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.     

Mating patterns of dermatophytes of diverse origin in India

The mating patterns of Trichophyton mentagrophytes var. interdigitale (74 isolates) and the Microsporum gypseum complex (17 isolates) of diverse origin and T. rubrum (25 isolates) and T. tonsurans (10 isolates) of clinical origin were studied. The results of the study showed that the teleomorph of the Indian isolates of T. mentagrophytes belong to Arthroderma vanbreuseghemii, undetermined teleomorphs of T. mentagrophytes var. interdigitale (+) mating types, and undetermined teleomorphs of T. mentagrophytes var. interdigitale indeterminate mating types. All the isolates of T. rubrum and T. tonsurans were found to be of the (-) mating type.     

Antifungal potential of essential oil and various organic extracts of <Emphasis Type="Italic">Nandina domestica</Emphasis> Thunb. against skin infectious fungal pathogens

This study was undertaken to assess the in vitro antifungal potential of the essential oil and n-hexane, chloroform, ethyl acetate, and methanol extracts of Nandina domestica Thunb. against dermatophytes, the casual agents of superficial infections in animals and human beings. The oil (1,000 μg/disc) and extracts (1,500 μg/disc) revealed 31.1–68.6% and 19.2–55.1% antidermatophytic effect against Trichophyton rubrum KCTC 6345, T. rubrum KCTC 6375, T. rubrum KCTC 6352, Trichophyton mentagrophytes KCTC 6085, T. mentagrophytes KCTC 6077, T. mentagrophytes KCTC 6316, Microsporum canis KCTC 6591, M. canis KCTC 6348, and M. canis KCTC 6349, respectively, along with their respective minimum inhibitory concentration values ranging from 62.5 to 500 and 125 to 2,000 μg/ml. Also, the oil had strong detrimental effect on spore germination of all the tested dermatophytic fungi as well as concentration and time-dependent kinetic inhibition of T. rubrum KCTC 6375. The present results demonstrated that N. domestica mediated oil and extracts could be potential sources of natural fungicides to control certain important dermatophytic fungi.     

An in vitro study of the photodynamic effect of rose bengal on trichophyton rubrum

Onychomycosis, a fungal infection of the finger or toenails, is predominantly caused by Trichophyton rubrum. Treatment is difficult due to high recurrence rates and problems with treatment compliance. For these reasons, alternative therapies are needed. Here we describe the photoactivation of Rose Bengal (RB) using a green laser (λ = 532 nm) at fluences of 68, 133 and 228 J/cm², and assess its fungicidal activity on T. rubrum spore suspensions. A 140 µM RB solution was able to induce a fungicidal effect on T. rubrum when photosensitized with the fluence of 228 J/cm². RB photosensitization using a green laser provides a potential novel treatment for T. rubrum infections. (© 2014 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Dermatophyte species,microscopic and cultural examination

The dermatophytes Epidermophyton floccosum, Microsporum canis, Trichophyton mentagrophytes var. interdigitale, T. rubrum, and T. verrucosum were compared with respect to the direct microscopic examination of a clinical material and the number of colonies obtained by culture.It was found that the results of microscopy as well as of culture depended to a marked extent upon which species were the cause of the mycosis.The extremes were E. floccosum and T. mentagrophytes var. interdigitale which showed 7.5 % and 32.5 % isolates with negative microscopic findings and 45.5 % and 5.0 % isolates with 10 colonies.     

In vitro evaluation of the antifungal activity of Allium sativum bulb extract against Trichophyton rubrum,a human skin pathogen

The aqueous extract of Allium sativum bulbs showed an antifungal effect against the fungal skin pathogen, Trichophyton rubrum, isolated from infected patients. For a given concentration (200 mg of bulbs/1 ml), the volume of the aqueous garlic extract loaded on to the discs, and the diameter of the inhibitory zone formed around the disc on the fungal lawn showed positive correlation. Extract-included microbial assay confirmed the antifungal effect of Allium sativum. The extract was not heat stable, it lost its antifungal property above 60 °C. This revised version was published online in July 2006 with corrections to the Cover Date.     

Molecular Analysis of Chitin Synthase 1 (CHS1) Gene Sequences of Trichophyton mentagrophytes Complex and T. rubrum

Nucleotide sequences of chitin synthase 1 (CHS1) gene of dermatophytes, Arthroderma benhamiae, A. simii, A. vanbreuseghemii, Trichophyton mentagrophytes var. interdigitale (T. interdigitale), and T. rubrum were analyzed for their phylogenetic relationship. About 620-bp genomic DNA fragments of the CHS1 gene were amplified from these dermatophytes by polymerase chain reaction (PCR) and sequenced. The CHS1 nucleotide sequences of these five dermatophytes showed more than 90% similarity between the species. The phylogenetic analysis of their sequences revealed that A. benhamiae, A. simii, A. vanbreuseghemii, and T. rubrum were genetically distinct from one another, but T. interdigitale was genetically very close to A. vanbreuseghemii. On the other hand, a specific restriction endonuclease site of HinfI was present in the CHS1 gene fragment of T. rubrum but not in those of A. benhamiae, A. simii, A. vanbreuseghemii and T. interdigitale. The molecular analysis of CHS1 genes will provide useful information for the identification of these Trichophyton species and the understanding of their evolution. Received: 6 March 1998 / Accepted: 4 May 1998     

Differentiation of trichophyton rubrum from trichophyton mentagrophytes

Conclusions Of the several morphological and physiological criteria that have been proposed to identifyTrichophyton rubrum andTrichophyton mentagrophytes differentially, only the hair invasion test agrees with the immunological results reported here.A typical strain ofT. rubrum andT. mentagrophytes was obtained from the Centraalbureau voor Schimmelcultures (Netherlands) and was used as reference strain. All isolates that did not invade hair shafts (in vitro) and that produced three precipitate lines in agargel diffusion tests against anti-T. rubrum serum (refence strain, Tr-1) were placed in one group. These isolates all also produced a red undersurface pigment and macroconidia with long parallel sides. They were labledT. rubrum.Other isolates that did invade hair shafts, and produced only two precipitate lines against anti-T. rubrum serum were placed in another group and were labeledT. mentagrophytes. These isolates had variable characteristics of pigment production, colony and conidial morphology.The antigenic studies thus corroborate the validity of the hair invasion test. The hair invasion test will probably remain in wider use because of its simplicity.     

Antimycotic Activity Potentiation of Allium sativum Extract and Silver Nanoparticles against Trichophyton rubrum

A natural and biocompatible extract of garlic as a support, decorated with silver nanoparticles, is a proposal to generate an effective antifungal agent against dermatophytes at low concentrations. Silver nanoparticles (AgNPs) with a diameter of 26±7 nm were synthesized and their antimycotic activity was examined against Trichophyton rubrum (T. rubrum), inhibiting 94 % of growth at a concentration of 0.08 mg ml^?1. Allium sativum (garlic) extract was also obtained (AsExt), and its MIC was 0.04 mg ml^?1. To increase the antifungal capacity of those systems, AsExt was decorated with AgNPs, obtaining AsExt‐AgNPs. Using an AsExt concentration of 0.04 mg ml^?1 in independent experiments with concentrations from 0.01 to 0.08 mg ml^?1 of AgNPs, it was possible to inhibit T. rubrum at all AgNPs concentrations; it proves a synergistic effect between AgNPs and AsExt. Even if 1 % of the minimum inhibitory concentration of AsExt (0.0004 mg ml^?1) is used, it was possible to inhibit T. rubrum at all concentrations of AgNPs, demonstrating the successful antimycotic activity potentiation when combining AsExt and AgNPs.     

Piper regnellii extract biopolymer‐based microparticles: production,characterization and antifungal activity

Aims

This study aims to improve characteristics of Piper regnellii extract to make it applicable in formulations to treat dermatophytosis, also known as ringworm.

Methods and Results

Microparticles (MPs) were produced by spray drying with gelatin, alginate and chitosan as encapsulating agents; characterized by scanning electron microscopy, encapsulation efficiency, thermal analyses and X‐ray diffraction; and tested against Trichophyton rubrum by broth microdilution. Produced MPs had a mean diameter less than 2 μm, an increase in stability and release of the extract and good results for encapsulation efficiency, being 85·6% to gelatin MP, 71·3% to chitosan MP and 60·6% to alginate. MPs preserved the antifungal activity of P. regnellii extract T. rubrum.

Conclusion

Microencapsulation provided a significant improvement in the stability of the P. regnellii extract and better solubilization of chemical compounds, maintaining the antifungal effect against T. rubrum.

Significance and Impact of the Study

These results are useful for developing a formulation to treat fungal infections caused by dermatophyte species.     

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.     

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.     

In vitro characterization of Trichophyton rubrum and T. mentagrophytes biofilms

Dermatophytes are fungi responsible for a disease known as dermatophytosis. Biofilms are sessile microbial communities surrounded by extracellular polymeric substances (EPS) with increased resistance to antimicrobial agents and host defenses. This paper describes, for the first time, the characteristics of Trichophyton rubrum and T. mentagrophytes biofilms. Biofilm formation was analyzed by light microscopy, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) as well as by staining with crystal violet and safranin. Metabolic activity was determined using the XTT reduction assay. Both species were able to form mature biofilms in 72?h. T. rubrum biofilm produced more biomass and EPS and was denser than T. mentagrophytes biofilm. The SEM results demonstrated a coordinated network of hyphae in all directions, embedded within EPS in some areas. Research and characterization of biofilms formed by dermatophytes may contribute to the search of new drugs for the treatment of these mycoses and might inform future revisions with respect to the dose and duration of treatment of currently available antifungals.     

In Vitro Fungicidal Photodynamic Effect of Hypericin on Trichophyton spp

Hypericin is a natural photosensitizer used in photodynamic therapy (PDT), which has shown in vitro antifungal effect against Candida spp. The aim of this study was to evaluate the in vitro fungicidal effect of hypericin-PDT on dermatophytes. Trichophyton rubrum and Trichophyton mentagrophytes strains were incubated with different concentrations of hypericin for different times and exposed to light-emitting diode lamp (602 ± 10 nm, 10.3 mW cm^?2, and fluence 37 J cm^?2). Using the optimal incubation time, 60 min, a 3-log fungicidal effect was achieved with hypericin concentration ranges of 10–20 μM for T. rubrum and 20–50 μM for T. mentagrophytes (p = 0.95). Confocal fluorescence microscopy showed the localization of hypericin inside the dermatophytes diffusely distributed in the cytoplasm of conidia and hyphae and outside the nucleus. In conclusion, hypericin-PDT has a fungicidal effect in vitro on dermatophytes. Hypericin seems to be a promising photosensitizer to treat localized dermatophytic infections such as tinea pedis and onychomycosis.     

Extensive dermatophytoses caused by Trichophyton mentagrophytes and Microsporum canis in a patient with AIDS

Retrospective studies have shown the occurrence of episodes of deep or superficial fungal infections in 58 to 81% of HIV/AIDS patients as a result of impairment of cell immunity. We describe a case of disseminated cutaneous dermatophytoses caused by Trichophyton mentagrophytes and Microsporum canis in a patients with AIDS. Diagnostic and therapeutic problems in relation to this unsual presentation are emphasized as well as the importance of an early mycologic diagnosis to prescribe antifungal therapy.     

Deep dermatophytoses in association with atopy anddiabetes mellitus: Majocchi's granuloma tricophyticum ordermatophytic pseudomycetoma?

Two patients presenting with subcutaneous nodules, plaques, papules and ulceration caused by dermatophytes are described in this report. The first case was atopic and had used low dosesystemic corticosteroids intermittently for his asthma. The second case was a poorly controlled and long-standing diabetic patient. The diagnoses were suspected after direct microscopical examinations of the discharge materials which revealed the presence of hyaline hyphae and spores, and histological examination which showed an inflammatory infiltrate with fungal elements in the dermis. Cultures of puncture materials and skin biopsies confirmed the diagnosis identifyingTrichophyton rubrumand T. mentagrophytes var interdigitale,in the first and second case respectively. Antifungal therapy with itraconazole was successful in both patients. The cases are presented to emphasize the possibility of this unusual condition in association with atopy and diabetes mellitus as in profoundly immunosuppressed cases. The nomenclature concerning this type of dermatophyte infections is also discussed. This revised version was published online in June 2006 with corrections to the Cover Date.     

Antifungal property of quaternized chitosan and its derivatives

Five water-soluble chitosan derivatives were carried out by quaternizing either iodomethane or N-(3-chloro-2-hydroxypropyl) trimethylammonium chloride (Quat188) as a quaternizing agent under basic condition. The degree of quaternization (DQ) ranged between 28 ± 2% and 90 ± 2%. The antifungal activity was evaluated by using disc diffusion method, minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) methods against Trichophyton rubrum (T. rubrum), Trichophyton mentagrophyte (T. mentagrophyte), and Microsporum gypseum (M. gypseum) at pH 7.2. All quaternized chitosans and its derivatives showed more effective against T. rubrum than M. gypseum and T. mentagrophyte. The MIC and MFC values were found to range between 125-1000 μg/mL and 500-4000 μg/mL, respectively against all fungi. Our results indicated that the quaternized N-(4-N,N-dimethylaminocinnamyl) chitosan chloride showed highest antifungal activity against T. rubrum and M. gypseum compared to other quaternized chitosan derivatives. The antifungal activity tended to increase with an increase in molecular weight, degree of quaternization and hydrophobic moiety against T. rubrum. However, the antifungal activity was depended on type of fungal as well as chemical structure of the quaternized chitosan derivatives.     

<Emphasis Type="Italic">Trichophyton rubrum</Emphasis> and <Emphasis Type="Italic">Trichophyton interdigitale</Emphasis>: Genetic Diversity Among Species and Strains by Random Amplified Polymorphic DNA Method

Onychomycosis is a common condition that represents up to 50% of all nail problems and 30% of all cases of dermatophytoses. Trichophyton rubrum and Trichophyton interdigitale are the most common agents involved in this condition. In cases of recurrent post-treatment onychomycosis, strain fingerprinting could reveal whether the original isolate is responsible, a new strain has been acquired or if multiple strains are involved. The aim of this study was to evaluate the efficacy of the RAPD method for species and strain differentiation of T. rubrum and T. interdigitale obtained from patients with subungeal distal-lateral onychomycosis. A set of 86 strains of onychomycosis causative dermatophytes were submitted to species differentiation and strain typing by RAPD method with two previously described primers. Both primers proved capable of strain differentiation when tested for each species. Nineteen molecular profiles were configured for T. rubrum isolates with primers 1 and 6. For T. mentagrophytes, ten molecular profiles were configured with primer 1 and twenty-one with primer 6. We found that T. interdigitale and T. rubrum species were grouped in different clusters when both primers were analyzed together. This study shows that these primers are valuable tools for strain differentiation with T. rubrum and T. intedigitale.     

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.     

A Study on Stability of Phenotype and Genotype of Trichophyton rubrum

Objective: To explore the stability of phenotype and genotype in Trichophyton rubrum. Methods: All the strains were cultured on Sabouraud’s dextrose agar slopes, and identified to species level. Strains isolated recently were subcultured on Sabouraud agar slopes four times at an interval of 4 weeks. DNA was extracted with CTAB method. A probe consisting of 3′ end of 18S rDNA, adjacent ITS1, 5.8S rDNA and ITS2 regions was amplified from template DNA of the T. rubrum standard strain using fungal universal primers NS5 and ITS4, labelled by P³² and hybridized with EcoR I-digested T. rubrum genomic DNA. Results: (1) Four phenotypes were isolated from 207 T. rubrum strains, with downy type (45.4%) in the first place, and granular type not found. After 1 year of conservation, 54 strains showed morphological variations with the total variation rate of 26.1%. (2) Eleven strains showed variations in colony morphology or pigment upon subculture. (3) AP-PCR analysis of 10 T. rubrum isolates and one T. rubrum standard strain showed similar DNA patterns with main bands at 2.2, 1.7, 1.3, 0.9 and 0.7 kb. No changes in DNA pattern were found upon subculture. (4) Hybridization analysis revealed that all the 11 T. rubrum strains presented three bands and were identified into two types (2.4, 3.9, 5.9 kb and 2.4, 4.4, 6.5 kb). No changes in band pattern were found upon subculture. Conclusions: Phenotype of T. rubrum was instable and the colonial morphology and pigment easily changed during conservation or subculture, while its genotype was relatively stable.