Immunological response and clinical profile in patients with recurrent dermatophytosis

Abstract

Background: An alarming increase in the number of patients with chronic and recurrent dermatophytosis has invoked the need to study the immunological parameters of the host. Objectives: To evaluate delayed type of hypersensitivity (DTH) response and immediate hypersensitivity (IH) response by flow cytometry evaluation of immune cells from peripheral blood and intradermal trichophyton skin test in patients with recurrent dermatophytosis. Methods: A hundred patients with recurrent dermatophytosis and 50 controls (healthy controls and acute dermatophytosis controls) were included. Relevant risk factors for recurrence were analysed, and serum IgE levels were estimated. Flow cytometry evaluation of immune cells in peripheral blood and intradermal trichophyton skin test was done. Dermatophyte pathogens were isolated, and antifungal susceptibility was performed.Results: Trichophyton mentagrophytes complex (95.84%) and T. rubrum (4.16%) were isolated in culture. Serum IgE was elevated in 83.15% cases (p = .01). IFNγ + cells (p = .0501, p = .0001, p = .0014), Th1 cells (p = .1197, p = .0024, p = .0169), IL-17 + cells (p = .0127, p = .0006, p = .0007) and Th17 cells (p = .0634, p = .0001, p = .0054) were reduced, and IL-4 + cells (p = .0108, p = .0175, p = .0018) were increased in cases.Intradermal test demonstrated negative DTH response in all cases (p < .001, p < .001, p < .001), strongly positive IH response in 6%, and borderline positive IH response in 85% cases (p = .018, p < .001, p < .001). Topical corticosteroids application, undergarment types (tight fit), poor frequency of washing clothes, family history of tinea, sharing of towels were significant risk factors for recurrent dermatophytosis. Conclusions:Reduced IFNγ + , Th1, IL-17 + and Th17 cells population along with impaired DTH response by the intradermal test was observed in patients with recurrent dermatophytosis.

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

“…Correlation analysis too points to significant correlation of low IFN‐γ levels with chronicity. Study comparing Th1(IFN‐γ+) cells in peripheral blood between recurrent cases, acute dermatophytosis and healthy control by Jha K. et al showed reduced Th1 cell population in chronic cases 13 . Our study supports this finding in terms of reduced levels of serum IFN‐γ in group B.…”

“…Though trichophytin intra dermal test was not performed by us, other investigators have demonstrated immediate hypersensitive (IH) type response in acute and chronic cases of dermatophytosis. 4,12,13 Presence of IL4 positive cells in both groups in our study provide scientific rationally behind these observations as Th2 cells are effector cell for IH response. Presence of IL-4 cells combining with high titres of IL-4 in serum in acute cases addresses a long-standing question that whether presence of Th2 response is responsible for chronicity.…”

“…This finding in our study suggests presence of IL4 response in tissue irrespective of duration or extent of disease. Though trichophytin intra dermal test was not performed by us, other investigators have demonstrated immediate hypersensitive (IH) type response in acute and chronic cases of dermatophytosis 4,12,13 . Presence of IL4 positive cells in both groups in our study provide scientific rationally behind these observations as Th2 cells are effector cell for IH response.…”

Trichophyton indotineae—An Emerging Pathogen Causing Recalcitrant Dermatophytoses in India and Worldwide—A Multidimensional Perspective

“…A significant change in the skin microbiome and the local immune system is conceivable. Significant risk factors for recurrent dermatophytoses, in addition to topical steroid application, are infrequent washing of clothes, occlusive tight-fitting underwear, a positive family history of tinea, and shared use of towels and bed linen [ 60 ]. Immunological characteristics of patients affected by chronic dermatophytosis include reduced interferon (IFN) γ, reduced Th1, IL-17-positive and Th17 cells, and an impaired immune reaction (delayed type of hypersensitivity, DTH) in the intradermal test [ 60 ].…”

Immunohistochemical analysis of chronic and recurrent dermatophytosis

“…This reemphasises the need for treatment of family members to ensure complete immunological clearance of dermatophytes. [9][10][11] While acute dermatophytosis has a complementarily acting Th1 and Th17 response, chronic dermatophytosis immune response is skewed towards a Th2 response. 12 However, the exact mechanism underlying the selective inhibition of CMI in chronic and recurrent dermatophytosis is insufficiently understood.…”