Clinical and microbiological pattern of intertrigo

Abstract

Background: Intertrigo is a common disorder affecting many flexural areas of the body with significant morbidity.
 Objectives: To determine the clinical pattern of intertrigo. To determine bacterial and fungal pathogens associated with intertrigo. To assess the antibacterial and antifungal sensitivity pattern of the responsible organisms.
 Methods: A total number of 230 patients with intertrigo attending dermatology unit were included in the study after ethical clearance. Laboratory investigations were done to identify the etiologic agent and their sensitivity pattern.
 Results: Majority of patients (75%) belonged to 20-60 years of age. Male to female ratio was 1.15:1. Remarkable proportion (52%) presented with the involvement of more than one intertriginous area. The most common site involved was toe web space (63%) in particular 4th toe web space. Of all positive bacterial cultures 45% revealed Staphylococcus aureus (MSSA+MRSA) followed by CNSA (Coagulase negative Staphylococcal aureus), diptheroids and pseudomonas. The majority of MSSA (Methicillin sensitive Staphylococcus aureus) isolates (91%) were sensitive to cloxacillin and MRSA (Methicillin resistant Staphylococcus aureus) to teicoplanin (85%). CNSA isolates showed considerable proportion of sensitivity to vancomycin (37%) and majority of diptheroids isolates were sensitive to penicillin(87%). All isolates (100%) of pseudomonas were sensitive to gentamicin. Of all positive fungal cultures, candida species constituted the majority (35%) followed by fusarium species (33%) and dermatophytes (30%). Overall fusarium species shows high value of MIC50 and MIC90 for itraconazole, fluconazole and ketoconazole. Fluconazole showed very high MIC50 and MIC90 (256 ug/ml) for dermatophytes and fusarium species whereas itraconazole and ketoconazole showed lower MIC for these fungi.
 Conclusion: Intertrigo can affect various intertriginous areas, among which toe web space is the most common region involved. Intertrigo can be caused by a variety of organisms: Staphylococcus aureus and candida species constituted the majority of cases. Majority of MSSA sensitive to cloxacillin and MRSA to teicoplanin. MIC of itraconazole, fluconazole and ketoconazole are high in fusarium species comparing to candida and dermatophytes. However, itraconazole and ketoconazole had lower MIC than dermatophytes and fusarium comparing to fluconazole.