Epidemiology of superficial mycosis (tinea pedis, onychomycosis) in elementary school children in Istanbul, Turkey

The purpose of this study is to determine the prevalence of tinea pedis and onychomycosis in children of elementary school age and to examine the socio-demographic attributes that may be effective in correlation of both mycoses. 3,390 female and 3,768 male children between ages 6-14 have been examined in seven schools. Skin scrapings and nail samples were taken from 13 students who were suspected to have tinea pedis and from 49 students who were suspected to have onychomycosis. According to direct microscopy (10-15% KOH+calcofluor white) and culturel examination (Sabouraud dextrose agar and dermatophyte test medium) 11 students were diagnosed as tinea pedis and 24 were diagnosed as onychomycosis. Trichophyton rubrum was isolated in 3 students with tinea pedis whose culture was positive and five Candida albicans, five Candida glabrata and one Candida tropicalis cases were isolated from 11 samples with onychomycosis. Tinea pedis prevalence has been found to be 3.3%0. Differences between onychomycosis prevalence based on age have been found to be significant (p < 0.001). In conclusion, it has been determined that the prevalence of tinea pedis and onychomycosis among children is low. Candida spp. was isolated from all of the 14 samples diagnosed as onychomycosis. Our study shows similar results with previous studies done in Turkey and that Trichophyton rubrum continues to be the most isolated agent.     

濮阳市部分浅部真菌病中癣菌和念珠菌混合感染的分析

目的了解濮阳地区部分浅部真菌病中两种及两种以上真菌混合感染的情况。方法对临床确诊为浅部真菌病的患者456例,取标本行10%KOH直接镜检、真菌培养及菌种鉴定。登记确诊患者相关临床资料,分析其中混合感染的发病特点。结果确诊皮肤癣菌和念珠菌混合感染病例36例,分离率为7.89%,多见于股部(58.33%)和足部(27.78%);分离菌株72株,皮肤癣菌中以红色毛癣菌为主(75.00%),念珠菌中以非白念珠菌为主(72.22%)。结论濮阳地区部分浅部真菌病中混合感染主要为皮肤癣菌和念珠菌的混合感染,多见于股部和足部;致病菌以红色毛癣菌和非白念珠菌为主。     

Onychomycosis and <Emphasis Type="Italic">Tinea Pedis</Emphasis> in Athletes from the State of Rio Grande Do Sul (Brazil): A Cross-Sectional Study

Onychomycosis and tinea pedis are common superficial infections caused primarily by dermatophytes. The aim of this investigation was to study the epidemiology, etiological agents, and potential risk factors for infection based on comparison of athletes and non-athletes from a northern region of Rio Grande do Sul (Brazil). Each group consisted of 100 male individuals with ages ranging from 18 to 40 years. After a clinical examination, samples were taken from individuals presenting signs of onychomycosis and/or tinea pedis for direct microscopic examination and culture. Among the athletes, the frequency of onychomycosis and/or tinea pedis was 32%, and for the control group, it was 20%. The athletes presented 16% of onychomycosis, 12% of tinea pedis, and 4% of onychomycosis and tinea pedis together. The distribution in the control group was 10% of onychomycosis, 7% of tinea pedis, and 3% of this association. The pathogens identified were dermatophytes (84.8%) and yeasts (15.2%), and the most commonly identified organism was Trichophyton rubrum, followed by Trichophyton mentagrophytes var. interdigitale. No significant differences were found when the frequency of species distribution in the athletes and non-athlete groups was compared. Risk factors for onychomycosis in athletes included familial cases of fungal infection, contact with domestic animals, and nail trauma, while the risk factors in non-athletes included the habit of not using sandals in public bathrooms and nail trauma. For tinea pedis, the habit of not using sandals in public bathrooms was a predisposing factor in both groups, while hyperhydrosis was a risk factor only in non-athletes. This study concludes that despite the higher number of fungal infections in athletes, there is no significant difference between these groups.     

822例浅部真菌病及其致病菌种分析

目的分析新疆乌鲁木齐市浅部真菌病病原菌的流行趋势。方法对2006年1月～2013年12月就诊于我院皮肤科门诊、有典型临床表现、真菌镜检及培养均阳性的822例患者进行致病病种及菌种分析。使用SPSS17．0统计软件对于结果进行统计分析。结果822例患者包括8个病种：体癣214例（26．0％）,足癣131例（15．9％）,头癣128例（15．6％）,甲真菌病125例（15．2％）,股癣119例（14．5％）,手癣54例（6．6％）,皮肤念珠菌病38例（4．6％）,花斑糠疹13例（1．6％）。菌种分布以须癣毛癣菌为首位,336株（40．9％）,其次为红色毛癣菌共239株（29．1％）,犬小孢子菌68株（8．3％）,铁锈色小孢子菌48株（5．8％）,念珠菌38株（4．6％）,断发毛癣菌33株（4．0％）,许兰黄癣菌23株（2．8％）,马拉色菌13株（1．6％）,疣状毛癣菌9株（1．1％）,紫色毛癣菌7株（0．9％）,支顶孢霉菌4株（0．5％）,曲霉、絮状表皮癣菌各2株（各0．2％）。统计学分析显示：不同性别足癣、股癣、甲真菌病及花斑糠疹构成比有统计学意义（P〈0．05）,除体癣及花斑糠疹外,本组其他浅部真菌病的分布在年龄方面有着明显的差别（P〈O．05）。结论乌鲁木齐市浅部真菌病发病率排在前3位的依次为体癣、足癣、头癣,致病病原菌以毛癣菌为主,须癣毛癣菌为首位致病菌,其次为红色毛癣菌。足癣及甲真菌病好发于女性,而股癣及花斑糠疹好发于男性。除体癣及花斑糠疹外,不同年龄段浅部真菌病分布有明显差异,其中头癣主要好发于青少年。     

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.     

无锡地区293例儿童浅部真菌病临床分析

目的研究无锡地区儿童浅部真菌病的流行及病原菌特点。方法采用真菌镜检和含氯霉素(和含氯霉素及放线菌酮)的葡萄糖蛋白胨琼脂培养,根据菌落形态及其镜下形态鉴定菌种。结果 293例临床诊断患儿中,直接镜检阳性245例,阳性率83.6%,其中皮肤念珠菌病、足癣、头癣发病例数居前3位,分别为79例(32.2%)、50例(20.4%)和46例(18.8%),共175例,占总病例数的71.4%,其次分别为体癣、甲真菌病、手癣、股癣、花斑糠疹,分别为29例(11.8%)、13例(5.3%)、11例(4.5%)、10例(4.1%)、7例(2.9%)。随着年龄增长,患儿易患疾病有所差异,花斑糠疹0～2岁发病率最高;皮肤念珠菌病0～3岁发病率最高;头癣4～8岁发病率最高;体股癣、手、足癣9～15岁发病率最高。238例镜检阳性标本(7例花斑糠疹除外)共培养出致病菌145株,阳性率为60.9%,其中皮肤念珠菌病培养阳性率为70.9%,股癣70%,体癣51.7%,甲真菌病53.8%,头癣65.2%,足癣50%,手癣45.5%。在145株致病菌中,念珠菌属63例(43.45%),红色毛癣菌43例(29.7%),犬小孢子菌26例(17.93%),须癣毛癣菌4例(2.76%),紫色毛癣菌3例(2.07%),石膏样小孢子菌3例(2.07%),断发毛癣菌2例(1.38%),絮状表皮癣菌1例(0.69%)。结论本研究为无锡地区防治儿童浅部真菌病提供了依据。     

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.     

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.     

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.     

A prospective epidemiologic survey on the prevalence of onychomycosis and dermatophytosis in male boarding school residents

Dermatophyte infections and onychomycosis are not usually serious in term of mortality; however, they may have significant clinical consequences such as secondary bacterial infections, chronicity, therapeutic difficulties and esthetic disfigurement in addition to serving as a reservoir of infection. Our aim was to determine the prevalence of onychomycosis and dermatophytosis in a selected high risk group, consisting of male boarding school residents. A total of 410 males inhabiting two houses were evaluated by two dermatologists. In cases of clinical suspicion, appropriate samples were taken for direct microscopy and culture. The results showed that the prevalences of tinea pedis (athletes foot) and pure pedal onychomycosis were 51.5% (n:211) and 4.4% (n:18), respectively. Thirty cases of those with tinea pedis were complicated by toenail onychomycosis. Tinea cruris was present only in five cases with tinea pedis. Interestingly 71.1% of those with tinea pedis and 45.8% of those with onychomycosis, associated with or without tinea pedis were unaware of their diseases. The most common fungal isolate was Trichophyton rubrum (76.6%) followed by Epidermophyton floccosum (11.6%), T. interdigitale (10.55%). Approximately one third of the cultures from nail specimens yielded pure growths of nondermatophyte moulds or Candida albicans. In conclusion, we found unexpectedly high prevalences of occult athletes foot and toenail onychomycosis among the male residents of student houses. Our results indicate that health-care workers of such common boarding-houses should be more aware of clinical and subclinical dermatophyte infections and onychomycosis, and have more active approaches to educational measures and management strategies to prevent further infections. To our knowledge, this is the first epidemiologic study on the prevalences of dermatophytosis and onychomycosis in boarding-houses from Turkey.     

Griseofulvin in the treatment of dermatomycoses and onychomycoses produced by dermatophytes of the Trichophyton group

Summary Based on observations on the therapy of 128 patients affected with tinea unguium, tinea manus et pedis, tinea granulomatosa nodularis (Granuloma Majocchi), tinea cruris, tinea corporis, tinea barbae and tinea capitis due to infection with dermatophytes of theTrichophyton group, determinations were made for the absolute and relative indication of griseofulvin in the treatment of these mycoses. For each affection, comparisons were made between the therapeutic results obtained by combined therapy with oral griseofulvin (uniform daily dose 1 g for each case) and local therapy with 1 % water solution organic dyes, coal tar on the one hand, and mere local therapy as described above, on the other. For treatment, griseofulvin of different production was available: British Grisovin, Likuden and Likuden M from West-Germany, and Griseofulvin produced in the German Democratic Republic. No essential differences were found in the therapeutic effect of the individual preparations, the tolerance, however, was found to be best with Likuden. On the basis of comparisons made for the results of the individual methods of treatment, griseofulvin therapy was found to be an absolute indication of the mycotic diseases as follows: tinea capitis, tinea cruris follicularis trichophytica and tinea unguium. A relative indication was found to be tinea corporis, tinea barbae, tinea cruris, and tinea manus et pedis.All patients were subjected to microscopic and culture examination. The frequency of the individual dermatophytes was as follows:Trichophyton rubrum in 56 cases,Trichophyton verrucosum in 19 cases,Trichophyton mentagrophytes in 16 cases, andTrichophyton violaceum in 1 case. Thirty six cases showed negative cultures.In conclusion, the author recommends individual selection of patients for the griseofulvin therapy.     

Studies in the Epidemiology of Tinea Pedis. IX: Tinea Pedis and Erythrasma in New Patients at a Chiropody Clinic

The feet of 259 new patients at a chiropody clinic were examined for tinea pedis, onychomycosis, and erythrasma: 23% of men and 4% of women were infected by dermatophytes, and the nails of seven males were infected by non-dermatophytes. Of 200 patients examined under Wood''s light 37% showed the coral-red fluorescence of erythrasma.Of the 259 patients, 9.7% were infected by Trichophyton interdigitale, 2.7% by T. rubrum, and 1.5% by Epidermophyton floccosum. Reasons are given, based on the method of selection of the patients, for supposing that T. interdigitale is still the dominant cause of tinea pedis in the population at large, despite figures from dermatological clinics suggesting the dominance of T. rubrum. The high incidence of infection in males compared with females corresponds with similar findings in school-children.     

Prevalence of tinea pedis,tinea unguium of toenails and tinea capitis in school children from Barcelona

ObjectiveTo evaluate the prevalence of tinea capitis, tinea pedis, and tinea unguium in children from several schools of Barcelona city.MethodsDuring the period of 2003–2004, a prospective cross-sectional study was carried out in 1,305 children (9% immigrant population) between the ages 3 and 15 in 17 schools in Barcelona. A systematic examination of the feet, (including nails and scalp), was performed to identify lesions compatible with tinea. Cultures of scalp and feet samples were done and analysis of environmental samples was performed for dermatophyte isolation.ResultsDermatophytes were isolated in 2.9% of the samples with a prevalence of 2.5% in feet, 0.23% in scalp, and 0.15% in nails of the feet. The predominant etiologic agents in feet were Trichophyton mentagrophytes in 45.7% of the cases and Trichophyton rubrum in 31.4%. In the nails, T. rubrum and Trichophyton tonsurans were isolated, while T. mentagrophytes (2 cases) and Trichophyton violaceum (1 case) were identified in scalp samples. Forty-five per cent of dermatophytes were isolated from healthy feet, the majority of cases in children 13–15 years old (p<0.05). Microsporum gypseum was the only agent identified in the environmental samples, and was also found in one of the cases of tinea pedis.ConclusionThe results of this study demonstrate a low prevalence of tinea capitis and tinea unguium in school children of Barcelona. On the contrary, high prevalence of dermatophytes in feet was found. It highlights the high prevalence of healthy carriers of dermatophytes in feet.     

趾间型足癣患者细菌菌种分布特征

目的了解趾间型足癣患者趾间和健康志愿者趾间细菌菌种分布特征。方法对37例经临床和真菌镜检确诊的趾间型足癣患者的趾间进行细菌培养,然后给予1%联苯苄唑霜1次/d外用治疗4周,在治疗后的第1、2、4周分别对趾间再进行细菌培养。33例健康志愿者作为对照。结果健康志愿者趾间细菌培养葡萄球菌属占92.5%,其中表皮葡萄球菌占32.5%,未分离到金黄色葡萄球菌。趾间型足癣患者细菌培养葡萄球菌属占74.4%,其中金黄色葡萄球菌占27.9%,表皮葡萄球菌仅占2.3%,还分离到化脓性链球菌、粪肠球菌、屎肠球菌、奇异变形杆菌、铜绿假单胞菌等。经过4周的外用联苯苄唑霜治疗,金黄色葡萄球菌消失,表皮葡萄球菌又成为优势菌（37.5%）。结论趾间型足癣患者趾间金黄色葡萄球菌的分离率明显高,此乃足癣继发细菌感染的主要致病菌,因此积极治疗足癣对预防足癣合并症有非常重要的意义。     

Chronically Recurrent and Widespread Tinea Corporis Due to <Emphasis Type="Italic">Trichophyton rubrum</Emphasis> in an Immunocompetent Patient

A 31-year-old immunocompetent male who presented with a 4-year history of extensive erythematous and scaly plaques involving the abdomen, gluteal and inguen regions with concomitant tinea pedis and onychomycosis is described. Diagnosis was based on positive mycological examination and positive histopathologic examination. Species identification was performed by growth on Sabouraud dextrose agar and by sequencing of the internal transcribed spacer regions of the rDNA region. The pathogen identified was Trichophyton rubrum. The same fungal species was cultured from his abdominal, gluteal, foot and toenail. A combination therapy with systemic terbinafine and topically applied terbinafine cream was successful. A 1-year follow-up did not show any recurrence of infection.     

亚热带地区部队皮肤真菌病及其病原菌的调查研究

亚热带地区是皮肤真菌病的高发地区,据报道,云南边防某部皮肤真菌病发病率为57.8％,占皮肤病发病率的第一位,美军在越南战争期间,发生的所有皮肤病中,最常见的是皮肤真菌感染,而且造成了非战斗减员。战争后期,美军把皮肤病的防治作为其疾病防治的重点。因此,我们于1992年10月底对海南地区部队皮肤真菌病的发病情况进行了流行病学凋查,并对皮肤真菌病的病原菌进行了分离鉴定,现报告如下。     

The Epidemiology of Tinea Manuum in Nanchang Area, South China

Tinea manuum is a common superficial fungal infection which is usually coexistent with tinea pedis; there are few studies available on the epidemiology of tinea manuum at present. This study aims to investigate the epidemiology of tinea manuum and its correlation with tinea pedis in south China. A total of 280 patients with tinea manuum were recruited. The epidemiological and clinical data were analyzed, and causative agents were isolated and identified mycologically. Totally, 84.3 % patients with tinea manuum had co-occurrence of tinea pedis, among which 88.4 % patients had experience of scratching their feet. There was a significant relationship between the touch habits and the hand infection (χ² = 65.451, P = 0.000). More than 90 % patients had quite the same species of isolates from multiple infected sites in one patient. Therefore, it seems that transmission of dermatophytes from the feet to hand by scratching might be a most common way. As for tinea manuum, whether “unilateral” or “bilateral” is just the result that pathogens spread from feet to hand(s), which is only a special clinical presentation of tinea.     

Practices of strength and conditioning coaches in Brazilian elite soccer

Brazil is the leading global exporter of soccer players, with approximately 2,000 international transfers to different clubs per year. Although Brazilian players compete in the most prestigious soccer leagues worldwide, the habitual training methods, strategies, and routines of Brazilian soccer strength and conditioning coaches (SCCs) are undocumented. This study used a standard online survey to collect and characterize the strength and conditioning practices of Brazilian soccer SCCs. Forty-nine SCCs (age: 40.4 ± 7.5 years; professional experience: 15.3 ± 7.5 years) working in Brazilian professional soccer teams participated in this study. The survey consisted of eight sections: 1) background information; 2) muscular strength-power development; 3) speed training; 4) plyometrics; 5) flexibility training; 6) physical testing; 7) technology use; and 8) programing. Results indicated that training and testing practices of Brazilian SCCs are strongly affected by the congested fixture schedules, extensive traveling distances, and socio-economic disparities between different regions of the country. We describe all these different strategies and methods in detail, providing a comprehensive view and a critical examination of Brazilian soccer strength and conditioning practices. Brazilian SCCs and professional soccer organizations can use the findings from this study to develop training strategies and customize education programs. Practitioners from other countries can use this information to design training programs closely tailored to the background of Brazilian athletes, which may support their adaptation to different competitive scenarios and game demands, such as those found in the most important soccer leagues worldwide.     

Updates on the Epidemiology of Dermatophyte Infections

The spectrum of dermatophytes isolated from skin lesions had changed in last 70 years. Before the Second World War in Germany, Microsporum audouinii and Epidermophyton floccosum ranked the first, whereas Trichophyton rubrum is the most common dermatophyte since the fifties of last century, accounting for 80-90% of the strains, followed by T. mentagrophytes. This evolution is typical for Central and North Europe and it needs to be connected with the increase in the incidence of tinea pedis. In contrast, in Southern Europe and in Arabic countries, zoophilic dermatophytes, such as Microsporum canis or Trichophyton verrucosum, are the most frequently isolated. In Europe, especially in Mediterranean countries, the incidence of M. canis infection has strongly increased during the recent years and this dermatophyte is now the most prevalent in tinea capitis in children. An analysis of the frequency and distribution of tinea pedis in different occupations and leisure-time activities as well as the routes of infection are reported. The spreading of this disease in most developed countries of the world represents a considerable economic problem, since it was accompanied by a parallel increase in the frequency of onychomycosis which implies, as tinea pedis, large financial charges. In poor developing countries, mycoses appear endemically, primarily with children, and their treatment often fails because of the lack of efficient antifungals. The particular epidemiological situations of dermatophytoses and the pathogenic spectrum of dermatophytes are examined at the example of numerous countries.     

A study of 3891 cases of mycoses in the tropics.

4103 cases suspected of mycoses were analysed as to sex, age and site of disease and 3891 were proved cases. This group formed 50% of total mycoses or 13-93% of all dermatoses recorded in the Government General Hospital, Madras, during the period of study. There were 66-26% adult female, 27-6% adult male and 6-14% were below 13 years. Dermatophytoses were found in 73-5%; the other common diseases were tinea versicolor (17-68%) and candidiasis (12-43%). Multiple sites of involvement or more than 1 disease in the same individual were mostly observed. The incidence of piedra (0-1%) and deep mycoses (0-156%) was very low. Mycetoma was the common disease (5/6) in deep mycoses. In dermatophytoses, tinea corporis (49-71%) and tinea cruris (47-85%) commonest; tinea axillaris (3-42%), tinea capitis (1-72%) and tinea barbae (1-29%) were less common. The incidence of tinea manuum, tinea pedis and tinea unguium was similar (4-97%-6-38%). High temperature and humidity were related to the higher incidence of tinea corporis, tinea cruris and tinea versicolor. Mainly children suffered from tinea capitis. All other mycoses were commonly found in adults between 2nd and 3rd decades. In all mycoses but candidiasis, female predominated. Cutaneous candidiasis was mainly a problem of housewives. Among the dermatophytes Trichophyton violaceum was predominant (33-7%) followed by T. rubrum (32-6%). Trichophyton schoenleinii and M. gypseum were rarely isolated. From mycetoma, Madurella mycetomii, Nocardia braziliensis, N. asteroides and Actinomadura spp. were isolated. Demonstration of Cryptococcus laurentii in 1 case is reported in this area for the first time.