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New Perspectives for Superficial Fungal Infections, Second Edition
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New Perspectives for Superficial Fungal Infections, Second Edition

A special issue of Journal of Fungi (ISSN 2309-608X).

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 6877

Special Issue Editors

Prof. Dr. Aditya K. Gupta

E-Mail Website
Guest Editor
Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
Interests: onychomycosis; tinea infection; antifungal therapy; antifungal resistance; clinical diagnosis; superficial non-dermatophyte infections
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Bianca Maria Piraccini

E-Mail Website
Guest Editor
Dermatology Unit, IRCCS of Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Interests: disorders of skin appendages; skin mycology; fungal nail infections; onychomycosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Technological advances have expanded the clinical perspective of superficial fungi from minor infective species to widespread agents with important roles in the human microbiome. New technologies allow us to better identify fungal agents, leading to an improved understanding of fungal species’ function and detection in infection. Furthermore, greater knowledge of fungal biology promotes a better clinical assessment of superficial fungal infection and enhanced methods of treatment. Thus, new perspectives on these infections are essential to establish optimal therapy routes for future patients.

Aims:

  • To review the changing biological factors of fungal infection:
    • New fungal ID methods/classification;
    • Possible changing epidemiology;
    • Fungal resistance;
    • Biofilms and other new fungal biology.
  • To address the role of non-dermatophyte fungi in superficial infection;
  • To provide strategies for improved standard therapies;
  • To discuss new treatment options/strategies.

Scope:

  • New classifications of species/epidemiology;
  • Interaction among dermatophytes/non-dermatophytes/other microbes;
  • New oral/topical/device therapies;
  • Immune system impacts of superficial infection;
  • Improved methods of fungal detection/identification.

Prof. Dr. Aditya K. Gupta
Prof. Dr. Bianca Maria Piraccini
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Fungi is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • tinea
  • trichophyton
  • non-dermatophyte
  • fungal resistance
  • azoles
  • terbinafine

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Related Special Issue

Published Papers (4 papers)

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Research

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12 pages, 2117 KiB  
Article
Extended Use of Topical Efinaconazole Remains Safe and Can Provide Continuing Benefits for Dermatophyte Toenail Onychomycosis
by Aditya K. Gupta and Elizabeth A. Cooper
J. Fungi 2024, 10(9), 620; https://doi.org/10.3390/jof10090620 - 30 Aug 2024
Viewed by 731
Abstract
Introduction: Efinaconazole 10% topical solution labeling for onychomycosis describes phase III trials of 12 months of treatment; the slow growth of onychomycotic nails suggests a longer treatment period may increase efficacy. We present here the first evaluation of extended use of efinaconazole 10% [...] Read more.
Introduction: Efinaconazole 10% topical solution labeling for onychomycosis describes phase III trials of 12 months of treatment; the slow growth of onychomycotic nails suggests a longer treatment period may increase efficacy. We present here the first evaluation of extended use of efinaconazole 10% topical solution for up to 24 months. Materials and Methods: Enrolled patients (n = 101) had one target great toenail with mild to moderate distal lateral subungual onychomycosis and applied efinaconazole 10% topical solution to all affected toenails once daily for 18 months (EFN18) or 24 months (EFN24). Efficacy and safety were evaluated at each visit by visual review and mycology sampling. Results: Regarding the target toenail for patients treated for 24 months (EFN24), mycological cure (negative microscopy and culture) was 66.0% at Month 12, increasing to 71.7% at Month 24; effective cure (mycological cure and ≤10% affected nail) was 13.2% at Month 12, rising to 22.6% at Month 24. Mild to moderate application site reactions (symptoms of erythema/scaling) were the only efinaconazole-related reactions, in eight patients (7.9%). No systemic efinaconazole events or drug interactions were found. Patients aged 70 years or more had similar efficacy to younger patients at all time periods and did not show any increased treatment risks. Thinner nails exhibited better clearance versus thicker nails. A higher proportion of patients with Trichophyton mentagrophytes complex infection experienced application site reactions (35.7%), and a higher effective cure was found at Month 24 versus T. rubrum patients. Conclusion: There is a trend of increasing mycological cure and effective cure beyond Month 12 to Month 24, without an increased safety risk. The enrolled population in this trial was significantly older than in the phase III trials, with a greater degree of onychomycosis severity; however, increased age did not appear to reduce the chance of efficacy to Month 24 in this study. Our data suggest that lack of ability to clear nail dystrophy remains a significant problem for patients, rather than any lack of efinaconazole action over long-term treatment periods. Full article
(This article belongs to the Special Issue New Perspectives for Superficial Fungal Infections, Second Edition)
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13 pages, 3080 KiB  
Article
Clinical Diagnosis and Laboratory Testing of Abnormal Appearing Toenails: A Retrospective Assessment of Confirmatory Testing for Onychomycosis in the United States, 2022–2023
by Aditya K. Gupta, Tong Wang, Elizabeth A. Cooper, Sara A. Lincoln, Hui-Chen Foreman, William P. Scherer and Wayne L. Bakotic
J. Fungi 2024, 10(2), 149; https://doi.org/10.3390/jof10020149 - 13 Feb 2024
Cited by 5 | Viewed by 2618
Abstract
Onychomycosis is an under-recognized healthcare burden. Despite the risk of misdiagnosis, confirmatory laboratory testing is under-utilized. Histopathologic examination with polymerase chain reaction (PCR) is currently the most effective diagnostic method; it offers direct detection and identification of a fungal invasion. In this retrospective [...] Read more.
Onychomycosis is an under-recognized healthcare burden. Despite the risk of misdiagnosis, confirmatory laboratory testing is under-utilized. Histopathologic examination with polymerase chain reaction (PCR) is currently the most effective diagnostic method; it offers direct detection and identification of a fungal invasion. In this retrospective cohort study, we assessed confirmatory testing results, with matching clinical diagnoses, in 96,293 nail specimens submitted during a 9-month period from 2022 to 2023. Toenail specimens were examined using fungal culture, histopathology and/or PCR. Clinical diagnoses were identified using the International Classification of Diseases 10th Revision codes. For clinically diagnosed onychomycosis patients, the overall positivity rate was 59.4%; a similar positivity rate (59.5%) was found in patients with clinically diagnosed non-fungal nail dystrophy. Performing a histopathologic examination with PCR was more likely to provide pathogen identification results than using fungal culture. Male patients had a higher rate of onychomycosis overall; however, female patients had more non-dermatophyte mold onychomycosis caused by Aspergillus. Clinically diagnosed onychomycosis patients with a co-diagnosis of tinea pedis were more likely to test positive for onychomycosis by PCR (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.7–6.4), histopathology (OR: 2.5; 95% CI: 2.0–3.1) and fungal culture (OR: 3.2; 95% CI: 1.5–6.6). Our results support the use of confirmatory laboratory testing when there is a clinical diagnosis of onychomycosis. Full article
(This article belongs to the Special Issue New Perspectives for Superficial Fungal Infections, Second Edition)
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15 pages, 2522 KiB  
Article
Molecular Signaling and Metabolic Responses during the Interaction between Human Keratinocytes (HaCaT) and the Dermatophyte Trichophyton rubrum
by Monise Fazolin Petrucelli, Leonardo Martins-Santana, Antonio Rossi and Nilce Maria Martinez-Rossi
J. Fungi 2024, 10(1), 72; https://doi.org/10.3390/jof10010072 - 16 Jan 2024
Viewed by 1759
Abstract
Trichophyton rubrum is the leading causative agent of dermatophytosis worldwide. Keratinocytes are the first line of defense that drives an immune response against fungal invasion. Host-specific pattern recognition receptors (PRRs) recognize pathogen-associated molecular patterns (PAMPs) to trigger immunological pathways. Fungal cell wall components [...] Read more.
Trichophyton rubrum is the leading causative agent of dermatophytosis worldwide. Keratinocytes are the first line of defense that drives an immune response against fungal invasion. Host-specific pattern recognition receptors (PRRs) recognize pathogen-associated molecular patterns (PAMPs) to trigger immunological pathways. Fungal cell wall components are the primary sources of fungal PAMPs, and some pathogens increase cell wall rearrangement to evade the immune system. Glycolysis and enhanced lactate levels are critical for improving host immune responses to fungal infections. Using reverse transcription–quantitative polymerase chain reaction (RT-qPCR), we evaluated the transcriptional responses of human genes involved in fungal recognition and glycolytic metabolism and fungal cell-wall-related genes in a co-culture model of human keratinocytes with T. rubrum. We observed the upregulation of several Toll-like receptors (TLRs), NOD-like receptors (NLRs), and glycolytic genes. Complementarily, we measured intra- and extracellular glucose levels and the increase in lactate production in the co-culture supernatant. We noted a distinct transcriptional regulation pattern of fungal cell-wall-related genes from fungal growth on keratin as the primary carbon source compared to co-culture with human keratinocytes. Our results showed new insights into the transcriptional adaptation of keratinocytes, particularly in regulating genes involved in sensing and metabolic processes, during the interaction with T. rubrum. Full article
(This article belongs to the Special Issue New Perspectives for Superficial Fungal Infections, Second Edition)
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Review

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15 pages, 2102 KiB  
Review
Diabetic Foot and Fungal Infections: Etiology and Management from a Dermatologic Perspective
by Aditya K. Gupta, Avner Shemer, Vasiliki Economopoulos and Mesbah Talukder
J. Fungi 2024, 10(8), 577; https://doi.org/10.3390/jof10080577 - 15 Aug 2024
Cited by 1 | Viewed by 1311
Abstract
Diabetes Mellitus (DM) is a significant global concern. Many diabetic patients will experience complications due to angiopathy, neuropathy, and immune dysfunction, namely diabetic foot ulcers (DFU) and diabetic foot infections (DFI), which can result in lower limb amputation and potentially death. The prevalence [...] Read more.
Diabetes Mellitus (DM) is a significant global concern. Many diabetic patients will experience complications due to angiopathy, neuropathy, and immune dysfunction, namely diabetic foot ulcers (DFU) and diabetic foot infections (DFI), which can result in lower limb amputation and potentially death. The prevalence of common superficial fungal infections, such as tinea pedis and onychomycosis, can directly increase a diabetic patient’s risk of developing both DFU and DFI. In this review article, we discuss the etiology of diabetic foot complications as well as considerations for both screening and management. We also discuss the role of the dermatologist within a multidisciplinary care team in prescribing and managing treatments for tinea pedis and onychomycosis infections within this patient population. We believe that reducing the burden of these fungal infections in the context of the diabetic foot will help reduce DFU and DFI complications and their associated morbidity and mortality. Full article
(This article belongs to the Special Issue New Perspectives for Superficial Fungal Infections, Second Edition)
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