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.
Bonnetblanc JM, Bédane C. Erysipelas: recognition and management. Am J Clin Dermatol. 2003;4:157–63. https://doi.org/10.2165/00128071-200304030-00002.
Celestin R, Brown J, Kihiczak G, Schwartz RA. Erysipelas: a common potentially dangerous infection. Acta Dermatovenerol Alp Pannonica Adriat. 2007;16:123–7.
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. https://doi.org/10.1093/clinids/23.5.1091.
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.
Geerts I, De Vos N, Frans J, Mewis A. The clinical-diagnostic role of antistreptolysin O antibodies. Acta Clin Belg. 2011;66:410–5. https://doi.org/10.2143/ACB.66.6.2062604.
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.
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. https://doi.org/10.1111/j.1468-3083.2006.01657.x.
Bartholomeeusen S, Vandenbroucke J, Truyers C, Buntinx F. Epidemiology and comorbidity of erysipelas in primary care. Dermatology. 2007;215:118–22.
Macit Ilkit & Murat Durdu. Tinea pedis: the etiology and global epidemiology of a common fungal infection. Crit Rev Microbiol. 2015;41:374–88. https://doi.org/10.3109/1040841X.2013.856853.
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.
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. https://doi.org/10.1177/0003319709351257.
Pavlotsky F, Amrani S, Trau H. Recurrent erysipelas: risk factors. J Dtsch Dermatol Ges. 2004;2:89–95. https://doi.org/10.1046/j.1439-0353.2004.03028.x.
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.
Greenberg J, DeSanctis RW, Mills RM Jr. Vein-donor-leg cellulitis after coronary artery bypass surgery. Ann Intern Med. 1982;97:565–6. https://doi.org/10.7326/0003-4819-97-4-565.16].
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. https://doi.org/10.1155/2014/563261.
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.
André J, Achten G. Onychomycosis. Int J Dermatol. 1987;26:481–90. https://doi.org/10.1111/j.1365-4362.1987.tb02287.x.
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).
Kim DM, et al. Fingernail onychomycosis due to Aspergillus niger. Ann Dermatol. 2012;24:459–63. https://doi.org/10.5021/ad.2012.24.4.459.
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. https://doi.org/10.1186/1476-7961-2-5.
Brooks KE, Bender JF. Tinea pedis: diagnosis and treatment. Clin Podiatr Med Surg. 1996;13:31–46.
Nigam PK, Saleh D. Tinea pedis. [Updated 2020 Feb 3]. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2020.
Metin A, Dilek N, Bilgili SG. Recurrent candidal intertrigo: challenges and solutions. Clin Cosmet Investig Dermatol. 2018;11:175–85. https://doi.org/10.2147/CCID.S127841.
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. https://doi.org/10.3923/pjbs.2013.208.218.
França K, Lotti T (eds). Advances in integrative dermatology. Wiley; 2019.
Asz-Sigall D, Tosti A, Arenas R. Tinea unguium: diagnosis and treatment in practice. Mycopathologia. 2017;182:95–100. https://doi.org/10.1007/s11046-016-0078-4.
Canavan TN, Elewski BE. Identifying signs of tinea pedis: a key to understanding clinical variables. J Drugs Dermatol. 2015;14:s42–7.
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. https://doi.org/10.12968/jowc.2017.26.4.179.
Moriarty B, Hay R, Morris-Jones R. The diagnosis and management of tinea. BMJ. 2012;345:e4380. https://doi.org/10.1136/bmj.e4380.
Al Hasan M, et al. Dermatology for the practicing allergist: tinea pedis and its complications. Clin Mol Allergy CMA. 2004;2:1–5. https://doi.org/10.1186/1476-7961-2-5.
Yorulmaz A, Yalcin B. Dermoscopy as a first step in the diagnosis of onychomycosis. Postepy Dermatologii i Alergologii. 2018;35:251–8. https://doi.org/10.5114/ada.2018.76220.
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. https://doi.org/10.1111/j.1468-3083.2011.04323.x.
Conflict of interest
No potential conflict of interest was reported by the authors.
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.
About this article
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). https://doi.org/10.1007/s15010-021-01582-0
- Tinea pedis