Epidemiology of Dermatophytes Isolated from Clinical Samples in a Hospital in Eastern Saudi Arabia: A 20-Year Survey

Antifungal activity of Carica papaya fruit extract against Microsporum canis: in vitro and in vivo study

Background

Tinea capitis (T. capitis), commonly known as scalp ringworm, is a fungal infection affecting the scalp and hair. Among the causative agents, Microsporum canis (M. canis) stands out, often transmitted from cats to humans (zoonotic disease). In this study, we investigated the efficacy of Carica papaya (C. papaya), fruit extract against dermatophytes, particularly M. canis, both in vitro and in vivo. Additionally, we aimed to identify the active compounds responsible for suppressing fungal growth and assess the toxicity of C. papaya on human cells.

Methodology

It conducted in two parts. First, In Vitro Study include the preparation of C. papaya fruit extract using methanol as the solvent, Phytochemical analysis of the plant extract including Gas chromatography-mass spectrometry (GC-MS) and Fourier-transform infrared spectroscopy (FTIR) was conducted, Cytotoxicity assays were performed using HUH-7 cells, employing the MTT assay (1-(3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide), Antimicrobial activity against M. canis was evaluated, including: Zone of inhibition (ZI), Minimum inhibitory concentration (MIC), Minimum fungicidal concentration (MFC), M. canis cell alterations were observed using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Second, In Vivo, Albino Wistar male rats were included.

Results

The phytochemical analysis of the methanolic extract from papaya revealed several functional groups, including hydroxyl, ammonia, alkane, carbonate, and alcohol. Additionally, the GC-MS analysis identified 15 compounds, with xanthosine and decanoic acid being the predominant components. The methanolic extract of papaya fruits demonstrated potent antifungal activity: ZI = 37 mm, MIC = 1,000 μg/mL, MFC = 1900 μg/mL, MTT results indicated lower cytotoxicity of the fruit extract at concentrations of 20 μg/mL, 50 μg/mL, 100 μg/mL, 150 μg/mL, and 200 μg/mL, The IC50 revealed a significant decrease in cell viability with increasing extract concentration. Notably, papaya extract induced considerable alterations in the morphology of M. canis hyphae and spores. In animal tissue, improvements were observed among the group of rats which treated with Papaya extract. This study highlights the potential of C. papaya fruits as a natural antifungal agent, warranting further exploration for clinical applications.

Microsporum gypseum Infection Among Two Related Families With a Zoonotic Aspect: A Prospective Case Series

Background and purpose The Microsporum gypseum complex is a globally distributed group of geophilic dermatophytes that primarily affect animals but can also rarely cause dermatomycoses in humans. With some regional and occupational variations, tinea corporis is the most prevalent presentation of the infection. The aim of this study was to report on the diagnosis and treatment of dermatophytosis cases among related families, and their pets, from southern Saudi Arabia. Up-to-date information on dermatophytes and dermatophytosis is needed. Methods This is a prospective case series undertaken at the Dermatology Outpatient Clinic of King Khalid University, Saudi Arabia. Six patients with suspected dermatophytosis were received at our hospital in 2022 and have been followed for recovery with or without scars. Characteristics of fungal pathogens were examined phenotypically on the basis of microscopic and growth characteristics, and laboratory data were used to initiate treatment with oral fluconazole, topical terbinafine cream, or oral itraconazole. Results Clinical features and culture results confirmed tinea capitis and tinea corporis caused by M. gypseum, which was also present in a pet cat. Tinea capitis cases (n = 4) did not respond to fluconazole and terbinafine treatment, but treatment with itraconazole resulted in a full recovery. Tinea corporis cases (n = 2) were treated with terbinafine, which resulted in a full recovery within four weeks, with no signs of scarring. Conclusions M. gypseum presents with serious persistent lesions and is extremely contagious. Treatment is durable but challenging, and breaking the transmission chain is more difficult.

Retrospective Analysis of Tinea Capitis in Xinjiang, China

Tinea capitis is a cutaneous infection of dermatophytes and predominant in children. It is one of common infectious diseases of children in Xinjiang, particularly in the southern Xinjiang. The aim of this study is to analyze the clinical and mycological characteristics of patients with tinea capitis in Xinjiang China. Medical records from 2010 to 2021, Mycology Laboratory Department of Dermatology in the First Affiliated Hospital of Xinjiang Medical University, retrospectively investigated the clinical and mycological characteristics of 198 patients with tinea capitis. Hairs have been obtained for fungal examination, and analysis with 20% KOH and Fungus Fluorescence Staining Solution has been conducted. Identification of fungi was using of morphological and molecular biological methods. Among total number of 198 patients, 189 (96%) were children with tinea capitis, of which 119 (63%) were male and 70 (37%) were female; 9 (4%) were adult patients with tinea capitis, of which 7 were female and 2 were male. Preschool children between the ages of 3 and 5 years had the highest distribution (54%), followed by those between the ages of 6 and 12 years (33%), the ages under 2 years (11%) and the ages of 13-15 years (2%) respectively. Among all patients, 135 (68.18%) were Uygur, 53 (26.77%) were Han, 5 (2.53%) were Kazak, 3 (1.52%) were Hui, 1 (0.5%) was Mongolian and nationality information of 1 patient (0.5%) is unknown. The indentification results of the isolates showed that 195 (98%) patients had single-species infections and 3 (2%) patients had double mixed infections. Among single-species infection patients, Microsporum canis (n = 82, 42.05%), Microsporum ferrugineum (n = 56, 28.72%) and Trichophyton mentagrophytes (n = 22, 11.28%) were the most prevalent species. Other dermatophytes included Trichophyton tonsurans (n = 12, 6.15%), Trichophyton violaceum (n = 10, 5.13%), Trichophyton schoenleinii (n = 9, 4.62%) and Trichophyton verrucosum (n = 4, 2.05%). Among 3 cases of mixed infections, 1 was M. canis + T. tonsurans (n = 1), and the other 2 were M.canis + T.mentagrophytes (n = 2). In conclusion, the majority of tinea capitis patients in Xinjiang, China are Uygur male children aged 3-5 years. M. canis was the most prevalent species causing tinea capitis in Xinjiang. These results provide useful information for the treatment and prevention of tinea capitis.

Cross-sectional investigation of mycological diagnosis challenges in Saudi Arabia

Background

The global incidence of fungal infection has increased dramatically over the last two decades. Fungal diseases threaten both immunocompetent, and immunocompromised patients. The current fungal diagnostics status in Saudi Arabia needs to be evaluated, especially with the increase of the immunosuppressed population. This cross-sectional study investigated the gaps in mycological diagnosis on a national level.

Materials and methods

The call interview questionnaire responses were collected to evaluate the demand for fungal assays, diagnostic methods' quality, and mycological expertise of laboratory technologists in both public and private medical intuitions. The data were analyzed using (IBM SPSS ^® software version 22.0).

Results

A total of 57 hospitals from all Saudi regions participated in the questionnaire; however, only 32% received or processed mycological samples. Most participants were from the Mecca region (25%), Riyadh region (19%), and Eastern region (14%). The top fungal isolates identified were Candida spp., Aspergillus spp., and dermatophyte. Fungal investigation is highly requested by intensive care, dermatology, and obstetrics and gynecology units. Most laboratories rely on fungal culture and microscopic examination, which mostly identify Candida to the genus level, and use 37°C incubators for culture (67%). Antifungal susceptibility testing (AST) and serological and molecular methods are rarely performed and mostly outsourced. Using accurate identification and AST are the primary factors to improve fungal diagnosis in respect to turnaround time and cost. The three major obstacles identified were availability of facility (47%), reagents and kits (32%), and good training (21%).

Conclusions

The results indicated that fungal diagnosis demand was relatively higher in high-population regions. This study highlighted the gaps in fungal diagnostics reference laboratories to encourage their improvement in Saudi hospitals.

Comparison of in vitro activities of newer triazoles and classic antifungal agents against dermatophyte species isolated from Iranian University Hospitals: a multi-central study

BACKGROUND

Dermatophytes have the ability to invade the keratin layer of humans and cause infections. The aims of this study were the accurate identification of dermatophytes by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism method and sequencing and comparison between the in vitro activities of newer and established antifungal agents against them.

METHODS

Clinical specimens of patients from five Iranian university laboratories were entered in this study. Samples were cultured on sabouraud dextrose agar medium. For molecular identification, extracted DNAs were amplified by the universal fungal primers ITS1 and ITS4, and digested with MvaI enzymes. The antifungal susceptibility test for each isolate to terbinafine, griseofulvin, caspofungin, fluconazole, itraconazole, luliconazole, and isavuconazole was performed, according to the microdilution CLSI M38-A2 and CLSI M61 standard methods.

RESULTS

Two hundred and seven fungi species similar to dermatophytes were isolated of which 198 (95.6%) were dermatophytes by molecular assay. The most commonly isolated were Trichophyton mentagrophytes (76/198), followed by Trichophyton interdigitale (57/198), Trichophyton rubrum (34/198), Trichophyton tonsurans (12/198), Microsporum canis (10/198), Trichophyton simii (3/198), Epidermophyton floccosum (3/198), Trichophyton violaceum (2/198), and Trichophyton benhamiae (1/198). The GM MIC and MIC₉₀ values for all the isolates were as follows: terbinafine (0.091 and 1 μg/ml), griseofulvin (1.01 and 4 μg/ml), caspofungin (0.06 and 4 μg/ml), fluconazole (16.52 and 32 μg/ml), itraconazole (0.861 and 8 μg/ml), isavuconazole (0.074 and 2 μg/ml), and luliconazole (0.018 and 0.25 μg/ml).

CONCLUSION

Trichophyton mentagrophytes, Trichophyton interdigitale, and Trichophyton rubrum were the most common fungal species isolated from the patients. luliconazole, terbinafine, and isavuconazole in vitro were revealed to be the most effective antifungal agents against all dermatophyte isolates.

Submission and Phylogenetical of Local Isolated Trichophyton interdigitale of Iraqi Patients in NCBI

Dermatophytes are species with slight genetic variation, and are yet several uncertainties about the differences among species. This study aims to isolate and diagnose the Trichophyton interdigitale by molecular technique and to reveal the phylogenetic distance and similarity of the Iraqi isolates to other isolates from the globe, in addition, to submit the obtained sequences to the NCBI database. This study included 86 with multiple lesions on different parts of the body. The results showed different variations within the ITS gene between the isolates. It was concluded that Trichophyton interdigitale in Iraqi isolates had two types of substitution variations (Transition and Transversion) different than global isolates. Moreover, it appeared according to the phylogenetic tree, the similarity was 97% with isolates from the Czech Republic and Japan, whereas 98% with the isolates from France and Germany. Keywords. Dermatophytes, genetic variations, ITS gene, multiple lessons