeutic paradigm using high technologic equipment such as computer- or robotic-approach, botulinum toxin, or stem cell use with potential therapeutic effect. Many other trials using newly developed devices, or combination of old and new therapies are ongoing to demonstrate the evidence, however obstacles still remain. Regarding rehabilitative therapy, the use of exercise-based treatment such as early intervention, gross motor task training, hippotherapy, reactive balance training, treadmill training with/without body weight support, and trunk-targeted training are promising. Virtual reality, robot-assisted and computer-enhanced therapies are very potent therapeutic tools for CP under way of mass commercialization. Regarding medical therapy, botulinum toxin injection showed the most concrete benefit for CP children. Stem cell therapy is just beginning, performing experimental studies in vivo. The author reviewed the current research, expanding therapeutic options to improve the posture and movement control in children with CP.
Body Weight ; Botulinum Toxins ; Cerebral Palsy* ; Child ; Dyskinesias ; Early Intervention (Education) ; Equine-Assisted Therapy ; Humans ; Nervous System Diseases ; Posture ; Rehabilitation ; Stem Cells ; Translational Medical Research

With the recent advancement of antenatal intensive care and facilities for neonatal intensive care, the survival rate of preterm infants including extremely low birth weight infants has been significantly improved. Despite without structural disruption of the brain, the altered brain development might drive preterm infants to be prone to every neurodevelopmental disorder including cerebral palsy, cognitive impairment, language delays, behavioral disorders, and executive function deficit in school age. Many studies reported that preterm children had long-term inferiority among peers in the area of cognitive and academic performance. Follow-up studies of neurodevelopmental outcome in children born prematurely deserve clinical attention, not only to decrease morbidity related prematurity but also to achieve high quality of life of preterm infants. Recent studies have been focused on the cognitive and language outcome of preterm infants. The aim of this article was to clarify the impact and consequences of preterm birth and/or very low birthweight without major disabilities on brain development throughout childhood, focusing on cognition and language function.
Brain ; Cerebral Palsy ; Child ; Cognition* ; Executive Function ; Follow-Up Studies ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Language Development Disorders ; Premature Birth ; Quality of Life ; Survival Rate ; Critical Care