Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
Private Office, Doha, Qatar.
Int J Dermatol. 2024 Oct;63(10):1398-1403. doi: 10.1111/ijd.17145. Epub 2024 May 7.
Recalcitrant dermatophytosis is an emerging phenomenon that occurs worldwide, and Trichophyton indotineae is currently the prominent cause.
Skin specimens from patients with tinea infection were obtained by scrubbing and then sectioned into three fragments. Two fragments were subjected to direct microscopic examination and culture, while the third portion was utilized in the PCR method.
Isolates were morphologically identified as Trichophyton mentagrophytes/interdigitale complex (n = 60 [83.33%]), Microsporum canis (n = 8 [11.11%]), Trichophyton rubrum (n = 3 [4.16%]), and Epidermophyton floccosum (n = 1 [1.38%]). Among 60 T. mentagrophytes complex isolates, 53 (88.33%) were classified as T. indotineae and seven as T. interdigitale genotype II. The disease duration was longer in the T. indotineae group (P = 0.035). Both Gradient PCR and skin-sampling methods yield similar results in terms of positive and negative cases (P = 1.0000). The time patients stopped their medication did not impact the positive case numbers (P = 0.803). Gender had no effects on the frequency (P = 0.699). Familial contamination, dermatologic disorder, and other underlying conditions did not differ in the two group infections (P > 0.05). Steroid usage is strongly associated with the emergence of tinea infection (P < 0.04). The duration of antifungal administration had a substantial effect on the emergence of resistant organisms (P = 0.05).
Steroid usage, T. indotineae involvement, and prolonged exposure to antifungals were the solid and influential factors in recalcitrant involvement. Regarding quick and suitable diagnosis and treatment, which is essential in preventing recalcitrant cases, we suggest that direct skin sample PCR can meet the demands.
顽固型皮肤癣菌病是一种全球性的新兴现象，目前 Trichophyton indotineae 是主要的致病原因。
通过刮擦获得患有癣感染的患者皮肤标本，然后将其切成三个片段。两个片段进行直接显微镜检查和培养，而第三部分则用于 PCR 方法。
分离株的形态学鉴定为 Trichophyton mentagrophytes/interdigitale 复合体（n = 60 [83.33%]）、Microsporum canis（n = 8 [11.11%]）、Trichophyton rubrum（n = 3 [4.16%]）和 Epidermophyton floccosum（n = 1 [1.38%]）。在 60 株 T. mentagrophytes 复合体分离株中，53 株（88.33%）被归类为 T. indotineae，7 株为 T. interdigitale 基因型 II。T. indotineae 组的疾病持续时间更长（P = 0.035）。梯度 PCR 和皮肤采样方法在阳性和阴性病例方面产生相似的结果（P = 1.0000）。患者停止用药的时间对阳性病例数量没有影响（P = 0.803）。性别对频率没有影响（P = 0.699）。两组感染的家族污染、皮肤病和其他潜在疾病没有差异（P > 0.05）。类固醇的使用与癣感染的出现密切相关（P < 0.04）。抗真菌药物的使用时间对耐药菌的出现有显著影响（P = 0.05）。
类固醇的使用、T. indotineae 的参与以及长时间暴露于抗真菌药物是导致顽固型参与的重要因素。鉴于快速和适当的诊断和治疗对于预防顽固型病例至关重要，我们建议直接皮肤样本 PCR 可以满足需求。
