Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review

Area of Science:

• Medical Mycology
• Infectious Diseases
• Immunology

Background:

• Dermatophytes are common worldwide fungal pathogens.
• While typically causing benign infections, they can manifest as severe, invasive diseases in immunocompromised individuals.
• Severe forms include extensive dermatophytosis, deep dermatophytosis, and Majocchi's granuloma.

Purpose of the Study:

• To review the characteristics of severe dermatophytosis in immunocompromised patients.
• To highlight diagnostic challenges and treatment considerations for these rare but serious infections.

Main Methods:

• Review of clinical manifestations and etiological factors of severe dermatophytosis.
• Discussion of diagnostic approaches, including mycological and histological findings.
• Analysis of current treatment strategies and their limitations.

Main Results:

• Severe dermatophytosis occurs in patients with primary (e.g., CARD9 deficiency) or acquired immunodeficiencies (e.g., HIV, transplantation, immunosuppressive therapy).
• Clinical presentation is often non-specific, with potential lymph node and organ involvement.
• Diagnosis relies on combined mycological and histological evidence.

Conclusions:

• Severe dermatophytosis poses a significant challenge in immunocompromised hosts.
• Effective treatment involves systemic antifungals like terbinafine and azoles.
• Long-term management necessitates consideration of infection extent and the specific underlying immunodeficiency.