A clinico-etiological study of toe web fungal infection

Background: Toe web fungal infection is a communicable disease and there have been many outbreaks in schools, orphanages, dormitories and other places. It is a common inflammatory skin condition which causes great discomfort and morbidity. We determined the various clinical forms of the disease and isolated the causative fungal pathogens. Patients and methods: During a period of nine months, 118 clinically suspected cases of toe web fungal infection were enrolled. The specimens from the involved toe webs were taken for direct microscopy and cultured on Sabouraud's dextrose agar with chloramphenicol and with or without cycloheximide. Culture swabs for bacteriology were also taken to rule out any other causative agent besides fungi in each patient. Results: The study revealed that toe web fungal infection was common in males and females between the ages of 21-50 years. Fourth toe web was the most commonly affected bilaterally. The intertriginous variety was the most frequent clinical presentation seen in 53 (83.3%) patients. Out of total 118 patients, 60 patients (50.8%) showed positive culture for fungus and 30 cases (25.4%) revealed positive culture for bacteria, including 6 patients in which dermatophytes as well as bacteria were isolated. The most common pathogen isolated was Candida albicans in 36 (60%) followed by Trichophyton rubrum in 19 (31.7%), T. violaceum in 4 (6.6%), and Epidermophyton floccosum 1 (1.7%) case. The bacteria isolated were Staphylococcus aureus in 25 (83.4%), Pseudomanas aeruginosa in 3 (10%) and Proteus spp. and β-hemolytic Streptococci in 1 (3.3%) case each, respectively. Conclusion: Toe web intertrigo is the most common type seen in our study caused by Candida albicans followed by T. rubrum, T. violaceum and E. floccosum. The patients between ages 21 to 50 years are more vulnerable to toe web fungal infection.