Megha Mariam George, (2020) Clinicomycological study of Dermatophytic Infections in a Teritary Care Hospital, Assessment of Risk Factors Causing Chronic Dermatophytic Infections and Anti Fungal Susceptibility to Terbinafine and Itraconazole in the Same Population. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Superficial fungal infections are commonly caused by dermatophytes, non-dermatophytic moulds and commensal yeasts. The common organisms implicated in causing dermatophytic infections are Trichophyton, Microsporum, and Epidermophyton. They degrade keratin causing disease. The tropical Indian climate is suitable for the growth of these organisms and recently disseminated disease has been increasingly reported. They affect the social, occupational and psychological health of patients by rendering them with a poor quality of life. OBJECTIVES: To study clinico-mycological characteristics of dermatophyte infections to assess risk factors, in causing chronic dermatophytosis in the patients coming to a tertiary care centre in South India.To assess the quality of life in patients with acute and chronic dermatophytic infections, to assess the antifungal susceptibility to itraconazole and terbinafine in a subset of patients with acute and chronic disease. METHODS: This was a cross sectional study done in a tertiary care centre in Tamil Nadu from May 2018 to June 2019 where the clinicomycological profile of patients with dermatophytosis was studied, patients who had chronic disease was compared with patients with acute disease for risk factors that may cause chronicity. Fungal cultures were done for all the patients and antifungal susceptibility testing for terbinafine and itraconazole was done on a subset of the samples. Quality of Life index (DLQI) was ascertained for the patients participating in the study. Descriptive statistics was reported using Mean+/-SD for continuous variables and categorical variables was reported using frequency and percentage. Association between the categorical variables was assessed using Chi square/Fisher exact test as appropriate. RESULTS: There were 128 patients in the study, 66 patients in the acute group and 62 patients in the chronic group. The mean age of the patients in the study was 39.6 ±13.63years. Males were affected more than females; male to female ratio was 1.28:1. Sharing of towels had an association with chronicity of the disease (p=0.034).There was an association between asthma and chronic dermatophytosis (p=0.024). There were 58.3% patients in the chronic group with family history of dermatophytosis (p=0.083) There were 54 (87.1%) patients with chronic dermatophytosis with more than 2 sites of involvement. (p=0.011). There were 55.9% patients with chronic dermatophytosis who had recurrence of lesions at the same and new sites. (p=0.029).Patients in the acute group had localized disease with 63.6% patients and 59.7% patients in the chronic group had generalized disease (p=0.008). Tinea corporis was the common clinical form in 93.1% patients, tinea pedis was seen in 17.7% of patients with chronic dermatophytosis (p=0.006). There were only 6.2% patients with circinate lesions with central clearing. There were many atypical morphological forms observed like eczematous lesions (34.4%), and psoriasiform (18.8%), circinate with central activity (17.1%), PIH with inconspicuous scaling (11.7%), erythema with inconspicuous scaling (18.7%), P. rosea (0.7%), pustular (5.4%), follicular (1.4%), seborrheic dermatitis like (3.9%), LSC like (3.9%), recidivans like (7.8%), inter- digital (0.7%) and pseudoimbricata (6.2%). Atypical morphologies were observed almost equally among both the groups. The DLQI score showed a that the disease had a very large effect on 39.3% patients with chronic dermatophytosis (0.057). T. mentagrophytes was the commonly isolated species in patients and was equal in both the groups (51.6%). This was followed by T. tonsurans (29.7%) which also showed an equal distribution among both the groups. Itraconazole was found to demonstrate higher in vitro activity against both T. mentagrophytes and T. tonsurans with an MIC90 of 0.5μg/ml while terbinafine was found to demonstrate a lower in-vitro activity with MIC90 of 16.0μg/ml. CONCLUSION: The factors like sharing of towels, asthma, family history of dermatophytosis, generalized lesions was found to be associated with chronicity of the disease. T. mentagrophytes was the commonest isolate followed by T. tonsurans and was found to be the causative species in both acute and chronic dermatophytosis. Itraconazole was found to have higher in vitro activity against T. mentagrophytes and T. tonsurans than terbinafine.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 201730303 |
| Uncontrolled Keywords: | Dermatophytic Infections, Teritary Care Hospital, Assessment of Risk Factors, Chronic Dermatophytic Infections, Anti Fungal Susceptibility, Terbinafine, Itraconazole, Clinicomycological study . |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Subramani R |
| Date Deposited: | 05 Feb 2021 15:19 |
| Last Modified: | 05 Feb 2021 15:19 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13890 |
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