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Zacharopoulou A, Tsiogka A, Tsimpidakis A, Lamia A, Koumaki D, Gregoriou S. Tinea Incognito: Challenges in Diagnosis and Management. J Clin Med 2024; 13:3267. [PMID: 38892976 PMCID: PMC11172699 DOI: 10.3390/jcm13113267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/07/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Tinea incognito is a dermatophyte infection with atypical features, due to the use of topical or systemic steroids or other immunosuppressive medications. Delayed diagnosis, spread of the infection to critical body surfaces, resistance to antifungal drugs, and increased costs due to prolonged hospitalization and multiple treatment regimens often complicate tinea incognito. It can affect individuals of all ages and genders, but it is more common in children. Atypical clinical appearance often necessitates differentiation from other diseases such as eczema, seborrheic dermatitis, lupus erythematosus, psoriasis, or other non-fungal skin conditions. The treatment of tinea incognito usually involves discontinuation of topical steroids or other immunosuppressive medications. Preventive measures and management of the underlying fungal infection are necessary and can be achieved with antifungal drugs. Patients should wear loose cotton clothes, use boiling water for laundry, and iron their clothing before wearing them. Additionally, they should avoid sharing bed linens, towels, clothes, and shoes. This review aims to raise awareness of tinea incognito among health practitioners, provide tips for detecting the disorder, include it in the differentials, and evaluate the available diagnostic procedures.
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Affiliation(s)
- Aikaterini Zacharopoulou
- Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, 16121 Athens, Greece; (A.T.); (A.T.); (A.L.); (S.G.)
| | - Aikaterini Tsiogka
- Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, 16121 Athens, Greece; (A.T.); (A.T.); (A.L.); (S.G.)
| | - Antonios Tsimpidakis
- Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, 16121 Athens, Greece; (A.T.); (A.T.); (A.L.); (S.G.)
| | - Androniki Lamia
- Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, 16121 Athens, Greece; (A.T.); (A.T.); (A.L.); (S.G.)
| | - Dimitra Koumaki
- Dermatology Department, University Hospital of Heraklion, 71110 Heraklion, Greece;
| | - Stamatios Gregoriou
- Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, 16121 Athens, Greece; (A.T.); (A.T.); (A.L.); (S.G.)
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Bescrovaine JDO, Warth JFG, de Souza C, Benoni VW, Baja F, Schneider GX, Vicente VA, de Hoog GS, Queiroz-Telles F. Nannizzia species causing dermatophytosis in cats and dogs: First report of Nannizzia incurvata as an etiological agent in Brazil. Med Mycol 2023; 61:myad105. [PMID: 37804177 DOI: 10.1093/mmy/myad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023] Open
Abstract
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.
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Affiliation(s)
- Jéssica de Oliveira Bescrovaine
- Postgraduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
- Laboratory of Immuno-Microbiological Diagnosis of the Veterinary Hospital, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, Brazil
| | - José Francisco Ghignatti Warth
- Laboratory of Immuno-Microbiological Diagnosis of the Veterinary Hospital, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, Brazil
| | - Cybelle de Souza
- Laboratory of Immuno-Microbiological Diagnosis of the Veterinary Hospital, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, Brazil
| | | | - Franciele Baja
- Postgraduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Gabriela Xavier Schneider
- Postgraduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Vania Aparecida Vicente
- Postgraduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Gerrits Sybren de Hoog
- Centre of Expertise in Mycology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Flavio Queiroz-Telles
- Postgraduate Program in Microbiology, Parasitology and Pathology, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
- Department of Public Health, Federal University of Paraná, Curitiba, Brazil
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Khurana A, Sharath S, Sardana K, Chowdhary A, Panesar S. Therapeutic Updates on the Management of Tinea Corporis or Cruris in the Era of Trichophyton Indotineae: Separating Evidence from Hype-A Narrative Review. Indian J Dermatol 2023; 68:525-540. [PMID: 38099117 PMCID: PMC10718250 DOI: 10.4103/ijd.ijd_832_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
The emergence and spread of Trichophyton indotineae (T. indotineae) has led to a sea change in the prescription practices of clinicians regarding the management of dermatophytic skin infections. An infection easily managed with a few weeks of antifungals, tinea corporis or cruris, is now often chronic and recurrent and requires prolonged treatment. Rising resistance to terbinafine, with documented squalene epoxidase (SQLE) gene mutations, and slow clinical response to itraconazole leave clinicians with limited treatment choices. However, in these testing times, it is essential that the tenets of antifungal stewardship be followed in making therapeutic decisions, and that the existing armamentarium of antifungals be used in rationale ways to counter this extremely common cutaneous infection, while keeping the growing drug resistance among dermatophytes in check. This review provides updated evidence on the use of various systemic antifungals for dermatophytic infection of the glabrous skin, especially with respect to the emerging T. indotineae species, which is gradually becoming a worldwide concern.
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Affiliation(s)
- Ananta Khurana
- From the Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Savitha Sharath
- From the Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Kabir Sardana
- From the Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Sanjeet Panesar
- Department of Community Medicine, ABVIMS and Dr. RML Hospital, New Delhi, India
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Chanyachailert P, Leeyaphan C, Bunyaratavej S. Cutaneous Fungal Infections Caused by Dermatophytes and Non-Dermatophytes: An Updated Comprehensive Review of Epidemiology, Clinical Presentations, and Diagnostic Testing. J Fungi (Basel) 2023; 9:669. [PMID: 37367605 DOI: 10.3390/jof9060669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023] Open
Abstract
Cutaneous fungal infection of the skin and nails poses a significant global public health challenge. Dermatophyte infection, mainly caused by Trichophyton spp., is the primary pathogenic agent responsible for skin, hair, and nail infections worldwide. The epidemiology of these infections varies depending on the geographic location and specific population. However, epidemiological pattern changes have occurred over the past decade. The widespread availability of antimicrobials has led to an increased risk of promoting resistant strains through inappropriate treatment. The escalating prevalence of resistant Trichophyton spp. infections in the past decade has raised serious healthcare concerns on a global scale. Non-dermatophyte infections, on the other hand, present even greater challenges in terms of treatment due to the high failure rate of antifungal therapy. These organisms primarily target the nails, feet, and hands. The diagnosis of cutaneous fungal infections relies on clinical presentation, laboratory investigations, and other ancillary tools available in an outpatient care setting. This review aims to present an updated and comprehensive analysis of the epidemiology, clinical manifestations, and diagnostic testing methods for cutaneous fungal infections caused by dermatophytes and non-dermatophytes. An accurate diagnosis is crucial for effective management and minimizing the risk of antifungal resistance.
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Affiliation(s)
- Pattriya Chanyachailert
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok 10700, Thailand
| | - Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok 10700, Thailand
| | - Sumanas Bunyaratavej
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok 10700, Thailand
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Haghani I, Akhtari J, Yahyazadeh Z, Espahbodi A, Kermani F, Javidnia J, Hedayati MT, Shokohi T, Badali H, Rezaei-Matehkolaei A, Aghili SR, Al-Rawahi A, Al-Harrasi A, Abastabar M, Al-Hatmi AMS. Potential Inhibitory Effect of Miltefosine against Terbinafine-Resistant Trichophyton indotineae. Pathogens 2023; 12:pathogens12040606. [PMID: 37111492 PMCID: PMC10146699 DOI: 10.3390/pathogens12040606] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Several prolonged and significant outbreaks of dermatophytosis caused by Trichophyton indotineae, a new emerging terbinafine-resistant species, have been ongoing in India in recent years, and have since spread to various countries outside Asia. Miltefosine, an alkylphosphocholine, is the most recently approved drug for the treatment of both visceral and cutaneous leishmaniasis. Miltefosine in vitro activity against terbinafine-resistant and susceptible T. mentagrophytes/T. interdigitale species complex, including T. indotineae, is limited. The current study aimed to assess miltefosine's in vitro activity against dermatophyte isolates, which are the most common causes of dermatophytosis. Miltefosine, terbinafine, butenafine, tolnaftate, and itraconazole susceptibility testing was performed using Clinical and Laboratory Standards Institute broth microdilution methods (CLSI M38-A3) against 40 terbinafine-resistant T. indotineae isolates and 40 terbinafine-susceptible T. mentagrophytes/T. interdigitale species complex isolates. Miltefosine had MIC ranges of 0.063-0.5 µg/mL and 0.125-0.25 µg/mL against both terbinafine-resistant and susceptible isolates. In terbinafine-resistant isolates, the MIC50 and MIC90 were 0.125 µg/mL and 0.25 µg/mL, respectively, and 0.25 µg/mL in susceptible isolates. Miltefosine had statistically significant differences in MIC results when compared to other antifungal agents (p-value 0.05) in terbinafine-resistant strains. Accordingly, the findings suggest that miltefosine has a potential activity for treating infections caused by terbinafine-resistant T. indotineae. However, further studies are needed to determine how well this in vitro activity translates into in vivo efficacy.
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Affiliation(s)
- Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Javad Akhtari
- Immunogenetics Research Center, Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Zahra Yahyazadeh
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Amirreza Espahbodi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Firoozeh Kermani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Javad Javidnia
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Hamid Badali
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249-0600, USA
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, School of Medicine, Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61357-15794, Iran
| | - Seyed Reza Aghili
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Ahmed Al-Rawahi
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa 616, Oman
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa 616, Oman
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Abdullah M S Al-Hatmi
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa 616, Oman
- Center of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
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Shah SR, Vyas HR, Shah BJ, Jangid NC, Choudhary A, Gehlawat T, Mistry D, Joshi R. A Clinical-Mycological Study of Dermatophytosis in Western India with Focus on Antifungal Drug Resistance as a Factor in Recalcitrance. Indian J Dermatol 2023; 68:234. [PMID: 37275803 PMCID: PMC10238971 DOI: 10.4103/ijd.ijd_999_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Background Dermatophytosis have assumed epidemic proportions in India. Antifungal drug resistance solely cannot explain disease magnitude and changing epidemiology. Objectives Aim of this study was to analyse clinical-mycological aspects of dermatophytosis, and estimate contribution of drug resistance in clinical recalcitrance. Methods This single-centre observational, cross-sectional, descriptive study was done in tertiary centre of western India after ethical approval, enrolling dermatophytosis patients of all ages and sex. After history and examination, KOH mount and culture in modified SDA medium was done. Culture positive isolates were subjected to E-strip antifungal susceptibility method to test MIC for Terbinafine, Itraconazole, Fluconazole and Griseofulvin. Results Total 300 patients were included, with mean age of 33.83±27.5 years and male-to-female ratio of 1.22:1; tinea corporis et cruris being commonest, 39.33% (n=118). Only 11.67% (n=35) were treatment naïve, having classical annular morphology. History of topical steroid abuse was found in 81.67% (n=245), with pseudoimbricate lesions in 70.61% (n=173). 86.67% (n=260) had KOH positivity while 83.33% (n=250) had culture positivity: Trichophyton mentagrophytes 45.6% (n=114), followed by Trichophyton rubrum in 34.4% (n=86). A total of 265 patients fit into definition of recalcitrance, from which 12.45%, i.e., 33 isolates showed in-vitro fluconazole resistance. 14.33% (n=43) cases were chronic, 37% (n=111) persistent, 46% (n=138) recurrent while 17% (n=51) had relapse in their disease course. Steroid abuse was the commonest denominator. Conclusion Role of antifungal resistance in recalcitrant dermatophytosis remains debatable. Stopping steroid abuse, which is often the commonest culprit, with adherence to standard antifungal therapy remains the paradigm in management.
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Affiliation(s)
- Shikha R. Shah
- From the Department of Dermatology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Harshita R. Vyas
- From the Department of Dermatology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Bela J. Shah
- From the Department of Dermatology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Neha C. Jangid
- From the Department of Dermatology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Ankita Choudhary
- From the Department of Dermatology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Tarun Gehlawat
- From the Department of Dermatology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Deval Mistry
- From the Department of Dermatology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Rutu Joshi
- From the Department of Dermatology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
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7
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Panda S, Ghosh A. Evidence-based management of dermatophytosis in India today. APOLLO MEDICINE 2023. [DOI: 10.4103/am.am_171_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Kumar MB, Gulati N, Chander J, Singla N, Bhalla M, Nayyar C, Sharma S, Kaur M. Species Distribution and Antifungal Susceptibility Profile of Dermatophytes from a Tertiary Care Centre in North India. J Lab Physicians 2022; 14:449-455. [DOI: 10.1055/s-0042-1748826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Objective Dermatophytoses, one of the most ancient diseases, is becoming a menace in recent times. This has made the knowledge of antifungal susceptibility a priority in today's times.
Material and Methods This is a prospective study conducted over 18 months including all dermatophytes isolated during the period. Dermatophytes were identified by routine phenotypic methods. Antifungal susceptibility testing was performed for griseofulvin, terbinafine, and itraconazole as per the Clinical Laboratory Standard Institute M38 A2, and minimum inhibitory concentrations (MICs) were read after 5 days.
Results Patient details and associated risk factors were recorded. Fixed dose combinations with steroids were associated with 79.3% (46 out of 58) of patients with dermatophytosis of skin. Among the 72 dermatophytes isolated during the study period, 58 (80.5%) were isolated from skin scrapings and 14 (19.4%) from nail samples. Tinea corporis with cruris was the most common presentation. The most common dermatophyte isolated from skin scrapings was Trichophyton mentagrophytes complex (70.6%, 41 out of 58), while from nail samples it was Trichophyton rubrum complex (78.57%, 11 out of 14). Based on the MIC50 and MIC90 results, itraconazole showed the lowest MICs, followed by terbinafine and then griseofulvin.
Conclusion With the changing epidemiology of species distribution and antifungal resistance, there is a need for continuous surveillance of these parameters of dermatophytes.
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Affiliation(s)
- Mani Bhushan Kumar
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Neelam Gulati
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Mala Bhalla
- Department of Dermatology, Venereology and Leprosy, Government Medical College Hospital, Chandigarh, India
| | - Charu Nayyar
- Department of Microbiology, Medanta Hospital, Sriganganagar, Rajasthan, India
| | - Swati Sharma
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Manharpreet Kaur
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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Pashootan N, Shams-Ghahfarokhi M, Chaichi Nusrati A, Salehi Z, Asmar M, Razzaghi-Abyaneh M. Phylogeny, Antifungal Susceptibility, and Point Mutations of SQLE Gene in Major Pathogenic Dermatophytes Isolated From Clinical Dermatophytosis. Front Cell Infect Microbiol 2022; 12:851769. [PMID: 35372131 PMCID: PMC8972121 DOI: 10.3389/fcimb.2022.851769] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/11/2022] [Indexed: 12/14/2022] Open
Abstract
Drug resistance is one of the major challenges to skin fungal infections, especially in tropical and subtropical infections caused by dermatophytes. This study aimed to determine the antifungal susceptibility of clinically dermatophytes and evaluate point mutations in terbinafine-resistant isolates. A total number of 123 clinical dermatophyte isolates in eight species were evaluated in terms of sensitivity to seven major antifungals. Furthermore, the point mutation in squalene epoxidase (SQLE) gene responsible for terbinafine resistance was studied. The dermatophytes species were identified by morphological characteristics and confirmed by the ITS sequencing. Also, the phylogenetic tree was drawn using the RAxML analyses for 123 dermatophytes isolates. A new XXIX genotype was also found in 4 Trichophyton mentagrophytes isolates. Based on the results obtained, terbinafine was the most effective antifungal drug followed by itraconazole and voriconazole. Trichophyton rubrum and Trichophyton tonsurans were the most susceptible species (MIC50 = 0.01, 0.09 μg/ml), and T. mentagrophytes was the most resistant species (MIC50 = 0.125 μg/ml) to terbinafine. Of the 123 dermatophytes isolates, six isolates showed reduced susceptibility to terbinafine, and only Trichophyton indotineae had a mutation in SQLE gene as a Phe397Leu substitution. Overall, the antifungal susceptibility test is necessary for managing dermatophytosis. These results help physicians to control the course of the disease and provide further insights to select effective drugs for patients with dermatophytosis, especially in tropical and subtropical regions of the world, where dermatophytosis is still a public health problem.
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Affiliation(s)
- Nasrin Pashootan
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University, Lahijan, Iran
| | | | - Arash Chaichi Nusrati
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University, Lahijan, Iran
| | - Zahra Salehi
- Department of Mycology, Pasteur Institute of Iran, Tehran, Iran
| | - Mehdi Asmar
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University, Lahijan, Iran
| | - Mehdi Razzaghi-Abyaneh
- Department of Mycology, Pasteur Institute of Iran, Tehran, Iran
- *Correspondence: Mehdi Razzaghi-Abyaneh, ;
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Pathogenesis, Immunology and Management of Dermatophytosis. J Fungi (Basel) 2021; 8:jof8010039. [PMID: 35049979 PMCID: PMC8781719 DOI: 10.3390/jof8010039] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/31/2022] Open
Abstract
Dermatophytic infections of the skin and appendages are a common occurrence. The pathogenesis involves complex interplay of agent (dermatophytes), host (inherent host defense and host immune response) and the environment. Infection management has become an important public health issue, due to increased incidence of recurrent, recalcitrant or extensive infections. Recent years have seen a significant rise in incidence of chronic infections which have been difficult to treat. In this review, we review the literature on management of dermatophytoses and bridge the gap in therapeutic recommendations.
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Verma KK, Senthilnathan G, Bhatia S, Xess I, Gupta V, Dwivedi SN, Sahni K. Oral Isotretinoin Combined with Oral Terbinafine Versus Oral Terbinafine Alone to Treat Recurrent Dermatophytosis: An Open-Label Randomised Clinical Trial. Indian Dermatol Online J 2021; 12:820-825. [PMID: 34934716 PMCID: PMC8653726 DOI: 10.4103/idoj.idoj_167_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 05/12/2021] [Indexed: 11/04/2022] Open
Abstract
Background Recurrent dermatophytosis is becoming arduous to treat. Recently, oral itraconazole with oral isotretinoin was successful in a patient suffering from recurrent dermatophytosis. Objectives To evaluate if oral isotretinoin confers any added benefit over oral terbinafine in the treatment of recurrent dermatophytosis. Materials and Methods This was an open-label randomized clinical trial including 100 adult patients with recurrent tinea cruris and/or tinea corporis randomized into two groups; Group A (oral isotretinoin 0.5 mg/kg/day and oral terbinafine 250 mg twice daily) and Group B (oral terbinafine 250 mg twice daily) for 4 weeks, and followed up for 3 months. Fungal culture and antifungal susceptibility testing against terbinafine, fluconazole, amphotericin B, itraconazole, and griseofulvin were performed. Results Out of the 100 patients, 91 patients (44 in Group A and 47 in Group B) completed the trial. Complete cure was seen in 19/44 (43.18%) patients in Group A and 20/47 (42.55%) patients in Group B (P = 0.951). Recurrence occurred in 12/19 (63.1%) patients in Group A and 13/20 (65%) patients in Group B (P = 0.904). Cheilitis and dryness of lips were the most common adverse effects seen in 32/44 (72.73%) patients in Group A. A total of 50 cultures were grown. The commonest species isolated was Trichophyton interdigitale in 36 (72%) patients, having a mean minimum inhibitory concentration of 3.13 μg/mL for terbinafine. However, for itraconazole, it was 0.13 μg/mL, and varied minimum inhibitory concentration (MIC) values were seen for fluconazole, griseofulvin, and amphotericin B. Conclusion The addition of isotretinoin to terbinafine has no added benefit in treating patients with recurrent dermatophytosis.
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Affiliation(s)
- Kaushal K Verma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Gridharan Senthilnathan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Bhatia
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kanika Sahni
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Tahiliani S, Saraswat A, Lahiri AK, Shah A, Hawelia D, Shah GK, Girdhar M, Rao PN, Raghav PA, Agarwal P, Kharkar RD, Gupta RP, Udare S, Hegde S, Haldar S. Etiological prevalence and antifungal sensitivity patterns of dermatophytosis in India - A multicentric study. Indian J Dermatol Venereol Leprol 2021; 87:800-806. [PMID: 34160163 DOI: 10.25259/ijdvl_1025_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The prevalence of dermatophytes varies with season, geographical area, socio-economic factors and effective management strategies. AIMS The aim of the study was to assess the prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infection, and in vitro antifungal drug susceptibility testing against dermatophytes. METHODS Three hundred and ninety five patients with dermatophytosis were enrolled from five cities (Mumbai, Delhi, Lucknow, Kolkata and Hyderabad) across India. All patients were subjected to clinical examination and investigations, including potassium hydroxide microscopy, fungal culture and antifungal drug susceptibility testing. RESULTS Trichophyton rubrum was the most common species identified (68.4%), followed by T. mentagrophytes (29.3%). Within species, T. mentagrophytes was prevalent in humid environmental conditions (Mumbai and Kolkata), whereas T. rubrum was prevalent in noncoastal areas (Delhi, Lucknow and Hyderabad). Tinea corporis (71.4%) and tinea cruris (62.0%) were the common clinical types observed. antifungal drug susceptibility testing data indicated that minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC-90) was lowest for griseofulvin (0.25-3.0 μg/mL). Among oral antifungals, the mean MIC of itraconazole was within the range (0.84 [0.252] μg/ mL), whereas high mean MIC values were reported for terbinafine (0.05 [0.043] μg/mL). Among topical agents, lowest mean MIC values were reported for luliconazole (0.29 [0.286] μg/mL), eberconazole (0.32 [0.251]) μg/mL and amorolfine (0.60 [0.306]) μg/mL. LIMITATIONS Lack of correlation between in vitro antifungal susceptibility and clinical outcome and absence of defined MIC breakpoints. CONCLUSION T. rubrum was the most common, followed by T. mentagrophytes as an emerging/codominant fungal isolate in India. Tinea corporis was the most common clinical type of dermatophytosis. Mean MIC of terbinafine was above the reference range, while it was within the range for itraconazole; griseofulvin had the lowest mean MIC. Luliconazole presented the lowest mean MIC values across cities.
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Affiliation(s)
- Sushil Tahiliani
- Dr. Tahiliani's Clinic, A 201/202, Gasper Enclave Ambedkar Road, Pali Market, Next to Gold's Gym, Bandra West, Mumbai, Maharashtra, India
| | - Abir Saraswat
- Indushree Skin Clinic, Near Hotel Bandhan, Faizabad Road, Indiranagar Colony, Lucknow, Uttar Pradesh, India
| | - A K Lahiri
- Skin and Laser Clinic, 204, Amsri Plaza, Sarojini Devi Road, Near to Domino's Pizza, Secunderabad, Telangana, India
| | - Avani Shah
- Dr. Miskeen's Central Clinical Microbiology Laboratory, Nirmal, 1st Floor, Behind Amrapali Hotel, Near Gadkari Rangayatan, Old Mumbai-Pune Road, Thane (West), Thane, Maharashtra, India
| | - Dinesh Hawelia
- Dr.Hawelia's Skin Clinic, 1st Floor, 245A, Chittaranjan Avenue, Kolkata, West Bengal, India
| | - G K Shah
- Skin Zone, No. 404, Vini Elegance, Above Tanishq Jewellers, L. T. Road, Borivali (West), Mumbai, Maharashtra, India
| | - Mukesh Girdhar
- Dr Mukesh Girdhar's Skin Clinic, 101, 1st Floor, Rishab Tower, Community Centre, Karkardooma, Anand Vihar, Delhi, India
| | - P Narasimha Rao
- Comprehensive Dermatology Clinic, Plot No 4, Satya Apartment, Masab Tank, Opposite Polytechnic College, Beside Golconda Hotel, Hyderabad, Telangana, India
| | - Potharaju Arun Raghav
- Comprehensive Dermatology Clinic, Plot No 4, Satya Apartment, Masab Tank, Opposite Polytechnic College, Beside Golconda Hotel, Hyderabad, Telangana, India
| | - Pramod Agarwal
- Yuva Skin and Laser Center, A-1031, A-Block, Indira Nagar, Lucknow, Uttar Pradesh, India
| | - R D Kharkar
- Dr. Kharkar's Skin Clinic, Room No 55 , 5th Floor, Dattani Chambers, S V Road, Opposite Shantinath Shopping Centre, Malad West, Mumbai, Maharashtra, India
| | - R P Gupta
- GNH Excel Medical Centre, BN-56, Jhulelal Mandir Marg, Shalimar Bagh, Block BN, Poorbi Shalimar Bag, Shalimar Bagh, Delhi, India
| | - Satish Udare
- Sparkle Skin and Aesthetic Centre, Shanti Center Building, Sector 17, Vashi, Navi Mumbai, India
| | - Sudha Hegde
- Dr. Sudha Hegade Clinic, 101, 1st Floor, Eknath Apartment, Near Paanch Rasta, Above Real Pharmacy, M G Road, Mulund (West), Mumbai, Maharashtra, India
| | - Susmit Haldar
- Calcutta Skin Institute, 169, Scheme 6 M, C I T Road, Kankurgachi, Kolkata, West Bengal, India
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13
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Siopi M, Efstathiou I, Theodoropoulos K, Pournaras S, Meletiadis J. Molecular Epidemiology and Antifungal Susceptibility of Trichophyton Isolates in Greece: Emergence of Terbinafine-Resistant Trichophytonmentagrophytes Type VIII Locally and Globally. J Fungi (Basel) 2021; 7:jof7060419. [PMID: 34072049 PMCID: PMC8229535 DOI: 10.3390/jof7060419] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023] Open
Abstract
Trichophyton isolates with reduced susceptibility to antifungals are now increasingly reported worldwide. We therefore studied the molecular epidemiology and the in vitro antifungal susceptibility patterns of Greek Trichophyton isolates over the last 10 years with the newly released EUCAST reference method for dermatophytes. Literature was reviewed to assess the global burden of antifungal resistance in Trichophyton spp. The in vitro susceptibility of 112 Trichophyton spp. molecularly identified clinical isolates (70 T. rubrum, 24 T. mentagrophytes, 12 T. interdigitale and 6 T. tonsurans) was tested against terbinafine, itraconazole, voriconazole and amorolfine (EUCAST E.DEF 11.0). Isolates were genotyped based on the internal transcribed spacer (ITS) sequences and the target gene squalene epoxidase (SQLE) was sequenced for isolates with reduced susceptibility to terbinafine. All T. rubrum, T. interdigitale and T. tonsurans isolates were classified as wild-type (WT) to all antifungals, whereas 9/24 (37.5%) T. mentagrophytes strains displayed elevated terbinafine MICs (0.25–8 mg/L) but not to azoles and amorolfine. All T. interdigitale isolates belonged to ITS Type II, while T. mentagrophytes isolates belonged to ITS Type III* (n = 11), VIII (n = 9) and VII (n = 4). All non-WT T. mentagrophytes isolates belonged to Indian Genotype VIII and harbored Leu393Ser (n = 5) and Phe397Leu (n = 4) SQLE mutations. Terbinafine resistance rates ranged globally from 0–44% for T. rubrum and 0–76% for T. interdigitale/T. mentagrophytes with strong endemicity. High incidence (37.5%) of terbinafine non-WT T. mentagrophytes isolates (all belonging to ITS Type VIII) without cross-resistance to other antifungals was found for the first time in Greece. This finding must alarm for susceptibility testing of dermatophytes at a local scale particularly in non-responding dermatophytoses.
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Affiliation(s)
- Maria Siopi
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (M.S.); (I.E.); (S.P.)
| | - Ioanna Efstathiou
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (M.S.); (I.E.); (S.P.)
| | - Konstantinos Theodoropoulos
- Second Department of Dermatology & Venereology, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece;
| | - Spyros Pournaras
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (M.S.); (I.E.); (S.P.)
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (M.S.); (I.E.); (S.P.)
- Correspondence: ; Tel.: +30-210-583-1909; Fax: +30-210-532-6421
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Sardana K, Gupta A, Mathachan SR. Immunopathogenesis of Dermatophytoses and Factors Leading to Recalcitrant Infections. Indian Dermatol Online J 2021; 12:389-399. [PMID: 34211904 PMCID: PMC8202482 DOI: 10.4103/idoj.idoj_503_20] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/27/2020] [Accepted: 12/20/2020] [Indexed: 11/11/2022] Open
Abstract
The pathogenesis of dermatophytic infections involves the interplay of three major factors: the dermatophyte, the inherent host defense, and the adaptive host immune response. The fungal virulence factors determine the adhesion and invasion of the skin while the immune response depends on an interaction of the pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMP) with pattern recognition receptors (PRRs) of the host, which lead to a differential Th (T helper) 1, Th2, Th17, and Treg response. While anthropophilic dermatophytes Trichophyton rubrum and now increasingly by T. interdigitale subvert the immune response via mannans, zoophilic species are eliminated due to a brisk immune response. Notably, delayed-type hypersensitivity (Th1) response of T lymphocytes causes the elimination of fungal infection, while chronic disease caused by anthropophilic species corresponds to toll-like receptor 2 mediated IL (interleukin)-10 release and generation of T-regulatory cells with immunosuppressive potential. Major steps that determine the ultimate clinical course and chronicity include genetic susceptibility factors, impaired epidermal and immunological barriers, variations in the composition of sebum and sweat, carbon dioxide tension, skin pH, and topical steroid abuse. It is important to understand these multifarious aspects to surmount the problem of recalcitrant dermatophytosis when the disorder fails conventional therapeutic agents.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Post Graduate Institute of Medical Education and Research Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Aastha Gupta
- Department of Dermatology, Post Graduate Institute of Medical Education and Research Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sinu Rose Mathachan
- Department of Dermatology, Post Graduate Institute of Medical Education and Research Dr. Ram Manohar Lohia Hospital, New Delhi, India
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15
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Sardana K, Mathachan SR. Super Bioavailable Itraconazole and Its Place and Relevance in Recalcitrant Dermatophytosis: Revisiting Skin Levels of Itraconazole and Minimum Inhibitory Concentration Data. Indian Dermatol Online J 2021; 12:1-5. [PMID: 33768016 PMCID: PMC7982045 DOI: 10.4103/idoj.idoj_618_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/04/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022] Open
Abstract
Itraconazole, is the most commonly prescribed oral antifungal agent in India, and has a low minimum inhibitory concentration as compared to other oral antifungals, and in conjunction with the markedly high skin levels, the drug should have a predictably good clinical response which is not the consistent experience of clinicians. Probably the variation in pelletization parameters might affect the bioavailability of the drug and consequently affect the serum levels. The maximum bioavailability of conventional itraconazole is 55 percent, which is neither consistent nor predictable. However, the novel itraconazole (Super bioavailable Itraconazole) with targeted drug release in the small intestine has predictable serum levels with minimum interindividual variability, which could make it a potentially useful drug in recalcitrant dermatophytosis.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
| | - Sinu Rose Mathachan
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
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16
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Verma SB, Panda S, Nenoff P, Singal A, Rudramuruthy SM, Uhrlass S, Das A, Bisherwal K, Shaw D, Vasani R. The unprecedented epidemic-like scenario of dermatophytosis in India: I. Epidemiology, risk factors and clinical features. Indian J Dermatol Venereol Leprol 2021; 87:154-175. [PMID: 33769736 DOI: 10.25259/ijdvl_301_20] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/01/2020] [Indexed: 12/21/2022]
Abstract
Dermatophytosis has attained unprecedented dimensions in recent years in India. Its clinical presentation is now multifarious, often with atypical morphology, severe forms and unusually extensive disease in all age groups. We hesitate to call it an epidemic owing to the lack of population-based prevalence surveys. In this part of the review, we discuss the epidemiology and clinical features of this contemporary problem. While the epidemiology is marked by a stark increase in the number of chronic, relapsing and recurrent cases, the clinical distribution is marked by a disproportionate rise in the number of cases with tinea corporis and cruris, cases presenting with the involvement of extensive areas, and tinea faciei.
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Affiliation(s)
| | - Saumya Panda
- Department of Dermatology, Belle Vue Clinic, Kolkata, West Bengal, India,
| | - Pietro Nenoff
- Department of Dermatology and Laboratory Medicine, Laboratory of Medical Microbiology, Moelbis, Germany
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India,
| | - Shivprakash M. Rudramuruthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Silke Uhrlass
- Department of Dermatology and Laboratory Medicine, Laboratory of Medical Microbiology, Moelbis, Germany
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India,
| | - Kavita Bisherwal
- Department of Dermatology, Venereology and Leprosy, Lady Hardinge Medical College and SSK Hospital, Delhi, India,
| | - Dipika Shaw
- Department of Medical Microbiology, PGI, Chandigarh, India,
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17
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Arammehr A, Dehghan P, Chadeganipour M, Katoueezadeh M, Shadzi S. Detection of Dermatophytes from Dermatophytosis-Suspected Cases in Iran, Evaluation of Polymerase Chain Reaction-Sequencing Method. Adv Biomed Res 2021; 9:56. [PMID: 33457339 PMCID: PMC7792868 DOI: 10.4103/abr.abr_21_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/25/2020] [Accepted: 08/05/2020] [Indexed: 11/04/2022] Open
Abstract
Background Dermatophytosis is mostly caused by dermatophytes species, and the diagnosis of disease is very important for early treatment. The aim of this study was to identify the commonly dermatophytes species isolated directly from the clinical samples, using the polymerase chain reaction (PCR) and evaluate both conventional and molecular methods. Materials and Methods This study was performed on 115 clinical samples. Dermatophyte isolates were initially identified by conventional method and confirmed by the sequencing molecular method. In this study, the molecular technique is implemented directly on clinical samples. Statistical analysis of the information was performed by the SPSS software, and the results were statistically analyzed. Results Our findings demonstrated that the most abundant dermatophyte species by PCR-sequencing were Trichophyton mentagrophytes (20%), followed by Trichophyton tonsurans (10%), Trichophyton rubrum (6.7%), T. interdigital (6.7%), Arthroderma otae, and Arthroderma vanbreuseghemii, (3.3%) for each one. Conclusion For medical laboratories, routine procedures are still preferred because of their lower cost, and the results are almost the same as the molecular methods. The sensitivity and specificity values for PCR under our laboratory condition were 60% and 87%, respectively. This study shows that molecular results performed better in nails than other samples, by culture results.
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Affiliation(s)
- Akbar Arammehr
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvin Dehghan
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Chadeganipour
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Katoueezadeh
- Department of Hematology and Medical Laboratory Science, Faculty of Allied Medicine, Kerman university of Medical Sciences, Kerman, Iran
| | - Shahla Shadzi
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Regional Differences in Antifungal Susceptibility of the Prevalent Dermatophyte Trichophyton rubrum. Mycopathologia 2020; 186:53-70. [PMID: 33313977 PMCID: PMC7946697 DOI: 10.1007/s11046-020-00515-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/25/2020] [Indexed: 01/24/2023]
Abstract
In vitro susceptibility testing for Trichophyton rubrum has shown resistance to terbinafine, azoles and amorolfine, locally, but epidemiological cutoffs are not available. In order to assess the appropriateness of current first-line antifungal treatment for T. rubrum in China, we characterized antifungal susceptibility patterns of Chinese T. rubrum strains to nine antifungals and also described the upper limits of wild-type (WT) minimal inhibitory concentrations (MIC) (UL-WT) based on our study and another six studies published during the last decades. Sixty-two clinical isolates originating from seven provinces in China were identified as T. rubrum sensu stricto; all Chinese strains showed low MICs to eight out of nine antifungal drugs. Terbinafine (TBF) showed the lowest MICs of all antifungal classes tested in both the Chinese and global groups, with a 97.5% UL-WT MIC-value of 0.03 mg/L. No non-WT isolates were observed for TBF in China, but were reported in 18.5% of the global group. Our study indicated that TBF was still the most active drug for Chinese T. rubrum isolates, and all strains were within the WT-population. TBF therefore remains recommended for primary therapy to dermatophytosis caused by T. rubrum in China now, but regular surveillance of dermatophytes and antifungal susceptibility is recommended.
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Gaurav V, Bhattacharya SN, Sharma N, Datt S, Kumar P, Rai G, Singh PK, Taneja B, Das S. Terbinafine resistance in dermatophytes: Time to revisit alternate antifungal therapy. J Mycol Med 2020; 31:101087. [PMID: 33360137 DOI: 10.1016/j.mycmed.2020.101087] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/21/2020] [Accepted: 11/17/2020] [Indexed: 01/13/2023]
Abstract
Resistant superficial dermatophytic infections of the skin and its appendages have emerged as a major health problem in India. Mutations in Squalene epoxidase gene have led to increasing incidence of resistance to terbinafine in dermatophytic isolates. We examined six patients with recalcitrant dermatophytosis attending Dermatology OPD at a tertiary care hospital and demonstrated terbinafine resistance by molecular method. Immediate hyperitivity (IH) reaction to Trichophytin antigen was highlighted in these patients. The patients were treated with alternate antifungals after demonstration of resistance to terbinafine based on the antifungal susceptibility testing (AFST). On follow up the patients responded well to the substitute but the duration of therapy had to be prolonged beyond six weeks.
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Affiliation(s)
- V Gaurav
- Department of Dermatology & STD, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
| | - S N Bhattacharya
- Department of Dermatology & STD, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India
| | - N Sharma
- Department of Microbiology, University College of Medical Sciences, Delhi 110095, India
| | - S Datt
- Department of Microbiology, University College of Medical Sciences, Delhi 110095, India
| | - P Kumar
- Genome Informatics and Structural Biology Unit, CSIR-IGIB, Sukhdev Vihar, Mathura Road, New Delhi 110020, India
| | - G Rai
- Department of Microbiology, University College of Medical Sciences, Delhi 110095, India
| | - P K Singh
- Department of Microbiology, University College of Medical Sciences, Delhi 110095, India
| | - B Taneja
- Genome Informatics and Structural Biology Unit, CSIR-IGIB, Sukhdev Vihar, Mathura Road, New Delhi 110020, India
| | - S Das
- Department of Microbiology, University College of Medical Sciences, Delhi 110095, India.
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20
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Kermani F, Javidnia J, Hedayati MT, Abastabar M, Haghani I, Didehdar M, Fami Zaghrami M, Shokohi T. In vitro activities of antifungal drugs against a large collection of Trichophyton tonsurans isolated from wrestlers. Mycoses 2020; 63:1321-1330. [PMID: 32854165 DOI: 10.1111/myc.13172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Trichophyton tonsurans is the most common agent causing tinea gladiatorum in wrestlers, and limited data on susceptibility profiles of Trichophyton tonsurans are available. OBJECTIVES We aimed to assess the in vitro activity of the common antifungal drug against a large collection of T tonsurans. MATERIALS/METHODS The in vitro activities to eight common antifungal drugs (sertaconazole, itraconazole, clotrimazole, fluconazole, butenafine, tolnaftate, terbinafine and griseofulvin) against 128 clinical isolates of T tonsurans strains, obtained from wrestlers with dermatophytosis, were performed according to CLSI M38-A2 broth microdilution document. RESULTS The geometric mean minimum inhibitory concentration was the lowest for tolnaftate (0.022 µg/mL), followed by itraconazole (0.026 µg/mL), terbinafine (0.033 µg/mL), butenafine (0.088 µg/mL), griseofulvin (0.566 µg/mL), sertaconazole (2.875 µg/mL), clotrimazole (3.419 µg/mL) and fluconazole (12.540 µg/mL). CONCLUSIONS Evaluation of antifungal susceptibility of dermatophytes showed that tolnaftate and itraconazole were the most effective drugs against T tonsurans and fluconazole had the least effect.
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Affiliation(s)
- Firoozeh Kermani
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Javad Javidnia
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad T Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojtaba Didehdar
- Department of Medical Mycology and Parasitology, Arak University of Medical Sciences, Arak, Iran
| | | | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Thakur R, Kalsi AS. Outbreaks And Epidemics Of Superficial Dermatophytosis Due To Trichophyton mentagrophytes Complex And Microsporum canis: Global And Indian Scenario. Clin Cosmet Investig Dermatol 2019; 12:887-893. [PMID: 31849509 PMCID: PMC6913057 DOI: 10.2147/ccid.s220849] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/29/2019] [Indexed: 12/27/2022]
Abstract
Until recently, superficial dermatophytosis, also known as tinea, was considered as a minor skin infection, which was easy to treat. There used to be rare outbreaks and epidemics of superficial dermatophytosis. Lately, there is a sweeping change in the clinical presentation due to extensive, atypical and recalcitrant dermatophytosis. Treating such infections poses a great challenge to the clinicians. Dermatophytosis is a superficial fungal infection of keratinized tissue (skin, hairs and nails) by dermatophytes (fungus). It is caused by the three genera of dermatophytes: Trichophyton, Epidermophyton and Microsporum. The conventional methods of laboratory diagnosis have now been substantiated by molecular characterization. Earlier epidemics were usually due to anthropophilic dermatophytes. Now, zoophilic dermatophytes are also responsible for many outbreaks and epidemics. We need to be equipped with the tools to face the current scenario, because this depends upon the competence of the staff working in the state-of-the-art laboratories, which is needed for the study of the epidemiology and appropriate treatment.
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Affiliation(s)
- Rameshwari Thakur
- Department of Dermatology and Microbiology, Muzaffarnagar Medical College and Hospital, Chaudhary Charan Singh University, Meerut, India
| | - Avneet Singh Kalsi
- Department of Dermatology and Microbiology, Muzaffarnagar Medical College and Hospital, Chaudhary Charan Singh University, Meerut, India
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Al-Obaidi H, Kowalczyk RM, Kalgudi R, Zariwala MG. Griseofulvin solvate solid dispersions with synergistic effect against fungal biofilms. Colloids Surf B Biointerfaces 2019; 184:110540. [DOI: 10.1016/j.colsurfb.2019.110540] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/27/2019] [Accepted: 09/29/2019] [Indexed: 01/22/2023]
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Maurya VK, Kachhwaha D, Bora A, Khatri PK, Rathore L. Determination of antifungal minimum inhibitory concentration and its clinical correlation among treatment failure cases of dermatophytosis. J Family Med Prim Care 2019; 8:2577-2581. [PMID: 31548935 PMCID: PMC6753804 DOI: 10.4103/jfmpc.jfmpc_483_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/19/2019] [Accepted: 08/01/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction: Dermatophytes are most common infectious agents causing superficial mycosis worldwide. A number of topical as well as systemic antifungal drugs are available for treatment of dermatophytosis. Superficial mycosis caused by dermatophytes can be easily treated by topical or oral antifungal drugs, but in the course of time, an increased number of treatment failure cases are appearing. Possible cause for treatment failure could be poor patient compliance, poor drug penetration into affected lesion, and also drug resistance in dermatophytes. The aim of this study is to investigate minimum inhibitory concentration and clinical correlation in treatment failure cases of dermatophytosis. Methods: Skin, hair and nail samples were collected from treatment failure cases of dermatophytosis. A total 75 isolates were tested for MIC against four antifungal drugs in the study. Fluconazole, itraconazole, ketoconazole and terbinafine were the antifungal drugs tested using broth microdilution method. MIC50 and MIC90 values were recorded. Results: A total of 75 dermatophytic isolates were tested. Dermatophytic isolates in this study were Trichophyton mentagrophytes (n = 31), T. rubrum (n = 13), T. tonsurans (n = 12), T. verrucosum (n = 9), M. gypseum (n = 5), E. floccosum (n = 4) and T. violaceum (n = 1). MIC90 value for fluconazole and terbinafine was significantly higher. Conclusion: MIC of 17.33% isolates for fluconazole and 33.33% isolates for terbinafine were lower than cut-off value, which indicates that not all treatment failure cases are due to drug resistance.
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Affiliation(s)
- Vinod K Maurya
- Department of Microbiology, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Dileep Kachhwaha
- Department of Skin and VD, Dr. S. N. Medical College, Jodhpur, Rajsthan, India
| | - Archana Bora
- Department of Microbiology, Dr. S. N. Medical College, Jodhpur, Rajsthan, India
| | - Prabhat K Khatri
- Department of Microbiology, Dr. S. N. Medical College, Jodhpur, Rajsthan, India
| | - Laxmi Rathore
- Department of Microbiology, Dr. S. N. Medical College, Jodhpur, Rajsthan, India
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Antifungal resistance in dermatophytes: Recent trends and therapeutic implications. Fungal Genet Biol 2019; 132:103255. [PMID: 31330295 DOI: 10.1016/j.fgb.2019.103255] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 12/15/2022]
Abstract
Dermatophytoses or tinea refers to superficial fungal infection of keratinized tissues. Although generally considered easy to treat, recalcitrant infections, presenting as extensive and difficult to treat tinea corporis and cruris, are on the rise in some parts of the world. The situation demands an understanding of the pharmacokinetic and pharmacodynamic properties of the available antifungals against dermatophytes and the possible contribution of drug resistance and other factors to the present scenario. In this review, we provide the readers a comprehensive account of the available literature on in-vitro and in-vivo resistance to clinically used antifungals among dermatophytes. We have also added, in brief, the relevant skin pharmacokinetics of important systemic drugs. The established and postulated mechanisms of drug resistance are discussed and aspects on lack of in vivo correlation of in vitro resistance are presented. Finally, the lacunae in our existing knowledge on the topic and the arenas for future research are highlighted.
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Nenoff P, Verma SB, Vasani R, Burmester A, Hipler UC, Wittig F, Krüger C, Nenoff K, Wiegand C, Saraswat A, Madhu R, Panda S, Das A, Kura M, Jain A, Koch D, Gräser Y, Uhrlaß S. The current Indian epidemic of superficial dermatophytosis due to Trichophyton mentagrophytes-A molecular study. Mycoses 2019; 62:336-356. [PMID: 30561859 DOI: 10.1111/myc.12878] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 01/27/2023]
Abstract
The disease burden of chronic-relapsing and therapy-refractory superficial dermatophytosis dramatically increased in India within the past 5-6 years. In order to evaluate the prevalence of this trend, 201 skin scrapings were collected from patients from all parts of India and were tested for dermatophytes using both fungal culture and a PCR-ELISA directly performed with native skin scrapings. Fungal culture material was identified by genomic Sanger sequencing of the internal transcribed spacer (ITS) region and the translation elongation factor (TEF)-1α gene. In total, 149 (74.13%) out of the 201 samples showed a dermatophyte-positive culture result. Out of this, 138 (92.62%) samples were identified as Trichophyton (T.) mentagrophytes and 11 (7.38%) as Trichophyton rubrum. The PCR-ELISA revealed similar results: 162 out of 201 (80.56%) samples were dermatophyte-positive showing 151 (93.21%) T mentagrophytes- and 11 (6.79%) T rubrum-positive samples. In this study, we show for the first time a dramatic Indian-wide switch from T rubrum to T mentagrophytes. Additionally, sequencing revealed a solely occurring T mentagrophytes "Indian ITS genotype" that might be disseminated Indian-wide due to the widespread abuse of topical clobetasol and other steroid molecules mixed with antifungal and antibacterial agents.
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Affiliation(s)
- Pietro Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
| | - Shyam B Verma
- Nirvan and In Skin Clinics, Vadodara, Gujarat, India
| | | | - Anke Burmester
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena, Germany
| | | | | | | | - Kolja Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
| | - Cornelia Wiegand
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena, Germany
| | - Abir Saraswat
- Department of Dermatology, Indushree Skin Clinic, Lucknow, India
| | - Rengarajan Madhu
- Department of Dermatology (Mycology), Madras Medical College, Chennai, India
| | - Saumya Panda
- Department of Dermatology, KPC Medical College, Kolkata, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College, Kolkata, India
| | - Mahendra Kura
- Department of Dermatology, Grant Medical College, Sir JJ Group of Hospitals, Mumbai, India
| | | | - Daniela Koch
- Laboratory for Medical Microbiology, Mölbis, Germany
| | - Yvonne Gräser
- Universitätsmedizin Berlin-Charité, Institut für Mikrobiologie und Hygiene, Nationales Konsiliarlabor für Dermatophyten, Berlin, Germany
| | - Silke Uhrlaß
- Laboratory for Medical Microbiology, Mölbis, Germany
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Poojary S, Miskeen A, Bagadia J, Jaiswal S, Uppuluri P. A Study of In vitro Antifungal Susceptibility Patterns of Dermatophytic Fungi at a Tertiary Care Center in Western India. Indian J Dermatol 2019; 64:277-284. [PMID: 31516136 PMCID: PMC6714203 DOI: 10.4103/ijd.ijd_456_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Recent years have seen an alarming rise in the prevalence of recalcitrant and relapsing dermatophyte infections in India associated with lack of clinical response to standard antifungal regimens. Aims and Objectives: A study was undertaken to identify the antifungal susceptibility patterns of dermatophyte species isolated from lesions of dermatophytoses in patients examined at our center. Materials and Methods: A total of 85 patients with clinically diagnosed dermatophytoses were subjected to skin scrapings for potassium hydroxide mount (microscopic examination) and culture using Sabouraud's agar medium containing chloramphenicol and cycloheximide (incubated at 30°C). Antifungal susceptibilities [minimum inhibitory concentration-90 (MIC-90)] of the identified dermatophytes were tested for seven systemic and topical antifungal agents (terbinafine, griseofulvin, itraconazole, fluconazole, sertaconazole, ketoconazole, and clotrimazole) using Clinical and Laboratory Standards Institute broth microdilution method (M38-A). Results: Trichophyton rubrum (50%) and Trichophyton mentagrophytes complex (47.2%) were the two major species isolated. Isolates of both showed downy and granular forms (61.11%, 38.89% and 32.35%, 67.65%, respectively). The overall in-vitro susceptibility profiles (MIC-90 ranges in μg/mL) of the seven drugs for T. rubrum and T. mentagrophytes complex respectively were as follows: terbinafine (0.008–0256, 0.016–0.256), griseofulvin (0.03-1, 0.06–1), itraconazole (0.125-2, 0.25–2), fluconazole (0.125–1, 0.25–32), sertaconazole (0.03-1, 0.03-1), ketoconazole (0.06–1, 0.125–1), and clotrimazole (0.03–2, 0.06–1). Conclusions: This study indicates a rising proportion of T. mentagrophytes complex with increased proportion of granular form (T. mentagrophytes var. mentagrophytes). This study represents the current antifungal susceptibility profile of dermatophytic infections in a tertiary care medical center in western India with rising MICs to terbinafine and itraconazole.
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Affiliation(s)
- Shital Poojary
- Department of Dermatology and Venereology, K. J. Somaiya Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Autar Miskeen
- DR Miskeen's Central Clinical Microbiology Laboratory, Thane, Maharashtra, India
| | - Jimish Bagadia
- Department of Dermatology and Venereology, K. J. Somaiya Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Saurabh Jaiswal
- Department of Dermatology and Venereology, K. J. Somaiya Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Priya Uppuluri
- David Geffen School of Medicine at UCLA Division of Infectious Diseases, Harbor-UCLA Medical Center, USA
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Correlation of In Vitro Susceptibility Based on MICs and Squalene Epoxidase Mutations with Clinical Response to Terbinafine in Patients with Tinea Corporis/Cruris. Antimicrob Agents Chemother 2018; 62:AAC.01038-18. [PMID: 30275090 DOI: 10.1128/aac.01038-18] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/22/2018] [Indexed: 11/20/2022] Open
Abstract
Recalcitrant dermatophytoses are on the rise in India. High MICs of terbinafine (TRB) and squalene epoxidase (SQLE) gene mutations conferring resistance in Trichophyton spp. have been recently documented. However, studies correlating laboratory data with clinical response to TRB in tinea corporis/cruris are lacking. For this study, we investigated the clinicomycological profile of 85 tinea corporis/cruris patients and performed antifungal susceptibility testing by CLSI microbroth dilution and SQLE mutation analysis of the isolates obtained and correlated these with the responses to TRB. Patients confirmed by potassium hydroxide (KOH) mounting of skin scrapings were started on TRB at 250 mg once a day (OD). If >50% clinical clearance was achieved by 3 weeks, the same dose was continued (group 1). If response was <50%, the dose was increased to 250 mg twice a day (BD) (group 2). If the response still remained below 50% after 3 weeks of BD, the patients were treated with itraconazole (ITR; group 3). Overall, skin scrapings from 64 (75.3%) patients yielded growth on culture. Strikingly, all isolates were confirmed to be Trichophyton interdigitale isolates by internal transcribed spacer (ITS) sequencing. Thirty-nine (61%) of the isolates had TRB MICs of ≥1 µg/ml. Complete follow-up data were available for 30 culture-positive patients. A highly significant difference in modal MICs to TRB among the three treatment response groups was noted (P = 0.009). Interestingly, 8 of the 9 patients in group 3 harbored isolates exhibiting elevated TRB MICs (8 to 32 µg/ml) and SQLE mutations. The odds of achieving cure with TRB MIC < 1 µg/ml strains were 2.5 times the odds of achieving cure with the strain exhibiting MIC ≥1 µg/ml.
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Haghani I, Shams-Ghahfarokhi M, Dalimi Asl A, Shokohi T, Hedayati MT. Molecular identification and antifungal susceptibility of clinical fungal isolates from onychomycosis (uncommon and emerging species). Mycoses 2018; 62:128-143. [DOI: 10.1111/myc.12854] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Iman Haghani
- Department of Mycology; Faculty of Medical Sciences; Tarbiat Modares University; Tehran Iran
| | | | - Abdolhossein Dalimi Asl
- Department of Medical Parasitology; Faculty of Medical Sciences; Tarbiat Modares University; Tehran Iran
| | - Tahereh Shokohi
- Department of Medical Mycology; Invasive Fungi Research Center; School of Medicine; Mazandaran University of Medical Sciences; Sari Iran
| | - Mohammad Taghi Hedayati
- Department of Medical Mycology; Invasive Fungi Research Center; School of Medicine; Mazandaran University of Medical Sciences; Sari Iran
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Tigga RA, Das S, Bhattacharya SN, Saha R, Pandhi D, Datt S, Rai G. Burden of Chronic Dermatophytosis in a Tertiary Care Hospital: Interaction of Fungal Virulence and Host Immunity. Mycopathologia 2018; 183:951-959. [DOI: 10.1007/s11046-018-0303-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/13/2018] [Indexed: 11/30/2022]
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Distribution of Species of Dermatophyte Among Patients at a Dermatology Centre of Nghean Province, Vietnam, 2015-2016. Mycopathologia 2017; 182:1061-1067. [PMID: 28831770 DOI: 10.1007/s11046-017-0193-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vietnam is a tropical country so fungal diseases including dermatophytosis may be prevalent, but epidemiological profiles of agents responsible for the infection have rarely been reported. OBJECTIVE To find out the distribution of dermatophytes among patients living in a central province of Vietnam. METHODS We examined dermatophyte infections in patients with lesions suspected of dermatophytosis referred to the Nghean provincial leprosy and dermatology centre from August 2015 to August 2016. The speciation of dermatophyte was performed by conventional and molecular approaches. RESULTS One hundred and thirty-six patients (90 males and 46 females) were included. Those aged from 11 to 30 contribute 59.1%. The most common agent found was Trichophyton rubrum (66.9%), followed by T. interdigitale (12.5%), T. tonsurans (9.6%), Microsporum incurvatum (8.1%), and the less frequent species were M. canis (2.2%) and T. violaceum (0.7%). Epidermophyton floccosum was not reported. T. rubrum were more common in men (74.4%) than in women (52.2%), while T. interdigitale and M. incurvatum were more common in women (21.7 and 15.2%) than in men (7.8 and 4.4%). Patients infected with Microsporum spp. had small-sized lesions for only 3 months, while those affected by Trichophyton spp. had large-sized lesions with longer duration. CONCLUSION Trichophyton species are the predominant agents of infection in Nghean province, while Epidermophyton species is absent. Additional investigations are required to clarify the epidemiological profile of dermatophytes in Vietnam.
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Rengasamy M, Chellam J, Ganapati S. Systemic therapy of dermatophytosis: Practical and systematic approach. CLINICAL DERMATOLOGY REVIEW 2017. [DOI: 10.4103/cdr.cdr_36_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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