Chapter 9. Dermatophytes and Dermatophytosis: A New Look at an Old Mycosis

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Germana Costa Paixão,1,2, Marcos Fábio Gadelha Rocha1,2, José Júlio Costa Sidrimand Raimunda Sâmia Nogueira Brilhante1
1Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
2State University of Ceará, Fortaleza, Ceará, Brazil

Part of the book: The Book of Fungal Pathogens

Abstract

Dermatophytes are closely related filamentous fungi characterized by their ability to invade and infect keratinized tissues. They belong to the oldest groups of microorganisms known to be pathogenic to humans and animals, causing dermatophytosis in between 20 and 25% of the world’s human population. The frequency and spectrum of distribution of these fungi in the population vary with geography, socioeconomic and climatic conditions and ecology. Dermatophytes are divided into three groups: anthropophilic, zoophilic and geophilic. The most recent phylogenetic taxonomy of dermatophytes classifies them into seven genera or clades, namely Arthroderma, Epidermophyton, Lophophyton, Microsporum, Nannizzia, Paraphyton and Trichophyton, placing these fungi at a new level of interest. The clinical aspects of dermatophytosis are varied and result from keratin destruction associated with an inflammatory response, more or less intense depending on the parasite/host binomial, which can compromise glabrous skin, nails and hair. There are two clinical classification systems of dermatophytosis. One of them follows the English current, according to which all infections are called tinea (in Latin), associated with another word (also in Latin) that indicates the anatomical site of the lesion, such as tinea corporis (location on the body), tinea capitis (scalp) and tinea unguium (nails). The other is the French system, by which dermatophytoses are classified as Tinea (any lesion that affects the scalp and/or beard and mustache region); epidermophytoses (lesions found on glabrous skin); onychomycosis (injury to the nails), and finally subcutaneous and deep dermatophytoses (lesions that affect the subcutaneous cell space or other deep organs, generally occurring in immunocompromised patients). Traditionally, dermatophytes are identified based on clinical symptoms caused by their infection, ecological preferences, in vitro morphological characteristics and the physiological behavior of the species. However, phenotypic instability, together with the microbial plasticity presented by some species, can produce overly generalized and erroneous classifications, making the identification of these fungi challenging, even for experienced mycologists. Therefore, the morphophenotypic characterization of dermatophytes has limitations and should no longer be used as the only taxonomic criterion. Instead, it is desirable to combine different approaches, including the study of genotypic and protein profiles, for the precise identification of these fungi. This accurate identification is essential for the establishment of effective programs for control and prevention of dermatophytoses, as well as for determining the most appropriate and effective antifungal therapies. Regarding the treatment of these infections, a variety of oral and topical antifungal agents can be used, such as imidazoles (clotrimazole, miconazole, etc.), triazoles (fluconazole, itraconazole and efinaconazole), allylamines (terbinafine and naphthyfine) and griseofulvin, with the treatment being guided by the species involved, ideally associating systemic agents with adjuvant topical treatments.

Keywords: dermatophytes, dermatophytosis, taxonomy, epidemiology, clinical symptoms, diagnosis, treatment


References


Algburi, A., Comito, N., Kashtanov, D., Dicks, L. M. & Chikindas, M. L. (2017). Control of biofilm formation:
antibiotics and beyond. Appl. Environ. Microbiol., 83, e02508-16.
Badillet, G. (1986). Dermatophyties et dermatophytes: Atlas clinique et biologique
[Dermatophytes and Dermatophytes: Clinical and Biological Atlas] (3rd ed). Paris: Ed. Varia.
Baert, F., Stubbe, D., D’Hooge, E., Packeu, A. & Hendrickx, M. (2020). Updating the taxonomy of
dermatophytes of the BCCN/IHEM Colection according to the new standard: a phylogenetic approach.
Mycopathologia, 185, 161-168.
Bastert, J. & Korting, H. C. (1998) Diagnostic methods for species-specific differentiation of various
dermathophytes: possibilities and limitations. Dtsch. Med. Wochenschr., 123, 499-503.
Bhat, Y. J., Zurak, S., Kanth, F., Yassen, A., Hassan, I. & Hakak, R. (2017). Clinicoepidemiological and
mycologycal study of tinea capitis in the pediatric population of Kashimir Valley: a study from a tertiary
care center. Indian Dermatol. Online J., 8, 100-103.
Bouchara, J. P., Mignum, B. & Chaturvedi, V. (2017) Dermatophytes and dermatophytoses: a thematic
overview of state of the art and the directions for future research and development. Mycopathologia, 12,1-4.
Brilhante, R. S. N., Correia, E. E. M., Guedes, G. M. M., Pereira, V. S., Oliveira, J. S., Bandeira, S. P. et al.
(2017). Quantitative and structural analyses of the in vitro and ex vivo biofilm forming ability of
dermatophytes. J. Med. Microbiol., 66, 1045-1052.
Brilhante, R. S. N., Paixão, G. C., Oliveira, J. S., Pereira, V. S., Rocha, M. F. G., De Lima-Neto, R. G. et al.
(2019). Chlamydoconidium-producing Trichophyton tonsurans: atypical morphological features of strains
causing tinea capitis in Ceará, Brazil. Asian Pac. J. Trop. Med., 12, 380-384.
Brilhante, R. S. N., Paixão, G. C., Pereira, V. S., Oliveira, J. S., Maciel, J. M., Pereira Neto, W. A. et al. (2021).
Atypical chlamydoconidium-producing Trichophyton tonsurans strains from Ceará State, Northeast
Brazil: investigation of taxonomy by phylogenetic analysis and biofilm susceptibility.
Microbiology, 167, 001018.
Burkharta, C. N., Burkhart, C. G. & Gupta, A. K. (2002). Dermatophytoma: recalcitrance to treatment because
of existence of fungal biofilm. J. Am. Acad. Dermatol., 47, 629-631.
Cafarchia, C., Iatta, R., Latrofa, M. S., Graser, Y. & Otranto, D. (2013). Molecular epidemiology, phylogeny,
and evolution of dermatophytes. Infect. Genet. Evol., 20, 336-351.
Calderaro, A., Motta, F., Montechinni, S., Gorrini, C., Piccolo, G., PiergiannI, M. et al. (2014). Identification
of dermatophytes species after implementation of the in-house MALDI-TOF MS database.
Int. J. Mol. Sci.,15, 6012-6024.
Cassagne, C., Normand, A. C., Olivier, C., Ranque & S., Piarroux, R. (2016). Performance of MALDI-TOF
platforms for fungal identification. Mycoses, 59, 678-690.
Chen, X., Jiang, X., Yang, M., Bennett, C., González, U. & Lin, X. (2017). Systemic antifungal therapy for
tinea capitis in children: an abridged cochrane review. J. Am. Acad. Dermatol., 76, 368-374.
Costa-Orlandi, C. B., Sardi, J. C., Santos, C. T., Fusco-Almeida, A. M. & Mendes, G. M. J. S. (2014). In vitro
characterization of Trichophyton rubrum and T. mentagrophytes biofilms. Biofouling, 30, 719-727.
Coulibaly, O., L’Ollivier, C., Piarroux, R. & Ranque, A. (2018). Epidemiology of human
dermatophyotoses in Africa. Med. Mycol., 56, 145-161.
Dabas, Y., Xess, I., Singh, G., Pandey, M. & Meena, S. (2017). Molecular identification and antifungal
susceptibility patterns of clinical dermatophytes following CLSI and EUCAST
guidelines. J. Fungi, 3, 17-23.
De Hoog, G. S., Guarro, J., Gené, J. & Figueras, M. J. (2015). Atlas of Clinical Fungi, (3rd web-ed): Hilversum.
De Hoog, G. S., Dukik, K., Monod, M., Packeu, A., Stubbe, D., Hendrickx, M. et al. (2017). Toward a novel
multilocus phylogenetic taxonomy for the dermatophytes. Mycopathologia, 182, 5-31.
Donlon, R. M. & Costerton, W. (2002). Biofilms: survival mechanisms of clinically relevant microorganisms.
Clin. Microbiol. Rev., 15, 167-193.
Duran-Valle, M. T., Regodon-Dominguez, M., Velasco-Rodríguez, M. J., Aragón, A. & Gómez-Garcéz, J. L.
(2016). Outbreak of Trichophyton tonsurans ringworm in a health area of the Community of Madri
(Spain). Rev. Iberoam. Micol., 33, 126-128.
Emmons, C. W. (1934). Dermatophytes: natural grouping based on the form
of the spores and accessory organs. Arch. Derm. Syphilol., 30, 362-377.
Fleece, D., Gaughan, J. P. & Aronoff, S. C. (2004). Griseofulvin and terbinafine in the treatment of tinea
capitis: a meta-analysis of randomized, clinical tials. Pediatrics, 114, 1312-1315.
Flemming, H. C., Wingender, J., Szewzyk, U., Steinberg, P., Rice, S. A. & Kjelleberg, S. (2016). Biofilms: an
emergent form of bacterial life. Nat. Rev. Microbiol., 14, 563-575.
Gostinčar, C. (2020). Towards genomic criteria for delineating fungal species. J. Fungi, 6, p. 246.
Gray, R. M., Champagne, C., Waghorn, D., Ong, E., Grabczynska, S. A. & Morris, J. (2015). Management of
a Trichophyton tonsurans outbreak in a day-care center. Pediatr. Dermatol., 32, 91-96.
Graser, Y., El Fari, M., Vilgalys, R., Kuijpers, A. F., De Hoog, G. S., Presber, W. et al. (1999). Phylogeny and
taxonomy of the Family Artrodermatacea (dermatophytes) using sequence analysis
of the ribossomal ITS region. Med. Mycol., 37, 105-114.
Graser, Y., Monod, M., Bouchara, J. P., Dukik, K., Nenoff, P., Kargl, A. et al. (2018). New insights in
dermatophytes research. Med. Mycol., 56, 2-9.
Gupta, A. K., Foley, K. A., Versteeg, S. G. (2017). New antifungal agents and new formulations against
dermatophytes. Mycopathologia, 182, 127-141.
Gupta, A. K., Mays, R. R., Versteeg, S. G., Piraccini, B. M., Shear, N. H., Piguet, V. et al. (2018). Tinea capitis
in children: a systematic review of management. J. Eur. Acad. Dermatol. Venereol., 32, 2264-2274.
Hayette, M. P. & Sachelli, R. (2017). Un unusual specie of dermatophytes: rarely identified or news?
Mycopathologia, 182, 203-213.
Hiruma, J., Ogawa, Y. & Hiruma, M. (2015). Trichophyton tonsurans infection in Japan:
epidemiology, clinical features, diagnosis, and infection control. J. Dermatol., 42, 245-249.
Irinyi, L., Serena, C., Garcia-Hermoso, D., Arabatzis, M., Desnos-Ollivier, M., Vu, D. et al. (2015).
International Society of Human and Animal Mycology (ISHAM)-ITS reference DNA barcoding
database—the quality controlled standard tool for routine identification of human
and animal pathogenic fungi. Med. Mycol., 53, 13-37.
Jamal, M., Ahmad, W., Andleeb, S., Jalil, F., Imran, M., Nawaz, M. A. et al. (2018). Bacterial biofilm and
associated infections. J. Chin. Med. Assoc., 81, 7-11.
Kandemir, H., Dukik, K., Hagen, F., Ilkit, M., Graser, Y. & De Hoog, G. S. (2020). Polyphasic discrimination
of Trichophyton tonsurans and T. equinum from humans and horses. Mycopathologia, 185, 113-122.
Karabiçak, N., Karatuna, O., Ilkit, M. & Makyar, I. (2015). Evaluation of the Bruker matrix-assisted laser
desorption-ionization time of-flight mass spectrometry (MALDI-TOF MS) system for the identification
of clinically important dermatophyte species. Mycopathologia, 180, 165-171.
Larone, D. H. (1995). Medically important fungi: A guide to identification (3rd ed).
Washington, DC: American Society for Microbiology.
L’Ollivier, C. & Ranque S. (2017). MALDI-TOF-Based dermatophyte identification.
Mycopathologia, 182, 183-192.
Marklein, G., Josten, M., Klanke, U., Muller, E., Horre, R., Maier, T. et al. (2009). Matrix-assisted laser
desorption ionization-time of flight mass spectrometry for fast and reliable identification of clinical yeast
isolates. J. Clin. Microbiol., 47, 2912-2917.
Mochizukit, T., Takeda, K. & Anzawa, K. (2017). Molecular markers useful for intraspecies subtyping and
strain differentiation of dermatophytes. Mycopathologia, 182, 57-65.
Monod, M. (2017). Récente révision des espèces de dermatophytes et de leur nomenclature [Recent revision
of dermatophyte species and their nomenclature]. Rev. Med. Suisse, 13, 703-708.
Murray, P. R. (2012). What is new in clinical microbiology-microbial identification by MALDI-TOF mass
spectrometry: a paper from the 2011 William Beaumont hospital symposium on molecular pathology.
J. Mol. Diagn., 14, 419-423.
Narayana, P. & Srihari, P. (2019). Biofilm resistant surfaces and coatings on implants: \
A review. Mater. Today Proc., 18, 4847-4853.
Nenoff, P., Kruger, C., Ginter-Hanselmayer, G. & Tietz, H. J. (2014). Mycology-an update. Part 1:
Dermatomycoses: causatives agents, epidemiology and pathogenesis.
J. Dtsch. Dermatol. Ges., 12, 88-209.
Paixão, G. C., Rocha, M. F. G., Castelo-Branco, D. S. C., Brilhante, R. S. N. & Sidrim, J. J. C. (2020).
Dermatophytes. In R. A. Cordeiro (org). Pocket Guide to Mycological Diagnosis (1ª edition, pp. 81-97).
Florida: CRC PRESS.
Pihet, M. & Le Govic, Y. (2017). Reappraisal of conventional diagnosis for dermatophytes.
Mycopathologia, 182, 169-180.
Ramage, G., Rajendran, R., Sherry, L. & Williams, C. (2012). Fungal biofilm resistance.
Int. J. Microbiol., 2012, 521-528.
Ranque, S., Normand, A. C., Cassagne. C., Murat, J. B., Bourgeois, N., Dalle, F. et al. (2014). MALDI-TOF
mass spectrometry identification of filamentous fungi in the clinical laboratory. Mycoses, 57, 135-140.
Rebell, G. & Taplin G. (1970). Dermatophytes, their identification and recognition (2ª edition). Miami, USA:
University of Miami Press.
Rezai-Matehkolei, A., Mirhendi, H., Makimura, K., De Hoog, G. S., Satoh, K., Najafzadeh, M. J. et al. (2014).
Nucleotide sequence analysis of beta tubulin gene in a wide range of dermatophytes.
Med. Mycol., 52, 674-688.
Rivalier, E. (1966). Sur la taxonomie de dermatophytes [On the taxonomy of dermatophytes].
Ann. Inst. Pasteur., 877-87.
Seng, P., Rolain, J. M., Fournier, P. E., Scola, L., Drancourt & M., Raoult, D. (2010). MALDI-TOF-mass
spectrometry applications in clinical microbiology. Future Microbiol., 5, 1733-1754.
Sidrim, J. J. C. & Rocha, M. F. G. (2004). Micologia médica à luz de autores contemporâneos [Medical
mycology in the light of contemporary authors] (1st ed). Rio de Janeiro, RJ: Editora Guanabara Koogan.
Stewart, P. S., White, B., Boegli, L., Hamerly, T., Williamson, K. S., Franklin, M. J. et al. (2019). Conceptual
model of biofilm antibiotic tolerance that integrates phenomena of diffusion, metabolism, gene expression,
and physiology. J. Bacteriol., 201, e00307-19.
Suh, S. O., Grosso, K. M. & Carrion, M. E. (2018). Multilocus phylogeny of the Trichophyton mentagrophytes
species complex and the application of matrix-assisted laser desorption/ionization-time-of-flight
(MALDI-TOF) mass spectrometry for the rapid identification of dermatophytes.
Mycologia, 110, 118-130.
Summerbell, R. C., Moore, M. K., Starink-Willemsa, M. & Van Iperen, A. (2007). ITS barcodes for
Trichopyton tonsurans and T. equinum. Med. Mycol., 45, 193-200.
Taghipour, S., Pchelin, J. M., Mahmoudabadi, A. Z., Ansari, S., Katiraee, F., Rafiei, A. et al. (2019).
Trichophyton mentagrophytes and T. interdigitale genotypes are associated with particular geographic
areas and clinical manifestations. Mycoses, 62, 1084-1091.
Takashio, M. (1979). Taxonomy of dermatophytes based on their sexual states. Mycologia, 71, 968-976.
Trentin, D. S., Giordani, R. B. & Macedo, A. J. (2013). Biofilmes bacterianos patogênicos: aspectos gerais,
importância clínica e estratégias de combate [Pathogenic bacterial biofilms: general aspects, clinical
importance and combat strategies]. Revista Liberato, 14, 213-238.
Van Veen, S. Q., Claas, E. C. J. & Kuijper, E. J. (2010). High-throughput identification of bacteria and yeast
by matrix-assisted laser desorption ionization-time of flight mass spectrometry in conventional medical
microbiology laboratories. J. Clin. Microbiol., 48, 900-907.
Vasanthi, R., Karthikeyan, D. & Jeya M. (2014). Study of biofilm production and antimicrobial resistance
pattern of the bacterial isolates from invasive devices. Int. J. Res. Health. Sci., 2, 415-424.
Verrier, J. & Monod, M. (2017). Diagnosis of dermatophytosis using molecular biology.
Mycopathologia, 182, 193-202.
Vingataramin, Y., Akhound, M., Bruel, C., Izri, A. & Brun, S. (2019). Epidemiological and molecular
characterization of a Trichophyton tonsurans epidemic in schools of a city in the northern suburbs of Paris,
France. Clin. Microbiol. Infect., 24, 529-530.
Weitzman, I., Salkin, I. F. & Rosenthal, R. A. (1983). Evaluation of Trichophyton agars for identification of
Trichophyton soudanense. J. Clin. Microbiol., 18, 203-205.
Weitzman, I., Mcginnis, M. R., Padhe, A. A. & Ajello, L. (1986). The genus Arthoderma and its synonym
Nannizia. Mycotaxon, 25, 505-518.
Weitzman I. & Summerbell, R. C. (1995). The dermatophytes. Clin. Microbiol. Rev., 8, 240-259.
Zhan, P. & Liu, W. (2017). The changing face of the dermatophytic infections worldwide.
Mycopathologia, 182, 77-86.

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