Species distribution and antifungal susceptibility profiles of yeasts isolated from onychomycosis: a cross-sectional study with insights into emerging species

Candida onychomycosis is a common fungal infection affecting the nails, primarily caused by Candida (C.) species. Regarding the increasing trend of Candida onychomycosis and the antifungal resistant phenomenon in recent years, this study aims to evaluate the epidemiological characteristics of Candida onychomycosis, the distribution of emerging species, and the antifungal susceptibility profiles of isolates. Onychomycosis caused by yeast species was confirmed through direct examination and culture of nail scraping among all individuals suspected to have onychomycosis and referred to a medical mycology laboratory between June 2019 and March 2022. Species of yeast isolates were identified using the multiplex PCR and PCR-RFLP methods. The antifungal susceptibility of isolates to common antifungal agents and imidazole drugs was evaluated according to the M-27-A3 CLSI protocol. Among 101 yeast strains isolated from onychomycosis, Candida parapsilosis complex (50.49%) was the most common species, followed by C. albicans (20.79%) and C. tropicalis (10.89%). Rare species of yeasts such as C. guilliermondii and Saccharomyces cerevisiae were also identified by molecular methods. Results obtained from antifungal susceptibility testing showed significant differences in MIC values of isoconazole, fenticonazole, and sertaconazole among different species. Overall, a fluconazole-resistant rate of 3% was found among Candida species. Moreover, there was a statistically significant difference in MICs of fenticonazole and clotrimazole between the two most prevalent causative species, C. parapsilosis complex and C. albicans. Correct identification of the causative agents of onychomycosis and performing susceptibility testing could be helpful in choosing the most appropriate antifungal therapy.

ONYCHOMYCOSIS FINGER AND TOE NAIL BY CRYPTOCOCCUS LAURENTII.T VERRUCOSSUM AND CANDIDA SP

ONYCHOMYCOSIS FINGER AND TOE NAIL BY Cryptococcus laurentii, Trychophyton verrucosum, and Candida sp  Dhelya Widasmara, Diane Tantia SariDepartment of Dermatology and Venereology, Medical Faculty, Brawijaya Universitydr.Saiful Anwar Regional Public Hospital, Malang, IndonesiaEmail: dhelya.widasmara@gmail.com AbstractIntroduction : Onychomycosis is included in most common nail disease and contributes to 50% of onychodystropic events. So far, there are rare cases of onychomycosis due to Cryptoccus laurentii and Trychophyton verrucosum. Case : Woman, 54 y.o, complaining of brittle nails and cracked on the soles of the feet and hands since 6 months ago. Patients have daily habits to go to rice fields without gloves and footwear, and rarely wash their hands and feet after the rice fields. Dermatologic examination of all unguium digiti manus and the right and left hand, obtained discolorization of yellow and white and some blackish, subungual hyperkeratosis, onikolisis, and onikodistrofik. In plantar dekstra et sinistra, obtained erythema plaque, multiple, irregular shape, varied size, with rough skuama, as well as multiple yellow and white hyperkeratotic plaques with fissures. A 20% KOH examination of a hand and foot nail, both of which obtained a long septae hyphae. Periodic Acid-Schiff coloration (PAS) obtained a description of spores. Fungal culture from fingernail obtained growth of Criptococcus laurentii and Trichophyton spp., culture of toenails obtained growth Trichophyton verrucosum and Candida sp. Patients were treated with itraconazole tablet dose of 2x200mg / day dose for a week every month, gentamicin ointment, and 20% urea cream, myologic improvement after 4 weeks of therapy. Discussion : The incidence of onychomycosis due to Cryptoccus laurentii and Trychophyton verrucosum is still rare. The predisposing factor of infection in these patients is due to the patient's habitual contact with the paddy fields. Keywords : onychomycosis, Cryptococcus laurentii, Trychophyton verrucosum

Comparison of topical anti- fungal agents sertaconazole and clotrimazole in the treatment of tinea corporis-an observational study

OBJECTIVES

To compare the efficacy of topical antifungal agents, Sertaconazole and Clotrimazole in Tinea corporis patients.

MATERIALS AND METHODS

A total of 60(n=60) patients were included in the study. They were divided into two groups of 30 patients each. First group included patients treated with topical Sertaconazole as test drug whereas the second group constituted patients treated with topical Clotrimazole as standard drug. The patients were advised to apply the drug on affected area twice daily for three weeks. The parameters like erythema, scaling, itching, margins and size of the lesion and KOH mount were taken for the assessment of efficacy. This was an open labelled study and patients were followed up every week for three weeks.

RESULTS

The total score included all grades in erythema, itching, scaling, margins and size of lesion and KOH mount. There was significant reduction in erythema (p<0.02) and highly significant reduction in scaling (p<0.001), itching (p<0.001) and margins of lesion (p<0.001) among Sertaconazole group. The mean difference and the standard deviation of total scores for Clotrimazole were 7.20 and 1.69 and for Sertaconazole group 8.80 and 1.52 respectively. The p-value on application of students unpaired t- test was p<0.001 (Highly significant).

CONCLUSION

From the present study, it can be concluded that topical Sertaconazole shows better improvement in the clinical parameters than topical Clotrimazole within a span of three weeks in the treatment of T corporis.

Sertaconazole: an antifungal agent for the topical treatment of superficial candidiasis

Sertaconazole is a useful antifungal agent against mycoses of the skin and mucosa, such as cutaneous, genital and oral candidiasis and tinea pedis. Its antifungal activity is due to inhibition of the ergosterol biosynthesis and disruption of the cell wall. At higher concentrations, sertaconazole is able to bind to nonsterol lipids of the fungal cell wall, increasing the permeability and the subsequent death of fungal cells. Fungistatic and fungicidal activities on Candida are dose-dependent. The antifungal spectrum of sertaconazole includes deramophytes, Candida, Cryptococcus, Malassezia and also Aspergillus, Scedosporium and Scopulariopsis. Sertaconazole also shows an antimicrobial activity against streptococci, staphylococci and protozoa (Trichomonas). In clinical trials including patients with vulvovaginal candidiasis, a single dose of sertaconazole produced a higher cure rate compared with other topical azoles such as econazole and clotrimazole, in shorter periods. Sertaconazole has shown an anti-inflammatory effect that is very useful for the relief of unpleasant symptoms.

Sertaconazole antifungal profile determined by a microdilution method versus nine topical substances against dermatophyte fungi

Antifungal activity and in vitro inhibition time for sertaconazole (STZ) and 9 other topical drugs, namely amorolfine, bifonazole, clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, terbinafine, and tioconazole were determined against 124 clinical isolates of dermatophyte (12 species) fungi by the microdilution method in a liquid medium and the measurement of optical density. STZ's antifungal activity was not always affected by the tested dermatophyte genus, as was the case with the remaining antifungals. In vitro antifungal activity was at the same level for all the studied azole derivatives, but, in terms of partial inhibitory concentrations, STZ starts its in vitro inhibitory activity in a shorter time than the other tested substances, particularly in those incubation periods when the growth of the dermatophyte fungi was more developed.

Sertaconazole nitrate shows fungicidal and fungistatic activities against Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum, causative agents of tinea pedis

The fungistatic and fungicidal activities of sertaconazole against dermatophytes were evaluated by testing 150 clinical isolates of causative agents of tinea pedis, Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum. The overall geometric means for fungistatic and fungicidal activities of sertaconazole against these isolates were 0.26 and 2.26 μg/ml, respectively, although values were higher for T. mentagrophytes than for the others. This is the first comprehensive demonstration of the fungicidal activity of sertaconazole against dermatophytes.

Characterization of the antimicrobial susceptibility of fungi responsible for onychomycosis in Spain

Due to the increase of choices relative to antifungals, there is a need to improve the standardization of in vitro methods used to determine the antifungal susceptibility of fungal pathogens. Our study evaluated the in vitro susceptibility of filamentous fungi isolated from patients with toenail onychomycosis against itraconazole, ciclopirox, eberconazole, fluconazole and terbinafine. The minimum inhibitory concentration (MIC) of these antifungal agents was determined with 100 isolates, including dermatophytes (70 strains) and non-dermatophyte molds (30 strains). The susceptibility of fungal isolates was measured by using a technique modified for dermatophytes (0.5 × 10(3)-0.5 × 10(4) conidia/ml as inocula) which followed the procedures described by the Antifungal Susceptibility Testing Subcommittee of the European Committee on Antimicrobial Susceptibility Testing (AFST-EUCAST) and the Clinical and Laboratory Standard Institute (CLSI M38-A). MIC ranges were 0.016-8.0 μg/ml for itraconazole, ciclopirox and eberconazole, 0.063-32.0 μg/ml for fluonazole, and 0.004-2.0 μg/ml for terbinafine. In vitro susceptibility tests indicated that eberconazole has a broad antimicrobial profile, including dermatophytes, as well as other filamentous fungi. Terbinafine was active (0.016-0.250 μg/ml) against dermatophytes.