P114 Clinical and microbiological spectrum of dermatophytosis from a tertiary care institute
Authors: Sudhaharan Sukanya , Pamidimukkala Umabala , Naaz Saba , Kovida Savitha , Sundarapu Naga Appala Raju , Shaw Dipika , Rudramurthy Shivaprakash M 
Published: September 2022

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

Objectives
There is an increasing incidence of recalcitrant dermatophytosis in India due to irrational use of antifungals, inappropriate treatment, and also in vitro resistance of the organism by itself. This study is done to determine the clinic-mycological profile, antifungal susceptibility, and outcome of patients with dermatophytosis in our institute.

Methods
All patients with culture-proven dermatophytosis attending the outpatient department of our hospital from January 2019 to December 2019 were included in the study. Detailed clinical data of all the patients were collected.
Morphological Identification of the dermatophytes was done by conventional mycological methods. The isolates were sent to PGIMER Chandigarh for further identification by MALDI-TOF and antifungal susceptibility testing. Antifungal susceptibility testing was done for 47 isolates of Trichophyton species.

Results
Of the 155 clinical suspected cases, growth of dermatophytes was observed in 55 (35.4%) of the cases. Tinea corporis 39/55(70.9%) was the predominant clinical type The duration of infection was less than 6 months in 22/55(40%) of cases and &gt;6 months in 33(60%) of the cases. Majority of the patients were in the age group of 20-30 years and were male. A total of 36/55 (65.4%) of the patients belong to middle socio-economic status and 19/55 to lower socioeconomic status (34.5%). In all, 10/55(19.2%) of the patients were students and 10/55 (19.2%) housewives; others include auto drivers, mechanics, teachers, cashiers, etc. All except 4 patients were from urban areas. Comorbid conditions noted were diabetes mellitus in 7/55 (12.7%), hypertension in 6/55 (10.9%), systemic steroid usage in 3/55 (5.4%), post-renal transplant status in 1/55 (1.8%), and SLE in 1/55 (1.8%). Sharing of personal use items was found in 12/55 (21.8%) of the patients and 9/55 (16.3%) of patients complained of excessive sweating.
Previous therapy with topical and systemic antifungals was given in 32/55 (58.8%) of the patients, other modes of treatment like homeopathy, and ayurveda in 4/55 (7.2%). Topical steroids were given to 4 patients and 19/55 (34.5%) of the patients were not treated for the infection.
Trichophyton mentagrophytes complex (69%) was the predominant species complex isolated followed by T. rubrum, M. gypseum, M.canis, and T. tonsurans.
Of the 47 Trichophyton isolates subjected to AFST, all the isolates showed MIC &gt;1ug/ml for fluconazole and griseofulvin. Majority of the isolates showed MIC of &lt;1 ug/ml for other antifungals; high MICs (MIC &gt;1) were exhibited by 5 isolates for terbinafine and naftifine, 2 isolates for sertoconazole, and 1 isolate for voriconazole. Molecular detection of terbinafine resistance done in 15/55 isolates showed mutation in the squalene epoxidase (SE) gene leading to F397L substitutions in 2 isolates. In the present study, the patients were treated with both oral and topical antifungals
Of the 55 cases, complete cure was observed in 21 (38%), partial cure in 9 (16.3%), and relapse in 5 (9%) on 2 years follow-up. However, 20/55 (36.3%) of the cases were lost to follow-up.

Conclusion
Trichophyton mentagrophytes complex was the predominant species isolated and Tinea corporis was the commonest clinical presentation. Resistance to terbinafine, griseofulvin, and fluconazole has been noted. Dermatophytosis has become a difficult to treat disease due to antifungal resistance, and chronicity/recurrence of the lesions. Early diagnosis followed by rational antifungal therapy are essential for improved outcome.