# Dermatophytosis in Bhairahawa, Nepal: Prevalence and Resistance Pattern of Dermatophyte Species

## Authors

- Subhash Lal Karn ([ORCID](https://orcid.org/0000-0002-5436-0330)) — Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal
- Ajay Gurung ([ORCID](https://orcid.org/0000-0002-4751-352X)) — Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal
- Amit Kumar Shrivastava ([ORCID](https://orcid.org/0000-0002-8915-9186)) — Department of Pharmacology, Universal College of Medical Sciences, Bhairahawa, Nepal
- Sulochana Khatiwada Poudel ([ORCID](https://orcid.org/0000-0003-1555-0542)) — Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal
- Shristi Raut Adhikari ([ORCID](https://orcid.org/0000-0002-5599-7763)) — Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal
- Chandra Mohan Sah ([ORCID](https://orcid.org/0000-0001-5173-5515)) — Department of Dermatology, Universal College of Medical Sciences, Bhairahawa, Nepal

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 7, Issue 2 (2021), pages 115–123
- **Article type:** Original Article
- **Published online:** 2021-06-26
- **DOI:** [10.5455/umj.20201208055254](https://doi.org/10.5455/umj.20201208055254)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=24159
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/24159.pdf

## Abstract

Introduction: Dermatophytosis is colonization by dermatophytic fungus of the keratinized tissues like hair, nails and skin. They are considered important as a public health problem. The study was aimed to isolate, identify, and detect the in-vitro antifungal sensitivity pattern of various dermatophytes isolates from clinically diagnosed cases of dermatophytosis. Materials and Methods: One hundred and sixty patients of all age groups and both sexes and clinically diagnosed with dermatophytosis were recruited in this study. The specimens included skin scales, hair pluckings, and nail clippings. Identification and isolation were done by microscopic examination, culture, and biochemical analysis. Results: Dermatophytosis was more common in males (60.62%) than females (39.37%). Tinea corporis (31.25%) was the most common clinical presentation followed by Tinea faciei (25%). Trichophyton rubrum (36.19%) was the most common isolate followed by Trichophyton mentagrophytes (15.23%). Out of four antifungal drugs used, fluconazole was found most resistant while Itraconazole was the most effective drug. Conclusion: The epidemiology of dermatophyte infections may change with time. Antifungal susceptibility testing will aid the clinician in initiating prompt and appropriate antifungal therapy and prevent the emergence of resistance.

## Keywords

Antifungal sensitivity; Dermatophytosis; Tinea infection; Trichophyton

## How to cite

Karn SL, Gurung A, Shrivastava AK, Poudel SK, Adhikari SR, Sah CM. Dermatophytosis in Bhairahawa, Nepal: Prevalence and Resistance Pattern of Dermatophyte Species. Ulutas Med J. 2021;7(2):115-123. doi:10.5455/umj.20201208055254

## References

1. Reiss HE, Shadomy H, Lyon M. Mycoses of implantation. Fundamental medical mycology: Wiley-Blackwell, Hoboken; 2012. p. 479-92 https://doi.org/10.1002/9781118101773
2. Rippon JW. The changing epidemiology and emerging patterns of dermatophyte species. Current topics in medical mycology. 1985:208-34 https://doi.org/10.1007/978-1-4613-9547-8_8
3. Nenoff P, Krüger C, Ginter‐Hanselmayer G, Tietz HJ. Mycology–an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2014;12(3):188-210 https://doi.org/10.1111/ddg.12245
4. Suganthi M. Pathogenesis and clinical significance of dermatophytes: A comprehensive review. Innovations in Pharmaceuticals and Pharmacotherapy. 2017;5(1):62-70 https://doi.org/10.31690/ipp
5. Karim MT, Ghosh S, Chougale R, Vatkar V, Deshkar D, Narute J. Study of Dermatophytes and their Biofilm Production. Journal of Advanced Medical and Dental Sciences Research. 2017;5(11):56-9
6. Adimi P, Hashemi SJ, Mahmoudi M, Mirhendi H, Shidfar MR, Emmami M, et al. In-vitro activity of 10 antifungal agents against 320 dermatophyte strains using microdilution method in Tehran. Iranian journal of pharmaceutical research: IJPR. 2013;12(3):537
7. Hanafy AM. In vitro antifungal drug susceptibility of dermatophytes isolated from patients in Al-Medina, Saudi Arabia. Egypt J Exp Biol (Bot). 2012;8(2):245-50
8. De Sarro A, La Camera E, Fera M. New and investigational triazole agents for the treatment of invasive fungal infections. Journal of Chemotherapy. 2008;20(6):661-71 https://doi.org/10.1179/joc.2008.20.6.661
9. Pakshir K, BAHA AL, Rezaei Z, Sodaifi M, Zomorodian K. In vitro activity of six antifungal drugs against clinically important dermatophytes. 2009 https://doi.org/10.1016/j.ijid.2008.05.762
10. Azambuja CVdA, Pimmel LA, Klafke GB, Xavier MO. Onychomycosis: clinical, mycological and in vitro susceptibility testing of isolates of Trichophyton rubrum. Anais brasileiros de dermatologia. 2014;89(4):581-6 https://doi.org/10.1590/abd1806-4841.20142630
11. Jha B, Mahadevamurthy S, Sudisha J, Bora A. Isolation, identification and antifungal susceptibility test of dermato phytes from the patients with onychomycosis in central Nepal. Am J Dermatol Venereol. 2015;4(3):30-6
12. Nweze E, Mukherjee P, Ghannoum M. Agar-based disk diffusion assay for susceptibility testing of dermatophytes. Journal of clinical microbiology. 2010;48(10):3750-2 https://doi.org/10.1128/jcm.01357-10
13. Agarwal R, Gupta S, Mittal G, Khan F, Roy S, Agarwal A. Antifungal susceptibility testing of dermatophytes by agar-based disk diffusion method. Int J Curr Microbiol Appl Sci. 2015;4(3):430-6
14. Rippon JW. Medical mycology; the pathogenic fungi and the pathogenic actinomycetes: Eastbourne, UK; WB Saunders Company; 1982
15. Khatri PK, Kachhawa D, Maurya V, Meena S, Bora A, Rathore L, et al. Antifungal resistance pattern among dermatophytes in Western Rajasthan. Int J Curr Microbiol App Sci. 2017;6: 499-509 https://doi.org/10.20546/ijcmas.2017.607.060
16. Indira G. In vitro antifungal susceptibility testing of 5 antifungal agents against dermatophytic species by CLSI (M38-A) micro dilution method. Clin Microbial. 2014;3(3) https://doi.org/10.4172/2327-5073.1000145
17. Tartor YH, Abo Hashem ME, Enany S. Towards a rapid identification and a novel proteomic analysis for dermatophytes from human and animal dermatophytosis. Mycoses. 2019;62(12):1116-26 https://doi.org/10.1111/myc.12998
18. Janagond AB, Rajendran T, Acharya S, Vithiya G, Ramesh A, Charles J. Spectrum of dermatophytes causing tinea corporis and possible risk factors in rural patients of madurai region, South India. Natl J Lab Med. 2016;5
19. Ramaraj V, Vijayaraman RS, Rangarajan S, Kindo AJ. Incidence and prevalence of dermatophytosis in and around Chennai, Tamilnadu, India. Int J Res Med Sci. 2016;4(3):695-700 https://doi.org/10.18203/2320-6012.ijrms20160483
20. Janardhan B, Vani G. Clinico mycological study of dermatophytosis. Int J Res Med Sci. 2017;5(1):31-9 https://doi.org/10.18203/2320-6012.ijrms20164399
21. Verenkar M, Pinto M, Rodrigues S, Roque W, Singh I. Clinico-microbiological study of dermatophytoses. Indian journal of pathology & microbiology. 1991;34(3):186-92
22. Sumathi S, Mariraj J, Shafiyabi S, Ramesh R, Krishna S. Clinicomycological study of dermatophytes. Int J Pharm Biomed Res. 2013;4(2):132-4
23. Gupta B, Kumar S, Kumar R, Khurana S. Mycological aspects of dermatomycosis in Ludhiana. Indian Journal of Pathology & Microbiology. 1993;36(3):233-7
24. Balakumar S, Rajan S, Thirunalasundari T, Jeeva S. Epidemiology of dermatophytosis in and around Tiruchirapalli, Tamilnadu, India. Asian Pacific Journal of Tropical Disease. 2012;2(4):286-9 https://doi.org/10.1016/s2222-1808(12)60062-0
25. Hemendra Kumar Sharma NV. In vitro antifungal Susceptibility testing of Dermatophytes isolated from clinical samples in tertiary care hospital around Jaipur, Rajasthan. International journal of medical and health research. 2019(3):40-5
26. Priyam Basak BM, Swetalona Pattanaik. Prevalence of dermatophytic infections including antifungal susceptibility pattern of dermatophytes in a tertiary care hospita. International Journal of Research in Medical Sciences 2019: 699-705 https://doi.org/10.18203/2320-6012.ijrms20190461
27. Dhyaneswari GP MV, Bhore AV. Clinicomycological profile of dermatophytosis in a tertiary care hospital in Western India. SAS J Med. 2015;1(4):160-5
28. Mahale RP RM, Tejashree A, Deepashree R, Kulkarni M. Clinicomycological profile of dermatophytosis in a teaching hospital. Int J Pharmaceut Sci Invent. 2014;3(8):43-6
29. Lavanya V SS. Clinico-mycological study of Dermatophytosis in a tertiary care centre in Bagalkot. Int J Med Health Res. 2015;1(2):63-6 Dermatophytosis Karn et al.
30. Lyngdoh CJ, Lyngdoh WV, Choudhury B, Sangma KA, Bora I, Khyriem AB. Clinico-mycological profile of dermatophytosis in Meghalaya. International Journal of Medicine and Public Health. 2013;3(4) https://doi.org/10.4103/2230-8598.123442
31. Walke HR, Gaikwad AA, Palekar SS. Clinico-mycological profile of dermatophytosis in patients attending dermatology OPD in tertiary care hospital, India. Int J Curr Microbiol App Sci. 2014;3(10):432-40
32. Agarwal R, Gupta S, Mittal G, Khan F, Roy S, Agarwal A. Antifungal susceptibility testing of dermatophytes by agar-based disk diffusion method. Int J Curr Microbiol Appl Sci. 2015;4:430-6
33. El Damaty HM, Tartor YH, Mahmmod YS. Species identification, strain differentiation, and antifungal susceptibility of dermatophyte species isolated from clinically infected Arabian horses. Journal of Equine Veterinary Science. 2017;59:26-33 https://doi.org/10.1016/j.jevs.2017.08.019