Tinea capitis in South Wales—observations in change of causative fungi

We report an observed change in the causative organisms in 45 consecutive cases of tinea capitis seen in the Cardiff area over the last 9 years. Direct microscopy using potassium hydroxide was positive in all but one case, but this was subsequently positive on culture. This retrospective analysis shows that more cases are being seen in our department, and that a higher proportion of cases are due to Trichophyton violaceum whereas previously we would have expected the majority of cases to be due to Microsporum canis. We believe that the change in causative organism that we have identified has important practical and diagnostic implications. Endothrix fungi such as T. violaceum do not fluoresce under Wood's lamp unlike ectothrix fungi such as M. canis, and therefore failure to perform adequate mycological examination of specimens could result in missed diagnoses. We are not aware of this change having been reported from other UK centres. The finding indicates a need for further prospective epidemiological studies to confirm this apparent trend.     

Trichophyton rubrum invasion of human hair apparatus in tinea capitis and tinea barbae: light- and electron microscopic study

Summary We have previously reported morphological changes ofTrichophyton violaceum andMicrosporum canis in hair apparatuses in tinea capitis. To investigate the morphology ofTrichophyton rubrum in the human hair apparatus, two cases of tinea capitis and one case of tinea barbae were examined by light- and electron microscopy. The fungal elements, which were located in the lower keratogenous zone, showed non-septate hyphae in the outer part of the hair cortex. With the upward development of the hair layers, some hyphae invaded the keratinized hair cuticle and keratinized inner root sheath and were transformed into arthrospores. Some hyphae remaining in the hair cortex were also transformed into arthrospores, while other hyphae in the hair cortex did not survive, but degenerated. InT. rubrum hair infection, there is a distinct relationship between the morphological changes of the fungi and the hair cell differentiation as seen inT. violaceum andM. canis infections. However,T. rubrum displays unique morphological changes, which are different from those ofT. violaceum andM. canis, in hair apparatuses.     

An institutional survey of tinea capitis in Harare, Zimbabwe and a trial of miconazole cream versus Whitfield''s ointment in its treatment

A study of the prevalence of tinea capitis at a residential school for physically handicapped children in Harare, Zimbabwe is reported. In the 7–12 year old age group the prevalence of ideologically proven fungus infection was 39%. It is suggested that this can be explained by their hygiene. Two species of dermatophyte were isolated: Trichophyton violaceum from 88% and Microsporum audouinii from 38% of cases which were positive following culture. Twenty-six per cent of these cases were mixed infections. There was a slightly higher rate of infection amongst boys. The effectiveness of the clinical and mycological examination was assessed. Affected children were treated with a 6-week course of either Whitfield's ointment or miconazole cream. Results are presented to show that neither treatment is fully effective.     

Tinea capitis in Tripoli

Mycological examination of 600 cases of tinea capitis in Tripoli showed Trichophyton violaceum to be the most common isolate, followed by Microsporum canis, Trichophyton schoenleinii and Trichophyton mentagrophytes. The various clinical patterns which scalp ringworm may present is discussed and attention is drawn to the relatively common non-inflammatory seborrhoeic or dry scaly pattern.     

Evaluation of the association of superficial dermatophytosis and athletic activities with special reference to its prevention and control

Objective This study was conducted to evaluate the association of superficial mycosis and athletic activities with special references to its prevention and control in Tehran. Participating in various kinds of sports can lead to direct and indirect exposures to and transmission of micro‐organisms between athletes and also passive observers. Methods A retrospective study of superficial fungal infections in athletes was carried out during the period of March 2002 to December 2006 on 656 mycological proven cases of dermatophytosis found in athletes in Tehran. Mycologic examination consisted of culturing of pathologic material followed by direct microscopic observation. Mycologic cultures were carried out on Sabouraud Chloramphenicol Agar, Sabouraud Chloramphenicol and Cyclohexamide Agar, and Dermatophyte Agar incubated at 25 °C for at least 28 d. Diagnosis was based on macroscopic and microscopic characteristics of the colonies. Results A total of 1075 athletes, from 201 institutions, suspected of cutaneous fungal infections were examined and 656 (61%) were found to be positive for fungal infections. The fungal isolates comprised Trichophyton tonsurans (56%), Epidermophyton floccosum (11.8%), Trichophyton mentagrophytes (8.9%), Trichophyton rubrum (8.3%), Trichophyton verrucosum (3.9%), Trichophyton violaceum (3.3%), Microsporum canis (2.5%), and Malassezia spp. (5.3%). The distribution of lesions on the body in decreasing order was as follows: trunk, groin, hair and scalp, sole, toe webs, finger nails, and toe nails. Fungal infections were more commonly seen in wrestlers and individuals that participate in aerobics. Conclusion The results suggest that athletic activity seems to be a predisposing factor, especially for fungal infections. Guidelines are provided regarding measures to prevent transmission of infectious diseases in athletic settings, including hygiene, infection control practices, and education of officials, coaches, trainers, and sports participants.     

TINEA CAPITIS IN SAUDI ARABIA

Background. Tinea capitis is a dermatophyte infection of the scalp, eyebrows, and eyelashes caused by species of Microsporum and Trichophyton. The purpose of this study was to discover the incidence and causal agents of tinea capitis in Saudi Arabia. Methods. Hair roots, skin scrapings, and pus swabs were collected from patients clincially diagnosed with tinea capitis and were processed for fungus. Results. Of 372 patients with tinea capitis investigated in Saudi Arabia, 240 were found to be positive by direct microscopic examination, and the causal agent was isolated from 237 patients. Tinea capitis accounted for 47.7% of all superficial mycoses, and 97% of it occurred in children below 15 years of age. Inflammatory lesions were found in 35% of cases, and 10 of them presented with kerion celsi. Favus-type lesion was found in one. Microsporum canis was the most common etiologic agent, responsible for 82.3% of the infections. Trichophyton violaceum was the next most common agent (13.9%), followed by M. audouini (2.2%); T. mertagrophytes, T. rubrum, T. verrucosum, and T. simii were isolated from one patient each. This is the first report of T. simii infection in a Saudi man. Conclusions. Although none of the patients owned pets, the predominance of M. canis may be explained by the large number of cats in the neighborhood. The disappearance of favus due to T. schoenleinii may be due to improved socio-economic conditions. Our results agreed with two previous reports.     

Fungus invasion of human hair tissue in tinea capitis caused by Microsporum canis: light and electron microscopic study

Summary Previously, we reported a morphological change of Trichophyton violaceum in hair tissue in black dot ringworm. To investigate the morphology of Microsporum canis in human hair tissue, three cases of tinea capitis by M. canis were examined by both light and electron microscopy. The fungal elements, which were located deeply in the keratogenous zone, showed nonseptate hyphae in the outer part of the hair cortex. With the upward development of hair tissues, some hyphae invaded the keratinized inner root sheath and were there transformed into arthrospores, which then occupied the large volume of the inner root sheath; each spore was surrounded by an electron-lucent halo. In some affected hair follicles, at the follicular isthmus level, a microabscess composed of polymorphonuclear leukocytes was often formed in the outer root sheath adjacent to the arthrospores in the keratinized inner root sheath. On the other hand, the remaining hyphae in the cortex became degenerated. Fungi did not invade the hair-germinative cells. There is a distinct relationship between the morphological change of fungi and the differentiation of hair cells in tinea capitis by M. canis as well as in that by T. violaceum, although the direction of invasion and pathological roles of fungal elements within hair tissue are significantly different between the two species of fungi.     

Dermatophytosis in children and adolescents: epidemiological, clinical, and microbiological aspects changing with age.

During a four year period, a total of 84 cases of dermatophytosis were seen in patients from 0 to 17 years of age attending our out-patient department. The sex distribution was about equal in preadolescents. Males predominated among adolescents. A peak incidence at early school age was due to cases of tinea capitis, mainly caused by Microsporum canis. A peak among adolescents was due to cases of tinea pedis, mainly caused by Trichophyton rubrum. In general, patients with Trichophyton rubrum infections were older than those with other types of dermatophytosis (p<0.05). Dermatophytosis due to Microsporum canis was most frequently seen in January and in September (p<0.01). Although onychomycosis due to dermatophytes was a comparatively rare disease, it did occur within all age subgroups. Entities which were very frequent in former times and which have become rare during the last decades, such as tinea capitis due to Trichophyton schönleinii, still contribute to the spectrum of dermatophytosis in childhood.     

Epidemiological trends in zoophilic and geophilic fungi in Iran

Background: Dermatophytes can be divided into geophilic (soil), zoophilic (animals) and anthropophilic (human) strains, depending on the source of the keratin. The predominant organisms vary within a given geographical region during different periods, which is influenced by a number of factors, such as population movements, socioeconomic circumstances and level of surveillance. Thus, the incidence is very variable. Aim: To determine the epidemiology of superficial fungal infections due to zoophilic and geophilic fungi in patients referred to the Pasteur Institute of Iran. Methods: The clinical presentation of zoophilic and geophilic dermatophyte‐related infections was reviewed retrospectively from the medical records of all subjects referred to our laboratory for assessment of cutaneous fungal infection. Mycological examination consisted of culturing of pathological material followed by direct microscopy. Diagnosis was based on the macroscopic and microscopic characteristics of the colonies. Results: Of the 3976 clinically suspected cases of dermatophytosis, 239 (39.6%) were zoophilic dermatophytosis, confirmed by direct examination and culture. They occurred in 93 (39%) female patients and 146 (61%) male patients (median age 27.4 years, range 1.5–75). The commonest zoophilic fungi isolated were Trichophyton mentagrophytes var. mentagrophytes (28%), followed by Trichophyton verrucosum (9.3%) and Microsporum canis (2.2%). The geophilic fungus Microsporum gypseum was isolated from 0.33% of patients. Conclusion: This study identifies the epidemiological trends and the predominant organisms causing zoophilic dermatophytosis in humans in Tehran. Consideration of the current epidemiological trends in the incidence of cutaneous zoophilic fungal pathogens is essential for investigation, diagnosis and treatment.     

Disseminated dermatophytic pseudomycetoma caused by Microsporum species

Background  Dermatophyte infection is almost exclusively a superficial cutaneous mycosis usually confined to the stratum corneum of nails and hairs of normal hosts. Deep cutaneous and subcutaneous infections due to dermatophytes are exceedingly rare and usually limited to immunosuppressed individuals. These infections remain chronic and persist in spite of treatment. Materials and methods  We report two clinical cases of disseminated dermatophytic pseudomycetoma caused by Microsporum gypseum and Microsporum canis in immunosuppressed patients. Results  Patient 1, in 2008, showed improvement with fluconazole, cephalothin, and terbinafine treatment for Microsporum gypseum. After suspension of the treatment, new lesions appeared and culture from material was positive. In 2009, she presented confluent papules and nodules forming plaques on her face and neck with the isolation of Microsporum canis. Clinical response to this treatment was poor. Patient 2 was affected by both tinea corporis due to Trichophyton rubrum and dermatophytic pseudomycetoma caused by Microsporum canis. The response to treatment was successful with oral itraconazole and local surgical excision. Conclusions  It is important to recognize these atypical presentations of dermatophytic infections in immunosuppressed patients, which may warrant a more aggressive treatment in order to achieve resolution.     

Analysis of Adult Patients with Tinea Capitis in Southeastern Korea

BackgroundTinea capitis is a cutaneous infection of dermatophytes and predominant in children. Although tinea capitis in Korea is controlled by oral antifungal medications and concerted public health initiatives, it''s still a health issue.ObjectiveTo investigate changes in the epidemiological and mycological characteristics of adult patients with tinea capitis in southeastern Korea.MethodsUsing medical records from Kyungpook National University Hospital and Catholic Skin Clinic from 1989 to 2018, we retrospectively investigated the epidemiological and mycological characteristics of 266 adult patients (aged over 20) with tinea capitis.Results Among total 266 patients, 239 were KOH-positive. The annual incidence of tinea capitis ranged from 3 to 18 between 1989 and 2018. Of the total, 54 (20.30%) were male and 212 (79.70%) were female. Eighty patients (30.08%) were in their seventies, the most commonly affected age group. Of the remaining, 58 (21.80%) were in their sixties, and 41 (15.41%) in eighties. Among all, 77 (28.95%) visited the hospital in summer, 72 (27.07%) in spring, 64 (24.06%) in winter, and 53 (19.92%) in fall. Dermatophytes were cultured from 171 patients. Microsporum canis was the most common dermatophyte (42.48%), while Trichophyton rubrum was the second (15.79%). Of the 266 patients, 186 (69.92%) lived in urban areas and 80 (30.08%) in rural areas.ConclusionThe epidemiological and mycological characteristics of adult patients with tinea capitis were different from those of children in terms of annual incidence, sex distribution, and isolated dermatophytes. These results provide useful information for the treatment and prevention of tinea capitis.     

Onychomycosis in Cameroon: a clinical and epidemiological study among dermatological patients

Background  There are currently no studies on epidemiology and clinical aspects of nail fungal infections in the general population of Cameroon. Patients and methods  Two series of patients observed at a hospital dermatological service of Yaoundé and in a volunteer service of Douala were evaluated. All the patients, regardless of the reason for the consultation, were examined by an expert dermatologist to discover signs of onychomycosis. Patients with suspected nail lesions underwent mycological examination according to the standard techniques. Results  Among 590 subjects (317 males and 273 females), aged 16–83 years, onychomycosis was mycologically confirmed in 52 cases (8.8%). The infection was most common in the fifth decade. Fingernails were affected in 12 cases, toenails in 30 cases, and both fingernails and toenails in 10 cases. Dermatophytes were isolated in 57.7% of cases, the most common species being Trichophyton rubrum (16 cases) and Trichophyton violaceum (eight cases). Non‐dermatophytic mould, including Aspergillus spp., Fusarium spp., and Neoscytalidium dimidiatum, was found in 10 cases. Onychomycosis was more common in patients from low social‐economic classes. Conclusions  This is the first investigation dealing with onychomycosis in Cameroon. These data may be useful for future research and in the development of preventive and educational strategies.     

TINEA CAPITIS IN LAHORE, PAKISTAN

Background. The causative fungi of tinea capitis vary with geography and time. This study was planned to identify the etiologic agents and determine clinicoetiologic correlations of tinea capitis in Lahore, Pakistan. Methods. From clinically suspected cases of tinea capitis, skin scrapings and hair samples were taken and subjected to microscopy and culture. Results. Of 180 evaluable patients, 95% were children below 12 years of age with equal sex incidence. Noninflammatory lesions were seen in 62.2% of cases. Trichophyton violaceum was the most common etiologic agent responsible for 69.4% of infection, followed by T. tonsurans (16.7%), T. verrucosum (10%), Microsporum audouinii (2.2%), and T. mentagrophyte (1.7%). Conclusions. T. violaceum is the predominant pathogen causing tinea capitis in children and adults in this part of the world and gives rise to a varied clinical picture. Our findings agree with data from other parts of Pakistan and many countries abroad.     

Estudio epidemiológico de la tinea capitis en una población de Santiago de Chile. La aparición de Trichophyton tonsurans como agente etiológico

Introduction

Tinea capitis (TC) is a dermatophytosis that affects the hair and scalp. The epidemiology of TC depends on the different geographical areas and is variable over time. Direct microscopic examination and fungal culture are essential to confirm the diagnostic suspicion and to identify the germ involved.

New Epidemiological Outcomes in Anthropophilic tinea capitis,a Case Series Study in Northwestern Spain

Although zoophilic dermatophytes remain the predominant cause of tinea capitis in Spain, an increase due to anthropophilic species has been reported. We report a retrospective observational study that included twenty-four children, who were diagnosed with tinea capitis due to anthropophilic species between 2004 and 2019. 75% of the patients were males with a mean age of 4,88 years. We observed 83,3% of cases from Africa, 4,2% from South America and 12,5% from Spain. Clinically, 70,8% of the patients presented scaly patches and non-scaring alopecia. Trichophyton soudanense was the main dermatophyte of the series (45,8%), followed by Microsporum audouinii (20,8%), Trichophyton tonsurans (12,5%) and Trichophyton violaceum (12,5%). Although this pattern of infection appears to be linked to immigration from Africa, we saw three native cases. The easier transmission of anthropophilic rather than zoophilic dermatophytes could predict a rise in the incidence of tinea capitis and a public health problem.     

Dermatophyte infections mimicking other skin diseases: a 154-person case survey of tinea atypica in the district of Cagliari (Italy)

Background Although usually simple, the diagnosis of dermatophyte infection is sometimes neglected. An observational study has been realized to evaluate the role of corticosteroid exposure (tinea incognito) and of other primary characteristics of the dermatophytosis that from onset mimic other diseases and mislead an unexperienced physician. Materials and methods Between 1990 and 2009, all cases of atypical dermatophytosis mimicking other skin diseases were collected from the more general number of dermatophyte infections diagnosed at the Dermatology Department of Cagliari University, Italy. Results One‐hundred and fifty‐four cases (71 male/83 female, 2–81 years old) were studied, with a median of 7 cases/year. The most observed clinical forms were those mimicking impetigo, eczematous dermatitis, lupus erythematosus, polymorphous light eruption, psoriasis, and rosacea. The identified dermatophytes were: Microsporum canis (70 cases), Trichophyton rubrum (43 cases), Trichophyton mentagrophytes var. mentagrophytes (29 cases), Trichophyton mentagrophytes var. interdigitale (six cases), Microsporum gypseum (three cases), Epidermophyton floccosum (two cases), and Trichophyton verrucosum (one case). Diagnostic difficulties are discussed, with special attention to the origin of the pathomorphosis. Conclusions In our experience, clinical atypia is not a mere consequence of corticosteroid therapy but present at the very onset of the illness, due to the variable dermatophyte invasive capacity, the site of invasion, physiological individual, and/or acquired condition, such as excessive washing or sun exposure. Therefore, we suggest using the term “tinea atypica” rather than “tinea incognito” to include all forms of dermatophytosis that do not present the classic features for both primary and secondary pathomorphosis.     

A 30‐year survey of paediatric tinea capitis in southern Spain

Background Tinea capitis (TC) is the most common mycological infection in childhood. The epidemiology of TC varies depending on the geographical area and the time of study, and although it is an important public health problem in our area, only a few long‐term studies have focused on children. Objectives The aim of this study was to analyse the main epidemiological, clinical and microbiological features of TC in children over 30 years and compare these features with those of other tineas. Methods We undertook a retrospective study of 818 tineas in children at a referral hospital in southern Spain diagnosed between 1977 and 2006, concentrating on TC. Results Of the 444 TC diagnosed, 61.5% were in boys. Most children (66.9%) were aged 4–9 years. Twelve patients were immigrants. Inflammatory clinical forms were present in 18.2% of cases. At the time of diagnosis, 10.4% of the cases had been treated with antifungal agents. The most frequently isolated dermatophyte was Microsporum canis (63.5%). Conclusions We report the largest study of TC in Spain. Our results were very similar to those in other national studies, noting a predominance of non‐inflammatory cases of TC caused by zoophilic dermatophytes. Although the species of the causal dermatophytes have not varied substantially in this period, the increasing number of immigrants may lead to a change in the aetiology of TC in the future. The number of cases referred to the dermatology department who have already been treated shows a lack of communication between primary care and dermatology.     

Clinical and Laboratory Characteristics of a Tinea Capitis Outbreak Among Novice Buddhist Monks

Sixty novice Buddhist monks with tinea capitis confirmed according to clinical presentation and mycological laboratory finding were included in this study. Mixed‐type clinical presentation was observed in approximately half of all cases, together with scarring alopecia (95%) and superficial fungal skin infection at locations other than the scalp (43.3%). The major isolated organism was Trichophyton violaceum, and mixed‐organism infection was found in 27 cases (45%). Slow‐onset presentation and an extensive area of infection were significantly associated with mixed‐type clinical presentation.     

[Artículo traducido] Nuevos hallazgos epidemiológicos en la tinea capitis antropófila,un estudio de una serie de casos en el noroeste de España

Although zoophilic dermatophytes remain the predominant cause of tinea capitis in Spain, an increase due to anthropophilic species has been reported. We report a retrospective observational study that included 24 children, who were diagnosed with tinea capitis due to anthropophilic species between 2004 and 2019. 75% of the patients were males with a mean age of 4,88 years. We observed 83,3% of cases from Africa, 4,2% from South America and 12,5% from Spain. Clinically, 70,8% of the patients presented scaly patches and non-scaring alopecia. Trichophyton soudanense was the main dermatophyte of the series (45,8%), followed by Microsporum audouinii (20,8%), Trichophyton tonsurans (12,5%) and Trichophyton violaceum (12,5%). Although this pattern of infection appears to be linked to immigration from Africa, we saw three native cases. The easier transmission of anthropophilic rather than zoophilic dermatophytes could predict a rise in the incidence of tinea capitis and a public health problem.     

THE PATTERN OF CHILDHOOD TINEA IN NEW SOUTH WALES, AUSTRALIA 1979–1988

A retrospective study was undertaken of 192 cases of culture proven tinea capitis occurring between 1979 and 1988 in a predominantly white population of children in New South Wales (NSW). The aim of the study was to identify whether Trichophyton tonsurans was increasing in importance in the causation of this condition in Australia as it was in many other parts of the world. The results of our study were compared with those of earlier Australian studies. Our study demonstrated that Trichophyton tonsurans is now equal in importance to Microsporum canis which was previously the strongly predominant organism.