Prevalence of bacteria and fungi in athlete's foot of varying severity and response to topical antibacterial and antifungal therapies

Abstract

Ninety-six patients with clinical evidence of interdigital lesions classified as mild, moderate and severe athlete's foot were investigated for bacterial and fungal populations in the interspaces. Gram-negative bacteria, which were not found in the toe spaces of 50 normal controls, were grown in increasing numbers and with increasing frequency as the symptoms progressed from mild to severe. Gram-positive bacteria were also isolated regularly and in increasing numbers commensurate with the severity of the disease. Similarly the isolation rates of dermatophytes and Candida species were higher in patients with moderate and severe disease compared to those with mild disease. Clinical and culture responses to topical applications with framycetin, tolnaftate, miconazole and clotrimazole were also studied. In some patients the prevalence of pathogenic fungi increased as bacterial numbers decreased. The pure antibacterial framycetin brought symptomatic relief, as did the purely anti-dermatophyte substance tolnaftate, but best results were seen with two azole compounds having mixed antibacterial and antifungal properties.

Recurrent lymphangitic cellulitis syndrome: A quintessential example of an immunocompromised district

“…13,14,17,[29][30][31][32] Specifically, to our knowledge, no evidence has been developed showing that a particular strain of β-hemolytic Streptococcus cultured from between the toes was truly responsible for a single attack of cellulitis. 13 Although unlikely to influence the definitive management of the syndrome because broad-spectrum topical and systemic treatment with azole antifungals will kill the range of dermatophytes causing this condition, confirmation of web space fungal cultures may serve to motivate a patient to maintain control of this underlying condition.…”

“…6,11,32 Azole antifungals, such as topical ketoconazole, clotrimazole, or econazole and systemic itraconazole, are most often used. A fungal culture is recommended, though it may take weeks or months to finalize, and false negative results are common in mixed bacterial/fungal interdigital infections.…”

“…When secondarily contaminated with ordinary nonvirulent bacteria, it manifests as a pruritic, moist, erythematous, scaling, macerated, and foulsmelling dermatitis. 17,[29][30][31][32] When inspecting the ipsilateral foot of a patient with lymphangitic cellulitis syndrome, however, the clinician must have a high index of suspicion, because many patients will have only minor signs of mycological infection, and they may have no symptoms.…”

“…Unfortunately, bacterial overgrowth in the toe webs, especially in chronic cases, may result in fungistatic or fungicidal effects, limiting the frequency with which dermatophytes can be cultured from interdigital lesions. 16,17,[30][31][32] Fungi are presumed to play a consistent role in the pathogenesis of lymphangitic cellulitis, and difficulty demonstrating their presence does not signify their absence. Interestingly, in a recent study, 25 of 31 cases of post-saphenous venectomy cellulitis had mycologically confirmed tinea pedis.…”

Infecciones cutáneas polimicrobianas que precisan colaboración multidisciplinar

“…2 ; y que puede sobreinfectarse por diferentes microorganismos: micóticos (Candida albicans), bacterianos (Pseudomonas auriginosa, principal causante de lesiones interdigitales [2][3][4] ; Sthapylococcus aureus, Proteus mirabilis, etc. 2 ), e incluso mixtos 5 . Hay una serie de factores que predisponen a esta patología, como algunas enfer- medades, falta de higiene y malnutrición 4 .…”