ABSTRACT
Background: Superficial dermatophytosis, commonly known as ringworm, is a fungal infection of the skin, hair, or nails caused by dermatophytes, primarily belonging to the genera Trichophyton, Microsporum, and Epidermophyton. Despite being a superficial infection, the rising incidence of treatment failure and recurrence has become a matter of concern in recent years. Methods: This prospective observational study, conducted at the department of dermatology and venereology of Chittagong Medical College Hospital, aimed to investigate the epidemiological factors associated with treatment failure and recurrent cases of superficial dermatophytosis. The study spanned from March 2022 to February 2023, involving 249 participants diagnosed with Tinea corporis, Tinea cruris, Tinea facies, or Tinea pedis. Factors such as excessive sweating, use of warm water, clothing habits, sharing practices, and topical corticosteroid application were analyzed. Results: The most common age group affected was 21-30 years, with a male preponderance (1.6:1). Excessive sweating, wearing water-soaked garments, and sharing towels were prevalent among participants. After 4 weeks of treatment, 81.5% achieved complete cure, but 52.7% of these cases experienced a recurrence within the subsequent 4 weeks. Multivariate analysis identified sharing towels, family history of dermatophytosis, and past topical steroid use as significant risk factors for treatment failure/recurrence. Conclusions: The study emphasizes the importance of linen (sharing towels) in the transmission of dermatophytosis and highlights the increased risk associated with a family history of the condition. Additionally, the injudicious use of topical steroids emerged as a significant factor contributing to treatment failure and recurrence.
ABSTRACT
Background & objectives: Azithromycin has been in use as an alternate treatment option for enteric fever even when the guidelines on the susceptibility testing were not available. There is lack of data on susceptibility and mechanisms of resistance of azithromycin in Salmonella Typhi and S. Paratyphi A. The aim of the present study was to determine the azithromycin susceptibility and resistance mechanisms in typhoidal salmonellae isolates archived in a tertiary care centre in north India for a period of 25 years. Methods: Azithromycin susceptibility was determined in 602 isolates of S. Typhi (469) and S. Paratyphi A (133) available as archived collection isolated during 1993 to 2016, by disc diffusion and E-test method.PCR was done for ereA, ermA, ermB, ermC, mefA, mphA and msrA genes from plasmid and genomic DNA and sequencing was done to detect mutations in acrR, rplD and rplV genes. Results: Azithromycin susceptibility was seen in 437/469 [93.2%; 95% confidence interval (CI), 90.5 to 95.1%] isolates of S. Typhi. Amongst 133 isolates of S. Paratyphi A studied, minimum inhibitory concentration (MIC) of ?16 mg/l was found in 102 (76.7%; 95% CI, 68.8 to 83.0). MIC value ranged between 1.5 and 32 mg/l with an increasing trend in MIC50and MIC90with time. Mutations were found in acrR in one and rplV in two isolates of S. Typhi. No acquired mechanism for macrolide resistance was found. Interpretation & conclusions: Azithromycin could be considered as a promising agent against typhoid fever on the basis of MIC distribution in India. However, due to emergence of resistance in some parts, there is a need for continuous surveillance of antimicrobial susceptibility and resistance mechanisms. There is also a need to determine the breakpoints for S. Paratyphi A.