Dermatomycoses in the Israeli defense forces—Epidemiological and clinical aspects

Dermatomycoses, involving skin, hair and nail infections, are among the most frequent human infections with global distribution and may have a public health and economic impact. The causative agents include Dermatophytes, Candida, Malassezia and non-Dermatophyte moulds. High morbidity may be associated with certain variables: age, gender, occupation—such as farming or military service, and climate or environmental conditions. The objectives of the present study included: (a). Assessment of epidemiological aspects of dermatomycoses in the Israeli Defense Forces (IDF). (b). Antifungal drug susceptibility of fungi isolated in culture from soldiers. (a) Epidemiological assessment: data based on IDF's medical registry during the period 2009-2013 on 10 831 male and female soldiers (8164 and 2667, respectively), of which 2589 were combat soldiers. (b) Susceptibility tests: to ketoconazole, fluconazole, itraconazole, terbinafine and griseofulvin of ~ 100 Dermatophyte and Candida isolates, using E test and/or disc diffusion assays. (c) Statistical analysis: logistic regression, chi-square and ANOVA. (a) Incidence in male soldiers higher than in female soldiers (35% vs. 28%). (b) Incidence in combat soldiers higher than in non-combat soldiers (39% vs 32%). (c) The major site of involvement—nails. (d) Infections peaked during summer months. (e) Dermatophytes constitute close to 90% of the aetiological agents (87% and 86%). (f) Trichophyton rubrum the dominant species. (g) terbinafine was the most active antifungal drug. The most significant conclusion of relevance of this study is the finding of higher morbidity rate among combat soldiers, as this may affect the activity of this group.