Tinea Infections Research Articles

Analysis of chemical composition and in vitro antidermatophyte activity of ethanol extracts of Dryopteris fragrans (L.) Schott

Ethnopharmacological relevanceDryopteris fragrans (L.) Schott is a deciduous perennial herb, which has been used traditionally for treatment of ringworm infections and others skin diseases in the north of China. Aim of the studyTo characterize the chemical composition, evaluate the antifungal activity and explore possible mechanisms about action of ethanol extracts of D. fragrans. Materials and methodsThe chemical components in the ethanol extracts of D. fragrans were detected by high-performance liquid chromatography coupled with electrospray ionization and quadruple time-of-flight mass spectrometry (HPLC-ESI-QTOF-MS/MS). The minimal inhibitory concentrations (MIC) and minimal fungicidal concentrations (MFC) of the ethanol extracts of D. fragrans were determined by the Clinical and Laboratory Standards Institute (CLSI) M38-A2 method against 62 isolates of dermatophytes. The kinetics of fungal kill, synergy testing by checkerboard dilution and quantitation of sterol by ultra-performance liquid chromatography (UPLC) on Trichophyton rubrum and Trichophyton mentagrophytes were also investigated. ResultsFourteen derivatives of phloroglucinol were identified in the ethanol extracts of D. fragrans. The MIC of the ethanol extracts of D. fragrans ranged from 0.059 to 3.780 mg/mL while MFC ranged from 0.118 to 3.780 mg/mL. The ethanol extracts of D. fragrans exerted fungicidal activity after 12 h of incubation against Trichophyton rubrum while it required 36 h of incubation against Trichophyton mentagrophytes at concentrations of 8 × MIC. In synergy testing, the interaction between miconazole (MCZ) and terbinafine (TBF) with the ethanol extracts of D. fragrans proved to be indifferent by testing fractional inhibitory concentration (FIC) values. Sterol in samples of fungal cells treated with the ethanol extracts of D. fragrans was significantly reduced. ConclusionsThe ethanol extracts of D. fragrans had antifungal and fungicidal activity against dermatophytes and was likely a strain-dependent fungicidal agent. Interaction between drugs was indifferent on tested isolates. The inhibition of ergosterol biosynthesis was one of the antifungal mechanisms of the ethanol extracts of D. fragrans. These results showed that the ethanol extracts of D. fragrans could be explored for promising antifungal drugs. Dozens of phloroglucinol derivatives may contribute to high antifungal activity of the ethanol extracts of D. fragrans.

Tinea Corporis Caused by Microsporum Canis in HIV Patient Treated For Neuromeningeal Cryptococcis: Report of A Nosocomial Outbreak

We report a nosocomial outbreak of Microsporum canis during inpatient treatment for HIV newly diagnosed with cryptococcal meningitis. The clinical presentation, though very typical of ringworm infection, samples were collected and examined by direct microscopy and culture on Sabouraud’s dextrose agar, revealing Microsporum canis. It is strongly believed that outdoor cats living in the hospital spaces are the main cause of disease transmission. Measures to limit zoophilic pathogens are necessary in immunosuppressed inpatient care unit

The Anti-inflammatory Property of Mitracarpus villosus (Sw.) DC. Extract is Responsible for its use in the Treatment of Ring Worm Infection

Background: Microbial pathogens continuously mutate in order to survive the activities of new antimicrobials. This is the reason new antimicrobials are easily rendered useless after introduction. Continuous search for new antimicrobial agents is therefore an imperative until a permanent solution is found. Natural products have contributed immensely to the development of new drugs. The extract of Mitracarpus villosus (Sw.) DC., family: Rubiaceae, which is used traditionally for topical treatment of eczema and ring worm infections is a potential source of new antimicrobial compounds. Method: The methanol-methyl chloride extracts of the whole plant and leaves were partitioned into n-hexane, ethyl acetate, n-butanol and aqueous fractions. Both the crude and fractions were tested for antifungal and anti-inflammatory properties. The cytotoxicity property of the leaf extract was also investigated. Results: Results showed that the whole plant extract had no bioactivity. The aqueous fraction also showed no activity while the n-butanol fraction showed considerable anti-inflammatory activity. There was no antifungal activity in both crude and fractions. The leaf extract and fractions also showed no antifungal properties but exhibited strong anti-inflammatory properties. M. villosus is used mainly for the treatment of ring worm which is a fungal infection. Conclusion: Based on the absence of in vitro antifungal properties in the entire specimen tested, we propose that the effectiveness of the herb as an anti-fungal agent is derived from its antiinflammatory property.

Antifungal photodynamic inactivation against dermatophyte Trichophyton rubrum using nanoparticle-based hybrid photosensitizers.

Trichophyton rubrum is one of the most common dermatophytes, which can cause fungal nail and ringworm infections. Infections associated with T. rubrum have become a global phenomenon. Herein, we report the antifungal photodynamic inactivation of T. rubrum (ATCC 28188) using the mesoporous silica-coated silver nanoparticle-based hybrid photosensitizers without involving antifungal drugs. Results show that the hybrid photosensitizers display low cytotoxicity under the experimental conditions where significant killing (∼3 orders of magnitude) against T. rubrum is observed. These results demonstrate the potential applications of the nanoparticle-based hybrid photosensitizers in antifungal photodynamic therapy against T. rubrum.

COMBINATION DRUG TREATMENT IN Tinea INFECTIONS OF CUTANEOUS SOFT TISSUES

Systemic antifungals are the most effective treatment and three major groups of antifungal agents in clinical use are azoles, polyenes and allylamine/thiocarbamates. Unlike the azoles, which are primarily fungistatic, terbinafine has a fungicidal mode of action through its ability to inhibit the enzyme squalene epoxidase, leading to a fungicidal accumulation of squalene within the fungal cell. The oral therapy is usually reserved for more severe infections and will lead to better mycological clearance. Therefore, the present study included the topical (1% terbinafine cream) and oral terbinafine drug (250 mg for 4-6 weeks) treatment with combination of itraconazole (100 mg/day for 4-6 weeks) was advised in Tinea infections. Of these, 40% (n=84) were male, while 60% (n=126) were female with mean age group was 35 years. The erythema (28.57%) and pruritis (21.42%) were the most common diagnosed symptoms. The 57.14% patients investigated with the moderate severity of Tinea infection, whereas 15.71% patients showed severe infections, in which older aged female patients reported more severe infections. In the present study about 70% patients reported 100% cure only with terbinafine, whereas 30% patients had slight improvements and further combination with itraconazole resulted in 100% cure rate. Henceforth further study is underway for molecular identification of different dermatophytes along with antimicrobial susceptibility testing so that better treatment with short interval of time should be recommended to the patients.

PREPARATION, CHARACTERIZATION, AND OPTIMIZATION OF MICROEMULSION FOR TOPICAL DELIVERY OF ITRACONAZOLE

Microemulsions (ME) have been proved to increase the cutaneous absorption of both lipophilic and hydrophilic medicaments when compared to conventional vehicles (emulsions, pure oils, aqueous solutions). Hence the aim of present investigation is to prepare, characterize and optimize microemulsion of Itraconazole (ITZ). Itraconazole is an anti fungal agent, most widely used in the ringworm infection. It is classified as class III drug as per BCS classification. It indicates lower permeability through skin. Therefore objective of the research is to improve permeability of Itraconazole through skin. Microemulsion was prepared using eucalyptus oil, tween 20 and methanol as oil phase, surfactant and co-surfactant respectively. Pseudo ternary phase diagrams were constructed to find out optimum ratio of oil: Smix (surfactant: Co-Surfactant): water. A 32 full factorial design was applied for the optimization of prepared microemulsion. Microemulsion was evaluated for globule size, zeta potential, in-vitro diffusion study etc. Results of globule size measurements and zeta potential indicated ME7 had high stability then other formulation of microemulsion. For the optimization transdermal flux and %Q6 was selected as dependant variables. Results of optimization study also revealed ME 7 as optimized microemulsion for high permeability to the skin. Further ME7 was compared to marketed Itraconazole preparation (ITASPORE) and evaluated using similarity factor F2. Results of F2 value was not near to 100 indicated there is no similarity in diffusion profiles of ME7 and ITASPORE. Hence, indirectly it suggest there was increased in permeability of drug by preparing microemulsion.

Prevalence and correlates of suicidal ideation with dermatological morbidities

Background: The dermatologic consultation might be a precious opportunity to recognize and treat depression associated with suicidal ideation in these patients. This study aimed to find the prevalence of suicidal ideation among patients with dermatologic conditions, and identifying demographic variables of suicidal ideation. Methods: This institution based cross-sectional study was conducted during February to March 2017, at dermatological out-patients department of the teaching hospital Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, India. Results: Of 396 adults with skin disease 272 (68.69%) were male. Prevalence of suicidal tendency was significantly more among young adults and higher in females (38.7%) than males (1.5%). In males, suicidal tendency was in patients suffering from tinea infection while among females, significantly more observed among patients suffering from tinea 38.71%, psoriasis 22.58% and chronic idiopathic urticaria 16.13%. The risk of suicidal tendency in males were significantly higher among 18–20 years, unemployed, belongs to smaller family, having lower body mass index and suffering from depression. While in females, suicidal tendency was significantly higher among early adulthood, not or lower education, unemployed, no personal income and vegetarian, belongs to large family, no family support, having lower body mass index and suffering from depression as well as suffering from some other medical comorbidity in addition to skin diseases. Conclusions: Risk correlates of suicidal ideation with skin diseases were early adulthood, lower education, unemployment with no personal income, vegetarian diet, large family, no family support, lower body mass index and suffering from depression and comorbidities.

Keratin hydrolysis by dermatophytes

Dermatophytes are the most common cause of superficial fungal infections (tinea infections) and are a specialized group of filamentous fungi capable of infecting and degrading keratinised tissues, including skin, hair, and nail. Essential to their pathogenicity and virulence is the production of a broad spectrum of proteolytic enzymes and other key proteins involved in keratin biodegradation and utilization of its breakdown products. The initial stage of biodegradation of native keratin is considered to be sulfitolysis, in which the extensive disulfide bridges present in keratin are hydrolyzed, although some secreted subtilisins can degrade dye-impregnated keratin azure without prior reduction (Sub3 and Sub4). Sulfitolysis facilitates the extracellular biodegradation of keratin by the dermatophytes' extensive array of endo- and exoproteases. The importance of dermatophyte proteases in infection is widely recognized, and these enzymes have also been identified as important virulence determinants and allergens. Finally, the short peptide and amino acid breakdown products are taken up by the dermatophytes, using as yet poorly characterised transporters, and utilized for metabolism. In this review, we describe the process of keratin biodegradation by dermatophytes, with an especial focus on recent developments in cutting edge molecular biology and '-omic' studies that are helping to dissect the complex process of keratin breakdown and utilization.

Tinea Infection, an Encumbrance of the Year

Tinea Infection, an Encumbrance of the Year

Clinicomycological study of dermatophytoses in children: Presenting at a tertiary care center

Background: Superficial tinea infections are some of the most common dermatological conditions in children. Recently, few studies done showed abrupt increase in dermatophytic infection in adults; however, similar recent studies describing clinicoepidemiological pattern in pediatric population are lacking. Aims and Objectives: The aims and objectives of this study are to identify the epidemiological profile of the dermatophytoses among pediatric population. Materials and Methods: Pediatric patients with suspected tinea infections presenting in the Department of Dermatology at a tertiary care medical college hospital in Northern India from April 2016 to 2017 were evaluated for inclusion in this study. Samples were collected in two parts; if first part was found to be potassium hydroxide (KOH) positive for septate hyphae, the second part was sent for fungal culture subsequently. Statistical Analysis Used: SPSS version 20 was used for statistical analysis. Results: Out of 235 patients, 152 were male and 83 were female. Only 200/235 (85.1%) KOH positive enrolled patients yielded positive fungal culture. Most common species identified on culture was Trichophyton mentagrophytes, followed by Trichophyton rubrum, and Trichophyton violaceum. Trunk was the most common site affected in 29.4% patients, palms and soles were least affected. Conclusion: More number of patients applied topical steroid for a longer period of time in patients with extensive disease as compared to limited disease. The present study provides evidence that dermatophytosis in pediatric patients is following the pattern of adult dermatophytosis clinically and microbiologically now.

A hospital-based observational study on the frequency of different skin diseases and patterns of topical steroid misuse

Background: Over-the-counter (OTC), unlabeled steroids are widely available as cosmetics and have been a recent area of interest in research and clinical practice due to the side effects. However, less is known about OTC-labeled steroid misuse for various cutaneous diseases at a primary care or community level. Objective: The present study was aimed to assess the frequency of different skin diseases and patterns of topical steroid (TS) misuse in them. Materials and Methods: All new patients attending dermatology outpatient department (OPD) on 6 random OPD days in November 2016 for skin diseases were inquired about the use of any unsupervised steroid-containing medication on their skin lesions. The diagnosis and the prescription of the chief consultant/faculty for the disease were also screened in the context of steroid prescription. Data were presented in absolute number and percentage scale, and risk of misuse was analyzed using INSTAT software. Results: A total of 463 patients with a mean age of 27.01 ± 14.57 years (range 3 months to 92 years) were included. The majority (66.09%) were male. The most common disease was infectious in nature (933.19%) of which tinea infection was the most common (22.69%). A total of 119 (25.70%) patients had used unsupervised and OTC TSs; 4.20% presented with steroid dermatitis. Misuse was highest in photodermatitis and melasma (60 and 50%, respectively). TS misuse was more common in 15–40 years' age group and in diseases affecting face (relative risk 1.64 and 1.70, respectively; P < 0.01). Gender was not a risk factor. Conclusion: TS misuse is rampant (25.70%), and steroid dermatitis is a frequent complication. Patients aged 15–40 years and those with diseases affecting face are at risk of misusing it.

Comparison of prescribing patterns between United States and Dominican Republic prescribers on short-term medical mission trips

Short-term medical missions (STMMs) have increased and are viewed as a way to extend care in low- and middle-income countries (LMICs). Although benefits may exist, visiting teams may lack insight into using medications safely and effectively. The primary objective was to assess prescribing differences between US-based and Dominican Republic (DR) healthcare providers on STMMs in the DR. A retrospective database review between January 2013 and 2015 was conducted. Data from US and DR groups were compared for differences in diagnoses, medication classes prescribed and prescriptions per patient. The mean number of medical conditions diagnosed per patient in the DR (n=423) and US groups (n=1585) were 1.4±0.9 and 1.0±0.8, respectively. The diagnosis of infectious diseases was the same as non-communicable diseases. The DR group prescribed more medications at each patient encounter (mean 2.6 vs 2.2, respectively; p<0.001). The US group prescribed more antibiotics for respiratory infections (US 46.2% vs DR 25.0%; p=0.0001), used more metronidazole than albendazole alone for parasite infections (p=0.0022) and used more oral fluconazole for vaginal candidiasis (p<0.0001) and tinea infections (US 44.6%, DR 14.3%, respectively; p=0.0020). Although some significant prescribing differences exist between US and DR providers, many similarities were present. Visiting providers should understand the medication use system and disease burden before providing care in an LMIC.

Tinea capitis-like infection caused by Rhodotorula mucilaginosa in a shelter for African Refugee Children in Northern Israel

Rhodotorula is a genus of unicellular pigmented yeasts, part of the division Basidiomycota. In this article, we report three cases of refugee children in a day care shelter in northern Israel who were clinically diagnosed and treated empirically as with ringworm infection but with clean and exclusive growth of Rhodotorula mucilaginosa in repeated cultures of several skin samples.Skin infections caused by this yeast are rare and there are few reports in the literature, mainly in patients who are immunocompromised. Here we report an infectious process of the scalp in immunocompetent children, caused by Rhodotorula mucilaginosa mimicking tinea capitis.

Spectrum of Pediatric Dermatoses in The Pediatric Outpatient Clinic of a Rural Teaching Hospital

Introduction: Skin diseases in the pediatric population are common all over the world including rural and urban areas. There is variation in the pattern and presentation of Dermatoses, with eczemas being the most common skin disorder in developountries and infections and infestations in the developing countries. Aims and Objectives: i) To study the spectrum of various dermatoses in infants and children attending pediatric outpatient clinic. ii) To study the pattern of common Dermatological conditions affecting the pediatric population of different age groups. Material &amp; Methods: It was an observational retrospective database study of the spectrum of various dermatoses in infants and children attending pediatric outpatient clinic over past 6 months from July 2016 to December 2016. We included all patients coming with skin disorders to the pediatrics outpatient department. Results: The entire data was entered and cleaned in MS Excel before its statistical analysis. Among 2078 pediatric skin patients attending the Dermatology OPD, 597 cases were Infectious and 1481 cases were Non infectious. Males outnumbered the females. The distribution of diagnosis of dermatoses differs significantly between male and female cases studied (P-value&lt;0.001). Three most common spectrums of dermatoses were pityriasisinfections (17.5%), Atopic dermatitis (11.4%) and Tinea infections (10.5%). Tinea infections were found to be highest (36.7%) and next common was scabies (24.5%) in Infectious variety followed by Chicken –pox / Varicella (7.7%). Conclusion: Over all fungal infections, Atopic Dermatitis and Pytiriasis were commonest which commonly occurred in adolescents and teen age groups which could be attributed to hormonal changes, excessive sweating, and bad hygiene.

Dermatophytosis: clinical profile and association between socio-demographic factors and duration of infection

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Dermatophytes are fungi that break down keratin of the stratum corneum and grow. They cause superficial infections of the skin, hair, and nail that are referred to as tinea infections. This study aims to assess the socio-demographic factors and clinical profile of subjects with dermatophytic infections and their impact on the duration of the illness.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 200 random subjects with dermatophytic infections were enrolled and assessed clinically.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There was significant association between duration of infection with age, diabetes, living condition and personal factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The impact of age, diabetes, living condition and personal factors on susceptibility to and duration of dermatophytic infections was elucidated.&lt;/p&gt;

Prevalence and zoonotic risks of Trichophyton mentagrophytes and Cheyletiella spp. in guinea pigs and rabbits in Dutch pet shops

Young rabbits and guinea pigs are often purchased as pets for children and may be infected with zoonotic skin infections. To assess the risk of acquiring such an infection from rabbits or guinea pigs, this study investigated the prevalence of the fungus Trichophyton mentagrophytes and the fur mite Cheyletiella parasitovorax in asymptomatic rabbits and guinea pigs in Dutch pet shops. In 91 pet shops a total of 213 rabbits and 179 guinea pigs were sampled using the Mackenzie technique and cultured. Clean cultures were examined microscopically and a PCR was performed on at least one sample from each pet shop. All animals were investigated for fur mite using a flea comb, a magnifying glass and white paper. From the fur of 3.8% (8/213) of the rabbits and 16.8% (30/179) of the guinea pigs, T. mentagrophytes was isolated. From 1 guinea pig (0,6%) Chrysosporium keratinophilum was isolated. Dermatophyte-positive rabbits and guinea pigs originated from 5.6% (5/90) and 27.3% (24/88) of the investigated pet shops, respectively. Fur mites were not found.Pet shops can play an important role in preventing transmission of zoonotic ringworm infections (dermatophytosis) and educating their customers. Specific preventive measures such as routine screening examinations and (prophylactic) treatment of rabbits and guinea pigs are recommended next to regular hygiene when handling animals.

Fungal Infections From Human and Animal Contact.

Fungal infections in humans resulting from human or animal contact are relatively uncommon, but they include a significant proportion of dermatophyte infections. Some of the most commonly encountered diseases of the integument are dermatomycoses. Human or animal contact may be the source of all types of tinea infections, occasional candidal infections, and some other types of superficial or deep fungal infections. This narrative review focuses on the epidemiology, clinical features, diagnosis and treatment of anthropophilic dermatophyte infections primarily found in North America. Other human-acquired and zoonotic fungal infections also are discussed in brief.

Ringworm Infections in Anambra State of Nigeria: Epidemiologic Features and Antifungal Potentials of Local Plant Remedies

Ringworm infection remains an important public health problem in Nigeria, as in other parts of the world where poor living conditions prevail. The epidemiologic pattern of the disease has not been well defined in Anambra State of Nigeria, hence the need for this study. A total of 51,092 individuals (48,084 children and 3,008 adults) were surveyed for ringworm lesions. The population constituted of primary school children and their contacts. Results showed that of the 51,092 individuals, 5,127 (or 10.04%) had ringworm lesions on their body. Scalp ringworm was more common in children than adults (X2=9.8482; P 0.05) or gender-related (X2=0.0057; P>0.05) pattern. Contact tracing showed that chances of transmitting ringworm infection from a case were higher in the family (38%) than in the school classroom (1.3%), which was higher than in the neighbourhood (0.8%). Transmission within the household was mainly horizontal among children, and occasionally from child to adults. Close and prolonged contacts with ringworm–afflicted individual appeared to enhance transmission. Of plant materials locally used to treat ringworm infections, the inhibitory concentrations against locally isolated dermatophyte fungi were as follows: leaves of Vanda roxburgii (MICrange=1.56-25.00 mg/ml; MIC90=25.00 mg/ml), Parkia biglobosa seeds (MICrange=3.13-12.50 mg/ml; MIC90=12.50 mg/ml), leaves of Sena alata (MICrange=3.13-12.50 mg/ml; MIC90=12.50 mg/ml), leaves of Mitracarpus villosus (MICrange=3.13-25.00 mg/ml; MIC90=25.00 mg/ml) and Gmelina arborea fruits (MICrange=6.25-100 mg/ml; MIC90=50.00 mg/ml). It could be concluded that tropical plants hold great promise as potential source of antifungal agents and are therefore, recommendable as possible option in the search for newer anti-fungal agents.

Ethanol Extract of Mylabris phalerata Inhibits M2 Polarization Induced by Recombinant IL-4 and IL-13 in Murine Macrophages.

Mylabris phalerata (MP) is an insect used in oriental herbal treatments for tumor, tinea infections, and stroke. Recent studies have shown that tumor-associated macrophages (TAM) have detrimental roles such as tumor progression, angiogenesis, and metastasis. Although TAM has phenotypes and characteristics in common with M2-polarized macrophages, M1 macrophages have tumor suppression and immune stimulation effects. Medicines polarizing macrophages to M1 have been suggested to have anticancer effects via the modulation of the tumor microenvironment. In this line, we screened oriental medicines to find M1 polarizing medicines in M2-polarized macrophages. Among approximately 400 types of oriental medicine, the ethanol extract of M. phalerata (EMP) was the most proficient in increasing TNF-α secretion in M2-polarized macrophages and TAM. Although EMP enhanced the levels of an M1 cytokine (TNF-α) and a marker (CD86), it significantly reduced the levels of an M2 marker (arginase-1) in M2-polarized macrophages. In addition, EMP-treated macrophages increased the levels of M1 markers (Inos and Tnf-α) and reduced those of the enhanced M2 markers (Fizz-1, Ym-1, and arginase-1). EMP-treated macrophages significantly reduced Lewis lung carcinoma cell migration in a transwell migration assay and inhibited EL4-luc2 lymphoma proliferation. In our mechanism study, EMP was found to inhibit STAT3 phosphorylation in M2-polarized macrophages. These results suggest that EMP is effective in treating TAM-mediated tumor progression and metastasis.

A Case of Localized Scalp Psoriasis Triggered by Microsporum canis Infected Tinea Capitis and Review of Published Literatures

We report a case in which patient was initially ill with tinea capitis infected by Microsporum canis later triggered the local scalp psoriasis. Tinea infections always confused with psoriasis, a review of published studies revealed 14 cases of fungal confused with psoriasis.