Mycotic superinfections in chronic ulcers of the legs: a mycologic study in 149 patients and review of the literature.

Veraldi S, Tortorano AM, Lunardon L , Persico MC, Francia C, Bottini S, Pozzi.

Background: Thus far, the role of fungi in superinfection of chronic leg ulcers has been poorly studied. Many articles are based on either a small number of patients or single cases. Furthermore, the study conclusions are conflicting. Objective. The objective of this study was to evaluate the percentage of mycotic superinfections and their clinical importance in chronic leg ulcers. Methods. A group of 149 consecutive patients without diabetes was subjected to mycologic examination of the ulcers. Two specimens were obtained from each ulcer. Results. Mycologic examinations were positive in 11 patients (7.4%). Candida albicans was the most frequently isolated species (7 patients), followed by C. parapsilosis (2 patients), C. krusei (1 patient), C. parapsilosis and C. lipolytica (1 patient). Neither dermatophytes nor molds were isolated. No particular features characterized the clinical appearance of ulcers superinfected by fungi, and no clinical improvement of ulcers with mycotic superinfections was observed with oral antimycotic therapy.

Conclusion: Based on the results of this study, mycologic examinations may be considered unnecessary in patients without diabetes who suffer with chronic leg ulcers. The role of fungi in superinfections of chronic ulcers of the skin of lower limbs has been poorly studied thus far. More than 20 articles on this topic have been published over the last 40 years,1-21 many of which have been based on a small number of patients5,7,10,13,16or single cases.2,11,18 Furthermore, conclusions of these studies are conflicting.

This study presents the results of mycologic examinations performed on a group of 149 patients without diabetes who had chronic leg ulcers.