, Volume 183, Issue 6, pp 951–959 | Cite as

Burden of Chronic Dermatophytosis in a Tertiary Care Hospital: Interaction of Fungal Virulence and Host Immunity

  • Richa Anjleen Tigga
  • Shukla Das
  • S. N. Bhattacharya
  • Rumpa Saha
  • Deepika Pandhi
  • Shyama Datt
  • Gargi Rai
Original Paper


Dermatophytosis is caused by keratinophilic dermatophytes and affects the superficial skin and its appendages. The nature of infection and response to treatment is influenced by host–pathogen factors like duration and severity of disease, prior drug history and type of causative organism. In our study, the burden of dermatophytosis affecting glabrous skin saw a rise in recalcitrant and reinfection cases with only 1.6% achieving complete cure. Chronicity of dermatophytic infection was reflected in the high serum IgE levels and immediate hypersensitivity reactions. Hence, it becomes pertinent for clinicians to identify the non-responders and modify therapy to achieve clinical cure with fungal clearance confirmed by mycological tools.


Chronic dermatophytosis Reinfection/recalcitrant dermatophytosis Trichophyton mentagrophytes complex Antifungal therapy 



This work was supported by the Intramural Grant from the University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.

Compliance with Ethical Standards

Conflict of interest

The authors state no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Supplementary material

11046_2018_303_MOESM1_ESM.doc (36 kb)
Supplementary material 1 (DOC 35 kb)


  1. 1.
    Marques S, Robles A, Tortorano A, Tuculet M, Negroni R, Mendes R. Mycoses associated with AIDS in the third world. Med Mycol. 2000;38(1):269–79.CrossRefGoogle Scholar
  2. 2.
    Lakshmanan A, Ganesh Kumar P, Mohan SR, HemaMalini M, Madhavan R. Epidemiological and clinical pattern of dermatomycoses in rural India. Indian J Med Microbiol. 2015;33(5):134–6.CrossRefGoogle Scholar
  3. 3.
    Zhan P, Liu W. The changing face of dermatophytic infections worldwide. Mycopathologia. 2017;182(1–2):77–86.CrossRefGoogle Scholar
  4. 4.
    Chinnapun D, Thammarat NS. Virulence factors involved in pathogenicity of dermatophytes. Walailak J Sci Technol. 2015;12(7):573–80.Google Scholar
  5. 5.
    Monod M, Lechenne B, Jousson O, Grand D, Zaugg C, Stocklin R, et al. Aminopetidases and dipeptidyl-peptidases secreted by the dermatophyte Trichophyton rubrum. Microbiology. 2005;151(1):145–55.CrossRefGoogle Scholar
  6. 6.
    Rudramurthy S, Shankarnarayan S, Dogra S, Shaw D, Mushtaq K, Paul R, et al. Mutation in the squalene epoxidase gene of Trichophyton interdigitale and Trichophyton rubrum associated with allylamine resistance. Antimicrob Agents Chemother. 2018. Scholar
  7. 7.
    Dabas Y, Xess I, Singh G, Pandey M, Meena S. Molecular identification and antifungal susceptibility patterns of clinical dermatophytes following CLSI and EUCAST guidelines. J Fungi. 2017;3(2):17.CrossRefGoogle Scholar
  8. 8.
    Dogra S, Uprety S. The menace of chronic and recurrent dermatophytosis in India: Is the problem deeper than we perceive? Indian Dermatol Online J. 2016;7(2):73–6.CrossRefGoogle Scholar
  9. 9.
    Gupta C, Das S, Ramachandran VG, Saha R, Bhattacharya SN, Dar SA, et al. Possible role of trichophytin antigen in inducing impaired immunological clearance of fungus in onychomycosis. Mycopathologia. 2016;181(3–4):247–51.CrossRefGoogle Scholar
  10. 10.
    White TJ, Bruns T, Lee S, Taylor JW. Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics. In: Innis MA, Gelfand DH, Sninsky JJ, White TJ, editors. PCR protocols: a guide to methods and applications. San Diego: Academic Press Inc; 1990. p. 315–22.Google Scholar
  11. 11.
    Verma S, Madhu R. The great Indian epidemic of superficial dermatophytosis: an appraisal. Indian J Dermatol. 2017;62(3):227–36.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Peerapur BBV, Inamdar AC, Pushpa PV, Microbiol M, Srikant B, Microbiol M. Clinicomycological study of dermatophytosis in Bijapur. Indian J Med Microbiol. 2004;22(4):273–5.PubMedGoogle Scholar
  13. 13.
    Surendran K, Bhat RR, Boloor R, Nandakishore B, Sukumar D. A clinical and mycological study of dermatophytic infections. Indian J Dermatol. 2014;59(3):262–7.CrossRefGoogle Scholar
  14. 14.
    Sahai S, Mishra D. Change in spectrum of dermatophytes isolated from superficial mycoses cases: first report from Central India. Indian J Dermatol Venereol Leprol. 2011;77(3):335–6.CrossRefGoogle Scholar
  15. 15.
    Shukla P, Yaqoob S, Haider F, Shukla V. Dermatophytoses; epidemiology and distribution among urban and sub urban population. Indian J Microbiol Res. 2016;3(3):292–8.CrossRefGoogle Scholar
  16. 16.
    Singh A, Masih A, Khurana A, Singh P, Gupta M, Hagen F, et al. High terbinafine resistance in Trichophyton interdigitale isolates in Delhi, India harbouring mutations in the squalene epoxidase gene. Mycoses. 2018.
  17. 17.
    Woodfolk JA. Allergy and dermatophytes. Clin Microbiol Rev. 2005;18(1):30–43.CrossRefGoogle Scholar
  18. 18.
    Gupta AK, Chaudhry M, Elewski B. Tinea corporis, tinea cruris, tinea nigra, and piedra. Dermatol Clin. 2003;21(3):395–400.CrossRefGoogle Scholar
  19. 19.
    de Hoog GS, Dukik K, Monod M, Packeu A, Stubbe D, Hendrickx M, et al. Toward a novel multilocus phylogenetic taxonomy for the dermatophytes. Mycopathologia. 2017;182(1–2):5–31.CrossRefGoogle Scholar
  20. 20.
    Nenoff P, Verma SB, Uhrlaß S, Burmester A, Gräser Y. A clarion call for preventing taxonomical errors of dermatophytes using the example of the novel Trichophyton mentagrophytes genotype VIII uniformly isolated in the Indian epidemic of superficial dermatophytosis. Mycoses. 2018.

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Richa Anjleen Tigga
    • 1
  • Shukla Das
    • 1
  • S. N. Bhattacharya
    • 2
  • Rumpa Saha
    • 1
  • Deepika Pandhi
    • 2
  • Shyama Datt
    • 1
  • Gargi Rai
    • 1
  1. 1.Department of MicrobiologyUniversity College of Medical Sciences & Guru Teg Bahadur HospitalDelhiIndia
  2. 2.Department of DermatologyUniversity College of Medical Sciences & Guru Teg Bahadur HospitalDelhiIndia

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