Tiña capitis por Trichophyton tonsurans en un paciente pediátrico / Tinea capitis by Trichophyton tonsurans in a pediatric patient

La tiña capitis (TC) es una micosis superficial del cuero cabelludo, considerada una de las infecciones más frecuentes por dermatofitos en niños. Hasta la actualidad, las especies descritas con mayor frecuencia en nuestro medio son el Microsporum y, en segundo término, Trichophyton, los cuales se contraen principalmente por contacto directo con animales o seres humanos infectados, respectivamente. Se presenta el caso de una paciente de 8 años con alopecia y lesiones inflamatorias de 2 años de evolución, en la que finalmente se llegó al diagnóstico de TC inflamatoria causada por T. tonsurans, un hongo antropofílico considerado poco frecuente en Argentina y emergente en la provincia de Buenos Aires. Este patógeno presenta alta transmisibilidad; son varios los países que han reportado brotes escolares y comunitarios. Se debe resaltar la importancia de su sospecha clínica temprana para un tratamiento adecuado.

Tinea capitis (TC) is a superficial mycosis of the scalp, considered one of the most common dermatophyte infections in children. Until now, the species mainly described in our environment are Microsporum and secondly Trichophyton, which are contracted mainly by direct contact with infected animals or humans, respectively. We present the case of an 8-year-old patient with alopecia and inflammatory lesions of 2 years of evolution, finally reaching the diagnosis of inflammatory tinea capitis caused by T. tonsurans, an anthropophilic fungus considered rare in Argentina and emerging in the province of Buenos Aires. This pathogen has high transmissibility; several countries have reported school and community outbreaks. The importance of its early clinical suspicion for adequate treatment should be emphasized.

Anti-dermatophyte activity of the aqueous extracts of Thai medicinal plants / Atividade antidermatófita dos extratos aquosos de plantas medicinais tailandesas

Medicinal plants have long been prescribed in Thailand for centuries. Different constituents of extracts have been used for treating of various infectious diseases. However, there is even less information available regarding the use in fungal skin infection. In order to assess traditional Thai claims about the therapeutic potential, this study is focused on exploring the anti-dermatophyte property of the plants that are currently used as traditional medicines. The potential of four different plant species were selected for investigate in vitro anti-dermatophyte activity. Ethanolic extracts of Chromolaena odorata (L.), Ageratina adenophora (Spreng.), Eclipta prostrate (Linn.), and Acorus calamus (L.). were analysed for their total phenolic content as well as total flavonoid content and were then subjected to test of their anti-dermatophyte properties using agar well diffusion method. Qualitative flavonoids and phenolics analysis of the extracts showed their biologically active constituents. Among the species examined, the result indicated that most of the extracts demonstrated anti-dermatophyte activity. In particular, A. calamus showed the highest efficacy against test organisms. The experiment confirmed the chemical constituents and efficacy of some selected plants and provides a scientific confirmation of the use of Thai plants in traditional medicine for fungal skin infections.

As plantas medicinais são prescritas há muito tempo na Tailândia, há séculos. Diferentes constituintes de extratos têm sido usados para o tratamento de várias doenças infecciosas. No entanto, existem ainda menos informações disponíveis sobre o uso em infecções fúngicas da pele. A fim de avaliar as alegações tradicionais tailandesas sobre o potencial terapêutico, este estudo está focado em explorar a propriedade antidermatófita das plantas que são usadas atualmente como medicamentos tradicionais. O potencial de quatro espécies de plantas diferentes foi selecionado para investigar a atividade antidermatófita in vitro. Extratos etanólicos de Chromolaena odorata (L.), Ageratina adenophora (Spreng.), Eclipta prostrate (Linn.) e Acorus calamus (L.) foram analisados quanto ao seu conteúdo fenólico total, bem como ao conteúdo de flavonoides totais. E então submetidos ao teste de suas propriedades antidermatófitas usando o método de difusão em ágar bem. A análise qualitativa de flavonoides e fenólicos dos extratos mostrou seus constituintes biologicamente ativos. Entre as espécies examinadas, o resultado indicou que a maioria dos extratos demonstrou atividade antidermatófita. Em particular, A. calamus mostrou a maior eficácia contra organismos de teste. O experimento confirmou os constituintes químicos e a eficácia de algumas plantas selecionadas e fornece uma confirmação científica do uso de plantas tailandesas na medicina tradicional para infecções fúngicas da pele.

Anti-dermatophyte activity of the aqueous extracts of Thai medicinal plants

Abstract Medicinal plants have long been prescribed in Thailand for centuries. Different constituents of extracts have been used for treating of various infectious diseases. However, there is even less information available regarding the use in fungal skin infection. In order to assess traditional Thai claims about the therapeutic potential, this study is focused on exploring the anti-dermatophyte property of the plants that are currently used as traditional medicines. The potential of four different plant species were selected for investigate in vitro anti-dermatophyte activity. Ethanolic extracts of Chromolaena odorata (L.), Ageratina adenophora (Spreng.), Eclipta prostrate (Linn.), and Acorus calamus (L.). were analysed for their total phenolic content as well as total flavonoid content and were then subjected to test of their anti-dermatophyte properties using agar well diffusion method. Qualitative flavonoids and phenolics analysis of the extracts showed their biologically active constituents. Among the species examined, the result indicated that most of the extracts demonstrated anti-dermatophyte activity. In particular, A. calamus showed the highest efficacy against test organisms. The experiment confirmed the chemical constituents and efficacy of some selected plants and provides a scientific confirmation of the use of Thai plants in traditional medicine for fungal skin infections.

Resumo As plantas medicinais são prescritas há muito tempo na Tailândia, há séculos. Diferentes constituintes de extratos têm sido usados para o tratamento de várias doenças infecciosas. No entanto, existem ainda menos informações disponíveis sobre o uso em infecções fúngicas da pele. A fim de avaliar as alegações tradicionais tailandesas sobre o potencial terapêutico, este estudo está focado em explorar a propriedade antidermatófita das plantas que são usadas atualmente como medicamentos tradicionais. O potencial de quatro espécies de plantas diferentes foi selecionado para investigar a atividade antidermatófita in vitro. Extratos etanólicos de Chromolaena odorata (L.), Ageratina adenophora (Spreng.), Eclipta prostrate (Linn.) e Acorus calamus (L.) foram analisados quanto ao seu conteúdo fenólico total, bem como ao conteúdo de flavonoides totais. E então submetidos ao teste de suas propriedades antidermatófitas usando o método de difusão em ágar bem. A análise qualitativa de flavonoides e fenólicos dos extratos mostrou seus constituintes biologicamente ativos. Entre as espécies examinadas, o resultado indicou que a maioria dos extratos demonstrou atividade antidermatófita. Em particular, A. calamus mostrou a maior eficácia contra organismos de teste. O experimento confirmou os constituintes químicos e a eficácia de algumas plantas selecionadas e fornece uma confirmação científica do uso de plantas tailandesas na medicina tradicional para infecções fúngicas da pele.

Determinants of Risk Factors On Dermatophytes Infections on Patients’ Knowledge, Attitude and Hygiene Practice Among Patients Attending Dermatology Department in A Government Hospital in Setif Province, Algeria

@#Introduction: Dermatophyte infections are superficial infections that affect the skin and are caused by fungi, namely dermatophytes. Objectives: This study aimed to determine the prevalence of dermatophyte infections among patients who attended the Dermatology Department in Setif public hospital, Algeria and to determine the associated risk factors to these infections. Methods: A cross-sectional study with a sample size of 400 respondents was designed to collect the data using a validated pre-tested questionnaire from February to June 2019. The collected data was then analyzed using IBM SPSS version 25. Results: The response rate was 98.4% (315 respondents) with an overall mean age (SD) of 38.81 (16.37) years old. The prevalence of dermatophyte infections among respondents was 33.7%, 26% of them have single infections. On the other hand, multiple logistic regression analysis showed an increased odd of having dermatophyte infections by three times among patients from low-income families (OR=3.23, 95% CI=1.09- 4.78, p=0.03). Similarly, the presence of chronic diseases led to a twofold increase in the odds of having dermatophyte infection among patients (OR=2.27, 95% CI=1.01-10.49, p=0.045). It was also found that poor attitudes towards preventing dermatophyte infections increased the odds of having dermatophyte infection by near to three times (OR=2.58, 95% CI=1.14-4.74, p=0.002). Conclusion: The high prevalence of dermatophyte infections presents a significant concern in Setif Province, Algeria. In this context, further efforts are needed to review the practiced control measures to optimize the effectiveness of these measures, which may reduce dermatophyte infections, especially among patients with chronic diseases.

Diversity and Anti-Dermatophyte Activities of Endophytic Fungi from Datura metel / 中国实验方剂学杂志

Objective:To investigate the taxonomic structure and diversity of endophytic fungi from <italic>Datura metel </italic>and screen the strains with anti-dermatophyte activities， so as to provide resources for the development of new lead compounds against dermatomycosis. Method:Endophytic fungi were isolated from the roots， stems and leaves of <italic>D. metel</italic> after tissue block incubation and then identified by morphological analysis and rDNA-internal transcribed spacer（ITS） sequencing. Their anti-dermatophyte activities were detected by agar diffusion assay. Result:A total of 292 strains of endophytic fungi were isolated from <italic>D. metel</italic>， belonging to 34 genera， with<italic> Fusarium</italic> （72.97%） in roots， <italic>Fusarium </italic>（37.25%） and <italic>Plectosphaerella </italic>（28.43%） in stems， and <italic>Colletotrichum </italic>（39.66%） in leaves as the dominant species. The isolation rate （89.23%）， colonization rate （84.62%）， and diversity index （1.82） of endophytic fungi in leaves were significantly higher than those in roots （70.48%， 70.48% and 1.23） and stems （69.39%，68.03% and 1.64）. The determination of anti-dermatophyte activities of 35 endophytic fungal fermented filtrates showed that the strains exhibiting inhibitory activities against <italic>Microsporum canis</italic>， <italic>Trichosporon mucoides</italic>， <italic>Trichophyton rubrum</italic> and <italic>Candida albicans </italic>accounted for 97.14%， 71.43%， 45.71%， and 25.71%， respectively. Among them， six strains （17.14%）， namely <italic>Fusarium </italic>sp. R1， <italic>Penicillium </italic>sp. R5， <italic>Aspergillus </italic>sp. R7， <italic>Metarhizium </italic>sp.<italic> </italic>S18， <italic>Diaporthe </italic>sp. S19， and <italic>Glomerella </italic>sp.<italic> </italic>L57， all inhibited the four types of cutaneous fungal pathogens. Conclusion:The endophytic fungi in <italic>D. metel</italic> are diverse， and the proportion of endophytic fungi possessing anti-dermatophyte activities is high， allowing them to serve as potential resources for the development of new anti-dermatophyte agents.

Dermatophytosis: an Epidemiological And Clinical Comparative Study in a Tertiary Care Centre

Introduction: Dermatophytosis is a common superficialmycosis associated with significant morbidity. Dermatophytosis which are recurrent and clinically unresponsive totherapy are showing an alarming increase in the last fewyears. These patients are a potential source of infection to theirfamily members and others closely associated with them. Ourstudy aimed to investigate the risk factors, clinical patternsand causative dermatophyte species in patients with chronic/recurrent dermatophytosis and patients with first episode oftypical tinea.Material And Methods: The enrolled patients werecategorized as group I consisting of 81 cases of chronic/recurrent dermatophytosis and group II consisting of 81 casesof first episode dermatophytosis. After detailed history andthorough clinical examination, wet-mount preparation fordirect microscopic examination was done along with fungalculture using Sabouraud’s dextrose agar.Results: In group I, T.mentagrophytes (51.7%) was themost common species isolated followed by T tonsurans(26.7%) and T rubrum(18.3%) while in group II, T tonsurans(43.3%) was the most common species isolated followed byT rubrum (28.4%)and T mentagrophytes(23.9%). Injudicioususe of topical steroids, non-compliance with treatment andpresence of dermatophyte infection among family memberswere the major risk factors with significant association withchronic/recurrent infections. Limitations: Lack of follow upof cases, antifungal susceptibility with clinical outcome andImmunological profile of the patients was not studied.Conclusion: Chronic and recurrent dermatophytosis areemerging as a major problem in dermatology practice.Injudicious use of topical steroid containing preparations,non-compliance, presence of intrafamilial infection are majorfactors for chronic and recurrent infections.

Prevalência de infecções fúngicas em um laboratório de análises clínicas da cidade de Veranópolis, Rio Grande do Sul / Prevalence of the fungal infecctions in a clinical analysis laboratory in the city of Veranópolis, Rio Grande do Sul

Objetivo: As infecções fúngicas, atualmente, constituem um problema de saúde pública, devido à elevada prevalência e frequência com que acometem a população. Fatores predisponentes como condições climáticas, região geográfica e características culturais e socioeconômicas favorecem a ocorrência destas infecções. O objetivo do presente estudo foi determinar a prevalência das infecções fúngicas em pacientes atendidos em um laboratório de análises clínicas na cidade de Veranópolis, Rio Grande do Sul (RS). Métodos: Foi realizado um estudo retrospectivo, por meio da consulta ao banco de dados, de 403 laudos de exames micológicos, direto e cultural, realizados no laboratório durante o período de abril de 2014 a abril de 2017. Resultados: Dentre os laudos analisados no estudo, houve positividade em 251 (62,28%) exames micológicos diretos (EMD) e em 226 (56,08%) exames culturais. As micoses superficiais e cutâneas constituíram as principais infecções diagnosticadas, sendo os fungos dermatófitos os agentes etiológicos mais isolados (69,47%), representados majoritariamente pela espécie Trichophyton mentagrophytes, seguidos por leveduras (20,35%), especialmente as pertencentes ao gênero Candida. Houve predomínio de infecções em pacientes do sexo feminino (64,54% EMD e 61,5% cultura) e adultos de 31 a 60 anos foram os mais acometidos pelas micoses diagnosticadas (58,96% EMD e 60,62% cultura). Conclusão: O conhecimento do perfil epidemiológico pode servir como guia na correta identificação do patógeno no diagnóstico laboratorial, influenciando diretamente no prognóstico e na escolha da conduta terapêutica adequada.

Objective: The fungal infections are a public health issue, because ofthe high prevalence and frequency that they victimize the population. Predisposal factors as bioclimatic conditions, geographic region and cultural and socioeconomic characteristics favor the occurrence of this infections, generating, this way, variation in the prevalence of species in each region. The goal of the present study was to determinate the prevalence of fungal infections in patients in a clinical analysis laboratory in the city of Veranópolis, Rio Grande do Sul (RS). Methods: A retrospective study was made, using the consult of data basis, of 403 direct and culture mycological examination reports made in the laboratory during the period of April 2014 to April 2017. Results: In the analyzed examination reports in the study, there was positivity in 251 (62,28%) mycological direct exams (EMD) and, in 226 (56,08%) cultural exams. The superficial and cutaneous mycosis constituted the mainly diagnosed infections, being the dermatophytic fungi the most isolated etiological factors (69,47%), represented mainly, by the Trichophyton mentagrophytes species, followed by yeasts (20,35%), especially those who belong to the Candida genre. There was prevalence of infections in women patients (64,54% EMD and 61,5% culture). Adults among 31 and 60 years old were the most victimized by the diagnosed mycosis (58,96% EMD e 60,62% cultural). Conclusion: Knowledge of the epidemiological profile can serve as guide in the correct identification of the pathogen in the laboratory diagnosis, influencing directly in the prognosis and in the choice of the right therapeutic conduct

Chlamydoconidium-producing Trichophyton tonsurans: Atypical morphological features of strains causing tinea capitis in Ceará, Brazil

Objective: To report atypical morphological features of Trichophyton (T.) tonsurans strains associated with tinea capitis. Methods: Eighty-two T. tonsurans strains isolated in Ceará, Brazil, were analyzed regarding macro and micromorphological features and nutritional patterns. Results: Fifty-two samples presented abundant chlamydoconidia, which were produced in chains. Macroscopically, these strains developed small glabrous colonies that were firmly attached to the surface of the culture medium, with few or no aerial mycelia and intense rusty yellow pigmentation. Seven strains did not grow with stimulus from thiamine. Samples were heterogeneous regarding urease production and none presented in vitro hair perforation. Conclusions: The observation of T. tonsurans strains with distinct phenotypic features indicates the need to revise the taxonomic criteria for routine identification of this dermatophyte.

Chlamydoconidium-producing Trichophyton tonsurans: Atypical morphological features of strains causing tinea capitis in Ceará, Brazil

Objective: To report atypical morphological features of Trichophyton (T.) tonsurans strains associated with tinea capitis. Methods: Eighty-two T. tonsurans strains isolated in Ceará, Brazil, were analyzed regarding macro and micromorphological features and nutritional patterns. Results: Fifty-two samples presented abundant chlamydoconidia, which were produced in chains. Macroscopically, these strains developed small glabrous colonies that were firmly attached to the surface of the culture medium, with few or no aerial mycelia and intense rusty yellow pigmentation. Seven strains did not grow with stimulus from thiamine. Samples were heterogeneous regarding urease production and none presented in vitro hair perforation. Conclusions: The observation of T. tonsurans strains with distinct phenotypic features indicates the need to revise the taxonomic criteria for routine identification of this dermatophyte.

In Vitro additive effect on griseofulvin and terbinafine combinations against multidrug-resistant dermatophytes

ABSTRACT Griseofulvin (GF) and terbinafine (TF) are commonly used drugs to treat dermatophytosis, a fungal infection of the skin. Today there is an increase in drug resistance to these antifungals which highlight the need for alternative synergistic therapies. Minimum Inhibitory Concentration (MIC) of GF and TF were determined against fungi clinical isolates from local hospitals with values ranging 0.03-2.0 µg mL-1 and 0.24-4.0 µg mL-1, respectively. A checkboard test was used to determine the combination of GF:TF which could induce an additive effect against the fungi isolates Multidrug-resistant isolates showed susceptibility after treatment with 16:2 µg mL-1 GF:TF. An MTT assay further verified that GF and TF combinations have greater additive effect against pathological and multidrug-resistant isolates than antifungals alone. Herein we disclose GF:TF combinations that could constitute as a possible new anti-dermatophyte therapy.

Dermatophyte colonization in rabbits kept in pet stores of Santiago of Chile / Colonización por dermatofitos en conejos mantenidos en tiendas de mascotas de Santiago de Chile

ABSTRACT Objective. The dermatophytes are keratinophilic fungi, of importance in public health because of their anthropozoophilic nature. Given the increasing acquisition of exotic animals as pets and the scarce studies on the state of colonization by dermatophytes on these animals; we raised the objective of determine the presence of dermatophytes in clinically healthy rabbits (Oryctolagus cuniculus) from pet stores in Santiago, Chile. Materials and Methods. 42 clinically healthy rabbits were studied. Clinical specimens were obtained from the hairy mantle and cultivated on Sabouraud glucose agar and dermatophyte test medium (DTM™); the identification of the fungal isolates was performed using classic mycological procedures that included direct microscopic examination and the analysis of micromorphological features on culture. Results. Of the total number of rabbits studied, three (7.1%) presented colonization by dermatophytes, being more frequent in males and in those animals that coexisted with Guinea Pigs. The species identified in all three cases was Trichophyton mentagrophytes. Conclusions. This study evidence colonization by dermatophytes in domestic rabbits, important information for veterinarians and owners of pets, at the time of being in contact with this animal species.

RESUMEN Objetivo. Los dermatofitos son hongos queratinofílicos, de importancia en salud pública por su rol antropozoofílico. Dado el aumento en la adquisición de animales exóticos como mascotas y los escasos estudios sobre el estado de colonización por dermatofitos en estos animales, nos planteamos el objetivo de determinar la presencia de dermatofitos en conejos (Oryctolagus cuniculus) clínicamente sanos procedentes de tiendas de mascotas en Santiago de Chile. Materiales y Métodos. Se estudiaron 42 conejos clínicamente sanos. Las muestras clínicas se obtuvieron desde el manto piloso y cultivadas en agar Sabouraud glucosado y dermatophyte test medium (DTM®). La identificación del agente aislado fue realizada por procedimientos micológicos clásicos que incluyeron examen microscópico directo y cultivo. Resultados. Del total de conejos estudiados, tres (7,1%) presentaron colonización por dermatofitos, siendo más frecuente en machos y en aquellos animales que convivían con cuyes. La especie identificada en los tres casos fue Trichophyton mentagrophytes. Conclusiones. Este estudio evidencia la colonización por dermatofitos en conejos domésticos, información importante para médicos veterinarios y propietarios de mascotas, al momento de estar en contacto con esta especie animal.

Pseudomicetoma dermatofítico disseminado em um gato persa - Relato de caso / Dermatophytic pseudomycetoma disseminated in a persian cat - Case report / Pseudomicetoma dermatofitos diseminada en un gato persa - Relato de caso

O pseudomicetoma dermatofítico (PMD) é uma profunda infecção dérmica, causada por fungos, sendo o Microsporum canis o agente etiológico mais frequentemente envolvido. O objetivo do presente trabalho é relatar um caso de pseudomicetoma em um gato persa e alertar os médicos veterinários para incluir a doença como diagnóstico diferencial em dermatopatias em gatos, principalmente os da raça persa. Um felino macho, da raça Persa, de três anos, veio para atendimento apresentando 22 nódulos subcutâneos, distribuídos em todo corpo, com diâmetros que variavam de 2 a 8 centímetros, inclusive dentro do pavilhão auricular direito. Realizou-se raspado cutâneo e citologia aspirativa por agulha fina, obtendo resultados pouco conclusivos. Após a realização de exérese cirúrgica de grande parte dos nódulos e encaminhamento para exame histopatológico, obteve-se o diagnóstico de PMD. Após tratamento com itraconazol 10mg/kg SID por 5 meses houve completa remissão do quadro. A excisão cirúrgica foi essencial para a resolução do quadro, que juntamente com o itraconazol sistêmico tornou o tratamento efetivo para o PMD.(AU)

Dermatophytic pseudomycetoma (DPM) is a deep skin infection. Microsporum canis is the etiologic agent most frequently involved in DPM. The purpose of this study is to report a case of DPM in a Persian cat and suggest the veterinarians to include the disease as a differential diagnosis in skin diseases in Persian cats. A male Persian cat, 3 years old, came to be attended at the Veterinary Hospital. The patient was presenting 22 subcutaneous nodules measuring 2-8 cm in diameter, in different parts of the body, including inside the right ear. Skin scraping and fine needle aspiration cytology were performed, yielding inconclusive results. After performing the surgical removal of most of the nodules and a skin biopsy, the diagnosis of DPM was obtained. The cat had a complete remission of the disease after the treatment with itraconazole 10mg/kg SID for 5 months. It is important to emphasize that, as a therapeutic point of view, surgical excision is considered essential, but not enough to establish a permanent cure. Since there can be recurrence, the systemic use of itraconazole is indicated to efficiently cure animals presenting DPM.(AU)

El pseudomicetoma dermatofitos (PMD) es una infección profunda de la piel causada por hongos, siendo el Microsporum canis el agente etiológico implicado con mayor frecuencia. El objetivo de este trabajo es presentar un caso de pseudomicetoma en un gato persa y alertar los médicos veterinarios para incluir la enfermedad como un diagnóstico diferencial de enfermedades de la piel en gatos, especialmente la raza persa. Un gato macho, de la raza persa, de tres años, llegó a la asistencia presentando 22 nódulos subcutáneos, distribuidos por todo el cuerpo, con diámetros que variaban de 2 a 8 cm, inclusive dentro de la oreja derecha. Se afeitó la piel y con citología por aspiración, con aguja fina, se obtuvo resultados poco conclusivos. Después de realizar la extirpación quirúrgica de la mayor parte de los nódulos y enrutamiento para el examen histopatológico, se ha obtenido el diagnóstico de PMD. Tras el tratamiento con itraconazol l0mg/kg SID, por cinco meses, hubo remisión completa. La escisión quirúrgica fue esencial para la resolución del cuadro, que junto con itraconazol sistémico se convirtió en un tratamiento eficaz para el PMD.(AU)

Mycology of Onychomycosis: A 5-year retrospective review (2011 – 2015) in Hospital Kuala Lumpur

Onychomycosis is a common nail disease with numerous etiological pathogens. In order to determine and trend the local mycological pattern of culture-positive diseased nail samples sent from the Department of Dermatology, Hospital Kuala Lumpur, a five-year retrospective audit was carried out, which revealed that non-dermatophyte molds were the predominant fungi isolated, followed by yeasts and dermatophytes. This is similar to two previous studies in Malaysia, but varies greatly from other studies around the world which showed a dermatophyte-predominant prevalence. This could be due to the nature of the environment our patients encountered.

Micosis superficiales: casuística del Departamento de Micología del Instituto Nacional de Higiene “Rafael Rangel”, Caracas,Venezuela (2001-2014) / Superficial mycoses: casuistry of the Mycology Department of the Instituto Nacional de Higiene “Rafael Rangel”, Caracas, Venezuela (2001-2014)

Las micosis superficiales son muy comunes y por ello son motivo de consulta médica frecuente. El objetivo de este trabajo fue conocer la frecuencia de diagnóstico de las micosis superficiales en el Departamento de Micología del Instituto Nacional de Higiene “Rafael Rangel” en Caracas, Venezuela, durante 14 años (2001-2014). Se realizó un estudio transversal y retrospectivo de revisión de historias micológicas de pacientes con diagnóstico presuntivo de micosis superficial. Las muestras procesadas fueron uñas, pelos y escamas epidérmicas. La identificación de los hongos se realizó mediante observación macro y microscópica de las colonias y pruebas de identificación bioquímicas y fisiológicas, según requerimiento del agente aislado. Para la investigación de Malassezia spp. solo se realizó examen directo. De las 3228 muestras procesadas, 1098 (34%) resultaron positivas y su distribución según el agente etiológico fue: 79,5% dermatofitos; 10,9% levaduras; 5,1% hongos no dermatofitos y 4,5% Malassezia spp. El dermatofito más aislado fue el Complejo Trichophyton rubrum (70,1%), seguido del Complejo T. mentagrophytes (15,1%), Microsporum canis (9,4%) y Epidermophyton floccosum (4%). Las tiñas más frecuentes fueron: Tinea unguium (66,8%), seguida de Tinea pedis (16,4%) y Tinea capitis (8,1%). En el grupo de levaduras el Complejo Candida parapsilosis (37,5%) fue el más aislado y entre los hongos no dermatofitos el más frecuente fue Fusarium spp. (53,6%), seguido de Aspergillus spp. (19,6%) y Acremonium spp. (10,7%). La identificación del agente etiológico es fundamental para orientar un tratamiento adecuado. Esta casuística constituye un aporte importante para el conocimiento de la epidemiología de las micosis superficiales en nuestro país.

The superficial mycoses are very common infectious diseases and therefore are a frequent reason for medical consultation. The aim of this study was to determine the diagnostic frequency of superficial mycoses in the Mycology Department of the Instituto Nacional de Higiene “Rafael Rangel” during 14 years (2001-2014). A retrospective cross-sectional study was performed to review the mycological records of patients with presumptive diagnosis of superficial mycosis. Nails, hairs and epidermal scales were the processed samples. The identification of fungi was performed by macro and microscopic observation of colonies and biochemical and physiological tests, as required of the isolated agent. For the investigation of Malassezia spp. only direct examination was performed. Of the 3 228 samples processed, 1 098 (34%) were positive and their distribution according to the etiological agent was: dermatophytes 79.5%; 10.9% yeasts; non-dermatophytes fungi 5.1% and 4.5% Malassezia spp. The most frequently isolated dermatophyte was Trichophyton rubrum Complex (70.1%), followed by T. mentagrophytes complex (15.1%), Microsporum canis (9.4%) and Epidermophyton floccosum (4%). The most frequent ringworms were: Tinea unguium (66.8%), followed by Tinea pedis (16.4%) and Tinea capitis (8.1%). Candida parapsilosis complex (37.5%) was the most frequently isolated yeast and Fusarium spp. (53.6%) was the most isolated among non-dermatophyte fungi, followed by Aspergillus spp. (19.6%) and Acremonium spp. (10.7%). The identification of the etiological agent is essential to guide appropriate treatment. This study constitutes an important contribution to the knowledge of the epidemiology of superficial mycoses in our country.

Comparative efficacy of continuous and pulse dose terbinafifine regimes in toenail dermatophytosis: A randomized double-blind trial.

Introduction: Dermatophytes are the most frequently implicated agents in toenail onychomycosis and oral terbinafi ne has shown the best cure rates in this condition. The pharmacokinetics of terbinafi ne favors its effi cacy in pulse dosing. Objectives: To compare the effi cacy of terbinafi ne in continuous and pulse dosing schedules in the treatment of toenail dermatophytosis. Methods: Seventy-six patients of potassium hydroxide (KOH) and culture positive dermatophyte toenail onychomycosis were randomly allocated to two treatment groups receiving either continuous terbinafi ne 250 mg daily for 12 weeks or 3 pulses of terbinafi ne (each of 500mg daily for a week) repeated every 4 weeks. Patients were followed up at 4, 8 and12 weeks during treatment and post-treatment at 24 weeks. At each visit, a KOH mount and culture were performed. In each patient, improvement in a target nail was assessed using a clinical score; total scores for all nails and global assessments by physician and patient were also recorded. Mycological, clinical and complete cure rates, clinical effectivity and treatment failure rates were then compared. Results: The declines in target nail and total scores from baseline were signifi cant at each follow-up visit in both the treatment groups. However, the inter-group difference was statistically insignifi cant. The same was true for global assessment indices, clinical effectivity as well as clinical, mycological, and complete cure rates. Limitations: The short follow-up in our study may have led to lower cure rates being recorded. Conclusion: Terbinafi ne in pulse dosing is as effective as continuous dosing in the treatment of dermatophyte toenail onychomycosis.

Efficacy and safety of 1% terbinafine hydrochloride versus 2% sertaconazole cream in the treatment of tinea corporis.

Background: Tinea corporis is a common superficial dermatophytosis seen in tropical countries. This study was done to compare the efficacy and safety of topical antifungal agents, terbinafine versus sertaconazole in the treatment of tinea corporis. Methods: This study was conducted in Babuji Hospital and Chigateri Government Hospital, Davangere. A total of 60 (n=60) patients were included and divided into two groups of 30 patients each in the study. 1st group - received topical 1% terbinafine hydrochloride and 2nd group - received 2% sertaconazole cream. Patients were advised to apply cream twice daily for 4 weeks. Improvement in clinical parameters like erythema, scaling, itching, and potassium hydroxide (KOH) mount were taken for assessing the efficacy of drugs. They were followed-up at the end of 2, 4, and 6 weeks to assess the improvement of the condition. Complete cure rate was defined as mycological cure with a complete absence of clinical signs and symptoms. For safety data of both drugs presence of any local side effects (like stinging sensation, swelling and increased erythema) were analyzed in both groups. Statistical analysis was done using students paired t-test and unpaired t-test. Results: When two groups were compared at the end of 2 weeks, complete cure rate for terbinafine was 80% as compared to 63.3% for sertaconazole (p<0.003). However, at the end of 4 weeks, sertaconazole was as effective as terbinafine and statistically non-significant (p>0.05) results were obtained. KOH mount was negative in both groups at the end of 2nd week. Local side effects like erythema, swelling, stinging sensation were not noticed during the study in both the groups. Conclusion: From this study, it was shown that 2% sertaconazole cream was as effective as 1% terbinafine cream, though 1% terbinafine had higher rates of complete cure at the end of 2 weeks as compared to sertaconazole.

Neutral red staining and trypsin treatment to study viability and culture yield of Dermatophytes.

Dermatophytosis is common fungal infection of human being. To diagnose dermatophytic infections microscopic examination should be followed by culture which is essential step. Many times fungus may fail to grow on culture even after direct microscopy is positive due to non-Viability of fungus and it has been revealed that trypsinization enhances the rate of isolation of fungus on culture. Therefore, the study was undertaken with an aim to look for the viability and yield of dermatophytes on neutral red staining and trypsinization respectively.

Primer caso de onicomicosis causada por Cylindrocarpon lichenicola, en un paciente inmunosuprimido en Costa Rica / First case of onychomycosis caused by Cylindrocarpon lichenicola in an immunosuppressed patient un Costa Rica

Antecedentes: la onicomicosis es una infección fúngica de las uñas, que puede ser causada por dermatofitos, levaduras y hongos filamentosos no dermatofitos. El objetivo del presente trabajo fue identificar-morfológica y molecularmente- un aislamiento realizado a partir de la uña del dedo medio de la mano derecha de un paciente inmunosuprimido con trasplante renal. Métodos: a la muestra se le realizó un examen microscópico directo en KOH 40 por ciento, y las características de la colonia fueron evaluadas en medio de cultivo Agar Sabouraud Glucosado y Agar Mycosel. El hongo aislado se identificó molecularmente mediante la amplificación, por reacción en cadena de la polimerasa (PCR) y secuenciación de la región espaciadora transcrita (ITS) de los genes ribosomales y de una porción del gen del factor de elongación 1 alfa (EF-1). La secuencia de nucleótidos de cada región fue comparada con las secuencias publicadas en la base de datos del Anco de Genes del Centro Nacional para la Información Biotecnológica (NCBI). Resultados: las características macro y microscópicas de la colonia concordaron con las directrices para Cylindrocarpon lichenicola (sinónimo Fusarium lichenicola). La secuencia de nucleótidos, tanto de la región ITS (544 pb) como de la porción del gen EF-1alfa (710 pb), presentó un 100 por ciento de similitud con secuencias de F. lichenicola. Conclusión: se identificó por primera vez en Costa Rica C. lichenicola asociado con onicomicosis en un paciente inmunosuprimidos. Este tipo de pacientes deben ser instruidos sobre las posibles fuentes de agentes infecciosos, particularmente los riesgos que pueden generar la jardinería y la agricultura...

The Clinical and Mycological Study of Tinea Manus and Concomitant Dermatophytosis / 대한의진균학회지

BACKGROUND: Tinea manus is a common superficial dermatophyte infection that is usually coexistent with tinea pedis. Trichophytom rubrum is the most commonly isolated agent in tinea manus. Despite this condition, there have been only a few reports on the clinical and mycological features of tinea manus. OBJECTIVE: This study aims to evaluate the variables related with tinea manus and to determine the correlation with other superficial dermatophyte infection. METHODS: Clinical and mycological features of 54 cases with tinea manus from the department of dermatology in Daegu Catholic University Hospital and the Catholic Skin Clinic from January 2011 to December 2012 were evaluated retrospectively. RESULTS: The male to female ratio was 2:1. The age distribution ranged from 14 to 81 years old. The affected site was the palm in 31 cases (57.4%), the dorsum in 13 cases (24.1%), and both palm and sole in 10 cases (18.5%). Tinea manus was accompanied with other superficial dermatophyte infections, such as tinea pedis, tinea unguium, and tinea corporis in 42 cases (77.8%) and not in 12 cases (22.2%). Fungal culture result was positive in 8 cases of tinea manus only group and in 26 cases of tinea manus with other dermatophyte infection group. The most commonly isolated agent was Trichophyton rubrum in both groups. CONCLUSION: The patients with only tinea manus tend to predilect the dorsum of hand and were relatively more caused by other fungus than Trichophyton ruburum when compared with the patients with other dermatophytosis.