Clinical isolates of Trichophyton rubrum are completely inhibited by photochemical treatment with a γ-cyclodextrin formulation of curcuminoids.

INTRODUCTION: It was shown previously that dermatophytes can markedly be inhibited by a photochemical treatment with curcumin. This kind of photo-inactivation needs to be improved, however, because curcumin is poorly water-soluble. Therefore, a new water-soluble γ-cyclodextrin formulation of curcuminoids was tested for its photochemical inactivation of Trichophyton (T.) rubrum. MATERIALS AND METHODS: Conidia were harvested from 6 typical strains of T rubrum and used to inoculate wells of microtiter plates. These wells were also filled with a γ-cyclodextrin curcuminoid formulation with 0.1% DMSO and Sabouraud broth. The assays were then irradiated with visible light (wavelength 420 nm, 45 J/cm2 ). After 24 hours, curcuminoid was added once more, and irradiation was repeated. Fungal growth was monitored photometrically for 8 days and compared with controls. RESULTS: Growth of all 6 T rubrum strains was completely inhibited by the photochemical treatment with the γ-cyclodextrin formulation of curcuminoids. The same curcuminoid formulation applied without irradiation had only a minor inhibitory effect. DISCUSSION: Photo-inactivation of dermatophytes with a γ-cyclodextrin formulation of curcuminoids plus visible light is a very promising procedure with potential for a new treatment of patients with superficial tinea.

Dermatomycoses in the Israeli defense forces-Epidemiological and clinical aspects.

Dermatomycoses, involving skin, hair and nail infections, are among the most frequent human infections with global distribution and may have a public health and economic impact. The causative agents include Dermatophytes, Candida, Malassezia and non-Dermatophyte moulds. High morbidity may be associated with certain variables: age, gender, occupation-such as farming or military service, and climate or environmental conditions. The objectives of the present study included: (a). Assessment of epidemiological aspects of dermatomycoses in the Israeli Defense Forces (IDF). (b). Antifungal drug susceptibility of fungi isolated in culture from soldiers. (a) Epidemiological assessment: data based on IDF's medical registry during the period 2009-2013 on 10 831 male and female soldiers (8164 and 2667, respectively), of which 2589 were combat soldiers. (b) Susceptibility tests: to ketoconazole, fluconazole, itraconazole, terbinafine and griseofulvin of ~ 100 Dermatophyte and Candida isolates, using E test and/or disc diffusion assays. (c) Statistical analysis: logistic regression, chi-square and ANOVA. (a) Incidence in male soldiers higher than in female soldiers (35% vs. 28%). (b) Incidence in combat soldiers higher than in non-combat soldiers (39% vs 32%). (c) The major site of involvement-nails. (d) Infections peaked during summer months. (e) Dermatophytes constitute close to 90% of the aetiological agents (87% and 86%). (f) Trichophyton rubrum the dominant species. (g) terbinafine was the most active antifungal drug. The most significant conclusion of relevance of this study is the finding of higher morbidity rate among combat soldiers, as this may affect the activity of this group.

Occurrence of dermatophytoses in patients from the Sistema Único de Saúde.

BACKGROUND: Dermatophytosis is a cutaneous disease caused by filamentous keratinophilic fungi belonging to the genera Trichophyton, Microsporum and Epidermophyton, which present a high prevalence in the general population, being among the most common mycoses affecting about 20% of the world's population. OBJECTIVE: To carry out the epidemiological survey of cases of dermatophytosis in patients from the Sistema Único de Saúde in a regional Laboratory in the period of 5 years (2009 to 2013). METHODS: A retrospective study (January 2009 to December 2013) was carried out with a qualitative and quantitative design, through the registry book of the laboratory, Mycology Sector, where cases of patients with suspected dermatomycosis were analyzed. RESULTS: In a 5-year period, a total of 4467 cases were suspected of having a fungal infection. Of these, 68.74% (3071) cases were of dermatomycosis. In relation to cultures with fungal growth, 12.54% (385 cases) were dermatophyte fungi and 7.97% (245 cases) non-dermatophyte fungi were isolated. Among the species identified, there was a higher prevalence of T. rubrum complex (75%), T. mentagrophytes complex (11.68%) and M. canis (7.01%). Regarding the sites analyzed, nail involvement was the most frequent in 75% of the cases. STUDY LIMITATIONS: This work is representative in the studied region. CONCLUSIONS: Dermatomycosis samples are the most frequent among all samples of fungal infections from these patients, with the nail being the most affected area and the fungi T. rubrum complex and T. mentagrophytes complex the most frequent.

Occurrence of dermatophytoses in patients from the Sistema Único de Saúde

Abstract: Background: Dermatophytosis is a cutaneous disease caused by filamentous keratinophilic fungi belonging to the genera Trichophyton, Microsporum and Epidermophyton, which present a high prevalence in the general population, being among the most common mycoses affecting about 20% of the world's population. Objective: To carry out the epidemiological survey of cases of dermatophytosis in patients from the Sistema Único de Saúde in a regional Laboratory in the period of 5 years (2009 to 2013). Methods: A retrospective study (January 2009 to December 2013) was carried out with a qualitative and quantitative design, through the registry book of the laboratory, Mycology Sector, where cases of patients with suspected dermatomycosis were analyzed. Results: In a 5-year period, a total of 4467 cases were suspected of having a fungal infection. Of these, 68.74% (3071) cases were of dermatomycosis. In relation to cultures with fungal growth, 12.54% (385 cases) were dermatophyte fungi and 7.97% (245 cases) non-dermatophyte fungi were isolated. Among the species identified, there was a higher prevalence of T. rubrum complex (75%), T. mentagrophytes complex (11.68%) and M. canis (7.01%). Regarding the sites analyzed, nail involvement was the most frequent in 75% of the cases. Study Limitations: This work is representative in the studied region. Conclusions: Dermatomycosis samples are the most frequent among all samples of fungal infections from these patients, with the nail being the most affected area and the fungi T. rubrum complex and T. mentagrophytes complex the most frequent.

Onychomycosis of the Middle Finger of a Japanese Judo Athlete due to Trichophyton tonsurans

We present a 17-year-old Japanese male high school student, who had applied steroid ointment for atopic dermatitis, with fingernail onychomycosis due to Trichophyton tonsurans. He was found positive for T. tonsurans infection based on hairbrush culture performed due to an epidemic of T. tonsurans infection in his judo club. The hairbrush culture method is very important in screening for this infection, and dermatologists should examine the entire body of athletes who are found positive using this method. For the diagnosis of T. tonsurans infection, other than the skin and hair, the nails should also be checked by dermoscopy because the fingernail may be the origin of this fungus.

The Energy Density and Treatment Times Are the Main Factors That Affect the Efficacy of Long-Pulsed 1,064-nm Nd:YAG Laser Treatment for Onychomycosis Caused by Trichophyton rubrum.

BACKGROUND: No optimal regimen exists for the LPNYL (long-pulsed 1,064-nm neodymium:yttrium-aluminum-garnet laser) for treating onychomycosis. OBJECTIVE: To establish an optimal LPNYL treatment regimen for onychomycosis caused by Trichophyton rubrum (OCTr). PATIENTS AND METHODS: First, 511 infected nails of 177 patients were treated using LPNYL with orthogonally designed regimens according to various energy densities, spot sizes, pulse widths, and treatment times. The optimal treatment regimen was established by multivariate analysis. Next, 69 patients with 221 infected nails were randomized to receive oral itraconazole (drug group) and the optimal regimen of LPNYL treatment (laser group). The clinical efficacy (CE) and mycological efficacy (ME) were evaluated at 6 and 12 months following the start of treatment, and adverse reactions were recorded in both groups. RESULTS: Both CE and ME were significantly correlated with the energy density (p < 0.05) and treatment times (p < 0.05), but not with the spot size (0.071 < p < 0.083) or pulse width (0.051 < p < 0.060), at 6 or 12 months. There were no significant differences at 6 or 12 months (p > 0.05), and no significant difference was observed in CE at 12 months between the two groups (p > 0.05). At 6 months, the CE in the laser group was significantly higher than that in the drug group (p < 0.001). CONCLUSIONS: LPNYL is effective and safe for treating OCTr. The energy density and treatment times are the main factors that affect the efficacy. The optimal regimen for LPNYL is an energy density of 45 J/cm2, pulse width of 35 ms, spot size of 4 mm, frequency of 1 Hz, and 6 treatments with 1-week intervals. Laser treatment has rapid clinical recovery.

Investigation of the antifungal potential of linalool against clinical isolates of fluconazole resistant Trichophyton rubrum.

The aim of this study was to investigate the activity of the monoterpene linalool against clinical isolates of Trichophyton rubrum. Initially, a sensitivity assay for commercial antifungals with solid disks in diffusion medium was performed. Minimum inhibitory concentration (MIC) of linalool and ketoconazole (positive control) were determined by microdilution in RPMI 1640 medium (CLSI M38-A2). We then evaluated the action of linalool and ketoconazole at different concentrations (1/2MIC, MIC and 2×MIC) on mycelial growth (radial mycelial growth), conidia production and conidia germination using a hemacytometer. The effects on cell membrane (release of intracellular material) were also investigated. Finally, changes in fungal morphology as induced by the test drugs were analyzed. Based on the sensitivity tests, the fungal strains showed resistance to 5-fluorocytosine and fluconazole. The linalool MIC values ranged from 256µg/mL to 512µg/mL, whereas ketoconazole showed values of 4µg/mL to 8µg/mL. For the LM 305 strain, the test drugs showed the following MIC values: linalool 256µg/mL and ketoconazole 8µg/mL. The mycelial growth of T. rubrum LM 305 was inhibited by linalool (2×MIC) and ketoconazole (1/2MIC, MIC, 2×MIC), in 7 days of treatment (P<0.05). The test-drugs also inhibited conidial germination and conidiogenesis (P<0.05). Linalool also caused leakage of intracellular material (P<0.05). Finally, we verified the effectiveness of linalool and ketoconazole to induce micro-morphological changes, forming abnormal, wide, short and crooked hyphae. Based on these results, we conclude that linalool presents as an antifungal agent with anti-Trichophyton rubrum potential, an important dermatophytosis agent.

Onychomycosis in diabetic patients in Fako Division of Cameroon: prevalence, causative agents, associated factors and antifungal sensitivity patterns.

BACKGROUND: Onychomycosis is an infection of the nail unit by a fungus. This is a very common infection amongst diabetics. Its occurrence among diabetics in Fako division is unknown. In this study we provide information on the characteristics of onychomycosis in diabetics in Fako division, Cameroon. METHODS: A cross-sectional descriptive and analytical hospital-based study was conducted in two diabetic clinics in the Buea and Limbe regional hospitals. We recruited 152 consenting diabetics into the study. Demographic, behavioural, and clinical data of patients were obtained through the use of structured questionnaires. Toenail, finger nail, skin scrapings and nail clippings were collected from participants, KOH mounts were prepared and observed under the microscope and cultured on Sabouraud Dextrose Agar supplemented with chloramphenicol to isolate causative fungi. Identification of isolates was done to species level using the cello tape flag method and slide culture. The presence of a dermatophyte by either microscopy or culture or both methods was considered positive for onychomycosis. Antifungal susceptibility testing was carried out using selected antifungals by the Kirby-Bauer disk diffusion method on Sabouraud Dextrose Agar. RESULTS: Clinical onychomycosis was found in 77 of the 152 diabetics tested giving a prevalence of 50.7% (95% CI 42.4-58.9) in diabetics in Fako. No socio-demographic or clinical factor studied was significantly associated with onychomycosis. Trichophyton rubrum was the most common isolate (62%). Other isolates included Trichophyton metagraphyte (22%) and Trichophyton tonsurans (16%). Dermatophytes were sensitive to miconazole (66%), amphotericin B (19%) and ketoconazole (14%). CONCLUSION: Onychomycosis is common in diabetics in Fako signifying the need for regular screening by either microscopy or culture. Infected nails could be treated with miconazole.

Terapia fotodinámica antimicrobiana in vitro aplicada sobre Trichophyton mentagrophytes con nuevo azul de metileno como fotosensibilizador / In vitro antimicrobial photodynamic therapy against Trichophyton mentagrophytes using new methylene blue as the photosensitizer

INTRODUCCIÓN Y OBJETIVOS: La terapia fotodinámica antimicrobiana combina el uso de un fármaco fotosensibilizante, la luz y el oxígeno para erradicar microorganismos patógenos. Trichophyton mentagrophytes es un hongo dermatofito capaz de invadir la piel y tejidos queratinizados. El objetivo de este trabajo es aplicar la terapia fotodinámica antimicrobiana para la inactivación in vitro de T. mentagrophytes utilizando el nuevo azul de metileno como agente fotosensibilizador. MATERIAL Y MÉTODOS: Se aplica un diseño factorial completo para optimizar los parámetros que permiten la fotoinactivación del dermatofito. Se tiene en cuenta la concentración del nuevo azul de metileno, el tiempo de contacto entre el fotosensibilizador y el hongo antes del tratamiento con luz y la fluencia de luz roja aplicada entre 620 y 645 nm. RESULTADOS: La mínima concentración de nuevo azul de metileno que produce una mortalidad de todas las células de T. mentagrophytes de la suspensión inicial (concentración∼106 ufc/ml) es 50 M para una fluencia de 81 J/cm-2 y un tiempo previo de contacto hongo-fotosensibilizador de 10 min. Si se aumenta la concentración a 100 M la fluencia que se necesita disminuye a 9 J/cm-2. CONCLUSIONES: La comparación de nuestros datos con otros publicados muestra que la susceptibilidad de T. mentagrophytes a la terapia fotodinámica antimicrobiana con nuevo azul de metileno es cepa-dependiente. El nuevo azul de metileno es un fotosensibilizador a tener en cuenta para el tratamiento de las micosis cutáneas causadas por este dermatofito

INTRODUCTION AND OBJECTIVES: Antimicrobial photodynamic therapy combines the use of a photosensitizing drug with light and oxygen to eradicate pathogens. Trichophyton mentagrophytes is a dermatophytic fungus able to invade the skin and keratinized tissues. We have investigated the use of new methylene blue as the photosensitizing agent for antimicrobial photodynamic therapy to produce the in vitro inactivation of T mentagrophytes. MATERIAL AND METHODS: A full factorial design was employed to optimize the parameters for photoinactivation of the dermatophyte. The parameters studied were new methylene blue concentration, contact time between the photosensitizing agent and the fungus prior to light treatment, and the fluence of red light (wavelength, 620---645 nm) applied. RESULTS: The minimum concentration of new methylene blue necessary to induce the death of all T. mentagrophytes cells in the initial suspension (approximate concentration, 106 colony forming units per milliliter) was 50 M for a fluence of 81 J/cm2 after a contact time of 10 minutes with the photosensitizing-agent. Increasing the concentration to 100 M allowed the fluence to be decreased to 9 J/cm2. CONCLUSIONS: Comparison of our data with other published data shows that the susceptibility of T. mentagrophytes to antimicrobial photodynamic therapy with new methylene blue is straindependent. New methylene blue is a photosensitizing agent that should be considered for the treatment of fungal skin infections caused by this dermatophyte

Detection and identification of Trichophyton tonsurans from clinical isolates and hairbrush samples by loop-mediated isothermal amplification system.

Since the 1990s, there have been reports of the spread of dermatophytosis caused by Trichophyton tonsurans among contact sports athletes in several countries, including Japan. This study was performed to develop a loop-mediated isothermal amplification (LAMP) system for rapid and accurate detection and identification of T. tonsurans from clinical isolates or hairbrush samples for diagnosis and to prevent the spread of infection. A specific primer set was prepared by comparing the whole genome sequence of T. tonsurans with those of six other closely related dermatophytes. After confirming the sensitivity and specificity of this system, LAMP assay was performed using 37 clinical samples obtained from three healthy volunteers and 24 judo athletes. A total of 155 fungal isolates (56 strains of various standard fungi, 96 identified T. tonsurans isolates, three hairbrush-cultured isolates from judo athletes) and 37 hairbrush samples (34 samples from 24 judo athletes, and three samples from three healthy volunteers) were used for culture and LAMP assay, respectively. The assay showed no cross-reactivity to standard strains other than T. tonsurans. The detection limit was 100 copies of DNA template per tube. All of the 96 T. tonsurans isolates were amplified, and all samples from healthy volunteers showed negative results. Four of the 34 hairbrush samples obtained from judo athletes showed positive results in LAMP assay, and two of the four were positive in both culture and LAMP assay. We developed a rapid LAMP system with high specificity and sensitivity for diagnosis of T. tonsurans infection.

Characterization of Antifungal Activity and Nail Penetration of ME1111, a New Antifungal Agent for Topical Treatment of Onychomycosis.

Fungal nail infection (onychomycosis) is a prevalent disease in many areas of the world, with a high incidence approaching 23%. Available antifungals to treat the disease suffer from a number of disadvantages, necessitating the discovery of new efficacious and safe antifungals. Here, we evaluate the in vitro antifungal activity and nail penetration ability of ME1111, a novel antifungal agent, along with comparator drugs, including ciclopirox, amorolfine, terbinafine, and itraconazole. ME1111 showed potent antifungal activity against Trichophyton rubrum and Trichophyton mentagrophytes (the major etiologic agents of onychomycosis) strains isolated in Japan and reference fungal strains with an MIC range of 0.12 to 0.5 mg/liter and an MIC50 and MIC90 of 0.5 mg/liter for both. Importantly, none of the tested isolates showed an elevated ME1111 MIC. Moreover, the antifungal activity of ME1111 was minimally affected by 5% wool keratin powder in comparison to the other antifungals tested. The ME1111 solution was able to penetrate human nails and inhibit fungal growth in a dose-dependent manner according to the TurChub assay. In contrast, 8% ciclopirox and 5% amorolfine nail lacquers showed no activity under the same conditions. ME1111 demonstrated approximately 60-fold-greater selectivity in inhibition of Trichophyton spp. than of human cell lines. Our findings demonstrate that ME1111 possesses potent antidermatophyte activity, maintains this activity in the presence of keratin, and possesses excellent human nail permeability. These results suggest that ME1111 is a promising topical medication for the treatment of onychomycosis and therefore warrants further clinical evaluation.

Successful Treatment of Refractory Majocchi's Granuloma with Voriconazole and Review of Published Literature.

Majocchi's granuloma (MG) is a rare deep skin dermatophyte infection that can occur either in immunocompetent or in immunocompromised individuals. Oral itraconazole or terbinafine is considered to be the first choice of treatment. We report an immunocompetent man with deep nodular form of MG, the form which is generally found in immunosuppressed individuals. Previous treatment with either oral itraconazole or terbinafine yielded no apparent improvement. After a series of examination, the man was diagnosed as having Trichophyton rubrum-induced MG mixed with bacterial infection as evidenced by growth of Klebsiella pneumoniae in tissue bacterial culture. The patient was treated with a combination of cefoselis and levofloxacin for bacterial clearance followed by voriconazole treatment. After approximately 4 months of voriconazole treatment, the lesions completely resolved. Alternative medicine (voriconazole) can be considered in case of refractory infections during MG treatment.

A chronic disseminated dermatophytosis due to Trichophyton violaceum.

A 48-year-old female had presented dandruff and breakable hair for more than 40 years, dry scaly erythema on bilateral palms and feet accompanying with nail destruction for 20 years, and scaling papules on the buttock for 5 years. Direct microscopic examination showed endothrix anthroconidia within broken hair and septate and branched hyphae within skin and nail lesion. Fungal cultures from all infected sites were examined by morphology, ITS sequencing, and random amplified polymorphic DNA fingerprinting, and were identified as Trichophyton violaceum from the same source. The patient was treated with oral terbinafine 0.25 g/day as well as with 1% terbinafine gel for external use and with 2% ketoconazole lotion for shampoo and bath. A follow-up after 4 weeks showed that the lesions decreased significantly.

Atividade antifúngica in vitro de óleos essenciais sobre linhagens de dermatófitos / Antifungal activity in vitro of essential oils on dermatophyte lines

A dermatofitose é uma doença fúngica, contagiosa, causada por um grupo de fungos chamados dermatófitos que tem uma forte afinidade por tecidos queratinizados da pele e seus apêndices (pêlo e unha). O uso de antifúngicos à longo prazo; de forma indiscriminada; associados a doses relativamente elevadas, pode selecionar micro-organismos resistentes e provocar efeitos colaterais severos, faz com que busquemos saídas para amenizar este quadro. Diante do exposto, avaliamos se os fitoterápicos em estudo ( óleo de Cravo-da-Índia, óleo de Melaleuca, óleo de Eucalipto e óleo de Citronela) possuem efeitos inibidores no controle e tratamento dos dermatófitos mais frequentes.OBJETIVOS: Avaliar se os óleos essenciais de Cravo-da-India, Melaleuca, Eucalipto e Citronela possuem efeitos inibitórios no controle e tratamento dos dermatófitos estudados, buscando alternativas naturais. MATERIAL E MÉTODOS: Foram utilizadas cepas de linhagens de dermatófitos Trichophyton rubrum e Trichophyton mentagrophytes isolados da rotina laboratorial do Laboratório de Micologia do Instituto Lauro de Souza Lima/Bauru, por demanda espontânea, de diferentes sítios anatômicos, sendo estes inoculados em placas de Petri contendo óleos de: cravo-da-India, melaleuca, eucalipto e citronela em 5 concentrações diferentes. Estas placas foram incubadas em estufa bacteriológica a 25°C durante 7 dias. Foram feitos controles positivos e controles negativos para cada amostra e também realizadas o mesmo procedimento com 4 cepas padrão (American Type Culture Collection) das mesmas linhagens de dermatófitos. Após o sétimo dia de inoculação, as leituras do diâmetro das colônias foram feitas e os resultados foram avaliados quanto ao óleo, ao agente etiológico, ao sexo e ao sítio anatômico. RESULTADOS E DISCUSSÃO: Os resultados mostraram a inibição dos microrganismos nas amostras em 99% do óleo de Cravo-da-índia, em 84% na Citronela, em 40% na Melaleuca e 15% no Eucalipto independente da e, do sítio ...

A case of tinea incognito.

Tinea incognito is a dermatophyte infection of the skin that presents atypically because it has previously been treated with imunnosuppresive medication. Herein we present a case of a middle-aged man who was initially clinically diagnosed to have plaque-type psoriasis on his arms. Over the course of two months of topical hydrocortisone and calciptriol treatment as well as phototherapy, the rash worsened. At the time of presentation to hospital the patient had a pruritic, widespread, sloughing, erythematous rash with areas of eschar. A punch biopsy skin confirmed dermatophyte fungal infection of the skin. Fungal culture was positive for Trichophyton Rubrum and the eruption resolved with systemic anti-fungal therapy. Patient specific risk factors for atypical presentation included poor hygiene and hepatatic disease.

Topical treatment of tinea pedis using 6% coriander oil in unguentum leniens: a randomized, controlled, comparative pilot study.

BACKGROUND: The antifungal activity of coriander oil has already been demonstrated in vitro. OBJECTIVE: Evaluation of the efficacy and tolerability of 6% coriander oil in unguentum leniens in the treatment of interdigital tinea pedis. METHODS: Half-side comparative pilot study on subjects with symmetric, bilateral interdigital tinea pedis. Active drug and placebo control were applied twice daily on the affected areas, and follow-up visits were performed on days 14 and 28. RESULTS: 40 participants (mean age 52.5 years, 60% male) were included in the study. For 6% coriander oil in unguentum leniens, a highly significant improvement of the clinical signs (p < 0.0001) was observed during the entire observation period; the number of positive fungal cultures also tended to decrease (p = 0.0654). The tolerability of the tested substances was good. CONCLUSION: Coriander oil is effective and well tolerated in the treatment of interdigital tinea pedis.

A herbal antifungal formulation of Thymus serpillum, Origanum vulgare and Rosmarinus officinalis for treating ovine dermatophytosis due to Trichophyton mentagrophytes.

A number of herbal products with anti-inflammatory, antiseptic and antimycotic properties are available for dermatological usage. The successful treatment of 13 sheep affected by ringworm due to Trichophyton mentagrophytes with a mixture consisting of essential oils (EOs) of Thymus serpillum 2%, Origanum vulgare 5% and Rosmarinus officinalis 5% in sweet almond (Prunus dulcis) oil. The effectiveness of EOs and of the major components of the mixture (thymol, carvacrol, 1,8 cineole, α-pinene, p-cymene, γ-terpinene) against the fungal clinical isolate was evaluated by a microdilution test. Thirteen animals were topically administered with the mixture twice daily for 15 days. The other sheep were administered with a conventional treatment (seven animals) or left untreated (two animals). Minimum inhibitory concentration (MIC) values were 0.1% for T. serpillum, 0.5% for O. vulgare, 2.5% for I. verum and 5% for both R. officinalis and C. limon. Thymol and carvacrol showed MICs of 0.125% and 0.0625%. A clinical and aetiological cure was obtained at the end of each treatment regimen in only the treated animals. Specific antimycotic drugs licenced for food-producing sheep are not available within the European Community. The mixture tested here appeared to be a versatile tool for limiting fungal growth.

Is Trichophyton simii endemic to the Indian subcontinent?

Trichophyton simii is considered to be prevalent only in the Indian subcontinent where it was isolated from soil, as well as from infections of humans and animals. We have investigated a case of onychomycosis caused by this exotic dermatophyte, not traceable to endemic areas. This case, as in others due to this fungus in man or animals, that have been previously and sporadically reported worldwide, suggests infections caused by T. simii might be underestimated, especially outside its primary geographic areas. Indeed, there are isolates that do not show species-specific morphology, as in our case isolate, and as a result may be misidentified by classical methods. By checking the identity of some strains preserved in the collection BCCM/IHEM, we found several that proved to be T. simii, originating from non-endemic areas (Belgium, France and Ivory Coast). Therefore, the natural distribution of T. simii is probably not as restricted as has previously been proposed.

The results of Trichophyton tonsurans screening examinations and infection management in University Judo Federation of Tokyo athletes over a 4-year period.

BACKGROUND: T. tonsurans infection is spreading among combat sport athletes in Japan, and preventive measures are necessary. METHODS: A questionnaire survey and hairbrush-culture tests were conducted over a 4-year period on university judo athletes from about 50 university teams affiliated with the University Judo Federation of Tokyo. Culture-positive individuals were given specific treatment recommendations based on culture results and were advised to seek treatment at a medical clinic. Culture-positive individuals were re-tested at 3 months post-treatment. RESULTS: Approximately 65% of participants reported a history of T. tonsurans infection. The incidence of hairbrush culture-positive individuals overall gradually decreased from 11.3% (academic year 2008) to 5.4% (2011). Each year the incoming freshmen had the highest infection rate of the four academic classes. Beginning in 2009 the infection rates decreased sharply among those who had participated in the survey the previous year, and the decreases continued the following year (s) until graduation. Among culture-positive individuals, the incidence of asymptomatic carriers increased each year, from 86% in 2008 to 98% in 2011. The culture-negative conversion rate was 86% overall for those undergoing treatment. CONCLUSION: Preventive measures against T. tonsurans infection in the University Judo Federation of Tokyo were successful in increasing awareness of the disease, lowering the incidence of infection, and detecting asymptomatic carriers who require treatment.

Extra-scalp black dot ringworm caused by Trichophyton tonsurans among contact sports players.

We describe here two patients with tinea corporis exhibiting black dot ringworm (BDR). A cluster of black dots was observed on the extensor surfaces of the extremities of two rather hairy male patients, a 15-year-old judo practitioner and a 26-year-old combined martial arts fighter, during treatment of tinea corporis with topical antimycotics. Direct KOH examination showed that the black dots were composed of degenerated hair with numerous arthroconidia and were indistinguishable from BDR of tinea capitis. Trichophyton tonsurans was isolated from the dots of both patients. Although they were diagnosed with tinea corporis, they required 2-3 months of treatment with oral terbinafine. Dermatologists should be aware that BDR can appear on areas of the skin other than the scalp.