Klinik Dermatofit İzolatlarının Tür Dağılımı, Tür Karakterizasyonu ve Antifungal Duyarlılığı

Öz

Antifungal ilaçlara dirençli dermatofitlerin ortaya çıkması nedeniyle dermatofitozun küresel epidemiyolojisi hızla değişmektedir. Epidemiyolojik sürveyans, tedavi kararları ve dirençli suşların erken tespiti için tür düzeyinde doğru tanımlama ve klinik mikrobiyoloji laboratuvarları ile klinisyenler arasındaki etkileşimin gerekliliğini vurgulamıştır. Bu çalışma, rutin klinik uygulamada karşılaşılan dermatofit enfeksiyonlarının epidemiyolojik özelliklerini, anatomik dağılımını ve antifungal duyarlılık profillerini değerlendirmeyi ve ayrıca MALDI-TOF MS ile geleneksel mikolojik yöntemlerin rutin klinik uygulamadaki tamamlayıcı rollerini araştırmayı amaçlamıştır. İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Hastanesi Tıbbi Mikrobiyoloji ve Mikoloji Laboratuvarı'nda, 2017-2018 yılları arasında yüzeysel mikozların klinik örneklerinden elde edilen 126 dermatofit izolatı, konvansiyonel ve MALDI-TOF yöntemleri kullanılarak analiz edildi. Tekrarlayan enfeksiyonları olan hastalara antifungal duyarlılık testi uygulandı. En sık görülen klinik tablo, vakaların %41,3'ünü oluşturan tinea corporis (vücut mantarı), ardından %30,2 ile tinea unguium (tırnak mantarı) ve %11,9 ile tinea pedis (ayak mantarı) idi. MALDI-TOF MS, 126 izolatın 71'i (%56,3) için tür düzeyinde güvenilir tanımlama sağlarken, geri kalan 55 izolat (%43,7) geleneksel mikolojik yöntemler kullanılarak karakterize edildi. Konvansiyonel yöntemlerle 39 izolatın Trichophyton mentagrophytes, dördünün Microsporum canis, üçünün Trichophyton rubrum, iki tanesinin Trichophyton tonsurans, bir tanesinin Microsporum audouinii ve bir tanesinin Trichophyton violaceum olduğu, beş izolatın ise diğer dermatofit türleri olduğu bildirildi. Genel olarak T. rubrum en sık izole edilen tür (%48,4) olurken, bunu T. mentagrophytes (%31,7) izledi. Antifungal duyarlılık testleri, kalıcı veya tekrarlayan vakalardan elde edilen izolatlar arasında değişken duyarlılık profilleri gösterdi. Dermatofitlerin tanımlanmasında MALDI-TOF MS ve geleneksel fenotipik yöntemler birbirini tamamlayıcı yaklaşımlar olarak değerlendirilmelidir. Tür tanımlamasına geleneksel yöntemlerin önemli katkısı, özellikle ticari MALDI-TOF MS veritabanlarının eksik olduğu durumlarda, bu yöntemlerin rutin klinik mikoloji laboratuvarlarındaki devam eden öneminin altını çizmektedir. Tanımlama ve duyarlılık testinin entegre edilmesi, dirençli dermatofitozun yönetimini ve izlenmesini geliştirir.

Anahtar Kelimeler

• Dermatofitler
• Geleneksel yöntemler
• Tanımlama
• MALDI-TOF MS
• Antifungal duyarlılık

Destekleyen Kurum

İSTANBUL ÜNİVERSİTESİ-CERRAHPAŞA REKTÖRLÜĞÜ Klinik Araştırmalar Etik Kurulu

Proje Numarası

Decision number: 2024-992631; Annex 1

Etik Beyan

Anabilim Dalınızda görevli Biyolog Zeynep YAZGAN'ın yürütücülüğünde, Prof.Dr.Gökhan AYGÜN'ün danışmanlığında yapılacak olan ''Klinik Örneklerden Üretilen Küf İzolatlarının Tanımında MALDI-TOF MS Kullanımı'' başlıklı çalışma 14.05.2024 tarihli etik kurulumuzca müzakere edilmiş olup, etik açıdan uygun görülmüştür.

Species Distribution, Species Characterization, and Antifungal Susceptibility of Clinical Dermatophyte Isolates

Öz

The global epidemiology of dermatophytosis is rapidly changing due to the emergence of antifungal-resistant dermatophytes. Epidemiological surveillance has highlighted the need for accurate species-level identification and interaction between clinical microbiology laboratories and clinicians for treatment decisions and early detection of resistant strains. This study evaluated the epidemiological characteristics, anatomical distribution, and antifungal susceptibility profiles of dermatophyte infections encountered in routine clinical practice, and also aimed to investigate the complementary roles of MALDI-TOF MS and traditional mycological methods in routine clinical practice. In the Medical Microbiology and Mycology Laboratory of Istanbul University-Cerrahpaşa Faculty of Medicine Hospital, 126 dermatophyte isolates obtained from clinical samples of superficial mycoses between 2017-2018 were analyzed using conventional and MALDI-TOF methods. Patients with recurrent infections underwent antifungal susceptibility testing. Tinea corporis was the predominant clinical presentation, accounting for 41.3% of cases, followed by tinea unguium (30.2%) and tinea pedis (11.9%). MALDI-TOF MS provided reliable species-level identification for 71 (56.3%) of 126 isolates, while the remaining 55 isolates (43.7%) were characterized using conventional mycological methods. Conventional methods identified 39 isolates as Trichophyton mentagrophytes, four as Microsporum canis, three as Trichophyton rubrum, two as Trichophyton tonsurans, one as Microsporum audouinii, and one as Trichophyton violaceum, while five isolates were reported as other dermatophyte species. Overall, T. rubrum was the most frequently isolated species (48.4%), followed by T. mentagrophytes (31.7%). Antifungal susceptibility testing showed variable susceptibility profiles among isolates from persistent or recurrent cases. MALDI-TOF MS and conventional phenotypic methods should be considered complementary approaches for dermatophyte identification. The significant contribution of conventional methods to species identification underscores their continued importance in routine clinical mycology laboratories, particularly in situations where commercial MALDI-TOF MS databases are incomplete. Integrating identification and susceptibility testing improves the management and monitoring of resistant dermatophytosis.

Anahtar Kelimeler

• Dermatophytes
• Conventional methods
• Identification
• MALDI-TOF MS
• Antifungal susceptibility

Destekleyen Kurum

Istanbul University-Cerrahpaşa Rectorate Clinical Research Ethics Committee

Proje Numarası

Decision number: 2024-992631; Annex 1

Teşekkür

The study entitled "Use of MALDI-TOF MS in the Identification of Mold Isolates Produced from Clinical Samples," to be conducted under the supervision of Biologist Zeynep YAZGAN, affiliated with your department, and with Prof. Dr. Gökhan AYGÜN as advisor, was discussed by our ethics committee on May 14, 2024, and found to be ethically appropriate.

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