Review of dermatophytoses in Galicia from 1951 to 1987, and comparison with other areas of Spain

Modulation of ERG gene expression in fluconazole-resistant human and animal isolates of Trichophyton verrucosum

Dermatophytes are a group of eukaryotic microorganisms characterized by high capacity to colonize keratinized structures such as the skin, hair, and nails. Over the past years, the incidence of infections caused by zoophilic species, e.g., Trichophyton verrucosum, has been increasing in some parts of the world, especially in Europe. Moreover, the emergence of recalcitrant dermatophytoses and in vitro resistant dermatophytes has become a cause of concern worldwide. Here, we analyzed the mechanisms underlying resistance to fluconazole among clinical isolates of T. verrucosum. Quantitative RT-PCR was carried out to determine the relative expression levels of mRNA transcripts of ERG3, ERG6, and ERG11 genes in the fungal samples using the housekeeping gene GAPDH as a reference. Our results showed that the upregulation of the ERG gene expression is a possible mechanism of resistance to fluconazole in this species. Furthermore, ERG11 is the most statistically significantly overexpressed gene in the pool of fluconazole-resistant T. verrucosum isolates. Additionally, we have demonstrated that exposure to fluconazole increases the levels of expression of ERG genes in fluconazole-resistant isolates of T. verrucosum. In conclusion, this study has shown one of the possible mechanisms of resistance to fluconazole among zoophilic dermatophytes, which involves the maintenance of high levels of expression of ERG genes after drug exposure.

Tinea corporis caused by Trichophyton equinum in a rider and review of the literature

BACKGROUND

Trichophyton equinum is a zoophilic dermatophyte usually causing ringworm in horses. Cases of skin infections in humans are very rare. CASE REPORT : ​We describe a case of tinea corporis caused by T. equinum on a buttock of a rider who often rode bareback with short trousers.

CONCLUSION

Although T. equinum was considered in the past as a strict zoophilic dermatophyte, our case report confirms that it can cause dermatophytoses also in humans. A review of epidemiological and clinical features of human infections caused by T. equinum is presented.

Human Infections with Microsporum gypseum Complex (Nannizzia gypsea) in Slovenia

Microsporum gypseum complex is a group of geophillic dermatophytes with a worldwide distribution and is a rare cause of dermatomycoses in humans. The infection most commonly presents as tinea corporis, with some geographical and occupational variations. We studied M. gypseum complex infections in patients examined in the Mycological Laboratory of the Department of Dermatovenereology, University Medical Centre Ljubljana, during the period 2000-2015. Diagnosis was confirmed by mycological examination. Skin scales were examined by direct microscopy and cultivated on Sabouraud glucose agar. A total of 226 patients were identified, representing 1.5% of all dermatophyte infections during the study period. Tinea corporis was diagnosed in majority of patients, followed by tinea manus, tinea faciei, tinea inguinalis and tinea pedis. Tinea capitis was observed in three and onychomycosis in two patients only. Infection was disseminated on different parts of the body in nine patients. In 39% of patients, infection was diagnosed in children younger than 9 years. Face and scalp infection was more often observed in children. The incidence was the highest during July and October. Contacts with soil and domestic animals were often reported. Data on the prevalence and clinical characteristics of M. gypseum complex infection in other countries are reviewed.

Microsporum spp. onychomycosis: disease presentation, risk factors and treatment responses in an urban population

Background

Dermatophytes are the main causative agent of all onychomycosis, but genus Microsporum is infrequent and the risk of acquiring the infection is often associated with exposure to risk factors.

Objectives

To describe clinical characteristics of onychomycosis due to Microsporum onychomycosis in an urban population.

Methods

This was a retrospective analysis of the epidemiological and clinical features of 18 Microsporum onychomycosis cases of a total of 4220 of onychomycosis cases diagnosed between May 2008 and September 2011 at the tertiary referral center for mycology in Guatemala.

Results

Eighteen cases of Microsporum onychomycosis (M. canis, n = 10; M. gypseum, n = 7; M. nanum, n = 1) were identified (prevalence = 0.43%). Infection was limited to nails only and disease duration ranged from 1 month to 20 years (mean = 6.55 years). The toenails were affected in all cases except for a single M. gypseum case of fingernail. The most common clinical presentation was distal lateral subungual onychomycosis (12/18) followed by total dystrophic onychomycosis (5/18), and superficial white onychomycosis (1/18). M. gypseum presented in 6 cases as distal lateral subungual onychomycosis and in 1 case like total dystrophic onychomycosis. Five cases (27.78%) were associated with hypertension, diabetes, and psoriasis. Treatment with terbinafine or itraconazole was effective. Two cases of M. canis distal lateral subungual onychomycosis responded to photodynamic therapy.

Conclusion

This is the largest reported series of Microsporum onychomycosis and demonstrates such a disease in an urban population. In 27.78% of the cases risk factors for infection were associated to comorbid states. We also report the first 2 cases of successfully treated M. canis onychomycosis with photodynamic therapy and a rare case of M. canis associated dermatophytoma.

Dynamics of dermatophytosis frequency in Mexico: an analysis of 2084 cases

We analysed 15,101 biological samples from patients presenting with superficial mycoses who attended outpatient services over a 10-year period. Scale samples were processed for direct microscopic examination with 15% KOH and cultured on Sabouraud glucose agar plus chloramphenicol and cycloheximide. Laboratory examination confirmed 4,709 cases of superficial mycosis (31.18%), of which 2,084 (44.26%) were dermatophytoses. The species most frequently encountered was Trichophyton rubrum (71.2%), followed by T. tonsurans (6.9%), T. mentagrophytes (5.5%), Microsporum canis (4.5%) and Epidermophyton floccosum (1.3%). The most frequent clinical form of dermatophytosis was tinea unguium (59.9%), followed by tinea pedis (24.5%). We demonstrate that the number of cases of T. rubrum is increasing in Mexico.

Epidemiology of tinea capitis in Europe: current state and changing patterns

Tinea capitis (scalp ringworm) is the most common dermatophyte infection of the scalp affecting mainly children and rarely adults. The epidemiology of tinea capitis varies within different geographical areas throughout the world. It may occur sporadically or epidemically and an increase in its incidence has been noted over the last few decades. The aim of the study is to obtain a general overview of the current state and changing pattern of tinea capitis in Europe. According to the literature, there has been a significant increase in the incidence of tinea capitis and a change in the pattern of infectious agents in particular. Microsporum canis, a zoophilic dermatophyte, is still the most common reported causative agent of tinea capitis in Europe. The countries reporting the highest incidence of M. canis infections are mainly in the Mediterranean but also bordering countries like Austria, Hungary, Germany and Poland. Besides the increase in Microsporum-induced tinea capitis, there is a shift towards anthrophilic tinea capitis mainly in urban areas in Europe. The largest overall increase with anthropophilic dermatophytes has been noted with Trichophyton tonsurans mainly in the UK and with Trichophyton soudanense and Microsporum audouinii in France. The occurrence of anthropophilic infections seems to be geographically restricted and is possibly linked to the immigration from African countries. Children (aged 3-7 years with no predilection of gender) remain the most commonly affected, but recently an increase of tinea capitis has been observed in adults and in the elderly. The results of the study clearly demonstrate the importance of diagnosing and proper treatment of mycotic scalp infection in the Europe. If not diagnosed and treated properly, its prevalence might reach epidemic proportions in the near future. Therefore, an increased level of surveillance (screening in schools), and a highly effective interdisciplinary cooperation among general practitioners, mycologists, veterinarians and dermatologists are strongly recommended.

Analysis of the dermatophyte species isolated in the British Isles between 1980 and 2005 and review of worldwide dermatophyte trends over the last three decades

Infections of the skin, hair and nails by dermatophyte fungi are common in developed and developing countries alike. However, the species involved and the resulting clinical entities vary both geographically and with time. We have surveyed 15,333 dermatophytes obtained from primary isolations at the Mycology Reference Laboratory, Bristol, UK from 1980 through 2005. Several striking trends in dermatophyte prevalence were apparent over this period. The relative frequencies of isolations of Microsporum canis (cat and dog ringworm), Trichophyton verrucosum (cattle ringworm), T. mentagrophytes var. mentagrophytes (rodent ringworm) and Epidermophyton floccosum (a cause of human groin and foot infections) all decreased by 90%. Conversely, the contributions of T. tonsurans and T. violaceum (two anthropophilic scalp-infecting species) to total dermatophyte isolations increased by 1000% over the same period. Finally, T. rubrum and T. mentagrophytes var. interdigitale, the two common causes of foot infection comprised 80% of all dermatophytes isolated in 1980 and 90% of isolations in 2005. Similar trends in dermatophyte prevalence were evidenced throughout the British Isles, based on the voluntary reporting of isolations from a large number of British laboratories at 5-yearly intervals over the same period. The implications of these changing patterns of dermatophyte species, and the clinical entities they produce are discussed in the context of a review of worldwide dermatophyte isolations over the last three decades, with emphasis on the causal agents of tinea capitis.

Study of the ITS region in an atypical isolate and comparison with six species of Microsporum

Microsporum species are a frequent cause of cutaneous mycoses in humans. Atypical strains of Microsporum can sometimes be difficult to identify with conventional methods. Recently, we have obtained a Microsporum isolate with atypical morphology and special nutritional requirements (Microsporum CHUS-126-02). As several molecular techniques have been developed for the identification of fungi, we analysed six Microsporum species (M. canis, M. gypseum, M. gallinae, M. nanum, M. ferrugineum and M. persicolor) in order to compare them with our isolate, by using polymerase chain reaction-restriction enzyme analysis (PCR-REA). We studied the nucleotide sequence of the internal transcribed spacer regions from the nuclear DNA encoding for the ribosomal domain. Digestion with MvaI and EcoRI endonucleases obtained specific patterns for M. gypseum, M. gallinae, M. nanum and M. persicolor. Microsporum canis, M. ferrugineum and Microsporum CHUS-126-02 yielded the same patterns. Based on these results and phenotypic criteria, we classified our atypical isolate as M. canis.

Perniosis-like tinea corporis caused by Trichophyton verrucosum in cold-exposed individuals

Trichophyton verrucosum is a zoophilic infectious agent causing 98% of the dermatophytic infections of cattle. Transmission to humans has, until recently, been rare. One reason for an increase of infection in humans and animals seems to be the decrease in immunisation of cattle. We report on three cases of pertinent human infections with disseminated, sharply defined, bluish red, partly oedematous nodules and plaques in particular not only on the thighs, but also on the trunk and arms. Two of our patients work with farm animals. The third one works as an assistant in a butcher shop, but lives on a cow farm. All three patients are often exposed to the cold. In all three cases T. verrucosum was detected by culture. Tinea corporis was histologically confirmed in two patients. Based on the microbiological results, we began a combined systemic and local antimycotic therapy with fluconazole 50 mg day(-1) in two patients, itraconazole 100 mg day(-1) in one patient p.o. combined with topical ciclopiroxolamine. All patients were cured. Dermatophytosis caused by T. verrucosum can, under certain circumstances, such as frequent exposure to cold or a long-term corticosteroid therapy, mimic the characteristic clinical picture of perniosis, as we demonstrate here.

A case of bullous tinea pedis with dermatophytid reaction caused by Trichophyton violaceum

Summary The authors report a case of bullous tinea pedis caused by Trichophyton violaceum with dermatophytid reaction in a 26-year-old woman who had been in Africa. Diagnosis was based on mycological examination (direct microscope observation and culture). Recovery was achieved after systemic antimycotic therapy with itraconazole and topical imidazole for a month.

Superficial mycoses due to Trichophyton violaceum in Athens, Greece: a 15-year retrospective study

This is a retrospective study on the superficial mycoses due to Trichophyton violaceum in the greater Athens area for the last 15 years - 1989-2003. During this period 104 patients were found to have an infection due to T. violaceum- an incidence rate of 0.75% of all dermatophytosis. Of the patients 59 were Greeks, 15 Greek Gypsies and 30 immigrants mostly from Albania (50%). Of them 58 were children, 46 adults (mainly women, 34 cases). Trichophyton violaceum infection was presented with a variety of manifestations (127 cases). The prevailing was tinea capitis present in 85 patients - 57 children, 24 women and four men (women : men 6 : 1). Tinea capitis together with other forms of the infection was found in 14 patients. Tinea facie, corporis, manuum, barbae and unguium were seen in nineteen patients. The isolation rate of T. violaceum infection in the Greek population remained at a low level for three decades after the mid-1960s. However, a substantial increase in the isolation rate is observed in the mid-1990s attributed mainly to the influx of economic immigrants from countries where the infection is endemic.

Dermatophyte infections in the Ljubljana region, Slovenia, 1995-2002

We studied dermatophyte infections in patients, examined in the Mycological Laboratory of the Department of Dermatology, University Medical Centre Ljubljana during the period 1995-2002. A total of 42,494 samples were collected from 33,974 patients suspected to have dermatomycosis. Dermatophytes were identified in 8286 (71.2%) positive cultures. Microsporum canis was the most frequent dermatophyte isolated (46.8%), followed by Trichophyton rubrum (36.7%), T. mentagrophytes var. interdigitale (7.9%) and T. mentagrophytes var. mentagrophytes (4.9%). Less frequently isolated were M. gypseum, T. verrucosum, Epidermophyton floccosum, T. tonsurans and T. violaceum. The most common dermatophyte infections included tinea corporis, onychomycosis, tinea pedis and tinea faciei. Zoophilic dermatophytes were most commonly recovered from children and adolescents with tinea capitis, tinea corporis and tinea faciei. Anthropophilic species were identified mostly in adults with tinea pedis, onychomycosis and tinea inguinalis. During the period studied, we recorded a decline in the rate of M. canis infections, while infections produced by T. rubrum increased in frequency.

Epidemiology of dermatomycoses in children living in Northern Greece 1996-2000

In the 5-years period, 1996-2000, 1045 children under 13 years old were examined for suspected dermatomycosis. In 611 cases fungi were isolated. Male children were mainly affected on the scalp and body area. Girls were more affected in the location of the arms and legs. There was a greater proportion of cases in the age range 2-12 years. The most prominent fungus was Microsporum canis (515 cases) followed by Trichophyton rubrum (34) and Candida albicans (20). Tinea capitis (280 cases) mainly caused by M. canis (276 cases) was the most common clinical form. Tinea corporis (109 cases) mainly caused by M. canis (88 cases), C. albicans (10 cases) and T. rubrum (seven cases) was the second most frequent clinical form.

Efficacy and tolerability of 8 weeks' treatment with terbinafine in children with tinea capitis caused by Microsporum canis: a comparison of three doses

BACKGROUND

Tinea capitis caused by Microsporum canis is the most common mycosis of the scalp in preschool and school-aged children in Greece.

OBJECTIVE

To compare the efficacy, safety and tolerability of an 8-week course of oral terbinafine at different doses.

METHODS

Patients received oral terbinafine at doses ranging from 3.3 to 12.5 mg/kg/day for 8 weeks, as follows: group A, terbinafine 3.3 to </= 6.0 mg/kg/day (40 patients); group B, terbinafine > 6.0 to 7.0 mg/kg/day (23 patients); group C, terbinafine > 7.0 to 12.5 mg/kg/day (37 patients). Fungal microscopy and cultures were performed 4 weeks before the start of the treatment, at the end of the treatment (week 8) and at a follow-up visit at week 16.

RESULTS

At week 8 mycological cure was achieved in one patient (2.7%) in group A, in 21 patients (91.3%) in group B and in 34 patients (97.1%) in group C. At week 16 mycological cure was achieved in one patient (2.7%) in group A, in 22 patients (95.7%) in group B and in 35 patients (100%) in group C. There was a statistically significant difference (P < 0.0005) between dose level and efficacy of terbinafine at the end of the treatment period and also at the follow-up visit at week 16. Five patients (three in group A and two in group C) discontinued treatment because of adverse events.

CONCLUSIONS

The administration of terbinafine at a dose of either 6-7 or 7-12.5 mg/kg/day for 8 weeks is safe and effective for the treatment in children of tinea capitis caused by M. canis.

Tinea barbae caused by a zoophilic strain of Trichophyton interdigitale

A deep absceding infection is reported of the inframandibular part of the face of a 22-year-old male student due to a zoophilic strain of Trichophyton interdigitale. The fungus was probably acquired from the cat of the patient. Initial therapy by a general practitioner was with topical glucocorticoids and oral antihistaminica. The patient developed a severe phlegmoneous inflammation of the bearded part of the face. Later, the patient was successfully treated by a combination of itraconazole and fluconazole. Identification of the species was confirmed by light and scanning microscopy as well as sequence analysis of the internal transcribed spacer region of the ribosomal DNA.

Estudio epidemiológico sobre las dermatofitosis en España (abril-junio 2001)

INTRODUCTION

A three-month (April-June 2001) cross-sectional study was designed to assess the epidemiological profile of dermatophytosis in Spain.

METHODS

Sixty-two medical centers belonging to 14 different autonomous regions of Spain took part in the survey. A total of 491 strains were sent the Mycology Unit of the National Microbiology Center together with a form containing information on each patient. Isolates were identified by routine methods.

RESULTS

The average age of the patients was 38.7 years and 55.6% were men. The most frequent dermatophytoses were tinea unguium (39.1%), tinea corporis (25.1%), tinea pedis (12.6%), and tinea capitis (11.2%). Trichophyton rubrum (43%) was the most prevalent species. T. mentagrophytes (21.2%) and Microsporum canis (9.8%) were the second and third most common species, respectively. Tinea unguium was significantly associated with urban residence, and tinea corporis with rural residence and contact with animals. T. rubrum was related with urban dermatophytosis and T. mentagrophytes with rural cases. Tinea capitis due to T. tonsurans and T. violaceum was related with patients of North African origin. Tinea unguium was the most prevalent infection by autonomous region, except in Castilla-León, Asturias, Andalucía and Aragón, where tinea corporis was the most common dermatophytosis. Tinea capitis was the most frequent infection in Castilla-La Mancha and Extremadura. T. mentagrophytes was more prevalent than T. rubrum in Valencia, Castilla-La Mancha, Aragón and Murcia.

CONCLUSION

This cross-sectional study shows regional differences in the clinical and microbiological features of dermatophytosis in Spain. Epidemiological surveys are an essential tool for developing strategies for infection control.

Tinea capitis in Van, Turkey

Forty patients with an average age of 6.5 +/- 3.2 years (28 male 12 female) who applied to the YYU Medical Faculty Dermatology Department outpatient clinic were investigated. Tinea capitis profunda was determined as the most frequent clinical type. The isolated dermatophytic flora of the patients consisted of Trichophyton verrucosum (43%), T. violaceum (30%), T. rubrum (23%) and T. mentagrophytes (3%). The patients with tinea capitis profunda were mostly from rural areas.

A study of dermatophytoses in Sana'a, Yemen Republic

The present study describes the extent and causative agents of dermatophytoses in Sana'a, the capital of Yemen Republic. Out of 1100 patients with various skin diseases, 16.6% were affected with dermatophytoses. Among them, 70% were male and the age group 11-20 years was most susceptible to tinea infections. Tinea corporis was the most common disease, followed by tinea capitis. One hundred and seventy isolates of dermatophytes related to 9 species were identified. Microsporum canis was the most prevalent species, followed by Trichophyton violaceum.

Subcutaneous infection by Microsporum gypseum

We report a case of subcutaneous infection caused by the dermatophyte Microsporum gypseum in an immunocompetent host. The patient acquired the infection in the knee through a traumatic inoculation of a splinter. To our knowledge this is the first case of subcutaneous infection caused by this fungus.

From Animal to Man: Tinea Barbae

Dermatophytic fungi cause human infection worldwide. One clinical syndrome--tinea barbae, which closely resembles tinea capitis--is a trichophytosis involving the beard and mustache areas of the face. The fungal agents responsible for tinea barbae (Trichophyton verrucosum and Trichophyton mentagrophytes) are contracted through occupational exposure to animals infected with zoophilic dermatophytes. Tinea barbae may be confused with other facial infections, especially those caused by Staphylococcus aureus or other facial dermatophytes (usually anthrophilic). In an afebrile patient without leucocytosis, a distinctive facial lesion, called a kerion, can be the essential diagnostic finding. Diagnosis requires suspicion based on appropriate exposure. Definitive diagnosis requires a combination of clinical examination, direct microscopic examination using potassium hydroxide, and culture confirmation. Topical treatment is not effective. Oral therapy with an antifungal (eg, terbinafine) or an azole is recommended. This article reviews these factors, as well as germane epidemiologic and prevention measures.

Dermatophytosis due to Trichophyton violaceum in Tuscany from 1985 to 1997

We describe 45 cases of dermatophytosis due to Trichophyton violaceum diagnosed in Tuscany from 1985 to 1997. Diagnosis was based on direct microscope mycological examination and culture. Nine of the 45 patients were Italian, eight of whom were born and resident in Tuscany; the others were Africans who contracted the infection in their country of origin. The first case in a non-European was observed in 1985, but since 1991 isolation from foreigners has become more frequent. The increase in cases of infection by T. violaceum in our region is certainly linked to immigration. The cases of epidermomycosis in Tuscans suggests that the fungus has already become autochthonous.

Tinea capitis

Tinea capitis is a common dermatophyte infection of the scalp in children. Dermatophytes are classified into three genera; tinea capitis is caused predominantly by Trichophyton or Microsporum species. On the basis of host preference and natural habitat, dermatophytes are also classified as anthropophilic, geophilic and zoophilic. The etiological agents of tinea capitis usually fall in the first and last categories. In North America, tinea capitis is now predominantly due to Trichophyton tonsurans. During the past 100 years the most common North American organism for tinea capitis was initially Microsporum canis followed later by M. audouinii. In other parts of the world the epidemiology varies. Tinea capitis is generally observed in children over the age of 6 years and before puberty, with African Americans being the most affected group. Clinical presentations are seborrheic-like scale, 'black dot' pattern, inflammatory tinea capitis with kerion and tiny pustules in the scalp. The clinical diagnosis should be confirmed by mycological examination. Wood's light examination was of value in diagnosing tinea capitis due to M. canis and M. audouinii; however, it is not helpful in T. tonsurans tinea capitis. Asymptomatic carriers may be a significant reservoir of infection and spread of spores may also involve inanimate objects. Carriers may benefit from shampooing their hair. Treatment of tinea capitis requires an oral antifungal agent. The data from the use of terbinafine, itraconazole and fluconazole are promising and suggest that these agents have an efficacy similar to griseofulvin while shortening the duration of therapy. Both griseofulvin and the newer antimycotics have a favorable adverse-effect profile and are associated with high compliance.

Tinea incognito due to Microsporum gypseum in three children

Tinea incognito is a dermatophytosis of atypical clinical character due to the absence of classic features of ringworm. It is caused by prolonged use of topical steroids, sometimes prescribed as a result of incorrect diagnosis. The cases reported in the literature have different clinical presentations and have generally been in adults. We report three children with tinea incognito in whom the lesions were psoriasis-like, eczema-like, and lichenoid, respectively. Diagnosis was confirmed by mycologic examination, which led to the identification of Microsporum gypseum, a geophilic dermatophyte which is an infrequent agent of mycotic infection in humans.

Epidemiology of dermatomycoses of humans in central Poland. Part I--Superficial infections caused by yeasts and moulds

This work presents the epidemiology of dermatomycoses and their etiological agents of people living in the Lódź region, Central Poland, over the years 1987-1996. The analysis involved subjects referred by physicians to three major mycological laboratories in Lódź (covering the entire mycological diagnostics of the Lódź region). The study comprised a total of 25,737 persons aged 1-82. Positive results of mycological examinations were obtained for 14,084 (54.7%) patients. The total number of 14,295 positive mycological results included 6902 (48.3%) isolations of non-dermatophyte fungi. The non-dermatophytes included: Candida-like (69.8%), moulds (26.9%) and lipophilic yeasts (3.3%). The distribution of non-dermatophytes was characterized by dependence on sociodemographic features such as subjects' age, place of residence, education and occupation. Candida-like fungi are etiological factors of superficial infections of all clinical types whereas moulds were found to cause infections of finger and toe nails and periungual walls.

A review of the epidemiology of tinea unguium in the community

Tinea unguium is a common, chronic fungal infection of the nails. Many epidemiological studies have looked at the frequency with which this condition is seen in hospital outpatients clinics or mycological laboratories along with other dermatomycoses. Only recently have studies begun to emerge looking at the prevalence of this condition in populations. Hospital and mycological laboratory-based studies give valuable information about tinea unguium prevalence in a particular clinic, but cannot be compared with other studies due to confounding factors inherent in the different people attending individual clinics. From population-based studies the prevalence of tinea unguium lies between 2 and 8%. Tinea unguium increases steadily with age. It is infrequent but definitely found in children. With the increasing life expectancy in the Western world the prevalence of tinea unguium is likely to increase further without adequate prevention and treatment.

Case of onychomycosis caused by Microsporum racemosum

We report the case of a Spanish 60-year-old female who presented in 1997 with onychomycosis of the left thumbnail following an injury caused by a fresh fish bone. Microsporum racemosum was repeatedly cultured from nail scrapings, and its identity was confirmed by sequencing the isolate's ITS1/ITS2 and 5.8S rRNA regions. The patient was successfully treated with itraconazole, which was administered for 12 weeks. This represents the first case of onychomycosis due to M. racemosum and the first time that this species has been isolated from a human in Europe.

Tinea barbae due to Trichophyton mentagrophytes related to persistent child infection

The case of a 42-year-old father is presented with 6 weeks' history of a painful kerion-like sycosis barbae. His two children had suffered from tinea manus 3 months previously, also caused by the zoophilic fungus Trichophyton mentagrophytes probably acquired from guinea-pigs. Seemingly ignoring the pathogenetic link, oral antibacterial treatment had been the first therapeutic attempt initiated by the family physician. Finally, successful treatment was performed by means of oral application of fluconazole 50 mg daily for a period of 6 weeks.

Onychomycosis due to Microsporum gypseum

The first four cases of onychomycosis due to Microsporum gypseum observed in Italy between 1990 and 1997 are reported. clinical manifestation was distal subungual onychomycosis in all cases. The lesions were asymptomatic in two patients. Three patients were treated with oral itraconazole (pulsed therapy) and the other with ciclopirox 8% nail lacquer. Clinical and mycological recovery was achieved in all cases. The cases are reported because of their rarity.

Human onychomycosis caused by Trichophyton equinum transmitted from a racehorse

We report fingernail onychomycosis caused by Trichophyton equinum in a farmer who breeds racehorses. In addition to the thumbnail, T. equinum had infected one of the racehorses. Oral terbinafine cured the infection in the farmer.