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Dermatophytosis is a prevalent infection in tropical and subtropical countries, including India. This study aims to investigate the epidemiology and clinical aspects of chronic and recurrent dermatophytosis, identify the clinical isolates, and assess the effectiveness of different microscopy and staining methods for diagnosis. The objective of the study is to study the epidemiology and clinical aspects of chronic and recurrent dermatophytosis and to identify the clinical isolates. Attempts to improve the diagnostic outcome by implementing different microscopy and staining methods have also been performed. Adult patients with chronic and recurrent cases and positive direct microscopy were included, and clinical details were recorded. The mycological culture was performed. Fifteen isolates were selected randomly and subjected to 0.9% NaCl, Chicago sky blue staining, Calcofluor white staining, and Congo red staining in addition to the standard lactophenol cotton blue (LPCB) preparation. Among the 178 patients in the study, females (56.7%) and patients aged 25-45 (50%) were more frequently affected. Tinea corporis was the most common clinical type (89.32%). Recurrent cases (56.1%) were more prevalent than chronic cases (43.9%). Culture positivity was seen in 60.1%, with Trichophyton mentagrophytes being the most common isolate (86%). Among the staining methods used on 15 selected isolates, Lactophenol Cotton Blue (LPCB) was scored as the most effective, scoring 2.6 out of 3. The study revealed several clinical and epidemiological findings related to dermatophytosis in India, including a high degree of communicability, inadvertent therapies including topical steroid misuse, and a persistent nature requiring an extended duration of therapy. Trichophyton mentagrophytes was the most frequently isolated pathogen. Of the staining methods evaluated, Lactophenol Cotton Blue (LPCB) was found to be the most effective. The findings suggest a need for continued research into effective treatments and diagnostic methods for dermatophytosis in India. [ABSTRACT FROM AUTHOR]

Objective We aimed to study and define "difficult dermatophytosis" encountered frequently; as well as examine demography, patient practices and clinico-etiological pattern among these patients. Methods A prospective, cross-sectional study was conducted to include 93(n) cases (after informed consent) from the patients attending the outpatient department in the Department of Dermatology, Venereology and Leprology between August 2019 and August 2020. The inclusion criteria were: - age >12 years and fulfilling one or more criteria defining "difficult dermatophytosis" i.e. multiple/large lesions, multifocal, recurrent therapy, multiple relapses, clustering and chronicity. The clinico-demographic data was recorded in a pre-designed pro forma, a KOH examination for skin scraping and fungal culture was done for all cases. Data was analysed with SPSS version 20. Results Males outnumbered females (M: F =1.2:1) and majority (67.8%) of patients were <40 years (Mean=34.13±11.5; Median=31yrs.). Body Mass Index (BMI) was higher than 25 in 55.9% cases; mean BMI seen in the study was 25.17±4.60. Multiple/large lesion (90.3%) was most common inclusion criteria followed by multifocal lesions (84.9%). All patients had tinea cruris; tinea corporis was most commonly associated followed by tinea faciei lesions. A significant proportion (76.3%) of cases had =4 family members cohabiting with them (Mean=5.07±0.03); more than half (56.98%) had an affected family member (Mean=0.90±1.00). The most common co-morbid condition seen was atopy seen in 16 (17.2%) patients. Presentation for dermatology consult was delayed by >1 month in 81.7% cases; >6 months in 47.3% cases and >1 year in 26.9% cases. A strong statistical association was found of multiple relapses with „delay in dermatology consults" (p value=0.002). A significant association of delay was also seen with chronicity (p value=0.046) was also seen. Nearly three-fourth study participants (72%) reported prior use of topical corticosteroid; oral (11.8%) and parental (20.4%) use were also reported. Prior use of luliconazole (40.8%) was most commonly reported among topical drugs, whereas itraconazole was used by 46% patients previously. Irrational use of anti-fungals was seen in 75%; including inappropriate doses (18%), inappropriate duration (34%), poly-pharmacy (6%) and non-compliance (1%). A statistically significant association of irrational use was found with multiple/large lesions (p value=0.008). Conclusion We propose this definition for the unusual presentations of the disease, particularly in the Indian sub-continent. Better access to clinical dermatology services and rational use of systemic anti-fungals as a means to mitigate difficult dermatophytosis. [ABSTRACT FROM AUTHOR]

Infections affecting the superficial keratinized layer of the skin, nails, and hair are referred to as dermatophytosis and dermatomycoses, which constitute the most common type of fungal infection that affects people. This clinical ailment has a prevalence of between 30 and 60% and is more common in India's hot, muggy, tropical climate. Examining the prevalence of superficial mycoses (SM), their clinical symptoms, and the fungal species that were identified as the disease-causing agents were the main objectives of the current study. This study comprised 250 clinically confirmed patients with SM who visited our dermatology department over the course of a year. Skin scrapings, nail clippings, and hair samples were gathered, mounted, and cultured using KOH. Macroscopic examination of culture, tease mount, and phenotypic tests were used to identify the species. The age group of 11–20 years (29%) had the highest prevalence of SM out of the 250 clinically verified cases of the condition that were included in our study, followed by 21–30 years (20%) and 31–40 years (18%). Candida albicans, dermatophytes, and non-dermatophytic moulds were the three most prevalent fungal isolates. The most typical dermatophyte isolate was T. rubrum, which was primarily found in Tinea corporis (TCo), Tinea cruris (TCr), and Tinea faciei (TFa). T. mentagrophytes was the second most frequent isolate. According to our investigation, it was determined that non-dermatophytic moulds constitute a significant contributor to the development of SM in addition to dermatophytes. [ABSTRACT FROM AUTHOR]

AIM- To evaluate the usefulness of two different microscopic techniques for the identification and isolation of dermatophytes from clinical sample. INTRODUCTION - Fungal infections are very common in man. They are assuming greater significance both in developed & developing countries due to advent of immunosuppressive drugs & disease(1) hot & humid climate in tropical & subtropical countries like India makes dermatophytosis or ringworm a very common superficial fungal skin infection. Dermatophytosis is caused by dermatophytes, a group of keratinophilic fungi that require long incubation period to grow. The clinical presentation, though very typical of ringworm infection, is very often confused with other skin disorder particularly due to rampant application of broad - spectrum steroid containing skin ointments and cream leading to further misdiagnosis and mismanagement. Even the newer antifungal agents are not completely devoid of slide effects which may affect the patient health on long term use. The long duration of treatment which seeks patient compliance and co-operation, every effort should be made to confirm the etiology by the use of appropriate laboratory tests before starting the treatment. Microscopy is the simplest and cheapest investigation to screen superficial fungal infections. It needs experienced observer to avoid false positive and false negative reports which affect the diagnosis. However, fungal culture still remains the gold standard investigation to confirm the causative agent (2,3). Identification of fungi at least to the genus level is necessary to initiate therapy. This study is aimed to evaluate diagnosis efficacy of laboratory methods microscopy and modified microscopy technique to identify fungal isolates causing fungal infections. This study is valuable to establish the accurate diagnosis and to start antifungal treatment. OBJECTIVES ---To evaluate the diagnosis sensitivity and usefulness of two microscopic techniques, KOH without DMSO and KOH with 40% DMSO for all skin, hair and nail sample. MATERIAL AND METHOD --Cross sectional lab based investigational study was conducted and skin, hair, nail sample from 110 clinically suspected cases of dermatophytosis were taken from OPD of district hospital of central India and were screened by direct microscopic examination using 10% potassium hydroxide (KOH) with and without 40% dimethyl sulphoxide (DMSO) mount. 10% potassium hydroxide (KOH) with 40% Dimethyl sulphoxide mount (DMSO) mixed in equal proportion. [ABSTRACT FROM AUTHOR]

Objective Dermatophytoses, one of the most ancient diseases, is becoming a menace in recent times. This has made the knowledge of antifungal susceptibility a priority in today's times. Material and Methods This is a prospective study conducted over 18 months including all dermatophytes isolated during the period. Dermatophytes were identified by routine phenotypic methods. Antifungal susceptibility testing was performed for griseofulvin, terbinafine, and itraconazole as per the Clinical Laboratory Standard Institute M38 A2, and minimum inhibitory concentrations (MICs) were read after 5 days. Results Patient details and associated risk factors were recorded. Fixed dose combinations with steroids were associated with 79.3% (46 out of 58) of patients with dermatophytosis of skin. Among the 72 dermatophytes isolated during the study period, 58 (80.5%) were isolated from skin scrapings and 14 (19.4%) from nail samples. Tinea corporis with cruris was the most common presentation. The most common dermatophyte isolated from skin scrapings was Trichophyton mentagrophytes complex (70.6%, 41 out of 58), while from nail samples it was Trichophyton rubrum complex (78.57%, 11 out of 14). Based on the MIC 50 and MIC 90 results, itraconazole showed the lowest MICs, followed by terbinafine and then griseofulvin. Conclusion With the changing epidemiology of species distribution and antifungal resistance, there is a need for continuous surveillance of these parameters of dermatophytes. [ABSTRACT FROM AUTHOR]

A resistant and hypervirulent dermatophyte from India has been described as a taxonomic novelty, Trichophyton indotineae, a species of the Trichophyton mentagrophytes complex. Rapid detection and correct identification of closely similar dermatophytes with different predilections are essential for efficient clinical management. We evaluated the efficacy of rapid diagnostic methods clinical and environmental strains in the T. mentagrophytes complex. The methods included Real-time-PCR, DermaGenius, LAMP, and MALDI-ToF MS, using rDNA ITS sequences as taxonomic standard. The results show that only MALDI-ToF MS can distinguish 96.97% T. indotineae from other closely related species. The complex comprises numerous clones which may differ in anonymous markers but with similar evolutionary behavior. Therefore, we recommend to distinguish species only when they show an appreciable degree of adaptation and thus are clinically significant. The distinction of remaining clonal diversity is an epidemiological query and can be solved by haplotype numbering. [ABSTRACT FROM AUTHOR]

• Dermatophytes in cats were identified by RFLP-PCR. • Lime sulphur in combination with oral itraconazone gives expeditious recovery. • Topical treatment with biocides will reduce dependence on specific antifungals. The surge in domestic cat adoption across India, particularly the rising preference for high-pedigree cats, coupled with environmental factors, has resulted in increased incidence of dermatophytosis among feline companions. Despite this growing concern, there is a noticeable scarcity of studies in India delving into the etiological factors contributing to dermatophytosis in cats. This disease is a threat to animal health and carries public health significance, given that cats are recognized reservoir hosts for Microsporum canis , a common dermatophyte affecting humans and animals. This study endeavours to identify the dermatophytes affecting cats and establish a standardized therapeutic regimen while accounting for the local stigma surrounding the regular bathing of cats. The study involved the examination of 82 cats presenting dermatological lesions, when subjected to cultural examination in dermatophyte test medium revealed 36 afflicted with dermatophytes. Isolates were presumptively identified by staining using lactophenol cotton blue, Chicago sky blue 6B, and Calcofluor white stains. Molecular-level identification of the isolates was confirmed through PCR-RFLP, amplifying the Internal Transcribed Spacer Sequence of 16 s rDNA, followed by restriction digestion using the Mva1 enzyme. Among the thirty-six isolates, 29 were identified as M. canis , while the remaining 7 were M. gypseum. The cases were categorized into five groups and treated with Lime Sulphur dip, 4 % chlorhexidine shampoo, a shampoo containing 2 % miconazole and 4 % chlorhexidine, oral itraconazole alone, and a combination of oral itraconazole with lime-Sulphur dip. Statistical analysis revealed that the response was notably swifter with lime Sulphur dip when considering only topical therapy. Moreover, the mycological cure was most expeditious when combining Lime Sulphur dip with oral itraconazole. These findings underscore the pivotal role of topical biocides in feline dermatophytosis treatment, potentially reducing the reliance on specific antifungals and thereby contributing to the mitigation of antimicrobial resistance emergence. [ABSTRACT FROM AUTHOR]

Summary: Background: Dermatophytosis is a worldwide public health problem, affecting > 25% of the world's population. There has been a rampant increase in the resistant, recurrent dermatophytosis in the past few years, especially in India. Azole resistance in dermatophytes has been reported to be as high as 19% worldwide, hence evaluating the efficacy and safety of a newer oral antifungal is important. Aim: To evaluate the efficacy and safety of oral voriconazole in the management of recalcitrant and recurrent dermatophytosis. Methods: Patients with extensive, recurring and resistant dermatophytosis. The clinical diagnosis was confirmed by potassium hydroxide staining. Patients were given a 2‐week course of oral voriconazole, administered as 800 mg on Day 1, followed by two daily doses of 200 mg (total 400 mg/day) for the remaining 13 days. The patients were followed up in Week 2 to assess response and in Week 6 to assess recurrence. Patients were monitored for any adverse effects (AEs). Results: In total, 40 patients completed the study. Complete clearance was seen in 90% and 75% at Weeks 2 and 6, respectively. By the end of Week 6, eight patients (20%) had partial improvement of disease without complete clearance and only 5% had recurrence. No AEs were recorded during the treatment course. Conclusion: Voriconazole, a novel oral antifungal that can be used for treatment of recurrent and resistant dermatophytosis, has a good efficacy and safety profile with a very low rate of recurrence. [ABSTRACT FROM AUTHOR]

Background: The prevalence of dermatophytes varies with season, geographical area, socio-economic factors and effective management strategies.Aims: The aim of the study was to assess the prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infection, and in vitro antifungal drug susceptibility testing against dermatophytes.Methods: Three hundred and ninety five patients with dermatophytosis were enrolled from five cities (Mumbai, Delhi, Lucknow, Kolkata and Hyderabad) across India. All patients were subjected to clinical examination and investigations, including potassium hydroxide microscopy, fungal culture and antifungal drug susceptibility testing.Results: Trichophyton rubrum was the most common species identified (68.4%), followed by T. mentagrophytes (29.3%). Within species, T. mentagrophytes was prevalent in humid environmental conditions (Mumbai and Kolkata), whereas T. rubrum was prevalent in noncoastal areas (Delhi, Lucknow and Hyderabad). Tinea corporis (71.4%) and tinea cruris (62.0%) were the common clinical types observed. antifungal drug susceptibility testing data indicated that minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC-90) was lowest for griseofulvin (0.25-3.0 μg/mL). Among oral antifungals, the mean MIC of itraconazole was within the range (0.84 [0.252] μg/ mL), whereas high mean MIC values were reported for terbinafine (0.05 [0.043] μg/mL). Among topical agents, lowest mean MIC values were reported for luliconazole (0.29 [0.286] μg/mL), eberconazole (0.32 [0.251]) μg/mL and amorolfine (0.60 [0.306]) μg/mL.Limitations: Lack of correlation between in vitro antifungal susceptibility and clinical outcome and absence of defined MIC breakpoints.Conclusion: T. rubrum was the most common, followed by T. mentagrophytes as an emerging/codominant fungal isolate in India. Tinea corporis was the most common clinical type of dermatophytosis. Mean MIC of terbinafine was above the reference range, while it was within the range for itraconazole; griseofulvin had the lowest mean MIC. Luliconazole presented the lowest mean MIC values across cities. [ABSTRACT FROM AUTHOR]

Background. Increase in resistance to conventional antifungals renders the need for antifungal sensitivity testing in dermatophytes. The present study aimed at determining the prevalence of dermatophytic infections and their susceptibility pattern in a rural healthcare facility. Methods. Patients with suspected dermatophytosis attending the dermatology outpatient department were enrolled in the study. Specimen collection for mycological examinations was done. Invitro antifungal sensitivity testing was performed as per the Clinical and Laboratory Standard Institute M38-A2 (2008) standards with broth microdilution method. Results. Onychomycosis was the commonest (41.9%) presentation. Dermatophytic prevalence based on culture was 110 (70.9%). The commonest species was Trichophyton rubrum (36.8%). Terbinafine was found to be the most effective drug, followed by ketoconazole and itraconazole. Conclusions. Antifungal sensitivity in dermatophytic infections should be made a routine in tertiary healthcare facilities as we are already witnessing the rampage of emerging fungal infection-Mucormycosis, in the nation and worldwide. [ABSTRACT FROM AUTHOR]

One of the canonical features of the current outbreak of dermatophytosis in India is its unresponsiveness to treatment in majority of cases. Though there appears to be discordance between in vivo and in vitro resistance, demonstration of in vitro resistance of dermatophytes to antifungals by antifungal susceptibility testing is essential as it may help in appropriate management. The practical problem in the interpretation of antifungal susceptibility testing is the absence of clinical breakpoints and epidemiologic cutoff values. In their absence, evaluation of the upper limit of a minimal inhibitory concentration of wild type isolates may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility. In the current scenario, most of the cases are unresponsive to standard dosages and duration of treatment recommended until now. This has resulted in many ex-cathedra modalities of treatment that are being pursued without any evidence. There is an urgent need to carry out methodical research to develop an evidence base to formulate a rational management approach in the current scenario. [ABSTRACT FROM AUTHOR]

Objectives: Olorofim is a novel antifungal agent with in vitro activity against Aspergillus and other opportunistic moulds. We investigated the in vitro activity of olorofim against a range of filamentous fungi comprising isolates of Aspergillus species, Scedosporium species, Alternaria alternata, dermatophytes, including terbinafine- and multidrug-resistant Trichophyton species, and Penicillium/Talaromyces species originating from patients in North India.Methods: Antifungal susceptibility of olorofim was tested against 241 mould isolates of Penicillium/Talaromyces species, Trichophyton species, A. fumigatus and cryptic Aspergillus species, Scedosporium species, and Alternaria alternata using CLSI broth microdilution. The comparators were five systemic azoles, amphotericin B, terbinafine, and luliconazole.Results: Overall, olorofim showed highly potent in vitro activity against dermatophytes and opportunistic moulds (MIC range of 0.004-0.125 mg/L) except for Alternaria alternata. Penicillium, and Talaromyces species and Trichophyton species exhibited a low geometric mean (GM) MIC (GM 0.027 mg/L and 0.015 mg/L, respectively) of olorofim. Importantly, a 2-12 dilution step decrease in in vitro activity of olorofim as compared with azoles was observed against Penicillium and Talaromyces. Notably, olorofim displayed potent in vitro activity against Trichophyton isolates including terbinafine-resistant and azole-resistant Trichophyton mentagrophytes/interdigitale with a modal MIC value of 0.008 mg/L. Further, azole-resistant A. fumigatus isolates harbouring mutations in azole target Cyp51A genes and several cryptic aspergilli displayed low MICs (range 0.004-0.03 mg/L) of olorofim. However, no in vitro activity of olorofim against Alternaria alternata was observed.Conclusions: The potent in vitro activity of olorofim against drug-resistant dermatophytes and opportunistic moulds is promising, warranting evaluation of the clinical utility of olorofim. [ABSTRACT FROM AUTHOR]

Introduction: Onychomycosis is a common fungal infection of nail. It may be caused by dermatophytes, non-dermatophytic moulds or yeasts involving nail bed, nail plate or matrix of nail. As the fungi show variable susceptibility to antifungal drugs and treatment requires long duration of antifungal therapy, so it's prevalence as well as proper laboratory diagnosis and antifungal susceptibility testing is essential for effective therapy. Aim: To find the prevalence of onychomycosis with demography along with various aetiology and the suitable antifungal drugs used for treatment. Materials and Methods: For this prospective study, over a period of two years a total of 300 nail samples were processed in the Department of Microbiology at IMS & SUM Hospital, Bhubaneswar, Odisha, India. The wet mount for microscopic examination was prepared using 20% Potassium Hydroxide (KOH) and examined after overnight incubation. Culture was done in duplicate in Sabouraud's Dextrose Agar (SDA) tubes; one with actidione and another without it and both were incubated at 25°C in Biological Oxygen Demand (BOD) incubator. Culture tubes growing yeasts were further subjected to speciation by germ tube test, culture on Chromogenic (CHROM) agar and on cornmeal agar. In-vitro antifungal susceptibility testing was performed against Candida species using disc diffusion method on Muller Hinton agar. Chi-square test was used for statistical analysis of the results. Results: Onychomycosis can affect a wide age group though seen commonly at 31-40 years equally in both male and females. Fingernail infection was observed mostly in female cases. It was caused by Candida species (66%), moulds (24%) and dermatophytes (10%) and out of Candida sp. C.albicans was the main culprit. Although all the Candida strains were susceptible to amphotericin B, still some of them showed resistance to the commonly used antifungals like fluconazole and itraconazole. Conclusion: Candida albicans was the most common aetiological agent which contributed for onychomycosis and showed a variable resistance pattern to the commonly used antifungals. Proper laboratory diagnosis and selection of antifungal drug is essential prior to institution of therapy for successful treatment of this disease. [ABSTRACT FROM AUTHOR]

Antifungal drug resistance in dermatophytes was first reported shortly after the turn of the millennium and has today been reported in Trichophyton and occasionally in Microsporum , but not in Epidermophyton species. Although drug resistance in dermatophytes is not routinely investigated, resistance in Trichophyton spp. is increasingly reported worldwide. The highest rates are observed in India (36% and 68% for terbinafine (MIC ≥4 mg/L) and fluconazole (MICs ≥16 mg/L), respectively), and apparently involve the spread of a unique clade related to the Trichophyton mentagrophytes / Trichophyton interdigitale complex. The European Committee on Antimicrobial Susceptibility Testing Subcommittee on Antifungal Susceptibility Testing (EUCAST-AFST) has released a new method (E.Def 11.0) for antifungal susceptibility testing against microconidia-forming dermatophytes including tentative MIC ranges for quality control strains and tentative breakpoints against Trichophyton rubrum and T. interdigitale. Here, the details of the new procedure E.Def 11.0 are described. This technical note is based on the multicentre validation of the EUCAST dermatophyte antifungal susceptibility testing method, the mould testing method (E.Def 9.3.2) and the updated quality control tables for antifungal susceptibility testing document, v 5.0 (available on the EUCAST website). The method is based on the EUCAST microdilution method for moulds but significant differences include: (a) an altered test medium selective for dermatophytes; (b) an altered incubation time and temperature; and (c) a different end-point criterion (spectrophotometric determination) of fungal growth. It can easily be implemented in laboratories already performing EUCAST microdilution methods and has been validated for terbinafine, voriconazole, itraconazole and amorolfine against T. rubrum and T. interdigitale. This standardized procedure with automated end-point reading will allow broader implementation of susceptibility testing of dermatophytes and so facilitate earlier appropriate therapy. This is important, as resistance is rapidly emerging and largely underdiagnosed. [ABSTRACT FROM AUTHOR]

Dermatophytes are the common etiological agent to cause superficial mycosis, however non-dermatophytes like yeast and non dermatophyte mould (NDM) are emerging as potential agent to cause superficial mycosis. In this study, we evaluated epidemiological, clinical and mycological characters of non-dermatophytes causing superficial infection in the Siddi tribal community. A total of 1004 samples were collected from 937 Siddi community patients with superficial infection. In that 158 samples shown culture positive, Candida species (32, 20.25%) was the predominant agent to cause superficial infection other than dermatophytes followed by Aspergillus species (12, 7.59%), Fusarium species (10, 6.32%) and cladosporium species (2, 1.26%). Further, Cladosporium species isolated from tineacapitis infection was subjected to PCR, sequencing of ITS region and identified as Cladosporium halotolerans. Therefore, this study also revealed non dermatophytic fungi are emerging as important cause of superficial infection. [ABSTRACT FROM AUTHOR]

Dermatophytosis is a serious fungal infection of superficial keratinized tissue in man and animal. At least one million people in India were suffering from this infection. Present investigation deals with the screening and study of 6 major compounds of essential oils like myrcene, linalool, citral, geraniol, limonene and citronellol against Candida albicans, Microsporum gypseum, M. canis and Trichophyton rubrum. The minimum inhibitory concentration was determined through semi-solid agar antifungal testing methods. Among all these compounds geraniol and citronellol exhibited excellent antidermatophytic activities. MIC of geraniol was ranged from 0.025 μL/mL to 0.1 μL/mL. MIC of citronellol was obtained > 0.012 μL/mL to 0.1 μL/mL concentrations. MIC of citral was ranged from 0.05 μL/mL to 0.2 μL/mL. Linalool also showed strong antifungal behavior against all tested microorganisms. Myrcene and limonene were found to be very less effective compounds as compared to others. M. canis was found to be resistant from both myrcene and limonene. [ABSTRACT FROM AUTHOR]

Background: An alarming increase in recalcitrant dermatophytosis has been witnessed in India over the past decade. Drug resistance may play a major role in this scenario. Objectives: The aim of the present study was to determine the prevalence of in vitro resistance to terbinafine, itraconazole and voriconazole in dermatophytes, and to identify underlying mutations in the fungal squalene epoxidase (SQLE) gene. Patients/Methods: We analysed skin samples from 402 patients originating from eight locations in India. Fungi were identified by microbiological and molecular methods, tested for antifungal susceptibility (terbinafine, itraconazole, voriconazole), and investigated for missense mutations in SQLE. Results: Trichophyton (T.) mentagrophytes internal transcribed spacer (ITS) Type VIII was found in 314 (78%) samples. Eighteen (5%) samples harboured species identified up to the T interdigitale/mentagrophytes complex, and T rubrum was detected in 19 (5%) samples. 71% of isolates were resistant to terbinafine. The amino acid substitution Phe397Leu in the squalene epoxidase of resistant T mentagrophytes was highly prevalent (91%). Two novel substitutions in resistant Trichophyton strains, Ser395Pro and Ser443Pro, were discovered. The substitution Ala448Thr was found in terbinafine‐sensitive and terbinafine‐resistant isolates but was associated with increased MICs of itraconazole and voriconazole. Conclusions: The high frequencies of terbinafine resistance in dermatophytes are worrisome and demand monitoring and further research. Squalene epoxidase substitutions between Leu393 and Ser443 could serve as markers of resistance in the future. [ABSTRACT FROM AUTHOR]

Introduction: Dermatophytes and opportunistic fungi are common skin infection mainly affecting superficial layers of integument with rare systemic involvement. The higher prevalence in India is supposedly due to the hot and humid climatic condition, occupation and low socio-economic status. Recent upsurge in fungal infections are due to increased incidence of immunosuppressive state. Aim: To study the clinical manifestation and mycological evaluation of dermatophytosis. Materials and Methods: The present study was conducted during December 2007 to October 2009 in MP Shah Medical College and GG Hospital, Jamnagar, Gujarat, India. Samples were taken from 200 patients with clinically diagnosed dermatophytosis. Depending on the site of lesion, samples from skin, hair or nail were taken. These samples were than examined directly under microscope and cultured on Sabouraud's Dextrose Agar (SDA) and Cornmeal Agar (CMA). Descriptive statistics like mean and percentages were used to infer results. Results: Out of 200 patients, 177 (88.5%) samples were positive by Potassium Hydroxide (KOH) mount while 127 (63.5%) samples were positive by Culture. Most common species of dermatophytes identified was Trichophyton rubrum followed by Trichophyton mentagrophytes. Agricultural workers were found to be more prone to dermatophytic infection and males (61%) were more commonly affected than females (39%). Conclusion: Dermatophytosis is a common superficial mycotic infection in Saurashtra region where hot and humid climate, poor socio-economic condition and compromised personal hygiene play an important role in fungal growth. In the present study, tinea corporis was found to be the most common clinical type with T. rubrum being the commonest isolated species. [ABSTRACT FROM AUTHOR]

The clinical types are TineaCapitis (scalp), Tineacorporis (body), Tineapedis (feet), Tineacruris (groin), and Tineaunguium (nails). An increased prevalence of dermatophytosis is seen in India due to its hot and humid climate and poor socioeconomic conditions leading to a lack of personal hygiene. Tineacorporis andTineacruris are the most common types of dermatophytosis seen in India. A variety of antifungal drugs with less toxicity and better pharmacokinetics are now available to treat dermatophytosis. With some exceptions (e.g., griseofulvin), the antifungal drugs commonly used (Fluconazole, Itraconazole and Terbinafine) act against the ergosterol synthesis pathway. However the emerging resistance to the common antifungal agents poses difficulty in the treatment of these conditions. Though topical antifungal therapy have good efficacy in treating most superficial fungal infections, severe infectionsand clinical types like Tineacapitis, Tineaunguium requires systemic therapy. Ininstruction to envisage the therapeutic outcome of a given antimycotic agent used in the treatment of dermatophytosis, purpose of the invitrodefenselessness of the drugs may demonstratecooperative. With dermatophytes, a good associationamong the invitro data and clinical outcome has beenestablished for the, test and discdiffusion method. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis is a major public health problem in our country. Although resistance to conventional oral and topical antifungal agents is being increasingly encountered, the sensitivity pattern of dermatophytes has not been systematically analysed.Aims: We aimed to determine the sensitivity pattern of dermatophyte isolates to amphotericin B and six oral antifungal drugs.Materials and Methods: Patients with dermatophytosis attending the outpatient department of dermatology were enrolled in the study. Samples were collected for mycological examination and in vitro antifungal sensitivity testing was done by broth microdilution as per the Clinical and Laboratory Standard Institute M38-A standards.Results: A total of 804 patients were enrolled. Specimens from 185 patients (23%) were both KOH and culture positive, and 44 of these isolates (41 Trichophyton mentagrophytes and 3 Trichophyton rubrum) were subjected to sensitivity testing. Minimum inhibitory concentrations (MIC) of itraconazole, ketoconazole, voriconazole and amphotericin B were comparable. The median MIC to fluconazole was higher than the other tested drugs. Dermatophytes were most susceptible to ketoconazole and voriconazole, followed by itraconazole, amphotericin B, fluconazole and griseofulvin. A high incidence of resistance was found to terbinafine and the difference was statistically significant in comparison to fluconazole, itraconazole, voriconazole, ketoconazole (P = 0.001) and griseofulvin (P = 0.003). The strains were more sensitive to amphotericin B as compared to griseofulvin (P = 0.02) and terbinafine (P < 0.001).Limitations: This was a hospital-based study and may not reflect the true pattern in the community. Only a few of the isolates were selected for study. The clinical response of patients, whose isolates were studied for in vitro sensitivity of the antifungals, was not studied.Conclusions: The sensitivity pattern of dermatophytes to various antifungals including amphotericin B, ketoconazole, voriconazole and itraconazole were determined. The studied isolates were least susceptible to terbinafine. [ABSTRACT FROM AUTHOR]

Background: Recent years have seen an alarming rise in the prevalence of recalcitrant and relapsing dermatophyte infections in India associated with lack of clinical response to standard antifungal regimens. Aims and Objectives: A study was undertaken to identify the antifungal susceptibility patterns of dermatophyte species isolated from lesions of dermatophytoses in patients examined at our center. Materials and Methods: A total of 85 patients with clinically diagnosed dermatophytoses were subjected to skin scrapings for potassium hydroxide mount (microscopic examination) and culture using Sabouraud's agar medium containing chloramphenicol and cycloheximide (incubated at 30°C). Antifungal susceptibilities [minimum inhibitory concentration-90 (MIC-90)] of the identified dermatophytes were tested for seven systemic and topical antifungal agents (terbinafine, griseofulvin, itraconazole, fluconazole, sertaconazole, ketoconazole, and clotrimazole) using Clinical and Laboratory Standards Institute broth microdilution method (M38-A). Results: Trichophyton rubrum (50%) and Trichophyton mentagrophytes complex (47.2%) were the two major species isolated. Isolates of both showed downy and granular forms (61.11%, 38.89% and 32.35%, 67.65%, respectively). The overall in-vitro susceptibility profiles (MIC-90 ranges in μg/mL) of the seven drugs for T. rubrum and T. mentagrophytes complex respectively were as follows: terbinafine (0.008–0256, 0.016–0.256), griseofulvin (0.03-1, 0.06–1), itraconazole (0.125-2, 0.25–2), fluconazole (0.125–1, 0.25–32), sertaconazole (0.03-1, 0.03-1), ketoconazole (0.06–1, 0.125–1), and clotrimazole (0.03–2, 0.06–1). Conclusions: This study indicates a rising proportion of T. mentagrophytes complex with increased proportion of granular form (T. mentagrophytes var. mentagrophytes). This study represents the current antifungal susceptibility profile of dermatophytic infections in a tertiary care medical center in western India with rising MICs to terbinafine and itraconazole. [ABSTRACT FROM AUTHOR]

Introduction: Superficial infections of skin, hair and nail are caused by dermatophytes due to its high affinity towards keratinized layers. Dermatophytosis is a progressing infection with an outer ring of active lesion and central healing. In recent years there is a worldwide increase in people getting affected by dermatophytic infections mainly due to increase in number of immunocompromised patients and widespread use of broad spectrum antibiotics. Aim: The present study was designed to investigate the age and genderwise seasonal prevalence of dermatophytosis visiting the tertiary care hospital, Puducherry. Materials and Methods: A total of 356 samples which comprises of 206 skin scrapings, 82 nail clippings and 68 hair samples were collected from 356 patients clinically suspected with dermatophytosis. The materials were subjected to direct microscopy (KOH mount) and cultured on to Sabouraud's dextrose agar slopes and dermatophyte test medium for selective isolation of dermatophytes. A pre-structured questionnaire was designed to collect various socio-demographic profiles from the study population to assess the age and genderwise seasonal distribution of dermatophytosis. Frequency distribution was performed for analysis of results. Results: Dermatophytosis was found to be more prevalent in males 223 (62.6%) compared to females 133 (37.4%) with male to female ratio being 1.67:1. Tinea corporis was the common clinical presentation in males 71/223 and Tinea unguium was common in females 58/133. Maximum number of cases affected with dermatophytosis was in the age group 21 to 30 years, 98 (27.5%), with least number of cases 27 (7.6%) in above 50 years. Trichophyton mentagrophytes was the major isolate from hair and nail specimens 14/18 and 11/23 respectively, whereas Trichophyton rubrum was the common isolate from skin scrapings 41/98. Maximum prevalence 127 (35.8%) of dermatophytosis cases was recorded during the summer months April to June. Conclusion: Skin infection being the most common clinical presentation followed by nail and hair infection. Though all ages were found susceptible, dermatophytosis was more common in 3rd decade of life. Males predominated in all clinical types except in cases with Tinea manuum and Tinea unguium females predominated. Dermatophytosis was reported in all seasons, since Puducherry's climatic condition is hot and humid all through the year which serves best for dermatophytes to establish an infection with increased prevalence during the months of April to June. Hence the present study emphasises that the population at risk in this locality needs to be awakened regarding the protective measures to cut down the prevalence. [ABSTRACT FROM AUTHOR]

Summary: The taxonomy of the dermatophytes has been revisited using a novel multilocus phylogenetic approach, and several neotypes and reference strains have been assigned for Trichophyton species. Single gene sequencing, that is the ITS region, for identification of highly related species T. mentagrophytes/T. interdigitale, warrant reassessment. The sequence database (Westerdijk and NCBI) needs to be updated as several incorrect/obsolete entries of reference and neotype strains of T. interdigitale/T. mentagrophytes hampers correct identification of this complex. [ABSTRACT FROM AUTHOR]

Background: Dermatophytes are keratinophilic fungi responsible for skin, nail, and scalp infections. Chronic dermatophytosis, defined as persistent infection for six months or more, was very rare in the 1980s and mostly limited to patients with nail involvement, but this is no longer true. Currently, patients with chronic dermatophytosis are increasing, and about 50 percent of patients with dermatophytosis have at least one other member of their family infected at the same time, sometimes with entire families being affected at once. Objective: We sought to study the possible risk factors associated with familial dermatophytosis. Methods: The present questionnaire-based study was conducted from May 2017 to July 2017. Patients with a clinical diagnosis of dermatophytosis and at least one other family member affected were included. A proforma was filled and history was taken, including number of family members affected, site of infection in the index case, site(s) of infection of all other subsequent family members affected, and use of over-the-counter drugs. Results: Out of the 113 families surveyed, which included 673 subjects, a little over half (55.4%) were affected by dermatophytosis. In 103 families, the initial site of infection in the subsequent family member affected was the same site as that affected in the first member. All families reported a history of using an irritant soap and over-the-counter drugs. Washing all the family's clothing together was a common factor. All families had a single bathroom and used the same soap and stool for bathing. Conclusion: Through our survey, we identified possible risk factors that might be responsible for the increasing epidemic of familial dermatophytosis in India, including sharing of soaps and towels, washing clothes in the same vessel, sharing of lavatories, abuse of topical steroids and over the counter topicals, and use of antiseptic soaps that kill normal flora. [ABSTRACT FROM AUTHOR]

Background: Recurrent and clinically unresponsive dermatophytosis is being increasingly encountered in our country. It runs a protracted course with exacerbations and remissions. However, there is little information regarding the extent of the problem and the characteristics of recurrent dermatophytosis in published literature.Aims: We sought to determine the prevalence, risk factors and clinical patterns of recurrent dermatophytosis in our institution. We also investigated the causative dermatophyte species and antifungal susceptibility patterns in these species.Methods: One hundred and fifty patients with recurrent dermatophytosis attending the outpatient department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India were enrolled in the study conducted from January 2015 to December 2015. A detailed history was obtained in all patients, who were then subjected to a clinical examination and investigations including a wet preparation for direct microscopic examination, fungal culture and antifungal susceptibility tests.Results: Recurrent dermatophytosis was seen in 9.3% of all patients with dermatophytosis in our study. Trichophyton mentagrophytes was the most common species identified (36 patients, 40%) samples followed by T. rubrum (29 patients, 32.2%). In-vitro antifungal susceptibility testing showed that the range of minimum inhibitory concentrations (MIC) on was lowest for itraconazole (0.015-1), followed by terbinafine (0.015-16), fluconazole (0.03-32) and griseofulvin (0.5-128) in increasing order.Limitation: A limitation of this study was the absence of a suitable control group (eg. patients with first episode of typical tinea).Conclusion: Recurrence of dermatophytosis was not explainable on the basis of a high (MIC) alone. Misuse of topical corticosteroids, a high number of familial contacts, poor compliance to treatment over periods of years, and various host factors, seem to have all contributed to this outbreak of dermatophytosis in India. [ABSTRACT FROM AUTHOR]

Onychomycosis refers to fungal nail infection. Despite a clearly diseased appearance, it is often deemed a merely cosmetic problem of relatively minor importance. However, it may result in much psychological or occupational turmoil, diminished self-esteem and resulting reluctance for public interaction. A wide number of factors determine the treatment outcome and its prevalence varies greatly. Our study was conducted between January 2011 and December 2014 in northeast India. Of 243 patients presenting with nail abnormalities, 158 (65%) were positively diagnosed by either direct microscopy or culture or both. A distal lateral subungual infection was the most predominant clinical pattern observed, and the most frequent aetiological agents were dermatophytes, of which Trichophyton rubrum was predominant. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis has gained significant importance in recent years owing to increased incidence, more atypical lesions, changing mycological profile and growing antifungal resistance. Therefore, this study was planned to know the clinicomycological profile of dermatophytic infections in patients attending our tertiary care centre., Materials and Methods: A total of 700 patients with superficial fungal infections belonging to all age groups and both sexes were taken up for this cross-sectional study. Sociodemographic and clinical details were noted on a prestructured proforma. Superficial lesions were clinically examined and the sample was collected by appropriate collection methods. Direct microscopy by potassium hydroxide wet mount was done to see hyphae. For culture Sabouraud's dextrose agar (SDA) with chloramphenicol and cyclohexamide was used., Results: Dermatophytic infections were detected in 75.8% (531/700) patients. Young people belonging to age group of 21-30 years were commonly affected. Tinea corporis was the commonest clinical picture seen in 20% of the cases. Oral antifungals were taken by 33.1% and topical creams were used by 74.2% of the patients. Direct microscopy was positive in 91.3% and culture was positive for dermatophytes in 61% of the study subjects. T. mentagrophytes was the commonest dermatophyte isolated., Conclusion: Irrational use of topical steroids needs to be controlled. KOH microscopy can be useful as a point of care test for rapid screening of dermatophytic infections. Culture is necessary to differentiate various dermatophytes and to guide the antifungal treatment., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Onychomycosis is a chronic infection of nails caused by fungi such as dermatophytes, yeasts or non-dermatophyte moulds. It is the most prevalent of all the nail ailments and affects 3-5% of the population worldwide and represents 20-40% of onychopathies and about 30% of mycotic cutaneous infections. Aims: 1)To isolate and identify the etiological fungi and to assess the prevalence of onychomycosis. 2)To analyse the epidemiological and mycological features of onychomychosis. Methods: 109 nail samples were collected from 102 clinically suspected cases of onychomycosis and further analysed. Results: Of 102 cases, the commonest age group was 41-50 years 38 (37.25%); males were 63 (61.76%) and females 39 (38.24%); involvement of toe nails in 73 (71.57%), finger nails 25 (24.51%) and both 4 (3.92%); 56 (54.90%) belonged to low socio-economic status, middle 31 (30.39%) and high 15 (14.71%). Labourers were 14 (13.73%), farmers and office personnel 10 (9.80%). Of 109 samples, direct microscopy by KOH mount was positive in 82 (75.23%) and fungal culture in 52 (47.71%) of which 29 (26.61%) yielded dermatophytes, NDM's 11(21.15%), Candida spp. 8 (15.38%) and mixed growth 4 (7.68%). Dermatophytes 25(48.08%) were the predominant group isolated from toe nails and Candida spp. 6 (11.54%) from the finger nails respectively. Among the 56 isolates, dermatophytes were the predominant group 31 (55.36%) followed by NDM's 15 (26.78%) and Candida spp.10 (17.86%). Conclusion: Onychomycosis is a frequent cause of nail infection. The mycological study and the identification of etiological agents of onychomycosis are needed to confirm the clinical diagnosis and for the choice of therapy. [ABSTRACT FROM AUTHOR]

Introduction: Dermatophytic infections are commonly encountered a problem and constitute more than 50% of cases in dermatology outpatient departments. Diagnosis of these infections requires the proper use of laboratory methods. Objectives: This study was conducted to know the etiology of dermatophytosis in patients attending Tertiary Care Level Hospital in South India and to compare the efficacy of Sabouraud's dextrose agar (SDA) with actidione and dermatophyte test medium (DTM) in isolating and identifying dermatophytes. Materials and Methods: A total of 110 samples which included 101 skin samples and 9 hair samples from clinically suspected dermatophytosis were collected. Direct microscopy by KOH and culture on SDA with actidione and DTM were done. Results: Of 110 samples collected, 58.18% were KOH positive for fungal filaments and 56.36% were culture positive for dermatophytes. More number of cases were observed between age groups of 21-40 years. Males were more affected compared to females. Tinea corporis was the common clinical presentation observed (40%). Trichophyton rubrum (58.06%) was the predominant isolate recovered in all clinical presentations but Trichophyton violaceum was the most common isolate in tinea capitis. All culture positives were grown on both SDA with actidione and DTM. Appearance of growth was earlier on DTM that is, within 10 days compared to SDA with actidione where growth started appearing only after 10 days. This is statistically significant P < 0.0001 (χ2 = 71.6). Species level identification on primary isolation was possible when grown on SDA with actidione and it was not possible with the growth on DTM on primary isolation. Conclusion: DTM is a good screening medium in laboratory diagnosis of dermatophytosis when compared to SDA with actidione. But DTM is inferior to SDA with actidione in identification of dermatophyte species. [ABSTRACT FROM AUTHOR]

Trichophyton rubrum is one of the major causative agents of dermatophytosis in humans worldwide. We report the draft genome sequence of T. rubrum var. raubitschekii from Delhi, India, isolated from a patient presenting symptoms of onychomycosis. The total estimated genome size of the clinical isolate is 25.2 MB containing 8265 predicted protein-coding sequences, 91 tRNA and 15 rRNA genes. Sequence analysis of the secreted subtilases, one of the major virulence factors in dermatophytes, clusters them into three subfamilies with distinct sequence features. The genome sequence is a step in understanding diversity of dermatophytes worldwide and will aid in identification of virulence factors and dissecting mechanisms of pathogenesis among them. [ABSTRACT FROM AUTHOR]

Objective To find out various clinical patterns, etiologic agents and to evaluate the clinicomycologic correlation. Patients and methods Two hundred and forty nine cases of clinically suspected onychomycosis were included in this study. Clinical patterns were noted and sample collected from most severely affected nail. They were subjected to direct microscopy and culture. Results Distal and lateral subungual onychomycosis was the commonest clinical pattern (56.6%) followed by proximal subungual onychomycosis (15.7%), total dystrophic onychomycosis (12.1%), white superficial onychomycosis (10.8%) and chronic paronychia (4.8%). 126 cases (50.6%) were confirmed by either microscopy or culture whereas 123 cases (49.4%) were negative by both. Dermatophytes were most common (55.9%) cause of onychomycosis. Amongst them Trichophyton rubrum was the most common isolate (65.9%). Candida albicans was important (79.2%) amongst the yeast isolates. Nondermatophytic moulds were involved in 15.5% of cases. Conclusion Onychomycosis might be an important cause of absenteeism amongst the working classes in this part of India. Yeasts and nondermatophytic moulds are gradually becoming an important cause of onychomycosis in different areas of the world. So, early diagnosis and initiation of antifungal treatment should be the approach to safeguard the social, emotional and physical well being of the patients. [ABSTRACT FROM AUTHOR]

Background & Objectives: Fungal infections are extremely common in the tropical regions and some of them are serious .Fungi produce diverse human infections ranging from superficial skin infections to systemic disease .The study of superficial mycosis is important due to the frequent occurrence in dermatology clinics. The present study was undertaken with a view to find out the clinical pattern of dermatophytic and non - dermatophytic fungi (superficial mycosis) and most common fungal pathogens in tertiary care hospital affiliated with medical college in Western India from August 2007 to July 2008. Methods: A clinical and mycological study of superficial mycosis was conducted on 215 cases (138 males and 77 females). Direct microscopy by KOH (potassium hydroxide) mount and culture was undertaken to isolate the fungal pathogen in each case. Results: Commonest age group involved was adults of 19-59 years age. Tinea corporis was the most common clinical presentation and Trichopyton rubrum was the most common fungal pathogen isolated. Dermatophytosis was the commonest superficial fungal infection and found in 147/215 cases (68.4%). Non dermatophytic fungus like pityriasis versicolor and yeast like candida species were isolated in 48/215(22.3%) cases and 20/215 (9.3%) cases respectively. The KOH positivity rate was 72.4% and total culture positivity rate was 62.8%.Interpretation & conclusion: Along with dermatophytes, nondermatophytic fungi are also emerging as important causes of superficial mycosis. Direct microscopy and culture both are important tools for diagnosis of the fungal infections. [ABSTRACT FROM AUTHOR]

Screening of 217 soil samples of different habitats, such as PG study centre, garden, farmhouse, nursery, roadside, hostel, animal habitat, bird habitat, marriage garden, temple, vegetable market and house dust, was carried out for the presence of dermatophytes and related fungi in relation to soil pH. A total of 461 isolates belonging to 26 genera and 34 species were recorded. Soil pH values vary from 3 to 10.5. Trichophyton verrucosum, Microsporum audouinii and M. canis were isolated for the first time in Jaipur from pH range 7.0 to 9.0. Chrysosporium tropicum (46.08%) was the most predominant fungus isolated from pH range 6.5 to 9.5. Trichophyton mentagrophytes (24.88%) was the second most common fungal species isolated from pH 6.5 to 9.5. Most of the keratinophilic fungi were isolated from pH 6.5 to 8.5. Only one isolate of Fusarium moniliforme was reported from a highly acidic site at pH 3. Roadside and garden soils were found to be the most suitable sites for almost all keratinophilic fungi. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance: Acalypha indica, Cassia alata, Lawsonia inermis, Punica granatum, Thespesia populnea and Wrightia tinctoria are folklore medicines extensively used in the treatment of ringworm infections and skin related diseases in Tamil Nadu, India. Aim: The present study was designed to investigate the in vitro antifungal activity of certain medicinal plants and the pure compound indirubin isolated from Wrightia tinctoria. Materials and methods: The hexane, chloroform, methanol and ethanol extracts of six different plants were investigated against dermatophytes, non-dermatophytes and yeasts. Chloroform extract of Wrightia tinctoria leaf was fractionated using column chromatography and the major compound was identified using spectroscopic techniques. Antifungal activity was studied by spore germination test using agar dilution method. The minimum inhibitory concentration (MIC) was determined using broth microdilution method. Results: Wrightia tinctoria showed promising activity against dermatophytic and non-dermatophytic fungi. Leaf chloroform extract showed activity at 0.5mg/ml against Trichophyton rubrum, Epidermophyton floccosum, Aspergillus niger and Scopulariopsis brevicaulis. The major compound, identified as indirubin, exhibited activity against dermatophytes such as Epidermophyton floccosum (MIC=6.25μg/ml); Trichophyton rubrum and Trichophyton tonsurans (MIC=25μg/ml); Trichophyton mentagrophytes and Trichophyton simii (MIC=50μg/ml). It was also active against non-dermatophytes (Aspergillus niger, Candida albicans and Cryptococcus sp.) within a MIC range of 0.75–25μg/ml. Conclusion: The indole compound indirubin from Wrightia tinctoria showed antifungal activity and may be useful in the treatment of dermatophytosis. [Copyright &y& Elsevier]

Background: Incidence of onychomycosis has increased tremendously in recent times. Relatively little work has been done on this problem in our country. Research in past has been concentrated mainly on superficial mycoses of the skin. Aim: It is a well-established fact that geographical distribution of the fungi may change from time to time; hence, this study was planned to analyze clinical, epidemiological, and mycological features of onychomycosis. Materials and Methods: Sixty patients clinically suspected and microscopically proven to have onychomycosis were taken up for the study. Nail samples, collected by scraping in 30 patients and by using a dental drill in the rest, were examined microscopically and cultured for fungus. Results and Conclusions: Forty-five fungal isolates were obtained from 60 patients. Trichophyton rubrum was the commonest fungus isolated (46.67%). Trichophyton mentagrophytes and Candida albicans accounted for 20% and 15.56% isolates, respectively. Two cases showed mixed growth of Trichophyton rubrum and Aspergillus niger in one and Trichophyton rubrum and Aspergillus fumigatus in the other. Isolation rate was higher by drilling compared to scraping, the rates being 83.33% and 66.67%, respectively. Superficial mycotic infections were present in 27 patients (45%). [ABSTRACT FROM AUTHOR]

Background: Pityriasis versicolor is a mild, chronic, usually asymptomatic superficial fungal infection of the stratum corneum, caused by Malassezia yeasts. The purpose of the present study is to assess the clinical profile of a group of patients with pityriasis versicolor and to find out the epidemiological characteristics in this part of India as well as any association, if any, with other diseases. Materials and Methods: For this purpose, 110 consecutive patients of pityriasis versicolor were evaluated clinically and diagnosis was confirmed mycologically at a tertiary care hospital in Kolkata. All data were recorded in a predesigned, pretested semi-structured schedule. The total duration of study period was 12 months. Results: Majority of the patients were young adults. Most of the patients were asymptomatic. There is prominent seasonal variation of the patients with a peak in August and September months. Most of the lesions were hypopigmented scaly macules and were KOH positive. Most commonly involved sites were chest, face and back. Seborrheic dermatitis sometimes coexisted with pityriasis versicolor and a number of patients also had diabetes mellitus and immunosuppressive conditions. Conclusions: Overall, the clinicomycological and epidemiological profile of pityriasis versicolor infection as observed in a tertiary care setting in eastern India does not differ significantly from those observed by previous workers elsewhere. [ABSTRACT FROM AUTHOR]

Background Onychomycosis is an important public health problem because of the increase in immunosuppressive states. Large-scale studies in India are scarce, and so the baseline incidence of onychomycosis is not firmly established. Methods Three hundred and two clinically suspected cases of onychomycosis were included in this study. Nail samples were collected for direct microscopic examination and culture. Clinical patterns and associated relevant factors were noted according to a predetermined protocol. Results The associated predisposing conditions included diabetes mellitus (3.9%) and systemic lupus erythematosus (2.3%). Distal and lateral subungual onychomycosis was the most common clinical pattern (62%), followed by total dystrophic onychomycosis (20.2%). The most common fungal isolates were dermatophytes (49.5%), followed by Candida spp. (40.4%) and nondermatophyte molds (10.1%). Of the dermatophytes, Trichophyton rubrum (47%) was the most common isolate, followed by Trichophyton tonsurans (20.4%). Of the Candida spp., Candida albicans was the most common (60%). Conclusions Until recently, yeasts and nondermatophyte molds were regarded as contaminants, but their emergence as a significant cause of onychomycosis in immunocompromised patients calls for mycologic diagnosis and antifungal susceptibility testing in onychomycosis. The recognition of the changing patterns of onychomycosis will aid in the therapeutic approach and the implementation of control measures. [ABSTRACT FROM AUTHOR]

Context: The worldwide incidence of onychomycosis is increasing and it continues to spread and persist. Knowledge of the epidemiological and mycological characteristics is an important tool for control of this infection. Aims: This study seeks to improve knowledge of onychomycosis epidemiology and mycological features. Settings and Design: Over a period of five years (Jan 2000 - Dec 2005) samples from 400 patients with clinical suspected fungal nail infections, who attended dermatology out patient department at a tertiary care hospital, were obtained. Materials and Methods: 400 nail specimens of suspected onychomycosis were evaluated clinically, KOH examination and fungal culture was done. Results: Onychomycosis was present in 218 (54.5%) by culture and /or direct examination. Fingernails and toenails were infected in 65% and 32% respectively and remaining 3% had both. Conclusions: This study demonstrated that dermatophytes were main agents causing onychomycosis in our region, as well as the importance of performing direct examination and culture in diagnosis of onychomycosis. [ABSTRACT FROM AUTHOR]

Onychomycosis is mainly caused by dermatophytes, but yeasts and nondermatophyte molds have also been implicated, giving rise to diverse clinical presentations. The etiological agents of the disease may show geographic variation. The aim of the present study was to isolate the causative pathogens and to determine the various clinical patterns of onychomycosis in central India. The study population comprised 90 patients with onychomycosis. Nail samples were collected for direct microscopic examination and culture. Clinical patterns were noted and correlated with causative pathogens. The male : female ratio was 3:1 and the mean age was 29.40 ± 13.61 years. Fingernails were involved in 60%, toenails in 26.67% and both fingernails and toenails in 13.34% of the 90 patients. The clinical types noted were distolateral subungual onychomycosis (64.44%), total dystrophic onychomycosis (17.78%), proximal subungual onychomycosis with paronychia (12.2%), proximal subungual onychomycosis without paronychia (4.44%) and superficial white onychomycosis (1.11%). Dermatophytes were the most common pathogens isolated, being found in 24 patients (26.36%) [ Tricophyton rubrum (23.07%), Tricophyton verrucosum (2.22%) and Epidermophyton floccosum (1.11%)], followed by Candida albicans, which was found in 22 patients (24.27%). Thirty-six (39.58%) nondermatophyte molds were isolated from 29 patients. Of these 29 cases, six were associated with Tricophyton rubrum, which was considered the primary pathogen. Distolateral subungual onychomycosis was the most common clinical presentation; however, total dystrophic onychomycosis and proximal subungual onychomycosis were not uncommon in this part of India. Tricophyton rubrum and Candida albicans were the major pathogens. The clinicoetiologic correlation revealed that a single pathogen could give rise to more than one clinical type. [ABSTRACT FROM AUTHOR]

Alcoholic and aqueous crude extracts of 37 traditionally-used medicinal plants were screened for antifungal activity against the pathogenic yeast, Candida albicans, and dermatophytes, Epidermophyton floccosum, Microsporum gypseum and Trichophyton rubrum. Alcoholic extracts of these 37 plants were demonstrated to have antifungal activity. Twenty-one extracts showed strong activity and the remaining 16 plants exhibited moderate activity against Candida albicans and to one or more dermatophytes. Such activity was detected in only 16 aqueous extracts. Alcoholic extracts of five medicinal plants were selected for further studies on the basis of their strong anticandidal activity. Minimum inhibitory concentration (MIC) values of these five extracts revealed their varied anticandidal potency. MIC values ranged between 4-9 mg/ml. Comparatively high potency was observed in the extracts of Plumbago zeylanica (4mg/ml) followed by Terminalia bellirica and Phyllanthus emblica (7 mg/ml), each Holarrhena antidysentrica (8 mg/ml), and least in Terminalia chebula (9 mg/ml). Preliminary phytochemical analysis of these extracts showed the presence of many biologically active constituents. [ABSTRACT FROM AUTHOR]

Superficial mycoses of skin, nails and hair are among the common fungal infections. They are caused by dermatophytes, non-dermatophyte moulds, yeasts and yeast-like fungi. Such fungal infections are widespread all over the world and are predominant in tropical as well as subtropical regions. Environmental factors, such as warm, humid and pitiable hygienic conditions, are conducive for their growth and proliferation. Although it does not cause mortality, it is known to be associated with excessive morbidity which may be psychological or physical. This affects the quality of life of the infected individuals which leads to a negative impact on their occupational, emotional and social status. Such infections are increasing on a global scale and, therefore, are of serious concern worldwide. This review article covers the global and Indian scenario of superficial mycoses taking into account the historical background, aetiological agents, prevalence, cultural and environmental factors, risk factors, pathogenesis and hygienic practices for the prevention of superficial mycoses., (© 2021 Wiley-VCH GmbH.)

Aim: Ring worm are fungal infection relevant to animal and human health. The study was aimed to assess the frequency of dermatophytes infection of the skin of dogs in and around the Jaipur city. Materials and methods: One twenty canine samples were obtained during three years (2008-2011) from dogs suffering from different dermatological disorders and were invitro processed for dermatophytes detection at the Department of Microbiology, Apollo College of veterinary medicine Agra Road, Jaipur. Result: Out of these, eighty nine samples were positive respectively for Microsporum gypseum 55.83%, Trichophyton mentagrophytes 18.3% and other fungal isolate Alternaria spp. sporadic in 15 samples (0.12%). Retrospective studies of dermatophytosis due to Microsporum and Trichophyton were performed with the sole consideration of public health consequence of the canine ringworm. Conclusion: In the present study samples were found positive for Microsporum gypseum 55.83%, Trichophyton mentagrophytes 18.3% and other fungal isolate Alternaria spp. Considering the veterinary and public health importance of canine ringworm it would be necessary to assess the prevalence of the dermatophytosis in Rajasthan. [ABSTRACT FROM AUTHOR]

The article discusses a study which examines the dermatophytes and associated keratinophilic fungi found in the soil of parks and agricultural locations in Uttar Pradesh, India. For the study, researchers collected soil samples from 25 parks across Agra, Kanpur and Lucknow. Among the isolates found by the researchers were Alternaria alternata, Aspergillus candidus and Aphanoascus fulvescens. Some parks produced lower numbers of fungal isolates.

Summary A total of 112 soil samples collected from various areas of Jammu, India, were screened for the prevalence of keratinophilic fungi and related dermatophytes. From 65 positive samples (58.1%), a total of six genera with 13 species were isolated. [ABSTRACT FROM AUTHOR]

In Mysore, India, 88 soil samples were collected from various areas and habitats and screened for the presence of dermatophytes and related keratinophilic fungi. [ABSTRACT FROM AUTHOR]

Dermatophytosis due to the Trichophyton mentagrophytes-Trichophyton interdigitale complex is being increasingly reported across India. Reports of therapeutic failure have surfaced recently, but there are no clinical break points (CBP) or epidemiological cutoffs (ECVs) available to guide the treatment of dermatophytosis. In this study, a total of 498 isolates of the T. mentagrophytes -interdigitale complex were collected from six medical centers over a period of five years (2014 to 2018). Antifungal susceptibility testing of the isolates was carried out for itraconazole, fluconazole, ketoconazole, voriconazole, luliconazole, sertaconazole, miconazole, clotrimazole, terbinafine, amorolfine, naftifine, ciclopirox olamine, and griseofulvin. The MICs (in mg/liter) comprising >95% of the modeled populations were as follows: 0.06 for miconazole, luliconazole, and amorolfine; 0.25 for voriconazole; 0.5 for itraconazole, ketoconazole, and ciclopirox olamine; 1 for clotrimazole and sertaconazole; 8 for terbinafine; 16 for naftifine; 32 for fluconazole; and 64 for griseofulvin. A high percentage of isolates above the upper limit of the wild-type MIC (UL-WT) were observed for miconazole (29%), luliconazole (13.9%), terbinafine (11.4%), naftifine (5.2%), and voriconazole (4.8%), while they were low for itraconazole (0.2%). Since the MICs of itraconazole were low against the T. mentagrophytes -interdigitale complex, this could be considered the choice of first-line treatment. The F397L mutation in the squalene epoxidase (SE) gene was observed in 77.1% of isolates with a terbinafine MIC of ≥1 mg/liter, but no mutation was detected in isolates with a terbinafine MIC of <1 mg/liter. In the absence of CBPs, evaluation of the UL-WT may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility., (Copyright © 2020 American Society for Microbiology.)

Background: Dermatophytosis is a major public health problem in our country. Although resistance to conventional oral and topical antifungal agents is being increasingly encountered, the sensitivity pattern of dermatophytes has not been systematically analysed., Aims: We aimed to determine the sensitivity pattern of dermatophyte isolates to amphotericin B and six oral antifungal drugs., Materials and Methods: Patients with dermatophytosis attending the outpatient department of dermatology were enrolled in the study. Samples were collected for mycological examination and in vitro antifungal sensitivity testing was done by broth microdilution as per the Clinical and Laboratory Standard Institute M38-A standards., Results: A total of 804 patients were enrolled. Specimens from 185 patients (23%) were both KOH and culture positive, and 44 of these isolates (41 Trichophyton mentagrophytes and 3 Trichophyton rubrum) were subjected to sensitivity testing. Minimum inhibitory concentrations (MIC) of itraconazole, ketoconazole, voriconazole and amphotericin B were comparable. The median MIC to fluconazole was higher than the other tested drugs. Dermatophytes were most susceptible to ketoconazole and voriconazole, followed by itraconazole, amphotericin B, fluconazole and griseofulvin. A high incidence of resistance was found to terbinafine and the difference was statistically significant in comparison to fluconazole, itraconazole, voriconazole, ketoconazole (P = 0.001) and griseofulvin (P = 0.003). The strains were more sensitive to amphotericin B as compared to griseofulvin (P = 0.02) and terbinafine (P < 0.001)., Limitations: This was a hospital-based study and may not reflect the true pattern in the community. Only a few of the isolates were selected for study. The clinical response of patients, whose isolates were studied for in vitro sensitivity of the antifungals, was not studied., Conclusions: The sensitivity pattern of dermatophytes to various antifungals including amphotericin B, ketoconazole, voriconazole and itraconazole were determined. The studied isolates were least susceptible to terbinafine., Competing Interests: None

Objective: Dermatophytes are resistant to some available antibiotics. Development of new plant drugs to control drug resistant microbes is urgently needed. This study evaluates the antidermatophytic potential of 18 selected medicinal plants used by traditional healers in Theni and Virudhunagar Districts of Tamil Nadu, India., Materials and Methods: Selected plant parts were collected, shade dried and powdered. Plant powders were extracted with ethanol and their antifungal potency was investigated against and clinical dermatophytes. The antioxidant effect of the extracts was screened using DPPH assay. Minimal Inhibitory Concentration (MIC) and Minimal Fungicidal Concentration (MFC) were estimated for the extracts. Ten plant extracts showed maximum MFC and they were selected to study their efficacy in interfering with ergosterol biosynthesis. Fluconazole-35μg/mL known fungicide was used as control. The most active extracts were taken for biocompatibility studies using 3T3-L1 fibroblast cell lines., Results: The ethanol extract of Phyllanthus reticulates leaves showed good antifungal activity compared to other plant extracts. The MIC and MFC for Phyllanthus reticulatus were 62.5 and 250μg/mL against M. pachydermatitis and T. rubrum respectively. The ethanol extracts of Phyllanthus reticulatus, Coldenia procumbens, Thespesia populnea and Senna alata significantly lowered the release of ergosterol by 16.37, 19.53, 24.79, and 21.44%, respectively. The ethanol extract of Phyllanthus reticulatus leaves was more biocompatible to host cells than other active extracts., Conclusion: Our study indicated that the ethanol extract of Phyllanthus reticulates leaves showed promising activity against dermatophytes. It could be a potential material for future development of antidermatophytic agents., (Copyright © 2017. Published by Elsevier Masson SAS.)

The article discusses a study by N. Puri and A. Puri about the prevalence of Tinea capitis or scalp ringworm among schoolchildren in India. It relates the role of the fungal dermatophytes in the Trichophytan and Microsporum genus in Tinea capitis. It compares the findings of the study with other studies regarding Tinea capitis in India, including one about the prevalence of the infection among boys who use coconut oil and boys who use castor oil against dermatophytes.