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.     

A 5‐year survey of dermatomycoses in southwest Poland,years 2003–2007

The study was performed to analyse the spectrum of dermatomycoses in southwest Poland during the period 2003–2007. A total of 10 486 patients were investigated for fungal skin infections by means of native specimen and cultivating procedures. Skin scrapings, plucked hairs and nail clippings were examined and identified by direct microscopy and culture. From 2468 patients, 2753 fungi were identified including dermatophytes, yeast and moulds. Among the dermatophytes, the most common pathogen isolated was Trichophyton rubrum (59.4%), followed in descending order by: Trichophyton mentagrophytes var. interdigitale (16.6%), Trichophyton mentagrophytes var. mentagrophytes (9.0%), Trichophyton tonsurans (6.8%), Microsporum canis (5.1%) and Epidermophyton floccosum (2.7%). Among the yeast‐like fungi, a marked predominance of Candida species was observed (86.3%). Scopulariopsis brevicaulis was the most commonly isolated mould (25.2%). The most frequently affected body sites were the toenails (53.9%), followed by the fingernails (19.0%). In children under 15 years of age, glabrous skin was the most commonly affected body site with M. canis as the most frequent causative agent.     

Epizootic and epidemic dermatophytose outbreaks caused by Trichophyton mentagrophytes from rabbits in Portugal, 2015

We report an outbreak of dermatophytoses in rabbits, which was the origin of a dermatophytose epidemic in an agricultural school in central Portugal, affecting 15 people. Both the phenotypic characteristics and internal transcribed spacer (ITS) sequence of the dermatophytes isolated from the rabbits and patients were identical, suggesting that a single strain was responsible for both the epizootic and epidemic dermatophytoses and confirming that these two outbreaks were linked. The ITS sequences were also 100% identical to the ITS sequence of five strains isolated from rabbits in Greece and Italy, but different from that of Trichophyton mentagrophytes commonly isolated from dogs and cats. These results suggest that a particular T. mentagrophytes genotype could be prevalent in rabbits in southern Europe.     

Study of onychomycosis in Isfahan,Iran

A mycological study was undertaken in 488 patients suspected of onychomycosis in Isfahan, a large province of Iran, to gain more insight into the prevalence and aetiology of this infection. Direct microscopy of the nail clips was positive in 194 (39.8%) and fingernail onychomycosis was recognised in 141 (72.7%) and toenail onychomycosis in 53 (27.3%) cases. As agents of onychomycosis, yeast were detected in 112 (57.7%), dermatophytes in 27 (13.9%) and non‐dermatophyte fungi in 55 (28.4%) patients. Of the samples cultured, Candida albicans was the most prevalent (84%) yeast. Among dermatophytes, Trichophyton mentagrophytes var. interdigitale was found to be the commonest aetiological agent (8.6%) followed by Epidermophyton floccosum and T. rubrum. Among the non‐dermatophyte moulds, Aspergillus flavus was the most prevalent species (13%). Moreover, nine samples with positive direct microscopy yielded no growth. Females were affected more frequently with fingernail candidal infections than males, and children under 7 years of age were predominantly involved with candidal paronychia. The majority of fungal nail infections were characterised clinically by distal and proximal subungual onychomycosis. The growing trend towards the frequency of fingernail onychomycosis in housewives was noticeable in the last decade in Iran.     

Trichophyton verrucosum infection in cattle farms of Umbria (Central Italy) and transmission to humans

Trichophyton verrucosum is the most common ringworm agent in cattle. Epidemiology of cattle dermatophytoses in Central Italy is not clear. Its diffusion among cattle and herdsmen was investigated in 20 Umbrian farms, Central Italy. Hairs and scales were taken from 395 animals and 31 workers. Typical ringworm was present in 71.7% of cattle under 6 months and in 11% of animals over 6 months. T. verrucosum was isolated from 98.9% of symptomatic heads and was the most prevalent dermatophyte in all herds investigated (isolated in 18 of the 20 farms). T. mentagrophytes var. mentagrophytes was found in 16 symptomatic and in eight asymptomatic young animals. Prevalence of asymptomatic carriers of both species was significantly higher in young heads (21.1% vs. 8.1%) and the age below 6 months was the only statistically significant risk factor associated with dermatophytosis. About the workers, all the 14 men with lesions were positive for T. verrucosum; copresence of T. verrucosum and Microsporum gypseum was noticed in one case. Results indicate a high diffusion of T. verrucosum among both animals and humans in Umbrian farms and confirm the dermatophyte infection as a public health problem. Periodic epidemiological surveys, treatment of sick livestock and workers, cleaning/sanitisation of herds and vaccination programmes may be useful in controlling the infection.     

Dermatophytoses in outpatients attending the Dermatology Center of Avicenna Hospital in Qazvin, Iran

Dermatophytosis is still being considered as one of the major public health problems in many parts of the world. To identify the prevalence and etiological agents of dermatophytoses, a study was carried out between 2004 and 2006. Out of 1023 subjects suspected to have cutaneous mycoses, 348 (34%) patients were affected with dermatophytoses. The causative agents were identified macroscopically and microscopically after the clinical samples were subjected to potassium hydroxide examination and culture isolation. Epidermophyton floccosum was the most frequently isolated species representing 32.8% of isolates, followed by T. rubrum (18.1%), T. verrucosum (17.2%), T. mentagrophytes var. interdigitale (15.8%), T. mentagrophytes var. mentagrophytes (6.6%) and T. violaceum, T. schoenleinii and Microsporum canis (0.9%). The most common type of infection was tinea cruris (31.9%) affecting in particular male patients. Some other most prevalent tinea types were tinea corporis (20.7%), tinea pedis (19%), and tinea unguium (11.2%). To the best of our knowledge, this is the first report on dermatophytoses in Qazvin and the first study that shows tinea cruris as a major type of superficial fungal infection in Iran. The frequency of tinea was higher in males and tinea cruris showed a remarkably increasing tendency and was an important public health issue in Qazvin.     

Screening examination and treatment of Trichophyton tonsurans infection in judo athletes affiliated with the University Judo Federation of Tokyo

In Japan, Trichophyton tonsurans infection has become an increasing problem among combat sports participants. We investigated the prevalence of T. tonsurans infection in athletes affiliated to judo clubs in the 21 First Division universities that were registered with the University Judo Federation of Tokyo in 2008. Study procedures performed by the subjects included (i) completion of a questionnaire concerning lifestyle, risk factors for tinea corporis and medical history; (ii) scrubbing the scalp with a circular hairbrush to obtain samples for fungal culture; (iii) anti‐fungal treatment as recommended by a dermatologist, based on the number of fungal colonies isolated from the hairbrush; and (iv) repeat testing using the hairbrush method 3 months after treatment recommendations were received. Of 902 study subjects, 102 (11.3%) yielded positive hairbrush culture results. Of these, 14 individuals (13.7%) had tinea corporis; the remainder were asymptomatic. Conversion to negative fungal culture was observed in 85 of 96 culture‐positive individuals who performed the second hairbrush culture test following treatment. Control of T. tonsurans infection among judo athletes could be achieved by educating athletes, trainers and coaches in judo clubs concerning detection, prevention, and treatment of T. tonsurans infection.     

Prevalence and aetiology of dermatophytoses in Isfahan, Iran

Summary. In this study the prevalence and causative agents of dermatophytoses in Isfahan, a large province of Iran, were determined. Of 16 578 clinically suspected cases 13.3% were affected with dermatophytoses. Lesions of tinea capitis were the most prevalent clinical type of dermatophytoses (54.1%), followed by tinea corporis (23.8%) and tinea pedis (8.9%). Trichophyton verrucosum was the most frequent causative agent (32.8%), followed by Epidermophyton floccosum (17.6%), T. mentagrophytes (16.2%) and Microsporum canis (12.3%). We found a relationship between the spread of dermatophytoses and live-stock infected with dermatophytoses in Isfahan.
Zusammenfassung. Prävalenz und Erregerspektrum von Dermatophytosen wurden in Isfahan untersucht, einer großen Provinz in Iran. Von 16 578 klinischen Verdachtsfällen waren 13,3% mit Dermatophytosen behaftet. Davon waren 54,1% Tinea capitis, 23,8% Tinea corporis und 8,9% Tinea pedis. Der häufigste Erreger war Trichophyton verrucosum (32,8%), gefolgt von Epidermophyton floccosum (17,6), T. mentagropytes (16,2%) und Microsporum canis (12,3%). Zusammenhänge zwischen der Dermatophytosen-Verbreitung und Dermatophytosen im Viehbestand konnten aufgezeigt werden.     

Case reports. Tinea gladiatorum due to Trichophyton mentagrophytes

Two cases of tinea gladiatorum due to Trichophyton mentagrophytes var. quinckeanum are described. A pet rabbit was probably the primary source of infection, which was then spread further by man-to-man contact. Besides these two patients, four other members of the same wrestling team were affected by tinea corporis.     

Suitability of hair type for dermatophytes perforation and differential diagnosis of T. mentagrophytes from T. verrucosum

Most of the dermatophyte species have the ability to perforate hair structure and consume its contents of keratin through secretion of keratinase enzyme. Two clinical isolated species of dermatophytes were diagnosed as Trichophyton mentagrophytes var. granulosum and Trichophyton verrucosum. To determine the perforation ability, the isolated fungi were incubated with the hair of four different animals (rabbit, rat, cow and cat) and human hairs with three different colours (black, albino and bleached yellow) for different periods. Variable perforating ability of T. mentagrophytes was shown in rat hair and all types of human hair after 15 days, while other mammalian hairs exhibited resistance to this fungal activity. On the other hand, T. verrucosum was revealed a slow perforating ability, which needed a long time (60 days) for most of tested hairs. Perforation of human black hair could be considered a diagnostic test for differentiation between T. mentagrophytes and T. verrucosum. In conclusion, the treated or untreated human hair was considered more suitable to use as a source of keratin for the growth of dermatophytes than animal hairs. The human black hair was a best type of hair to use in the perforating test for differentiation between T. mentagrophytes and T. verrucosum.     

In vitro activity of the protegrin IB‐367 alone and in combination compared with conventional antifungal agents against dermatophytes

The occurrence of resistance or side effects in patients receiving antifungal agents leads to failure in the treatment of mycosis. The aim of this experimental study was to investigate the in vitro effects of IB‐367 alone and in combination with three standard antifungal drugs, fluconazole (FLU), itraconazole (ITRA) and terbinafine (TERB), against 20 clinical isolates of dermatophytes belonging to three species. Minimum inhibitory concentrations (MICs), minimal fungicidal concentrations (MFCs), synergy test, time‐kill curves, fungal biomass (FB) and hyphal damage using 2,3‐bis‐(2‐methoxy‐4‐nitro‐5‐sulfenylamino carbonil)‐2H‐tetrazolium hydroxide assay (XTT) were performed to study the efficacy of IB‐367. In this study, we observed that TERB and ITRA had MICs lower values for all the strains compared to IB‐367 and FLU. Synergy was found in 35%, 30% and 25% of IB‐367/FLU, IB‐367/ITRA and IB‐367/TERB interactions respectively. IB‐367 exerted a fungicidal activity against Trichophyton mentagrophytes, T. rubrum and Microsporum canis at concentrations starting from 1x MIC. At a concentration of 5x MIC, IB‐367 showed the highest rates of hyphae damage for M. canis 53% and T. mentagrophytes 50%; against the same isolates it caused a reduction of 1 log of the total viable count cell hyphae damage. We propose IB‐367 as a promising candidate for the future design of antifungal drugs.     

Molecular identification and classification of Trichophyton mentagrophytes complex strains isolated from humans and selected animal species

Species differentiation within Trichophyton mentagrophytes complex group currently poses a major diagnostic challenge, with molecular methods increasingly supplementing classical identification based on the morphological and physiological properties of the fungi. Diagnostic and epidemiological research aimed at determining the source and means of transmission of dermatophytoses in both humans and animals requires not only species differentiation of isolates but also differentiation within species. The study was conducted on 24 isolates originating in humans and various animal species with clinical symptoms of dermatophytosis. The analysis included phenotypical identification methods and molecular methods: internal transcribed spacer sequencing and ITS‐restriction fragment length polymorphism (RFLP) with multi‐enzyme restriction. ITS sequence analysis identified the isolates to species – Trichophyton interdigitale, Arthroderma benhamiae and A. vanbreuseghemii, and ITS‐RFLP detected six different genotypes. Genotypes I, II and III characterised strains belonging to A. benhamiae, genotype IV characterised the A. vanbreuseghemii strain, and genotypes V and VI occurred only within the species T. interdigitale. Strains isolated from guinea pigs were dominant within genotype I, while genotype II was found mainly in strains from foxes. Multi‐enzyme restriction analysis of this region enables intraspecific differentiation, which may be useful in epidemiological research, particularly in determining the source of infections.     

Epidemiology of dermatophytosis in junior combat and non‐combat sports participants

Participation in competitive sports is popular and widely encouraged worldwide. Herein, we investigated 252 male and 67 female sports players, aged 16.4 ± 1.3 years, active in 15 different types of combat (n = 143) and non‐combat (n = 176) sports. Of the 319 participants in this study, 11 (3.5%) players, including six wrestlers, four football players and one handball player, all of whom were men, harboured dermatophytic fungi. Briefly, Trichophyton tonsurans was present in three athletes, who were scalp carriers of the fungus. Furthermore, T. rubrum (4), T. interdigitale (3) and Arthroderma simii (1) were recovered from eight participants with tinea inguinalis (4), tinea pedis (2) or both (1). One patient was a trunk carrier of concomitant tinea pedis. All dermatophytic fungi were identified using both direction sequence of the rDNA regions spanning the internal transcribed spacers (ITS1 and ITS2) and 5.8 rRNA gene. Although sports‐active individuals are active and sweat more, we observed a low prevalence of dermatophytosis, both in combat (5.2%) and non‐combat sports participants (3.4%) (P > 0.05). However, dermatophyte infections require more attention and appropriate management to eradicate the infection and to prevent possible outbreaks. This study also documents the first case of zoophilic A. simii in Turkey.     

Dermatophyte susceptibility varies towards antimicrobial textiles

Dermatophytoses are a widespread problem worldwide. Textiles in contact with infected skin can serve as a carrier for fungus propagation. Hitherto, it is unknown, whether antifungal textiles could contribute in controlling dermatophytes e.g. by disrupting the chain of infection. Testing of antimicrobial fabrics for their antifungal activities therefore is a fundamental prerequisite to assess the putative clinical relevance of textiles for dermatophyte prevention. Fabrics finished with either didecyldimethylammonium chloride (DDAC), poly‐hexamethylenbiguanide, copper and two silver chloride concentrations were tested for their antifungal activity against Trichophyton rubrum, Trichophyton mentagrophytes and Candida albicans. To prove dermatophyte susceptibility towards the textiles, swatches were subjected to DIN EN 14199 (Trichophyton sp.) or DIN EN ISO 20743 (C. albicans) respectively. In addition, samples were embedded, and semi‐thin sections were analysed microscopically. While all samples showed a clear inhibition of C. albicans, activity against Trichophyton sp. varied significantly: For example, DDAC completely inhibited T. rubrum growth, whereas T. mentagrophytes growth remained unaffected even in direct contact to the fibres. The results favour to add T. mentagrophytes as a test organism in textile dermatophyte efficacy tests. Microscopic analysis of swatches allowed detailed evaluation of additional parameters like mycelium thickness, density and hyphae penetration depth into the fabric.     

Onychomycosis in Tehran: mycological study of 504 patients

Onychomycosis is a common nail disorder resulting from the invasion of the nail plate by a dermatophyte, yeast or mould species and gives rise to some diverse clinical presentations. The purpose of the present study was to isolate and identify the causative fungi of onychomycosis in the population of Tehran, Iran. Nail samples from 504 patients with prediagnosis of onychomycosis during 2005 were examined both by direct microscopical observation of fungal elements in KOH preparations and in culture for the identification of the causative agent. All samples were inoculated on (i) Sabouraud dextrose agar (SDA, Merck), (ii) SDA with 5% chloramphenicol and cycloheximide in duplicate for dermatophyte and (iii) SDA with 5% chloramphenicol in triplicate for mould isolation. The criteria for the diagnosis of onychomycosis caused by non‐dermatophytic moulds were based on microscopical observation of fungal elements, growth of the same mould in all triplicate culture and no growth of a dermatophyte or yeast in all the cultures. Of 504 cases examined, 216 (42.8%) were mycologically proven cases of onychomycosis (144 fingernails, 72 toenails). Among the positive results, dermatophytes were diagnosed in 46 (21.3%), yeasts in 129 (59.7%) and non‐dermatophytic moulds in 41 (19%). Trichophyton mentagrophytes was the most common causative agent (n = 22), followed by Trichophyton rubrum (n = 13), Candida albicans (n = 42), Candida spp. (n = 56) and Aspergillus spp. (n = 21). Nearly half of the clinically suspected fungal nail infections are onychomycosis and yeast is responsible for most of the infections in Iran.     

Polymorphisms in the ITS rDNA regions for differentiating strains of the Trichophyton mentagrophytes complex in Sfax‐Tunisia

The Trichophyton mentagrophytes complex is the main cause of superficial mycoses in humans and animals. Molecular research has provided useful insights into the taxonomy of this complex to overcome the challenges with conventional diagnostics. The aim of this study was to identify, type and differentiate anthropophilic and zoophilic species of the T. mentagrophytes complex. Sixty clinical samples identified as T. mentagrophytes by morphological characteristics were isolated using polymerase chain reaction‐restriction fragment length polymorphism and sequence analysis of the internal transcribed spacer (ITS) regions. The identification of our strains by conventional methods was confirmed using polymerase chain reaction (PCR) sequencing in 93.34% of the cases. The strains under investigation were recategorised as T. rubrum (Tr2711). In addition, PCR products were independently digested with the restriction endonucleases, MvaI and HinfI, to produce a single dominant profile for T. interdigitale. ITS sequence analysis revealed a polymorphism in the ITS1 and 5.8S regions. Analysis of the consensus sequences distinguished four types of genotypes among our T. interdigitale species. Moreover, ITS type I was the dominant genotype characterising the anthropophilic variant of T. interdigitale. The phylogenetic study showed that only 5% of our strains were zoophilic. PCR sequencing was useful for distinguishing anthropophilic and zoophilic species of T. interdigitale, in which the differentiation is relevant because it helps to prescribe the correct treatment and to identify the surrounding source of infection.     

The current Indian epidemic of superficial dermatophytosis due to Trichophyton mentagrophytes—A molecular study

The disease burden of chronic‐relapsing and therapy‐refractory superficial dermatophytosis dramatically increased in India within the past 5‐6 years. In order to evaluate the prevalence of this trend, 201 skin scrapings were collected from patients from all parts of India and were tested for dermatophytes using both fungal culture and a PCR‐ELISA directly performed with native skin scrapings. Fungal culture material was identified by genomic Sanger sequencing of the internal transcribed spacer (ITS) region and the translation elongation factor (TEF)‐1α gene. In total, 149 (74.13%) out of the 201 samples showed a dermatophyte‐positive culture result. Out of this, 138 (92.62%) samples were identified as Trichophyton (T.) mentagrophytes and 11 (7.38%) as Trichophyton rubrum. The PCR‐ELISA revealed similar results: 162 out of 201 (80.56%) samples were dermatophyte‐positive showing 151 (93.21%) T mentagrophytes‐ and 11 (6.79%) T rubrum‐positive samples. In this study, we show for the first time a dramatic Indian‐wide switch from T rubrum to T mentagrophytes. Additionally, sequencing revealed a solely occurring T mentagrophytes “Indian ITS genotype” that might be disseminated Indian‐wide due to the widespread abuse of topical clobetasol and other steroid molecules mixed with antifungal and antibacterial agents.     

Dermatophytoses in Würzburg 1976–1985*,**

Summary: In the decade 1976–1985, 8973 dermatophytes were isolated from patients at the University Dermatological Clinic, Würzburg. Trichophyton rubrum comprised 73.9% und Trichophyton mentagrophytes 19.6% of all isolates, while isolation rates of all other species of dermatophytes were under 5%. The most common dermatomycoses were tinea pedum in 43.8% and tinea unguium pedum in 28.8% of all localizations of tinea. A comparison of our results with those of an investigation in the same clinic undertaken between 1956–1958 (Veltman et al.) reveals that the epidemiological shift from T. mentagrophytes to T. rubrum as the most common causative agent of dermatomycoses, a shift that has been observed world-wide, must have taken place in Würzburg between 1959 and 1975. Zusammenfassung: Im Zehnjahreszeitraum 1976–1985 wurden von Patienten der Universitäts-Hautklinik Würzburg 8973 Dermatophyten isoliert. Trichophyton rubrum machte 73,9% und Trichophyton mentagrophytes 19,6% alter Dermatophytenisolate aus, während alle übrigen Dermatophytenspezies in unter 5% isoliert wurden. Die häufigsten Dermatomykosen waren die Tinea pedum mit 43,8% und die Tinea unguium pedum mit 28,8% aller Tinea-Krankheiten. Der Vergleich mit einer Untersuchung an unserer Klinik aus den Jahren 1956–1958 (Veltman und Mitarb.) ergibt, daß die weltweit beobachtete epidemiologische Verschiebung von T. mentagrophytes zu T. rubrum als dem häufigsten Erreger von Dermatomykosen in Würzburg zwischen 1959 und 1975 stattgefunden haben muß.     

Epidemiology of dermatomycoses of humans in central Poland. Part IV. Onychomycosis due to dermatophytes

The total number of dermatophytoses (7393) included 1567 (21.2%) cases of onychomycosis. Etiological factors in descending order were: Trichophyton rubrum (58.8%), Trichophyton mentagrophytes var. granulosum (26.2%), T. mentagrophytes var. quinckeanum, T. mentagrophytes var. interdigitale (5.1%), Trichophyton tonsurans (4.1%), Trichophyton violaceum (1.5%), Trichophyton spec. (1.1%). An increase in the incidence was noted between 1994 and 1996. At present, onychomycosis is third by incidence among all clinical forms of dermatophyte infections of skin and skin appendages in the Lód? region.