A Case of Tinea Pedis in a Child Caused by Trichophyton interdigitale with Two Different Colony Phenotypes on Primary Culture

Detection of terbinafine-resistant Trichophyton indotineae isolates within the Trichophyton mentagrophytes species complex isolated from patients in Hue City, Vietnam: A comprehensive analysis

The Trichophyton mentagrophytes complex comprises a group of dermatophyte fungi responsible for various dermatological infections. The increasing drug resistance of this species complex, especially terbinafine resistance of Trichophyton indotineae, is a major concern in dermatologist practice. This study provides a comprehensive analysis of T. mentagrophytes complex strains isolated from patients in Hue City, Vietnam, focusing on their phenotypic and genetic characteristics, antifungal susceptibility profiles, and molecular epidemiology. Keratinophilic fungi from dermatophytosis culture samples were identified morphologically and phenotypically, with species and genotypes confirmed by internal transcribed spacer sequencing and phylogenetic analysis. Antifungal susceptibility testing was carried out to evaluate their susceptibility to itraconazole, voriconazole, and terbinafine. The 24% (n = 27/114) of superficial mycoses were phenotypically attributed to T. mentagrophytes complex isolates. Trichophyton interdigitale, mainly genotype II*, was predominant (44.4%), followed by T. mentagrophytes genotype III* (22.2%), T. indotineae (14.8%), T. tonsurans (11.2%), and T. mentagrophytes (7.4%). While all isolates were susceptible to itraconazole and voriconazole, half of T. indotineae isolates exhibited resistance to terbinafine, linked to the Phe397Leu mutation in the SQLE protein. This study highlighted the presence of terbinafine-resistant T. indotineae isolates in Vietnam, emphasizing the need to investigate dermatophyte drug resistance and implement effective measures in clinical practice.

Tinea pedis: an updated review

Background

Tinea pedis is one of the most common superficial fungal infections of the skin, with various clinical manifestations. This review aims to familiarize physicians with the clinical features, diagnosis and management of tinea pedis.

Methods

A search was conducted in April 2023 in PubMed Clinical Queries using the key terms 'tinea pedis' OR 'athlete's foot'. The search strategy included all clinical trials, observational studies and reviews published in English within the past 10 years.

Results

Tinea pedis is most often caused by Trichophyton rubrum and Trichophyton interdigitale. It is estimated that approximately 3% of the world population have tinea pedis. The prevalence is higher in adolescents and adults than in children. The peak age incidence is between 16 and 45 years of age. Tinea pedis is more common amongst males than females. Transmission amongst family members is the most common route, and transmission can also occur through indirect contact with contaminated belongings of the affected patient. Three main clinical forms of tinea pedis are recognized: interdigital, hyperkeratotic (moccasin-type) and vesiculobullous (inflammatory). The accuracy of clinical diagnosis of tinea pedis is low. A KOH wet-mount examination of skin scrapings of the active border of the lesion is recommended as a point-of-care testing. The diagnosis can be confirmed, if necessary, by fungal culture or culture-independent molecular tools of skin scrapings. Superficial or localized tinea pedis usually responds to topical antifungal therapy. Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis or in immunocompromised patients.

Conclusion

Topical antifungal therapy (once to twice daily for 1-6 weeks) is the mainstay of treatment for superficial or localized tinea pedis. Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate and amorolfine. Oral antifungal agents used for the treatment of tinea pedis include terbinafine, itraconazole and fluconazole. Combined therapy with topical and oral antifungals may increase the cure rate. The prognosis is good with appropriate antifungal treatment. Untreated, the lesions may persist and progress.

Antifungal Activity and the Chemical and Physical Stability of Microemulsions Containing Citrus hystrix DC Leaf Oil

Citrus hystrix DC (kaffir lime) leaf oil exhibited antifungal activities against Aspergillus niger and Candida albicans. This study aimed to evaluate the antifungal activity of kaffir lime leaf oil and microemulsions containing kaffir lime oil against Trichophyton mentagrophytes var. interdigitale. The chemical components of kaffir lime leaf oil were analyzed by gas chromatography coupled with mass spectrometry. Microemulsions containing kaffir lime oil were formulated using Tween 80, propylene glycol, and water using a phase titration method. The microemulsion of kaffir lime leaf oil was evaluated for droplet size, polydispersity index, and zeta potential using a dynamic light scattering technique. The antifungal activities of kaffir lime oil and its microemulsion were investigated through macrodilution and agar well diffusion methods, respectively. The degradation of citronellal in the microemulsion was analyzed by validated UV-Visible spectrophotometry. The minimum inhibitory concentration value of kaffir lime oil was 1.08 ± 0.00 mg/mL. The microemulsion of kaffir lime leaf oil exhibited potent antifungal activity against T. mentagrophytes var. interdigitale. The size, polydispersity index, and zeta potential of freshly prepared microemulsion were 12.82 ± 0.40 nm, 0.183 ± 0.072, and −7.87 ± 0.06 mV, respectively. The microemulsion of kaffir lime leaf oil also demonstrated good physical and chemical stability at specific temperatures. The kaffir lime oil microemulsion was highly stable when stored at 4 °C and 30 °C for 1 month but was unstable at 45 °C. The microemulsion of kaffir lime leaf oil may be an alternative therapeutic against tinea pedis caused by T. mentagrophytes var. interdigitale.