Epidemiology of dermatomycoses and onychomycoses in Ireland (2001–2020): A single‐institution review

Abstract

Background Fungal skin infections are recognised as one of the most common health disorders globally, and dermatophyte infections of the skin, hair and nails are the most common fungal infections. Dermatophytes can be classified as anthropophilic, zoophilic or geophilic species based on their primary habitat association, and this classification makes epidemiological analysis useful for the prevention and control of these infections. The Irish contribution to the epidemiology of these infections has been scant, with just two papers (both reporting paediatric tinea capitis only) published in the last 20 years, and none in the last seven. Objectives To perform a comprehensive retrospective epidemiological analysis of all dermatological mycology tests performed in University Hospital Limerick over a 20‐year period. Methods All mycology laboratory test results were extracted from the Laboratory Information Management System (LIMS, iLab, DXC Technologies) from 2001 to 2020 inclusive for analysis. Specimen types were categorised according to the site of sampling. The data were analysed using Microsoft Excel. Results About 12,951 specimens of skin, hair and nails were studied. Median patient age was 42 years (IQR 26–57) with a slight female preponderance (57.2%). Two thirds of samples (67%, n = 8633) were nail, 32% were skin scrapings (n = 4118) and 200 hair samples (1.5%) were received. Zoophilic dermatophytes were more commonly present in females (38% F, 23% M, proportion of dermatophytes) and in those under 10 years of age or from 45 to 70 years (36% and 34% zoophiles, respectively, proportion of dermatophytes), although anthropophiles predominated every age and gender category. Anthropophiles had their highest prevalence in the 10–20 years age category (80% anthropophiles, proportion of dermatophytes), and yeast infections were more prevalent in older patients (29% of >60 year olds vs. 17% of <60 year olds, proportion of all fungal positives). Trichophyton rubrum was the most prevalent pathogen detected, accounting for 53% of all dermatophytes detected, 61% of those detected from nail samples and 34% from skin and hair samples. Trichophyton tonsurans was the most prevalent dermatophyte in tinea capitis, accounting for 37% of dermatophytes detected. Both of these organisms are anthropophilic, and this group showed consistently increased prevalence in proportion to all fungal isolates. The proportion of this dermatophyte class (anthropophiles) increased among both nail samples and skin/hair samples during the study period, from 55% of samples in the first 5 years of the study (2001–2005) to 88% (proportion of dermatophytes) in the final 5 years. Conversely, yeast detection decreased. Conclusions This study provides a detailed overview of the epidemiology of the fungal cultures of skin, nail and hair samples in the Mid‐West of Ireland over a 20‐year period. Monitoring this changing landscape is important in identifying likely sources of infections, to identifying potential outbreaks, and may help guide empiric ...

Hyaluronic Acid-Based CuS Nanoenzyme Biodegradable Microneedles for Treating Deep Cutaneous Fungal Infection without Drug Resistance

“…Fungal diseases are reported to affect about one billion people and result in over 1.5 million deaths worldwide each year. , Fungal skin and soft tissue infections have been recognized as the fourth most common health disorder worldwide . Deep cutaneous fungal infection (DCFI) faces great challenges in its treatment because it is difficult for drugs to reach the lesions.…”

“…1,2 Fungal skin and soft tissue infections have been recognized as the fourth most common health disorder worldwide. 3 Deep cutaneous fungal infection (DCFI) faces great challenges in its treatment because it is difficult for drugs to reach the lesions. At present, skin fungal infection is mainly treated with topical creams, ointments, and gels.…”

Dermatology mycology diagnostics in Ireland: National deficits identified in 2022 that are relevant internationally

“… 33 Despite this, dermatophyte infections are not listed as a notifiable disease in this country, so there is no obligation to report them. A considerable shift in the epidemiology of dermatophytes has been demonstrated in our region in the last 20 years, with an increasing proportion of anthropophilic species detected from both skin or hair samples and from nail samples, 8 and this has been mirrored in many other countries. 34 , 35 , 36 , 37 The migration of people, children in particular, during wartime has been linked with an increase in dermatomycoses.…”

“…Of note, there are no electronic patient records in this group of hospitals. Previous related research from our institution includes fungal bloodstream infections in our ICU patients, 28 an epidemiological analysis of dermatomycoses and onychomycoses in our region over a period spanning 20 years, 8 and several reports of multi‐resistant organisms detected in our hospitals, many of which resulted in outbreaks. 29 , 30 …”

“…5,6 Historically there has been a preponderance of zoophilic dermatophytes in our region, 7 but a recent epidemiological study demonstrated a shift in prevalence to predominantly anthropophilic species over a 20-year period. 8 In the latter period of this study, mycology testing of skin, hair and nail samples was outsourced, and access was curtailed for patients in primary care settings. Conventional mycological diagnostic methods are time-consuming, 3 and when faced with staff shortages in 2016, mycology testing was outsourced to a referral laboratory.…”