scholarly journals Epidemiological and Microbiological Study of Onychomycosis

2021 ◽  
Author(s):  
Sunita Kabi ◽  
Bichitrananda Swain ◽  
Swati Jain
Keyword(s):  
Candida Species ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Nail Plate ◽  
Laboratory Diagnosis ◽  
Antifungal Susceptibility Testing ◽  
Antifungal Drugs ◽  
Diffusion Method ◽  
Resistance Pattern

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 and 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.

scholarly journals In vitro susceptibility testing of four antifungal drugs against fungal isolates in onychomycosis

2018 ◽  
Vol 6 (8) ◽  
pp. 2774 ◽  
Author(s):  
Smita S. Kulkarni ◽  
Jayshree B. Bhakre ◽  
Ajit S. Damle
Keyword(s):  
Amphotericin B ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Antifungal Susceptibility Testing ◽  
Antifungal Drugs ◽  
Etiological Agent ◽  
Diffusion Method ◽  
In Vitro Susceptibility ◽  
Broth Macrodilution

Background: Onychomycosis is chronic fungal infection of fingernails and toenails. Variety of fungi cause onychomycosis. Due to importance of high prevalence rate of onychomycosis this study was conducted.Methods: In this study 100 patients suspected of onychomycosis were examined. Diagnosis of onychomycosis was based on the patient’s history, physical examination, microscopy and culture of nail specimens.Results: Direct microscopy of the nail clippings in 20% KOH solution was positive in 61% and culture was positive in 54% cases. The common etiological agent was dermatophytes (79.6% cases) followed by non dermatophyte moulds (11.1% cases) and yeasts (9.2% cases). Amongst dermatophytes, T. rubrum was found to be commonest etiological agent (57.6%) followed by T. mentagrophytes. We had performed the in vitro antifungal susceptibility testing of isolated fungal species against Amphotericin B, Fluconazole, Itraconazole and Terbinafine according to standard guidelines recommended by the CLSI. Antifungal susceptibility testing of dermatophytes and non-dermatophyte moulds was performed by broth macrodilution method. For Candida species we used broth macrodilution method as well as disk diffusion method. All three Candida albicans isolates were sensitive to amphotericin B, fluconazole and itraconazole. Two strains of Candida krusei were sensitive to amphotericin B and resistant to fluconazole and itraconazole. Two isolates of T. rubrum had MIC >64µg/ml and one T. Mentagrophytes isolate had MIC 32µg/ml for fluconazole. Among non dermatophyte moulds, Aspergillus niger and one isolate of Fusarium oxysporum showed high MICs against fluconazole.Conclusions: Terbinafine exhibited the lowest MICs among all the tested antifungal drugs.

scholarly journals Identification of Fungal Pathogens in Otomycosis and Their Drug Sensitivity: Our Experience

2018 ◽  
Vol 22 (04) ◽  
pp. 400-403 ◽  
Author(s):  
Khaled Ali ◽  
Mahmood Hamed ◽  
Hameda Hassan ◽  
Amira Esmail ◽  
Abeer Sheneef
Keyword(s):  
Enzymatic Activity ◽  
Candida Species ◽  
Fungal Pathogens ◽  
Antifungal Agents ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Antifungal Susceptibility Testing ◽  
Antifungal Drugs ◽  
High Recurrence Rate ◽  
Fungal Culture

Introduction Otomycosis is a common problem in otolaryngology practice. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents, and present high recurrence rate. Objectives To determine the fungal pathogens that cause otomycosis as well as their susceptibility to the commonly used antifungal agents. Additionally, to discover the main reasons for antifungal resistance. Methods We conducted an experimental descriptive study on 122 patients clinically diagnosed with otomycosis from April 2016 to April 2017. Aural discharge specimens were collected for direct microscopic examination and fungal culture. In vitro antifungal susceptibility testing was performed against the commonly used antifungal drugs. We tested the isolated fungi for their enzymatic activity. Results Positive fungal infection was found in 102 samples. The most common fungal pathogens were Aspergillus and Candida species, with Aspergillus niger being the predominant isolate (51%). The antifungal susceptibility testing showed that mold isolates had the highest sensitivity to voriconazole (93.48%), while the highest resistance was to fluconazole (100%). For yeast, the highest sensitivity was to nystatin (88.24%), followed by amphotericin B (82.35%), and the highest resistance was to terbinafine (100%), followed by Itraconazole (94.12%). Filamentous fungi expressed a high enzymatic ability, making them more virulent. Conclusion The Aspergillus and Candida species are the most common fungal isolates in otomycosis. Voriconazole and Nystatin are the medications of choice for the treatment of otomycosis in our community. The high virulence of fungal pathogens is owed to their high enzymatic activity. Empirical use of antifungals should be discouraged.

scholarly journals Speciation of Candida using CHROMagar from various clinical specimens and their antifungal susceptibility pattern at a tertiary care hospital.

2020 ◽  
Vol 16 (2) ◽  
pp. 107-111
Author(s):  
Sanjana Raj Kumari ◽  
Neetu Adhikaree
Keyword(s):  
Candida Albicans ◽  
Candida Species ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Epidemiological Data ◽  
Antifungal Susceptibility Testing ◽  
Antifungal Drugs ◽  
Care Hospital ◽  
Clinical Specimens

Background: Candida albicans remains the most common and are responsible for various clinical infections ranging from mucocutaneous infection to life threatening invasive diseases. But recent epidemiological data shift from C.albicans to non albicans Candida species and also increased resistance to antifungal drugs made the scenario a serious concern. Methods: A total of 156 Candida isolates from various clinical specimens received in the department of Microbiology were taken up for the study over a period of one year i.e. from March 2019 to February 2020. The Candida were grown on Sabouraud dextrose agar to be  evaluated for colony  appearance, macroscopic examination, Gram staining, germ tube, urea hydrolysis etc. The Candida isolates were speciated by using CHROMagar medium. Antifungal susceptibility testing was performed as recommended by Clinical and Laboratory Standards Institute (CLSI) M44-A document. Results: The isolation of non albicans Candida (54.5%) predominated over Candida albicans (45.5%). Non albicans Candida isolated were Candida tropcalis 40(25.6%), Candida krusei 21(13.4%), Candida glabrata 17(10.8%) and Candida dublinensis 07(4.4%) each. Candida species were all susceptible to Amphotericin B, followed by fluconazole (67.4%), miconazole (51.9%) and ketoconazole (22.5%). Conclusions: The accurate species identification of Candida is important for the treatment because not all species respond to the same treatment and also because of the increasing antifungal resistance. CHROMagar is a convenient and rapid method of identification of Candida species specially in resource limited poor settings.   Keywords: antifungal susceptibility testing; Candida albicans; CHROMagar; non albicans Candida

scholarly journals Antifungal Susceptibly Testing by Concentration Gradient Strip Etest Method for Fungal Isolates: A Review

2019 ◽  
Vol 5 (4) ◽  
pp. 108 ◽  
Author(s):  
Eric Dannaoui ◽  
Ana Espinel-Ingroff
Keyword(s):  
Concentration Gradient ◽  
Susceptibility Testing ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Antifungal Susceptibility Testing ◽  
Epidemiological Surveillance ◽  
Diffusion Method ◽  
Dilution Method ◽  
Strip Method

Antifungal susceptibility testing is an important tool for managing patients with invasive fungal infections, as well as for epidemiological surveillance of emerging resistance. For routine testing in clinical microbiology laboratories, ready-to-use commercial methods are more practical than homemade reference techniques. Among commercially available methods, the concentration gradient Etest strip technique is widely used. It combines an agar-based diffusion method with a dilution method that determinates a minimal inhibitory concentration (MIC) in µg/mL. Many studies have evaluated the agreement between the gradient strip method and the reference methods for both yeasts and filamentous fungi. This agreement has been variable depending on the antifungal, the species, and the incubation time. It has also been shown that the gradient strip method could be a valuable alternative for detection of emerging resistance (non-wild-type isolates) as Etest epidemiological cutoff values have been recently defined for several drug-species combinations. Furthermore, the Etest could be useful for direct antifungal susceptibility testing on blood samples and basic research studies (e.g., the evaluation of the in vitro activity of antifungal combinations). This review summarizes the available data on the performance and potential use of the gradient strip method.

scholarly journals Population differentiation, antifungal susceptibility, and host range of Trichophyton mentagrophytes isolates causing recalcitrant infections in humans and animals

2020 ◽  
Vol 39 (11) ◽  
pp. 2099-2113
Author(s):  
Sebastian Gnat ◽  
Dominik Łagowski ◽  
Aneta Nowakiewicz ◽  
Marcelina Osińska ◽  
Łukasz Kopiński
Keyword(s):  
Host Range ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Trichophyton Mentagrophytes ◽  
Antifungal Susceptibility Testing ◽  
Antifungal Drugs ◽  
Genomic Diversity ◽  
Clinical Isolates ◽  
Chemical Groups

Abstract The major problems in determining the causative factors of the high prevalence of dermatophytoses include the lack of a well-standardized antifungal susceptibility testing method, the low consistency of in vitro and clinical minimal inhibitory concentration values, the high genomic diversity of the population, and the unclear mechanism of pathogenicity. These factors are of particular importance when the disease is recalcitrant and relapses. Herein, we identified and characterized Trichophyton mentagrophytes isolates obtained from therapy-resistant cases in humans and animals. We used genomic diversity analysis of 17 human and 27 animal clinical isolates with the MP-PCR technique, determined their phenotypic enzymatic activity and host range, and performed antifungal susceptibility testing to currently available antifungal drugs from various chemical groups. Genomic diversity values of 35.3% and 33.3% were obtained for clinical isolates from humans and animals, respectively, yet without any relationship to the host species or antifungal drug to which resistance in therapy was revealed. The highest activity of keratinase enzymes was recorded for fox, guinea pig, and human hairs. These hosts can be considered as the main species in the host range of these isolates. A phenyl morpholine derivative, i.e. amorolfine, exhibited superior activity against strains obtained from both humans and animals with the lowest MIC50. Interestingly, high compliance of terbinafine in vitro resistance with clinical problems in the treatment with this substance was shown as well. The high resistance of dermatophytes to drugs is the main cause of the recalcitrance of the infection, whereas the other features of the fungus are less important.

scholarly journals The Emerging Terbinafine-Resistant Trichophyton Epidemic: What Is the Role of Antifungal Susceptibility Testing?

Dermatology ◽  
2021 ◽  
pp. 1-20
Author(s):  
Julia J. Shen ◽  
Maiken C. Arendrup ◽  
Shyam Verma ◽  
Ditte Marie L. Saunte
Keyword(s):  
Gene Mutation ◽  
Susceptibility Testing ◽  
Geometric Mean ◽  
Antifungal Susceptibility ◽  
Antifungal Susceptibility Testing ◽  
Squalene Epoxidase ◽  
Exclusion Criteria ◽  
Huge Variation

<b><i>Background:</i></b> Dermatophytosis is commonly encountered in the dermatological clinics. The main aetiological agents in dermatophytosis of skin and nails in humans are <i>Trichophyton</i> (<i>T</i>.) <i>rubrum</i>, <i>T. mentagrophytes</i> and <i>T. interdigitale</i> (former <i>T. mentagrophytes-</i>complex). Terbinafine therapy is usually effective in eradicating infections due to these species by inhibiting their squalene epoxidase (SQLE) enzyme, but increasing numbers of clinically resistant cases and mutations in the SQLE gene have been documented recently. Resistance to antimycotics is phenotypically determined by antifungal susceptibility testing (AFST). However, AFST is not routinely performed for dermatophytes and no breakpoints classifying isolates as susceptible or resistant are available, making it difficult to interpret the clinical impact of a minimal inhibitory concentration (MIC). <b><i>Summary:</i></b> PubMed was systematically searched for terbinafine susceptibility testing of dermatophytes on October 20, 2020, by two individual researchers. The inclusion criteria were <i>in vitro</i> terbinafine susceptibility testing of <i>Trichophyton (T.) rubrum</i>, <i>T. mentagrophytes</i> and <i>T. interdigitale</i> with the broth microdilution technique. The exclusion criteria were non-English written papers. Outcomes were reported as MIC range, geometric mean, modal MIC and MIC<sub>50</sub> and MIC<sub>90</sub> in which 50 or 90% of isolates were inhibited, respectively. The reported MICs ranged from &#x3c;0.001 to &#x3e;64 mg/L. The huge variation in MIC is partly explained by the heterogeneity of the <i>Trichophyton</i> isolates, where some originated from routine specimens (wild types) whereas others came from non-responding patients with a known SQLE gene mutation. Another reason for the great variation in MIC is the use of different AFST methods where MIC values are not directly comparable. High MICs were reported particularly in isolates with SQLE gene mutation. The following SQLE alterations were reported: F397L, L393F, L393S, H440Y, F393I, F393V, F415I, F415S, F415V, S443P, A448T, L335F/A448T, S395P/A448T, L393S/A448T, Q408L/A448T, F397L/A448T, I121M/V237I and H440Y/F484Y in terbinafine-resistant isolates.

Use of spectrophotometric reading for in vitro antifungal susceptibility testing ofAspergillusspp.

1999 ◽  
Vol 45 (10) ◽  
pp. 871-874 ◽  
Author(s):  
Eric Dannaoui ◽  
Florence Persat ◽  
Marie-France Monier ◽  
Elisabeth Borel ◽  
Marie-Antoinette Piens ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
Antifungal Susceptibility ◽  
Reference Method ◽  
Antifungal Susceptibility Testing ◽  
Aspergillus Species ◽  
National Committee ◽  
Broth Microdilution Method

A comparative study of visual and spectrophotometric MIC endpoint determinations for antifungal susceptibility testing of Aspergillus species was performed. A broth microdilution method adapted from the National Committee for Clinical Laboratory Standards (NCCLS) was used for susceptibility testing of 180 clinical isolates of Aspergillus species against amphotericin B and itraconazole. MICs were determined visually and spectrophotometrically at 490 nm after 24, 48, and 72h of incubation, and MIC pairs were compared. The agreement between the two methods was 99% for amphotericin B and ranged from 95 to 98% for itraconazole. It is concluded that spectrophotometric MIC endpoint determination is a valuable alternative to the visual reference method for susceptibility testing of Aspergillus species.Key words: antifungal, susceptibility testing, Aspergillus, spectrophotometric reading.

Anti-Candida Activity of Pomegranate Peel Extract in Comparison with Curcumin Extract and their Synergism with Fluconazole and Nystatin

2021 ◽  
Vol 30 (2) ◽  
pp. 81-87
Author(s):  
Sara Y. Maxwell ◽  
Sally Elnawasany ◽  
Azza M. Hassan ◽  
Marwa M. E. Abd-Elmonsef
Keyword(s):  
Candida Species ◽  
Synergistic Effects ◽  
Systemic Disease ◽  
Antifungal Drugs ◽  
Diffusion Method ◽  
Oropharyngeal Candidiasis ◽  
Pomegranate Peel ◽  
Methanolic Extracts ◽  
Pomegranate Peel Extract

Background: Oropharyngeal candidiasis is an important sign that may reflect a serious systemic disease, especially in immunocompromised patients who face the intolerable side effects of the available antifungal drugs. This necessitates the development of safe and effective natural components. Objectives: to evaluate the in vitro activities of both pomegranate peel and curcumin extracts and to compare them with nystatin and fluconazole drugs against Candida species. As far as we know, this is the first study comparing between the antifungal potency of both extracts. Methodology: Different Candida species were isolated from patients with oropharyngeal candidiasis. The antifungal activities of methanolic extracts of pomegranate peel and curcumin were tested by disc diffusion method. Both extracts were added to each of nystatin and fluconazole discs to measure their synergistic effects. Results: Highly significant synergism was detected between both extracts and each of antifungal drugs. Curcumin extract was more potent than pomegranate extract. Conclusion: When used in combination with nystatin and fluconazole, curcumin and pomegranate peel extracts are promising and effective anti-Candida agents.

Vaginitis Due To Pichia fermentans in a Patient Affected by Endometrial Cancer: A Novel Case Report

2021 ◽  
Vol 17 ◽  
Author(s):  
Zarifeh Adampour ◽  
Malihe Hasanzadeh ◽  
Hossein Zarrinfar ◽  
Maryam Nakhaei ◽  
Monika Novak Babič
Keyword(s):  
Endometrial Cancer ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Female Genital Tract ◽  
Antifungal Susceptibility Testing ◽  
Vein Thrombosis ◽  
Microbial Infections ◽  
Life Threatening ◽  
In Vitro Antifungal Susceptibility

Introduction: Endometrial cancer is one of the most common malignancies of the female genital tract, which can be serious or life-threatening. Microbial infections can be one of the underlying causes of this type of cancer. Case Presentation: The present study describes the isolation of Pichia fermentans (Candida firmentaria var. firmentaria) from the vaginal secretions of a 61-year-old woman affected by endometrial cancer. She reported abdominal pain and vaginal discharge for 3 months, and had a history of diabetes, hypertension, Deep Vein Thrombosis (DVT), and Acute Myeloid Leukemia (AML). The isolated yeast was identified based on nuclear ribosomal internal transcribed spacer (ITS1-ITS2 rDNA) sequence analysis. The in vitro antifungal susceptibility testing showed a higher effect for ketoconazole against P. fermentans than fluconazole, itraconazole and voriconazole. Conclusion: Correct differentiation between P. fermentans and other yeast should be considered. The in vitro antifungal susceptibility testing is recommended for rare yeast, and will help the physicians in providing the best treatment.

Sign in / Sign up

Export Citation Format

Share Document