Epidemiology of dermatomycoses of humans in central Poland. Part III. Tinea pedis

The total number of dermatophytoses (7393) included 2025 (27.4%) tinea pedis cases. Etiological factors in descending order by contribution were: Trichophyton rubrum (41.7%), Trichophyton mentagrophytes var. granulosum (30.9%), T. mentagrophytes var. interdigitale (10.0%), Epidermophyton floccosum (7.4%), T. mentagrophytes var. quinckeanum (6.9%), Trichophyton tonsurans (2.3%), Trichophyton spec. (0.4%), Trichophyton terrestre (0.2%), Trichophyton violaceum (0.1%). In the years 1987-93 the incidence of tinea pedis substantially increased over 1994-96. Today tinea pedis is second by incidence among all clinical forms of dermatophyte infections of skin and skin appendages in the Lód? region.     

Epidemiology of dermatomycoses of humans in central Poland. Part V. Tinea corporis

The total number of dermatophytoses (7393) included 2204 (29.8%) cases of tinea glabrosa. Etiological factors in descending order were: Microsporum canis (23.5%), Trichophyton mentagrophytes var. granulosum (21.6%), Trichophyton rubrum (17.8%), Trichophyton tonsurans (10.4%), Epidermophyton floccosum (7.7%), T. mentagrophytes var. quinckeanum (6.0%), Microsporum gypseum (5.3%), Trichophyton violaceum (3.7%), T. mentagrophytes var. interdigitale (2.3%), Microsporum equinum (0.7%), Trichophyton verrucosum (0.4%), Trichophyton spec. (0.4%), Microsporum cookei (0.14%). At present tinea glabrosa is dominant among all clinical forms of dermatophyte infections of skin and skin appendages in the Lód? region.     

Case Report. Trichophyton mentagrophytes var. nodulare causing tinea pedis

The identification of Trichophyton mentagrophytes var. nodulare is described, based on a strain recently isolated from tinea pedis. Different culture media and physiological tests were used in order to compare this strain with related strains. The main characteristics of T. mentagrophytes var. nodulare were its deep yellow-orange pigmentation, which was released from the mycelium, the flat growth of its colonies and the formation of nodular bodies. Supplementation of Sabouraud glucose agar with 3% NaCl reduced the aerial mycelium and stimulated the formation of conidia. Until now an identification of T. mentagrophytes var. nodulare based on DNA-patterns has not been published. Trichophyton mentagrophytes var. nodulare is supposed to be an anthropophilic dermatophyte causing ordinary tinea and onychomycosis. The low number of reports indicates that it is a very rare variety.     

Dermatophyte infections in the Ljubljana region, Slovenia, 1995-2002

We studied dermatophyte infections in patients, examined in the Mycological Laboratory of the Department of Dermatology, University Medical Centre Ljubljana during the period 1995-2002. A total of 42,494 samples were collected from 33,974 patients suspected to have dermatomycosis. Dermatophytes were identified in 8286 (71.2%) positive cultures. Microsporum canis was the most frequent dermatophyte isolated (46.8%), followed by Trichophyton rubrum (36.7%), T. mentagrophytes var. interdigitale (7.9%) and T. mentagrophytes var. mentagrophytes (4.9%). Less frequently isolated were M. gypseum, T. verrucosum, Epidermophyton floccosum, T. tonsurans and T. violaceum. The most common dermatophyte infections included tinea corporis, onychomycosis, tinea pedis and tinea faciei. Zoophilic dermatophytes were most commonly recovered from children and adolescents with tinea capitis, tinea corporis and tinea faciei. Anthropophilic species were identified mostly in adults with tinea pedis, onychomycosis and tinea inguinalis. During the period studied, we recorded a decline in the rate of M. canis infections, while infections produced by T. rubrum increased in frequency.     

Onychomycosis is no longer a rare finding in children

Onychomycosis was considered uncommon in children. This survey was carried out to estimate the frequency of fungal nail infections in children and adolescents (0-18 years of age) attending our clinic in the last decade and gain more insight into the aetiology and clinics of this entity in the paediatric age group. This study is based on data obtained from 2320 children and adolescents suspected of superficial fungal infection. Onychomycosis was diagnosed in 99 cases, representing 19.8% of all mycologically confirmed superficial mycoses (500 cases) in our material. Fingernail onychomycosis was recognized in 52 (10.4%) cases; children under 3 years of age were predominantly involved. Candida albicans was the most common isolated pathogen. Toenail onychomycosis concerned 47 (9,4%) patients; the incidence increased steadily with increasing age. Trichophyton rubrum was the most common aetiological agent with respect to toenail infection followed by T. mentagrophytesvar. interdigitale and T. mentagrophytes var. granulosum. The majority of fungal nail infections were characterized clinically by distal and lateral subungual onychomycosis. The growing trend towards the frequency of toenail and fingernail onychomycosis in children and adolescents was found in the last decade in north Poland. The results of our study show that onychomycosis in prepubertal children is not exceptional and should be considered in differential diagnosis of nail plate disorders.     

Retrospective study of onychomycosis in Italy: 1985-2000

Cases of onychomycosis diagnosed by mycological examination in three mycology units (Florence, Siena and Milan) of central and northern Italy over the 15-year period, 1985-2000, were studied retrospectively. The number of cases was 4046 (1952 women, 2094 men). Dermatophytes were isolated in 2859, yeasts in 655 and moulds in 532 cases. The most frequent dermatophyte was Trichophyton rubrum (87%), followed by T. mentagrophytes var. interdigitale (10%). Candida albicans (93.2%) was the prevalent yeast. Moulds were mainly Scopulariopsis brevicaulis (48.6%) and Aspergillus spp. (25.2%). Dermatophytes and moulds most commonly infected the toenails, yeasts the fingernails.     

Tinea capitis in Basrah, Iraq.

Tinea capitis is the most common type of dermatophytosis constituting 35.2% (173/491) of all cases of dermatophytosis seen at two out-patients dermatological clinics of the Basrah General Hospital and at two private dermatological clinics between October 1994 and December 1995. Males were more commonly affected than females represented by 60 and 40%, respectively. Out of 173 mycologically positive cases, 143 specimens were culture-positive, represented by five dermatophyte species; Trichophyton violaceum was the most frequent causative agent (38.5%), followed by Trichophyton verrucosum (28.7%), Microsporum canis (26.5%), Trichophyton mentagrophytes var. mentagrophytes (5.6%) and Microsporum gypseum (0.7%). Six atypical cases appeared as cases of seborrheic dermatitis or dandruff and were proved to be atypical cases of tinea capitis caused by T. violaceum.     

Onychomycosis observed in children over a 20‐year period

There are few reports studying the aetiology of onychomycosis in children in Spain. To study childhood dermatophyte onychomycosis, a retrospective study of children was carried out, who were <16 years of age with dermatophyte onychomycosis diagnosed between 1987 and 2007. Of 4622 nail samples from 3550 patients, 218 came from 181 children up to 16 years old. Onychomycosis caused by dermatophytes was demonstrated in 28 (15.5%) cases. Trichophyton rubrum (18 cases) was the most prevalent species, followed by Trichophyton tonsurans (five cases), Trichophyton mentagrophytes var. interdigitale (four cases) and Trichophyton mentagrophytes var. mentagrophytes (one case). Concomitant dermatophytosis at other locations was confirmed in seven cases (25%). Toenail onychomycosis was associated with tinea pedis in five cases. Distal and lateral subungual onychomycosis was the most common clinical pattern. The superficial white type was found in two cases of toenail onychomycosis caused by T. rubrum and T. tonsurans. During the period of study, only 5.1% of all investigated people were children up to 16 years. The prevalence of onychomycosis tended to increase over the years and represented 15.5% of all nail dystrophies in children. Therefore, dermatologists must consider onychomycosis in the differential diagnosis of nail alterations in children and always perform a mycological study to confirm the diagnosis.     

Epidemiological trends in skin mycoses worldwide

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.     

An Epizootic of Trichophyton mentagrophytes Infection in Laboratory Mice in Nigeria/ Epizootie durch Trichophyton mentagrophytes bei Laboratoriumsmäusen in Nigeria

Summary: An epizootic of dermatophytosis due to Trichophyton mentagrophytes in a colony of laboratory mice is reported of a total of four hundred white laboratory mice (5–8 weeks old) investigated over a period of six weeks at two animal houses in Enugu and Nsukka, twenty seven (approx. 7%) showed active ringworm lesions yielding pure cultures of T. mentagrophytes. The dermatophyte was also recovered from 16 (24.2%) out of 66 apparently healthy mice investigated for carriage of the dermatophyte. A detailed study of the cultural and morphological characteristics of the isolates showed that they belonged to var. mentagrophytes. No case of ringworm infection was recorded amongst the animal house staff.
Zusammenfassung: Bericht über epizootisches Auftreten einer Trichophyton mentagrophytes-Infektion bei Laboratoriumsmäusen, die in einer Tierkolonie gehalten wurden. Von insgesamt 400 weißen Labormäusen (5–8 Wochen alt), die während 6 Wochen in zwei Tierhäusern in Enugu und Nsukka untersucht wurden, zeigten 27 (ca. 7%) aktive Mykoseherde, aus denen T. mentagrophytes in Reinkultur isoliert werden konnte. Der gleiche Dermatophyt wurde auch bei 16 von 66 (24,2%) offenbar gesunden Mäusen gefunden, die untersucht worden waren, um festzustellen, ob sie Träger des Erregers sind. Aufgrund ihrer morphologischen Merkmale waren die Isolate als T. mentagrophytes var. mentagrophytes einzuordnen. Infektionen beim Tierpfle-gepersonal wurden nicht beobachtet.     

Wandel des dermatomykologischen Erregerspektrums

Zusammenfassung. In der vorliegenden Arbeit wurde das Erregerspektrum bei 3607 Patienten mit Verdacht auf Dermatomykose im Einzugsgebiet der Berliner Charité untersucht. Die Identifizierung von Dermatophyten und Schimmelpilzen erfolgte konventionell, die der Hefen unter Einbeziehung biochemischer und genetischer Verfahren. Charakteristisch für den gegenwärtigen Erregerwandel sind Veränderungen innerhalb der Dermatophytenflora und die wachsende Bedeutung von opportunistischen Hefen. Ausgehend von einem stabilen 5-Arten-Grundbestand aus Trichophyton rubrum, T. mentagrophytes, Candida albicans, C. parapsilosis und Trichosporon cutaneum wird über die zunehmende Verbreitung von Microsporum canis, T. mentagrophytes var. granulosum und T. tonsurans berichtet.
Summary. The spectrum of aetiologic agents isolated from 3607 patients suspicious for dermatomycosis being in the care of the Berlin Charité Clinics was analysed. Identification of dermatophytes and moulds were performed conventionally. For the identification of yeasts biochemical and genetic methods were used. Among the dermatophytes in comparison of present with previous incidence rates changes can be observed. Opportunistic yeasts are recognized in increasing importance. Five fungal species are forming a stable base of aetiologic agents of dermatomycoses, i.e. Trichophyton rubrum, T. mentagrophytes, Candida albicans, C. parapsilosis and Trichosporon cutaneum , completed by increasing incidence of Microsporum canis, T. mentagrophytes var. granulosum and T. tonsurans .     

Onychomycosis in children: a survey of 46 cases

This is a retrospective study of the agents, clinical aspects, sources of infection and therapy of onychomycosis in children. In the period 1989-2000, we observed 46 consecutive children, until 16 years of age with onychomycosis (29 boys, 17 girls, mean age 10.8 years). Dermatophytes were isolated in 30 cases (Trichophyton rubrum in 22 cases, Trichophyton mentagrophytes in five, Epidermophyton floccosum in two and Trichophyton violaceum in one) and Candida spp. in 16, associated with Trichophyton rubrum in two. Moulds were isolated in three children (Fusarium oxysporum in one, Scopulariopsis brevicaulis in another and Aspergillus fumigatus associated with Trichophyton rubrum in a third). The commonest features were distal and distolateral subungual hyperkeratosis in dermatophyte infections (93%) and onychodystrophy and paronychia in Candida infections (56% and 50% respectively). Forty patients achieved clinical and mycological recovery. It is appropriate to suspect onychomycosis in children, perform microbiological diagnosis and undertake early treatment. An approach of this kind may help to prevent nail dystrophy and the spread of infection.     

Tinea pedis and onychomycosis in Danish soldiers before and after service in ex-Yugoslavia.

Seventy-three 1-year-experienced Danish soldiers were examined for tinea pedis as well as onychomycoses before and after a duty period of 6 months in ex-Yugoslavia. The incidence of fungal infections was 16.4% before and 32.3% after their duty period abroad. At first investigation Trichophyton rubrum and T. mentagrophytes were dominant but onychomycosis and tinea pedis were found as well. In contrast, Candida albicans was the predominant pathogen in the second investigation. We explain this by means of the more aggressive nature that yeasts can show when host-parasite relations are disturbed or compromised. Twelve soldiers with positive mycology were offered treatment and the final investigation showed a cure rate of 50%. This result is satisfactory in view of the difficult sanitary conditions.     

Dermatophytes isolated from domestic animals in Iran

Between 1994 and 1998, a total of 790 feather, hair and skin specimens from a variety of animals with suspected dermatophytoses were studied, of which 248 (31.4%) yielded dermatophytes. The most frequent dermatophytes isolated were Microsporum canis (38.3%), Trichophyton verrucosum (31.8%), T. mentagrophytes (13.3%) and M. gypseum (7.7%). There was a significantly higher proportion of positive cultures from cats (54.8%) than dogs (8.2%), and M. canis was the most common species isolated (87.2 and 50% respectively). Trichophyton verrucosum was the most frequent causative agent of dermatophytoses in ruminants, M. equinum in horses, M. gypseum in rabbits, M. gallinae in chickens and T. mentagrophytes in pet squirrels.     

Prevalence of tinea capitis in primary schools in Turkey

The aim of our study was to determine the prevalence of tinea capitis in Middle Anatolia. Between February 2000 and April 2000, a school survey of 4760 primary school children was carried out and 34 cases of tinea capitis were clinically diagnosed. Sixteen (0.3%) of them were diagnosed both clinically and using culture. Eighteen cases (52.9%) were diagnosed microscopically whereas the remaining 16 cases (47.0%) had a clinical diagnose. We also isolated and identified the following species of fungi causing the infection: Trichophyton verrucosum (five cases), T. rubrum (three), T. mentagrophytes var. mentagrophytes (three), Microsporum canis (three) and T. tonsurans (two). We detected a higher rate of infection than that of the country's average.     

Onychomycosis in Lebanon: a mycological survey of 772 patients

Accurate diagnosis of onychomycosis is based on clinical findings, direct microscopic investigation and mycological culture. If the diagnosis is not confirmed by culture and improvement does not occur, it is impossible to tell whether this represents treatment failure or an initial incorrect diagnosis. The aim of this study was to identify the major organisms involved in onychomycosis with emphasis on the importance of culture in treating onychomycosis. The study was performed at the Lebanese University, Beirut, Lebanon over a 5-year period (2000-2004). Clinically suspected patients were referred to our mycology laboratory for KOH test and culture. The study included 772 patients (520 women, 252 men). Cultures were positive in 54.3% of cases (predominantly male). The ratio of onychomycosis in toenails/fingernails was 1.9. In toenails, dermatophytes were found in 77.1% of cases, Candida in 18.9% and moulds in 4%. In fingernails, Candida was found in 81% of cases, dermatophytes in 18.1% and moulds in 0.9%. The most commonly isolated dermatophytes were Trichophyton mentagrophytes (36%), T. rubrum (27.5%) and T. tonsurans (26%). Pathogens involved in onychomycosis change according to each geographical area. Therefore, treatments should be based on studies carried out in the same region.     

An Experimental Model for Transepidermal Elimination of a Dermatophytic Granuloma: Ein experimentelles Modell für die transepidermale Elimination dermatophytischer Granulome

Summary: Transepidermal elimination (T. E. E.) is a phenomenon which occurs in a wide variety of skin disorders. For a better understanding of this process, observed only rarely in granulomatous cutaneous mycosis, we induced an experimental dermatophytic granuloma by injecting intracutaneously an aqueous suspension of Microsporum canis or Trichophyton mentagrophytes var. mentagrophytes to 32 adult guinea pigs. Biopsies from reactive dermal granuloma aged 7–10 days showed the T. E. E. through the acanthotic epidermis and/or hyperplastic follicles in 13 of the animals.
Our experimental model documented also the possibility of inducing a superficial hair fungus infection from a primary dermal mycosis.
Zusammenfassung: Die transepidermale Elimination ist ein Phänomen, welches sich bei einer großen Anzahl von Hautkrankheiten zeigt. Für ein besseres Verständnis von diesem Verlauf, selten beobachtet bei granulomatösen Dermatomykosen, haben wir ein experimentelles Dermatophyten-Granulom provoziert. 32 erwachsenen Meerschweinchen wurde eine Suspension von Microsporum canis oder Trichophyton mentagrophytes var. mentagrophytes eingespritzt. Die nach 7 bis 10 Tagen gewonnenen Biopsien von Hautgranulomen zeigten eine transepidermale Elimination durch akanthotische Epidermis und/oder durch hyperplastische Follikel bei 13 der Meerschweinchen.
Unser experiementelles Modell beweist außerdem die Möglichkeit der Entstehung einer oberflächlichen mykotischen Haarinfektion aus einer primär dermalen Mykose.     

Fungal skin infections among prison inmates in Abakaliki, Nigeria

Of 402 prison inmates screened for fungal skin lesions, 79 (19.7%) showed skin lesions, which proved mycologically positive by microscopy and culture. Dermatophytes were responsible for skin lesions in 61 (77.2%) of the inmates, while non-dermatophytes accounted for 18 (22.8%) of the lesions. The dermatophytes recovered were mostly anthropophilic and included Trichophyton rubrum 33 (41.8%); T. mentagrophytes var. interdigitale 3 (3.8%); T. tonsurans 3 (3.8%); T. violaceum 2 (2.5%); Epidermophyton floccosum 10 (12.7%). A zoophilic dermatophyte, Microsporum canis, was recovered from 10 (12.7%) cases. The non-dermatophytes were Candida albicans 15 (19%) and Candida spp. 3 (3.8%). Trichophyton rubrum was the most frequently recovered dermatophyte (41.8%) and caused infections in a variety of sites. The groin was the most common site of infection being infected in 50% of the cases by both the dermatophytes and non-dermatophytes. Younger inmates (17-24 years) recorded the highest prevalence of infection (45.6%). Newer inmates (>2 years) were found to be more infected than older ones.     

Infections by dermatophytes simulating neurodermatitis and psoriasis

Es wird über 58 Fälle von Infektionen durch Dermatophyten berichtet, von denen 45 eine Neurodermitis und 13 eine Psoriasis vortäuschten.
Beim Neurodermitis-Typ war Trichophyton rubrum mit 31 Isolaten der häufigste Erreger (69% der Fälle); danach kamen Epidermophyton floccosum (mit 8 Fällen = 18%), Trichophyton mentagrophytes — var. granulosum (mit 3 Fällen = 7%), Trichophyton tonsurans (mit 2 Fällen = 4%) und Trichophyton violaceum (1 Fall = 2%). Die Crural- und Perinealregion waren der bevorzugte Sitz dieser Art von Krankheitserscheinungen, doch waren auch andere Bezirke befallen (Unterschenkel, Ellenbogen, Achselhöhle usw.).
Bei der Psoriasis-ähnlichen Infektion wurde Trichophyton rubrum in 6 Fällen gefunden, Epidermophyton floccosum in 3, Trichophyton mentagrophytes in 2 Fällen, Trichophyton violaceum und Trichophyton verrucosum in je 1 Fall. Die letztgenannte Form variierte mehr im Hinblick auf den Sitz der Krankheitserscheinungen.     

Occurrence of pathogenic fungi in soil of burrows of rats and of other sites in bamboo plantations in India and Nepal

This study examined 215 samples of soil from burrows of rats, other sites in bamboo plantations in different parts of India and Nepal by dilution plating and mouse passage technique for occurrence of Penicillium marneffei and other pathogenic fungi. None of the samples including 25 collected from the burrows of a bamboo rat (Cannomys badius) known to be a carrier of P. marneffei, was positive for the fungus. Among the pathogenic fungi recovered were four isolates of Pseudallescheria boydii (including one from Nepal), two of Trichosporon asteroides, one of Scytalidium hyalinum, 23 isolates of Trichophyton mentagrophytes var. mentagrophytes (including two from Nepal), and two of Microsporum gypseum. Fourteen of the 23 isolates of T. mentagrophytes var. mentagrophytes when tested with the mating types of Arthroderma vanbreuseghemii were found to be of the '+' mating type. The frequent recovery of this dermatophyte from soils of bamboo plantations in several parts of India is remarkable. The study also demonstrates for the first time the occurrence of P. boydii and T. mentagrophytes var. mentagrophytes in Nepalese soil. Among the other fungi recovered were several isolates of species of Aspergillus, Penicillium, Paecilomyces, Fusarium, Chrysosporium, Acremonium, Rhizopus, Mucor, Geotrichum, Trichosporon and Rhodotorula.