Invasive dermatophyte infection: A systematic review

Abstract

Dermatophyte infections usually present as various types of superficial cutaneous mycoses; on very rare occasions, dermatophytes enter deep into the dermis and cause invasive infections. In this study, we aimed to perform a systematic review of all reported invasive dermatophytosis cases over the past 20 years. We performed systematic searches in PubMed/Medline, EMBASE and Web of Science and identified 123 papers reporting 160 individual cases of invasive dermatophytosis between 2000 and 2020. Our study included 103 (64.4%) males, and the mean age at diagnosis was 43.0 years (range: 3–87 years). The most common predisposing factor was superficial dermatophytosis (56.9%), followed by solid organ transplantation (26.9%), the use of topical immunosuppressants (15.6%), gene mutations (14.4%), diabetes (14.4%) and trauma (6.9%). Trichophyton (T.) rubrum was the most prevalent pathogen (53.1%) responsible for invasive dermatophytosis, followed by T. mentagrophytes (7.5%), Microsporum canis (6.9%), T. tonsurans (5.6%), T. interdigitale (5.0%) and T. violaceum (3.8%). Patients with CARD9 or STAT3 mutations were prone to have mixed infection of two or more dermatophytes, present with eosinophilia and high IgE, and develop disseminated infections. Overall mortality was 7.9%, and the mortality in patients with and without gene mutations was 17.4% and 5.5%, respectively. Most of the normal host patients responded well to oral antifungal agents, while gene‐deficient patients usually required lifelong treatment to stabilise their infection status. Our review indicated the importance of preventive treatment of superficial tinea in patients with immunosuppression and gene deficiencies to avoid the development of invasive dermatophytosis.

Invasive Microsporum canis infection as a presenting complaint of late-diagnosed HIV infection

“…Invasive dermatophytosis is rare, affecting exclusively immunocompromised patients including those with advanced HIV infection or patients with anti-fungal immunodeficiency, always with concomitant superficial dermatophytosis. 10 However, there is no concomitant superficial dermatophytosis in our patient living with HIV. The dermatophyte may have been inoculated by trauma from the pet.…”

Invasive Trichophyton infection in a liver transplant recipient

“…7 The duration of treatment is uncertain, ranging from 2.5 1 to 4 months 8 or until the lesions disappear 9 and up to lifelong treatment in patients with gene deficiency. 4 The reported average time after transplant for diagnosis is between 7.5 and 16 months. 6 In our case the diagnosis was made 17 years after transplantation.…”

State-of-the-Art Dermatophyte Infections: Epidemiology Aspects, Pathophysiology, and Resistance Mechanisms

“…The occurrence of cutaneous dermatophytosis may also lead to invasive and deep infections. A systematic review of cases of deep dermatophytosis worldwide, from 2000 to 2020 [ 20 ], showed that half of the patients presented chronic cutaneous infections at the same anatomical site before invasive lesions. Predisposing factors included the use of immunosuppressants, solid organ transplantation, mutations in the CARD9 or STAT3 (signal transducer and activator of transcription 3) genes, diabetes, and trauma.…”

“…In this study, T. rubrum was the most prevalent dermatophyte, isolated in 53.1% of invasive cases, followed by T. mentagrophytes , M. canis , T. tonsurans , T. interdigitale , and T. violaceum . Other dermatophytes associated with these invasive cases were Trichophyton schoenleinii , Trichophyton verrucosum , Nannizzia gypsea (formerly Microsporum gypseum ), Microsporum inferrugineum , M. audouinni , and Arthroderma gypseum [ 20 ].…”