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Etiological prevalence and antifungal sensitivity patterns of dermatophytosis in India - A multicentric study
Sushil Tahiliani1, Abir Saraswat2, A K Lahiri3
1Dr. Tahiliani's Clinic, A 201/202, Gasper Enclave Ambedkar Road, Pali Market, Next to Gold's Gym, Bandra West, Mumbai, Maharashtra, India.
Background:
The prevalence of dermatophytes varies with season, geographical area, socio-economic factors and effective management strategies.
Aims:
The aim of the study was to assess the prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infection, and in vitro antifungal drug susceptibility testing against dermatophytes.
Methods:
Three hundred and ninety five patients with dermatophytosis were enrolled from five cities (Mumbai, Delhi, Lucknow, Kolkata and Hyderabad) across India. All patients were subjected to clinical examination and investigations, including potassium hydroxide microscopy, fungal culture and antifungal drug susceptibility testing.
Results:
Trichophyton rubrum was the most common species identified (68.4%), followed by T. mentagrophytes (29.3%). Within species, T. mentagrophytes was prevalent in humid environmental conditions (Mumbai and Kolkata), whereas T. rubrum was prevalent in noncoastal areas (Delhi, Lucknow and Hyderabad). Tinea corporis (71.4%) and tinea cruris (62.0%) were the common clinical types observed. antifungal drug susceptibility testing data indicated that minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC-90) was lowest for griseofulvin (0.25-3.0 μg/mL). Among oral antifungals, the mean MIC of itraconazole was within the range (0.84 [0.252] μg/ mL), whereas high mean MIC values were reported for terbinafine (0.05 [0.043] μg/mL). Among topical agents, lowest mean MIC values were reported for luliconazole (0.29 [0.286] μg/mL), eberconazole (0.32 [0.251]) μg/mL and amorolfine (0.60 [0.306]) μg/mL.
Limitations:
Lack of correlation between in vitro antifungal susceptibility and clinical outcome and absence of defined MIC breakpoints.
Conclusion:
T. rubrum was the most common, followed by T. mentagrophytes as an emerging/codominant fungal isolate in India. Tinea corporis was the most common clinical type of dermatophytosis. Mean MIC of terbinafine was above the reference range, while it was within the range for itraconazole; griseofulvin had the lowest mean MIC. Luliconazole presented the lowest mean MIC values across cities.
Insights
Trichophyton rubrum is the most common cause of fungal skin infections in India, with Tinea corporis being the most frequent clinical presentation. Luliconazole showed the lowest mean minimum inhibitory concentration (MIC) values against dermatophytes.
Area of Science:
- Medical Mycology
- Dermatology
- Infectious Diseases
Background:
- Dermatophyte prevalence is influenced by environmental and socio-economic factors.
- Understanding regional variations in fungal infections is crucial for effective management.
- Geographical and seasonal variations impact dermatophyte prevalence.
Purpose of the Study:
- To determine the prevalence of pathogenic dermatophytes in India.
- To identify common clinical types of dermatophytosis.
- To evaluate the in vitro susceptibility of dermatophytes to various antifungal agents.
Main Methods:
- Clinical examination and laboratory investigations were performed on 395 patients with dermatophytosis across five Indian cities.
- Diagnostic methods included potassium hydroxide (KOH) microscopy and fungal culture.
- Antifungal drug susceptibility testing was conducted using established protocols.
Main Results:
- Trichophyton rubrum (68.4%) was the predominant species, followed by T. mentagrophytes (29.3%).
- Tinea corporis (71.4%) and tinea cruris (62.0%) were the most prevalent clinical diagnoses.
- Griseofulvin exhibited the lowest minimum inhibitory concentration (MIC-90). Luliconazole demonstrated the lowest mean MIC among topical agents.
Conclusions:
- Trichophyton rubrum remains the leading cause of dermatophytosis in India, with T. mentagrophytes emerging as a co-dominant isolate.
- Tinea corporis is the most common clinical manifestation.
- Variations in antifungal susceptibility were observed, with griseofulvin showing the lowest MIC and luliconazole the lowest among topical agents.
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