Dermatophyte agents in the city of São Paulo, from 1992 to 2002

Nannizzia species causing dermatophytosis in cats and dogs: First report of Nannizzia incurvata as an etiological agent in Brazil

Dermatophytosis is a superficial cutaneous infection, most commonly caused by fungal species such as Microsporum canis, Nannizzia gypsea (Microsporum gypseum), and Trichophyton mentagrophytes in dogs and cats. The zoonotic potential of these species is concerning, as companion animals are increasingly close to their owners. Therefore, the objectives of the study were to evaluate the current prevalence of Nannizzia-causing canine and feline dermatophytosis in Curitiba and Metropolitan Region, as well as perform phenotypic and phylogenetic characterizations of these isolates. Thus, 241 skin and fur samples from 163 dogs and 78 cats were analyzed from 2020 to 2021. The samples were obtained from animals of three sources: Veterinary Hospital of the Federal University of Paraná, animal shelters, and private clinics. The diagnosis was performed through phenotypic characterization and sequencing ITS rDNA region. Among 97 positive samples for dermatophytes, Nannizzia was identified in 14 (14.4%) samples, while other dermatophyte genera were found in the remaining 83 (85.6%) samples. Among the canine samples, nine (90%) were N. gypsea, and one (10%) was N. incurvata. Whereas in feline samples, three (75%) were N. gypsea, and one (25%) was N. incurvata. It was concluded that among 97 animals infected with dermatophytes, dogs (24.4%; 10/41) were significantly more affected by Nannizzia than cats (7.1%; 4/56) (P < .05). According to molecular analyses, the ITS rDNA region provided satisfactory results for species-level identification of Nannizzia, confirming the first report of N. incurvata as an etiological agent of canine and feline dermatophytosis in Brazil.

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.

Species distribution of the main aetiologic agents causing skin dermatophytosis in Colombian patients: A 23-year experience at a Mycological Reference Center

BACKGROUND

Dermatophytosis is one of the most frequent superficial mycoses in the world.

MAIN AIM

To describe the cases of skin dermatophytosis and its main aetiologic agents in patients referred to a Mycological Reference Laboratory in Medellín, Colombia.

METHODS

A retrospective study was carried out with records of patients referred between 1994 and 2016 to the Corporación para Investigaciones Biológicas (CIB), Medellín-Colombia, because of clinical suspicion of skin dermatophytosis.

RESULTS

Of a total of 5628 clinical records of patients with suspicion of skin dermatophytosis analysed, 2780 (49.4%) had a proven or probable dermatophytosis diagnosis, 2774 cultures were performed, and aetiologic agents were isolated in 2576 samples (92.9%). The most frequently isolated aetiologic agents were Trichophyton rubrum (44.3%), followed by Trichophyton mentagrophytes complex (33.3%), Epidermophyton floccosum (12.4%), Nannizzia gypseum complex (5.7%, formerly Microsporum gypseum), Microsporum canis (3.5%) and Trichophyton tonsurans (0.8%). The most frequent clinical forms were tinea pedis (72.7%) and tinea corporis (12.7%). In addition, a group of patients (0.9%) developed mixed infections by two dermatophyte agents and another (4.1%) developed infections in more than one anatomical site.

CONCLUSIONS

The results of the present study are coherent with previous reports where T rubrum and T mentagrophytes complex were the main causative agents of dermatophytosis. However, the increased incidence of N gypsea complex over M canis is worth highlighting.

Epidemiological investigation and molecular typing of dermatophytosis caused by Microsporum canis in dogs and cats

The objective of the present study was investigate the prevalence of dermatophytes in dogs, cats and environment floor through molecular epidemiology tools to identify the genetic profile of these infectious agents. This was an observational study with cross-sectional surveys design. Sample were collected from the hair and skin of 52 dogs and cats with the clinical suspicion of dermatophytosis, over a period of one year in Maringá, in the state of Paraná, Brazil. Household samples (carpets and floor), were collected from animals that were positive for dermatophytosis by morphological colonies characteristics, and samples of dogs or cats living in the same household as with the positive animals were also collected. After mycological confirmation, molecular typing was performed by random amplified polymorphic DNA (RAPD). Microsporum canis was the unic dermatophyto isolated whose prevalence was 26.9% (14/52) in animals with the clinical suspicion of dermatophytosis and four other animals that lived with positive animals. As some animals had more than one lesion site, there were 22 total positive cultures from samples from animals and another ten from abiotic sources. The majority of the animals that provided positive cultures for M. canis were aged up to five months (77.8%) and were female (66.7%). Molecular typing using the P1 primer revealed genetically distinct profiles in the symptomatic, asymptomatic and environmental animal samples, or the same animal, furthermore, showed that M. canis could have microevolution.

Human Infections with Microsporum gypseum Complex (Nannizzia gypsea) in Slovenia

Microsporum gypseum complex is a group of geophillic dermatophytes with a worldwide distribution and is a rare cause of dermatomycoses in humans. The infection most commonly presents as tinea corporis, with some geographical and occupational variations. We studied M. gypseum complex infections in patients examined in the Mycological Laboratory of the Department of Dermatovenereology, University Medical Centre Ljubljana, during the period 2000-2015. Diagnosis was confirmed by mycological examination. Skin scales were examined by direct microscopy and cultivated on Sabouraud glucose agar. A total of 226 patients were identified, representing 1.5% of all dermatophyte infections during the study period. Tinea corporis was diagnosed in majority of patients, followed by tinea manus, tinea faciei, tinea inguinalis and tinea pedis. Tinea capitis was observed in three and onychomycosis in two patients only. Infection was disseminated on different parts of the body in nine patients. In 39% of patients, infection was diagnosed in children younger than 9 years. Face and scalp infection was more often observed in children. The incidence was the highest during July and October. Contacts with soil and domestic animals were often reported. Data on the prevalence and clinical characteristics of M. gypseum complex infection in other countries are reviewed.

Clinico-microbiological study of dermatophytosis in a tertiary-care hospital in North Karnataka

Context:

The dermatophytoses constitute a group of superficial fungal infections of keratinized tissues, namely, the epidermis, hair, and nails. The distribution and frequency of dermatophytosis and their etiologic agents vary according to the geographic region studied, the socio-economic level of the population, the time of study, the climatic variations, the presence of domestic animals, and age.

Aims:

The present study was undertaken to assess the clinical profile of dermatophytic infections and to identify the causative fungal species in the various clinical presentations.

Settings and Design:

This was a hospital-based observational study.

Materials and Methods:

One hundred and fifty clinically suspected cases of dermatophytosis attending the outpatient department of a tertiary care hospital were included in the study. History was taken, general physical and cutaneous examination was done and details of skin lesions noted. Direct microscopy in 10% KOH (40% KOH for nail) and fungal culture on SDA with 0.05% chloramphenicol and 0.5% cycloheximide was done in every case.

Statistical Analysis Used:

Statistical analysis was done using SPSS 17.0 software. Chi-square test and contingency coefficient test were used as significant tests for analysis.

Results:

Out of 150 patients studied, majority belonged to the age group of 21–30 years (22.7%). Male-to-female ratio was 1.63:1. Tinea corporis (24.7%) was the most common clinical type observed. The overall positivity by culture was 40% and by direct microscopy was 59.3%. Trichophyton mentagrophytes was the predominant species isolated (48.3%).

Conclusions:

The present study reveals the changing trend in the prevalence of dermatophyte species in this part of Karnataka.

Determination of minimum inhibitory concentrations of itraconazole, terbinafine and ketoconazole against dermatophyte species by broth microdilution method

PURPOSE

Various antifungal agents both topical and systemic have been introduced into clinical practice for effectively treating dermatophytic conditions. Dermatophytosis is the infection of keratinised tissues caused by fungal species of genera Trichophyton, Epidermophyton and Microsporum, commonly known as dermatophytes affecting 20-25% of the world's population. The present study aims at determining the susceptibility patterns of dermatophyte species recovered from superficial mycoses of human patients in Himachal Pradesh to antifungal agents; itraconazole, terbinafine and ketoconazole. The study also aims at determining the minimum inhibitory concentrations (MICs) of these agents following the recommended protocol of Clinical and Laboratory Standards Institute (CLSI) (M38-A2).

METHODOLOGY

A total of 53 isolates of dermatophytes (T. mentagrophyte-34 in no., T. rubrum-18 and M. gypseum-1) recovered from the superficial mycoses were examined. Broth microdilution method M38-A2 approved protocol of CLSI (2008) for filamentous fungi was followed for determining the susceptibility of dermatophyte species.

RESULTS

T. mentagrophyte isolates were found more susceptible to both itraconazole and ketoconazole as compared to terbinafine (MIC50: 0.125 µg/ml for itraconazole, 0.0625 µg/ml for ketoconazole and 0.5 µg/ml for terbinafine). Three isolates of T. mentagrophytes (VBS-5, VBSo-3 and VBSo-73) and one isolate of T. rubrum (VBPo-9) had higher MIC values of itraconazole (1 µg/ml). Similarly, the higher MIC values of ketoconazole were observed in case of only three isolates of T. mentagrophyte (VBSo-30 = 2 µg/ml; VBSo-44, VBM-2 = 1 µg/ml). The comparative analysis of the three antifungal drugs based on t-test revealed that 'itraconazole and terbinafine' and 'terbinafine and ketoconazole' were found independent based on the P < 0.005 in case of T. mentagrophyte isolates. In case of T. rubrum, the similarity existed between MIC values of 'itraconazole and ketoconazole' and 'terbinafine and ketoconazole'.

CONCLUSION

The MIC values observed in the present study based on standard protocol M38-A2 of CLSI 2008 might serve as reference for further studies covering large number of isolates from different geographic regions of the state. Such studies might reflect on the acquisition of drug resistance among isolates of dermatophyte species based on MIC values.

In vitro activity of new azoles luliconazole and lanoconazole compared with ten other antifungal drugs against clinical dermatophyte isolates

In vitro susceptibilities of 100 clinical dermatophyte isolates belonging to five species from Iran toward lanoconazole and luliconazole were compared with ten other antifungal agents including econazole, itraconazole, miconazole, fluconazole, griseofulvin, butenafine, terbinafine, caspofungin, anidulafungin and tolnaftate. MIC and MEC values were analyzed according to CLSI M38-A2 document. The isolates were previously identified to the species level using PCR-RFLP on ITS rDNA region. The range of luliconazole and lanoconazole minimum inhibitory concentrations (MICs) was 0.016-0.032 and 0.063-1 μg/ml, respectively for dermatophyte species. Luliconazole and lanoconazole revealed potent activity against all dermatophyte isolates. Anidulafungin, caspofungin, and luliconazole showed the best activity with the lowest geometric mean 0.01, 0.016, and 0.018 μg/ml, respectively, followed by tolnaftate (0.06 μg/ml), terbinafine (0.07 μg/ml), itraconazole (0.183 μg/ml), butenafine (0.188 μg/ml), econazole (0.20 μg/ml), lanoconazole (0.24 μg/ml), griseofulvin (1.28 μg/ml), miconazole (2.34 μg/ml) and fluconazole (15.34 μg/ml). The current study demonstrated luliconazole and lanoconazole displayed excellent activity against all dermatophyte isolates, although the majority of dermatophyte isolates showed low susceptibility to griseofulvin and very low to miconazole, and fluconazole.

Epidemiological Characterization of Skin Fungal Infections Between the Years 2006 and 2010 in Korea

OBJECTIVES

The purpose of this study was to build and provide a basic database of skin fungal infections for the effective management of skin fungal infections in the future.

METHODS

We collected health insurance data between the years 2006 and 2010 from the Health Insurance Corporation (Seoul, Korea) and analyzed the data to determine the prevalence and treatment management of skin fungal infections.

RESULTS

Skin fungal infections were divided into two groups: namely dermatophytosis and other superficial mycoses. Dermatophytosis showed a higher prevalence (16,035,399 cases) than the other superficial mycoses (794,847 cases) within the study period. The prevalence rate decreased consecutively by 0.01% to 0.19% every year. The prevalence according to region showed that Jeolla-do had a high prevalence distribution. The prevalences in men and women were similar (7.01% vs. 6.26%). It is interesting to note that adults from the 50-79-year age group showed a higher prevalence than children and young adults. The average convalescence time (days) of dermatophytosis was longer than that of other superficial mycoses. The total medical expenses were also much higher in dermatophytosis than in the other superficial mycoses.

CONCLUSION

This study provides useful data for study trends of skin fungal infections.

Effectiveness of five antidandruff cosmetic formulations against planktonic cells and biofilms of dermatophytes

This study aimed to investigate the in vitro antifungal effectiveness of five different formulations against dandruff and ringworm dermatophytes. Candida albicans was also included in our assays. Fungal susceptibility tests were performed with planktonic cells and biofilms of reference strains. Microbiological and physicochemical quality parameters were assessed for all formulations. Our data indicated that the formulations were effective against the dermatophytes strains, and to our knowledge, the effectiveness of cosmetic formulations against fungal biofilms is shown for the first time. The formulations were considered effective against the explored dermatophytes and were considered safe given the adequate microbiological and physicochemical characteristics shown in the proposed assays.

Dermatophytosis and immunovirological status of HIV-infected and AIDS patients from Sao Paulo city, Brazil

Over the past decades, more people became infected with human immunodeficiency virus (HIV) and developed acquired immunodeficiency syndrome (AIDS). Because of that the incidence of fungal infections rose dramatically. It happened because this virus can modify the course of fungal diseases, leading to altered clinical pictures. The aim of this study was to evaluate epidemiological and biological aspects of dermatophytosis in HIV-positive and AIDS patients living in the city of São Paulo, Brazil. A total of 84 (44 HIV-positive and 40 AIDS) patients were enrolled in this study. The patients were tested for dermatophyte infections, as well as for the CD4(+) /CD8(+) and HIV viral load counts. Tinea unguium was most frequently observed in AIDS patients, whereas Tinea pedis was mostly observed in HIV-positive patients. The most frequent dermatophyte species was Trichophyton rubrum. CD4(+) counts and CD4(+) /CD8(+) ratios were not associated with a higher risk for dermatophytosis. On the other hand, viral load higher than 100 000 copies/ml was associated with a higher frequency of dermatophytosis. The results suggest to that although dermatophytosis is common in HIV-positive and AIDS patients, the degree of immunosuppression does not seems to correlate with increased risk of this fungal infection. In addition, high viral load as a predictive risk factor for dermatophyte infection should be subject of further evaluations.

Prevalence and risk factors for scrotal lesions/anomalies in a cohort of Brazilian men ≥ 40 years of age

OBJECTIVE

To estimate the prevalence of and risk factors for cutaneous lesions of the scrotum and intrascrotal lesions/anomalies among men included in a prostatic cancer screening program in a Brazilian metropolitan city.

DESIGN AND SETTING

Cross-sectional study, private outpatient healthcare service.

METHODS

1731 men aged 40 years or over, participating in a prostate cancer screening program conducted by the municipal public employees' healthcare system, underwent systematic urological assessment by a single examiner.

RESULTS

The prevalence of scrotal diseases in our sample was 44.7% (773/1731). Tinea cruris occurred in 203 (11.7%) of the participants, with higher risk among diabetics and lower prevalence among nonwhite individuals; scrotal tinea in eight (0.5%), with higher risk among hypertensive men; subcutaneous nodules in 12 (0.7%), especially in individuals with low schooling level; hydrocele in 283 (16.4%), with higher frequency among participants over the age of 60 years, diabetics or individuals with previous histories of nonspecific urethritis; spermatoceles in 174 (10.1%), with greater prevalence among individuals over the age of 60 years or diabetics, and lower frequency among individuals who underwent vasectomy; unilateral testicular hypotrophy/atrophy in 167 (9.7%) and bilateral hypotrophy/atrophy in 93 (5.4%), both occurring more frequently in individuals over the age of 60 years; absence of palpable testicles due to cryptorchidism in 7 (0.4%); and epididymitis/orchitis in 5 (0.3%), with higher prevalence among diabetics. No cases of cancer were identified in this sample.

CONCLUSIONS

Scrotal diseases were highly prevalent in this population of Brazilian men.

Dermatophytosis diagnosed at the Evandro Chagas Institute, Pará, Brazil

Dermatophytosis is caused by a dermatophyte fungus that affects the stratum corneum and keratinized tissue. Dermatophyte fungus has been reported worldwide as the causative agent of dermatophytosis, but the etio-epidemiological aspects of these mycoses in the state of Pará remain unknown. The purpose of this study was to describe the etio-epidemiological profile of dermatophytosis diagnosed in patients at the Evandro Chagas Institute from May 2005 to June 2006. A total of 494 patients were admitted, and their samples were collected, submitted for direct microscopic examination using 20% KOH and cultured in Sabouraud and Mycosel medium. The identification was based in macro and microscopic characteristics. Direct examinations were positive in 13% (66/494) of the patients, and agent isolation by cultivation of the biological sample was successful in 4% (20/494), with a high prevalence of T. mentagrophytes (40%; 8/20). Dermatophytosis was more frequent in women (58%; 38/66). Fifty-two percent (21/38) of the cases were children with an average age of 8 years. The most frequent clinical presentation was Tinea corporis (55%, 36/66). For the cases in which the dermatophyte agent was not isolated, we discuss the factors that may be interfering with isolation. Tinea corporis occurred more frequently observed when T. mentagrophytes and T. rubrum were the major etiologic agents.

Characterization of the cellular immunity in patients presenting extensive dermatophytoses due to Trichophyton rubrum

Dermatophytes invade the stratum corneum of the skin and other keratinized tissues such as hair and nails, and Trichophyton rubrum causes approximately 80% of cutaneous mycoses in humans. To evaluate the cellular immune response of patients with extensive dermatophytosis caused by T. rubrum, we evaluated lymphocyte populations, the lymphoproliferative response to: phytohaemagglutinin (PHA); anti-CD3 (OKT3); and pokeweed mitogen (PWM), Candida sp. (CMA), an extract of T. rubrum, and the main fungal epitope TriR2 (T). We also evaluated interleukin (IL)-4, IL-10, IL-12 and IFN-γ after stimulation by PHA, CMA and TriR2. The immunophenotyping showed no differences between patients and controls. The lymphoproliferation test showed significant differences between the groups stimulated by PWM and CMA, as well as against TriR2, being significantly higher for the control group. Conversely, there were similar results for the groups after stimulation by the extract. The cytokines' quantification showed a significant difference between the groups only for IFN-γ stimulated by PHA and TriR2. We can conclude that the fungal extract can stimulate lymphoproliferation by both groups' lymphocytes. However, the response to Tri r2 was more specific. We showed that some patients with extensive dermatophytosis have normal cellular response, recognising both the extract and TriR2.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Antifungal susceptibility of dermatophytes isolated from patients with chronic renal failure

BACKGROUND

The prevalence of dermatophytosis in the general population is high, particularly in patients with chronic renal failure. Treatment requires the use of topical and/or systemic antifungal drugs. The efficacy of antifungal agents for the treatment of dermatophytosis has yet to be evaluated. Studies evaluating the in vitro activity of antifungal agents are rare, particularly in filamentous fungi.

OBJECTIVE

To evaluate the susceptibility profile of different species of dermatophytes isolated from patients with chronic renal failure to nine antifungal drugs available on the market for the treatment of dermatophytosis.

METHODS

Twenty-six isolates of dermatophytes obtained from patients with chronic renal failure were analyzed with respect to their susceptibility to nine antifungal agents (ketoconazole, ciclopirox olamine, fluconazole, griseofulvin, itraconazole, miconazole, piroctone olamine, terbinafine and tioconazole), using the broth microdilution method proposed by the Clinical and Laboratory Standards Institute (CLSI) and adapted for dermatophytes.

RESULTS

Of the antifungal agents tested, the best results in terms of sensitivity were found with terbinafine and tioconazole, while the antifungal activity of fluconazole was found to be weak, particularly against strains of M. gypseum. Ciclopirox olamine, although less effective than terbinafine, also yielded satisfactory results.

CONCLUSIONS

In general, the sensitivity profile of the antifungal agents tested in this study was similar to results obtained in previous studies, confirming the need to determine which species is causing the dermatophytosis given that antifungal susceptibility varies from one species to another. Furthermore, the present findings show the importance of conducting in vitro sensitivity tests, since the sensitivity profile may differ among isolates of the same species.

Trichophyton tonsurans in a family microepidemic

Trichophyton tonsurans is a highly transmissible anthropophilic dermatophyte fungus, which invades keratinized tissues. This study reports a case of family microepidemic caused by this dermatophyte. Despite their excellent hygiene conditions, it remained active for several years, spreading to all family members. The hypothesis that the fungus was being kept alive in the family home was confirmed after samples collected from it were analyzed. Pure cultures of the fungus were isolated and identified. After diagnosis, the house was disinfected with concomitant oral treatment for all family members.

Antifungal susceptibility patterns of yeasts and filamentous fungi isolated from nail infection

BACKGROUND

Onychomycosis is the nail infection caused by a wide spectrum of fungi species, including yeasts, dermatophytes and filamentous fungi non-dermatophytes (FFND). This fungal infection represents an important medical problem because it involves the patient's life quality.

OBJECTIVE

The aim was to isolate and identify the fungal agents of onychomycosis, and to determine the in vitro susceptibility to antifungal agents.

METHODS

During the period of March 2008 to March 2009, 114 patients clinically suspected of having onychomycosis were examined. Demographic data, mainly age and gender were obtained from each patient. The nail samples collected (136) were submitted to direct examination with potassium hydroxide 20% and grown on Sabouraud dextrose agar. The in vitro antifungal susceptibility testing was performed according to the method of broth microdilution, recommended by the Clinical Laboratory Standards Institute (CLSI).

RESULTS

Onychomycosis was observed in 95 (83.3%) patients, including 16 men (16.8%) and 79 women (83.2%), with mean age of 48.1 years. Candida parapsilosis, Trichophyton rubrum and Fusarium spp were the fungi most frequently isolated. The most of the isolated yeasts showed susceptibility to antifungal agents studied. Among filamentous fungi, high MIC values to itraconazole were found for T. rubrum and T. mentagrophytes, while Fusarium spp showed decreased susceptibility to itraconazole and voriconazole.

CONCLUSION

C. parapsilosis was the most common fungal species isolated from patients with onychomycosis. The different response obtained by in vitro susceptibility testing to drugs shows the importance of these methods to assist clinicians in choosing the best therapeutic option.

Comparison of in vitro activity of five antifungal agents against dermatophytes, using the agar dilution and broth microdilution methods

The purpose of this study was to compare the agar dilution and broth microdilution methods for determining the minimum inhibitory concentration (MIC) of fluconazole, itraconazole, ketoconazole, griseofulvin and terbinafine for 60 dermatophyte samples belonging to the species Trichophyton rubrum, Trichophyton mentagrophytes and Microsporum canis. The percentage agreement between the two methods, for all the isolates with < 2 dilutions that were tested was 91.6% for ketoconazole and griseofulvin, 88.3% for itraconazole, 81.6% for terbinafine and 73.3% for fluconazole. One hundred percent agreement was obtained for Trichophyton mentagrophytes isolates evaluated with ketoconazole and griseofulvin. Thus, until a reference method for testing the in vitro susceptibility of dermatophytes is standardized, the similarity of the results between the two methods means that the agar dilution method may be useful for susceptibility testing on these filamentous fungi.

In vitro susceptibility testing of dermatophytes isolated in Goiania, Brazil, against five antifungal agents by broth microdilution method

The antifungal activities of fluconazole, itraconazole, ketoconazole, terbinafine and griseofulvin were tested by broth microdilution technique, against 60 dermatophytes isolated from nail or skin specimens from Goiania city patients, Brazil. In this study, the microtiter plates were incubated at 28 ºC allowing a reading of the minimal inhibitory concentration (MIC) after four days of incubation for Trichophyton mentagrophytes and five days for T. rubrum and Microsporum canis. Most of the dermatophytes had uniform patterns of susceptibility to the antifungal agents tested. Low MIC values as 0.03 µg/mL were found for 33.3%, 31.6% and 15% of isolates for itraconazole, ketoconazole and terbinafine, respectively.

Epidemiology of dermatophytoses in Sfax, Tunisia

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

Epidemiologia, etiologia e formas clínicas das dermatofitoses em Pernambuco, 1995-2005

Num total de 1.238 casos de dermatofitoses, ocorridas na Cidade de Recife /PE, observou-se predomínio das tinhas de couro cabeludo (33,7%) e Trichophyton tonsurans (25,5%), entre 1995 e 1999, enquanto as tinhas de pele glabra (35,5%) e Trichophyton rubrum (34%) foram mais freqüentes entre 2000 e 2005. Detectou-se importante redução do Trichophyton mentagrophytes, no último período.

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

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

Analysis of the dermatophyte species isolated in the British Isles between 1980 and 2005 and review of worldwide dermatophyte trends over the last three decades

Infections of the skin, hair and nails by dermatophyte fungi are common in developed and developing countries alike. However, the species involved and the resulting clinical entities vary both geographically and with time. We have surveyed 15,333 dermatophytes obtained from primary isolations at the Mycology Reference Laboratory, Bristol, UK from 1980 through 2005. Several striking trends in dermatophyte prevalence were apparent over this period. The relative frequencies of isolations of Microsporum canis (cat and dog ringworm), Trichophyton verrucosum (cattle ringworm), T. mentagrophytes var. mentagrophytes (rodent ringworm) and Epidermophyton floccosum (a cause of human groin and foot infections) all decreased by 90%. Conversely, the contributions of T. tonsurans and T. violaceum (two anthropophilic scalp-infecting species) to total dermatophyte isolations increased by 1000% over the same period. Finally, T. rubrum and T. mentagrophytes var. interdigitale, the two common causes of foot infection comprised 80% of all dermatophytes isolated in 1980 and 90% of isolations in 2005. Similar trends in dermatophyte prevalence were evidenced throughout the British Isles, based on the voluntary reporting of isolations from a large number of British laboratories at 5-yearly intervals over the same period. The implications of these changing patterns of dermatophyte species, and the clinical entities they produce are discussed in the context of a review of worldwide dermatophyte isolations over the last three decades, with emphasis on the causal agents of tinea capitis.

A twenty-year survey of dermatophytoses in Braga, Portugal

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Incidence of Tinea capitis in São Paulo, Brazil

To determine the incidence of tinea capitis in São Paulo, Brazil, an investigation was performed in Private and Public Pediatrics Service involving 4,500 children from 0 to 15 years old during 5 years (1996-2000). Samples were taken from 132 children with suspected fungal infection of the scalp, for direct microscopy and culture. Tinea of scalp was mycologically confirmed in 112 patients (85%). Males were more affected than females in all age groups. Children below 8 years old accounted for more than 75% of the occurrences. Only three cases of tinea capitis were diagnosed in children from 12 to 15 years of age. Tinea capitis was prevalent in 103 cases (91.96%); inflammatory kerion type lesions were diagnosed in 9 patients (8.04%). Microsporum canis (70.5%) and Trichophyton tonsurans (23.2%) were the most common agents followed by T. mentagrophytes (3.6%), M. gypseum (1.8%) and T. rubrum (0.9%).

Epidemiological and aetiological study on tinea pedis and onychomycosis in Algeria

Epidemiological studies on tinea pedis and onychomycosis, common fungal infections, have been conducted in many parts of the world. There are currently no studies of tinea pedis and/or onychomycosis in Algeria. The aim of this paper was to study the epidemiology of foot diseases, including tinea pedis and onychomycosis and to identify the aetiological factors of these infections in outpatients attending the Department of Dermatology of the Central Hospital of Army in Algiers, Algeria. A total of 1300 male subjects, mean age 35.9 +/- 16 years (range: 16-80) were recruited during the period November 2003 to November 2004 and were clinically examined. A complete dermatological examination was performed on all subjects, and skin and nail specimens of the feet were taken from those patients presenting signs of tinea pedis and/or onychomycosis for microscopy and fungal culture. Clinical diagnosis for tinea pedis and onychomycosis was suspected in 249 and 72 subjects, respectively, and confirmed in 197 and 60 cases, respectively, by positive cultures, resulting in a global prevalence of tinea pedis and toenail onychomycosis of 15% and 4.6% respectively. The age groups most commonly infected were 50-59 and 20-29 years. The yeast species Candida parapsilosis and the dermatophytic species Trichophyton rubrum were shown to be the most common pathogens in both tinea pedis (C. parapsilosis 20.4%; T. rubrum 17%) and onychomycosis (T. rubrum 35%; C. parapsilosis 28.3%). This is the first investigation dealing with fungal foot diseases in Algeria. The clinical and epidemiological data collected would serve as reference for future research and may be useful in the development of preventive and educational strategies.

Aspectos epidemiológicos das micoses dos pés em um time chinês de futebol

As infecções fúngicas podais podem interferir no desempenho esportivo ao provocar desconforto e dor nos atletas. O objetivo deste estudo foi avaliar a prevalência das infecções fúngicas podais em um time profissional de futebol, verificando os agentes mais freqüentes e os fatores predisponentes. O delineamento da pesquisa foi transversal e descritivo. A amostra foi composta de 22 homens, com idades entre 23 e 36 anos, integrantes do time de futebol profissional chinês, quando de sua participação de jogos em Curitiba (PR). Todos foram avaliados clinicamente e submetidos a exames micológicos (direto e cultura) de escamas de pele e unha dos pés e estudo histopatológico de fragmento ungueal. Os resultados encontrados foram: 12 casos (54,5%) não apresentavam micose; cinco casos (22,72%) apresentavam onicomicose isolada e cinco casos (22,72%) apresentavam onicomicose associada a tinea pedis, tendo como principal agente isolado o Trichophyton rubrum. Os fatores predisponentes apontados pelos atletas incluíram: banho em local público (85%), prática de esporte (76%), uso de calçados fechados (70%), contato com animal doméstico (63%) e irregularidade na higiene dos pés (50%). CONCLUSÃO: A freqüência da onicomicose em atletas chineses foi maior do que na população em geral. O agente mais freqüente foi o Trichophyton rubrum. Os hábitos individuais podem contribuir para a aquisição dessas infecções fúngicas, além do trauma direto pelo calçado e bola, bem como pelo contato físico durante treinos e jogos que podem favorecer lesões cutâneas e ungueais.

In vitro sensitivity of dermatophytes to urea

OBJECTIVE

Urea is commonly used as a keratolytic substance in the treatment of onychomycoses to improve the penetration of antifungal drugs in the lesion sites. The aim of the present study was to investigate the inhibitory action of urea on samples of dermatophytes in vitro.

METHOD

Minimum inhibitory concentration of urea was determined for 31 samples of dermatophytes cultured in Sabouraud-dextrose broth containing different concentrations (7.5% up to 40%) of urea. Absence of growth was the criterion adopted to determine the minimum inhibitory concentration.

RESULTS

The majority of samples (87%) were sensitive to urea at 12.5%, or less. 2 isolates of Trichophyton tonsurans and 2 of Trichophyton rubrum required 30%, and 40% urea, respectively, to be completely inhibited.

CONCLUSION

In vitro results demonstrate inhibitory activity of urea on dermatophytes, suggesting that it could be used as an adjuvant in topical treatments.

The complete DNA sequence of the mitochondrial genome of the dermatophyte fungus Epidermophyton floccosum

We report here the complete nucleotide sequence of the 30.9-kb mitochondrial genome of the dermatophyte fungus Epidermophyton floccosum. All genes are encoded on the same DNA strand and include seven subunits of the reduced nicotinamide adenine dinucleotide ubiquinone oxireductase (nad1, nad2, nad3, nad4, nad4L, nad5, and nad6), three subunits of cytochrome oxidase (cox1, cox2, and cox3), apocytochrome b (cob), three subunits of ATP synthase (atp6, atp8, and atp9), the small and large ribosomal RNAs (rns and rnl), and 25 tRNAs. A ribosomal protein gene (rps5) is present as an intronic ORF in the large ribosomal subunit. The genes coding for cob and cox1 carry one intron and nad5 carries two introns with ORFs. The mtDNA of E. floccosum has the same gene order as Trichophyton rubrum mtDNA, with the exception of some tRNA genes. Maximum likelihood phylogenetic analysis confirms T. rubrum as a close relative of E. floccosum. This is the first complete mitochondrial sequence of a species of the order Onygenales. This sequence is available under GenBank accession number AY916130.

Tinea capitis: epidemiologia e ecologia dos casos observados entre 1983 e 2003 na Faculdade de Medicina de Botucatu, Estado de São Paulo, Brasil

FUNDAMENTOS: Tinea capitis é importante infecção fúngica de interesse dermatológico e pediátrico. No Brasil sua prevalência é desconhecida, e os agentes causais principais são o Trichophyton tonsurans nas regiões Norte-Nordeste e o Microsporum canis no Sul-Sudeste do país. Conhecimento sobre gênero e espécies mais prevalentes tem importância sanitária e terapêutica. OBJETIVOS: Identificar espécies de dermatófitos, causa de Tinea capitis, em serviço universitário que atende clientela do Sistema Único de Saúde, de procedência urbana e rural, no interior do Estado de São Paulo. MÉTODOS: Amostras de casos clínicos suspeitos de Tinea capitis, procedentes da área de abrangência da Faculdade de Medicina de Botucatu-Unesp, foram investigadas por exame direto e cultivo visando ao diagnóstico e isolamento do agente causal. RESULTADOS: De 1.055 suspeitas, 594 foram confirmadas por exame direto, em 364 (61,1%) isolou-se o agente: M. canis em 88,2%, seguindo-se T. tonsurans (4,7%), T. rubrum (3,3%), M. gypseum (1,9%), T. mentagrophytes (1,6%). O sexo masculino correspondeu a 55,7% dos casos, e a faixa etária entre 0-5 anos predominou com 62,6% (p < 0,05). CONCLUSÕES: A prevalência detectada do M. canis superou o esperado para a Região Sudeste do Brasil. A freqüência de 88,2% pode estar influenciada por pacientes procedentes da zona rural. Esse dado deve ser considerado quando de decisão terapêutica.