Epidemiological and aetiological study on tinea pedis and onychomycosis in Algeria

Onychomycosis in Patients with Diabetes Mellitus in Africa: A Global Scoping Review, 2000-2021

Onychomycosis is commonly studied in Africa but not in patients with diabetics despite having a significant number of her population living with diabetes mellitus (DM). Our review highlights a total of 15 studies with only two from Africa over the past two decades; 8 (53.3%) from Asia, 4 (26.7%) from Europe, 2 (13.3%) from Africa and 1 (6.7%) from North America. A total number of 4321 participants were involved with onychomycosis prevalence of 35.3% (1527/4321). Seven studies documented preponderance of onychomycosis in males, one showed preponderance in females, one showed no statistically significant difference in gender, while correlation with gender was unclear in the remainder. The risk factors identified were duration of diabetes, increasing age, occupation (agriculture), subclinical atherosclerosis, metabolic syndrome, obesity, triglyceride levels, and glycosylated haemoglobin. Three case control studies showed a statistically significant correlation between onychomycosis and individuals with DM. Diagnosis was mainly by microscopy and culture with Trichophyton (T) rubrum as the predominant isolate. Fungal nail infections are grossly underdiagnosed and/or underreported in Africa and hence the need for improved awareness and diagnosis especially in patients with DM. Although focused on Africa, this study also revealed paucity of data on onychomycosis in diabetic patients living in the Americas despite evidence from the literature showing a significant number of individuals from that region are living with diabetes. The need to evaluate this at-risk population for onychomycosis cannot be over emphasized.

Trends in the epidemiology of dermatophytosis in the Middle East and North Africa region

Dermatophytosis corresponds to a broad series of infections, mostly superficial, caused by a group of keratinophilic and keratinolytic filamentous fungi called dermatophytes. These mycoses are currently considered to be a major public health concern worldwide, particularly in developing countries such as those in the Middle East and North Africa (MENA) region. Here we compiled and discussed existing epidemiologic data on these infections in the MENA region. Most of the available studies were based on conventional diagnostic strategies and were published before the last taxonomic revision of dermatophytes. This has led to misidentifications, which might have resulted in the underestimation of the real burden of these infections in the MENA countries. Our analysis of the available literature highlights an urgent need for further studies based on reliable diagnostic tools and standard susceptibility testing methods for dermatophytosis, which represents a major challenge for these countries. This is crucial for guiding appropriate interventions and activating antifungal stewardship programs in the future.

Onychomycosis and Tinea Pedis in the Feet of Patients With Diabetes

This study aimed to determine the prevalence of onychomycosis and interdigital tinea pedis in a cohort of Spanish patients with diabetes in whom onychomycosis was clinically suspected (n = 101). Samples from a first toenail scraping and the fourth toe clefts were subjected to potassium hydroxide direct vision and incubated in Sabouraud and dermatophyte test medium. Fifty-eight samples were also analyzed by a pathologist using periodic acid-Schiff staining and Calcofluor white direct fluorescence microscopy. Onychomycosis was only confirmed in 41 patients (40.6%). The most frequent aetiological agent was Trichophyton rubrum, isolated in 10 patients (36%), followed by Candida parapsilosis in 7 patients (25%). Tests on the fourth toe cleft samples were only positive in 11 patients (10.9%), and in all cases, onychomycosis was also diagnosed. Neuroischemic foot was the only significant variable associated with onychomycosis in the univariate analysis (P < .01). A positive result for mycosis in the fourth toe cleft was found in 11 cases (10.9%) and was associated with a history of myocardial infarction (P< .01; odds ratio [OR]: 84.2, confidence interval [CI]: 6.8-1036.4) and neuroischemic foot (P< .01; OR: 13.7, CI: 12.6-71.6) in the multivariate model. In conclusion, the prevalence of onychomycosis and tinea pedis in patients with diabetes in whom onychomycosis was clinically suspected was 40.6% and 10.9%, respectively. In addition, onychomycosis was not always associated with tinea pedis. These results show that clinical diagnosis has low accuracy in people with diabetes mellitus, and that diagnosis should not be based on clinical toenail characteristics alone.

Epidemiological Characteristics and Risk Factors of Tinea Pedis Disease Among Adults Attending Tikrit Teaching Hospital/ Iraq

BACKGROUND

Tinea pedis is one of the most common skin infections of interdigital toe webspace as well as feet skin and may affect the nail or the hand. It is caused by dermophytes fungi especially Trichophyton species. Direct contact with a contaminated environment or animal is the main mode of transmission. Tinea pedis is more frequent among adults than children and more among those with the previous infection with the disease, diabetes mellites, abnormally increased sweating, and the disease is common among individuals who wear unventilated (occlusive) footwear. Tinea pedis is 2-4 times more common in men than females.

AIM OF THE STUDY

To study the epidemiological characteristics and risk factors of tinea pedis disease.

METHODS

Descriptive study was conducted on patients attending the dermatology outpatient clinic in Tikrit Teaching Hospital, Tikrit, Iraq. The study was done during the period from 1st November 2018-10th June 2019. The sample included 680 persons. The cases were diagnosed clinically and by a direct microscope. The demographic information of patients was obtained according to certain questionnaire design. The study was done to reveal the epidemiology of tenia pedis disease among affected patients.

RESULTS

The frequency of tinea pedis cases among the study sample was 7% (48/ 680). It has been observed that there was no significant association as a result of the difference in gender, body weight, positive family history, history, presence of fungal skin disease, and presence of nail trauma. On the contrary, a significant association was observed as a result of the presence of the young age group, diabetes mellitus, and history of wearing occlusive shoes.

CONCLUSION

The frequency of tinea pedis disease among the study sample was 7%. There was a significant association between age group and the presence of diabetes mellitus disease and wearing occlusive shoes.

Characterization of Skin Microbiome in Tinea Pedis

Tinea pedis has been associated with Trichophyton rubrum infection. However, it's not clear whether other microbes were implicated in disease pathogenesis. The composition of microbial communities of patients with tinea pedis and healthy controls were analyzed to identify the characteristics of tinea pedis and differences associated with clinical patterns. We found that microbial community structures were different in patients with tinea pedis compared with healthy controls. Moreover, skin microbiome varied in different forms of tinea pedis. Healthy controls exhibited greater fungal diversity than patients with tinea pedis. In patients with tinea pedis, the dominant bacterial and fungal genera were Staphylococcus and Trichophyton. Compared with healthy controls, Corynebacterium tuberculostearicum was decreased and T. rubrum was increased. C. tuberculostearicum was more abundant in vesicular tinea pedis than in hyperkeratotic and interdigital tinea pedis. Interdigital tinea pedis had a higher detection rate of Corynebacterium minutissimum and T. rubrum than the other forms. These results indicated that bacterial microbes may take part in the development of tinea pedis.

Antimicrobial activity of puffball(Bovistella radicata) and separation of bioactive compounds

Background

To test the antimicrobial activity of different extracts and fermentation broth from puffball(Bovistella radicata), the different extracts and fermentation broth of puffball were prepared, the active fraction was investigated by UPLC–UV–MS and semi-preparative chromatograph.

Results

Through zones of inhibition (ZOI) and minimum inhibitory concentrations (MIC) tests, the supernatant of fermentation possessed best antimicrobial activity in all extracts whose MIC value is 31.2 μg/ml against T. rubrum, T. mentagrophytes, S. aureus and P. aeruginosa. And ZOI value is 29.01, 21.02, 35.02, 28.01 mm against T. rubrum, T. mentagrophytes, S. aureus and P. aeruginosa. Then we compare the puffball fermentation supernatant with blank contrast by LC–MS. There are the characteristic peaks named PBR-1 and PBR-2 with the puffball fermentation supernatant, the separation of compound PBR-1 and PBR-2 was done on semi-preparative C18 column and the MIC and ZOI of compound PBR-1 and PBR-2 are 15.6 μg/ml and 34 mm with the antifungal test.

Conclusions

The fermentation supernatant and compound PBR-1 and PBR-2 have promising antifungal activity against T. rubrum and T. mentagrophytes.

Prevalence, Etiology, and Risk Factors of Tinea Pedis and Tinea Unguium in Tunisia

Background

Foot mycoses are a frequent disease that represents a public health problem worldwide.

Objectives

This study aims to evaluate the epidemiology of foot mycoses among Tunisian patients, in order to determine the fungal etiological agents and to identify possible risk factors.

Patients and Methods

A prospective study of three hundred and ninety-two patients was undertaken during one year (2013-2014). All subjects were asked to collect demographic data related to the risk factors of foot mycoses. A complete mycological diagnosis was carried out on all patients.

Results

A total of 485 samples were collected; tinea pedis and tinea unguium were confirmed in 88.2% of cases. Dermatophytes were isolated in 70.5% and the most frequent pathogen was Trichophyton rubrum (98.1%), followed by yeasts (17.7%) commonly Candida parapsilosis. Non-dermatophyte molds (NDMs) were observed in 8.02% cases and Fusarium sp. was the frequent genus (29.1%). The main predisposing factors of fungal foot infections were practicing ritual washing (56.6%) and frequentation of communal showers (50.5%).

Conclusion

This is a recent survey of foot mycoses in Tunisia. Epidemiological studies can be useful to eradicate these infections and to provide further measures of hygiene and education.

[The burden of fungal infections in Algeria]

In Algeria, superficial mycoses are very commonly diagnosed. Deep fungal infections are less often observed. Few data from Algeria are found in the literature. We report for the first time the main causes of these diseases in our country and provide burden estimates. We searched for existing data and estimated the incidence and prevalence of fungal diseases based on the population at risk and available epidemiological data. Demographic data were derived from the Service (Office) of the Statistics (ONES), World Health Organization (WHO), The Joint Nations Programme on HIV/AIDS (UNAIDS) and national published reports. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology. Algeria has 40.4 million inhabitants and probably at least 568,900 (1.41 %) of Algerians have a serious fungal infection each year. Recurrent vulvovaginal candidiasis (485,000) and fungal asthma (72,000) are probably the commonest problems as there are over 1 million adult asthmatics. Candidaemia is estimated in 2020, invasive aspergillosis in 2865, intra-abdominal candidiasis in 303 people and are the most common life-threatening problems. AIDS is uncommon, but cancer is not (45,000 new cases of cancer among including 1500 in children) and nor is COPD (an estimated 317,762 patients of whom 20.3 % are admitted to hospital each year). A focus on improving the diagnosis and epidemiological data related to fungal infection is necessary in Algeria.

Burden of fungal infections in Algeria

We report for the first time in Algeria and provide burden estimates. We searched for existing data and estimated the incidence and prevalence of fungal diseases based on the population at risk and available epidemiological data. Demographic data were derived from the National Office of Statistics (Office National des Statistiques: ONS), World Health Organization (WHO), The Joint Nations Programme on HIV/AIDS (UNAIDS) and national published reports. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology. Algeria has 40.4 million inhabitants, and probably at least 568,900 (1.41%) of Algerians have a serious fungal infection each year. Recurrent vulvovaginal candidiasis (485,000) and fungal asthma (72,000) are probably the commonest problems, as there are over 1 million adult asthmatics. Candidaemia is estimated in 2,020 people, invasive aspergillosis in 2,865 people, and intra-abdominal candidiasis in 303 people; these are the most common life-threatening problems. AIDS is uncommon, but cancer is not (45,000 new cases of cancer including 1,500 in children), nor is COPD (an estimated 317,762 patients, of whom 20.3% are admitted to hospital each year). A focus on improving the diagnosis and epidemiological data related to fungal infection is necessary in Algeria.

Tavaborole - a treatment for onychomycosis of the toenails

INTRODUCTION

Onychomycosis is a fungal nail infection that accounts for half of all nail diseases. Oral drugs on the market have adverse effects, while it is difficult for traditional topical drugs to penetrate the nail plate to reach the diseased nail bed. Tavaborole is a new drug that addresses the unmet needs of currently available treatments. Tavaborole (5%) is FDA approved for treating toenail onychomycosis and has shown antifungal activities against yeast, moulds and dermatophytes.

AREAS COVERED

The objective of this article is to review the efficacy, pharmacokinetics, pharmacodynamics, and safety of tavaborole for treatment of toenail onychomycosis. Expert commentary: Tavaborole, with its unique mechanism, may be a good candidate for use in treating children with fungal infections, diabetic individuals, and treating mixed infections. Tavaborole may be paired with other therapies to potentially increase cure rates.

Fungal interdigital tinea pedis in Dakar (Senegal)

Fungal interdigital tinea pedis (FITP) is the most frequent dermatomycosis in industrial countries. In African tropics, it's a rare motive of consultation and is discovered while complicated. The aims of this article were: to determine the frequency of interdigital tinea pedis among overall mycological analysis in our laboratory; to study epidemiological, clinical and mycological aspects of FITP in outpatients attending the Le Dantec mycology laboratory in Dakar. A total of 62 males (60%) and 42 females (40%), mean age: 43.15 years (range: 11-81 years), were received from January 2011 to December 2015 for suspicion of FITP. Skin specimens were taken from all patients for microscopy and fungal culture. The frequency of ITP represents 5.6% (104/1851) among our overall mycological analysis. FITP was confirmed in 68 patients (SPI=65.38%), mainly located between the 4th and 5th toes and 71 fungal species were isolated (CPI=68.27%). Among patients with confirmed FITP, there were 38 males (56%) and 30 females (44%). The prevalence was highest in patients between 44 and 54 years (26%). Candida albicans, Fusarium solani and Trichophyton interdigitale were shown to be the most common pathogens respectively for yeasts (39%), non-dermatophytic filamentous fungi (NDFF; 21%) and dermatophytes (11%). So FITP isn't a common reason for consultation in Dakar but its simple parasitic index (SPI) is still very high and dermatophytes formerly the main causative agents are being relegated to third place behind yeasts and NDFF.

Is it possible to sanitize athletes' shoes?

CONTEXT

Footwear should be designed to avoid trauma and injury to the skin of the feet that can favor bacterial and fungal infections. Procedures and substances for sanitizing the interior of shoes are uncommon but are important aspects of primary prevention against foot infections and unpleasant odor.

OBJECTIVE

To evaluate the efficacy of a sanitizing technique for reducing bacterial and fungal contamination of footwear.

DESIGN

Crossover study.

SETTING

Mens Sana basketball team.

PATIENTS OR OTHER PARTICIPANTS

Twenty-seven male athletes and 4 coaches (62 shoes).

INTERVENTION(S)

The experimental protocol required a first sample (swab), 1/shoe, at time 0 from inside the shoes of all athletes before the sanitizing technique began and a second sample at time 1, after about 4 weeks, April 2012 to May 2012, of daily use of the sanitizing technique.

MAIN OUTCOME MEASURE(S)

The differences before and after use of the sanitizing technique for total bacterial count at 36 °C and 22 °C for Staphylococcus spp, yeasts, molds, Enterococcus spp, Pseudomonas spp, Escherichia coli , and total coliform bacteria were evaluated.

RESULTS

Before use of the sanitizing technique, the total bacterial counts at 36 °C and 22 °C and for Staphylococcus spp were greater by a factor of 5.8 (95% confidence interval [CI] = 3.42, 9.84), 5.84 (95% CI = 3.45, 9.78), and 4.78 (95% CI = 2.84, 8.03), respectively. All the other comparisons showed a reduction in microbial loads, whereas E coli and coliforms were no longer detected. No statistically significant decrease in yeasts (P = .0841) or molds (P = .6913) was recorded probably because of low contamination.

CONCLUSIONS

The sanitizing technique significantly reduced the bacterial presence in athletes' shoes.

Rapid detection of dermatophytes and Candida albicans in onychomycosis specimens by an oligonucleotide array

Background

Onychomycosis is a fungal infection of nails, leading to the gradual destruction of the nail plate. Treatment of onychomycosis may need long-time oral antifungal therapy that can have potential side effects, thus accurate diagnosis of the disease before treatment is important. Culture for diagnosis of onychomycosis is time-consuming and has high false-negative rates. To expedite the diagnosis, an oligonucleotide array, based on hybridization between immobilized oligonucleotide probes and PCR products, for direct detection of dermatophytes and Candida albicans in clinical specimens was evaluated.

Methods

Species-specific oligonucleotide probes designed from the internal transcribed spacer (ITS) regions of the rRNA gene were immobilized on a nylon membrane. The assay procedures consisted of PCR amplification of the ITS using universal primers, followed by hybridization of the digoxigenin-labeled amplicons to probes on the array. Thirty two nail samples (29 patients) were analyzed by the array, and the results were compared with those obtained by culture. Array-positive but culture-negative samples were confirmed by cloning and re-sequencing of the amplified ITS and by reviewing patient’s clinical data. The total recovery of culture and confirmed array-positive but culture-negative results was considered 100% and was used for performance evaluation of both methods.

Results

Concordant results were obtained in 21 samples (10 positives and 11 negatives) by both methods. Eleven samples were array-positive but culture-negative; among them, 9 samples were considered true positives after discrepant analysis. Comparing with culture, the array had significantly higher sensitivity [100% (95% CI 82.2% −100%) vs 52.6% (28.9% −75.5%), p <0.001] and negative predictive value [100% (71.3% −100%) vs 59.1% (36.4% −79.3%), p <0.05), while no significant differences were observed in specificity (84.6% vs 100%, p =0.48) and positive predictive value (90.5% vs 100%, p =1.0). The whole procedures of the array were about 24 h, whilst results from culture take 1 to 3 weeks.

Conclusions

The array offers an accurate and rapid alternative to culture. Rapid diagnosis can expedite appropriate antifungal treatment of onychomycosis. However, the single site nature of this study conducted at a referral hospital invites caution.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-014-0581-5) contains supplementary material, which is available to authorized users.

The prevalence of onychomycosis in the global population: a literature study

BACKGROUND

Onychomycosis is a common disorder, and high prevalence figures are commonly cited in the literature.

OBJECTIVES

Evaluate the prevalence of onychomycosis based on published studies.

METHODS

Relevant studies were identified in Medline by using specific search criteria.

RESULTS

Eleven population-based and 21 hospital-based studies were identified. The mean prevalence in Europe and North America was 4.3% [95% Confidence Interval (CI): 1.9-6.8] in the population-based studies, but it was 8.9% (95% CI: 4.3-13.6) for the hospital-based studies. Both population-based and hospital-based studies showed that onychomycosis is more common in toenails and is seen more frequently in males. The main causative agent was a dermatophyte in 65.0% (95% CI: 51.9-78.1) of the cases. Trichophyton rubrum was the single most common fungus and was cultured on average in 44.9% of the cases (95% CI: 33.8-56.0). Moulds were found on average in 13.3% (95% CI: 4.6-22.1) and yeasts in 21.1% (95% CI: 11.0-31.3).

LIMITATIONS

We may not have been able to locate all studies.

CONCLUSIONS

Onychomycosis is a common disorder, but it may not be as common as cited in the literature, because hospital-based studies might overestimate the prevalence of onychomycosis. It is more frequent in males, and toenails are more commonly affected. Dermatophytes, particularly T. rubrum, are the main causative agents.

Onychomycosis in Cameroon: a clinical and epidemiological study among dermatological patients

BACKGROUND

There are currently no studies on epidemiology and clinical aspects of nail fungal infections in the general population of Cameroon.

PATIENTS AND METHODS

Two series of patients observed at a hospital dermatological service of Yaoundé and in a volunteer service of Douala were evaluated. All the patients, regardless of the reason for the consultation, were examined by an expert dermatologist to discover signs of onychomycosis. Patients with suspected nail lesions underwent mycological examination according to the standard techniques.

RESULTS

Among 590 subjects (317 males and 273 females), aged 16-83 years, onychomycosis was mycologically confirmed in 52 cases (8.8%). The infection was most common in the fifth decade. Fingernails were affected in 12 cases, toenails in 30 cases, and both fingernails and toenails in 10 cases. Dermatophytes were isolated in 57.7% of cases, the most common species being Trichophyton rubrum (16 cases) and Trichophyton violaceum (eight cases). Non-dermatophytic mould, including Aspergillus spp., Fusarium spp., and Neoscytalidium dimidiatum, was found in 10 cases. Onychomycosis was more common in patients from low social-economic classes.

CONCLUSIONS

This is the first investigation dealing with onychomycosis in Cameroon. These data may be useful for future research and in the development of preventive and educational strategies.

Complementary role of a polymerase chain reaction test in the diagnosis of onychomycosis

BACKGROUND

The successful treatment of onychomycosis depends on accurate diagnosis. Conventional diagnostic methods, including direct microscopy and fungal culture, are non-specific, insensitive and time-consuming. Recently, PCR has shown promise in improving the diagnosis of onychomycosis. We aimed to evaluate a commercially available PCR kit for the in vitro detection of dermatophytes and specifically Trichophyton rubrum in nail specimens with suspected onychomycosis, and to compare the detection rates of PCR with conventional diagnostic methods.

METHODS

Nail specimens were prospectively collected from patients with clinically suspected onychomycosis. All nail specimens were positive on direct microscopic examination. PCR and fungal cultures were administered, and the detection rates of dermatophytes were compared.

RESULTS

 In all, 107 nail specimens were analysed. The fungal culture was positive in 57 (53%) specimens (38 dermatophytes and 19 non-dermatophytes). PCR was positive in 77 (72%) specimens (63 T. rubrum and 14 pan-dermatophyte). A total of 37 specimens (35%) were positive for both fungal culture and PCR. PCR detected dermatophytes in 39 specimens that were missed by the fungal culture, increasing the diagnosis of dermatophyte-positive specimens by 37%. Five dermatophyte-culture-positive specimens were negative for PCR.

CONCLUSIONS

This study demonstrates that PCR increases the sensitivity of detection of dermatophytes in nail specimens. Despite its limitations, the use of PCR can complement direct microscopic examination and fungal cultures to aid clinicians in the diagnosis of suspected dermatophytic onychomycosis.

Clinical and mycological features of onychomycosis in central Tunisia: a 22 years retrospective study (1986-2007)

Onychomycosis is the most frequently encountered nail disease and may be difficult to diagnose and treat. The objective of this study was to determine the prevalence, the clinical and mycological characteristics of onychomycosis in central Tunisia. It is a retrospective study performed over a 22-year period (1986-2007). It included 7151 patients (4709 women and 2442 men) with suspected fingernails and/or toenails onychomycosis. The patients were referred to the Mycology-Parasitology Laboratory of Farhat Hached hospital in Sousse for mycological examination. Both direct microscopy and culture of the nail material were performed to diagnose and identify the causative fungal species. Onychomycosis was confirmed in 78.6% of investigated patients (5624/7151). The positivity rate was higher in women as compared with men. In both men and women, fingernails were most frequently involved than toenails. No significant relation was found between gender and toenails onychomycosis, whereas fingernails were frequently involved in women. As far as aetiological agents are considered, dermatophytes, yeast and moulds were responsible for 49.9%, 47.4% and 2.7% of onyxis cases respectively. In fingernail infections, yeast were the most frequent fungi (83.6%), Candida albicans being the leading species (51.6%). In contrast, in toenail infections, dermatophytes were more frequent (74.1%). Trichophyton rubrum was by far the dominant species (88.1%). Yeast were observed more frequently in women whereas dermatophytes were more common in men. Moulds were involved in 4.2% of cases. The most frequent species were Aspergillus sp. and Chrysosporium sp. Onychomycosis is a frequent disease in central Tunisia. T. rubrum is the predominant agent in toenails infection and yeast, mainly C. albicans, in fingernails onychomycosis.

Calcofluor white combination antifungal treatments for Trichophyton rubrum and Candida albicans

Superficial mycoses caused by dermatophyte fungi are among the most common infections worldwide, yet treatment is restricted by limited effective drugs available, drug toxicity, and emergence of drug resistance. The stilbene fluorescent brightener calcofluor white (CFW) inhibits fungi by binding chitin in the cell wall, disrupting cell wall integrity, and thus entails a different mechanism of inhibition than currently available antifungal drugs. To identify novel therapeutic options for the treatment of skin infections, we compared the sensitivity of representative strains of the dermatophyte Trichophyton rubrum and Candida albicans to CFW and a panel of fluorescent brighteners and phytoalexin compounds. We identified the structurally related stilbene fluorescent brighteners 71, 85, 113 and 134 as fungicidal to both T. rubrum and C. albicans to a similar degree as CFW, and the stilbene phytoalexins pinosylvan monomethyl ether and pterostilbene inhibited to a lesser degree, allowing us to develop a structure-activity relationship for fungal inhibition. Given the abilities of CFW to absorb UV(365 nm) and bind specifically to fungal cell walls, we tested whether CFW combined with UV(365 nm) irradiation would be synergistic to fungi and provide a novel photodynamic treatment option. However, while both treatments individually were cytocidal, UV(365 nm) irradiation reduced sensitivity to CFW, which we attribute to CFW photoinactivation. We also tested combination treatments of CFW with other fungal inhibitors and identified synergistic interactions between CFW and some ergosterol biosynthesis inhibitors in C. albicans. Therefore, our studies identify novel fungal inhibitors and drug interactions, offering promise for combination topical treatment regimes for superficial mycoses.

Involvement of serine protease and proteinase-activated receptor 2 in dermatophyte-associated itch in mice

We investigated the involvement of serine protease and proteinase-activated receptor 2 (PAR(2)) in dermatophyte-induced itch in mice. An intradermal injection of an extract of the dermatophyte Arthroderma vanbreuseghemii (ADV) induced hind-paw scratching, an itch-related behavior. ADV extract-induced scratching was inhibited by the opioid receptor antagonists naloxone and naltrexone, the serine protease inhibitor nafamostat mesylate, and the PAR(2) receptor antagonist FSLLRY-NH(2). ADV extract-induced scratching was not inhibited by the H(1) histamine receptor antagonist terfenadine or by mast cell deficiency. Heat pretreatment of the ADV extract markedly reduced the scratch-inducing and serine protease activities. Proteolytic cleavage within the extracellular N terminus of the PAR(2) receptor exposes a sequence that serves as a tethered ligand for the receptor. The ADV extract as well as tryptase and trypsin cleaved a synthetic N-terminal peptide of the PAR(2) receptor. The present results suggest that serine protease secreted by dermatophytes causes itching through activation of the PAR(2) receptors, which may be a causal mechanism of dernatophytosis itch.

Species of Candida isolated from anatomically distinct sites in military personnel in Cuiabá, Mato Grosso, Brazil

BACKGROUNDS

Some fungi are natural inhabitants of the human body but may result in disease when conditions are conducive to their development. Yeast infections are common and often occur in the skin and mucous membranes; however emerging species have changed this epidemiological profile. The ability to colonize different anatomical sites has been associated with the pathogenicity of Candida when environmental conditions are particularly favorable. In the case of hot, humid climates, the attrition suffered by the skin and weakened immune defenses may result in yeasts becoming pathogenic rather than commensal organisms.

OBJECTIVE

The objective of this study was to diagnose yeast infections in military personnel and to evaluate the frequency of these infections in the individuals evaluated.

METHODS

The clinical material analyzed was seeded in duplicate in Sabouraud dextrose agar (Difco™) and Mycosel medium (Difco™). The etiological agents were identified by observing the germ tubes, microculture and physiological characteristics, assimilation of carbon sources (auxanogram) and fermentation of carbon sources (zymogram).

RESULTS

Of a total of 197 patients evaluated, 91 (46.2%) had episodes of candidiasis. The genitocrural region was the most commonly affected area (47.7%) followed by the interdigital regions (between the toes or fingers) (27.8%). Candida albicans, Candida parapsilosis, Candida tropicalis, Candida glabrata and emergent species such as Candida krusei and Candida guilliermondii were found.

CONCLUSIONS

In the work environment, having to use shoes and uniforms for extended periods of time, in addition to stress and perspiration, were considered predisposing factors for the development of fungal infections.

Evaluation of PCR for the diagnosis of dermatophytes in nail specimens from patients with suspected onychomycosis

BACKGROUND

Conventional methods for detecting fungi in nail specimens are either nonspecific (microscopy) or insensitive (culture). Recently, PCR has been used to improve sensitivity in detecting the causative fungi in nail specimens from patients with suspected onychomycosis.

AIM

To compare the detection rates of PCR with those of microscopy (with potassium hydroxide; KOH) and culture for dermatophytes in nail specimens from patients with suspected onychomycosis.

METHODS

In total, 120 patients with clinically suspected onychomycosis were recruited, and using a topoisomerase II-based PCR, we compared the detection rate of dermatophytes for the three methods.

RESULTS

KOH microscopy, culture and PCR respectively yielded positive rates of 35 (29.2%), 12 (10%) and 48 (40%), and negative rates of 85 (70.8%), 108 (90%) and 72 (60%). Two culture-positive specimens were not detected by PCR, but PCR picked up 38 specimens missed by culture. Of the 35 specimens that were microscopy-positive, 12 grew dermatophytes and 23 nondermatophytes.

CONCLUSIONS

This study demonstrates that PCR has a higher positive and lower negative rate for detection of dermatophytes compared with KOH microscopy or culture. We suggest that PCR should be used as a complementary method for confirmation of clinically suspected dermatophytic onychomycosis.

The prevalence of tinea pedis and tinea manuum in adults in rural areas in Turkey

The aim of this study was to determine the frequency of tinea pedis and manuum (dermatophyte infections of the hands and feet) in adults in rural areas of Turkey, the risk factors and self-administered treatment options. A total of 2,574 people living in a rural area were enrolled in the study. Participants were asked demographic data, hygienic habits in a questionnaire. KOH preparations and culture were performed from suspicious lesions. Medical and alternative therapy methods and former dermatophytosis diagnosis history were taken from the respondents with suspicious lesions. Microbiological samples were taken from 285 (11.1%) participants. Culture was positive in 109 (4.2%) of those. The most common agent was Trichophyton rubrum. The predisposing factors were found as age older than 40, male gender and obesity. Forty-nine (44.9%) of patients had taken a medical therapy, 56 (51.4%) had performed non-medical methods (cologne, Lawsonia inermis-Henna and softener creams). Patient's education about the treatment compliance is important.

Onychomycosis in Iran: epidemiology, causative agents and clinical features

BACKGROUND

Onychomycosis represents the most frequently encountered nail disease, which is difficult to eradicate with drug treatment.

AIM

This study was undertaken to document the clinico-mycological pattern of onychomycosis in Iran. Results of mycological tests of nail scrapings collected over a 4-year period were analyzed.

METHODS

Both direct microscopy and cultures of the nail material were performed to identify the causative agents.

RESULTS

The microscopic and/or cultural detection of fungi was positive in 40.2% of samples. The most common clinical type noted was distolateral subungual onychomycosis in 48.4% of cases. Etiological fungal agents were 50% dermatophytes, 46.8% yeasts, and 3.2% saprophytic moulds. The most frequently detected dermatophyte species were Trichophyton rubrum (48.4%) and T. mentagrophytes (41.9%). Among yeasts, Candida albicans (58.6) was most common, followed by C. parapsilosis (17.2%), C. glabrata (10.3%), C. krusei and C. tropicalis (each 6.9%). Aspergillus niger and A. flavus were the most frequent saprophytic moulds. Females were affected more frequently than males, and in both sexes those most infected were between 40-49 years of age. Fingernails were affected more frequently than toenails.

CONCLUSIONS

The clinico-epidemiological data collected can serve as reference for future research and may be useful in the development of preventive and educational strategies.

Candida parapsilosis: a review of its epidemiology, pathogenesis, clinical aspects, typing and antimicrobial susceptibility

The Candida parapsilosis family has emerged as a major opportunistic and nosocomial pathogen. It causes multifaceted pathology in immuno-compromised and normal hosts, notably low birth weight neonates. Its emergence may relate to an ability to colonize the skin, proliferate in glucose-containing solutions, and adhere to plastic. When clusters appear, determination of genetic relatedness among strains and identification of a common source are important. Its virulence appears associated with a capacity to produce biofilm and production of phospholipase and aspartyl protease. Further investigations of the host-pathogen interactions are needed. This review summarizes basic science, clinical and experimental information about C. parapsilosis.

Preclinical studies with 5,10,15-Tris(4-methylpyridinium)-20-phenyl-[21H,23H]-porphine trichloride for the photodynamic treatment of superficial mycoses caused by Trichophyton rubrum

Dermatophytes are fungi that cause infections of keratinized tissues. We have recently demonstrated the susceptibility of the dermatophyte Trichophyton rubrum to photodynamic treatment (PDT) with 5,10,15-Tris(4-methylpyridinium)-20-phenyl-[21H,23H]-porphine trichloride (Sylsens B) in 5 mm citric acid/sodium citrate buffer (pH 5.2, formulation I). In this work, we examined the penetration of Sylsens B in healthy and with T. rubrum infected skin and we investigated the susceptibility of T. rubrum to PDT using formulation I and UVA-1 radiation (340-550 nm). Skin penetration studies were performed with formulations I and II (Sylsens B in PBS, pH 7.4) applied on dermatomed skin, human stratum corneum (SC), disrupted SC by T. rubrum growth and SC pretreated with a detergent. No penetration was observed in healthy skin. Disruption of SC by preceding fungal growth caused Sylsens B penetration at pH 7.4, but not at pH 5.2. However, chemically damaged SC allowed Sylsens B to penetrate also at pH 5.2. UVA-1 PDT was applied ex vivo during two fungal growth stages of two T. rubrum strains (CBS 304.60 and a clinical isolate). Both strains could be killed by UVA-1 alone (40 J/cm(2)). Combined with formulation I (1 and 10 microm Sylsens B for, respectively, CBS 304.60 and the clinical isolate), only 18 J/cm(2) UVA-1 was required for fungal kill. Therefore, PDT with 10 microm Sylsens B (formulation I) and 18 J/cm(2) UVA-1 could be considered as effective and safe. This offers the possibility to perform clinical studies in future.

Dermatophytoses in outpatients attending the Dermatology Center of Avicenna Hospital in Qazvin, Iran

Dermatophytosis is still being considered as one of the major public health problems in many parts of the world. To identify the prevalence and etiological agents of dermatophytoses, a study was carried out between 2004 and 2006. Out of 1023 subjects suspected to have cutaneous mycoses, 348 (34%) patients were affected with dermatophytoses. The causative agents were identified macroscopically and microscopically after the clinical samples were subjected to potassium hydroxide examination and culture isolation. Epidermophyton floccosum was the most frequently isolated species representing 32.8% of isolates, followed by T. rubrum (18.1%), T. verrucosum (17.2%), T. mentagrophytes var. interdigitale (15.8%), T. mentagrophytes var. mentagrophytes (6.6%) and T. violaceum, T. schoenleinii and Microsporum canis (0.9%). The most common type of infection was tinea cruris (31.9%) affecting in particular male patients. Some other most prevalent tinea types were tinea corporis (20.7%), tinea pedis (19%), and tinea unguium (11.2%). To the best of our knowledge, this is the first report on dermatophytoses in Qazvin and the first study that shows tinea cruris as a major type of superficial fungal infection in Iran. The frequency of tinea was higher in males and tinea cruris showed a remarkably increasing tendency and was an important public health issue in Qazvin.

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.

[Onychomycosis: clinical, epidemiological and mycological study in the municipality of São José do Rio Preto]

This was a clinical-epidemiological and mycological study on 184 patients at the university hospital: 200 samples, 142 positive samples, 98 yeasts and 68 filamentous fungi. Candida parapsilosis (47%) and Trichophyton rubrum (38%) were prevalent. They were 100% sensitive to ketoconazole and 99% sensitive to amphotericin B. The highest prevalences were among women (80%), adults (62%) and toes (84%).

Epidemiology of dermatophytoses in a rural community in Eastern Nigeria and review of literature from Africa

A total of 4,287 primary school children, comprising 1,740 males and 2,547 females in Arochukwu local government area of Abia state Nigeria were examined for clinical signs of dermatophytoses. About 873 (20.4%), consisting of 505 males and 368 females had lesions consistent with dermatophytoses. The disease was more prevalent in males (29%) than females (14.4%) in a ratio of approximately 2:1 (P < 0.05). The infection rate increased from 16.8% in the 4-6 year age group to a peak of 28.1% in the 10-12 year age bracket and dropped sharply to 5.6% in the 16-18 year group. The highest prevalence (39%) was observed among males aged 10-12 years while females 16-18 years had the lowest prevalence (2.5%). Tinea capitis was the predominant clinical type of dermatophytoses, and occurred in 13.7% of the total population studied and 67% of lesion positive cases. Trichophyton soudanense and Trichophyton tonsurans the predominant aetiological agents of dermatophytoses with a prevalence of 26.2% and 21.6%, respectively. Others include Trichophyton mentagrophytes (18.8%), Epidermophyton floccosum (8.3%), Microsporum audouinii (6.4%), Microsporum gypseum (6.0%), Trichophyton rubrum (5.5%) and Microsporum ferrugineum (7.3%), which was isolated for the first time in Nigeria.

A clinicomycological study of fungal foot infections among Algerian military personnel

There have been few studies on fungal infection of the foot in military personnel. The aim of this study was to determine the prevalence and aetiological factors of superficial mycoses of the foot in military personnel attending the Department of Dermatology of the Army Central Hospital in Algiers, Algeria. A complete dermatological examination was performed in 650 male military personnel. Cultures of skin and nail specimens of the feet were performed for each participant. Fungal infection of the foot (including tinea pedis and Candida interdigital infection) was clinically diagnosed in 147, and confirmed in 119 by positive cultures, resulting in a total prevalence of 18.3%. When subjects were grouped according to military rank, fungal infection of the foot was prevalent in troop soldiers; when grouped according to years of service to the army, the infection was frequent in military recruits. The dermatophyte species Trichophyton rubrum (20.9%) and the yeast species Candida parapsilosis (18.7%) were shown to be the major causal agents isolated. Tinea pedis and Candida interdigital infection are the most prevalent (68%) superficial fungal infections among Algerian military personnel.