Dermatophytoses in Mexico

The dermatophytic infections are superficial mycoses common in Mexico, they have an estimated frequency of 5% in dermatological outpatients. In this review we present a global view of these mycoses as well as their etiological agents in tinea capitis, tinea pedis, tinea corporis, tinea cruris and onychomycosis and also uncommon infections such as tinea imbricata and epidermophytosis of the diaper area. We also analyze these infections in diabetic patients, healthy carriers and dermatophytic infections in pets and laboratory animals. The most important publications about dermatophytosis in Mexico in the dermatological, epidemiological or mycological area are reviewed, specially those published in the last ten years.     

New data on the epidemiology of Tinea cruris in Israel

Among 250 patients with tinea cruris (160 males, 90 females) lesions of both tinea pedis and tinea unguium were found in 221 and lesions of only tinea pedis in another 25. The four children were free of associated dermatophytic lesions. The predominant causative agent was T. rubrum, which was also found to be responsible for the hairy area invasion of the beard and pubis in 12 patients and for the widespread lesions of tinea corporis in 10 patients with lymphoma. None of these patients had noticed the discrete nail and foot involvement. It is therefore recommended that all patients with tinea cruris be subjected to careful examination of all possible mycotic foci, particularly the feet and nails.     

Tinea unguium in the north-west of Iran (1996-2004)

Tinea unguium is a common mycosis in many part of the world including Iran. The prevalence of this mycosis varied depending on time, health level and geographical location. To stabilise the etiological, epidemiological and risk factors of tinea unguium in North-west Iran, a study of patients with suspected dermatophyte infections of their nails was carried out between 1996 and 2004. During this study 590 (354 females and 236 males) patients with clinical presentation of fungal infection in fingernails, toenails or in the both sites, were investigated using direct microscopy and culture of clinical samples. Tinea unguium was documented in 41 cases (7%) and among positive cases, 16 cases (39% total positive cases) were female and 25 cases (61% total positive cases) were male. Seventeen patients (41% total positive cases) had tinea unguium in their finger nails and 24 patients (59% total positive cases) had infection in their toe nails. According to the isolated etiologic agent, 66% (19 cases) of tinea unguium infections were caused by zoophilic drematophytes, 31% (9 cases) were caused by anthropophilic drematophytes and 3% (1 case) were caused by geophilic dermatophytes. With regard of sex, tinea unguium did not show a significant difference. The highest prevalence of tinea unguium was found in patients between 11 and 40 years of age. In conclusion the current results identified the etiological agents and epidemiological aspects of tinea unguium in North-west Iran. Tinea unguium in this region is associated with animal husbandry and direct or indirect contact with their products (wool, leather).     

Epidemiology of dermatophytoses: retrospective analysis from 2005 to 2010 and comparison with previous data from 1975

Dermatophyte infections are extremely frequent worldwide and their epidemiological features vary according to the geographical area and have changed in the last decades. We studied the spectrum of dermatophytoses by means of a retrospective analysis involving 6,133 patients referred to the Mycology Service of the Dermatology Clinic of Policlinico Hospital - University of Bari, Italy during the period 2005-2010. The most frequent clinical forms were tinea unguium (39.2% of the total dermatophytoses), tinea corporis (22.7%) and tinea pedis (20.4%). There was a predominance of women for tinea unguium and corporis and of men for tinea pedis and especially tinea cruris. T. rubrum was the prevalent causative agent, implicated in 64% of total cases, followed by M. canis (14%) and T. mentagrophytes (10%). The retrospective evaluation of epidemiological data collected at our Clinic since 1975 showed a gradual decrease in the frequency of tinea cruris, tinea corporis, and tinea capitis over time. On the contrary, during the past two decades, there has been a progressive increase in the frequency of tinea pedis and especially of tinea unguium. In parallel with this changing pattern, the frequency of isolation of T. rubrum has shown a continuous increase during the last 35 years, whereas a progressive decline of the etiological role of T. violaceum, M. canis and even more of E. floccosum has been noted.     

Epidemiology of Dermatophytoses in an Area South of Tehran,Iran

Dermatophyte infections have been considered to be a major public health problem in many parts of the world. The aim of this study was to identify the etiological and epidemiological factors of dermatophyte infections in an area south of Tehran. A total of 1254 patients suspected to have dermatophytic lesions were examined over a period of three years (1999-2001). Material collected from skin, hair, and nails was submitted to direct microscopic examination using KOH, cultured in Sabouraud dextrose agar and microscopically examined for colony morphology, in order to the identify the 169 dermatophytes isolated. The prevalence of dermatophytoses was 13.5% (95% CI: 11.7-15.5%). Their incidence was 10.6 per 100,000 person-years (95% CI: 8.5-13.2). Epiderophyton floccosum was the most frequent dermatophyte isolated (31.4%) followed by Trichophyton rubrum (18.3%), T. mentegrophytes (17.2%), T. violaceum (16.6%), Microsporum canis (6.5%), T. verrucosum (4.7%) and M. gypseum (4.1%). Epidermophytes floccosum was found to be the most common isolated dermatophyte in age groups 20-29 (30.2%). Tinea corporis (31.4%) was the most common type of infection, followed by tinea cruris (20.7%), tinea manuum (15.4%), tinea capitis (12.4%), tinea pedis (10.6%), tinea faciei (7.1%), and tinea unguium (2.4%). The frequency rate of all of the types of tinea was higher in males than in females. The anthrophilic species E. floccosum was the most common dermatophyte as a causative agent of tinea. The most prevalent fungal infection was tinea corporis caused by E. floccosum.     

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.     

Update in Antifungal Therapy of Dermatophytosis

Treatment of dermatophyte infection involves primarily oral and/or topical formulations of azoles or allylamines, particularly itraconazole and terbinafine. Topical medications applied once or twice daily are the primary treatment indicated for tinea corporis/cruris, and tinea pedis/manuum. Use of oral antifungals may be practical where the tinea involvement is extensive or chronic, or where application of a topical is not feasible. For tinea unguium (onychomycosis) and tinea capitis, oral therapies are the primary treatments provided. Recently, topical amorolfine and ciclopirox formulations have been approved for use in milder onychomycosis cases, and their role in the treatment of the different clinical forms of onychomycosis is currently being defined. Relapse of infection remains a problem, particularly with tinea pedis/unguium. Appropriate follow-up duration and education of patients on proper foot hygiene are also important components in providing effective therapy.     

Pathogenic Dermatophytes Survive in Nail Lesions During Oral Terbinafine Treatment for Tinea Unguium

Tinea unguium caused by dermatophyte species are usually treated with oral antimycotic, terbinafine (TBF). To understand the mechanisms of improvement and recalcitrance of tinea unguium by oral TBF treatment, a method of quantifying dermatophyte viability in the nail was developed, and the viability of dermatophytes was analyzed in toenail lesions of 14 patients with KOH-positive tinea unguium treated with oral TBF 125 mg/day for up to 16 weeks. Mycological tests, including KOH examination and fungal culture, and targeted quantitative real-time PCR for internal transcribed spacer (ITS) region, including rRNA, were demonstrated at the initial visit and after 8 and 16 weeks of treatment. Assays in eight patients showed that average ITS DNA amount significantly decreased, to 44% at 8 weeks and 36% at 16 weeks compared with 100% at initial visit. No significant difference was observed between at 8 and 16 weeks, despite the TBF concentration in the nail supposedly more than 10-fold higher than the minimum fungicidal concentration for dermatophytes. This finding suggests the pathogenic dermatophytes in nail lesions could survive in a dormant form, such as arthroconidia, during oral TBF treatment. Both antimycotic activity and nail growth are important factors in treatment of tinea unguium.     

New Antifungal Agents and New Formulations Against Dermatophytes

A variety of oral and topical antifungal agents are available for the treatment of superficial fungal infections caused by dermatophytes. This review builds on the antifungal therapy update published in this journal for the first special issue on Dermatophytosis (Gupta and Cooper 2008;166:353–67). Since 2008, there have not been additions to the oral antifungal armamentarium, with terbinafine, itraconazole, and fluconazole still in widespread use, albeit for generally more severe or recalcitrant infections. Griseofulvin is used in the treatment of tinea capitis. Oral ketoconazole has fallen out of favor in many jurisdictions due to risks of hepatotoxicity. Topical antifungals, applied once or twice daily, are the primary treatment for tinea pedis, tinea corporis/tinea cruris, and mild cases of tinea unguium. Newer topical antifungal agents introduced include the azoles, efinaconazole, luliconazole, and sertaconazole, and the oxaborole, tavaborole. Research is focused on developing formulations of existing topical antifungals that utilize novel delivery systems in order to enhance treatment efficacy and compliance.     

甲癣的病原学研究进展

甲真菌病是由皮肤癣菌、酵母菌及霉菌引起的甲板和甲下组织感染,皮肤癣菌是主要致病菌,其所致的甲真菌病称为甲癣.皮肤癣菌分为3个属:毛癣菌属、小孢子菌属和表皮癣菌属.随着医学真菌学基础知识的普及和真菌学诊疗水平的提高,越来越多的皮肤癣菌在甲中分离,临床上对甲癣致病真菌的正确鉴定对于制定治疗方案、评价预后以及流行病学监测等都有重要的指导意义.该文对国内外现有文献报道的甲癣的致病菌进行综述.     

两种抗真菌药治疗甲癣成本效果分析

目的：对特比萘芬、氟康唑2种不同抗真菌药物治疗60例甲癣病患者的成本效果分析。方法：选择60例病例,随机分为2组。分别给予特比萘芬、氟康唑治疗,观察各组疗效并运用成本效果法进行分析。结果：2种药物均有较好的抗真菌疗效,特比萘芬疗效优于氟康唑,但氟康唑最具有成本效果。结论：药物经济学分析结果为氟康唑治疗甲癣病较优。     

甲癣局部用药体外药效实验方法研究进展

甲真菌病是皮肤科的常见病,是由皮肤癣菌、酵母菌和非皮肤癣菌性霉菌侵犯甲板和(或)甲床所致的病变,其中由皮肤癣菌感染引起的甲真菌病称为甲癣。人甲板中角蛋白硬、厚且致密,从而形成一个完美屏障。针对甲板的特殊解剖结构,需要局部治疗药物具备穿透指甲屏障,体现高活性抗皮肤癣菌的特质。目前,甲癣的局部用药体外药效学研究没有统一的标准,缺乏指导依据。本文查阅近年来文献报道,综述甲癣局部治疗药物的体外药敏实验、药物与甲板内角蛋白亲和力实验以及药物在甲板内的渗透等,并阐述上述实验方法的模型选择、方式方法及方法间的比较,以推荐适合化合物筛选的方法。     

Aloe-emodin-mediated antimicrobial photodynamic therapy against dermatophytosis caused by Trichophyton rubrum

Trichophyton rubrum is responsible for the majority of dermatophytosis. Current systemic and topical antifungals against dermatophytosis are often tedious and sometimes unsatisfactory. Antimicrobial photodynamic therapy (aPDT) is a non-invasive alternative suitable for the treatment of superficial fungal infections. This work investigated the photodynamic inactivation efficacy and effects of aloe-emodin (AE), a natural photosensitizer (PS) against T. rubrum microconidia in vitro, and evaluated the treatment effects of AE-mediated aPDT for T. rubrum-caused tinea corporis in vivo and tinea unguium ex vivo. The photodynamic antimicrobial efficacy of AE on T. rubrum microconidia was evaluated by MTT assay. The inhibition effect of AE-mediated aPDT on growth of T. rubrum was studied. Intracellular location of AE, damage induced by AE-mediated aPDT on cellular structure and surface of microconidia and generation of intracellular ROS were investigated by microscopy and flow cytometry. The therapeutic effects of AE-mediated aPDT against dermatophytosis were assessed in T. rubrum-caused tinea corporis guinea pig model and tinea unguium ex vivo model. AE-mediated aPDT effectively inactivated T. rubrum microconidia in a light energy dose-dependent manner and exhibited strong inhibitory effect on growth of T. rubrum. Microscope images indicated that AE is mainly targeted to the organelles and caused damage to the cytoplasm of microconidia after irradiation through generation of abundant intracellular ROS. AE-mediated aPDT demonstrated effective therapeutic effects for T. rubrum-caused tinea corporis on guinea pig model and tinea unguium in ex vivo model. The results obtained suggest that AE is a potential PS for the photodynamic treatment of dermatophytosis caused by T. rubrum, but its permeability in skin and nails needs to be improved.     

Superficial infections caused by Microsporum canis in humans and animals

Dermatophytic infections caused by M. canis in humans and animals have a world wide distribution and they are zoonotic. The objective in this work was to know the frequency of M. canis infections in humans and pets. We studied our cases from January 1994 to December 2002. The human samples were obtained from a Dermatological Department in a General Hospital and we registered the next data: age, sex, job, and affected area. The animal samples were obtained from a mycological veterinary laboratory, and we registered the presence or absence of clinical lesions. A total of 46 clinical cases of M. canis infections were recorded, 26 female and 20 males: tinea capitis 21, tinea corporis 17, tinea pedis five, onychomycosis two, and only one case with tinea faciei. The 46 cases with positive culture yield 42 positive samples in KOH. The age range varied from 2 to 60 years. Among the animals, we studied 461 dogs and found six KOH positive (1%) samples and cultured 23 isolates (4.98%): 21 M. canis, one M. gypseum and one Trichophyton spp. From the 68 samples of cats, eight (11.76%) were positive to KOH, being 26 (38.23%) M. canis isolates. In M. canis infections in humans, the age rage was wide with predominance in women. In animals, M. canis isolates represented the most dermatophytic infection.     

Multicentric and localized tineas in immunocompromised patients

From the dermatological point of view, multifocal or multicentric tineas are widespread dermatophytic infections affecting two or more anatomical areas. In the immunosuppressed patient, these lesions are frequently atypical and the risk factors are not well established. The aims of this study were: to determine the risk factors associated to multicentric tinea in immunocompromised patients; to evaluate the immune response by trichophytin and candidin skin test, to determine the etiological agent and to quantify some serum interleukines. Thirty-six multicentric tinea and 37 localized tinea patients, both with immunocompromised factors, were included. By means of a questionnaire several risk factors were identified; the trichophytin and candidin skin test was evaluated after 48 hours. Mycological direct examination and culture were performed. The interleukins IL-2, IL-4, IL-10 and interferon gamma were quantified by ELISA. Statistical analysis was made by Chi-square, U Mann Whitney and logistic regression. In disseminated tinea patients a predominance of females (69%) versus localized tinea patients (30%) was observed. Prednisone, azathioprine and cyclophosphamide treatment was associated to multicentric tinea. Trichophytin was negative in all disseminated tinea patients and positive in only three localized tinea cases, candidin was positive in six and eight cases of multicentric and localized tinea respectively. Trichophyton rubrum was the most frequent etiological agent. No differences in interleukin concentrations were found. Female gender and some immunosuppressor treatments were associated with a high probability to develop multicentric tinea. In this study a defect in the cellular immune response was the possible explanation for the extensive reactions.     

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%).     

Trichophyton tonsurans scalp carriage among wrestlers in a national competition in Turkey

Trichophyton tonsurans tinea gladiatorum is an emerging epidemic among combat-sport athletes across the globe. In the present study, we investigated the prevalence of symptomatic and asymptomatic dermatophytic infections among wrestlers in the National Greco-Roman Championship in Turkey. In total, 194 wrestlers from 32 provinces and 72 clubs were examined for scalp, trunk, groin, and toe web dermatophytic infections. We also administered a questionnaire to obtain information on the participants' lifestyles, wrestling characteristics, and risk factors for dermatophytic infections. The hairbrush method was used for scalp and trunk sampling, whereas a cotton swab was used for groin, toe web, and mat sampling. Three wrestling mats in the gymnasium were surveyed for dermatophytes using the touch preparation method. A total of 17 (8.8%) wrestlers harbored dermatophytes, and 22 strains were isolated: 13 (59.1%) T. tonsurans and 9 (40.9%) T. rubrum. These isolates were found on the scalp (8), trunk (2), forearm (1), hand (1), groin (3), and feet (7). In addition, we recovered 8 dermatophyte strains from the 150 mat samples (5.3%): T. rubrum in 6 samples (75%) and T. tonsurans in two samples (25%). T. tonsurans was only recovered from 11 out of 194 (5.7%) wrestlers. Scalp carriage represents the predominant (72.7%) clinical picture of a T. tonsurans infection in these Greco-Roman wrestlers in Turkey.     

Etiologic and epidemiologic study of dermatomycoses in Navarra (Spain)

We review the etiology of the dermatophytosis in Navarra (Spain) over a 5-year period and it is compared with previous studies. We have isolated 312 strains of dermatophyte fungi in 285 patients (188 men and 97 women). Trichophyton rubrum was the most frequently isolated species (58.6%) followed by Trichophyton mentagrophytes (26.2%) and Microsporum canis (10.5%). Concerning the location of the lesions, tinea pedis was the clinical pattern found in the greatest number of patients, followed by tinea corporis, tinea unguium and tinea capitis. Twenty eight percent of the isolations were accomplished in October and November. More than half of those patients questioned had had epidemiological contact with animals or practiced sports. The rise of tinea pedis in our region is emphasised. The possible causes of this increment are analyzed and some recommendations for its control are made.     

Clinical and epidemiological survey of dermatophytoses in Jaen (Spain)

Prevalence of dermatophytosis, with respect to age and sex and dermatophyte species, in Jaen was investigated during a period of three years (1996-1999). The prevalence of dermatophytosis over three years was 4.48 cases / 1000 inhabitants. The isolated species were: Microsporum canis (48.6%), Trichophyton mentagrophytes (27.1%), Epidermophyton floccosum (10%), Trichophyton rubrum (8.6%), Trichophyton violaceum (4.3%), and Microsporum gypseum (1.4%). The most frequently observed dermatophytoses were tinea corporis (62.8%), followed by tinea capitis (12.8%); other clinical forms encountered were, in decreasing order of frequency, tinea cruris, tinea pedis and tinea unguium, tinea faciei and tinea barbae. Men were more affected than women.     

Epidemiological trends of dermatophytoses and dermatophytes in Jerusalem between 1954 and 1981

Data for dermatophyte infections analysed for five 3-year periods between 1954 to 1981 led to the following conclusions: (1) Tinea pedis, tinea cruris and tinea manuum showed an increase in the 50's and 60's and declined in the 70's; (2) Tinea unguium and tinea corporis showed an increase during the whole period; (3) At all these sites, the percentage of Trichophyton rubrum, the main etiologic agent, increased steadily over the periods while the percentage of Trichophyton mentagrophytes, the secondary etiological agent, decreased. Epidermophyton floccosum, the third etiological agent in these sites, showed no sharp fluctuations; (4) These three dermatophytes which show similar microclimatic requirements and favour the same microecological niches, were called glabrohydrophilic. In tinea corporis they form a definite subset, their percentage being similar to that at other glabrous sites; (5) Tinea capitis was at its peak in the 50's, decreased sharply until the second half of the 70's, its main etiological agent being Trichophyton violaceum. Since 1979, an increase of tinea capitis occurred due to the newly introduced Microsporum canis; (6) Dermatophytes favouring scalp hair were called trichophilic. In tinea corporis they form a definite subset, their percentage being similar to that of tinea capitis; (7) A comparison with other studies from this country shows that macroclimate (i.e. humid warm coastal climate compared with dry cooler inland-mountain climate) is not an important factor in the etiology of tinea.