A twenty-year survey of dermatophytoses in Braga, Portugal

Conventional and natural compounds for the treatment of dermatophytosis

Dermatophytes are a group of pathogenic fungi that exclusively infect the stratum corneum of the skin, nails, and hair, causing dermatophytosis. Superficial skin infections caused by dermatophytes have increased in the last decades. There are conventional antifungals that treat these infections, such as terbinafine, fluconazole, and others. However, the limitations of these treatments (resistance, side effects and toxicity) along with the increasing over-prescription, the misuse of these antifungals and the high treatment costs led to the search for new, alternative, natural-based antifungal drugs. These have multiple mechanisms of action, which works to their advantage, making it difficult for a fungus to create resistance mechanisms against all of them at the same time. The main objective of this work is to provide a state-of-the-art review on dermatophytes, dermatophytosis, and the existing treatments, both conventional and natural, such as chitosan and essential oils.

S1 guidelines: Tinea capitis

Tinea capitis describes a dermatophyte infection of scalp and hair that predominately occurs in children. The diagnostic workup includes microscopic examination, culture and/or molecular tests. Treatment is guided by the specific organism involved and should consist of systemic agents as well as adjuvant topical treatment. The aim of the present update of the interdisciplinary German S1 guidelines is to provide dermatologists, pediatricians and general practitioners with a decision tool for selecting and implementing appropriate diagnostic and therapeutic measures in patients with tinea capitis. The guidelines were developed based on current international guidelines, in particular the 2010 European Society for Pediatric Dermatology guidelines and the 2014 British Association of Dermatologists guidelines, as well as on a review of the literature conducted by the guideline committee. This multidisciplinary committee consists of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guidelines were approved by the participating medical societies following a comprehensive internal and external review.

The influence of immune status, age, and sex on Majocchi granuloma: a review of 52 cases from a tertiary level hospital and published Korean cases in literature

BACKGROUND

Majocchi granuloma (MG) is a rare dermal and subcutaneous granulomatous inflammation caused by dermatophytes. The detailed characteristics of MG are not fully elucidated. This study investigated the influence of systemic immune status, age, and sex on the clinical, demographic, mycological, and therapeutic characteristics of MG in Korea.

METHODS

We analyzed cases of histopathologically diagnosed MG at our tertiary referral center from January 2001 to December 2016. We also analyzed all Korean MG cases published in Korean and English literature to date. The different features based on immune status, age, and sex were compared. P < 0.05 were considered statistically significant.

RESULTS

We enrolled 52 patients, 33 (63.5%) were male and 19 (36.5%) were female. The mean age was 45.4 ± 23.1 years. Immunosuppression was reported in 13 cases (26.5%). Statistical analysis showed that the immune status affects the anatomical location and clinical manifestation. Age has an influence on involved sites and identified fungal species. The frequent fungal pathogens were different based on sex.

CONCLUSION

The results of our study revealed that distinctive features of MG exist based on immune status, age, and sex.

Serious fungal infections in Portugal

There is a lack of knowledge on the epidemiology of fungal infections worldwide because there are no reporting obligations. The aim of this study was to estimate the burden of fungal disease in Portugal as part of a global fungal burden project. Most published epidemiology papers reporting fungal infection rates from Portugal were identified. Where no data existed, specific populations at risk and fungal infection frequencies in those populations were used in order to estimate national incidence or prevalence, depending on the condition. An estimated 1,510,391 persons develop a skin or nail fungal infection each year. The second most common fungal infection in Portugal is recurrent vulvovaginal candidiasis, with an estimated 150,700 women (15-50 years of age) suffering from it every year. In human immunodeficiency virus (HIV)-infected people, oral or oesophageal candidiasis rates were estimated to be 19.5 and 16.8/100,000, respectively. Candidaemia affects 2.19/100,000 patients, in a total of 231 cases nationally. Invasive aspergillosis is less common than in other countries as chronic obstructive pulmonary disease (COPD) is uncommon in Portugal, a total of 240 cases annually. The estimated prevalence of chronic pulmonary aspergillosis after tuberculosis (TB) is 194 cases, whereas its prevalence for all underlying pulmonary conditions was 776 patients. Asthma is common (10% in adults) and we estimate 16,614 and 12,600 people with severe asthma with fungal sensitisation and allergic bronchopulmonary aspergillosis, respectively. Sixty-five patients develop Pneumocystis pneumonia in acquired immune deficiency syndrome (AIDS) and 13 develop cryptococcosis. Overall, we estimate a total number of 1,695,514 fungal infections starting each year in Portugal.

Growth Inhibition and Morphological Alterations of Trichophyton Rubrum Induced by Essential oil from Cymbopogon Winterianus Jowitt Ex Bor

Trichophyton rubrum is one of the most common fungi causer of dermatophytosis, mycosis that affect humans and animals around the world. Researches aiming new products with antifungal activity become necessary to overcome difficulties on treatment of these infections. Accordingly, this study aimed to investigate the antifungal activity of essential oil from Cymbopogon winterianus against the dermatophyte T. rubrum. The antifungal screening was performed by solid medium diffusion method with 16 T. rubrum strains, minimum inhibitory concentration (MIC) and minimum fungicide concentration (MFC) were determined using the microdilution method. The effects on mycelial dry weight and morphology were also observed. Screening showed essential oil in natura inhibited all the tested strains, with inhibition zones between 24-28 mm diameter. MIC50 and MIC90 values of the essential oil were 312 μg/mL for nearly all the essayed strains (93.75 %) while the MFC50 and MFC90 values were about eight times higher than MIC for all tested strains. All tested essential oil concentrations managed to inhibit strongly the mycelium development. Main morphological changes on the fungal strains observed under light microscopy, which were provided by the essential oil include loss of conidiation, alterations concerning form and pigmentation of hyphae. In the oil presence, colonies showed folds, cream color and slightly darker than the control, pigment production was absent on the reverse and with evident folds. It is concluded that C. winterianus essential oil showed activity against T. rubrum. Therefore, it could be known as potential antifungal compound especially for protection against dermatophytosis.

Epidemiology of dermatophytoses in Sfax, Tunisia

The distribution of dermatophytes varies in different countries and geographical areas depending on several factors. To determine the frequency of aetiological agents and the clinical variants of dermatophytoses, we carried out a study between 1998 and 2007. Out of 25 432 subjects suspected to have superficial mycoses, 9960 (39.2%) were affected with dermatophytoses; 14957 positive samples were obtained. The mean age was 35.7 years (range: 21 days to 97 years). Sex ratio was 0.9. Our patients were from urban regions in 81.9% of cases. The most common type of infection was onychomycosis (30.3%), followed by tinea pedis (24.8%), intertrigo (21.7%), tinea corporis (11.4%) and tinea capitis (9.6%). Fifteen patients had generalised dermatophytosis. Hadida and Schousboe disease was diagnosed in one case with lethal evolution. The most isolated dermatophyte was Trichophyton rubrum (74.5%), followed by T. violaceum (7.9%), T. mentagrophytes (7.5%), Microsporum canis (3.8%), Epidermophyton floccosum (0.7%) and T. verrucosum (0.54%). Other species were occasionally isolated: T. schoenleinii, T. tonsurans, M. audouinii and M. ferrugineum. The prevalence of dermatophytoses remains high in our country (996 cases/year). Trichophyton rubrum is the predominant causal agent. However, zoophilic agents become more prevalent. Epidemiological surveys are an essential tool for developing strategies for infection control.

Freqüência das dermatofitoses em exames micológicos em Hospital Geral de Porto Alegre, Brasil

FUNDAMENTOS- As espécies de dermatófitos podem variar de uma região para outra, tendo esse fato importância epidemiológica e terapêutica. OBJETIVO- Descrever a freqüência dos dermatófitos nos exames micológicos em pacientes ambulatoriais do Hospital de Clínicas de Porto Alegre (HCPA). MÉTODOS - Foi realizada análise retrospectiva dos exames micológicos realizados em pacientes ambulatoriais do Serviço de Dermatologia do Hospital de Clínicas de Porto Alegre (HCPA) durante o período de agosto de 1998 a fevereiro de 2006. Os dados foram comparados com os de trabalhos anteriores locais e de outras cidades do Brasil utilizando o teste do qui-quadrado. RESULTADOS - Das 5.077 amostras coletadas, 2.033 (40,0%) foram positivas para dermatófitos, sendo entre os dermatófitos o Trichophyton rubrum a espécie mais isolada (62,4%), seguido de T. mentagrophytes (18,2%), Microsporum canis (5,7%), Epidermophyton floccosum (2,0%), M. gypseum (1,4%) e T.tonsurans (0,3%). CONCLUSÕES - Não houve variação significativa na epidemiologia dos dermatófitos nos últimos sete anos na cidade de Porto Alegre (p>0,05). Entretanto, o estudo evidencia diferenças na microbiota de Porto Alegre, comparada à de alguns outros centros urbanos do país (p<0,001). Foi observada menor ocorrência de T. tonsurans e M. canis em relação a São Paulo; ao contrário do T. mentagrophytes, que é quase três vezes mais freqüente em Porto Alegre.