A survey of dermatophytes isolated from human patients in the United States from 1979 to 1981 with chronological listings of worldwide incidence of five dermatophytes often isolated in the United States

A survey of dermatophytes isolated from patients seeking medical advice was made from 1979 to 1981 in the United States. The survey included 54 locations with data from 40 cities and 2 states. Correlations of these data with that of the other localities of the world were made to illustrate the dynamic epidemiology of several common dermatophytes. The most often isolated dermatophyte in this survey was Trichophyton rubrum having 53.66% of the total for these three calendar years. In a chronological listing of ringworm infections caused by this organism, many areas of the world have reported similar increased incidence of this pathogen. Trichophyton tonsurans was isolated 27.85% of the total. A dramatic increase of this pathogen as a cause of tinea capitis has been observed in most cities of the United States. It has been isolated in 25 different countries of the world. The percentage of isolation of Trichophyton mentagrophytes was 8.56%. This percentage may not be near the true incidence of infection by this dermatophyte because the infections are mild and respond to treatment without the individual seeking medical advice. Since the 1950s the percentage of isolations of the total has dropped for T. mentagrophytes in the United States. Epidermophyton floccosum accounted for 4.36% of the total. In a few areas of the world it causes over 30% of the total of dermatophytoses. Microsporum canis was isolated 3.72% of the total in the United States. It has recently been reported to be the dominant agent of tinea capitis in several South American countries, Tucson, Arizona and Kuwait. Once the dominant pathogen of tinea capitis in children in the United States, it was replaced by Microsporum audouinii before 1960. Today in the United States, M. audouinii only accounts for 0.30% of the total. It is considered eliminated as a pathogen in England. In this survey, isolated less than 1.0% of the total were Microsporum gypseum, Microsporum ferrugineum, Microsporum nanum, Microsporum fulvum and Trichophyton schoenleinii. Trichophyton meginii and Trichophyton terrestre were reported isolated but no numerical data were available.     

A survey of dermatophytes isolated from human patients in the United States from 1982 to 1984

A survey of dermatophytes isolated from patients seeking medical advice was made from 1982 to 1984 in the United States. The survey included 59 locations with data from 49 cities and one state. Listing of the isolated dermatophytes and the frequency given by percentage of total follows: Trichophyton rubrum 46.8%, T. tonsurans 33.3%, T. mentagrophytes 10.1%, Microsporum canis 4.5%, Epidermophyton floccosum 3,5%, M. gypseum and T. verrucosum both 0.7%, M. audouinii and T. terrestre both 0.1%, and T. violaceum 0.06%. No isolations of M. ferrugineum or T. schoenleinii were reported.Temporal increases were observed for frequencies of T. mentagrophytes, T. tonsurans and M. canis, and decreases occurred for frequencies of E. floccosum and T. rubrum when the data from this survey were compared by the goodness of fit test to data of the 1979 to 1981 survey. The percent of dermatophyte isolations identified as T. tonsurans correlated significantly with the percentage of blacks in cities of 100000 or more people.     

Identification and genetic homogeneity of Trichophyton tonsurans isolated from several regions by random amplified polymorphic DNA

Trichophyton tonsurans is an anthropophilic dermatophyte mostly causing tinea capitis and tinea corporis. This study was carried out to identify T. tonsurans and to clarify whether it has any genetic differences depending on the phenotype or region of isolation by random amplified polymorphic DNA (RAPD) analysis with three random primers. The assay was performed in 11 Korean, 2 Japanese, 2 Taiwanese, 5 Brazilian and 1 American isolates of T. tonsurans together with the other 10 anamorphic species of dermatophytes and 3 Arthroderma spp. All tested species of dermatophytes showed distinct bands and T. tonsurans was differentiated from other dermatophytes. It was most clearly ifferentiated from T. mentagrophytes by using primer 5-GAAGGCTCCC-3 (OPAO-15). No difference was found in RAPD band patterns in all strains of T. tonsurans with these random primers. It was considered that T. tonsurans is a genetically homogeneous species regardless of its isolation regions, morphologic or physiologic characteristics.This revised version was published online in October 2005 with corrections to the Cover Date.     

Some data on the occurrence of trichophyton tonsurans in Romania

Summary During the last 12 years,T. tonsurans has been isolated from 250 cases of various mycotic infections, 80% in the adults, the rest in children. The age of infected patients varied from 1 to 66 years, the female being represented by 10%.Most of the cases (93%) involved the hair follicles, 45 of them affecting the bearded area, in which 4 clinical types could be distinguished: the superficial form, the kerion type (in 11% of the cases) and 2 intermediate forms.In 16% of cases,T. tonsurans attacked the scalp, simulating various nonmycotic dermatoses as impetigo, seborrheic dermatitis, tinea amiantacea etc. 5 cases of the scalp infection were found in the adults (3 of black-dot type, the other 2 of superficial tinea capitis). The same variety of clinical manifestations was observed in the glabrous skin, which this species affected in 7% of the cases. It also involved the nails in 2 cases only. T. tonsurans is in continuous decrease in Romania for the last ten years (4% of all the dermatophytes). This dermatophyte remained, till now, the main agent of tinea barbae in Romania. Community epidemics as those caused byM. audouinii andM. ferrugineum have not yet occurred in this country.     

A critical survey of 1000 cases of dermatophytosis in the tel aviv area during 1970–1975

Clinical and mycological data on 1000 cases of dermatophytosis seen from 1970 to 1975 are reported. Tinea pedis was present in 44%, T. rubrum being the main causative agent; nail involvement was present in 41% of these cases. Tineainguinalis was present in 13%, 38% of them females, withT. rubrum isolated in 87% and the swimming-pool incriminated as the main source of contamination. There were various manifestations of tinea corporis in 128 patients, withT. rubrum responsible in 91%. Among the 21 cases of tinea capitis, there was one adult female with a kerion-type due toT. violaceum, 4 cases due toM. gypseum and 2 toM. canis. Tinea favosa was seen in 6 patients, all of them females and one with a spreading fungus on the soles and palms. Amonh the 10 cases with tinea barbae,T. rubrum was found in 4,T. tonsurans in 3,T. mentagrophytes in 2 andM. gypseum in one. There were widespread lesions ofT. rubrum located on large areas of the body and including the legs, arms, groins and nails, in 11 patients with other disorders, including diabetes, Cushing's syndrome and lymphoma.It was apparent that the dermatophytic flora of Israel comprises 10 dermatophytes,T. rubrum being the predominant agent of infection (in more than 80%), with a gradually increasing incidence evident. The other agents found in our survey wereT. mentagrophytes, T. violaceum, T. schoenleinii, T. tonsurans (found sporadically),E. floccosum andMicrosporum spp.M. canis andM. gypseum, the latter being reported for the first time in this country.T. verruccosum andT. megnini, mentioned in former publications, were not found in this survey.     

Cytobrush-culture method to diagnose tinea capitis

This is a comparative study to isolate the dermatophytes of tinea capitis using the cytobrush and comparing it versus the standard method. A prospective, observational, comparative trial of 178 probable cases of tinea capitis was conducted in two dermatological centers. Each patient underwent mycological tests that included direct exam with KOH and cultures with either of two methods: scraping the scalp to remove hair and cell debris, and the cytobrush. A total of 135 clinically and mycologically proven cases of tinea capitis were included; 119 were non-inflammatory and 16 inflammatory tinea. A total of 131 had a positive direct exam and subsequent primary isolation cultures were obtained in 135 cases. The main dermatophytes isolated were Microsporum canis (68%) and Trichophyton tonsurans (20%). A total of 115/135 (85.1%), were detected with the traditional method, with an average of 11.2 days until positive, while the number detected with the cytobrush was 132/135 (97.7%) with an average of 8.5 days until positive. The chi-square statistical method showed that the cytobrush culture was superior to the standard one with a chi-square of 5.078 (P = 0.025), with a statistically significant difference versus the standard method.     

Review of dermatophytoses in Galicia from 1951 to 1987, and comparison with other areas of Spain

We have reviewed all the dermatophytoses diagnosed in Galicia during four consecutive 9-year periods 1951–86 and 1987. From 4571 patients, we isolated 3351 fungal strains belonging, in decreasing order of frequency, to the following dermatophyte species: Microsporum canis (25.5%), Trichophyton rubrum (24.6%), T. mentagrophytes (21.4%), Epidermophyton floccosum (11.8%), M. gypseum (5.2%), T. tonsurans (3.9%), T. verrucosum (3.1%), T. schoenleinii (2.5%), T. violaceum (1.2%), T. mengninii (0.3%), M. audouinii (0.2%), T. equinum (0.1%) and T. soudanense (0.1%). Tinea capitis has diminished in frequency since 1951, though there was been a slight increase since 1978; M. canis has always been the most common agent, and between 1951 and 1959 T. schoenleinii was also very frequent but is no longer found. The frequency of tinea corporis, on the other hand, has experienced a considerable increase. Its most common causal agents in the last few years have been T. mentagrophytes, M. canis and T. rubrum. Until 1977 the most common tinea cruris dermatophyte was E. floccosum, but since then it has been T. rubrum. The commonest tinea pedis dermatophytes have been T. rubrum and T. mentagrophytes. Tinea unguium and tinea barbae have been the most frequent dermatophytoses, and their commonest causal agents T. rubrum and T. mentagrophytes respectively. We have documented the distribution of the various causal agents by location of the lesions, age and source of the patients (private or National Health Service patients), and we have compared the results with those obtained in other regions of Spain.     

A study of dermatophytoses in Hamadan,the governmentship of West Iran

In order to determine the extent and causative agents of dermatophytoses in the Hamadan region of West Iran; a study was made during a 9-month period from October 1991 to June 1992. A total of 7495 individuals were studied of whom 681 (9%) were suspect of having cutaneous mycoses. Among them dermatophytoses were the commonest infections (259/681=38%). Of 259 individuals infected with dermatophytes, tinea capitis were observed in 163 (62.9%); t. corporis in 27 (10.4%); t. manuum and t. cruris in 19 (7.3%) each; t. barbae and faciei in 14 (5.4%); t. pedis in 13 (5%) and t. unguium in 4 (1.5%). A total of 144 patients yielded dermatophyte cultures. The frequency of the isolated species in decreasing order was as follows: Trichophyton verrucosum, 78 (54.1%); T. schoenleinii, 48 (33.3%); Microsporum canis, 8 (5.5%); Epidermophyton floccosum, 5 (3.5%); T. mentagrophytes and M. gypseum, 2 (1.4%) each; T. tonsurans, 1 (0.7%). In conclusion, the most prevalent dermatophytosis in this region was t. capitis with the infecting agent of T. schoenleinii.     

Frequency and aetiology of dermatophytosis in children age 12 and under in the state of Amazonas,Brazil

BackgroundFew scientific studies have evaluated dermatophytosis among children in the state of Amazonas or in the greater northern region of Brazil.AimsThe aim of this study was to research the frequency and aetiology of dermatophytosis in children age 12 and under, who were seen between March 1996 and November 2005 at the Mycology Laboratory of the National Institute of Amazonian Research.MethodsFor mycological diagnoses, epidermal scales and/or hairs were used. A portion of this material was treated with potassium hydroxide for direct examination, and another portion was cultivated in Mycobiotic Agar for the isolation of dermatophytes.ResultsOf the 590 samples analysed, 210 showed positive diagnoses by direct examination and cultivation. Tinea capitis (153 cases) was the most frequent type of dermatophytosis, and Trichophyton tonsurans (121 cases) was the most frequently isolated fungal agent. Tinea corporis was observed in 48 cases where the most frequently isolated fungal agent was also T. tonsurans (17 cases), and the corporal regions most affected were the face, arms and trunk. The laboratory confirmed tinea pedis in 6 cases, and the principal fungal agents isolated were Trichophyton rubrum (3) and Trichophyton mentagrophytes (3). The presence of tinea cruris was confirmed in 3 cases, and T. rubrum, T. tonsurans and Epidermophyton floccosum were isolated from these cases.ConclusionsThe children examined were primarily affected by tinea capitis, and the main fungal agent for this dermatophytosis was T. tonsurans.     

Epidemiologic study of dermatophyte infections in Nigeria (clinical survey and laboratory investigations)

The commonest dermatophyte infection among the referred dermatology cases in Nigeria is tinea pedis, whereas among the surveyed population of school children, the commonest fungal infection was tinea capitis.It was found that the most ubiquitcus causative organism for tinea pedis was E. fluccosum, that for tinea capitis was M. audouinii, while that for tinea corporis was T. soudanese.The source of infection of tinea capitis among the school children was found to be most likely the local barber who serviced the schools in all the villages, and this might explain the high incidence rate of T. soudanese in tinea capitis. Tinea pedis infection is believed to be highly favoured by the wearing of shoes among the senior students. Animals were not a major source of transmission of dermatophytes in Nigeria.No new species of dermatophytes has been identified among the cultured organisms.     

Causative Agents of Superficial Mycoses in Istanbul,Turkey: Retrospective Study

The aim of the present study was to determine the percentage of agents, which can give rise to superficial fungal infections in Istanbul, Turkey. Between 2000 and 2007, the clinical samples collected from 8,200 patients attending the outpatient Dermatology Clinic at Mihrimahsultan Medical Center were examined by direct microscopy and culture. Pathogen fungi were detected in 5,722 of the patients. Of the isolates were 4,218 (74%) dermatophytes, 1,196 (21%) Candida sp., 170 (3%) Malassezia furfur, and 138 (2%) Trichosporon sp. Among the dermatophytes, Trichophyton sp. was the most common isolate followed by Epidermophyton floccosum (243) and Microsporum sp. Among the Candida species, C. albicans (549) was also frequently found. Onychomycosis was the most prevalent type of infection, followed by tinea pedis, tinea cruris, tinea corporis, and tinea capitis. In conclusion, our study showed that the most common isolated agents from superficial infections were T. rubrum being Candida sp. the second most prevalent.     

Dermatophytes isolated from patients in University Hospital,Kuala Lumpur,Malaysia

A total of 576 dermatophytes were isolated from patients with a variety of skin infections from January 1993 to May 2000. Ten species of dermatophytes were identified: Epidermophyton floccosum (0.7%), Microsporum audouinii (1.1%), M. canis (3.1%), M. gypseum (0.3%), Trichophyton concentricum(3.5%), T. equinum (0.2%), T. mentagrophytes (36.%), T . rubrum (53.8%), T. verrucosum (0.2) and T. violaceum (1.0%). The body sites most frequently affected by dermatophytes were the buttocks, nails and trunk. Anthropophilic dermatophytes made up 60.1% of the isolates; the most common species was T. rubrum, T. mentagrophytes and M. canis were the two main zoophilic dermatophytes. T. mentagrophytes was isolated from all body sites except the scalp. M. canis was found to be associated with domestic dogs and wasnot isolated from ethnic Malays. The only geophilic dermatophyte was M. gypseum, an uncommon dermatophyte associated with tinea pedis.This revised version was published online in October 2005 with corrections to the Cover Date.     

Dermatophyte Infections in Cairo,Egypt

In this study, we examined dermatophyte infections in patients referred to the Department of Dermatology, EL-Houd El-Marsoud Hospital, Cairo, during March 2004 to June 2005. Of 506 patients enrolled in this investigation, 403 (79.6%) were clinically diagnosed as having dermatophytoses (age range 6–70 years; males 240; females 163). Species identification determined by observation of their macroscopic and microscopic characteristics was complemented with sequencing of the internal transcribed spacer ITS1-5.8S-ITS2 rDNA region. The most common dermatophyte infection diagnosed was tinea capitis (76.4%), followed by tinea corporis (22.3%) and tinea unguium (1.2%). The most frequently isolated dermatophyte species was Trichophyton violaceum, which accounted for most (71.1%) of all the recovered dermatophytes, followed by Microsporum canis (21.09%), Trichophyton rubrum (6.2%), and Microsporum boullardii (0.49%); both Epidermophyton floccosum and Trichophyton tonsurans were each only rarely isolated (0.24%).     

Incidence of dermatophytosis in Jordan with special reference to tinea capitis

Clinical data on 1068 cases of dermatophytosis as well as mycological data on 382 of these cases seen from March 1983 to September 1984 are reported. Tinea cruris was present in 34.1%, with Trichophyton rubrum and Epidermophyton floccosum isolated from 31% and 25% respectively. Tinea corporis was found in 17.9% of all patients of dermatophytosis with T. tonsurans responsible in 30.8%. Tinea pedis and Tinea unguium were present in 7.2% and 2% respectively, T. rubrum being the main causative agent; nail involvement was present in 27.3% of these cases. Tinea capitis was observed in 38.7% of 1068 dermatophytosis cases with T. violaceum and M. canis causing 48% and 32% of all T.C. cases respectively.The dermatophytic flora of the West Bank of Jordan apparently comprises about 14 dermatophytes, T. violaceum being the predominant agent of infection (in more than 34%). Other most common agents found in this survey were M. canis, T. rubrum, E. floccosum, T. schoenleini, T. tonsurans, and T. mentagrophytes.Formerly Assistant Professor at the Department of Internal Medicine, Faculty of Medical Sciences, University of Jordan, Amman     

Tinea Capitis in Southeastern China: A 16-Year Survey

This survey was a retrospective of a 16-year (1993–2008) study on the incidence, clinical features, and etiological agents of tinea capitis mainly representing the Southeastern China. The diagnosis was confirmed by direct microscopic examination. Eight hundred and sixty-six patients with tinea capitis, 381 males (44%) and 485 females (56%), were enrolled in this study. Patients were between 20 days and 84 years old with an average of 10.5 years and the peak incidence was in the age group of 6–10 (48.5%). Five hundred and sixty-two patients (64.9%) were ectothrix and 303 patients (35.0%) were endothrix with only one patient was favus. The incidence of tinea capitis from 1993 was gradually increasing and reaching to its peak in 2001. Positive cultures of dermatophytes were obtained in 715 patients: Microsporum canis (62.4%) was predominant, followed by Trichophyton violaceum (19.0%), Trichophyton tousurans (9.8%). M. canis was the major pathogen for ectothrix infection, while T. violaceum and T. tousurans contributed to the most endothrix form. M. canis, T. violaceum, and T. rubrum were the major pathogens for kerion.     

Dermatophytosis among the students of the elementary schools in Taipei city

Summary A survey of dermatophytosis among the students of all elementary schools in Taipei City was performed from April to June, 1957. A total of 2687 students, 1419 boys and 1268 girls, were examined as a random sample.There were 85 cases of dermatophytosis (3.16%) including 80 cases of tinea capitis (2.98 %), two cases of tinea glabrosa (0.07 %), one case of tinea pedis (0.04 %) and two cases of favus (0.07 %). Seventy eight out of 80 cases of tinea capitis were male.Mycological study of 80 cases from these patients was performed and 49 strains of the causative organisms were obtained. Among 46 strains cultured from tinea capitis, there were 39 cases (84.8 %) ofT. ferrugineum, which is the commonest species in Formosa, 6 cases (13.0 %) ofT. violaceum and one case ofT. rubrum.Favus is an endemic dermatophytosis in middle and southern China but is rare in Taipei City.The relationship between the causative dermatophytes and the clinical findings of tinea capitis were described. Clinical symptom due toT. ferrugineum was different from that due to other organisms.     

Sur l'état actuel des dermatophytes en Roumanie

Summary The actual state of dermatophytes in Romania is briefly reviewed. From the 20 species discovered, up to now, 14 belonged to the group of human and animal origin, the other 6 to geophilic dermatophytes.The most frequently isolated wereT. mentagrophytes, (var.interdigitale),M. audouinii, T. violaceum andT. rubrum, which altogether caused more than 50 % of the human ringworm found in the last 15 years.WhileT. mentagrophytes still remains the agent no. 1 of tinea pedis in Romania andT. rubrum keeps the first place in the nail involvements by dermatophytes, the first organism of tinea capitis areM. audouinii andT. violaceum, the former causing mainly the epidemic foci. Such epidemics may also be due toT. ferrugineum. The number of cases byT. schönleinii is more and more reduced. The infections byT. verruccosum are increasing. The rarity of cases due toT. gallinae, toT. equinum and toT. mengninii are pointed out.From the so called geophilic dermatophytes,M. gypseum, K. ajelloi andChrysosporium keratinophilum are mostly isolated from the Romanian soil.T. terrestre, T. evolceanui, T. indicum andM. cookei are infrequently found. A few isolates ofT. mentagrophytes andT. quinckeanum were also discovered in the soil.     

Polymorphic exocellular protease expression in clinical isolates of Trichophyton tonsurans

Tinea capitis continues to be an overwhelmingly prevalent disease in children. Despite the fact that it was recognized over a century ago, the factors that dictate the divergent clinical presentations seen with tinea capitis (e.g., carrier state, chronic non-inflammatory infection, acute severely-inflammatory infection) remain unknown. Given the pathogenicrole of exocellular proteases in dermatophyte infections and their potential immunogenic role, this investigation was designed to characterize strain-specific variability in fungal protease expression and activity in Trichophyton tonsurans isolates identified from children with tinea capitis. This revised version was published online in June 2006 with corrections to the Cover Date.     

Survey of Scalp Dermatophyte Carriage in a Day Care Center in Turkey

The prevalence of tinea capitis and the symptom-free colonisation of the scalp with dermatophytes were examined in 502 mentally retarded participants who attended day care centers in the Tarsus district, Mersin, Turkey. Between December 2006 and May 2007, a screening study was conducted in three centers on a total of 316 (62.9%) male and 186 (37.1%) female participants aged 12 ± 6.2 years. The examinations were carried out in parallel with the hairbrush, toothbrush, and cotton swab methods by inoculation onto Sabouraud glucose agar. No participant was diagnosed with tinea capitis; however, we detected three carriers, all of whom were boys aged 2–16 years. The total prevalence of carrier state was 0.6%. Of three boys, T. tonsurans was seen in two cases (66.7%), and in one case a zoophilic variant of T. mentagrophytes (33.3%) was isolated. The diagnosis was made via the hairbrush method in all three carriers. We also did a screening study on ten households of the three asymptomatic carriers. T. mentagrophytes also was isolated in a 5-year-old sister of the boy with T. mentagrophytes colonisation. All the carriers were followed-up without any antimycotic treatment. In two of the participants, the carrier state persisted at the 13th and 17th week follow-ups, and mycological clearance was documented at the 20th and 24th week for these individuals. The third case and the household’s culture were found negative at the 7- and 12-week follow-ups. Despite poor hygienic conditions and the participants’ difficulties in performing basic hygiene practices, asymptomatic carriage was found to be surprisingly less prevalent among the mentally retarded individuals.     

Dermatophytes isolated from patients in University Hospital,Kuala Lumpur,Malaysia

A total of 576 dermatophytes were isolated from patients with a variety of skin infections from January 1993 to May 2000. Ten species of dermatophytes were identified: Epidermophyton floccosum (0.7%), Microsporum audouinii (1.1%), M. canis (3.1%), M. gypseum (0.3%), Trichophyton concentricum (3.5%), T. equinum (0.2%), T. mentagrophytes (36.1%), T. rubrum (53.8%), T. verrucosum (0.2) and T. violaceum (1.0%). The body sites most frequently affected by dermatophytes were the buttocks, nails and trunk. Anthropophilic dermatophytes made up 60.1% of the isolates; the most common species was T. rubrum, T. mentagrophytes and M. canis were the two main zoophilic dermatophytes. T. mentagrophytes was isolated from all body sites except the scalp. M. canis was found to be associated with domestic dogs and was not isolated from ethnic Malays. The only geophilic dermatophyte was M. gypseum, an uncommon dermatophyte associated with tinea pedis.