Fungi responsible for skin mycoses in Turin (Italy)

Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance

Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes.

Transmission of Onychomycosis and Dermatophytosis between Household Members: A Scoping Review

Onychomycosis is a common fungal infection of the nail, caused by dermatophytes, non-dermatophytes, and yeasts. Predisposing factors include older age, trauma, diabetes, immunosuppression, and previous history of nail psoriasis or tinea pedis. Though many biological risk factors have been well characterized, the role of the environment has been less clear. Studies have found evidence of transmission in 44% to 47% of households with at least one affected individual, but the underlying mechanisms and risk factors for transmission of onychomycosis between household members are incompletely understood. A scoping literature review was performed to characterize and summarize environmental risk factors involved in the transmission of onychomycosis within households. A total of 90 papers met the inclusion criteria, and extracted data was analyzed in an iterative manner. Shared household surfaces may harbor dermatophytes and provide sources for infection. Shared household equipment, including footwear, bedding, and nail tools, may transmit dermatophytes. The persistence of dermatophytes on household cleaning supplies, linen, and pets may serve as lasting sources of infection. Based on these findings, we provide recommendations that aim to interrupt household transmission of onychomycosis. Further investigation of the specific mechanisms behind household spread is needed to break the cycle of transmission, reducing the physical and social impacts of onychomycosis.

Asymptomatic Scalp Carriage among Household Contacts of Children Affected by Tinea Capitis: A Prospective Study in the Metropolitan Area of Brussels, Belgium

<b><i>Introduction:</i></b> Tinea capitis (TC) is a superficial fungal infection affecting the scalp. The existence of asymptomatic carriers (ACs) could represent a potential reservoir responsible of (re)contamination and failure of treatment. No prospective studies on ACs in household contacts of TC patients in Europe have been published to date. <b><i>Objectives:</i></b> The aim of this study was to assess the prevalence of ACs in a cohort of household contacts of children who were diagnosed with TC in the metropolitan area of Bruxelles, Belgium. <b><i>Methods:</i></b> This prospective observational study was conducted from October 2015 to April 2016 at the Dermatology Department of the University Hospitals Brugmann, Saint-Pierre, Queen Fabiola Children Hospital. <b><i>Results:</i></b> Ninety-nine cases of TC from 95 different family circles were included. The main infectious agent identified was <i>Microsporum audouinii</i> in 53 cases. The mean age of TC patients was 5.8 years. Male/female ratio was 2.8. Eighty-one household contacts of TC patients were enrolled in the study. Two cases of ACs (5%) were identified. <b><i>Conclusions:</i></b> <i>M. audouinii</i> was the most common pathogen identified. The prevalence of ACs we report is on average higher compared to other European large cities. Larger prospective studies including all close contacts of affected patients are required in order to establish guidelines regarding identification and management of ACs.

Superficial mycoses, a matter of concern: Global and Indian scenario-an updated analysis

Superficial mycoses of skin, nails and hair are among the common fungal infections. They are caused by dermatophytes, non-dermatophyte moulds, yeasts and yeast-like fungi. Such fungal infections are widespread all over the world and are predominant in tropical as well as subtropical regions. Environmental factors, such as warm, humid and pitiable hygienic conditions, are conducive for their growth and proliferation. Although it does not cause mortality, it is known to be associated with excessive morbidity which may be psychological or physical. This affects the quality of life of the infected individuals which leads to a negative impact on their occupational, emotional and social status. Such infections are increasing on a global scale and, therefore, are of serious concern worldwide. This review article covers the global and Indian scenario of superficial mycoses taking into account the historical background, aetiological agents, prevalence, cultural and environmental factors, risk factors, pathogenesis and hygienic practices for the prevention of superficial mycoses.

Cortisol levels in cats' hair in presence or absence of Microsporum canis infection

The purpose of this work was to perform a preliminary screening in the domestic cat to assess the concentration of cortisol in hairs by radioimmunoassay technique (RIA) in presence or absence of Microsporum canis infections. A total of 245 cats (7 with cutaneous lesions referable to dermatophytosis and 238 apparently healthy) coming from 14 shelters were examined. M. canis was isolated in 126 (51.4%) cats. The cortisol levels were significantly higher in cats with lesions or without lesions but with a high number of colonies in the plates (≥ 10 CFU) than in cats negative or with a lower number of colonies. The results obtained seem to highlight that chronic high levels of cortisol in cats could possibly promote the dermatophytes infections. Furthermore, in High-CFU asymptomatic cats, it could be present a state of infectious, and they, therefore, represents not a simple mechanical carrier.

Isolation and molecular identification of keratinophilic fungi from public parks soil in Shiraz, Iran

Introduction. Keratinophilic fungi are an important group of fungi that live in soil. The aim of this study was to isolate and identify keratinophilic fungi from the soil of different parks in Shiraz. Materials and Methods. A total of 196 soil samples from 43 parks were collected. Isolation of the fungi was performed by hair bait technique. The isolated colonies were identified by morphologic feature of macro- and microconidia and molecular method, using DNA sequence analysis. ITS region of ribosomal DNA was amplified and the PCR products were sequenced. Results. 411 isolates from 22 genera were identified. Fusarium (23.8%), Chrysosporium (13.13%), Acremonium (12.65%), Penicillium (12.39%), Microsporum gypseum (1.94%), Bionectria ochroleuca (1.21%), Bipolaris spicifera (1.21%), Scedosporium apiospermum (0.82%), Phialophora reptans (0.82%), Cephalosporium curtipes (0.49%), Scedosporium dehoogii (0.24%), Ochroconis constricta (0.24%), Nectria mauritiicola (0.49%), Chaetomium (0.49%), Scopulariopsis (0.24%), Malbranchea (0.24%), and Tritirachium (0.24%) were the most important isolates. Most of the fungi were isolated from the soils with the PH range of 7 to 8. Conclusion. Our study results showed that many keratinophilic fungi isolated from the parks soil are important for public health and children are an important group at a high risk of being exposed to these fungi.

Fungal agents in different anatomical sites in Public Health Services in Cuiabá, state of Mato Grosso, Brazil

INTRODUCTION

A contribution to the regional epidemiological profile of the most common fungal agents in Public Health Services in Cuiabá, state of Mato Grosso, including university hospitals and polyclinics.

METHODS

Clinical specimens (n = 1,496) from 1,078 patients were collected, submitted to direct mycological exam (potash or stick tape method) and cultured in specific mediums. Dermatophytic and non-dermatophytic agents were identified according to micromorphology (Ridell technique).

RESULTS

The majority of the 1,496 specimens were skin (n = 985) and nail exams (n = 472). Of the 800 positive cultures, 246 (30.8%) corresponded to dermatophytes and 336 (42%) to yeasts of the genus Candida, 190 (23.7%) to other yeasts, 27 (3.4%) to non-dermatophytic filamentous fungi and one (0.1%) the agent of subcutaneous mycosis. Lesions considered primary occurred in greater numbers (59.5%) than recurrent lesions (37.4%), with a greater concentration of positivity occurring on the arms and legs.

CONCLUSIONS

Comorbidities, allergies and diabetes mellitus were conditions associated with greater positivity in direct mycological exams and cultures. Positive culture was considered a definitive diagnosis of fungal infection and confirmed 47.8% of diagnostic hypotheses.

Pediatric tinea faciei in southern Spain: a 30-year survey

Tinea faciei (TF) is a common clinical form of tinea in children that is frequently misdiagnosed and treated with corticosteroids. No large case series of TF focusing on children have been published. The aim of this study was to analyze the main epidemiologic, clinical, and microbiologic features of TF in children over a period of 30 years and compare these features with those of other tineas. We undertook a retrospective study of 818 cases of tinea in children at a referral hospital in southern Spain, diagnosed between 1977 and 2006, concentrating for this study on TF. Of the 73 cases of TF diagnosed, 50.7% were in girls. Most children (46.6%) were 4 to 9 years old. At the time of diagnosis, 29.2% of the cases had been treated with topical steroids. The most frequently isolated dermatophyte was Trichophyton mentagrophytes, which was isolated significantly more frequently in TF than in the other tineas. Cases of TF in children were not extremely unusual, emphasizing that TF must be considered in children with inflammatory facial eruptions. This consideration and the more-frequent use of mycologic tests can help achieve the correct diagnosis, when present.

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.

Characteristics of superficial fungal infections in the Riyadh region of Saudi Arabia

BACKGROUND

The prevalence and characteristics of superficial fungal infections (SFIs) vary with climatic conditions, lifestyle, and population migration patterns. This study was undertaken to determine the characteristics of SFIs amongst patients visiting the dermatology clinic of Riyadh Military Hospital, Riyadh, Saudi Arabia, during the period 2003-2005.

METHODS

One hundred and nineteen patients with confirmed SFI (37 males and 82 females), aged between 5 months and 67 years, were included in this study. The diagnosis of SFI was based on clinical presentation confirmed by laboratory analysis. The type of mycotic pathogen and the site of infection were recorded as a function of age and sex.

RESULTS

Onychomycosis (40.3%) was the most frequent infection, followed by tinea capitis (21.9%), tinea pedis (16%), tinea cruris (15.1%), and tinea corporis (6.7%). Tinea capitis was most prevalent (15.1%) in children (male to female ratio, 1 : 1.57), whereas tinea pedis was most common (11.8%) in adults (male to female ratio, 1 : 2.5). Trichophyton mentagrophytes and Microsporum canis were the most common dermatophytes responsible for tinea infections, and T. mentagrophytes, Candida spp., and Aspergillus spp. were mainly responsible for onychomycosis.

CONCLUSION

The prevalence of SFI was twofold greater in females than males. Children were most commonly affected by tinea capitis, whereas adults generally suffered from tinea pedis. The frequency of onychomycosis was nearly three times higher in adults. This study clearly shows that SFIs are of concern in both genders and in all age groups.

Dermatophytoses in cats and humans in central Italy: epidemiological aspects

Two hundred hair/skin samples were collected from 2002 to 2004 from two groups of cats (privately owned and stray cats from a shelter) and 165 samples were obtained during the same period from persons in whom dermatophyte infection was highly suspected. The epidemiological data were statistically evaluated. Thirteen of the 100 privately owned cats (13%) and 100% of the stray cats were positive; of the 165 human samples examined 109 (66%) were positive for dermatophytes. Microsporum canis was the most common dermatophyte isolated in both cat groups while Trichophyton mentagrophytes was the most common in humans. Interestingly, a geophylic dermatophyte species (Microsporum gypseum) was found to be present and associated with clinical signs. Living in the countryside proved to be a risk factor for dermatophytoses in privately owned cats while in humans the main risk factor for M. canis was contact with animals followed by young age. None of the variables considered was associated with positivity for T. mentagrophytes while positivity for other fungi was correlated with life in the countryside.

Epidemiology of dermatophytic infections in Rome, Italy: a retrospective study from 2002 to 2004

In the present study, we determined the incidence of dermatophyte species causing superficial mycoses among outpatients referred to the Department of Dermatology of the "La Sapienza" University of Rome between 2002 and 2004. Of the 3160 subjects studied, 1275 (40.3%) were positive for fungal infection, but only 252 (19.7%) of these had infections caused by dermatophytes. The dermatophyte most frequently isolated was Microsporum canis. Our epidemiological data were compared with those obtained previously by other authors in the same geographic area. For the first time we described an inversion of the T. rubrum/T. mentagrophytes ratio, the latter being more frequently encountered. We also observed the emergence of M. audouinii.

A twenty-year survey of dermatophytoses in Braga, Portugal

BACKGROUND

Modifications in social habits together with the increase of emigration have contributed not only to increased dermatophytoses but also to an altered etiology. During the last few years, Braga has suffered a radical change from a rural to a cosmopolitan life-style.

METHODS

A statistical study of dermatophytoses and the etiology of their causative agents was performed by a retrospective survey carried out among patients of Hospital de São Marcos, Braga, Portugal, from 1983-2002. In this study, a total of 10,003 patients were analyzed.

RESULTS

Over this period the frequency of dermatophytoses, as defined by the recovery of a dermatophyte in culture, was found to be 23.6%, whereas nondermatophytic infections accounted for 7.0%. Analysis of the clinical forms and the isolated fungi supports that the dermatophyte species have a predilection for certain body areas (P <or= 0.01). Age is a very important factor regarding the occurrence of dermatophytoses (P <or= 0.0001), with a correlation between increasing age and infection, positive for Trichophyton rubrum and negative for Microsporum canis. Overall the gender of the patients is not an association factor for the development of dermatophytoses; however, significant differences were detected in the distribution of some etiologic agents (P <or= 0.05).

CONCLUSIONS

The results showed the main etiologic agent of dermatophytoses to be Trichophyton rubrum (37.4%). Moreover, dermatophytoses are both decreasing and showing a new profile in Braga, and a pronounced decrease of Trichophyton megninii was observed throughout the study.

Aetiological agents of tinea capitis in Tehran (Iran)

A total of 1568 patients with suspected tinea capitis were examined for causative fungal agents between 1994 and 2001. Laboratory examination confirmed tinea capitis in 209 patients. Males were affected more frequently (67.5%) than females (32.5%) and in both sexes, those who were 3-11 years old, were more infected. Trichophyton violaceum was the most common aetiological agent (37.3%) followed by Trichophyton schoenleinii (21.5%), Microsporum canis (18.6%), Trichophyton verrocosum (14.8%), Trichophyton tonsurans (5.3%), Trichophyton rubrum (1%), Microsporum gypseum (1%) and Trichophyton mentagrophytes (0.5%). A higher incidence of the disease was found to be correlated with larger family and class size. The findings are discussed in relation to different socioeconomic and hygienic backgrounds of the children.

Dermatophyte infections in the Ljubljana region, Slovenia, 1995-2002

We studied dermatophyte infections in patients, examined in the Mycological Laboratory of the Department of Dermatology, University Medical Centre Ljubljana during the period 1995-2002. A total of 42,494 samples were collected from 33,974 patients suspected to have dermatomycosis. Dermatophytes were identified in 8286 (71.2%) positive cultures. Microsporum canis was the most frequent dermatophyte isolated (46.8%), followed by Trichophyton rubrum (36.7%), T. mentagrophytes var. interdigitale (7.9%) and T. mentagrophytes var. mentagrophytes (4.9%). Less frequently isolated were M. gypseum, T. verrucosum, Epidermophyton floccosum, T. tonsurans and T. violaceum. The most common dermatophyte infections included tinea corporis, onychomycosis, tinea pedis and tinea faciei. Zoophilic dermatophytes were most commonly recovered from children and adolescents with tinea capitis, tinea corporis and tinea faciei. Anthropophilic species were identified mostly in adults with tinea pedis, onychomycosis and tinea inguinalis. During the period studied, we recorded a decline in the rate of M. canis infections, while infections produced by T. rubrum increased in frequency.

Epidemiology of dermatomycoses in children living in Northern Greece 1996-2000

In the 5-years period, 1996-2000, 1045 children under 13 years old were examined for suspected dermatomycosis. In 611 cases fungi were isolated. Male children were mainly affected on the scalp and body area. Girls were more affected in the location of the arms and legs. There was a greater proportion of cases in the age range 2-12 years. The most prominent fungus was Microsporum canis (515 cases) followed by Trichophyton rubrum (34) and Candida albicans (20). Tinea capitis (280 cases) mainly caused by M. canis (276 cases) was the most common clinical form. Tinea corporis (109 cases) mainly caused by M. canis (88 cases), C. albicans (10 cases) and T. rubrum (seven cases) was the second most frequent clinical form.

Characteristics of dermatophytoses among children in an area south of Tehran, Iran

The aim of this study was to determine the prevalence and etiological agents of dermatophytoses, and also their distribution according to age, gender, and body site among children in an area south of Tehran. A total of 382 children aged </=16 years suspected to have dermatophytic lesions were examined over a period of 3 years (1999-2001). The incidence rate of dermatophytoses was 6.6 per 100 000 person-years. Trichophyton violaceum was the most frequent isolate (28.3%) followed by Microsporum canis (15.1%), Epidermophyton floccosum (15.1%), T. rubrum (13.2%), T. mentagrophytes (11.3%), M. gypseum (7.5%), and T. verrucosum (5.7%). Tinea capitis (39.6%) was the most common type of infection, followed by tinea corporis (30.2%), tinea faciei (18.9%), and tinea manuum (7.5%).

Bizarre annular lesion emerging as tinea incognito. Bizarre anulare Erytheme als Ausdruck einer Tinea incognito

Tinea incognito has first been described in 1968. The term describes a tinea infection whose clinical morphology has been modified by the application of topical corticosteroids. The clinical manifestation can masquerade a number of other dermatoses and leads to misdiagnosis of annular eruptions. We describe a patient who showed a bizarre appearance of annular, inflammatory skin lesions at the umbilical region. Mycological culture yielded Microsporum canis.

Dermatophytoses in Split and Dalmatia, Croatia, 1996-2002. Dermatophytosen in Split und Dalmatien, Kroatien, 1996-2002

The aim of the study was to investigate the epidemiology of dermatophyte infections in Split and Dalmatia County, Croatia, between 1996 and 2002. Of 5792 samples 1318 (23.8%) were positive. Tinea corporis and tinea cruris were the most common types of dermatophytoses. Microsporum canis (36.5%), Trichophyton mentagrophytes (24.8%), and T. rubrum (21.5%) were the main etiologic factors.

Environmental detection of Microsporum canis arthrospores in the households of infected cats and dogs

Microsporum canis is the dermatophyte most frequently recovered from canine and feline ringworm cases. The household environment can be contaminated both by symptomatic animals and through asymptomatic M canis carriage, resulting in a potential human health risk. The load of M canis arthrospores was determined in households harbouring infected pets, in order to evaluate the infectivity of the animals versus the environment. The environments inhabited by 30 symptomatic animals (21 cats and 9 dogs) infected by M canis were examined by sampling both surfaces and indoor air. The surfaces were examined by means of contact plates; the air sampling was performed with a Sas super-100 AIR SAMPLER (PBI, Italy). Environmental contamination was detected in all households with cats, while only four out of nine houses harbouring dogs were found positive. The frequence of isolation in each sampling, and the results in terms of colony forming units per plate in the different houses appeared to be quite homogeneous. Heavily infected environments harboured kittens only. Infected owners were observed in eight households, in all of which at least one infected cat was present. No history of human dermatophytosis in households harbouring dogs was found. On the basis of our results, infected cats appear to cause substantial environmental contamination, and provoke a substantial presence of viable airborne fungal elements. Dogs seem to be of lower importance in the spread of M CANIS: they contaminated surfaces, but they never contaminated the air. The results of this study confirm the potential leading role of the feline species in the environmental spread of M canis.

Ecology of dermatophytes and other keratinophilic fungi in swimming pools and polluted and unpolluted streams

The biodiversity and richness of keratinophilic fungal communities including dermatophytes were assessed in three stream sites and three swimming pools in the Nablus district in Palestine, using hair baiting (HBT) and surface dilution plate (SDP) techniques, over 8- and 6-month periods, respectively. The effect of wastewater effluent and selected ecological factors on these fungi in relation to species diversity and population densities were also considered. Fifty keratinophilic fungal species were recovered from the aquatic habitats studied, of which 42 were recovered from stream sites and 22 from swimming pools. Of these fungi 6 were either dermatophytes (Microsporum gypseum, and Trichophyton mentagrophytes) or dermatophyte related species (Chrysosporium merdarium, Ch. tropicum, Ch. keratinophilum and T. terrestre). The most frequently isolated species in the three pools were Acremonium strictum and Cladosporium cladosporioides, using Sabouraud dextrose agar medium (SDA). The most abundant species were Acr. strictum, and Aspergillus flavus. However, only 4 species were isolated using the SDA medium amended with 5-flurocytosine (5-FC). The most frequent and abundant species in the three stream sites using SDA medium were Geotricum candidum, and Penicillium chrysogenum. The most frequent species in the three sites using the 5-FC medium, was Paecilomyces lilacinus. Using HBT, the most abundant and frequent species in the three stream sites were G. candidum, and Pa. lilacinus, on SDA medium, and Pa. lilacinus, and Gliocladium nigrovirens on the 5-FC medium. The 5-FC medium was more suitable for the isolation of dermatophytes and closely related species than the SDA medium; 6 were recovered on 5-FC, whereas only one on the SDA medium. Variation in the levels of keratinophilic fungal populations from the three stream sites sampled 5 times over an 8-month period, followed comparable fluctuation patterns. Wastewater affected fungal population densities with the highest levels in the un-polluted stream sites, and lowest in the heavily polluted sites. Swimming pools, polluted and un-polluted stream sites were found to be rich in pathogenic and potentially pathogenic fungi.

Characteristics of superficial mycoses in Malta

BACKGROUND

A study was conducted to determine the chief agents of superficial mycoses in Malta. Data were collected over a 5-year period from mycologic investigations carried out on all dermatologic specimens sent to the Mycology Laboratory at St. Luke's Hospital in Malta.

METHODS

In the period between January 1995 and December 1999, a total of 1271 specimens from skin, nails, or hair were collected from 1200 clinically suspected cases of dermatomycoses.

RESULTS

The fungi cultivated included dermatophytes (n = 371), yeasts (n = 33), and nondermatophyte filamentous fungi (n = 12). Trichophyton rubrum (n = 121) was the most prevalent, followed by Microsporum canis (n = 109), T. mentagrophytes (n = 80), M. gypseum (n = 27), Epidermophyton floccosum (n = 17), T. soudanense (n = 10), T. tonsurans (n = 2), T. verrucosum (n = 2), M. persicolor (n = 1), and T. violaceum (n = 1). Candida species were also cultivated, with C. parapsilosis (n = 14) being the most common, followed by C. albicans (n = 12) and C. tropicalis (n = 6). Nondermatophyte filamentous fungi were isolated from nail specimens only.

CONCLUSIONS

In this study, superficial fungal infections were reported more commonly in female (n = 207) than in male (n = 182) patients. M. canis was the chief agent of tinea capitis and tinea corporis, whilst T. rubrum was the main causative agent of tinea pedis, tinea manuum, and tinea unguium. Onychomycosis due to Candida species was more common in female than in male patients.

Prevalence of tinea capitis as well as of asymptomatic carriers in school children in Nablus area (Palestine)

A study of tinea capitis was carried out during October 1998, involving 8531 school children aged 6-14 years (4718 males and 3813 females), attending 12 primary schools located in urban, rural, and refugee camp communities in the Nablus district in the Palestinian Authority. A total of approximately 1389 of the school children aged 6-12 years (724 males and 665 females) were also surveyed on three occasions at 2-3 month intervals, over a 9-month period (October 1998-May 1999) using the hair brush technique, for prevalence of asymptomatic tinea capitis carriage. Twenty-three(0.27%) mycologically proven cases of tinea capitis were detected.

Tinea capitis: focus on African American women

Tinea capitis is a common cutaneous fungal infection in US school children, but adults may be carriers of tinea pathogens in the scalp. However, few cases of actual tinea capitis in adults have been reported in the literature. A retrospective analysis of all adult patients with positive scalp fungal cultures from June 1997 to March 2000 were reviewed. Seventy-nine cases of tinea capitis were identified. Nine (11.4%) were adults, 7 of whom were African American women, who were an average of 46 years old (range, 25 to 64 years). Three of these patients had prior exposure to a child with tinea capitis. These results suggest that tinea capitis affects adult African Americans, particularly women. Widespread scalp culture is indicated for papulosquamous disease and alopecia in this segment of the population.

Morphological evidence for keratinolytic activity of Scopulariopsis spp. isolates from nail lesions and the air

The morphological expression of human hair and nail invasion in vitro by 31 isolates of nine Scopulariopsis species was studied by light microscopy on whole material and on semi-thin sections, as well as by transmission electron microscopy. Only some isolates of Scopulariopsis brumptii, S. candida, S. carbonaria and S. koningii were keratinolytically active. They came either from nail lesions or from outdoor aerosols. The most active isolate belonged to S. koningii and was recovered from a fingernail lesion. Both hair and nail degradation followed the biochemical and morphogenetic model described by the authors for other keratinolytic fungi.

Incidence of Candida species isolated from human skin and nails: a survey

Distribution of Candida species was investigated by examining 245 samples from skin lesions and nails. The isolates were identified using standard laboratory methods including germ tube test, micromorphology of colonies on rice agar, the commercial kit, saccharide assimilation and fermentation tests. Eight species of Candida were identified: C. albicans accounted for 56.4% of the isolates, C. parapsilosis 29.1, C. tropicalis 7.8, C. pulcherrima 2.9, C. guilliermondii 1.5, C. krusei and C. zeylanoides for 0.9% each, and C. robusta for 0.5%. The factors significantly associated with colonization were prolonged antibiotic therapy, parenteral nutrition, low birth body mass of infants, intubation, duration of stay in hospital, indwelling intravenous catheter, malignancies, diabetes, surgery, and obesity.

Tinea capitis

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

Incidence and distribution of Candida species isolated from human skin in Jordan

In the period between December 1992 and September 1993 a total of 1060 clinically suspected cases of dermatomycoses were examined for causative fungi. Of these 330 (31%) were suspected as cutaneous candidosis. A higher incidence was observed in adults (62.9%) than in children (36.2%) and infants (19.5%). The infected patients that were adults were divided into four categories: diabetics; those receiving steroid; those receiving antibiotic therapy; and a non-risk control group. Analysis of the data revealed that the incidence rate appears to be approximately doubled in diabetes (49.3%), steroid therapy (33.8%) and antibiotic therapy (27.4%) than in the control group (15.7%). Candida albicans was the most frequent isolate (57.6%) followed by Candida tropicalis (16.5%).

Ecology of cycloheximide-resistant fungi in field soils receiving raw city wastewater or normal irrigation water

The effect of raw city wastewater irrigation on biodiversity and population densities of a cycloheximide-resistant (CH) fungal community was studied in 13 field soils receiving either raw city wastewater or normal irrigation, and in raw city wastewater in the Nablus area, using the hair baiting technique (HBT) and a surface soil dilution plating (SSDP) technique. Three of these fields [one had been receiving raw city wastewater for more than ten years and was designated a heavily polluted field, and the other 2 were cultivated for the first time and were either irrigated with raw city wastewater (newly polluted field) or normal irrigation water (nonpolluted)], were sampled 4-7 times over a 9-month period. The other ten fields, which had been under raw city wastewater irrigation for more than 10 years, were sampled only once. Fifty-seven CH-resistant species belonging to 18 genera were recovered, of which 49 species were recovered from soil habitats and 28 species from raw city wastewater. The HBT had shown to be more efficient in the isolation of pathogenic and potentially pathogenic fungi including dermatophytes. A higher percentage of this group of fungi was recovered from the three main field soils studied using HBT (70% of all isolates), than the SSDP (35.5%); no dermatophytes were recovered by the SSDP method. Two dermatophytes (Microsporum gypseum, and Trichophyton ajelloi), and five more fungi (Arthroderma cuniculi, A. curreyi, Chrysosporium keratinophilum, C. tropicum, C. pannorum), were recovered from these habitats. Wastewater irrigation seemed to have affected the fungal population densities, with the highest population densities being found in the heavily polluted field soil, while lower population densities were found in the nonpolluted field soil. Increases in organic matter were also observed as a result of sewage effluent irrigation. However, basic similarities in the biodiversity of CH-resistant fungal communities existed in nonpolluted and polluted field soils, and raw city wastewater. Comparable numbers of fungal species were recovered from the three main field soils. The species most commonly found in those habitats included: Alternaria alternata, Aspergillus candidus, Geotrichum candidum, and Paecilomyces lilacinus. Field soils receiving either raw city wastewater or normal irrigation water, were found to be rich in pathogenic and potentially pathogenic CH-resistant fungi, including dermatophytes, with raw city wastewater yielding the highest percentage (81%), followed by the newly wastewater irrigated field (77.7%), the nonpolluted field (67%), and the heavily polluted field (63.4%) Hygienic measures should therefore be taken to control the spread of these fungi in the environment of human communities, and to avoid mycotic infections among farmers.

A review of the epidemiology of tinea unguium in the community

Tinea unguium is a common, chronic fungal infection of the nails. Many epidemiological studies have looked at the frequency with which this condition is seen in hospital outpatients clinics or mycological laboratories along with other dermatomycoses. Only recently have studies begun to emerge looking at the prevalence of this condition in populations. Hospital and mycological laboratory-based studies give valuable information about tinea unguium prevalence in a particular clinic, but cannot be compared with other studies due to confounding factors inherent in the different people attending individual clinics. From population-based studies the prevalence of tinea unguium lies between 2 and 8%. Tinea unguium increases steadily with age. It is infrequent but definitely found in children. With the increasing life expectancy in the Western world the prevalence of tinea unguium is likely to increase further without adequate prevention and treatment.

Epidemiological study of tinea capitis in schoolchildren in the Nablus area (West Bank)

A study of tinea capitis was carried out during the period January-June 1996 in 7525 primary schoolchildren aged 6-14 years comprising 4050 boys and 3475 girls in the Nablus district in the Palestinian area. Fourteen primary schools located in rural, urban and refugee camp areas were surveyed in this study. Seventy-five (1.0%) mycologically proven cases of tinea capitis were detected. The incidence was higher in schools in rural areas (1.9%) than in refugee camps (1.1%) or urban areas (0.4%). Also, the incidence was higher in young children (1.4%) aged 6-10 years than in older children (0.5%) aged 10-14 years. Boys 52 (1.3%) were more commonly affected than girls 23 (0.7%). Higher disease incidence was found to be correlated with larger family and class sizes. Trichophyton violaceum was the most common aetiological agent (82.7%) followed by Microsporum canis (16%) and Trichophyton schoenleinii (1.3%). The findings are discussed in relation to the children's different socioeconomic and hygienic backgrounds. A mycological investigation carried out on 117 tinea capitis cases at a clinic in the area under study showed similar results to those of the school survey.

Dermatophytoses in Crete, Greece, between 1992 and 1996

Pathological specimens from 1361 patients with clinical manifestations of dermatophytosis from the island of Crete, Greece, were examined for dermatophytes during a 5-year period (1992-96). Dermatophytes of the genus Trichophyton, Microsporum and Epidermophyton were isolated from 327 (24%) of the patients. Trichophyton rubrum was the most frequently isolated dermatophyte accounting for 44.4% of the strains, followed by M. canis (25%), T. mentagrophytes var. interdigitale (14.4%) and E. floccosum (7.6%). Less frequent isolates included T. mentagrophytes (3.4%), T. violaceum (3.1%), T. verrucosum (1.8%) and M. gypseum (0.3%). An analysis of the distribution and frequency of the dermatophytes according to the cutaneous area affected and the sex of the patients is also reported.

Itraconazole susceptibility of feline isolates of Microsporum canis

The in vitro activity of itraconazole against Microsporum canis was evaluated with 38 feline isolates. Based on the observed minimum inhibitory concentrations it can be concluded that the drug could be effective in the therapy of cats affected by M. canis ringworm.