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Background Chronic fungal infections are known to exacerbate allergic symptoms, including those of asthma and chronic urticaria (CU). We applied four prepared fungal antigens of Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, and Candida albicans to examine sensitization to each in subjects with CU and onychomycosis and in healthy subjects, and to evaluate the etiologic role of dermatophytic infection in CU and observe any cross-reactions among these four antigens. Methods Participants were divided into four groups, including those with CU with onychomycosis (experiment group), those with onychomycosis without allergic diseases (control group 1), those with CU without fungal infections (control group 2), and a healthy group (control group 3). In all subjects, skin prick tests with the four fungal antigens were performed. Subjects in the experiment group and control group 1 were also submitted to mycologic investigations. Results The experiment group showed significantly higher rates of positivity than the three control groups to T. rubrum, E. floccosum, and T. mentagrophytes antigens. Control group 1 showed rates higher than those in control groups 2 and 3; no significant difference emerged between control groups 2 and 3. Positivity to the C. albicans antigen did not differ among the four groups. In control group 1, rates of positivity to the three dermatophytic antigens did not differ significantly but did for C. albicans. Conclusions Fungal infection seems to be an important determinant of trichophyton hypersensitivity. Cross-reactions among T. mentagrophytes, T. rubrum, and E. floccosum antigens were obvious, but none emerged between the antigens of the three dermatophytes and that of C. albicans.

Traditional systems of identifying yeasts and dermatophytes have many disadvantages. Preliminary data on a radically different approach based on optical spectroscopic techniques suggest that these techniques may offer some advantages. We conducted a trial to verify the practical applicability of Fourier transform infrared (FTIR) spectroscopy in the identification of some yeast and dermatophyte species, in which samples from 50 patients with superficial fungal infections were cultured on Sabouraud dextrose agar with chloramphenicol and cycloheximide (actidione) and studied using FTIR microspectroscopy. Spectra of the same species were identical, whereas spectra of different species did not show similarity. This study showed that FTIR microspectroscopy is promising and can be used to obtain, with a single measurement, a "molecular fingerprint" of Candida and dermatophyte species. It can be improved further in terms of reliability.

Background Tinea capitis is a common disease of the pediatric population. This disease typically follows one of several clinical patterns, i.e., scaling, hair loss, and/or inflammatory lesions, which are usually caused predominantly by two dermatophytic genera: Microsporum and Trichophyton. The aim of this study was to investigate tinea capitis and its etiological agents in Sari city of Mazandaran province, Iran. Methods We studied the spectrum of tinea capitis by means of a retrospective analysis involving 1745 patients referred to both the Reference Laboratory of Medical Mycology (RLMM) and Bo Ali Sina Hospital at Sari, Iran (1998–2012). Specimens were assessed by standard mycological techniques based on macroscopic and microscopic morphology. Results Among the patients, 480 (27.5%; 61 males and 39% females) were confirmed through a mycological examination. The peak incidence was in the 5–14 years age group. Endothrix (263 cases; 54.8%) was the most frequent clinical feature by direct exam. The predominant causative agents of tinea capitis were T. tonsurans (186 cases; 38.8%) and T. violaceum (119 cases; 24.8%), followed by T. mentagrophytes (46 cases; 9.6%), T. schoenleinii (28; 5.8%), T. rubrum (20 cases; 4.2%), M. gypseum (15 cases; 3.1%), T. verrucosum (14 cases; 2.9%), and Epidermophyton floccosum (1 cases; 0.2%). Conclusion The present study showed that tinea capitis is mainly due to the anthropophilic species, and the most common species were T. tonsurans and T. violaceum. Owing to the high frequency of anthropophilic species, future studies may be useful in the development of preventive and educational strategies to reduce healthcare expenditure.

Objectives Dermatophytes, belonging to genera including Trichophyton, Epidermophyton, and Microsporum, are the causative agents of superficial fungal infections, prevalences of which are estimated to be as high as 25% in the worldwide population. This study evaluated the activity of topical formulations of NVC-422 (sodium 2-[dichloroamino]-2-methylpropane-1-sulfonate), the lead compound in a new class of antimicrobials that consist of broad-spectrum, fast-acting, nonantibiotic antimicrobial molecules based on the endogenously produced N-chlorotaurines. Methods The antifungal efficacy of NVC-422 was investigated using a guinea pig model of infection with Trichophyton mentagrophytes. Infected guinea pigs were randomly assigned to four treatment and two control groups. The efficacy of the treatments was assessed clinically and mycologically at 72 hours after the final topical dose. Results The test compound 2% NVC-422 in 1% Noveon Gel demonstrated the highest level of clinical efficacy. Outcomes of treatment with all other test compounds differed significantly from outcomes in the untreated control group (P = 0.003, P = 0.029, P = 0.012, and P < 0.0001, respectively). Fungal elements were detectable in skin sections from untreated guinea pigs but not in skin sections obtained from any of the treatment groups. Conclusions Evaluation of the efficacy of NVC-422 in the treatment of dermatophytosis using an experimental guinea pig model showed that this compound possesses potent antifungal efficacy as measured by mycological and clinical endpoints. The highest degree of clinical and mycological efficacy was demonstrated by 2% NVC-422 in 1% Noveon Gel. These data show that NVC-422 has potent antifungal activity in vivo. Clinical evaluation of NVC-422 in the treatment of superficial infections caused by dermatophytes, including onychomycosis, is warranted.

Background Although usually simple, the diagnosis of dermatophyte infection is sometimes neglected. An observational study has been realized to evaluate the role of corticosteroid exposure (tinea incognito) and of other primary characteristics of the dermatophytosis that from onset mimic other diseases and mislead an unexperienced physician. Materials and methods Between 1990 and 2009, all cases of atypical dermatophytosis mimicking other skin diseases were collected from the more general number of dermatophyte infections diagnosed at the Dermatology Department of Cagliari University, Italy. Results One-hundred and fifty-four cases (71 male/83 female, 2–81 years old) were studied, with a median of 7 cases/year. The most observed clinical forms were those mimicking impetigo, eczematous dermatitis, lupus erythematosus, polymorphous light eruption, psoriasis, and rosacea. The identified dermatophytes were: Microsporum canis (70 cases), Trichophyton rubrum (43 cases), Trichophyton mentagrophytes var. mentagrophytes (29 cases), Trichophyton mentagrophytes var. interdigitale (six cases), Microsporum gypseum (three cases), Epidermophyton floccosum (two cases), and Trichophyton verrucosum (one case). Diagnostic difficulties are discussed, with special attention to the origin of the pathomorphosis. Conclusions In our experience, clinical atypia is not a mere consequence of corticosteroid therapy but present at the very onset of the illness, due to the variable dermatophyte invasive capacity, the site of invasion, physiological individual, and/or acquired condition, such as excessive washing or sun exposure. Therefore, we suggest using the term “tinea atypica” rather than “tinea incognito” to include all forms of dermatophytosis that do not present the classic features for both primary and secondary pathomorphosis.

Background An isotopic response is the occurrence of a new skin disease at the site of another unrelated, healed skin disorder. Methods We report three cases of unilateral granulomatous fungal infection in immunocompetent patients at sites of resolved herpes zoster on the face. Diagnoses were made by potassium hydroxide preparation, histopathologic findings, and fungal culture. Two patients had Candida albicans folliculitis, and the other was infected with both Epidermophyton floccosum and Trichophyton mentagrophytes. Results The patients responded well to antifungal therapy. Conclusions Localized isotopic fungal infections, although rare, can occur in immunocompetent patients.

The syndrome of tinea pedis caused by human-adapted Trichophyton mentagrophytes (interdigitale) can be recognized by two signs not characteristically seen in tinea pedis caused by T. rubrum and Epidermophyton flocccsum: 1 bullous > 2 mm vesicles in the thin skin of the plantar arch and along the sides of the feet and heel adjacent to the thick plantar stratum corneum, 2 and white superficial onychomycosis. The relationship of the syndrome to zoophilic T mentagrophytes remains in question.

Background Tinea pedis is a commonly encountered dermatophytic infection with a clinical prevalence of 15–25%. Limited studies have evaluated the prevalence of occult tinea pedis. Objectives The aims of this study were to evaluate the prevalence of occult tinea pedis in asymptomatic subjects with feet that appeared healthy and to identify possible related risk factors. Methods A prospective study of 221 asymptomatic subjects with apparently normal feet was conducted. All subjects completed a questionnaire covering anamnestic details (personal and family histories of tinea pedis, preferred footwear) and were examined for foot odor and the clinical presence of tinea pedis and onychomycosis. Samples were taken from the foot for direct microscopic examination and culture. Results Among the 221 patients, 31 (14.0%) were positive for occult tinea pedis. Positive cultures from both the anterior and posterior aspects of the foot were obtained in 22 patients. The most common pathogen isolated was Trichophyton rubrum. Strong correlations emerged between occult tinea pedis and characteristics such as male gender, foot odor, previous personal and family histories of tinea pedis, and clinical and mycological evidence of onychomycosis. No significant associations were found between occult tinea pedis and age or preferred footwear. Conclusions The prevalence of occult tinea pedis is similar to that of clinical tinea pedis. This may imply that patients with subclinical infection carry a risk for transmitting disease similar to that of clinical carriers. This is of great importance in the prevention and management of the disease as high-risk asymptomatic carriers can be identified.

Background In this study, we aimed to establish the in vitro antifungal susceptibilities of terbinafine, miconazole, itraconazole, ketoconazole, griseofulvin, and amphotericin B against dermatophyte isolates. Methods One hundred and seventy-seven clinical isolates were tested: Trichophyton rubrum (n = 78), Trichophyton mentagrophytes (n = 49), Epidermophyton floccosum (n = 30), Trichophyton verrucosum (n = 16), and Trichophyton tonsurans (n = 4). The broth microdilution assay for antifungal susceptibility testing of dermatophytes was performed according to Clinical and Laboratory Standards Institute guidelines in the M38-A2 document. Results Our minimum inhibitory concentration (MIC) results showed that the values for terbinafine for all dermatophyte isolates were significantly lower than the values for amphotericin B, miconazole, itraconazole, ketoconazole, and griseofulvin. For T. rubrum isolates, amphotericin B was more active than miconazole, itraconazole, and ketoconazole. Among the antifungal drugs tested, griseofulvin had the highest minimum inhibitory concentration values for T. mentagrophytes isolates. Conclusion Terbinafine was found to be the most effective antifungal drug against all tested dermatophyte isolates. Griseofulvin was the less active antifungal drug against T. mentagrophytes isolates. Performing antifungal susceptibility testing is especially important for screening the development of antifungal resistance.

Although usually simple, the diagnosis of dermatophyte infection is sometimes neglected. An observational study has been realized to evaluate the role of corticosteroid exposure (tinea incognito) and of other primary characteristics of the dermatophytosis that from onset mimic other diseases and mislead an unexperienced physician.Between 1990 and 2009, all cases of atypical dermatophytosis mimicking other skin diseases were collected from the more general number of dermatophyte infections diagnosed at the Dermatology Department of Cagliari University, Italy.One-hundred and fifty-four cases (71 male/83 female, 2-81 years old) were studied, with a median of 7 cases/year. The most observed clinical forms were those mimicking impetigo, eczematous dermatitis, lupus erythematosus, polymorphous light eruption, psoriasis, and rosacea. The identified dermatophytes were: Microsporum canis (70 cases), Trichophyton rubrum (43 cases), Trichophyton mentagrophytes var. mentagrophytes (29 cases), Trichophyton mentagrophytes var. interdigitale (six cases), Microsporum gypseum (three cases), Epidermophyton floccosum (two cases), and Trichophyton verrucosum (one case). Diagnostic difficulties are discussed, with special attention to the origin of the pathomorphosis.In our experience, clinical atypia is not a mere consequence of corticosteroid therapy but present at the very onset of the illness, due to the variable dermatophyte invasive capacity, the site of invasion, physiological individual, and/or acquired condition, such as excessive washing or sun exposure. Therefore, we suggest using the term "tinea atypica" rather than "tinea incognito" to include all forms of dermatophytosis that do not present the classic features for both primary and secondary pathomorphosis.

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

Superficial cutaneous fungal infection, principally dermatophytosis, is an extremely common skin disease. Various in vitro test systems have been developed in recent years to determine the antifungal activity of various drugs. The minimum inhibitory concentration (MIC) obtained may give an indication of the in vivo potency of the drugs.One hundred patients (69 men and 31 women) with a clinical diagnosis of dermatophytosis were entered into the study. Direct microscopy and culture were done on all patients. The MICS were determined using the broth dilution method.The age range was 1-76 years. The most common diagnosis was tinea corporis (36%), followed by tinea cruris (22%), and tinea pedis (19%). The most common fungus isolated was T. rubrum (58%), followed by E. floccosum (14%), and T. mentagrophytes (10%). The majority of the isolates was sensitive to the three drugs tested (griseofulvin, ketoconazole, and itraconazole). Of the isolates, 82% were sensitive to griseofulvin, 78% to ketoconazole, and 81% to itraconazole, all at a concentration of0.25 micrograms/mL. For T. rubrum, there were four isolates that had an MIC ofor = 64 micrograms/mL to griseofulvin, seven isolates and nine isolates with an MICor = 64 micrograms/mL to ketoconazole and itraconazole, respectively. T. interdigitale was relatively resistant to the three drugs in vitro with four of seven isolates having an MICor = 4 micrograms/mL with griseofulvin, one of seven isolate with an MICor = 64 micrograms/mL with ketoconazole, and three of seven isolates with an MICor = 32 micrograms/mL with itraconazole.The in vitro antifungal activity of griseofulvin, ketoconazole, and itraconazole are similar against dermatophytes in Singapore. Griseofulvin may be given as the first-line drug for treating such infections in Singapore.

This study was conducted to evaluate the association of superficial mycosis and athletic activities with special references to its prevention and control in Tehran. Participating in various kinds of sports can lead to direct and indirect exposures to and transmission of micro-organisms between athletes and also passive observers.A retrospective study of superficial fungal infections in athletes was carried out during the period of March 2002 to December 2006 on 656 mycological proven cases of dermatophytosis found in athletes in Tehran. Mycologic examination consisted of culturing of pathologic material followed by direct microscopic observation. Mycologic cultures were carried out on Sabouraud Chloramphenicol Agar, Sabouraud Chloramphenicol and Cyclohexamide Agar, and Dermatophyte Agar incubated at 25 °C for at least 28 d. Diagnosis was based on macroscopic and microscopic characteristics of the colonies.A total of 1075 athletes, from 201 institutions, suspected of cutaneous fungal infections were examined and 656 (61%) were found to be positive for fungal infections. The fungal isolates comprised Trichophyton tonsurans (56%), Epidermophyton floccosum (11.8%), Trichophyton mentagrophytes (8.9%), Trichophyton rubrum (8.3%), Trichophyton verrucosum (3.9%), Trichophyton violaceum (3.3%), Microsporum canis (2.5%), and Malassezia spp. (5.3%). The distribution of lesions on the body in decreasing order was as follows: trunk, groin, hair and scalp, sole, toe webs, finger nails, and toe nails. Fungal infections were more commonly seen in wrestlers and individuals that participate in aerobics.The results suggest that athletic activity seems to be a predisposing factor, especially for fungal infections. Guidelines are provided regarding measures to prevent transmission of infectious diseases in athletic settings, including hygiene, infection control practices, and education of officials, coaches, trainers, and sports participants.

BACKGROUND Allylamines are a newly developed group of drugs possessing a broad spectrum of activity against a wide range of fungi. With the advent of new antifungal drugs, susceptibility testing of fungi is receiving increased attention as important laboratory procedures for aiding in the selection of appropriate drug therapy. METHODS In vitro susceptibility testing of 43 clinical isolates of dermatophytes which included Microsporum sp., (18) Trichophyton sp., (23) and Epidermophyton floccosum (2) were carried out against the two allylamine derivatives, naftifine and terbinafine, by agar dilution and disk diffusion methods. RESULTS Terbinafine was found to be more active minimal inhibitory concentration (MIC range < or = 0.0001-0.1 micrograms/mL), inhibiting 50% (MIC 50) and 90% (MIC 90) of the isolates at 0.01 and 0.1 micrograms/mL, respectively. The MIC 50s and MIC 90s of naftifine were 0.1 micrograms/mL (MIC range 0.001-0.5 micrograms/mL). Both the drugs showed good correlation between the MIC and sizes of zones of inhibition around the disks. Regression analysis was used to measure the degree of correlation between the MIC values and matched averaged zones of inhibition; the correlation coefficients for both terbinafine and naftifine were -0.6841 (P < 0.001) and -0.5455 (P < 0.001), respectively. CONCLUSIONS The allylamines, naftifine and terbinafine, could be used successfully for susceptibility testing of dermatophytes by the disk diffusion method. With proper standardization of the test conditions, in vitro susceptibility testing of filamentous fungi by disk diffusion would become a useful laboratory procedure in the near future for determining the best drug therapy.

Background. Interest in herbal medicine is enjoying a renaissance at present. Garlic (Allium sativum) is an intriguing herb with a long history of medicinal use for a variety of diseases including ringworm infections. Methods. Antidermatophytic activity of the aqueous extract of garlic (A. sativum) was investigated against 88 clinical isolates of dermatophytes by an agar dilution technique. The isolates included Microsporum canis (50), M. audouinii (5), Trichophyton rubrum (6), T. mentagrophytes (5), T. violaceum (12), T. simii (5), T. verrucosum (1), T. erinacei (1), and Epidermophyton floccosum (2). The results were compared with the minimal inhibitory concentrations of ketoconazole. Results. The aqueous extract of garlic, diluted 1:150 and 1:100, had inhibited 50 and 90% of the isolates tested, whereas the respective values for ketoconazole were 1 and 2.5 μg/mL. Conclusions. Garlic (A. sativum) could be used as an effective antidermatophytic agent. Further purification and extraction of the active principle of garlic would give a true antidermatophytic activity comparable to standard antifungal drugs.

A double-blind study with terbinafine was performed in 39 patients with dermatophyte infection, between 1987 and 1989, to compare the safety and efficacy of two dosage schedules of 125 mg twice daily versus 250 mg once daily. Mycologic assessments were negative by microscopic examination and Sabouraud's culture in 59% and 100% of patients in the first and the fourth weeks of treatment, respectively. There was no statistically significant difference between the two groups of patients receiving 125 mg b.i.d. and 250 mg q.d. with respect to the safety and efficacy of the treatment; however, the differences between the sums of clinical scores before and after the treatment were statistically significant. There were no adverse effects, and the drug was well tolerated.

Mycological examination of 104 Egyptian patients showed Trichophyton violaceum to be the most common isolate, followed by Trichophyton schoenleinii, Microsporum canis, Trichophyton verrucosum, Epidermophyton floccosum, Trichophyton rubrum, and Trichophyton mentagrophytes.

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.

A study of the causative agents of tinea corporis and pedis in Puerto Rico in 1982 disclosed four different dermatophytes from a total of 97 cases. Among the total of 49 fungus specimens collected in tinea corporis, the mycologic flora consisted of four different fungus species: Trichophyton rubrum, 42 isolates (85.7%); Epidermophyton floccosum, 4 (8.1%); Trichophyton mentagrophytes, 2 (4%); and Microsporum ferrugineum, 1 (2%). Among the total of 48 fungus specimens collected in tinea pedis, the mycologic flora consisted of 3 different fungus species as follows: T. rubrum, 35 isolates (72.9%); T. mentagrophytes 8 (16.6%); and E. floccosum, 5 (10.4%). Trichophyton rubrum caused 77 of 97 fungal isolates (79.3%). One surprising finding was the isolation of M. ferrugineum in a case of tinea corporis, documenting the first autochtonous case of this species in the island. This dermatophyte had previously been known only in Japan and adjacent areas of the Far East, Southern Europe, and Africa.