A localized outbreak in New York of tinea capitis due to Trichophyton violaceum: observations with special reference to mixed infections of the scalp

Outbreaks And Epidemics Of Superficial Dermatophytosis Due To Trichophyton mentagrophytes Complex And Microsporum canis: Global And Indian Scenario

Until recently, superficial dermatophytosis, also known as tinea, was considered as a minor skin infection, which was easy to treat. There used to be rare outbreaks and epidemics of superficial dermatophytosis. Lately, there is a sweeping change in the clinical presentation due to extensive, atypical and recalcitrant dermatophytosis. Treating such infections poses a great challenge to the clinicians. Dermatophytosis is a superficial fungal infection of keratinized tissue (skin, hairs and nails) by dermatophytes (fungus). It is caused by the three genera of dermatophytes: Trichophyton, Epidermophyton and Microsporum. The conventional methods of laboratory diagnosis have now been substantiated by molecular characterization. Earlier epidemics were usually due to anthropophilic dermatophytes. Now, zoophilic dermatophytes are also responsible for many outbreaks and epidemics. We need to be equipped with the tools to face the current scenario, because this depends upon the competence of the staff working in the state-of-the-art laboratories, which is needed for the study of the epidemiology and appropriate treatment.

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Tinea Capitis: Mixed or Consecutive Infection with White and Violet Strains of Trichophyton violaceum: A Diagnostic or Therapeutic Challenge

Tinea capitis is a common dermatophyte infection affecting scalp and hair of pre-pubertal children. With introduction of Griseofulvin in 1958, there has been considerable improvement in the treatment of tinea capitis. A seven-year-old male child was brought to the dermatology clinic. He presented with diffuse white scaly patches of alopecia on scalp of one-year duration. The child was sent to the microbiology section of the National Health laboratory, Botswana for the collection of the samples. The samples consisted of scalp scrapings and few plucked hairs from the suspicious areas, which were collected by swab and scalpel blade methods. Potassium hydroxide (10% KOH) mounts were prepared for scales and hair samples. Scales were positive for fungal elements and endothrix type of perforation was seen in hair. Cultures on Sabouraud's dextrose agar (SDA) and Derm agar were incubated at 25°C, which yielded white variant of Trichophyton violaceum after two weeks of incubation. T. vioaceum (white variant) grew in all the plates. After six weeks of treatment with griseofulvin, the repeat culture grew only T. violaceum (violet strain). The child showed a definite clinical improvement.

Isolation of Trichophyton violaceum and Trichophyton soudanense in Baltimore, Maryland

Tinea capitis is of public health importance because of its transmissibility. Trichophyton violaceum and Trichophyton soudanense, which are common causes of tinea capitis in parts of Africa and West Asia, have only rarely been reported to cause dermatophytoses in the United States. We identified 24 patients with 25 positive cultures for T. violaceum or T. soudanense that were processed in a single hospital laboratory in Baltimore, Maryland, between 1 January 2000 and 30 June 2006. Most patients for whom clinical information was available had tinea capitis. There was a marked increase in the isolation of these organisms between the period from 2000 to 2002 and the period from 2003 to 2006, possibly associated with changes in immigration to the Baltimore metropolitan area. The changing epidemiology of this transmissible fungal infection not only is of public health interest as an example of the introduction of a "new" pathogen to an area where it traditionally was not endemic but also is of clinical and microbiological importance given reports suggesting an increasing incidence of tinea capitis in some areas and increasing clinical failure rates of current therapies.