Tinea pedis in children

OBJECTIVE

To demonstrate that tinea pedis should be considered in the differential diagnosis of children with foot dermatitis.

DESIGN

Patient series.

SETTING

Outpatient dermatology practice at the Children's Hospital of Pittsburgh (Pa).

PARTICIPANTS

Children with culture-proven tinea pedis from 1987 until 1990.

MEASUREMENTS/MAIN RESULTS

Fungal cultures were used to identify 13 girls and 13 boys ranging in age from 17 months to 18 years with tinea pedis. A parent was the probable source of infection in at least 25% of cases.

CONCLUSIONS

Tinea pedis is not a rare occurrence in children and should be considered in any patient with a foot rash.

Fungal infection as a cause of skin disease in the eastern province of Saudi Arabia: tinea pedis and tinea manuum

In the period between April 1984 and April 1988 a total of 4294 clinically suspected cases of dermatomycoses were examined for causative fungi. Of these cases 680 were suspected as tinea pedis and tinea manuum. These cases belonged to 21 different nationalities. Both sexes were represented and 649 cases (95.4%) were adults while 31 (4.6%) were prepubertals. Clinical diagnosis was confirmed by direct microscopy in 505 cases or 74.4% (485 adults and 20 prepubertal children). Out of these, 504 cases were positive on culture and yielded 516 isolates. Candida species and other yeasts were responsible for 88.9% and dermatophytes for 11.1% of these infections. The interdigital type of lesions was the most common type (91.9% of all infections) followed by the hyperkeratotic scaling type (6.9%) while the acute inflammatory type was only 1.2% of infections. Treatment showed satisfactory results in most of the cases.

Tinea pedis in children

Tinea pedis is a superficial mycosis, unusual in children. Epidemiological and clinical data regarding cases of tinea pedis observed in children over a period of 20 years are discussed and some explanation given for the conditions which predisposed children to the infection. Clinical features are variable and similar to adults. Bullous lesions are more frequently seen in children. Most of the cases were seen in children over 10 years of age. Males are more often affected with tinea pedis: this is particularly true for 10 to 13 year-old children. As in adults, Trichophyton rubrum is the most frequently isolated etiological agent.

Dermatophyte feet infection among students enrolled in swimming courses at a university pool

The aim of this study was to determine the prevalence of dermatophyte feet infection among students enrolled in swimming courses at a university swimming pool. Tinea pedis infection was determined on two occasions. The first study took place on the first day of classes and the second on day twelve of swimming lessons. Culture and KOH examination of the interdigital skin scrapings of the left foot showed superficial foot infection with dermatophytes or Candida albicans in 13.2% of the students (11/83) in the first study, and in 22.2% of the students (16/72) in the second study. The most common agent of tinea pedis in the first study was Trichophyton rubrum (82%), infections by T. mentagrophytes (9%) and Epidermophyton floccosum (9%) were less common. At that time, no dermatophyte was recovered from any of 30 floor samples taken from the bathroom and pool facilities. In the second study the following dermatophytes were isolated from the student's feet: T. mentagrophytes (70.6%), T. rubrum (17.6%) and Candida albicans (11.8%). On this occasion T. mentagrophytes was recovered from 5 out of 30 floor samples. It is possible that the frequency of the use of the pool facilities may influence the prevalence of tinea pedis as well as the etiological agent involved in this disease.

Incidence of occult athlete's foot in swimmers

Athlete's foot is a dermatophytic infection frequently found in adults. This disease is, in some cases, asymptomatic. In order to evaluate the incidence of subclinical infection, we obtained 300 toe-web samples from the fourth interdigital space of 150 regular swimmers. More over, 66 specimens from the pool area were analysed. The method used was the carpet technique described by Mariat et al. (10). The fungal isolates were identified according to standard methods. A list of epidemiological data was completed for every swimmer. In our results, 22 swimmers had positive cultures (15%), 8 of these cases had no lesions (36%). They included 7 infections with Trichophyton mentagrophytes (87.5%) and one with T. rubrum (12.5%). We observed one case with a dual infection. Only one sample from the inanimate environment was positive. This study showed a significant incidence of occult athlete's foot in swimmers. To control this endemic problem, adequate preventive measures must be taken.

The Auckland skin clinic tinea pedis and erythrasma study

Three hundred consecutive patients attending the Auckland Hospital dermatology clinic were examined clinically and microbiologically for evidence of interdigital or plantar mycological or bacterial infection. One hundred and nine patients were shown by laboratory investigation to have an infection. Of these, only 89 displayed clinical signs of infection. Erythrasma, a desquamative condition caused by Corynebacterium minutissimum, was the commonest infection in this study. The commonest dermatophyte isolated was Trichophyton mentagrophytes var interdigitale. There was a significant rise in the incidence of both types of infection with age.

A study of dermatophytoses in Esfahan (Iran)

The present study determined the extent and causative agents of dermatophytoses in Esfahan, a large city of Iran. Specimens from patients were examined for etiologic agents by direct microscopic procedure and by culture. Out of 12,000 patients with skin diseases, 10.8% were affected with dermatophytoses. Among the 10.8% group, lesions of tinea capitis were most common (72.1%) and Trichophyton verrucosum was the most frequent (43.8%) dermatophyte isolated from the patients. We found a relationship between the spread of dermatophytoses and live-stock infected with dermatophytoses.

Dermatophytes in Iceland

Prior to 1982, no reliable information was available on prevailing dermatophyte species or infections in Iceland. In 1983-1984 fungal cultures performed on 96 patients revealed that Trichophyton tonsurans was the most common isolate, followed by Trichophyton mentagrophytes and Trichophyton rubrum. There were no cases of tinea capitis and tinea corporis was rare, but the most common sites of infection were the feet and toenails.

Tinea pedis and erythrasma in Danish recruits. Clinical signs, prevalence, incidence, and correlation to atopy

Prior to military service, 665 recruits were examined clinically and microbiologically for tinea pedis and erythrasma and 546 of these were reexamined at the end of military service. The prevalence of clinical signs, erythrasma, and dermatophyte infection at the first investigation was 58.8%, 51.3%, and 6.2%, respectively, and at the second investigation, 81.1%, 77.1%, and 7.0%, respectively. The incidence of tinea pedis was 4.2% during the 9 months of military service. Of those infected at the first visit 41% had persistent infection mainly due to Trichophyton rubrum, whereas new infections were largely caused by Trichophyton mentagrophytes. Some of those persistently infected had signs of chronicity at the follow-up visit, indicating that chronic dermatophytosis may become established in the early twenties. The prevalence of atopy was 15.0% in all the recruits but was almost 50% in those with persistent tinea pedis.

[Swimming pool dermatoses]

Diseases of the skin related to the use of swimming pools do not appear very often in medical reports. In this review of such diseases we designate changes in the skin and hair as being infectious, toxic or allergic in origin. Particular attention is given to allergenic additives in the water. There is no indication that public swimming pools in the Federal Republic of Germany present any danger to the skin.

The changing epidemiology and emerging patterns of dermatophyte species

The anthropophilic agents of tinea capitis are being eradicated from their historic areas in developed and developing nations. The one exception is T. tonsurans in the United States and Canada. In these nations, the infections are increasing among black children, probably because of hair style and hygiene habits. Elsewhere in the world, M. canis has become or is becoming the dominant agent of tinea capitis. Tinea corporis reflects either the dominant agent of tinea capitis or the sphere of T. rubrum. Trichophyton rubrum is the most common agent worldwide of crural and pedal disease and often tinea corporis. The other anthropophilic species, T. mentagrophytes var. interdigitale and E. floccosum, are also firmly established, but as a distant second and third. These five species account for most ringworm worldwide. Other species are of lowlevel infection, are rare, are locally endemic, or--in the case of some anthropophiles--are dying out. The only evidence of active evolution among the dermatophytes is seen in M. canis and T. mentagrophytes. In both, host-specific strains have emerged and will probably separate as species. This probably has happened already in the case of the variety interdigitale of T. mentagrophytes.

A clinical and mycologic study of tinea corporis and pedis in Puerto Rico

A study of the causative agents of tinea corporis and pedis in Puerto Rico in 1982 disclosed four different dermatophytes from a total of 97 cases. Among the total of 49 fungus specimens collected in tinea corporis, the mycologic flora consisted of four different fungus species: Trichophyton rubrum, 42 isolates (85.7%); Epidermophyton floccosum, 4 (8.1%); Trichophyton mentagrophytes, 2 (4%); and Microsporum ferrugineum, 1 (2%). Among the total of 48 fungus specimens collected in tinea pedis, the mycologic flora consisted of 3 different fungus species as follows: T. rubrum, 35 isolates (72.9%); T. mentagrophytes 8 (16.6%); and E. floccosum, 5 (10.4%). Trichophyton rubrum caused 77 of 97 fungal isolates (79.3%). One surprising finding was the isolation of M. ferrugineum in a case of tinea corporis, documenting the first autochtonous case of this species in the island. This dermatophyte had previously been known only in Japan and adjacent areas of the Far East, Southern Europe, and Africa.

Tinea Pedis caused by Trichophyton violaceum

This, to authors' knowledge, is the first report in the United States of Tinea pedis caused by Trichophyton violaceum in a recent Southeast Asian immigrant. Because of the recent entry into this country of refugees from an area of the world where T. violaceum is endemic, this anthropophilic dermatophyte may become a significant cause of dermatophytosis in the United States.

An epidemic of infection with Trichophyton tonsurans revealed in a 20-year survey of fungal infections in Chicago

Trichophyton tonsurans has long been recognized as an important, but hitherto uncommon, cause of tinea capitis in the United States. Today it is known to be more common, but infection of the glabrous skin by this organism is still not well appreciated. In an epidemiologic study during the two decades from 1961 to 1980, 1,292 isolates of thirteen species of dermatophytes were obtained from patients at Cook County Hospital, Chicago. During the last 3 years of study, T. tonsurans accounted for 207 cases (96%) of tinea capitis and ninety-seven cases (75%) of tinea corporis. Ninety-five percent of cases of tinea capitis caused by T. tonsurans occurred in children (59% girls, 41% boys). By contrast, 62% of cases of tinea corporis caused by that organism occurred in adults. Substantially more women than men were affected in a ratio of nearly six to one. The majority of the women were between 15 and 29 years of age; about half of all had lesions on the arm. Over the past 20 years, T. tonsurans has emerged as a major cause of both tinea capitis and tinea corporis in Chicago. The disproportionate number of cases of tinea corporis in women of childbearing age may be due to their more frequent contact with infected children.

An outbreak of Tinea pedis and Tinea cruris in a tyre factory in Messina, Italy

A case of an epidemic by Tinea cruris and Tinea pedis in a tyre factory in Sicily is reported. There was noticeable spread of the causative agents throughout the environment. They were mainly transmitted by wash-basins in the footbaths, by footboards of showers and in smaller numbers by towels. Trichosporon beigelii was the most common fungus isolated from the environment, followed by Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Candida parapsilosis and Geotrichum candidum.

Fungal diseases in Shiraz

In 122 patients with fungal diseases studied over a six month period, sixty were seen with dermatophyte infections. Tinea pedis, cruris and ungruium occurred mainly in adult males attending the private hospital and tinea corporis and capitis children attending the University Hospital. The organisms found were Trichophyton rubrum, T. mentagrophytes, T. schonleinii, T. tonsurans, Epidermophyton floccosum and Microsporum canis. Infections with Candida albicans occurred both in the urban and rural population and included case of familial chronic muco-cutaneous candidiasis. Pityriasis versicolor was the commonest fungal disease seen.

A study of 3891 cases of mycoses in the tropics

4103 cases suspected of mycoses were analysed as to sex, age and site of disease and 3891 were proved cases. This group formed 50% of total mycoses or 13-93% of all dermatoses recorded in the Government General Hospital, Madras, during the period of study. There were 66-26% adult female, 27-6% adult male and 6-14% were below 13 years. Dermatophytoses were found in 73-5%; the other common diseases were tinea versicolor (17-68%) and candidiasis (12-43%). Multiple sites of involvement or more than 1 disease in the same individual were mostly observed. The incidence of piedra (0-1%) and deep mycoses (0-156%) was very low. Mycetoma was the common disease (5/6) in deep mycoses. In dermatophytoses, tinea corporis (49-71%) and tinea cruris (47-85%) commonest; tinea axillaris (3-42%), tinea capitis (1-72%) and tinea barbae (1-29%) were less common. The incidence of tinea manuum, tinea pedis and tinea unguium was similar (4-97%-6-38%). High temperature and humidity were related to the higher incidence of tinea corporis, tinea cruris and tinea versicolor. Mainly children suffered from tinea capitis. All other mycoses were commonly found in adults between 2nd and 3rd decades. In all mycoses but candidiasis, female predominated. Cutaneous candidiasis was mainly a problem of housewives. Among the dermatophytes Trichophyton violaceum was predominant (33-7%) followed by T. rubrum (32-6%). Trichophyton schoenleinii and M. gypseum were rarely isolated. From mycetoma, Madurella mycetomii, Nocardia braziliensis, N. asteroides and Actinomadura spp. were isolated. Demonstration of Cryptococcus laurentii in 1 case is reported in this area for the first time.

Control of tinea pedis in a swimming bath

Random samples of the weekly entry of bathers to a swimming pool were examined for tinea pedis and verruca before and at intervals after the supply of individual sachets of foot powder to all bathers.Over three and a half years the overall incidence of tinea pedis decreased from 8.5% to 2.1%, and in adult males it decreased from 21.5% to 6.9%. The incidence of infection with Trichophyton mentagrophytes var. interdigitale decreased from 5.3% to 0.5%, and the incidence of infection with T. rubrum (1.2%-1.1%) and Epidermophyton floccosum (0.9%-0.5%) did not change significantly. The incidence of verruca decreased from 4.8% to 1.2%. Issuing foot powder clearly minimizes the spread of infection and is recommended for general use.

Foot infections in swimming baths

A 10% random sample of all bathers at a public swimming bath were examined for tinea pedis and verruca.The overall incidence of tinea pedis was 8.5% and of verruca 4.8%. The incidence of tinea pedis in 205 male adults was 21.5%, in 288 boys 6.3%, in 60 adult females 3.3%, and in 220 girls 0.9%. The incidence of verruca in juveniles ranged from 4.2% in boys to 10.5% in girls.It was clear that both infections spread within the baths, and since a relatively small proportion of users admitted to taking precautions to avoid contracting or developing infections it seems advisable that more publicity about recommendations on foot care should be provided.