Antifungal susceptibility and virulence factors of clinically isolated dermatophytes in Tehran, Iran.
OBJECTIVE
Dermatophytes possess a wide array of virulence factors and various antifungal susceptibility patterns which influence their pathogenesis in humans and animals. The aim of this study was to evaluate antifungal susceptibility and keratinase and proteinase activity of 49 dermatophyte strains from the genera Microsporum, Trichophyton and Epidermophyton which were isolated from human cases of dermatophytosis.


METHODS
Forty-nine dermatophyte strains isolated from clinical samples were cultured on general and specific culture media. Keratinase and proteinase activity was screened on solid mineral media and confirmed in liquid cultures. Drug susceptibility toward azoles (fluconazole, ketoconazole and itraconazole), griseofulvin and terbinafine was evaluated using disk diffusion method on Mueller-Hinton agar and minimum inhibitory concentrations (MICs) were determined using microbroth dilution assay according to the Clinical and Laboratory Standards Institute (CLSI) guidelines.


RESULTS
Our results indicated that clinically isolated dermatophytes from 7 major species produced keratinase and proteinase at different extents. The mean keratinase and proteinase activity was reported as 6.69 ± 0.31 (U/ml) and 2.10 ± 0.22 (U/ml) respectively. Disk diffusion and microbroth dilution (MIC) results of antifungal susceptibility testing showed that ketoconazole was the most effective drug against Epidermophyton floccosum and Trichophyton mentagrophytes, itraconazole against T. rubrum and E. floccosum, and griseofulvin and terbinafine against Trichophyton verrucosum. Our results showed that all dermatophyte isolates were resistant to fluconazole. Overall, ketoconazole and itraconazole were the most effective drugs for all dermatophyte species tested.


CONCLUSIONS
Our results showed that antifungal susceptibility testing is an urgent need to select drugs of choice for treatment of different types of dermatophytosis and further indicated the importance of keratinase and proteinase in pathogenesis of dermatophyte species.
Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, 14115-331 Tehran, Iran.
Mohammad Ali
MA
Afshari
Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, 14115-331 Tehran, Iran.
Masoomeh
M
Shams-Ghahfarokhi
Department of Mycology, Pasteur Institute of Iran, 13164 Tehran, Iran; Microbiology Research Center, Pasteur Institute of Iran, 13164 Tehran, Iran.
Mehdi
M
Razzaghi-Abyaneh
Antifungal susceptibility testing; Dermatophytes; Keratinase activity; Proteinase activity; Virulence factors