Trichophyton Mentagrophytes Complex Research Articles

Dual quantitative PCR assays for the rapid detection of Trichophyton indotineae from clinical samples.

Trichophyton indotineae is an emerging species of the Trichophyton mentagrophytes complex (TMC), responsible for an epidemic of widespread hairless skin infections that is frequently (50-70%) resistant to terbinafine. In order to initiate appropriate treatment as quickly as possible without waiting for culture positivity (10-15 days) and molecular identification from the strain, we developed a dual quantitative PCR (qPCR) for the direct detection of T. indotineae in clinical samples. We first designed a T. indotineae-specific qPCR assay (TI-qPCR) targeting a single specific polymorphism in the internal transcribed spacer region. Although none of the 94 non-dermatophyte and 7 dermatophyte species were amplified, this TI-qPCR allowed amplification of other TMC species at a lower yield. With equal amounts (0.1ng) of DNA per reaction, the mean quantitative cycle (Cq) values for T. indotineae and non-indotineae TMC were 27.9 (±0.1) and 38.9 (±0.3), respectively. Therefore, we normalized this assay against a previously validated pan-dermatophyte qPCR assay (PD-qPCR) and relied on the ΔCq [(TI-qPCR) - (PD-qPCR)] to identify T. indotineae versus other TMC species. Dual assay was validated using 86 clinical samples of culture-confirmed T. indotinea and 19 non-indotineae TMC cases. The mean ΔCq for non-indotineae TMC was 9.6±2.7, whereas the ΔCq for T. indotinea was -1.46±2.1 (P<.001). Setting the ΔCq at 4.5 as a cutoff value resulted in 100% specificity for the detection of T. indotineae. This dual qPCR assay quickly detects T. indotineae from skin scrapings, aiding in early diagnosis and treatment for patients with suspected infection.

Trichophyton indotineae, an Emerging Drug-Resistant Dermatophyte: A Review of the Treatment Options.

Background: Dermatophytosis is a prevalent superficial infection caused by filamentous fungi, primarily affecting the skin and/or its appendages. In recent years, there has been a notable increase in mycotic strains resistant to standard antifungal therapies, including Trichophyton indotineae, a dermatophyte of the Trichophyton mentagrophytes complex. This review aims to provide a comprehensive overview of the treatment options for T. indotineae, elucidating their effectiveness in managing this challenging mycotic infection. Methods: For this review, a search was conducted in the PubMed, Scopus, Web of Science, Embase, and Google Scholar databases, encompassing all published data until March 2024. English-language articles detailing therapy outcomes for patients confirmed to be affected by T. indotineae, identified through molecular analysis, were included. Results: Itraconazole was shown to be a good therapeutic choice, particularly when administered at a dosage of 200 mg/day for 1-12 weeks. Voriconazole was also demonstrated to be effective, while terbinafine exhibited a reduced response rate. Griseofulvin and fluconazole, on the other hand, were found to be ineffective. Although topical treatments were mostly ineffective when used alone, they showed promising results when used in combination with systemic therapy. Mutational status was associated with different profiles of treatment response, suggesting the need for a more tailored approach. Conclusions: When managing T. indotineae infections, it is necessary to optimize therapy to mitigate resistances and relapse. Combining in vitro antifungal susceptibility testing with mutational analysis could be a promising strategy in refining treatment selection.

Tinea faciei clinical characteristics, causative agents, treatments and outcomes; a retrospective study in Thailand.

Tinea faciei is a relatively uncommon dermatophyte infection. The studies, which included clinical forms, and isolated species of dermatophytes, are limited. This retrospective study aims to determine the causative organism, clinical characteristics, treatments and outcomes of patients with tinea faciei attending the dermatologic clinic, Siriraj Hospital, from 1 January 2017 to 30 September 2021. Demographic data, clinical presentations, isolated dermatophyte species, treatments and outcomes were collected and analysed. A total of 151 tinea faciei cases were observed. Trichophyton rubrum (48.6%), Trichophyton mentagrophytes complex (22.2%) and Microsporum canis (18.1%) were common causative agents. Tinea faciei was commonly detected in females (64.9%) with a history of pets (54.6%). Clinical presentations often involved plaques and scales on the cheeks. Among patients with lesions on the cheek, mycological cure was observed significantly less often compared to those without cheek lesions. Patients with other concurrent skin or nail infections, a history of topical steroids and a history of previous fungal infection had a slightly longer duration of mycological cure than those without factors. Recurrent infection was found in 33.3%. Male, history of previous fungal infection, and lesions on the cheeks were significantly associated with recurrent infection. Fungal infection of the face was commonly found in women and patients with pets. The most common pathogen that caused tinea faciei was T. rubrum. Topical antifungal treatments could be used with favourable outcomes. The history of past infection and lesion on the cheeks should be carefully assessed to be vigilant for recurrent infection.

A resurgence of tinea cruris caused by Epidermophyton floccosum: An outbreak among Thai naval cadets

BackgroundA decreasing trend in tinea cruris caused by Epidermophyton floccosum, an anthropophilic dermatophyte, has been observed. MethodsThis retrospective study involved Thai naval cadets aged 18 years or older with suspected groin lesions. Both clinical evaluations and laboratory investigations were conducted. ResultsIn total, 86 male participants with a median age of 19 years who presented with groin rash were enrolled in the study. Branching septate hyphae from KOH examination were found in 55 patients (64.0 %). Fungal identifications were Epidermophyton floccosum (42 cases; 76.4 %), Trichophyton mentagrophytes complex (3 cases; 5.5 %), and no growth (10 cases; 18.2 %). An E. floccosum outbreak was identified, with a prevalence of 76.4 %. Most lesions exhibited admixed erythema and hyperpigmentation. Approximately two-thirds displayed prominent, easily visible scaling. Scrotal involvement was absent in 95.2 % of lesions, with 87.2 % presenting bilaterally. A gradual symptom onset lasting up to 2 months was observed in 78.9 % of cases. Lesion morphologies included annular (73.8 %), patchy (14.3 %), and polycyclic (9.5 %). Severe itching disrupting daily activities was reported by only 7.1 % of participants. Approximately two-thirds used over-the-counter (OTC) topical medications without consulting a physician. Risk factors related to clothing included sharing clothes (59.5 %), wearing sweaty clothes (100 %), and reusing unwashed clothes (81.0 %). ConclusionsThe E. floccosum tinea cruris outbreak among naval cadets was characterized by a gradual onset and mild symptoms. OTC medication use without physician consultation was prevalent.

Prevalence of Dermatophyteic Infection in A Tertiary Care Hospital in Chennai in India

Dermatophytes are fungi that infect keratinized tissues in animals and humans. The group's most prevalent and only anthropophilic species is Trichophyton rubrum, whereas species from the Trichophyton mentagrophytes complex are zoophilic and anthropophilic. The prevalence of dermatophyte infections varies depending on environmental factors and location, with higher rates observed in tropical countries like India. Hence, this study was conducted to comprehend the distribution of various species and clinical symptoms to assess the prevalence and features of dermatophyte infections in patients receiving tertiary care. This study's main objective was to identify the frequency of dermatophyte species in clinical samples taken from suspected patients in a tertiary care centre.1000 patients attending Sree Balaji Medical College in Chennai were the subjects of cross-sectional observational research. The prevalence of dermatophyte infection was assessed using clinical sample data. The analysis included information on gender, age group, and clinical symptoms. In the examined samples, dermatophyte infection was shown to be clinically prevalent (14.2%). More men (64.7%) than women (35.2%) were impacted. The most common age group for dermatophyteic infection was those between 31 and 40 years. The most typical clinical presentation was tinea corporis, characterized by scaly, red areas on the skin. The most frequent dermatophyte species found was Trichophyton rubrum. The study revealed that the clinical samples taken from the tertiary care centre had a significant prevalence of dermatophyteic infection. These infections were more likely to affect men and those in the age range of 31 to 40 years. The most commonly noticed clinical sign was tinea corporis, caused by Trichophyton rubrum. These findings emphasize the need to detect and treat dermatophyteic infections, particularly tinea corporis, highlighting the need for suitable treatment techniques in the population under study.

Clinical evaluation of a dermatophyte RT-PCR assay and its impact on the turn-around-time: a prospective study.

Onychomycosis is an important public health problem whose prevalence continues to grow and impact public health at several levels. Nevertheless, today the main diagnostic methods used in routine practice have many drawbacks. The aim of this study was to evaluate, for the first time, the clinical performance of a new multiplex PCR (Novaplex®) in the identification of the causative agent on nail samples, and its impact on the turnaround time, compared to our traditional laboratory methods. From 06/29/2022 to 12/21/2022, all nail samples sent to our laboratory for suspected onychomycosis were included in this prospective study. We collected for each sample the result obtained with the NovaplexࣨPCR method and with the traditional direct microscopy examination and culture. Each discordant result was checked using a third method, which is another PCR method (DermaGenius®kit) as resolver. For culture-positive samples, a turnaround time was calculated and compared to the one obtained with the Novaplex®method. A total of 131 samples were included. Among them, 5 were positive (3.8%) on direct microscopy, 33 positive (25.2%) after culture and 98 negative (74.8%). All positive (n=33) and negative (n=69) cultures were also positive/negative with the Novaplex®PCR. Twenty-nine samples were positive with the Novaplex®method but negative with culture (discordant results). The percentage agreement between the culture and the Novaplex® methods was 77.9% (102/131). While tested with the resolver (DermaGenius® PCR), 28 out 29 discordant results were similarly found positive. The percentage agreement between the 2 PCR methods (Novaplex® and DermaGenius®) was 96.6%. The Novaplex® PCR method evaluated proved to be very reliable and allowed the direct identification of 62/131 positive samples (47.3%) with the following distribution: 79.0% of Trichophyton rubrum complex, 11.3% of Trichophyton mentagrophytes complex, 6.5% of both Trichophyton rubrum complex and Trichophyton mentagrophytes complex and 3.2% Candida albicans. The median time [± 95% CI] for positive culture (between incubation and validation of the final identification) was 15 [12-23] days while the turnaround time for the Novaplex® method adapted to our clinical laboratory routine is ≤ 7 days. Laboratory confirmation of onychomycosis is crucial and should always be obtained before starting treatment. The evaluated PCR method offered a rapid, reliable, robust, and inexpensive method of identification of the causative agent compared to traditional methods.

Dermatophytosis caused by Trichophyton mentagrophytes complex in organic pigs

BackgroundDermatophytosis (ringworm) caused by members of the Trichophyton mentagrophytes complex is rarely diagnosed in pigs but has been recognized as an increasingly common infection in humans. Further, resistance to antifungal drugs have been reported both in Asia and in Europe. This is the first scientific report of infection by the T. mentagrophytes complex in pigs in the Nordic countries.Case presentationSkin lesions developed in grower pigs in an organic fattening pig farm with outdoor production and following laboratory analyses, dermatophytosis caused by members of the T. mentagrophytes complex was diagnosed. Infection was linked to poor hygiene, high humidity, and moderate outdoor temperatures, in combination with high pig density. A farm worker developed a skin lesion after close contact with affected pigs, which highlighted the zoonotic potential of porcine dermatophytosis. The dermatophytes may have originated from the herd supplying the growers where similar lesions occurred in pigs. Further, pigs from another organic fattening herd that received growers from the same supplier herd also developed dermatophytosis. The lesions healed without treatment as the housing conditions were improved. Isolation of affected pigs prevented spread to other pigsConclusionMembers of the T. mentagrophytes complex can cause ringworm in pigs. The fungi probably persist in the haircoat and may cause overt disease when environmental conditions promote growth of mycelia.

Capacidad antifúngica de los extractos acuosos de los frutos de Ilex paraguariensis frente a los hongos dermatofitos

Increasing resistance to antifungal agents and the toxicity of currently available antifungal agents has stimulated the development of new compounds with antifungal action of natural origin. Numerous scientific studies have reported on the biomedical and pharmacological properties of the de-rivatives of Ilex paraguariensis (Yerba mate). Very few scientific studies have been conducted on the phytochemical and/or pharmacological properties of its fruits, and practically none on its antimicrobial capacity. The aim of this study was to evaluate the in vitro antifungal capacity of aqueous extracts of I. paraguariensis fruits on dermatophyte fungi. Strains isolated from clinical samples of Trichophyton men-tagrophytes complex, Trichophyton rubrum, Microsporum canis, Trichophyton tonsurans and Nannizzia gypsea were used. To evaluate the antifungal capacity of the aqueous extract of yerba mate (EAFYM), a stock solution of 500 mg/ml was prepared. The quantitative microdilution method was applied in RPMI broth. A fungal inoculum of 1-3 x103 CFU/ml was used. Controls for fungal growth, sterility and commercial reference antifungals were performed. Cultures were incubated for 96 h at 35 °C. The minimum concentration of EAFYM that produced complete inhibition of fungal growth was determined by visual observation and subsequent puncture on solid medium. It is concluded that EAFYM has in vitro antifungal activity against the dermatophyte strains studied, ranging from 31.25 to 125 mg/ml.

Trichophyton mentagrophytes complex: A retrospective study of 64 dogs from the Central United States (1997-2020).

There are limited clinical studies evaluating the Trichophyton mentagrophytes complex, with most reports confined to small case studies. Additionally, the studies are dated and provide limited information on response to newer or currently available therapies. The aim of the study was to determine if there is a breed prevalence, lesion distribution and seasonality associated with the T.mentagrophytes complex for dogs evaluated in the central United States. An additional aim of the study was to evaluate response to therapies because there are minimal data available on clinical response with newer systemic antifungal drugs. A total of 64 canine medical records were evaluated that had a previous diagnosis of T.mentagrophytes complex infection. A retrospective study of medical records to evaluate signalment, time of onset of clinical signs, clinical presentation and therapeutic management. A higher incidence of T.mentagrophytes complex infection was observed in the American Kennel Club (AKC) Sporting group (43%) and Terrier group (20%). A seasonal influence was noted, with the onset of clinical signs being highest in October. Lesions most often affected the muzzle (48%), followed by the head excluding the pinnae (21%). Ketoconazole, itraconazole and terbinafine appeared equivalent as systemic therapeutic options to treat T.mentagrophytes complex infections. This study identified patterns in breeds, seasonality and lesion distribution for the T.mentagrophytes complex in dogs from the central United States. Additionally, the study found several reasonable and reliable treatment options for systemic therapy.

Molecular epidemiology of Trichophyton infections among canines from Northern India.

Dermatophytes are keratinophilic fungi that cause skin infections in both humans and animals. Recently, the incidence rates of fungal infections associated with Trichophyton spp. have been considered endemic in many locations. The aim of this study was to isolate and characterize Trichophyton spp. from canines and felines. In the present study, screened 442 canine (n=386) and feline (n=56) samples for dermatophytes. Among all the samples, ten isolates were identified asTrichophytonspp. based on micro-morphological features. For comparative analysis, we included three human strains of Trichophyton mentagrophytes complex. In vitro susceptibility of antifungal drugs indicated the highest sensitivity except for fluconazole. The canine and human strains were genetically characterized by sequencing three genes: theinternaltranscribed spacer region of rDNA, translation elongation factor 1- gene, and beta-tubulin. Based on sequence homology and phylogenetic analysis, the ten canine strains belonged to four different species/ genotypes such as T. mentagrophytes genotype VIII (T. indotineae) (n=5), T. interdigitale (n=2), T. simii (n=2) and T. quinckeanum (n=1). The three human strains used for comparative analysis were identified as T. mentagrophytes genotype VIII (n=2) and T. benhamiae (n=1). The study hence indicates that the T. mentagrophytes genotype VIII, considered as an endemic and emerging human pathogenic clone in India, is also the prevalent in animals.

P114 Clinical and microbiological spectrum of dermatophytosis from a tertiary care institute

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PMObjectivesThere is an increasing incidence of recalcitrant dermatophytosis in India due to irrational use of antifungals, inappropriate treatment, and also in vitro resistance of the organism by itself. This study is done to determine the clinic-mycological profile, antifungal susceptibility, and outcome of patients with dermatophytosis in our institute.MethodsAll patients with culture-proven dermatophytosis attending the outpatient department of our hospital from January 2019 to December 2019 were included in the study. Detailed clinical data of all the patients were collected.Morphological Identification of the dermatophytes was done by conventional mycological methods. The isolates were sent to PGIMER Chandigarh for further identification by MALDI-TOF and antifungal susceptibility testing. Antifungal susceptibility testing was done for 47 isolates of Trichophyton species.ResultsOf the 155 clinical suspected cases, growth of dermatophytes was observed in 55 (35.4%) of the cases. Tinea corporis 39/55(70.9%) was the predominant clinical type The duration of infection was less than 6 months in 22/55(40%) of cases and >6 months in 33(60%) of the cases. Majority of the patients were in the age group of 20-30 years and were male. A total of 36/55 (65.4%) of the patients belong to middle socio-economic status and 19/55 to lower socioeconomic status (34.5%). In all, 10/55(19.2%) of the patients were students and 10/55 (19.2%) housewives; others include auto drivers, mechanics, teachers, cashiers, etc. All except 4 patients were from urban areas. Comorbid conditions noted were diabetes mellitus in 7/55 (12.7%), hypertension in 6/55 (10.9%), systemic steroid usage in 3/55 (5.4%), post-renal transplant status in 1/55 (1.8%), and SLE in 1/55 (1.8%). Sharing of personal use items was found in 12/55 (21.8%) of the patients and 9/55 (16.3%) of patients complained of excessive sweating.Previous therapy with topical and systemic antifungals was given in 32/55 (58.8%) of the patients, other modes of treatment like homeopathy, and ayurveda in 4/55 (7.2%). Topical steroids were given to 4 patients and 19/55 (34.5%) of the patients were not treated for the infection. Trichophyton mentagrophytes complex (69%) was the predominant species complex isolated followed by T. rubrum, M. gypseum, M.canis, and T. tonsurans.Of the 47 Trichophyton isolates subjected to AFST, all the isolates showed MIC >1ug/ml for fluconazole and griseofulvin. Majority of the isolates showed MIC of <1 ug/ml for other antifungals; high MICs (MIC >1) were exhibited by 5 isolates for terbinafine and naftifine, 2 isolates for sertoconazole, and 1 isolate for voriconazole. Molecular detection of terbinafine resistance done in 15/55 isolates showed mutation in the squalene epoxidase (SE) gene leading to F397L substitutions in 2 isolates. In the present study, the patients were treated with both oral and topical antifungalsOf the 55 cases, complete cure was observed in 21 (38%), partial cure in 9 (16.3%), and relapse in 5 (9%) on 2 years follow-up. However, 20/55 (36.3%) of the cases were lost to follow-up.Conclusion Trichophyton mentagrophytes complex was the predominant species isolated and Tinea corporis was the commonest clinical presentation. Resistance to terbinafine, griseofulvin, and fluconazole has been noted. Dermatophytosis has become a difficult to treat disease due to antifungal resistance, and chronicity/recurrence of the lesions. Early diagnosis followed by rational antifungal therapy are essential for improved outcome.

P076 The promising antimycotic activities of a novel cyclic antifungal lipopeptide against Human Dermatophyte Isolates

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PMObjectivesTo determine the minimum inhibitory concentrations (MICs) of a novel antifungal lipopeptide against clinical isolates of dermatophytes of human origin.MethodsTo perform antifungal susceptibility testing (AFST) by CLSI microbroth dilution method, a reversed-phase high-performance liquid chromatography (RP-HPLC) purified lipopeptide of 1071.4 Da from a wild-type soil isolate Bacillus subtilis was used and compared with the standard allylamine terbinafine MICs. Briefly, 1200 ml of cell-free culture supernatant was extracted using a solvent mixture and silica gel (230-400 mesh size)-based adsorption chromatography. The semi-preparative RP-HPLC system consisted of an Agilent quaternary pump and a variable wavelength detector equipped with a Phenomenex Luna C18 column (10 mm × 250 mm, 5 μm). The solvent system for RP- HPLC was (A) water with 0.1% trifluoroacetic acid (TFA) and (B) acetonitrile containing 0.1% TFA. The gradient of solvent B used for purification was as follows: 0%-54% for 0-20 min at the flow rate of 1 ml/min, 54%-60% from 20-48 min at 0.5 ml/min, 60%-100% from 48-58 min at 0.5 ml/min, 100%-0% from 58-65 min at 1 ml/min and monitored at 210 nm.ResultsSuperficial skin infections are caused by dermatophytes including Trichophyton spp. Nowadays, resistance to terbinafine in Trichophyton spp. isolates with higher MICs have been documented in India. We report here the antifungal prowess of a novel small antifungal lipopeptide against 20 clinical isolates of Trichophyton spp. of human origins (from human skin scrapings and nails) with the clinical diagnosis of tinea corporis/cruris and tinea unguium. The representative photographs of T. tonsurans, T. rubrum, and T. mentagrophytes complex are provided below. A total of 6 isolates of T. mentagrophytes and T. rubrum carry point mutations at F397L of squalene epoxidase (SQLE) protein. The in vitro antifungal efficacies determined by AFST revealed that the lipopeptide showed less or equivalent MICs (100% inhibition) in the case of five dermatophytes. The lipopeptide drug has exhibited improved MICs against two T. mentagrophytes complex and two T. rubrum isolates with amino acid substitution F397L in SQLE protein. Trichophyton mentagrophytes complex and T. rubrum with F397L mutations were inhibited at MICs 4-32 μg/mL of terbinafine. In comparison, the lipopeptide showed 4-16 μg/ml (100% inhibition). In the case of all four Trichophyton tonsurans, the MICs ranged between 2-4 μg/ml for the lipopeptide.ConclusionsThe broad-spectrum lipopeptide showed promising antifungal activity against dermatophytes and may be considered for nano-emulsion formulation and tested for topical application in a mice model.

Detection of emerging genotypes in Trichophyton mentagrophytes species complex: A proposal for handling biodiversity in dermatophytes.

A resistant and hypervirulent dermatophyte from India has been described as a taxonomic novelty, Trichophyton indotineae, a species of the Trichophyton mentagrophytes complex. Rapid detection and correct identification of closely similar dermatophytes with different predilections are essential for efficient clinical management. We evaluated the efficacy of rapid diagnostic methods clinical and environmental strains in the T. mentagrophytes complex. The methods included Real-time-PCR, DermaGenius, LAMP, and MALDI-ToF MS, using rDNA ITS sequences as taxonomic standard. The results show that only MALDI-ToF MS can distinguish 96.97% T. indotineae from other closely related species. The complex comprises numerous clones which may differ in anonymous markers but with similar evolutionary behavior. Therefore, we recommend to distinguish species only when they show an appreciable degree of adaptation and thus are clinically significant. The distinction of remaining clonal diversity is an epidemiological query and can be solved by haplotype numbering.

Meta-analysis of the antifungal activities of three essential oils as alternative therapies in dermatophytosis infections

AimsThis work examines the available scientific evidence about the efficiency of essential oils (EO) as an alternative therapy to traditional treatment of fungal infections, including onychomycosis, assessing the effect of the three EO most frequently studied for their antifungal activity (thyme, cinnamon and tea tree EO) against three causative agents of fungal diseases in humans: Trichophyton rubrum, Trichophyton mentagrophytes complex and Candida albicans.Methods and ResultsThe PRISMA statement protocol was followed to conduct a bibliographical search and 54 articles that met all the inclusion criteria were retrieved. Differences were observed in the MIC and MFC values depending on the micro‐organism strain and the EO used. The lowest MIC were observed with Cinnamomum zeylanicum EO (0.013–1120 μl ml−1) against the three micro‐organisms. For MFC, the lowest value was found for Thymus vulgaris EO (4.2 μl ml−1) against Trichophyton rubrum.ConclusionsThe antifungal effects of EO could be a very promising solution to overcome the therapeutic shortcomings of antimycotic medication. More experiments are needed to examine the properties of these oils to devise effective and nonaggressive therapies for treatment of dermatophytosis.Significance and Impact of StudyThe results indicate that EO remain good candidates for future treatments and could provide a solution for failed medications and/or adverse reactions to current pharmacological treatments.

Comparative evaluation of host immune response and cytokine signature pertaining to Th1 and Th2 immune arms in serum and tissue among patients of acute localised vs. chronic disseminated dermatophytosis.

India is witnessing an epidemic of dermatophytosis. The role of host immune response against fungi in chronicity and dissemination is topic of ongoing research. We conducted cross-sectional comparative study to determine the difference in Th1 (IFN-γ) and Th2 (IL4) response in serum and tissue between acute and localised vs. chronic and disseminated cases. Patients (18-60 years) were divided in two groups-group A (n=114, BSA <5%, single anatomic site, duration <6 months, n=118) and group B (n=107 BSA >10%, > one anatomic site, duration >12months, n=118). Clinical parameters along with serum levels of IgE, IL-4 and IFN-γ and expression of IL4 and IFN-γ in dermal infiltrate were compared between group. Trichophyton mentagrophytes complex was commonest causative fungi. Serum levels of IgE were significantly higher (median A-539.2, B-2901.0, p < .001) whereas levels IL-4(median A-21.3, B-20.4, p < .001) and IFN-γ(median A-9.6, B-5.1, p < .001) were significantly lower in chronic cases. Expression of IL-4 was observed in most biopsy specimens in both groups without any difference in intensity of staining. Expression of IFN-γ was not detected in all but one specimen across both the groups. Severe itching (OR:0.050, CI:0.018, 0.139, p < .001), sign of topical steroid abuse (OR:0.203,CI:0.077, 0.537; p=.001), ↓IFN-γ (OR:4.683, CI:1.634, 13.418; p=.004) correlated significantly and independently with chronic dermatophytosis. Our study shows chronic and disseminated cases of dermatophytosis differ immunologically in terms of higher IgE, and lower IL4 and IFN-γ. Expression of IL4 is present in tissue of both acute, localised and chronic disseminated cases. Expression of IFN-γ cannot be established in our study.

Species Distribution and Antifungal Susceptibility Profile of Dermatophytes from a Tertiary Care Centre in North India.

Objective Dermatophytoses, one of the most ancient diseases, is becoming a menace in recent times. This has made the knowledge of antifungal susceptibility a priority in today's times. Material and Methods This is a prospective study conducted over 18 months including all dermatophytes isolated during the period. Dermatophytes were identified by routine phenotypic methods. Antifungal susceptibility testing was performed for griseofulvin, terbinafine, and itraconazole as per the Clinical Laboratory Standard Institute M38 A2, and minimum inhibitory concentrations (MICs) were read after 5 days. Results Patient details and associated risk factors were recorded. Fixed dose combinations with steroids were associated with 79.3% (46 out of 58) of patients with dermatophytosis of skin. Among the 72 dermatophytes isolated during the study period, 58 (80.5%) were isolated from skin scrapings and 14 (19.4%) from nail samples. Tinea corporis with cruris was the most common presentation. The most common dermatophyte isolated from skin scrapings was Trichophyton mentagrophytes complex (70.6%, 41 out of 58), while from nail samples it was Trichophyton rubrum complex (78.57%, 11 out of 14). Based on the MIC 50 and MIC 90 results, itraconazole showed the lowest MICs, followed by terbinafine and then griseofulvin. Conclusion With the changing epidemiology of species distribution and antifungal resistance, there is a need for continuous surveillance of these parameters of dermatophytes.

Epidemiology of dermatomycoses in children in Northern Mato Grosso 2015‐2020

Dermatomycoses, fungal diseases that affect the superficial layers of skin, hair or nails, are a public health concern due to their high prevalence. In Brazil, dermatomycoses are not notifiable diseases, so only fragmented epidemiological studies have been reported in the national literature. To evaluate the epidemiological profile of dermatomycoses in preschoolers and school children in Sinop, Mato Grosso (MT), Brazil. Classic methods were used to perform 782 mycological examinations to identify dermatophytosis, cutaneous candidosis and pityriasis versicolor in preschoolers and school children aged between 6months and 12years in 11 educational institutions in Sinop, MT. Among the evaluated clinical specimens, 5.2% tested positive for dermatophytosis, with 58.45% of these cases corresponding to tinea capitis, followed by skin (tinea corporis and tinea pedis) and toenail (tinea unguium) lesions; zoophilic fungi predominated. Microsporumcanis and Trichophytonmentagrophytes complex were isolated in 53.66% and 24.39% of the cases, respectively. Regarding cutaneous candidosis, 9.1% of the specimens tested positive for this disease, with 59.16% and 12.7% of the cases corresponding to toenails and interdigitoplantar lesions, respectively. Candidaalbicans caused 70.43% of the lesions. The remaining specimens (85.7%) tested positive for pityriasis versicolor; children aged between 6 and 12 were the most affected (71.79%). Our results agree with most epidemiological studies carried out in Brazil and demonstrate the high frequency of mycoses in preschoolers and school children, a result of poor personal hygiene and favourable weather conditions in Northern Mato Grosso, Brazil.

Emergence of Difficult-to-Treat Tinea Corporis Caused by Trichophyton mentagrophytes Complex Isolates, Paris, France.

We describe 7 cases of extensive tinea corporis since 2018 in a hospital in Paris, France, after failure to cure with terbinafine. Molecular analysis indicated Trichophyton mentagrophytes internal transcribed spacer type VIII (T. indotineae). This strain, which has mutations in the squalene epoxidase gene, is spreading on the Indian subcontinent.

Clinico-Mycological Profile of Treatment-Naïve, Chronic, Recurrent and Steroid-Modified Dermatophytosis at a Tertiary Care Centre in Eastern India: An Institution-Based Cross-SectionalStudy.

Background:Dermatophytosis has recently emerged as a major public health problem in the Indian subcontinent, most cases becoming chronic and recurrent.Aims:Assessing the clinico-epidemiologic and mycologic profile of treatment naïve, chronic, recurrent and steroid-modified dermatophytosis.Materials and Methods:We conducted across-sectional study involving 111 cases of dermatophytosis. Detailed epidemiology, clinical parameters, treatment history and other host factors were assessed along with scraping for potassium hydroxide (KOH) and fungal culture.Results:Among 111 patients,(F: M 1.7:1; mean age 44.4 ± 18.2 years), 51.4% were treatment naïve, while 34.2% and 14.4% presented with chronic and recurrent tinea respectively. Family history and sharing of fomites among infected family members was commoner in the latter groups (P = 0.001). Topical steroid application was reported in 49.5%, however only 7.2% presented with steroid modified tinea. Tinea corporis et cruris (41.4%) was the predominant clinical type followed by tinea corporis (34.2%) and tinea cruris (27.9%). KOH mount and culture were positive in 62.2% and 39.6% cases respectively; commonest isolates being Trichophyton rubrum, and Trichophyton mentagrophytes complex in 15.3% cases each. Trichophyton rubrum was the commonest etiology for treatment naïve and recurrent cases, while Trichophyton mentagrophytes was the commonest isolate from chronic and steroid-modified cases (P = 0.0003). Interestingly, T.mentagrophytes complex and T. rubrum were the commonest causes of tinea corporis and tinea cruris respectively (P = 0.07).Conclusion:Trichophyton rubrum was the commonest organism in treatment naïve and recurrent cases, while Trichophyton mentagrophytes complex accounted for most cases of chronic and steroid modified tinea. The difference in predominant species seems to be a major contributory factor for chronicity and recurrence. However, several host factors like topical steroid use and sharing of fomites also play additional roles.

Nail dermatophytoma in HIV-infected patients in Cali, Colombia

IntroductionA dermatophytoma is a mass of hyphae that is observed at direct examination, it responds poorly to treatment with antifungal drugs, some authors have proposed that it is actually a biofilm. This pathology is underdiagnosed, and its true incidence is unknown. ObjectivesThis study presents the clinical findings of dermatophytoma in HIV/AIDS patients from Colombia presenting onychomycosis. Material and MethodsA transversal observational descriptive study was carried out in a third level university hospital. One hundred thirty HIV positive patients diagnosed using ELISA and Western Blot that presented nail lesions on their hands and/or feet compatible with onychomycosis were included. Samples taken from affected nails were observed in direct examination with KOH and seeded onto Sabouraud agar, mycosel agar and dextrose-potato agar. Molds were identified based on macroscopic and microscopic characteristics. ResultsSix (4.6%) individuals presented dermatophytoma. Average age was 43 years (range 33–50); nails more commonly affected (5/6) were on the toes, principally the hallux. Clinical manifestations included a yellow or white, rounded or linear dense area on the nail. Superficial white onychomycosis was present in 83.3% of the patients. Fungal cultures were obtained in only 5 patients; Trichophyton mentagrophytes complex was found in 2 individuals while T. rubrum, T. tonsurans and Epidermophyton floccosum were in the other 3. Average cell count for CD4+T lymphocytes was 86.8 cells/mm3 (range 9–282). ConclusionsThis is the first report in Colombia of dermatophytoma in HIV/AIDS patients, most of them had a CD4+ T lymphocytes count less than 200 cells/mm3. Several clinical forms of onychomycosis were observed, the most frequent was the white superficial onychomycosis.