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Brescini L, Fioriti S, Morroni G, Barchiesi F. Antifungal Combinations in Dermatophytes. J Fungi (Basel) 2021; 7:jof7090727. [PMID: 34575765 PMCID: PMC8469868 DOI: 10.3390/jof7090727] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
Dermatophytes are the most common cause of fungal infections worldwide, affecting millions of people annually. The emergence of resistance among dermatophytes along with the availability of antifungal susceptibility procedures suitable for testing antifungal agents against this group of fungi make the combinatorial approach particularly interesting to be investigated. Therefore, we reviewed the scientific literature concerning the antifungal combinations against dermatophytes. A literature search on the subject performed in PubMed yielded 68 publications: 37 articles referring to in vitro studies and 31 articles referring to case reports or clinical studies. In vitro studies involved over 400 clinical isolates of dermatophytes (69% Trichophyton spp., 29% Microsporum spp., and 2% Epidermophyton floccosum). Combinations included two antifungal agents or an antifungal agent plus another chemical compound including plant extracts or essential oils, calcineurin inhibitors, peptides, disinfectant agents, and others. In general, drug combinations yielded variable results spanning from synergism to indifference. Antagonism was rarely seen. In over 700 patients with documented dermatophyte infections, an antifungal combination approach could be evaluated. The most frequent combination included a systemic antifungal agent administered orally (i.e., terbinafine, griseofulvin, or azole-mainly itraconazole) plus a topical medication (i.e., azole, terbinafine, ciclopirox, amorolfine) for several weeks. Clinical results indicate that association of antifungal agents is effective, and it might be useful to accelerate the clinical and microbiological healing of a superficial infection. Antifungal combinations in dermatophytes have gained considerable scientific interest over the years and, in consideration of the interesting results available so far, it is desirable to continue the research in this field.
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Affiliation(s)
- Lucia Brescini
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, 60020 Ancona, Italy; (L.B.); (S.F.); (G.M.)
| | - Simona Fioriti
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, 60020 Ancona, Italy; (L.B.); (S.F.); (G.M.)
| | - Gianluca Morroni
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, 60020 Ancona, Italy; (L.B.); (S.F.); (G.M.)
| | - Francesco Barchiesi
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, 60020 Ancona, Italy; (L.B.); (S.F.); (G.M.)
- Malattie Infettive, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
- Correspondence: ; Tel.: +39-721-36-5505
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Ribeiro CSDC, Zaitz C, Framil VMDS, Ottoboni TSDC, Tonoli MSDC, Ribeiro RP. Descriptive study of onychomycosis in a hospital in São Paulo. Braz J Microbiol 2015; 46:485-92. [PMID: 26273263 PMCID: PMC4507540 DOI: 10.1590/s1517-838246220130541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/19/2014] [Indexed: 12/02/2022] Open
Abstract
Onychomychosis, a nail fungus infection is the most frequent nail ailment, constituting about half of all nail disorders. It can be caused by dermatophytes, non-dermatophytes, yeasts and Prothoteca spp. Methods include 5407 samples of patients with suspected onychomycosis, studied from January 2002 to December 2006, by direct mycological examination and fungi culture. The diagnosis of onychomycosis was confirmed in samples from 3822 direct mycological and/or culture positive. The diagnosis was established by culture for fungi. Among the 1.428 identified agents, the dermatophytes were responsible for 68.6% (N = 980) of cases, followed by yeasts with 27.6% (N = 394), non-dermatophytes fungi with 2.2% (N = 31), Prothoteca spp with 0.1% (N = 2), and associations with 1.5% (N = 22). Females were more affected, with 66% (N = 2527) of cases, and the most affected age group ranged from 31 to 60 years of age (median 47 years). Fungal microbiota is often changed in the world, both quantitatively and qualitatively, and is affected by several environmental factors. Thus, the periodic review of the composition of this microbiota is important to evaluate the epidemiology and thus proportion a better therapeutic response.
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Affiliation(s)
- Clarissa Santos de Carvalho Ribeiro
- Faculdade de Ciências Médicas da Santa Casa
São Paulo, Departamento de Dermatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil, Departamento de Dermatologia, Faculdade de
Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Clarisse Zaitz
- Faculdade de Ciências Médicas da Santa Casa
São Paulo, Departamento de Dermatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil, Departamento de Dermatologia, Faculdade de
Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Valéria Maria de Souza Framil
- Faculdade de Ciências Médicas da Santa Casa
São Paulo, Departamento de Dermatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil, Departamento de Dermatologia, Faculdade de
Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Thaíssa Santos de Carvalho Ottoboni
- Faculdade de Medicina de
Itajubá, Faculdade de Medicina de Itajubá, Itajubá, MG, Brasil, Faculdade de Medicina de Itajubá, Itajubá, MG,
Brazil
| | - Melissa Santos de Carvalho Tonoli
- Universidade Estadual Paulista, Universidade Estadual Paulista, São José dos Campos, SP, Brasil, Universidade Estadual Paulista, São José dos
Campos, SP, Brazil
| | - Renata Pinheiro Ribeiro
- Universidade Federal de Alfenas, Universidade Federal de Alfenas, Alfenas, MG, Brasil, Universidade Federal de Alfenas, Alfenas, MG,
Brazil
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Zhang H, Xiong X, Liu T, Ran Y. Generalized superficial mycosis caused by Trichophyton raubitschekii in China: case report and review of the literature. Mycopathologia 2014; 179:279-84. [PMID: 25502847 DOI: 10.1007/s11046-014-9835-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/13/2014] [Indexed: 11/26/2022]
Abstract
This is a generalized superficial mycosis case from which Trichophyton raubitschekii was isolated. A male adult was presented with a 3-year history of fingernail and toenail changes, and a 50-day history of severe and multiple skin lesions. He also complained of intense itching. T. raubitschekii was identified from every skin lesion (trunk, extremities and nail) through microscopic examination, physiological experiment and DNA sequencing. Generalized superficial mycosis was diagnosed and treated by administering a combination of oral (terbinafine tablets) and topical (naftifine hydrochloride and ketoconazole cream) antimycotic drugs. After treatment, the patient was cured and no recurrence has been observed.
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Affiliation(s)
- Hao Zhang
- Department of Dermatovenerology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China,
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Adamski Z, Kowalczyk MJ, Adamska K, Kubisiak-Rzepczyk H, Bowszyc-Dmochowska M, Banaszak A, Bartkiewicz P, Zaba R. The first non-African case of Trichophyton rubrum var. raubitschekii or a urease-positive Trichophyton rubrum in Central Europe? Mycopathologia 2014; 178:91-6. [PMID: 24792359 PMCID: PMC4097339 DOI: 10.1007/s11046-014-9751-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/18/2014] [Indexed: 12/05/2022]
Abstract
We report a case of a 34-year-old Polish Caucasian male who was diagnosed with tinea manuum caused by Trichophyton rubrum var. raubitschekii. It would be the first described case of a dermatophytosis caused by this fungus in Poland and one of a few cases in Central Europe described so far. Admittedly, it would be the first case in Central Europe with no evidence pointing to African origin. The clinical condition improved after administering itraconazole (daily dose 100 mg orally) supplemented with a topical treatment, while the patient was totally cured after 2 months. The histopathological examination turned out to be highly useful in the diagnostic process. The genetic analysis of the urease gene pointed to a urease-positive T. rubrum rather than T. rubrum var. raubitschekii.
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Affiliation(s)
- Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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Nkondjo Minkoumou S, Fabrizi V, Papini M. Onychomycosis in Cameroon: a clinical and epidemiological study among dermatological patients. Int J Dermatol 2013; 51:1474-7. [PMID: 23171013 DOI: 10.1111/j.1365-4632.2012.05509.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are currently no studies on epidemiology and clinical aspects of nail fungal infections in the general population of Cameroon. PATIENTS AND METHODS Two series of patients observed at a hospital dermatological service of Yaoundé and in a volunteer service of Douala were evaluated. All the patients, regardless of the reason for the consultation, were examined by an expert dermatologist to discover signs of onychomycosis. Patients with suspected nail lesions underwent mycological examination according to the standard techniques. RESULTS Among 590 subjects (317 males and 273 females), aged 16-83 years, onychomycosis was mycologically confirmed in 52 cases (8.8%). The infection was most common in the fifth decade. Fingernails were affected in 12 cases, toenails in 30 cases, and both fingernails and toenails in 10 cases. Dermatophytes were isolated in 57.7% of cases, the most common species being Trichophyton rubrum (16 cases) and Trichophyton violaceum (eight cases). Non-dermatophytic mould, including Aspergillus spp., Fusarium spp., and Neoscytalidium dimidiatum, was found in 10 cases. Onychomycosis was more common in patients from low social-economic classes. CONCLUSIONS This is the first investigation dealing with onychomycosis in Cameroon. These data may be useful for future research and in the development of preventive and educational strategies.
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Hiruma M, Kano R, Sugita T, Mochizuki T, Hasegawa A, Hiruma M. Epidemiological aspects of Trichophyton rubrum var. raubitschekii in Japan. J Dermatol 2012; 39:1000-1. [PMID: 22900925 DOI: 10.1111/j.1346-8138.2012.01635.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 06/13/2012] [Indexed: 11/29/2022]
Abstract
Trichophyton rubrum var. raubitschekii is a rare anthropophilic dermatophyte isolated around the world from tinea corporis, tinea cruris, tinea pedis and tinea unguium. In this study, the isolation rate of T. rubrum var. raubitschekii was studied in 200 cases of tinea pedis and tinea unguium in Japan. The 200 clinical isolates were shown to be of downy type as their colonies on Sabouraud's dextrose agar were white to cream, suede-like to downy, with a yellow-brown to wine-red reverse, and they produced few macroconidia. The type strain of T. rubrum var. raubitschekii (CBS 100084) and one clinical isolate (KMU 8337; isolated at Kanazawa) of downy type tested positive for urease, but the reference strain of T. rubrum (CBS 392.58) and the remaining 199 clinical isolates tested negative. Further epidemiological investigations are required to study human cases of infection with the granular type of T. rubrum and T. rubrum var. raubitschekii in Japan.
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Affiliation(s)
- Midori Hiruma
- Department of Dermatology and Allergology, Juntendo University Nerima Hospital, Tokyo, Japan
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Ilkit M, Saraclı MA, Yuksel T. Trichophyton Rubrum with the ‘raubitschekii’ Morphotype: The First Report from Turkey. Mycopathologia 2010; 171:119-22. [DOI: 10.1007/s11046-010-9355-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 08/05/2010] [Indexed: 11/29/2022]
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Kano R, Nagata M, Suzuki T, Watanabe S, Kamata H, Hasegawa A. Isolation ofTrichophyton rubrumvar. raubitschekii from a dog. Med Mycol 2010; 48:653-5. [DOI: 10.3109/13693780903403043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gómez Moyano E, Crespo-Erchiga V, Samaniego González E, del Boz González J, Martínez García S. Tinea cruris (glutealis) de importación por Trichophyton rubrum var. raubitschekii en España. Rev Iberoam Micol 2008; 25:250-3. [DOI: 10.1016/s1130-1406(08)70059-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ma L, Li R, Yu J, Wang C, Wan Z, Wang X. Majocchi's granuloma in a liver transplant recipient caused by a Trichophyton spp., phenotypically consistent with Trichophyton rubrum var. raubitschekii. Med Mycol 2008; 47:312-6. [PMID: 19212894 DOI: 10.1080/13693780802562951] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The authors report a case of Majocchi's granuloma and onychomycosis in a liver transplant recipient caused by a Trichophyton spp., phenotypically consistent with Trichophyton rubrum var. raubitschekii. A 48-year-old female patient who had undergone liver transplantation nine months earlier, presented with red papules and nodular lesions on her back, buttock and thigh of two months duration. She also had onychomycosis of toe nails for a few years, which worsened post transplant. Two fungal isolates were derived from her infected toe nails and nodular tissue. Physical, pathological and mycological examination, including KOH preparation, fungal culture and DNA sequencing of the internal transcribed spacer(ITS) of rRNA were performed. The clinical diagnosis was Majocchi's granuloma and onychomycosis caused by the Trichophyton rubrum var. raubitschekii. This is the first case report of this organism from China.
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Affiliation(s)
- Lei Ma
- Department of Dermatology/Research Center for Medical Mycology, Peking University First Hospital, Beijing, PR China
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Abstract
Trichophyton raubitschekii was originally described as a distinct dermatophyte species but is now classified as a variant of Trichophyton rubrum. The variant raubitschekii differs from common strains of T. rubrum with regard to morphology, physiology, epidemiology and patterns of infection. It is mostly found in Africa, Asia and South America, but the literature and our observations reveal that seven patients (four men, three women) with T. rubrum var. raubitschekii-infections were meanwhile seen in Germany. All of them were born in Africa and they suffered from tinea corporis or tinea pedum, but onychomycosis was seen as well. All strains matched the typical characteristics of the variant raubitschekii except that one strain had a minimal capacity to perforate hair. Until now, the strains of T. rubrum var. raubitschekii isolated in Germany were probably imported by migration of the patients and so far no further spreading within Germany was observed. However, such a spreading is likely to occur in the future and therefore a monitoring is needed. This can be achieved only when the variant raubitschekii is looked for in the laboratories and is reported with its full name.
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Affiliation(s)
- Jochen Brasch
- Department of Dermatology, University Clinics of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Arabatzis M, Velegraki A, Kantardjiev T, Stavrakieva V, Rigopoulos D, Katsambas A. First report on autochthonous urease-positive Trichophyton rubrum (T. raubitschekii) from South-east Europe. Br J Dermatol 2005; 153:178-82. [PMID: 16029346 DOI: 10.1111/j.1365-2133.2005.06615.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Trichophyton raubitschekii is a dermatophyte belonging to the T. rubrum complex and is differentiated principally by its positive urease activity and production of profuse macroconidia and microconidia in culture. It is classically isolated from African, South-east Asian and Australian aboriginal patients with tinea corporis or tinea cruris. OBJECTIVES This study was undertaken to screen Greek and Bulgarian clinical isolates identified as T. rubrum for T. raubitschekii and to delineate these strains by two molecular methods used for the first time in T. rubrum epidemiological studies. METHODS Ninety-five Greek and 10 Bulgarian strains, originating from various body sites, initially identified as T. rubrum, were screened for urease activity. The biochemical properties and morphology of the urease-positive strains were determined. Strains were delineated with polymerase chain reaction (PCR)-ribotyping amplifying repeat elements of the intergenic spacer region and by PCR fingerprinting. RESULTS Five Greek and one Bulgarian T. raubitschekii strains were identified comprising isolates from patients with tinea manuum (one), tinea corporis (one), tinea cruris (one) and tinea unguium (three). Only one strain had the classical T. raubitschekii microscopic morphology, whereas the remaining five presented a dominant arthroconidial phenotype. Both typing methods clustered all T. raubitschekii and T. rubrum isolates together in the same group, indicating strain homogeneity in the genetic regions examined. CONCLUSIONS The reported isolation of T. raubitschekii in the Balkan and South-eastern Mediterranean regions extends the geographical distribution of this species. As the more primitive T. raubitschekii probably represents the parental population of T. rubrum, the Greek and Bulgarian T. raubitschekii strains could represent a remnant of the T. rubrum spread that took place after the First World War, rather than being a recent epidemiological event.
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Affiliation(s)
- M Arabatzis
- Microbiology Department, Medical School, University of Athens, Greece.
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