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

Uhrlaß, Silke; Verma, Shyam; Gräser, Yvonne; Rezaei‐Matehkolaei, Ali; Hatami, Maryam; Schaller, Martin; Nenoff, P.

doi:10.3390/jof8070757

Cited by 92 publications

(140 citation statements)

References 63 publications

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“…In particular, NDM onychomycoses are recalcitrant to terbinafine and azoles, and treatment by topical amphotericin B should be considered as first-line therapy [ 13 , 14 , 15 ]. Drug resistance is also an increasingly recognized concern with some dermatophytes, especially Trichophyton rubrum and Trichophyton mentagrophytes [ 16 , 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Identification of Dermatophyte and Non-Dermatophyte Agents in Onychomycosis by PCR and DNA Sequencing—A Retrospective Comparison of Diagnostic Tools

Pospischil

Reinhardt

Bontems

et al. 2022

JoF

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Rapid and reliable fungal identification is crucial to delineate infectious diseases, and to establish appropriate treatment for onychomycosis. Compared to conventional diagnostic methods, molecular techniques are faster and feature higher accuracy in fungal identification. However, in current clinical practice, molecular mycology is not widely available, and its practical applicability is still under discussion. This study summarizes the results of 16,094 consecutive nail specimens with clinical suspicion of onychomycosis. We performed PCR/sequencing on all primary nail specimens for which conventional mycological diagnostics remained inconclusive. In specimens with a positive direct microscopy but negative or contaminated culture, molecular mycology proved superior and specified a fungal agent in 65% (587/898). In 75% (443/587), the identified pathogen was a dermatophyte. Positive cultures for dermatophytes, yeasts and non-dermatophyte molds (NDMs) were concordant with primary-specimen-DNA PCR/sequencing in 83% (10/12), 34% (22/65) and 45% (76/169), respectively. Among NDMs, agreement was high for Fusarium spp. (32/40; 80%), but low for Penicillium spp. (5/25; 20%) and Alternaria spp. (1/20; 5%). This study underlines the improvement in diagnostic yield by fungal primary-specimen-DNA PCR/sequencing in the event of a negative or contaminated culture, as well as its significance for the diagnosis of dermatophyte and non-dermatophyte onychomycosis. Molecular mycology methods like PCR and DNA sequencing should complement conventional diagnostics in cases of equivocal findings, suspected NDM onychomycosis or treatment-resistant nail pathologies.

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Section: Introductionmentioning

confidence: 99%

Identification of Dermatophyte and Non-Dermatophyte Agents in Onychomycosis by PCR and DNA Sequencing—A Retrospective Comparison of Diagnostic Tools

Pospischil

Reinhardt

Bontems

et al. 2022

JoF

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“…16,18 A species shift to Trichophyton indotineae is another likely cause of the observed recalcitrance. 19 Taking in consideration the significant number of recalcitrant cases, one of us (DGS) decided to conduct a trial of daily dose fluconazole for patients with dermatophytosis.…”

Section: Discussionmentioning

confidence: 99%

An open label, single arm, pilot study to evaluate the safety, tolerability, and efficacy of daily fluconazole 150 mg in subjects suffering from Tinea cruris and Tinea corporis

Saple¹,

Save²,

Kumar³

et al. 2022

F1000Res

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Background: Dermatophytes are the most common superficial fungal infections worldwide and are treated with prescribed regimens of terbinafine and itraconazole, or with weekly doses of fluconazole. Dermatologists are increasingly encountering treatment failures, and experts suggest that standard treatment regimens are not applicable anymore. We planned an open-label study to evaluate the results of fluconazole 150 mg daily for 8 weeks in patients with tinea cruris and tinea corporis. Methods: Patients were enrolled from the La’Mer Clinic, Mumbai, India. We included adult subjects with uncomplicated dermatophytosis confirmed by microscopic examination of skin scrapings. Pregnancy, poor renal function, and recent exposure to anti-fungal therapy were exclusion criteria. Patients were reviewed on days 14, 28 and 56. The treating doctor scored the severity of erythema, scaling, and pruritus on a four-point scale: absent, mild, moderate, and severe. Of 107 subjects screened, 100 were finally included in the study. Eleven were lost to follow up and one subject withdrew consent. Results: The site of disease was body alone in 29, groin alone in 7, and both body and groin in 64 cases. At 5 weeks, 98%, 100%, and 97% of patients had no scaling, erythema, and pruritus, respectively. Skin scrapings showed 100% mycological cure. In one patient the alanine transaminase level rose from 54.9 to 100.2 U/L, and qualified as a grade 1 adverse event not requiring intervention. No other significant adverse events were noted. Conclusions: Our results suggest that fluconazole 150 mg daily for eight weeks effectively treats dermatophytosis. This regimen is safe and well-tolerated even in patients with co-morbidities. Fluconazole is about eight times less expensive than itraconazole or terbinafine and may be the preferred therapy. Registration: The trial was registered with Clinical Trials Registry, India (Registration number CTRI/2020/06/026110) on 24 June 2020. FDC Company, India, provided financial support for the study.

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“…The prevalence of superficial mycotic infections is on the rise in the recent time has risen to such a level in the last decades that skin mycoses now affect more than 20-25% of the world's population, making them one of the most frequent forms of infections 13 . The distribution of the dermatomycoses, their causative agents and the prevailing infection patterns vary with geographical location and are also affected by a wide range of environmental and cultural factors [14][15] . In addition, the frequency of dermatomycoses is fostered by low socioeconomic status: crowded living conditions which provide multiple opportunities for skin-to-skin contact.…”

Section: Cjstmentioning

confidence: 99%

Dermatophytes and Dermatophytoses Acquisition Among School-Age Children in Cameroun, Ivory Coast, Mali and Nigeria: A Systematic Review

David¹,

Ogunleye²,

PO³

et al. 2022

CJST

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Fungal infections tend to be the most commonly diagnosed skin disease in Africa and with a high percentage of incidence among school-age children. This epidemiological survey summarized the epidemiological trends of dermatophytoses reported in West African countries. The review protocol was done in March 2019 through a literature search using Medline, Google Scholar, PubMed and African Journals Online (AJOL) databases to download all published papers reporting fungal infections among school-age children in West Africa. The period included in the reports was February 2007 to January 2019. A total number of 36,299 samples were investigated by the authors across West African countries and a total of 6262 were recorded positive with dermatophytes segregated by male and female. Tinea capitis has a prevalence of 44.4% and mainly affected children of ages 6–10 years (78.09%). This was followed by Tinea corporis and Tinea unguium with a prevalence of 19.4% and 13.9% respectively. Trichophyton species [n=67 (54.92%)], Microsporum species [n=34 (27.87%)], Aspergillus species [n=6 (4.92%)] and Epidermophyton species [n=5 (4.10%)] are most keratinophilic fungi isolated. The scalp [n=2471 (38.51%)], scalp and body [n= 2142 (33.38%)] and toe and nails [n=479 (7.46%)] were the most affected body parts recorded. Tinea capitis remains a common infection among the subjects, and various interventions are needed to reduce the spread of dermatophytic infections in this category.

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

Cited by 92 publications

References 63 publications

Identification of Dermatophyte and Non-Dermatophyte Agents in Onychomycosis by PCR and DNA Sequencing—A Retrospective Comparison of Diagnostic Tools

Identification of Dermatophyte and Non-Dermatophyte Agents in Onychomycosis by PCR and DNA Sequencing—A Retrospective Comparison of Diagnostic Tools

An open label, single arm, pilot study to evaluate the safety, tolerability, and efficacy of daily fluconazole 150 mg in subjects suffering from Tinea cruris and Tinea corporis

Dermatophytes and Dermatophytoses Acquisition Among School-Age Children in Cameroun, Ivory Coast, Mali and Nigeria: A Systematic Review

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