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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
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KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : WK01 - WK02 Full Version

Assessment of Cell-mediated Immunity to Trichophyton Antigen in Patients with Dermatophytosis: A Case-control Study

Published: December 1, 2022 | DOI:
Shubham Chopra, Sudhir Singh, Bhushan Madke

1. Resident, Department of Dermatology, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 2. Professor and Head, Department of Dermatology, Datta Meghe Institute of Medical Sciences, Nagpur, Maharashtra, India. 3. Professor, Department of Dermatology, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.

Correspondence Address :
Dr. Shubham Chopra,
Resident, Department of Dermatology, AVBRH, Sawangi Meghe,
Wardha-442001, Maharashtra, India.


Introduction: Dermatophytosis are presenting for longer durations and at atypical sites and are quite persistent. If changes in the Cell-Mediated Immunity (CMI) will be studied then, it will help to set treatment guidelines for the management of dermatophytosis to certain extent, considering the current changes in the resistance to dermatophytosis. There is paucity in literature regarding the CMI to Trichophyton antigen in dermatophytosis patients in the geographical region of Vidarbha, Maharashtra, India.

Aim: To assess the CMI to intradermal Trichophyton antigen in dermatophytosis patients and to study its adverse reaction in these patients.

Materials and Methods: The present prospective cross-sectional case-control study will be conducted on patients of dermatophytosis attending Skin Outpatient Department (OPD) in Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Wardha, Maharashtra, India, during January 2022 to January 2023 (13 months). Patients will be enrolled following fulfillment of study’s eligibility criteria. Clearance has been acquired from the Institutional Ethical Committee (IEC). Participants will be required to sign a written informed consent form in their native language. A detailed history will be collected and cutaneous examination will be done before conducting the study. The area for intradermal injection will be marked. For the study 0.1 mL, Intradermal Trichophyton antigen will be injected in the patient’s forearm. Patient will be called after 48 hours to check for the CMI response (delayed response).


Filamentous fungi, Hypersensitivity, Intradermal skin test, Trichophyton cell

Dermatophytes are an assemblage of filamentous fungi which invades the keratinised tissues of human being or natural world to produce a contagion termed “Dermatophytosis” commonly referred as ringworm. Owing to their filamentous structure they cannot penetrate deeper tissues and hence the infection is limited to the immunocompromised host’s non living cornified skin layers (1),(2). The cutaneous reactions could be varied from mild to severe depending upon the host’s reactions to the inherent products of fungus, its hostility, host’s infection site and local factors. Trichophyton rubrum being commonest causative variant responsible for preponderance of fungal infections which are superficial (3),(4),(5). A distinctive feature of T. rubrum immunity is its competency to reduce hypersensitivity response (immediate or delayed). This scrupulous immune response is host dependent and the preceding exposure to the antigen (1). A preliminary defence mechanism of host includes Toll Like Receptor (TLR) 2, 4 and 6 and Human Beta Defensin 1, -2, -1 B and Interleukin-8. Annotations suggest that “T Lymphocyte Infection” is critical in recuperation from a dermatophytic infection. Induration is the symptomatic trademark event of a delayed type hypersensitivity response (6),(7).

In a study by Kaaman T, importance of CMI in the eradication of cutaneous infections was highlighted. The authors suggested that, the CMI in humans could be assessed using intradermal skin test causing delayed-type skin reactions are to dermatophyte antigen which are indicative of previous or actual dermatophytosis (8).

Over the course of dermatophyte contaminations, the delayed-type skin reactivity is positive, at peak and at last decreases as a sign of clinical insusceptibility. (Th1) CD4-T lymphocyte is seen in classical postponed sort extreme hypersensitivity (6),(7). In current scenario, the need for a dermatologist is to form an evidence based treatment protocol for better patient management. Till date, literature regarding the CMI to Trichophyton antigen in dermatophytosis patients in Vidarbha (Maharashtra) as, its soil is known to be a significant reservouirs of dermatophytes (9),(10). Hence, the present study aimed to assess the CMI to Trichophyton antigen in persistent dermatophytosis patients.

Research Question

What is the CMI response (delayed response) in a patient with persistent dermatophyte infection to intradermal Trichophyton antigen?


1. To study the CMI to intradermal Trichophyton antigen in patients with dermatophytosis.
2. To study the adverse effect of intradermal Trichophyton antigen in patients with persistent dermatophyte infection.

Material and Methods

The present prospective case-control study will be carried out in the Skin OPD of AVBRH, Sawangi (M), Wardha, Maharashtra, India, during January 2022-January 2023 (13 months). Approval was obtained from IEC with approval number Ref No. DMIMS(DU)IEC/2022/854 (5/4/22).

Study Population

a) Eighty gender-matched participants who are clinical diagnosed cases of dermatophytosis, willing to give written informed consent, from rural population of Sawangi, Wardha, Maharashtra, India.
b) Eighty gender-matched participants who are clinically fit i.e. control and do not have dermatophyte infection, willing to give written informed consent, from rural population of Sawangi, Wardha, Maharashtra, India.
c) The sample size was estimated using the formula, N=(Zα/2)2 P(1-P)*1/E2

Where, P is the prevalence or proportion of event of interest for the study, E is the Precision (or margin of error). (1.96)2*0.276*(1-0.276)/(0.07)2=156.66. The prevalence of 27.6% dermatophytosis as obtained from the study of Lakshmanan A et al., (9).

Inclusion criteria:

1. Patients of both genders.
2. Patients willing to give informed consent and participate in the study.
3. Clinically-diagnosed cases of persistent dermatophytosis of age above 18 years.

Exclusion criteria:

1. Patients who refuse to take part in the research.
2. Clinically suspected cases of dermatophytosis.

Study Procedure

Dermatophytosis patients attending Skin OPD in AVBRH, Sawangi, Wardha, India will be included when the study’s eligibility criteria have been considered. Clearance has been acquired from the Institutional Ethical Committee (IEC). Participants will be required to sign a written informed consent form in their native language. A detailed history will be collected and cutaneous examination will be done before conducting the study. The area where the intradermal injection will be given will be marked. For the study, 0.1 mL Intradermal Trichophyton antigen will be injected in the patient’s forearm. Patient will be called after 48 hours, to check for the CMI response (delayed response) using wheal test, which involve formation of wheal at the sites of injection, the size and degree of erythema, and degree of induration at 48 hours. A wheal greater than 10 mm in diameter, with or without a flare will be considered a positive immediate reaction. The CMI response will be intercepted as positive, if any degree of erythema, oedema observed (11).

Outcome Measures

Primary outcome: Delayed response CMI to Trichophyton antigen in a patient, who has been suffering from persistent dermatophyte infection (case group) and those, who were suffering from non dermatophyte skin conditions (control group).

Secondary outcome: Any adverse event post injection will be recorded in both the groups.

Statistical Analysis

Standard statistical methods will be used, to evaluate both categorical like demographic characteristics and non categorical data like positive or negative wheal test or any reported adverse event, using paired ‘t’-test and Chi-square test respectively. Statistical Package for the Social Sciences (SPSS) software version 26.0 will be used for analysing these data. A p-value <0.05 will be deemed significant.


Jones HE, 1994 (1), conducted an in human experiment with injected dermatophytes and on the basis of their cellular resistive response, participants were divided into two groups: (1) Those who mount conclusive delayed-type excessive responsiveness as a result of contamination clearance, (2) Those who lack or have a fault in their cellular insusceptibility, which prevents them from building a powerful reaction to their presence in the body and hence, predisposes them to infection. The authors discovered that, the severe provoking illness was linked to T-cell mediated delayed type of sensitivity to a “Trichophyton intradermal test” and the ability of those impacted to recognise mycologic involvement. Constant contamination was related to a tall (anti-Trichophyton IgE-mediated) responsiveness and a nil or vanishing T-cell mediated delayed type of sensitivity response to Trichophyton in differentiated mice (1).

Khosravi AR et al., demonstrated cell-mediated immunity in 98 patients with acute dermatophytosis (group I) and 131 chronic dermatophytosis patients (group 2). They found 96 members of group I (98%) had positive delayed-type hypersensitivity responses to Trichophyton, whereas only 43 subjects (32.8%) of group 2 had positive delayed-type hypersensitivity responses (11).

Begum J et al., studied about specificity over the ordinary strategies of culture and microscopy for dermatophytes distinguishing competency. The symptomatic methods within the study, which give the objective and reproducible species distinguishing proof for the particular treatment, observing and control of dermatophytosis. All the strategies talked about within this audit, have a critical benefit in terms of affectability, the time required, financial matters, complexity and species range (2).

Jain S et al., observed Tinea corporis to be the most prevalent clinical variant in 1,200 cases from eastern Odisha in 2020. Culture positive was 61.75% and coordinate potassium hydroxide (KOH) positivity was 89.4%. T. mentagrophyte was the most frequent dermatophyte (77.5%), followed by T. rubrum (13.3%) (3).


Jones HE. Immune response and host resistance of humans to dermatophyte infection. J Am Acad Dermatol. 1993;28(5):S12-S18. [crossref] [PubMed]
Begum J, Mir NA, Lingaraju MC, Buyamayum B, Dev K. Recent advances in the diagnosis of dermatophytosis. J Basic Microbiol. 2020;60(4):293-03. [crossref] [PubMed]
Jain S, Kabi S, Swain B. Current trends of dermatophytosis in Eastern Odisha. J Lab Physicians. 2020;12(1):10-14. Doi: 10.1055/s-0040-1713063. Epub 2020 Jun 11. [crossref] [PubMed]
Blutfield MS, Lohre JM, Pawich DA, Vlahovic TC. The immunologic response to Trichophyton rubrum in lower extremity fungal infections. J Fungi (Basel). 2015;1(2):130-37. [crossref] [PubMed]
Nenoff P, Krüger C, Ginter-Hanselmayer G, Tietz HJ. Mycology-an update. Part 1: Dermatomycoses: Causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges. 2014;12(3):188-09; quiz 210, 188-211; quiz 212. [crossref] [PubMed]
Weitzman I, Summerbell RC. The dermatophytes. Clin Microbiol Rev. 1995;8(2):240-59. [crossref] [PubMed]
Woodfolk JA. Allergy and dermatophytes. Clin Microbiol Rev. 2005;18(1):30-43. Doi: 10.1128/CMR.18.1.30-43.20052. [crossref] [PubMed]
Kaaman T. Dermatophyte antigens and cell-mediated immunity in dermatophytosis. Curr Top Med Mycol. 1985;1:117-34. [crossref] [PubMed]
Lakshmanan A, Ganeshkumar P, Mohan SR, Hemamalini M, Madhavan R. Epidemiological and clinical pattern of dermatomycoses in rural India. Indian J Med Microbiol. 2015;33 (Suppl-1):S134-36. [crossref] [PubMed]
Deshmukh SK, Verekar SA. Incidence of keratinophilic fungi from selected soils of Vidarbha region of Maharashtra State, India. Journal of Mycology. 2014;2014: Article ID 148970 | [crossref]
Khosravi AR, Franco M, Mahmoudi M. Evaluation of the role of cell-mediated immunity in dermatophytosis. Medical Journal of The Islamic Republic of Iran (MJIRI). 1993;7(3):165-69.

DOI and Others

DOI: 10.7860/JCDR/2022/60281.17204

Date of Submission: Sep 16, 2022
Date of Peer Review: Oct 01, 2022
Date of Acceptance: Oct 17, 2022
Date of Publishing: Dec 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Sep 19, 2022
• Manual Googling: Oct 13, 2022
• iThenticate Software: Oct 15, 2022 (3%)

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