Les mycoses superficielles en zone forestière gabonaise: bilan des champignons isolés

Résumé Les auteurs, effectuant une rétrospective de 2 années d'activité en mycologie à Libreville (Gabon), exposent et analysent l'ensemble des résultats positifs obtenus à partir des teignes et épidermomycoses qu'ils ont eu l'occasion d'observer. Signalant simplement l'existence du Pityriasis versicolor, ils replacent les agents des différentes mycoses selon leur importance respective.Ce premier inventaire des dermatophytes au Gabon, (13 espèces au total) en zone forestière humide et chaude, montre la nette prédominance de Microsporum langeroni, Trichophyton soudanense, Trichophyton rubrum, Epidermophyton floccosum. Trichophyton violaceum est isolé dans une proportion non négligeable de cas. D'autres espèces, plus rares, sont mentionnées.

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The authors draw up an inventory of the dermatophytes in Gabon (13 species isolated from 593 people in the wet and hot forest). They show the clear prevalence of Microsporum langeroni, Trichophyton soudanense, Trichophyton rubrum, and Epidermophyton floccosum, Trichophyton violaceum also is fairly often isolated.More infrequently, they find T. mentagrophytes, T. mentagrophytes var. interdigitale, T. gourvili, M. canis, M. audouini, T. yaoundei, M. gypseum.

     

Tinea Capitis in the Paediatric Population in Milan, Italy: The Emergence of Trichophyton violaceum

Tinea capitis (TC) is the most common type of dermatophytosis in children. The epidemiology of TC depends on the geographical areas, and it changes over time. The aim of the study is to determine the incidence of TC and to identify the causative species in children observed at Dermatology Outpatient Department of the University of Milan, Italy, between January 2004 and December 2011. Four hundred and eighty-six children with suspected dermatomycosis were observed; TC was the most prevalent dermatomycoses with 86 cases. The most common isolated dermatophyte in scalp lesions was Trichophyton violaceum with 33 cases. The most recent epidemiological Italian studies still show zoophilic fungi as primary cause of TC. We are the first medical team in Italy to demonstrate a dominance of anthropophilic fungi, in particular T. violaceum.     

Analysis of Dermatomycoses in Lanzhou District of Northwestern China

The skin mycoses, perticularly dermatophytoses, in Lanzhou district, Northwestern China, was investigated during July 2002–June 2003. The specimens from patients suspected of having dermatomycoses were examined microscopically in KOH preparations and cultured on Sabouraud dextrose agar (SDA). Among 1443 suspected cases, 594 were KOH positive and 221 cultures of fungi were isolated. The most frequently isolated fungi were Trichophyton rubrum (43.9%) Trichophyton mentagrophytes (29.4%) and Candida species (14.0%). The frequency of tinea pedis, onychomycosis and tinea manuum were 38.7, 27.8 and 13.5%, respectively. In Lanzhou district, tinea pedis is the most commonly seen dermatophytoses, and T. rubrum is the most frequent etiologic agent.     

Favus of the Scalp: An Overview and Update

Tinea capitis favosa, a chronic inflammatory dermatophyte infection of the scalp, affects over 90% of patients with anthropophilic Trichophyton schoenleinii. T. violaceum, T. verrucosum, zoophilic T. mentagrophytes (referred to as ‘var. quinckeanum’), Microsporum canis, and geophilic M. gypseum have also been recovered from favic lesions. Favus is typically a childhood disease, yet adult cases are not uncommon. Interestingly, favus is less contagious than other dermatophytoses, although intrafamilial infections are reported and have been widely discussed in the literature. Clinical presentation of T. schoenleinii infections is variable: this fungus can be isolated from tinea capitis lesions that appear as gray patches, but symptom-free colonization of the scalp also occurs. Although in the past T. schoenleinii was the dominant fungus recovered from dermatophytic scalp lesions, worldwide the incidence has decreased except in China, Nigeria, and Iran. Favus of the glabrous skin and nails are reported less frequently than favus of the scalp. This review discusses the clinical features of favus, as well as the etiological agents, global epidemiology, laboratory diagnosis, and a short history of medical mycology.     

The Changing Face of Dermatophytic Infections Worldwide

Dermatophytes evolve along with the geography and socioeconomic conditions. Epidermophyton floccosum, Microsporum audouinii and Trichophyton schoenleinii acted as the major pathogens of superficial fungal diseases 100 years ago, but their frequency decreased dramatically since the middle of the twentieth century and they are limited to some less-developed countries nowadays; meanwhile, frequency of Trichophyton rubrum, Trichophyton interdigitale, Trichophyton tonsurans and Microsporum canis increased gradually, and these fungi have become the major species globally. Some other dermatophytes, i.e., Trichophyton violaceum, Trichophyton verrucosum and Microsporum ferrugineum, are mainly endemic in some parts of Africa, Asia and Europe. At present, T. rubrum is the leading pathogen for skin and nail fungal infections, whereas M. canis, T. tonsurans and T. violaceum present as the predominant dermatophytes involved in tinea capitis. Population mobility, changes in human lifestyle and advents of antifungal drugs will continually drive the dermatophyte evolution in the skin microenvironment. Comprehensive observation is needed to better understand this kind of organisms and prospect the trends of their changes in future.     

Considérations sur trichophyton violaceum et sur son épidémiologie en Roumanie; L'Aspect clinique des lésions causées par ce dermatophyte

Résumé Exposé sur 1510 cas (944 hommes et 566 femmes) de mycoses àT. violaceum, observés depuis avril 1945 jusqu'à juillet 1964, à la Clinique et au Centre Dermato-Vénéréologique, hôpital Colentina Bucarest. Jusqu'en 1954 c'était le premier parasite des teignes. Cette première place revient à présent auM. audouinii. Les épidémies àT. violaceum, observées par l'auteur, ont eu un caractère plutôt familial et les foyers épidémiques, contrairement aux microsporons, ont été éliminés. Le cuir chevelu a été le siège principal de la mycose chez 1463 malades. La barbe a été envahie chez 11, les sourcils chez 2, les ongles chez 21 malades. Chez 110 malades les plaques du cuir chevelu étaient légèrement inflammatoires et chez 4 il y avait un kérion de Celse. Chez 153 malades (10,12%) les plaques ont évolué vers l'alopécie atrophique. La trichophytie de l'adulte a été dépistée chez 32 personnes (5 hommes et 27 femmes) dont l'âge était compris entre 22 et 65 ans. Chez 6 malades il s'agissait d'une infection récente. Chez les autres 26, elle évoluait depuis l'enfance (trichophytie chronique).

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Summary From April 1945 to July 1964, in the Dermato-Venerological Department of Colentina Hospital — Bucarest, studies were carried out on 1510 cases (944 males and 566 females) of ringworm caused byT. violaceum. In tinea capitis this fungus predominated until 1954. Later the first place was taken byMicrosporon audouinii. Epidemics withTrichophyton violaceum occurred only among small groups of persons, especially in families. Infections did not become widely epidemic, like those with microsporons. The scalp was involved in 1463 patients, the beard only in 11, the eyebrows in 2 and nails in 21 patients. In 110 patients the patches became inflammatory (moderately) and in 4 ones they turned into kerion. In 153 patients (10,12%) the patches turned into atrophy like in pseudo-pelade of Brooq. Trichophytosis of adult was observed in 32 patients (5 males and 27 females) aged 22 to 65 years. In 6 patients, the infection was recent, but the other 26 acquired their ringworm in infancy (chronic trichophytosis of adult).

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TRAVAIL DÉDIÉ AU PROFESSEUR ST. G. NICOLAU, MEMBRE DE L'ACADÉMIE ROUMAINE, À L'OCCASION DE SON 90-ÈME ANNIVERSAIRE     

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.     

Prevalence of Dermatophytoses in the Zarqa District of Jordan

A total of 350 clinically suspected cases of dermatomycoses were examined for causative fungi during July 1997 to September 1998. Mycotic infection was demonstrable by microscopy and culture in 199 (56.8%) cases. The most common superficial mycotic infections were tinea pedis (35.2%) followed by tinea capitis (23.1%), tinea unguium (21.6%) and tinea corporis (10.6%). Most of the infected patients were 1–9, 20–29 and 30–39 years old. Men were mainly infected with tinea cruris and tinea pedis, while women were infected with tinea pedis, tinea unguium and tinea capitis. The frequencies of etiological agents isolated from patients were as follows: Trichophyton mentagrophytes var. interdigitale (32.7%), T. rubrum (28.6%), Epidermophyton floccosum (20.1%), Microsporum canis (11.1%), T.schoenleinii (4%), T.verrucosum (2%), T.violaceum (1%), and M. gypseum (0.5%). The number of infections varied with the seasons. The highest number of cases of tinea pedis and tinea cruris occurred in the summer months, while tinea capitis, tinea corporis and tinea unguium occurred in the spring and winter months. This revised version was published online in June 2006 with corrections to the Cover Date.     

Dermatophytes in Portugal (1972–1981)

For the years 1972–1981, 7 333 isolates of dermatophytes belonging to 14 species were obtained from glabrous skin (32%), feet (28%), groin (19%), scalp (8%), toenails (7%), fingernails (3%) and beard (1%)., T. rubrum represented 50% of all the isolates and was the most frequent species on glabrous skin, groin and nails. T. mentagrophytes (24%) was mainly obtained from the feet, E. floccosum (9%) from the groin and T. megninii (4%) from uncovered areas of the skin, fingernail and beard. These 4 species predominated in men. M. canis was the commonest agent on the scalp and in children up to 11 years. T. violaceum, previously the main cause of tinea capitis, and T. tonsurans have been decreasing for the period of this study, just as T. schoenleinii for the years 1962–71.The rising prevalence of T. rubrum was observed since 1962. In the whole it seems stable after 1969, but the analysis of the main sites involved shows that in the glabrous skin this species increased from 1962 to 1974; in the groin it was gone up from 30% during 1962–1965, to 64% in the years 1969–1971; in the feet the evolution was slower and only in 1980 T. rubrum became more frequent than T. mentagrophytes.The increase in certain species, whereas others become rare, lacks a satisfactory explanation.

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Résumé Depuis 1972 jusqu'à 1981, 7 333 isolements de dermatophytes concernant 14 espèces ont été obtenus de la peau glabre (32%), des pieds (28%), des plis inguinaux (19%), des ongles des orteils (7%), des ongles des mains (3%) et de la barde (1%). T. rubrum a réprésenté 50% de tous les isolements, étant l'espèce la plus fréquente dans la peau glabre, aux plis inguinaux et dans les ongles. T. mentagrophytes (24%) a été isolé surtout des pieds; E.floccosum (9%) des plis inguinaux; et T. megninii (4%) des régions découvertes de la peau, des ongles de la main et de la barbe. Ces 4 espèces ont prédominé chez des adultes du sexe masculin. M. canis a été l'agent le plus commun dans le cuir chevelu et chez des enfants jusqu'à 11 ans. T. violaceum (auparavant la cause principale des teignes du cuir chevelu) et T. tonsurans sont devenus beaucoup moins fréquents pendant cette étude, comme d'ailleurs T. schoenleinii était devenu rare au cours d'une enquête anterieur (1962–1971).La prévalence de T. rubrum s'est beaucoup elevée dès 1962. Dans l'ensemble, elle parait stabilisée depuis 1969, mais l'analyse des principales localisations de la maladie démontre que dans la peau glabre cette espèce a augmenté depuis 1962 jusqu'à 1974; aux plis inguinaux elle a changé de 30% en 1962–1965 pour 64% en 1969–1971; aux pieds l'évolution a été moins rapide et seulement dès 1980 T. rubrum est devenu plus fréquent que T. mentagrophytes.L'augmentation de certaines espèces tandis que d'autres deviennent rares n'a pas trouvée une interpretation satisfaisante.

     

Tinea capitis an endemic disease in Madras

A study ofTinea capitis in Outpatient Clinic, Skin Department, Government General Hospital, Madras during a three year period from November, 1973 to October, 1976, has shown a gradual increase in incidence of 3.56%, 5.09 % and 6.25 % respectively. Findings suggest thatTinea capitis is endemic in South India. Male children were more commonly affected than female children and the age groups chiefly affected were between 5 and 10 years. A considerable number of adults were also affected. The disease showed no correlation to environmental temperature, humidity and rainfall but was correlated to all types of mycoses and total incidence of mycoses.Among 357 isolates,Trichophyton violaceum was the commonest in 264 (73.94%) andT. tonsurans was the next common in 47 (13.16%). The other agents wereT. rubrum in 30 (8.4%),T. mentagrophytes in 11 (3.08%) andT. simii in 5 (1.4%). Noninflammatory lesions were more common than inflammatory lesions and both were produced byT. violaceum andT. tonsurans, suggesting strain differences in pathogenesis. Treatment with oral griseofulvin was satisfactory in all but had to be discontinued in 4 patients due to side effects.     

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.     

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.     

Phylogeny of the genera Trichophyton using mitochondrial DNA analysis

Diversity of mitochondrial DNA (mtDNA) was investigated in 92 Trichophyton rubrum strains, 2 T. mentagrophytes var. mentagrophytes, 2 T. m. vor. interdigitale, 2 T. m. var. goetzii, 1 T. m. var. erinacei, 2 T. quinckeanum, 2 T. schoenleinii, 1 T. tonsurans, 2 T. verrucosum var. album, 2 T. v. var. discoides, 1 T. violaceum var. violaceum, 1 Arthroderma benhamiae, and 1 A. vanbreuseghemii using endonucleases, Hae III, Msp I, Hind III, Xba I, and Bgl II. Trichophyton species were divided into 7 groups, and a phylogenetic tree was produced based on sequence divergence within mtDNA. The following results were obtained: (1) T. rubrum was divided into 2 groups Type I and Type II, and was suggested to be a complex. (2) A. benhamiae was closely related to T. m. var. erinacei. (3) T. rubrum Type II, T. tonsurans, and A. vanbreuseghemii showed identical restriction profiles, and were suggested to be closely related to each other or identical. (4) T. quinckeanum and T. schoenlenii showed identical restriction profiles, which differed slightly from those of A. vanbreuseghemii. (5) mtDNA analysis was useful in identifying pleomorphic strains.     

Molecular confirmation of a Trichophyton violaceum isolate from human black-dot ringworm

A clinical isolate from a black-dot ringworm lesion of a 28-year-old female Japanese was investigated by morphological and biochemical analyses as well as molecular analyses. The isolate grew well onthiamine enriched agar and did not produce violetpigment, macroconidia or microconidia on Sabouraud's dextrose agar. Approximately 620-bp genomic DNA fragments of the CHS1 gene were amplified from Trichophyton mentagrophytes, T. rubrum, T. tonsurans and T. violaceum by polymerase chain reaction (PCR) and sequenced. The chitin synthase 1 (CHS1) nucleotide sequences of the clinical isolate showed more than 97% similarity to that of T. violaceum and less than 96% similarity to that of T. mentagrophytes, T. rubrum and T. tonsurans. The phylogenetic analysis of their sequences revealed that the clinical isolate was genetically close to T. violaceum and distinct from T. mentagrophytes, T. rubrum and T. tonsurans. Therefore, the isolate was confirmed as T. violaceum by mycological examination and molecular analyses. This revised version was published online in June 2006 with corrections to the Cover Date.     

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.     

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.     

Chicory extracts from Cichorium intybus L. as potential antifungals

In this work extracts from roots of the common vegetable Cichorium intybus L., highly appreciated for its bitter taste, were studied to investigate their possible biological activity on fungi from a variety of ecological environments: some are parasites on plants (phytopathogens) or of animals and humans (zoophilic and anthropophilic dermatophytes), others live on the soil and only seldom parasitize animals (geophilic dermatophytes). The extracts were ineffective on geophilic species and on tested phytopathogens, with the exception of Pythium ultimum, whereas they inhibited the growth of zoophilic and anthropophilic dermatophytes, in particular Trichophyton tonsurans var. sulfureum, whose treatment caused morphological anomalies, here observed by scanning electron microscopy. This behaviour is discussed on the basis of the presence in the chicory extract of the two main sesquiterpene lactones, 8-deoxylactucin and 11β,13-dihydrolactucin.     

Analisis de 6000 especímenes micológicos Sintesis estadística. — Comentarios

Resumen En este trabajo se estudia en la Parte I todo el material procedente de especímenes clínicos.En primer lugar se estudian las cepas aisladas de Micosis Superficiales o Dermatomicosis.En segundo lugar, los hongos levuriformes del género Candida procedentes de materiales clínicos varios.En tercer lugar los agentes de Micosis Profundas, y finalmente los hongos del aire de Caracas que tienen interes alergológico.Los resultados de todo aparecen en los cuadros sinópticos adjuntos.

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Summary In this part of our work we deal with fungi of clinical interest.Firstly, we study specimens isolated from dermatomycoses.Secondly, yeast-like fungi of the genusCandida of clinical origin.Thirdly, fungi producing systemic mycoses and lastly, air-borne fungi of allergic interest from Caracas and its surroundings.

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Résumé Dans la première partie de ce travail, on étudie tout le matériel d'intérêt médical.En premier lieu, les souches isolées de matériel clinique de Mycoses Superficielles ou Dermatomycoses.En deuxième lieu, les champignons lévuriformes du genre Candida provenant de matériaux cliniques variés.En troisième lieu, les Agents de Mycoses Profondes et, finalement, les champignons contenus dans l'air de Caracas intéressant la Mycologie Allergique.

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(Trabajo de la Sección de Micología del Instituto Nacional de Higiene)

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Trabajo presentado al IV Congreso Venezolano de Tisiología y Neumonología, Valencia, Diciembre 1959.

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Jefe de Sección Micología. — Instituto Nacional de Higiene. Jefe de Sección Micología.-Hospital Universitario. Profesor de la Catedra de Micología.-Escuela de Bioanálisis Fac. de Medicina U C V.

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Directora de la Micoteca Nacional.-Seccion de Micología, Instituto Nacional de Higiene.     

Forty four years of dermatophytes in a Chicago clinic (1944–1988)

Data are presented on 39270 cultures taken over a 44 year span (1944–1988) at the University of Chicago's Dermatology Clinic. In the mid 1940's Microsporum audouinii accounted for 60–80% of isolates. It gradually decreased over the next two decades and disappeared altogether in the 1970's. Trichophyton rubrum, rare in the 1940's accounted for over 60% of isolates in the mid-1960's only to be overtaken by T. tonsurans. This species, not isolated till the mid 1950's, became and remains the dominant dermatophyte at the present time. Both T. mentagrophytes and Epidermophyton floccosum increased in the 1970's and decreased later. Unusual circumstances resulted in clusters of T. verrucosum, T. terrestre, and T. schoenleinii isolates. Infections were associated with rural dairy workers, zoo handlers and immigrant families respectively. M. canis and M. gypseum were steady at a low rate throughout the entire period. Rare isolates included M. cookei, M. persicolor, M. racemosum, T. simii, T. soudanense, T. violaceum, and the soil keratinophile, Aphanoascus fulvescens.