Frequency of culture-proven dermatophyte infection in patients with suspected tinea pedis

BACKGROUND: This study examined the incidence of culture-proven tinea pedis in patients who presented with a foot rash clinically suspected to be tinea pedis. METHODS: Cultures were taken from 874 patients in 4 dermatology clinics across the country. The incidence of patients with positively cultured tinea pedis was compared with the total number of patients in the study. RESULTS: The surprisingly low percentage of patients correctly diagnosed with tinea pedis was determined to be 32%. The remaining 68% of patients either had a nonfungal foot dermatitis or tinea pedis with false-negative cultures. CONCLUSIONS: This study demonstrates the need for fungal cultures when patients present with scaling feet as well as the importance of a broad differential diagnosis to ensure timely and appropriate therapy.     

The prevalence of skin eruptions and mycoses of the buttocks and feet in aged care facility residents: A cross-sectional study

The prevalence of skin mycoses in the elderly remains unclear. The proportion of people with skin eruptions who are positive for mycoses using direct microscopy is not known. The purpose of this study is to identify the prevalence of skin eruptions and skin mycoses (e.g. candidiasis and tinea) in the buttocks and feet, which are common sites of skin mycoses in residents of long-term care facilities. This multi-site cross-sectional study used visual inspection and direct microscopy to diagnose the type of skin eruption. Subjects were residents of facilities covered by long-term care insurance schemes in Japan. Of the 171 residents enrolled in this study, 72.5% had a skin eruption. Only 4.8% of participants had tinea in the buttocks; 2.4% had buttock candidiasis. In those with a nail abnormality, 58.3% of residents had tinea unguium. For tinea pedis, residents who had any form of interdigital or plantar region skin eruption, 22.5% and 31.4% of residents were positive, respectively. The prevalence of observed skin mycoses was: buttock candidiasis 1.8%; buttock tinea 3.5%; tinea unguium 56.2%; interdigital tinea pedis 20.5%; and plantar tinea pedis 22.5%. The very low proportion of residents with mycoses in the buttocks suggests that anti-inflammatory agents, such as steroids, should be used as first choice. Our observation that not all residents with skin eruptions on the feet had tinea, should remind clinicians to perform direct microscopy before initiating antifungal treatments.     

Common viral and fungal skin infections

Skin infections account for a significant portion of dermatologic diseases, often resulting in, or as a consequence of a disruption in the skin's integrity. This paper covers the presentation, diagnosis, and treatment of the more common viral and fungal skin infections. The viral infections presented in this paper include herpes simplex virus, herpes zoster, condyloma acuminata, and molluscum contagiosum. The fungal infections presented include tinea pedis, tinea cruris, tinea capitis, tinea unguium, tinea versicolor, and candidiasis. Once a diagnosis is made, treatment with appropriate antifungal, antiviral, destructive, or immune modifying therapies can be instituted.     

From animal to man: Tinea barbae

Dermatophytic fungi cause human infection worldwide. One clinical syndrome—tinea barbae, which closely resembles tinea capitis—is a trichophytosis involving the beard and mustache areas of the face. The fungal agents responsible for tinea barbae (Trichophyton verrucosum and Trichophyton mentagrophytes) are contracted through occupational exposure to animals infected with zoophilic dermatophytes. Tinea barbae may be confused with other facial infections, especially those caused by Staphylococcus aureus or other facial dermatophytes (usually anthrophilic). In an afebrile patient without leucocytosis, a distinctive facial lesion, called a kerion, can be the essential diagnostic finding. Diagnosis requires suspicion based on appropriate exposure. Definitive diagnosis requires a combination of clinical examination, direct microscopic examination using potassium hydroxide, and culture confirmation. Topical treatment is not effective. Oral therapy with an antifungal (eg, terbinafine) or an azole is recommended. This article reviews these factors, as well as germane epidemiologic and prevention measures.     

Fungal foot infection,cellulitis and diabetes: a review

Aims To review the current evidence for the presence of fungal foot infection (tinea pedis and toenail onychomycosis) as a risk factor for the development of cellulitis within the lower limb, particularly for those individuals with diabetes. Methods A structured review of medline , embase and cinahl databases was undertaken to identify publications investigating fungal foot infection as a risk factor for the development of cellulitis. Results Sixteen studies were identified. Eight studies adopted a case–control methodology, with the remainder being cross‐sectional surveys. The majority of studies established the presence of tinea infection by clinical rather than established microbiological methods. Although the majority of papers suggested a link, only two case–control studies employed microbiological diagnosis to demonstrate that fungal foot infection was a risk for the development of lower limb cellulitis, particularly when infection was located between the toes. There were insufficient data to suggest that fungal foot infection posed an increased risk to patients with diabetes. Conclusion There is some evidence to suggest that fungal infection of the foot is a factor in the development of lower limb cellulitis, but further robust research is needed to confirm these findings and quantify the risk that fungi pose, particularly to the diabetic foot. Meanwhile, improved surveillance and treatment of tinea infections on the foot by healthcare professionals should be encouraged to reduce potential complications.     

交叉引物恒温扩增检测技术在疑似肺结核患者临床诊断中的价值

目的 评估交叉引物恒温扩增(cross priming amplification, CPA)检测技术在肺结核早期临床诊断中的应用价值。 方法 以2016年1—10月广东省佛山市和江门市及所辖7个县(区)级结核病防治机构(简称“结防机构”)就诊的初诊疑似肺结核患者为研究对象,共纳入患者6507例;所有患者均进行了胸部影像学检查并送检痰标本进行涂片镜检、固体培养和CPA检测,培养阳性菌株进行菌种鉴定,项目点临床医生结合实验室和临床检查结果对纳入患者进行初诊诊断,国家级临床专家对初诊临床诊断结果进行现场复核。分析项目地区确诊活动性肺结核患者中病原学阳性患者所占比例,并与专家复核后的临床诊断结果进行比较,分析涂片镜检、固体培养和CPA诊断肺结核的敏感度及特异度。 结果 6507例疑似肺结核患者中,涂片镜检、固体培养和CPA检测阳性率分别为18.2%(1187/6507)、25.0%(1629/6507)和23.9%(1555/6507)。3199例临床确诊为活动性肺结核患者中,涂片联合培养阳性检出率为48.5%(1550/3199),涂片联合CPA阳性检出率为47.9%(1531/3199),涂片、培养和CPA三种方法联合检测阳性率为54.4%(1740/3199)。以临床诊断结果为标准,涂片镜检、固体培养和CPA检测诊断活动性肺结核的敏感度分别为35.0%(1120/3199)、46.4%(1485/3199)和44.6%(1428/3199),特异度分别为98.0%(3241/3308)、95.7%(3164/3308)和96.2%(3181/3308)。 结论 县(区)级结防机构可应用CPA检测技术用于疑似肺结核患者的快速诊断,多种诊断技术联合应用可显著提高活动性肺结核患者的病原学诊断阳性率。     

Mycotic infections. Effective management of conditions involving the skin, hair, and nails

Superficial mycotic infections of the skin, hair, or nails are recurring presentations in the geriatric primary care setting. The most common infections are those caused by dermatophytes. The genus Trichophyton gives rise to most of the tinea dermatophytoses, including tinea capitis, tinea pedis, and tinea unguium (onychomycosis). Part of the diagnostic challenge lies in distinguishing the mycotic lesions from those caused by cutaneous diseases such as psoriasis, eczema, dyshidrosis, and contact dermatitis. Because environmental conditions play a major role in fungal infection onset, clinical management should include patient education about conditions conducive to fungal propagation. Oral agents are the primary mode of treatment for fungal infections of the scalp and nails, whereas topical treatments are frontline agents for other superficial skin conditions.     

Dysidrose : étude étiologique et apport des tests épicutanés

The etiology of pompholyx (dyshidrotic eczema) is a challenging diagnostic problem. The only established etiological link is between dyshidrosis and tinea pedis. Here, we report the results of a review of the causes of dyshidrosis in our patient population, focussing on allergic aspects. This was a prospective study carried out between June, 2003 and May, 2004. Epidemiological and clinical data were obtained for all the patients. They all had patch tests with the European patch test series. Sixty-two patients with pompholyx were included. Gender distribution was equal and the mean age of the patients was 31 years. Tinea pedis was reported in 35.5% of the patients. The patch tests were positive in 35.5% and relevant in 19% of the cases. The statistical analysis showed, on one hand, a significant relationship between gender and a positive patch test to nickel, and on the other hand, between work in a hot, wet environment and a positive patch test to chromium. These results revealed evidence of an increased frequency of tinea pedis and of sensitization to metals in patients with pompholyx compared to the general population. This suggests that in the development of pompholyx, sensitization to metals may be involved in a multifactorial process that includes both environmental and personal factors. However, we could not demonstrate a causal relationship between metal sensitization and pompholyx. Nevertheless, common factors might be involved in generating these two skin conditions.     

设计性实验在医学微生物学教学中的尝试

以2006级临床医学本科生为研究对象,在医学微生物学教学中开设"医学生浅部真菌感染的调查与分析"设计性实验课,并对实验结果和教学效果进行分析。结果显示,浅部真菌的感染与环境及个人卫生状况相关,男生感染率高于女生,且以足癣最为常见。设计性实验的实施,理论与实践相结合,不但提高了学生运用所学理论知识分析和解决实际问题的能力,同时也增强了学生学习的兴趣和主动性。     

侵袭性真菌病实验室诊断方法临床应用专家共识

侵袭性真菌病的诊断引起临床多学科关注,早期确切诊断是改善患者预后的关键。其方法主要包括真菌直接镜检、真菌培养和鉴定、真菌血清学检查、分子生物学检测和组织病理学检查。为了促进临床医师深入了解并合理应用这些方法,提高侵袭性真菌病诊断水平,我们邀请多学科专家共同编写了此共识。本共识对侵袭性真菌病诊断方法的应用人群、送检要求、结果解读及临床意义进行了介绍并提出建议,强调对于侵袭性真菌病高危患者,应综合应用多种诊断方法、正确取材送检、提高结果解读能力、了解不同方法的临床意义,以便合理应用,更好地服务于患者。     

侵袭性真菌病实验室诊断方法临床应用专家共识

侵袭性真菌病的诊断引起临床多学科关注,早期确切诊断是改善患者预后的关键。其方法主要包括真菌直接镜检、真菌培养和鉴定、真菌血清学检查、分子生物学检测和组织病理学检查。为了促进临床医师深入了解并合理应用这些方法,提高侵袭性真菌病诊断水平,我们邀请多学科专家共同编写了此共识。本共识对侵袭性真菌病诊断方法的应用人群、送检要求、结果解读及临床意义进行了介绍并提出建议,强调对于侵袭性真菌病高危患者,应综合应用多种诊断方法、正确取材送检、提高结果解读能力、了解不同方法的临床意义,以便合理应用,更好地服务于患者。     

Office practice-based confirmation of onychomycosis: a US nationwide prospective survey

BACKGROUND: Onychomycosis is sufficiently prevalent to be seen and treated by primary care physicians. The diagnosis of onychomycosis is most often confirmed from nail specimens by microscopy and fungal culture done at a central laboratory; these are relatively expensive tests with a turnaround time of a month or more. This study was conducted (1) to evaluate the use of in-office dermatophyte test medium (DTM) culture, and (2) to determine the epidemiology of onychomycosis in a large, nationwide sample of patients who were not participants in a clinical trial. METHODS: A nationwide sample of primary care physicians and podiatrists enrolled 670 patients with clinical signs of toenail onychomycosis. Dermatophyte test medium cultures were performed in the office and the results were compared with fungal cultures performed by a central laboratory. RESULTS: Central laboratory fungal cultures were positive in 44% (n = 297) of patients and DTM cultures in 51% (n = 345). Dermatophytes accounted for 93% of the confirmed infections and nondermatophyte molds the rest. In the 617 patients with paired dermatophyte test medium and laboratory fungal culture results, the 2 tests were in agreement (both positive or both negative) in 68% of cases (kappa, 0.37; asymptotic SE, 0.04; 95% confidence interval, 0.299-0.441). CONCLUSIONS: A DTM culture is a relatively rapid, easy, and inexpensive method to confirm dermatophyte infections in patients with signs of onychomycosis in the primary care setting. Because the available drugs for treating onychomycosis are effective against all dermatophyte species, the confirmation of dermatophyte infection, without further identification of genus and species, is sufficient evidence to begin treatment.     

实时荧光PCR技术在不同类型结核病诊断中的应用价值

目的 分析比较实时荧光PCR与涂片镜检、培养三种方法在结核杆菌检测的差异.方法 对我院疑似结核病患者的临床标本同时进行实时荧光PCR检测、涂片镜检和培养,将三组检测结果进行比较.结果 215例疑似肺结核患者痰标本同时采用实时荧光PCR、涂片镜检和培养三种方法检测,阳性检出率分别为46.5％、32.6％和44.7％.实时荧光PCR法与涂片镜检法的阳性率间比较有统计学意义,实时荧光PCR法与培养法的阳性率同比较无统计学意义.112例疑似其他类型结核病患者的胸腹水、脑脊液、穿刺液和尿液等非痰标本同时采用上述三种方法检测,阳性率分别为18.8％、3.6％和16.1％.统计学意义同上.结论 实时荧光PCR检测技术在临床上对结核病的诊断和鉴别具有较好的应用价值.     

老年人肺部真菌感染38例尸检分析

目的　探讨老年人肺部真菌感染的临床特征与早期诊断。　方法　分析１９７７～１９９７ 年经尸检证实的老年人肺部真菌感染３８ 例。　结果　在原发病中，恶性肿瘤和感染性疾病共２４ 例，占６３０％ 。临床表现和胸部Ｘ线征象对诊断老年人肺部真菌感染缺乏特异性。痰真菌培养１５ 例中１２ 例阳性，阳性率为８００％ 。　结论　对于老年或免疫系统功能受损害的患者，要警惕合并肺部真菌感染，并应及早进行病原学检查。     

A ten-year survey of Tinea pedis in the central region of the Rio Grande do Sul, Brazil.

Tinea pedis in the most common type of dermatophytosis, but can mimic many cutaneous diseases and tend to be chronic. We present a study of the frequency, epidemiology and clinical aspects of tinea pedis in the central region of Rio Grande do Sul during the period 1988-1997.     

The reaction to trichophytin in dermatophytoses]

The authors investigated the specific immunological competence of 31 patients with dermatophytosis using tricophytin antigen. Among them, 54.8% showed reaction to the delay phase (48 h) in the following proportions: tinea inguinale, 75%; tinea pedis, 61.5%; tinea unguium, 50% and tinea corporis, 20%. Other 62.5% showed positive result to the early phase (30 m). The association between these reactions revealed that, although the majority of cases with early positive reaction showed negativity to the delayed reaction, 20.8% presented positively to both phases of the reaction. Out of the non-reactive patients to the delayed phase, 8 were submitted to the other cutaneous tests such as PPD, streptokinase, candidin, vaccinia and DNCB and showed preserved cellular immunity in 75%. These results suggest that, while using this reaction for immunological evaluation of patients with dermatophytosis, one should consider the overall immune status of the patient, the presence of early hypersensibility and the localization of the infection.     

传染性肺结核病例不同检出和诊断方法评价

目的比较和评价基于胸透筛选的诊断规程与直接痰涂片方法检出、诊断传染性肺结核的效率和效益。方法对有可疑肺结核病症状者，采用胸透、拍摄胸片、痰涂片和痰培养４项检查。结果世界银行贷款中国结核病控制项目省的诊断规程，对涂阳、培阳和菌阳病例的漏检分别可达１０．５％、２８．３％、２８．２％，且较直接痰涂片方法诊断准确性差，支付费用高。结论直接痰涂片法为检出、诊断涂阳新病例的最佳方法，适用于我国广大农村地区。     

Dermatophytoses in children: study of 137 cases

Dermatophytoses are common fungal infections caused by dermatophytes but there are few data about this condition in the childhood. 137 children below the age of 12 and clinically diagnosed as tineas were investigated prospectively at Instituto de Puericultura e Pediatria, Rio de Janeiro, from 1994 to 1999. Hair, skin/nails scraping and pus swabs were collected from lesions and processed for fungus. Male children from 2 to 12 years were mostly affected; tinea capitis (78 cases) mainly caused by Microsporum canis (46 cases) was the most common clinical form. Tinea corporis (43 cases) mainly caused by Trichophyton rubrum (17 cases) accounted for the second most frequent clinical form. Tinea cruris (10 cases) with Trichophyton rubrum (5 cases) as the most common etiologic agent accounted for the third most frequent clinical form. Tinea pedis and tinea unguium were much less frequent (3 cases each). Trichophyton rubrum was the most common etiologic agent isolated in these cases (3 cases).     

结核分支杆菌镜检、培养和PCR技术诊断结核病的临床评估

目的　评估结核分支杆菌PCR、培养、镜检对结核病诊断的临床效果。方法 对1217例临床可疑结核病人用PCR、培养和镜检三种方法的阳性检出率进行比较。结果 不同临床标本用PCR技术诊断结核病,其敏感性高于培养和涂片镜检,阳性检出率分别为:88.7%,43.4%,26.5%。结论 通过三种方法比较分析,说明PCR技术是一种速度快、检出率高的检测结核分支杆菌的重要方法,对结核病的诊断有重要的参考价值。     

猪小孢子菌所致头癣的扫描电镜观察

本文报告我国首见的由猪小孢子菌所引起的头癣,经真菌KOH直接镜检、培养检查及病发扫描电镜检查确诊。这种人兽共患病虽然比较少见,但值得引起重视,注意防制。