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Fernandes C, Sousa-Baptista J, Lenha-Silva AF, Calheiros D, Correia E, Figueirinha A, Salgueiro L, Gonçalves T. Azorean Black Tea ( Camellia sinensis) Antidermatophytic and Fungicidal Properties. Molecules 2023; 28:7775. [PMID: 38067505 PMCID: PMC10707949 DOI: 10.3390/molecules28237775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
The treatment of dermatophytoses, the most common human fungal infections, requires new alternatives. The aim of this study was to determine the antidermatophytic activity of the aqueous Azorean Black Tea extract (ABT), together with an approach to the mechanisms of action. The phytochemical analysis of ABT extract was performed by HPLC. The dermatophytes susceptibility was assessed using a broth microdilution assay; potential synergies with terbinafine and griseofulvin were evaluated by the checkerboard assay. The mechanism of action was appraised by the quantification of the fungal cell wall chitin and β-1,3-glucan, and by membrane ergosterol. The presence of ultrastructural modifications was studied by Transmission Electron Microscopy (TEM). The ABT extract contained organic and phenolic acids, flavonoids, theaflavins and alkaloids. It showed an antidermatophytic effect, with MIC values of 250 µg/mL for Trichophyton mentagrophytes, 125 µg/mL for Trichophyton rubrum and 500 µg/mL for Microsporum canis; at these concentrations, the extract was fungicidal. An additive effect of ABT in association to terbinafine on these three dermatophytes was observed. The ABT extract caused a significant reduction in β-1,3-glucan content, indicating the synthesis of this cell wall component as a possible target. The present study identifies the antidermatophytic activity of the ABT and highlights its potential to improve the effectiveness of conventional topical treatment currently used for the management of skin or mucosal fungal infections.
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Affiliation(s)
- Chantal Fernandes
- CNC-UC—Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-504 Coimbra, Portugal; (C.F.); (J.S.-B.); (A.F.L.-S.); (D.C.); (E.C.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - José Sousa-Baptista
- CNC-UC—Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-504 Coimbra, Portugal; (C.F.); (J.S.-B.); (A.F.L.-S.); (D.C.); (E.C.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
- FMUC—Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
| | - Ana Filipa Lenha-Silva
- CNC-UC—Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-504 Coimbra, Portugal; (C.F.); (J.S.-B.); (A.F.L.-S.); (D.C.); (E.C.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Daniela Calheiros
- CNC-UC—Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-504 Coimbra, Portugal; (C.F.); (J.S.-B.); (A.F.L.-S.); (D.C.); (E.C.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
- FMUC—Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
| | - Edmilson Correia
- CNC-UC—Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-504 Coimbra, Portugal; (C.F.); (J.S.-B.); (A.F.L.-S.); (D.C.); (E.C.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Artur Figueirinha
- Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de S. Comba, 3000-548 Coimbra, Portugal; (A.F.); (L.S.)
- Associated Laboratory for Green Chemistry (LAQV) of the Network of Chemistry and Technology (REQUIMTE), University of Porto, 4099-002 Porto, Portugal
| | - Lígia Salgueiro
- Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de S. Comba, 3000-548 Coimbra, Portugal; (A.F.); (L.S.)
- Chemical Process Engineering and Forest Products Research Centre, Department of Chemical Engineering, Faculty of Sciences and Technology, University of Coimbra, 3030-790 Coimbra, Portugal
| | - Teresa Gonçalves
- CNC-UC—Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, 3004-504 Coimbra, Portugal; (C.F.); (J.S.-B.); (A.F.L.-S.); (D.C.); (E.C.)
- CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-504 Coimbra, Portugal
- FMUC—Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
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Shamsizadeh F, Zarei Mahmoudabadi A, Shariat Nabavi M, Guillot J, Taghipour S, Rezaei-Matehkolaei A. In vitro activities of 8 antifungal agents against geophilic dermatophyte isolates. Mycoses 2021; 65:255-262. [PMID: 34861084 DOI: 10.1111/myc.13408] [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: 10/19/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Members of the Nannizzia gypsea complex are globally the most common geophilic dermatophytes which cause infection in animals and human. Although the susceptibility patterns of anthropophilic or zoophilic dermatophyte species to antifungal agents are well documented, the effectiveness of such drugs against geophilic species have rarely been explored. OBJECTIVES This study was aimed to evaluate the in vitro antifungal activity of common and new antifungals against a set of environmental and clinical geophilic dermatophyte isolates. METHODS 108 soil and clinical geophilic isolates from two genera Nannizzia (N. fulva n = 59; N. gypsea n = 43) and Arthroderma (A. quadrifidum n = 4; A. gertleri n = 1; A. tuberculatum n = 1) were included in the study. The in vitro antifungal susceptibility patterns of eight common and new antifungals against the isolates were determined according to broth microdilution method and by CLSI M38-A3 (3rd edition) protocol. RESULTS MIC values across all isolates from five species ranged as: luliconazole: 0.0002-0.002 µg/ml, terbinafine: 0.008-0.125 µg/ml, efinaconazole: 0.008-0.125 µg/ml, ciclopirox olamine: 0.03-0.5 µg/ml, itraconazole: 0.125-1 µg/ml, amorolfine hydrochloride: 0.125-4 µg/ml, griseofulvin: 0.25-2 µg/ml and tavaborole: 1-8 µg/ml, respectively. CONCLUSION Luliconazole, terbinafine and efinaconazole exhibited the highest in vitro efficacy, regardless of the dermatophyte species. Further surveillance studies are recommended to confirm the implication of such in vitro data for the clinical recovery rate of dermatophytosis with geophilic species following antifungal therapy.
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Affiliation(s)
- Forough Shamsizadeh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Zarei Mahmoudabadi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Shariat Nabavi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Jacques Guillot
- Dynamic Research Group, UPEC, EnvA, USC Anses, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.,Dermatology Parasitology Mycology Department, Oniris Ecole Nationale Veterinaire, Agroalimentaire et de l'Alimentation, Nantes, France
| | - Simin Taghipour
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Ali Rezaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Abastabar M, Jedi A, Guillot J, Ilkit M, Eidi S, Hedayati MT, Shokohi T, Daie Ghazvini R, Rezaei-Matehkolaei A, Katiraee F, Javidnia J, Ahmadi B, Badali H. In vitro activities of 15 antifungal drugs against a large collection of clinical isolates of Microsporum canis. Mycoses 2019; 62:1069-1078. [PMID: 31408550 DOI: 10.1111/myc.12986] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Microsporum canis is a zoophilic species, found to be the most frequently isolated species in animals. M. canis causes sporadic outbreaks of infections in humans, such as the one that occurred in Canada, where more than 1000 human cases were detected over an 8-year period. Despite the medical importance of M. canis infections, there are limited in vitro data on the antifungal susceptibility to antifungal drugs, including new generation triazoles and imidazoles. OBJECTIVE The aim of the current study was to comprehensively evaluate the in vitro activity of new azoles and comparator drugs against a large panel of M. canis isolates using a microdilution assay. METHODS The in vitro susceptibility to novel triazoles and imidazoles was compared to that of other antifungal drugs using a large collection of M. canis clinical isolates (n = 208) obtained from patients and animals with dermatophytosis in Iran, France and Turkey. RESULTS All isolates exhibited high susceptibility to the majority of the tested antifungal agents. However, luliconazole, lanoconazole and efinaconazole, as well as econazole, demonstrated superior activity against all strains in comparis on with the other drugs. CONCLUSION FDA-approved antifungal drugs, that is luliconazole, efinaconazole and lanoconazole, showed the highest antifungal activity and should be promising candidates for the treatment of dermatophytosis caused by M canis. However, their therapeutic effectiveness remains to be determined in clinical settings.
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Affiliation(s)
- Mahdi Abastabar
- Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences.,Department of Medical Mycology, Mazandaran University of Medical Sciences
| | - Ali Jedi
- Department of Medical Mycology, Mazandaran University of Medical Sciences.,Student Research Committee, Mazandaran University of Medical Sciences
| | - Jacques Guillot
- Department of Parasitology, Mycology, Dermatology, EA Dynamyc, UPEC, Ecole nationale vétérinaire d'Alfort
| | - Macit Ilkit
- Department of Medical Microbiology, Faculty of Medicine, University of Çukurova
| | - Samaneh Eidi
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences.,Department of Medical Mycology, Mazandaran University of Medical Sciences
| | - Tahereh Shokohi
- Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences.,Department of Medical Mycology, Mazandaran University of Medical Sciences
| | - Roshanak Daie Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, Faculty of Medicine/Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences
| | - Farzad Katiraee
- Department of Pathobiology, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Javad Javidnia
- Student Research Committee, Mazandaran University of Medical Sciences
| | - Bahram Ahmadi
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences
| | - Hamid Badali
- Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences.,Department of Medical Mycology, Mazandaran University of Medical Sciences
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Antifungal resistance in dermatophytes: Recent trends and therapeutic implications. Fungal Genet Biol 2019; 132:103255. [PMID: 31330295 DOI: 10.1016/j.fgb.2019.103255] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 12/15/2022]
Abstract
Dermatophytoses or tinea refers to superficial fungal infection of keratinized tissues. Although generally considered easy to treat, recalcitrant infections, presenting as extensive and difficult to treat tinea corporis and cruris, are on the rise in some parts of the world. The situation demands an understanding of the pharmacokinetic and pharmacodynamic properties of the available antifungals against dermatophytes and the possible contribution of drug resistance and other factors to the present scenario. In this review, we provide the readers a comprehensive account of the available literature on in-vitro and in-vivo resistance to clinically used antifungals among dermatophytes. We have also added, in brief, the relevant skin pharmacokinetics of important systemic drugs. The established and postulated mechanisms of drug resistance are discussed and aspects on lack of in vivo correlation of in vitro resistance are presented. Finally, the lacunae in our existing knowledge on the topic and the arenas for future research are highlighted.
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Bonifaz A, Córdoba-García B, Simancas-Llanos T, Hernández MA, Martínez-Herrera E, Tirado-Sánchez A. Dermatophytosis caused by Nannizzia nana in two siblings. Rev Iberoam Micol 2019; 36:30-33. [DOI: 10.1016/j.riam.2018.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 10/27/2022] Open
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Moriello KA, Coyner K, Paterson S, Mignon B. Diagnosis and treatment of dermatophytosis in dogs and cats.: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology. Vet Dermatol 2017; 28:266-e68. [PMID: 28516493 DOI: 10.1111/vde.12440] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dermatophytosis is a superficial fungal skin disease of cats and dogs. The most common pathogens of small animals belong to the genera Microsporum and Trichophyton. It is an important skin disease because it is contagious, infectious and can be transmitted to people. OBJECTIVES The objective of this document is to review the existing literature and provide consensus recommendations for veterinary clinicians and lay people on the diagnosis and treatment of dermatophytosis in cats and dogs. METHODS The authors served as a Guideline Panel (GP) and reviewed the literature available prior to September 2016. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) provided guidance and oversight for this process. A draft of the document was presented at the 8th World Congress of Veterinary Dermatology (May 2016) and was then made available via the World Wide Web to the member organizations of the WAVD for a period of three months. Comments were solicited and posted to the GP electronically. Responses were incorporated by the GP into the final document. CONCLUSIONS No one diagnostic test was identified as the gold standard. Successful treatment requires concurrent use of systemic oral antifungals and topical disinfection of the hair coat. Wood's lamp and direct examinations have good positive and negative predictability, systemic antifungal drugs have a wide margin of safety and physical cleaning is most important for decontamination of the exposed environments. Finally, serious complications of animal-human transmission are exceedingly rare.
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Affiliation(s)
- Karen A Moriello
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive West, Madison, WI, 53706, USA
| | - Kimberly Coyner
- Dermatology Clinic for Animals, 8300 Quinault Drive NE Suite A, Lacey, WA, 98516, USA
| | - Susan Paterson
- Department of Veterinary Dermatology, Rutland House Referral Hospital, Abbotsfield Road, St Helens, WA9 4HU, UK
| | - Bernard Mignon
- Department of Infectious and Parasitic Diseases, Veterinary Mycology, FARAH (Fundamental and Applied Research for Animals & Health), Faculty of Veterinary Medicine, University of Liège, Quartier Vallée 2, Avenue de Cureghem 10, B43A, 4000, Liège, Belgium
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Pathogenic Dermatophytes Survive in Nail Lesions During Oral Terbinafine Treatment for Tinea Unguium. Mycopathologia 2017; 182:673-679. [PMID: 28281037 PMCID: PMC5500682 DOI: 10.1007/s11046-017-0118-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/23/2017] [Indexed: 11/27/2022]
Abstract
Tinea unguium caused by dermatophyte species are usually treated with oral antimycotic, terbinafine (TBF). To understand the mechanisms of improvement and recalcitrance of tinea unguium by oral TBF treatment, a method of quantifying dermatophyte viability in the nail was developed, and the viability of dermatophytes was analyzed in toenail lesions of 14 patients with KOH-positive tinea unguium treated with oral TBF 125 mg/day for up to 16 weeks. Mycological tests, including KOH examination and fungal culture, and targeted quantitative real-time PCR for internal transcribed spacer (ITS) region, including rRNA, were demonstrated at the initial visit and after 8 and 16 weeks of treatment. Assays in eight patients showed that average ITS DNA amount significantly decreased, to 44% at 8 weeks and 36% at 16 weeks compared with 100% at initial visit. No significant difference was observed between at 8 and 16 weeks, despite the TBF concentration in the nail supposedly more than 10-fold higher than the minimum fungicidal concentration for dermatophytes. This finding suggests the pathogenic dermatophytes in nail lesions could survive in a dormant form, such as arthroconidia, during oral TBF treatment. Both antimycotic activity and nail growth are important factors in treatment of tinea unguium.
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Bexton S, Nelson H. Comparison of two systemic antifungal agents, itraconazole and terbinafine, for the treatment of dermatophytosis in European hedgehogs (Erinaceus europaeus). Vet Dermatol 2016; 27:500-e133. [PMID: 27620985 DOI: 10.1111/vde.12378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatophytosis caused by Trichophyton erinacei is a common scaling and crusting skin disease affecting European hedgehogs (Erinaceus europaeus) admitted to wildlife rescue centres. The application of topical therapy can be challenging because wild hedgehogs are subject to stress and often roll into a ball when handled. Systemic antifungal therapy is more convenient but has not been evaluated in this species. HYPOTHESIS/OBJECTIVES To compare the efficacy of oral itraconazole versus oral terbinafine for the treatment of dermatophytosis affecting hedgehogs. ANIMALS A treatment trial was undertaken in a wildlife hospital involving 165 hedgehogs with naturally occurring dermatophytosis. METHODS Animals were randomly divided into two groups and treated with either itraconazole or terbinafine orally for 28 days. The therapeutic efficacy was evaluated after 14 and 28 days by mycological culture and clinical dermatological lesion scores. RESULTS Both drugs were well tolerated and clinically effective. After 14 and 28 days of treatment, the respective mycological cure rate was 36.6% and 65.9% for the itraconazole-treated group and 92.8% and 98.8% for the terbinafine-treated group. CONCLUSION AND CLINICAL IMPORTANCE Itraconazole and terbinafine were both effective for the treatment of dermatophytosis affecting hedgehogs; however, terbinafine was more effective.
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Affiliation(s)
- Steve Bexton
- Royal Society for the Prevention of Cruelty to Animals (RSPCA) East Winch Wildlife Centre, Station Road, East Winch, Kings Lynn, Norfolk, PE32 1NR, UK
| | - Helen Nelson
- Royal Society for the Prevention of Cruelty to Animals (RSPCA) East Winch Wildlife Centre, Station Road, East Winch, Kings Lynn, Norfolk, PE32 1NR, UK
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Iwanaga T, Anzawa K, Mochizuki T. Quantification of dermatophyte viability for evaluation of antifungal effect by quantitative PCR. Mycopathologia 2014; 177:241-9. [PMID: 24760383 DOI: 10.1007/s11046-014-9745-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 04/07/2014] [Indexed: 11/30/2022]
Abstract
Dermatophytosis is a common disease caused by dermatophyte fungi such as Trichophyton rubrum and Trichophyton mentagrophytes. A method of quantifying fungal viability in the lesions of dermatophytosis is indispensable for understanding the therapeutic process and outcome; however, no such method has yet been developed. The aim of this study was to develop a method for quantifying dermatophyte viability by quantitative polymerase chain reaction (qPCR). The internal transcribed spacer (ITS) and D1/D2 regions, including each of rRNA and rDNA, were chosen as the targets, and dermatophyte-specific primer pairs were designed corresponding to ITS and D1/D2 regions. The amounts of target RNA and DNA after heat or antifungal treatment were measured by qPCR and compared with colony-forming unit (CFU) counts. RNA and DNA could extract from dermatophytes by mechanical pulverization of conidia using a Multi-Beads Shocker cell disruptor. Our method was sufficiently sensitive to detect 10 copies by qPCR using both ITS and D1/D2 primer pairs. The most sensitive target was ITS-cDNA after heat or antifungal treatment, and essentially consistent with CFU counts. On the other hands, ITS-DNA and D1/D2-DNA were not decreased soon after heat or antifungal treatment, but those were decreased significantly and reflected the CFU counts after 48 h of antifungal treatment. We conclude that ITS-cDNA is useful mainly for quantifying dermatophyte viability at early responses, but ITS-DNA and D1/D2-DNA are also available for evaluation, which does not need an early response.
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Yenişehirli G, Tunçoğlu E, Yenişehirli A, Bulut Y. In vitro activities of antifungal drugs against dermatophytes isolated in Tokat, Turkey. Int J Dermatol 2013; 52:1557-60. [PMID: 24134487 DOI: 10.1111/ijd.12100] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In this study, we aimed to establish the in vitro antifungal susceptibilities of terbinafine, miconazole, itraconazole, ketoconazole, griseofulvin, and amphotericin B against dermatophyte isolates. METHODS One hundred and seventy-seven clinical isolates were tested: Trichophyton rubrum (n = 78), Trichophyton mentagrophytes (n = 49), Epidermophyton floccosum (n = 30), Trichophyton verrucosum (n = 16), and Trichophyton tonsurans (n = 4). The broth microdilution assay for antifungal susceptibility testing of dermatophytes was performed according to Clinical and Laboratory Standards Institute guidelines in the M38-A2 document. RESULTS Our minimum inhibitory concentration (MIC) results showed that the values for terbinafine for all dermatophyte isolates were significantly lower than the values for amphotericin B, miconazole, itraconazole, ketoconazole, and griseofulvin. For T. rubrum isolates, amphotericin B was more active than miconazole, itraconazole, and ketoconazole. Among the antifungal drugs tested, griseofulvin had the highest minimum inhibitory concentration values for T. mentagrophytes isolates. CONCLUSION Terbinafine was found to be the most effective antifungal drug against all tested dermatophyte isolates. Griseofulvin was the less active antifungal drug against T. mentagrophytes isolates. Performing antifungal susceptibility testing is especially important for screening the development of antifungal resistance.
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Affiliation(s)
- Gülgün Yenişehirli
- Departments of Microbiology and Clinical Microbiology, Faculty of Medicine, Gaziosmanpaşa University, Tokat, Turkey
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Nardoni S, Mugnaini L, Papini R, Fiaschi M, Mancianti F. Canine and feline dermatophytosis due to Microsporum gypseum : A retrospective study of clinical data and therapy outcome with griseofulvin. J Mycol Med 2013; 23:164-7. [DOI: 10.1016/j.mycmed.2013.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/15/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
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Abstract
The pharmacokinetics of terbinafine was studied in six healthy fasted cats following a single intravenous and oral administration at a dose of 10 mg/kg and 30 mg/kg, respectively, according to a two-period crossover design. Plasma terbinafine concentrations were determined using a reverse phase liquid chromatographic method. The pharmacokinetic parameters were calculated by non-compartmental analysis with WinNonlin 5.2.1 software. After intravenous administration, the terminal half-life and area under the curve from time 0 to infinity were 10.40 ± 4.56 h, 15.20 ± 3.61 h·µg/ml, respectively. After oral dosing, the mean maximum concentration was 3.22 ± 0.60 µg/ml, reached at 1.33 ± 0.41 h. The terminal half-life, area under the curve from time 0 to infinity and apparent volume of distribution were 8.01 ± 3.46 h, 13.77 ± 4.99 h·µg/ml, 25.63 ± 6.29 l/kg, respectively. The absolute bioavailability of terbinafine hydrochloride tablets after oral administration was 31.00 ± 10.85%. Although bioavailability was low, excellent penetration at the site of infection and low minimum inhibitory concentrations values provided terbinafine with good efficacy against dermatophyte infections.
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Affiliation(s)
- Ang Wang
- Laboratory of Veterinary Pharmacology, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
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Sakai MR, May ER, Imerman PM, Felz C, Day TA, Carlson SA, Noxon JO. Terbinafine pharmacokinetics after single dose oral administration in the dog. Vet Dermatol 2011; 22:528-34. [PMID: 21599768 DOI: 10.1111/j.1365-3164.2011.00985.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Terbinafine is an allylamine antifungal prescribed for the treatment of mycoses in humans. It is increasingly being used in veterinary patients. The purpose of this study was to evaluate the pharmacokinetic properties of terbinafine in dogs after a single oral dose. Ten healthy adult dogs were included in the study. A single dose of terbinafine (30-35 mg/kg) was administered orally, and blood samples were periodically collected over a 24 h period during which dogs were monitored for adverse effects. Two of 10 dogs developed transient ocular changes. A high-performance liquid chromatography assay was developed and used to determine plasma terbinafine concentrations. Pharmacokinetic analysis was performed using PK Solutions(®) computer software. Area under the curve (AUC) from time 0 to 24 h was 15.4 μg·h/mL (range 5-27), maximal plasma concentration (C(max) ) was 3.5 μg/mL (range 3-4.9 μg/mL) and time to C(max) (T(max) ) was 3.6 h (range 2-6 h). The time above minimal inhibitory concentration (T > MIC) as well as AUC/MIC was calculated for important invasive fungal pathogens and dermatophytes. The T > MIC was 17-18 h for Blastomyces dermatitidis, Histoplasma capsulatum and dermatophytes (Microsporum spp. and Trichophyton mentagrophytes), while the MIC for Sporothrix schenckii and Coccidioides immitis was exceeded for 9.5-11 h. The AUC/MIC values ranged from 9 to 13 μg h/mL for these fungi. Our results provide evidence supporting the use of terbinafine as an oral therapeutic agent for treating systemic and subcutaneous mycoses in dogs.
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Affiliation(s)
- Mary R Sakai
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, IA 50011, USA.
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15
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Foy DS, Trepanier LA. Antifungal treatment of small animal veterinary patients. Vet Clin North Am Small Anim Pract 2011; 40:1171-88. [PMID: 20933143 DOI: 10.1016/j.cvsm.2010.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antifungal therapy has progressed significantly with the development of new drugs directed at various processes in fungal cell metabolism. Within veterinary medicine, treatment options for systemic mycoses remain limited to amphotericin B, ketoconazole, fluconazole, and itraconazole. However, newer triazoles, echinocandins, and lipid-based formulations of amphotericin B are now approved for use in humans. This article provides a comprehensive review of the antifungal medications available for veterinary patients, and includes a brief discussion of the newer, presently cost-prohibitive, antifungal therapies used for systemic mycoses in humans.
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Affiliation(s)
- Daniel S Foy
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
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16
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Keeble EJ, Neuber A, Hume L, Goodman G. Medical management of Trichophyton dermatophytosis using a novel treatment regimen in L'Hoest's monkeys (Cercopithecus lhoesti). Vet Rec 2010; 167:862-4. [PMID: 21262652 DOI: 10.1136/vr.c5426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
An outbreak of Trichophyton dermatophytosis was diagnosed in a group of four L'Hoest's monkeys (Cercopithecus lhoesti) housed in the primate section at a zoological collection. The affected animals presented with areas of non-pruritic alopecia, scaling and crusting. The diagnosis was based on culture and direct microscopy of hair plucks. Treatment was commenced with oral terbinafine at a dose of 8.25 mg/kg bodyweight, topical enilconazole washes and disinfectant fogging of the enclosure. Control measures were designed to limit the spread of infection and reduce the zoonotic risk. Treatment was successful, with no further clinical cases being diagnosed and with resolution of the clinical signs after four weeks and mycological cure after eight weeks.
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Affiliation(s)
- E J Keeble
- Exotic Animal and Wildlife Service, Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Midlothian.
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17
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Arabatzis M, Kyprianou M, Velegraki A, Makri A, Voyatzi A. Microsporum canis antifungal susceptibilities: concerns regarding their clinical predictability. Int J Antimicrob Agents 2010; 36:385-6. [PMID: 20685087 DOI: 10.1016/j.ijantimicag.2010.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 06/02/2010] [Accepted: 06/09/2010] [Indexed: 11/18/2022]
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18
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Nuttall TJ, German AJ, Holden SL, Hopkinson C, McEwan NA. Successful resolution of dermatophyte mycetoma following terbinafine treatment in two cats. Vet Dermatol 2009; 19:405-10. [PMID: 19055614 PMCID: PMC7169289 DOI: 10.1111/j.1365-3164.2008.00712.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Microsporum canis sensitive to itraconazole and terbinafine was isolated from two cats presented with generalized dermatophytosis and dermatophyte mycetoma. Itraconazole therapy was withdrawn through lack of efficacy in one cat (a Persian) and unacceptable adverse effects in the other (a Maine Coon). Both cats achieved clinical and mycological cure after 12–14 weeks therapy with 26–31 mg kg−1 terbinafine every 24 h per os (PO). Clinical signs in the Maine Coon resolved completely after 7 weeks treatment. Four weeks of therapy with additional weekly washes with a 2% chlorhexidine/2% miconazole shampoo following clipping produced a 98% reduction in the Persian cat's mycetoma, which was then surgically excised. Recurrent generalized dermatophytosis in the Persian cat has been managed with pulse therapy with 26 mg kg−1 terbinafine every 24 h PO for 1 week in every month. No underlying conditions predisposing to dermatophytosis were found in either cat despite extensive investigation. Terbinafine administration was associated with mild to moderate lethargy in the Persian cat, but no other adverse effects or changes in blood parameters were seen. To the best of the authors’ knowledge this is the first report of a dermatophyte mycetoma in a Maine Coon and of successful resolution of this condition in cats following terbinafine therapy.
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Affiliation(s)
- T J Nuttall
- The University of Liverpool Small Animal Teaching Hospital, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK.
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19
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Thian A, Woodgyer AJ, Holloway SA. Dysgonic strain ofMicrosporum canispseudomycetoma in a Domestic Long-hair cat. Aust Vet J 2008; 86:324-8. [PMID: 18673475 DOI: 10.1111/j.1751-0813.2008.00328.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Thian
- University of Melbourne Veterinary Clinic and Hospital, 250 Princes Highway, Werribee, Victoria 3030, Australia.
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20
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Dermatophytoses in Animals. Mycopathologia 2008; 166:385-405. [PMID: 18478363 DOI: 10.1007/s11046-008-9102-7] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 01/15/2008] [Accepted: 01/30/2008] [Indexed: 10/22/2022]
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21
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Foust AL, Marsella R, Akucewich LH, Kunkle G, Stern A, Moattari S, Szabo NJ. Evaluation of persistence of terbinafine in the hair of normal cats after 14 days of daily therapy. Vet Dermatol 2007; 18:246-51. [PMID: 17610490 DOI: 10.1111/j.1365-3164.2007.00603.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study determined the residual concentration of terbinafine in cat hair after 14 days of oral treatment. Ten clinically normal cats were administered terbinafine orally at a daily dose of 34-45.7 mg kg(-1) for a total of 14 days. Areas of 15 cm(2) were shaved on the lateral thorax at day 0 and weekly for 8 weeks after the last dose of terbinafine. The hair samples were analysed by high-pressure liquid chromatography to determine the persistence of terbinafine over time. The mean terbinafine concentration in hair was 2.30 ng mg(-1) after 14 days of therapy. The half life was 1.84 weeks after the last dose of terbinafine. With a 99% confidence interval, the concentration of terbinafine remained in the cat hair at or above 0.03 ng mg(-1) (minimal inhibitory concentration (MIC)(90) = 0.03 microg mL(-1)) for 5.3 weeks. Slight deviations in the complete blood cell count and serum chemistry values were not attributed to terbinafine. Four cats experienced vomiting during the terbinafine treatment; two of these cats also experienced intense facial pruritus followed by a macular to papular skin reaction 7-14 days after the discontinuation of terbinafine. In summary, terbinafine persists in hair at concentrations above the MIC for several weeks after stopping medication, even after short-term therapy (14 days). These results suggest that pulse therapy of terbinafine should be further researched and potentially considered as a treatment modality for feline dermatophytosis, an approach that would decrease treatment duration while maintaining effectiveness.
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Affiliation(s)
- Abby L Foust
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
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22
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Osborne CS, Leitner I, Hofbauer B, Fielding CA, Favre B, Ryder NS. Biological, biochemical, and molecular characterization of a new clinical Trichophyton rubrum isolate resistant to terbinafine. Antimicrob Agents Chemother 2006; 50:2234-6. [PMID: 16723593 PMCID: PMC1479141 DOI: 10.1128/aac.01600-05] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 01/24/2006] [Accepted: 03/26/2006] [Indexed: 11/20/2022] Open
Abstract
We have characterized a new clinical strain of Trichophyton rubrum highly resistant to terbinafine but exhibiting normal susceptibility to drugs with other mechanisms of action. Resistance to terbinafine in this strain is caused by a missense mutation in the squalene epoxidase gene leading to the amino acid substitution F397L.
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Affiliation(s)
- Colin S Osborne
- Infectious Diseases, Novartis Institutes for BioMedical Research, Inc., Cambridge, MA 02139, USA.
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23
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Hector RF. An Overview of Antifungal Drugs and Their Use for Treatment of Deep and Superficial Mycoses in Animals. ACTA ACUST UNITED AC 2005; 20:240-9. [PMID: 16317914 DOI: 10.1053/j.ctsap.2005.07.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fungal infections are often challenging to manage, given the limited numbers of therapeutics and a general lack of applicable clinical literature for their use in a given animal species. This article reviews some of the underlying principles that can affect the therapeutic outcome for a given antifungal, and provides specific information from the literature that is intended to highlight the distinctive properties of the most commonly used antifungals in veterinary medicine to better facilitate their successful application in clinical practice.
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Affiliation(s)
- Richard F Hector
- Institute for Global Health, University of California San Francisco, San Francisco, CA 94105, USA.
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24
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Osborne CS, Leitner I, Favre B, Ryder NS. Amino acid substitution in Trichophyton rubrum squalene epoxidase associated with resistance to terbinafine. Antimicrob Agents Chemother 2005; 49:2840-4. [PMID: 15980358 PMCID: PMC1168638 DOI: 10.1128/aac.49.7.2840-2844.2005] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
There has only been one clinically confirmed case of terbinafine resistance in dermatophytes, where six sequential Trichophyton rubrum isolates from the same patient were found to be resistant to terbinafine and cross-resistant to other squalene epoxidase (SE) inhibitors. Microsomal SE activity from these resistant isolates was insensitive to terbinafine, suggesting a target-based mechanism of resistance (B. Favre, M. Ghannoum, and N. S. Ryder, Med. Mycol. 42:525-529, 2004). In this study, we have characterized at the molecular level the cause of the resistant phenotype of these clinical isolates. Cloning and sequencing of the SE gene and cDNA from T. rubrum revealed the presence of an intron in the gene and an open reading frame encoding a protein of 489 residues, with an equivalent similarity (57%) to both yeast and mammalian SEs. The nucleotide sequences of SE from two terbinafine-susceptible strains were identical whereas those of terbinafine-resistant strains, serially isolated from the same patient, each contained the same single missense introducing the amino acid substitution L393F. Introduction of the corresponding substitution in the Candida albicans SE gene (L398F) and expression of this gene in Saccharomyces cerevisiae conferred a resistant phenotype to the transformants when compared to those expressing the wild-type sequence. Terbinafine resistance in these T. rubrum clinical isolates appears to be due to a single amino acid substitution in SE.
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Affiliation(s)
- Colin S Osborne
- Infectious Diseases, Novartis Institutes for BioMedical Research, Vienna, Austria.
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25
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Krakhecke AG, Afonso E, Ferreira JC, Candido RC. In vitro susceptibility testing of Microsporum gypseum isolated from healthy cattle and soil samples against itraconazole, terbinafine, fluconazole and topical veterinarian drugs. Mycopathologia 2005; 159:377-80. [PMID: 15883722 DOI: 10.1007/s11046-005-0252-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Revised: 01/06/2005] [Indexed: 10/25/2022]
Abstract
The present study evaluated in vitro susceptibility testing of dermatophytes isolates from healthy cattle and soil samples against three antifungal agents and three topical veterinarian drugs. Itraconazole and terbinafine showed a higher in vitro fungicidal activity than fluconazole. The veterinarian drugs LEPECID and iodine 5% were more active in vitro than the UNGUENTO spray. All drugs showed fungicidal activity against Microsporum gypseum, and they may be considered as efficient agents for the topical treatment of dermatophytoses in cattle.
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Affiliation(s)
- Alessandra Gonçalves Krakhecke
- Faculdade de Ciências Agrárias e Veterinárias of Universidade Estadual Paulista, Estopeira street 363 carandê Bosque II, Campo Grande, 79032150 Mato Grosso do Sul, Brazil.
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26
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Esteban A, Abarca ML, Cabañes FJ. Comparison of disk diffusion method and broth microdilution method for antifungal susceptibility testing of dermatophytes. Med Mycol 2005; 43:61-6. [PMID: 15712608 DOI: 10.1080/13693780410001711972] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The use of the agar diffusion Neo-Sensitabs method to determine antifungal susceptibility of 59 isolates of dermatophytes, namely Epidermophyton floccosum, Microsporum canis, M. gypseum, Trichophyton mentagrophytes, T. rubrum and T. tonsurans to Clotrimazole (CLZ), Itraconazole (ITZ) and Terbinafine (TBF) is described. Results obtained are compared to the minimum inhibitory concentrations (MIC) determined by an adaptation of the NCCLS-M38-A procedure. Using the diffusion method, all strains showed a broad zone of inhibition at the first available reading time (3 or 7 days). Using the broth microdilution method, the geometric mean MIC (microg/ml) with regard to all isolates was < or = 0.03 for TBF, < or = 0.069 for CLZ and < or = 0.919 for ITZ. In both methods, TBF was the most active antifungal agent against all isolates tested. The two methods evaluated were able to detect the resistance of the quality control strains of Aspergillus fumigatus to ITZ. Even though a reference method for testing dermatophytes still has not been developed, our data suggest that the Neo-Sensitabs diffusion method could provide a simple procedure for the antifungal susceptibility testing of dermatophytes in the routine clinical laboratory.
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Affiliation(s)
- A Esteban
- Departament de Sanitat i d'Anatomia Animals (Microbiologia), Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
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27
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Chadeganipour M, Nilipour S, Havaei A. In vitro evaluation of griseofulvin against clinical isolates of dermatophytes from Isfahan. In-vitro-Empfindlichkeit klinischer Dermatophyten-Isolate aus Isfahan, Iran, gegenuber Griseofulvin. Mycoses 2004; 47:503-7. [PMID: 15601457 DOI: 10.1111/j.1439-0507.2004.01050.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fifty dermatophyte isolates, recently obtained from clinical materials, belonging to Trichophyton mentagrophytes, T. verrucosum, Microsporum canis and Epidermophyton floccosum were examined for their susceptibility to griseofulvin. The minimum inhibitory concentration (MIC) values were obtained using the modified microdilution method. All 100% tested isolates had MIC geometric mean at a concentration between 0.43 and 0.95 microg ml(-1) The MIC(90)s and MIC(50)s were 8 microg ml(-1) and <0.25-1 microg ml(-1) respectively. From all isolates, 12% including three T. verrucosum, one M. canis and two T. mentagrophytes isolates had MIC values out of the standardized range, therefore, they were considered as relatively griseofulvin-resistant. At least some of the isolates tested might be difficult to eradicate in clinical terms with griseofulvin treatment in Isfahan.
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Affiliation(s)
- Mostafa Chadeganipour
- Mycology and Parasitology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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28
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Osborne CS, Hofbauer B, Favre B, Ryder NS. In vitro analysis of the ability of Trichophyton rubrum to become resistant to terbinafine. Antimicrob Agents Chemother 2004; 47:3634-6. [PMID: 14576134 PMCID: PMC253782 DOI: 10.1128/aac.47.11.3634-3636.2003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this study, we have investigated in vitro the resistance frequency and development of resistance to terbinafine of Trichophyton rubrum. Results demonstrated that naturally occurring mutants are rare and that T. rubrum appears to have little capacity to develop resistance to terbinafine even after prolonged exposure.
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29
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Osborne CS, Leitner I, Favre B, Ryder NS. Antifungal drug response in anin vitromodel of dermatophyte nail infection. Med Mycol 2004; 42:159-63. [PMID: 15124869 DOI: 10.1080/13693780310001656803] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Despite terbinafine being fungicidal against Trichophyton rubrum in standard NCCLS assays and rapidly accumulating in nails in vivo, onychomycosis patients require prolonged terbinafine treatment to be cured. To investigate this, we developed a more clinically relevant onychomycosis in vitro test model. Human nail powder inoculated with T. rubrum and incubated in liquid RPMI 1640 salt medium, which did not support growth alone, developed extensive and invasive mycelial growth. Antifungal drugs were added at different concentrations and cultures incubated for 1 to 4 weeks. Fungal survival was determined by spreading cultures on PDA plates without drug and measuring CFU after 1 to 4 weeks incubation. Drug activity was expressed as the nail minimum fungicidal concentration (Nail-MFC) required for 99.9% elimination of viable fungus. Terbinafine Nail-MFC was 4 microg/ml after 1 week exposure, decreasing to 1 microg/ml after 4 weeks exposure, much higher than MFCs < or = 0.03 microg/ml determined in standard NCCLS MIC assays. In contrast, other clinically used drugs were unable to kill T. rubrum after 4 weeks incubation in this model. Invasive mycelial growth on nail appears to protect T. rubrum from the cidal action of systemic drugs, thus providing a rationale for the long treatment periods in onychomycosis.
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Affiliation(s)
- C S Osborne
- Infectious Diseases Department, Novartis Research Institute, Vienna, Austria.
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30
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Favre B, Hofbauer B, Hildering KS, Ryder NS. Comparison of in vitro activities of 17 antifungal drugs against a panel of 20 dermatophytes by using a microdilution assay. J Clin Microbiol 2003; 41:4817-9. [PMID: 14532230 PMCID: PMC254304 DOI: 10.1128/jcm.41.10.4817-4819.2003] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2003] [Revised: 04/30/2003] [Accepted: 07/29/2003] [Indexed: 11/20/2022] Open
Abstract
The in vitro activities of 17 antifungal drugs against a panel of 20 dermatophytes comprising 6 different species were determined using a microdilution assay according to the NCCLS M38-P method with some modifications. Terbinafine was the most potent systemic drug while tolnaftate and amorolfine were the most active topical agents.
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