Molecular typing of Trichophyton rubrum clinical isolates from Poland

The aim of this study was to investigate the intraspecific diversity of Trichophyton rubrum clinical isolates. Thirty clinical isolates of T. rubrum were selected for molecular typing by PCR amplification of two tandemly repetitive elements (TRS-1 and TRS-2) of the rDNA and randomly amplified polymorphic DNA (RAPD) analysis with primers designated 1 and 6. The assignment to the species T. rubrum was achieved by nested PCR of ITS1. Five PCR types were produced from the TRS-1 and three from the TRS-2 locus. Thirteen and 23 individual profiles were obtained by RAPD, with primer 1 and 6 respectively. At the phylogenetic level, 26 (87%) isolates were allocated into four clusters, with each cluster comprising isolates of over 80% similarity. The reproducibility of TRS typing was 100%, whereas that of RAPD was 40% and 30%, when using primer 1 and 6 respectively. Neither correlation between the morphological characteristics and the TRS-1-TRS-2 or RAPD genotype nor between TRS-1-TRS-2 and RAPD genotyping was observed. Although both the TRS amplification and RAPD analysis possess the ability to discriminate between T. rubrum strains, the TRS typing method is particularly valuable as its results are much more reproducible, more easily interpreted and recorded than those generated by RAPD.     

In vitro activities of four antifungal drugs against Trichophyton rubrum isolates exhibiting resistance to fluconazole

Thirty-two clinical isolates of Trichophyton rubrum exhibiting resistance to fluconazole [minimum inhibitory concentrations (MICs) > or = 64 microg ml(-1)] were selected to test the antifungal activity of ketoconazole, itraconazole, griseofulvin and terbinafine. We followed the guidelines of the National Committee for Clinical Laboratory Standards for testing filamentous fungi. The strains Candida parapsilosis (ATCC 22019), Candida krusei (ATCC 6258), T. rubrum (ATCC 40051) and Trichophyton mentagrophytes (ATCC 40004) were included for quality control. The microdilution plates were incubated at 28 degrees C and were read visually after 7 days of incubation and endpoint determination readings were performed visually. The MIC ranges for the four antifungals were: 0.0625-2 microg ml(-1) for ketoconazole, 0.25-2.0 microg ml(-1) for griseofulvin, < or =0.031-1.0 microg ml(-1) for itraconazole and < or =0.031 microg ml(-1) for terbinafine (for all tested isolates). Terbinafine was the most potent drug against T. rubrum, in vitro, followed by itraconazole, ketoconazole and griseofulvin. Much work is still needed to correlate the MICs of these drugs with clinical outcomes to develop interpretative breakpoints for T. rubrum and other dermatophytes.     

First isolation of Trichophyton raubitschekii (syn. T. rubrum) in Europe

Trichophyton raubitschekii is a rare dermatophyte which belongs to the Trichophyton rubrum species complex. Since 1981, only a few cases of dermatophytosis due to this anthropophilic causative agent were published. In this paper the authors report the first cases of Tinea corporis caused by Trichophyton raubitschekii (syn. T. rubrum) in Europe. The patients, one immigrant from Ghana and three from Cameroon, had typical lesions of tinea corporis. Four strains were isolated and characterized by conventional and molecular methods. On morphological and physiological grounds the isolates were identified as T. raubitschekii by the following phenotypical features: (1) velvety colony texture; (2) brown pigment; (3) abundant macroconidia and (4) positive urease activity. Molecular diagnostics were performed by single strand conformation polymorphism (SSCP) and sequence analysis of the ATPase9 intron of the mitochondrial (mt) DNA and the internal transcribed spacer (ITS) region of the rDNA, respectively. The ITS sequences and SSCP patterns of the ATPase9 intron were found to be identical among the four strains and also when compared to reference strains of T. rubrum. As shown in the present paper, T. raubitschekii is genetically identical to T. rubrum but differs in some phenotypical characteristics. Since misidentification with other dark-coloured dermatophyte variants is possible, medical mycologists should bear in mind the special morphological characteristics of T. raubitschekii (syn. T. rubrum) for future identifications.     

Dermatophytosis in children and adolescents in Gdansk, Poland

During a 3-year period (1999-2001) a total of 94 cases of dermatophytosis were seen in patients from 0 to 18 years of age attending the Department of Dermatology, Venerology and Allergology of Gdańsk Medical University. Mycoses were diagnosed on the basis of clinical picture and direct microscopy and were confirmed by positive cultures. The most frequent pathogens were Microsporum canis (62%) and Trichophyton rubrum (12%). The most often forms of dermatophytosis in children were tinea cutis glabrae (42%) and tinea capitis (30%). Microsporum canis predominated in both locations. Glabrous skin lesions were the most frequent in children aged 8-15 years; the peak of scalp lesions was observed mainly in children aged 4-7 years. Tinea pedis occurred more frequently than suspected. Tinea pedis was observed mainly in adolescents (above the age of 12 years)--the majority of cases were caused by T. rubrum and T. mentagrophytes var. granulosum. Onychomycosis was highly uncommon, caused mainly by T. rubrum. Dermatomycoses in general were most frequent in October and November.     

A 7-year survey of dermatophytoses in Crete, Greece

Dermatophytoses are of worldwide distribution. Epidemiological studies concerning dermatophyte infections have been performed in many countries and differences in the incidence and the aetiological agents have been reported in different geographical locations. This study was undertaken to investigate the prevailing species of dermatophytes in the island of Crete, Greece, and their pattern of infection during a 7-year period (1997-2003). A total of 5544 samples obtained from 3751 patients with clinically suspected dermatomycoses were examined mycologically in the laboratory of Clinical Microbiology at the University Hospital of Crete, Greece. Skin, hair and nail specimens were subjected to direct microscopy and culture. Dermatophytes were isolated from 520 patients (13.9%). Trichophyton rubrum was the most frequently isolated dermatophyte accounting for 48% of the infections, followed by Microsporum canis (17.9%), Trichophyton mentagrophytes var. interdigitale (14.2%) and Epidermophyton floccosum (6%). Tinea unguium, tinea pedis, tinea corporis, tinea capitis, tinea cruris, tinea manuum and tinea facei were the clinical types of dermatophytoses in decreasing order of frequency. Trichophyton rubrum is the predominant dermatophyte in our area. As the epidemiology of dermatophytoses is changing over time it is important to review periodically the incidence of dermatophytes and their distribution.     

Onychomycosis in children: a survey of 46 cases

This is a retrospective study of the agents, clinical aspects, sources of infection and therapy of onychomycosis in children. In the period 1989-2000, we observed 46 consecutive children, until 16 years of age with onychomycosis (29 boys, 17 girls, mean age 10.8 years). Dermatophytes were isolated in 30 cases (Trichophyton rubrum in 22 cases, Trichophyton mentagrophytes in five, Epidermophyton floccosum in two and Trichophyton violaceum in one) and Candida spp. in 16, associated with Trichophyton rubrum in two. Moulds were isolated in three children (Fusarium oxysporum in one, Scopulariopsis brevicaulis in another and Aspergillus fumigatus associated with Trichophyton rubrum in a third). The commonest features were distal and distolateral subungual hyperkeratosis in dermatophyte infections (93%) and onychodystrophy and paronychia in Candida infections (56% and 50% respectively). Forty patients achieved clinical and mycological recovery. It is appropriate to suspect onychomycosis in children, perform microbiological diagnosis and undertake early treatment. An approach of this kind may help to prevent nail dystrophy and the spread of infection.     

Case report. Kerion Celsi effectively treated with terbinafine. Characteristics of kerion Celsi in the elderly in Japan

A 75-year-old non-working male living in Sagamihara, Kanagawa Prefecture, had erythematous plaques with scales associated with follicular pustules in the head area extending from the occipital to right temporal regions about 1 month prior to his initial visit, when hair loss increased. The diagnosis was kerion Celsi. Trichophyton rubrum was isolated from scales and tissues taken from lesions in the head. Histopathological examinations showed irregular epidermal thickening with dense cell infiltration from the dermis to subcutaneous adipose tissues. Granulomatous reactions involving neutrophils, histiocytes and giant cells were seen mainly in the hair follicles. Periodic acid-Schiff (PAS) and Grocott-positive microbial elements were detected in the horny layer, and inside and outside the hair follicles. Pustules disappeared 1 week after starting the oral treatment with terbinafine (125 mg day-1). A cure was achieved 2 weeks after starting the treatment, with only slight scales remaining. No recurrence has been observed to date. Terbinafine was thought to be very effective and safe for kerion Celsi. We reviewed 27 cases of kerion Celsi reported in patients, aged at least 70 years, in Japan and found that the major characteristics of this disease in Japan include the following: (1) female cases outnumber male cases; (2) the causative organism was T. rubrum in 14 of 27 patients (51.9%); and (3) topical application of steroids often induces this disease in patients with superficial tinea capitis.     

Role of Chrysosporium keratinophillum in the parasitic evolution of dermatophytes

Anti-dermatophytic activity of Chrysosporium keratinophillum against species of the genera Trichophyton, Microsporum and Epidermophyton floccosum was tested in vitro. When C. keratinophillum and different species of dermatophytes were inoculated on Sabouraud's dextrose agar plates 2 cm apart, no antagonistic effect of C. keratinophillum on the mycelial growth of dermatophytes was observed. However, conidia production was not observed on the hyphae of Trichophyton rubrum, Trichophyton tonsurans and E. floccosum grown near C. keratinophillum. The secretory substances released by C. keratinophillum inhibited the growth of T. rubrum, T. tonsurans, Trichophyton mentagrophytes var. interdigitale and E. floccosum at a concentration of 2,000 microg ml(-1) when tested by broth dilution technique. No inhibition of the growth was observed for Microsporum gypseum and Microsporum nanum. The anti-fungal activity of secretory substances released by C. keratinophillum was recorded to be heat stable. Results of the present study suggest that the anti-dermatophytic activity of the secretory substances of C. keratinophillum on T. rubrum, T. mentagrophytes var. interdigitale, T. tonsurans and E. floccosum may be responsible in part, for the absence of these dermatophyte species in soil. Considering the global prevalence of C. keratinophillum in soil one may speculate that the anti-dermatophytic activity of C. keratinophillum is one of the early events for the evolutionary divergence of saprophytic archi-dermatophytes to obligate parasitic dermatophyte species.     

In vitro susceptibility of dermatophytes from Munich to griseofulvin, miconazole and ketoconazole

Various recent clinical isolates of Trichophyton rubrum, Trichophyton mentagrophytes, Microsporum canis and Epidermophyton floccosum from Munich were subjected to antimicrobial susceptibility testing using the microdilution method. Both azoles miconazole and ketoconazole were found to be more active than griseofulvin. Comparatively high inhibitory concentrations of griseofulvin were especially found with Tr. mentagrophytes. On the whole miconazole turned out to be even somewhat more effective than ketoconazole. Considering the minimum inhibitory concentrations found at least some of the strains tested might not be open to eradication in clinical terms with conventional treatment protocols.     

Fungal infection as a cause of skin disease in the Eastern Province of Saudi Arabia: cutaneous candidosis

In the period between April 1984 and April 1988 a total of 4,294 clinically suspected cases of dermatomycoses were examined for causative fungi. Of these cases 174 (4.1%) were suspected as cutaneous candidosis. These cases belonged to 15 different nationalities. Both sexes were involved (122 males and 52 females). Thirty four cases were prepubertal children while 140 were adults. Of these cases 163 had their clinical diagnosis confirmed by direct microscopy and on culture yielded 164 isolates (Candida albicans 161, C. stellatoidea 1 and Trichophyton rubrum 1).     

Erythema mwltiforme in Dermatophytosis

Summary: Erythema multiforme (EMF) due to dermatophytosis caused by Tricho-phyton rubrum has been described in a 64 year old male with grandmal. Specific treatment with oral griseofulvin cleared the condition in 3 weeks time. This case is reported for the rarity of EMF being produced by an anthropophilic dermatophyte, Trichophyton rubrum.
Zusammenfassung: Ein Erythema exsudativum multiforme bei einem 64 jährigen Patienten wird beschrieben, das durch eine Dermatophytose mit Trichophyton rubrum als Erreger hervorgerufen wurde. Eine spezifische Behandlung mit Griseofulvin brachte die Erscheinungen innerhalb von drei Wochen zur Abheilung. Dieser Fall wird berichtet, weil die Verursachung eines Erythema exsudativum multiforme durch den anthropo-philen Dermatophyten Trichophyton rubrum eine Rarität darstellt.     

Die humanpathogene Dermatophytenflora des Saarlandes und der westlichen Pfalz — gegenwärtiger Stand

Zusammenfassung: In den Jahren 1980 bis 1985 konnten von Patienten unserer Klinik und Poliklinik (Einzugsbereich Saarland AVestpfalz) mit Pilzinfektionen verschiedener Lokalisation im Mykologischen Labor der Klinik 1198 Dermatophyten isoliert werden. Trichophyton rubrum wurde als vorherrschender Erreger festgestellt (83,9%). Andere Spezies waren — in absteigender Häufigkeit — Trichophyton mentagrophytes, Epidermophyton floccosum, Microsponun canis und Trichophyton verrucosum. Die Ergebnisse werden mit Befunden früherer epidemiologischer Auswertungen aus anderen Regionen verglichen. Die weltweite Zunahme von Trichophyton rubrum bestätigt sich in unseren Untersuchungen. Mögliche Ursachen werden diskutiert.
Summary: In the last six years (1980–1985) a total of 1198 dermatophytes have been isolated from patients in our clinic (representing the population of Saarland and Western Palatia) with dermatomycosis of different localization. Trichophyton rubrum was found to be the predominant causative organism (83.9%). Other species involved were — in decreasing incidence — Trichophyton mentagrophytes, Epidermophyton floccosum, Microsponun canis and Tr. verrucosum. The results have been compared with data from earlier epidemiologic investigations in other regions. Our results confirm of a significant increase in Trichophyton rubrum in different parts of the world. Possible causal factors are discussed.     

In vitro antifungal activity of Polyporaceae against yeasts and dermatophytes

Summary. The antifungal activity of 38 Polyporaceae sensu lato against yeasts and dermatophytes was tested in vitro by the agar dilution method. Strains were typed organisms and clinical isolates. In this first report Pycnoporellus fulgens (Fr. Donk was found to be the most active species against pathological fungi and showed broad-spectrum antifungal activity against yeasts ( Candida albicans, Candida glabrata ) and dermatophytes ( Trichophyton mentagrophytes, Trichophyton rubrum. Microsporum canis. Microsporum gypseum. Epidermophyton floccosum ). Other Polyporaceae species also showed antifungal activity, but only against dermatophytes.
Zusammenfassung. Alkoholische Rohextrakte von 38 Polyporaceae-Arten wurden in vitro mittels Agardilutiontest auf ihre antimyzetische Wirkung gegen Hefen und Dermatophyten geprüft. Die Teststämme waren einige Sammlungsstämme, in der Mehrzahl aber klinische Isolate. In dieser Studie erwies sich der Extrakt von Pycnoporellus fulgens (Fr.) Donk als antimyzetisch aktivste Spezies gegen pathogene Hefen ( Candida albicans, C. glabrata ) sowie gegen Dermatophyten ( Trichophyton mentagrophytes, T. rubrum, Microsporum canis, M. gypseum, Epidermophyion floccosum ). Andere Polyporaceae zeigten ebenfalls antimyzetische Aktivitat, jedoch nur gegen Dermatophyten.     

Some Unusual Cutaneous Manifestations of Trichophyton rubrum in Israel*: Einige ungewöhnliche Varianten von Dermatomykosen durch Trichophyton rubrum

Summary: Unusual forms of Trichophyton rubrum infection seen in 40 patients are described. Observed were localized lesions resembling the following clinical entities: discoid lupus erythematosus (14 patients), granulomatous folliculitis and perifolliculitis (4), abscesses (3), granuloma annulare (3), annular lichen planus (4, erythema chronicum migrans (2), keloid-like lesion (1) and condylomata lata-like lesions on the scrotum of a young man. Widely desseminated lesions were seen in 10 patients with endocrinologic neoplastic and immunologic disturbances. These showed the following dermatological aspects: disseminated neurodermatitis (2), psoriasis gyrata (t), seborrheic dermatitis (2), erythema annulare centrifugum (4, papular pityriasis rosea (1) and dermatitis herpetiformis (1). In four cases there was en ectothrix invasion of affected hairy areas. The granular variety of T. rubrum was isolated from one case with localized infection, and from two cases with disseminated lesions. Zusammenfassung: Ungewöhnliche Formen einer Trichophyton rubrum Infektion die bei 40 Patienten beochachtet wurden, werden beschrieben. Es wurden umschriebene Hautveränderungen beobachtet, die den folgenden klinischen Diagnosen ähnelten: Discoider Lupus erythematodes (14 Patienten), granulomatäse Follikulitis und Perifollikulitis (3), Abszesse (3), Granuloma anulare (3), Lichen ruber planus anularis (2), Erythema chronicum migrans (2), keloidartige Hautveränderungen (I), Condylomata lata-artige Hautveränderungen am Scrotum eines jungen Mannes. Großflächig disseminierte Herde wurden bei 10 Patienten mit endokrinologischen, neoplastischen und immunologischen Erkrankungen gesehen. Bei diesen fanden sich morphologische Anklange an die folgenden dermatologischen Erkrankungen: Disseminierte Neurodermitis (2), gyrierte Psoriasis vulgaris (2), seborrhoische Dermatitis (2), Erythema anulare centrifigum (2), papulöse Pityriasis rosea (1) und Herpetitis herpetiformis Duhring (1). Bei 4 Fällen wurde ein ektotriches Wachstum im Haar beobachtet. Die granuläre Variante des T. rubrum wurde von einem Fall mit einer umschriebenen Infektion und von 2 Fällen mit disseminierten Herden isoliert.     

Widespread, chronic, and fluconazole-resistant Trichophyton rubrum infection in an immunocompetent patient

Chronic, widespread and invasive cutaneous dermatophytoses due to Trichopyhton rubrum are common in immunocompromised patients. In immunocompetent individuals, however, chronic widespread dermatophytoses are more often associated with onychomycosis and tinea pedis. We describe a 54-year-old immunocompetent female who presented with a 2-year history of extensive erythematous and hyper-pigmented scaly plaques involving the abdominal, gluteal and crural regions without concomitant tinea pedis, tinea manus or onychomycosis. The diagnosis was made by mycological examination including culture. The pathogen identified was T. rubrum. The patient had a history of resistance to systemic fluconazole and topical ketoconazole. After an 8-week therapy period with systemic itraconazole and sertaconazole nitrate cream, a near-complete clearing of all lesions was observed. Trichophyton rubrum may thus present atypical aspects in immmunocompetent patients.     

Tinea incognito in Italy: a 15-year survey

Tinea incognito or steroid modified tinea is a dermatophytic infection in which topical or systemic steroids, administered as a result of dermatological misdiagnosis or preexisting pathologies, have modified the clinical appearance of the fungal infection, transforming the typical ringworm and mimicking other skin diseases. This is a retrospective study of the agents, clinical aspects, sources of infection of 200 cases (98 males, 102 females, mean age 42 years) of tinea incognito, observed in Siena and Milan, Italy, in the period 1987-2002. In order of decreasing frequency, Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis, Microsporum gypseum, Trichophyton violaceum and Trichophyton erinacei were isolated. The clinical appearance of the infection was lupus erythematosus discoid-like, eczema-like, rosacea-like, especially on the face, impetigo-like and eczema-like on trunk and limbs. Less often the dermatophytosis resembled psoriasis, purpura, seborrhoic dermatitis and lichen planus. There was folliculitis in 9% of cases and dermatophytid in 3% of cases. Antimycotic therapy brought about clinical and mycological recovery in all patients except one, who had iatrogenic immunodepression.     

Infections by dermatophytes simulating neurodermatitis and psoriasis

Es wird über 58 Fälle von Infektionen durch Dermatophyten berichtet, von denen 45 eine Neurodermitis und 13 eine Psoriasis vortäuschten.
Beim Neurodermitis-Typ war Trichophyton rubrum mit 31 Isolaten der häufigste Erreger (69% der Fälle); danach kamen Epidermophyton floccosum (mit 8 Fällen = 18%), Trichophyton mentagrophytes — var. granulosum (mit 3 Fällen = 7%), Trichophyton tonsurans (mit 2 Fällen = 4%) und Trichophyton violaceum (1 Fall = 2%). Die Crural- und Perinealregion waren der bevorzugte Sitz dieser Art von Krankheitserscheinungen, doch waren auch andere Bezirke befallen (Unterschenkel, Ellenbogen, Achselhöhle usw.).
Bei der Psoriasis-ähnlichen Infektion wurde Trichophyton rubrum in 6 Fällen gefunden, Epidermophyton floccosum in 3, Trichophyton mentagrophytes in 2 Fällen, Trichophyton violaceum und Trichophyton verrucosum in je 1 Fall. Die letztgenannte Form variierte mehr im Hinblick auf den Sitz der Krankheitserscheinungen.     

Epidemiology of the Dermatophytoses in the Florence Area: 1982–84. II. Trichophyton rubrum Infections: Epidemiologie der Dermatophytosen in Florenz und Umgebung:1982–84. II. Trichophyton rubrum-Infektionen

Summary: 41.6% of the dermatophytoses observed in the Dept. of Dermatology at Florence between 1982 and 1984 were caused by Trichophyton rubrum. The most frequent dermatophytoses were tinea pedis, tinea cruris and tinea corporis, all of which particularly affected males. The data are compared to those of a previous study (1979–1981) showing that the incidence of tinea pedis and tinea cruris has increased since then. Certain unusual clinical cases are described.
Zusammenfassung: 41,6% der Dermatophytosen, die in den Jahren 1982 bis 1984 beobachtet wurden, wurden von Trichophyton rubrum verursacht. Die häufigsten Dermatophytosen waren Tinea pedis, Tinea cruris und Tinea corporis, vorwiegend beim männlichen Geschlecht Die Angaben werden mit jenen unserer vorherigen Untersuchungen (1979–1981) verglichen. Eine zunehmende Häufigkeit der Tinea pedis und der Tinea cruris wird beobachtet Es wird über einige besondere klinische Bilder berichtet.     

Inhibition of growth of dermatophytes by Indian hair oils.

A survey on the use of hair oils for hair dressings by the Indian population revealed that mustard oil is preferred by males and coconut oil by females. Amla oil is used equally by both. These oils contain different percentages of various saturated and unsaturated fatty acids which largely determine their toxicity against dermatophytes. For Microsporum canis, M. gypseum and Trichophyton rubrum, amla oil was most toxic, followed by cantharidine and coconut oil, while Trichophyton mentagrophytes was most susceptible to coconut oil followed by amla and cantharidine oil. Mustard oil showed least toxicity to all four test species. The rarity of tinea capitis in India has been concluded to be due to the common use of hair oils by the Indian population.     

Epidemiology of dermatomycoses in children living in Northern Greece 1996-2000

In the 5-years period, 1996-2000, 1045 children under 13 years old were examined for suspected dermatomycosis. In 611 cases fungi were isolated. Male children were mainly affected on the scalp and body area. Girls were more affected in the location of the arms and legs. There was a greater proportion of cases in the age range 2-12 years. The most prominent fungus was Microsporum canis (515 cases) followed by Trichophyton rubrum (34) and Candida albicans (20). Tinea capitis (280 cases) mainly caused by M. canis (276 cases) was the most common clinical form. Tinea corporis (109 cases) mainly caused by M. canis (88 cases), C. albicans (10 cases) and T. rubrum (seven cases) was the second most frequent clinical form.