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Benedict K, Lipner SR, Caplan AS, Gold JAW. Household Transmission of Tinea Infections: Analysis of a Large Commercial Health Insurance Claims Database, United States, 2021. Open Forum Infect Dis 2024; 11:ofae334. [PMID: 38957688 PMCID: PMC11218768 DOI: 10.1093/ofid/ofae334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
Among 207 914 multimember households with a tinea case, a secondary case was diagnosed in another household member in 8.5%. Excluding same-day diagnoses (20%), the median time from index case to first secondary case was 138 days. To prevent household tinea transmission, appropriate treatment and strategies to reduce environmental contamination are needed.
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Affiliation(s)
- Kaitlin Benedict
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Avrom S Caplan
- The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Maschio-Lima T, Lemes TH, Marques MDR, Siqueira JPZ, de Almeida BG, Caruso GR, Von Zeska Kress MR, de Tarso da Costa P, Regasini LO, de Almeida MTG. Synergistic activity between conventional antifungals and chalcone-derived compound against dermatophyte fungi and Candida spp. Int Microbiol 2024:10.1007/s10123-024-00541-7. [PMID: 38819732 DOI: 10.1007/s10123-024-00541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/01/2024]
Abstract
The scarce antifungal arsenal, changes in the susceptibility profile of fungal agents, and lack of adherence to treatment have contributed to the increase of cases of dermatomycoses. In this context, new antimicrobial substances have gained importance. Chalcones are precursors of the flavonoid family that have multiple biological activities, have high tolerability by humans, and easy synthesis. In this study, we evaluated the in vitro antifungal activity, alone and in combination with conventional antifungal drugs, of the VS02-4'ethyl chalcone-derived compound against dermatophytes and Candida spp. Susceptibility testing was carried out by broth microdilution. Experiments for determination of the target of the compound on the fungal cell, time-kill kinetics, and toxicity tests in Galleria mellonella model were also performed. Combinatory effects were evaluated by the checkerboard method. Results showed high activity of the compound VS02-4'ethyl against dermatophytes (MIC of 7.81-31.25 μg/ml). The compound targeted the cell membrane, and the time-kill test showed the compound continues to exert gradual activity after 5 days on dermatophytes, but no significant activity on Candida. Low toxicity was observed at 250 mg/kg. Excellent results were observed in the combinatory test, where VS02-4'ethyl showed synergistic interactions with itraconazole, fluconazole, terbinafine, and griseofulvin, against all isolates tested. Although further investigation is needed, these results revealed the great potential of chalcone-derived compounds against fungal infections for which treatments are long and laborious.
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Affiliation(s)
- Taiza Maschio-Lima
- Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil.
| | - Thiago Henrique Lemes
- Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Mariela Domiciano Ribeiro Marques
- Department of Dermatological, Infectious, and Parasitic Diseases, School of Medicine São José Do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - João Paulo Zen Siqueira
- Department of Dermatological, Infectious, and Parasitic Diseases, School of Medicine São José Do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | | | - Glaucia Rigotto Caruso
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Marcia Regina Von Zeska Kress
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Paulo de Tarso da Costa
- Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Luis Octávio Regasini
- Laboratory of Antibiotics and Chemotherapy, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Margarete Teresa Gottardo de Almeida
- Department of Dermatological, Infectious, and Parasitic Diseases, School of Medicine São José Do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
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Bui TS, Katz KA. Resistant Trichophyton indotineae Dermatophytosis-An Emerging Pandemic, Now in the US. JAMA Dermatol 2024:2818524. [PMID: 38748418 DOI: 10.1001/jamadermatol.2024.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Affiliation(s)
- Toan S Bui
- University of Maryland School of Medicine, Baltimore
| | - Kenneth A Katz
- Dermatology Department, Kaiser Permanente San Francisco Medical Center, San Francisco, California
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4
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Hill RC, Caplan AS, Elewski B, Gold JAW, Lockhart SR, Smith DJ, Lipner SR. Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance. Am J Clin Dermatol 2024; 25:359-389. [PMID: 38494575 PMCID: PMC11201321 DOI: 10.1007/s40257-024-00848-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/19/2024]
Abstract
Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes.
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Affiliation(s)
| | - Avrom S Caplan
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Boni Elewski
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeremy A W Gold
- Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA, USA
| | - Shawn R Lockhart
- Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA, USA
| | - Dallas J Smith
- Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA.
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Amr K, Elissawy AM, Ibrahim N, Elnaggar MS, Fawzy IM, Singab ANB. Unveiling the Antimicrobial and Larvicidal Potential of Butyrolactones and Orsellinic Acid Derivatives from the Morus alba-derived Fungus Aspergillus terreus via Integrated In vitro and In silico Approaches. Chem Biodivers 2024; 21:e202301900. [PMID: 38282171 DOI: 10.1002/cbdv.202301900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 01/30/2024]
Abstract
The emergence of multi-drug-resistant microbial strains spurred the search for antimicrobial agents; as a result, two distinct approaches were combined: four in vitro studies and four corresponding molecular docking investigations. Antituberculosis, anti-methicillin-resistant Staphylococcus aureus (anti-MRSA), antifungal, and larvicidal activities of the crude extract, two fractions, and seven isolated compounds from Aspergillus terreus derived from Morus alba roots were explored. The isolated compounds (5 butyrolactones and 2 orsellinic acid derivatives) showed potent to moderate antitubercular activity with MIC values ranging from 1.95 to 62.5 μg/mL (compared to isoniazid, 0.24 μg/mL) and promising anti-MRSA potential with inhibition zone diameters ranging from 8 to 25 mm. Additionally, the in silico study proved that the isolated compounds bind to the two corresponding proteins' active sites with high to moderate -(C-Docker interaction energies) and stable interactions. The isolated compounds displayed antifungal activities against different fungal strains at diverse degrees of activity, among them compound (8"S,9")-dihydroxy-dihydrobutyrolactone I eliciting the best antifungal activity. Meanwhile, all isolated compounds, fractions, and the crude extract demonstrated extremely selective potent to moderate activity against Cryptococcus neoformans. The isolated five butyrolactone derivatives could develop potential mosquito larvicidal agents as a result of promising docking outcomes in the larval enzyme carboxylesterase.
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Affiliation(s)
- Khadiga Amr
- Department of Pharmacognosy, Faculty of Pharmacy, Ain-Shams University, Organization of African Unity Street 1, 11566, Cairo, Egypt
| | - Ahmed M Elissawy
- Department of Pharmacognosy, Faculty of Pharmacy, Ain-Shams University, Organization of African Unity Street 1, 11566, Cairo, Egypt
- Center of Drug Discovery Research and Development, Ain-Shams University, Organization of African Unity Street 1, 11566, Cairo, Egypt
| | - Nehal Ibrahim
- Department of Pharmacognosy, Faculty of Pharmacy, Ain-Shams University, Organization of African Unity Street 1, 11566, Cairo, Egypt
| | - Mohamed S Elnaggar
- Department of Pharmacognosy, Faculty of Pharmacy, Ain-Shams University, Organization of African Unity Street 1, 11566, Cairo, Egypt
| | - Iten M Fawzy
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Future University in Egypt, Cairo, 12311, Egypt
| | - Abdel Nasser B Singab
- Department of Pharmacognosy, Faculty of Pharmacy, Ain-Shams University, Organization of African Unity Street 1, 11566, Cairo, Egypt
- Center of Drug Discovery Research and Development, Ain-Shams University, Organization of African Unity Street 1, 11566, Cairo, Egypt
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Schaller M, Walker B, Nabhani S, Odon A, Riel S, Jäckel A. Activity of amorolfine or ciclopirox in combination with terbinafine against pathogenic fungi in onychomycosis-Results of an in vitro investigation. Mycoses 2024; 67:e13710. [PMID: 38414346 DOI: 10.1111/myc.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Onychomycoses are difficult-to-treat fungal infections with high relapse rates. Combining oral and topical antifungal drugs is associated with higher success rates. Additive or synergistic modes of action are expected to enhance treatment success rates. OBJECTIVES Investigation of the combined effects of antifungal drugs in vitro with different modes of action and application on clinical isolates from mycotic nails. METHODS Isolates of Trichophyton rubrum, Trichophyton interdigitale and Scopulariopsis brevicaulis were collected from infected toenail specimens of patients with onychomycosis. Susceptibility testing was performed in 96-well polystyrene plates using a standard stepwise microdilution protocol. Additive or synergistic activity at varying concentrations was investigated by the checkerboard method. RESULTS Combining terbinafine with amorolfine tended to be more effective than terbinafine in conjunction with ciclopirox. In most combinations, additive effects were observed. Synergy was detected in combinations with involving amorolfine in S. brevicaulis. These additive and synergistic interactions indicate that combined therapy with topical amorolfine and oral terbinafine is justified. Sublimation of amorolfine (and terbinafine) may enhance the penetration in and through the nail plate, and support treatment efficacy. CONCLUSIONS These in vitro results support the notion that combining oral terbinafine and topical amorolfine is beneficial to patients with onychomycosis, particularly if the pathogen is a non-dermatophyte fungus such as S. brevicaulis.
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Affiliation(s)
- Martin Schaller
- Department of Dermatology, Eberhard-Karls University Hospital, Tübingen, Germany
| | - Birgit Walker
- Department of Dermatology, Eberhard-Karls University Hospital, Tübingen, Germany
| | - Schafiq Nabhani
- Medical and Regulatory Department, Galderma Laboratorium GmbH, Düsseldorf, Germany
| | - Astrid Odon
- Department of Dermatology, Eberhard-Karls University Hospital, Tübingen, Germany
| | - Simon Riel
- Department of Dermatology, Eberhard-Karls University Hospital, Tübingen, Germany
| | - Andreas Jäckel
- Medical and Regulatory Department, Galderma Laboratorium GmbH, Düsseldorf, Germany
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Punchihewa N, Orchard D. Combination oral antifungal therapy for paediatric fungal infection: An option to improve efficacy and overcome clinical resistance. Australas J Dermatol 2024; 65:59-62. [PMID: 37927148 DOI: 10.1111/ajd.14186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
There is increasing evidence of clinically resistant cutaneous fungal infections. The use of combination oral antifungals is described in adults but not in paediatric patients. We present seven paediatric cases of clinically resistant fungal infections treated successfully with combination oral antifungal therapy after inadequate response to a single agent.
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Affiliation(s)
- Nisal Punchihewa
- Department of Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - David Orchard
- Royal Children's Hospital, Melbourne, Victoria, Australia
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Benedict K, Smith DJ, Chiller T, Lipner SR, Gold JAW. ------Topical Antifungal Prescribing for Medicare Part D Beneficiaries - United States, 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:1-5. [PMID: 38206854 DOI: 10.15585/mmwr.mm7301a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Incorrect use of topical antifungals and antifungal-corticosteroid combinations is likely contributing to the global emergence and spread of severe antimicrobial-resistant superficial fungal infections, which have recently been detected in the United States. Understanding prescribing patterns is an initial step in establishing and promoting recommended use of these medications. Using 2021 Medicare Part D data, CDC examined prescription volumes, rates, and costs for topical antifungals (including topical combination antifungal-corticosteroid medications). Total prescription volumes were compared between higher-volume prescribers (top 10% of topical antifungal prescribers by volume) and lower-volume prescribers. During 2021, approximately 6.5 million topical antifungal prescriptions were filled (134 prescriptions per 1,000 beneficiaries), at a total cost of $231 million. Among 1,017,417 unique prescribers, 130,637 (12.8%) prescribed topical antifungals. Primary care physicians wrote the highest percentage of prescriptions (40.0%), followed by nurse practitioners or physician assistants (21.4%), dermatologists (17.6%), and podiatrists (14.1%). Higher-volume prescribers wrote 44.2% (2.9 million) of all prescriptions. This study found that enough topical antifungal prescriptions were written for approximately one of every eight Medicare Part D beneficiaries in 2021, and 10% of antifungal prescribers prescribed nearly one half of these medications. In the setting of emerging antimicrobial resistance, these findings highlight the importance of expanding efforts to understand current prescribing practices while encouraging judicious prescribing by clinicians and providing patient education about proper use.
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Gupta AK, Elewski B, Joseph WS, Lipner SR, Daniel CR, Tosti A, Guenin E, Ghannoum M. Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents. Mycoses 2024; 67:e13683. [PMID: 38214375 DOI: 10.1111/myc.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/02/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
A growing body of literature has marked the emergence and spread of antifungal resistance among species of Trichophyton, the most prevalent cause of toenail and fingernail onychomycosis in the United States and Europe. We review published data on rates of oral antifungal resistance among Trichophyton species; causes of antifungal resistance and methods to counteract it; and in vitro data on the role of topical antifungals in the treatment of onychomycosis. Antifungal resistance among species of Trichophyton against terbinafine and itraconazole-the two most common oral treatments for onychomycosis and other superficial fungal infections caused by dermatophytes-has been detected around the globe. Fungal adaptations, patient characteristics (e.g., immunocompromised status; drug-drug interactions), and empirical diagnostic and treatment patterns may contribute to reduced antifungal efficacy and the development of antifungal resistance. Antifungal stewardship efforts aim to ensure proper antifungal use to limit antifungal resistance and improve clinical outcomes. In the treatment of onychomycosis, critical aspects of antifungal stewardship include proper identification of the fungal infection prior to initiation of treatment and improvements in physician and patient education. Topical ciclopirox, efinaconazole and tavaborole, delivered either alone or in combination with oral antifungals, have demonstrated efficacy in vitro against susceptible and/or resistant isolates of Trichophyton species, with low potential for development of antifungal resistance. Additional real-world long-term data are needed to monitor global rates of antifungal resistance and assess the efficacy of oral and topical antifungals, alone or in combination, in counteracting antifungal resistance in the treatment of onychomycosis.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Boni Elewski
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Warren S Joseph
- Arizona College of Podiatric Medicine, Midwestern University, Glendale, Arizona, USA
| | | | - C Ralph Daniel
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Eric Guenin
- Ortho Dermatologics (a division of Bausch Health US, LLC), Bridgewater, New Jersey, USA
| | - Mahmoud Ghannoum
- Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Malallah OS, Coleman L, Nasereddin SM, Lockhat M, Chen T, Jones SA. Systematic review and QSPR analysis of chemical penetration through the nail to inform onychomycosis candidate selection. Drug Discov Today 2024; 29:103844. [PMID: 38000719 DOI: 10.1016/j.drudis.2023.103844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
Recalcitrant nail plate infections can be life-long problems because localizing antifungal agents into infected tissues is problematic. In this systematic review, guided by the SPIDER method, we extracted chemical nail permeation data for 38 compounds from 16 articles, and analyzed the data using quantitative structure-property relationships (QSPRs). Our analysis demonstrated that low-molecular weight was essential for effective nail penetration, with <120 g/mol being preferred. Interestingly, chemical polarity had little effect on nail penetration; therefore, small polar molecules, which effectively penetrate the nail, but not the skin, should be set as the most desirable target chemical property in new post-screen onychomycosis candidate selections.
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Affiliation(s)
- Osamah S Malallah
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Lucy Coleman
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford GU2 7XH, UK
| | - Sara M Nasereddin
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK; College of Pharmacy, Amman Arab University, Mubis, Amman 11953, Jordan
| | - Mohammad Lockhat
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Tao Chen
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford GU2 7XH, UK
| | - Stuart A Jones
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK; Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King's College, SE1 9NH, UK.
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11
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Khodadadi RB, Yetmar ZA, Montagnon CM, Johnson EF, Abu Saleh OM. Majocchi's granuloma-A multicenter retrospective cohort study. JAAD Int 2023; 13:104-111. [PMID: 37744668 PMCID: PMC10517273 DOI: 10.1016/j.jdin.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
Background Majocchi's granuloma (MG) is an uncommon deep fungal folliculitis predominantly caused by dermatophytes. Given the rarity of this condition, available data regarding predisposing comorbidities/risk factors, clinical characteristics, offending microbiologic pathogens, diagnostics, pathologic findings, and treatment approaches has been inferred from historical cases. Objectives To review our institutional experience with MG. Methods We retrospectively analyzed a multicenter cohort of adult patients diagnosed with MG between 1992 and 2022. Results We analyzed 147 patients with MG, 105 of which were male with a median age of 55.6 years. Immunosuppressant and topical corticosteroid use were common prior to development of MG. Dermatologic lesions and their sites of involvement did not differ based on the immune status of patients. Trichophyton rubrum was the most common causative pathogen of MG, in addition to other dermatophytes. Treatment duration for all prescribed agents was median 31.5 days with oral terbinafine being the most frequently utilized agent. Clinical resolution was achieved in 96.6% of cases. Limitations Retrospective, nonrandomized study. Conclusions Although rare and clinically variable in presentation, diagnosis of MG often requires histopathologic confirmation to subsequently direct prolonged treatment with systemic antifungal therapy for mycological cure.
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Affiliation(s)
- Ryan B. Khodadadi
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
| | - Zachary A. Yetmar
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Emma F. Johnson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Omar M. Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
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12
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Benedict K, Gold JAW, Jones CT, Tushla LA, Lipner SR, Joseph WS, Tower DE, Elewski B, Pappas PG. Concerning rates of laboratory-confirmed antifungal-resistant onychomycosis and tinea pedis: An online survey of podiatrists, United States. Health Sci Rep 2023; 6:e1694. [PMID: 38028688 PMCID: PMC10667959 DOI: 10.1002/hsr2.1694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Kaitlin Benedict
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Jeremy A. W. Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Carolynn T. Jones
- Mycoses Study Group Education and Research ConsortiumBirminghamAlabamaUSA
- College of NursingThe Ohio State UniversityColumbusOhioUSA
| | | | - Shari R. Lipner
- Department of DermatologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Warren S. Joseph
- Arizona College of Podiatric MedicineMidwestern UniversityGlendaleArizonaUSA
| | - Dyane E. Tower
- American Podiatric Medical AssociationBethesdaMarylandUSA
| | - Boni Elewski
- Department of DermatologyUniversity of BirminghamBirminghamAlabamaUSA
| | - Peter G. Pappas
- Department of Medicine, Division of Infectious DiseasesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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13
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Moore JE, Tang KWK, Millar BC. Improving health literacy of antifungal use-Comparison of the readability of antifungal medicines information from Australia, EU, UK, and US of 16 antifungal agents across 5 classes (allylamines, azoles, echinocandins, polyenes, and others). Med Mycol 2023; 61:myad084. [PMID: 37562942 PMCID: PMC10802897 DOI: 10.1093/mmy/myad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023] Open
Abstract
Adherence to antifungals is poor in high endemic regions where antifungal resistance is high. Poor readability of prescription/over-the-counter (OTC) antifungals may contribute to poor adherence, due to the patient not fully understanding the purpose, importance, and dosage of their antifungal medicine. As there are no reports on the readability of antifungals, this study examined the readability of patient-facing antifungal information. Antifungals (n = 16; five classes [allylamines, azoles, echinocandins, polyenes, and others-flucytosine and griseofulvin]) were selected. Readability of four sources of information, (i) summary of product characteristics, (ii) patient information leaflets (PILs), (iii) OTC patient information, and (iv) patient web-based information, was calculated using Readable software, to obtain readability scores [(i) Flesch Reading Ease [FRE], (ii) Flesch-Kinkaid Grade Level [FKGL], (iii) Gunning Fog Index, and (iv) Simple Measure of Gobbledygook (SMOG) Index) and text metrics [word count, sentence count, words/sentence, and syllables/word]. PILs, web-based resources, and OTC patient information had good readability (FRE mean ± sd = 52.8 ± 6.7, 58.6 ± 6.9, and 57.3 ± 7.4, respectively), just falling short of the ≥ 60 target. For FKGL (target ≤ 8.0), PILs, web-based resources, and OTC patient information also had good readability (mean ± sd = 8.5 ± 1.0, 7.2 ± 0.86, and 7.8 ± 0.1, respectively). Improved readability scores observed correlate with reduced words, words/sentence and syllables/word. Improving readability may lead to improved patient health literacy. Healthcare professionals, academics, and publishers preparing written materials regarding antifungals for the lay/patient community are encouraged to employ readability calculators to check the readability of their work, so that the final material is within recommended readability reference parameters, to support the health literacy of their patients/readers.
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Affiliation(s)
- John E Moore
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA, Northern Ireland, UK
- Laboratory for Disinfection and Pathogen Elimination Studies, Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD, Northern Ireland, UK
| | - Ka Wah Kelly Tang
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA, Northern Ireland, UK
| | - Beverley C Millar
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA, Northern Ireland, UK
- Laboratory for Disinfection and Pathogen Elimination Studies, Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD, Northern Ireland, UK
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14
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Badiane AS, Ramarozatovo LS, Doumbo SN, Dorkenoo AM, Mandengue C, Dunaisk CM, Ball M, Dia MK, Ngaya GSL, Mahamat HH, Kalombo H, Bah A, Cá Z, Langa JC, Mohamed AM, Mokomane M, Ahmed SA, Rapalanoro Rabenja F, Hay RJ, Penney ROS, Orefuwa E, Denning DW. Diagnostic capacity for cutaneous fungal diseases in the African continent. Int J Dermatol 2023; 62:1131-1141. [PMID: 37340531 DOI: 10.1111/ijd.16751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/11/2023] [Accepted: 05/26/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Cutaneous fungal infections are very common, especially in poorer communities and with intercurrent HIV infection. Determining the fungal pathogen in skin-related fungal neglected tropical diseases (NTDs) determines optimal therapy. We undertook a country survey across many African countries to determine the diagnostic capacity for skin fungal diseases. METHODS A detailed questionnaire was delivered to country contacts to collect data on availability, frequency, and location of testing for key diagnostic procedures and followed up with 2 rounds of validation by video call and by confirmation of individual country data confirmation by email. RESULTS Of 47 countries with data, seven (15%) and 21 (45%) do not offer skin biopsy in the public or private sector, respectively, but 22 (46%) countries do it regularly, mostly in university hospitals. Direct microscopy is often performed in 20 of 48 (42%) countries in the public sector and not done in 10 (21%). Fungal cultures are often performed in 21 of 48 (44%) countries in the public sector but not done in nine (20%) or 21 (44%) in either public or private facilities. Histopathological examination of tissue is frequently used in 19 of 48 (40%) countries but not in nine (20%) countries in the public sector. The cost of diagnostics to patients was a major limiting factor in usage. CONCLUSION Major improvements in the availability and use of diagnostic tests for skin, hair, and nail fungal disease are urgently needed across Africa.
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Affiliation(s)
- Aida S Badiane
- Cheikh Anta Diop University of Dakar, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Lala S Ramarozatovo
- USFR Dermatologie-Rhumatologie, de ahead of Dermatologie, Hôpital Universitaire JRB Antananarivo, Antananarivo, Madagascar
| | - Safiatou N Doumbo
- Department of Epidemiology in Parasitic Diseases, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ameyo M Dorkenoo
- Département des Sciences Biologiques et Fondamentales, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | | | - Cara M Dunaisk
- Health Sciences, Namibia University of Science and Technology, Windhoek, Namibia
| | - Mamadou Ball
- The Faculty of Medicine at the University of Nouakchott and Ministry of Health, Nouakchott, Mauritania
| | - Mariem K Dia
- The Faculty of Medicine at the University of Nouakchott and Ministry of Health, Nouakchott, Mauritania
| | | | - Hassane H Mahamat
- L'Association des Vétérinaires Africains (Rég. Afrique Centrale), N'Djamena, Chad
| | - Hortense Kalombo
- Direction des Laboratoires de Santé, Ministère de la Santé Publique, Hygiène et Prévention, Kinshasa, Democratic Republic of Congo (DRC)
| | - Alasana Bah
- Medical Research Council (MRC) Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Zimania Cá
- Guinea Bissau National Health Center (CENAS), Bissau, Guinea Bissau
| | - Jose C Langa
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Ayni M Mohamed
- National Public Health Reference Laboratory, Ministry of Health, Mogadishu, Somalia
| | | | - Sarah A Ahmed
- Center of Expertise in Mycology Radboudumc, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | | | | | - Emma Orefuwa
- Global Action For Fungal Infections (GAFFI), Geneva, Switzerland
| | - David W Denning
- Global Action For Fungal Infections (GAFFI), Geneva, Switzerland
- Manchester Fungal Infection Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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15
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Gupta AK, Talukder M, Carviel JL, Cooper EA, Piguet V. Combatting antifungal resistance: Paradigm shift in the diagnosis and management of onychomycosis and dermatomycosis. J Eur Acad Dermatol Venereol 2023; 37:1706-1717. [PMID: 37210652 DOI: 10.1111/jdv.19217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/26/2023] [Indexed: 05/22/2023]
Abstract
Antifungal resistance has become prevalent worldwide. Understanding the factors involved in spread of resistance allows the formulation of strategies to slow resistance development and likewise identify solutions for the treatment of highly recalcitrant fungal infections. To investigate the recent explosion of resistant strains, a literature review was performed focusing on four main areas: mechanisms of resistance to antifungal agents, diagnosis of superficial fungal infections, management, and stewardship. The use of traditional diagnostic tools such as culture, KOH analysis and minimum inhibitory concentration values on treatment were investigated and compared to the newer techniques such as molecular methods including whole genome sequencing, and polymerase chain reaction. The management of terbinafine-resistant strains is discussed. We have emphasized the need for antifungal stewardship including increasing surveillance for resistant infection.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mesbah Talukder
- Mediprobe Research Inc., London, Ontario, Canada
- School of Pharmacy, BRAC University, Dhaka, Bangladesh
| | | | | | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
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16
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Taing MW, Choong J, Suppiah V, El-Den S, Park JS, McCullough M, Teoh L. A Cross-Sectional Survey Exploring Australian Pharmacists' and Students' Management of Common Oral Mucosal Diseases. PHARMACY 2023; 11:139. [PMID: 37736911 PMCID: PMC10514864 DOI: 10.3390/pharmacy11050139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Oral mucosal conditions are commonly experienced in the general population and can have a negative impact on one's quality of life. This study evaluated the ability of Australian pharmacists and final-year pharmacy students to recognise and manage these common oral mucosal diseases through the use of case vignettes. METHODS Australian pharmacists and final-year pharmacy students were invited through social media, university learning management systems, or email to complete an online questionnaire consisting of six case vignettes covering topics relating to common oral mucosal presentations. RESULTS A total of 65 pharmacists and 78 students completed the questionnaire. More than 50% of the participants reported having seen all types of oral mucosal presentations, except for denture stomatitis, in their practice. The provision of best practice recommendations was reported by only 14%, 15%, 8%, and 6% of the participants for geographic tongue, hairy tongue, angular cheilitis, and denture-associated stomatitis, respectively, whereas 82% offered an appropriate anti-viral treatment for cold sore and 33% provided the best practice recommendations for oral thrush. CONCLUSION This study emphasised the importance of further developing and integrating best practice oral healthcare training programs specifically tailored to the Australian pharmacy profession.
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Affiliation(s)
- Meng-Wong Taing
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia;
| | - Joshua Choong
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia;
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia;
| | - Sarira El-Den
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Joon Soo Park
- UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia;
| | - Michael McCullough
- Melbourne Dental School, University of Melbourne, Carlton, VIC 3053, Australia; (M.M.); (L.T.)
| | - Leanne Teoh
- Melbourne Dental School, University of Melbourne, Carlton, VIC 3053, Australia; (M.M.); (L.T.)
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17
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Gupta AK, Venkataraman M, Bamimore MA. Relative impact of traditional vs. newer oral antifungals for dermatophyte toenail onychomycosis: a network meta-analysis study. Br J Dermatol 2023; 189:12-22. [PMID: 37253047 DOI: 10.1093/bjd/ljad070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/09/2023] [Accepted: 03/08/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a paucity of evidence regarding the relative therapeutic efficacy of treatments for onychomycosis. OBJECTIVES We determined the relative efficacy of monotherapies for dermatophyte toenail onychomycosis with Bayesian network meta-analyses (NMAs). METHODS We searched PubMed, Scopus, EMBASE (Ovid) and CINAHL to identify studies that investigated the efficacy of monotherapy with oral antifungals for dermatophyte toenail onychomycosis in adults. In this paper, 'regimen' corresponds to a given agent and its dosage. The relative effects and surface under the cumulative ranking curve (SUCRA) values of the various regimens were estimated; evidence quality was assessed at the study level and across networks. RESULTS Data from 21 studies were used. Our two efficacy-related endpoints were: (i) mycological and (ii) complete cure at 1 year; safety--related endpoints were: (i) 1-year count of any adverse event (AE), (ii) 1-year odds of discontinuation due to any AE, (iii) 1-year odds of discontinuation due to liver issues. Thirty-five regimens were identified; the newer agents among these included posaconazole and oteseconazole. We compared the efficacy of newer regimens with traditional ones like 'terbinafine 250 mg daily for 12 weeks' and 'itraconazole 200 mg daily for 12 weeks. We found that an agent's dosage was associated with its efficacy; for example, the 1-year odds of mycological cure with terbinafine 250 mg daily for 24 weeks (SUCRA = 92.4%) were significantly greater than those of terbinafine 250 mg daily for 12 weeks (SUCRA = 66.3%) (odds ratio 2.62, 95% credible interval 1.57-4.54). We also found that booster regimens can increase efficacy. Our results showed that some triazoles could be more effective than terbinafine. CONCLUSIONS This is the first NMA study of monotherapeutic antifungals - and their various dosages - for dermatophyte toenail onychomycosis. Our findings could provide guidance for the selection of the most appropriate antifungal agent, especially amid the growing concerns about terbinafine resistance.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada
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Hwang JK, Bakotic WL, Gold JAW, Magro CM, Lipner SR. Isolation of Terbinafine-Resistant Trichophyton rubrum from Onychomycosis Patients Who Failed Treatment at an Academic Center in New York, United States. J Fungi (Basel) 2023; 9:710. [PMID: 37504699 PMCID: PMC10381657 DOI: 10.3390/jof9070710] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Onychomycosis is a common nail infection. Terbinafine-resistant dermatophyte infections pose an emerging global public health concern, but few cases have been described in the United States. We retrospectively reviewed and characterized clinical, histopathological, and mycological features of patients with mycologically confirmed onychomycosis who failed oral terbinafine treatment for onychomycosis at a U.S. academic nail referral center and ascertained for terbinafine-resistant isolates. During 1 June 2022-31 January 2023 at Weill Cornell Medicine in New York City, USA, 96 patients with mycologically confirmed onychomycosis were treated with oral terbinafine. Among 64 patients with adequate follow-up, 36 had clinical or complete cure. Of 28 patients who failed treatment, 17 underwent terbinafine resistance testing. Trichophyton rubrum with terbinafine resistance-conferring mutations was isolated from two patients. Overall, terbinafine failures for onychomycosis were relatively common, with some cases associated with terbinafine-resistant T. rubrum infections. These findings underscore the need for a clinical awareness of this emerging problem and public health efforts to monitor and prevent spread. We highlight the importance of diagnostic testing and species identification for onychomycosis patients and the increasingly important role of fungal identification and susceptibility testing to guide therapy.
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Affiliation(s)
| | | | - Jeremy A W Gold
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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19
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Shetty P, Rangegowda SM, Vinay KN, Ravikumar BC, Nagesha PC. Comparative study of safety and efficacy of combination therapy of fractional CO 2 laser and topical amorolfine cream versus oral itraconazole in the treatment of onychomycosis. Lasers Med Sci 2023; 38:147. [PMID: 37354212 DOI: 10.1007/s10103-023-03804-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/08/2023] [Indexed: 06/26/2023]
Abstract
Onychomycosis is a fungal infection of the nail unit caused by various species of dermatophytes, non-dermatophytic moulds or yeasts. They pose a therapeutic challenge to the treating dermatologist as the infection is often resistant to treatment and requires prolonged therapy. To evaluate the efficacy and safety profile of fractional CO2 laser and 0.25% Amorolfine hydrochloride cream in the treatment of onychomycosis. In this randomized controlled study on 50 patients with fingernail onychomycosis, one group (25 patients, 30 nails) were treated with fractional CO2 laser and 0.25% Amorolfine hydrochloride cream, and the second group (25 patients, 31 nails) with oral itraconazole pulse therapy. Four treatment sessions were carried out in the first group at an interval of two weeks each. Whereas, the second group received 2 doses of itraconazole pulse therapy with one month interval each. Both the groups were followed up for a period of 4 months. Results were assessed by Onychomycosis severity index(OSI), Physician global assessment scale, patient's subjective score and fungal microscopy. Complete resolution was seen in 14 out of 25(56%) patients and 6 out of 25(24%) patients in group 1 and group 2 respectively. There was statistically significant difference in the response between the two groups during 1st and 2nd follow up (p value - 0.004 and 0.023 respectively). Fractional CO2 laser with amorolfine cream is proved to be a better modality in onychomycosis therapy compared to oral itraconazole pulse therapy, especially in distal lateral subungual and superficial white onychomycosis.
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Affiliation(s)
- Prajna Shetty
- Department of DVL, Father Muller Medical College, Mangalore, India
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20
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Post-Traumatic Single-Digit Onychomycosis. J Fungi (Basel) 2023; 9:jof9030313. [PMID: 36983481 PMCID: PMC10051499 DOI: 10.3390/jof9030313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Onychomycoses are a group of fungal nail infections commonly classified either according to the pathogenic fungus, to the duration of the disease or to the mode of fungal invasion. Most cases are diagnosed clinically, although there is a general consensus that the pathogen should be identified prior to initiating a treatment. However, this is often difficult as the classical mycologic methods of direct microscopy and culture frequently remain negative. We came across a particular subset of onychomycoses, which posed extreme diagnostic and therapeutic challenges. Over a period of 15 years, 44 patients were seen in specialized nail clinics with a single nail dystrophy that was examined and treated in vain by many practitioners and dermatologists prior to their consultation. Of the forty-four cases, thirty-nine patients had a fingernail affected and five had a toenail affected. The nail was almost completely onycholytic, the nail bed visibly keratotic, the proximal nail fold smooth and shiny and slightly swollen. All patients except five brought the results of negative mycologic cultures. Thirty-four patients had received antifungal therapy, mostly topical, as a single nail would not qualify for systemic treatment according to most national and international guidelines. The diagnosis was finally confirmed by histopathology of the nail plate showing an invasive onychomycosis in all cases. After nail avulsion and combined topical and systemic antifungal therapy, thirty-six patients were cured, three were lost from follow-up, and five showed improved nails but not a complete clinical and mycologic cure. A single-digit nail disease raises the suspicion of a tumor or a trauma; although, in rare cases, diseases normally affecting several nails may only affect a single nail. Such a case should prompt the clinician to ask for a previous trauma to this digit and to intensify the search for a specific pathogen. This study also underlines the importance of histopathology for the diagnosis of onychomycoses.
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21
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Arsène MMJ, Viktorovna PI, Alla M, Mariya M, Nikolaevitch SA, Davares AKL, Yurievna ME, Rehailia M, Gabin AA, Alekseevna KA, Vyacheslavovna YN, Vladimirovna ZA, Svetlana O, Milana D. Antifungal activity of silver nanoparticles prepared using Aloe vera extract against Candida albicans. Vet World 2023; 16:18-26. [PMID: 36855352 PMCID: PMC9967710 DOI: 10.14202/vetworld.2023.18-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/25/2022] [Indexed: 01/07/2023] Open
Abstract
Background and Aim Resistance to antifungal agents is a serious public health concern that has not been investigated enough because most studies on antimicrobials are dedicated to antibacterial resistance. This study aimed to synthesize silver nanoparticles (AgNPs) using Aloe vera extract, and to assess its antifungal activity against Candida albicans. Materials and Methods Silver nanoparticles were synthesized by reducing Ag nitrate with aqueous A. vera extracts. Physicochemical properties of synthesized AgNPs were determined by ultraviolet-visible spectrophotometry, photon cross-correlation spectroscopy, energy-dispersive X-ray fluorescence spectrometry, X-ray diffraction analysis, and Fourier-transform infrared spectroscopy. An antifungal investigation was performed against four clinical C. albicans (C1, C2, C3, and C4) and a reference strain, C. albicans ATCC 10321. Results Cubic AgNPs with a mean X50 hydrodynamic diameter of 80.31 ± 10.03 nm were successfully synthesized. These AgNPs exhibited maximum absorbance at 429.83 nm, and X-ray fluorescence (XRF) confirmed the presence of Ag in AgNPs solution by a characteristic peak in the spectrum at the Ag Kα line of 22.105 keV. Infrared spectra for AgNPs and A. vera extract indicated that the compounds present in the extract play an essential role in the coating/capping of synthesized AgNPs. Different concentrations (200, 100, 50, 25, 10, and 5 μg/mL) of AgNPs were tested. The antifungal activity was shown to be dose-dependent with inhibition zones ranging from 10 mm to 22 mm against C. albicans ATCC 10231, 0 mm to 15 mm against C1, 0 mm to 16 mm against C2 and C3, and 0 mm to 14 mm for C4. Minimum inhibitory concentration ranged from 16 μg/mL to 32 μg/mL against clinical C. albicans (C1, C2, C3, and C4) and was 4 μg/mL against C. albicans ATCC 10231. Conclusion This study showed the ability of A. vera to serve as an efficient reducing agent for the biogenic synthesis of AgNPs with excellent antifungal activity.
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Affiliation(s)
- Mbarga Manga Joseph Arsène
- Department of Microbiology V.S. Kiktenko, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia,Research Institute of Molecular and Cellular Medicine, Peoples Friendship University of Russia (RUDN University), Moscow, Russia,Corresponding author: Mbarga Manga Joseph Arsène, e-mail: Co-authors: PIV: , MA: , MM: , SAN: , AKLD: , MEY: , MR: , AAG: , KAA: , YNV: , ZAV: , OS: , DM:
| | - Podoprigora Irina Viktorovna
- Department of Microbiology V.S. Kiktenko, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia,Research Institute of Molecular and Cellular Medicine, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Marukhlenko Alla
- Department of Pharmaceutical and Toxicological Chemistry, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Morozova Mariya
- Department of Pharmaceutical and Toxicological Chemistry, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Senyagin Alexander Nikolaevitch
- Department of Microbiology V.S. Kiktenko, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia,Research Institute of Molecular and Cellular Medicine, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Anyutoulou Kitio Linda Davares
- Department of Microbiology V.S. Kiktenko, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Mumrova Evgenia Yurievna
- Research Institute of Molecular and Cellular Medicine, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Manar Rehailia
- Department of Agrobiotechnology, Agrarian Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Ada Arsene Gabin
- Department of Traumatology and Orthopedics, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Kulikova A. Alekseevna
- Department of Oral and Maxillofacial Surgery, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Yashina Natalia Vyacheslavovna
- Department of Microbiology V.S. Kiktenko, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Zhigunova Anna Vladimirovna
- Department of Microbiology V.S. Kiktenko, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Orlova Svetlana
- Department of Dietetics and Clinical Nutritiology, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Das Milana
- Department of Microbiology V.S. Kiktenko, Medical Institute, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
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Lindsø Andersen P, Jørgensen IF, Saunte DML, Jemec GB, Pedersen OB, Brunak S. An Increase in Specialist Treatment for Onychomycosis: An Unexplained Tendency. A Retrospective Study of Patients Treated for Onychomycosis in Danish Hospitals from 1994 to 2018. J Fungi (Basel) 2022; 9:jof9010033. [PMID: 36675854 PMCID: PMC9865894 DOI: 10.3390/jof9010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Onychomycosis is a common disease with a significant negative impact on quality of life. While the disease is usually manageable in general practice, a proportion of patients need specialist treatment in academic hospital clinics. However, it is an unknown question whether the incidence in those needing specialist treatments is changing. Furthermore, the comorbidity burden in this patient population severely affected by onychomycosis has never been characterized. We conducted a retrospective study on patients treated for onychomycosis in Danish hospitals from 1994 to 2018. The cohort was observed for 24 years, and the data comprise 7.2 million Danes and their hospital diagnoses. A disease trajectory algorithm was used to examine the comorbidity burden in the cohort. A total of 2,271 patients received hospital treatment for onychomycosis during the time period, of which 1358 (59.8%) were men. The data show an increase in the incidence of hospital-treated cases since 2012 and that the most common comorbidities in this patient population include cardiovascular disease, alcohol-related diagnoses, and diabetes. One explanation of the increase in specialist treatment may include a general increase in patients with decreased resilience to fungal disease. This lack of resilience may both include an increasing elderly population with atherosclerosis, diabetes, and immunosuppression but also a potential increase in patients treated with immunosuppressive agents. Another possible explanation may include a shift in patient expectations in the case of treatment failure. Thus, patients may have an increasing demand for specialist treatment. While our data document an increase in the number of patients in need of specialist treatment for onychomycosis, we suggest future research to examine the general incidence of onychomycosis but also whether this increase in an apparently recalcitrant disease may be attributed to increased antifungal resistance, more specialist treatment options, or increased attention to dermatomycoses.
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Affiliation(s)
- Pernille Lindsø Andersen
- Department of Dermatology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Immunology, Zealand University Hospital, 2100 Copenhagen, Denmark
- Correspondence: ; Tel.: + 45-4732-2600
| | - Isabella Friis Jørgensen
- The Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, 1350 Copenhagen, Denmark
| | - Ditte Marie Lindhardt Saunte
- Department of Dermatology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, 1350 Copenhagen, Denmark
| | - Gregor Borut Jemec
- Department of Dermatology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, 1350 Copenhagen, Denmark
| | - Ole Birger Pedersen
- Department of Clinical Immunology, Zealand University Hospital, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, 1350 Copenhagen, Denmark
| | - Søren Brunak
- The Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, 1350 Copenhagen, Denmark
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Xiao C, Qiao D, Xiong L, Tian W, Wang D, Deng S, Guo J. Clinical and Microbiological Characteristics of Aspergillosis at a Chinese Tertiary Teaching Hospital. Infect Drug Resist 2022; 15:7249-7257. [PMID: 36533254 PMCID: PMC9753761 DOI: 10.2147/idr.s391069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/23/2022] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Aspergillus spp. infection in immunocompromised patients results in increasing morbidity and mortality. This study investigated clinical and microbiological characteristics of aspergillosis in a Chinese tertiary teaching hospital. METHODS A total of 114 patients with aspergillosis were included over a 5-year period at Ruijin Hospital. In sum, 114 Aspergillus strains were isolated and identified at species level using matrix-assisted laser desorption ionization time-of-flight mass spectrometry, confirmed by ITS gene region and β-tubulin (BenA) gene sequencing. Sensititre YeastOne was used in vitro to test susceptibility to antifungal drugs: amphotericin B, itraconazole, voriconazole, posaconazole, isavuconazole, micafungin, anidulafungin, and caspofungin. RESULTS The median age of the patients was 61 (19) years, men accounted for 53.5% (n=61) of the sample, about 64% were immunocompromised, and 36% had underlying diseases. Pulmonary diseases accounted for 27.2%. Aspergillus isolates were mainly isolated from sputum (n=42, 36.8%). Antifungal therapy was administered to 106 (93.0%) patients and voriconazole (n=76, 66.7%) was the most frequently used as empirical therapy. Aspergillus fumigatus (n=69, 60.5%) was the most common species. There was a 73.7% concordance between MALDI-TOF MS and molecular identification. All Aspergillus isolates showed good susceptibility to anidulafungin and caspofungin. CONCLUSION Immunocompromised patients are an at-risk population for aspergillosis, and voriconazole was used as empirical therapy in Ruijin Hospital, China. A. fumigatus was the predominant Aspergillus species causing aspergillosis, and A. flavus - as non-A. fumigatus species are increasing - the second-leading cause of aspergillosis. Anidulafungin and caspofungin were the most active in vitro against the Aspergillus isolates tested. The MALDI-TOF MS method showed good accuracy for identification of common Aspergillus spp. In vitro antifungal-susceptibility testing is crucially important for decisions on effective therapy with aspergillosis.
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Affiliation(s)
- Chenlu Xiao
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Dan Qiao
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Lijuan Xiong
- Department of Laboratory Medicine, Second Affiliated Hospital of Traditional Chinese Medicine of Guizhou University, Guizhou, People’s Republic of China
| | - Wenjie Tian
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Dongjiang Wang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Shuwen Deng
- Department of Medical Microbiology, People’s Hospital of Suzhou New District, Suzhou, Jiangsu, People’s Republic of China
| | - Jian Guo
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
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24
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Sobhy N, Talla Eweed H, Omar SS. Fractional CO2 laser - assisted methylene blue photodynamic therapy is a potential alternative therapy for onychomycosis in the era of antifungal resistance. Photodiagnosis Photodyn Ther 2022; 40:103149. [PMID: 36228978 DOI: 10.1016/j.pdpdt.2022.103149] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Treatment of onychomycosis is challenging by virtue of the impact of nail disfigurement, the location of the fungi within the nail and reported antifungal resistance worldwide. Light-based technologies are promising primary or adjunctive therapeutic modalities. We aimed to compare the efficacy of photodynamic therapy and fractional CO2 laser monotherapy either alone or in combination for onychomycosis. PATIENTS AND METHODS This prospective randomized comparative study was conducted on 51 onychomycosis patients divided into three groups. In group A, patients were treated using 6 photodynamic therapy sessions using methylene blue and IPL (560 to 700 nm, fluence 12 J/cm2). Group B patients were treated using 6 bimonthly fractional CO2 laser sessions (10,600 nm, 1.600 mj energy and 0.6 mm density) and group C patients were treated using 6 combined fractional CO2 laser and photodynamic therapy sessions. Patients were evaluated mycologically, dermoscopically and clinically by calculation of proximal nail diameter percentage at baseline, monthly, at the end of treatment and after a 6-month follow-up period post-treatment. RESULTS Candida was the most commonly isolated organismin in 64.7%, 70.6% and 70.6% of the pateints in groups A, B and C, respectively. The dermoscopic findings in the total dystrophic onychomycosis was subungual hyperkeratosis in 6 patients (100%), longitudinal streaks and striae in 1 patient (16.7%). In dorsolateral subungual onychomycosis, jagged proximal edge in 31 patients (70.5%), and pigmentation in 30 patients (68.2%) were noted. In proximal subungual onychomycosis irregular matt patches were seen in 1 patient (100%). Proximal nail diameter percentage showed statistically significant improvement after treatment and 6 months follow up in the 3 studied groups. Mean increase of proximal nail diameter after treatment was highest in group C (52.94 ± 20.24), followed by group B (43.82 ± 21.03) and least in group A (35.29 ± 17.0). This difference was statistically significant (p = 0.044). Reported side effects were mild-moderate pain, discoloration and paronychia. CONCLUSION We conclude that fractional CO2 laser and photodynamic monotherapy, and their combination achieve high success rates, good patient satisfaction and safety profile. Fractional CO2-assisted photodynamic therapy is associated with the highest improvement over either fractional CO2 or photodynamic therapy alone.
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Affiliation(s)
- Nagat Sobhy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Elkhartoum Square 21521, Egypt
| | - Heba Talla Eweed
- Bakkous Dermatology Clinic, Ministry of Health, Alexandria, Egypt
| | - Salma Samir Omar
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Elkhartoum Square 21521, Egypt.
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25
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Nasirzadeh Fard Y, Kelidari H, Kazemi Nejad A, Mousavi SJ, Hedayati MT, Mosayebi E, Nabili M, Faeli L, Asare-Addo K, Nokhodchi A, Moazeni M. Enhanced treatment in cutaneous dermatophytosis management by Zataria multiflora-loaded nanostructured lipid carrier topical gel: A randomized double-blind placebo-controlled clinical trial. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.104132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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26
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Pospischil I, Reinhardt C, Bontems O, Salamin K, Fratti M, Blanchard G, Chang YT, Wagner H, Hermann P, Monod M, Hoetzenecker W, Guenova E. Identification of Dermatophyte and Non-Dermatophyte Agents in Onychomycosis by PCR and DNA Sequencing—A Retrospective Comparison of Diagnostic Tools. J Fungi (Basel) 2022; 8:jof8101019. [PMID: 36294584 PMCID: PMC9605175 DOI: 10.3390/jof8101019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 12/02/2022] Open
Abstract
Rapid and reliable fungal identification is crucial to delineate infectious diseases, and to establish appropriate treatment for onychomycosis. Compared to conventional diagnostic methods, molecular techniques are faster and feature higher accuracy in fungal identification. However, in current clinical practice, molecular mycology is not widely available, and its practical applicability is still under discussion. This study summarizes the results of 16,094 consecutive nail specimens with clinical suspicion of onychomycosis. We performed PCR/sequencing on all primary nail specimens for which conventional mycological diagnostics remained inconclusive. In specimens with a positive direct microscopy but negative or contaminated culture, molecular mycology proved superior and specified a fungal agent in 65% (587/898). In 75% (443/587), the identified pathogen was a dermatophyte. Positive cultures for dermatophytes, yeasts and non-dermatophyte molds (NDMs) were concordant with primary-specimen-DNA PCR/sequencing in 83% (10/12), 34% (22/65) and 45% (76/169), respectively. Among NDMs, agreement was high for Fusarium spp. (32/40; 80%), but low for Penicillium spp. (5/25; 20%) and Alternaria spp. (1/20; 5%). This study underlines the improvement in diagnostic yield by fungal primary-specimen-DNA PCR/sequencing in the event of a negative or contaminated culture, as well as its significance for the diagnosis of dermatophyte and non-dermatophyte onychomycosis. Molecular mycology methods like PCR and DNA sequencing should complement conventional diagnostics in cases of equivocal findings, suspected NDM onychomycosis or treatment-resistant nail pathologies.
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Affiliation(s)
- Isabella Pospischil
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University Linz, 4020 Linz, Austria
- Correspondence: (I.P.); (W.H.); (E.G.)
| | - Charlotte Reinhardt
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University Linz, 4020 Linz, Austria
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Olympia Bontems
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Karine Salamin
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Marina Fratti
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Gabriela Blanchard
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Yun-Tsan Chang
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Helga Wagner
- Center for Clinical Studies (CCS Linz), Johannes Kepler University Linz, 4020 Linz, Austria
- Institute of Applied Statistics, Johannes Kepler University Linz, 4020 Linz, Austria
| | - Philipp Hermann
- Center for Clinical Studies (CCS Linz), Johannes Kepler University Linz, 4020 Linz, Austria
| | - Michel Monod
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital, Johannes Kepler University Linz, 4020 Linz, Austria
- Correspondence: (I.P.); (W.H.); (E.G.)
| | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital (CHUV) and the Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland
- Department of Dermatology, University Hospital Zurich and the University of Zurich, 8091 Zurich, Switzerland
- Department of Dermatology, Hospital 12 de Octubre, Medical School, University Complutense, 28040 Madrid, Spain
- Correspondence: (I.P.); (W.H.); (E.G.)
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Costa PDS, Prado A, Bagon NP, Negri M, Svidzinski TIE. Mixed Fungal Biofilms: From Mycobiota to Devices, a New Challenge on Clinical Practice. Microorganisms 2022; 10:microorganisms10091721. [PMID: 36144323 PMCID: PMC9506030 DOI: 10.3390/microorganisms10091721] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Most current protocols for the diagnosis of fungal infections are based on culture-dependent methods that allow the evaluation of fungal morphology and the identification of the etiologic agent of mycosis. Most current protocols for the diagnosis of fungal infections are based on culture-dependent methods that enable the examination of the fungi for further identification of the etiological agent of the mycosis. The isolation of fungi from pure cultures is typically recommended, as when more than one species is identified, the second agent is considered a contaminant. Fungi mostly survive in highly organized communities that provoke changes in phenotypic profile, increase resistance to antifungals and environmental stresses, and facilitate evasion from the immune system. Mixed fungal biofilms (MFB) harbor more than one fungal species, wherein exchange can occur that potentialize the effects of these virulence factors. However, little is known about MFB and their role in infectious processes, particularly in terms of how each species may synergistically contribute to the pathogenesis. Here, we review fungi present in MFB that are commensals of the human body, forming the mycobiota, and how their participation in MFB affects the maintenance of homeostasis. In addition, we discuss how MFB are formed on both biotic and abiotic surfaces, thus being a significant reservoir of microorganisms that have already been associated in infectious processes of high morbidity and mortality.
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28
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Bieber K, Harder M, Ständer S, Boch K, Kridin K, Köhler B, Anemüller W, Ernst AL, Zillikens D, Cavalar M, Ludwig RJ. DNA-Chip-basierte Diagnose der Onychomykose und Tinea pedis. J Dtsch Dermatol Ges 2022; 20:1112-1122. [PMID: 35971577 DOI: 10.1111/ddg.14819_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
HINTERGRUND UND ZIELE Onychomykose (OM) und Tinea pedis (TP) sind häufige Pilzinfektionen der Haut. Aktuell basiert die Diagnose vornehmlich auf mikroskopischem Direktnachweis und/oder Kultur. Beide Methoden haben jedoch eine geringe bis mäßige Sensitivität und benötigen teilweise mehrere Wochen, bis endgültige Laborergebnisse vorliegen. Um die Diagnose kutaner Pilzinfektionen zu verbessern, wurden PCR-basierte Methoden entwickelt. Hier haben wir hier die Sensitivität und Spezifität einer Chip-basierten Multiplex-PCR mit mikroskopischen Direktnachweis und verglichen. PATIENTEN UND METHODIK In einer monozentrischen, prospektiven Studie wurden bei Patienten mit Verdacht auf OM (n = 67) oder TP (n = 73) Schuppenpräparate entnommen und mittels mikroskopischem Direktnachweis, Kultur und DNA-Chip-Technologie der Erregernachweis durchgeführt. In einem weiteren Ansatz wurde überprüft, ob Abstriche als Alternative zur Entnahme eines Schuppenpräparates verwendet werden können. Hierfür wurden 24 weitere OM/TP-Patienten rekrutiert und die Ergebnisse der DNA-Chip-Technologie aus Abstrichen mit denen aus den Schuppenpräparaten verglichen. ERGEBNISSE Im Vergleich aller Methoden hatte die DNA-Chip-Technologie die höchste Sensitivität, eine Kombination von DNA-Chip-Technologie mit mikroskopischem Direktnachweis erhöhte dies weiter. Ergebnisse dieser kombinierten Labordiagnostik sind innerhalb von 24 Stunden verfügbar. Der Vergleich der Probenentnahmetechniken (Abstrich beziehungsweise Schuppenpräparat) zeigte vergleichbare Ergebnisse. SCHLUSSFOLGERUNGEN Die molekulare Diagnostik (mittels DNA-Chip-Technologie) hat eine hohe Sensitivität für die OM- und TP-Diagnostik, insbesondere in Kombination mit dem mikroskopischen Direktnachweis.
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Affiliation(s)
- Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Sascha Ständer
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Birgit Köhler
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Anna Lara Ernst
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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29
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Bieber K, Harder M, Ständer S, Boch K, Kridin K, Köhler B, Anemüller W, Ernst AL, Zillikens D, Cavalar M, Ludwig RJ. DNA chip‐based diagnosis of onychomycosis and tinea pedis. J Dtsch Dermatol Ges 2022; 20:1112-1121. [DOI: 10.1111/ddg.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Katja Bieber
- Lübeck Institute of Experimental Dermatology University of Lübeck Lübeck Germany
| | | | - Sascha Ständer
- Department of Dermatology University of Lübeck Lübeck Germany
| | - Katharina Boch
- Department of Dermatology University of Lübeck Lübeck Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology University of Lübeck Lübeck Germany
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
| | - Birgit Köhler
- Department of Dermatology University of Lübeck Lübeck Germany
| | | | - Anna Lara Ernst
- Lübeck Institute of Experimental Dermatology University of Lübeck Lübeck Germany
| | | | | | - Ralf J. Ludwig
- Lübeck Institute of Experimental Dermatology University of Lübeck Lübeck Germany
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30
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Nickles MA, Lio PA, Mervak JE. Complementary and Alternative Therapies for Onychomycosis: A Systematic Review of the Clinical Evidence. Skin Appendage Disord 2022; 8:269-279. [PMID: 35983465 PMCID: PMC9274952 DOI: 10.1159/000521703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/30/2021] [Indexed: 12/13/2023] Open
Abstract
INTRODUCTION Onychomycosis is notoriously difficult to treat. While oral antifungals are the most efficacious treatment for onychomycosis, they are contraindicated in certain patient populations, and patients may desire lower risk and accessible alternatives to systemic agents. In this study, we examine the clinical evidence supporting the use of complementary and alternative therapies in the treatment of onychomycosis. METHODS PubMed, Embase, and Cochrane Library were searched for clinical trials, observational studies, and case reports/case series, examining the efficacy of a complementary or alternative therapy for the treatment of onychomycosis. RESULTS We identified 17 articles studying a complementary and alternative therapy for onychomycosis, including tea tree oil (n = 5), Ageratina pichinchensis (n = 3), Arthrospira maxima (n = 2), natural coniferous resin lacquer (n = 2), Vicks VapoRub® (n = 2), propolis extract (n = 2), and ozonized sunflower oil (n = 1). CONCLUSION Given the rise of antifungal resistance, complementary and alternative therapies should continue to be studied as adjunctive or alternative therapy for onychomycosis. While preliminary evidence exists for several complementary and alternative therapies in the treatment of onychomycosis, large-scale, randomized, placebo-controlled trials are needed prior to endorsing their use to patients.
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Affiliation(s)
- Melissa A. Nickles
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Peter A. Lio
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Medical Dermatology Associates of Chicago, Chicago, Illinois, USA
| | - Julie E. Mervak
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Fuhr R, Cook D, Ridden J, Nield K, Leigh E, Cook J, Davies‐Strickleton H, Dobmeyer J. Results from Phase 1/2 trial of BB2603, a terbinafine‐based topical nano‐formulation, in onychomycosis and tinea pedis. Mycoses 2022; 65:661-669. [DOI: 10.1111/myc.13448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/17/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - David Cook
- Blueberry Therapeutics Limited Macclesfield SK10 4TG UK
| | - John Ridden
- Blueberry Therapeutics Limited Macclesfield SK10 4TG UK
| | - Kerry Nield
- Blueberry Therapeutics Limited Macclesfield SK10 4TG UK
| | - Emma Leigh
- Blueberry Therapeutics Limited Macclesfield SK10 4TG UK
| | - Julie Cook
- Blueberry Therapeutics Limited Macclesfield SK10 4TG UK
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32
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Gupta AK, Friedlander SF, Simkovich AJ. Tinea capitis: An update. Pediatr Dermatol 2022; 39:167-172. [PMID: 35075666 DOI: 10.1111/pde.14925] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
Abstract
Tinea capitis is an important superficial infection and affects children globally. A literature review was conducted to identify recent findings and the current understanding of this fungal infection. Here, we highlight updates on important aspects of tinea capitis including advances in dermatophyte detection and diagnosis and comparing these new methods to more traditional techniques. Additionally, aspects of treating tinea capitis are discussed, including the importance of mycological confirmation and current means of treatment, and the treatment of asymptomatic carriers are reviewed. This review also examines the subject of laboratory monitoring of patients undergoing treatment with systemic antifungals; we discuss the opinions of prominent researchers and currently accepted guidelines. Lastly, we provide answers to several common questions that practitioners may encounter when treating a child with tinea capitis.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.,Mediprobe Research Inc., London, Ontario, Canada
| | - Sheila Fallon Friedlander
- Department of Dermatology, University of California School of Medicine, San Diego, California, USA.,Department of Dermatology, Scripps Clinic, San Diego, California, USA
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Fink S, Burmester A, Hipler U, Neumeister C, Götz MR, Wiegand C. Efficacy of antifungal agents against fungal spores: An in vitro study using microplate laser nephelometry and an artificially infected 3D skin model. Microbiologyopen 2022; 11:e1257. [PMID: 35212482 PMCID: PMC8756736 DOI: 10.1002/mbo3.1257] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 09/09/1999] [Accepted: 12/01/2021] [Indexed: 12/13/2022] Open
Abstract
Dermal fungal infections seem to have increased over recent years. There is further a shift from anthropophilic dermatophytes to a growing prevalence of zoophilic species and the emergence of resistant strains. New antifungals are needed to combat these fungi and their resting spores. This study aimed to investigate the sporicidal effects of sertaconazole nitrate using microplate laser nephelometry against the microconidia of Trichophyton, chlamydospores of Epidermophyton, blastospores of Candida, and conidia of the mold Scopulariopsis brevicaulis. The results obtained were compared with those from ciclopirox olamine and terbinafine. The sporicidal activity was further determined using infected three-dimensional full skin models to determine the antifungal effects in the presence of human cells. Sertaconazole nitrate inhibited the growth of dermatophytes, molds, and yeasts. Ciclopirox olamine also had good antifungal activity, although higher concentrations were needed compared to sertaconazole nitrate. Terbinafine was highly effective against most dermatophytes, but higher concentrations were required to kill the resistant strain Trichophyton indotineae. Sertaconazole nitrate, ciclopirox olamine, and terbinafine had no negative effects on full skin models. Sertaconazole nitrate reduced the growth of fungal and yeast spores over 72 h. Ciclopirox olamine and terbinafine also inhibited the growth of dermatophytes and molds but had significantly lower effects on the yeast. Sertaconazole nitrate might have advantages over the commonly used antifungals ciclopirox olamine and terbinafine in combating resting spores, which persist in the tissues, and thus in the therapy of recurring dermatomycoses.
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Affiliation(s)
- Sarah Fink
- Department of DermatologyUniversity Hospital JenaJenaGermany
| | - Anke Burmester
- Department of DermatologyUniversity Hospital JenaJenaGermany
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Antimicrobials and Resistance Part II: Antifungals, Antivirals, and Antiparasitics. J Am Acad Dermatol 2022; 86:1207-1226. [DOI: 10.1016/j.jaad.2021.11.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
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Deshayes C, Arafath MN, Apaire-Marchais V, Roger E. Drug Delivery Systems for the Oral Administration of Antimicrobial Peptides: Promising Tools to Treat Infectious Diseases. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:778645. [PMID: 35146486 PMCID: PMC8821882 DOI: 10.3389/fmedt.2021.778645] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022] Open
Abstract
Antimicrobial peptides (AMPs) have a great potential to face the global expansion of antimicrobial resistance (AMR) associated to the development of multidrug-resistant (MDR) pathogens. AMPs are usually composed of 10–50 amino acids with a broad structural diversity and present a range of antimicrobial activities. Unfortunately, even if the oral route is the most convenient one, currently approved therapeutic AMPs are mostly administrated by the intravenous route. Thus, the development of novel drug delivery systems (DDSs) represents a promising opportunity to protect AMPs from chemical and enzymatic degradation through the gastrointestinal tract and to increase intestinal permeability leading to high bioavailability. In this review, the classification and properties as well as mechanisms of the AMPs used in infectiology are first described. Then, the different pharmaceutical forms existing in the market for oral administration are presented. Finally, the formulation technologies, including microparticle- and nanoparticle-based DDSs, used to improve the oral bioavailability of AMPs are reviewed.
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Affiliation(s)
| | | | | | - Emilie Roger
- University of Angers, INSERM, CNRS, MINT, SFR ICAT, Angers, France
- *Correspondence: Emilie Roger
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The current state of clinical mycology in Africa: a European Confederation of Medical Mycology and International Society for Human and Animal Mycology survey. THE LANCET MICROBE 2022; 3:e464-e470. [DOI: 10.1016/s2666-5247(21)00190-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/12/2021] [Accepted: 07/13/2021] [Indexed: 12/17/2022] Open
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Gupta AK, Talukder M, Venkataraman M. Review of the alternative therapies for onychomycosis and superficial fungal infections: posaconazole, fosravuconazole, voriconazole, oteseconazole. Int J Dermatol 2021; 61:1431-1441. [PMID: 34882787 DOI: 10.1111/ijd.15999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 12/16/2022]
Abstract
Terbinafine and itraconazole are the most commonly used oral antifungals to treat onychomycosis and superficial dermatomycoses. Recently, poor response to oral terbinafine has been reported. We have summarized the most appropriate dosing regimens of posaconazole, fosravuconazole, voriconazole, and oteseconazole (VT-1161) to treat onychomycosis and superficial fungal infections. A structured search on PubMed and Google Scholar was conducted. Additionally, the bibliographies of selected articles were searched to identify relevant records. The number of records identified from the searches was 463, with 50 articles meeting the inclusion criteria for review. None of the new azoles are US FDA approved for onychomycosis treatment; however, an increasing number of studies have evaluated these agents. The efficacies (complete cure and mycologic cure) of the antifungal agents for dermatophyte great toenail onychomycosis treatment are terbinafine 250 mg/day × 12 weeks (Phase III trial) (38%, 70%), itraconazole 200 mg/day × 12 weeks (Phase III trial) (14%, 54%), posaconazole 200 mg/day × 24 weeks (Phase IIB) (54.1%, 70.3%), fosravuconazole 100 mg/day ravuconazole equivalent × 12 weeks (Phase III) (59.4%, 82.0%), and oteseconazole 300 mg/day loading dose × 2 weeks (Phase II), followed by 300 mg/week × 10 weeks (maintenance dose) (45%, 70%). Guidelines for monitoring are also presented.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Mediprobe Research Inc, London, Ontario, Canada
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Kappes S, Faber T, Nelleßen L, Yesilkaya T, Bock U, Lamprecht A. Improving Transungual Permeation Study Design by Increased Bovine Hoof Membrane Thickness and Subsequent Infection. Pharmaceutics 2021; 13:pharmaceutics13122098. [PMID: 34959379 PMCID: PMC8707648 DOI: 10.3390/pharmaceutics13122098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022] Open
Abstract
Ungual formulations are regularly tested using human nails or animal surrogates in Franz diffusion cell experiments. Membranes sometimes less than 100 µm thick are used, disregarding the higher physiological thickness of human nails and possible fungal infection. In this study, bovine hoof membranes, healthy or infected with Trichophyton rubrum, underwent different imaging techniques highlighting that continuous pores traversed the entire membrane and infection resulted in fungal growth, both superficial, as well as in the membrane’s matrix. These membrane characteristics resulted in substantial differences in the permeation of the antifungal model substance bifonazole, depending on the dosage forms. Increasing the thickness of healthy membranes from 100 µm to 400 µm disproportionally reduced the permeated amount of bifonazole from the liquid and semisolid forms and allowed for a more pronounced assessment of the effects by excipients, such as urea as the permeation enhancer. Similarly, an infection of 400-µm membranes drastically increased the permeated amount. Therefore, the thickness and infection statuses of the membranes in the permeation experiments were essential for a differential readout, and standardized formulation-dependent experimental setups would be highly beneficial.
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Affiliation(s)
- Sebastian Kappes
- Department of Pharmaceutics, Institute of Pharmacy, University of Bonn, Gerhard-Domagk-Str. 3, 53121 Bonn, Germany; (S.K.); (T.F.); (L.N.)
| | - Thilo Faber
- Department of Pharmaceutics, Institute of Pharmacy, University of Bonn, Gerhard-Domagk-Str. 3, 53121 Bonn, Germany; (S.K.); (T.F.); (L.N.)
| | - Lotta Nelleßen
- Department of Pharmaceutics, Institute of Pharmacy, University of Bonn, Gerhard-Domagk-Str. 3, 53121 Bonn, Germany; (S.K.); (T.F.); (L.N.)
| | | | - Udo Bock
- Bock Project Management, 54456 Tawern, Germany;
| | - Alf Lamprecht
- Department of Pharmaceutics, Institute of Pharmacy, University of Bonn, Gerhard-Domagk-Str. 3, 53121 Bonn, Germany; (S.K.); (T.F.); (L.N.)
- PEPITE EA4267, University of Burgundy/Franche-Comté, 25000 Besançon, France
- Correspondence: ; Tel.: +49-228-735-243; Fax: +49-228-735-268
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Trifan A, Luca SV, Bostănaru AC, Brebu M, Jităreanu A, Cristina RT, Skalicka-Woźniak K, Granica S, Czerwińska ME, Kruk A, Greige-Gerges H, Sieniawska E, Mareș M. Apiaceae Essential Oils: Boosters of Terbinafine Activity against Dermatophytes and Potent Anti-Inflammatory Effectors. PLANTS (BASEL, SWITZERLAND) 2021; 10:plants10112378. [PMID: 34834740 PMCID: PMC8623916 DOI: 10.3390/plants10112378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 05/03/2023]
Abstract
Dermatophyte infections represent an important public health concern, affecting up to 25% of the world's population. Trichophyton rubrum and T. mentagrophytes are the predominant dermatophytes in cutaneous infections, with a prevalence accounting for 70% of dermatophytoses. Although terbinafine represents the preferred treatment, its clinical use is hampered by side effects, drug-drug interactions, and the emergence of resistant clinical isolates. Combination therapy, associating terbinafine and essential oils (EOs), represents a promising strategy in the treatment of dermatophytosis. In this study, we screened the potential of selected Apiaceae EOs (ajowan, coriander, caraway, and anise) to improve the antifungal activity of terbinafine against T. rubrum ATCC 28188 and T. mentagrophytes ATCC 9533. The chemical profile of EOs was analyzed by gas chromatography. The minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC) of EOs/main compounds were determined according to EUCAST-AFST guidelines, with minor modifications. The checkerboard microtiter method was used to identify putative synergistic combinations of EOs/main constituents with terbinafine. The influence of EOs on the viability and pro-inflammatory cytokine production (IL-1β, IL-8 and TNF-α) was determined using an ex vivo human neutrophils model. The binary associations of tested EOs with terbinafine were found to be synergistic against T. rubrum, with FICI values of 0.26-0.31. At the tested concentrations (6.25-25 mg/L), EOs did not exert cytotoxic effects towards human neutrophils. Anise EO was the most potent inhibitor of IL-1β release (46.49% inhibition at 25 mg/L), while coriander EO displayed the highest inhibition towards IL-8 and TNF-α production (54.15% and 54.91%, respectively). In conclusion, the synergistic combinations of terbinafine and investigated Apiaceae EOs could be a starting point in the development of novel topical therapies against T. rubrum-related dermatophytosis.
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Affiliation(s)
- Adriana Trifan
- Department of Pharmacognosy, Faculty of Pharmacy, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- Correspondence: (A.T.); (A.-C.B.)
| | - Simon Vlad Luca
- Department of Pharmacognosy, Faculty of Pharmacy, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- Biothermodynamics, TUM School of Life and Food Sciences, Technical University of Munich, 85354 Freising, Germany;
| | - Andra-Cristina Bostănaru
- Laboratory of Antimicrobial Chemotherapy, Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” Iasi University of Life Sciences, 700489 Iasi, Romania;
- Correspondence: (A.T.); (A.-C.B.)
| | - Mihai Brebu
- Physical Chemistry of Polymers Laboratory, Petru Poni Institute of Macromolecular Chemistry, 700481 Iasi, Romania;
| | - Alexandra Jităreanu
- Department of Toxicology, Faculty of Pharmacy, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
| | - Romeo-Teodor Cristina
- Department of Pharmacology, The Banat University of Agricultural Sciences and Veterinary Medicine, 300645 Timisoara, Romania;
| | - Krystyna Skalicka-Woźniak
- Department of Natural Products Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (K.S.-W.); (E.S.)
| | - Sebastian Granica
- Microbiota Lab, Centre for Preclinical Studies, Department of Pharmacognosy and Molecular Basis of Phytotherapy, Medical University of Warsaw, 02-097 Warsaw, Poland; (S.G.); (A.K.)
| | - Monika E. Czerwińska
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland;
- Centre for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Aleksandra Kruk
- Microbiota Lab, Centre for Preclinical Studies, Department of Pharmacognosy and Molecular Basis of Phytotherapy, Medical University of Warsaw, 02-097 Warsaw, Poland; (S.G.); (A.K.)
| | - Hélène Greige-Gerges
- Bioactive Molecules Research Laboratory, Department of Chemistry and Biochemistry, Faculty of Sciences, Section II, Lebanese University, Jdaidet el-Matn B.P. 90656, Lebanon;
| | - Elwira Sieniawska
- Department of Natural Products Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (K.S.-W.); (E.S.)
| | - Mihai Mareș
- Laboratory of Antimicrobial Chemotherapy, Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” Iasi University of Life Sciences, 700489 Iasi, Romania;
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40
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Gupta AK, Venkataraman M, Renaud HJ, Summerbell R, Shear NH, Piguet V. A Paradigm Shift in the Treatment and Management of Onychomycosis. Skin Appendage Disord 2021; 7:351-358. [PMID: 34604322 DOI: 10.1159/000516112] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022] Open
Abstract
There is an increase in the incidence of onychomycosis, especially in at-risk populations. Onychomycosis is difficult to treat, as the efficacy of most antifungal agents is relatively low. Nondermatophyte molds (NDMs) and mixed infection (dermatophyte plus NDM) onychomycosis are contributing to growing antifungal resistance, as they are often underestimated and ignored due to incorrect diagnosis. There is a need for a paradigm shift in the management of onychomycosis to a patient-centered, holistic approach with an emphasis on laboratory diagnosis prior to initiating treatment, which enables the rational choice of the antifungal agent. Additionally, in the case of resistant infections, antifungal susceptibility testing is recommended. Strategies for effective management of onychomycosis include disinfection of fungal reservoirs in shoes and socks and prophylaxis posttreatment using topical antifungal agents. These measures may reduce the recurrence of onychomycosis and improve long-term clinical success.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Mediprobe Research Inc., London, Ontario, Canada
| | | | | | - Richard Summerbell
- Sporometrics, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
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Vlahovic TC, Gupta AK. Efinaconazole topical solution (10%) for the treatment of onychomycosis in adult and pediatric patients. Expert Rev Anti Infect Ther 2021; 20:3-15. [PMID: 34106031 DOI: 10.1080/14787210.2021.1939011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Onychomycosis, a common nail disorder caused by fungal infection, can be managed pharmaceutically with oral or topical treatments. While oral treatments are often used first-line to treat nail infections, these systemic antifungals are not appropriate for all patients, and no oral treatments are approved for use in children in the USA. Given this need, topical antifungals were developed, which can be used as monotherapy or in combination with oral drugs.Areas Covered: Efinaconazole 10% solution is an azole antifungal indicated for topical treatment of toenail onychomycosis in pediatric and adult patients. This qualitative literature review summarizes available chemical, pharmacological, efficacy, safety, and post-marketing surveillance data of efinaconazole 10% topical solution. Efinaconazole 10% has been shown to be safe and efficacious regardless of disease severity/duration at baseline; patient gender, ethnicity, or age (including pediatrics); or comorbidities such as diabetes or tinea pedis. Overall, efinaconazole is a safe and effective clinical option for the treatment and management of onychomycosis.Expert Opinion: Efinaconazole is the first new antifungal approved for onychomycosis in 10 years in the USA. It has comparable efficacy to systemic antifungal agents such as itraconazole, and a favorable adverse events profile with minimal systemic exposure and no drug-drug interactions.
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Affiliation(s)
- Tracey C Vlahovic
- Temple University School of Podiatric Medicine, Philadelphia, PA, US
| | - Aditya K Gupta
- Mediprobe Research Inc., London, ON, CAN.,Department of Medicine, University of Toronto, Toronto, ON, CAN
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Abstract
BACKGROUND AND OBJECTIVE With the widespread use of antifungals to treat superficial mycoses, reports of antifungal resistance are increasing. Antifungal resistance is becoming a public health challenge and needs to be addressed in parallel with antibacterial and antiviral resistance. METHODS We review the growing resistance of fungal pathogens such as Trichophyton species and the emergence of novel pathogens, including multidrug-resistant strains in superficial mycoses. We also discuss the importance of laboratory diagnosis and antifungal susceptibility testing (AFST) in the management of recalcitrant infections. RESULTS AND CONCLUSION Antifungal resistance can occur naturally or develop over time when fungi are exposed to antifungals. The frequency of terbinafine-resistant Trichophyton isolates is increasing. Opportunistic pathogens such as Aspergillus and Candida species have developed resistance to classic azoles such as itraconazole and fluconazole, and the newer azoles such as posaconazole and voriconazole. Although uncommon, topical antifungals such as efinaconazole and tavaborole have shown to induce resistance in Trichophyton rubrum. The emergence of multidrug-resistant Trichophyton mentagrophytes/interdigitale, Candida auris, and Aspergillus species causing severe infections is highly concerning. Routine AFST should be considered to determine the most effective treatment, especially if there is failure to therapy. Combination treatment of oral and topical antifungals may be a consideration for managing recalcitrant infections.
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Affiliation(s)
- Aditya K Gupta
- Department of Medicine, Division of Dermatology, University of Toronto School of Medicine, Toronto, ON, Canada.,Mediprobe Research Inc., London, ON, Canada
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43
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Singh A, Singh P, Dingemans G, Meis JF, Chowdhary A. Evaluation of DermaGenius ® resistance real-time polymerase chain reaction for rapid detection of terbinafine-resistant Trichophyton species. Mycoses 2021; 64:721-726. [PMID: 33760310 DOI: 10.1111/myc.13271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Treatment-resistant dermatophytosis caused by Trichophyton mentagrophytes/interdigitale complex has emerged as a global public health threat, particularly in endemic countries like India and has spread to many other countries. This veritable spread is alarming due to increase in resistance to terbinafine, which targets the ergosterol biosynthetic pathway by inhibiting the enzyme squalene epoxidase (SQLE). About two third of studies worldwide have reported amino acid substitutions Phe397Leu and Leu393Phe in the SQLE protein to be responsible for high terbinafine MICs. OBJECTIVES We evaluated the efficacy of the newly developed DermaGenius® Resistance real-time PCR assay to rapidly identify Trichophyton isolates harbouring most common SQLE mutant (Phe397Leu and Leu393Phe) conferring high terbinafine resistance from wild-type susceptible isolates. METHODS A total of 97 Trichophyton isolates confirmed by ITS sequencing as T. mentagrophytes/interdigitale (recently named T. indotineae n = 90), T. rubrum/T. soudanense (n = 3), T mentagrophytes (n = 2) and T tonsurans (n = 2) were analysed to evaluate DermaGenius® Resistance real-time PCR assay. All 40 T. indotineae isolates exhibiting amino acid substitutions Phe397Leu or Leu393Phe identified by SQLE gene sequencing were evaluated for detection of non-wild-type strains by real-time PCR. Antifungal susceptibility testing for terbinafine was done by CLSI microbroth dilution method. RESULTS All terbinafine-resistant isolates harbouring amino acid substitutions Phe397Leu or Leu393Phe in SQLE gene were correctly recorded as SQLE mutants by the DermaGenius® Resistance real-time PCR assay. CONCLUSIONS The DermaGenius® Resistance real-time PCR assay effectively identified Trichophyton species and distinguished wild-type from SQLE mutant genotype that harbour Phe397Leu and Leu393Phe amino acid substitutions.
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Affiliation(s)
- Ashutosh Singh
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, India
| | - Prerna Singh
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, India
| | | | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, India
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Gupta AK, Summerbell RC, Venkataraman M, Quinlan EM. Nondermatophyte mould onychomycosis. J Eur Acad Dermatol Venereol 2021; 35:1628-1641. [PMID: 33763903 DOI: 10.1111/jdv.17240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/09/2021] [Indexed: 01/21/2023]
Abstract
Nondermatophyte moulds (NDMs) onychomycosis is often difficult to diagnose as NDMs have been considered contaminants of nails. There are several diagnostic methods used to identify NDMs, however, repeated laboratory isolation is recommended to validate pathogenicity. With NDM and mixed infection (dermatophytes plus NDM) onychomycosis on the rise, accurate clinical diagnosis along with mycological tests is recommended. Systemic antifungal agents such as itraconazole and terbinafine (e.g. pulse regimen: 1 pulse = every day for one week, followed by no treatment for three weeks) have shown efficacy in treating onychomycosis caused by various NDMs such as Aspergillus spp., Fusarium spp., Scopulariopsis brevicaulis, and Onychocola canadensis. Studies investigating topical therapy and devices for NDM onychomycosis are limited. The emergence of antifungal resistance necessitates the incorporation of antifungal susceptibility testing into diagnosis when possible, for the management of recalcitrant infections. Case studies documented in the literature show newer azoles such as posaconazole and voriconazole as sometimes effective in treating resistant NDM onychomycosis. Treatment with broad-spectrum antifungal agents (e.g. itraconazole and efinaconazole) and other combination therapy (oral + oral and/or oral + topical) may be considerations in the management of NDM onychomycosis.
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Affiliation(s)
- A K Gupta
- Mediprobe Research Inc., London, ON, Canada.,Department of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - R C Summerbell
- Sporometrics, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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