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.

Tinea Capitis by Microsporum audouinii: Case Reports and Review of Published Global Literature 2000-2016.

Tinea capitis caused by Microsporum audouinii is reported herein from two Brazilian schoolchildren, which are brothers. Arthroconidia were evidenced on direct examination of scalp hair, and a fungus of the genus Microsporum was isolated from cultures of each patient. The isolated fungi were classified as M. audouinii by visualization of species-specific structures, including: pectinate hyphae, chlamydospores, and fusiform macroconidia, sterile growth with characteristic brown pigment in rice grains, and through DNA sequencing of the internal transcriber spacer region. Patients were refractory to ketoconazole, but the two cases had a satisfactory response to oral terbinafine. All M. audouinii infections described in this century were reviewed, and to our knowledge, this is the first literature description of this species from South America. Misidentification of M. audouinii with Microsporum canis can occur in this area, leading to erroneous data about the occurrence of this species.

Management of endemic Microsporum canis dermatophytosis in an open admission shelter: a field study.

Endemic Microsporum canis dermatophytosis was identified in a large, open admission, private, no-kill shelter that admitted >1200 cats per year. Fungal culture (FC) screening revealed that 166/210 (79%) and 38/99 (38%) cats in the non-public and public area were culture positive, respectively. However, pending screening FC results, the 99 cats in the public area were treated with once-weekly lime sulfur rinses and monitored with once-weekly FC. Cats in the non-public area were not treated. When FC results were available, cats were separated into low-risk (n = 61) and high-risk (n = 38) groups based upon the presence or absence of skin lesions. Low-risk cats continued to receive once-weekly topical lime sulfur and rapidly achieved culture-negative status. High-risk cats were divided into two groups based upon the number of colony-forming units/plate (low or high). All 38 cats were treated with twice-weekly lime sulfur and oral terbinafine and within 6-7 weeks only 5/38 cats were still FC-positive. These cats were moved to a separate room. Dermatophytosis was eradicated within 5 months; eradication was prolonged owing to reintroduction of disease into the remaining room of cats under treatment from three kittens returning from foster care. Continued admissions and adoptions were possible by the institution of intake procedures that specifically included careful Wood's lamp examination to identify high-risk cats and use of a 'clean break strategy'.

In vitro and in vivo antifungal activity of some essential oils against feline isolates of Microsporum canis.

The treatment of dermatophytoses due to Microsporum canis is cumbersome and relapses can occur. Volatile essential oils (EOs) obtained from plants would seem to represent suitable tools to contrast mycoses both in human and animals. The anti-M. canis activity of some EOs chemically characterized was evaluated both in vitro and in vivo. Eleven feline isolates of M. canis were tested by microdilution against EOs extracted from Thymus serpillum, Origanum vulgare, Rosmarinus officinalis, Illicium verum and Citrus limon. A mixture composed by 5% O. vulgare, 5% R. officinalis and 2% T. serpillum, in sweet almond oil was administered to seven infected, symptomatic cats. T. serpillum and O. vulgare showed the lowest MICs, followed by I. verum, R. officinalis and C. limon. The assay performed on mixture showed that antimycotic activity of each component was enhanced. Four out of seven treated cats recovered both clinically and culturally. T. serpillum and O. vulgare EOs showed a strong antifungal activity. Preliminary data suggest a possible application in managing feline microsporiasis. Considering the potential zoonotic impact of this infection, the use of alternative antimycotic compounds would be of aid to limit the risk of environmental spreading of arthrospores.

Changing face of tinea capitis in Europe.

PURPOSE OF REVIEW: The aim of this review is to update the latest epidemiological situation in Europe, explore recent issues in recognition and emerging opportunities in diagnosis and look at progressions in treatment. Papers reviewed have, in the main, been published within the last 2 years. RECENT FINDINGS: The predominantly responsible organism varies with country. Trichophyton tonsurans accounts for 50-90% of cases in the UK, Microsporum canis is commonest in Central and Southern Europe and T. violaceum in Greece and Belgium. Confirming the diagnosis of tinea capitis is best undertaken with more than one sampling method to include scraping of scalp, and either scalp massage brush, toothbrush, moistened cotton gauze swab or cytobrush to increase sensitivity. Advances in the speed of species identification is offered by the novel PCR-based detection/identification scheme, and although not yet commercially available, with potential turnaround times of <24 h this will offer a significant advance in the speed of diagnosis, allowing treatment to be organism tailored. Although griseofulvin remains the only licensed treatment in the UK and a meta-analysis confirms it is effective against the major tinea capitis pathogens, a new granule formulation of terbinafine has been shown to be more effective against T. tonsurans. SUMMARY: With the evolving organism profile across Europe, obtaining an accurate diagnosis and species identification is crucial. Using more than one sampling method followed by rapid species identification techniques will facilitate this. Although there are no changes in specific product license to include children, the production of a child-friendly formulation of terbinafine will contribute to improved compliance.

Use of a sustained release preparation of clotrimazole to treat dermatophytosis in a siamang (Hylobates syndactylus).

In November 2004, an adult male siamang (Hylobates syndactylus) from The Tisch Family Zoological Gardens-Jerusalem Biblical Zoo (Israel) presented with skin lesions on various body parts. Lesions consisted of alopecia and dry, crusty areas of hyperkeratosis. A diagnosis of dermatophytosis due to Microsporum canis was determined by fungal culture of skin scraping taken from the edge of several lesions. Treatment with various oral and topical antifungal agents such as griseofluvin, itraconozole, and lufenuron resulted in the resolution of most lesions and a decrease in size of the single remaining lesion, which continued to be culture positive for M. canis. The animal was anesthetized and an experimental sustained-release clotrimazole varnish was painted directly on the lesion. Initially there was no change in the lesion, and 2 months later a slightly altered formula was applied under anesthesia. One month later, the lesion began to reduce in size; 3 months after the start of treatment, although 2 years after the onset of clinical signs, the lesion resolved. Minimizing the number of treatments is always an advantage when dealing with exotic animals or zoological collections.

Evaluation of Microsporum canis in different methods of storage.

The main objective of this investigation was to evaluate different methods of storage for Microsporum canis based on materials and equipment that are readily available in developing countries. We tested 32 strains of M. canis at - 20 degrees C in potato dextrose agar (PDA) in its plain condition, or amended with 10% dimethyl sulfoxide or with 10% glycerol. In addition, we tested 25 degrees C storage of isolates in plain saline (0.9% NaCl) and in saline covered with a mineral-oil layer. After 9 months of storage, none of the M. canis strains frozen in PDA supplemented with glycerol survived, while only 16 and 6%, respectively, of the isolates in plain and DMSO medium lost viability. Nine month's storage in saline with or without mineral oil increased the amount of pleomorphic development of sterile hyphae; this phenomenon occurred at a significantly higher level than was seen in isolates stored at -20 degrees C. The physiological characteristics of M. canis were not affected by the different storage tests. The results suggest that, in order to ensure optimal viability, purity and pristine isolate condition, each M. canis isolate maintained should be held in at least two methods of storage, namely, PDA at -20 degrees C and saline with a mineral-oil layer at 25 degrees C.

[Study on the inhibitory activity, in vitro, of baicalein and baicalin against skin fungi and bacteria].

In this paper, we concentrated in examining, in vitro, the antiseptic activity of the baicalein and baicalin upon the seventeen pathogenic skin fungal and sixteen skin bacterial strains, these two flavonic compounds were known principally as the biosubstances of a traditional Chinese medicinal plant: Scutellaria baicalensis. In agar media, the baicalein possessed potent specific activity against the pathogenic yeasts with MICs of 70-100 micrograms/ml; But in the same condition, no inhibitory effect was observed upon dermatophytes and filamentous imperfect fungi for baicalein, and upon all used strains for baicalin. According to the antibacterial test of baicalein, a high efficacy was achieved against certain causative specie of axillary and foot's odour such as Micrococcus sedentarius, Staphylococcus epidermidis, S. hominis and C. xerosis with a MICs inferior to 250 micrograms/ml. The good inhibitory activity of baicalein could be linked to the group hydroxyl (-OH) in position seven of the molecule.

Effect of glucose and thiamine concentrations on the formation of macroconidia in dermatophytes. Occurrence of dysgonic Microsporum canis strains in Athens, Greece.

Data collected from multiple trials with 110 fresh and preserved clinical isolates of Trichophyton mentagrophytes var. mentagrophytes, T. violaceum, T. rubrum, T. verrucosum, Microsporum canis and Epidermophyton floccosum revealed that production of macroconidia depends on glucose and thiamine concentrations in the medium. Optimal macroconidia production was obtained at the critical concentrations of 5 g l-1 glucose and 0.6 g l-1 thiamine when the two compounds were used in combination. The same conditions also encouraged macroconidia production in aconidial strains of T. verrucosum. Cutaneous inoculation in immunocompetent laboratory rabbits further enhanced the macroconidia producing capacity of the tested strains. Emphasis was placed on the occurrence of dysgonic/atypical strains of M. canis, which readily reverted to their typical phenotypes after growth on medium supplemented with 0.6 g l-1 thiamine, a process greatly augmented after cutaneous animal inoculation. It was verified that selective exogenous factors affect macroconidial production and that the dysgonic group of M. canis constitutes an epidemiologically significant group in the Greater Athens area. This is the first report of the occurrence of such M. canis strains from Greece.

Evaluation of topical therapies for the treatment of dermatophyte-infected hairs from dogs and cats.

Seven commonly used, topical antifungal products (i.e., lime sulfur, chlorhexidine, captan, povidone-iodine, sodium hypochlorite, and enilconazole solutions, and ketoconazole shampoo) were evaluated for their antifungal activity on Microsporum canis-infected hairs from dogs and cats in an in vitro study. Hairs were soaked or shampooed in each product for five minutes twice a week for four weeks. Of the seven products used in this study, lime sulfur and enilconazole solutions were superior in inhibiting fungal growth; no growth occurred on fungal cultures after two treatments with either product. Chlorhexidine and povidone iodine solutions were effective after four treatments, and sodium hypochlorite solution and ketoconazole shampoo inhibited fungal growth after eight treatments. Captan did not inhibit fungal growth during the test period.

Treatment of superficial mycoses in the tropics: Whitfield's ointment versus clotrimazole.

BACKGROUND: In tropical primary health care, essential drugs should be safe, effective, and as inexpensive as possible. To treat the very common dermatophyte infections of the skin, one may use inexpensive Whitfield's preparations, more expensive topical imidazole derivatives, or extremely expensive oral antifungals. Because a cream base is felt to be more appropriate than an ointment in tropical conditions, we wanted to compare the effectiveness of Whitfield's cream and a topical imidazole derivative in field conditions in the tropics. METHODS: A double-blind trial was performed involving 153 patients with a dermatophyte infection of the skin in Karonga District, Northern Malawi, including 25 patients who were HIV-1-seropositive, comparing Whitfield's cream with clotrimazole cream. RESULTS: 75 patients were treated with Whitfield's cream and 78 with clotrimazole cream for a period of 6 weeks. Cure rates ranged from 80% to over 90% depending on the definition of cure. If positive cultures after treatment were used as criterion for treatment failure, six were found in each treatment group. One in each treatment failure group was an HIV-1-seropositive patient. CONCLUSIONS: The great majority of patients in the tropics with a dermatophyte infection of the skin can be cured with a topical antimycotic preparation and do not need expensive oral therapy. This also proved to be valid for HIV-1-seropositive patients. Whitfield's cream and clotrimazole cream are both very effective. The lower cost makes Whitfield's cream the treatment of choice in dermatophyte infections of the skin in tropical primary health care.

Studies on fungal flora in hair from domestic and laboratory animals suspected of dermatophytosis. I. Dematophytes.

Hairsamples of domestic and laboratory animals suspected of dermatophytosis were examined for the presence of dermatophytes. A nutritionally poor base-medium developed by the author was successfully used in the isolation and identification of dermatophytes. Casein-medium supplemented with vitamins and Sabouraud-liquid medium were used in special cases. Dermatophytes were isolated in 36 of 331 samples (10.9%). The dermatophytes recovered were Microsporum canis: 13 isolates from cat. 4 from dog. 1 from horse; Trichophyton mentagrophytes var. granulare: 3 isolates from dog, 3 from horse, 2 from guinea pig and 1 from rabbit; Trichophyton terrestre 1 isolate from dog. Eleven of the 13 feline isolates originated from house cats and the relative frequency was higher among the purebred cats. Two of the cat isolates were connected with human dermatophytosis.

Topical treatment of dermatophytoses and candidoses.

In a double-blind trial clotrimazole cream was compared with tolnaftate cream in the treatment of dermatophytoses and with nystatin cream in the treatment of candidoses. Clotrimazole was shown to be effective against both dermatophytoses and candidoses and was as effective and acceptable as tolnaftate and nystatin creams in each condition.