Superficial fungal infections in end stage renal disease patients

Authors

  • Upma Narain Department of Microbiology, Tejas Microdiagnostics, Allahabad, Uttar Pradesh, India
  • Arvind Gupta Department of Nephrology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20163746

Keywords:

Dermatophytes, End stage renal disease, Superficial fungal infections, Tinea

Abstract

Background: Patients with end stage renal disease commonly present a spectrum of dermatological disorders. Each one has its own unique presentation and treatment approaches. Superficial fungal infections of the skin do not account for much in the end stage renal disease patients; hence most of the reports do not discuss this issue. In the present study we analysed patients with end stage renal disease who had developed superficial fungal infections.

Methods: During January 2015 to June 2016, we tried to analyse 150 patients with end stage renal disease, who developed superficial fungal infections and were undergoing haemodialysis at least thrice a week for a minimum of three months at our centre.

Results: Out of the 150 suspected cases we identified, 36 cultures tested positive. The macroscopic examination of the scalp, skin and the nails revealed 2.2% Tinea capitis, 13.9% Tinea versicolor, 44.5% Tinea corporis, 8.4% Tinea mannum, 16.8% onychomycosis, 5.7% Tinea cruris and 8.5% Tinea pedis. The culture examination highlighted 44.4% Trichyopyton rubrum, 27.8% Trychophyton mentagrophyte, 2.8% Trychophyton violaceum, 2.8% Trichophyton verrucosum, 2.8% Microsporum canis, 2.8% Epidermophyton flucossum, 2.8% Scopulariopsis brevicaulis and 13.8% Malessesia). The predominant clinical abnormality observed was Tinea corporis and the prevalent fungal isolate was Trichophyton rubrum.

Conclusions: The current study illustrates that a significant number of patients with the end stage renal disease had a prevalence of superficial fungal infections; hence, a prompt recognition of skin lesions and the identification of these superficial fungi may alarm us so that early and the judicious management to reduce the associated morbidity and in turn to improve the quality of life in these patients is taken.

References

Shafiee MA, Akbarian F, Memon KK, Aarabi M, Boroumand B. Dermatologic Manifestations in End-stage Renal Disease. IJKD. 2015;9:339-53.

Kato S, Chmielewski M, Honda H, Pecoits-Filho R, Matsuo S, Yuzawa Y, et al. Aspects of Immune Dysfunction in End-stage Renal Disease. Clin J Am Soc Nephrol. 2008;3(5):1526-33.

Schwartz RA. Superficial fungal infections. The Lancet. 2004;364:1173-82.

Criado PR, Dantas KC, Benini LV, Oliveira CB, Takiguti FA, Vasconcellos C. Superficial mycosis and the immune response elements. An Bras Dermatol. 2011;86(4):726-31.

Narain U, Gupta A. Peritoneal Dialysis Related Candida Peritonitis: A 16-year Single-Centre Experience. Arch Clin Microbiol. 2016;7:2.

Borman AM, Campbell CK, Fraser M, Johnson EM. Analysis of the dermatophyte species isolated in the British Isles between 1980 and 2005 and review of worldwide dermatophyte trends over the last three decades. Medical Mycology. 2007;45:131-41.

Kimmel PL, Phillips TM, Simmens SJ, Peterson RA, Weihs KL, Alleyne S, et al. Immunologic function and survival in hemodialysis patients. Kidney Int. 1998;54:236-44.

Stenvinkel P, Ketteler M, Johnson RJ, Lindholm B, Pecoits-Filho R, Riella M, et al. IL-10, IL-6, and TNF-alpha: central factors in the altered cytokine network of uremia–the good, the bad, and the ugly. Kidney Int. 2005;67:1216-33.

Calderon RA. Immunoregulation in dermatophytosis. Crit Rev Microbiol. 1989;16:339-68.

King RD, Khan HA, Foye JC, Greenberg JH, Jones HE. Transferrin, iron, and dermatophytes. I. Serum dermatophyte inhibitory component definitively identified as unsaturated transferrin. J Lab Clin Med. 1975;86:204-12.

Hay RJ. Fungi and Skin Disease. London: Gower Medical Publishing. 1993.

Hay RJ, Calderon RA, Mackenzie CD. Experimental dermatophytosis in mice: correlation between light and electron microscopic changes in primary, secondary and chronic infections. Br J Exp Pathol. 1988;69:703-16.

Acorci-Valério MJ, Bordon-Graciani AP, Dias-Melicio LA, Golim MA, Nakaira-Takahagi E, Soares AMVC. Role of TLR2 and TLR4 in human neutrophil functions against Paracoccidioides brasiliensis. Scand J Imm. 2010;71:99-108.

Mignon B, Tabart J, Baldo A, Mathy A, Losson B, Vermout S. Immunization and dermatophytes. Curr Opin Infect Dis. 2008;21:134-40.

MacGregor JM, Hamilton A, Hay RJ. Possible mechanisms of immune modulation in chronic dermatophytosis - an in vitro study. Br J Dermatol. 1992;127:233-8.

Vermout S, Tabart J, Baldo A, Mathy A, Losson B, Mignon B. Pathogenesis of dermatophytosis. Mycopathologia. 2008;166:267-75.

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Published

2016-12-24

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Section

Original Research Articles