Diagnosing the superficial fungal infection is important for initiating appropriate treatment and epidemiological purposes. Dermatophytes cause the majority of these infections. The rising prevalence of these infections worldwide, increased and uncontrolled use of antifungals and corticosteroids, rising burden of the immune-compromised population, and antifungal drug resistance pose therapeutic challenges to practitioners. The study's main objective was to isolate, identify and determine the antifungal susceptibility of the dermatophytes causing superficial mycosis. This was a cross-sectional study from a tertiary care centre in South India. Samples were collected from 130 patients clinically diagnosed to have dermatophytosis. All the samples were examined by microscopy using a KOH mount and culture. Species identification was done by slide culture and Lactophenol Cotton Blue mount, and performed antifungal susceptibility testing against common antifungals by broth microdilution method. Descriptive statistics expressed the nominal variables' number of cases and percentage (%). On analysis, the males to females’ ratio was 1.7:1. Adults were affected more than children. Tineacorporis was the commonest clinical type (65.3%), followed by tineacruris (26.2%). Among the clinically diagnosed dermatophytosis, KOH mount had a higher positivity rate over yield in culture (69.2% versus 48.4%). Trichophyton mentagrophytes were the commonest isolate, 38 (60.3%), followed by Trichophyton rubrum 23 (36.5%). Voriconazole was found to have low MIC values for most of the isolates tested compared to the standard strain. The percentage of isolates having higher MIC than the standard for Itraconazole, amphotericin B, terbinafine, and fluconazole were 11.6%, 20.9%, 32.5%, and 41.8%, respectively. Most isolates had higher MIC for griseofulvin, suggesting resistance in South India. The findings conclude that the direct microscopic examination by KOH mount was more sensitive than culture, and the most common fungal pathogen isolated was Trichophyton mentagrophytes. Griseofulvin showed the least activity among the six antifungals tested, and voriconazole performed best with the least number of isolates with high MIC.
Patwardhan N, Dave R. Dermatomycosis in and around Aurangabad. Indian J Pathol Microbiol. 1999Oct;42(4):455-62. PMID 11127378.
Bhagra S, Ganju SA, Kanga A, Sharma NL, Guleria RC. Mycological pattern of dermatophytosis in and around Shimla hills. Indian J Dermatol. 2014May;59(3):268-70. doi: 10.4103/0019-5154.131392, PMID 24891658.
LohouéPetmy J, Lando AJ, Kaptue L, Tchinda V, Folefack M. Superficial mycoses and HIV infection in Yaoundé. J EurAcadDermatolVenereol. 2004May;18(3):301-4.
Venkatesan G, Singh AJ, Murugesan AG, Janaki C, Shankar SG. Trichophyton rubrum-the predominant etiological agent in human dermatophytoses in Chennai India. Afr J Microbiol Res.2007;1(1):9-12.
Mukherjee PK, Leidich SD, Isham N, Leitner I, Ryder NS, Ghannoum MA. Clinical Trichophyton rubrum strain exhibiting primary resistance to terbinafine. Antimicrob Agents Chemother.2003Jan;47(1):82-6. doi: 10.1128/AAC.47.1.82-86.2003, PMID 12499173.
Osborne CS, Leitner I, Favre B, Ryder NS. Amino acid substitution in Trichophytonrubrumsqualeneepoxidase associated with resistance to terbinafine. Antimicrob Agents Chemother.2005;49(7):2840-4. doi: 10.1128/AAC.49.7.2840-2844.2005, PMID 15980358.
Sarifakioglu E, Seçkin D, Demirbilek M, Can F. In vitro antifungal susceptibility patterns of dermatophyte strains causing tinea unguium. ClinExp Dermatol.2007Nov;32(6):675-9. doi: 10.1111/j.1365-2230.2007.02480.x, PMID 17714532.
Sardana K, Kaur R, Arora P, Goyal R, Ghunawat S. Is antifungalresistance a cause for treatmentfailure in dermatophytosis: A studyfocused on TineaCorporis and cruris from a tertiarycentre?Indian Dermatol Online J.2018Mar-Apr;9(2):90-5. doi: 10.4103/idoj.IDOJ_137_17, PMID 29644192.
Forbes BA, Sahm DF, Weissfeld AS.Laboratory methods in Basic Mycology in Bailey and Scotts Diagnostic.Microbiology;12th edition.p 662-716.
CLSI. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi: approved standard.2nded. CLSI document M38-A2. Wayne, PA: Clinical and Laboratory Standards Institute; 2008.
Cm G, K T, S T, Y R, S N, Ag D. Current trends of Clinico mycological profile of Dermatophytosis in CentralIndia. IOSRJDMS. 2014;13(10):23-6. doi: 10.9790/0853-131032326.
Patel P, Mulla S, Patel D, Shrimali G. A study of superficialmycosis in South Gujarat region. Natl J Community Med.2010;1(2):85-8.
Hitendra KB, Dhara JM,Nidhi KS.Hetal S S. A study of superficial mycoses with clinical mycological profile in tertiary care hospital in Ahmedabad, Gujarat. NatlJ MedRes.2012;2(2):60-164.
Poluri LV, Indugula JP, Kondapaneni SL. Clinicomycological study of dermatophytosis in South India. J Lab Phys.2015;7(2):84-9. doi: 10.4103/0974-2727.163135, PMID 26417157.
Singh S, Beena PM. Profile of dermatophyte infections in Baroda. Indian J Dermatol Venereol Leprol Venereol Leprol2003. 2003;69(4):281-3. PMID 17642912.
Sharma P, Sharma S. Non-dermatophytes emerging as predominant cause of onychomycosis in a tertiary care centre in rural part of Punjab, India. J AcadClinMicrobiol.2016;18(1):36-9. doi: 10.4103/0972-1282.184754.
Ranganathan S, Menon T, SelviSG, Kamalam A. Effect of socio-economic status on the prevalence of dermatophytosis in Madras. Indian J Dermatol Venereol Leprol Venereol Leprol1995. 1995;61(1):16-8. PMID 20952864.
Prasad PV, Priya K, Kaviarasan PK, Aanandhi C, Sarayu L. A study of chronic dermatophyte infection in a rural hospital. Indian J Dermatol Venereol Leprol Venereol Leprol2005. 2005;71(2):129-30. doi: 10.4103/0378-6323.14003, PMID 16394392.
Kannan P, Janaki C, Selvi GS. Prevalence of dermatophytes and other fungal agents isolated from clinical samples. Indian J Med Microbiol.2006;24(3):212-5. doi: 10.1016/S0255-0857(21)02353-7, PMID 16912443.
Prasad N, Mahapatra A, Chayani N. Changing trends in the fungal isolates from clinical specimens of suspected superficial mycoses. Indian MedGaz. 2013Feb;13(1):60-2.
Rajagopalan M, Inamadar A, Mittal A, Miskeen AK, Srinivas CR, Sardana Ket al.Expert consensus on the management of dermatophytosis in India (ectodermIndia). BMC Dermatol. 2018Dec;18(1):6. doi: 10.1186/s12895-018-0073-1, PMID 30041646.
Milne LJR. Fungi. In:Collee JG, Marmion BP, Fraser AG, Simmons A editors. Mackie& McCartney Practical Medical Microbiology.14thed.SGBAmyes. Churchill Livingstone; 2007.p.695-720.
Bindu V, Pavithran K. Clinico – mycological study of dermatophytosis in Calicut. Indian J Dermatol Venereol Leprol Venereol Leprol2002. 2002;68(5):259-61. PMID 17656961.
Sowmya N, Appalaraj B, Srinivas CR, Surendran P. Antifungal susceptibility testing for dermatophytes isolated from clinical samples by broth dilution method in a tertiary care hospital.J Med Res.2015;1(2):64-7. doi: 10.31254/jmr.2015.1208.
Noronha TM, Tophakhane RS, Nadiger S. Clinico-microbiological study of dermatophytosis in a tertiary-care hospital in North Karnataka. Indian Dermatol Online J.2016;7(4):264-71. doi: 10.4103/2229-5178.185488, PMID 27559499.
YadavAet al. Optimization and isolation of dermatophytes from clinical samples and in vitroantifungal susceptibility testing by disc diffusion method. RespirRes.2013;2(3):19-34.