Chronic widespread dermatophytosis due to Trichophyton rubrum: a syndrome associated with a Trichophyton-specific functional defect of phagocytes

Author(s)

de Sousa, Maria da Gloria T. ^{[1, 2]} ; Santana, Grazielle B. ^[3] ; Criado, Paulo R. ^[4] ; Benard, Gil ^{[1, 2, 3]}

Affiliation

^[1] Univ Sao Paulo, Sch Med, Div Clin Dermatol, Lab Med Invest, Unit 53, BR-05403000 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Inst Trop Med, Med Mycol Lab, BR-05403000 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Sch Med, Div Clin Dermatol, Lab Med Invest, Unit 56, BR-05403000 Sao Paulo - Brazil

^[4] Univ Sao Paulo, Sch Med, Clin Hosp, Div Clin Dermatol, BR-05403000 Sao Paulo - Brazil

• Document type: Journal article
• Source: FRONTIERS IN MICROBIOLOGY; v. 6, AUG 6 2015.
• Web of Science Citations: 8

Abstract

Dermatophytes are agents of typically benign superficial infections. However, an increasing number of severe infections in immunocompromised hosts has been reported. We aimed to understand the factors underlying the existence of a cohort of patients presenting with chronic widespread dermatophytosis (CWD) due to Trichophyton rubrum, but with no signs of immunodeficiency. Their disease is usually recurrent and difficult to manage. Fourteen patients meeting the following criteria for CWD were studied: T rubrum culture-proven skin lesions of >= 10 cm in at least one dimension; the involvement of at least three non-contiguous localizations of > 1 year's duration; and no predisposing conditions. For comparison, we also studied 13 acute Tinea pedis patients. Macrophages and neutrophils were isolated and tested for T rubrum conidia phagocytic and killing activity. H2O2, NO, and pro- and anti-inflammatory cytokine release were measured. All experiments were run with age- and sex-matched healthy donors' cells in parallel. CWD patients' macrophages and neutrophils presented with reduced T rubrum phagocytic and killing abilities, and reduced H2O2 and NO release when compared with those of healthy donors. CWD patients' macrophages secreted lower levels of the proinflammatory cytokines interleukin (IL)-1 beta, IL-6, IL-8, and tumor necrosis factor (TNF)-alpha, but enhanced levels of the anti-inflammatory cytokine IL-10. Neutrophil secretion closely followed this unbalanced pattern. In contrast, responses to the positive controls zymosan, lipopolysaccharide, and phorbol myristate acetate were comparable with those of healthy donors. The same experiments were performed with macrophages and neutrophils from the acute Tinea pedis patients and showed no differences when compared with the matched healthy donors. Patients with CWD have a T rubrum-related functional deficiency of phagocytes and may represent a distinct clinical entity in the complex spectrum of the Trichophyton host interaction. (AU)

• FAPESP's process: 10/19369-6 - Characterization of the innate and adaptive immune responses during the infection with Trichophyton rubrum
• Grantee: Gil Benard
• Support Opportunities: Regular Research Grants