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PubMed2004

Epidemiologic surveillance of cutaneous fungal infection in the United States from 1999 to 2002.

BACKGROUND: Cutaneous fungal infections are common in the United States, and causative organisms include dermatophytes, yeasts, and nondermatophyte molds. These organisms are in constant competition for their particular environmental niche, often resulting in the emergence of one or more predominant pathogens and displacement of other less competitive species. Changes in the incidence of fungal pathogens can be followed from laboratory culture results of infected cutaneous tissues over time. These data can be used to ascertain past and present trends in incidence, predict increases in antifungal resistance and the adequacy of our current pharmacologic repertoire, and provide insight into future developments. OBJECTIVE: This study identifies epidemiologic trends and the predominant organisms causing superficial fungal infections in the United States. METHODS: A total of 15,381 specimens were collected from clinically suspected tinea corporis, tinea cruris, tinea capitis, tinea faciei, tinea pedis, tinea manuum, and finger and toe onychomycosis from 1999 through 2002. Specimens were submitted to the Center for Medical Mycology in Cleveland, Ohio, for fungal culture and identification, and the incidence of each species was calculated. RESULTS: Dermatophytes remain the most commonly isolated fungal organisms except from clinically suspected finger onychomycosis, in which case Candida species comprise >70% of isolates. Trichophyton rubrum remains the most prevalent fungal pathogen, and increased incidence of this species was observed in finger and toe onychomycosis, tinea corporis and tinea cruris, tinea manuum, and tinea pedis. As the causal agent of tinea capitis, T tonsurans continues to increase in incidence, achieving near exclusionary proportions in the United States. CONCLUSION: Consideration of the current epidemiologic trends in the incidence of cutaneous fungal pathogens is of key importance to investigational efforts, diagnosis, and treatment.

Candida↗

PubMed2003

Dermatophyte infections.

Dermatophytes are fungi that require keratin for growth. These fungi can cause superficial infections of the skin, hair, and nails. Dermatophytes are spread by direct contact from other people (anthropophilic organisms), animals (zoophilic organisms), and soil (geophilic organisms), as well as indirectly from fomites. Dermatophyte infections can be readily diagnosed based on the history, physical examination, and potassium hydroxide (KOH) microscopy. Diagnosis occasionally requires Wood's lamp examination and fungal culture or histologic examination. Topical therapy is used for most dermatophyte infections. Cure rates are higher and treatment courses are shorter with topical fungicidal allylamines than with fungistatic azoles. Oral therapy is preferred for tinea capitis, tinea barbae, and onychomycosis. Orally administered griseofulvin remains the standard treatment for tinea capitis. Topical treatment of onychomycosis with ciclopirox nail lacquer has a low cure rate. For onychomycosis, "pulse" oral therapy with the newer imidazoles (itraconazole or fluconazole) or allylamines (terbinafine) is considerably less expensive than continuous treatment but has a somewhat lower mycologic cure rate. The diagnosis of onychomycosis should be confirmed by KOH microscopy, culture, or histologic examination before therapy is initiated, because of the expense, duration, and potential adverse effects of treatment.

Antifungal Agents↗

PubMed1982

[Dermatomycoses in the tropical rain forest of Nigeria (author's transl)].

This paper reports upon an examination of 312 Nigerians with regard to dermatomycoses. The Tinea versicolor alba presented the largest part of verified infections (5.5%), 57% of which were localized at the head. 16 to 20 year old patients were especially affected; women showed the infection 2.5 times more often than men did. Two out of 12 children revealed tinea capitis. Tinea manus et pedis proved to be rare. 60.5% of the patients showed nail alterations. Apart from dermatophytes, yeast and hyphomycetes grew in facultative pathogenicity. These are discussed to be, especially with males, causative organism of secondary mycoses and indicators of dirt.

Adolescent↗

PubMed1998

Prevalence of skin disease in rural Tanzania and factors influencing the choice of health care, modern or traditional.

OBJECTIVES: To determine the prevalence of skin disease in a rural Tanzanian community and to investigate the health-seeking behavior of this community. DESIGN: The study was in 3 parts: (1) 120 heads of households were interviewed to determine the factors that influence the families' health-seeking behavior; (2) the 800 members of these families were examined for evidence of skin disease; and (3) a focus group discussion was held with influential members of the community to get a broader view of health-seeking behavior. SETTING: A rural village in the southwestern area of Tanzania: Individuals were interviewed and examined in their own homes. RESULTS: A total of 34.7% of 800 villagers had one or more skin diseases, the most common of which were tinea capitis, tinea corporis, scabies, acne, and eczema. Modern and traditional health facilities were equally used, but heads of the households older than 55 years who had never been to school and individuals who were not Christians favored traditional medicine. It was cheaper to go to a traditional healer, but modern medicine was thought to be more scientific. CONCLUSIONS: Skin disease was a problem in this village and was perceived to be a problem by both individuals and the community. There is a need to assess the clinical and diagnostic skills of both modern and traditional health practitioners and to instigate a preventive health education program to eradicate the common infections and infestations.

Adolescent↗

PubMed1993

Pathophysiology of dermatophyte infections.

Dermatophyte infections are among the most common infections encountered in medicine. Often considered trivial, these infections are in fact frequently refractory and recurrent. This article presents an overview of the causes, symptoms, differential diagnosis, and clinical course of the most prevalent dermatophyte infections: tinea pedis, tinea cruris, tinea capitis, tinea corporis, and onychomycosis. Complicated situations such as follicular involvement, dermatophytoses in patients who are immunocompromised, and the exaggerated response to zoologically acquired fungal infections are also discussed.

Dermatomycoses↗

PubMed1996

Treatment of fungal infection in AIDS.

Fungal infections affect virtually all patients with the Acquired Immunodeficiency Syndrome (AIDS). Superficial infection (seborrheic dermatitis, tinea capitis, tinea corporis and tinea cruris) is more common than in the general population and can be difficult to eradicate. Mucosal disease (oropharyngeal, oesophageal and vaginal candidosis) is very common and often recurs. In advanced AIDS, patients usually fail to respond to topical therapy and often to systemic therapy and isolates of Candida spp. from these patients are frequently resistant in vitro to fluconazole and other azoles. Systemic fungal infection is less common but life threatening. The commonest such infection is Pneumocystis carinii pneumonia (PCP) although prophylaxis is usually successful in preventing either the first episode or recurrent episodes. Histoplasmosis, coccidioidomycosis and Penicillium marneffei infections are common in endemic areas. Cryptococcal meningitis and invasive aspergillosis occur worldwide. The prophylaxis and treatment of all these except PCP are discussed and reviewed.

AIDS-Related Opportunistic Infections↗

PubMed2005

Dermatophyte infections in the Ljubljana region, Slovenia, 1995-2002.

We studied dermatophyte infections in patients, examined in the Mycological Laboratory of the Department of Dermatology, University Medical Centre Ljubljana during the period 1995-2002. A total of 42,494 samples were collected from 33,974 patients suspected to have dermatomycosis. Dermatophytes were identified in 8286 (71.2%) positive cultures. Microsporum canis was the most frequent dermatophyte isolated (46.8%), followed by Trichophyton rubrum (36.7%), T. mentagrophytes var. interdigitale (7.9%) and T. mentagrophytes var. mentagrophytes (4.9%). Less frequently isolated were M. gypseum, T. verrucosum, Epidermophyton floccosum, T. tonsurans and T. violaceum. The most common dermatophyte infections included tinea corporis, onychomycosis, tinea pedis and tinea faciei. Zoophilic dermatophytes were most commonly recovered from children and adolescents with tinea capitis, tinea corporis and tinea faciei. Anthropophilic species were identified mostly in adults with tinea pedis, onychomycosis and tinea inguinalis. During the period studied, we recorded a decline in the rate of M. canis infections, while infections produced by T. rubrum increased in frequency.

Adolescent↗

PubMedDate not supplied

Dermatophytosis: the management of fungal infections.

Dermatophytosis is an infection of the hair, skin, or nails caused by a dermatophyte, which is most commonly of the Trichophyton genus and less commonly of the Microsporum or Epidermophyton genera. Tinea capitis, tinea pedis, and onychomycosis are common dermatologic diseases that may result from such an infection. The treatment of fungal infections caused by a dermatophyte has been successful when treated with oral or topical antifungal agents. Terbinafine, itraconazole, and fluconazole are oral antimycotics that are effective in the treatment of superficial mycoses, although, depending on the severity of the infection, a topical antifungal may be sufficient.

Administration, Oral↗

PubMed1997

Oral terbinafine: a new antifungal agent.

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, adverse effects, drug interactions, and dosage guidelines of terbinafine. Available comparative data of terbinafine and other antimycotic agents are described for understanding the potential role of terbinafine in patient care. DATA SOURCES: A MEDLINE search restricted to English language during 1966-1996 and extensive review of journals was conducted to prepare this article. MeSH headings included allylamines, terbinafine, SF 86-327, dermatophytosis, dermatomycosis. DATA EXTRACTION: The data on pharmacokinetics, adverse effects, and drug interactions were obtained from open-label and controlled studies and case reports. Controlled single- or double-blind studies were evaluated to describe the efficacy of terbinafine in the treatment of various fungal infections. DATA SYNTHESIS: Terbinafine is the first oral antimycotic in the allylamines class: a fungicidal agent that inhibits ergosterol synthesis at the stage of squalene epoxidation. Terbinafine demonstrates excellent in vitro activity against the majority of dermatophyte species including Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum; less activity is seen against Dematiaceae and the filamentous fungi. It is least active against the pathogenic yeast and this correlates with the relatively poor efficacy against these organisms in vivo. High concentrations of terbinafine are achieved in keratinous tissues, the site of superficial infections, and these concentrations are maintained for up to 3 months. The clinical efficacy of terbinafine against a number of dermatophyte infections exceeds that of the current standard of therapy, griseofulvin. The efficacy of terbinafine may be as good or better than that of the azole antifungals. Additional studies are required to confirm these observations. Terbinafine demonstrates a good safety profile, and relatively few drug interactions have been identified. CONCLUSIONS: Terbinafine is more effective than the gold standard, griseofulvin, in the treatment of tinea pedis and tinea unguinum, with considerably shorter treatment duration in the latter. It has been proven as effective as griseofulvin in the treatment of tinea capitis, tinea corporis, and tinea cruris. Terbinafine does not appear to offer any advantage in the treatment of nondermatophyte infections; its utility in the treatment of systemic infections has yet to be established. Depending on individual institutional costs, terbinafine may be a front-line drug for some superficial infections responding poorly to the current standard of therapy.

Antifungal Agents↗

PubMed1992

Superficial fungal infections of the skin. Diagnosis and current treatment recommendations.

Superficial fungal infections are common. Most diagnoses of fungal infections of the skin can be made by physical examination, assisted by the use of a Wood's lamp, skin scrapings for microscopic examination, and fungal cultures. Dermatophyte infections are common at all ages, in both sexes, and they have a worldwide distribution. These infections include tinea capitis, tinea cruris, tinea pedis, tinea corporis, tinea manuum and tinea barbae. Tinea versicolor, caused by Malassezia furfur, and candidal infections are also common. Treatment modalities include oral and topical agents. Good personal hygiene is an important adjunct to antifungal therapy. Decisions regarding the appropriateness of therapy in a given patient must take into account the extent and location of the infection, the benefits and risks of each of the treatments, and cost. Oral therapies include griseofulvin, ketoconazole, and itraconazole. There are a large variety of topical treatments, including nystatin, selenium sulfide, tolnaftate, haloprogin, miconazole, clotrimazole, and sodium thiosulfate. Important to successful treatment is compliance with what is sometimes a long course of treatment, and good personal hygiene.

Administration, Topical↗

PubMed1999

Superficial fungal infections in children and adolescents.

Children with superficial fungal infections are commonly seen in clinical practice. Although tinea capitis and tinea corporis are the most common childhood mycoses, thrush and candida diaper dermatitis also occur frequently in infants. At times, diagnosis can be a challenge, but is made easier with the use of the potassium hydroxide microscopy and fungal cultures. Most childhood superficial fungal infections are adequately treated with topical antifungal medication. These medications are effective and the majority are safe for use in children. Oral antifungal drugs are required for children with tinea capitis, tinea unguium, and those who are immunosuppressed either from disease or therapy. Griseofulvin is the current systemic drug of choice to use in children. Several newer systemic antimycotics are currently being investigated for pediatric use. Terbinafine appears to have the best safety profile and the least risk of drug interactions. Itraconazole and fluconazole are also potential substitutes for griseofulvin in the future. The new agents, fluconazole, itraconazole, and terbinafine, have definitely improved the treatment of tinea unguium. Despite the availability of effective medications for treatment of superficial fungal infections, failure to take local and environmental measures to prevent transmission and reinfection will nullify the use of any treatment.

Adolescent↗

PubMed2000

Mycotic infections. Effective management of conditions involving the skin, hair, and nails.

Superficial mycotic infections of the skin, hair, or nails are recurring presentations in the geriatric primary care setting. The most common infections are those caused by dermatophytes. The genus Trichophyton gives rise to most of the tinea dermatophytoses, including tinea capitis, tinea pedis, and tinea unguium (onychomycosis). Part of the diagnostic challenge lies in distinguishing the mycotic lesions from those caused by cutaneous diseases such as psoriasis, eczema, dyshidrosis, and contact dermatitis. Because environmental conditions play a major role in fungal infection onset, clinical management should include patient education about conditions conducive to fungal propagation. Oral agents are the primary mode of treatment for fungal infections of the scalp and nails, whereas topical treatments are frontline agents for other superficial skin conditions.

Antifungal Agents↗

PubMed2001

Common viral and fungal skin infections.

Skin infections account for a significant portion of dermatologic diseases, often resulting in, or as a consequence of a disruption in the skin's integrity. This paper covers the presentation, diagnosis, and treatment of the more common viral and fungal skin infections. The viral infections presented in this paper include herpes simplex virus, herpes zoster, condyloma acuminata, and molluscum contagiosum. The fungal infections presented include tinea pedis, tinea cruris, tinea capitis, tinea unguium, tinea versicolor, and candidiasis. Once a diagnosis is made, treatment with appropriate antifungal, antiviral, destructive, or immune modifying therapies can be instituted.

Candidiasis, Cutaneous↗

PubMed2002

[Dermatophytoses in Mexico].

The dermatophytic infections are superficial mycoses common in Mexico, they have an estimated frequency of 5% in dermatological outpatients. In this review we present a global view of these mycoses as well as their etiological agents in tinea capitis, tinea pedis, tinea corporis, tinea cruris and onychomycosis and also uncommon infections such as tinea imbricata and epidermophytosis of the diaper area. We also analyze these infections in diabetic patients, healthy carriers and dermatophytic infections in pets and laboratory animals. The most important publications about dermatophytosis in Mexico in the dermatological, epidemiological or mycological area are reviewed, specially those published in the last ten years.

English Abstract↗

PubMed1998

Skin and wound infections: an overview.

Skin infections are common and may be caused by bacteria, fungi or viruses. Breaks in the skin integrity, particularly those that inoculate pathogens into the dermis, frequently cause or exacerbate skin infections. Bacterial skin infections caused by corynebacteria include erythrasma, trichomycosis axillaris and pitted keratolysis. Staphylococci may cause impetigo, ecthyma and folliculitis. Streptococcal skin infections include impetigo and erysipelas. Human papillomavirus skin infections present as several different types of warts, depending on the surface infected and its relative moisture, and the patterns of pressure. The many dermatomycoses (skin infections caused by fungi or yeasts) include tinea capitis, tinea barbae, tinea cruris, tinea manus, tinea pedis and tinea unguium (onychomycosis). Candidal infections occur in moist areas, such as the vulva, mouth, penis, skinfolds and diaper area. Wounds caused by wood splinters or thorns may result in sporotrichosis. Animal bites may result in complex, serious infections, requiring tetanus and, possibly, rabies prophylaxis in addition to appropriate antibiotic therapy.

Humans↗

PubMed1999

Prevalence of dermatophytoses in the Zarqa district of Jordan.

A total of 350 clinically suspected cases of dermatomycoses were examined for causative fungi during July 1997 to September 1998. Mycotic infection was demonstrable by microscopy and culture in 199 (56.8%) cases. The most common superficial mycotic infections were tinea pedis (35.2%) followed by tinea capitis (23.1%), tinea unguium (21.6%) and tinea corporis (10.6%). Most of the infected patients were 1-9, 20-29 and 30-39 years old. Men were mainly infected with tinea cruris and tinea pedis, while women were infected with tinea pedis, tinea unguium and tinea capitis. The frequencies of etiological agents isolated from patients were as follows: Trichophyton mentagrophytes var. interdigitale (32.7%), T. rubrum (28.6%), Epidermophyton floccosum (20.1%), Microsporum canis (11.1%), T. schoenleinii (4%), T. verrucosum (2%), T. violaceum (1%), and M. gypseum (0.5%). The number of infections varied with the seasons. The highest number of cases of tinea pedis and tinea cruris occurred in the summer months, while tinea capitis, tinea corporis and tinea unguium occurred in the spring and winter months.

Adult↗

PubMed1997

Systemic antifungal treatment of children with terbinafine.

BACKGROUND: At present, griseofulvin is the only licensed drug for oral treatment of dermatophyte infections in children. OBJECTIVE: Children were treated with the fungicidal allylamine terbinafine. Efficacy and tolerability were evaluated. METHODS: Fifteen children (14 months to 11 years old, below 40 kg body weight) with culture-confirmed tinea capitis or tinea corporis were systemically treated with terbinafine. Five children suffered from tinea capitis, 6 from tinea corporis and 4 from a combined infection of the scalp and body. As causing agents Trichophyton violaceum (5), Microsporum canis (8) and Trichophyton mentagrophytes (2) were isolated. RESULTS: Mycological and clinical cure was achieved in all children after oral treatment with terbinafine for 4-8 weeks. Cure after discontinuation of therapy could be observed in 13 children. Two children with tinea capitis caused by M. canis relapsed within 1-2 months after the end of therapy. The overall tolerability of terbinafine in children was good; 1 child suffered from acute urticaria during treatment, which might be related to the medication. CONCLUSIONS: The applied therapy regimes were effective in most cases. In scalp infections by M. canis, the children should be treated for more than 4 weeks or with a higher dose. To find the optimal dosage and treatment periods for children, further prospective studies are necessary.

Administration, Oral↗

PubMed1986

Humoral antibody responses in the immunopathogenesis of dermatophytosis.

Cell-mediated immunity is generally considered as the principal immunological response to dermatophyte infection. However, certain clinical manifestations associated with a humoral antibody response occasionally occur as complications to dermatophytosis (e.g. vasculitis, urticaria). Immediate wheal reaction to intradermal application of "trichophytin" is frequent in patients with chronic T. rubrum infection and can be passively transferred with serum, which demonstrates the presence of specific IgE antibodies in these patients. Crossed immunoelectrophoresis and modifications thereof were applied for studies of (i) the antigenic structure of dermatophytes in sera from patients with dermatophytosis. The antigenic composition was found to differ between species but was characteristic and constant for different strains of the same species. Partial cross reactivity between different species, especially T. rubrum and T. mentagrophytes was noted. The presence of specific IgG antibodies towards corresponding dermatophytes was associated with tinea capitis (100%), tinea pedis with dermatophytid eruption (62%) and chronic T. rubrum infection (25%). Sera from 50 healthy persons were all negative. Specific IgE antibodies toward T. rubrum were demonstrated in serum from eight patients with chronic T. rubrum infection while specific IgE antibodies were not present in sera from ten patients with tinea capitis and four controls. The possible role of IgG and IgE antibodies in inflammatory and non-inflammatory dermatophyte infections is discussed.

Antibody Formation↗