Evaluation of the susceptibility of dermatophytes to antifungal drugs: a new technique

A novel murine model of Fusarium solani keratitis utilizing fluorescent labeled fungi

Fungal keratitis is a common disease that causes blindness. An effective animal model for fungal keratitis is essential for advancing research on this disease. Our objective is to develop a novel mouse model of Fusarium solani keratitis through the inoculation of fluorescent-labeled fungi into the cornea to facilitate the accurate and early identification and screening of fungal infections. F. solani was used as the model fungus in this study. In in vitro experiment, the effects of Calcofluor White (CFW) staining concentration and duration on the fluorescence intensity of F. solani were determined through the mean fluorescence intensity (MFI); the effects of CFW staining on the growth of F. solani were determined by the colony diameter. In in vivo experiment, the F. solani keratitis mice were induced and divided into a CFW-unlabeled and CFW-labeled groups. The positive rate, corneal lesion score and several positive rate determination methods were measured. The MFIs of F. solani in the 30 μg/ml CFW-30 min, 90 μg/ml CFW-10 min and 90 μg/ml CFW-30 min groups were higher than that in the 10 μg/ml CFW-10 min group (P < 0.01). Compared with the 30 μg/ml CFW-30 min group, only the 90 μg/ml CFW-30 min group showed higher MFI (P < 0.05). No significant difference was observed in the colony diameter in the CFW unstained group compared with that in the 10, 30, 90, 270, or 810 μg/ml CFW groups stained for either 10 or 30 min (P > 0.05). No significant differences (P > 0.05) were observed for the positive rate or the corneal lesion scores between the CFW-unlabeled and the CFW-labeled group. On day 1 and 2, the positive rates of the infected corneas in the scraping group were lower than those in the fluorescence microscopy group (P < 0.05). On day 3, these observe methods showed no significant difference (P > 0.05). Thus, these experiments established a novel murine model of F. solani keratitis utilizing fluorescent labeled fungi. This model facilitates the accurate identification and screening of fungal infections during the early stages of fungal keratitis and provides a novel and reliable technology to study the fungal keratitis.

Agar-based disk diffusion assay for susceptibility testing of dermatophytes

Currently, no agar-based susceptibility testing method has been standardized for testing dermatophytes. We describe a newly developed agar-based method employing disk diffusion assay to test the susceptibility of 47 isolates of dermatophytes against 8 antifungals. Our results show that the method is reproducible, is simple, and could be used to determine the antifungal susceptibility of dermatophytes.

Fungal skin infections among prison inmates in Abakaliki, Nigeria

Of 402 prison inmates screened for fungal skin lesions, 79 (19.7%) showed skin lesions, which proved mycologically positive by microscopy and culture. Dermatophytes were responsible for skin lesions in 61 (77.2%) of the inmates, while non-dermatophytes accounted for 18 (22.8%) of the lesions. The dermatophytes recovered were mostly anthropophilic and included Trichophyton rubrum 33 (41.8%); T. mentagrophytes var. interdigitale 3 (3.8%); T. tonsurans 3 (3.8%); T. violaceum 2 (2.5%); Epidermophyton floccosum 10 (12.7%). A zoophilic dermatophyte, Microsporum canis, was recovered from 10 (12.7%) cases. The non-dermatophytes were Candida albicans 15 (19%) and Candida spp. 3 (3.8%). Trichophyton rubrum was the most frequently recovered dermatophyte (41.8%) and caused infections in a variety of sites. The groin was the most common site of infection being infected in 50% of the cases by both the dermatophytes and non-dermatophytes. Younger inmates (17-24 years) recorded the highest prevalence of infection (45.6%). Newer inmates (>2 years) were found to be more infected than older ones.

In vitro activities of four antifungal drugs against Trichophyton rubrum isolates exhibiting resistance to fluconazole

Thirty-two clinical isolates of Trichophyton rubrum exhibiting resistance to fluconazole [minimum inhibitory concentrations (MICs) > or = 64 microg ml(-1)] were selected to test the antifungal activity of ketoconazole, itraconazole, griseofulvin and terbinafine. We followed the guidelines of the National Committee for Clinical Laboratory Standards for testing filamentous fungi. The strains Candida parapsilosis (ATCC 22019), Candida krusei (ATCC 6258), T. rubrum (ATCC 40051) and Trichophyton mentagrophytes (ATCC 40004) were included for quality control. The microdilution plates were incubated at 28 degrees C and were read visually after 7 days of incubation and endpoint determination readings were performed visually. The MIC ranges for the four antifungals were: 0.0625-2 microg ml(-1) for ketoconazole, 0.25-2.0 microg ml(-1) for griseofulvin, < or =0.031-1.0 microg ml(-1) for itraconazole and < or =0.031 microg ml(-1) for terbinafine (for all tested isolates). Terbinafine was the most potent drug against T. rubrum, in vitro, followed by itraconazole, ketoconazole and griseofulvin. Much work is still needed to correlate the MICs of these drugs with clinical outcomes to develop interpretative breakpoints for T. rubrum and other dermatophytes.

Dermatophytes growth curve and in vitro susceptibility test: a broth micro-titration method

The introduction of systemic antifungal drugs which act upon different targets is the main issue of the in vivo antifungal resistance control. Different factors, such as growth curve phase, quality of the specimen, quantity of the inoculum, temperature, pH, culture medium composition, incubation duration and solvent, are believed important factors affecting minimum inhibitory concentration (MIC) value to most of the antifungal agents. We assayed an in vitro susceptibility test with 40 isolates of dermatophytes: Microsporum canis, Trichophyton rubrum, Trichophyton mentagrophytes and Epidermophyton floccosum against griseofulvin, fluconazole, itraconazole and terbinafine, using the guidelines of the M38-P document approved by the NCCLS. We determined the growth curves, to estimate the specific growth rate (mu max) and the generation time (G) of each dermatophyte, using dry weight and spectrophotometry methods. We demonstrate that, at 192 h, all fungi tested had a constant growth curve and we considered this as the optimal time for MIC determination. Terbinafine, griseofulvin and itraconazole possessed the highest antifungal activity against the four groups of dermatophytes studied. Fluconazole demonstrated no efficacy. Our MIC results differ from other authors and this difference is due to the timing of the MIC determination based on the growth curve of each fungi tested.

Evaluation of broth microdilution antifungal susceptibility testing conditions for Trichophyton rubrum

Fifty clinical isolates of Trichophyton rubrum were selected to test with ketoconazole, fluconazole, itraconazole, griseofulvin, and terbinafine by following the National Committee for Clinical Laboratory Standards susceptibility testing guidelines for filamentous fungi (M38-A). In addition, other susceptibility testing conditions were evaluated: (i) three medium formulations including RPMI 1640 (standard medium), McVeigh & Morton (MVM), and Sabouraud dextrose broth (SDB); (ii) two incubation temperatures (28 and 35 degrees C); and (iii) three incubation periods (4, 7, and 10 days). The strains Candida parapsilosis (ATCC 22019), Candida krusei (ATCC 6258), T. rubrum (ATCC 40051), and Trichophyton mentagrophytes (ATCC 40004) were included as quality controls. All isolates produced clearly detectable growth only after 7 days of incubation. MICs were significantly independent of the incubation temperature (28 or 35 degrees C) (P < 0.05). Different incubation periods resulted in MICs which were consistently different for each medium when azoles and griseofulvin were tested (P < 0.05). MICs obtained from different media at the same incubation time for the same isolate were significantly different when azoles and griseofulvin were tested (P < 0.05). MICs were consistently higher (usually 1 to 2 dilutions) with RPMI than with MVM or SDB (P < 0.05). When terbinafine was tested, no parameter had any influence on MICs (P < 0.05). RPMI standard medium appears to be a suitable testing medium for determining the MICs for T. rubrum. MICs obtained at different incubation times need to be correlated with clinical outcome to demonstrate which time has better reliability.

In vitro Antifungal Activity of Sertaconazole Compared with Nine Other Drugs against 250 Clinical Isolates of Dermatophytes and Scopulariopsis brevicaulis

We have tested 250 strains belonging to 15 species of clinically important dermatophytes and Scopulariopsis against ten antifungal drugs using an agar diffusion method (NeoSensitabstrade mark, Rosco, Taastrup, Denmark). Some of the experimental factors were adapted to dermatophyte development, such as temperature (28 vs. 35 degrees C) and time of incubation (2-5 days vs. 21-74 h). The antifungals used are itraconazole, ketoconazole, miconazole, clotrimazole, sertaconazole, terbinafine, tioconazole, fluconazole, isoconazole and econazole. Except for fluconazole, all the drugs tested have shown to be highly effective, especially sertaconazole and terbinafine. Percentages of susceptibility ranged between 94% for terbinafine, 87.6% for sertaconazole and 86.4% clotrimazole; 81.6% econazole; 42.8% fluconazole; 57.2% isoconazole; 78.4% itraconazole; 74.4% ketoconazole; 73.3% miconazole, and 85.2% for tioconazole. Percentages of resistance were similar between sertaconazole and terbinafine (4%) but in contrast to the 48% obtained for fluconazole.

Collaborative evaluation of optimal antifungal susceptibility testing conditions for dermatophytes

A multicenter study was conducted to define the most suitable testing conditions for antifungal susceptibility of dermatophytes. Broth microdilution MICs of clotrimazole, itraconazole, and terbinafine were determined in three centers against 60 strains of dermatophytes. The effects of inoculum density (ca. 10(3) and 10(4) CFU/ml), incubation time (3, 7, and 14 days), endpoint criteria for MIC determination (complete [MIC-0] and prominent [MIC-2] growth inhibition), and incubation temperature (28 and 37 degrees C) on intra- and interlaboratory agreement were analyzed. The optimal testing conditions identified were an inoculum of 10(4) CFU/ml, a temperature of incubation of 28 degrees C, an incubation period of 7 days, and MIC-0.

Pseudomycetoma caused by Microsporum canis in a Persian cat: lack of response to oral terbinafine

An eight-year-old neutered female Persian cat with a four-year history of relapsing skin disease, characterised by ulcerated nodules with a yellow granular discharge, was examined. A diagnosis of granulomatous dermatitis and panniculitis (pseudomycetoma) caused by Microsporum canis was made on the basis of history, clinical signs, histopathological examination of skin biopsy specimens and culture of macerated tissue. Because previous therapy, comprising repeated surgical excision and the administration of griseofulvin and itraconazole, had not been successful, terbinafine was administered for an eight-month period. However, lesions progressed despite this treatment and the cat was euthanased.

Antifungal susceptibility testing: practical aspects and current challenges

Development of standardized antifungal susceptibility testing methods has been the focus of intensive research for the last 15 years. Reference methods for yeasts (NCCLS M27-A) and molds (M38-P) are now available. The development of these methods provides researchers not only with standardized methods for testing but also with an understanding of the variables that affect interlaboratory reproducibility. With this knowledge, we have now moved into the phase of (i) demonstrating the clinical value (or lack thereof) of standardized methods, (ii) developing modifications to these reference methods that address specific problems, and (iii) developing reliable commercial test kits. Clinically relevant testing is now available for selected fungi and drugs: Candida spp. against fluconazole, itraconazole, flucytosine, and (perhaps) amphotericin B; Cryptococcus neoformans against (perhaps) fluconazole and amphotericin B; and Aspergillus spp. against (perhaps) itraconazole. Expanding the range of useful testing procedures is the current focus of research in this area.

In vitro activities of 10 antifungal drugs against 508 dermatophyte strains

We have tested 508 strains belonging to 24 species of dermatophytes against 10 antifungal drugs following mainly the NCCLS (M38-P) standard for filamentous fungi. However, several important factors, such as the temperature (28 versus 35 degrees C) and time of incubation (4 to 10 days versus 21 to 74 h), have been modified. The antifungals used were itraconazole, ketoconazole, miconazole, clotrimazole, voriconazole, terbinafine, amphotericin B, fluconazole, UR-9825, and G-1. In general, with the exception of fluconazole and G-1, all antifungals were shown to be highly effective.

An evaluation of the in vitro activity of terbinafine

Terbinafine has previously been shown to be highly active against dermatophytes and many other filamentous fungi. However, its activity against yeasts is controversial, with earlier reports suggesting that it has low activity, while more recent studies demonstrated that terbinafine is effective against yeasts. In this study, the in vitro activity of terbinafine was evaluated against a broad range of fungal isolates. We examined the susceptibility of 100 yeast strains (10 species including Candida albicans, non-C. albicans, fluconazole-susceptible and -resistant candidal strains), and 184 strains of filamentous fungi and dermatophytes (29 species including Aspergillus, Fusarium, Sporothrix, Trichophyton rubrum, T. mentagrophytes, T. tonsurans, Microsporum canis and Epidermophyton floccosum), using the NCCLS M27-A microdilution methodology for yeasts and a modified M38-P methodology for moulds. The endpoint for terbinafine was defined as 80% inhibition compared with the growth control well. The mean yeast and filamentous fungi minimum inhibitory concentration values +/- SEM (in microg ml(-1)) for terbinafine were: 6.60 +/- 0.73 and 1.04 +/- 0.28, respectively. In conclusion, our data suggest that terbinafine, in addition to its potent activity against dermatophytes, is considerably effective against a broad range of yeasts and filamentous fungi in vitro. Therefore, investigations concerning its antifungal activity in vivo against such organisms should be pursued.