Incidence and prevalence of dermatophytosis in and around Chennai, Tamilnadu, India

Background: Dermatophytes are group of fungi that infect keratinized tissues of human and animals. The group consist of three different genera namely, Trichophyton, Microsporum, Epidermophyton and several species within each genera. Among Trichophyton, Trichophyton rubrum is predominant, followed by various strains of Trichophyton mentagrophytes, which include both anthropophiles and zoophiles. Prevalence of dermatophytes varies with location and environmental condition. The infection is common worldwide with higher prevalence in tropical countries like India. Molecular diagnosis renders accurate identification of clinical dermatophyte isolates to species level. The main objective of this study was to determine the prevalence of dermatophytoses, isolate and identify the dermatophyte from samples of clinically suspected cases attending tertiary care centre using conventional and molecular methods.Methods: A total of 210 patients showing lesions typical of dermatophytes infection from outpatient Department of dermatology were sent to mycology unit, Department of Microbiology for the period of April 2011-March 2014 were studied. Diagnosis was confirmed by conventional and polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) technique.Results: Out of 210 samples received, tinea corporis was the predominant clinical site which was followed by tinea cruris. A total of 143 dermatophytes were isolated from the clinical samples. T. rubrum was the predominant etiological agent with 70/143 isolates and T. mentagrophytes was the second most common with 64/143 isolates. Amplification of internal transcribed spacers (ITS) was successful in all the clinical isolates by PCR and produced species specific banding pattern in RFLP using restriction enzyme Mva I.Conclusions: Among dermatophytoses, T. rubrum was the predominant etiological agent present in the whole of Chennai District and T. mentagrophytes takes the second place

Pattern of susceptibility to azoles by E test method in candidemia patients

Background: Blood stream infections due to Candida sp have considerably increased in recent years, along with the increase of drug-resistant isolates in immunocompromised patients. This increase in resistance makes it important to determine the antifungal susceptibility profile of each Candida species isolated from blood prior to treatment. Hence, this study was done to detect the resistant strains of Candida causing candidemia.Methods: About Seventy Candida species isolated from blood cultures were used for this study. These included 27 Candida albicans, 23 Candida tropicalis, 8 Candida parapsilosis, 3 Candida krusei, 2 Candida glabrata and 7 other candida species. Minimum inhibitory concentrations (MIC) of the most commonly used azoles like fluconazole, ketoconazole, itraconazole and voriconazole were determined by E test method.Results: The resistance percentage of Candida albicans for fluconazole and itraconazole was 11.1% and 7.4%; fluconazole resistance in Candida tropicals was 8.7%. Candida parapsilosis had good activity against all azoles with only 12.5% resistance for itraconazole.Conclusions: Fluconazole had good activity against most of the Candida sp except for Candida glabrata and Candida krusei with MIC 90 > 256 µg/ml. Itraconazole was less effective for Candida albicans, Candida glabrata and Candida parapsilosis (MIC 90 >32 µg/ml). Voriconazole was found to be the most effective drug against all species of Candida with low MIC values (MIC 90 < 0.25 µg/ml). Hence it can be used to treat blood stream infections caused by Candida species.

Rise of Mucormycosis during the COVID-19 Pandemic and the Challenges Faced

Mucormycosis (previously called zygomycosis) is a diverse group of increasingly recognized and frequently fatal mycotic diseases caused by members of the class zygomycetes. Mucormycosis is around 80 times more common in India, compared to other developed countries, with a frequency of 0.14 cases per 1,000 population. The most frequent causative agent of mucormycosis is the following genera from the Order Mucorales: Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella, and Saksenaea. The major risk Mucormycosis (previously called zygomycosis) is a diverse group of increasingly recognized and frequently fatal mycotic diseases caused by members of the class zygomycetes. Mucormycosis is around 80 times more common in India, compared to other developed countries, with a frequency of 0.14 cases per 1,000 population. The most frequent causative agent of mucormycosis is the following genera from the Order Mucorales: Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella, and Saksenaea. The major risk factors for the development of mucormycosis are diabetic ketoacidosis, deferoxamine treatment, cancer, solid organ or bone marrow transplantations, prolonged steroid use, extreme malnutrition, and neutropenia. The common clinical forms of mucormycosis are rhino-orbital-cerebral, pulmonary, cutaneous, and gastrointestinal. During the second wave of COVID-19, there was a rapid increase in mucormycosis with more severity than before. Amphotericin B is currently found to be an effective drug as it is found to have a broad spectrum activity and posaconazole is used as a salvage therapy. Newer triazole isavuconazole is also found effective against mucormycosis. This article aimed to review various studies on the laboratory diagnosis and treatment of mucormycosis

Schizophyllum Commune a Causative Agent of Fungal Sinusitis: A Case Report

We present a case of maxillary sinusitis caused by Schizophyllum commune, in a 50-year-old female. The patient presented with nasal obstruction, purulent nasal discharge from right side of the nose, cough, headache, and sneezing. Computed tomography revealed extensive opacity of the right maxillary sinus as well as erosion of the nasal wall and maxillary bone. Functional endoscopic sinus surgery was done, and fungal debris present on right side of the maxillary sinus was removed and sent to laboratory. Potassium hydroxide (KOH) examination of the nasal discharge showed hyaline, septate hyphae. Primary isolation on Sabouraud's dextrose agar (SDA) yielded a white woolly mould. Banana peel culture after 8 weeks showed macroscopically visible fan-shaped fruiting bodies. Lactophenol cotton blue (LPCB) mount of the same revealed hyaline septate hyphae, often with clamp connections. Identification was confirmed by the presence of clamp connections formed on the hyphae and by vegetative compatibility with known isolates

Evaluation of antifungal susceptibility testing in Candida isolates by Candifast and disk-diffusion method

With the increase in invasive fungal infections due to Candida species and resistance to antifungal therapy, in vitro antifungal susceptibility testing is becoming an important part of clinical microbiology laboratories. Along with broth microdilution and disk diffusion method, various commercial methods are being increasingly used for antifungal susceptibility testing, especially in the developed world. In our study, we compared the antifungal susceptibility patterns of 39 isolates of Candida to three antifungal drugs (fluconazole, amphotericin B, ketoconazole) by Candifast and disk diffusion method. The following resistance pattern was found by Candifast: Fluconazole (30.8%), ketoconazole (12.8%), amphotericin B (0%). The results obtained by disk diffusion method were in complete agreement with Candifast results

Postoperative fungal endophthalmitis due to Basidiobolus ranarum: Report of a rare case

Postoperative fungal endophthalmitis is a significant cause of visual loss due to the rapid progress and severe inflammation. Management is dictated by the precise identification of fungus subspecies, choice of antifungal agent, and associated systemic features. We report a rare case caused by Basidiobolusranarum, never known to have caused endophthalmitis or any form of ocular infection or inflammation. A 59-year-old, Asian, immunocompetent, agriculturist presented with endophthalmitis on the 3 rd postoperative day. Smear and culture from the aqueous and vitreous samples detected a species of fungus called Basidiobolusranarum. Fungal endophthalmitis should be suspected even in patients who present in the early postoperative period and rare species considered even in immunocompetent individuals. Early detection and aggressive treatment is necessary for preventing morbidity or mortality due to these infections