Abstract :
Background: Dermatophytes hyphal fragments accidently deposited on stratum corneum sometimes, in contact with other infected person; cause communicable skin infections particularly, in higher altitudes; due to availability of ample of moisture. Diagnosis specified, primarily by clinical appearance, followed by mass culture of dermatophytes in lab, their identification under microscope & molecular identification by ITS regions.
Problem: Spatial locations of Uttarakhand, Commendable to most mycosis species. Unanticipated number of mycosis patients during monsoon & recalcitrant nature of dermatophytes in consecutive years after 1 infection, grab attention. Study designed to calculate susceptibility range & intensity of modification in pathogen at various altitudes.
Approach: Throughout Monsoon (from July to Nov 2023-24) skin samples from public hospitals of Uttarakhand at Skin-OPDs were collected, mass lab production & subsequently identification; to perceive their appearance time & relationship with increasing height. Standard Disc diffusion & broth dilution tests were carried out to calculate MIC range of frequently used antifungal drugs at public hospitals & modified current available pathogen.
Findings: MIC of Trichophyton, Epidermophyton& Microsporum (5-25µg/ml) for terbinafine, for Itraconazole (0.09-1.5µl/ml) & for Fluconazole (0.03-0.5µl/ml) found much more higher than previously reported.Arthroderma, Blastomycosis & Nanninzzia sp was also isolated from Haldwani region. Species identification confirmed by ITS1 & ITS4 regions of rDNA & squalene epoxidase was also sequenced up to 600bp in a doubt of modification in pathogenic gene of T.mentagrophytes & T.rubrum. F397L, A448T in mentagrophytes & L393F in rubrum found altered by comparatively to control agent.
Conclusion: Initially it looks critical to observe direct output from increased suseptibility range of pathogen but associated in evaluating efficacy of drug,which is contributing in calculating C/MIC, plasma drug diffusion & retention time ratiosfinallytheir susceptibility range (MIC)for pathogen.This pharmacokinetics guide to choose,combination of drugs & dose schedules
Keyword :
Disc diffusion test, Microdilution test, MIC, Squalene epoxidase, PK/PD, Cladogram