Orientador: Luis Octavio Regasini / Resumo: As micoses superficiais e cutâneas são infecções fúngicas que acometem a camada mais externa do estrato córneo da pele e seus anexos. São as micoses mais frequentes dentre todas as infecções fúngicas e estão distribuídas por todo o mundo, afetando todas as faixas etárias. O impacto primário destas micoses é seu aspecto visual com estética negativa. Contudo, não se restringem apenas ao aspecto estético, vindo a ser um grave problema de saúde na população neonatal, senescente e de imunocomprometidos. Além disso, muitos fármacos exibem toxicidade alta, interações medicamentosas e alto custo econômico. As recidivas por meio do tratamento convencional costumam ser frequentes, as quais podem ser ocasionadas por cepas resistentes. Esse cenário torna premente a busca por antifúngicos inovadores. No presente estudo avaliou-se atividade antifúngica de 19 curcuminoides, provenientes da composteca do Laboratório de Antibióticos e Quimioterápicos (LAQ), contra fungos filamentosos dermatofíticos dos gêneros Trichophyton, Epidermophyton e Microsporum e leveduriformes (Candida spp.), de cepas de referência ATCC e de isolados clínicos, provenientes da coleção do Laboratório de Microbiologia da Faculdade de Medicina de São José do Rio Preto (FAMERP), bem como avaliou-se toxicidade dos curcuminoides mais potentes contra células de queratinócitos humanos (HaCat) e larva G. mellonella. Afim de verificar a atividade antifúngica dos compostos, foram determinados os valores: Concentração Inibitória ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Superficial and cutaneous mycoses are fungal infections that affect the outermost layer of the stratum corneum of the skin and its attachments. They are the most frequent mycoses among all fungal infections and are distributed all over the world. The first impact of these mycoses is their visual appearance with a negative aesthetic. However, they are not restricted to the aesthetic aspect, becoming a serious health problem in the neonatal, senescent and immunocompromised population. In addition, many drugs exhibit high toxicity, drug interactions and high economic cost. Relapses through conventional treatment are often frequent, which can be caused by resistant strains. This scenario demands the development of potent but safer compounds. Herein, we described the antifungal activity of a novel curcuminoid against dermatophyte and Candida species. A series of nineteen curcuminoid analogs was submitted to antifungal assay to assess MIC (minimum inhibitory concentration) and MFC (minimum fungicidal concentration) determined by the broth microdilution method. First, all compound were tested at 31.2 µg mL-1 in order to select the most active compound. The compound 3, 3'-Dimethoxycurcumin (DMC) showed the highest growth-inhibitory activity the largest spectrum of action against dermatophyte clinical isolates and reference strains of Candida tropicalis ATCC and Trichophyton rubrum CBS, with MIC values range of 1.9±31.2 µg mL-1. DMC exhibited fungistatic activity. Inverted microscope ... (Complete abstract click electronic access below) / Mestre

Pour déterminer les caractéristiques épidémiologiques des dermatophytoses chez les élèves, nous avons effectué trois enquêtes transversales entre décembre 2009 et février 2012 dans des écoles primaires publiques situées dans trois zones éco-climatiques différentes du Mali. Sur un échantillon aléatoire de 590 élèves (âge moyen de 9,7 ans ; 286 garçons), la prévalence clinique des dermatophytoses était de 59,2%. La teigne du cuir chevelu (39.3%) représentait la forme clinique la plus fréquente ; la prévalence des autres dermatophytoses était de 13,6% avec une prédominance de l'atteinte de la peau glabre (81,3%). Une forte prévalence (59,5%) des cas confirmés de teigne a été enregistrée dans la zone climatique soudano-guinéenne. Nous avons mis en évidence le genre masculin et la résidence dans la zone bioclimatique Soudano-guinéenne comme facteurs de risque indépendants associés à la teigne du cuir chevelu. Les espèces de dermatophytes identifiées étaient T. soudanense (41,3%), M. audouinii (36,5%), T. violaceum (3,7%), T. mentagrophytes (2,1%) et l'association de T. soudanense avec M. audouinii (14,8%) ou T. mentagrophytes (1,6%). Sur 41 instruments de coiffure prélevés, 73,2%, étaient contaminés par deux espèces anthropophiles : T. soudanense (53,3%) et M. audouinii (46,7%). Au plan thérapeutique, nous avons évalué l'activité de la squalamine, contre des dermatophytes in vitro. Cette molécule a présenté des CMIs variant de 4 à 16 mg/l. Nous avons ensuite montré une bonne tolérance et une efficacité partielle de la squalamine en topique dans le traitement de la teigne du cuir chevelu dans un essai clinique de phase II, randomisé, en double aveugle, contrôlé par placebo. / To determine the epidemiological characteristics of dermatophytoses in Malian schoolchildren, we conducted three cross-sectional surveys between December 2009 and February 2012 in three public primary schools located in three climatic zones. A randomly selected sample of 590 schoolchildren (mean age: 9.7 years, 286 males) participated in this study. Overall, three hundred and twelve participants were diagnosed to have dermatophytosis lesions, giving a 52.9 % prevalence of clinical dermatophytoses. Tinea capitis was the most common clinical presentation, with a 39.3% prevalence, whereas the prevalence other dermatophytoses was 13.6%. A high (59.5%) prevalence rate of confirmed cases of tinea capitis was observed in the Sudano-Guinean climatic zone. Male gender and living in this climatic zone were independent risks factors associated with tinea capitis. Mycological culture found T. soudanense (41.3%), M. audouinii (36.5%), T. violaceum (3.7%), T. mentagrophytes (2.1%), and the combination of T. soudanense with M. audouinii (14.8%) or T. mentagrophytes (1.6%). In addition, we found a high contamination rate (73.2%), with two anthropophilic dermatophytes: T. soudanense (53.3%) and M. audouinii (46.7%), of hairdressing tools in peri-urban area of Bamako. Regarding anti-dermatophyte therapy, we showed a significant in vitro activity of squalamine against clinical dermatophyte isolates, with MICs ranging from 4 to 16 mg/l. In a phase II, randomized, double-blind, placebo-controlled, clinical trial, a topical treatment with squalamine ointment was well tolerated and exhibited a partial clinical activity in the treatment of tinea capitis.

Dermatófitos são um grupo de fungos intimamente relacionados, que tem a capacidade de invadir tecidos queratinizados como pele, cabelos e unhas de homens e outros animais causando dermatofitoses. Os agentes envolvidos nessas infecções pertencem aos gêneros Trichophyton, Microsporum ou Epidermophyton e, de acordo com seu habitat natural, são classificados em espécies geofílicas, zoofílicas ou antropofílicas. A maior incidência de dermatofitoses é causada pelo gênero Trichophyton, sendo T. rubrum a espécie mais prevalente em infecções de pele e unhas em humanos. Devido à severidade e longevidade destas infecções, e à resistência ao tratamento, o estudo de fatores envolvidos na interação patógeno-hospedeiro, na resistência dos dermatófitos a agentes antifúngicos e na manutenção do processo infeccioso são de grande relevância. Por análises morfológicas, fisiológicas e de expressão gênica, comparamos cinco dermatófitos cujos genomas foram sequenciados por iniciativa do Broad Institute, Microsporum canis, Trichophyton equinum, Trichophyton interdigitale, Trichophyton rubrum e Trichophyton tonsurans. Cultivos em queratina, mimetizando o processo infeccioso, foram utilizados para analisar o envolvimento dos dermatófitos na interação patógeno-hospedeiro e manutenção do processo infeccioso. Também expusemos as espécies a concentrações subinibitórias de agentes terapêuticos, de modo a verificar a resposta destes fungos a diferentes drogas. Observamos que o acúmulo de transcritos dos genes relacionados à virulência em dermatófitos avaliados durante o crescimento em queratina sugere que a maquinaria metabólica com atividade de formação da parede celular do fungo, metabolização do substrato e adesão ao hospedeiro ativa nos períodos iniciais de infecção. Contudo, um padrão de expressão correlacionado à similaridade das sequências genômicas não foi observado nas condições testadas. Também não se observa correlação direta entre o nicho preferencial dos dermatófitos e os níveis transcricionais em resposta à queratina de origem animal. Analisamos três genes envolvidos na resistência a múltiplas drogas (MDR) durante crescimento na presença de drogas com atividade antifúngica. Nossos dados sugerem que os genes MDR atuam sinergicamente em dermatófitos, e podem atuar de forma compensatória quando em presença de drogas antifúngicas, o que pode ser uma importante causa de falhas no tratamento. Nossos resultados fornecem evidências de que a expressão dos genes analisados não se correlaciona com as relações filogenéticas entre estes dermatófitos, visto que apesar da íntima relação entre o conteúdo genético e organização do genoma, os níveis transcricionais destes genes são diferentes entre as espécies. Assim, diferenças na adaptação a nichos específicos e a progressão da doença entre os dermatófitos podem ser explicadas por diferentes perfis de transcrição do gene. / Dermatophytes are a group of closely related fungi, which have the ability to invade keratinized tissues, such as skin, hair, and nails of both human and animal hosts causing dermatophytosis. The agents involved in these infections belong to the genera Trichophyton, Microsporum or Epidermophyton and, according to their natural habitat, are classified as geophilic, zoophilic or anthropophilic species. The higher incidence of dermatophytosis is caused by the genera Trichophyton, being the specie T. rubrum the most prevalent causative of human skin and nail infections. Because of the severity and longevity of these infections and their resistance to treatment, the study of the factors involved in host-pathogen interaction, in resistance of dermatophytes to antifungal agents, and in maintenance of the infection is relevant. Through morphological, physiological and gene expression analysis we compared five dermatophytes, whose genomes were sequenced by initiative of the Broad Institute: Microsporum canis, Trichophyton equinum, Trichophyton interdigitale, T. rubrum and Trichophyton tonsurans. Growth in keratin, which mimetize the infectious process, was used to analyze the involvement of dermatophytes in host-pathogen interaction and maintenance of the infectious process. We also exposed the species to subinibitory concentrations of therapeutic agents to verify the response of these fungi to different drugs. We observed that the accumulation of transcripts of genes related to virulence in dermatophytes evaluated during growth in keratin, suggest that the metabolic machinery with activity on fungal cell wall formation, substrate metabolization, and host adhesion is activated in early stages of infection. However, an expression pattern correlating to genomic sequence similarity was not observed in the conditions tested. We also did not observe a direct correlation between the preferential niche of these dermatophytes and the transcriptional levels in response to the keratin from animal origin. We analyze three genes involved in multidrug resistance (MDR) during growth in the presence of drugs with antifungal activity. Our data suggest that MDR genes act synergistically in dermatophytes, and they may compensate for one another when challenged with antifungal drugs, which can be an important cause of therapeutic failure. We provide evidence that the expression of the analyzed genes does not correlate with the phylogeny of these dermatophytes since, in spite of the different species being highly related in gene content and genome organization, the transcription level of these genes is different among these species. Thus, differences in adaptation to a specific niche and disease progression among dermatophytes would be explained by different gene transcription profiles.

Dermatófitos são um grupo de fungos intimamente relacionados, que tem a capacidade de invadir tecidos queratinizados como pele, cabelos e unhas de homens e outros animais causando dermatofitoses. Os agentes envolvidos nessas infecções pertencem aos gêneros Trichophyton, Microsporum ou Epidermophyton e, de acordo com seu habitat natural, são classificados em espécies geofílicas, zoofílicas ou antropofílicas. A maior incidência de dermatofitoses é causada pelo gênero Trichophyton, sendo T. rubrum a espécie mais prevalente em infecções de pele e unhas em humanos. Devido à severidade e longevidade destas infecções, e à resistência ao tratamento, o estudo de fatores envolvidos na interação patógeno-hospedeiro, na resistência dos dermatófitos a agentes antifúngicos e na manutenção do processo infeccioso são de grande relevância. Por análises morfológicas, fisiológicas e de expressão gênica, comparamos cinco dermatófitos cujos genomas foram sequenciados por iniciativa do Broad Institute, Microsporum canis, Trichophyton equinum, Trichophyton interdigitale, Trichophyton rubrum e Trichophyton tonsurans. Cultivos em queratina, mimetizando o processo infeccioso, foram utilizados para analisar o envolvimento dos dermatófitos na interação patógeno-hospedeiro e manutenção do processo infeccioso. Também expusemos as espécies a concentrações subinibitórias de agentes terapêuticos, de modo a verificar a resposta destes fungos a diferentes drogas. Observamos que o acúmulo de transcritos dos genes relacionados à virulência em dermatófitos avaliados durante o crescimento em queratina sugere que a maquinaria metabólica com atividade de formação da parede celular do fungo, metabolização do substrato e adesão ao hospedeiro ativa nos períodos iniciais de infecção. Contudo, um padrão de expressão correlacionado à similaridade das sequências genômicas não foi observado nas condições testadas. Também não se observa correlação direta entre o nicho preferencial dos dermatófitos e os níveis transcricionais em resposta à queratina de origem animal. Analisamos três genes envolvidos na resistência a múltiplas drogas (MDR) durante crescimento na presença de drogas com atividade antifúngica. Nossos dados sugerem que os genes MDR atuam sinergicamente em dermatófitos, e podem atuar de forma compensatória quando em presença de drogas antifúngicas, o que pode ser uma importante causa de falhas no tratamento. Nossos resultados fornecem evidências de que a expressão dos genes analisados não se correlaciona com as relações filogenéticas entre estes dermatófitos, visto que apesar da íntima relação entre o conteúdo genético e organização do genoma, os níveis transcricionais destes genes são diferentes entre as espécies. Assim, diferenças na adaptação a nichos específicos e a progressão da doença entre os dermatófitos podem ser explicadas por diferentes perfis de transcrição do gene. / Dermatophytes are a group of closely related fungi, which have the ability to invade keratinized tissues, such as skin, hair, and nails of both human and animal hosts causing dermatophytosis. The agents involved in these infections belong to the genera Trichophyton, Microsporum or Epidermophyton and, according to their natural habitat, are classified as geophilic, zoophilic or anthropophilic species. The higher incidence of dermatophytosis is caused by the genera Trichophyton, being the specie T. rubrum the most prevalent causative of human skin and nail infections. Because of the severity and longevity of these infections and their resistance to treatment, the study of the factors involved in host-pathogen interaction, in resistance of dermatophytes to antifungal agents, and in maintenance of the infection is relevant. Through morphological, physiological and gene expression analysis we compared five dermatophytes, whose genomes were sequenced by initiative of the Broad Institute: Microsporum canis, Trichophyton equinum, Trichophyton interdigitale, T. rubrum and Trichophyton tonsurans. Growth in keratin, which mimetize the infectious process, was used to analyze the involvement of dermatophytes in host-pathogen interaction and maintenance of the infectious process. We also exposed the species to subinibitory concentrations of therapeutic agents to verify the response of these fungi to different drugs. We observed that the accumulation of transcripts of genes related to virulence in dermatophytes evaluated during growth in keratin, suggest that the metabolic machinery with activity on fungal cell wall formation, substrate metabolization, and host adhesion is activated in early stages of infection. However, an expression pattern correlating to genomic sequence similarity was not observed in the conditions tested. We also did not observe a direct correlation between the preferential niche of these dermatophytes and the transcriptional levels in response to the keratin from animal origin. We analyze three genes involved in multidrug resistance (MDR) during growth in the presence of drugs with antifungal activity. Our data suggest that MDR genes act synergistically in dermatophytes, and they may compensate for one another when challenged with antifungal drugs, which can be an important cause of therapeutic failure. We provide evidence that the expression of the analyzed genes does not correlate with the phylogeny of these dermatophytes since, in spite of the different species being highly related in gene content and genome organization, the transcription level of these genes is different among these species. Thus, differences in adaptation to a specific niche and disease progression among dermatophytes would be explained by different gene transcription profiles.

Dermatophytes are a group of fungi, some of which can cause skin diseases in humans and animals due to their ability to degrade keratinized tissue. Representatives of this group also include strains from the Trichophyton benhamiae complex, known to cause dermatophytosis especially of small rodents and rabbits. In the last decade, one of four populations of this complex has spread epidemically across Europe among guinea pigs and their breeders. To answer the question what stands behind the successful spread of this population, the gene expression and production of volatile organic compounds of epidemic and non-epidemic populations of T. benhamiae was investigated. Gene expression of three strains from each population was studied during growth in liquid medium and on ex vivo mouse skin models prepared according to a newly optimized protocol. RNAseq and RT-qPCR methods were chosen for the gene expression analysis. Based on the literature and the results of RNAseq preliminary analysis, several genes were selected for which specific primers were designed. The spectra of the produced volatile organic compounds of the same strains growing on sheep wool in vials were analyzed by GC-MS. While non-epidemic populations did not differ in gene expression and production of volatile organic compounds, the...

Global und insbesondere in Indien ist in den letzten Jahren eine steigende Inzidenz chronischer und therapierefraktärer Dermatomykosen beobachtet worden. Zunehmend wird dies als Epidemie und Bedrohung der öffentlichen Gesundheit wahrgenommen. In vitro-Resistenz der Erreger wird als eine mögliche Ursache diskutiert. Bisherige Studien zeigten eine Assoziation von Mutationen im Squalenepoxidase (SQLE)-Gen der Dermatophyten mit In vitro-Resistenz gegenüber Terbinafin und Therapieversagen. Die Prävalenz dieses Phänomens ist jedoch unklar. Im Rahmen einer Multicenter-Studie identifizierten wir mittels konventioneller und molekularbiologischer Methoden Hautschuppen von 402 indischen Patienten unter dem Verdacht einer Dermatomykose. Zudem führten wir Resistenztestungen und SQLE-Sequenzierungen durch. In 83% der Schuppen wiesen wir Trichophyton (T.) indotineae und in 5% T. rubrum nach. 279 Isolate wurden Resistenztestungen und Sequenzierungen des SQLE-Gens zugeführt. Hiervon zeigten sich 72% in vitro-resistent gegenüber Terbinafin. All diese wiesen charakteristische Mutationen im SQLE-Gen auf, welche wiederum in Enzymsubstitutionen wie Phe397Leu resultierten. In Terbinafin-sensiblen Isolaten wurde ausnahmslos ein SQLE-Wildtyp oder die Substitution Ala448Thr nachgewiesen. Diese Zusammenhänge könnten den Einsatz von SQLE-Genotypen als Biomarker für einen Therapieerfolg mit Terbinafin ermöglichen. Wir untersuchten zudem die Empfindlichkeit der Isolate gegenüber Itraconazol und Voriconazol. Aufgrund bisher geringer Evidenz für MHK-Grenzwerte dieser Substanzen ließ sich keine Resistenzrate ermitteln, jedoch war ein Trend zur Kreuzresistenz zwischen beiden Triazolen festzustellen. Zudem war die SQLE-Substitution Ala448Thr mit geringerer Empfindlichkeit gegenüber Itraconazol und Voriconazol assoziiert. Dieser Zusammenhang sowie der Einfluss von SLQE-Genotypen auf In vitro-Resistenz insgesamt bedarf weiterer eingehender Untersuchungen, um mögliche resistente Erreger im Rahmen chronischer Dermatophytosen früh zu erkennen.:Inhaltsverzeichnis 1 Einführung ........................................................................................................................................ 1 1.1 Bedeutung von Dermatophytosen weltweit und in Indien .......................................................... 1 1.2 Nomenklatorische Herausforderungen in der Erregerdifferenzierung ......................................... 2 1.3 Pharmakotherapie der Tinea im Wandel ...................................................................................... 4 1.4 Mögliche Gründe des Therapieversagens .................................................................................... 5 1.4.1 Rolle topischer Glukokortikoide ................................................................................................ 5 1.4.2 Entwicklungen der In-vitro-Empfindlichkeit von Dermatophyten in Indien .............................. 6 1.4.2.1 Terbinafin .................................................................................................................................. 6 1.4.2.2 Azole ......................................................................................................................................... 7 1.5 Resistenztestung von Dermatophyten ......................................................................................... 8 1.5.1 Bedeutung und Interpretation .................................................................................................. 8 1.5.2 Methoden der Resistenztestung .............................................................................................. 9 1.5.2.1 Mikrodilution ............................................................................................................................. 9 1.5.2.2 Agardilution ............................................................................................................................... 9 1.5.2.3 Molekularbiologische Verfahren ............................................................................................. 10 1.6 Wirk- und Resistenzmechanismen untersuchter Pharmaka ...................................................... 10 1.6.1 Terbinafin ................................................................................................................................ 10 1.6.2 Azole ....................................................................................................................................... 12 1.7 Zielstellungen ............................................................................................................................. 13 2 Originalarbeit .................................................................................................................................. 14 3 Zusammenfassung der Arbeit ........................................................................................................ 27 4 Literaturverzeichnis ........................................................................................................................ 31 5 Darstellung des eigenen Beitrags zur Publikation .......................................................................... 43 6 Erklärung über die eigenständige Abfassung der Arbeit ................................................................ 63 7 Lebenslauf ...................................................................................................................................... 64 8 Publikationen .................................................................................................................................. 65 9 Danksagung .................................................................................................................................... 66 / Recently, a rising incidence of chronic and difficult-to-treat dermatophytoses has been observed globally. Particularly in India, this is seen as a threat to public health. In vitro resistance of the pathogens – dermatophytes – against antifungal agents may be a possible explanation. Recent studies show an association between mutations in the squalene epoxidase gene (SQLE) of the dermatophytes and in vitro resistance to terbinafine, resulting in therapeutic failure. The prevalence of this phenomenon, however, is unknown. We performed a multicenter study with skin samples of 402 patients from India with the clinical diagnosis of dermatophytosis and identified the causing pathogens using conventional and biomolecular methods. Furthermore, we performed antifungal susceptibility testing und sequencing of the SQLE gene. In 83% of samples, Trichophyton (T.) indotineae and in 5%, T. rubrum was isolated. 279 samples were further subjected susceptibility testing and sequencing of the SQLE gene. Of these, 72% were in vitro resistant to terbinafine. All of those isolates showed mutations in the SQLE gene resulting in specific substitutions of the enzyme such as Phe397Leu. Dermatophytes which were classified as sensitive to terbinafine all incorporated a SQLE wild type or substitution Ala448Thr. These associations could justify the use of SQLE genotypes as biological markers of therapeutic resistance to terbinafine. We also performed antifungal susceptibility testing for itraconazole and voriconazole. Due to lacking evidence for MIC breakpoints for these substances, we did not deduce rates of resistance. However, we did note a tendency of cross resistance between these triazole agents. Furthermore, SQLE substitution Ala448Thr was associated with reduced susceptibility against itraconazole and voriconazole. In conclusion, these connections as well as the general impact of SQLE genotypes on antifungal susceptibility require further research in order to quickly identify resistant pathogens maintaining the ongoing epidemic of chronic dermatophytoses in India.:Inhaltsverzeichnis 1 Einführung ........................................................................................................................................ 1 1.1 Bedeutung von Dermatophytosen weltweit und in Indien .......................................................... 1 1.2 Nomenklatorische Herausforderungen in der Erregerdifferenzierung ......................................... 2 1.3 Pharmakotherapie der Tinea im Wandel ...................................................................................... 4 1.4 Mögliche Gründe des Therapieversagens .................................................................................... 5 1.4.1 Rolle topischer Glukokortikoide ................................................................................................ 5 1.4.2 Entwicklungen der In-vitro-Empfindlichkeit von Dermatophyten in Indien .............................. 6 1.4.2.1 Terbinafin .................................................................................................................................. 6 1.4.2.2 Azole ......................................................................................................................................... 7 1.5 Resistenztestung von Dermatophyten ......................................................................................... 8 1.5.1 Bedeutung und Interpretation .................................................................................................. 8 1.5.2 Methoden der Resistenztestung .............................................................................................. 9 1.5.2.1 Mikrodilution ............................................................................................................................. 9 1.5.2.2 Agardilution ............................................................................................................................... 9 1.5.2.3 Molekularbiologische Verfahren ............................................................................................. 10 1.6 Wirk- und Resistenzmechanismen untersuchter Pharmaka ...................................................... 10 1.6.1 Terbinafin ................................................................................................................................ 10 1.6.2 Azole ....................................................................................................................................... 12 1.7 Zielstellungen ............................................................................................................................. 13 2 Originalarbeit .................................................................................................................................. 14 3 Zusammenfassung der Arbeit ........................................................................................................ 27 4 Literaturverzeichnis ........................................................................................................................ 31 5 Darstellung des eigenen Beitrags zur Publikation .......................................................................... 43 6 Erklärung über die eigenständige Abfassung der Arbeit ................................................................ 63 7 Lebenslauf ...................................................................................................................................... 64 8 Publikationen .................................................................................................................................. 65 9 Danksagung .................................................................................................................................... 66

Dermatophyten sind keratinophile Pilze, d.h. sie besiedeln und infizieren die Haut und ihre Anhangsgebilde (Haare, Nägel) bei Mensch und Tier. Die derzeit häufigsten durch Dermatophyten hervorgerufenen Infektionen sind die Onychomykose, Tinea pedis, Tinea capitis und Tinea corporis. Da Antimykotika nicht bei alle Erregern von Dermatophytosen gleich wirksam sind, sollte im Vordergrund einer Behandlung zunächst die korrekte Erregerdifferenzierung stehen. Konventionell erfolgt diese Differenzierung über morphologische Merkmale wie Form und Farbe der auf dem Nährmedium gewachsenen Pilzkolonie, charakteristische mikromorphologische Elemente (Konidien) und biochemische Eigenschaften. Diese Merkmale werden jedoch oftmals nicht exprimiert. Damit ist in diesen Fällen keine Speziesdiagnose möglich. Eine zuverlässige Diagnostik sollte zudem das natürliche Klassifizierungssystem direkt reflektieren. Die Studien zur molekularen Biodiversität innerhalb der Dermatophyten sollten deshalb zur Klärung evolutionärer, taxonomischer und populationsgenetischer Zusammenhänge bei den verschiedenen Spezies der Gattungen Arthroderma, Trichophyton, Microsporum und Epidermophyten beitragen und helfen, geeignete DNA-Marker für die Anwendung in der medizinischen Diagnostik zu finden und einzusetzen. Dazu wurden verschiedene Methoden und Zielsequenzen genutzt, wie die Sequezierung der internal transcribed spacer (ITS) Region der ribosomalen DNA, das PCR-Fingerprinting, single strand conformation polymorphism (SSCP) und amplified fragment length polymorphism (AFLP)-Analyse. Es wurden weit über 200 Stämme, die bisher ca. 100 verschiedenen Taxa zuzuordnen waren, analysiert. Die molekularen Studien zeigen, dass die phylogenetisch ältesten Dermatophytenspezies geophil sind und sich die wärmeliebenden, zoophilen Arten erst später durch Koevolution mit warmblütigen Tieren entwickelt haben. Die anthropophilen scheinen dagegen erst mit Entstehung des Menschen evolviert und demzufolge am jüngsten zu sein. Damit kann man ihre geringe Biodiversität und ihr verändertes pathogenetisches Verhalten erklären. Es konnte gezeigt werden, dass die molekularen Phylogenie der Spezies besser mit ihrer Ökologie und dem Krankheitsbild als mit morphologischen Eigenschaften übereinstimmt und dass etliche Dermatophytenspezies überklassifiziert sind. Aus diesem Grunde wurde eine neue Systematik vorgeschlagen. Für den Nachweis des häufigsten Erreger, Trichophyton rubrum wurde eine Gensonde entwickelt, die in der medizinischen Diagnostik einsetzbar ist. / Dermatophytes are keratinophilic fungi which colonise and infect skin, hair and nails of man and animals. The most common infections caused by dermatophytes are onychomycosis, tinea pedis, tinea capitis and tinea corporis. Antimycotics may have different spectra of activity even in related dermatophyte species. Therefore a correct species identification is necessary before onset of antifungal therapy. Conventionally, the identification of dermatophytes is performed by the use of morphological features, such as shape and colour of the colony, micromorphological characteristics (conidia) and biochemical properties. However, these characters may not be expressed and then identification down to the species level is frequently impossible. Reliable diagnostics directly reflects the natural system. Studies of biodiversity in dermatophytes should therefore focus on elucidation of the connection of evolution, taxonomy and population genetics of the species of the genera Arthroderma, Trichophyton, Microsporum and Epidermophyten and thus contribute to development of stable DNA markers to be applied in routine diagnostics. Several methods and targets were applied such as sequencing of the internal transcribed spacer region (ITS) of the ribosomal DNA, PCR fingerprinting, single strand conformation polymor phism (SSCP) and amplified fragment length polymorphism (AFLP) analysis. More than 200 strains belonging to about 100 dermatophyte taxa were analysed. Phylogenetically, the molecular data show the oldest dermatophyte species to be geophilic and subsequently co-evolved as zoophilic dermatophytes with warm blooded animals. In contrast, the anthropophilic dermatophytes are much younger as they evolved in association with humans. This hypothesis is supported by their low biodiversity and changing pathogenicity. The molecular data show correspondence between phylogeny of species and their ecology and clinical picture, rather than with morphological features. Many dermatophyte species were shown to be overclassified. A new systematic system was proposed. For the identification of Trichophyton rubrum, the most common dermatophyte species, an oligonucleotide probe was developed which is applicable in medical routine diagnostics.

Made available in DSpace on 2016-12-23T13:56:03Z (GMT). No. of bitstreams: 1 dissertacao-simonebrmaifrede.pdf: 1273260 bytes, checksum: d5439bcf28dc75da348359e5efa529ef (MD5) Previous issue date: 2009-03-06 / INTRODUÇÃO: Onicomicose é a infecção da unha causada por amplo espectro de espécies fúngicas, incluindo leveduras e fungos filamentosos dermatófitos e nãodermatófitos. Devido à variável suscetibilidade dos diversos agentes etiológicos às drogas antifúngicas, o diagnóstico laboratorial vem sendo considerado uma ferramenta importante para se estabelecer a etiologia e auxiliar na escolha do tratamento da onicomicose. Com base na elevada porcentagem de falha terapêutica no tratamento da onicomicose, tem-se evidenciado o interesse na padronização de testes de suscetibilidade in vitro de fungos filamentosos. OBJETIVOS: Estabelecer a freqüência das onicomicoses em relação a outras dermatomicoses; definir a etiologia das onicomicoses através do isolamento e identificação dos fungos; comparar o padrão de suscetibilidade entre fungos dermatófitos e não-dermatófitos às drogas fluconazol, cetoconazol, itraconazol, miconazol, ciclopirox, terbinafina e griseofulvina. MÉTODOS: As amostras clínicas foram colhidas através de raspagem e/ou fragmentação da unha e o exame microscópico direto foi realizado através do tratamento destas amostras com hidróxido de potássio (KOH) a 20% e tinta Parker. As culturas foram realizadas nos meios de ágar Sabouraud dextrose adicionado de 0,05 mg.mL-1 de cloranfenicol e ágar Mycose, incubados à temperatura ambiente e por um período de até 15 dias. A identificação dos fungos filamentosos foi baseada na observação de suas características macroscópicas e microscópicas e os testes de suscetibilidade in vitro a drogas antifúngicas foram baseados no Documento M38-A do CLSI. RESULTADOS: O diagnóstico laboratorial das dermatomicoses foi estabelecido em 69% dos 1.008 pacientes com lesões sugestivas de dermatomicoses encaminhados ao Laboratório de Diagnóstico Micológico do Depto. de Patologia / UFES, no período de 12/03/2004 a 14/08/2008. Onicomicose foi diagnosticada em 333 pacientes e os grupos de fungos mais isolados foram: leveduras 55,6%, fungos filamentosos não-dermatófitos 27,2% e dermatófitos 17,3%. Fungos dermatófitos foram mais inibidos in vitro que fungos não-dermatófitos. As drogas fluconazol e griseofulvina inibiram apenas fungos dermatófitos, enquanto a terbinafina foi a droga que mais inibiu os dois grupos de fungos e em baixas concentrações. A quantificação do inóculo por contagem em hemocitômetro e em placas de ágar Sabouraud revelou que o acerto do inóculo em espectrofotômetro pode ter uma boa correspondência se estabelecido em faixas de transmitância diferenciadas para os diversos tipos de fungos. CONCLUSÃO: É necessário estabelecer o diagnóstico laboratorial das onicomicoses, já que estas podem ser causadas por diversos agentes etiológicos e com diferentes suscetibilidades in vitro a várias drogas antifúngicas. / INTRODUCTION: Onychomycosis is the nail infection caused by a wide spectrum of fungi species, including yeasts, dermatophyte and nondermatophyte mould. Due to the variable susceptibility of the several etiologic agents to the antifungal drugs, the laboratorial diagnosis is being considered an important tool to establish the etiology and to help in the choice of the treatment of onychomycosis. Based on the high percentage of therapeutic flaw in the treatment of onychomycosis, there has been some evident interest in the standardization of the susceptibility tests in vitro of filamentous fungi. OBJECTIVES: To establish the frequency of the onychomycosis in relation to other dermatomycosis; to define the etiology of the onychomycosis by the isolation and identification of the fungi; to compare the pattern of susceptibility among dermatophytes and nondermatophytes mould to drugs such as fluconazole, cetoconazole, itraconazole, miconazole, ciclopirox, terbinafine and griseofulvine. METHODS: The clinical samples were collected by the scratching and/or fragmentation of the nail and the direct microscopic examination was made by the treatment of these samples with potassium hydroxide (KOH) at 20% and Parker ink. The cultures were made in dextrose agar Sabouraud with 0,05 mg.mL-1 of cloranphenicol and agar Mycosel, incubated to room temperature and for a period of up to 15 days. The identification of the filamentous fungi was based on the observation of its macroscopic and microscopic characteristics and the tests of susceptibility in vitro to the antifungal drugs were based on CLSI M38-A reference method. RESULTS: The laboratorial diagnosis of the dermatomycosis was established in 69% of the 1.008 patients with lesions that suggested dermatomycosis sent to the Laboratory of Mycologic Diagnosis from the Dept. of Pathology / UFES, in the period of 03/12/2004 to 08/14/2008. Onychomycosis was diagnosed in 333 patients and the groups of more isolated fungi were: yeasts 55,6%, nondermatophyte mould 27,2% and dermatophytes 17,3%. Dermatophytes were more inhibited in vitro than nondermatophytes ones. Drugs such as fluconazole and griseofulvine inhibited just dermatophytes fungi while terbinafine was the drug which most inhibited both groups of fungi and in low concentrations. The quantification of the inoculum for counting in haemocytometer and in plates of agar Sabouraud revealed that the correctness of the inoculum in espectrofotometer may have established a good correspondence in transmission bands differentiated for the various types of fungi. CONCLUSION: It is necessary to establish the laboratorial diagnosis of the onychomycosis, as these may be caused by several etiologic agents and with different susceptibilities in vitro to several antifungal drugs.

Made available in DSpace on 2014-07-29T15:30:40Z (GMT). No. of bitstreams: 1 Dissertacao CrystianeAraujo.pdf: 881195 bytes, checksum: da026b75ed78f3c38d78f44f6a15271e (MD5) Previous issue date: 2007-05-31 / Dermatophytes are keratinophilic fungi that colonize and invade the stratum corneum of the skin, hair and nails causing the dermatophytosis. An increasing number of antifungal agents has become available for the treatment of dermatophytosis, however not all species have the same susceptibility pattern and may occur relative or absolute resistance of some dermatophytes. The document M38-A developed by Clinical and Laboratory Standards Institute (CLSI) for determining the minimal inhibitory concentration (MIC) of different antifungal agents against filamentous fungi, has not included the dermatophytes. The broth microdilution method has been evaluated by various researchers, and some parameters as inoculum size, temperature and duration of incubation and endpoint determination has been investigated. In this study, the in vitro activity of fluconazole, itraconazole, ketoconazole, griseofulvin and terbinafine against 60 dermatophyte isolates, belong to three species, using the broth microdilution technique, with modifications at temperature and incubation time was used. Additionally, the MIC values obtained by broth microdilution method were compared with those obtained by the agar dilution technique. The results obtained by broth microdilution method showed that all isolates produced clearly detectable growth at 28oC and the MIC values could be determined after 4 days of incubation for the isolates of Trichophyton mentagrophytes and 5 days for T. rubrum and Microsporum canis isolates. Itraconazole, ketoconazole and terbinafine had the lowest MIC values (0.03 μg/ml) for 33.3%, 31.6% and 15% of the isolates, respectively. A good concordance was observed between the agar dilution and broth microdilution methods. The levels of agreement were 91.6% with ketoconazole and griseofulvin, 83.3% with itraconazole, 81.6% with terbinafine and 73.3% with fluconazole for all the tested isolates. In summary, the results of this study suggest that an incubation time of 5 days and temperature at 28oC used in broth microdilution and agar dilution methods can contribute to define and to better interpret the MIC values. Beside, until a reference method for testing the susceptibilities of dermatophytes is standardized, the similar results with broth microdilution method become the agar dilution useful for testing the susceptibility of these fungi. / Os dermatófitos são fungos filamentosos queratinofílicos capazes de colonizar e invadir o extrato córneo da pele, pêlo e unhas produzindo as dermatofitoses. Há vários agentes antifúngicos disponíveis para o tratamento das dermatofitoses, entretanto as espécies de dermatófitos possuem perfis de suscetibilidade diferentes, podendo ocorrer resistência relativa ou absoluta. O documento M38-A desenvolvido pelo Clinical and Laboratory Standards Institute (CLSI) para determinar a concentração inibitória mínima (CIM) de diferentes agentes antifúngicos para fungos filamentosos, não inclui os dermatófitos. O método de microdiluição em caldo tem sido avaliado por vários pesquisadores, e alguns parâmetros como tamanho do inóculo, temperatura e tempo de incubação e determinação das leituras de CIM são investigados. Neste trabalho, foi avaliada a atividade in vitro de fluconazol, itraconazol, cetoconazol, griseofulvina e terbinafina para 60 isolados de dermatófitos, pertencentes a três espécies, através da técnica de microdiluição em caldo, com modificações na temperatura e tempo de incubação. Adicionalmente, os valores de CIM obtidos pelo método de microdiluição em caldo foram comparados com aqueles obtidos pela técnica de diluição em ágar. Os resultados encontrados através do método de microdiluição em caldo mostraram que todos os isolados produziram crescimento claramente detectável a temperatura de 28oC e os valores de CIMs foram determinados após 4 dias de incubação para os isolados de Trichophyton mentagrophytes e 5 dias para os isolados de T. rubrum e Microsporum canis. Itraconazol, cetoconazol e terbinafina mostraram os menores valores de CIM (0,03 μg/ml) para 33,3%, 31,6% e 15% dos isolados, respectivamente. Uma boa concordância foi observada entre os métodos de diluição em ágar e microdiluição em caldo. A concordância entre os dois métodos foi de 91,6% para cetoconazol e griseofulvina, 83,3% para itraconazol, 81,6% para terbinafina e 73,3% para fluconazol para todos os isolados analisados. Em conclusão, os resultados deste estudo sugerem que uma incubação de 5 dias e temperatura de 28oC, utilizados no método de microdiluição em caldo e diluição em ágar, podem contribuir para definir e melhor interpretar os valores de CIM. Além disso, até que um método de referência de teste de suscetibilidade para dermatófitos seja padronizado, os resultados similares entre os métodos de microdiluição em caldo e diluição em ágar tornam este último útil para testar a suscetibilidade in vitro destes fungos.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-04-15T19:16:37Z No. of bitstreams: 1 edilenebolutaribaptista.pdf: 6189497 bytes, checksum: 9b5a9896c31c59b43d9001520bb0f8c9 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-04-24T03:18:16Z (GMT) No. of bitstreams: 1 edilenebolutaribaptista.pdf: 6189497 bytes, checksum: 9b5a9896c31c59b43d9001520bb0f8c9 (MD5) / Made available in DSpace on 2016-04-24T03:18:16Z (GMT). No. of bitstreams: 1 edilenebolutaribaptista.pdf: 6189497 bytes, checksum: 9b5a9896c31c59b43d9001520bb0f8c9 (MD5) Previous issue date: 2015-12-11 / As dermatofitoses são doenças fúngicas que nos animais são causadas principalmente por microrganismos dos gêneros Microsporum spp e Trichophyton spp. Afetam os tecidos queratinizados resultando no aparecimento de lesões em anel e alopecia e podem ser transmissíveis ao homem. Na busca por tratamentos naturais alternativos aos fármacos sintéticos de toxicidade conhecida, os óleos essenciais destacam-se por possuírem uma composição química complexa e diversas ações farmacológicas conhecidas. O objetivo do presente trabalho foi desenvolver uma formulação veterinária de uso tópico com óleo essencial para tratamento da dermatofitose e avaliar a sua estabilidade. Foram realizadas a caracterização morfológica dos fungos Trichophyton mentagrophytes ATCC 11480, Microsporum canis ATCC 32903 e Microsporum gypseum ATCC 14683; a identificação e quantificação dos componentes químicos dos óleos essenciais da Pimenta pseudocaryophyllus (Gomes) L.R. Landrum e do Eucalyptus smithii e, posteriormente, a análise de seus potenciais antifúngicos. Uma formulação tópica (creme aniônico tipo O/A) com o óleo da P. pseudocaryophyllus foi desenvolvida e submetida a 50 °C e 90% de Umidade Relativa - UR por 3 meses para o estudo de estabilidade acelerada. Durante esse período, foram avaliados os parâmetros organolépticos e físico-químicos da formulação, além do estudo termoanalítico, espectroscópico na região do infravermelho e de cromatografia gasosa (CG). Os resultados para a P. pseudocaryophyllus foram mais promissores indicando uma concentração inibitória mínima (CIM) de 250 μg/mL para os três fungos e uma concentração fungicida mínima (CFM) de 250 μg/mL para o M. canis e de 1000 μg/mL para T. mentagrophytes e M. gypseum. A formulação contendo o óleo da P. pseudocaryophyllus na concentração de 1% (m/m) mostrou-se eficaz no combate fúngico e, por meio da microscopia eletrônica de varredura (MEV), foram observadas as principais alterações morfológicas nas hifas e macroconídeos dos fungos causadas pelos óleos e pela formulação. Durante o estudo de estabilidade a formulação manteve-se estável em relação aos parâmetros organolépticos e físicoquímicos, apresentando apenas uma perda na concentração de eugenol (composto majoritário do óleo essencial) comprovada por CG. Por meio de técnicas termoanalíticas foi possível verificar a estabilidade térmica e avaliar a compatibilidade entre os excipientes e o óleo essencial. De forma geral, os resultados encontrados para a formulação foram satisfatórios, porém vale ressaltar que os estudos termoanalíticos ainda não substituem os estudos convencionais de estabilidade e que para avaliar a real toxicidade dessa formulação, testes de segurança precisam ser realizados antes da comercialização do produto. / Dermatophytosis are fungal diseases and they are caused in animals by microorganisms of the genus Microsporum spp and Trichophyton spp. Tissues containing keratin are affected resulting in ring lesions and alopecia and it can be transmitted to humans.Trying to find alternative natural treatments, the essential oils are notable for having a complex chemical composition and many known pharmacological actions. The objective of this study was to develop a veterinary formulation for topical use with essential oil to treat the dermatophytosis and evaluate its stability. A morphological characterization of the fungi Trichophyton mentagrophytes ATCC 11480, Microsporum canis ATCC 32903 and Microsporum gypseum ATCC 14683 was performed and also the identification and quantification of chemical components of the essential oils of Pimenta pseudocaryophyllus (Gomes) L.R. Landrum and the Eucalyptus smithii and, subsequently , the analysis of their potential antifungal. A topical formulation (anionic cream type O/A) with the oil of P. pseudocaryophyllus was developed and submitted to 50 °C and 90% relative humidity for 3 months to study of accelerated stability. During this period, physical, chemical and organoleptic parameters of the formulation were evaluated, in addition to thermoanalytical, infrared spectroscopic and gas chromatography (GC) study. The results for P. pseudocaryophyllus were more promising indicating a minimum inhibitory concentration (MIC) of 250 μg mL-1 for all three fungi and minimum fungicidal concentration (MFC) of 250 μg mL-1 for M. canis and 1000 μg mL-1 for T. mentagrophytes and M. gypseum. The formulation containing the oil of P. pseudocaryophyllus with a concentration of 1% (w/w) was effective in combating fungal and, by scanning electron microscopy (SEM), the main morphological changes in hyphae and fungal macroconidia caused by oils and the formulation were observed. During stability study, the formulation was stable in relation to physical, chemical and organoleptic parameters, with only a loss in eugenol concentration (major compound of the essential oil) confirmed by GC. It was possible to verify, by thermoanalytical techniques, the thermal stability and to evaluate the compatibility of the excipients and the essential oil. In general, the results of formulation were satisfactory, but it´s important to emphasize that the thermoanalytical studies does not replace conventional stability studies. To evaluate the real toxicity of this formulation, safety tests need to be performed before to marketing the product.