INTRODUCTION
Dermatophytoses is one of the most common dermatoses. Though not a serious disease, it significantly affects quality of life.[1 2 clotrimazole , miconazole , fluconazole , and itraconazole.
MATERIALS AND METHODS
All clinically suspected cases of dermatophytoses visiting dermatology OPD in our institute whose KOH mount was positive were included in the study. Those on immunosuppressants and topical and systemic antifungals in the last 1 month were excluded. A total number of 48 patients were included.
A detailed history including demographics, recurrences, previous treatment, etc. was taken. A detailed physical examination was done. Sample like scrapings of skin, nail clippings, and hair clippings was taken for KOH mount.
All samples (skin scrapings and nail and hair clippings) which showed fungal elements on KOH mount were inoculated on to Sabouraud dextrose agar (SDA) plate under aseptic precautions and incubated at 25°C for 2–3 weeks. Isolates were identified based on gross colony characteristics and microscopic morphology of their micro- and macroconidia and accessory structures. The isolates were then transferred to sterile distilled water (DW) in vials and stored.
Antifungal susceptibility testing
Antifungal susceptibility testing was done for the clinical isolates using disc diffusion method and E strip method. Paper disks containing clotrimazole (10 mcg), miconazole (30 mcg), and fluconazole (10 mcg) from Hi Media were used in the disk diffusion method to evaluate the in-vitro activity of the antifungal agents by measuring the mean diameter of inhibition around the disks. Griseofulvin E strip (0.002–32 mcg/mL, Hi Media) is used for calculating the minimum inhibitory concentration (MIC) of the drug [Table 1 ].
Table 1: Cut-off value for resistant, intermediate, and resistance
The clinical isolates stored in the stock solution were subcultured on to Potato dextrose agar to enhance sporulation, and inoculum was prepared using colonies containing mixture of mycelia and conidia. The inoculum was spread evenly on the surface of 10 cm Petri dishes containing SDA medium and exposed to air dry. Then, the antifungal disks and Griseofulvin E strip were applied on to the plates, after which the plates were incubated at 25°C for 5–10 days. The zones of inhibition around the disks were measured and recorded. In the case of E strip, the MIC value is read from the scale in terms of µg/mL, where the ellipse edge intersects the strip. Criteria of susceptibility and resistance of antifungal disks were measured according to manufacturers’ guidelines.
Statistical analysis
Data were entered in MS Excel and analyzed using SPSS version 19.
RESULTS
The total number of cases included were 48. Males were 34 and females 14.
Mean age of the patients was 35 years. Mean duration of the disease was 9 months.
The commonest clinical presentation was co-occurrence of Tinea cruris and T. corporis (33.3%), followed by T. cruris (20.8%) and by T. corporis (18.7%).
Trichophyton mentagrophytes T. rubrum was isolated in 16.6% of the cases. Microsporum species accounted for 12.5%. [Table 2 , graph 1]
Table 2: Fungal isolate in different clinical presentations
Graph 1: Fungal isolates in different clinical presentations
Drug sensitivity results
All dermatophytes combined showed highest sensitivity to clotrimazole (87.5%), followed by miconazole (60.4%).
Only 8.3% were sensitive to fluconazole and 37.5% were sensitive to griseofulvin . [Table 3 , graph 2]
Table 3: In-vitro sensitivity pattern of dermatophytes to antifungals
Graph 2: In-vitro sensitivity pattern of dermatophytes to antifungals
Among T. mentagrophytes which was the major species causing infection, 88% were sensitive to clotrimazole , 8% to fluconazole , 60% to miconazole , and 38% to griseofulvin .
DISCUSSION
Dermatophytoses is one of the most common infections of skin. Recently, there have been reports about the increase in the number of cases with extensive infection, resistant infections, and recurrent infections.[3 4
Most of the patients in our study were males (70.8%). The studies by Ghuse et al. [5 et al. [6
In our study, co-occurrence of T. cruris and T. corporis was the most common clinical presentation constituting 33%, followed by T. cruris 21% and T. corporis 19%. This is similar to the study by Poojary et al .,[6 T. cruris and T. corporis was the most common presentation.
T. mentagrophytes was the most common organism which was isolated in 56% of the patients and T. rubrum in 17% of the patients. T. mentagrophytes was the most common organism in most of the clinical types.
Many studies from India show T. rubrum to be the dominant species.[7 8 9 T. mentagrophytes ,[6 10 11 5 12
The shift in the species causing dermatophytoses could be one of the reasons for resistant and recurrent infections.
Among topical antifungals tested, 88% of the isolates were sensitive to clotrimazole and 60% of the isolates were sensitive to miconazole . Among systemic drugs tested, 38% of the isolates were sensitive to griseofulvin and 8% of the isolates were sensitive to fluconazole [Tables 4 and 5 , graph 3].
Table 4: Comparison between topical and systemic antifungals
Table 5: A sensitivity pattern of our study could be compared with that in a study by Pakshir et al. [13]
Graph 3: Comparison between topical (clotrimazole and miconazole ) and systemic (fluconazole and griseofulvin ) antifungals
These findings could not be compared with more studies as most of the studies used broth method for sensitivity testing.
Limitations
Small sample size
Other commonly used drugs such as terbinafine, itraconazole, luliconazole etc. could not be tested in our study.
CONCLUSION
T. mentagrophytes is the causative organism in a significant number of dermatophytic infections. Most of the isolated dermatophytes are still sensitive to clotrimazole in vitro . Though broth dilution is the standard method for sensitivity assay of dermatophytes, disc diffusion method can become a more simple alternative. In this regard, further studies on disc diffusion method are needed.[13
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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