In vivo fungicidal effect of KP-103 in a guinea pig model of interdigital tinea pedis determined by using a new method for removing the antimycotic carryover effect

We developed a new technique for culture study that successfully recovers fungi from drug-treated skin tissues, in which tissue specimens were homogenized, dialyzed against water, digested with trypsin, and then washed with PBS, to eliminate the drug that remaining in the skin tissue specimens. With this modified culture method, we reevaluated the efficacy of KP-103, neticonazole, and lanoconazole in a guinea pig interdigital tinea pedis model. Guinea pigs with tinea pedis were topically treated with a 1% solution of KP-103 or a reference drug once a day for 10 consecutive days. Five days after the last treatment, left and right feet were subjected to culture study by the conventional and modified recovery culture methods, respectively. One hundred percent (20/20) of lanoconazole-treated feet were judged as culture-negative by the conventional culture method, but 85% (17/20) of the feet were shown to be culture-positive when the modified recovery culture method was used. On the other hand, KP-103 achieved high rates of culture-negative rates, 95% (19/20) and 85% (17/20), in both conventional and modified culture methods, respectively. Furthermore, on day-30 posttreatment, KP-103 sterilized 14 of the 20 infected feet, whereas neticonazole and lanoconazole were not effective even in reducing fungal burden. KP-103 proved to be highly effective in achieving mycological cure and preventing relapse against tinea pedis presumably because of its good bioavailability in the skin based on its low keratin-affinity, along with its potent antifungal activity.

KP-103, a novel triazole derivative, is effective in preventing relapse and successfully treating experimental interdigital tinea pedis and tinea corporis in guinea pigs

The therapeutic efficacy of KP-103, a triazole derivative, for 10 guinea pigs with interdigital tinea pedis or tinea corporis was investigated. Topical KP-103 solution (0.25 to 1%) was dose-dependently effective in treating both dermatophytoses. A 1% KP-103-treatment rendered all infected skins culture-negative on day-2 posttreatment. A high negative-culture rate was obtained with 1% solutions of butenafine and lanoconazole but not with 1% neticonazole solution. The follow up study performed on day-30 and day-9 posttreatment demonstrated that the relapse rates for 1% KP-103-treated animals with tinea pedis and for those with tinea corporis were 20 and 30%, respectively, and that these values were the same as those for 1% butenafine-treated animals, but lower than those for 1% lanoconazole-treated animals (55 and 80%, respectively). When a single dose of 1% KP-103 was applied to the back skin 48 hr before fungal inoculation, 9 of the 10 animals were protected from the dermatophytosis, suggesting that active KP-103 is retained in skin tissue for at least 48 hr after dosing. Moreover, it was suggested that KP-103 retains a high activity in the horny layer because of its lower keratin-affinity. The effectiveness of KP-103 against dermatophytoses may be due to the favorable pharmacokinetic properties in the skin tissues, together with its potent antifungal activity.

Experimental tinea unguium model to assess topical antifungal agents using the infected human nail with dermatophyte in vitro

Therapy for onychomycosis is difficult because a complete cure requires long-term treatment. Although strong systemic antifungal drugs are potent enough to achieve a cure, they often have side effects. Therefore, one approach is to develop a new topical antifungal drug to act directly on the nail tissue. In this study, we developed a new in vitro model for assessing antifungal activity using the human nail. An O-ring was fixed with silicon bond to the dorsal surface of the nail. An antifungal agent applied to the surface will penetrate the nail tissue. The ventral side of the nail was placed on an agar plate inoculated with conidia of Trichophyton mentagrophytes. Nail specimens were infected with the fungi from the agar, and a clear fungal colony formed on the agar surrounding the nail on the fifth day of cultivation. After 14 days, the fungal colony in the control groups was shown to be expanding over the entire nail. The fungal colony in the group treated with sodium pyrithione had disappeared. Although the in vitro antifungal activity of sodium pyrithione has poor potency among the agents used, it showed remarkable antifungal activity, as assessed by image analysis. This model enables one to evaluate the activity of a topical antifungal agent that has penetrated human nail tissue, and it may facilitate research on a topical agent for onychomycosis.

Effect of lactoferrin feeding on the host antifungal response in guinea-pigs infected or immunised with Trichophyton mentagrophytes

Earlier studies revealed that oral administration of lactoferrin (LF), a multi-functional milk protein, facilitated curing of dermatophytosis in guinea-pigs and man by an unknown mechanism. The present study aimed to assess the effect of feeding bovine LF on the host antifungal defence systems in guinea-pigs infected or immunised with Trichophyton mentagrophytes, a dermatophytosis-causing fungus. The unbound iron-binding capacity (UIBC) of the plasma of individual animals varied, and plasma with higher UIBC inhibited growth of T. mentagrophytes in vitro. However, LF administration did not enhance plasma UIBC or the anti-T. mentagrophytes activity of plasma in infected or uninfected animals. Phagocytic activity and reactive oxygen (RO) production of blood neutrophil polymorphonuclear leucocytes (PMNLs) were estimated by flow cytometry. LF administration caused no significant effects on phagocytic activity or RO production of neutrophil PMNLs in infected or uninfected animals. The functions of mononuclear cells (MNC) from the spleen were investigated in guinea-pigs immunised with heat-killed T. mentagrophytes conidia. The MNC were cultured with concanavalin A or inactivated T. mentagrophytes. In the bromo-deoxyuridine incorporation assay, the stimulation index was higher for MNC derived from LF-treated animals than for those from control animals. The culture supernates of MNC enhanced the ability of macrophages to kill T. mentagrophytes conidia. Furthermore, stronger augmentation was observed with the culture supernate from LF-treated animals than with that from control animals. In conclusion, LF feeding may potentiate the host antifungal defence systems by modulating MNC function rather than plasma antifungal activity or peripheral blood neutrophil PMNL activity.

[The influence of urea, ammonia and nitrate as they affect growth and viability of Trichophyton verrucosum]

Six strains of Trichophyton verrucosum were used in a test to determine effects of urea and sodium nitrate on their growth. Despite having urease activity, the strains failed to utilize the urea and sodium nitrate for their growth. Moreover, the organisms were killed if large amounts of these nitrogen compounds and ammonia were added to the medium. These nitrogen compounds, distributed in cattle breeding soil, inhibited the growth of T. verrucosum. Thus, soil in cattle breeding environments does not seem to be a reservoir of this pathogen.

Prevalence of tinea capitis as well as of asymptomatic carriers in school children in Nablus area (Palestine)

A study of tinea capitis was carried out during October 1998, involving 8531 school children aged 6-14 years (4718 males and 3813 females), attending 12 primary schools located in urban, rural, and refugee camp communities in the Nablus district in the Palestinian Authority. A total of approximately 1389 of the school children aged 6-12 years (724 males and 665 females) were also surveyed on three occasions at 2-3 month intervals, over a 9-month period (October 1998-May 1999) using the hair brush technique, for prevalence of asymptomatic tinea capitis carriage. Twenty-three(0.27%) mycologically proven cases of tinea capitis were detected.

Identification and subtyping of Trichophyton mentagrophytes by random amplified polymorphic DNA

Trichophyton mentagrophytes is one of the most common pathogens for human and animal dermatophytoses and known as a complex species with variable morphology, and ecologic and genetic backgrounds. We performed random amplified polymorphic DNA (RAPD) analysis on 43 human and 18 animal isolates of T. mentagrophytes along with other 10 anamorphic species of dermatophytes and three teleomorphic species of T. mentagrophytes. Using RAPD analysis with primer 5'-ATGGATC(G,C)(G,C)C-3' (ATGS), all T. mentagrophytes strains produced identical band patterns with those of Arthroderma vanbreuseghemii, one of the teleomorphs of T. mentagrophytes, regardless of their phenotypes. Therefore, T. mentagrophytes could be identified by RAPD analysis with primer ATGS. Using RAPD analysis with primer 5'-ATGGATCGGC-3' (ATG) on T. mentagrophytes, human isolates yielded two distinct subgroups related by their colony morphologies at the time of primary isolation from patients. Three morphologic types--cottony, powdery and persicolor--revealed identical bands whereas the granular type lacked one minor band (0.74 kbp). Animal isolates of T. mentagrophytes produced five band patterns and some of them were identical with those of human isolates. With primer 5'-GAAGGCTCCC-3' (OPAO-15), animal isolates of T. mentagrophytes showed diverse band patterns in contrast to the uniform band pattern of human isolates. These results suggest that RAPD analysis may be a useful tool to identify and subtype T. mentagrophytes complex.

Expression of ubiquitin gene in Microsporum canis and Trichophyton mentagrophytes cultured with fluconazole

The expression of the ubiquitin (Ub) gene in dermatophytes was examined for its relation to resistance against the antifungal drug fluconazole. The nucleotide sequences and the deduced amino acid sequences of the Ub gene in Microsporum canis were proven to be 99% similar to those of the Ub gene in Trichophyton mentagrophytes. Expression of mRNA of Ub in M. canis and T. mentagrophytes was enhanced when the fungi were cultured with fluconazole. The antifungal activity of fluconazole against these dermatophytes was increased in the presence of Ub proteasome inhibitor.

Variation in restriction fragment length polymorphisms among serial isolates from patients with Trichophyton rubrum infection

Molecular genotyping of strains of Trichophyton rubrum and T. mentagrophytes from patients with onychomycosis of the toes was performed to ascertain whether the fungal genotype changes over the course of time as sequential samples were obtained from patients receiving antifungal therapy and during follow-up. Sixty-six serial strains of T. rubrum and 11 strains of T. mentagrophytes were obtained from 20 patients (16 patients with T. rubrum, 4 with T. mentagrophytes) who were treated with oral antifungal therapy and observed over periods of up to 36 months. These strains were screened for genetic variation by hybridization of EcoRI-digested genomic DNAs with a probe amplified from the small-subunit (18S) ribosomal DNA and adjacent internal transcribed spacer regions. A total of five restriction fragment length polymorphism (RFLP) types were observed among 66 strains of T. rubrum. Two major RFLP types, differentiated by one band shift, represented 68% of the samples. None of the patients had a unique genotype. More than one RFLP type was often observed from a single patient (same nail) over a period of 1, 2, or 3 years, even in cases that did not appear cured at any time. Samples taken from different nails of the same patient had either the same or a different genotype. The genotypic variation did not correspond to any detectable phenotypic variation. Furthermore, no correlation was observed between the efficacy of the treatment administered and the genotype observed. While the DNA region studied distinguished among T. rubrum, T. mentagrophytes, and T. tonsurans, intraspecific RFLP variation was observed for T. rubrum and T. mentagrophytes strains. While independent multiple infection and coinhabitation of multiple strains may explain the presence of different genotypes in a nail, microevolutionary events such as rapid substrain shuffling, as seen in studies of repetitive regions in Candida species, may also produce the same result. The recovery of multiple strains during the course of sequential sampling of uncured patients further suggests that the typing system is not able to distinguish between relapse or reinfection, ongoing infection, and de novo infection.

Comparative efficacies of commonly used disinfectants and antifungal pharmaceutical spray preparations against dermatophytic fungi

Arthroconidia from five fungal strains belonging to three Trichophyton species, Trichophyton mentagrophytes, T. raubitschekii and T. tonsurans, were tested against commercial chemical disinfectants and pharmaceutical antifungal agents. The chemical disinfectants included chlorine, phenol, sodium dodecyl sulphate and several quaternary ammonium salts, while the two pharmaceutical preparations contained bifonazole and terbinafine as active agents. Arthroconidia were exposed to the antifungal agent either in a suspension solution for a given period of time and assayed for kill rate, or on a sprayed agar plate and monitored for surviving colonies over a period of 14 days. Chlorine (1%) and terbinafine (0.01%) were found to be high level disinfectants bringing about a rapid inactivation of conidia in all five strains. Phenol was equally effective against T. raubitschekii and T. tonsurans; however, T. mentagrophytes cells were able to survive for up to 1 h in 5% phenol. Quaternary ammonium compounds were less rapid in their action against dermatophytes and were needed at a level of about 0.5% to be completely fungicidal. Three commercial spray formulations with a range of 0.1 to 0.3% quaternary ammonium salts were fungistatic against T. mentagrophytes strains. Bifonazole (1%) was also fungistatic in its action against T. mentagrophytes. Sodium dodecyl sulphate (0.5%) was largely ineffective against Trichophyton arthroconidia.

Evaluation of the dermatophyte test medium RapidVet-D

The performance of the dermatophyte test medium (DTM) RapidVet-D was assessed using hair samples collected from experimentally infected guinea pigs. Three dermatophyte species were included in the study: Microsporum canis, Trichophyton mentagrophytes and Trichophyton equinum. DTM substrates were inoculated with infected hairs and scales, incubated at 18, 21, 24, 27 or 37 degrees C and examined daily for 15 days. The rapidity of colour change was clearly related to the incubation temperature and to the number of infected hairs deposited on the reactive substrates. With the optimum incubation temperature 27 degrees C, a systematic colour change could be observed only a few days post-inoculation: 3 days with M. canis infected hairs, 4 days with T. equinum and 5 days with T. mentagrophytes.

In-vitro and in-vivo anti-Trichophyton activity of essential oils by vapour contact

The minimum inhibitory doses (MIDs) of essential oils by vapour contact to inhibit the growth of Trichophyton mentagrophytes and Trichophyton rubrum on agar medium were determined using airtight boxes. Among seven essential oils examined, cinnamon bark oil showed the least MID, followed by lemongrass, thyme and perilla oils. Lavender and tea tree oils showed moderate MID, and citron oil showed the highest MID, being 320 times higher than that of cinnamon bark oil. The MID values were less than the minimum inhibitory concentration (MIC) values determined by agar dilution assay. Furthermore, the minimum agar concentration (MAC) of essential oils absorbed from vapour was determined at the time of MID determination as the second antifungal measure. The MAC value by vapour contact was 1.4 to 4.7 times less than the MAC remaining in the agar at the time of MIC determination by agar dilution assay. Using selected essential oils, the anti-Trichophyton activity by vapour contact was examined in more detail. Lemongrass, thyme and perilla oils killed the conidia, inhibited germination and hyphal elongation at 1-4 micrograms ml-1 air, whereas lavender oil was effective at 40-160 micrograms ml-1 air. The in-vivo efficacy of thyme and perilla oils by vapour contact was shown against an experimental tinea pedis in guinea pigs infected with T. mentagrophytes. These results indicated potent anti-Trichophyton action of essential oils by vapour contact.

Effect of sub-MICs of antimycotics on expression of intracellular esterase of Trichophyton rubrum

The electrophoretic pattern of the intracellular esterase of the dermatophyte Trichophyton rubrum was altered when this fungus was grown in the presence of subinhibitory concentrations of the antimycotics tioconazole or griseofulvin. All strains (original isolate and antimycotic resistant mutants) presented five clearly visible bands when cultivated on medium containing below-minimum inhibitory concentrations (sub-MICs) of tioconazole or griseofulvin, and only two clearly visible bands when cultivated in medium without antimycotics. No extra bands were detected in the electrophoretic patterns of the extracellular esterase of these fungi (mutants or the original isolate) when cultivated with or without tioconazole or griseofulvin (sub-MIC values). These results suggest that additional forms of esterase are produced inside the cell and may be a nonspecific response to cellular stress, or may participate in cellular detoxification processes in the presence of these antimycotics.

[The effect of Medicago spp. on growth of Trichophyton mentagrophytes in microculture]

The study aimed at assessing effect of dried root and aerial parts of Medicago spp. on growth of Trichophryton mentagrophytes. Fungus strains were inoculated onto microcultures with Sabouraud agar supplemented each with 1 g of dried and pulverised roots or aerial parts of 3 species: Medicago arabica, M. sativa, and M. murex. The strongest inhibitory effect on T. mentagrophytes growth was that of aerial parts of M. arabica (median diameter 6 mm compared to 13 mm of control), followed by root of M. arabica (10 mm) and root of M. murex (10.5 mm)--in all cases p < 0.001. Slight inhibitory effect was also found in the case of aerial parts of M. murex (median diameter 12 mm, p = 0.03). In contrast, M. sativa has shown stimulating effect on growth of T. mentagrophytes (15 mm for root and 16.5 mm for aerial part, p<0.001).

Amino acid- or protein-dependent growth of Trichophyton mentagrophytes and Trichophyton rubrum

Culture conditions were examined for Trichophyton mentagrophytes and Trichophyton rubrum, which are major pathogens involved in dermatophytosis. They grew well in Sabouraud's dextrose broth or RPMI 1640. Growth in phosphate-buffered yeast nitrogen base supplemented with glucose was very slow, although growth improved significantly with the addition of amino acids or proteins to the medium. The fungi could also grow using human nail fragments as the only source of nutrition. Examination of proteases by substrate gel electrophoresis indicated that distinct sets of proteases are secreted from the dermatophytes in two different media, Sabouraud's dextrose broth and nail fragments. A protease inhibitor, phenylmethanesulfonyl fluoride, inhibited the growth of the fungi on nail fragments, but it did not inhibit their growth in Sabouraud's dextrose broth.

Onychomycosis in Malaysia

The common etiological agents of onychomycosis are dermatophytes, molds and yeasts. A mycological nail investigation of onychomycosis using direct microscopy and culture was conducted by the Mycology Unit, Department of Medical Microbiology, University of Malaya from March 1996 to November 1998. The study involved 878 nail clippings or subungal scrapings from subjects with onychomycosis. On direct microscopy examination, 50% of the specimens were negative for fungal elements. On culture, 373 specimens had no growth; bacteria were isolated from 15 nail specimens. Among the 490 specimens with positive fungal cultures, 177 (36.1%) were dermatophytes, 173 (35.5%) were molds and 130 (26.5%) were Candida. There were 2% (10/490) mixed infections of molds, yeasts and dermatophytes. Trichophyton rubrum (115/177) and Trichophyton mentagrophytes (59/177) were the main dermatophytes isolated. The molds isolated were predominantly Aspergillus niger (61/173), Aspergillus nidulans (30/173), Hendersonula toruloidea (26/173) and Fusarium species (16/173). 96.9% of the Candida species identified were Candida albicans.

Evaluation of the growth dynamics of Trichophyton rubrum cultures by morphometry and non-linear curve fitting analysis

To determine the size of dermatophyte thalli, a point-counting procedure with a square lattice grid is proposed instead of using the one-dimensional diameter as the size parameter. For an analysis of the growth dynamics of such colonies, the area values might be subjected to a non-linear curve-fitting procedure. To demonstrate the method, samples of 15 Trichophyton rubrum strains, isolated from human skin and cultured concomitantly on Sabouraud and Selective agar during a period of 8 weeks, were used. The morphometric assessment of the area of the thalli, subjected to non-linear curve fitting, disclosed only a slight difference in the growth dynamics.

Molecular confirmation of a Trichophyton violaceum isolate from human black-dot ringworm

A clinical isolate from a black-dot ringworm lesion of a 28-year-old female Japanese was investigated by morphological and biochemical analyses as well as molecular analyses. The isolate grew well on thiamine enriched agar and did not produce violet pigment, macro-conidia or micro-conidia on Sabouraud's dextrose agar. Approximately 620-bp genomic DNA fragments of the CHS1 gene were amplified from Trichophyton mentagrophytes, T. rubrum, T. tonsurans and T. violaceum by polymerase chain reaction (PCR) and sequenced. The chitin synthase 1 (CHS1) nucleotide sequences of the clinical isolate showed more than 97% similarity to that of T. violaceum and less than 96% similarity to that of T. mentagrophytes, T. rubrum and T. tonsurans. The phylogenetic analysis of their sequences revealed that the clinical isolate was genetically close to T. violaceum and distinct from T. mentagrophytes, T. rubrum and T. tonsurans. Therefore, the isolate was confirmed as T. violaceum by mycological examination and molecular analyses.

Electrophoretic patterns of Trichophyton mentagrophytes mutants with changed growth rate at different cultivation temperatures

Five mutants of Trichophyton mentagrophytes with changed optimum cultivation temperature and the wild strain were used in this study. The growth rates, the keratinolytic activities and the 1-D electrophoretic patterns of these mutants were examined repeatedly. The differences among the individual mutants and the wild strain can be useful for a better understanding of the participating individual proteins for thermotolerance of this fungus.

Human cases of cattle ringworm due to Trichophyton verrucosum in Victoria, Australia

Between 1962 and 1994, 32 isolates of Trichophyton verrucosum from cases of tinea corporis, tinea faciei and tinea capitis were referred to the Mycology Reference Laboratory of the Microbiological Diagnostic Unit at The University of Melbourne, Victoria, Australia. Patients had presented at clinics in metropolitan Melbourne and country towns in the State of Victoria, Australia. They included dairy and cattle farmers, a slaughterman who worked in an abattoir, a veterinary tutor and children who lived on farms. Many patients lived in one of the three dairy farming areas of Victoria. A few lived in the outer suburbs of Melbourne. One cattle farmer came from south-east New South Wales. Specimens were not received for examination from animal contacts of the patients. The only patient from overseas was a boy from Lebanon. The literature recording human infections due to T. verrucosum in Australia is reviewed.

Fluorometric assessment of In vitro antidermatophytic activities of antimycotics based on their keratin-penetrating power

Keratin particles impregnated with amorolfine or clotrimazole in serial doubling dilutions (64 to 0.125 microg/ml) were used to evaluate the activities of these agents against 20 isolates each of Trichophyton mentagrophytes and Trichophyton rubrum in a yeast carbon broth medium incorporating Alamar Blue dye. The proposed MIC with keratin impregnation (MIC(K)) is defined as the lowest concentration of an agent used to impregnate keratin particles that effects a fluorescence-based fungal growth quotient of 0.05 or less. The conventional colorimetric and visual MICs of amorolfine for the dermatophytes, </=0.03 microg/ml for T. mentagrophytes and </=0.063 microg/ml for T. rubrum, were approximately half of those of clotrimazole for the same isolates. The superiority of the MIC(K)s of amorolfine for isolates of T. mentagrophytes (2.0 microg/ml; range, 0.5 to 8.0 microg/ml) and T. rubrum (4.0 microg/ml; range, 2. 0 to 8.0 microg/ml) over those of clotrimazole (32 microg/ml [range, 8.0 to >64 microg/ml] and 64 microg/ml [range, 16 to >64 microg], respectively) may indicate the strong in vivo antidermatophytic activity of amorolfine as a topical agent. The new antidermatophytic susceptibility testing procedure has potential clinical utility for the in vitro screening of agents for use in the topical treatment of superficial mycoses.

Molecular markers reveal exclusively clonal reproduction in Trichophyton rubrum

Genotypic variability among 96 Trichophyton rubrum strains which displayed different colony morphologies and were collected from four continents was investigated. Twelve markers representing 57 loci were analyzed by PCR fingerprinting, amplified fragment length polymorphism, and random amplified monomorphic DNA markers. Interestingly, none of the methods used revealed any DNA polymorphism, indicating a strictly clonal mode of reproduction and a strong adaptation to human skin.

Optimal growth conditions for the determination of the antifungal susceptibility of three species of dermatophytes with the use of a microdilution method

As a prerequisite to standardization of dermatophyte susceptibility testing, conditions that support optimal growth of different dermatophyte species must be established. Eighteen isolates of Trichophyton spp. (T rubrum, T mentagrophytes, T tonsurans) were grown in 4 different media: RPMI 1640 with L-glutamine, without sodium bicarbonate and buffered at pH = 7.0; antibiotic medium #3 (Penassay); yeast nitrogen base with 0.5% dextrose buffered at pH = 7.0; and Sabouraud dextrose broth. Incubation for 6 days at 35 degrees C produced the following results: RPMI and Sabouraud dextrose supported equally sufficient growth for all strains tested; Penassay supported growth of only 33% of the isolates tested, and buffered yeast nitrogen base did not support growth of any isolates. RPMI was selected as the optimal medium, and organisms were tested at both 30 degrees C and 35 degrees C with a standardized inoculum density of 10(3) conidia/mL. No temperature differences were noted in the amount of growth of the dermatophytes tested. With RPMI at an incubation temperature of 35 degrees C, 3 inoculum sizes (10(3), 10(4), and 10(5) conidia/mL) were tested against 4 antifungal agents: griseofulvin, itraconazole, terbinafine, and fluconazole. Inoculum size did not affect minimum inhibitory concentration (MIC) results for itraconazole or terbinafine, but a larger inoculum produced a slightly higher MIC for griseofulvin and a noticeably higher MIC for fluconazole. Our data support the use of RPMI 1640, 35 degrees C, and 4 days as an incubation temperature and time, respectively, and an inoculum of 10(3) conidia/mL as optimal conditions for the determination of the antifungal susceptibility of dermatophytes.

Survey of keratinophilic fungi isolated from city park soils of Pisa, Italy

A survey of geophilic dermatophytes and related keratinophilic fungi isolated from city park soils of Pisa is reported. Twenty-three (48%) soil samples out of 48 were positive by hair baiting. The following species were isolated: Microsporum gypseum (39%), Trichophyton ajelloi (31%), Chrysosporium keratinophilum (14%), T. terrestre (8%), M. fulvum, Ch. luteum, Ch. indicum (5% each) and M. cookei (2%). The presence of the different species is discussed in relation to the risk of fungal skin infections.