Growth Inhibition of Trichophyton Species by Pseudomonas Aeruginosa
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STUDY Growth Inhibition of Trichophyton Species by Pseudomonas aeruginosa James Treat, MD; William D. James, MD; Irving Nachamkin, DrPH, MPH; John T. Seykora, MD, PhD Objective: To assess the ability of Pseudomonas aeru- Results: There was a 73% and 46% reduction of total ginosa to inhibit the growth of Trichophyton menta- fungal units and a final hyphal-spore ratio of 0.16 and grophytes (TM) and Trichophyton rubrum (TR). 0.04, respectively, when TM and TR were co-cultured with P aeruginosa. The number of fungal units increased when Design: Pseudomonas aeruginosa, Escherichia coli,or TM and TR were cultured with E coli (28% and 42%, re- Staphylococcus epidermidis were grown in co-culture with spectively), S epidermidis (13% and 18%, respectively), either TM or TR. and control media (44% and 62%, respectively), and the hyphal-spore ratio increased to above 30 in the pres- ence of S epidermidis, E coli, and control media. Setting: An academic medical center. Conclusion: Pseudomonas aeruginosa exhibits growth in- Main Outcome Measures: The total fungal units hibitory properties against TM and TR. and hyphal-spore ratio were measured at days 1, 5, 10, and 15. Arch Dermatol. 2007;143:61-64 NTERDIGITAL TOE WEB SPACE IS A co-culture experiments examining how warm, moist, protected environ- Trichophyton species grow in the pres- ment that predisposes to the ence of various bacteria. The ability of proliferation of both derma- P aeruginosa to affect fungal growth was tophytes and gram-negative or- evaluated, given its association with ganisms.1 Tinea pedis is by far the most bacterial toe web infections. Escherichia I 2 common fungal infection. Maceration, coli and Staphylococcus epidermidis were scaling, and fissures result, allowing for chosen as controls to evaluate other rel- overgrowth of bacteria that normally in- evant bacterial species. The fungal spe- habit this interspace.3 Proliferation of these cies evaluated were Trichophyton organisms, which include most promi- rubrum (TR) and Trichophyton menta- nently Pseudomonas aeruginosa, other grophytes (TM) because they represent gram-negative bacteria (eg, Escherichia coli the most common causes of tinea and Proteus mirabilis), and gram-positive pedis.8-10 bacteria, leads to an aggressive, painful infection.4 Once these bacterial species propagate, fungi, which initiated the toe METHODS For editorial comment Both TR and TM were obtained from the American Type Culture Collection (Manas- see page 105 sas, Va) and were reconstituted in 1.0 mL of distilled water for 24 hours. Aliquots (30 µL) web infection, cannot usually be recov- were inoculated separately onto plates of Sab- ered via culture.3 Therefore, growth of bac- ouraud dextrose agar (Becton Dickinson BBL, teria associated with toe web infections Sparks, Md) and grown for 2 weeks at 25°C. Author Affiliations: may exhibit fungistatic and/or fungicidal Pseudomonas aeruginosa was reconstituted per Departments of Dermatology properties. In fact, P aeruginosa has been American Type Culture Collection instruc- (Drs Treat, James, and Seykora) tions. Pseudomonas aeruginosa, control bacte- shown to inhibit both Candida albicans and ␣ and Pathology and Laboratory 5-7 ria, E coli DH-5 , and S epidermidis (provided Medicine (Dr Nachamkin), Aspergillus fumigatus in vitro. by the Clinical Microbiology Laboratory, University of Pennsylvania To extend these observations to addi- Hospital of the University of Pennsylvania, School of Medicine, tional fungal species relevant to toe web Philadelphia), were freshly plated on sheep Philadelphia. infections, we conducted a series of blood agar 2 days prior to each co-culturing (REPRINTED) ARCH DERMATOL/ VOL 143, JAN 2007 WWW.ARCHDERMATOL.COM 61 ©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 A B Control 100 S epidermidis 100 E coli P aeruginosa 75 75 50 50 Hyphal-Spore Ratio Hyphal-Spore Ratio 25 25 0 0 0 5 10 15 0 5 10 15 Days of Incubation Days of Incubation Figure 1. Fungal growth inhibition by Pseudomonas aeruginosa. Bacterial-fungal co-cultures (A, Trichophyton mentagrophytes;B,Trichophyton rubrum) were evaluated to determine the hyphal-spore ratio at days 1, 5, 10, and 15. The ratios are presented graphically for Staphylococcus epidermidis, Escherichia coli, and P aeruginosa. Note the increase in hyphal-spore ratio in each control strain and the dramatic decrease in the P aeruginosa samples. Error bars indicate 95% confidence intervals. experiment. Colonies of P aeruginosa, E coli, and S epidermidis recorded so that a ratio could be calculated. Photomicro- were each inoculated into Mueller-Hinton (MH) broth, and graphs were taken using light microscopy and epifluores- the bacterial density was adjusted to 4ϫ107 colony-forming cence. The duplicate 15-day samples were reconstituted with units (CFU)/mL, as determined by optical density 600 nm. a pipette in 30 µL of gentamicin solution (1 mg/mL) and cul- tured on Sabouraud agar at 25°C. The growth of these isolates FUNGAL LAWN ASSAY was observed at 96 hours. Separate 15-day samples were re- constituted with 30 µL of MH media and then grown on sheep Fifty-microliter aliquots of P aeruginosa or E coli grown in MH blood agar and observed at 96 hours. Samples incubated for media or MH control media were inoculated on mature lawns 15 days were also reinoculated onto sheep blood agar to assess of both TR and TM and observed at 96 hours for morphologic viability. changes in the fungal lawn. RESULTS BACTERIA-FUNGAL CO-CULTURE Approximately 10 mg of TM (8ϫ107 CFU) or TR (3ϫ106 Co-culture of TM and TR with P aeruginosa resulted in CFU) was plated on Sabouraud dextrose agar. Then, 30 µL of a 73% and 46% reduction of total fungal units (hyphae 4ϫ107 CFU/mL of P aeruginosa, E coli, S epidermidis,orMH plus spores), respectively (Figure 1). Numbers of fun- media alone were separately inoculated into a 1.3-cm demar- gal units increased when TM and TR were cultured with cated area in the center of plates from each fungus and grown E coli (28% and 42%, respectively) and S epidermidis at 25°C. Inhibition of fungal growth was evaluated at 5, 10, (13% and 18%, respectively), although at a slightly and 15 days. slower rate than when cultured with MH media alone (44% and 62%, respectively). There was one slide of TR DIRECT VISUALIZATION OF grown with P aeruginosa at 15 days that did show a sig- BACTERIAL-FUNGAL INTERACTIONS nificant number of spores, but this slide had dried out, potentially destroying the P aeruginosa and its inhibi- One milligram of TM (8ϫ106 CFU) and TR (3ϫ105 CFU) was smeared evenly onto separate polarized glass slides to cover the tory ability. area with a thin layer of fungus in a 1.3-cm diameter circle de- Co-culture of TM and TR with P aeruginosa marcated with a wax pencil. Thirty microliters of MH broth con- decreased the hyphal-spore ratio to 0.16 and 0.04 com- taining 4ϫ107 CFU/mL of P aeruginosa, E coli, S epidermidis, pared with control TM and TR cultures, respectively. In or broth alone were inoculated onto the slides containing fun- contrast, the hyphal-spore ratio increased to above 30 gus. Each of the slides marked “15 day” contained a duplicate in the presence of S epidermidis, E coli, and control circle with the same bacteria and fungi or control media. The media (Figure 1). No fungal organisms could be recov- slides were kept moist by suspending them in a 50-mL tube ered by culture from a 15-day co-culture of TM or TR with 20 mL of deionized water. At 1, 5, 10, and 15 days, slides with P aeruginosa, while fungi were easily recoverable were removed from the tubes and 2 drops of calcofluor white from co-cultures using Ecolior S epidermidis. There (Becton, Dickinson, and Company, Franklin Lakes, NJ) were applied and the slides were coverslipped. The number of fungi, was bacterial growth in each control after 15 days of including yeast and hyphal forms, in 9 representative high- coculturing. powered fields (original magnification ϫ40) was evaluated us- The fungi, which had been co-cultured for 15 days with ing epifluorescence. A maximum of 100 fungal units was re- control broth, S epidermidis, or E coli, grew successfully corded in each field, and if no spores could be found,a1was at 96 hours when restreaked on Sabouraud agar. The fungi, (REPRINTED) ARCH DERMATOL/ VOL 143, JAN 2007 WWW.ARCHDERMATOL.COM 62 ©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 A B A B Figure 2. Gram stains of control bacteria with Trichophyton mentagrophytes (TM ) at day 10. Gram stains of Staphylococcus epidermidis (A) and Escherichia coli (B) co-cultured with TM. Note the vigorous growth of TM in the presence of S epidermidis and E coli. Figure 4. Pseudomonas aeruginosa eroded through the mature Trichophyton mentagrophytes (TM ) fungal lawn at 96 hours. Mature lawn of TM on Sabouraud agar with a 50-µL droplet of control Mueller-Hinton media Table. Inhibition (؉) or No Inhibition (−) of Fungal Growth sitting on top of the fungal lawn, demonstrated by the fact that it has rolled by 30 µL of Control Media, Staphylococcus epidermidis, to the side of the lawn (A); a 50-µL aliquot of P aeruginosa shown eroded through the fungal lawn (B). Escherichia coli,orPseudomonas aeruginosa Inoculated in the Center of Freshly Plated TR or TM Inhibition of TM Inhibition of TR Day 1 Day 5 Day 10 Day 15 Day Day Day Day Day Day Control Bacteria 5 10 15 5 10 15 S epidermidis −−−−−− E coli −−−−−− S epidermidis P aeruginosa ϩϩϩϩϩϩ E coli Abbreviations: TM, Trichophyton mentagrophytes; TR, Trichophyton rubrum.