A clinico-mycological, antifungal drug sensitivity and therapeutic study of extensive dermatophytosis in coastal Andhra Pradesh

Abstract

Background: In India, an increased prevalence of chronic, recurrent, and recalcitrant dermatophytosis is being observed. The present study assesses the clinico-mycological profile, antifungal drug sensitivity and therapeutic efficacy of various systemic antifungal drug regimens, in extensive dermatophytosis patients of coastal Andhra Pradesh. Materials and Methods: One hundred and fifty clinically diagnosed cases of extensive dermatophytosis affecting more than one body region were enrolled. Skin samples were taken for direct microscopy and fungal culture. Antifungal drug sensitivity testing was done with broth microdilution test. Therapeutic efficacy of systemic antifungal drug regimens was determined by randomly dividing the patients into 5 groups of 30 each. Results: The most common clinical patterns observed were tinea corporis et cruris (62.7%) followed by extensive tinea corporis (11.3%). KOH and culture positivity were seen in 132 (88%) and 84 cases (56%) respectively. Trichophyton mentagrophytes was isolated in 78 cases (92.8%) followed by Microsporum gypseum in 6 patients (7.1%). The overall mean minimum inhibitory concentration values for itraconazole (0.04 μg/mL) were low when compared to griseofulvin (4.61 μg/mL) and terbinafine (6.9 μg/mL) ( P < 0.05). Combination of itraconazole and griseofulvin achieved highest clinical and mycological cure rates (93.1%). Among patients receiving single drugs, itraconazole had higher cure rates (71.4%) compared to terbinafine (59.2%) and griseofulvin (53.8%) ( P < 0.05). Conclusion: Trichophyton mentagrophytes has replaced Trichophyton rubrum as the predominant species causing dermatophytosis in Andhra Pradesh, presenting with a severe phenotype. Itraconazole was found to be the most effective drug both in vivo and in vitro . A combination of systemic drugs should be considered in cases of monotherapy failure and in recalcitrant dermatophytosis.

Eficácia Do Tratamento Da Tinea Corporis Comparando a Terbinafina E O Itraconazol: Uma Revisão Sistemática

“…Por conseguinte, sabe-se que a terapia sistêmica para a tinea corporis é indicada em casos extensos e que não responde ao tratamento tópico. Assim, grande variedade de antifúngicos sistêmicos está disponível para o tratamento da tinea, que consiste em terbinafina, griseofulvina, itraconazol e fluconazol (Vanapalli et al, 2022). Destes, os medicamentos comumente prescritos são o itraconazol e a terbinafina.…”

Clinico Mycological Profile of Dermatophyte Infections at A Tertiary Care Hospital from South India

“…8 Although most of the dermatophytic infection is non-interventive and straight forward to cure, its extensive universal nature, social embarrassment, disablement of quality of life and harm to the lucrative standing because of the price of the treatment square measure major public considerations. 9 The aim of the present study is to determine the clinical and mycological pattern of dermatophyte infections in patients arriving at our dermatology outpatient department and also to correlate the formal clinical diagnosis with KOH positivity and culture positivity.…”