Prevalence of Dermatophytic Infection and the Spectrum of Dermatophytes in Patients Attending a Tertiary Hospital in Addis Ababa, Ethiopia

Skin Disease Profile in Geriatric Inpatients at a Tertiary Referral Hospital

Background

Elderly people are susceptible to various skin diseases. To monitor disease trends in the geriatric population, epidemiologic data on skin diseases are essential. However, studies on skin diseases in geriatric patients in Indonesia, particularly those who are hospitalised, are limited. Therefore, this retrospective study aims to determine the skin disease profile in geriatric patients at a tertiary referral hospital in Indonesia.

Methods

The subjects were all geriatric inpatients who were consulted at the Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo National General Hospital between 2017 and 2019. The patients were analysed according to sex, age and comorbidities. They were divided into 15 groups according to the diseases. Chi-square test or Fisher's exact test was used to compare categorical variables.

Results

The most common skin diseases were infections (35.8%), dermatitis (21.8%), ulcers (12.8%), age-related skin changes (8.4%) and vascular diseases (5.3%). Dermatitis was significantly more common in males (P < 0.05), whereas infections were significantly more common in females (P < 0.05).

Conclusion

Consistent with previous studies, our inpatient data showed that infections were significantly more common in females, whereas dermatitis was significantly more common in males. The data collected may contribute to epidemiologic data on skin diseases in the geriatric population.

Global Demographic Characteristics and Pathogen Spectrum of Tinea Capitis

Tinea capitis is an important superficial fungal infection with a global distribution. It mainly affects prepubertal children and is more common in males. Anthropophilic and zoophilic dermatophytes are responsible for most infections. The pathogen spectrum of tinea capitis varies across different regions and changes over time, and is influenced by multiple factors, such as economic development, changes in lifestyle, immigration and animal distribution. This review aimed to clarify the demographic and etiological characteristics of tinea capitis worldwide and determine the common trends of causative pathogens. By mainly analyzing the literature published from 2015 to 2022, we found that the incidence and demographic characteristics of tinea capitis remained generally stable. Zoophilic Microsporum canis, anthropophilic Trichophyton violaceum and Trichophyton tonsurans were the predominant pathogens. The pathogen spectra in different countries changed in different directions. In some countries, the main pathogen shifted to an anthropophilic dermatophyte, such as T. tonsurans, Microsporum audouinii or T. violaceum; in contrast, it shifted to a zoophilic agent, such as M. canis, in some other countries. Dermatologists are advised to continue monitoring the pathogen spectrum and implement preventive measures according to the reported changes.

Dermatophytosis and its risk factors among children visiting dermatology clinic in Hawassa Sidama, Ethiopia

Dermatophytosis represents one of the common fungal diseases that attack the skin, hair and nail of human beings worldwide. It causes chronic morbidity in children and the condition is more common, in developing countries. The study aimed to determine dermatophytosis and its associated factors among children in Hawassa Sidama, Ethiopia April 2021-October 2021. A cross-sectional study was conducted on children suspected of cutaneous fungal infections. Data were surveyed based on a semi-structured questionnaire. Standard laboratory methods were used to identify the dermatophytes. The data entry and analysis were conducted with SPSS version 26. The Chi-square test was used to check the predictor and a p-value < 0.05 was taken as a significant value. A total of 83 study subjects included in the study in which all 83 (100%) patients were positive for fungal elements (hyphae/and spores) in microscopy, of this 81 (97.6%) yielded growth on culture. Hair scalps 75 (90.4%) were the dominant among the case. Trichophyton 52 (62.6%) was the dominant aetiology followed by Microsporum 22 (26.6%). Intervention measures to tackle dermatophytosis should emphasis on tinea capitis among 6-10 years old children with history of recent migration by raising awareness of communities through health extension programs.

Comparison of in vitro activities of newer triazoles and classic antifungal agents against dermatophyte species isolated from Iranian University Hospitals: a multi-central study

BACKGROUND

Dermatophytes have the ability to invade the keratin layer of humans and cause infections. The aims of this study were the accurate identification of dermatophytes by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism method and sequencing and comparison between the in vitro activities of newer and established antifungal agents against them.

METHODS

Clinical specimens of patients from five Iranian university laboratories were entered in this study. Samples were cultured on sabouraud dextrose agar medium. For molecular identification, extracted DNAs were amplified by the universal fungal primers ITS1 and ITS4, and digested with MvaI enzymes. The antifungal susceptibility test for each isolate to terbinafine, griseofulvin, caspofungin, fluconazole, itraconazole, luliconazole, and isavuconazole was performed, according to the microdilution CLSI M38-A2 and CLSI M61 standard methods.

RESULTS

Two hundred and seven fungi species similar to dermatophytes were isolated of which 198 (95.6%) were dermatophytes by molecular assay. The most commonly isolated were Trichophyton mentagrophytes (76/198), followed by Trichophyton interdigitale (57/198), Trichophyton rubrum (34/198), Trichophyton tonsurans (12/198), Microsporum canis (10/198), Trichophyton simii (3/198), Epidermophyton floccosum (3/198), Trichophyton violaceum (2/198), and Trichophyton benhamiae (1/198). The GM MIC and MIC₉₀ values for all the isolates were as follows: terbinafine (0.091 and 1 μg/ml), griseofulvin (1.01 and 4 μg/ml), caspofungin (0.06 and 4 μg/ml), fluconazole (16.52 and 32 μg/ml), itraconazole (0.861 and 8 μg/ml), isavuconazole (0.074 and 2 μg/ml), and luliconazole (0.018 and 0.25 μg/ml).

CONCLUSION

Trichophyton mentagrophytes, Trichophyton interdigitale, and Trichophyton rubrum were the most common fungal species isolated from the patients. luliconazole, terbinafine, and isavuconazole in vitro were revealed to be the most effective antifungal agents against all dermatophyte isolates.

Development, preparation, and evaluation of a novel dotted lateral flow immunochromatographic kit for rapid diagnosis of dermatophytosis

Dermatophytosis is a widely spread contagious zoonotic disease, affecting both man (tinea) and animals (ringworm). This disease is caused by a group of closely related keratinophilic fungi known collectively as the dermatophytes group. Although the wide distribution of dermatophytosis cases throughout the whole world and its adverse clinical effect on human health, economical effect on productive animals, and pet animal welfare, there is no rapid accurate diagnostic tool for such disease. The current conducted study tries to accomplish the difficult equation by achieving an accurate, sensitive, specific, user-friendly, rapid, robust, device-less, deliverable to end-users, and economic cost for the development and production of diagnostic kits. Through the development of a rapid diagnostic kit based on immunochromatographic assay with three major affordable reproducible production stages; preliminary stage, developmental and standardization stage, and evaluation stage. Obtaining dermatophytes-specific polyclonal antibodies against criteria-based selected dermatophytes strains associating proper gold nanoparticle preparation, characterization, and conjugation, with proper loading of the different bio-reactants on the efficiently laminated and fabricated lateral flow strips were the main challenge and control points through the whole process. Also, as a result of examining 100 animal samples using the new kit, the κ coefficients of the kit with the direct microscopy while the kit with the culture were 0.44 and 0.76, respectively. Therefore, the newly designated and developed kit showed a very promising competitive diagnostic result within 5-7 min through easy-to-be-performed three steps.

First study on molecular epidemiology of dermatophytosis in cats, dogs, and their companions in the Kurdistan region of Iraq

Background and Aim

Dermatophytosis is a zoonotic infection of the hair, skin, or nails in animals and humans caused by dermatophytes fungi. This study aimed to estimate the prevalence of dermatophytosis and its associated factors in cats, dogs, and humans in the Kurdistan region of Iraq.

Materials and Methods

Skin scraping samples were taken from cats, dogs, and humans with or without skin lesions. In total, 271 samples were collected; 133 from cats, 94 from dogs, and 44 from humans. The collected samples were cultured on dermatophyte test media for fungal isolation and molecular identification.

Results

The prevalence of the disease was 44.36%, 40.43%, and 65.91% in cats, dogs, and humans, respectively. Microsporum canis, the most frequently isolated dermatophyte, occurred in 94.92% of cats, 92.11% of dogs, and 100.0% of humans whereas, Trichophyton mentagrophytes was only isolated from 5.08% of cats to 7.89% of dogs. Animals and humans at younger ages were more susceptible to the infection. Males were more susceptible than females among animals, while the reverse was true in humans. Housed cats were at higher risk of dermatophytosis than outdoor-reared cats, whereas outdoor-reared dogs were at higher risk of dermatophytosis than indoor-reared dogs. The affected skin in animals and humans is significantly associated with higher prevalence rates of the disease. Contact with infected cats and dogs was associated with increased infection rates in humans. Patients with a history of coronavirus disease 2019 (COVID-19) were found to be at higher risk of dermatophytosis than those with no history of COVID-19.

Conclusion

Awareness should be raised among people about the zoonotic aspect of the disease, especially among those with COVID-19, to avoid contact with cats and dogs, who are at risk of the disease.

Mycological Profile and Its Associated Factors Among Patients Suspected of Dermatophytosis at Bisidimo Hospital, Eastern Ethiopia

Background

Dermatophytosis is a common problem across the globe that is caused by a group of closely related fungi known as the dermatophytes that can invade keratinized tissues. It is a usual refractory infection and deleteriously affects the quality of life of humans. Despite the common presence of dermatophytes on the human host, research evidence in this area is limited.

Objective

Aimed to assess the mycological profile and its associated factors among patients suspected of dermatophytosis at Bisidimo Hospital, Eastern Ethiopia, from March to October 2021.

Methods

A cross-sectional study was conducted on 289 patients who visited the dermatology department of Bisidimo Hospital. Data were collected by reviewing patients’ charts and using a structured questionnaire to assess the associated factors of dermatophytosis. The patients’ medical charts were reviewed to assess chronic conditions. Skin, hair, or nail samples were collected and transported to Medical Microbiology Laboratory at Haramaya University Department of Medical Laboratory Sciences. Samples were inoculated into Potato dextrose agar and Sabouraud dextrose agar, and fungal isolates were identified morphologically and microscopically. Data were analyzed using Statistical Package for the Social Sciences version 26. Bivariate and multivariable logistic regression analyses with 95% confidence intervals were carried out to identify factors associated with dermatophytosis.

Results

The overall magnitude of dermatophytosis infection was 28.4% (95%CI: 23.2–32.2). Tinea capitis and tinea corporis were the common clinical presentations. The fungal isolates include Trichophyton species (68 isolates) and Epidermophyton species (17 isolates). Patients with features involving male sex (AOR = 2.5), age group of 1–10 years (AOR = 3.5), hypertension (AOR = 2.2), a family history of dermatophytosis (AOR = 2.0), and a history of animal contact (AOR = 1.5) had the increased odds of being infected with the dermatophytosis.

Conclusion

We found more than one in four patients assessed had dermatophytosis infection. It was considerably high in patients with a family history of the infection, animal contacts, hypertension, and below 10 years of age. Therefore, the control program for this disease should specifically target at a high risk populations, which must hinge on the evidence of molecular characterization and antifungal susceptibility patterns of the fungi.

Epidemiology of Dermatophytes Isolated from Clinical Samples in a Hospital in Eastern Saudi Arabia: A 20-Year Survey

BACKGROUND

Dermatophytes are group of fungi that cause superficial infections via enzymes that degrade keratin in human skin. Several factors, including climate, gender, age, lifestyle, human migration, cultural habits, and socioeconomic status influence the prevalence of dermatophyte infections. We analyzed the prevalence of dermatophyte isolates in a hospital in Eastern Saudi Arabia from 2000 to 2019.

METHODS

The data on fungal cultures were obtained from the Laboratory Information System of the Mycology Laboratories at Johns Hopkins Aramco Healthcare, and were used for the analysis. Fungal isolates were examined microscopically for the presence of specialized hyphal structures and conidia. The Vitek^® MS microbial identification system (biomerieux) was used if the culture type was not identified microscopically.

RESULTS

Among the 10,021 samples analyzed, 3040 (30.33%) were positive for fungi and only 398 (3.97%) were dermatophytes. Microsporum species was the most common dermatophyte accounting for 50.5% (n = 201) followed by trichophyton with 36.9% (n = 147). The most common positive samples were scrapping (251, 63%) and hair (68, 17%). Culture positivity relative to the age groups revealed a cluster of positive dermatophyte species in children < 10 years of age with 215 (54%) of all cases and among 10-19 years of age with 60 (15) of the cases (p < 0.001). Microsporum species were the prevalent dermatophytes in patients  < 10 years of age, while Epidermophyton species were the most frequent dermatophyte species in age groups 10-19, 20-29, and 30-39 years. However, Trichophyton species were the most frequent dermatophyte species in individuals 70-79 years. The percentage of Microsporum and Trichophyton species decreased significantly over time (p < 0.001). In addition, there was a significant seasonal variation in relation to Trichophyton species. A comparison between the most frequent species showed that there was no difference in relation to gender, but there was a difference in relation to the specimen type and age group.

CONCLUSION

Dermatophytosis was common among children and adolescent with the most common samples were scrapping and hair. There was a significant reduction in Microsporum and Trichophyton species over time.

New approach to the use of propolis against dermatomycosis

In recent years, propolis extract (PE) has demonstrated antimicrobial and anti-inflammatory properties. The aim of this study was to evaluate the antifungal activity of a bioadhesive thermoresponsive system containing 16% propolis (BTSP 16%) against Microsporum canis, Nannizzia gypsea, Trichophyton mentagrophytes and T. rubrum. We also evaluated PE alone against the same strains. The results showed that both PE and BTSP 16% significantly reduced the fungal viability of all evaluated strains. In addition, they interacted with the biofilm of these species in different stages of biofilm formation. We observed that the bioadhesive and thermoresponsive properties of BTSP 16% prolonged propolis presence at infection sites, leading to positive results against planktonic fungal cells and mature biofilms. These characteristics make this formulation a valuable alternative treatment for dermatomycosis.

Prevalence and antifungal drug resistance of dermatophytes in the clinical samples from Pakistan

Dermatophytosis is a major health problem all over the world including Pakistan. This is the first report of detection of dermatophytes and their antifungal drug resistance in the Northern and Western parts of Pakistan. A total of 154 samples were collected from different hospitals of Khyber Pakhtunkhwa, and out of them 136 samples were found positive. Tinea corporis (35%) was the most predominant type of infection followed by Tinea capitis (22%). The fungi identified in Tinea corporis infection types were identified as Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum. The fungi identified in Tinea capitis included Trichophyton violaceum, T. mentagrophytes, Microsporum ferrugineum. The gender wise distribution showed both males (52%) and females (48%) were infected with the fungi. More cases belonged to the rural parts of the country. Age wise distribution showed that the infection was more prevalent in the children and the prevalence decreased with the increase in age. The positive samples were checked against two antifungal agents: fluconazole and nystatin. Among 136 positive samples, none of the isolates showed resistance to nystatin while 7% of the samples showed resistance to fluconazole. The resistant isolates were then identified by amplifying the 18S rRNA gene, using universal primers (ITS1, ITS4). Among the 9 resistant isolates, 5 isolates were identified as Trichophyton spp., 3 as Microsporum spp. and 1 as Epidermophyton spp.

Clinical clues and trends in epidemiology and pathogens in paediatric tinea capitis: a retrospective cohort study

BACKGROUND

Tinea capitis is the most common dermatophyte infection in children. Pathogens differ between populations. During the past few decades pathogen shifts have been reported in many countries around the world. This study aimed to characterize the pathogens involved in tinea capitis in a large tertiary paediatric medical centre in Israel.

METHODS

The electronic medical records of the dermatology unit were searched for patients diagnosed with tinea capitis from 2010 to 2019, and demographic, clinical and mycological data were retrieved. A stepwise logistic regression was performed to determine the variables most significantly associated with positive cultures.

RESULTS

The prevalence of Trichophyton tonsurans isolates was found to be significantly increased during 2019. In the logistic regression analysis, alopecia was most significantly associated with a positive culture (OR = 8.72, 95% CI 4.29-17.7, P < 0.001) while positive culture was also associated with age (OR = 1.11 per year of age, 95% CI 1.02-1.22, P = 0.01) and Ethiopian ethnicity (OR = 3.67, 95% CI 1.42-9.45, P = 0.01). The presentation of alopecia was significantly related to having a positive culture. This symptom was more prevalent in boys than in girls, and the diagnosis of tinea capitis was delayed by an average of 2 months in girls.

CONCLUSION

The results of this study may herald a pathogen shift in Israel. Physicians should be aware that rates of alopecia are lower in girls and this can result in delayed diagnosis and the development of complications, including chronicity, scarring alopecia and kerion formation.

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.

Lactobacillus plantarum strain HT-W104-B1: potential bacterium isolated from Malaysian fermented foods for control of the dermatophyte Trichophyton rubrum

The objective was to screen and evaluate the anti-fungal activity of lactic acid bacteria (LABs) isolated from Malaysian fermented foods against two Trichophyton species. A total of 66 LAB strains were screened using dual culture assays. This showed that four LAB strains were very effective in inhibiting growth of T. rubrum but not T. interdigitale. More detailed studies with Lactobacillus plantarum strain HT-W104-B1 showed that the supernatant was mainly responsible for inhibiting the growth of T. rubrum. The minimum inhibitory concentration (MIC), inhibitory concentration, the 50% growth inhibition (IC₅₀) and minimum fungicide concentration (MFC) were 20 mg/mL, 14 mg/mL and 30 mg/mL, respectively. A total of six metabolites were found in the supernatant, with the two major metabolites being L-lactic acid (19.1 mg/g cell dry weight (CDW)) and acetic acid (2.2 mg/g CDW). A comparative study on keratin agar media showed that the natural mixture in the supernatants predominantly contained L-lactic and acetic acid, and this significantly controlled the growth of T. rubrum. The pure two individual compounds were less effective. Potential exists for application of the natural mixture of compounds for the treatment of skin infection by T. rubrum.

Epidemiological Characterization of Dermatomycosis in Ethiopia

Background

Superficial mycosis is common worldwide and their epidemiological characteristics are different in different geographical areas and have shown variations in the last decades. The aim of this study was to analyze and characterize the epidemiology of dermatomycosis and their causative fungi species in Ethiopia between 2015 and 2019.

Methods

A laboratory-based cross-sectional study was conducted using the data of mycological examination and culture findings from all patients who visited the Dermatology Department of Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia. The direct wet mount microscopy and culture data of the isolates were collected from the database of the dermatology unit from 2015 to 2019 after permission was obtained from the laboratory head. The data were double-entered into Microsoft Excel, exported and analyzed using SPSS version 20.

Results

The total prevalence of fungi causing dermatomycosis was 67.7% (760/1122 cases) using direct wet mount microscopy and from these 489/1122 (43.5%) were culture positive. Dermatomycosis was found to be higher among females 694/1122 (61.9%) than male participants. Age group 25–44 years was the most affected 442/1122 (39.4%) followed by 1–14 years old 291/1122 (25.94%). Tinea unguium (50.8%) is the most common type of dermatomycosis followed by tinea capitis (24.1%) and tinea corporis (13.9%). Trichophyton spp. (32%) was the most highly distributed causative agent, followed by Epidermophyton spp. (20.2%) and Aspergillus fumigatus (8.3%).

Conclusion

The retrospective analysis of epidemiological data collected at Arsho Advanced Medical Laboratory since 2015 showed a gradual increase in the frequency of tinea unguium and tinea pedis. However, during the past years, there was a gradual decline in the frequency of tinea corporis. In parallel with this variable pattern, the rate of isolation of non-dermatophytes especially Aspergillus fumigates and Candida species has shown a gradual increment during the past five years.

Phenotypic Characterization of Enzymatic and Non-enzymatic Virulence Factors in Etiopathogenesis and Evolution of Drug Resistance among Dermatophytes

The virulence factors of dermatophytes play a vital role in the etio-pathogenesis and emergence of drug resistance. Regular surveillance is essential for constant monitoring of association of virulence factors in the emergence of drug resistant isolates and to guide proper therapeutic strategies to combat infections due to drug resistant isolates of dermatophytes. The aim of this study is to isolate and identify various enzymatic and non-enzymatic virulence factors of dermatophytes isolated from clinically suspected cases of dermatophytosis attending the dermatology outpatient clinic. From 30 clinical samples received from department of Dermatology to the department of Microbiology during the study period July to December 2019, KOH mount and fungal culture was done and only the isolates which grew dermatophytes were used for detecting virulence factors using standard methods. Among 30 affected patients, 13 were male (43.3%) and 17 were female (56.7%) with age range of 13 to 60 years. Skin sample yielded positive growth in 96.6% of the cases. Out of 30 samples, 6 samples were positive for Trichophyton mentagrophytes. Tinea corporis was the common manifestation which yielded positive growth. Female predominance was seen. Male predominance was seen in younger age group while females were more commonly affected in older age group. Adolescents were commonly affected age group (40%). Then people between age 41-50 (middle age group) were mostly affected. The six Trichophyton mentagrophytes were found to have enzymatic and non- enzymatic virulence factors. All the virulence factors included in the study were present in Trichophyton mentagrophytes.

Recent trends in rapid diagnostic techniques for dermatophytosis

Dermatophytosis is a common contagious disease of both humans and animals. It is caused by a group of filamentous fungi known as dermatophytes, including several genera and various species. An accurate diagnosis of dermatophytes as a causative agent of a skin lesion requires up to one month of conventional laboratory diagnostics. The conventional gold standard diagnostic method is a direct microscopic examination followed by 3 to 4 weeks of Sabouraud's dextrose agar (SDA) culturing, and it may require further post-culturing identification through biochemical tests or microculture technique application. The laborious, exhaustive, and time-consuming gold standard method was a real challenge facing all dermatologists to achieve a rapid, accurate dermatophytosis diagnosis. Various studies developed more rapid, accurate, reliable, sensitive, and specific diagnostic tools. All developed techniques showed more rapidity than the classical method but variable specificities and sensitivities. An extensive bibliography is included and discussed through this review, showing recent variable dermatophytes diagnostic categories with an illustration of weaknesses, strengths, and prospects.

Quinolines derivatives as promising new antifungal candidates for the treatment of candidiasis and dermatophytosis

Fungal infections have emerged as a current serious global public health problem. The main problem involving these infections is the expansion of multidrug resistance. Therefore, the prospection of new compounds with efficacy antifungal becomes necessary. Thus, this study evaluated the antifungal profile and toxicological parameters of quinolines derivatives against Candida spp. and dermatophyte strains. As a result, a selective anti-dermatophytic action was demonstrated by compound 5 (geometric means (GM = 19.14 μg ml⁻¹)). However, compounds 2 (GM = 50 μg ml⁻¹) and 3 (GM = 47.19 μg ml⁻¹) have presented only anti-Candida action. Compounds 3 and 5 did not present cytotoxic action. Compound 5 did not produce dermal and mucosal toxicity. In addition, this compound showed the absence of genotoxic potential, suggesting safety for topical and systemic use. Quinolines demonstrated a potent anti-dermatophytic and anti-yeast action. Moreover, compound 5 presented an excellent toxicological profile, acting as a strong candidate for the development of a new effective and safe compound against dermatophytosis of difficult treatment.

Prevalence of skin infections, infestations, and papular urticaria among adolescents in secondary schools in Calabar, Nigeria

Background

Acne is an inflammatory disorder of the pilosebaceous gland, and the most common dermatosis in adolescents globally. Infectious dermatoses are common in the tropics, but due to the paucity of epidemiologic surveys, not much is known about the prevalence and common types found in different sub-populations including adolescents. It is however presumed that the prevalence will be high and the pattern diverse. We therefore conducted a school-based survey to ascertain the prevalence and pattern of infectious dermatoses, infestations, and papular urticaria (insect bite reactions) in teenage adolescents in Calabar, Nigeria.

Methods

A cross sectional observational survey of adolescents aged 13–19 years attending randomly selected secondary schools in Calabar, Nigeria. It involved the use of questionnaires and subsequent whole body examination.

Results

A total of 1447 senior secondary school students were examined. Infectious dermatoses, infestations, and papular urticaria (IDIP) were observed in 505 (34.9%) persons, among whom were 269 (53.3%) males, and 236 (46.7%) females (X²=34.87, p=<0.001). Fungal dermatoses constituted more than 90% of the diseases, the bulk of which was contributed by pityriasis versicolor [430 (79.6%)]. The six most common dermatoses in descending order of frequencies were Pityriasis versicolor, tinea, papular urticaria, candidiasis, furuncles, and viral warts.

Conclusion

A high prevalence of cutaneous infections exists among teenage adolescents in Calabar, Nigeria. Males have a higher predisposition to fungal dermatoses. Control of the predominant cause of cutaneous infections — pityriasis versicolor, will significantly affect the prevalence of infectious dermatoses, and invariably, the burden of skin disorders in adolescents in Calabar, Nigeria.

Funding

Self sponsored

Epidemiology of Dermatophyte and Non-Dermatophyte Fungi Infection in Ethiopia

Background

Dermatophytosis represents one of the common infectious diseases worldwide and it is a major public health problem around the globe. The disease causes considerable morbidity and still continues to increase especially in developing countries.

Objective

This study was undertaken to determine the prevalence of dermatophytes and the spectrum of fungal agents in patients attending Rank Higher Specialized Dermatology Clinic.

Methods

A cross-sectional study has been conducted, in which 318 samples from 318 suspected patients were collected. Samples include hair, nail, and skin. A portion of each sample was examined microscopically and the remaining portion of each sample was cultured onto plates of Sabouraud's dextrose agar containing chloramphenicol with and without cycloheximide. Isolates were identified by studying the macroscopic and microscopic characteristics of the colonies.

Results

Tinea capitis was the predominant clinical manifestation accounting for 53.4% of the cases. Patients with age group 1-14 years were more affected. Of 318 samples, fungi were detected in 133 (54.4%) by direct wet mount while 148/315 (46.5%) of them were culture positive. From these 72/148 (46.8%) were dermatophytes. T. tonsurans was the most common pathogen in tinea capitis, whereas T. mentagrophytes was the most common pathogen in tinea corporis. Among dermatophyte isolates, T. tonsurans 29/72 (40.2%) was the most common cause of infection. Among non-dermatophyte molds, Cladosporiumspp. 21/63 (33.3%) was predominant isolate followed by Neoscytalidim dimidatum 11/63 (17.4%) and Alternariaspp. 9/63 (14.2%), respectively. Yeasts also account for 13 (8.7%) of the total suspects of dermatophytosis.

Conclusion

In this study, the prevalence of dermatophytes was higher in tinea capitis 46/72 (63.8%) and T. tonsurans 29/72 (40%) was the dominant-isolated dermatophyte. Recovery of a large number of dermatophytes and non-dermatophyte fungi in our study showed that non-dermatophyte fungi are emerging as important causes of dermatophytosis warranting further intensive epidemiological studies that have public health significance are needed.

Trichophyton rubrum Elicits Phagocytic and Pro-inflammatory Responses in Human Monocytes Through Toll-Like Receptor 2

Dermatophytosis is a superficial fungal infection mostly restricted to keratinized tissues such as skin, hair, and nails but with potential to cause invasive or even systemic disease in immunocompromised patients. Trichophyton rubrum is the main etiologic agent, accounting for approximately 80% of the cases. Mononuclear phagocytes respond to pathogens through phagocytosis followed by production of several antimicrobial molecules, such as reactive oxygen and nitrogen species, and failure in doing so may contribute to development of chronic fungal infections. Toll-like receptors (TLRs) located on the surface of phagocytic cells bind either directly to target particles or through opsonizing ligands and trigger an actin-mediated ingestion. Even though the mechanisms involved in TLR-mediated cytokine responses are well established, the contribution of TLR in the recognition of T. rubrum by adherent monocytes remains unclear. Here, we report that phagocytosis of T. rubrum conidia by adherent monocytes is mediated by TLR2. Blockade of TLR2 by neutralizing antibodies impaired the fungicidal activity of monocytes as well their secretion of tumor necrosis factor (TNF)-α, but neither nitric oxide (NO) production nor interleukin (IL)-10 secretion was disturbed. So far, our data suggest that TLR2 is required for efficient conidial phagocytosis, and the absence of TLR2 signaling in human monocytes may impair the subsequent inflammatory response. These findings expand our understanding of phagocyte modulation by this important fungal pathogen and may represent a potential target for interventions aiming at enhancing antifungal immune responses.

In situ immune response in human dermatophytosis: possible role of Langerhans cells (CD1a+) as a risk factor for dermatophyte infection

Dermatophytosis is a cutaneous mycosis caused by a plethora of keratinophilic fungi, but Trichophyton rubrum is the most common etiological agent. Despite its high prevalence worldwide, little is known about the host defense mechanisms in this infection, particularly the in situ immune response. Using an immunohistochemistry approach, we investigated the density of CD1a+, factor XIIIa+ and CD68+ cells in the skin of dermatophytosis patients. Langerhans cells (CD1a+ cells) were significantly decreased in the epidermis of patients, both in affected and unaffected areas. In the dermis, however, no differences in the density of macrophages (CD68+ cells) and dermal dendrocytes (factor XIIIa+ cells) were observed. These results suggest that the decreased number of Langerhans cells may be a risk factor for development of dermatophytosis.

Antifungal Susceptibility of Dermatophytes Isolated From Cutaneous Fungal Infections: The Vietnamese Experience

AIM:

Evaluate the resistance of dermatophytes to systemic antifungal drugs in the Vietnamese population.

METHODS:

We enrolled 101 patients with cutaneous dermatophytosis at the Dermato-Venereology hospital in HCMC from August 2016 to March 2017. All the specimens were subjected to direct examination (10% KOH mount) and culture on Sabouraud dextrose agar. In vitro antifungal sensitivity testing was done on species isolated from a culture with broth microdilution method.

RESULTS:

Direct microscopy was positive for dermatophytes in all patients. However this pathogen was found in fungal cultures in only 61.38% of patients. The main causative agent isolated was Trichophyton spp. (90.3%), followed by Microsporum spp. (8%) and Epidermophyton spp. (1.7%). Trichophyton spp. Has shown resistance to fluconazole, griseofulvin, ketoconazole, and itraconazole in 92.9%, 46.4%, 5.4% and 1.8% of strains, respectively. All Microsporum spp. Strains were found resistant to fluconazole and griseofulvin while resistance to ketoconazole was demonstrated in only 20% of strains and none of them was resistant to itraconazole. Epidermophyton spp strains were all resistant to fluconazole, griseofulvin, ketoconazole while none of them was resistant to itraconazole.

CONCLUSION:

Based upon our results, Itraconazole shows the greatest probability of efficacy in the treatment of cutaneous dermatophytosis in Vietnamese patients.

Dermatophytosis: Prevalence of Dermatophytes and Non-Dermatophyte Fungi from Patients Attending Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia

BACKGROUND

Dermatophytosis is a disease of major public health problem around the globe causing a considerable morbidity.

OBJECTIVE

To study the prevalence of dermatophytosis and the spectrum of fungi implicated in causing the infection.

METHODS

Nail, skin, and scalp scrapings were collected from 318 patients and were used for microscopy and culture study. Fungal pathogens were identified by studying the macroscopic and microscopic characteristics of their colonies.

RESULT

Tinea capitis was the predominant clinical manifestation consisting of 48.1% of the cases. Among 153 patients with tinea capitis, 73.2% were in the age group of 1-14 years. Of 318 study participants, 213 (67.98%) were found to be positive for dermatophytosis microbiologically. Out of 164 fungal isolates, 86 were dermatophytes and 78 were non-dermatophyte fungi. Among 86 dermatophytes, T. violaceum represented 38.4% of dermatophyte isolates and 89.7% of the isolates were recovered from tinea capitis. Of 76 non-dermatophyte molds, Aspergillus spp., Scytalidium dimidiatum, and Cladosporium spp. were the most common isolates, respectively.

CONCLUSIONS

Failure to detect or isolate fungal pathogens in a large number of clinical samples revealed the limitation of clinical diagnosis in differentiating dermatophytosis from other skin infections demonstrating that clinical diagnosis should be coupled with laboratory methods. Recovery of large number of non-dermatophyte fungi along with dermatophytes in our study showed that non-dermatophyte fungi are emerging as important causes of dermatophytosis, warranting the implementation of intensive epidemiological studies of dermatophytosis across the country.

Epidemiology of dermatomycoses in Kerman province, southeast of Iran: A 10-years retrospective study (2004-2014)

OBJECTIVES

Superficial and cutaneous fungal infections (SCFIs) are an important public health problem and are common in tropical and subtropical countries. Pityriasis versicolor, dermatophytosis, erythrasma, onychomycosis, and otomycosis are the major diseases associated with SCFIs. The aim of this study was to evaluate the prevalence and causative agents of dermatomycoses over a period of 10 years in Kerman province, southeast of Iran.

METHODS

A number of 1782 subjects, including 1096 females and 686 males, with cutaneous disorders in their skin, nail, and hair suspected to have SCFIs participated in this study. The collected specimens were examined using direct microscopy examination, staining, culture on specific media and PCR-RFLP technique.

RESULTS

In total, 617 (34.62%) subjects had SCFIs, of whom 290 (47%) were female and 327 (53%) were male. Identified SCFIs included yeast infections, dermatophytosis, saprophyte onychomycosis, erythrasma, and otomycosis due to non-dermatophytic molds (NDMs). The highest prevalence of dermatomycoses was found among the 41-50-year and 31-40-year age groups. Tinea unguium was the most common clinical pattern of dermatomycoses, and T. mentagrophytes was the predominant agent. Also, Aspergillus spp. were the most common NDMs agents of onychomycosis and otomycosis.

CONCLUSIONS

This study summarized the epidemiological trends and etiologic agents of SCFIs in a 10-year period in Kerman, southeast of Iran. Consideration of the current epidemiologic trends in the prevalence and knowledge of the exact causative agents of SCFIs may play an important key role towards further investigations, diagnosis, and modification of current treatments.