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Distribution and Species Composition of Causative Agents of Dermatophytoses in Lithuania

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The aim of the investigation was to determine diversity of the causative agents of dermatophytoses and characterize the epidemiological situation in Lithuania in 2001-2010. During this period, dermatophytes showed a tendency to decline. The following dermatophytes were isolated: Trichophyton (T.) Malamsten, Microsporum (M.) Gruby and Epidermophyton E. Lang. The number of nondermatophytes increased. At the beginning of the investigation, nondermatophytes accounted for 3.4%, whereas at the end their number grew up to 35.9%. Among the agents of dermatomycosis, the incidence of yeasts was observed to have a growing tendency. Among dermatophytes, T. rubrum was the most common pathogen, which in 2001 amounted to 55.7% and in 2010 to only 11.0%. Among the Microsporum species, M. canis and M. gypseum were detected. A small number of Epidermophyton species were observed in 2001-2003, which accounted for 0.2%-0.8% of all isolates. Tinea unguium (75.5%) was the most common type of dermatophytosis, followed by tinea capitis (11.7%), tinea corporis (9.2%) and tinea pedis (1.2%). In 2001-2010, dermatophytes showed a decreasing tendency, whereas the incidence of Candida yeasts and other causative agents of dermatomycosis greatly increased.
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ACTA DERMATOVENEROLOGICA CROATICA
Distribution and Species Composition of Causative
Agents of Dermatophytoses in Lithuania
Algimantas Paškevičius
1, 2
, Jurgita Švedienė
1
1
Institute of Botany, Nature Research Centre, Laboratory of Biodeterioration
Research,
2
Centre of Laboratory Diagnosis, Vilnius University Hospital Santariškių
Clinics, Laboratory of Microbiology, Vilnius, Lithuania
Corresponding author:
Algimantas Paškevičius
Institute of Botany, Nature Research Centre
Laboratory of Biodeterioration Research
Žaliųjų Ežerų Str. 49
LT-08406 Vilnius
Lithuania
algimantas.paskevicius1964@gmail.com
Received: January 16, 2012
Accepted: November 30, 2012
Acta Dermatovenerol Croat 2013;21(2):- CLINICAL ARTICLE
SUMMARY The aim of the investigation was to determine diversity of the
causative agents of dermatophytoses and characterize the epidemiologi-
cal situation in Lithuania in 2001-2010. During this period, dermatophytes
showed a tendency to decline. The following dermatophytes were isolated:
Trichophyton (T.) Malamsten, Microsporum (M.) Gruby and Epidermatophy-
ton E. Lang. The number of nondermatophytes increased. At the beginning
of the investigation, nondermatophytes accounted for 3.4%, whereas at the
end their number grew up to 35.9%. Among the agents of dermatomycosis,
the incidence of yeasts was observed to have a growing tendency. Among
dermatophytes, T. rubrum was the most common pathogen, which in 2001
amounted to 55.7% and in 2010 to only 11.0%. Among the Microsporum
species, M. canis and M. gypseum were detected. A small number of Epider-
mophyton species were observed in 2001-2003, which accounted for 0.2%-
0.8% of all isolates. Tinea unguium (75.5%) was the most common type of
dermatophytosis, followed by tinea capitis (11.7%), tinea corporis (9.2%)
and tinea pedis (1.2%). In 2001-2010, dermatophytes showed a decreas-
ing tendency, whereas the incidence of Candida yeasts and other causative
agents of dermatomycosis greatly increased.
KEY WORDS: dermatophytes, Trichophyton, Microsporum, Epidermophyton,
distribution
INTRODUCTION
Dermatophytosis is a type of dermatomycosis and
a worldwide common skin disease caused by micro-
scopic fungi dermatophytes belonging to the three
genera: Trichophyton, Microsporum and Epidermophy-
ton. Dermatophytes are able to infect the hair, nails and
skin and are divided according to the source of infection
into anthropophilic, zoophilic and geophilic species. It is
believed that the causative agents of dermatophytoses
have aected 20%-25% of the world population and it
seems that their incidence has a tendency to grow (1,2).
The endogenous and exogenous factors are very impor-
tant for the prevalence of dermatophytes. Exogenous
factors include geographic region, natural diseases
and infection source, type of occupation, and biologic
peculiarities of the fungus. The incidence of dermato-
phytes is also increased by endogenous factors, such
as a weakened immune system of the body, impaired
metabolism, chronic diseases, physiologic alterations,
intensive antibiotic therapy, insucient nutrition, and
many other factors that emaciate the body (3-5).
ACTA DERMATOVENEROLOGICA CROATICA
The main causative agent of dermatophytosis is
the anthropophilic fungus Trichophyton (T.) rubrum.
This dermatophyte, as well as T. mentagrophytes and
Epidermophyton occosum, are widely distributed in
economically underdeveloped and developing coun-
tries (6-8). From the geographic viewpoint, other spe-
cies of Trichophyton are less common and prevail in
certain regions, e.g., T. schoenleinii in Eurasia and Af-
rica continents, T. soudanense in Africa, T. violaceum in
Africa, Asia and Europe, and T. concentricum on Pacic
Islands, in the Far East and India (9-11).
Microsporum (M.) canis is a dominant dermato-
phyte in Central and South Europe, although it is also
found on other continents (12). M. audouinii prevails
in Africa, particularly in the northern and southern
parts; furthermore, this fungus has been spreading
into Europe and North America (13-15).
There are few data on the causative agents of der-
matophytosis in Lithuania (16). Some agents of der-
matophytosis are typical of certain geographic zones
and are not recorded in our country. Nevertheless, it
should be borne in mind that travelling of Lithuanian
residents and growing international migration will
lead to the emergence of new, alien to our country,
causative agents of dermatophytosis.
The main aim of the investigation was to deter-
mine diversity of the causative agents of dermato-
phytosis and characterize the epidemiological situa-
tion in Lithuania in 2001-2010.
MATERIALS AND METHODS
The study included 9135 outpatients and inpa-
tients with suspected fungal infections treated at
the Centre of Dermatovenereology, Vilnius University
Hospital Santariškių Clinics (VUH SC) from 2001 to
2010. The investigation was performed at the Labora-
tory of Microbiology, Centre of Laboratory Diagnosis,
VUH SC. A total of 4580 causative agents of dermato-
mycosis were isolated during the study period.
Accuracy of the methods and the quality of work
were ensured by the following factors: proper sam-
pling, microscopic detection of fungus in tested ma-
terial, isolation of pure culture and its identication,
as well as precise implementation of requirements for
reagents and preparation of media.
Primary samples were obtained from untreated le-
sions. Prior to sampling, the skin or nails were cleaned
with 70% ethanol and pathologic material was exam-
ined immediately upon sampling. To cultivate the
pathogenic fungi, standard media such as Sabouraud
agar and Corn Meal Agar (Oxoid, England) supple-
mented with antibiotics were used. The pathologic
material was plated on the agar with a microbiologi-
cal needle at 2-4 points at a distance of 1-2 cm. The
plates were cultivated in an incubator for 14-30 days
at a temperature of 28±2 ºC.
Identication of dermatophytes was performed
following the handbooks (17,18).
The data obtained were processed using Micro-
soft Excel XP (mean, standard deviation).
RESULTS
In this study, 9135 patients were investigated
for dermatomycoses and 4580 cases were positive.
The results showed that 35.6% to 67.8% of causative
agents of dermatomycoses, isolated from patients,
were able to grow on the media (Table 1). During ten
years, the dermatophytes showed a tendency to de-
cline. In 2001, dermatophytes accounted for 64.2%
and in 2011 for only 16.7% of all isolates. On the con-
trary, the number of nondermatophytes increased
from 3.4% at the beginning to 35.9% at the end of the
investigation. Additionally, a growing tendency was
also observed for the yeasts causing dermatomyco-
ses. These fungi accounted for 32.4% of all isolates at
the beginning and for 47.4% at the end of the inves-
tigation (Table 1).
During the study period, dermatophytes belong-
ing to the Trichophyton, Microsporum and Epider-
mophyton were isolated. The results showed a de-
creasing tendency for all dermatophytes. Trichophy-
ton species accounted for even 56.9% in 2001 and for
only 13% in 2010; meanwhile, the fungi of Microspo-
rum accounted for 7.0% in 2001 and for 3.7% in 2010.
A small number of Epidermophyton species were ob-
served in 2001-2003, which accounted for 0.2%-0.8%
of all isolates. It should be noted that Epidermophyton
species were not recorded in the 2004-2010 period.
Among dermatophytes, the most commonly iso-
lated pathogen was T. rubrum, which accounted for
55.7% in 2001 and for only 11.0% in 2010 (Table 2). De-
spite the fact that this fungus is considered one of the
main causative agents, a decrease in its incidence was
evident during the investigation. The following Tricho-
phyton species were isolated: T. mentagrophytes, T. in-
terdigitale, T. tonsurans and T. violaceum. T. mentagro-
phytes was less frequently found, nevertheless, during
the investigation, a growing tendency in its prevalence
was observed: in 2001, the incidence of this fungus was
0.2%, whereas in 2010 it was 1.4% of all isolates.
Among Microsporum species, M. canis and M. gyp-
seum were isolated, with the former accounting for
3.0%-8.2% of all isolates. During the investigation, E.
occosum was also found, accounting for 0.2%-0.8%
during the 2001-2003 period.
Paškevičius and Švediene et al. Acta Dermatovenerol Croat
Dermatophytoses in Lithuania 2013;21(2):-
ACTA DERMATOVENEROLOGICA CROATICA
Paškevičius and Švediene et al. Acta Dermatovenerol Croat
Dermatophytoses in Lithuania 2013;21(2):-
The clinical forms of dermatophytosis are shown
in Table 3. Tinea unguium (75.5%) was the most com-
mon type of dermatophytosis, followed by tinea ca-
pitis (11.7%), tinea corporis (9.2%) and tinea pedis
(1.2%). T. rubrum was the most common species caus-
ing all types of tinea, while T. violaceum and T. gyp-
seum caused tinea corporis, tinea capitis and tinea
faciei. Tinea capitis was the most prevalent type of M.
canis infection.
DISCUSSION
Fungal infections still constitute a major health
problem all over the world (19). During the 2001-2010
period, mycologically positive isolations conrmed by
cultures were found in 51.2% of all examined patients
suspected of dermatomycoses. In our study, yeasts
(50.3%) were the most common isolates, followed
by dermatophytes (35.4%) and nondermatophytes
(14.3%). Candida species typically infect the skin and
nails, and are part of the transient or commensal
ora in specic regions of the body. They are oppor-
tunistic pathogens that only become pathogenic to
humans under particular systemic and local condi-
tions. Candida and other yeasts can also be found as
saprophytes in nail tissue, directly invading the nail
plate only when host defenses are disturbed, such
as in immune suppression (1,20). Nondermatophyte
fungi have been considered secondary pathogens
of the nails that are already diseased, although they
may act as primary pathogens in a small number of
cases. The prevalence of nondermatophyte fungi as
nail invaders ranges between 1.5% and 17.6% (20,21).
Petanović et al. (22) report that nondermatophytes
accounted for 52.4% in 2002-2008. In Tehran, during
the 2006-2009 period, the causative agents of der-
matomycoses were dermatophytes (65.7%), yeasts
(30.1%) and nondermatophytes (4.2%) (23).
The most frequent etiologic agents of derma-
tophytoses in Lithuania were Trichophyton species.
These fungi can infect ngernails, toenails, spaces be-
tween ngers or toes, feet and skin in any area of the
body. Similar to other countries, in Lithuania T. rubrum
is the main causative agent of all types of tinea. This
dermatophyte prevails in many countries of Europe
(1,6,24,25). Our results show that dermatophytoses
Table 1.
Distribution of causative agents of dermatomycoses in Lithuania
Year Number of
patients
Isolated
fungi
Culturability Yeasts Dermatophytes Nondermatophytes
n n % % % %
2001 965 413 42.8 32.4 64.2 3.4
2002 1155 470 40.7 44.7 52.8 2.6
2003 819 374 45.7 50.8 43.3 5.9
2004 1052 375 35.6 62.9 33.1 4.0
2005 950 453 47.7 63.4 29.6 7.1
2006 936 489 52.2 54.0 35.8 10.2
2007 836 458 54.8 52.3 34.5 13.2
2008 724 491 67.8 46.8 20.6 32.6
2009 829 483 58.3 48.0 23.2 28.8
2010 869 574 66.1 47.4 16.7 35.9
Table 2. Spectrum of causative agents of dermatophytoses (%) in Lithuania 2001-2010
Species
Year
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Trichophyton rubrum 55.7 43.6 34.2 28.0 20.8 31.5 28.4 14.7 19.7 11.0
Trichophyton mentagrophytes 0.2 0.6 0.8 1.3 0.2 0 0.6 0.8 0.2 1.4
Trichophyton interdigitale 0.5 0 0 0 0 0 0 0 0 0.5
Trichophyton tonsurans 0 0.4 0.3 0 0.4 0 0.8 0.6 0.2 0
Trichophyton violaceum 0.5 0 0.3 0 0 0 0 0 0 0
Microsporum canis 7.0 7.8 6.4 3.7 8.2 4.3 4.7 4.4 3.0 3.8
Microsporum gypseum 0 0 0.3 0 0 0 0 0 0 0
Epidermophyton occosum 0.2 0.4 0.8 0 0 0 0 0 0 0
Yeasts 32.4 44.7 50.8 62.9 63.4 54.0 52.3 46.8 48.0 47.4
Others 3.4 2.6 5.9 4.0 7.1 10.2 13.2 32.6 28.8 35.9
ACTA DERMATOVENEROLOGICA CROATICA
caused by T. rubrum decreased from 55.7% in 2001 to
11% in 2010 of all isolates. In Lithuania, the decrease
of dermatophytoses caused by T. rubrum has been
observed since 1978 (26). T. mentagrophytes is also
found in our country and able to infect hair and skin.
This causative agent often causes purulent forms of
dermatophytoses. Infections caused by T. mentagro-
phytes were on an increase: from 0.38% in 1993-1998
to 1.4% of all isolates in 2010 (27). T. interdigitale is an
exceptionally anthropophilic species and was found
rarely, only in 2001 and 2010 accounting for 0.5% of
all isolates. In Europe, T. rubrum and T. interdigitale are
the main causative agents of tinea pedis and onycho-
mycosis (2,25,28). T. violaceum and T. tonsurans were
also found, but their incidence was not high. These
fungi are anthropophilic and can cause tinea capitis
and tinea corporis. In Lithuania, they are usually spo-
radic and during the study, they accounted for 0-0.8%
of all isolates. A similar tendency of T. violaceum and
T. tonsurans spread was observed in 1979-1998 (26).
Recently in Europe, infections caused by T. violaceum
and T. tonsurans have been increasing. In 1991-1993
in the United Kingdom, in Birmingham, T. tonsurans
accounted for 36%-72% of all tinea capitis cases. In
Sweden and Belgium, tinea capitis caused by T. vio-
laceum and T. tonsurans is on an increase (15,28). In
some continents, other very aggressive diseases have
been observed, such as favus caused by T. schoenleinii.
Causative agents of this disease have not been found
in Lithuania. T. schoenleinii has been mostly detected
in Eurasia and Africa (2). In Europe, this dermatophyte
prevails in the eastern part (29). Single cases of T. sou-
danense have been detected among immigrants in
Spain (30). Until 2000 in Lithuania, only single cases
of T. verrucosum and T. avum were recorded, whereas
in 2001-2010 they were not detected at all.
In the present work, M. canis was found to be the
main causative agent of tinea capitis in Lithuania. M.
canis aects mostly 6- to 14-year-old children and
only rarely adults. In 2001, M. canis accounted for
7.0% and in 2010 for 3.8% of all isolates. Until 2000,
M. gypseum was rarely found, whereas during the in-
vestigation period this fungus was detected in 2010.
In many European countries, such as Austria, Spain
and Greece, diseases caused by M. canis are known
to be increasing (31,32). Poland also reports a high
incidence of infections of tinea capitis and indicates
that the main causes of the infection are abandoned
cats (33).
Similar to the pattern of other causative agents of
dermatophytoses in Lithuania, a decreasing tenden-
cy in the prevalence of E. occosum was revealed. E.
occosum was detected in 2001-2003 and comprised
0.2%-0.8% of all isolates. This fungus is distributed all
over the world (2,11,32).
The results showed that in Lithuania all dermato-
phytes are decreasing, whereas the incidence of non-
dermatophytes and yeasts is on an increase. Today,
when large-scale migration takes place, tourism is
growing and economic conditions are changing, the
epidemiologic situation of dermatophytes can also
alter in the main.
CONCLUSION
In 2001-2010 in Lithuania, the causative agents of
dermatophytoses, i.e. the Trichophyton, Microsporum
and Epidermophyton fungi, showed a tendency to
decrease, whereas the incidence of yeasts and other
causative agents of dermatomycoses increased.
Table 3.
Dermatophytes isolated from 1502 patients with tinea infection (%)
Fungus Clinical form Percentage
Tinea
corporis
Tinea
unguium
Tinea
pedis
Tinea
capitis
Tinea
faciei
Tinea
manuum
Tinea
cruris
Trichophyton rubrum 2.3 74.9 1.1 1.7 0.3 0.3 0.7 81.4
Trichophyton gypseum 0.4 - - 0.1 0.2 - - 0.8
Trichophyton interdigitale - 0.2 0.06 - - - - 0.3
Trichophyton tonsurans 0.1 0.1 - 0.4 0.06 - - 0.7
Trichophyton violaceum 0.1 - - 0.06 0.06 - - 0.3
Trichophyton mentagrophytes 0.1 0.2 - 0.4 - - - 0.7
Trichophyton sp. 0.1 0.1 - - - - - 0.3
Microsporum canis 5.9 - - 9.1 0.06 - - 15.1
Microsporum gypseum 0.06 - - - - - - 0.06
Epidermophyton occosum - - - - - - 0.3 0.3
Total 9.2 75.5 1.2 11.7 0.8 0.3 1.0 100
Paškevičius and Švediene et al. Acta Dermatovenerol Croat
Dermatophytoses in Lithuania 2013;21(2):-
ACTA DERMATOVENEROLOGICA CROATICA
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Dermatophytoses in Lithuania 2013;21(2):-
... It is important to clarify that there is no reported predisposition due to types of hair. 1,1,3,7,11,58,60,63,75,93,104,114,117,120,122,123,127,158,163,164,166,169,171,179,182,183,[185][186][187][188][189] Although it has been observed that TC is more common in school-age children, there are reports of TC in new borns, although extremely rare. This finding suggests that when inflammatory lesions are seen in the scalps of neonates, TC should be suspected. ...
... 151,152,169,[172][173][174][175][177][178][179][180][181][182][183][184][185][186][187]189 In Western Europe, it was noted that M. canis is being replaced by T. violaceum, M. audouinii and T. mentagrophytes. 150,153,154,156,159,160,164,166,174 In Northern Europe, M. canis is the main causal agent followed by T. tonsurans, T. violaceum, and T. soudanense. 157,161,167,168 (Fig. 1). ...
Article
Dermatophyte infections are the most common fungal infections in humans; among them, tinea capitis (TC)-the most contagious fungal infection-is caused by anthropophilic, zoophilic, and geophilic dermatophytes.. The purpose of this systematic review was to determine the different aetiological variants involved in TC and the overall epidemiology of the causes of this infection in the last two decades. We searched the MEDLINE (PubMed) and Embase databases for articles published from July 2000 to August 2019 using the following search terms: 'Tinea capitis', 'Africa', 'America', 'Asia', 'Europe', 'Oceania', and the names of the countries on each continent. The flow of information through the different phases in this systematic review were depicted using a PRISMA flow diagram, which mapped the number of records identified, included, and excluded, and the reasons for exclusion. Our findings indicate that the frequency of different etiologic agents of TC in the reported studies varied globally, from 0.4-87.7% in Africa, 0.2-74.0% in North America, 0.0-91.2% in Eastern Asia, 0.0-69.0% in Eastern Europe, and 2.9-86.4% in Oceania. Microsporum canis is the most frequent reported zoophilic agent worldwide, while Trichophyton violaceum and Trichophyton tonsurans are the predominant anthropophilic agents. Over time, the frequency of these latter fungal infections has increased globally, and these fungi have become the major species globally. Anthropophilic transmission-the most prevalent type of transmission-could be explained by two factors: 1) the socioeconomic status of affected countries and population groups with associated risk factors; and 2) movement of populations importing new causes of infection to areas where they had not been encountered previously. We observed that intercontinental migration and travel; globalization; environmental, climatic, and ecological changes; and accelerated evolution of health technologies may influence the observed epidemiological changes and, consequently, contributed to the variations in the global status of TC.
... Trichophyton tonsurans is the major etiologic agent of TC in North America [20,[28][29][30][31][32][33], while Microsporum canis is the prevalent etiologic agent in South America [34][35][36][37][38][39][40]. In Europe, the causative agent of pediatric TC varies from T. tonsurans [41][42][43][44][45] to Trichophyton soudanense [46,47] and Trichophyton violaceum [48,49], although M. canis remains the major agent in most parts of the continent [21,[50][51][52][53][54][55][56][57][58][59][60][61]. In North Africa, M. canis and T. violaceum are implicated in most cases of pediatric TC [23,26,27,[62][63][64][65][66][67]. ...
Chapter
The growing incidence of scalp ringworm infection globally has generated a lot of public health interest. While the disease remains a common superficial infection among young schoolchildren, it has increasingly been reported in older persons. The disease is caused by some keratin-degrading filamentous fungi, called dermatophytes, especially by zoophilic or anthropophilic species. In this chapter, we describe the pathogenesis of dermatophytes, focusing on the ability of the pathogen to attach and invade the epidermal layers of the skin. The chapter also discusses the epidemiologic spread of the disease in different parts of the world, particularly its growing incidence in older people and infants. When not properly diagnosed or promptly treated, ringworm infection can cause complications leading to other conditions such as folliculitis, alopecia, and dermatophytid reactions. The chapter highlights the complications of the infection, as well as current methods used in the diagnosis, treatment, and community management of the infection. Overall, it provides a recent and comprehensive overview of Tinea capitis and may serve as a useful resource for educators, clinicians, and students, as well as in helping to formulate adequate health policies for managing Tinea capitis infection.
... Epidemiology of infectious Candida (C.) species was not well documented in Lithuania. Several studies have reported the prevalence of Candida species in dermatomycosis and onychomycosis (9)(10)(11). Paškevičius et al. ...
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The aim of this study was to determine distribution of the Candida (C.) species in onychomycosis and analyses in vitro susceptibility to fluconazole and itraconazole. In recent years, cases of onychomycosis in Lithuania caused by Candida have increased significantly. In the period between 2009 and 2016, a total of 8149 clinical cases (outpatients and inpatients) were investigated at the Vilnius University Hospital Santaros Clinics (VUH SC). Candida yeasts were identified using VITEK 2 (BioMerieux, France) and IVD Maldi biotyper 2.3 (Bruker Daltonik GmbH, Germany), automated systems for identification of yeasts. The antifungal susceptibility to the Candida species were determined by disc diffusion. Candida spp. were the most frequently isolated pathogens in onychomycosis during the investigation period. The main species in onychomycosis were C. albicans (38.6%), followed by C. krusei (33.7%), C. tropicalis (11.1%), C. parapsilosis (7.9%), and other Candida (8.7%). The different antifungal susceptibility patterns among Candida species confirm the need to perform antifungal susceptibility in vitro testing of yeasts from patients with onychomycosis.
... As might be expected, there are certain differences in epidemiology of tinea corporis, sometimes even between bordering countries or within one country. While in Lower Silesia, T. rubrum was the most prevalent agent, in Lithuania [18] most cases were due to M. canis. In Teheran, Iran, T. tonsurans was most often reported, however in the northeast of Iran T. mentagrophytes was the main etiological agent [19]. ...
Article
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Introduction: Superficial mycosis is one of the most common diseases worldwide, however its epidemiology is changing over time. Aim: To present epidemiological data of the skin fungal infections diagnosed in the years 2011-2016 in Lower Silesia. Material and methods: A total of 11 004 patients with a clinically suspected superficial mycosis were investigated. Skin scrapings, nail clippings and plucked hair were examined with a direct microscopy, Wood's lamp and culture. Particular species were identified via polymerase chain reaction (PCR) examination. The lesions suspected for pityriasis versicolor were screened for Malassezia with Wood's lamp and direct microscopy. Results: Dermatomycosis was diagnosed in 1653 (15.00%) patients with 1795 fungi identified. 1858 specimens were indicative of fungal infection including dermatophytes, yeasts and moulds. Out of 924 cases of dermatophytic infections (51.48%), Trichophyton rubrum accounted for the majority (71.75%) and was followed by Trichophyton tonsurans (16.77%). Among the yeasts (716; 39.89%), Candida spp. was the most common agent identified (521; 67.66%). The sites affected most often were toenails (956; 51.45%) and fingernails (319; 17.17%). In paediatric population the most common diagnosis was tinea corporis (60, 41.10%). Conclusions: Our study revealed that toenail onychomycosis remains the most common superficial mycosis and T. rubrum is the most common pathogen. However, in a longer period of observation, a decrease in the number of tinea capitis cases and an increase in infections caused by T. tonsurans were noticed. Observed changes indicate the need for continuing studies to detect the upcoming epidemiological trends.
... 4 This fungus is attributed to main causative agents of tinea pedis and onychomycosis in Lithuania. 5 As soon as the infection becomes systematic, even lethal outcome may follow if no treatment is performed. 6 Apart from the invasive treatment methods such as surgery, the chemical antifungal treatments are widely used resulting in an up to 80% successful clinical outcome. ...
Article
The dermatophytes infect the skin by adherence to the epidermis followed by germination, growth and penetration of the fungal hyphae within the cells. The aim of this study was to investigate the efficacy of the pulsed electric fields (PEF) of controlled inactivation of Trichophyton rubrum (ATCC 28188). In this work we have used bursts of the square wave PEF pulses of different intensity (10-30 kV/cm) to induce the irreversible inactivation in vitro. The electric field pulses of 50 µs and 100 µs have been generated in bursts of 5, 10 and 20 pulses with repetition frequency of 1 Hz. The dynamics of the inactivation using different treatment parameters were studied and the inactivation map for the T. rubrum has been defined. Further, the combined effect of pulsed electric fields with the antifungal agents itraconazole, terbinafine and naftifine HCl was investigated. It has been demonstrated that the combined effect results in the full inactivation of T. rubrum colony. This article is protected by copyright. All rights reserved.
... C. albicans is the predominant cause of invasive fungal infections in many countries (Odds 2010;Sardi et al. 2013a, b;Alam et al. 2014;Pappas 2006). From 2001-2010 the incidence of dermatomycosis caused by Candida yeasts increased in Lithuania (Paškevičius and Švedienė 2013). ...
Article
Pathogenic fungi cause many life-threatening infections, especially among individuals with immune system dysfunction. The antifungal drugs commonly used to suppress fungal pathogens can result in long-lasting and toxic therapy. In this work, irreversible electropermeabilization was used to investigate the dynamics of the decrease in Candida albicans colony vitality after application of a pulsed electric field (PEF) and use of antifungal drugs. The fungi were subjected to single 250-µs to 2-ms (0.5-2.5 kV/cm) pulses or repeated short 5-µs pulses, and efficacy was compared. It was shown that electropermeabilization combined with antifungal agents results in rapid and more effective treatment, eliminating more than 90 % of C. albicans colony-forming units in a single procedure, which is advantageous in biomedicine. It was also observed that, because of application of PEF and use of the antifungal agents, the Candida cells form cell aggregates and average live cell size is reduced by as much as 53 %.
Chapter
In Germany, the anthropophilic dermatophyte Microsporum ferrugineum has been rarely isolated for the last 50 years. Currently, started in 2016, M. ferrugineum strains were occasionally identified although this dermatophyte is difficult to differentiate from Microsporum audouinii or Microsporum canis. Furthermore, a small outbreak of infections was observed in Germany. From July 2016 until April 2019, 19 patients with M. ferrugineum infections were diagnosed all over Germany. This included 15 both culture and molecular confirmed cases, and four cases exclusively diagnosed based on sequencing of fungal DNA. Cultural analysis revealed slowly growing colonies with white thallus and peripheral yellow-brownish submerged hyphae bundles. The reverse side of the furrowed colonies showed cream color to yellow staining. Microscopically, big spherical and oval double-walled intercalary-localized chlamydospores, typical “bamboo” hyphae, and acute-angled branched hyphae were observed. Fungal culture material from all isolates was identified by polymerase chain reaction (PCR), Sanger sequencing of the internal transcribed spacer (ITS) region, and/or the translation elongation factor (TEF)-1α gene. Results were referred to the M. ferrugineum CBS 497.48 strain (Centraalbureau voor Schimmelcultures CBS, Utrecht, The Netherlands, www.westerdijkinstitute.nl). Patients were children and adolescents under 18 years, mainly males. Suggested source of infection was martial sports, e.g., wrestling, judo, and boxing. Surprisingly, a significant part of affected patients were Germans of Russian descent. A migrant 3-year-old boy from Afghanistan suffering from Tinea capitis was also among the patients. Another strain was isolated from a 10-year-old wrestler with suspected Tinea corporis. There was no migration background or contact to foreigners, the boy did not stay abroad. The mycological challenge is the cultural identification of M. ferrugineum due to the morphological similarity not only to M. canis, but also to M. audouinii, and Trichophyton verrucosum. Phylogenetic analysis of ITS region of ribosomal DNA and the TEF-1α gene was performed using MEGAX, the statistical maximum likelihood method, and the Tamura-Nei substitution model. Bootstrapping was performed with 1000 replicates. The alignment of the ITS sequences (partial 18.S, ITS1, 5.8S, ITS2, partial 28.S) with known sequences deposited at the Genbank database available at the National Center for Biotechnology Information (NCBI), Bethesda, Maryland, U.S., clearly identified the M. ferrugineum strains after cultural analysis. The phylogenetic analysis of the dermatophytes—the dendrogram of fungal strains—demonstrated the genetic differences between M. ferrugineum strains and M. audouinii or M. canis. The three species could be clearly distinguished from each other. In particular, sequencing of the TEF-1α gene allowed a better differentiation between M. ferrugineum and M. audouinii or M. canis than sequencing of the ITS 2 region.
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The growing resistance of bacteria to conventional antibiotics elicited considerable interest to non-typical drugs. In this study, antimicrobial investigations were performed on low-size dispersion cobalt ferrite nanoparticles (Nps) fabricated by co-precipitation approach in several average sizes, in particular, 15.0, 5.0, and 1.65 nm. A variety of experimental tests demonstrated that the size of these Nps is determinant for antimicrobial efficiency against S. cerevisiae and several Candida species, in particular, C. parapsilosis, C. krusei, and C. albicans. The small and ultra-small fractions of CoFe2O4 Nps possess especially strong antimicrobial activity against all tested microorganisms. The possible reasons are discussed. Nps were characterized by means of transmission and high-resolution transmission electron microscopy, X-ray diffraction, energy dispersive X-ray spectroscopy and atomic force microscopy, chemical analysis and magnetic measurements. Graphical Abstract
Article
Objective Dermatophytosis is the most frequent fungal infection all over the world and its frequency is constantly increasing. The aim of this study was to evaluate clinical features and epidemiological trends of dermatophytosis over the years 2010 to 2014 in Tehran, Iran. Patients and methods A total of 13,312 patients clinically suspected of cutaneous fungal infections were examined. Skin scales, plucked hairs, nail clippings and sub-ungual debris were examined by direct microscopy and culture. Dermatophyte species were identified at the species level by a combination of morphological and physiological criteria. Results Direct microscopy confirmed a contamination rate of 19.7% (2622/13,312 cases) of which 1535 cases (58.5%) were culture positive distributed in male (1022 cases) and female (513 cases). The most commonly infected age group was the 30–39 years old. Tinea pedis (30.4%) was the most prevalent type of dermatophytosis followed by tinea cruris (29.8%) and tinea corporis (15.8%). Epidermophyton floccosum (31%) was the most prevalent causative agent, followed by Trichophyton rubrum (26.2%) and Trichophyton mentagrophytes (20.3%). Conclusion Our results showed considerable distribution of dermatophytosis from zoophilic, anthropophilic and geophilic species among population with diverse age groups. Although anthropophilic fungi such as T. mentagrophytes, E. floccosum, and T. rubrum were the main etiologic agents of dermatophytosis, the prevalence of T. verrucosum showed a meaningful increase over the years, which highlights the importance of rural dermatophytosis mainly transmitted from large animals. This noticeable information improves our current knowledge about dermatophytosis and assists to establish effective prevention and therapeutic strategies to overcome the disease.
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The ultimate benchtool for diagnostics. All currently 660 fungi proven infectious agents are full described, many with beautiful photo-plates in full color and with informative line-drawings. Ample information is provided on pathogenicity, biosafety levels and antifungal susceptibility, supported by over 7000 references. Chapters on diseases, diagnostic methods and therapy are added. With more than 3000 citations in the literature, the Atlas is unchallenged as an aid in hospital diagnostics
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Dermatophytic fungal infections are one of the most common infectious diseases in the world and are among the most commonly diagnosed skin diseases in Africa. They are caused by several dermatophyte species made up of three genera: Trichophyton, Microsporum and Epidermophyton. The pathogen spectrum and the clinical manifestations are totally different from those seen in other continents. The hot and humid environment in Africa is probably the major reason for their high prevalence. In this era of rapid movement from one continent to another and the increasing mobility of humans, agents of dermatophytic infections can no longer be said to be restricted within a given geographical area. This implies that an infection contracted in one part of the world may become manifest in another country where the etiological agent is not normally found. Therefore, updating our knowledge of the geographical distribution of the predominant causative agents of dermatophytosis will provide a better understanding of the risk factors and future epidemiologic trends. This review discusses the clinical signs and manifestations of dermatophytoses and attempts to summarize the current epidemiological trends on dermatomycosis of glabrous skin in Western Africa.
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Scopulariopsis (S.) brevicaulis (Saccardo) Bainier 1907 is a ubiquitous fungus frequently isolated as a saprophyte from various layers of the soil, wood, straw, paper, food, and occasionally in animals and humans. This nondermatophyte filamentous fungus is multiresistant and is frequently associated with onychomycosis in humans. In the last two decades, the number of reports on its pathogenic role in different localized and disseminated infections has been on an increase. Identification was done by native KOH microscopy and culture on the Mycobios selective agar (Biolife). From January 1, 2002 till January 23, 2008, a total of 7161 samples were examined by use of mycology methods; S. brevicaulis accounted for 39 (2.2%) of 1834 (25.6%) positive samples. During the study period, S. brevicaulis was isolated from nail, skin and scalp scrapings of 39 patients (17 male and 22 female), mean age ( SD) 43.920.7 (range 8-87) years. Specimens were most frequently obtained from the foot (n=16; 41%), i.e. great toe nail in 10 and other foot areas in 6 cases, followed by palm and fingers in 8 (20.5%), scalp in 3 (7.7%) and other parts of the body in 12 (30.8%) cases. Most of the study subjects lived in a rural setting (n=22; 56%), working as farmers in close contact with the soil and domestic animals. Seventeen (44%) subjects were from urban setting (n=9) or unknown place of residence (n=8). Underlying risk factors were present in 29 (74%) of 39 study subjects, some of them with multiple risk factors. Besides close contact with the soil, the most common predisposing factors were various dermatoses (atopic dermatitis, psoriasis, dysseborrhea, etc.), lower extremity circulatory insufficiency, trauma, microtrauma, and metabolic disorders. Although the clinical picture of onychomycosis caused by S. brevicaulis shows some specific features, timely sampling for mycology is crucial to verify the diagnosis and to identify the causative agent prior to the introduction of appropriate therapy for dermatomycosis.
Article
Tinea capitis (scalp ringworm) is the most common dermatophyte infection of the scalp affecting mainly children and rarely adults. The epidemiology of tinea capitis varies within different geographical areas throughout the world. It may occur sporadically or epidemically and an increase in its incidence has been noted over the last few decades. The aim of the study is to obtain a general overview of the current state and changing pattern of tinea capitis in Europe. According to the literature, there has been a significant increase in the incidence of tinea capitis and a change in the pattern of infectious agents in particular. Microsporum canis, a zoophilic dermatophyte, is still the most common reported causative agent of tinea capitis in Europe. The countries reporting the highest incidence of M. canis infections are mainly in the Mediterranean but also bordering countries like Austria, Hungary, Germany and Poland. Besides the increase in Microsporum-induced tinea capitis, there is a shift towards anthrophilic tinea capitis mainly in urban areas in Europe. The largest overall increase with anthropophilic dermatophytes has been noted with Trichophyton tonsurans mainly in the UK and with Trichophyton soudanense and Microsporum audouinii in France. The occurrence of anthropophilic infections seems to be geographically restricted and is possibly linked to the immigration from African countries. Children (aged 3–7 years with no predilection of gender) remain the most commonly affected, but recently an increase of tinea capitis has been observed in adults and in the elderly. The results of the study clearly demonstrate the importance of diagnosing and proper treatment of mycotic scalp infection in the Europe. If not diagnosed and treated properly, its prevalence might reach epidemic proportions in the near future. Therefore, an increased level of surveillance (screening in schools), and a highly effective interdisciplinary cooperation among general practitioners, mycologists, veterinarians and dermatologists are strongly recommended.
Article
Objective Dermatomycoses are considered as an important group of fungal diseases with worldwide distribution. This study was performed to analyze the spectrum of dermatomycoses in Tehran during a 4-year period from 2006 to 2009. Patients and methods A total of 12461 patients were investigated for mycoses. Of these, 4871 cases were positive. Plucked hairs, skin and nail scraping were examined and identified by direct microscopy and culture. Results From 4871 patients, 4015 strains were identified including dermatophytes (2635 cases, 65.7%), yeasts (1210 cases, 30.1%) and molds (170 cases, 4.2%). Among the dermatophytes, the most common pathogen isolated was Trichophyton rubrum (28.7%), followed by Epidermophyton floccosum (25.0%), Trichophyton mentagrophytes (23.8%) and Trichophyton tonsurans (11.5%). Among the yeast-like fungi, a predominance of Candida spp. (54.5%) was observed. Of these, 29.3% were C. albicans. Aspergillus spp. was the most prevalent isolated mold (71.8%). Conclusion Our results have demonstrated epidemiologic trends of dermatomycoses and their causative agents in recent years in comparison with the past records in Tehran and other parts of the world. This noticeable information can help to develop fungal diagnosis as well as more effective therapeutic methods.
Article
Fungal infections of the skin and nails are a common global problem. The high prevalence of superficial mycotic infections shows that 20-25% of the world's population has skin mycoses, making these one of the most frequent forms of infection. Pathogens responsible for skin mycoses are primarily anthropophilic and zoophilic dermatophytes from the genera Trichophyton (T.), Microsporum (M.) and Epidermophyton (E.). There appears to be considerable inter- and intra-continental variability in the global incidence of these fungal infections. Trichophyton rubrum, T. interdigitale (mentagrophytes var. interdigitale), M. canis, M. audouinii, T. tonsurans and T. verrucosum are the most common, but the attack rates and incidence of specific mycoses can vary widely. Local socio-economic conditions and cultural practices can also influence the prevalence of a particular infection in a given area. For example, tinea pedis (athlete's foot) is more prevalent in developed countries than in emerging economies and is likely to be caused by the anthropophilic germ T. rubrum. In poorer countries, scalp infections (tinea capitis) caused by T. soudanense or M. audouinii are more prevalent. This review summarises current epidemiological trends for fungal infections and focuses on dermatomycosis of glabrous skin on different continents.
Article
Cutaneous fungal infections are a major public health problem. The distribution of the dermatophytoses varies between countries and geographical areas. The aim of this study was to determine the incidence, epidemiology, etiology, and clinical course of the dermatophytoses caused by anthropophilic fungi in Cadiz, Spain, over the past 12 years. The study, conducted between 1997 and 2008, included 2,235 samples from lesions of the skin, hair, and nails of 2,220 patients with a clinical suspicion of mycosis. Samples were examined by microscopy using potassium hydroxide and were cultured on mycological media. The dermatophytes were identified by their macroscopic and microscopic characteristics. Cultures were positive in 283 cases (12.7%). Anthropophilic dermatophytes (53.3%) were more common than zoophilic (41.3%) and geophilic (5.3%) dermatophytes. Trichophyton rubrum (38.2%) was the predominant pathogen isolated, followed by Microsporum canis (22.3%) and Trichophyton mentagrophytes (15.5%). Five other species of anthropophilic fungi were identified: Trichophyton tonsurans (5.6%), Trichophyton violaceum (4.9%), Epidermophyton floccosum (2.8%), Trichophyton soudanense (1.0%), and Trichophyton schoenleinii (0.7%). Infections caused by the anthropophilic fungi included tinea unguium (29.1%), tinea corporis (25.8%), tinea pedis (19.2%), tinea cruris (11.9%), tinea capitis (5.3%), and tinea faciei (3.3%). The principal fungus responsible for dermatomycosis in Cadiz was T. rubrum, and its incidence has been rising since 2000. The prevalence of other anthropophilic fungi, such as T. tonsurans and T. violaceum, has increased, though this is not directly related to immigration. E. floccosum, T. soudanense, and T. schoenleinii are isolated occasionally.
Article
Fungal infections of the skin, hair, and nails are common worldwide, and their incidence continues to increase. The principal causative agents are dermatophytes, and their geographic distribution is variable. This is reflected in the differing patterns of dermatophytoses seen in different parts of the world. The epidemiology of dermatophyte infection has changed as a result of migration, lifestyle, drug therapy, and socioeconomic conditions. This contribution discusses global patterns of dermatophyte infection and the changing epidemiology of the causative agents.
Article
Onychomycosis is a frequent nail disease caused by dermatophytes, yeasts, and nondermatophyte molds. Trichophyton rubrum, T mentagrophytes, and Epidermophyton floccosum are the most common etiologic agents worldwide. Candida spp are the most frequent among the yeasts. Diagnosis is corroborated by direct microscopic examination, culture, and histomycology with periodic acid-Schiff stain. Other new methods of diagnosis are discussed. Treatment is based on oral antifungals: terbinafine, itraconazole, and fluconazole, including other emerging triazole drugs. Therapeutic outcome with ciclopirox and amorolfine lacquers alone and combined with systemic therapy are also reviewed, as well as the new nail enhancers and physical and chemical removal of the diseased nails.