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

Abstract

The burden of fungal infections is not widely appreciated. Although these infections are responsible for over one million deaths annually, it is estimated that one billion people are affected by severe fungal diseases. Mycoses of nails and skin, primarily caused by fungi known as dermatophytes, are the most common fungal infections. Trichophyton rubrum appears to be the most common causative agent of dermatophytosis, followed by Trichophyton interdigitale. An estimated 25% of the world’s population suffers from dermatomycosis. Although these infections are not lethal, they compromise the quality of life of infected patients. The outcome of antidermatophytic treatments is impaired by various conditions, such as resistance and tolerance of certain dermatophyte strains. The adage “know your enemy” must be the focus of fungal research. There is an urgent need to increase awareness about the significance of these infections with precise epidemiological data and to improve knowledge regarding fungal biology and pathogenesis, with an emphasis on adaptive mechanisms to tackle adverse conditions from host counteractions. This review outlines the current knowledge about dermatophyte infections, with a focus on signaling pathways required for fungal infection establishment and a broad perspective on cellular and molecular factors involved in antifungal resistance and tolerance.

Terbinafine Resistance in Dermatophytes: A French Multicenter Prospective Study

“…The main etiological agents of dermatophytosis of skin and nails in humans are Trichophyton rubrum , T. interdigitale and T. mentagrophytes [ 1 ]. Terbinafine is the first-line treatment for these superficial mycoses.…”

Invasive Trichophyton infection in a liver transplant recipient

“…Rare atypical presentations have been described and 4 Main risk factors for these invasive forms of dermatophytoses are superficial infections, trauma, diabetes, mutation of caspase recruitment domain family member 9 or signal transducer and activator of transcription 3, HIV infection, use of immunosuppressive drugs and SOT. 4,5 Liver transplant recipients have been described as a subgroup of patients at risk for invasive dermatophytoses, though rarely reported. 1 In a recent case of dermatophytoses in a liver transplant recipient reported by Reis et al, the patient had received a recent diagnosis of acute myeloid leukemia 6 months after liver transplant.…”

“…In selected cases, the use of molecular biology methods may be used. 5 Our patient was referred to our transplant center after a misdiagnosis and was cared for by a multidisciplinary team formed by a dermatologist and two infectious disease specialists both with expertise in the transplant field. In our case, the histological examination showed granulomatous inflammation but did not directly show fungal forms.…”

In Vitro Activity of Ebselen and Diphenyl Diselenide Alone and in Combination with Drugs against Trichophyton mentagrophytes Strains

“…Superficial fungal infections are one of the most prevalent infectious diseases globally [1]. Literature reports have revealed that dermatomycoses can affect almost one billion people around the world, and approximately $1.67 billion is spent on the treatment of these kinds of infections each year [2,3].…”