Molecular Identification and Antifungal Susceptibility Patterns of Clinical Dermatophytes Following CLSI and EUCAST Guidelines

Dabas, Y. P. S.; Xess, Immaculata; Singh, Gagandeep; Pandey, M. B.; Meena, Suneeta

doi:10.3390/jof3020017

Cited by 49 publications

(58 citation statements)

References 33 publications

(39 reference statements)

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“…Previous worldwide studies as well as older Indian data report T. rubrum as the predominant dermatophyte causing tinea corporis/cruris, while T. interdigitale has previously been reported as a prominent species from only a few geographical areas (15)(16)(17)(18)(19)(20). However, a few recent Indian reports have also found T. interdigitale in a large percentage of isolates (9,10,21). Our results also reconfirm the unfortunate trend of high MICs of TRB for T. interdigitale.…”

Section: Discussionsupporting

confidence: 88%

Correlation ofIn VitroSusceptibility Based on MICs and Squalene Epoxidase Mutations with Clinical Response to Terbinafine in Patients with Tinea Corporis/Cruris

Khurana

Masih

Chowdhary

et al. 2018

Antimicrob Agents Chemother

102

108

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Recalcitrant dermatophytoses are on the rise in India. High MICs of terbinafine (TRB) and squalene epoxidase (SQLE) gene mutations conferring resistance inTrichophytonspp. have been recently documented. However, studies correlating laboratory data with clinical response to TRB in tinea corporis/cruris are lacking. For this study, we investigated the clinicomycological profile of 85 tinea corporis/cruris patients and performed antifungal susceptibility testing by CLSI microbroth dilution and SQLE mutation analysis of the isolates obtained and correlated these with the responses to TRB. Patients confirmed by potassium hydroxide (KOH) mounting of skin scrapings were started on TRB at 250 mg once a day (OD). If >50% clinical clearance was achieved by 3 weeks, the same dose was continued (group 1). If response was <50%, the dose was increased to 250 mg twice a day (BD) (group 2). If the response still remained below 50% after 3 weeks of BD, the patients were treated with itraconazole (ITR; group 3). Overall, skin scrapings from 64 (75.3%) patients yielded growth on culture. Strikingly, all isolates were confirmed to beTrichophyton interdigitaleisolates by internal transcribed spacer (ITS) sequencing. Thirty-nine (61%) of the isolates had TRB MICs of ≥1 µg/ml. Complete follow-up data were available for 30 culture-positive patients. A highly significant difference in modal MICs to TRB among the three treatment response groups was noted (P = 0.009). Interestingly, 8 of the 9 patients in group 3 harbored isolates exhibiting elevated TRB MICs (8 to 32 µg/ml) and SQLE mutations. The odds of achieving cure with TRB MIC < 1 µg/ml strains were 2.5 times the odds of achieving cure with the strain exhibiting MIC ≥1 µg/ml.

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Section: Discussionsupporting

confidence: 88%

Correlation ofIn VitroSusceptibility Based on MICs and Squalene Epoxidase Mutations with Clinical Response to Terbinafine in Patients with Tinea Corporis/Cruris

Khurana

Masih

Chowdhary

et al. 2018

Antimicrob Agents Chemother

102

108

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“…According to this most recently suggested classification and new taxonomy of dermatophytes, the former “ T mentagrophytes complex” is differentiated into T mentagrophytes (zoophilic strains) and T interdigitale (anthropophilic strains). We have noticed that in some recent studies the causative agent of the chronic, relapsing dermatophytosis outbreak in India has been described as T interdigitale . In our opinion, it is very likely that these T interdigitale strains isolated in Delhi and Chennai and other places in India are indeed strains more closely related to the neotype of T mentagrophytes and not strains of T interdigitale .…”

Section: Discussionmentioning

confidence: 81%

“…We have noticed that in some recent studies the causative agent of the chronic, relapsing dermatophytosis outbreak in India has been described as T interdigitale. 7,8,58,59 In our opinion, it is very likely that these T interdigitale strains isolated in Delhi and Chennai and other places in India are indeed strains more closely related to the neotype of T mentagrophytes and not strains of T interdigitale. 10 We therefore want to underscore the importance of a common nomenclature of species in accordance with the new taxonomy of dermatophytes.…”

Section: Trichophyton Interdigitale or Trichophyton Mentagrophytes?mentioning

confidence: 77%

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

Nenoff¹,

Verma²,

Vasani³

et al. 2019

Mycoses

184

216

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Summary 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.

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“…24 Brazilian studies have revealed resistance of many strains to griseofulvin but in vitro antifungal susceptibility of dermatophytosis for the griseofulvin and terbinafine combination. 24,25 Within patient studies though largely uncommon has been documented in the field of Dermatology due to the superficial nature of the lesions as well as the use of topical treatment which are often unlikely to have a systemic effect. A randomized, double-blind, activecontrolled within patient design was used to compare the effectiveness of Fenticonazole (2%) cream b.i.d.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of modified Whitfield’s ointment with oral griseofulvin in the treatment of dermatophytosis poorly responsive to standard antifungal therapy: a randomized, double blind, within patient placebo control

2019

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Background: Dermatophytosis is a superficial fungal infection found in hot and humid areas particularly in tropical regions and affects the keratinized regions of the body. It is usually treated with a combination of topical and systemic antifungal therapy as well as improved hygienic measures. Over the last few decades there has been an increase in the prevalence of dermatophyte infections which are poorly responding to standard antifungal therapy. Methods: Modified Whitfield's ointment is a combination of 5%-5% Salicylic acid and Benzoic acid with an emulsifying ointment as a vehicle which has both a fungistatic and a keratolytic action. Oral Griseofulvin is a systemic antifungal agent which is a fungistatic agent. The combination of the above agents is synergistic. A randomized double blind, within-patient-placebo-controlled trial was designed for the treatment of dermatophytosis poorly responsive to standard antifungal therapy. Conclusions: This may shed light on the treatment of dermatophytosis poorly responsive to standard antifungal therapy. Trial Registration: This trial is registered with WHO trial registry number (Universal trial number): U111-1235-8791.

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Molecular Identification and Antifungal Susceptibility Patterns of Clinical Dermatophytes Following CLSI and EUCAST Guidelines

Cited by 49 publications

References 33 publications

Correlation ofIn VitroSusceptibility Based on MICs and Squalene Epoxidase Mutations with Clinical Response to Terbinafine in Patients with Tinea Corporis/Cruris

Correlation ofIn VitroSusceptibility Based on MICs and Squalene Epoxidase Mutations with Clinical Response to Terbinafine in Patients with Tinea Corporis/Cruris

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

Effectiveness of modified Whitfield’s ointment with oral griseofulvin in the treatment of dermatophytosis poorly responsive to standard antifungal therapy: a randomized, double blind, within patient placebo control

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