Silva L B, de Oliveira D B C, da Silva B V, de Souza R A, da Silva P R, Ferreira-Paim K, Andrade-Silva L E, Silva-Vergara M L, Andrade A A
Laboratory of Microbiology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
J Eur Acad Dermatol Venereol. 2014 May;28(5):633-40. doi: 10.1111/jdv.12151. Epub 2013 Apr 5.
Dermatomycoses are superficial fungal infections of the skin, hair and nails that affect more than 20-25% of the people worldwide. These infections can be caused by yeasts, dermatophytes and non-dermatophyte filamentous fungi (NDFF) and are considered a public health problem. Despite this, few studies have investigated the prevalence and antifungal susceptibility of causative agents of dermatomycoses in the developing world.
The aims of this study were to identify and determine the antifungal susceptibility profile of yeast and filamentous fungi isolated from dermatomycoses in Uberaba, Minas Gerais, Brazil.
Specimens were obtained from patients with clinically diagnosed and laboratory confirmed dermatomycosis between July 2009 and July 2011. Fungal identification was based on classical methods and antifungal susceptibility testing was performed by broth microdilution method.
Of the 216 fungal isolates, 116 (53.8%) were yeasts, 70 (32.4%) dermatophytes and 30 (13.8%) NDFF. Onychomycosis was the most common clinical condition. Candida parapsilosis (24.1%) and Trichophyton rubrum (17.1%) were the fungi most frequently isolated. Voriconazole, ketoconazole and itraconazole were the most potent antifungal agents against yeast, whereas terbinafine, voriconazole and itraconazole had a high in vitro activity against dermatophytes. Overall, the antifungal agents had little or no activity against NDFF and the highest minimum inhibitory concentrations were those against Fusarium spp.
Yeasts, particularly C. parapsilosis, play an important role as causative agents of dermatomycosis in our region. Our results suggest that the antifungal susceptibility testing coupled with proper identification of the fungi may be useful to assist clinicians in determining the appropriate therapy for dermatomycoses.
皮肤癣菌病是皮肤、毛发和指甲的浅表真菌感染，全球超过20%-25%的人受其影响。这些感染可由酵母菌、皮肤癣菌和非皮肤癣菌丝状真菌（NDFF）引起，被视为一个公共卫生问题。尽管如此，在发展中世界，很少有研究调查皮肤癣菌病病原体的流行情况和抗真菌药敏性。
本研究的目的是鉴定并确定从巴西米纳斯吉拉斯州乌贝拉巴的皮肤癣菌病中分离出的酵母菌和丝状真菌的抗真菌药敏谱。
2009年7月至2011年7月期间，从临床诊断和实验室确诊为皮肤癣菌病的患者身上获取标本。真菌鉴定基于经典方法，抗真菌药敏试验采用肉汤微量稀释法进行。
在216株真菌分离物中，116株（53.8%）为酵母菌，70株（32.4%）为皮肤癣菌，30株（13.8%）为NDFF。甲癣是最常见的临床病症。近平滑念珠菌（24.1%）和红色毛癣菌（17.1%）是最常分离出的真菌。伏立康唑、酮康唑和伊曲康唑是对酵母菌最有效的抗真菌药物，而特比萘芬、伏立康唑和伊曲康唑对皮肤癣菌具有较高的体外活性。总体而言，抗真菌药物对NDFF几乎没有活性或完全没有活性，最低抑菌浓度最高的是针对镰刀菌属。
酵母菌，尤其是近平滑念珠菌，在我们地区作为皮肤癣菌病的病原体发挥着重要作用。我们的结果表明，抗真菌药敏试验结合对真菌的正确鉴定可能有助于临床医生确定皮肤癣菌病的适当治疗方法。
