RESUMEN
Antifungal-resistant dermatophytes (ARD) infection is a hotspot issue in clinical microbiology and the dermatology field. Trichophyton indotineae as the dominant species of dermatophyte with terbinafine-resistance or multidrug resistance, is easy to be missed detection clinically, which brings severe challenges to diagnosis and treatment. ARD infection cases have emerged in China, and it predicts a risk of transmission among human. Based on the existing medical evidence and research data, the Mycology Group of Combination of Traditional and Western Medicine Dermatology and Chinese AntifungalâResistant Dermatophytoses Expert Consensus Group organized experts to make consensus on the management of the infection. Here, the consensus formulated diagnosis and treatment recommendations, to raise attention to dermatophytes drug resistance problem, and expect to provide reference information for the clinical diagnosis, treatment, prevention and control.
Asunto(s)
Antifúngicos , Consenso , Farmacorresistencia Fúngica , Tiña , Humanos , Antifúngicos/uso terapéutico , Antifúngicos/farmacología , Arthrodermataceae/efectos de los fármacos , China , Tiña/tratamiento farmacológico , Tiña/microbiología , Tiña/diagnóstico , Trichophyton/efectos de los fármacos , Trichophyton/aislamiento & purificaciónAsunto(s)
Quiste Epidérmico , Granuloma , Tiña , Humanos , Tiña/microbiología , Tiña/tratamiento farmacológico , Granuloma/microbiología , Granuloma/patología , Quiste Epidérmico/patología , Quiste Epidérmico/microbiología , Masculino , Trichophyton/aislamiento & purificación , Antifúngicos/uso terapéutico , Biopsia , Microscopía Electrónica de Transmisión , Femenino , Resultado del Tratamiento , ArthrodermataceaeRESUMEN
This case describes a 58-year-old woman who presented to the dermatology outpatient clinic with progressive skin lesions on the hands. Physical examination showed erythematosquamous plaques. The diagnosis zoonotic dermatomycosis was made based on fungal cultures, which showed a Trichophyton erinacei. This dermatophyte is particularly transmitted through hedgehogs. The patient appeared to have taken care of an infected hedgehog.
Asunto(s)
Erizos , Tiña , Trichophyton , Humanos , Femenino , Persona de Mediana Edad , Erizos/microbiología , Tiña/diagnóstico , Tiña/tratamiento farmacológico , Tiña/microbiología , Animales , Trichophyton/aislamiento & purificación , Zoonosis/diagnóstico , Antifúngicos/uso terapéuticoRESUMEN
Caffeine affords several beneficial effects on human health, acting as an antioxidant, anti-inflammatory agent, and analgesic. Caffeine is widely used in cosmetics, but its antimicrobial activity has been scarcely explored, namely against skin infection agents. Dermatophytes are the most common fungal agents of human infection, mainly of skin infections. This work describes the in vitro effect of caffeine during keratinocyte infection by Trichophyton mentagrophytes, one of the most common dermatophytes. The results show that caffeine was endowed with antidermatophytic activity with a MIC, determined following the EUCAST standards, of 8 mM. Caffeine triggered a modification of the levels of two major components of the fungal cell wall, ß-(1,3)-glucan and chitin. Caffeine also disturbed the ultrastructure of the fungal cells, particularly the cell wall surface and mitochondria, and autophagic-like structures were observed. During dermatophyte-human keratinocyte interactions, caffeine prevented the loss of viability of keratinocytes and delayed spore germination. Overall, this indicates that caffeine can act as a therapeutic and prophylactic agent for dermatophytosis.
Asunto(s)
Antifúngicos , Arthrodermataceae , Cafeína , Queratinocitos , Cafeína/farmacología , Queratinocitos/efectos de los fármacos , Queratinocitos/microbiología , Humanos , Antifúngicos/farmacología , Arthrodermataceae/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Pared Celular/efectos de los fármacos , Tiña/tratamiento farmacológico , Tiña/microbiología , Quitina/farmacología , Quitina/químicaRESUMEN
BACKGROUND: Over the past decades, the increasing incidence of recurrent dermatophytosis associated with terbinafine-resistant Trichophyton has posed a serious challenge in management of dermatophytosis. Independent reports of failure of treatment and high minimum inhibitory concentrations (MIC) of antifungals are available, but data correlating MIC and clinical outcomes is still sparse. Therefore, the present study was conducted to evaluate the outcomes of systemic treatment of dermatophytosis and its correlation with MIC of the etiological agents isolated from such patients. METHODS: Retrospective analysis of 587 consecutive patients with dermatophytosis was done from March 2017 to March 2019. Demographic and clinical details of the patients were noted, along with the results of direct microscopy and fungal culture. The isolates were identified by sequencing the internal transcribed spacer region of rDNA. Antifungal susceptibility testing was performed following the CLSI M38 protocol. Mutation in the squalene epoxidase (SE) gene was detected by DNA sequencing and ARMS-PCR. Based on the culture-positivity and prescribed systemic antifungal, patients were categorised into Group I culture-positive cases treated with systemic terbinafine and Group II culture-positive cases treated with systemic itraconazole, each for a total period of 12 weeks. RESULTS: In the present study, 477 (81.39%) were culture-positive; however, 12 weeks follow-up was available for 294 patients (Group I-157 and Group II-137) who were included for statistical analysis. In both groups [Group I-37/63 (51.4%) and Group II-14/54 (58.3%)], a better cure rate was observed if the initiation of therapy was performed within <6 months of illness. Treatment outcome revealed that if therapy was extended for 8-12 weeks, the odds of cure rate are significantly better (p < .001) with either itraconazole (Odd Ratio-15.5) or terbinafine (Odd Ratio-4.34). Higher MICs for terbinafine were noted in 41 cases (cured-18 and uncured-23) in Group I and 39 cases (cured-16 and uncured-23) in Group II. From cured (Group I-17/18; 94.4% and Group II-14/16; 87.5%) and uncured (Group I-20/23; 86.9% and Group II-21/23; 91.3%) cases had F397L mutation in the SE gene. No significant difference in cure rate was observed in patients with Trichophyton spp. having terbinafine MIC ≥ 1or <1 µg/mL (Group I-p = .712 and Group II-p = .69). CONCLUSION: This study revealed that prolonging terbinafine or itraconazole therapy for beyond 8 weeks rather than the standard 4 weeks significantly increases the cure rate. Moreover, no correlation has been observed between antifungal susceptibility and clinical outcomes. The MIC remains the primary parameter for defining antifungal activity and predicting the potency of antifungal agents against specific fungi. However, predicting therapeutic success based solely on the MIC of a fungal strain is not always reliable, as studies have shown a poor correlation between in vitro data and in vivo outcomes. To address this issue, further correlation of antifungal susceptibility testing (AFST) data with clinical outcomes and therapeutic drug monitoring is needed. It also highlights that initiation of the treatment within <6 months of illness increases cure rates and reduces recurrence. Extensive research is warranted to establish a better treatment regime for dermatophytosis.
Asunto(s)
Antifúngicos , Itraconazol , Mutación , Escualeno-Monooxigenasa , Terbinafina , Tiña , Trichophyton , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Antifúngicos/uso terapéutico , Antifúngicos/farmacología , Farmacorresistencia Fúngica/genética , Itraconazol/farmacología , Itraconazol/uso terapéutico , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , Escualeno-Monooxigenasa/genética , Terbinafina/uso terapéutico , Terbinafina/farmacología , Tiña/tratamiento farmacológico , Tiña/microbiología , Resultado del Tratamiento , Trichophyton/efectos de los fármacos , Trichophyton/genéticaRESUMEN
BACKGROUND: Dermatophytosis impacts a significant portion of the global population. Recent shifts in the disease's presentation, severity and response to treatment, primarily due to emerging drug resistance, underscore the need for reliable assessment tools. The Dermatophytosis Severity Score (DSS) aims to standardise the evaluation of the disease's severity and monitor therapeutic responses. METHODS: In a cross-sectional pilot study, 25 adults with clinically diagnosed dermatophytosis were evaluated using the DSS. The study also aimed to establish the correlation of DSS with different stages of treatment, dermatophyte species and patient-reported outcomes. Participants were recruited from a dermatology outpatient clinic, and the DSS was applied at baseline, Weeks 4 and 8. The validity and reliability of the DSS were assessed using statistical measures, including Cronbach's alpha and intraclass correlation coefficient. RESULTS: The study comprised of a near-equal distribution of male (52%) and female (48%) patients, primarily within the age group of 20-39 years. A high recurrence rate of dermatophytosis (60%) was noted, and more than half of the patients (56%) had used topical steroids before presentation. The mean DSS significantly decreased from baseline to the final visit, mirroring the substantial reduction in the 5D itch scale and Dermatology Life Quality Index, with strong positive correlations observed between these measures. CONCLUSION: The DSS demonstrated high inter-rater reliability and internal consistency, indicating its utility as a reliable clinical tool for assessing dermatophytosis severity. The strong correlation of DSS with itch intensity and quality of life validates its role in patient-centered care. Continued use and further validation of the DSS are recommended to enhance dermatophytosis management and treatment outcomes.
Asunto(s)
Medición de Resultados Informados por el Paciente , Índice de Severidad de la Enfermedad , Tiña , Humanos , Masculino , Femenino , Adulto , Tiña/tratamiento farmacológico , Tiña/microbiología , Tiña/diagnóstico , Estudios Transversales , Proyectos Piloto , Adulto Joven , Persona de Mediana Edad , Reproducibilidad de los Resultados , Calidad de Vida , Antifúngicos/uso terapéuticoRESUMEN
Antifungal-resistant dermatophyte infections have recently emerged as a global public health concern. A survey of US infectious diseases specialists found that only 65% had heard of this issue and just 39% knew how to obtain testing to determine resistance. Increased clinician awareness and access to testing for antifungal-resistant dermatophytosis are needed.
Asunto(s)
Antifúngicos , Farmacorresistencia Fúngica , Tiña , Humanos , Antifúngicos/uso terapéutico , Antifúngicos/farmacología , Estados Unidos/epidemiología , Tiña/microbiología , Tiña/epidemiología , Tiña/tratamiento farmacológico , Encuestas y Cuestionarios , Arthrodermataceae/efectos de los fármacos , Pruebas de Sensibilidad MicrobianaRESUMEN
A 20-year-old man had developed dermatitis on his scalp and facial hair between his lower lip and chin, his 'soul patch', for one month. He initially presented to urgent care, where the dermatitis was attributed to Herpes simplex infection, for which he was treated with both oral valacyclovir and topical acyclovir. When no change was observed, he consulted his pediatrician, who prescribed oral clindamycin and referred him to dermatology. Physical examination revealed a crusted plaque on an erythematous and edematous base at the lower cutaneous border of the lower lip (Figure 1). Examination additionally revealed an erythematous scaling plaque on the left temporal area with associated flaking, tenderness, and hair loss and left-sided cervical lymphadenopathy. A fungal culture grew Trichophyton mentagrophytes, but a bacterial culture did not grow. Further investigation revealed that he had a dog; however, no other animal contact to account for a fungal reservoir was present. He was successfully treated with oral terbinafine for 6 weeks, plus ketoconazole 2% shampoo and ketoconazole 2% cream with complete reso-lution (Figure 2).
Asunto(s)
Antifúngicos , Humanos , Masculino , Antifúngicos/uso terapéutico , Antifúngicos/administración & dosificación , Adulto Joven , Cetoconazol/uso terapéutico , Cetoconazol/administración & dosificación , Terbinafina/uso terapéutico , Terbinafina/administración & dosificación , Tiña/tratamiento farmacológico , Tiña/diagnóstico , Animales , Perros , Naftalenos/uso terapéutico , Naftalenos/administración & dosificación , Preparaciones para el Cabello , Trichophyton/aislamiento & purificaciónRESUMEN
Trichophyton indotineae is a recently identified dermatophyte that frequently causes extensive and persistent dermatomycosis, particularly tinea corporis, tinea cruris, and tinea faciei. The infection is frequently encountered in countries of the Indian subcontinent and surrounding areas. In Europe, T. indotineae has mainly been detected in patients with an epidemiological link to the aforementioned regions. Unlike dermatomycoses caused by other dermatophyte species, infections caused by T. indotineae often exhibit treatment failure with commonly prescribed antifungal drugs. Reduced susceptibility to terbinafine is often observed in T. indotineae. In addition, reduced susceptibility to itraconazole has also been reported. Due to the extensive and persistent nature of the infection, as well as the reduced susceptibility to antifungal drugs, international experts recommend aggressive treatment of T. indotineae using a combination of oral and topical antifungals. Susceptibility testing may be warranted to guide treatment decisions. Early recognition of T. indotineae infections is crucial to prevent prolonged recurrences.
Asunto(s)
Antifúngicos , Tiña , Humanos , Antifúngicos/uso terapéutico , Tiña/tratamiento farmacológico , Tiña/diagnóstico , Trichophyton/aislamiento & purificación , Trichophyton/efectos de los fármacos , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/diagnósticoAsunto(s)
Antifúngicos , ADN de Hongos , Farmacorresistencia Fúngica , Análisis de Secuencia de ADN , Tiña , Trichophyton , Humanos , Tiña/microbiología , Tiña/tratamiento farmacológico , Tiña/diagnóstico , Trichophyton/genética , Trichophyton/efectos de los fármacos , Trichophyton/aislamiento & purificación , Trichophyton/clasificación , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Farmacorresistencia Fúngica/genética , ADN de Hongos/genética , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana EdadRESUMEN
Over the past few years, a recalcitrant dermatophytosis has been observed on the Indian subcontinent, including Sri Lanka, which has caused a major public health issue in the region. An emerging species, Trichophyton indotineae, first described as Trichophyton mentagrophytes ITS genotype VIII, is thought to be responsible for this fast-spreading, mostly terbinafine-resistant dermatophytosis. Recalcitrant dermatophytosis is a challenge to dermatologists, and knowing the causative species and antifungal sensitivity in the earlier stage of management would be invaluable. We report a case series of patients with dermatophytosis caused by T. indotineae in Sri Lanka. This is the first detection of this highly terbinafine-resistant strain in Sri Lanka, and existence of this species should be taken seriously by dermatologists and healthcare policymakers for better management of tinea infections and antifungal stewardship in the country.
Asunto(s)
Antifúngicos , Genotipo , Terbinafina , Tiña , Humanos , Tiña/tratamiento farmacológico , Tiña/microbiología , Sri Lanka , Antifúngicos/uso terapéutico , Antifúngicos/farmacología , Masculino , Femenino , Terbinafina/uso terapéutico , Adulto , Persona de Mediana Edad , Farmacorresistencia Fúngica , Trichophyton/genética , Trichophyton/aislamiento & purificación , Trichophyton/efectos de los fármacos , Trichophyton/clasificación , Arthrodermataceae/genética , Arthrodermataceae/aislamiento & purificación , Arthrodermataceae/efectos de los fármacos , Arthrodermataceae/clasificaciónAsunto(s)
Antifúngicos , Tiña , Trichophyton , Humanos , Masculino , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Australia , Farmacorresistencia Fúngica , Tiña/tratamiento farmacológico , Tiña/diagnóstico , Tiña/microbiología , Trichophyton/efectos de los fármacos , Trichophyton/aislamiento & purificación , AdultoAsunto(s)
Antifúngicos , Tiña , Trichophyton , Humanos , Tiña/diagnóstico , Tiña/tratamiento farmacológico , Tiña/microbiología , Antifúngicos/uso terapéutico , Antifúngicos/administración & dosificación , Antifúngicos/farmacología , Trichophyton/aislamiento & purificación , Trichophyton/efectos de los fármacos , Masculino , Farmacorresistencia Fúngica Múltiple , Femenino , Persona de Mediana EdadRESUMEN
Dermatophytosis is a critical sort of skin infection caused by dermatophytes. The long-term treatment of such skin infections may be improved through the application of nanotechnology. This study aimed to prepare griseofulvin zinc Nanohybrid emulsion (GF-Zn-NHE) to improve griseofulvin activity against dermatophytes and some opportunistic pathogenic yeasts and bacteria. The GF-Zn-NHE is prepared by ultra-homogenization ultra-sonication strategies and validated by UV-visible spectroscopy analysis that confirms presences of griseofulvin and Zn-NPs peaks at 265 and 360 nm, respectively. The GF-Zn-NHE has mean distribution size 50 nm and zeta potential in the range from -40 to -36 mV with no significant changes in size distribution and particle size within 120 day ageing. Fourier transform infrared spectroscopy spectrum confirmed the presence of griseofulvin and Zn-NPs stretching vibration peaks. Gamma ray has a negative influence on GF-Zn-NE production and stability. GF-Zn-NHE drug release 95% up to 24 h and 98% up to 72 h of GF was observed and Zinc 90% up to 24 h and 95% up to 72 h, respectively. High antimicrobial activity was observed with GF-Zn-NHE against dermatophytic pathogens in compare with GF, GF-NE, zinc nitrate and ketoconazole with inhibition zone ranged from 14 to 36 mm. The results have shown that the MIC value for Cryptococcus neoformans, Prophyromonas gingivalis and Pseudomonas aeruginosa is 0.125 mg ml -1 and for Trichophyton rubrum, L. bulgaricus and Escherichia coli value is 0.25 mg ml -1 and for Candida albicans, Malassezia furfur and Enterococcus faecalis is 0.5 mg ml -1 and finally 1 mg ml -1 for Streptococcus mutans. TEM of treated Cryptococcus neoformans cells with GF-Zn-NHE displayed essentially modified morphology, degradation, damage of organelles, vacuoles and other structures.
Asunto(s)
Antifúngicos , Arthrodermataceae , Emulsiones , Griseofulvina , Pruebas de Sensibilidad Microbiana , Zinc , Griseofulvina/farmacología , Griseofulvina/química , Zinc/farmacología , Zinc/química , Emulsiones/farmacología , Emulsiones/química , Antifúngicos/farmacología , Antifúngicos/química , Humanos , Arthrodermataceae/efectos de los fármacos , Tamaño de la Partícula , Bacterias/efectos de los fármacos , Bacterias/crecimiento & desarrollo , Tiña/microbiología , Tiña/tratamiento farmacológico , Espectroscopía Infrarroja por Transformada de Fourier , Nanopartículas del Metal/químicaRESUMEN
Tinea incognita (TI) can mimic other dermatoses, presenting a diagnostic challenge for dermatologists. In some uncertain cases, it is crucial to accurately identify the causative agent using internal transcribed spacer (ITS) sequencing. The global issue of drug-resistant dermatophytosis is increasing, with Trichophyton (T.) indotineae being the main cause. This study presents four cases of TI (diagnosed as eczema) by terbinafine-resistant T. indotineae strains and reviews the current global TI epidemiology based on geographical continent and related conditions. Furthermore, squalene epoxidase (SQLE)-associated resistance mechanisms are evaluated. Lesions caused by terbinafine-resistant T. indotineae strains do not respond to allylamine antifungals, thus allowing the infection to spread. Among T. indotineae isolates, the SQLE F397L substitution is the most prevalent mutation contributing to azole resistance. F397L and L393F replacements in SQLE were detected in all isolates that exhibited high-level resistance. L393S was seen in isolates with low-resistant strains. Interestingly, and for the first time, an L393F amino acid substitution in the SQLE gene product was detected in the Iranian clinical T. indotineae strain. Also, a genomics-based update on terbinafine resistance that focuses on T. indotineae is discussed in this study.
Asunto(s)
Antifúngicos , Farmacorresistencia Fúngica , Terbinafina , Tiña , Trichophyton , Humanos , Tiña/tratamiento farmacológico , Tiña/microbiología , Tiña/genética , Terbinafina/uso terapéutico , Farmacorresistencia Fúngica/genética , Antifúngicos/uso terapéutico , Antifúngicos/farmacología , Masculino , Trichophyton/genética , Trichophyton/efectos de los fármacos , Femenino , Mutación/genética , Persona de Mediana Edad , Adulto , Escualeno-Monooxigenasa/genética , Corticoesteroides/uso terapéuticoRESUMEN
BACKGROUND: Tinea faciei is a relatively uncommon dermatophyte infection. The studies, which included clinical forms, and isolated species of dermatophytes, are limited. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Asunto(s)
Antifúngicos , Arthrodermataceae , Microsporum , Tiña , Humanos , Estudios Retrospectivos , Femenino , Masculino , Tiña/microbiología , Tiña/tratamiento farmacológico , Tiña/epidemiología , Tailandia/epidemiología , Adulto , Antifúngicos/uso terapéutico , Persona de Mediana Edad , Arthrodermataceae/aislamiento & purificación , Arthrodermataceae/clasificación , Arthrodermataceae/efectos de los fármacos , Adulto Joven , Adolescente , Microsporum/aislamiento & purificación , Niño , Resultado del Tratamiento , Anciano , Dermatosis Facial/microbiología , Dermatosis Facial/tratamiento farmacológico , PreescolarRESUMEN
Tinea infections are caused by dermatophytes, except for tinea versicolor, which is caused by yeasts in the Malassezia genus. If available, potassium hydroxide preparation should be performed to confirm diagnosis of tinea capitis or onychomycosis. In some cases, fungal culture, UV light examination, or periodic acid-Schiff stain can be helpful. Topical drugs are effective for tinea corporis, tinea cruris, and tinea pedis. Tinea incognito is an atypical presentation that usually requires systemic treatment. Management of tinea capitis always requires oral drugs. Oral drugs are preferred for onychomycosis treatment but should not be prescribed without confirmation of fungal infection. Localized cases of tinea versicolor can be managed with topical drugs, but oral drugs might be needed for severe, widespread, or recurrent cases. Warts are superficial human papillomavirus infections. Common treatments include irritant, destructive (eg, cryotherapy), immune stimulant (eg, intralesional Candida antigen), and debridement and excision methods. Scabies infestation results in intensely itchy papules, nodules, or vesicles. Mites and burrows on the skin are pathognomonic but difficult to identify. Dermoscopy, particularly with UV light, can make identification easier. Topical permethrin and oral ivermectin are two of the most commonly used treatments. All household and close contacts should be treated regardless of the presence or absence of symptoms.