Fungal infections of the feet in patients with erysipelas of the lower limb: is it a significant clinical problem?



Erysipelas is a bacterial infection of the superficial layers of the skin usually caused by Group A Streptococci, often seen in clinical practice. Fungal infections of the feet and elderly age are some of the most significant risk factors for the infection. The aim of the study was to evaluate the frequency of fungal infections from different regions of the feet in patients with erysipelas.


56 patients with clinically diagnosed erysipelas and 56 healthy individuals were clinically examined and tested for fungal infection in three locations: toenails, interdigital space, and soles. The collected samples were evaluated under a microscope and then mycological cultures on Sabouraud’s medium were prepared. After 4 weeks of incubation, the cultures were analysed with the identification of particular pathogens.


42.9% (24/56) of the patients with erysipelas had positive mycological cultures. Toenails and interdigital spaces (both 62.5%) were the most frequently affected areas, followed by soles (37.5%). The most common pathogen was T. rubrum (43.18%), followed by Candida spp. (27.27%), and T. mentagrophytes var.interdigitale (13.63%). Only 14.3% (8/56) of the samples taken from the control group were positive and T.rubrum was the only type of fungus cultured.


Fungal infections of the feet are important risk factors for the first episode as well as recurrent erysipelas. Prevention and early treatment of fungal infections, especially in elderly people, can significantly reduce the incidence of erysipelas.

This is a preview of subscription content, access via your institution.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.


  1. 1.

    Bonnetblanc JM, Bédane C. Erysipelas: recognition and management. Am J Clin Dermatol. 2003;4:157–63.

    Article  PubMed  Google Scholar 

  2. 2.

    Celestin R, Brown J, Kihiczak G, Schwartz RA. Erysipelas: a common potentially dangerous infection. Acta Dermatovenerol Alp Pannonica Adriat. 2007;16:123–7.

    CAS  PubMed  Google Scholar 

  3. 3.

    Eriksson B, Jorup-Rönström C, Karkkonen K, Sjöblom AC, Holm SE. Erysipelas: clinical and bacteriologic spectrum and serological aspects. Clin Infect Dis. 1996;23:1091–8.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Kozłowska D, Myśliwiec H, Kiluk P, Baran A, Milewska AJ, Flisiak I. Clinical and epidemiological assessment of patients hospitalized for primary and recurrent erysipelas. Przegl Epidemiol. 2016;70(4):575–84.

    PubMed  Google Scholar 

  5. 5.

    Geerts I, De Vos N, Frans J, Mewis A. The clinical-diagnostic role of antistreptolysin O antibodies. Acta Clin Belg. 2011;66:410–5.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Dupuy A, Benchikhi H, Roujeau JC, Bernard P, Vaillant L, Chosidow O, et al. Risk factors for erysipelas of the leg (cellulitis): case–control study. BMJ. 1999;318:1591–4.

    CAS  Article  Google Scholar 

  7. 7.

    Goettsch WG, Bouwes Bavinck JN, Herings RM. Burden of illness of bacterial cellulitis and erysipelas of the leg in the Netherlands. J Eur Acad Dermatol Venereol. 2006;20:834–9.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Bartholomeeusen S, Vandenbroucke J, Truyers C, Buntinx F. Epidemiology and comorbidity of erysipelas in primary care. Dermatology. 2007;215:118–22.

    Article  Google Scholar 

  9. 9.

    Macit Ilkit & Murat Durdu. Tinea pedis: the etiology and global epidemiology of a common fungal infection. Crit Rev Microbiol. 2015;41:374–88.

    Article  PubMed  Google Scholar 

  10. 10.

    Semel JD, Goldin H. Association of athlete’s foot with cellulitis of the lower extremities: diagnostic value of bacterial cultures of ipsilateral interdigital space samples. Clin Infect Dis. 1996;23:1162–4.

    CAS  Article  Google Scholar 

  11. 11.

    Pereira de Godoy JM, Galacini Massari P, Yoshino Rosinha M, Marinelli Brandão R, Foroni Casas AL. Epidemiological data and comorbidities of 428 patients hospitalized with erysipelas. Angiology. 2010;61:492–4.

    Article  PubMed  Google Scholar 

  12. 12.

    Pavlotsky F, Amrani S, Trau H. Recurrent erysipelas: risk factors. J Dtsch Dermatol Ges. 2004;2:89–95.

    Article  PubMed  Google Scholar 

  13. 13.

    Hirschmann JV, Raugi GJ. Lower limb cellulitis and its mimics: part I. Lower limb cellulitis. J Am Acad Dermatol. 2012;67:163.e1-163.e12.

    Article  Google Scholar 

  14. 14.

    Greenberg J, DeSanctis RW, Mills RM Jr. Vein-donor-leg cellulitis after coronary artery bypass surgery. Ann Intern Med. 1982;97:565–6.].

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Uludag Altun H, Meral T, Turk Aribas E, Gorpelioglu C, Karabicak N. A case of onychomycosis caused by Rhodotorula glutinis. Case Rep Dermatol Med. 2014;2014:563261.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Perea S, Ramos MJ, Garau M, Gonzalez A, Noriega AR, del Palacio A. Prevalence and risk factors of tinea unguium and tinea pedis in the general population in Spain. J Clin Microbiol. 2000;38:3226–30.

    CAS  Article  Google Scholar 

  17. 17.

    André J, Achten G. Onychomycosis. Int J Dermatol. 1987;26:481–90.

    Article  PubMed  Google Scholar 

  18. 18.

    Prasanna S, Jayakumar K, Jayashree V. Primary cutaneous aspergillosis-tinea pedis caused by Aspergillus niger in animmunocompetent adult individual residing in silk city of Kancheepuram District. Int J Adv Res. 2016;4:443–6 (ISSN 2320-5407).

    Google Scholar 

  19. 19.

    Kim DM, et al. Fingernail onychomycosis due to Aspergillus niger. Ann Dermatol. 2012;24:459–63.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G. Dermatology for the practicing allergist: tinea pedis and its complications. Clin Mol Allergy. 2004;2:5.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Brooks KE, Bender JF. Tinea pedis: diagnosis and treatment. Clin Podiatr Med Surg. 1996;13:31–46.

    CAS  PubMed  Google Scholar 

  22. 22.

    Nigam PK, Saleh D. Tinea pedis. [Updated 2020 Feb 3]. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2020.

    Google Scholar 

  23. 23.

    Metin A, Dilek N, Bilgili SG. Recurrent candidal intertrigo: challenges and solutions. Clin Cosmet Investig Dermatol. 2018;11:175–85.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Chan GF, Sinniah S, Idris TI, Puad MS, Abd Rahman AZ. Multiple rare opportunistic and pathogenic fungi in persistent foot skin infection. Pak J Biol Sci. 2013;16:208–18.

    Article  PubMed  Google Scholar 

  25. 25.

    França K, Lotti T (eds). Advances in integrative dermatology. Wiley; 2019.

  26. 26.

    Asz-Sigall D, Tosti A, Arenas R. Tinea unguium: diagnosis and treatment in practice. Mycopathologia. 2017;182:95–100.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Canavan TN, Elewski BE. Identifying signs of tinea pedis: a key to understanding clinical variables. J Drugs Dermatol. 2015;14:s42–7.

    CAS  PubMed  Google Scholar 

  28. 28.

    Goto T, Nakagami G, Takehara K, et al. Examining the accuracy of visual diagnosis of tinea pedis and tinea unguium in aged care facilities. J Wound Care. 2017;26:179–83.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Moriarty B, Hay R, Morris-Jones R. The diagnosis and management of tinea. BMJ. 2012;345:e4380.

    Article  PubMed  Google Scholar 

  30. 30.

    Al Hasan M, et al. Dermatology for the practicing allergist: tinea pedis and its complications. Clin Mol Allergy CMA. 2004;2:1–5.

    Article  Google Scholar 

  31. 31.

    Yorulmaz A, Yalcin B. Dermoscopy as a first step in the diagnosis of onychomycosis. Postepy Dermatologii i Alergologii. 2018;35:251–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Piraccini BM, Balestri R, Starace M, Rech G. Nail digital dermoscopy (onychoscopy) in the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol. 2013;27:509–13.

    CAS  Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Katarzyna Korecka.

Ethics declarations

Conflict of interest

No potential conflict of interest was reported by the authors.

Ethical statement

The authors confirm that this material is original and has not been published in whole or in part elsewhere; that the manuscript is not currently being considered for publication in another journal; and that all authors have been personally and actively involved in substantive work leading to the manuscript and will hold themselves jointly and individually responsible for its content.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Korecka, K., Mikiel, D., Banaszak, A. et al. Fungal infections of the feet in patients with erysipelas of the lower limb: is it a significant clinical problem?. Infection (2021).

Download citation


  • Erysipelas
  • Tinea pedis
  • Dermatophytosis
  • Infection
  • Onychomycosis