Clinico-morphological Profile of Cutaneous Fungal Infections: An Experience from a Tertiary Care Government Hospital in North India
AbstractBackground: Cutaneous fungal infections are predominantly seen in hot tropical countries like India. In the past decade, there has been an escalation in recurrent and chronic fungal infections. Skin biopsy may play a critical role in rapid identification of these infections. Methods: Fifteen cases of cutaneous fungal infections over a period of 6 years were included. Formalin-fixed tissue was subjected to hematoxylin and eosin and histochemical staining including Gomori Methanamine Silver and Periodic Acid Schiff . Results of KOH smear test and fungal culture were included wherever available. The clinico-morphological patterns in various cutaneous fungal infections was evaluated. Results: Most patients were between 25 to 40 years of age and commonly presented as skin ulceration, followed by nodular swelling and multiple discharging sinuses. Candidiasis and Mycetoma infections were the commonest infections. Others included: Cryptococcosis, Dermatophytosis, Chromoblastomycosis and Mucormycosis. The predominant histopathologic patterns were perivascular and interstitial inflammation. Eleven cases were confirmed by KOH examination and culture. Conclusion: The morphologic spectrum of cutaneous fungal infections is varied. Initial presentations of these fungal infections may be indicative of the onset of a life-threatening systemic mycoses. Thus, the histopathologic evaluation of skin tissue specimens is critical for their rapid and accurate diagnosis.
Kannan P, Janaki C and Selvi GS (2006): Prevalence of dermatophytes and other fungal agents isolated from clinical samples. Indian J Med Microbiol., 24(3): 212-215.
Oke OO, Onayemi O, Olasode OA, Omisore AG, Oninla OA. The prevalence and pattern of superficial fungal infections among school children in ile‑ife, South‑Western Nigeria. Dermatol Res Pract 2014.
Narasimhalu CR, Kalyani M, Somendar S. A cross-sectional, clinico-mycological research study of prevalence, aetiology, speciation and sensitivity of superficial fungal infection in Indian patients. J Clin Exp Dermatol Res. 2016;7(324):2.
Molly H, Longley J. Fungal diseases. In: Lever’s histopathology of the skin. Lipincott Williams and Wilkins. 9th ed. 2005;591-620.
Dash M, Panda M, Patro N, Mohapatra M. Sociodemographic profile and pattern of superficial dermatophytic infections among pediatric population in a tertiary care teaching hospital in Odisha. Indian Journal of Paediatric Dermatology. 2017;18(3):191-5.
WHO, 2005. Epidemiology and management of common skin diseases in children in developing countries. World Health Organization, Geneva. WHO/FCH/CAH/05.12.
Lakshmanan A, Ganeshkumar P, Mohan SR, Hemamalini M, Madhavan R. Epidemiological and clinical pattern of dermatomycoses in rural India. Indian journal of medical microbiology. 2015;33(5):134-6.
Shenoy MM, Jayaraman J. Epidemic of difficult‑to‑treat tinea in India: Current scenario, culprits, and curbing strategies. Arch Med Health Sci 2019;7:112-7.
Petmy LJ, Lando AJ, Kaptue L, Tchinda V, Folefack M. Superficial mycoses and HIV infection in Yaounde. J Eur Acad Deramtol Venereol 2004; 8: 301-4
Kim MS, Lee SM, Sung HS, Won CH, Chang S, Lee MW, et al. Clinical analysis of deep cutaneous mycoses: a 12-year experience at a single institution. Mycoses 2012;55:501-6.
Singh N. Fungal infection in the recipients of solid organ transplantation. Infect Dis Clin North Am 2003;17:113.
Jackson P, Blythe D. Immunohistochemical techniques. In: Bancroft JD, Gamble M, editors. Theory and practice of histological techniques. 6th ed. Philadelphia: Elsevier/Churchill Livingstone; 2008. 433–69.
Berenji F, Sivaki MM, Sadabadi F, Aliabadi ZA, Ganjbakhsh M, Salehi M. A retrospective study of cutaneous fungal infections in patients referred to Imam Reza Hospital of Mashhad, Iran during 2000-2011. Current medical mycology. 2016;2(1):20.
Miklić P, Skerlev M, Budimčić D, Lipozenčić J. The frequency of superficial mycoses according to agents isolated during a ten-year period (1999- 2008) in Zagreb area, Croatia. Acta Dermatovenerol Croat. 2010;18(2):92-8.
Grover S, Roy P. Clinico-mycological profile of superficial mycosis in a hospital in North-East India. Medical journal armed forces India. 2003;59(2):114-6.
Mandell, Dauglus Bennett’s. Principle and Practice of Infectious Diseases, Sixth Edition, Volume 2, Chapter 265, Dermatophytosis and Other Superficial Mycoses :3051-62.
Santiago TM, Pritt B, Gibson LE, Comfere NI. Diagnosis of deep cutaneous fungal infections: Correlation between skin tissue culture and histopathology. Journal of the American Academy of Dermatology. 2014;71(2):293-301.
Schofield CM, Murray CK, Horvath EE, Cancio LC, Kim SH, Wolf SE, et al. Correlation of culture with histopathology in fungal burn wound colonization and infection. Burns 2007;33:341-6.
Guarner J, Brandt M. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev 2011;24: 247-80.
Sangoi AR, Rogers WM, Longacre TA, Montoya JG, Baron EJ, Banaei N. Challenges and pitfalls of morphologic identification of fungal infections in histologic and cytologic specimens: a ten-year retrospective review at a single institution. American journal of clinical pathology. 2009 Mar 1;131(3):364-75.
Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clinical microbiology reviews. 2011 Apr 1;24(2):247-80.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).