Clinico-Mycological Profile of Dermatophytosis in a Tertiary Care Hospital of Eastern Nepal

Background: Dermatophytes are keratinophilic and keratinolytic fungi which are responsible for dermatophytosis. There are three genera of dermatophytes; Trichophyton, Microsporum and Epidermophyton. As they have affinity to keratin rich tissue, they produce dermal inflammatory response, intense itching and cosmetically poor appearance. The varied clinical presentation of tinea results in delay in diagnosis, poor compliance in follow up of cases, and consequently spread of infection in the community has rekindled interest in rapid identification of species. Materials and Methods: A hospital based cross sectional study was carried out in the department of Microbiology, Nobel medical college from January 2019 to December 2019. Clinically suspected 200 cases of dermatophytosis attending Out Patient Department were studied. Isolation and identification was done by various tests like macroscopic, microscopic and biochemical tests. Results: Out of 200 specimens, 138 (69%) were skin scraping, 42 (21%) were nail clipping and 20 (10%) were hair stubs. Highest incidence was seen in the age group 21-40 years with 115 (57.5%) cases followed by 41-60 years 46 (23%) cases. In our study male preponderance of 158 (79%) and female of 42 (21%) were seen. Tinea corporis was found to be the commonest clinical type with 96 (48%) cases followed by tinea unguinum, 42 (21%), Tinea cruris 10 (11.36%), Tinea capitis 5 (5.68%), Tinea faciei 4 (4.54%), Tinea pedis 2 (2.27%). Among the fungal isolates Trichophyton rubrum (67.04%) was the most common etiological agent followed by Trichophyton mentagrophytes (13.63%), Epidermophyton 10 (11.36%), Trichophyton violaceum 4 (4.54%) and Epidermophyton floccosum 3 (3.4%). Conclusion: The most common clinical presentation was tinea corporis followed by tinea unguinum. T. rubrum was the most common etiological agent of dermatophytosis

The clinical type and etiological agents of superficial dermatophytosis: A cross sectional study

Dermatophytosis are fungal infections caused by three genera of fungi that have the unique ability to invade and multiply within keratinized tissue (hair, skin, and nails). Although dermatomycoses are globally distributed, the endemic and most prevalent species of dermatophytosis differ strikingly from one geographic locality to another. Changing trend has been noticed in last few years with dermatophytic infections presenting as chronic, treatment unresponsive and recurrent. Also various microscopic and fungal culture studies have shown shift in identification of causative fungal species in recent years. Numerous studies have been done on the occurrence of dermatophytes in various parts of our country illustrating the range and changing pattern of fungal infection as well as causative fungal species. Total number of 150 patients attending outpatient department of our hospital who were clinically diagnosed as having superficial dermatophytosis were enrolled into the study. Patients were carefully screened as per inclusion and exclusion criteria and then enrolled in the study. Samples were taken from all the patients and examined for KOH direct microscopy and sent for fungal culture on Sabouraud’s Dextrose Agar as well as on Dermtophyte Test Medium. Results were then analyzed using standard statistical methods. Out of total 150 patients, 101 were males and 49 were females. Most common age group was 21-30 years (37.3%). 58 patients (38.7%) showed positivity to KOH microscopy as well as fungal culture. Additionally 25 more samples demonstrated positivity to KOH microscopy (total 83 patients) but negativity to culture, while 9 patient samples were positive to culture but negative to direct microscopy. Predominant fungal species isolated on culture was Trichophyton mentagrophytes (50.7%) while next common species isolated was T. tonsurans (29.9%). No significant association was found between dermatophyte isolate on culture and clinical type. Trichophyton mentagrophytes and Trichophyton tonsurans were the most common species isolated among subjects with Tinea faciei, Tinea cruris and Tinea corporis. The study showed a male preponderance and T. corporis was the commonest clinical type found. Majority of patients were in the 3rd decade and came within a duration of 1 month to 6 months of getting an infection. In patients diagnosed with tinea corporis, tinea cruris, tinea pedis and tinea manuum, T. mentagrophytes was the most predominant species isolated.

A Comparative Study of 50-Millesimal Potencies and Centesimal Potencies in the Treatment of Tinea Corporis: An Open, Randomised, Pilot Trial

Introduction Standard management of dermatophytosis involves the use of topical antifungals in limited disease and oral therapy for more extensive cases. Despite the evidences favouring homeopathy in tinea corporis (TC) is inadequate, patients are increasingly opting for it. This trial attempts to assess the feasibility of a trial evaluating individualised homeopathic (IH) medicines in centesimal and 50-millesimal potencies in treating TC. Methods An open, randomised, pilot feasibility trial was conducted at the dermatology outpatient of D. N. De Homoeopathic Medical College and Hospital, West Bengal, India. Patients were randomised to receive IH medicines in either centesimal potencies (n = 30) or in 50-millesimal potencies (n = 30). Primary outcome measure was intensity of pruritus on a 0 to 10 numeric rating scale; secondary outcomes were Skindex-29 and dermatology life quality index questionnaires—all measured at baseline, and after 6 and 12 weeks of intervention. Group differences were calculated on intention-to-treat (ITT) sample as well as following per protocol (PP) analysis. Results Recruitment and attrition rates were 69 and 16.7% respectively. Both ITT and PP analysis revealed that intra-group changes in both the primary and secondary outcomes to be statistically significant in both the groups (all p < 0.05, one-way repeated measure analysis of variance). There were no significant group differences over 6 and 12 weeks (all p > 0.05, unpaired t-tests); thus, indicating similar pattern of improvement in both the groups. Most frequently used medicines were Natrum sulphuricum (28.3%), Natrum muriaticum (25%), Sulphur (8.3%) and Bacillinum (6.7%). No harms, unintended effects, homeopathic aggravations or any serious adverse events were reported from either group. Conclusion An adequately powered trial exploring effectiveness of both scales in TC appeared to be feasible in future. Though the sample size was too small to arrive at any definite conclusion, both centesimal and 50-millesimal potencies of IH medicines appeared to be equally useful in improving pruritus intensity and quality of life in patients suffering from TC.

A clinicomycological study on chronic dermatophytosis in a tertiary care hospital in North India: An observational study

Background: Chronic dermatophytosis is a considerable challenge in routine clinical practice. There is, however, scarce information available in the literature on its extent and characteristics. Aim: The aim of this study was to evaluate the host-related factors of chronic dermatophytosis and to identify the common fungal isolates. Methods: The study enrolled a total of 145 cases of chronic dermatophytosis attending the out-patient department of a tertiary care hospital in Jammu from November 2017 through October 2018. A detailed history was taken, followed by a clinical examination and investigations such as routine baseline investigations, an absolute eosinophil count, a wet mount for direct microscopy, and a fungal culture. Results: The most common presentation was tinea corporis with tinea cruris (33.1%), followed by tinea corporis alone. The majority of the patients (54.5%) had more than 20% of the body surface area involved. Most of the patients were manual workers (n = 44; 30.3%). The number of hours of sun exposure varied between 1 to 8.5 hours (mean ± SD: 3.53 ± 1.75 h). The fungal culture was positive in 65 (44.8%) patients. The most frequent isolates were Trichophyton mentagrophytes (53.8%), followed by Trichophyton rubrum (38.5%). Conclusion: We found Trichophyton mentagrophytes the predominant pathogen in chronic dermatophytosis, followed by Trichophyton rubrum, which demonstrates a changing trend as far as the causative organism is considered. Besides, various risk factors for chronicity such as prolonged sun exposure, lack of proper hygiene, wearing tight-fitting synthetic clothes, the use of topical steroids, and non-compliance to treatment were identified.

Real World Analysis of Response Rate and Efficacy of Oral Ketoconazole in Patients with Recalcitrant Tinea Corporis and Cruris

Recalcitrant dermatophytosis has had an alarming rise in India with concomitant decreased effectiveness of conventional antifungal agents. This has prompted the use of second-line agents for treatment. In this retrospective study, we aimed to analyze the response rate, efficacy, relapse rate, and side effects of oral ketoconazole (KZ) in the treatment of recalcitrant tinea corporis and cruris. Institutional records were reviewed for patients presenting with tinea cruris or corporis who had failed treatment with conventional antifungal drugs and treated with oral KZ. Potassium hydroxide (KOH) findings, culture reports, and response to treatment was noted based on the percentage improvement in lesions and reduction in itching compared with baseline. Fourty-three patients (mean age 31.3 years) with tinea corporis/cruris who had taken prior treatment with antifungals were recruited in the study. KOH mount and culture were positive in 76.7% patients. Trichophyton mentagrophytes was the commonest species, isolated in 62.8% of patients. Ketoconazole showed the lowest minimum inhibitory concentration on antifungal susceptibility tests with various antifungals. With a dose of 400 mg daily, 67.4% of patients were cured of disease with mean duration of 9.4 weeks. Patients having less than 40% clearance at 2 weeks had a 68.9% less probability of getting cured of disease. Of the 29 patients cured, 37.9% relapsed because of various predisposing factors. Two patients developed increase in liver enzymes on treatment. Our analysis suggests that KZ can be used as alternative drug in cases with failure to conventional antifungal drugs. Though there are relapses, these can be partially explained by various predisposing factors that support fungal survival and transmission.