CC BY
9
Ahmedova S. D., Ph. D., of Medical Sciences Farajev Z. Q., D.Sc., Amirova I. A., D.Sc., Agayeva N. A., D.Sc., Azerbaijan Medical University Department of dermatovenereology, Baku, Azerbaijan E-mail: matlabm@yandex.ru
IDENTIFICATION OF SENSITIVITY OF DERMATOMYCOSIS AGENTS TOWARDS ANTIMYCOTICS
Abstract: The given article presents the outcomes of a research that was held with the goal of identification of sensitivity of skin and its appendages mycosis agents to antimycotics (nystatin, ketoconazole, itraconazole, fluconazole, clotrimazole) in isolates, separated from patients with dermatomycosis. Identification of sensitivity of dermatomycosis agents to antifungal drugs must be held in recurrent cases, and in cases resistant to standard therapy, as well as during mixed infections. Despite labo-riousness and long terms of sensitivity identification, this method can be recommended as it is considered a "golden standard". Clotrimazole was found to be an antimycotic most sensitive to dermatomycosis agents, and is followed by ketoconazole and nystatin in the third place. Fluconazole and itraconazole did not represent sensitivity and were found to be resistant to agents.
Keywords: resistance, antimycotics, dermatomycosis, mixed-infection.
Introduction. Around 400 types of fungus are recognized to be must be held towards all infectious agents, as well as during recurring provocatives offungal diseases, 100 ofwhich are met most frequently. cases and cases, resistant to standard therapy of the illness. Methods They are distinguished by the extraordinary vitality and resistance of serial breedings [6] comprise referential methods of identification
to environmental impact. Dermatophytes, causing dermatomycosis can survive in the environment for more than 2 years [1]. Due to that dermatophytes relate to pathogenic provocative, a great role in development of infectious process is given to reactivity of the macro-organism, and therefore, the risk of falling sick to fungal infection is multiplied in case of mixed fungal infection in individuals with concomitant diseases, and increases and doubles every 10 years oflife [2].
Dermatophytes constitute one of the primary groups offungus pathogenic for people. Dermatophytes consist of 39 types, integrated in three kinds - Trichophyton, Microsporum and Epidermophyton. Keratin, which comprises the stratum corneum of epidermis, nails and hair is a primary source of nourishment for anthropophilic dermatophytes, necessary for existence, reproduction and growth [T. rubrum, T. Interdigitale]. Animals and birds comprise the habitat of zoophilic dermatophytes [M. canis, M. distortium, T. equinum, T. mentagrophytes var. erinacei, T. mentagrophytes var. gypseum, T. Ver-rucosum]. Some kinds of zoophilic dermatophytes parasitize in skin, hair and nails of a human, and they are considered zooanthropo-philic dermatophytes. Geophilic dermatophytes, inhabiting in the soil comprise a small group of dermatophytes [3].
Despite numerous studies of dermatomycosis, mixed forms of mycosis (mixed infections) still comprise a complicated problem, creating additional difficulties for diagnostics and therapy. Role of mixed-microbiota, emitted from the lesions in pathogenesis, proliferation and sensitivity to antomycotic therapy of this group of diseases is still not clear [4].
According to international clinical recommendations [5], definition in vitro of sensitivity of dermatomycosis agents to antifungal drugs
of sensitivity of dermatomycosis agents. Yet, these methods are too complicated for application in everyday practice of laboratories due to their laboriousness and significant expenditures for materials.
There exists a row of commercial, as well as automatized systems and test-systems for identification of sensitivity of dermatomycosis agents to antimycotics, and disco-diffusive method gained great popularity [7].
The goal of the research - is the identification of sensitivity of dermatomycosis agents to antimycotics (nystatin, ketoconazole, itraconazole, fluconazole, clotrimazole) in isolates, separated from patients with fungal lesions.
Materials and methods. 114 isolates emitted from biomaterials of patients with dermatomycosis were used in the frames of multi-centered research in Azerbaijan (2014-2016). Within this period, 253 patients with mycotic lesions of scalp and smooth skin aged between 3-80 referred to the Republican skin and venereal dispensary and Children skin and venereal dispensary № 3.
All the patients were held clinical and mycolologic survey, including microscopic and cultural surveys of samples of pathologic material from the lesions. During squamous form of smooth skin mycosis, mycosis-like flakes of skin furrow received as a result of scraping were studied, during dyshidrotic form of mycotic lesion of hands and feet samples were taken from exfoliating epidermis of the periphery of lesions, and during the lesion of nail plates stratum corneum was scraped with scalpel, as well as during trichomycosis pieces of hair, taken from the lesions were studied. The "crop" was generated in the breeding ground Saburo and was cultivated at 28°C in a thermostat for 7 days.
IDENTIFICATION OF SENSITIVITY OF DERMATOMYCOSIS AGENTS TOWARDS ANTIMYCOTICS
Results and the discussion. Results of identification of sensi- azole, itraconazole, fluconazole, clotrimazole) are presented below. tivity of dermatomycosis agents to antimycotics (nystatin, ketocon-
Table 1.
Infectious Agents Antimycotics
Ketoconazole Clotrimazole Nystatin Fluconazole Itraconazole
Microsporum audouinii (8) + + + + - - - + -
Trichophyton spp. (6) + + + + + + + - - -
Trichophyton rubrum (5) - + + + + + + - -
Trichophyton spp. + Cladosporium spp. (7) + + + + + + + + + - -
Trichophyton spp. + Candida albicans (4) + - + + + + + + - -
Trichophyton spp. + Stafilok(5) + - + + + + + + - -
Epidermophiton spp. (8) + + + + + + + - - -
Cladosporium spp. (8) + + + + - + + + - -
Microsporum audouinii + Cladosporium spp. (9) + + + + + + + + + - -
Cladosporium spp. + Penicillum (3) + + + + - + + + - -
Aspergillus spp. (9) + + + + + + + - - -
Aspergillus spp. + Cladosporium spp. (6) + + + + + + + + + - -
Aspergillus niger (4) - + + + - - -
Aspergillus versicolor (6) + + + + + + + - - -
Candida albicans (11) + + + - + - -
Aspergillus spp. + Candida albicans + Penicillum (7) + + +
Cladophialofora spp. (8) + + + + + + + + + - +
Criteria of sensitivity of dermatomycosis agents to antimycotics (nystatin, ketoconazole, itraconazole, fluconazole, clotrimazole) (n = 114) Remarks: + + + high sensitivity;
+ + moderate senstivity; + low sensitivity; + - questionable sensitivity; - complete absence of sensitivity (resistance).
Cladosporium spp., and mixed-microbiota during mixed infections Cladosporium spp. + Penicillum spp., Cladosporium spp. + Aspergillus spp., Microsporum audouinii + Cladosporium spp represented high sensitivity for ketoconazole. Cladophialofora spp. is highly sensitive for ketoconazole, clotrimazole and nystatin.
Infectious agents of Aspergillus spp., Aspergillus niger, Aspergillus versicolor in the form of monoinfection, as well as in the form of mixed-infection are equally positively sensitive for clotrimazole.
Candida albicans represented moderate sensitivity for ketoconazole, low sensitivity for nystatin and questionable sensitivity for clotrimazole.
Results. Thus, clotrimazole was found to be an antifungal anty-biotics that is most sensitive to to dermatomycosis agents, and is followed by ketoconazole, and nystatin in the third place. Fluconazole and itraconazole were found to be resistant to infectious agents and did not represent sensitivity. Despite laboriousness and long terms of the test, this method of sensitivity identification can be recommended in resistant to standard antimycotic therapy forms of disease.
References:
1. Белоусова Т. А., Горячкина М. В., Грязева Т. М. Принципы наружной терапии дерматозов сочетанной этиологии. Conc Med (Дерматология) - 2011. - 2. - P. 16-20.
2. Соколова Т. В., Малярчук А. П., Малярчук Т. А. Клинико-эпидемиологический мониторинг поверхностных микозов в России и совершенствование терапии. Русский медицинский журнал. - 2011. - 19 (21). - P. 1327-32.
When comparing the results, no sensitivity of dermatomycosis agents towards fluconazole and itraconazole during both mono and mixed infections was identified. Microsporum audouinii found during trichomycosis demonstrated high sensitivity for ketoconazole, questionable sensitivity for clotrimazole and itroconazole, and resistance for nystatin and fluconazole. During mixed-infections Microsporum audouinii + Cladosporium spp high sensitivity of mixed-microbiota was revealed for ketoconazole, clotrimazole and nystatin, along with resistance for fluconazole and itraconazole.
Trichophyton spp is highly sensitive for ketoconazole and clotrimazole and is questionably sensitive for nystatin. Trichophyton rubrum and mixed-microbiota during mixed infections Trichophyton spp. + Cladosporium: Trichophyton spp. + Candida albicans; Trichophyton spp. + Stafilok represented high sensitivity for clotrimazole and nystatin.
Epidermophiton spp. is highly sensitive for ketoconazole and clotrimazole.
3. Borelli C., Korting H. C., Bodeker R. H., Neumeister C. Safety and efficacy of sertaconazole nitrate cream 2% in the treatment of tinea pedis interdigitalis: a subgroup analysis. Cutis- 85. - 2010. - 2. - P. 107-111.
4. Котрехова Л. П. Диагностика и рациональная терапия дерматозов сочетанной этиологии. Consilium Medicum (приложение «Дерматология») - 2010. - 4. - P. 6-11.
5. Zhan G., Perez - Perez G. I., Chen Yu., Blaser M. J. Quantitation of Major Human Cutaneous Bacterial and Fungal Populations. J Clin Microbiol - 48. - 2010. - 10. - P. 3575-3581.
6. Грибанова Т. В. Дерматозы крупных складок: диагностика, клиника, рациональная наружная терапия. Клиническая дерматология и венерология. - 1. - 2010. - P. 40-4.
7. Sharma A., Saple D. G., Surjushe A. et al. Efficacy and tolerability of sertaconazole nitrate 2% cream vs. miconazole in patients with cutaneous dermatophytosis. Mycoses - 54. - 2011. - 3. - P. 217-222.
