Non-dermatophyte Fungi Research Articles

ANTIFUNGAL EFFECT OF GOLD NANOPARTICLES ON FUNGI ISOLATED FROM ONYCHOMYCOSIS PATIENTS

Onychomycosis is a widely distributed fungal nail infection which can be caused by dermatophytes, yeasts or non-dermatophytic fungi. In our study a total of 7 species related to 4 genera were isolated from 50 patients suspected with the fungal nail infection (onychomycosis) these namely Aspergillus flavus (8 isolates), Aspergillus niger (13 isolates), Candida albicans (8 isolates), C. tropicalis (5 isolates), Epidermophyton floccosum (1 isolate), Trichophyton mentagrophytes (2 isolates) and Trichophyton rubrum (1 isolate). Nowadays the field of nanotechnology becomes one of the most topics of interest. The impact of gold nanoparticles on the isolated fungal species was evaluated by agar well diffusion method and micro-dilution method. Best antifungal activity of gold nanoparticles was observed by using 100 µl of AuNps containing 20 µg of gold nanoparticles with the greatest zone of inhibition (19 mm) against C. albicans. AuNps showed variable MIC (minimum inhibitory concentration). MIC50 and MIC90 values of AuNPs ranged from 3.125 to 25.0 μg/ml and from 12.5 to100 μg/ml respectively. All isolated fungi could grow on keratin agar medium but with variable degrees indicating their ability to hydrolyze keratin. Keratinase activity in presence and absence of AuNPs was determined for dermatophytes and Aspergillus species. AuNPs had an inhibitory effect causing reduction in keratinase enzyme activity reaching 52.17 %, 40 % and 37.5 % was attained in case of E. floccosum, A. flavus and A. niger (the most susceptible isolates) respectively, by application of 20 µg/ml of AuNPs.

Children’s public health: Danger of exposure to pathogenic fungi in recreational places in the middle-west region of Brazil

BackgroundDermatophytes are keratinophilic fungi, considered etiological agents of cutaneous mycoses in man and animals. The objective of this work was to isolate dermatophytic and non-dermatophytic fungi in recreational sandboxes (rainy and dry periods) in public day-care centers located in the city of Cuiabá-MT (Middle-west of Brazil). MethodsSamples (n=200) were collected from the superficial layer of the sandboxes at a depth of 2–5cm in 10 public nurseries in Cuiabá-MT. Hair baits measuring 1–2cm were autoclaved and dispersed in 50g of the sample in sterile plates, incubated at 28°C, moistened with chloramphenicol solution (50mg/L). After 6 weeks the baits were inoculated on Sabouraud agar plus 50mg/L chloramphenicol and 500mg/L cycloheximide. The fungi were identified according to macroscopic and micromorphological characteristics. ResultsFrom the collected sand samples, 1318 colonies and 56 species of fungi belonging to 22 genera were isolated. The most important genera were Paecilomyces spp. (30.42%), Penicillium spp. (19.12%), Fusarium spp. (11.46%) and Aspergillus spp. (11.15%). Dermatophytes were recovered in 50% of day-care centers in a total of 29 identified colonies, the Trichophyton genus (86.2%) being the most frequently isolated. ConclusionsThe dermatophytes in the recreational areas of day-care centers can pose a risk to the health of its users, especially for children and the employees. Work with this profile is very important to guide actions related to health surveillance.

Recent Findings in Onychomycosis and Their Application for Appropriate Treatment.

Onychomycosis is mainly caused by two dermatophyte species, Trichophyton rubrum and Trichophyton interdigitale. A study of nail invasion mechanisms revealed that the secreted subtilisin Sub6, which has never been detected under in vitro growth conditions, was the main protease secreted by T. rubrum and T. interdigitale during infection. In contrast, most of the proteases secreted during the digestion of keratin in vitro were not detected in infected nails. The hypothesis that proteases isolated from dermatophytes grown in a keratin medium are virulence factors is no longer supported. Non-dermatophyte fungi can also be infectious agents in nails. It is necessary to identify the infectious fungus in onychomycosis to prescribe adequate treatment, as moulds such as Fusarium spp. and Aspergillus spp. are insensitive to standard treatments with terbinafine or itraconazole, which are usually applied for dermatophytes. In these refractory cases, topical amphotericin B treatment has shown to be effective. Terbinafine treatment failure against dermatophytes is also possible, and is usually due to resistance caused by a missense mutation in the squalene epoxidase enzyme targeted by the drug. Trichophyton resistance to terbinafine treatment is an emerging problem, and a switch to azole-based treatment may be necessary to cure such cases of onychomycosis.

Occurrence of dermatophytoses in patients from the Sistema Único de Saúde

AbstractBackground: Dermatophytosis is a cutaneous disease caused by filamentous keratinophilic fungi belonging to the genera Trichophyton, Microsporum and Epidermophyton, which present a high prevalence in the general population, being among the most common mycoses affecting about 20% of the world’s population.Objective: To carry out the epidemiological survey of cases of dermatophytosis in patients from the Sistema Único de Saúde in a regional Laboratory in the period of 5 years (2009 to 2013).Methods: A retrospective study (January 2009 to December 2013) was carried out with a qualitative and quantitative design, through the registry book of the laboratory, Mycology Sector, where cases of patients with suspected dermatomycosis were analyzed.Results: In a 5-year period, a total of 4467 cases were suspected of having a fungal infection. Of these, 68.74% (3071) cases were of dermatomycosis. In relation to cultures with fungal growth, 12.54% (385 cases) were dermatophyte fungi and 7.97% (245 cases) non-dermatophyte fungi were isolated. Among the species identified, there was a higher prevalence of T. rubrum complex (75%), T. mentagrophytes complex (11.68%) and M. canis (7.01%). Regarding the sites analyzed, nail involvement was the most frequent in 75% of the cases.Study limitations: This work is representative in the studied region.Conclusions: Dermatomycosis samples are the most frequent among all samples of fungal infections from these patients, with the nail being the most affected area and the fungi T. rubrum complex and T. mentagrophytes complex the most frequent.

Dermatophytosis: Prevalence of Dermatophytes and Non-Dermatophyte Fungi from Patients Attending Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia.

Background Dermatophytosis is a disease of major public health problem around the globe causing a considerable morbidity. Objective To study the prevalence of dermatophytosis and the spectrum of fungi implicated in causing the infection. Methods Nail, skin, and scalp scrapings were collected from 318 patients and were used for microscopy and culture study. Fungal pathogens were identified by studying the macroscopic and microscopic characteristics of their colonies. Result Tinea capitis was the predominant clinical manifestation consisting of 48.1% of the cases. Among 153 patients with tinea capitis, 73.2% were in the age group of 1-14 years. Of 318 study participants, 213 (67.98%) were found to be positive for dermatophytosis microbiologically. Out of 164 fungal isolates, 86 were dermatophytes and 78 were non-dermatophyte fungi. Among 86 dermatophytes, T. violaceum represented 38.4% of dermatophyte isolates and 89.7% of the isolates were recovered from tinea capitis. Of 76 non-dermatophyte molds, Aspergillus spp., Scytalidium dimidiatum, and Cladosporium spp. were the most common isolates, respectively. Conclusions Failure to detect or isolate fungal pathogens in a large number of clinical samples revealed the limitation of clinical diagnosis in differentiating dermatophytosis from other skin infections demonstrating that clinical diagnosis should be coupled with laboratory methods. Recovery of large number of non-dermatophyte fungi along with dermatophytes in our study showed that non-dermatophyte fungi are emerging as important causes of dermatophytosis, warranting the implementation of intensive epidemiological studies of dermatophytosis across the country.

Majocchi's granuloma: current perspectives.

Majocchi’s granuloma (MG) is a rare fungal infection of the dermis that is mainly caused by dermatophytes (in ≥95% of cases); the most frequently identified cause is anthropophilic Trichophyton rubrum. In the rest of the cases, the causes are non-dermatophytic fungi such as Aspergillus species. This review aimed to provide information about the current perspectives on MG regarding its clinical characteristics, predisposing factors, laboratory diagnosis, and treatment strategies. Although the lower extremities were reported to be the most common site of infection, facial involvement has been predominant in the past 5 years. Our literature research showed that the most common predisposing factor (55%) is the use of topical steroid creams without potassium hydroxide examination during treatment of erythematous squamous dermatoses. A reliable diagnosis of MG is based on histopathological examination, including fungal culture and molecular analyses. MG should be treated not only with topical agents but also with systemic antifungal agents that are continued until the lesions are completely resolved. In systemic treatment, the most preferred drug is terbinafine, because of its efficacy, side effects, and safety.

The Hygienic Importance of Fungi Colonizing the Sheep Wool in Erbil/Iraq

Aims: The study was conducted to identify a non-dermatophytic fungi associated with wool hairs in Erbil city. The common and dominate fungal genera were recorded, as well as the hygienic importance of all isolates were reviewed. Materials and Methods: Wool samples were collected during February 2017. Pieces of wool hair were cultured on Sabouraud's dextrose agar. Cultured plates were incubated in room temperature. The growing fungi were counted and were identified microscopically. The occurrence % (O%), and the frequency of occurrence % (FQ%) for the identified genera were calculated. Results: A 22 fungal isolates belong to 16 genera beside one isolate of Actinomycetes were recognized. The Hyphomycetes represented in (10 genera 62.5%), they were (Alternaria, Aspergillus (5 sp), Scytelidium, Chrysosporium, Curvelaria, Cladosporium, Penecilium, Scpulariopsis, Fusarium and Ulocladium. Two genera belong to each of Ascomycetes and Zygomycetes (12.5%) include (Chaetomium, Pseudallescheria) and (Mucor, Rhizopus) respectively Basidiomycetes and Coelomycetes represent one genus (6.25%), they were Rhodotorula and phoma. Aspergillus showed the highest O% and FO% (88%; 32.9%) followed by Cladosporium (36%; 13.8%). Conclusion: The results showed that: 1-Hyphomycetes is predominant and Aspergillus is the common genus. 2- All the recorded fungi had an effects on human health. According to the previous studies their infections ranging from mild skin mycoses to serious deep infections. 3-A 81.25% of the recorded fungal genera in this study were previously isolated from upper respiratory tract of individuals have asthma and allergic symptoms in Iraq. 4-It is the first recorded of Rhodotorula mucilaginosa from wool samples in Iraq.

The Dispersal of Rodent-Borne Strains ofAphanoascus KeratinophilusandChrysosporium Tropicumby Pellets of Predatory Birds

The species composition of keratinophilic fungi in 153 pellets of nine species of predatory birds was analysed. Based on morphological criteria, a total of 439 strains of non-dermatophytic fungi of the Chrysosporium group were isolated and identified. Dermatophytes were not detected. The collection was verified using molecular methods, such as PCR-RFLP (restriction fragments length polymorphism) and two potentially pathogenic species, Aphanoascus keratinophilus and Chrysosporium tropicum, were detected. Pellet colonisation by these fungi ranged between 37.5% and 91.7% depending on the bird species. As the analysis of undigested remains found in the pellets showed, rodents, mostly Microtus, which constituted from 57% to 100% of the birds’ diet, were a chief source of A. keratinophilus and Ch. tropicum strains. It was demonstrated that the survival and dispersal of A. keratinophilus strains was supported by higher pellet moisture while those of Ch. tropicum strains by drying, which was conditioned by the site where pellets were dropped and deposited by individual species of predatory birds. Based on the results, circulation routes of both opportunistic pathogens using pellets of predatory birds as carriers are proposed.

An Assessment of In Vitro Antifungal Activities of Efinaconazole and Itraconazole against Common Non-Dermatophyte Fungi Causing Onychomycosis.

Onychomycosis is a fungal nail infection which is relatively common and difficult to treat. Treatment modalities include nail avulsion, surgical debridement and combination therapy with oral and topical antifungal drugs. In spite of a host of available drugs, clinical cure rates remain discouraging. Drug toxicities, prolonged regimens, lack of patient compliance, and high keratin affinity of drugs are all contributive factors. Efinaconazole is a novel topical triazole antifungal agent that has shown excellent in vitro activity against both dermatophyte and non-dermatophyte fungi causing onychomycosis. This study presents the in vitro susceptibility profiles of 44 common non-dermatophyte fungi against efinaconazole and itraconazole, another azole drug used in the treatment of onychomycosis.

Incidence and biodiversity of yeasts, dermatophytes and non-dermatophytes in superficial skin infections in Assiut, Egypt

The aim was to identify the incidence of the causal agents from dermatophytes, non-dermatophytes and yeasts in Assiut Governorate employing, beside the morphological and physiological techniques, the genotypic ones. Samples from infected nails, skin and hair were taken from 125 patients. Patients who presented with onychomycosis, tinea capitis, tinea corporis, tinea cruris and tinea pedis during the period from February 2012 to October 2015 were clinically examined and diagnosed by dermatologists and were guided to Assiut University Mycological Centre for direct microscopic examination, culturing and identification. Onychomycosis was the most common infecting (64.8% of the cases) followed by tinea capitis (17.6%). Direct microscopic preparations showed only 45 positive cases, while 96 cases showed positive cultures. Infections were more frequent in females than males. Fifty-one fungal species and 1 variety were obtained. Yeasts were the main agents being cultured from 46.02% of total cases. Non-dermatophytes were the second etiologic agents. Aspergillus was responsible for infecting 19.47% of total cases and dermatophytes appeared in only 15.93% of the cases. Yeasts were the main causal agents followed by non-dermatophytic fungi (mainly species of Aspergillus, then Alternaria, Scopulariopsis and Fusarium). Both direct microscopic preparations and culturing are recommended for mycological evaluation of clinical specimens. Sequence analysis of ITS region is recommended for yeast identification.

Prevalence and epidemiology of tinea pedis and toenail onychomycosis and antifungal susceptibility of the causative agents in patients with type2 diabetes in Turkey.

Diabetes patients are particularly susceptible to fungal infections because their vascular and immunological systems are compromised. The present study aimed to determine prevalences of tinea pedis and onychomycosis, factors predisposing to their development, and antifungal susceptibilities of causative fungal species against fluconazole, itraconazole, and terbinafine in patients with type2 diabetes mellitus (DM). Study groups were defined according to hemoglobin A1C rates of ≥6.5% for the diabetes group and ≤5.7% for control subjects. A total of 600 diabetes subjects and 152 control subjects were evaluated. Rates of onychomycosis and tinea pedis in diabetes patients, and associations with age, gender, blood glucose level, duration of diabetes and serum lipid profile were investigated, as were the distribution and antifungal susceptibility of agents isolated. Patients with onychomycosis and/or tinea pedis numbered 85 in the diabetes group and nine in the control group (P=0.006). The development of onychomycosis or tinea pedis was significantly related to increasing age and male gender. Although the most common agents were dermatophytes, non-dermatophyte fungal isolates were not uncommon. Terbinafine was the most effective drug against dermatophytes but was invalid for non-dermatophyte isolates by invitro antifungal susceptibility testing. The development of onychomycosis or tinea pedis was significantly related to type2 DM, increasing age, and male gender. The most common isolate was Trichophyton rubrum. The isolation and identification of the fungus is important to the effective management of tinea pedis and onychomycosis in diabetes patients because non-dermatophyte fungi can cause these infections.

Isolation of dermatophytes from 50 asymptomatic domestic cats treated at the Federal University of Mato Grosso Veterinary – Hospital in Cuiabá, MT

Dermatophytosis, commonly known as ringworm, is a zoonotic disease caused by complex fungi that grow as hyphae and attach to the skin, hair and nails or claws. About 40 species of fungi of the genera Microsporum spp., Trichophyton spp. and Epidermophyton spp. are considered dermatophytes, and Microsporum canis is the genus most commonly isolated from cats. This study investigated the occurrence of dermatophytes in cats without clinical signs of skin diseases. The study involved the physical examination of 50 clinically healthy cats and the collection of samples for direct examination and fungal culture at a university veterinary hospital. The resulting data were evaluated by the chi-square association test. Of the 50 cats, 11 (22%) presented dermatophytes, with a predominance of Microsporum spp. The other 39 animals were diagnosed for non-dermatophytic fungi. Sex, breed and the presence of contactants showed no statistical difference, although there was a predominance of adult animals. The high dermatophyte infection rate confirms that cats without clinical signs can harbor these fungi, acting as asymptomatic carriers, contaminating the environment and increasing the infection rate. This study confirms that cats without clinical signs can be carriers of ringworm, which underscores the importance of the adoption of control methods even for clinically healthy animals.

Therapies Available for the Treatment of Fungal Nail Infection

Onychomycosis, a fungal infection caused by dermatophyte fungi such as T. rubrum and non-dermatophyte fungi which affect about 2-8% of people worldwide. Treatment of onychomycosis is hampered owing to poor systemic circulation into the nail apparatus and highly compact structure of nail plate that limits the topical delivery of drugs. Basically, two types of therapies are discussed in this review article, which are traditional and device based therapies. Traditional therapy includes surgical, topical and systemic treatments of onychomycosis. Device-based therapy is a non-invasive treatment which includes Iontophoresis, Ultrasound, Photodynamic, and Laser treatments.

Profile of Dermatophyte and Non Dermatophyte Fungi in Patients Suspected of Dermatophytosis

Fungal infections of hair, nail and skin are common worldwide and continue to increase. The present study was undertaken to determine the prevalence of dermatophytosis, isolation rates and the profile of fungi associated with dermatophytosis. Samples were collected from 305 patients and a portion of each sample was examined microscopically and the remaining portion was cultured on to plates of Sabouraud’s Dextrose Agar containing chloramphinical with and without cychloheximide. Fungal cultures were identified by studying macroscopic and microscopic characteristics of their colonies. Of 305 clinical samples, fungi were detected in 265 (86.9%) samples by KOH and 224 (73.4%) clinical samples were culture positive. Dermatophytes were the most common isolates accounting 130 (58.0%) of the total isolates and this was followed by non- dermatophyte molds and yeasts that accounted 49 (21.9 %.) and 45 (20.0%) respectively. T. violaceum was the dominant species accounting for 49 (37.7%) dermatophyte isolates. Candida albicans was the dominant species accounting 30 (66.7%) of the total yeast isolates. The genus Aspergillus was the most common non-dermatophyte molds consisting of 13 (26.5%) species. Tinea unguium was the predominant clinical manifestation accounting 51.1% of the cases of which 119 (76.3%) were from females and 37 (23.7%) from males. T. violaceum was the most common pathogen in tinea unguium and tinea capitis, whereas T. mentagrophytes was the most common pathogen in tinea pedis and tinea manum. Seventy five percent of yeasts and 77.6% non dermatophyte molds were isolated from nails. Along with dermatophytes, non-dermatophyte fungi are also emerging as important causes of dermatophytosis. Both direct microscopy and culture are important tools for diagnosis of the fungal infections.

Advances in Microbiology, Infectious Diseases and Public Health: Fungal Occurrence in the Hair and Skin of Symptomatic Pets in Turin, Italy.

Companion animals, often asymptomatic reservoir of fungi, can be important sources of infection in humans, due to the close contact with their owners. The present study was aimed to assess the occurrence of dermatophytes and other fungi isolated from pet dermatological lesions in Turin, Italy. Dermatological specimens were examined for fungal elements by direct microscopy and cultured to detect dermatophytes, other filamentous fungi and yeasts: 247 pets (118 cats, 111 dogs and 18 dwarf rabbits) were positive for fungal detection in culture. Microsporum canis was the most frequent dermatophyte in cats and dogs, whereas Trichophyton mentagrophytes was the most common in rabbits. Among the other fungi, for all examined pets, dematiaceous fungi were the most isolated, followed by Mucorales, penicilli, yeasts and yeast-like fungi, and aspergilli. No gender predisposition was detected for dermatophyte growth; on the contrary, for the other fungi male cats were more susceptible than female. The highest fungal occurrence was recorded in <1-year-old cats for dermatophytes, and in <5-year-old cats and dogs for the other fungi. Autumn was the period associated with a relevant incidence of fungal infection. Finally, fungi were more frequent in non pure-breed cats and in pure-breed dogs. These data underline the importance to timely inform pet owners about the potential health risk of infection caused not only by dermatophytes but also by non-dermatophyte fungi, routinely considered to be contaminants or harmless colonizers, since their role as source of zoonotic infections is not to be excluded.

Etiologic significance of &lt;i&gt;Aspergillus terreus&lt;/i&gt; in primary cutaneous mycosis of an agricultural worker

This pilot study was aimed to elucidate the growing role of non-dermatophytic filamentous moulds in the cutaneous lesions of laborers who worked in agriculture field in the villages of Bharauch, Gujarat ,India. Eighteen patients (13 males and 5 females, aged 21 to 46 years) with various skin problems presented to the outpatient department (OPD) of Welfare Hospital and Research Center, and Shashwat Skin Clinic, Bharauch, India were examined for the non-dermatophytic filamentous fungi by using standard mycological techniques. All the specimens were treated in 10 % potassium hydroxide solution of direct microscopy; and cultural isolation was done onto Sabouraud medium with chloramphenicol. The detailed identification of fungal isolates was carried out in “ Narayan” stain. The treatment of patient was attempted with oral administration of itraconazole. Aspergillus terreus was identified in the cutaneous lesion of 1 of the 18 patients both by direct microscopy as well as by cultural isolation. The cinnamon-brown coloured colonies of A. terreus grew in pure culture from the biopsied tissue on Sabouraud dextrose agar with chloramphenicol. In “Narayan” stain, conidial heads of A. terreus were found compact, biseriate, and densely columnar. The patient had received trauma on the skin of right lower leg by wooden splinter while working in the field. The oral administration of itraconazole for 12 weeks showed good clinical response. The demonstration of A. terreus in the skin lesion by direct microscopy and cultural isolation, and good response to antifungal drugs clearly indicated that our patient was suffering with cutaneous mycosis. The patient with chronic cutaneous lesion, history of the skin trauma, and occupational exposure to the soil should be investigated for cutaneous mycosis. The immediate attention to traumatic injury to the skin is highly imperative to prevent the further complications. This seems to be first report of primary cutaneous mycosis due to A. terreus in an immunocompetent patient from this part of India.

Opportunistic toenail onychomycosis. The fungal colonization of an available nail unit space by non‐dermatophytes is produced by the trauma of the closed shoe by an asymmetric gait or other trauma. A plausible theory

Opportunistic onychomycosis is defined, when a non-dermatophyte mould is cultured from an abnormal nail unit in the absence of a dermatophyte. The presumption is that the mould has caused the abnormal clinical appearance of the nail unit, yet there are no data available to substantiate this claim. Reports have only identified the mould being recovered from the nail unit niche. A review of the published dermatologic literature describing toenail opportunistic onychomycosis by non-dermatophyte fungi has shown toenails with onycholysis, nail bed (NB) keratosis and nail plate surface abnormalities. The appearance of these clinical changes is indistinguishable from the diagnosis of the Asymmetric Gait Nail Unit Signs (AGNUS). AGNUS is produced by the friction of the closed shoe in patients with an asymmetric gait, resulting primarily from the ubiquitous uneven flat feet. Most commonly, species of Acremonium (Cephalosporium), Aspergillus, Fusarium, Scopulariopsis and rarely species of many different fungi genera are capable of surviving and reproducing in a keratinous environment and change the clinical appearance of the involved nail unit. AGNUS toenails predispose to the colonization by the non-dermatophyte opportunistic fungi but not by dermatophyte fungi.

Proportion of Superficial fungal infections among the cleaning staff members at University of Sri Jayewardenepura

Introduction Superficial fungal infections (SFIs) are infections of the keratinous tissue caused by dermatophytes, yeasts and non-dermatophyte fungi. Cleaning staff are identified as a risk category for the SFI as they are frequently exposed to moist environment. Objective To determine the proportion of infection, knowledge, attitudes, practices and risk factors of superficial fungal infections among the cleaning staff members at University of Sri Jayewardenepura Methods Eighty two cleaning staff members were included in the study. Clinical examination for SFIs was done by a medical officer and sample processing was carried out at the Department of Microbiology at University of Sri Jayewardenepura between May to October 2012. Laboratory identification of the fungal organisms was done using direct microscopy (10% KOH) followed by culture on Sabouraud's Dextrose Agar. Morphological and physiological methods were used to specieate the isolated fungi. An interviewer administrated questionnaire was carried out to assess the knowledge, attitudes and practices (KAPs) on SFIs. Data were categorized and scored based on variables that were to be analyzed. Results Forty one of 82 participants (51.2%) had SFIs. Out of the 56 clinically suspected cases 76 specimens were collected from different infected sites. Four skin scrapings were identified as Pityriasis versicolor by direct smear . Out of 57 scrapings and nail clippings, 45 (79%) were KOH positive, twelve (21%) were negative for direct smear. Out of direct smear positive specimens only 28 were culture positive while 17 were culture negative. Aspergillus niger was the commonest organism isolated from these specimens (20) followed by the non albicans Candida spp. (7), Candida albicans (2), dematiaceous fungi (7), Pityriasis versicolor (4), Fusarium spp. (3) and dermatophyte species. Multiple fungal species were isolated in 4 specimens. Regarding total marks presentation of KAPs, our study population had an unsatisfactory level of knowledge 35(42.2%) while majority 40 (48.8%) had good attitudes, and 48 (58.5%) were shown to have a satisfactory level of safety practices. Describing the risk factors for SFIs among cleaning staff was one objective of our study. However our study showed that there was no statistically significant relationship between the risk factors with SFIs. Conclusion Aspergillus niger was the commonest pathogen causing SFIs in the study group. Although participants have a satisfactory level of knowledge, attitudes and practices towards the SFIs regular examination of this population is recommended because they are at high risk for SFIs. DOI: http://dx.doi.org/10.4038/sljid.v4i1.6061

A Clinico-Mycological Study of Superficial Mycoses from a Tertiary Care Hospital of a North Indian Town

Introduction: Superficial mycoses refer to the diseases of skin and its appendages caused by fungi. Aims & Objectives: The present study was undertaken to find out the prevalence of different clinical types of Dermatomycoses including Dermatophytes, candida spp. and dermatomycotic mold infections of skin and its appendages and their etiological agents in and around Aligarh region of Northern India. Material and Methods: The study was conducted at the Department of Microbiology, JNMC,AMU, Aligarh, during the period of July 2011-July 2013. A total of 425 samples were collected including skin, nail and hair for a period of 5 years. Skin, nail scraping and clippings of infected hair from patients were collected. The samples were subjected to direct microscopy and culture. Results: Out of 425 samples, Dermatophytoses was manifested clinically more in the males between the age of 11-30 years. In our study, KOH positivity rate was 61.2% and culture positivity rate was 58.8%. 18.8% of samples were culture positive alone; while, 21.2% of specimens were positive on direct microscopy alone. Dermatophytoses was the commonest superficial fungal infection in 123 cases 28 (9.5%), followed by Dermatomycotic molds in 32 (7.2%) and candidiasis in 15 (3.5%). T.rubrum was the predominant pathogen followed by T. mentagrophytes. Conclusions: It is concluded that along with Dermatophytes, non-dermatophytic fungi are also emerging as an important cause of superficial mycoses.

Tinea incognito simulating herpes simplex virus infection.

Dear Editor: A 30-year-old-man presented with a 2-month history of a facial lesion. He was examined by general practitioners, and the eruption was diagnosed as eczema. Topical corticosteroid was applied for 1 month, and the eruption initially seemed to improve with this treatment; but later on, it persisted, and gradually extended in size. Dermatological examination revealed the presence of grouped erythematous papules, vesicles and crusts on erythematous bases, on the right lower eyelid (Fig. 1A). He had no medical history, and no family member who had had similar skin eruptions or symptoms. The initial clinical differential diagnosis included herpes simplex, herpes zoster, and allergic contact dermatitis, caused by an antibiotic eye drop. We prescribed oral and topical acyclovir, and performed a skin biopsy, to reveal the exact diagnosis. Skin lesions did not respond to 5 days of acyclovir therapy, and histologic examination showed infiltration of various inflammatory cells from the upper to lower dermis, parakeratosis, irregular acanthosis, intraepidermal exocytosis of neutrophils, and extravasation of erythrocytes (Fig. 2A, B). Fungal hyphae and spores in the stratum corneum were identified on the periodic acid Schiff stained section (Fig. 2C). These findings led to the diagnosis of superficial fungal infection that had lost its typical clinical appearance, because of the use of steroids. The cause of infection might be dermatophytes, but non-dermatophytic fungi could be possible. Afterwards, the history that he had had contact with his cat was verified. He was administered oral terbinafine 250 mg daily, and topical terbinafine cream. After 8 weeks, the number of papules decreased, and the inflammatory reaction improved (Fig. 1B). Treatment was continued a month longer, and the facial eruption finally cleared (Fig. 1C). Fig. 1 (A) On the lateral side of the right lower eyelid, grouped erythematous papules, vesicles and crusts on erythematous bases. (B) At 8 weeks of treatment with antifungal agents, facial eruptions improved, but some papules and vesicles on mild erythema persisted. ... Fig. 2 Infiltration of various inflammatory cells from the upper to lower dermis, parakeratosis, irregular acanthosis, intraepidermal exocytosis of neutrophils, and extravasation of erythrocytes in H&E stain (A: ×40, B: ×400), fungal ... The clinical features of tinea faciei are characterized by various morphology, and because of that, the entity can mimic many other cutaneous disorders1. Moreover, because tinea faciei is relatively uncommon when compared with other forms of superficial fungal infection, it is often misdiagnosed; and treated with glucocorticosteroids, not antifungal agents1. Imprecise use of topical or oral corticosteroids in tinea faciei can modify their clinical features, and make the correct diagnosis more difficult2; therefore, tinea faciei is one of the considerable examples of tinea incognito1. One retrospective study showed 35.7% cases of tinea incognito among tinea faciei, because of improper diagnosis, and inappropriate therapy3. Other authors revealed that 50% to 70% of patients with tinea faciei are initially misdiagnosed as having other dermatoses2. The pathomechanism of tinea incognito is thought to be closely associated with a steroid-modified response of the host to cutaneous fungal infection4. Topical corticosteroids allow fungi to grow readily, and alter the clinical feature of the lesions, because they have immunosuppressive activity5. Regretfully, glucocorticosteroids are extensively used by patients and non-dermatologists, and lead to long-lasting fungal infections1, similar to that which occurred in our case. Atypical presentations of tinea faciei can lead to misdiagnosis. The present case underlines that physicians should keep in mind that clinical features of superficial fungal infection can be substantially modified by incorrect treatment, to mimic even herpes simplex virus infection. Fungal infection should be on the list of differential diagnoses of facial eruptions, especially in cases not responding to preceding management.