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PubMedDate not supplied

Etiologic agents of dermatophyte infection in Lebanon.

BACKGROUND: Dermatophytes are common and cause important human fungal infections in many parts of the world, including Lebanon. The prevalence of these fungi, however, tends to vary with time and geographic location. In our region, studies on the prevalence of dermatophytoses and the distribution of the various dermatophyte species involved are rare. In Lebanon, only one study was published on this subject over the last forty years. OBJECTIVES: This study was undertaken to shed light on the types and prevalence of dermatophytes recovered at the American University of Beirut Medical Center (AUBMC), and to compare the findings with those of the only study from the same hospital published in the early 1960s. METHODS: Records from the clinical microbiology section were reviewed for the patients on whom dermatophyte cultures were requested between 1996 and 2002. All positive cultures were identified and analyzed. RESULTS: Among 1631 submitted specimens for culture (one per patient), 208 (12.7%) yielded 11 species of dermatophytes, dominated by Trichophyton spp. (89.9%), followed by Microsporum spp. (9.1%), Epidermophyton floccosum (0.4%) and Trichosporum beigelii (0.4%). The male to female ratio was almost 1:1, and the age range was 1 to 77 yrs for both sexes; 14% were children (< or = 15 yrs). The most commonly recovered species were: T. tonsurans (54.8%), T. mentagrophytes (24.5%), M. canis (7.7%), T. rubrum (5.3%) and T. verrucosum (4%). The distribution of infection according to body sites was : tinea unguium (44.2%), tinea corporis (43.2%), tinea capitis (7.7%) and tinea pedis (4.8%). Compared to the previous study from AUBMC in 1962, the current study showed an overall lower prevalence of dermatophytoses (12.7 vs 18.5%, p = 0.001) and variations in the prevalence rates of the dermatophyte species involved (dominated by T. tonsurans and T. mentagrophytes in the current study compared to E. floccosum and T. rubrum recovered in 1962). Based on the source of infection the current study showed higher transmission from human to human (anthropophylic) (86.5 vs 66.3%) and animal to human (zoophylic) (12.5 vs 1.1 %), but lower transmission from soil to human (geophylic) (1% vs 32.6%). CONCLUSIONS: The prevalence of dermatophytoses remains high in this country. The recognition of the changing prevalence in the causative dermatophyte species should help with the treatment approach and for potential implementation of control measures.

Adolescent↗
PubMedDate not supplied

Microsporum canis infections in children: results of a new oral antifungal therapy.

Clinical and laboratory data from 22 children with tinea corporis and tinea capitis caused by Microsporum canis (10 tinea corporis, 12 tinea capitis), confirmed by microscopic examination and culture and partly pretreated with griseofulvin or terbinafine, are summarized. The children were treated consecutively with itraconazole in our clinic during 1994/95. The age of the children ranged between 4 and 13 years, with girls being affected much more frequently than boys. Oral, individually adapted, high-dose treatment of 5 mg itraconazole per kg body weight proved to be successful. In all 22 children, although pretreatment with griseofulvin or terbinafine was partly unsuccessful, fungal infections could be cured clinically and also were culture negative at control examinations. In 10 children with tinea corporis treatment was performed only for 4-14 (middle 11) days. In the children with tinea capitis itraconazole treatment was continued for 3-11 weeks. Among the six children without pretreatment, itraconazole solution was administered for 4-11 weeks (average 7.5 weeks). Of the patients in whom pretreatment was unsuccessful, four with griseofulvin and two with terbinafine, the duration of the subsequent oral treatment with itraconazole solution was 3-5 weeks (average 3.6 weeks). The drug seemed to be well tolerated-no significant side-effects occurred, with the exception of possible minor gastrointestinal disturbances in two patients. Laboratory values remained within normal limits.

Antifungal Agents↗
PubMed1983

An epidemic of infection with Trichophyton tonsurans revealed in a 20-year survey of fungal infections in Chicago.

Trichophyton tonsurans has long been recognized as an important, but hitherto uncommon, cause of tinea capitis in the United States. Today it is known to be more common, but infection of the glabrous skin by this organism is still not well appreciated. In an epidemiologic study during the two decades from 1961 to 1980, 1,292 isolates of thirteen species of dermatophytes were obtained from patients at Cook County Hospital, Chicago. During the last 3 years of study, T. tonsurans accounted for 207 cases (96%) of tinea capitis and ninety-seven cases (75%) of tinea corporis. Ninety-five percent of cases of tinea capitis caused by T. tonsurans occurred in children (59% girls, 41% boys). By contrast, 62% of cases of tinea corporis caused by that organism occurred in adults. Substantially more women than men were affected in a ratio of nearly six to one. The majority of the women were between 15 and 29 years of age; about half of all had lesions on the arm. Over the past 20 years, T. tonsurans has emerged as a major cause of both tinea capitis and tinea corporis in Chicago. The disproportionate number of cases of tinea corporis in women of childbearing age may be due to their more frequent contact with infected children.

Adolescent↗
PubMed1993

Dermatophytosis of children in Kuwait: a prospective survey.

BACKGROUND: Tinea capitis in children is widely reported, whereas there have been only isolated reports on involvement of sites other than the scalp. The purpose of this study was to examine the epidemiological features and treatment responses of dermatophytosis of children in Kuwait. METHODS: Epidemiological features and the treatment responses of 202 consecutive children with dermatophytosis were studied. RESULTS: The 202 children constituted 44% of the total dermatophytic infections seen during a period of 1 year. Tinea capitis was the most commonly encountered infection (78%), followed by tinea corporis, tinea faciei, tinea cruris and manus, respectively. Microsporum canis was the most prevalent species (96%) in this region. A history of pets at home could be elicited in 52% of the cases. A familial occurrence of similar infections was seen in 56% of the patients. In patients with tinea capitis, addition of topical clotrimazole or ketoconazole to oral griseofulvin produced better therapeutic results compared to griseofulvin alone or in combination with selenium sulfide shampoo. CONCLUSIONS: Tinea capitis is the most common dermatophytic infection in children. Thirty percent of the children may have dermatophytosis at sites other than the scalp. A combination of topical clotrimazole or ketoconazole with oral griseofulvin is superior to griseofulvin alone or in combination with selenium sulfide shampoo in the treatment of tinea capitis.

Animals↗
PubMedDate not supplied

Dermatophytomycoses in children in rural Kenya: the impact of primary health care.

In a survey of 5780 children from 13 schools in rural Kisumu District (western Kenya) in 1993, a prevalence rate of dermatophytomycoses of 10.1% was found. Three-quarters of the affected children suffered from tinea capitis (prevalence rate 7.8%), caused by Microsporum audouinii var. langeronii, Trichophyton violaceum and Microsporum canis. In 1994, a dermatology programme within the primary health care system was started. Twelve community health workers (CHWs), trained in diagnosis and treatment of the most common skin diseases, carried out regular school visits once a week. All dermatophytomycoses, dry forms of tinea capitis included, were treated locally with Whitfield's ointment. In 1995 the prevalence rate of fungal skin infections in the same schools was found to be 9.3%; the difference to 1993 was not significant. Only tinea capitis, with a prevalence rate of 5.8%, showed a significant reduction (P < 0.05). Altogether, a distinctive improvement regarding the extent and the severity of dermatophytomycoses could be noticed. In the cultures from tinea capitis, Microsporum canis was not found to be present. Trained community health workers are capable of the diagnosis and treatment of fungal skin infections of children in rural areas, which leads to a reduction in the prevalence of tinea capitis.

Antifungal Agents↗
PubMed1998

An overview of topical antifungal therapy in dermatomycoses. A North American perspective.

Dermatophytes cause fungal infections of keratinised tissues, e.g. skin, hair and nails. The organisms belong to 3 genera, Trichophyton, Epidermophyton and Microsporum. Dermatophytes may be grouped into 3 categories based on host preference and natural habitat. Anthropophilic species predominantly infect humans, geophilic species are soil based and may infect both humans and animals, zoophilic species generally infect non-human mammals. It is important to confirm mycologically the clinical diagnosis of onychomycosis and other tinea infections prior to commencing therapy. The identity of the fungal organism may provide guidance about the appropriateness of a given topical antifungal agent. Special techniques may be required to obtain the best yield of fungal organisms from a given site, especially the scalp and nails. It is also important to realise the limitations of certain diagnostic aids e.g., Wood's light examination is positive in tinea capitis due to M. canis and M. audouinii (ectothrix organisms); however, Wood's light examination is negative in T. tonsurans (endothrix organism). Similarly, it is important to be aware that cicloheximide in culture medium will inhibit growth of non-dermatophytes. Appropriate media are therefore required to evaluate the growth of some significant non-dermatophyte moulds. For tinea infections other than tinea capitis and tinea unguium, topical antifungals may be considered. For effective therapy of tinea capitis an oral antifungal is generally necessary. Similarly, oral antifungals are the therapy of choice, especially if onychomycosis is moderate to severe. Furthermore, where the tinea infection involves a large area, in an immunocompromised host or if infection is recurrent with poor response to topical agents, then oral antifungal therapy may be necessary. Topical antifungal agents may be broadly divided into specific and nonspecific agents. The former group includes the polyenes, azoles, allylamines, amorolfine, ciclopirox and butenafine. Generally the topical agent is available as a cream, sometimes for use intravaginally. Less commonly, the formulation may be in the form of a powder, lacquer, spray, gel or solution. Many of these agents have a broad spectrum of activity, being effective against dermatophytes, yeasts and Malassezia furfur. For the treatment of tinea corporis, tinea cruris tinea versicolor and cutaneous candidosis, once or twice daily application may be required, the most common duration of therapy being 2 to 4 weeks. For tinea pedis the most common treatment duration is 4 to 6 weeks.

Administration, Topical↗
PubMed2006

Isolation of Trichophyton violaceum and Trichophyton soudanense in Baltimore, Maryland.

Tinea capitis is of public health importance because of its transmissibility. Trichophyton violaceum and Trichophyton soudanense, which are common causes of tinea capitis in parts of Africa and West Asia, have only rarely been reported to cause dermatophytoses in the United States. We identified 24 patients with 25 positive cultures for T. violaceum or T. soudanense that were processed in a single hospital laboratory in Baltimore, Maryland, between 1 January 2000 and 30 June 2006. Most patients for whom clinical information was available had tinea capitis. There was a marked increase in the isolation of these organisms between the period from 2000 to 2002 and the period from 2003 to 2006, possibly associated with changes in immigration to the Baltimore metropolitan area. The changing epidemiology of this transmissible fungal infection not only is of public health interest as an example of the introduction of a "new" pathogen to an area where it traditionally was not endemic but also is of clinical and microbiological importance given reports suggesting an increasing incidence of tinea capitis in some areas and increasing clinical failure rates of current therapies.

Antifungal Agents↗
PubMed2001

Systemic antifungal agents.

Anti-fungal agents are classified under two major headings, systematic and topical agents. Only systematic anti-fungal agents will be discussed in this chapter. Since the discovery in 1955, amphotericin B has been the cornerstone of anti-fungal treatment. It is active against most species of fungi. However, Candida lusitaniae, Pseudallescheria boydii, and fusarium spp have primary resistance to amphotericin B. Recently, new liposomal preparations of amphotericin B have been developed. They are less nephrotoxic. The azole family of anti-fungal includes two broad classes: the imidazoles (clotrimazote, ketoconazote, miconazole) and the triazoles (flucouazole and itracouazole). Imidazoles are still widely used for the treatment of superficial mycoses and vaginal candidiasis. The systematic triazoles are more slowly metabolized and have less effect on human synthesis than imidazoles, hence they are preferred for systemic therapy. Flucytosine is a fluorinated pyrimidine. Clinically, the principal use of flucytosine is as adjunctive therapy with amphotericin B in the treatment of candidial or cryptococcal diseases, Griseofuluin is derived from penicillium. It is fungistatic in vitro for species of dermatophytes. It is useful for the treatment of tinea capitis and tinea unginum.

Administration, Oral↗
PubMed1997

[Fluorescence with Wood's light. Current applications in dermatologic diagnosis, therapy follow-up and prevention].

The invisible long-wave ultraviolet radiation (340-450 nm, max.365 nm) produced by a Wood lamp can help to diagnose dermatoses with a characteristic fluorescence (tinea capitis, erythrasma, tinea versicolor, Pseudomonas infections, porphyrians, and pigmentary alterations). It is also used in the detection of medications that are taken systemically (tetracycline) or that are applied to the skin. Recently, a fluorescence technique with Wood light has been used as a preventive measure to monitor and quantify skin protection at the workplace and to teach workers in high-risk occupations the proper use of protective creams.

Dermatitis, Occupational↗
PubMed2005

A study of dermatophytosis in South West of Iran (Ahwaz).

Two hundred and seventy nine patients suspected of having fungal lesions were examined. Skin scrapping, hair samples and nail clippings were collected from patients. Direct and culture examinations were performed for all samples. About 115 cases of examined subjects had dermatophytosis. Dermatophytosis occurred mainly in adults males (20-29 years). Tinea cruris (24.3%) was the most common type of dermatophytosis followed by tinea pedis (16.5%), tinea corporis (14.8%), tinea ungium (13%), tinea capitis (11.3%), tinea faciei (11.3%), tinea manuum (7%) and tinea barbae (1.7%). Trichophyton mentagrophytes was the most prevalent species followed by Epidermophyton floccosum.

Adolescent↗
PubMed1990

Itraconazole in common dermatophyte infections of the skin: fixed treatment schedules.

Itraconazole is an effective medication against the most common dermatophytoses. It has been shown to be more active than griseofulvin and ketoconazole. Ease of use, affinity for keratinized tissues, lack of toxicity, continued activity after discontinuation, and the possibility of using fixed schedules are advantages of itraconazole. The fixed schedules indicated by pharmacokinetics and clinical studies are one 100 mg capsule daily for 15 days in cases of tinea corporis and tinea cruris and the same dosage for 30 days in cases of tinea pedis and tinea manuum. These fixed treatments have some limitations, and they are not recommended for treating tinea capitis and tinea unguium. The drug is well tolerated.

Antifungal Agents↗
PubMed2003

Epidemiology of dermatophytoses in an area south of Tehran, Iran.

Dermatophyte infections have been considered to be a major public health problem in many parts of the world. The aim of this study was to identify the etiological and epidemiological factors of dermatophyte infections in an area south of Tehran. A total of 1254 patients suspected to have dermatophytic lesions were examined over a period of three years (1999-2001). Material collected from skin, hair, and nails was submitted to direct microscopic examination using KOH, cultured in Sabouraud dextrose agar and microscopically examined for colony morphology, in order to the identify the 169 dermatophytes isolated. The prevalence of dermatophytoses was 13.5% (95% CI: 11.7-15.5%). Their incidence was 10.6 per 100,000 person-years (95% CI: 8.5-13.2). Epiderophyton floccosum was the most frequent dermatophyte isolated (31.4%) followed by Trichophyton rubrum (18.3%), T. mentegrophytes (17.2%), T. violaceum (16.6%), Microsporum canis (6.5%), T. verrucosum (4.7%) and M. gypseum (4.1%). Epidermophytes floccosum was found to be the most common isolated dermatophyte in age groups 20-29 (30.2%). Tinea corporis (31.4%) was the most common type of infection, followed by tinea cruris (20.7%), tinea manuum (15.4%), tinea capitis (12.4%), tinea pedis (10.6%), tinea faciei (7.1%), and tinea unguium (2.4%). The frequency rate of all of the types of tinea was higher in males than in females. The anthrophilic species E. floccosum was the most common dermatophyte as a causative agent of tinea. The most prevalent fungal infection was tinea corporis caused by E. floccosum.

Adolescent↗
PubMed2004

Frequency and risk factors of dermatophytosis in students living in rural areas in Eskişehir, Turkey.

Our study included 2384 students from five villages around Eskişehir, Turkey. We asked every student for their personal identification and also for their sanitation in order to get an idea about dermatophytosis. Samples taken from suspicious lesion were collected and inoculated onto Sabouraud dextrose agar slants. For identification of fungi which were grown, macroscopic appearance of colonies, microscopic examination and biochemical tests were used. We found suspicious lesions in 245 (10.3%) and diagnosed dermatophytosis in 86 (3.6%) of the students. The dermatophyte species were Trichophyton rubrum 37 (43%) at first, Trichophyton mentagrophytes 17 (19.8%), Microsporum canis 11 (12.8%), Microsporum gypseum 8(9.3%), Epidermophyton floccosum 6 (7%), Trichophyton verrucosum 6 (7%) and Trichophyton violaceum 1 (1.1%). Tinea pedis (59.3%) was the most frequent clinic form of dermatophytosis, followed by tinea corporis (22.1%), tinea capitis (9.3%), tinea manum (7.0%) and tinea unguium (2.3%). Older age, male gender, poor hygiene, living in dormitory, low level mother education, history of dermatophytosis within family and sanitary conditions were computed as independently variables associated with dermatophytosis infection. For prevention and control of dermatophyte infection in children living rural areas, field studies should be done and sanitary conditions should be improved.

Adolescent↗
PubMed2000

Survey on the epidemiology of Microsporum canis infections in Crete, Greece over a 5-year period.

BACKGROUND: Microsporum canis is a frequent cause of tinea capitis and tinea corporis in Europe and especially in the Mediterranean area. Objective This study was undertaken to examine the epidemiologic features of all cases of M. canis infections recorded in Crete, Greece, during a 5-year period (1994-1998). METHODS: The epidemiology of 111 cases of dermatophytoses due to M. canis was analyzed according to the sex, age, origin of the infection, place of residence, body site affected, and seasonal progression. RESULTS: M. canis constituted 24.5% of all dermatophytes isolated during the study period. Women were more frequently affected than men (54%), and infections were most prevalent in patients up to the age of 9 years (46.8%). Cats were identified as the commonest source of the infection (82%). As regarding the place of residence, most of the infected patients came from rural areas (64.9%). The commonest sites of M. canis infection (in decreasing order of frequency) were: the head, the lower extremities, the trunk, and the upper extremities. The greatest number of cases were seen in September and December. CONCLUSIONS: The findings of the present study indicate that M. canis infections have gradually decreased in recent years in this geographic area. Eradication requires elimination of the natural source of the infection, represented mainly by stray animals.

Adolescent↗
PubMed2003

Characteristics of superficial mycoses in Malta.

BACKGROUND: A study was conducted to determine the chief agents of superficial mycoses in Malta. Data were collected over a 5-year period from mycologic investigations carried out on all dermatologic specimens sent to the Mycology Laboratory at St. Luke's Hospital in Malta. METHODS: In the period between January 1995 and December 1999, a total of 1271 specimens from skin, nails, or hair were collected from 1200 clinically suspected cases of dermatomycoses. RESULTS: The fungi cultivated included dermatophytes (n = 371), yeasts (n = 33), and nondermatophyte filamentous fungi (n = 12). Trichophyton rubrum (n = 121) was the most prevalent, followed by Microsporum canis (n = 109), T. mentagrophytes (n = 80), M. gypseum (n = 27), Epidermophyton floccosum (n = 17), T. soudanense (n = 10), T. tonsurans (n = 2), T. verrucosum (n = 2), M. persicolor (n = 1), and T. violaceum (n = 1). Candida species were also cultivated, with C. parapsilosis (n = 14) being the most common, followed by C. albicans (n = 12) and C. tropicalis (n = 6). Nondermatophyte filamentous fungi were isolated from nail specimens only. CONCLUSIONS: In this study, superficial fungal infections were reported more commonly in female (n = 207) than in male (n = 182) patients. M. canis was the chief agent of tinea capitis and tinea corporis, whilst T. rubrum was the main causative agent of tinea pedis, tinea manuum, and tinea unguium. Onychomycosis due to Candida species was more common in female than in male patients.

Adolescent↗
PubMed2006

Isolation of Microsporum canis from the hair coat of pet dogs and cats belonging to owners diagnosed with M. canis tinea corporis.

Microsporum canis has been frequently isolated from human cases of tinea capitis and tinea corporis. The infection may be acquired from infected animals with cutaneous lesions but also from asymptomatic carriers or from the environment. As asymptomatic M. canis carriers are considered to be a critical factor in the epidemiology of dermatophytosis in humans, this study investigated the relationship between the presence of dermatophytes on the hair coats of dogs and cats without cutaneous lesions and the occurrence of the disease in their respective owners. A total of 136 dogs and 248 cats were sampled from January 1999 to January 2005. Seventy-eight animals (22 dogs and 56 cats) belonged to individuals affected by tinea corporis caused by M. canis and 306 (114 dogs and 192 cats) to individuals without dermatophytosis. Age, sex, breed, habitat and season were recorded for each animal and examined as potential risk factors. Dermatophytes were isolated from 20.5% of the dogs and 28.2% of the cats. Microsporum canis was isolated from 36.4% of dogs cohabiting with owners diagnosed with tinea corporis but it was never isolated from dogs whose owners had no lesions. By contrast, M. canis was isolated from 53.6% of cats cohabiting with owners diagnosed with tinea corporis and from 14.6% of cats whose owners had no signs of the disease. These results clearly indicate that both cats and dogs should be considered as a major source of pathogenic dermatophytes for humans even when they do not present clinical signs of dermatophytosis.

Animals↗
PubMed1986

Dermatophytes in Iceland.

Prior to 1982, no reliable information was available on prevailing dermatophyte species or infections in Iceland. In 1983-1984 fungal cultures performed on 96 patients revealed that Trichophyton tonsurans was the most common isolate, followed by Trichophyton mentagrophytes and Trichophyton rubrum. There were no cases of tinea capitis and tinea corporis was rare, but the most common sites of infection were the feet and toenails.

Arthrodermataceae↗
PubMedDate not supplied

Dermatophytosis in northern Greece during the decade 1981-1990.

Dermatophytic infections are very common in Greece. In the Mycological Laboratory of the Venereal and Skin Diseases Hospital in Thessaloniki, 6572 isolates of different dermatophytes were obtained from 17,120 patients examined. It is suggested that 5% of the people who present with skin problems in Greece suffer from dermatophyte infections. They are frequent causative agents of tinea pedis, tinea cruris, tinea corporis, tinea capitis and tinea unguium. In this paper, the species, the number and the prevalence of the dermatophytes were studied according to location and sex of the patients. The contribution of dermatophyte infections to the overall incidence of superficial fungal infection over 10 years was also studied.

Adult↗