DELAYED RESOLUTION OF AN EXTENSIVE DERMATOPHYTE INFECTION: CLIENT AND CLINICIAN PERCEPTIONS OF TREATMENT RESPONSE IN AN ADULT DEPENDENT ON HAEMODIALYSIS

JT HUGHES^1,2, O AYE MIN², SW MAJONI^1,2,3, BJ CURRIE^2,4, H HALL^{1, 5},R KIRKHAM²

¹Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia; ²Menzies School of Health Research, Charles Darwin University, Darwin, NT; ³Northern Territory Clinical School, Flinders University, Darwin NT; ⁴Infectious Diseases Unit, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia; ⁵Panuku, Western Desert Nganampa Walytja Palyantjaku Tjutaku, Darwin, NT

Aim: To examine the factors associated with delayed resolution of an extensive dermatophyte infection.

Background: Dermatophyte infections of the skin (tinea corporis) are common in northern Australia.  Clinical guidelines suggest resolution within 2 weeks following topical and/ or oral antifungal therapy.  Infections are common among Indigenous Australians dependent on haemodialysis, with infection-free clearances required to gain wait-listing for renal transplantation.

Methods: We documented the treatment response for tinea corporis for one client during the time between haemodialysis initiation and renal transplant waitlisting.  Follow-up interviews with the client and supporting clinicians informed individual perspectives of care.

Results: Following dialysis initiation, renal transplant wait-listing and subsequent transplantation was achieved on days 496 and 950 in a 44 year old Aboriginal female with diabetic nephropathy.  Skin scrapings on day-61 from extensive lesions (trunk and all limbs) cultured Trichophyton rubrum.  She attended dialysis regularly and received treatment over 238 days including three 12 week courses of oral terbinafine (250mg post dialysis three times weekly), each with partial but not complete resolution.  Complete resolution was documented at day-396 following oral fluconazole (100mg weekly at dialysis for 4 weeks).

Adherence with therapy was complicated by systemic and individual factors including disjointed communication, access to medication, normalisation of skin conditions in this population and competing priorities of the client.

Conclusions: Tinea corporis was a significant factor in the prolonged time to achieve renal transplant waitlisting.  We recommend a prospective observational study documenting the treatment responses to tinea corporis in haemodialysis, including optimal dose and timing and case management to better inform