Question

D. Fred presents with a 3-year history of pain and itching of the toes of both feet and of his left palm and fingers. Small red lesions are visible on the left fingers. He is in good health and training for college athletic teams in baseball, volleyball and swimming. During the 3 years, Fred has been using his medication sporadically and has now returned to the clinic since the condition is no longer responding to the current medication. Direct examination of palm skin scrapings with calcofluor reveals septate, nonpigmented hyphae, some coiled. A PDA culture of scrapings from Fred's feet grew a white fungus with thin-walled macroconidia and numerous microconidia.

9. What is wrong with Fred and how did he likely get it?

10. Describe the usual treatment for this condition? Why was it not working for Fred?

Answer 1

9.Fred is infected with a fungal infection (Athlete's foot) . This fungus thrives in warm and moist environment. It's common in showers, locker room floors, and around swimming pools. Wearing right fitting closed toe shoes , keeping feet wet for long time are risk factors for the infection. As he is a swimmer , volleyball baseball player he's prone to get athelets foot. Long term treatment with antifungal medications may be necessary to keep athelets foot from recurring.

Trichophyton rubrum is the causative organism .Dermatophytes can cause infections in healthy, immune-competent individuals. T.rubrum is a dermatophyte.

10. Usual treatment is fungal medications. It can be treated with topical antifungal treatment (ex: terbinafine) and oral antifungal agents. Wearing non occlusive shoes ,changing shoes and socks on a daily basis, thoroughly drying feet after showering or swimming, and not sharing towels are some of the precautions to escape this fungal infection.

As Fred was using the medications sporadically he would have developed resistance towards the antifungal medications.