Cutaneous Fungal Disease Research Articles

Optimizing Diagnostic Test Accuracy of Skin Tissue Assays in Cutaneous Invasive Fungal Disease

Optimizing Diagnostic Test Accuracy of Skin Tissue Assays in Cutaneous Invasive Fungal Disease

Multidrug Therapy for Leprosy Can Cure Patients with Lobomycosis in Acre State, Brazil: A Proof of Therapy Study.

Lobomycosis, also referred to as lacaziosis, is an endemic cutaneous and subcutaneous fungal disease that mainly affects Amazonian forest dwellers in Brazil. There is no disease control program in place in Brazil, and antifungal therapy failures are common, and the therapy is inaccessible to most patients. We performed a randomized, unblinded clinical trial testing the cure rate of multiple drug therapy (MDT) for leprosy with surgical excision, with or without itraconazole. A control arm consisted of patients who did not adhere to either therapeutic regimens but continued to be followed up. Multiple drug therapy consisted of monthly supervised doses of 600 mg rifampicin, 300 mg clofazimine, and 100 mg dapsone, in addition to daily doses of 50 mg clofazimine and 100 mg dapsone. The patients in the MDT plus itraconazole arm also received itraconazole 100 mg twice daily. We followed up 54 patients from the MDT group and 26 patients from the MDT plus itraconazole group for an average of 4 years and 9 months. The 23 controls were followed up for 6 months on average. The following endpoints were observed: 1) unchanged (no apparent improvement), 2) improved (reduction in lesion size and/or pruritus), and 3) cured (complete remission of the lesions, no viable fungi, and no relapse for 2 years after the end of the drug treatment). The results indicated a significantly greater likelihood of cure associated with the use of multidrug therapy for leprosy with or without itraconazole when compared with the control group. The addition of itraconazole to MDT was not associated with improved outcomes, suggesting that MDT alone is effective.

Ringworm: Evaluation of C-reactive Protein and Lipid Profile as well as Their Correlation with the Patients Age and Body Mass Index

Objectives: Ringworm is a common cutaneous fungal disease with worldwide distribution.It may lead to the abnormal c-reactive protein levels and metabolism of lipid. Thus this study has been designed for determining serum CRP and also evaluating the Lipid profile in patients associated with ringworm.
 Materials and methods: This study recruited 25 patients with ringworm (cases) and 25 healthy individuals (controls). A questionnaire of personal characteristics was completed for each patient and control. Inflammatory marker (CRP) and Serum lipid profile (total, lowdensity lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol and triglyceride) was recorded for each case and control. The test of significance was applied for statistical analysis.
 Results and discussion: The mean serum CRP were 1.608±0.14 and 0.648±0.03 mg/dl and total cholesterol level were 175.09±3.26 and 182.09±3.01 mg/dl in ringworm patients and control subject respectively. It was also observed that the serum TG; HDL; LDL levels were 131.76±3.07 and 139.84±3.47 mg/dl; 80.79±1.79 and 73.35±4.14 mg/dl; 67.95±4.64 and 86.55±3.70 mg/dl in patients and control group respectively. The value of CRP was significantly increased in patients compared to control group (p <0.05). There was no significant difference of lipid profile study between patients and control
 Conclusion: Findings of this study indicate increased concentrations of CRP in patients affected to ringworm and its role in this infection. Patients should thus be routinely screened for such abnormalities Probably observation of lipid profile in healthy individuals in compare with patients group indicates that it has no relationship in case of ringworm.
 Bangladesh Journal of Medical Science Vol.19(4) 2020 p.673-677

A SYSTEMATIC REVIEW OF DIAGNOSIS AND TREATMENT OPTIONS FOR TINEA IMBRICATA

Tinea imbricata is a cutaneous fungal disease and sometimes called (Tokelau). The causative agent is a dermatophyte known as Trichophyton concentricum. It is an endemic in developing countries particularly in South Pacific, India, Central and South America, as well as Mexico. It is generally observed in people with poor living conditions and poor personal hygiene. Predisposing factors are hot weather, humidity, and host immunity in addition to genetic factors. The patients usually presented with concentric or lamellar skin lesions. The aim of this review is to highlight important information about microbial, clinical and therapeutic aspects of tinea imbricta. In this review, we search the literature to identify articles talking different aspects of tinea imbricta. The electronic search was performed in four databases to identify eligible articles in the literature. Electronic databases were searched including MEDLINE and EMBASE using PubMed search engine. In addition, Cochrane library and ovid was searched. The titles and abstracts of the resulted articles were screened to identify eligible studies. Based on the primary screening results the irrelevant studies, duplicated and reviews were excluded. Tinea imbricta is found to be endemic in 3 main geographical regions, Southwest Pacific, Southeast Asia, and Central and South America. There is an autosomal recessive genetic factor which increases the vulnerability to tinea imbricta infection. The levels of both general and specific IgE class antibodies were higher than normal values. Usual clinical findings of tinea imbricta are multiple annular, concentric, squamous sores and may be associated with erythema. The infection usually starts in young people on the facial region and disseminate to the trunk, arms or legs.The eradication of the disease has not been possible yet, thus preventative procedures should be adopted as a strategy of disease control.

Isolation and identification of an extracellular subtilisin-like serine protease secreted by the bat pathogen Pseudogymnoascus destructans.

White nose syndrome (WNS) is a cutaneous fungal disease of bats. WNS is responsible for unprecedented mortalities in North American cave bat populations. There have been few descriptions of enzyme activities that may function in WNS host/pathogen interactions, while no study has isolated and described secreted proteases. To address the hypothesis that Pseudogymnoascus destructans secretes extracellular proteases that function in wing necrosis during WNS infection, the object of this study was to culture P. destructans on various media, then isolate and structurally identify those proteases accumulated stably in the culture medium. We found a single dominant protease activity on minimal nutrient broth enriched with protein substrates, which was strongly inhibited by phenylmethylsulfonyl fluoride. This P. destructans serine protease (PdSP1) was isolated by preparative isoelectric focusing and concanavalin A lectin affinity chromatography. PdSP1 showed a molecular weight 27,900 (estimated by SDS-PAGE), broad pH optimum 6-8, and temperature optimum 60°C. Structural characterization of PdSP1 by MALDI-TOF MS, Orbitrap MS/MS, and Edman amino-terminal peptide sequencing matched it directly to a hypothetical protein accession from the sequenced P. destructans genome that is further identified as a MEROPS family S8A subtilisin-like serine peptidase. Two additional isoforms, PdSP2 and PdSP3, were identified in the P. destructans genome with 90% and 53% homology, respectively. P. destructans S8A serine proteases showed closer sequence conservation to P. pannorum and plant pathogenic fungi than to human pathogenic dermatophytes. Peptide-specific polyclonal antibodies developed from the PdSP1 sequence detected the protein in western blots. These subtilisin-like serine proteases are candidates for further functional studies in WNS host-pathogen interaction.

Molecular epidemiology of human sporotrichosis in Venezuela reveals high frequency of Sporothrix globosa.

BackgroundSporotrichosis is a cutaneous and subcutaneous fungal disease of humans and other mammals, known to be caused by the Sporothrix schenckii species complex, which comprises four species of clinical importance: S. brasiliensis, S. globosa, S. luriei, and S. schenckii sensu stricto. Of them, S. globosa and S. schenckii s. str. show global distribution and differences in global frequency as causal agents of the disease. In the Americas, only three species are present: S. schenckii s. str., S. brasiliensis (so far, only reported in Brazil), and S. globosa. In Venezuela, since the first case of sporotrichosis reported in 1935, S. schenckii have been considered its unique etiological agent. In the present work, the presence of more than one species in the country was evaluated.MethodsBy phenotypic key features and molecular phylogeny analyses, we re-examined 30 isolates from diverse Venezuelan regions belonging to the fungi collection of Instituto de Biomedicina, Caracas, Venezuela, and national reference center for skin diseases. All isolates were collected between 1973 and 2013, and maintained in distilled water.ResultsSporotrichosis in Venezuela is mainly caused by S. schenckii s. str. (70%). However, a significant proportion (30%) of sporotrichosis cases in the country can be attributable to S. globosa. A correlation between intraspecific genotypes and clinical presentation is proposed.ConclusionsOur data suggest that sporotrichosis various clinical forms might be related to genetic diversity of isolates, and possibly, to diverse virulence profiles previously reported in the S. schenckii species complex. Sporothrix globosa was found to be the causative agent of 30% of sporotrichosis for the Venezuelan cases re-examined, the highest frequency of this species so far reported in the Americas. The high genetic variability presented by S. schenckii s. str. indicates that species distinction based on phenotypic key features could be a challenging and uncertain task; molecular identification should be always employed.

Fatty acid methyl ester profiles of bat wing surface lipids.

Sebocytes are specialized epithelial cells that rupture to secrete sebaceous lipids (sebum) across the mammalian integument. Sebum protects the integument from UV radiation, and maintains host microbial communities among other functions. Native glandular sebum is composed primarily of triacylglycerides (TAG) and wax esters (WE). Upon secretion (mature sebum), these lipids combine with minor cellular membrane components comprising total surface lipids. TAG and WE are further cleaved to smaller molecules through oxidation or host enzymatic digestion, resulting in a complex mixture of glycerolipids (e.g., TAG), sterols, unesterified fatty acids (FFA), WE, cholesteryl esters, and squalene comprising surface lipid. We are interested if fatty acid methyl ester (FAME) profiling of bat surface lipid could predict species specificity to the cutaneous fungal disease, white nose syndrome (WNS). We collected sebaceous secretions from 13 bat spp. using Sebutape(®) and converted them to FAME with an acid catalyzed transesterification. We found that Sebutape(®) adhesive patches removed~6× more total lipid than Sebutape(®) indicator strips. Juvenile eastern red bats (Lasiurus borealis) had significantly higher 18:1 than adults, but 14:0, 16:1, and 20:0 were higher in adults. FAME profiles among several bat species were similar. We concluded that bat surface lipid FAME profiling does not provide a robust model predicting species susceptibility to WNS. However, these results provide baseline data that can be used for lipid roles in future ecological studies, such as life history, diet, or migration.

The cutaneous bacterium Janthinobacterium lividum inhibits the growth of Trichophyton rubrum in vitro

Tinea pedis (athlete's foot) is a fungal infection that is both widespread and challenging to treat. Standard treatments consist of topical and systemic therapies of antifungal agents, such as miconazole, itraconazole, and terbinafine. The extended nature of topical therapy and the toxicity of long-term systemic therapy limit the utility of current treatments. An alternate approach relies on an understanding of bacterial-fungal interactions. Specifically, a probiotic antifungal bacterium such as Janthinobacterium lividum can counter infection; Janthinobacterium is a major constituent of the human skin microbiota. Janthinobacterium lividum has been shown to ameliorate the effects of the cutaneous fungal disease chytridiomycosis in a vertebrate species (Rana muscosa). Dual-culture plate challenge assays were performed using J.lividum and Trichophyton rubrum, the leading cause of athlete's foot. In all cases, T.rubrum colonies grew significantly smaller when co-cultured with J.lividum. These in vitro results suggest that J.lividum merits further investigation as a human cutaneous probiotic.

STUDIED THE CUTANEOUS FUNGAL DISEASE OF ATTENDING PATIENTS AT PARASITOLOGY LABORATORY, HUE UNIVERSITY HOSPITAL

Objectives: To determine the prevalence of cutaneous fungal disease and the related factors of 415 attending patients at Parasitology Laboratory, Hue University Hospital. Materials and methods: A crossectional survey for describe on 415 patients of clinically suspected dermatomycose lesions at the Dermatology Clinic. The samples of skin, hair and nails were collected and were examined by KOH 20% solution to diagnose fungal disease. We interviewed patients to get some related factors. Results: 1. The prevalence of fungal disease was 51.81 and clinical types included: tinea corporis 33.02%, tinea cruris 29.30%, tinea pedis 6.05%, paronychia - onychomycosis 5.58%, tinea capitis 3.72%, tinea unguium 3.72%, tinea mannum and interdigital of fingers 3.72%, multiple clinical type 14.88%. 2. Factors associated with cutaneous fungal disease included: Age: age group from 16 to 25 had the highest prevalence fungal infection (73.95%); Gender: males were more infected (71.16%) than females (28.84%); Occupation: the prevalence cutaneous fungal disease of students (58.85%), farmers (62.50%), blue - collar workers (58.33%) and craftsmen (62.50%) were higher than other occupations; Habitat: living in rural and dormitory had the prevalence cutaneous fungal disease higher than private house in urban; Drug using for previous treat: treating with corticoides were more affected than antibiotics and other drugs, living facilities and personal characteristics: unavailable freshwater, physical activities, usual sweat. Conclusion: The prevalence of cutaneous fungal disease in patients of clinically suspected dermatomycose lesion was 51.81%. Tinea corporis is the commonest clinical type. Related factors of this disease were age, gender, occupation, habitat, previous treating by corticoides, unavailable freshwater, physical activities, usual sweat. Key words: Cutaneous fungal disease, clinical types, tinea. Key words: Cutaneous fungal disease, clinical types, tinea

Connubial tinea gladiatorum due to Trichophyton mentagrophytes

Trichophyton mentagrophytes is one of the most common dermatophytes causing cutaneous human fungal disease worldwide. Pubic and/or vulvar localisation of dermatophytosis has rarely been reported and may often be misdiagnosed as bacterial infections. We present a connubial case of severe inflammatory tinea in the genital region caused by T. mentagrophytes. The case illustrates the importance of getting material for cultivation before treatment and emphasises the difficulty of diagnosis and treatment of fungal infections in the genital region.

Histopathologic Criteria to Confirm White-nose Syndrome in Bats

White-nose syndrome (WNS) is a cutaneous fungal disease of hibernating bats associated with a novel Geomyces sp. fungus. Currently, confirmation of WNS requires histopathologic examination. Invasion of living tissue distinguishes this fungal infection from those caused by conventional transmissible dermatophytes. Although fungal hyphae penetrate the connective tissue of glabrous skin and muzzle, there is typically no cellular inflammatory response in hibernating bats. Preferred tissue samples to diagnose this fungal infection are rostral muzzle with nose and wing membrane fixed in 10% neutral buffered formalin. To optimize detection, the muzzle is trimmed longitudinally, the wing membrane is rolled, and multiple cross-sections are embedded to increase the surface area examined. Periodic acid-Schiff stain is essential to discriminate the nonpigmented fungal hyphae and conidia. Fungal hyphae form cup-like epidermal erosions and ulcers in the wing membrane and pinna with involvement of underlying connective tissue. In addition, fungal hyphae are present in hair follicles and in sebaceous and apocrine glands of the muzzle with invasion of tissue surrounding adnexa. Fungal hyphae in tissues are branching and septate, but the diameter and shape of the hyphae may vary from parallel walls measuring 2 microm in diameter to irregular walls measuring 3-5 microm in diameter. When present on short aerial hyphae, curved conidia are approximately 2.5 microm wide and 7.5 microm in curved length. Conidia have a more deeply basophilic center, and one or both ends are usually blunt. Although WNS is a disease of hibernating bats, severe wing damage due to fungal hyphae may be seen in bats that have recently emerged from hibernation. These recently emerged bats also have a robust suppurative inflammatory response.

The prevalence of dermatophyte infection in patients infected with human immunodeficiency virus

It is not known whether human immunodeficiency virus (HIV) infection is associated with an increased susceptibility to dermatophytes. In this study, we determined the prevalence of cutaneous fungal infection in a cohort of HIV-infected patients and HIV-negative controls, and examined the factors associated with an increased risk of infection. Using a multiple regression analysis, we found that the strongest independent predictor of cutaneous fungal infection in both groups was a self-reported history of homosexual sex. There was no relationship between HIV infection or reduced CD4 count and the prevalence of dermatophyte infection. HIV infection is not independently associated with an increased risk of cutaneous fungal disease.

Lacaziose (doença de Jorge Lobo): revisão e atualização

Lacaziose ou doença de Jorge Lobo é micose crônica, granulomatosa, causada por implantação traumática do fungo Lacazia loboi - patógeno não cultivável até o presente - nos tecidos cutâneo e subcutâneo, manifestando-se clinicamente por lesões nodulares queloidianas predominantes, envolvendo sobretudo pavilhões auriculares, face, membros superiores e inferiores, e não comprometendo as mucosas. A maioria dos casos humanos está registrada em países da América do Sul. Entretanto, a enfermidade apresenta aspectos epidemiológicos destacados, como o aparecimento em tribo Caiabi, no Brasil Central e em mamíferos não humanos, golfinhos de duas espécies (Tursiops truncatus e Sotalia guianensis) capturados na costa da Flórida (EUA), na foz do rio Suriname, na costa de Santa Catarina (Brasil), no golfo de Gasconha (baía de Biscaia-Europa), com manifestações cutâneas e achados histopatológicos muito similares às encontradas no homem. O artigo objetiva abordar características do fungo e sua taxonomia, e aspectos históricos, ecoepidemiológicos, clínicos, imuno-histoquímicos, histopatológicos, ultra-estruturais e terapêuticos.

Neonatal cutaneous fungal infections

Cutaneous fungal infections are not uncommon in newborns and are seen in premature or otherwise immunocompromised neonates as well as in healthy full-term neonates. Healthy newborns can develop clinical manifestations as a result of infection with Candida species or as a result of skin colonization with Malassezia species; cutaneous infection with other fungal pathogens is rare. Immunocompromised and premature neonates, however, are susceptible to infection with opportunistic pathogens and are also at higher risk for invasive infection with common pathogens such as Candida. This review discusses the fungal species associated with cutaneous fungal infection in neonates, emphasizes the relevant clinical features, and also reviews the use of newer antifungal agents, including lipid-associated amphotericin B, voriconazole, and caspofungin. Neonatal cutaneous infections with opportunistic fungal pathogens, including Aspergillus and the Zygomycetes, have been reported with increasing frequency as advances in neonatal care have improved the survival rate in very low birthweight neonates. Although these infections are frequently fatal, survival in some neonates has been reported with the use of aggressive surgical debridement and systemic antifungal therapy. Newer antifungal agents, including voriconazole and caspofungin, show promise in the treatment of potentially fatal fungal infections in neonates. Cutaneous fungal infections in neonates range from generally benign conditions such as congenital candidiasis and neonatal cephalic pustulosis to potentially fatal infections with opportunistic pathogens in very low birthweight or immunocompromised neonates. The prompt recognition and appropriate treatment of cutaneous fungal disease in neonates is critical to the prevention of adverse outcomes.

Nondermatologists are more likely than dermatologists to prescribe antifungal/corticosteroid products: An analysis of office visits for cutaneous fungal infections, 1990–1994

Background: Dermatologists have greater accuracy than nondermatologists for diagnosis of skin disease. However, it is not clear whether this affects medical outcome. Objective: We tested the hypothesis that nondermatologists would be more likely than dermatologists to prescribe combination products for the treatment of common fungal skin infections. Methods: We analyzed office-based physician visits for fungal skin infections recorded in the 1990–1994 National Ambulatory Medical Care Survey. Results: There were 4.1 million visits for cutaneous fungal disease of which 82% were to nondermatologists. Nondermatologists were more likely to prescribe combination agents (34.1%) than dermatologists (4.8%, p = 0.001). If the percentage of combination agents used by nondermatologists was reduced to that of dermatologists, an estimated $24.9 million or $10.3 million would be saved if clotrimazole or ketoconazole, respectively, were the substituted drug for the combination agent clotrimazole/betamethasone dipropionate. Conclusion: Nondermatologists are more likely to use a more expensive, less effective regimen than are dermatologists, suggesting that dermatologists are more cost-effective than nondermatologists in the treatment of common fungal skin disorders. (J Am Acad Dermatol 1998;39:43-7.)

Variant of Hyper-IgE Syndrome: The Differentiation from Atopic Dermatitis Is Important because of Treatment and Prognosis

The hyper-IgE syndrome is characterized clinically by recurrent staphylococcal abscesses of the skin, lungs and other sites from infancy. Affected patients also have a pruritic dermatitis that differs in character and distribution from lesions of atopic dermatitis. Most lack other signs of atopic disease, develop persistent pneumatoceles and have osteopenia. Laboratory abnormalities include the consistent presence of marked hyperimmunoglobulinemia E and eosinophilia of blood, sputum and tissues. They may have other inconsistent abnormalities of humoral and cellular immune responses and sometimes of phagocytic cell chemotactic responsiveness. Other clinical problems reported in such patients have included lymphomas, cryptococcal meningitis and cutaneous fungal disease. An 18-year-old male patient with a variant of the hyper-IgE syndrome, which he had acquired after a measles attack at the age of 5 years, suffered from recurrent ulcerative dermatitis and lymph node abscesses. Immunological investigation revealed an excessively elevated total serum IgE level (46,850 IU/ml), the presence of specific IgE to staphylococci, and quantitative and functional deficiency of IgG2. Skin and serological (radioallergosorbent) tests to inhalant and nutritive allergens were negative. Differentiation from atopic dermatitis should be made, because a long-term antistaphylococcal regime not only improves skin lesions but hinders the occurrence of lung abscesses and pneumatoceles.

The effect of corticosteroids on serum fungistatic activity.

The direct impairment of a serum fungistatic factor has been postulated as a mechanism to account for the greater severity of cutaneous fungal disease in patients treated with corticosteroids.Trichophyton mentagrophytes andTrichophyton rubrum were grown on Mycosel® agar containing increasing concentrations of normal human sera and sera from patients with Cushing's syndrome and from those receiving high doses of prednisone. Fungistatic activity, observed as a retardation of the normal growth pattern, was not significantly different in any of the sera tested.