Clinico-mycological Profile of Superficial Mycosis in a Hospital in North-East India

The study of tryptophol containing emulgel on fungal reduction and skin irritation

Tryptophol (TOH), a fungal quorum-sensing molecule, that possesses anti-fungal activities for controlling the growth of human pathogenic fungi. In the present study, we developed TOH-containing emulgel formulations and examined the antifungal activities and potential use as topical treatments on the skin. The results showed that TOH-containing emulgel at 1000 μM has excellent physical characteristics as homogenous, stability, and inhibits the growth of 30 species of human pathogenic fungi in vitro. TOH-containing emulgel did not cause skin irritation in mouse model of irritation and in healthy human volunteers. Moreover, an increase in skin hydration and a decrease in trans-epidermal water loss (TEWL) were observed after TOH-containing emulgel treatment on human skin. Our findings indicated that TOH-containing emulgel can be utilize as an antifungal agent for topical treatment against fungal infections on the skin.

Homeopathic Medicines in the Management of Dermatophytosis (Tinea Infections): A Clinico-epidemiological Study with Pre-post Comparison Design

BACKGROUND

 Dermatophytosis is a common fungal infection of the skin and nails. Insufficient data exist regarding the clinico-epidemiological profile of dermatophytosis and the usefulness of individualized homeopathic medicines (IHMs) for patients visiting a homeopathy outpatient department (OPD).

OBJECTIVES

 This article undertakes a clinico-epidemiological profiling of dermatophytosis and the usefulness of IHMs in its management.

METHODS

 This open-label, pre-post, comparative observational study was conducted in a homeopathy OPD from November 2018 to February 2020. IHMs were prescribed based on symptom totality and repertorization. A numeric rating scale (NRS) and the Dermatology Life Quality Index (DLQI) patient questionnaires were used, and results were analyzed using SPSS-IBM version 20.

RESULTS

 Data from a total of 103 patients, mean age 29.65 ± 15.40 years, were analyzed. Tinea cruris was the most common infection (29.1%), followed by tinea corporis (13.6%). After 3 months of treatment, significant reductions in NRS and DLQI scores were observed (8.51 ± 1.24 to 0.59 ± 0.83, p < 0.001, and 16.28 ± 5.30 to 1.44 ± 1.56, p < 0.001, respectively), with Sepia (15.5%), Sulphur (14.6%), Calcarea carbonica (11.7%), Natrum muriaticum (9.7%) and Bacillinum (8.7%) being the most frequently prescribed medicines. There was no significant correlation between occupation, sex, home location or marital status and the clinical types of dermatophytosis. No adverse events were reported.

CONCLUSION

 T. cruris and T. corporis were prevalent dermatophytic infections. The decrease in NRS and DLQI scores associated with homeopathy indicates its usefulness as an integrative treatment option for dermatophytosis. Further research in larger and more diverse population samples is needed.

Developing diagnostic criteria to differentiate fungal foot infections caused by Neoscytalidium dimidiatum and dermatophytes

Background

The predisposing factors and clinical presentations of fungal foot infections caused by non-dermatophytes and dermatophytes are challenging to differentiate. Definite diagnoses of non-dermatophyte infections at first visits facilitate their treatment.

Objectives

This study aimed to develop diagnostic criteria to differentiate fungal foot infections caused by Neoscytalidium dimidiatum and dermatophytes.

Methods

Diagnostic prediction research based on a retrospective, observational, cross-sectional study. The reviewed patients were aged ≥18 and underwent a mycological examination for fungal foot infections. A fungal culture at the initial visit was the gold standard for determining causative organisms.

Results

Analyses were carried out on the data from 371 patients. N. dimidiatum accounted for 184 (49.6%) infections, and dermatophytes caused the remaining 187 (50.4%) cases. Five significant predefined predictors were used to develop the diagnostic criteria and score. They were immunocompetence status, no family history of fungal infections, the absence of pruritus, the absence of other concurrent fungal skin infections, and agricultural work. The lower score cutoff was <8 (sensitivity 97.8% and specificity 25.7%). The higher cutoff was >11 (sensitivity 83.7% and specificity 57.8%). The score showed an area under the receiver operating characteristic curve of 0.755 and was well calibrated.

Conclusions

The criteria and score show promise for clinical use, with acceptable discriminative performance and good calibration. They will help physicians differentiate the causative organisms in patients with fungal foot infections at the first visit, enabling the determination of appropriate antifungal treatment.

Analytical Study on Current Trends in the Clinico-Mycological Profile among Patients with Superficial Mycoses

Infections affecting the superficial keratinized layer of the skin, nails, and hair are referred to as dermatophytosis and dermatomycoses, which constitute the most common type of fungal infection that affects people. This clinical ailment has a prevalence of between 30 and 60% and is more common in India's hot, muggy, tropical climate. Examining the prevalence of superficial mycoses (SM), their clinical symptoms, and the fungal species that were identified as the disease-causing agents were the main objectives of the current study. This study comprised 250 clinically confirmed patients with SM who visited our dermatology department over the course of a year. Skin scrapings, nail clippings, and hair samples were gathered, mounted, and cultured using KOH. Macroscopic examination of culture, tease mount, and phenotypic tests were used to identify the species. The age group of 11-20 years (29%) had the highest prevalence of SM out of the 250 clinically verified cases of the condition that were included in our study, followed by 21-30 years (20%) and 31-40 years (18%). Candida albicans, dermatophytes, and non-dermatophytic moulds were the three most prevalent fungal isolates. The most typical dermatophyte isolate was T. rubrum, which was primarily found in Tinea corporis (TCo), Tinea cruris (TCr), and Tinea faciei (TFa). T. mentagrophytes was the second most frequent isolate. According to our investigation, it was determined that non-dermatophytic moulds constitute a significant contributor to the development of SM in addition to dermatophytes.

In Vitro Antidermatophytic and Biochemical Studies on Aqueous Extracts of Avicennia marina and Suaeda monoica Plants from the Yanbu Region

Many infectious diseases can be treated using herbal medicines. Therefore, plant materials play a major role in therapeutic medicine and are widely used in many developing countries. In this study, we analyzed the potential of Avicennia marina and Suaeda monoica leaf extracts as antidermatophytic agents. Molecular identification of the plant samples was performed via DNA sequencing of the internal transcribed spacer region using the primers ITS-u1 and ITS-u4. Leaf extracts of A. marina and S. monoica were prepared in cold and hot distilled water. Their antidermatophytic activities were evaluated against Trichophyton mentagrophytes, T. verrucosum, Microsporum gallinae, M. gypseum, M. canis, Epidermophyton floccosum, Candida albicans, and C. tropicalis using the dry weight method. E. floccosum was the most sensitive to both cold extracts of A. marina and S. monoica, whereas T. verrucosum was the most sensitive to the hot extract of A. marina. The minimum inhibitory concentrations of the hot extracts were determined. They ranged from 10 to 30 mg/ml, defining the anti-scavenging activity and total phenolic content of both plants. The hot extract of A. marina possessed the highest anti-scavenging activity (76%), whereas the cold extract of A. marina contained the highest phenolic content (40.06 mg/g dry weight). In addition, high-performance liquid chromatography was used to separate and estimate some of the bioactive compounds present in the plant extracts.

Dermatophytic infection and in vitro activities of antifungal drugs against dermatophytes in rural India

Background Increase in resistance to conventional antifungals renders the need for antifungal sensitivity testing in Dermatophytes.   The present study aimed at determining the prevalence of dermatophytic infections and their susceptibility pattern in a rural healthcare facility. Methods Patients with suspected dermatophytosis attending the dermatology outpatient department were enrolled in the study. Specimen collection for mycological examinations was done. In-vitro antifungal sensitivity testing was performed as per the Clinical and Laboratory Standard Institute (CLSI) M38-A2 (2008) standards with broth microdilution method. Results Onychomycosis was the commonest (41.9%) presentation. Dermatophytic prevalence based on culture was 110 (70.9%). The commonest species was Trichophyton rubrum (36.8%). Terbinafine was found to be the most effective drug, followed by ketoconazole and itraconazole. Conclusion Antifungal sensitivity in dermatophytic infections should be made a routine in tertiary healthcare facilities as we are already witnessing the rampage of emerging fungal infection– Mucormycosis in the nation and worldwide.

Clinico-Mycological Profile of Treatment-Naïve, Chronic, Recurrent and Steroid-Modified Dermatophytosis at a Tertiary Care Centre in Eastern India: An Institution-Based Cross-SectionalStudy

Background:

Dermatophytosis has recently emerged as a major public health problem in the Indian subcontinent, most cases becoming chronic and recurrent.

Aims:

Assessing the clinico-epidemiologic and mycologic profile of treatment naïve, chronic, recurrent and steroid-modified dermatophytosis.

Materials and Methods:

We conducted across-sectional study involving 111 cases of dermatophytosis. Detailed epidemiology, clinical parameters, treatment history and other host factors were assessed along with scraping for potassium hydroxide (KOH) and fungal culture.

Results:

Among 111 patients,(F: M 1.7:1; mean age 44.4 ± 18.2 years), 51.4% were treatment naïve, while 34.2% and 14.4% presented with chronic and recurrent tinea respectively. Family history and sharing of fomites among infected family members was commoner in the latter groups (P = 0.001). Topical steroid application was reported in 49.5%, however only 7.2% presented with steroid modified tinea. Tinea corporis et cruris (41.4%) was the predominant clinical type followed by tinea corporis (34.2%) and tinea cruris (27.9%). KOH mount and culture were positive in 62.2% and 39.6% cases respectively; commonest isolates being Trichophyton rubrum, and Trichophyton mentagrophytes complex in 15.3% cases each. Trichophyton rubrum was the commonest etiology for treatment naïve and recurrent cases, while Trichophyton mentagrophytes was the commonest isolate from chronic and steroid-modified cases (P = 0.0003). Interestingly, T.mentagrophytes complex and T. rubrum were the commonest causes of tinea corporis and tinea cruris respectively (P = 0.07).

Conclusion:

Trichophyton rubrum was the commonest organism in treatment naïve and recurrent cases, while Trichophyton mentagrophytes complex accounted for most cases of chronic and steroid modified tinea. The difference in predominant species seems to be a major contributory factor for chronicity and recurrence. However, several host factors like topical steroid use and sharing of fomites also play additional roles.

Nanoarchitectures in Management of Fungal Diseases: An Overview

Fungal infections, from mild itching to fatal infections, lead to chronic diseases and death. Antifungal agents have incorporated chemical compounds and natural products/phytoconstituents in the management of fungal diseases. In contrast to antibacterial research, novel antifungal drugs have progressed more swiftly because of their mild existence and negligible resistance of infections to antifungal bioactivities. Nanotechnology-based carriers have gained much attention due to their magnificent abilities. Nanoarchitectures have served as excellent carriers/drug delivery systems (DDS) for delivering antifungal drugs with improved antifungal activities, bioavailability, targeted action, and reduced cytotoxicity. This review outlines the different fungal diseases and their treatment strategies involving various nanocarrier-based techniques such as liposomes, transfersomes, ethosomes, transethosomes, niosomes, spanlastics, dendrimers, polymeric nanoparticles, polymer nanocomposites, metallic nanoparticles, carbon nanomaterials, and nanoemulsions, among other nanotechnological approaches.

Superficial mycoses, a matter of concern: Global and Indian scenario-an updated analysis

Superficial mycoses of skin, nails and hair are among the common fungal infections. They are caused by dermatophytes, non-dermatophyte moulds, yeasts and yeast-like fungi. Such fungal infections are widespread all over the world and are predominant in tropical as well as subtropical regions. Environmental factors, such as warm, humid and pitiable hygienic conditions, are conducive for their growth and proliferation. Although it does not cause mortality, it is known to be associated with excessive morbidity which may be psychological or physical. This affects the quality of life of the infected individuals which leads to a negative impact on their occupational, emotional and social status. Such infections are increasing on a global scale and, therefore, are of serious concern worldwide. This review article covers the global and Indian scenario of superficial mycoses taking into account the historical background, aetiological agents, prevalence, cultural and environmental factors, risk factors, pathogenesis and hygienic practices for the prevention of superficial mycoses.

Phenotypic Characterization of Enzymatic and Non-enzymatic Virulence Factors in Etiopathogenesis and Evolution of Drug Resistance among Dermatophytes

The virulence factors of dermatophytes play a vital role in the etio-pathogenesis and emergence of drug resistance. Regular surveillance is essential for constant monitoring of association of virulence factors in the emergence of drug resistant isolates and to guide proper therapeutic strategies to combat infections due to drug resistant isolates of dermatophytes. The aim of this study is to isolate and identify various enzymatic and non-enzymatic virulence factors of dermatophytes isolated from clinically suspected cases of dermatophytosis attending the dermatology outpatient clinic. From 30 clinical samples received from department of Dermatology to the department of Microbiology during the study period July to December 2019, KOH mount and fungal culture was done and only the isolates which grew dermatophytes were used for detecting virulence factors using standard methods. Among 30 affected patients, 13 were male (43.3%) and 17 were female (56.7%) with age range of 13 to 60 years. Skin sample yielded positive growth in 96.6% of the cases. Out of 30 samples, 6 samples were positive for Trichophyton mentagrophytes. Tinea corporis was the common manifestation which yielded positive growth. Female predominance was seen. Male predominance was seen in younger age group while females were more commonly affected in older age group. Adolescents were commonly affected age group (40%). Then people between age 41-50 (middle age group) were mostly affected. The six Trichophyton mentagrophytes were found to have enzymatic and non- enzymatic virulence factors. All the virulence factors included in the study were present in Trichophyton mentagrophytes.

Efficacy of Terbinafine and Itraconazole in Different Doses and in Combination in the Treatment of Tinea Infection: A Randomized Controlled Parallel Group Open Labeled Trial with Clinico-Mycological Correlation

Background:

There is a rising prevalence of dermatophyte infection especially in the tropics. It has been observed that the antifungals are not as effective as they used to be.

Aims:

To determine the effectiveness of terbinafine and itraconazole in different doses and in combination in the treatment of tinea infection.

Materials and Methods:

Study design was a randomized parallel group trial. Patients were randomly divided into five parallel arms in which two of the standard drugs in recommended doses were compared with their double doses and with combination of both the drugs. Patients were followed up every 2 weeks. Outcomes were assessed at 4 and 8 weeks. Cure was considered as complete clinical resolution of the lesions. Fungal culture and sensitivity were done by disk diffusion method for all patients. Parametric one-way analysis of variance (F test) and Chi-square test were used for the analysis.

Results:

Two-hundred seventy-five patients were included in the study. Itraconazole containing groups showed significantly higher cure rates than terbinafine only groups both at 4 and 8 weeks (P < 0.001). Itraconazole containing groups, when compared against each other, were not found to be significantly different. The outcomes between terbinafine only groups were also not significantly different. Cure rates at 8 weeks were found to be greater than that at 4 weeks for all groups which were found to be highly significant (P < 0.001).

Conclusions:

Itraconazole seems to be more effective than terbinafine. There is no benefit in increasing the dose or using a combination regimen in the treatment of tinea. Prolonged duration of treatment is required for complete cure.

Fluconazole conjugated-gold nanorods as an antifungal nanomedicine with low cytotoxicity against human dermal fibroblasts

Herein, a nanotechnology-based approach was adopted to develop a facile and effective nanoplatform for the treatment of superficial fungal infections. Gold nanorods (GNR) functionalized with thiolated poly ethylene glycol (PEG-SH) or thiolated PEGylated cholesterol (Chol-PEG-SH) moieties were conjugated with Fluconazole and loaded into poloxamer 407 hydrogel. The obtained nanocomplexes; PEG-Fluc-GNR and Chol-Fluc-GNR were characterized by optical spectroscopy, hydrodynamic size and effective surface charge. The anti-fungal activity of the nanocomplexes was investigated by estimating the minimum inhibitory concentration (MIC) and the percentage reduction of fungal viable count against Candida (C.) albicans. PEG-Fluc-GNR and Chol-Fluc-GNR resulted in 5-fold and 14-fold reduction in MIC of GNR, and in 9-fold and 12-fold reduction in MIC of Fluconazole, respectively. The average log-reduction of the viable fungal cells upon treatment with the nanocomplexes was 5 log cycles, and it ranged from 1.3–3.7 log cycles when loaded into poloxamer 407 hydrogel. Transmission electron microscope imaging of the treated C. albicans revealed an enhanced uptake of the nanoparticles into the fungus's cell wall within the first 120 min of exposure. The nanocomplexes demonstrated low cytotoxicity towards human dermal fibroblasts which represent the human skin dermal cells. Conjugating Fluconazole with GNR is a promising approach for the effective treatment of superficial fungal infections.

A nanotechnology-based approach was adopted to develop a facile and effective nanoplatform for the treatment of superficial fungal infections.

Epidemiological characterization of dermatophytes at a tertiary care hospital in Eastern Uttar Pradesh, India

Background and Purpose:

Superficial mycosis is more prevalent in tropical and subtropical countries, such as India. Regarding this, the present study was conducted to determine the epidemiology of superficial mycosis and identify the most common dermatophytic species in this region.

Materials and Methods:

For the purpose of the study, a total of 220 skin scraping, nail, and hair root specimens were collected. Direct microscopic examination was performed using potassium hydroxide mount. Additionally, the samples were inoculated onto Sabouraud dextrose agar (SDA) and dermatophyte test medium (DTM). The fungal colony of each isolates was stained with lactophenol cotton blue mount, and observed under microscope for species identification.

Results:

Out of 220 isolates, 172 samples, obtained from 108 males 64 females, were positive for skin fungal infections by either KOH mount or culture. Furthermore, 113 isolates were identified as dermatophytes, while 59 samples were found to be non-dermatophytes. Among the dermatophytes isolated from different clinical samples, Trichophyton verrucosum (42/113, 38%) was the most common species, and Tinea corporis was the most common infection (36.2%).

Conclusion:

As the findings indicated, dermatophytes had an isolation rate of 78%, which is higher than normal. This can be due to the fact that the majority of the patients were from a rural background (71.7%) with a low socioeconomic status and poor personal hygiene who were exposed to climatic changes.

A comparative study of the various patterns of oro-cutaneous fungi and their sensitivity to anti fungals between HIV patients and normal healthy individuals

Background

Dermatological diseases are the first recognized clinical manifestation Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS).1, 2 The present study was undertaken to find out the clinical spectrum of the superficial mycoses, the etiological organisms and their drug sensitivity patterns among HIV positive patients and non HIV individuals attending the tertiary care hospital.

Methods

The study population was 100 HIV patients and control patients were consecutive 100 HIV negative patients. Skin scrapings and swabs were obtained from the upper back, web spaces of toes, inguinal region, dorsum of tongue. All the samples were subjected to potassium hydroxide mount and stained with Calcoflour White and were cultured. The fungi were identified on the basis of colony and microscopic features in conjunction with results of physiologic evaluation by standard phenotypic identification criteria.

Results

The total number of seropositive patients who had atleast one fungal infection was 57 and the total number of seronegative patients who had atleast one fungal infection was 21. In our study, fungal colonization was seen in 3.6% in clinically normal sites in retropositive patients and 1.6% in retronegatives. 76.59% in retropositive and 85.71% in retronegative patients the fungi cultured were sensitive to fluconazole.

Conclusion

The findings of this study suggest that the skin of HIV patients may more frequently harbour common fungi even in the absence of visible clinical signs. Antifungal-resistant fungi should be kept in mind while treating fungal infections.

Changing Trend of Superficial Mycoses with Increasing Nondermatophyte Mold Infection: A Clinicomycological Study at a Tertiary Referral Center in Assam

Background:

Superficial mycosis is the commonest infections affecting human globally. Though they do not cause mortality, their clinical significance lies in their morbidity, recurrence, and cosmetic disfigurement, thus creating a major public health problem. The infections are more prevalent in the tropical regions. The etiological agents are also seen to vary with time and geographical location.

Aim:

This study was carried out to find out the trend of superficial mycosis in Assam, along with a clinicomycological correlation.

Materials and Methods:

A total of 130 clinically diagnosed cases of superficial mycoses attending the outpatient department (OPD) of a tertiary hospital in Assam for a period of 1 year were taken up for the study. After taking the informed consent and a proper history, the clinical materials like skin scrapings, nail clippings, and infected hair were sent for mycological examination.

Results:

The infection was found to be more prevalent among males than females (M:F, 3:2) and among the farmers and laborers (24.61%). Tinea corporis was the commonest clinical type (21.5%). Among the fungal isolates, dermatophytes were the most frequent isolates (43.54%), out of which Trichophyton rubrum was commonest. nondermatophyte moulds like Fusarium, Aspergillus, Scopulariopsis, Trichosporon, and Penicillium spp. were isolated.

Conclusion:

The epidemiology of fungal infection and the causative fungi is seen to vary geographically and with time. This study reflects the changing trend of fungal infection in the north eastern region with a high rate of isolation of nondermatophyte moulds as the causative agent.

Profile of Dermatophytosis in a Tertiary Care Center in Kerala, India

Background:

The incidence of dermatophytosis is increasing over the last few years and there are many cases which are recurrent and chronic.

Aim:

The aim was to study the host and pathogen factors in dermatophytosis, to identify the species responsible, and to study the histopathological features of chronic dermatophytosis.

Materials and Methods:

It was a descriptive study conducted in the Department of Dermatology for a period of 1 year and all patients who were clinically diagnosed as dermatophytosis were included. Isolated hair, and nail involvement were excluded from the study. Epidemiological parameters and treatment history were analyzed, scrapings, and fungal culture were done in all patients. Histopathological examination was done in patients with chronic dermatophytosis who had applied topical steroids.

Results:

Chronic dermatophytosis was seen in 68%; tinea corporis was the most common presentation; topical steroid application was seen in 63%; azoles were the most common antifungals used; varied morphologies such as follicular and nonfollicular papules, arciform lesions, pseudoimbricata were seen in steroid modified tinea. Trichophyton rubrum and Trichophyton mentagrophytes were the most common species isolated in culture, but rare species such as Trichophyton tonsurans, Trichophyton schoenleinii, Epidermophyton floccosum, and Microsporum audouinii were also isolated from chronic cases. Histopathology showed perifolliculitis in steroid modified tinea. Minimal inhibitory concentration was lowest for itraconazole in susceptibility studies.

Conclusion:

Chronicity in dermatophytosis is due to various factors such as topical steroid application, noncompliance, and change in predominant species.

Profile of Dermatophytosis in a Tertiary Care Center

Background:

The incidence of dermatophytosis is increasing over the last few years and there are many cases which are recurrent and chronic.

Aim:

The aim was to study the host and pathogen factors in dermatophytosis, to identify the species responsible, and to study the histopathological features of chronic dermatophytosis.

Materials and Methods:

It was a descriptive study conducted in the Department of Dermatology for a period of 1 year and all patients who were clinically diagnosed as dermatophytosis were included. Isolated hair, and nail involvement were excluded from the study. Epidemiological parameters and treatment history were analyzed, scrapings, and fungal culture were done in all patients. Histopathological examination was done in patients with chronic dermatophytosis who had applied topical steroids.

Results:

Chronic dermatophytosis was seen in 68%; tinea corporis was the most common presentation; topical steroid application was seen in 63%; azoles were the most common antifungals used; varied morphologies such as follicular and nonfollicular papules, arciform lesions, pseudoimbricata were seen in steroid modified tinea. Trichophyton rubrum and Trichophyton mentagrophytes were the most common species isolated in culture, but rare species such as Trichophyton tonsurans, Trichophyton schoenleinii, Epidermophyton floccosum, and Microsporum audouinii were also isolated from chronic cases. Histopathology showed perifolliculitis in steroid modified tinea. Minimal inhibitory concentration was lowest for itraconazole in susceptibility studies.

Conclusion:

Chronicity in dermatophytosis is due to various factors such as topical steroid application, noncompliance, and change in predominant species.

Clinicomycological Characterization of Superficial Mycoses from a Tertiary Care Hospital in Nepal

Background. Superficial mycosis is a common fungal infection worldwide, mainly caused by dermatophytes. However, the prevalence of species varies geographically. In addition, fungal treatment is best guided according to species isolated. This study was carried out to determine the clinical as well as mycological profile of superficial mycoses in a tertiary care hospital, Nepal. Methods. This was a prospective case-control laboratory based study conducted over a period of six months from January to June 2014 at Tribhuvan University Teaching Hospital, Nepal. A total of 200 specimens were collected from the patients suspected of superficial mycoses. The specimens were macroscopically as well as microscopically examined. The growth was observed up to 4 weeks. Results. Out of total 200 specimens from the patients suspected of superficial mycoses, tinea corporis 50 (25%) was most common clinical types. KOH mount was positive in 89 (44.5%) and culture was positive in 111 (55.5%). Trichophyton mentagrophytes 44 (39.6%) was the most common isolate. Conclusions. The diagnostic yields of KOH mount and culture were found to be complementary to each other. Thus both the methods added with clinical findings are equally important to establish superficial mycosis.

Relapse after Oral Terbinafine Therapy in Dermatophytosis: A Clinical and Mycological Study

Background:

The incidence of recurrent tinea infections after oral terbinafine therapy is on the rise.

Aim:

This study aims to identify the appearance of incomplete cure and relapse after 2-week oral terbinafine therapy in tinea corporis and/or tinea cruris.

Materials and Methods:

A total of 100 consecutive patients clinically and mycologically diagnosed to have tinea corporis and/or tinea cruris were included in the study. The enrolled patients were administered oral terbinafine 250 mg once daily for 2 weeks. All clinically cured patients were then followed up for 12 weeks to look for any relapse/cure.

Results:

The common dermatophytes grown on culture were Trichophyton rubrum and Trichophyton tonsurans in 55% and 20% patients, respectively. At the end of 2-week oral terbinafine therapy, 30% patients showed a persistent disease on clinical examination while 35% patients showed a persistent positive fungal culture (persisters) at this time. These culture positive patients included all the clinically positive cases. Rest of the patients (65/100) demonstrated both clinical and mycological cure at this time (cured). Over the 12-week follow-up, clinical relapse was seen in 22 more patients (relapse) among those who had shown clinical and mycological cure at the end of terbinafine therapy. Thus, only 43% patients could achieve a long-term clinical and mycological cure after 2 weeks of oral terbinafine treatment. Majority of the relapses (16/22) were seen after 8 weeks of completion of treatment. There was no statistically significant difference in the body surface area involvement or the causative organism involved between the cured, persister, or relapse groups.

Conclusions:

Incomplete mycological cure as well as relapse is very common after standard (2-week) terbinafine therapy in our patients of tinea cruris/corporis.

A clinical and mycological study of dermatophytic infections

BACKGROUND

Dermatophytoses refer to superficial fungal infection of keratinized tissues caused by keratinophilic dermatophytes. According to observations worldwide, dermatophytoses are the most common of the superficial fungal infections. It is common in tropics and may present in epidemic proportions in areas with high rates of humidity. Although common, the precise size of the problem defies measurement.

AIMS

The present study was undertaken to assess the clinical profile of dermatophytic infection and to identify the species of fungi that are prevalent in this region.

MATERIALS AND METHODS

A total of 100 patients clinically suspected for dermatophytoses were selected for the study. Direct microscopy in 10% potassium hydroxide (KOH) and culture was done in each case.

RESULTS

Out of 100 patients, the maximum were seen in the age groups of 16-30 years. Tinea corporis was the most common clinical type (44.3%) followed by tinea cruris (38.2%). Overall positivity by culture was 39% and by direct microscopy 96%.

CONCLUSION

Trichophyton rubrum was the predominant species isolated (67.5%) in all clinical types followed by Trichophyton mentagrophytes. Culturing the fungus may identify the species, but it is not essential for the diagnosis as it is not a sensitive test.

Epidemiological studies on Dermatophytosis in human patients in Himachal Pradesh, India

Dermatophytes are among the common fungal agents implicated in superficial skin infections worldwide. They include species of Trichophyton, Microsporum and Epidermophyton. In hot and humid climates of tropical and subtropical regions, the incidence of these pathogens is higher. We present in this article, the epidemiological data regarding the prevalence of different dermatophyte species involved in superficial mycoses in human patients in the state of Himachal Pradesh (India) and different clinical conditions, age and sex of the patients. A total of 202 samples in the form of skin and nail scrapings, hair follicles were collected from different ringworm/tinea conditions which included: Tinea corporis, T. capitis, T. cruris, T. pedis, T. unguium, T. faciei, T. manuum and T. gladiatorum. On culturing, 74 samples (36.6%) were found positive for dermatophyte spp. Trichophyton spp. was the predominant one (98.65% cases) followed by Microsporum gypseum (1.35% cases). However, we did not recover any Epidermophyton spp. Among the Trichophyton spp., T. mentegrophyte was the predominant spp. (63.5%) followed by T. rubrum (35.1%). The male to female ratio of the positive cases was recorded as 63:11. The most effected age group was 21–50 years (64.9%) followed by 1–20 years (28.4%) and above 50 years (6.8%).

A clinicomycological study of cutaneous mycoses in sawai man singh hospital of jaipur, north India

BACKGROUND

Because of the widespread prevalence of the various cutaneous mycoses in a tropical country like India, it is important to know their patterns of etiology and clinical presentations.

AIM

The present study was conducted in order to identify the clinical pattern of various cutaneous mycoses and the common etiological agents affecting the study populations admitted in SMS Hospital, Jaipur, in North India.

MATERIALS AND METHODS

Skin scrapings and hair and nail samples of 160 patients with clinical suspicion of dermatophytosis were collected and subjected to direct microscopy and were cultured in Sabouraud's dextrose agar. Fungal species were identified by macroscopic and microscopic examination. Data were presented as simple descriptive statistics (SPSS, Version 17.0 (Chicago Il, USA). Epi Info Version 3.5.1 (CDC, Atlanta, Georgia, USA).

RESULTS

Among the 160 clinically suspected patients of cutaneous mycoses, 60 (37.5%) were confirmed by culture. Dermatophytes and non-dermatophytes (NDM) were isolated from 66.6% (40/60) and 33.3% (20/60) of the positive cultures, respectively. Tinea capitis (50%) 30/60 was the most frequent clinical pattern and genus Trichophyton violaceum 32.5% (13/40) was the most common isolate in dermatophytosis-positive samples. Among the patients positive for NDM by culture, Tinea unguium 35% (7/20) was the most common clinical presentation and Aspergillus species 40% (8/20) were the most common etiological agents isolated.

CONCLUSION

Although dermatophtes have been isolated from the cases of cutaneous mycoses all over the world with various frequencies, the role of NDM in the different cutaneous infections other than those of nail infections need to be evaluated.