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Is Antifungal Resistance a Cause for Treatment Failure in Dermatophytosis: A Study Focused on Tinea Corporis and Cruris from a Tertiary Centre?

BACKGROUND: Dermatophytoses are one of the most common skin diseases that have been largely simple to treat. However, in recent years, these infections have become recalcitrant to treatment which can possibly be due to antifungal resistance. AIM: To analyze the resistance pattern of patients with re...

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Autores principales: Sardana, Kabir, Kaur, Ravinder, Arora, Pooja, Goyal, Ritu, Ghunawat, Sneha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885633/
https://www.ncbi.nlm.nih.gov/pubmed/29644192
http://dx.doi.org/10.4103/idoj.IDOJ_137_17
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author Sardana, Kabir
Kaur, Ravinder
Arora, Pooja
Goyal, Ritu
Ghunawat, Sneha
author_facet Sardana, Kabir
Kaur, Ravinder
Arora, Pooja
Goyal, Ritu
Ghunawat, Sneha
author_sort Sardana, Kabir
collection PubMed
description BACKGROUND: Dermatophytoses are one of the most common skin diseases that have been largely simple to treat. However, in recent years, these infections have become recalcitrant to treatment which can possibly be due to antifungal resistance. AIM: To analyze the resistance pattern of patients with recalcitrant dermatophytoses. MATERIALS AND METHODS: A cross-sectional evaluation was undertaken of 40 consecutive patients with recalcitrant tinea corporis/cruris/both who had taken systemic antifungal treatment and did not respond completely to therapy or had recurrent lesion within 1 month of stopping the therapy. Terbinafine, fluconazole, itraconazole, ketoconazole, amphotericin B, and voriconazole were the antifungals tested using broth microdilution assay for antifungal susceptibility testing of dermatophytes, and MIC50, 90 values were recorded. RESULTS: KOH mount was positive in 18 (45%) patients, culture was positive in 28 (70%) patients. Trichophyton mentagrophytes (35%) and T. rubrum (27.5%) were the predominant isolates. Overall, activity of terbinafine and itraconazole were significantly higher than the other drugs tested. For terbinafine, both T. mentagrophytes and T. rubrum were inhibited at MIC(90) of 0.125 μg/ml. Itraconazole-inhibited T. mentagrophytes and T. rubrum at MIC(90) of 0.0625 and 0.25 μg/ml, respectively. All isolates had reduced susceptibility to fluconazole. CONCLUSION: While MIC seen were higher than western data, in-vitro resistance (>1 μg/ml) to antifungals was not seen and probably may not be a cause of treatment failure. Possibly, treatment failure lies in the intricate host fungal interaction and virulence of species which help it to evade host immune response.
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spelling pubmed-58856332018-04-11 Is Antifungal Resistance a Cause for Treatment Failure in Dermatophytosis: A Study Focused on Tinea Corporis and Cruris from a Tertiary Centre? Sardana, Kabir Kaur, Ravinder Arora, Pooja Goyal, Ritu Ghunawat, Sneha Indian Dermatol Online J Original Article BACKGROUND: Dermatophytoses are one of the most common skin diseases that have been largely simple to treat. However, in recent years, these infections have become recalcitrant to treatment which can possibly be due to antifungal resistance. AIM: To analyze the resistance pattern of patients with recalcitrant dermatophytoses. MATERIALS AND METHODS: A cross-sectional evaluation was undertaken of 40 consecutive patients with recalcitrant tinea corporis/cruris/both who had taken systemic antifungal treatment and did not respond completely to therapy or had recurrent lesion within 1 month of stopping the therapy. Terbinafine, fluconazole, itraconazole, ketoconazole, amphotericin B, and voriconazole were the antifungals tested using broth microdilution assay for antifungal susceptibility testing of dermatophytes, and MIC50, 90 values were recorded. RESULTS: KOH mount was positive in 18 (45%) patients, culture was positive in 28 (70%) patients. Trichophyton mentagrophytes (35%) and T. rubrum (27.5%) were the predominant isolates. Overall, activity of terbinafine and itraconazole were significantly higher than the other drugs tested. For terbinafine, both T. mentagrophytes and T. rubrum were inhibited at MIC(90) of 0.125 μg/ml. Itraconazole-inhibited T. mentagrophytes and T. rubrum at MIC(90) of 0.0625 and 0.25 μg/ml, respectively. All isolates had reduced susceptibility to fluconazole. CONCLUSION: While MIC seen were higher than western data, in-vitro resistance (>1 μg/ml) to antifungals was not seen and probably may not be a cause of treatment failure. Possibly, treatment failure lies in the intricate host fungal interaction and virulence of species which help it to evade host immune response. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC5885633/ /pubmed/29644192 http://dx.doi.org/10.4103/idoj.IDOJ_137_17 Text en Copyright: © 2018 Indian Dermatology Online Journal http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Sardana, Kabir
Kaur, Ravinder
Arora, Pooja
Goyal, Ritu
Ghunawat, Sneha
Is Antifungal Resistance a Cause for Treatment Failure in Dermatophytosis: A Study Focused on Tinea Corporis and Cruris from a Tertiary Centre?
title Is Antifungal Resistance a Cause for Treatment Failure in Dermatophytosis: A Study Focused on Tinea Corporis and Cruris from a Tertiary Centre?
title_full Is Antifungal Resistance a Cause for Treatment Failure in Dermatophytosis: A Study Focused on Tinea Corporis and Cruris from a Tertiary Centre?
title_fullStr Is Antifungal Resistance a Cause for Treatment Failure in Dermatophytosis: A Study Focused on Tinea Corporis and Cruris from a Tertiary Centre?
title_full_unstemmed Is Antifungal Resistance a Cause for Treatment Failure in Dermatophytosis: A Study Focused on Tinea Corporis and Cruris from a Tertiary Centre?
title_short Is Antifungal Resistance a Cause for Treatment Failure in Dermatophytosis: A Study Focused on Tinea Corporis and Cruris from a Tertiary Centre?
title_sort is antifungal resistance a cause for treatment failure in dermatophytosis: a study focused on tinea corporis and cruris from a tertiary centre?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885633/
https://www.ncbi.nlm.nih.gov/pubmed/29644192
http://dx.doi.org/10.4103/idoj.IDOJ_137_17
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