Nimesulide inhibits pathogenic fungi: PGE2-dependent mechanisms

Certain non-steroidal anti-inflammatory drugs can inhibit fungal growth, fungal prostaglandin E2 production, and enzyme activation. This study aims to investigate the antifungal effect of nimesulide against pathogenic filamentous fungi and yeast. The experiments detailed below were also designed to investigate whether the action is dependent on E2 fungal prostaglandins. Our data showed that nimesulide exhibited potent antifungal activity, mainly against Trichophyton mentagrophytes (ATCC 9533) and Cryptococcus neoformans with MIC values of 2 and 62 μg/mL, respectively. This drug was also able to inhibit the growth of clinic isolates of filamentous fungi, such as Aspergillus fumigatus, and dermatophytes, such as T. rubrum, T. mentagrophytes, Epidermophyton floccosum, Microsporum canis, and M. gypseum, with MIC values ranging from 112 to 770 μg/mL. Our data also showed that the inhibition of fungal growth by nimesulide was mediated by a mechanism dependent on PGE2, which led to the inhibition of essential fungal enzymes. Thus, we concluded that nimesulide exerts a fungicidal effect against pathogenic filamentous fungi and yeast, involving the inhibition of fungal prostaglandins and fungal enzymes important to the fungal growth and colonization.     

Solanum melongena: A potential source of antifungal agent

The antifungal activity of Solanum melongena leaf, extracted with petroleum ether, chloroform, methanol and water was evaluated against three human pathogenic dermatophytes namely Trichophyton mentagrophytes, T. rubrum and T. tonsurans and two opportunistic fungi Candida albicans and Trichosporon beigelii. Maximum yield of plant components was 4.32 g, extracted in water and minimum 1.07 g in petroleum ether from 150 g of dry plant material. Except water extract, all the extracts possessed significant antifungal property. All the test pathogens showed highest sensitivity towards chloroform extract, exhibiting maximum inhibition zone diameter of 50.0 mm in T. mentagrophytes and minimum 30.0 mm in C. albicans at 2 × 10⁵ μg/ml concentration. Chloroform extract at lower concentration 2.5 × 10⁴ μg/ml was inhibitory for all the test pathogens, exhibiting inhibition zone diameter 21.0 mm against T. tonsurans and 15.0 mm against C. albicans and T. beigelii. The activity of the different solvent extracts against the test pathogens in terms of inhibition zone diameter in decreasing order was as followsChloroform extract > Petroleum ether extract > Methanol extract for T. mentagrophytes, T. rubrum and T. tonsurans.Chloroform extract > Methanol extract > Petroleum ether extract for C. albicans and T. beigelii.     

In Vitro Antifungal Activity of Micafungin and Caspofungin Against Dermatophytes Isolated from China

Aims

The aims of this study are to investigate the in vitro activities of micafungin and caspofungin that are two new echinocandin antifungal drugs against clinically isolated dermatophytes in China and to define MEC (minimal effective concentration) as the reading endpoints of this study in accordance with (Clinical and laboratory Standards Institute) CLSI M38-A2 reference.

Methods

Minimal effective concentrations (MECs) of micafungin and caspofungin for 82 dermatophyte strains were determined according to CLSI (formerly NCCLS) M38-A2 broth microdilution methods.

Results

(1) The MEC_90s of micafungin for Trichophyton violaceum and Trichophyton tonsurans were 0.25 μg/mL, and for Microsporum canis and Trichophyton verrucosum were 0.06 μg/mL. The MEC_90s for Trichophyton rubrum, Trichophyton mentagrophytes, Microsporum gypseum and Epidermophyton floccosum were 0.03 μg/mL. (2) The MEC_90s of caspofungin for T. rubrum, T. violaceum and T. tonsurans were 1 μg/mL, and for T. mentagrophytes, M. canis, M. gypseum, E. floccosum and T. verrucosum were 0.5 μg/mL. (3) Compared with caspofungin, micafungin demonstrated lower MEC value to dermatophytes (P < 0.05).

Conclusions

Micafungin has stronger in vitro antifungal activity than caspofungin.     

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.     

In vitro susceptibility of dermatomycoses agents to six antifungal drugs and evaluation by fractional inhibitory concentration index of combined effects of amorolfine and itraconazole in dermatophytes

To investigate the antifungal drug susceptibility of fungi responsible for dermatomycoses, minimum inhibition concentration (MIC) tests were performed in 44 strains of dermatophytes, including Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton verrucosum, Trichophyton tonsurans, Microsporum canis, Microsporum gypseum and Epidermophyton floccosum, with six antifungal drugs (amorolfine, terbinafine, butenafine, ketoconazole, itraconazole and bifonazole) by broth microdilution assay according to Clinical Laboratory Standard Institute protocols. Six possible dermatomycosis‐causing non‐dermatophytic fungi were also tested. The two major causes of tinea, T. rubrum and T. mentagrophytes, showed significantly different sensitivities to ketoconazole and bifonazole. Clinically derived dermatophytes were sensitive to the six antifungal drugs tested. However, non‐dermatophytes, especially Fusarium spp., tended to be resistant to these antifungal drugs. In Trichophyton spp., the MICs of non‐azole drugs had narrower distributions than those of azoles. To evaluate the effects of antifungal drug combinations, the fractional inhibitory concentration index was calculated for the combination of amorolfine and itraconazole as representative external and internal drugs for dermatophytes. It was found that this combination had synergistic or additive effects on most dermatophytes, and had no antagonistic effects. The variation in susceptibility of clinically derived fungal isolates indicates that identification of causative fungi is indispensable for appropriately choosing effective antifungal drugs in the early stages of infection. The results of combination assay suggest that multiple drugs with different antifungal mechanisms against growth of dermatophytes should be used to treat refractory dermatomycoses, especially onychomycosis.     

Fungal Leukonychia and Melanonychia: a Review

Fungal leukonychia is a common condition in immunosuppressed patients; the most common clinical forms are white superficial and proximal white superficial onychomycosis. It is frequently associated with Trichophyton mentagrophytes var. interdigitale and with Trichophyton rubrum. The diagnosis can be easily made by direct examination and culture. Fungal melanonychia is the nail plate pigmentation caused by fungal infections. The most frequently isolated fungi is T. rubrum and melanized molds like Neoscytalidium dimidiatum. The main differential diagnosis is malignant melanoma, although other causes include subungueal hematomas, exogenous pigmentation, and bacterial infection. If homogeneous pigmentation in lines or structureless discoloration, and the absence of melanin inclusions are seen by dermoscopy, diagnosis must be complemented with KOH preparations and cultures.     

<Emphasis Type="Italic">Trichophyton rubrum</Emphasis> Infection Characterized by Majocchi’s Granuloma and Deeper Dermatophytosis: Case Report and Review of Published Literature

Infections caused by Trichophyton rubrum are very common in dermatological disease. It most often appears as superficial cutaneous mycosis, such as tinea manuum, tinea pedis, and tinea corporis. However, deep infection caused by T. rubrum was rarely reported. We describe a case of mixed type of deep infection caused by T. rubrum in a 45-year-old man with no significant immunodeficiency. This patient had a history of onychomycosis on the toenails without regular treatment for nearly 6 years. And, he had erythema, papule, and nodules on the submandibular area, neck, and chest for almost 1 year. After treated with intravenous infusion of cefotiam for 2 weeks, the lesion aggravated. The fungal direct microscopic examination of pyogenic fluid was positive, and the fungal cultures that produced reddish-brown and yellow pigment showed cottony, wooly, and white colony. After the DNA sequencing, it was identified as T. rubrum. We gave the patient oral terbinafine 250 mg per day and bifonazole cream for external use. Six months later, the patient’s skin lesion was disappeared, and healthy nail growth was seen in two-thirds of nail bed. The terbinafine is effective against deep infection caused by T. rubrum.     

Toward a Novel Multilocus Phylogenetic Taxonomy for the Dermatophytes

Type and reference strains of members of the onygenalean family Arthrodermataceae have been sequenced for rDNA ITS and partial LSU, the ribosomal 60S protein, and fragments of β-tubulin and translation elongation factor 3. The resulting phylogenetic trees showed a large degree of correspondence, and topologies matched those of earlier published phylogenies demonstrating that the phylogenetic representation of dermatophytes and dermatophyte-like fungi has reached an acceptable level of stability. All trees showed Trichophyton to be polyphyletic. In the present paper, Trichophyton is restricted to mainly the derived clade, resulting in classification of nearly all anthropophilic dermatophytes in Trichophyton and Epidermophyton, along with some zoophilic species that regularly infect humans. Microsporum is restricted to some species around M. canis, while the geophilic species and zoophilic species that are more remote from the human sphere are divided over Arthroderma, Lophophyton and Nannizzia. A new genus Guarromyces is proposed for Keratinomyces ceretanicus. Thirteen new combinations are proposed; in an overview of all described species it is noted that the largest number of novelties was introduced during the decades 1920–1940, when morphological characters were used in addition to clinical features. Species are neo- or epi-typified where necessary, which was the case in Arthroderma curreyi, Epidermophyton floccosum, Lophophyton gallinae, Trichophyton equinum, T. mentagrophytes, T. quinckeanum, T. schoenleinii, T. soudanense, and T. verrucosum. In the newly proposed taxonomy, Trichophyton contains 16 species, Epidermophyton one species, Nannizzia 9 species, Microsporum 3 species, Lophophyton 1 species, Arthroderma 21 species and Ctenomyces 1 species, but more detailed studies remain needed to establish species borderlines. Each species now has a single valid name. Two new genera are introduced: Guarromyces and Paraphyton. The number of genera has increased, but species that are relevant to routine diagnostics now belong to smaller groups, which enhances their identification.     

Onychomycoses in a Military Population in Brazil

Purpose of Review

This study aimed to isolate and characterize filamentous fungi onychomycosis agents in a military population assisted at a hospital outpatient clinic.

Recent Findings

In onychomycosis, the fungi colonize the subungual region causing thickening, discoloration, or cracking of the nail bed. Samples were collected from patients with clinical sights of onychomycosis.

Summary

Among 80 samples collected, 50 (62.5%) had positive culture. Isolated dermatophytes (86%) were Trichophyton rubrum (21; 42%), T. mentagrophytes var. interdigitale (19; 38%), and Microsporum gypseum (3; 6%) and non-dermatophyte molds were Fusarium spp. (1; 2%), Scytalidium spp. (1; 2%), and Chaetomium globosum (5; 10%). Minimal inhibitory concentrations (mg/L) of terbinafine, itraconazole, and fluconazole necessary to inhibit 50/90% of the isolates were respectively 0.015/0.06, 0.06/0.12, and 32/32. Etiological agents of onychomycosis in a military hospital are similar as reported in studies for the general population. High prevalence of non-dermatophytic agents was observed, especially for Chaetomium globosum.

     

Tinea Unguium: Diagnosis and Treatment in Practice

Onychomycosis is caused by dermatophytes, yeasts or non-dermatophyte molds; when caused by dermatophytes, it is called tinea unguium. The main etiological agents are Trichophyton rubrum and Trichophyton interdigitale. The most frequent types are distal and lateral subungual onychomycosis. Diagnosis usually requires mycological laboratory confirmation. Dermoscopy can be helpful and also biopsy is an excellent diagnostic method in uncommon cases or when mycological test is negative. Treatment must be chosen according to clinical type, number of affected nails and severity. The goal for antifungal therapy is the clearing of clinical signs or mycological cure.     

Human mycoses in Portugal [1960–1973]

A critical survey is made of human mycoses diagnosed in European Portugal and in the Portuguese Overseas Provinces. Dermatophyte infections and pityriasis versicolor are commom in the entire territory. The more frequently isolated dermatophytes in Continental Portugal wereTrichophyton violaceum, Microsporum canis, Trichophyton tonsurans andTrichophyton schoenleinii, in the scalp andTrichophyton rubrum, Trichophyton mentagrophytes, Trichophyton megninii andEpidermophyton floccosum in the other body sites. In the Overseas Provinces the species found in white people were very much the same, whereas in negroes mainlyMicrosporum audouinii andT. violaceum in Mozambique,M. audouinii in Angola, andTrichophyton soudanense, M. audouinii andT. rubrum in Guinea were identified.In Continental Portugal cases of candidiasis, mycetoma, aspergillosis, sporotrichosis and cryptococcosis were described in patients who had never been outside Europe; and tinea nigra, African histoplasmosis and South-American blastomycosis in individuals who live or lived in India, Africa and Brazil.The first case of North-American blastomycosis was reported in Mozambique.     

Morpho-Molecular Characterization of Soil Inhabitant Dermatophytes from Ahvaz,Southwest of Iran,a High Occurrence of <Emphasis Type="Italic">Microsporum fulvum</Emphasis>

Occurrence and diversity of dermatophyte mycoflora in 298 soil samples from Ahvaz, Southwest of Iran was investigated by using the hair-baiting technique. The samples were collected during spring (n = 210) and autumn (n = 88) of 2015, and the fungal isolates were identified based on the macro- and micro-morphology of colonies and with further ITS-rDNA RFLP and sequencing. Totally, 60 soil samples (20.1%) were positive for dermatophyte growth whose pH varied from 7.0 to 7.9. The highest (26.6%) and the lowest (14.3%) recovery rates were from the animal resorts and the streets soils samples, respectively. Seasonally, 16.7% of the spring samples and 28.4% of the autumn samples were positive. Based on molecular identification, three species of two genera were identified viz. M. fulvum (n = 57), M. canis (n = 2) and zoophilic Trichophyton interdigitale (n = 1). As a specific goal in the study, differentiation of the species in Microsporum gypseum complex was established by measuring the mean length and width of macroconidia in some strains of M. gypseum, M. fulvum and M. incurvatum. Mean size for macroconidia length and width in three species showed that M. gypseum and M. incurvatum can morphologically be differentiated from M. fulvum but not from each other. M. fulvum was the most abundant species isolated from the soils of Ahvaz; however, to comprehensively specify the distribution pattern of geophilic dermatophytes in the soils of this city further investigations are needed. Identification based on micro-morphometric is not effective for species distinction in M. gypseum complex, while molecular procedures based on sequencing of certain DNA regions are the most reliable and applicable strategies for this purpose.     

Antifungal activity of lichen compounds against dermatophytes: a review

The growth rate inhibition of dermatophytes by compounds extracted by acetone, ethanol, methanol and water derived from representatives of several lichen genera (e.g. Caloplaca, Everniastrum, Heterodermia, Hypotrachyna, Platismatia and Ramalina) were compared on the basis of a worldwide review of published research. The examined dermatophytes included Epidermophyton floccosum, Microsporum audouinii, M. canis, M. gypseum, M. nanum, Trichophyton longifusus, T. mentagrophytes, T. rubrum, T. tonsurans and T. violaceum. The influence of selected secondary lichen compounds, for example, usnic acid, on the growth rates of these dermatophytes was also reviewed. The measurement of inhibition by lichen compounds was performed by several methods, but mostly those employing disc diffusion, broth dilution and agar dilution. The fungicidal activity of water-extracted compounds from Heterodermia leucomela and Hypotrachyna cirrhata and of methanol-extracted compounds from Evernia divaricata and Ramalina pollinaria, as well as protolichesterinic and 2-hydroxy-4-methoxy-3,6-dimethylbenzoic acids, are distinguished.     

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     

Dermatophyte and non dermatophyte fungi in Riyadh City,Saudi Arabia

BackgroundDermatophytes are a scientific label for a group of three genera (Microsporum, Epidermophyton and Trichophyton) of fungus that causes skin disease in animals and humans. Conventional methods for identification of these fungi are rapid and simple but are not accurate comparing to molecular methods.ObjectiveThis study aimed to isolate human pathogenic dermatophytes which cause dermatophytosis in Riyadh City, Saudi Arabia and to identify these fungi by using conventional and molecular methods.MethodsThe study was conducted in Medical Complex, Riyadh and King Saud University. Samples of infected skin, hairs and nails were collected from 112 patients. Diagnosis of skin infections, direct microscopic test, isolation and identification of dermatophytes by conventional and molecular methods were carried out.ResultsThe results indicated that the tinea capitis infection had the highest prevalence among the patients (22.3%) while Tinea barbae had the lowest. In this study the identified dermatophyte isolates belong to nine species as Trichophyton violaceum, Trichophyton verrucosum, Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton schoenleinii, Trichophyton concentricum, Microsporum canis, Microsporum audouinii and Epidermophyton floccosum which cause skin infections were isolated during this study. Non dermatophyte isolates included 5 isolates from Aspergillus spp. 4 isolates from Acremonium potronii and 15 isolates from Candida spp. M. canis were the most common species (25% of isolated dermatophytes). Out of the 52 dermatophyte isolates identified by conventional methods, there were 45 isolates identified by the molecular method.ConclusionsThe results concluded that approximately M. canis caused a quarter of dermatophyte cases, tinea capitis infection was prevalent and the molecular method was more accurate than conventional methods.     

A survey of dermatophytes from human patients in the United States from 1985 to 1987

A survey of dermatophytes isolated from patients seeking medical advice was made from 1985 to 1987 in the United States. The survey included 54 locations with data from 45 cities and one state. Listing of the isolated dermatophytes and the frequency given by percentage of the total follows: Trichophyton rubrum 54.8%, T. tonsurans 31.3%, T. mentagrophytes 6.0%, Microsporum canis 4.0%, Epidermophyton floccosum 2.0%, M. gypseum 0.6%, and T. verrucosum 0.2%. Out of a total of 14,696 isolates M. audouinii was cultured 13 times, T. violaceum 12 times, M. nanum 6 times, T. terrestre 4 times, and T. soudanense twice. Single isolations were made of M.fulvum, M. ferrugineum and T. schoenleinii.Collection of dermatophyte data in Tucson, Arizona, began in 1966. In 1987, the first case of tinea capitis caused by T. tonsurans was observed. Other isolates of this organism as the cause of tinea capitis were made in this city during that year. These infections were in black children. With the recent growth of Tucson, the percentage of blacks in the population increased and this pathogen was introduced into the general population.     

The Oomycete <Emphasis Type="Italic">Pythium oligandrum</Emphasis> Can Suppress and Kill the Causative Agents of Dermatophytoses

Pythium oligandrum (Oomycota) is known for its strong mycoparasitism against more than 50 fungal and oomycete species. However, the ability of this oomycete to suppress and kill the causal agents of dermatophytoses is yet to be studied. We provide a complex study of the interactions between P. oligandrum and dermatophytes representing all species dominating in the developed countries. We assessed its biocidal potential by performing growth tests, on both solid and liquid cultivation media and by conducting a pilot clinical study. In addition, we studied the molecular background of mycoparasitism using expression profiles of genes responsible for the attack on the side of P. oligandrum and the stress response on the side of Microsporum canis. We showed that dermatophytes are efficiently suppressed or killed by P. oligandrum in the artificial conditions of cultivations media between 48 and 72 h after first contact. Significant intra- and interspecies variability was noted. Of the 69 patients included in the acute regimen study, symptoms were completely eliminated in 79% of the patients suffering from foot odour, hyperhidrosis disappeared in 67% of cases, clinical signs of dermatomycoses could no longer be observed in 83% of patients, and 15% of persons were relieved of symptoms of onychomycosis. Our investigations provide clear evidence that the oomycete is able to recognize and kill dermatophytes using recognition mechanisms that resemble those described in oomycetes attacking fungi infecting plants, albeit with some notable differences.     

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.     

Boric Acid Inhibition of <Emphasis Type="Italic">Trichophyton rubrum</Emphasis> Growth and Conidia Formation

Trichophyton rubrum is a common human dermatophyte that is the causative agent of 80–93% of fungal infections of the skin and nails. While dermatophyte infections in healthy people are easily treatable with over-the-counter medications, such infections pose a higher risk for patients with compromised immune function and impaired regenerative potential. The efficacy of boric acid (BA) for the treatment of vaginal yeast infections prompted an investigation of the effect of BA on growth and morphology of T. rubrum. This is of particular interest since BA facilitates wound healing, raising the possibility that treating athlete’s foot with BA, either alone or in combination with other antifungal drugs, would combine the benefits of antimicrobial activity and tissue regeneration to accelerate healing of infected skin. The data presented here show that BA represses T. rubrum growth at a concentration reported to be beneficial for host tissue regeneration. Oxygen exposure increases BA toxicity, and mycelia growing under BA stress avoid colonizing the surface of the growth surface, which leads to a suppression of aerial mycelium growth and surface conidia formation. BA penetrates into solid agar matrices, but the relative lack of oxygen below the substrate surface limits the effectiveness of BA in suppressing growth of embedded T. rubrum cells.     

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.