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Host immune responses in dermatophytes infection
Giovanna Azevedo Celestrino1, John Verrinder Veasey2, Gil Benard1
1Laboratório de Micologia Médica - LIM-53, Divisão de Dermatologia Clínica, Faculdade de Medicina, Hospital das Clínicas and Instituto de Medicina Tropical de São Paulo, USP, São Paulo, Brazil.
Abstract:
Dermatophytosis is a skin infection caused by keratinophilic, filamentous fungi. These are highly prevalent, common mycoses, affecting approximately 20% of the population. These fungi invade the stratum corneum, and other keratinised tissues, like nails and hair, where they grow by secreting enzymes and degrading keratin to obtain nutrients. Clinical presentation is variable and may depend on many factors, such as the infection site, the host's immunity and the dermatophyte's virulence. Generally, patients with acute superficial dermatophytosis mount cell-mediated immune responses. However, those suffering from chronic or recurrent infections are unable to develop this response, for reasons yet unknown. Several reports have described severe and occasionally life-threatening invasive diseases (deep dermatophytosis) associated with genetic mutations in the innate immunity-associated molecule CARD9, displaying the need to better understand its immune response. These dermatoses have substantial clinical consequences, producing chronic and difficult to treat skin lesions. They also lead to a decline in the patient's quality of life and impact their self-esteem. This review summarises findings on the immune response against dermatophytes.
Insights
Dermatophytosis, a common fungal skin infection, affects 20% of people. Understanding the immune response is crucial for treating chronic cases and severe invasive diseases.
Area of Science:
- Mycology
- Immunology
- Dermatology
Background:
- Dermatophytosis is a prevalent superficial fungal infection affecting keratinized tissues.
- It impacts approximately 20% of the global population, causing significant quality of life decline.
- The immune response to dermatophytes varies, with chronic infections lacking effective cell-mediated immunity.
Purpose of the Study:
- To review the current understanding of the immune response against dermatophytes.
- To highlight the need for better understanding due to severe invasive cases linked to CARD9 mutations.
- To explore factors influencing clinical presentation and treatment outcomes.
Main Methods:
- Literature review of studies on dermatophytosis and host immune responses.
- Analysis of clinical presentations and etiological agents.
- Examination of genetic factors influencing susceptibility and disease severity.
Main Results:
- Acute infections typically elicit a cell-mediated immune response.
- Chronic or recurrent infections are associated with an impaired immune response.
- Genetic defects, such as in CARD9, can lead to severe, life-threatening invasive dermatophytosis.
Conclusions:
- The immune response to dermatophytes is complex and incompletely understood.
- Further research into immune mechanisms is essential for developing effective treatments for chronic and invasive forms.
- Understanding CARD9's role in innate immunity is critical for managing severe dermatophytosis.
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