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Abastabar M, Babaei M, Mohammadi R, Valadan R, Javidnia J, Zaedi A, Aghili SR, Haghani I, Khojasteh S, Reazaei-Matehkolaei A, Kiasat N, Hesari KK, Ghasemi Z, Azish M, Zarrinfar H, Taghizadeh-Armaki M, Keikha N, Kharazi M, Khodadadi H, Hedayati MT, Shokohi T. Iranian National Survey on Tinea Capitis: Antifungal Susceptibility Profile, Epidemiological Characteristics, and Report of Two Strains with a Novel Mutation in SQLE Gene with Homology Modeling. Mycopathologia 2023; 188:449-460. [PMID: 35980496 DOI: 10.1007/s11046-022-00657-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The data on the epidemiological and antifungal susceptibility profile of tinea capitis (TC) in Iran has not been updated in recent decades. This report presents the Iranian epidemiological and drug susceptibility data regarding the distribution of dermatophytes species isolated by six national mycology centers for a period of one year (2020-2021). MATERIAL AND METHODS A total of 2100 clinical samples from individuals suspeted to TC were subjected to mycological analysis of direct microscopy and culture. For definite species identification, the culture isolates were additionally subjected to PCR-RFLP and PCR-sequencing of the ITS ribosomal DNA (ITS-rDNA) region. Antifungal susceptibility profiles for eight common antifungal drugs were determined by CLSI M38-A3 guidelines. The SQLE gene was partially amplified and sequenced in two terbinafine-resistant and two susceptible T. mentagrophytes isolates to elucidate probable substitutions involved in resistance. RESULTS TC (n = 94) was diagnosed in 75 children (79.8%) and 19 adults (20.2%) by direct microscopy and culture. Frequency of TC was significantly more among males (66 males = 70.2% vs 28 females = 29.8%). The prevalent age group affected was 5-9 years (39.36%). Thirty-two (34.04%) T. mentagrophytes, 27 (28.7%) T. tonsurans, 14 (14.9%) M. canis, 13 (13.8%) T. violaceum, 5 (5.32%) T. indotineae, 2 (2.1%) T. benhamiae, and 1 (1.1%) T. schoenleinii were identified as the causative agents. MIC values of isolates showed susceptibility to all antifungal agents, except for fluconazole and griseofulvin with GM MIC of 11.91 μg/ml and 2.01 μg/ml, respectively. Terbinafine exhibited more activity against isolates, with GM MIC 0.084 μg/ml followed by ketoconazole (0.100 μg/ml), econazole (0.107 μg/ml), itraconazole (0.133 μg/ml), butenafine (0.142 μg/ml), and miconazole (0.325 μg/ml). Two resistant T. mentagrophytes isolates harbored missense mutations in SQLE gene, corresponding to amino acid substitution F397L. Remarkably, one unique mutation, C1255T, in the SQLE sequence of two terbinafine-susceptible T. mentagrophytes strains leading to a change of leucine at the 419th position to phenylalanine (L419F) was detected. CONCLUSIONS T. mentagrophytes, T. tonsurans, and M. canis remained the main agents of TC in Iran, however less known species such as T. indotinea and T. benhamiae are emerging as new ones. Terbinafine could still be the appropriate choice for the treatment of diverse forms of TC.
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Affiliation(s)
- Mahdi Abastabar
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Babaei
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Valadan
- Molecular and Cell Biology Research Center (MCBRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - Javad Javidnia
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Arezoo Zaedi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Reza Aghili
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iman Haghani
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shaghayegh Khojasteh
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Reazaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Kiasat
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Kamyab Hesari
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghasemi
- Department of Medical Mycology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Azish
- Department of Parasitology and Medical Mycology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Taghizadeh-Armaki
- Department of Parasitology and Mycology, Infectious Diseases and Tropical Medicine Research Center, Health Research Center, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Naser Keikha
- Medical Laboratory Sciences Department, Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahboobeh Kharazi
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Khodadadi
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Taghi Hedayati
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Tahereh Shokohi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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Chen XQ, Yu J. Global Demographic Characteristics and Pathogen Spectrum of Tinea Capitis. Mycopathologia 2023; 188:433-447. [PMID: 37012556 DOI: 10.1007/s11046-023-00710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/07/2023] [Indexed: 04/05/2023]
Abstract
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.
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Affiliation(s)
- Xiao-Qing Chen
- Department of Dermatology and Venereology, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, China
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Jin Yu
- Department of Dermatology and Venereology, National Clinical Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, China.
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T. Hedayati M, Kermani F, Javidnia J, Moosazadeh M, Nosratabadi M, Salimi M, Asadi S, Mosayebi E, Hajheydari Z, Golpour M, Rahmatpour Rokni G, Kazemi Nejad A, Shokohi T, Bongomin F. Predominance of Trichophyton tonsurans causing tinea capitis: A 12-year retrospective study in the north of Iran. Curr Med Mycol 2023; 9:21-27. [PMID: 37867593 PMCID: PMC10590191 DOI: 10.18502/cmm.2023.345026.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/06/2023] [Accepted: 07/13/2023] [Indexed: 10/24/2023] Open
Abstract
Background and Purpose Among different clinical entities of dermatophytosis, tinea capitis (TC) is considered a major public health challenge in the world, especially in regions with poor health and low income. Therefore, this study aimed to provide a retrospective analysis of the patients suspected of TC who were referred to the medical mycology laboratory of Mazandaran, a northern province of Iran. Materials and Methods A retrospective analysis was performed on the patients suspected of TC who were referred to the medical mycology laboratory from July 2009 to April 2022. Hair roots and skin scrapings were collected from the participants. The laboratory diagnosis was confirmed by direct microscopic examination and culture. Finally, 921 out of 11095 (8.3%) patients were suspected of TC. Results Based on the findings, TC was confirmed in 209 out of 921 patients (22.7%). In terms of gender, 209 TC patients (75.1%) were male. Moreover, the male to female ratio of TC patients was 1:3.0. Trichophyton tonsurans (146/174, 83.91%) was the most etiological agent, followed by T. mentagrophytes (13/174, 7.47%), T. violaceum (9/174, 5.17%), Microsporum canis (3/174, 1.71%), T. verrucosum (2/174, 1.15%) and T. rubrum (1/174, 0.57%). Besides, endothrix (77.0%) was the most prevalent type of hair invasion. Conclusion The results revealed the predominance of T. tonsurans, as a causative agent of TC. Despite the prevalence of TC, the absence of appropriate consideration highlights that it is a neglected complication among children.
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Affiliation(s)
- Mohammad T. Hedayati
- Invasive Fungi Research Centre (IFRC), Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Firoozeh Kermani
- Invasive Fungi Research Centre (IFRC), Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Javad Javidnia
- Invasive Fungi Research Centre (IFRC), Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohsen Nosratabadi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Salimi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sabrieh Asadi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Mosayebi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zohreh Hajheydari
- Department of Dermatology, School of Medicine, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoud Golpour
- Department of Dermatology, School of Medicine, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ghasem Rahmatpour Rokni
- Department of Dermatology, School of Medicine, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Armaghan Kazemi Nejad
- Department of Dermatology, School of Medicine, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Centre (IFRC), Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Bitew A, Yilma B, Taye T. High Trichophyton violaceum-Induced Tinea Capitis with Isolation of Many Non-Dermatophyte Molds in Scalp Scrapings in Patients Referred to a Dermatology Clinic in Addis Ababa, Ethiopia. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:1313-1324. [PMID: 35847420 PMCID: PMC9285527 DOI: 10.2147/ccid.s367763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022]
Abstract
Objective This work aimed to determine the magnitude of tinea capitis, the diversity and species composition of fungi, and the predominant dermatophytes implicated in causing tinea capitis. Methods A prospective, cross-sectional study was conducted at a dermatology clinic. Scalp scrapings were collected and cultured, and dermatophyte and non-dermatophyte molds were identified. Results Of 364 scalp scrapings, fungi were recovered from 301 (82.7%) clinical samples. About 60.7% of the samples were collected from women, while 39.3% were collected from male study subjects. The association between the magnitude of scalp ringworm and gender was not statistically significant (P = 0.105). Two hundred eighty study subjects were less than 15 years of age, of which 254 were culture positive. The association of tinea capitis and the age of patients was statistically significant (P = 0). Three hundred forty-nine fungal isolates were isolated, of which 54.2% were dermatophytes, while 45.8% were non-dermatophyte molds. The occurrence of dermatophytes in their decreasing order was T. violaceum (138; 73%), Trichophyton mentagrophytes (18; 9.5%), Trichophyton tonsurans (16; 8.5%), Trichophyton verrucosum (8; 4.5%), Microsporum audouinii (7; 3.7%), Trichophyton schoenleinii (1; 0.5%), and Trichophyton soudanense (1; 0.5%). Conclusion A high prevalence rate of T. violaceum-induced tinea capitis was reported. The magnitude of scalp ringworm in adults was remarkably high. Therefore, conducting a nationwide epidemiological survey on tinea capitis regardless of age is suggested. The isolation of many non-dermatophyte molds in the current study may shade questions about the perception that tinea capitis is caused by dermatophytes only. Therefore, studies on their potential pathogenic role on skin and skin-related (nail and the scalp) infections appear to be an active field of research.
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Affiliation(s)
- Adane Bitew
- Department of Medical Laboratory Science, College Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Betelhem Yilma
- Saint Peter's Specialized Tuberculosis Referral Hospital, Addis Ababa, Ethiopia
| | - Tomas Taye
- Rank Specialized Dermatology Clinic, Addis Ababa, Ethiopia
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Abstract
Trichophyton (T.) tonsurans is considered as the main causative agent of tinea gladiatorum (ringworm) in contact and martial arts worldwide and regularly leads to outbreaks. In the national wrestling squad in Leipzig, dermatophytoses occurred frequently and recurrently in children and adolescents for over a 2-year period. The wrestlers came to the dermatologist's office for clinical examination and sampling. Dermal scales and hair roots as well as smears were examined mycologically with fluorescence optical preparation, fungal culture, and polymerase chain reaction (PCR) for dermatophyte DNA. Sequencing of the dermatophyte rDNA served as culture confirmation test. Environmental investigations in the wrestler training center included contact cultures and smears from surfaces, in particular from the mats. T. tonsurans was culturally and/or with PCR detectable in 21 out of 25 children and adolescents plus one trainer. T. tonsurans grew in one of ten contact cultures of mats and floors in the wrestling training center, and T. interdigitale was found in another culture. Smears from the mats resulted in a culture of T. tonsurans detection twice. The PCR was positive for T. tonsurans three times. Within 14 days, T. tonsurans developed small, flat, radiating, granular and white-colored colonies with a mahogany-brown reverse side on the fungal culture media. The sequencing of the internal transcribed spacer (ITS) region of the rDNA and the translation elongation factor 1 α (TEF 1 α) gene confirmed the species T. tonsurans in all cases. T. interdigitale that was found from a mat was also identified by sequencing. Eight T. tonsurans strains were subjected to in vitro susceptibility testing to terbinafine. All isolates were sensitive to terbinafine in vitro with minimal inhibitory concentrations of ≤ 0.1 µg/ml.
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