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Philipp P. Bosshard - One of the best experts on this subject based on the ideXlab platform.
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Epidemiological and clinical aspects of Trichophyton mentagrophytes/Trichophyton Interdigitale infections in the Zurich area: a retrospective study using genotyping.
Journal of the European Academy of Dermatology and Venereology : JEADV, 2021Co-Authors: M. Klinger, Martin Theiler, Philipp P. BosshardAbstract:BACKGROUND Trichophyton mentagrophytes (formerly Arthroderma vanbreuseghemii) and its clonal offshoot Trichophyton Interdigitale, which are leading causes of dermatophytoses, have recently been recognized as two separate species. Over the last 20 years several internal transcribed spacer (ITS) genotypes of Trichophyton mentagrophytes and Trichophyton Interdigitale have been identified, some of which have specific characteristics and lead to typical clinical manifestations. OBJECTIVES The aim of this study was to determine the current epidemiology of Trichophyton mentagrophytes and Trichophyton Interdigitale genotypes in Switzerland, particularly in the Zurich area. METHODS Consecutive cases diagnosed by ITS sequencing between 2009 and 2019 were retrospectively analyzed. RESULTS A total of 81 Trichophyton mentagrophytes and 81 Trichophyton Interdigitale cases were investigated. T. mentagrophytes infections clearly differed from T. Interdigitale infections by affecting younger and more frequently female patients, targeting almost exclusively head and body rather than feet and toenails, leading to inflammatory dermatophytosis and often requiring a combination of systemic and topical treatment. Seven different T. mentagrophytes genotypes (II*, III, III*, IV, VII, VIII, XXVI) were observed, with genotype XXVI being discovered in this study. Genotype III occurred most frequently (56% of all T. mentagrophytes cases) and affected predominantly children. Genotypes III* and VII led to inflammatory tinea in most cases. Four strains that proved to be terbinafine resistant belonged to the "Indian genotype" VIII, which mostly caused tinea glutealis and inguinalis. CONCLUSION Being able to distinguish between Trichophyton mentagrophytes and Trichophyton Interdigitale is of paramount importance as the two species cause different clinical presentations. In addition, ITS genotyping allows recognizing sources of infection and potential terbinafine resistance. The latter needs to be confirmed by resistance testing or by sequencing part of the squalene epoxidase (SQLE) gene.
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epidemiological and clinical aspects of Trichophyton mentagrophytes Trichophyton Interdigitale infections in the zurich area a retrospective study using genotyping
Journal of The European Academy of Dermatology and Venereology, 2021Co-Authors: M. Klinger, Martin Theiler, Philipp P. BosshardAbstract:BACKGROUND Trichophyton mentagrophytes (formerly Arthroderma vanbreuseghemii) and its clonal offshoot Trichophyton Interdigitale, which are leading causes of dermatophytoses, have recently been recognized as two separate species. Over the last 20 years, several internal transcribed spacer (ITS) genotypes of Trichophyton mentagrophytes and Trichophyton Interdigitale have been identified, some of which have specific characteristics and lead to typical clinical manifestations. OBJECTIVES The aim of this study was to determine the current epidemiology of Trichophyton mentagrophytes and Trichophyton Interdigitale genotypes in Switzerland, particularly in the Zurich area. METHODS Consecutive cases diagnosed by ITS sequencing between 2009 and 2019 were retrospectively analysed. RESULTS A total of 81 Trichophyton mentagrophytes and 81 Trichophyton Interdigitale cases were investigated. T. mentagrophytes infections clearly differed from T. Interdigitale infections by affecting younger and more frequently female patients, targeting almost exclusively head and body rather than feet and toenails, leading to inflammatory dermatophytosis and often requiring a combination of systemic and topical treatment. Seven different T. mentagrophytes genotypes (II*, III, III*, IV, VII, VIII and XXVI) were observed, with genotype XXVI being discovered in this study. Genotype III occurred most frequently (56% of all T. mentagrophytes cases) and affected predominantly children. Genotypes III* and VII led to inflammatory tinea in most cases. Four strains that proved to be terbinafine resistant belonged to the 'Indian genotype' VIII, which mostly caused tinea glutealis and inguinalis. CONCLUSION Being able to distinguish between Trichophyton mentagrophytes and Trichophyton Interdigitale is of paramount importance as the two species cause different clinical presentations. In addition, ITS genotyping allows recognizing sources of infection and potential terbinafine resistance. The latter needs to be confirmed by resistance testing or by sequencing part of the squalene epoxidase (SQLE) gene.
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tinea genitalis a new entity of sexually transmitted infection case series and review of the literature
Sexually Transmitted Infections, 2015Co-Authors: Isabelle Luchsinger, Philipp P. Bosshard, Romano Silvio Kasper, Dominic Reinhardt, Stephan LautenschlagerAbstract:Objective Investigation on recent cases of tinea genitalis after travelling to South East Asia. Methods Patients with tinea in the genital region, which emerged after sex in South East Asia, underwent further assessment including microscopy, cultures and DNA analyses. Results The case series includes seven patients. In six patients, Trichophyton Interdigitale (former Trichophyton mentagrophytes ) was detected. Three patients suffered from a severe inflammatory reaction of the soft tissue and two of them needed hospitalisation due to severe pain. In four patients, cicatrising healing was noticed. Five patients were declared incapacitated for work. Conclusions Sexual activity should be considered as a potentially important and previously underappreciated means of transmission of T. Interdigitale . To avoid irreversible scarring alopecia, prompt initiation of antifungal treatment is essential and adequate isolation and identification of the pathogen is mandatory.
Arunaloke Chakrabarti - One of the best experts on this subject based on the ideXlab platform.
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mic and upper limit of wild type distribution for 13 antifungal agents against a Trichophyton mentagrophytes Trichophyton Interdigitale complex of indian origin
Antimicrobial Agents and Chemotherapy, 2020Co-Authors: Dipika Shaw, Sunil Dogra, Arunaloke Chakrabarti, Shreya Singh, Jyothi Jayaraman, Ramesh M Bhat, Saumya Panda, Nishat Anjum, Aruna Chowdappa, Mahantesh B NagamotiAbstract:Dermatophytosis due to the Trichophyton mentagrophytes-Trichophyton Interdigitale complex is being increasingly reported across India. Reports of therapeutic failure have surfaced recently, but there are no clinical break points (CBP) or epidemiological cutoffs (ECVs) available to guide the treatment of dermatophytosis. In this study, a total of 498 isolates of the T. mentagrophytes -Interdigitale complex were collected from six medical centers over a period of five years (2014 to 2018). Antifungal susceptibility testing of the isolates was carried out for itraconazole, fluconazole, ketoconazole, voriconazole, luliconazole, sertaconazole, miconazole, clotrimazole, terbinafine, amorolfine, naftifine, ciclopirox olamine, and griseofulvin. The MICs (in mg/liter) comprising >95% of the modeled populations were as follows: 0.06 for miconazole, luliconazole, and amorolfine; 0.25 for voriconazole; 0.5 for itraconazole, ketoconazole, and ciclopirox olamine; 1 for clotrimazole and sertaconazole; 8 for terbinafine; 16 for naftifine; 32 for fluconazole; and 64 for griseofulvin. A high percentage of isolates above the upper limit of the wild-type MIC (UL-WT) were observed for miconazole (29%), luliconazole (13.9%), terbinafine (11.4%), naftifine (5.2%), and voriconazole (4.8%), while they were low for itraconazole (0.2%). Since the MICs of itraconazole were low against the T. mentagrophytes -Interdigitale complex, this could be considered the choice of first-line treatment. The F397L mutation in the squalene epoxidase (SE) gene was observed in 77.1% of isolates with a terbinafine MIC of ≥1 mg/liter, but no mutation was detected in isolates with a terbinafine MIC of <1 mg/liter. In the absence of CBPs, evaluation of the UL-WT may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility.
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MIC and Upper Limit of Wild-Type Distribution for 13 Antifungal Agents against a Trichophyton mentagrophytes-Trichophyton Interdigitale Complex of Indian Origin.
Antimicrobial agents and chemotherapy, 2020Co-Authors: Dipika Shaw, Sunil Dogra, Arunaloke Chakrabarti, Shreya Singh, Jyothi Jayaraman, Ramesh M Bhat, Saumya Panda, Nishat Anjum, Aruna Chowdappa, Mahantesh B NagamotiAbstract:Dermatophytosis due to the Trichophyton mentagrophytes-Trichophyton Interdigitale complex is being increasingly reported across India. Reports of therapeutic failure have surfaced recently, but there are no clinical break points (CBP) or epidemiological cutoffs (ECVs) available to guide the treatment of dermatophytosis. In this study, a total of 498 isolates of the T. mentagrophytes -Interdigitale complex were collected from six medical centers over a period of five years (2014 to 2018). Antifungal susceptibility testing of the isolates was carried out for itraconazole, fluconazole, ketoconazole, voriconazole, luliconazole, sertaconazole, miconazole, clotrimazole, terbinafine, amorolfine, naftifine, ciclopirox olamine, and griseofulvin. The MICs (in mg/liter) comprising >95% of the modeled populations were as follows: 0.06 for miconazole, luliconazole, and amorolfine; 0.25 for voriconazole; 0.5 for itraconazole, ketoconazole, and ciclopirox olamine; 1 for clotrimazole and sertaconazole; 8 for terbinafine; 16 for naftifine; 32 for fluconazole; and 64 for griseofulvin. A high percentage of isolates above the upper limit of the wild-type MIC (UL-WT) were observed for miconazole (29%), luliconazole (13.9%), terbinafine (11.4%), naftifine (5.2%), and voriconazole (4.8%), while they were low for itraconazole (0.2%). Since the MICs of itraconazole were low against the T. mentagrophytes -Interdigitale complex, this could be considered the choice of first-line treatment. The F397L mutation in the squalene epoxidase (SE) gene was observed in 77.1% of isolates with a terbinafine MIC of ≥1 mg/liter, but no mutation was detected in isolates with a terbinafine MIC of
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mutation in the squalene epoxidase gene of Trichophyton Interdigitale and Trichophyton rubrum associated with allylamine resistance
Antimicrobial Agents and Chemotherapy, 2018Co-Authors: Shivaprakash M Rudramurthy, Shamanth A Shankarnarayan, Sunil Dogra, Dipika Shaw, Khurram Mushtaq, Raees A Paul, Tarun Narang, Arunaloke ChakrabartiAbstract:Dermatophytosis, the commonest superficial fungal infection, has gained recent attention due to its change of epidemiology and treatment failures. Despite the availability of several agents effective against dermatophytes, the incidences of chronic infection, reinfection, and treatment failures are on the rise. Trichophyton rubrum and Trichophyton Interdigitale are the two species most frequently identified among clinical isolates in India. Consecutive patients (n = 195) with suspected dermatophytosis during the second half of 2014 were included in this study. Patients were categorized into relapse and new cases according to standard definitions. Antifungal susceptibility testing of the isolated Trichophyton species (n = 127) was carried out with 12 antifungal agents: fluconazole, voriconazole, itraconazole, ketoconazole, sertaconazole, clotrimazole, terbinafine, naftifine, amorolfine, ciclopirox olamine, griseofulvin, and luliconazole. The squalene epoxidase gene was evaluated for mutation (if any) in 15 T. Interdigitale and 5 T. rubrum isolates exhibiting high MICs for terbinafine. A T1189C mutation was observed in four T. Interdigitale and two T. rubrum isolates. This transition leads to the change of phenylalanine to leucine in the 397th position of the squalene epoxidase enzyme. In homology modeling the mutant residue was smaller than the wild type and positioned in the dominant site of squalene epoxidase during drug interaction, which may lead to a failure to block the ergosterol biosynthesis pathway by the antifungal drug.
M. Klinger - One of the best experts on this subject based on the ideXlab platform.
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Epidemiological and clinical aspects of Trichophyton mentagrophytes/Trichophyton Interdigitale infections in the Zurich area: a retrospective study using genotyping.
Journal of the European Academy of Dermatology and Venereology : JEADV, 2021Co-Authors: M. Klinger, Martin Theiler, Philipp P. BosshardAbstract:BACKGROUND Trichophyton mentagrophytes (formerly Arthroderma vanbreuseghemii) and its clonal offshoot Trichophyton Interdigitale, which are leading causes of dermatophytoses, have recently been recognized as two separate species. Over the last 20 years several internal transcribed spacer (ITS) genotypes of Trichophyton mentagrophytes and Trichophyton Interdigitale have been identified, some of which have specific characteristics and lead to typical clinical manifestations. OBJECTIVES The aim of this study was to determine the current epidemiology of Trichophyton mentagrophytes and Trichophyton Interdigitale genotypes in Switzerland, particularly in the Zurich area. METHODS Consecutive cases diagnosed by ITS sequencing between 2009 and 2019 were retrospectively analyzed. RESULTS A total of 81 Trichophyton mentagrophytes and 81 Trichophyton Interdigitale cases were investigated. T. mentagrophytes infections clearly differed from T. Interdigitale infections by affecting younger and more frequently female patients, targeting almost exclusively head and body rather than feet and toenails, leading to inflammatory dermatophytosis and often requiring a combination of systemic and topical treatment. Seven different T. mentagrophytes genotypes (II*, III, III*, IV, VII, VIII, XXVI) were observed, with genotype XXVI being discovered in this study. Genotype III occurred most frequently (56% of all T. mentagrophytes cases) and affected predominantly children. Genotypes III* and VII led to inflammatory tinea in most cases. Four strains that proved to be terbinafine resistant belonged to the "Indian genotype" VIII, which mostly caused tinea glutealis and inguinalis. CONCLUSION Being able to distinguish between Trichophyton mentagrophytes and Trichophyton Interdigitale is of paramount importance as the two species cause different clinical presentations. In addition, ITS genotyping allows recognizing sources of infection and potential terbinafine resistance. The latter needs to be confirmed by resistance testing or by sequencing part of the squalene epoxidase (SQLE) gene.
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epidemiological and clinical aspects of Trichophyton mentagrophytes Trichophyton Interdigitale infections in the zurich area a retrospective study using genotyping
Journal of The European Academy of Dermatology and Venereology, 2021Co-Authors: M. Klinger, Martin Theiler, Philipp P. BosshardAbstract:BACKGROUND Trichophyton mentagrophytes (formerly Arthroderma vanbreuseghemii) and its clonal offshoot Trichophyton Interdigitale, which are leading causes of dermatophytoses, have recently been recognized as two separate species. Over the last 20 years, several internal transcribed spacer (ITS) genotypes of Trichophyton mentagrophytes and Trichophyton Interdigitale have been identified, some of which have specific characteristics and lead to typical clinical manifestations. OBJECTIVES The aim of this study was to determine the current epidemiology of Trichophyton mentagrophytes and Trichophyton Interdigitale genotypes in Switzerland, particularly in the Zurich area. METHODS Consecutive cases diagnosed by ITS sequencing between 2009 and 2019 were retrospectively analysed. RESULTS A total of 81 Trichophyton mentagrophytes and 81 Trichophyton Interdigitale cases were investigated. T. mentagrophytes infections clearly differed from T. Interdigitale infections by affecting younger and more frequently female patients, targeting almost exclusively head and body rather than feet and toenails, leading to inflammatory dermatophytosis and often requiring a combination of systemic and topical treatment. Seven different T. mentagrophytes genotypes (II*, III, III*, IV, VII, VIII and XXVI) were observed, with genotype XXVI being discovered in this study. Genotype III occurred most frequently (56% of all T. mentagrophytes cases) and affected predominantly children. Genotypes III* and VII led to inflammatory tinea in most cases. Four strains that proved to be terbinafine resistant belonged to the 'Indian genotype' VIII, which mostly caused tinea glutealis and inguinalis. CONCLUSION Being able to distinguish between Trichophyton mentagrophytes and Trichophyton Interdigitale is of paramount importance as the two species cause different clinical presentations. In addition, ITS genotyping allows recognizing sources of infection and potential terbinafine resistance. The latter needs to be confirmed by resistance testing or by sequencing part of the squalene epoxidase (SQLE) gene.
Dipika Shaw - One of the best experts on this subject based on the ideXlab platform.
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mic and upper limit of wild type distribution for 13 antifungal agents against a Trichophyton mentagrophytes Trichophyton Interdigitale complex of indian origin
Antimicrobial Agents and Chemotherapy, 2020Co-Authors: Dipika Shaw, Sunil Dogra, Arunaloke Chakrabarti, Shreya Singh, Jyothi Jayaraman, Ramesh M Bhat, Saumya Panda, Nishat Anjum, Aruna Chowdappa, Mahantesh B NagamotiAbstract:Dermatophytosis due to the Trichophyton mentagrophytes-Trichophyton Interdigitale complex is being increasingly reported across India. Reports of therapeutic failure have surfaced recently, but there are no clinical break points (CBP) or epidemiological cutoffs (ECVs) available to guide the treatment of dermatophytosis. In this study, a total of 498 isolates of the T. mentagrophytes -Interdigitale complex were collected from six medical centers over a period of five years (2014 to 2018). Antifungal susceptibility testing of the isolates was carried out for itraconazole, fluconazole, ketoconazole, voriconazole, luliconazole, sertaconazole, miconazole, clotrimazole, terbinafine, amorolfine, naftifine, ciclopirox olamine, and griseofulvin. The MICs (in mg/liter) comprising >95% of the modeled populations were as follows: 0.06 for miconazole, luliconazole, and amorolfine; 0.25 for voriconazole; 0.5 for itraconazole, ketoconazole, and ciclopirox olamine; 1 for clotrimazole and sertaconazole; 8 for terbinafine; 16 for naftifine; 32 for fluconazole; and 64 for griseofulvin. A high percentage of isolates above the upper limit of the wild-type MIC (UL-WT) were observed for miconazole (29%), luliconazole (13.9%), terbinafine (11.4%), naftifine (5.2%), and voriconazole (4.8%), while they were low for itraconazole (0.2%). Since the MICs of itraconazole were low against the T. mentagrophytes -Interdigitale complex, this could be considered the choice of first-line treatment. The F397L mutation in the squalene epoxidase (SE) gene was observed in 77.1% of isolates with a terbinafine MIC of ≥1 mg/liter, but no mutation was detected in isolates with a terbinafine MIC of <1 mg/liter. In the absence of CBPs, evaluation of the UL-WT may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility.
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MIC and Upper Limit of Wild-Type Distribution for 13 Antifungal Agents against a Trichophyton mentagrophytes-Trichophyton Interdigitale Complex of Indian Origin.
Antimicrobial agents and chemotherapy, 2020Co-Authors: Dipika Shaw, Sunil Dogra, Arunaloke Chakrabarti, Shreya Singh, Jyothi Jayaraman, Ramesh M Bhat, Saumya Panda, Nishat Anjum, Aruna Chowdappa, Mahantesh B NagamotiAbstract:Dermatophytosis due to the Trichophyton mentagrophytes-Trichophyton Interdigitale complex is being increasingly reported across India. Reports of therapeutic failure have surfaced recently, but there are no clinical break points (CBP) or epidemiological cutoffs (ECVs) available to guide the treatment of dermatophytosis. In this study, a total of 498 isolates of the T. mentagrophytes -Interdigitale complex were collected from six medical centers over a period of five years (2014 to 2018). Antifungal susceptibility testing of the isolates was carried out for itraconazole, fluconazole, ketoconazole, voriconazole, luliconazole, sertaconazole, miconazole, clotrimazole, terbinafine, amorolfine, naftifine, ciclopirox olamine, and griseofulvin. The MICs (in mg/liter) comprising >95% of the modeled populations were as follows: 0.06 for miconazole, luliconazole, and amorolfine; 0.25 for voriconazole; 0.5 for itraconazole, ketoconazole, and ciclopirox olamine; 1 for clotrimazole and sertaconazole; 8 for terbinafine; 16 for naftifine; 32 for fluconazole; and 64 for griseofulvin. A high percentage of isolates above the upper limit of the wild-type MIC (UL-WT) were observed for miconazole (29%), luliconazole (13.9%), terbinafine (11.4%), naftifine (5.2%), and voriconazole (4.8%), while they were low for itraconazole (0.2%). Since the MICs of itraconazole were low against the T. mentagrophytes -Interdigitale complex, this could be considered the choice of first-line treatment. The F397L mutation in the squalene epoxidase (SE) gene was observed in 77.1% of isolates with a terbinafine MIC of ≥1 mg/liter, but no mutation was detected in isolates with a terbinafine MIC of
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mutation in the squalene epoxidase gene of Trichophyton Interdigitale and Trichophyton rubrum associated with allylamine resistance
Antimicrobial Agents and Chemotherapy, 2018Co-Authors: Shivaprakash M Rudramurthy, Shamanth A Shankarnarayan, Sunil Dogra, Dipika Shaw, Khurram Mushtaq, Raees A Paul, Tarun Narang, Arunaloke ChakrabartiAbstract:Dermatophytosis, the commonest superficial fungal infection, has gained recent attention due to its change of epidemiology and treatment failures. Despite the availability of several agents effective against dermatophytes, the incidences of chronic infection, reinfection, and treatment failures are on the rise. Trichophyton rubrum and Trichophyton Interdigitale are the two species most frequently identified among clinical isolates in India. Consecutive patients (n = 195) with suspected dermatophytosis during the second half of 2014 were included in this study. Patients were categorized into relapse and new cases according to standard definitions. Antifungal susceptibility testing of the isolated Trichophyton species (n = 127) was carried out with 12 antifungal agents: fluconazole, voriconazole, itraconazole, ketoconazole, sertaconazole, clotrimazole, terbinafine, naftifine, amorolfine, ciclopirox olamine, griseofulvin, and luliconazole. The squalene epoxidase gene was evaluated for mutation (if any) in 15 T. Interdigitale and 5 T. rubrum isolates exhibiting high MICs for terbinafine. A T1189C mutation was observed in four T. Interdigitale and two T. rubrum isolates. This transition leads to the change of phenylalanine to leucine in the 397th position of the squalene epoxidase enzyme. In homology modeling the mutant residue was smaller than the wild type and positioned in the dominant site of squalene epoxidase during drug interaction, which may lead to a failure to block the ergosterol biosynthesis pathway by the antifungal drug.
Mahantesh B Nagamoti - One of the best experts on this subject based on the ideXlab platform.
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MIC and Upper Limit of Wild-Type Distribution for 13 Antifungal Agents against a Trichophyton mentagrophytes-Trichophyton Interdigitale Complex of Indian Origin.
Antimicrobial agents and chemotherapy, 2020Co-Authors: Dipika Shaw, Sunil Dogra, Arunaloke Chakrabarti, Shreya Singh, Jyothi Jayaraman, Ramesh M Bhat, Saumya Panda, Nishat Anjum, Aruna Chowdappa, Mahantesh B NagamotiAbstract:Dermatophytosis due to the Trichophyton mentagrophytes-Trichophyton Interdigitale complex is being increasingly reported across India. Reports of therapeutic failure have surfaced recently, but there are no clinical break points (CBP) or epidemiological cutoffs (ECVs) available to guide the treatment of dermatophytosis. In this study, a total of 498 isolates of the T. mentagrophytes -Interdigitale complex were collected from six medical centers over a period of five years (2014 to 2018). Antifungal susceptibility testing of the isolates was carried out for itraconazole, fluconazole, ketoconazole, voriconazole, luliconazole, sertaconazole, miconazole, clotrimazole, terbinafine, amorolfine, naftifine, ciclopirox olamine, and griseofulvin. The MICs (in mg/liter) comprising >95% of the modeled populations were as follows: 0.06 for miconazole, luliconazole, and amorolfine; 0.25 for voriconazole; 0.5 for itraconazole, ketoconazole, and ciclopirox olamine; 1 for clotrimazole and sertaconazole; 8 for terbinafine; 16 for naftifine; 32 for fluconazole; and 64 for griseofulvin. A high percentage of isolates above the upper limit of the wild-type MIC (UL-WT) were observed for miconazole (29%), luliconazole (13.9%), terbinafine (11.4%), naftifine (5.2%), and voriconazole (4.8%), while they were low for itraconazole (0.2%). Since the MICs of itraconazole were low against the T. mentagrophytes -Interdigitale complex, this could be considered the choice of first-line treatment. The F397L mutation in the squalene epoxidase (SE) gene was observed in 77.1% of isolates with a terbinafine MIC of ≥1 mg/liter, but no mutation was detected in isolates with a terbinafine MIC of
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mic and upper limit of wild type distribution for 13 antifungal agents against a Trichophyton mentagrophytes Trichophyton Interdigitale complex of indian origin
Antimicrobial Agents and Chemotherapy, 2020Co-Authors: Dipika Shaw, Sunil Dogra, Arunaloke Chakrabarti, Shreya Singh, Jyothi Jayaraman, Ramesh M Bhat, Saumya Panda, Nishat Anjum, Aruna Chowdappa, Mahantesh B NagamotiAbstract:Dermatophytosis due to the Trichophyton mentagrophytes-Trichophyton Interdigitale complex is being increasingly reported across India. Reports of therapeutic failure have surfaced recently, but there are no clinical break points (CBP) or epidemiological cutoffs (ECVs) available to guide the treatment of dermatophytosis. In this study, a total of 498 isolates of the T. mentagrophytes -Interdigitale complex were collected from six medical centers over a period of five years (2014 to 2018). Antifungal susceptibility testing of the isolates was carried out for itraconazole, fluconazole, ketoconazole, voriconazole, luliconazole, sertaconazole, miconazole, clotrimazole, terbinafine, amorolfine, naftifine, ciclopirox olamine, and griseofulvin. The MICs (in mg/liter) comprising >95% of the modeled populations were as follows: 0.06 for miconazole, luliconazole, and amorolfine; 0.25 for voriconazole; 0.5 for itraconazole, ketoconazole, and ciclopirox olamine; 1 for clotrimazole and sertaconazole; 8 for terbinafine; 16 for naftifine; 32 for fluconazole; and 64 for griseofulvin. A high percentage of isolates above the upper limit of the wild-type MIC (UL-WT) were observed for miconazole (29%), luliconazole (13.9%), terbinafine (11.4%), naftifine (5.2%), and voriconazole (4.8%), while they were low for itraconazole (0.2%). Since the MICs of itraconazole were low against the T. mentagrophytes -Interdigitale complex, this could be considered the choice of first-line treatment. The F397L mutation in the squalene epoxidase (SE) gene was observed in 77.1% of isolates with a terbinafine MIC of ≥1 mg/liter, but no mutation was detected in isolates with a terbinafine MIC of <1 mg/liter. In the absence of CBPs, evaluation of the UL-WT may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility.
