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Trichophytin extraction: biological comparison of trichophytin extracted from Trichophyton mentagrophytes grown in a complex medium and a defined medium.

The extraction of antigens (trichophytin) from Trichophyton mentagrophytes var. asteroides grown in both a complex medium and a defined medium proved to be reproducible and feasible. These extracts were first evaluated by skin testing in both infected and noninfected guinea pigs. Further evaluation and standardization was accomplished in selected humans by comparing these antigens to a trichophytin known to elicit allergic reactions to the dermatophytes. The trichophytins produced by this extraction procedure gave no false positive (or negative) skin test reactions. These antigens did, however, reliably elicit allergic sensitivity of both the immediate and delayed type. The potency of both complex and defined media antigen was shown to be equal to that of the standard trichophytin.

Acetone↗

Purified trichophytin: lymphocyte reactivity in vitro and trichophytin-induced suppression.

Three trichophytin preparations from different strains of Trichophyton mentagrophytes were produced according to the ethylene glycol method and assessed for their lymphocyte stimulation activity in vitro (LST). These trichophytin preparations showed significant variations in their effects on cord lymphocytes reactivity. The preparations also varied in their stimulation of lymphocytes from patients with dermatophytosis. Conclusions could be drawn about the immunological specificity, sensitivity and lymphocyte toxicity, which is important for the standardization of antigens. Furthermore, it was demonstrated that trichophytin-preincubated lymphocytes mediated a suppression of lymphocyte reactivity to this antigen.

Adult↗

The clinical significance of cutaneous reactions to trichophytin in dermatophytosis.

An intracutaneous test was performed in 114 patients with dermatophytosis verified by culture and in 32 control subjects, unsing purified trichophytin (according to the ethylene glycol method) and commercially available trichophytin. Immediate reactions occurred with both trichophytin antigens at a similar frequency in 12-14% of cases. Delayed reactions occurred significantly more often to the purified trichophytin in patients with dermatophytosis (36%) but in none of the controls. Immediate reactions to purified trichophytin occurred in 26% of the chronically infected patients. Delayed reactions were correlated to patients with tinea cruris (50% positive reactions), to infections with Epidermophyton floccosum (50%) and to patients not chronically infected. Thus, chronic dermatophytosis was characterized by immediate reactions to purified trichophytin and few delayed reactions. In contrast, patients not chronically infected were characterized by delayed reactions and few immediate reactions.

Antigens↗

Human epidermal Langerhans cells induce cellular immune response to trichophytin in dermatophytosis.

Human epidermal cell suspensions were prepared from patients sensitized to trichophytin. The cells were 75% to 95% viable, and contained 2% to 6% Langerhans cells as judged by immunofluorescence staining with an anti-DR antiserum. T lymphocytes from the same patients were co-cultured with trichophytin, with or without epidermal cells or macrophages. Proliferative T-cell response to trichophytin was obtained in cultures containing epidermal cells or macrophages. Pretreatment of the epidermal cells with anti-DR antiserum abolished the response, but normal rabbit serum did not, indicating that HLA-DR positive Langerhans cells are able to induce the cellular immune response to trichophytin. These data indicate that Langerhans cells play an important role in dermatophytosis.

Dermatomycoses↗

Cell-mediated reactivity in dermatophytosis: differences in skin responses to purified trichophytin in tinea pedis and tinea cruris.

Cell-mediated immune responses were measured in 91 patients with dermatophytosis by means of delayed-type skin hypersensitivity to a purified trichophytin preparation (ethylene glycol method) and to tuberculin (purified protein derivative, PPD). The findings indicate that dermatophytes differ in their sensitizing capacity as measured by trichophytin skin sensitivity. Trichophyton mentagrophytes appeared to be a potent sensitizer compared with Trichophyton rubrum (p < 0.01), whereas Epidermophyton floccosum appeared as a moderate sensitizer. The localization of infection also affected the cell-mediated response to trichophytin, i.e. the frequency of reactions was 44% in tinea cruris and 33% in tinea pedis, while tinea pedis with nail infections elicited delayed-type reactivity in 60% of cases. On the basis of the significant difference (p < 0.001) in cell-mediated reactivity between chronically and non-chronically infected subjects as measured with trichophytin, it is concluded that the cell-mediated response is of importance for the development of host resistance to dermatophytic infections. This study provides further evidenced in support of the view that a partial defect in the cell-mediated system may be responsible for establishment of chronic dermatophytosis.

Adult↗

ELISA-determined serological reactivity against purified trichophytin in dermatophytosis.

Serological activity in 62 patients wih dermatophytosis was investigated using purified trichophytin preparation as antigen (produced by the ethylene glycol method). Antibodies of IgG and IgM classes were determined by means of ef enzyme linked immunosorbent assay (ELISA). In comparison with 79 controls consisting of groups of healthy blood donors and dermatological outpatients, the dermatophyte-infected patients showed a significantly higher mean IgG response to trichophytin antigen preparation. On the other hand several individual cases were low responders. In a group of 10 control children, no IgG activity against trichophytin could be demonstrated. IgM class antibodies showed no significant differences between the groups investigated. These findings indicate that differences in the amounts of antibodies of IgG class against trichophytin as measured by the ELISA method reflect differences in the degree of mycotic sensitization between groups of individuals having experienced varying degrees of exposure to dermatophytes. Nevertheless, the determination of IgG antibodies in dermatophytosis seems to be of limited clinical value.

Antibody Formation↗

[Amino acid and carbohydrate levels in Trichophyton verrucosum and homologous purified trichophytin].

The object of this study was to determine of aminoacids and sugar contents of T. verrucosum mycelium and of homologous purified trichophytin Tv-GP. The analysis of aminoacids contents was performed by ion-exchange chromatography on Czechoslovak analyser (type AAA-881) in acid and alkaline hydrolizates. Sugar were identified on gas chromatograph (PYE-105) by Sawerdeker and Sloneker technique. Seventeen identical aminoacids were determined in mycelium and trichophytin, but some quantity differences were observed. In mycelium there was 40.8% aminoacid nitrogen and 59.2% aminosaccharide nitrogen. In trichophytin, however, 93.5% nitrogen originated from aminoacids and only 6.5% from aminosaccharides. In both analized materials hexoses dominated: mannose, glucose and galactose. Besides trace quantities of D-glycero-D-mannoheptose, L-glycero-D-mannoheptose and L-glycero-D-glucoheptose were identified.

Amino Acids↗

On the significance of the trichophytin reactivity in atopic dermatitis.

Patients with pure atopic dermatitis with and without tinea infection were investigated and compared with patients with long-lasting tinea infections and with controls, for presence of intracutaneous reactivity to trichoptin, Penicillium, Cladosporium and Alternaria antigens. RAST to Penicillium and Cladosporium was also performed. The results showed a lack of delayed reactivity, but an immediate reactivity to trichophytin in 50%/40% of atopic patients with/without tinea infection. Non-atopics infected with tinea showed 66% immediate and 33% delayed response to trichophytin. The reactivities in atopic dermatitis (but not in the non-atopic group) went general parallel with mould reactions tested intracutaneously or by RAST. It is assumed that a positive trichophytin reaction in atopic dermatitis does not necessarily mean sensitisation to dermatophytes, but is primarily the sign of a cross sensitivity to moulds.

Adult↗

In vivo and in vitro immune responses to trichophytin in dermatophytosis.

Cell-mediated immunity in patients with verified dermatophytosis was investigated by means of skin test and lymphocyte stimulation test (LST) using purified trichophytin, prepared by the ethylene glycol method, and commercially available trichophytin. The purified trichophytin seemed to be more specific and sensitive both in skin test and in LST. In the majority of cases skin-positive patients were also positive in LST, especially when T. mentagrophytes or E. floccosum was the causative organism. Patients with non-chronic infections also showed a close correlation between skin reactivity and LST. Patients with chronic mycosis or infected with T. rubrum, on the other hand, were often skin-negative. Their lymphocyte reactivity in vitro, however, was usually positive, thus showing a discrepancy in the ability of these two methods to measure cell-mediated immunity.

Antigens↗

Trichophytin contact sensitivity in patients with dermatophytosis.

Trichophytin contact sensitivity was investigated in patients with dermatophytosis by patch testing with highly concentrated purified trichophytin on partially stripped skin. The lack of primary irritant reactions was confirmed on the skin of children. Positive patch tests were noted in 113 of 178 patients (63.5%). However, there was a great difference in the incidence of trichophytin contact sensitivity between cases with different clinical types. The highest frequency of positive patch tests was obtained in patients with the vesiculobullous type of tinea pedis (83.3%). In contrast, a very low incidence was noted in patients with tinea corporis (37%) and the squamous hyperkeratotic type of tinea pedis (36%). Causative organisms and the age and sex of the patients did not show a relationship with the reactivity. A diminished incidence of positive reactions was noted in atopic individuals and in patients seen in winter. Patients who had persistent or recurrent infections for a long period of time, especially those having inflammatory lesions, had a higher frequency of positive patch tests.

Adolescent↗

Reactivity to trichophytin antigen in patients with onychomycosis: effect of terbinafine.

BACKGROUND: Many patients with chronic dermatophytosis and onychomycosis have depressed cell-mediated immunity (CMI) to trichophytin. OBJECTIVE: The fungicidal properties of oral terbinafine provide a unique opportunity to explore whether elimination of antigen could restore CMI response in these patients. METHODS: A double-blind, placebo-controlled study evaluated the effect of terbinafine (250 mg/d for 12 weeks) on skin immunoreactivity to intradermal trichophytin antigen (TRIPA), mycologic status of the nail, and nail growth in patients with toenail onychomycosis. RESULTS: Skin reactivity, in an optimized, dose response challenge series to TRIPA was inversely related to disease chronicity. Mycologic/clinical response rates were 72%/84% for terbinafine and 0%/7% for placebo. Terbinafine increased the number of TRIPA reactors 2-fold and the mean TRIPA reaction area 4-fold; responses in placebo-treated patients were relatively unchanged. Of the 7 (of 25) patients receiving terbinafine who still had positive mycology 6 months after treatment, all were anergic to TRIPA at baseline and all but one remained so after treatment. CONCLUSION: Terbinafine treatment enhances and restores CMI to TRIPA in patients with Trichophyton rubrum onychomycosis and may thereby reduce susceptibility to reinfection. Terbinafine reversal of immunologic anergy may be an important model of microbial tolerance in chronic dermatophyte infections.

Antifungal Agents↗

Allergic delayed skin reactions from lipid fractions of trichophytin.

Crude trichophytin was fractionated to find out if its lipid fraction could cause inflammatory delayed allergic skin reactions in dermatophyte-sensitized guinea pigs. The following fractions were obtained: polysaccharide-peptide, total lipids, total lipids without free fatty acids and free fatty acids. The crude trichophytin and polysaccharide-peptide fraction gave rise to strong and equal allergic delayed skin reactions after 24 h. The total lipids gave statistically significant weaker, but clearly positive reactions, and of the same degree as the free fatty acid fraction. The total lipids without free fatty acids did not produce reactions in the sensitized animals, indicating that free fatty acids are responsible for the allergic skin reactions. In some cases the free fatty acids showed comparatively intense reactions. It can be concluded that free fatty acids are antigenic substances that are, sometimes, involved in the allergic delayed skin reactions in dermatophytosis.

Animals↗

Hypersensitivity to trichophytin in small animals experimentally infected with Trichophyton equinum.

Typical lesions resulting from experimental Trichophyton equinum infection in laboratory animals persisted for 3-4 weeks. Lesions in rabbits were slightly less severe than those in guinea pigs. In experimentally infected dogs lesions persisted for longer and developed in the form of a deep, crusty dermatophytosis. In skin tests with three trichophytins it was shown that specific hypersensitivity resulting from infection of laboratory animals persists for at least 6 months. Stronger local reactions were produced with homologous trichophytins, especially in the final tests after 6 months.

Animals↗

Lack of delayed reaction in presence of cell-mediated immunity in trichophytin hypersensitivity.

Five patients with atopy who had chronic dermatophytosis manifested an immediate and strong trichophytin skin reaction but no delayed reaction. This phenomenon may be caused by the neutralization of injected antigen by serum antibodies during the immediate reaction. When we injected a second dose of trichophytin into the wheal of the immediate reaction, 20 minutes after the first injection, a strong delayed reaction was elicited, demonstrating cell-mediated immune responses in these patients.

Adolescent↗

In vitro release of interferon-gamma by trichophytin-stimulated whole blood cell cultures from ringworm-vaccinated and control calves experimentally inoculated with Trichophyton verrucosum.

Of a group of seven calves, four were vaccinated against bovine ringworm with the vaccine Ringvac bovis LTF-130 (Alpharma, Oslo, Norway), while three calves were left unvaccinated. All calves were inoculated epicutaneously with a virulent strain of Trichophyton verrucosum. Clinical signs were recorded. In response to stimulation with trichophytin, in vitro interferon-gamma (IFN-gamma) production in whole blood cell cultures was assessed in samples obtained pre- and post-vaccination and pre- and post-inoculation. A commercial enzyme immunoas say kit was used to measure IFN-gamma levels (Bovigam, CSL, Victoria, Australia). Control calves developed typical ringworm lesions, whereas vaccinated calves did not. Following vaccination, release of IFN-gamma in whole blood cell cultures indicated the presence of circulating trichophytin-specific lymphocytes. After inoculation with T. verrucosum, IFN-gamma production was demonstrated in samples from both vaccinated and control calves. This study showed that vaccination with Ringvac bovis LTF-130 elicits a protective immune response suggesting involvement of the cellular branch of the immune system. Experimental infection of naïve nonvaccinated calves with T. verrucosum, also indicated stimulation of a cell-mediated immune response essential for resolution of lesions.

Animals↗

Cytokine production of peripheral blood mononuclear cells in a dermatophytosis patient in response to stimulation with trichophytin.

Interferon-gamma (IFN-gamma), interleukin 2 (IL-2) and granulocyte/macrophage colony-stimulating factor (GM-CSF) were detected in the culture supernatant after 72 hours incubation with trichophytin in the peripheral blood mononuclear cells (PBMC) obtained from a patient who had a dermatophyte infection. These findings indicate that this patient has peripheral T-lymphocytes that produced IFN-gamma, IL-2 and GM-CSF, which may play roles in the development of delayed-type hypersensitivity (DTH) reaction in the skin.

Cytokines↗

Dermatophytosis: association between ABO blood groups and reactivity to the trichophytin.

The authors investigated the relationship between dermatophytosis and ABO blood groups through blood typing, identification of isolated dermatophytes and specific cellular immune response of 40 individuals carriers of this mycosis. They verified that the fungus Trichophyton rubrum, isolated from 54.5% of the patients, was more frequent in individuals belonging to blood group A. The cellular immune response, evaluated through the trichophytin antigen, was positive in 25% of the studied patients; the presence of immediate reactions (30 minutes) was verified in 35%. The blood group distribution among patients with dermatophytosis and control groups was, respectively: 47.5% X 36% in group A, 40% X 50% in group O, 12. 5% X 11% in group B. Even though the authors have found a higher number of patients belonging to blood group A infected by T. rubrum, these results suggest that there is no statistical evidence that these individuals are more susceptible to dermatophytosis.

ABO Blood-Group System↗

An evaluation of delayed hypersensitivity in guinea pigs to various trichophytin preparations.

Guinea pigs immunized with mycelium from Trichophyton mentagrophytes in Freund's complete adjuvant were tested intradermally with the following trichophytin preparations: TrI extracted by ethylene glycol, TrII extracted by phenol and TrII, a commercially obtained preparation fromSächsisches Serumverk KG. In our experience, TrI was found to be superior to the other preparations. It showed signifiicant delayed skin reactions in all sensitized animals and none in the controls. Lymphocyte stimulation test with this preparation (TrI) gave positive results.

Animals↗