Epidemiologic study of dermatophytoses in Salamanca (Spain)

Epidemiology of dermatophyte infection in Auckland, New Zealand

This report describes the epidemiology of culture-proven dermatophyte infection in Auckland, New Zealand. The authors undertook a retrospective review of laboratory data for the period from June 1999 to July 2002. There were 10 004 dermatophyte isolates. The most common isolates were Trichophyton rubrum (69%) and Trichophyton mentagrophytes (19%). Microsporum canis was mainly isolated from children. The prevalence of T. mentagrophytes increased with patient age (P < 0.001). Trichophyton rubrum was most common in those aged between 20 and 59 years. The incidence of culture-proven dermatophyte infection was 2.9/1000 population for the year 2000, and the incidence increased with patient age (P < 0.001). It is concluded that dermatophytes causing superficial mycoses in the Auckland region are essentially similar to Australia and other Western countries, although some new organisms are seen as a result of the migration of people from other countries. The incidence of local dermatophyte infection increases with age.

Tinea capitis

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

Prevalence and aetiology of dermatophytoses in Isfahan, Iran

In this study the prevalence and causative agents of dermatophytoses in Isfahan, a large province of Iran, were determined. Of 16,578 clinically suspected cases 13.3% were affected with dermatophytoses. Lesions of tinea capitis were the most prevalent clinical type of dermatophytoses (54.1%), followed by tinea corporis (23.8%) and tinea pedis (8.9%). Trichophyton verrucosum was the most frequent causative agent (32.8%), followed by Epidermophyton floccosum (17.6%), T. mentagrophytes (16.2%) and Microsporum canis (12.3%). We found a relationship between the spread of dermatophytoses and live-stock infected with dermatophytoses in Isfahan.

A study of dermatophytoses in Hamadan, the governmentship of West Iran

In order to determine the extent and causative agents of dermatophytoses in the Hamadan region of West Iran; a study was made during a 9-month period from October 1991 to June 1992. A total of 7495 individuals were studied of whom 681 (9%) were suspect of having cutaneous mycoses. Among them dermatophytoses were the commonest infections (259/681 = 38%). Of 259 individuals infected with dermatophytes, tinea capitis were observed in 163 (62.9%); t. corporis in 27 (10.4%); t. manuum and t. cruris in 19 (7.3%) each; t. barbae and faciei in 14 (5.4%); t. pedis in 13 (5%) and t. unguium in 4 (1.5%). A total of 144 patients yielded dermatophyte cultures. The frequency of the isolated species in decreasing order was as follows: Trichophyton verrucosum, 78 (54.1%); T. schoenleinii, 48 (33.3%); Microsporum canis, 8 (5.5%); Epidermophyton floccosum, 5 (3.5%); T. mentagrophytes and M. gypseum, 2 (1.4%) each; T. tonsurans, 1 (0.7%). In conclusion, the most prevalent dermatophytosis in this region was t. capitis with the infecting agent of T. schoenleinii.

Frequency of Trichophyton rubrum in tinea capitis

Trichophyton rubrum has led to unprecedented worldwide suppression of other dermatophytes which had been predominant earlier as a causative agent of superficial dermatomycoses. In tinea capitis on the other hand, several other species of Trichophyton or Microsporum are dominant depending on the region or continent. Tinea capitis caused by T. rubrum is a rare event worldwide. Occasional concentrations may be explained by several cases occurring by chance in one family or community. The relative frequency of this causative agent in tinea capitis in children is under 1%. In adults, however, where tinea capitis occurs very infrequently indeed, the incidence of T. rubrum appears to exceed 10%. Apart from two studies from India, one from Iran, two from Portugal and observations from Germany, which in the first country report of around 30% of all cases published, while the others document some 10% each, there are not only any conspicuous, unequivocal concentrations at all. Increased frequency of T. rubrum in this clinical picture has not been easily recognizable over the last decades due to low absolute case numbers.

Dermatophytes and dermatophytoses in the Milan area between 1970 and 1989

Between 1970 and 1989 we examined 13,019 patients with dermatophytoses in the Milan area, Northern Italy. The results obtained during the 1980-89 period were compared with those obtained in the years 1970-79. From the data collected, tinea corporis emerged as the most frequently observed dermatophytosis, followed by tinea pedis and unguium. As far as dermatophytes are concerned, the dermatological pattern is dominated by Microsporum canis and Trichophyton rubrum. Other species, such as Epidermophyton floccosum, T. mentagrophytes, M. gypseum, T. violaceum, T. verrucosum, T. tonsurans and T. schoenleinii, have progressively become less evident. Other mycetes, such as T. megninii, T. soudanense, M. langeroni, T. vanbreuseghemii, M. ferrugineum, sporadically isolated in the 1970-79 period, have disappeared in recent years. An analysis of the distribution and frequency of the dermatophytes according to the cutaneous area affected is reported.

Incidence of dermatophytoses in rabbit farms in Catalonia, Spain, and its repercussion on human health

Over the past decades there has been an important increase in the incidence of dermatophytoses in humans as a result of contact with animals, although etiological agents can vary as can the animals transmitting the disease. A large-scale study was carried out in 220 farms raising rabbits for consumption. Most of the farms (85%) were located in the autonomous community of Catalonia (Spain). Mycological studies showed that 79.5% of the rabbits were infected with Trichophyton mentagrophytes var. granulosum. Microsporum canis was isolated in only two animals, which had been imported from France. Healthy animal carriers were detected in 3.2% of the apparently non-infected farms. T. mentagrophytes were also found in samples taken from rabbits' nests and from the surrounding environment of the two infected farms. In a survey carried out among the staff responsible for the care of the animals, 77% of those working on infected farms suffered or had suffered dermatophytic lesions. This was confirmed in 8 out of 10 cases sampled. Attention is drawn to the high incidence of dermatophytoses in rabbits on farms and the importance of T. mentagrophytes as the etiological agent of tinea in people in close contact with infected animals.

An inactivated vaccine against ringworm

A new vaccine against ringworm, containing the inactivated Trichophyton verrucosum strain, was assessed on guinea pigs and calves under experimental conditions and on three herds of cattle under natural conditions. The vaccine elicited a distinct immune response of the cellular type. This type of immunity assessed by the migration inhibition test of leukocytes corresponded to the immunity evaluated by the challenge. In herds in which there were from 30 to 67% of naturally infected animals with T. verrucosum, two doses of the vaccine resulted in after 4 weeks a decrease of the number of animals with clinical changes from 40.5 to 100% depending on the group of animals under study.

Fungal infection as a cause of skin disease in the eastern province of Saudi Arabia: tinea corporis and tinea cruris

In the period between April 1984 and April 1988 a total of 4,294 clinically suspected cases of dermatomycoses were examined for causative fungi. Of these cases 768 (17.9%) were suspected as tinea corporis (427 cases) and tinea cruris (341 cases). Twenty two different nationalities were represented. Both sexes were involved and the age range was 19 days to 70 years. Of the 768 patients examined, 738 (96.1%) had their diagnosis confirmed by direct microscopy and in 631 of these positive cases the etiology was determined. Of the 408 patients who had suffered from tinea corporis, 323 isolates were obtained from 313 culturally positive cases. Microsporum canis was the main etiologic agent followed by Trichophyton violaceum, T. mentagrophytes, T. rubrum and Epidermophyton floccosum. Of the 330 patients who had suffered from tinea cruris, 388 isolates were obtained from 318 culturally positive cases and E. floccosum was the main etiologic agent. Next in frequencies were T. rubrum and T. mentagrophytes while Candida albicans was isolated from 45 of 70 patients with mixed isolates. Treatment with topical antifungal agents was effective in most of the cases. Oral griseofulvin in addition to the topical application was found necessary in extensive widespread cases.

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

We have reviewed all the dermatophytoses diagnosed in Galicia during four consecutive 9-year periods 1951-86 and 1987. From 4571 patients, we isolated 3351 fungal strains belonging, in decreasing order of frequency, to the following dermatophyte species: Microsporum canis (25.5%), Trichophyton rubrum (24.6%), T. mentagrophytes (21.4%), Epidermophyton floccosum (11.8%), M. gypseum (5.2%), T. tonsurans (3.9%), T. verrucosum (3.1%), T. schoenlenii (2.5%), T. violaceum (1.2%), T. mengninii (0.3%), M. audouinii (0.2%), T. equinum (0.1%) and T. soudanense (0.1%). Tinea capitis has diminished in frequency since 1951, though there was been a slight increase since 1978; M. canis has always been the most common agent, and between 1951 and 1959 T. schoenleinii was also very frequent but is no longer found. The frequency of tinea corporis, on the other hand, has experienced a considerable increase. Its most common causal agents in the last few years have been T. mentagrophytes, M. canis and T. rubrum. Until 1977 the most common tinea cruris dermatophyte was E. floccosum, but since then it has been T. rubrum. The commonest tinea pedis dermatophytes have been T. rubrum and T. mentagrophytes. Tinea unguium and tinea barbae have been the most frequent dermatophytoses, and their commonest causal agents T. rubrum and T. mentagrophytes respectively. We have documented the distribution of the various causal agents by location of the lesions, age and source of the patients (private or National Health Service patients), and we have compared the results with those obtained in other regions of Spain.

A study of dermatophytoses in Esfahan (Iran)

The present study determined the extent and causative agents of dermatophytoses in Esfahan, a large city of Iran. Specimens from patients were examined for etiologic agents by direct microscopic procedure and by culture. Out of 12,000 patients with skin diseases, 10.8% were affected with dermatophytoses. Among the 10.8% group, lesions of tinea capitis were most common (72.1%) and Trichophyton verrucosum was the most frequent (43.8%) dermatophyte isolated from the patients. We found a relationship between the spread of dermatophytoses and live-stock infected with dermatophytoses.

Multicenter study of dermatophyte distribution in the metropolitan area of Barcelona (Catalonia, Spain)

The results of a multicenter study on the distribution of dermatophyte species in the metropolitan area of Barcelona (Spain) are presented. In the period 1977-1983, 638 dermatophyte strains were isolated from tineas by three different mycological laboratories. Zoophilic strains were prevalent comprising 64.4% of the isolates. T. mentagrophytes var. granulosum was isolated in 51% of the cases. A significant drop in the prevalence of T. tonsurans and T. violaceum was noted. Important variations were observed in dermatophyte distribution in relation to other geographical areas of Spain.

Incidence of dermatophytosis in Jordan with special reference to tinea capitis

Clinical data on 1068 cases of dermatophytosis as well as mycological data on 382 of these cases seen from March 1983 to September 1984 are reported. Tinea cruris was present in 34.1%, with Trichophyton rubrum and Epidermophyton floccosum isolated from 31% and 25% respectively. Tinea corporis was found in 17.9% of all patients of dermatophytosis with T. tonsurans responsible in 30.8%. Tinea pedis and Tinea unguium were present in 7.2% and 2% respectively, T. rubrum being the main causative agent; nail involvement was present in 27.3% of these cases. Tinea capitis was observed in 38.7% of 1068 dermatophytosis cases with T. violaceum and M. canis causing 48% and 32% of all T.C. cases respectively. The dermatophytic flora of the West Bank of Jordan apparently comprises about 14 dermatophytes, T. violaceum being the predominant agent of infection (in more than 34%). Other most common agents found in this survey were M. canis, T. rubrum, E. floccosum, T. schoenleini, T. tonsurans, and T. mentagrophytes.

A survey of dermatophytes isolated from human patients in the United States from 1979 to 1981 with chronological listings of worldwide incidence of five dermatophytes often isolated in the United States

A survey of dermatophytes isolated from patients seeking medical advice was made from 1979 to 1981 in the United States. The survey included 54 locations with data from 40 cities and 2 states. Correlations of these data with that of the other localities of the world were made to illustrate the dynamic epidemiology of several common dermatophytes. The most often isolated dermatophyte in this survey was Trichophyton rubrum having 53.66% of the total for these three calendar years. In a chronological listing of ringworm infections caused by this organism, many areas of the world have reported similar increased incidence of this pathogen. Trichophyton tonsurans was isolated 27.85% of the total. A dramatic increase of this pathogen as a cause of tinea capitis has been observed in most cities of the United States. It has been isolated in 25 different countries of the world. The percentage of isolation of Trichophyton mentagrophytes was 8.56%. This percentage may not be near the true incidence of infection by this dermatophyte because the infections are mild and respond to treatment without the individual seeking medical advice. Since the 1950s the percentage of isolations of the total has dropped for T. mentagrophytes in the United States. Epidermophyton floccosum accounted for 4.36% of the total. In a few areas of the world it causes over 30% of the total of dermatophytoses. Microsporum canis was isolated 3.72% of the total in the United States. It has recently been reported to be the dominant agent of tinea capitis in several South American countries, Tucson, Arizona and Kuwait. Once the dominant pathogen of tinea capitis in children in the United States, it was replaced by Microsporum audouinii before 1960. Today in the United States, M. audouinii only accounts for 0.30% of the total. It is considered eliminated as a pathogen in England. In this survey, isolated less than 1.0% of the total were Microsporum gypseum. Microsporum ferrugineum , Microsporum nanum , Microsporum fulvum and Trichophyton schoenleinii . Trichophyton meginii and Trichophyton terrestre were reported isolated but no numerical data were available.

Superficial mycoses in Italy

A total of 1244 cases suspected of superficial mycoses were analysed in a period of 12 months in Italy. Dermatophytoses were found in 62.4%; the other common disease was Pityriasis versicolor (44.1%)., The predominant species Epidermophyton floccosum (34,2%) was strikingly high in relation to other statistics; this species was commonest in tinea cruris. Among the other dermatophytes M. canis was predominant (31.3%) commonest in tinea corporis, followed by T. mentagrophytes (17,8%) and T. rubrum (10,3%). A high rate of yeasts was found in tinea manum (81.6%) and tinea pedis (47.7%). ?