Use of MALDI-TOF MS for fungal species distribution of interdigital intertrigo in seafarers, Dakar, Senegal.

To determine fungal species distribution of interdigital intertrigo among seafarers in Dakar, Senegal, a cross-sectional study was carried out from May to August 2017 among seafarers clinically diagnosed with interdigital intertrigo. A questionnaire was filled to each patient before sampling the affected folds and transporting to Aristide Le Dantec University Hospital where mycological analyses were realized. Species identification by MALDI-TOF MS was performed in Marseille, France. In total, 169 men (21-66 years) were included. Few of them (3%) had a high level of education and the duration of the mycosis exceed 10 years for 88% of patients. Direct microscopic examination (ME) was positive in 34.3%. Among samples with positive ME, 58.6% had positive culture. An overall incidence of 30.2% was found. Patients with confirmed cases aged between 28 and 66 years. Among them, those between 36-50 years were predominant (52.9%). Those with a high level of education were less representative (2%). For 52.1% of patients, the duration of the mycosis was superior to 10 years. Furthermore, 57% of cases were significantly associated with other types of tinea pedis and/or onychomycosis (P=0.03). Culture was positive in 23.7% isolating 43 strains successfully identified at the species level by MALDI-TOF MS for 31 isolates: 20 Candida and 11 dermatophytes. The rest was identified only at the genus level belonged to Fusarium. In definitive, MALDI-TOF MS could be a useful tool for routine and fast identification of dermatophytes, yeasts and NDFF in clinical mycology laboratories.

[Clinical and etiological aspects of intertrigos caused by fungal infections in Abidjan (Cote d'Ivoire)]. / Aspects cliniques et étiologiques des intertrigos d'origine fongique à Abidjan (Côte d'Ivoire).

INTRODUCTION: Epidemiology of these disorders, mainly caused by mycosis, is little known in the Ivory Coast. The aim of this study was to determine the different clinical aspects of intertrigos caused by fungal infections. METHODS: We conducted a cross-sectional study in the Department of Clinical Dermatology at the University Hospital in Yopougon (Abidjan, Ivory Coast) from April to October 2012. The study involved the patients come to consultation with lesions in the folds suggesting a mycosis. Samples of serous fluid by swabbing or of scales by scrape cutting with the scalpel blade were performed at the level of the lesions. The fungal agents responsible for these lesions were identified after biological culture. RESULTS: A total of 200 patients had lesions suggesting intertrigo caused by fungal infection. The average age of patients was 29.8 years (with a standard deviation of 11.1 years). Mycosis-related intertrigos accounted for 6.7% of reasons for consultation. A female predominance was observed (76.7%). Lesions mainly occurred in the groin area (40.8%) and in the intergluteal clefts (36.9%). The most observed symptoms were maceration (52.4%) followed by burning (18.4%). In 89.3% of cases, intertrigos were caused by yeasts, including Candida albicans (33%), and Candida parapsilosis(19.4%) which were predominant. CONCLUSION: Mycosis-related intertrigos mainly affect the young adults of female sex. Lesions mainly occur at the level of the inguinal folds and intergluteal clefts. The main etiological agents are yeasts (Candida).

Cutaneous infections in the mature patient.

Dermatologists must be familiar with the peculiarities of the micro-organisms that may affect the elderly, in order to optimize the diagnosis and treatment of infections, which may affect their skin, especially because the world population is rapidly aging. It is estimated that there will be 434 million individuals over 80 years of age in 2050. Since the elderly population is rapidly increasing and their infections are usually more severe and different from those observed in younger adults, it leads to a statistical increase of the rates regarding hospitalization and mortality caused by infectious diseases among people over 85 years. Other health issues may be involved in the older population. These include nutritional alterations, as malnutrition or obesity, which can aggravate the infections. Also the usual signs and symptoms of infection are subtle or uncharacteristic in elderly patients, and frequently, they are unable to report their symptoms, which can delay the diagnosis. Among the many infections that may affect the elderly we reviewed the most frequent and those that are different in this age group, as herpes zoster, cytomegalovirus, herpes simplex, bacterial skin infections, erysipelas, celullitis, impetigo, folliculitis, furunculosis and carbunculosis, secondary infections, intertrigo (body folds), fungal infection, and scabies.

Toe web intertrigo in Kaposi's sarcoma patients: a microbiological study in a large cohort of patients.

Kaposi 's sarcoma (KS) is a rare multifocal angioproliferative disease associated with human herpes virus 8 (HHV-8) infection, characterized by cutaneous nodules or plaques especially on the lower limbs. Some skin modifications, such as chronic lymphedema, plantar hyperkeratosis and interdigital desquamation, may be associated with consequent impairment of the local immunosurveillance and increased risk of some bacterial or mycotic infections. With the objective of evaluating if bacterial or mycotic infections in KS patients are supported by different microorganisms compared to control patients, we performed an observational retrospective study, comparing positive cultural swabs of interdigital intertrigo of KS patients with positive cultural swabs of interdigital intertrigo of patients admitted to our dermatologic unit during the last 10 years. One hundred KS patients and 84 control patients were admitted to this study. Some of the skin swabs from interdigital spaces were positive for more than one microorganism, and therefore we found 187 microorganisms among the KS group and 182 microorganisms in the control group. The most common microrganisms among KS patients were T. mentagrophytes (16%), S. aureus (14.9%), P. aeruginosa (13.9%), S. marcescens (5,9%), while among non-KS patients were S. aureus (26,9%), C. albicans (22%), S. agalactiae (7.7%) and E. coli (9.9%). These differences are statistically significant (p < 0.01). KS patients may be more affected by toe web intertrigo due to other bacteria and dermatophytes than the general population. During clinical examination, a careful inspection is necessary for an early diagnosis of toe web intertrigo, in order to prevent serious complications, such as cellulitis and sepsis. Consequently, a cultural examination with antibiogram is required to identify the causative agent of intertrigo and guide antimicrobial therapy.

[Fusarioses to Fusarium solani in an immunocompetent and immunocompromised diagnosed in military hospital of Rabat]. / Fusarioses superficielles à Fusarium solani chez un immunocompétent et un immunodéprimé diagnostiquées à l'Hôpital militaire de Rabat.

Fusarium are ubiquitous hyalohyphomycoses, usually encountered in the soil. They are the second unusual fungal pathogens after the Trichosporon. Intertrigo Fusarium sp. is a rare achievement. We report a case of intertrigos interorteils in an immunocompetent 45years old and a same case associated with a total onychodystrophy in an immunocompromised 75year-old. Laboratory diagnosis has found Fusarium solani confirmed with the positivity of a pure culture twice. Good progress was noted with terbinafine treatment. One or more aggravating factors must always be sought. These cases are in addition to cases increasingly frequent intertrigo due to Fusarium sp.

Intertrigo Caused by Streptococcus pyogenes.

Well-demarcated, beefy-red lesions of the skin folds, without satellite lesions, are the clinical hallmarks of intertrigo, frequently misdiagnosed especially in young children. We present 6 cases of streptococcal intertrigo to draw attention to this easily diagnosed and treated, but frequently overlooked, infection.

[Trichophyton tonsurans associated with non-albicans Candida species in hands onychomycosis about a Moroccan case]. / Trichophyton tonsurans associé à Candida non albicans lors d'une onychomycose des mains, à propos d'un cas au Maroc.

INTRODUCTION: Trichophyton tonsurans is an anthropophilic dermatophyte, frequent in the USA and in Asia where it is responsible for causing tinea capitis. At present, we attend an emergence of this species in certain regions where it was not or little met. Here, we report a case of onychomycosis of the hand due to T. tonsurans associated with non-albicans Candida species at an adult woman. OBSERVATION: The patient is a 62-year-old woman, with hypertension and diabetes. She reports the rather frequent use of chemical cleaners for the housework. She presented one year previously a distal onycholysis of the last four fingers of the left hand. The clinical examination objectified a presence of intertrigo in the second interdigital space. The mycological examination showed at the direct examination mycelial elements and the culture allowed the isolation of T. tonsurans associated with non-albicans Candida species. DISCUSSION-CONCLUSION: Our observation highlights especially the identification of a species, which has been described only once in Morocco about a case with onychomycosis of the feet. A possible emergence of this species in our country is not far from being possible.

[Etiology of intertrigo in adults: A prospective study of 103 cases]. / Les étiologies des intertrigos chez l'adulte : étude prospective de 103 cas.

INTRODUCTION: The etiologies of intertrigo in adults are numerous and different. The objective of our work was to study the epidemiological, clinical and the risk factors of intertrigo in adults. METHODS: We conducted a prospective study for a period of seven months in two Dermatology Units in Dakar (Senegal). All adults patient with intertrigo seen during this period who gave consent were included. RESULTS: One hundred and three patients with intertrigo were diagnosed with a hospital prevalence of 2.54%. The sex -ratio was 0.63 and the average age was 41. The study of habits and lifestyles of the patients found a history of intensive skin lightening, sport, wearing synthetic clothes and smoking in 26, 22, 20 and 22 cases, respectively. Infectious complications mainly bacterial (3.88%) and viral (1.94%) were reported in nine cases (8.7%). A dry erythroderma was noted in 3 cases (2.9%). It was found that the intertigo was commonly caused by fungal infections with a prevalence of 48.5% followed by immuno-allergic reactions with a prevalence of 34.9%, suppurative hidradenitis and inverse psoriasis with the same prevalence of 2.9%. Fifty-eight percent of cases with tinea and 63% of cases with candidiasis were women. Thirty-five percent of tinea cases and 45% of candidiasis cases were found to have a history of intensive skin lightening. CONCLUSION: The cause of intertrigo in adults are mainly infectious, particularly fungi, infections and immuno-allergic diseases. There are predisposing factors and some professions are more at risk.

Bacterial infections of the folds (intertriginous areas).

The axillary, inguinal, post-auricular, and inframammary areas are considered skin folds, where one skin layer touches another. Skin fold areas have a high moisture level and elevated temperature, both of which increase the possibility of microorganism overgrowth. A massive amount of bacteria live on the surface of the skin. Some are purely commensal; thus, only their overgrowth can cause infections, most of which are minor. In some cases, colonization of pathogenic bacteria causes more serious infections. This contribution reviews the bacterial infections of the skin fold areas.

Intertrigo and secondary skin infections.

Intertrigo is a superficial inflammatory dermatitis occurring on two closely opposed skin surfaces as a result of moisture, friction, and lack of ventilation. Bodily secretions, including perspiration, urine, and feces, often exacerbate skin inflammation. Physical examination of skin folds reveals regions of erythema with peripheral scaling. Excessive friction and inflammation can cause skin breakdown and create an entry point for secondary fungal and bacterial infections, such as Candida, group A beta-hemolytic streptococcus, and Corynebacterium minutissimum. Candidal intertrigo is commonly diagnosed clinically, based on the characteristic appearance of satellite lesions. Diagnosis may be confirmed using a potassium hydroxide preparation. Resistant cases require oral fluconazole therapy. Bacterial superinfections may be identified with bacterial culture or Wood lamp examination. Fungal lesions are treated with topical nystatin, clotrimazole, ketoconazole, oxiconazole, or econazole. Secondary streptococcal infections are treated with topical mupirocin or oral penicillin. Corynebacterium infections are treated with oral erythromycin.

Streptococcus pyogenes cervical intertrigo with secondary bacteremia.

We report a 12-month-old infant girl with cervical intertrigo caused by Streptococcus pyogenes. This form of intertrigo has been reported in only five children, but it is clearly underestimated. It should be suspected for well-demarcated beefy-red lesions of the neck not responding to antifungal therapy. A rapid streptococcal antigen test of a lesion specimen is a useful diagnostic tool. Our patient was notable for the development of S. pyogenes bacteremia, a complication that has not been previously associated with this condition.

Rapid relief of intertrigo-associated pruritus due to Candida albicans with isoconazole nitrate and diflucortolone valerate combination therapy.

A 43-year-old male, with intertrigo due to Candida albicans located at the inguinal folds and accompanied by severe pruritus, was treated with topical 1% isoconazole nitrate and 0.1% diflucortolone valerate (2 applications/day for 7 days). An improvement of pruritus was reported 2 days after the beginning of the treatment. Skin lesions improved after 3 days of treatment. Complete remission of both skin lesions and pruritus was observed at day 7. No side effects were observed.

Greenish-blue staining of underclothing due to Pseudomonas aeruginosa infection of intertriginous dermatitis.

Intertrigo (intertriginous dermatitis) is an inflammatory condition of the skin folds, induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation. Intertrigo can become secondarily infected. Three cases of intertrigo are described herein which presented with greenish-blue staining of underclothing. Cultures revealed Pseudomonas aeruginosa which is a gram-negative aerobic bacillus that produces the pigments pyocyanin and pyoverdin that responsible for this characteristic hue. All three patients responded to a course of oral ciprofloxacin with resolution of the intertriginous dermatitis. Therefore, greenish-blue staining of clothing is an important indicator for pseudomonal intertrigo.