Evaluation of antifungal effects of terbinafine and itraconazole using neutral red staining

[Dermatomycoses and medically important fungi that are necessary subjects of study for dermatology specialists -a personal experience]

Among the numerous skin diseases, dermatomycosis is the one caused by fungus (parasite) infecting the skin (host) . Once diagnosis is made, dermatomycosis can be cured with the use of appropriate anti-fungal drugs. Therefore, it is a much more easily treatable disease compareds with intractable skin diseases. From his own experience, the author shows that dermatomycoses are good subspecialties to deal with because many of them are controllable. At the same time, the author points out that basic research on medically important fungi needs to be done as collaborative studies with basic scientists and dermatology specialists. This brief review covers several topics including diagnostics of medical mycoses, imported medical mycoses, tinea, and cutaneous deep mycoses.

Antifungal susceptibility testing method for dermatophytes -determination of MIC and MFC values

In vitro antifungal susceptibility of pathogenic fungi is important information for physicians when selecting an appropriate antifungal drug, deciding the route of drug administration, surveying resistant strains, and so on. Although both the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) are well known endpoints of antifungal susceptibility, the MIC is by far the more highly referred in clinical laboratories. In fact, while methods for determining the MIC have been standardized in Japan and the West to ensure accuracy and reproducibility of the results, by contrast, scant attention has been paid to standardizing methods for determining the MFC. The same preference for MIC topical antifungal drugs for dermatophytes are concerned. In 1999, the Japanese Society of Medical Mycology published a new, standardized method of testing the MIC for dermatophytes and this has since been widely adopted. Nonetheless, the fact remains that the MFC is still determined using methods derived from antifungal pharmacology. Recently in Japan, however, the MFC of topical antifungal drugs has begun attracting more attention due to the development of new antifungal agents with fungicidal activity. These new developments call for improving our understanding of both the MIC and MFC as endpoints of antifungal susceptibility, and for standardizing methods for determining the MFC.The present paper has two objectives : first, to overview the MIC and MFC for topical drugs as endpoints of antifungal susceptibility; and second, to describe a novel test based on the standardized broth microdilution method combined with the trans-well system and neutral red, which we recently developed in our laboratory for directly measuring the MFC.

Simple PCR-based DNA microarray system to identify human pathogenic fungi in skin

Fungal diseases in immunocompromised hosts pose significant threats to their prognoses. An accurate diagnosis and identification of the fungal pathogens causing the infection are critical to determine the proper therapeutic interventions, but these are often not achieved, due to difficulties with isolation and morphological identification. In an effort to ultimately carry out the simultaneous detection of all human pathogenic microbes, we developed a simple system to identify 26 clinically important fungi by using a combination of PCR amplification and DNA microarray assay (designated PCR-DM), in which PCR-amplified DNA from the internal transcribed spacer region of the rRNA gene was hybridized to a DNA microarray fabricated with species-specific probes sets using the Bubble Jet technology. PCR-DM reliably identified all 26 reference strains; hence, we applied it to cases of onychomycosis, taking advantage of the accessibility of tissue from skin. PCR-DM detected fungal DNA and identified pathogens in 92% of 106 microscopy-confirmed onychomycosis specimens. In contrast, culture was successful for only 36 specimens (34%), 3 of which had results inconsistent with the results of PCR-DM, but sequence analysis of the isolates proved that the PCR-DM result was correct. Thus, PCR-DM provides a powerful method to identify pathogenic fungi with high sensitivity and speed directly from tissue specimens, and this concept could be applied to other fungal or nonfungal infectious human diseases in less accessible anatomical sites.

Evaluation of combined deactivators-supplemented agar medium (CDSAM) for recovery of dermatophytes from patients with tinea pedis

Using a newly-developed medium, i.e., combined deactivators-supplemented agar medium (CDSAM), the viability of dermatophytes in skin scales was evaluated. Culture studies were conducted with skin scales collected from 44 patients with tinea pedis who had been treated for two weeks with topical antifungal drugs. Sixty-four percent of the specimens were mycologically positive on CDSAM, while only 23% of these same specimens were positive when cultured on conventional Sabouraud's dextrose agar medium (SDA). Alternatively, 36% of all cases were negative on both media. The experimental data from this clinical study indicate that CDSAM was more useful than SDA in accurately evaluating the efficacy of antifungal drugs since the former minimized the residual effects of drug residues remaining in the skin samples.

Cytotoxicity of prodigiosin and benznidazole on V79 cells

The cytotoxicity of prodigiosin, an antibiotic and potential trypanocide produced by Serratia marcescens, and Benznidazole, a trypanocidal drug, were assayed on V79 fibroblast cell line. Three independent endpoints for cytotoxicity were evaluated; namely, the nucleic acid content (NAC), MTT reduction and neutral red uptake (NRU). IC(50) values of 1-20 microM were obtained for prodigiosin in the NRU, MTT and NAC tests. Prodigiosin had greater trypanocidal activity (IC(50)=5 microM) than Nifurtimox (IC(50)=150 microM) a known trypanocide drug used in Chagas' disease therapy. Benznidazole was less toxic (IC(50)=2000 microM) than prodigiosin (IC(50)=1-20 microM) in V79 cells based on the MTT and NAC assays. Benznidazole stimulated the NRU until 2 mM. Indeed, the cell viability measured with the NRU was higher at all concentrations of benznidazole tested than that measured by MTT reduction and NAC assays.

Neutral red assay in minimum fungicidal concentrations of antifungal agents

We assayed the fungicidal effects of antifungal agents using neutral red staining. Fungal elements of Trichophyton mentagrophytes and T. rubrum were treated with various concentrations of antifungal agents in 96-well filtration plates and then stained with neutral red. The amount of neutral red incorporated by the surviving viable cells was determined from the automated spectrophotometric readings at 550 nm. The minimum fungicidal concentrations (MFCs) of antifungal agents determined by this assay correlated well with those determined by conventional assay. This newly developed procedure should provide a rapid, reproducible, quantitative, qualitative and semi-automated susceptibility test for determination of the MFCs of the fungicidal agents.