Superficial Fungal Infections in ESRD Patients

Research Article

Austin Renal Dis. 2016; 1(1):1003.

Superficial Fungal Infections in ESRD Patients

Narain U¹* and Gupta A²

¹Microbiologist & Immunologist, Tejas Micro diagnostics, Allahabad, Uttar Pradesh, India

²Division of Nephrology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India

*Corresponding author: Narain U, Microbiologist & Immunologist, Tejas Micro diagnostics, 62 Jawahar Lal Nehru Road, Tagore Town, Allahabad, Uttar Pradesh, India

Received: July 10, 2016; Accepted: August 30, 2016; Published: September 01, 2016


Background: Patients with end stage renal disease commonly present a spectrum of dermatological disorders. Each one has its own unique presentation and treatment approaches. Superficial fungal infections of the skin do not account for much in the end stage renal disease patients; hence most of the reports do not discuss this issue. In the present study we analyzed patients with end stage renal disease who had developed superficial fungal infections.

Methods: During January 2015 to June 2016, we tried to analyze 150 patients with end stage renal disease, who developed superficial fungal infections and were undergoing haemodialysis at least thrice a week for a minimum of three months at our centre.

Results: Out of the 150 suspected cases we identified, 36 cultures tested positive. The macroscopic examination of the scalp, skin and the nails revealed 2.2% Tinea capitis, 13.9% Tinea versicolor, 44.5% Tinea corporis, 8.4% Tinea mannum, 16.8% onychomycosis, 5.7% Tinea cruris and 8.5% Tinea pedis. The culture examination highlighted 44.4% Trichyopyton rubrum, 27.8% Trychophyton mentagrophyte, 2.8% Trychophyton violaceum, 2.8% Trichophyton verrucosum, 2.8% Microsporum canis, 2.8% Epidermophyton flucossum, 2.8% Scopulariopsis brevicaulis and 13.8% Malessesia). The predominant clinical abnormality observed was Tinea corporis and the prevalent fungal isolate was Trichophyton rubrum.


The current study illustrates that a significant number of patients with the end stage renal disease had a prevalence of superficial fungal infections; hence, a prompt recognition of skin lesions and the identification of these superficial fungi may alarm us so that early and the judicious management to reduce the associated morbidity and in turn to improve the quality of life in these patients is taken.

Keywords: End stage renal disease; Superficial fungal infections; Dermatophytes; Tinea


Patients with End Stage Renal Disease (ESRD) suffer from a multitude of symptoms with very low quality of life accompanied by a particularly high prevalence of dermatological disorders [1]. Uremia is associated with a state of immune dysfunction characterized by immunodepression that likely contributes to the high prevalence of infections among these patients [2]. Superficial mycoses are prevalent worldwide. Superficial fungal infections arise from a pathogen that is restricted to the stratum corneum, with little or no tissue reaction [3]. The host’s immune response against infections caused by dermatophytes basically depends on the host’s defence against metabolites of the fungi, virulence of the infecting strain of species and anatomical site of the infection [4]. Much has been reported about the cutaneous changes and invasive fungal infections among these patients but dedicated description of superficial fungal infections lack in literature. Thus the aim of this study is to evaluate the prevalence of superficial fungal infections in ESRD patients at our centre.

Materials and Methods

This retrospective study included 150 suspected cases of fungal infections undergoing haemodialysis at least thrice a week for a minimum of three months at our centre. Dermatological evaluation and confirmation of the presenting lesions were done by the dermatologist. In all cases, data related to the age, sex, duration of the lesions, occupation, personal habits etc was noted. After a detailed clinical examination, the physical features of the scalp, skin and nails were recorded. A lot of care was particularly taken to record the past history of superficial mycotic infections.

Before obtaining a specimen, the infected areas were cleansed by swabbing them liberally with alcohol to eliminate as many bacteria as possible, because they can overgrow and inhibit the growth of dermatophytes. Scrapings and clippings were collected from the diseased portions of the scalp, skin and nails. When both the skin and the nails were affected, specimens were collected from both the sites.

Each specimen was divided into two parts; one was taken for direct microscopic examination after 10% KOH solution treatment and the second was inoculated on sabouraud dextrose agar (M286) and sabouraud cycloheximide chloramphenicol agar (M664). Two successive cultures were performed to establish the colonization of the pathogen because successive sampling rarely demonstrates the same contaminant. Cultures were routinely incubated at 25–30°C and examined daily for up to 4 weeks. The identification of the individual fungi was based on standard methods such as microscopy, morphology, colonial characterization and pigment production, rate of growth and biochemical test [5].


A total of 150 clinically suspected cases of superficial fungal infections were undertaken for mycological studies during the period spanning from Jan 2015 to June 2016 at our centre. The base line and the demographic data of all 150 patients are summarized (Table 1).