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Incidence and Biodiversity of Yeasts, Dermatophytes and Non

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Incidence and Biodiversity of Yeasts, Dermatophytes and Non Journal de Mycologie Médicale (2017) 27, 166—179 Available online at ScienceDirect www.sciencedirect.com ORIGINAL ARTICLE/ARTICLE ORIGINAL Incidence and biodiversity of yeasts, dermatophytes and non-dermatophytes in superficial skin infections in Assiut, Egypt Incidence et biodiversite´ des levures, des dermatophytes, et non dermatophytes, agents de mycoses superficielles dans le gouvernorat d’Assiout — ´Egypte A.H. Moubasher, M.A. Abdel-Sater *, Z. Soliman Department of Botany and Microbiology, Faculty of Science, Assiut University Mycological Centre, Assiut University, Assiut, Egypt Received 1st October 2016; received in revised form 28 December 2016; accepted 11 January 2017 Available online 7 February 2017 KEYWORDS Summary Skin infections; Objective. — The aim was to identify the incidence of the causal agents from dermatophytes, Yeasts; non-dermatophytes and yeasts in Assiut Governorate employing, beside the morphological and Dermatophytic; physiological techniques, the genotypic ones. Non-dermatophytic; Patients. — Samples from infected nails, skin and hair were taken from 125 patients. PCR Materials and methods. — Patients who presented with onychomycosis, tinea capitis, tinea corporis, tinea cruris and tinea pedis during the period from February 2012 to October 2015 were clinically examined and diagnosed by dermatologists and were guided to Assiut University Mycological Centre for direct microscopic examination, culturing and identification. Results. — Onychomycosis was the most common infecting (64.8% of the cases) followed by tinea capitis (17.6%). Direct microscopic preparations showed only 45 positive cases, while 96 cases showed positive cultures. Infections were more frequent in females than males. Fifty-one fungal species and 1 variety were obtained. Yeasts were the main agents being cultured from 46.02% of total cases. Non-dermatophytes were the second etiologic agents. Aspergillus was responsible for infecting 19.47% of total cases and dermatophytes appeared in only 15.93% of the cases. * Corresponding author. E-mail address: [email protected] (M.A. Abdel-Sater). http://dx.doi.org/10.1016/j.mycmed.2017.01.005 1156-5233/# 2017 Elsevier Masson SAS. All rights reserved. Diversity of mycobiota in superficial infections 167 Conclusions. — Yeasts were the main causal agents followed by non-dermatophytic fungi (mainly species of Aspergillus, then Alternaria, Scopulariopsis and Fusarium). Both direct microscopic preparations and culturing are recommended for mycological evaluation of clinical specimens. Sequence analysis of ITS region is recommended for yeast identification. # 2017 Elsevier Masson SAS. All rights reserved. Re´sume´ MOTS CLÉS Objectif. — Ce travail a pour but de connaître les agents de mycoses superficielles chez l’homme dans le gouvernorat d’Assiout, en utilisant le diagnostic morphologique, les techniques physio- Mycoses superficielles ; logiques et génétiques. Levures ; Patients. — Les échantillons prélevés ont concerné la peau, les cheveux, et des ongles infectés Dermatophytes et non de 125 malades. dermatophytes ; PCR Mate´riel et me´thodes. — Nous avons examiné les patients atteints de teigne des ongles, du corps et du cuir chevelu de février 2012 à octobre 2015. Ces cas ont été diagnostiqués cliniquement par des dermatologistes, à la faculté de médecine, université d’Assiout. Après prélèvement des échantillons nous avons réalisé un examen microscopique et des cultures sur milieux appropriés pour identifier les champignons par les moyens morphologiques et génétiques, utilisés au centre de mycologie de l’université d’Assiout. Re´sultats. — Les cas d’onychomycose sont les plus répandus dans les infections superficielles (64,8 %). La teigne du cuir chevelu vient au deuxième rang après l’onychomycose (17,6 %) L’examen microscopique direct des échantillons a révélé l’infection de 43 cas, mais le résultat des cultures mycologiques a été positif dans 96 cas. On a observé que les infections dermiques superficielles ont été plus répandues chez les femmes que chez les hommes. Cinquante et une espèces fongiques ont été isolées. Les levures étaient la cause principale de l’infection avec 46,02 % des cas total, les non dermatophytes occupaient la deuxième place. Des Aspergillus ont été isolés dans 19,47 % des cas, les dermatophytes ont été isolés seulement dans 15,93 % des cas. Conclusion. — En premier, les levures étaient la cause principale des infections, suivies par les non-dermatophytes : Aspergillus, Alternaria, Scopulariopsis, et Fusarium. Il est donc recom- mandé d’utiliser les techniques d’examen direct et de faire des cultures mycologiques des échantillons étudiés. Pour les levures, le séquençage de la région ITS est recommandée pour l’identification. # 2017 Elsevier Masson SAS. Tous droits réservés. Introduction mainly T. rubrum, T. mentagrophytes while Candida albicans is the major yeast causing onychomycosis of fingernails [9,10]. Genetic predisposition, age, swimming, psoriasis, Although not all fungi are pathogenic, some can cause serious diabetes and immunodeficiency are the risk factors for ony- diseases and pose a significant public health risk. Within the chomycosis. Tinea unguium is most common in adults [11]. last three decades, fungi (especially yeasts of the Candida Tinea manuum, in which palms and interdigital areas of genus) are a major cause of nosocomial infections among hands are affected, is usually caused by T. rubrum and other immunocompromised patients but the leading cause remains Trichophyton and Microsporum species. Tinea capitis (infec- bacteria [1—3]. Fungal infections, particularly yeast infec- tion of the scalp that range from mild scaling lesions to a tions, represent the most widespread and prevalent mycotic highly inflammatory reaction and usually caused by Micro- diseases of man and animals [4]. Despite aggressive treat- sporum or Trichophyton species) and tinea corporis (infection ment with new licensed antifungal agents, these infections may involve the trunk, shoulders and limbs and may range are important causes of morbidity and mortality, especially from mild to severe, commonly presenting as annular scaly in immunocompromised patients [5]. lesions with sharply defined, raised, erythematous vesicular Fungal infections are generally divided into four types; edges) are most frequently seen in children. Tinea pedis superficial, cutaneous, subcutaneous, and systemic mycosis. (known also as Athlete’s foot in which toe webs and soles Superficial and cutaneous infections are both sometimes of the feet are most commonly affected with the common referred to as superficial. Superficial mycoses are characte- agents are T. rubrum, T. mentagrophytes var. interdigitale rized by fungal invasion into the superficial stratum corneum and E. floccosum) is more common in adults [11]. Tinea cruris with little to no inflammatory response [6]. These infections involve infections of groin, perianal and perineal sites and are among the most common skin diseases affecting millions most common in adult males, with T. rubrum and of people throughout the world [7] and are common in hot and E. floccosum are the most commonly implicated fungi. humid climate of tropical countries [8]. Of these, onychomy- Yeast pathogens include organisms from both Ascomycota cosis is a fungal infection of nails caused by yeasts, derma- (like Candida spp.) and Basidiomycota (like Cryptococcus tophytic and non-dermatophytic fungi. The causative agents spp.) phyla. Candidiasis is caused by species of Candida of onychomycosis of toenails (so called tinea unguium) are 168 A.H. Moubasher et al. (most commonly C. albicans) that is part of the microbiome mycologically positive when fungal elements such as in the human gastrointestinal tract (including the mouth) hyphae, spores, or yeast cells are observed. and the vagina. Candida species are one of the largest groups of pathogenic fungi with C. albicans, C. glabrata, Culturing C. parapsilosis, C. tropicalis and C. krusei being the most Skin scrapings, hairs, pus, and nail fragments were placed on common pathogens [12]. Also, of Rhodotorula, the surface of two types of media; Sabouraud Dextrose Agar R. mucilaginosa, R. glutinis, and R. minuta are known to (SDA) which contained (g/L): glucose, 20; peptone, 10; agar, cause disease in humans [13]. Species of Rhodotorula have 20; chloramphenicol 250 mg/L, and SDA supplemented with been recognized as emerging yeast pathogens in humans in 0.5 g/L cycloheximide to reduce saprobic fungi. Cultures the last three decades. While no cases of Rhodotorula were incubated at 25 8C for up to 4 weeks during which infection were reported in the medical literature before the growing fungi were examined and identified. Pure cultu- 1985, the number of infections increased after that time, res were prepared for further investigations. most likely because of the wider use of intensive treatments and central venous catheters (CVCs) [14]. Trichosporon Phenotypic identification of the human pathogenic contains also emerging opportunistic pathogens of humans, fungi and is the third most commonly isolated non-candidal yeast. The fungi were identified based on their macro- and micro- Trichosporon asahii and T. asteroides are the most impor- scopical features following the keys of [20] for dermatophy- tant species causing disseminated disease in immunocom- tic and other opportunistic pathogens [21,22] for non- promised patients [15]. dermatophytes and Barnett et al. [23], for yeasts. Not many reports on superficial fungal infections are pre- sented in Assiut [16—19].
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