<p>Sir,</p> <p>Incidence rates of fungal infections have increased significantly over the last 15 to 20 years. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>This disorder is significant due to clinical consequence with respect to its contagious nature, cosmetic consequences, chronicity, recurrences, and therapeutic difficulties.</p> <p>The present study was done to assess the clinico-epidemiological profile of fungal infections, species identification, and to compare clinical diagnosis with direct microscopy and culture positivity from clinically suspected cases. From March to August 2011, 80 specimens were processed from clinically suspected cases of dematophytosis/dermatomycosis attending the Dermatology Out Patient Department and sent to Microbiology for mycological work-up. Specimens included skin scales, hair, nails (superficial mycoses), and tissue (deep mycoses). Specimens were analyzed by direct microscopy and subjected to culture study (Sabouraud′s Dextrose Agar, cornmeal agar, blood agar).</p> <p>Pathogens were differentiated from contaminants following these guidelines: (1) Dermatophyte isolated on culture was considered a pathogen, (2) a non-dermatophyte mould (NDM) or yeast cultured was significant only if direct microscopy was positive and (3) NDM required repeated isolation. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>Most common age group among the 80 patients analyzed were 31-40 years (31.25%). Male to female ratio was 1.5:1 which could be the result of more outdoor activities, traumas and common use of occlusive footwear in males, a finding similar to Singh et al. (M:F- 1.3:1) <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>but contrary to Sahai et al. (M:F - 2:1). <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup></p> <p>Most common fungal isolates were dermatophytes 19/30 (63.33%) of which 8/30 (26.66%) were Microsporum audouinii <xref ref-type="table" rid="T1">Table 1</xref>. There were three cases (3.75%) where direct microscopy (10% Potassium Hydroxide 10% KOH mount) showed sclerotic bodies suggestive of chromoblastomycosis but were culture negative. Among dermatophytoses, 11 isolates were obtained from nail, 2 from scalp/ scalp hair, and 6 from skin scales.{Table 1}</p> <p>M. audouinii was the main isolate from nails/skin scales contrary to other studies where Trichophyton rubrum is commonly reported. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref6">6</xref> </sup>This finding may perhaps mark the change in spectrum of dermatophytic infections but further studies need to be done. Isolation rate in this study seemed to be lower (37.50%) when compared to other studies (45.3-52.2%) <xref ref-type="table" rid="T2">Table 2</xref>. <sup> <xref ref-type="bibr" rid="ref7">7</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref8">8</xref> </sup>{Table 2}</p> <p>Aspergillus niger was isolated from nails in patients with diabetes and chronic recurrent infections. Candidiasis (non-albicans) was seen in 16.66% of the cases which is slightly higher but comparable than those reported elsewhere (10% cases). <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>Present data indicates that fungal infections are uncommon in children in India unlike reports from other countries. <sup> <xref ref-type="bibr" rid="ref9">9</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref10">10</xref> </sup>History of contact with infected family members was seen in 26.6% which is higher in accordance with other studies. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>Disease recurrence was noted in 16.66% of patients (lack of local immunity /inadequate treatment). Thirty (37.50%) specimens were positive by culture alone whereas 65 (81.25%) by direct microscopy alone. This is in keeping with data published by Veer et al. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>To conclude, the conventional methods for fungi identification, direct microscopy and fungal culture are both important in definitive diagnosis of dermatophytosis. The sensitivity of these diagnostic tests depends on the method of sampling, sample preparation, failure rate of microscopy/culture, and final interpretation of results.</p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Brown</surname> <given-names>TE</given-names> </name> <name> <surname>Chin</surname> <given-names>TW</given-names> </name> <name> <surname>Dipiro</surname> <given-names>JJ</given-names> </name> <name> <surname>Talbert</surname> <given-names>RL</given-names> </name> <name> <surname>Yee</surname> <given-names>GC</given-names> </name> </person-group> <article-title>Superficial fungal infections: A pathophysiologic approach.5th ed</article-title> <source>New York: McGraw- Hill;</source> <year>0</year> <volume></volume> <fpage></fpage> <comment>Superficial fungal infections: A pathophysiologic approach 5th ed New York: McGraw- Hill; 2000</comment> </nlm-citation> </ref> <ref id="ref2"> <label>2</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Veer</surname> <given-names>P</given-names> </name> <name> <surname>Patwardhan</surname> <given-names>NS</given-names> </name> <name> <surname>Damle</surname> <given-names>AS</given-names> </name> </person-group> <article-title>Study of onychomycosis: Prevailing fungi and pattern of infection</article-title> <source>Indian J Med Microbiol</source> <year>2007</year> <volume>25</volume> <fpage>53</fpage> <lpage>6</lpage> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Singh</surname> <given-names>S</given-names> </name> <name> <surname>Beena</surname> <given-names>PN</given-names> </name> </person-group> <article-title>Profile of dermatophytic infections in Baroda</article-title> <source>Indian J Dermatol Venereal Leprol</source> <year>2003</year> <volume>69</volume> <fpage>281</fpage> <lpage>3</lpage> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Sahai</surname> <given-names>S</given-names> </name> <name> <surname>Mishra</surname> <given-names>D</given-names> </name> </person-group> <article-title>Change in spectrum of dermatophytes isolated from superficial mycoses cases: First report from Central India</article-title> <source>Indian J Dermatol Venereol Leprol</source> <year>2011</year> <volume>77</volume> <fpage>335</fpage> <lpage>6</lpage> </nlm-citation> </ref> <ref id="ref5"> <label>5</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Bassiri-Jahromi</surname> <given-names>S</given-names> </name> <name> <surname>Khaksari</surname> <given-names>AA</given-names> </name> </person-group> <article-title>Epidemiological survey of dermatophytosis in Tehran, Iran, from 2000 - 2005</article-title> <source>Indian J Dermatol Venereol Leprol</source> <year>2009</year> <volume></volume> <fpage>75;142</fpage> <lpage>7</lpage> </nlm-citation> </ref> <ref id="ref6"> <label>6</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Adhikari</surname> <given-names>L</given-names> </name> <name> <surname>Atrayee</surname> <given-names>G</given-names> </name> <name> <surname>Ranabir</surname> <given-names>P</given-names> </name> <name> <surname>Singh</surname> <given-names>TS</given-names> </name> </person-group> <article-title>Clinic- etiologic correlates of onychomycosis in Sikkim</article-title> <source>Indian J Pathol Microbiol</source> <year>2009</year> <volume>52</volume> <fpage>194</fpage> <lpage>7</lpage> </nlm-citation> </ref> <ref id="ref7"> <label>7</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Kaviarasan</surname> <given-names>PK</given-names> </name> <name> <surname>Jaisankar</surname> <given-names>TJ</given-names> </name> <name> <surname>Thappa</surname> <given-names>DM</given-names> </name> <name> <surname>Sujatha</surname> <given-names>S</given-names> </name> </person-group> <article-title>Clinical variations in dermatophytes in HIV infected patients</article-title> <source>Indian J Dermatol Venereol Leprol</source> <year>2002</year> <volume>68</volume> <fpage>213</fpage> <lpage>6</lpage> </nlm-citation> </ref> <ref id="ref8"> <label>8</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Bindu</surname> <given-names>V</given-names> </name> </person-group> <article-title>Clinico-mycological study of dermatophytosis in Calicut</article-title> <source>Indian J Dermatol Venereol Leprol</source> <year>2002</year> <volume>68</volume> <fpage>259</fpage> <lpage>61</lpage> </nlm-citation> </ref> <ref id="ref9"> <label>9</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Fernandes</surname> <given-names>NC</given-names> </name> <name> <surname>Akiti</surname> <given-names>T</given-names> </name> <name> <surname>Barreiros</surname> <given-names>MG</given-names> </name> </person-group> <article-title>Dermatophytes in children: Study of 137 cases</article-title> <source>Rev Inst Med Trop Sao Paulo</source> <year>2001</year> <volume>43</volume> <fpage>83</fpage> <lpage>5</lpage> </nlm-citation> </ref> <ref id="ref10"> <label>10</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Hernandez</surname> <given-names>AD</given-names> </name> </person-group> <article-title>An approach to the diagnosis and therapy of dermatophytosis</article-title> <source>Indian J Dermatol Venereal Leprol</source> <year>1987</year> <volume>53</volume> <fpage>174</fpage> <lpage>5</lpage> </nlm-citation> </ref> <ref id="ref11"> <label>11</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"></person-group> <article-title></article-title> <source></source> <year></year> <volume></volume> <fpage></fpage> </nlm-citation> </ref> </ref-list> </back> </article>

JRMS

J Res Med Sci

Journal of Research in Medical Sciences

1735-1995 1735-7136

Medknow Publications Pvt Ltd

India

JRMS-17-817

23798955

Letter to Editor

Clinico-mycological evaluation of dermatophytes and non-dermatophytes isolated from various clinical samples: A study from north India

Sharma

Yukti

Jain

Sanjay

Chandra

Kapil

Khurana

V K

Kudesia

Madhur

Department of Microbiology, Hindu Rao Hospital, Delhi, India Department of Microbiology, Hindu Rao Hospital, Delhi, India Department of Dermatology, Hindu Rao Hospital, Delhi, India Department of Dermatology, Hindu Rao Hospital, Delhi, India Department of Pathology, Hindu Rao Hospital, Delhi, India

Address for correspondence:Yukti Sharma, 272 SFS (DDA) Flats, Mukherjee Nagar, Delhi, India dryukti2006@yahoo.com

August 2012

17 8 817 818

2012

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

<p>Sir,</p> <p>Incidence rates of fungal infections have increased significantly over the last 15 to 20 years. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>This disorder is significant due to clinical consequence with respect to its contagious nature, cosmetic consequences, chronicity, recurrences, and therapeutic difficulties.</p> <p>The present study was done to assess the clinico-epidemiological profile of fungal infections, species identification, and to compare clinical diagnosis with direct microscopy and culture positivity from clinically suspected cases. From March to August 2011, 80 specimens were processed from clinically suspected cases of dematophytosis/dermatomycosis attending the Dermatology Out Patient Department and sent to Microbiology for mycological work-up. Specimens included skin scales, hair, nails (superficial mycoses), and tissue (deep mycoses). Specimens were analyzed by direct microscopy and subjected to culture study (Sabouraud′s Dextrose Agar, cornmeal agar, blood agar).</p> <p>Pathogens were differentiated from contaminants following these guidelines: (1) Dermatophyte isolated on culture was considered a pathogen, (2) a non-dermatophyte mould (NDM) or yeast cultured was significant only if direct microscopy was positive and (3) NDM required repeated isolation. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>Most common age group among the 80 patients analyzed were 31-40 years (31.25%). Male to female ratio was 1.5:1 which could be the result of more outdoor activities, traumas and common use of occlusive footwear in males, a finding similar to Singh et al. (M:F- 1.3:1) <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>but contrary to Sahai et al. (M:F - 2:1). <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup></p> <p>Most common fungal isolates were dermatophytes 19/30 (63.33%) of which 8/30 (26.66%) were Microsporum audouinii <xref ref-type="table" rid="T1">Table 1</xref>. There were three cases (3.75%) where direct microscopy (10% Potassium Hydroxide 10% KOH mount) showed sclerotic bodies suggestive of chromoblastomycosis but were culture negative. Among dermatophytoses, 11 isolates were obtained from nail, 2 from scalp/ scalp hair, and 6 from skin scales.{Table 1}</p> <p>M. audouinii was the main isolate from nails/skin scales contrary to other studies where Trichophyton rubrum is commonly reported. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref6">6</xref> </sup>This finding may perhaps mark the change in spectrum of dermatophytic infections but further studies need to be done. Isolation rate in this study seemed to be lower (37.50%) when compared to other studies (45.3-52.2%) <xref ref-type="table" rid="T2">Table 2</xref>. <sup> <xref ref-type="bibr" rid="ref7">7</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref8">8</xref> </sup>{Table 2}</p> <p>Aspergillus niger was isolated from nails in patients with diabetes and chronic recurrent infections. Candidiasis (non-albicans) was seen in 16.66% of the cases which is slightly higher but comparable than those reported elsewhere (10% cases). <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>Present data indicates that fungal infections are uncommon in children in India unlike reports from other countries. <sup> <xref ref-type="bibr" rid="ref9">9</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref10">10</xref> </sup>History of contact with infected family members was seen in 26.6% which is higher in accordance with other studies. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>Disease recurrence was noted in 16.66% of patients (lack of local immunity /inadequate treatment). Thirty (37.50%) specimens were positive by culture alone whereas 65 (81.25%) by direct microscopy alone. This is in keeping with data published by Veer et al. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>To conclude, the conventional methods for fungi identification, direct microscopy and fungal culture are both important in definitive diagnosis of dermatophytosis. The sensitivity of these diagnostic tests depends on the method of sampling, sample preparation, failure rate of microscopy/culture, and final interpretation of results.</p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Brown</surname> <given-names>TE</given-names> </name> <name> <surname>Chin</surname> <given-names>TW</given-names> </name> <name> <surname>Dipiro</surname> <given-names>JJ</given-names> </name> <name> <surname>Talbert</surname> <given-names>RL</given-names> </name> <name> <surname>Yee</surname> <given-names>GC</given-names> </name> </person-group> <article-title>Superficial fungal infections: A pathophysiologic approach.5th ed</article-title> <source>New York: McGraw- Hill;</source> <year>0</year> <volume></volume> <fpage></fpage> <comment>Superficial fungal infections: A pathophysiologic approach 5th ed New York: McGraw- Hill; 2000</comment> </nlm-citation> </ref> <ref id="ref2"> <label>2</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Veer</surname> <given-names>P</given-names> </name> <name> <surname>Patwardhan</surname> <given-names>NS</given-names> </name> <name> <surname>Damle</surname> <given-names>AS</given-names> </name> </person-group> <article-title>Study of onychomycosis: Prevailing fungi and pattern of infection</article-title> <source>Indian J Med Microbiol</source> <year>2007</year> <volume>25</volume> <fpage>53</fpage> <lpage>6</lpage> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Singh</surname> <given-names>S</given-names> </name> <name> <surname>Beena</surname> <given-names>PN</given-names> </name> </person-group> <article-title>Profile of dermatophytic infections in Baroda</article-title> <source>Indian J Dermatol Venereal Leprol</source> <year>2003</year> <volume>69</volume> <fpage>281</fpage> <lpage>3</lpage> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Sahai</surname> <given-names>S</given-names> </name> <name> <surname>Mishra</surname> <given-names>D</given-names> </name> </person-group> <article-title>Change in spectrum of dermatophytes isolated from superficial mycoses cases: First report from Central India</article-title> <source>Indian J Dermatol Venereol Leprol</source> <year>2011</year> <volume>77</volume> <fpage>335</fpage> <lpage>6</lpage> </nlm-citation> </ref> <ref id="ref5"> <label>5</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Bassiri-Jahromi</surname> <given-names>S</given-names> </name> <name> <surname>Khaksari</surname> <given-names>AA</given-names> </name> </person-group> <article-title>Epidemiological survey of dermatophytosis in Tehran, Iran, from 2000 - 2005</article-title> <source>Indian J Dermatol Venereol Leprol</source> <year>2009</year> <volume></volume> <fpage>75;142</fpage> <lpage>7</lpage> </nlm-citation> </ref> <ref id="ref6"> <label>6</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Adhikari</surname> <given-names>L</given-names> </name> <name> <surname>Atrayee</surname> <given-names>G</given-names> </name> <name> <surname>Ranabir</surname> <given-names>P</given-names> </name> <name> <surname>Singh</surname> <given-names>TS</given-names> </name> </person-group> <article-title>Clinic- etiologic correlates of onychomycosis in Sikkim</article-title> <source>Indian J Pathol Microbiol</source> <year>2009</year> <volume>52</volume> <fpage>194</fpage> <lpage>7</lpage> </nlm-citation> </ref> <ref id="ref7"> <label>7</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Kaviarasan</surname> <given-names>PK</given-names> </name> <name> <surname>Jaisankar</surname> <given-names>TJ</given-names> </name> <name> <surname>Thappa</surname> <given-names>DM</given-names> </name> <name> <surname>Sujatha</surname> <given-names>S</given-names> </name> </person-group> <article-title>Clinical variations in dermatophytes in HIV infected patients</article-title> <source>Indian J Dermatol Venereol Leprol</source> <year>2002</year> <volume>68</volume> <fpage>213</fpage> <lpage>6</lpage> </nlm-citation> </ref> <ref id="ref8"> <label>8</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Bindu</surname> <given-names>V</given-names> </name> </person-group> <article-title>Clinico-mycological study of dermatophytosis in Calicut</article-title> <source>Indian J Dermatol Venereol Leprol</source> <year>2002</year> <volume>68</volume> <fpage>259</fpage> <lpage>61</lpage> </nlm-citation> </ref> <ref id="ref9"> <label>9</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Fernandes</surname> <given-names>NC</given-names> </name> <name> <surname>Akiti</surname> <given-names>T</given-names> </name> <name> <surname>Barreiros</surname> <given-names>MG</given-names> </name> </person-group> <article-title>Dermatophytes in children: Study of 137 cases</article-title> <source>Rev Inst Med Trop Sao Paulo</source> <year>2001</year> <volume>43</volume> <fpage>83</fpage> <lpage>5</lpage> </nlm-citation> </ref> <ref id="ref10"> <label>10</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Hernandez</surname> <given-names>AD</given-names> </name> </person-group> <article-title>An approach to the diagnosis and therapy of dermatophytosis</article-title> <source>Indian J Dermatol Venereal Leprol</source> <year>1987</year> <volume>53</volume> <fpage>174</fpage> <lpage>5</lpage> </nlm-citation> </ref> <ref id="ref11"> <label>11</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"></person-group> <article-title></article-title> <source></source> <year></year> <volume></volume> <fpage></fpage> </nlm-citation> </ref> </ref-list> </back> </article>