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Chiriac A, Diaconeasa A, Voicu C, Ivaniciuc M, Miulescu R, Chiriac AE, Nenoff P, Wollina U. Kerion Celsi in infants and children-A narrative review 2010-2023. Mycoses 2024; 67:e13675. [PMID: 37983862 DOI: 10.1111/myc.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
Kerion Celsi is an inflammatory, deep fungal infection of the scalp. It is rare in neonates but gets more common in children about 3 years and older. It represents with swelling, boggy lesions, pain, alopecia and purulent secretions. Secondary bacterial infection is not unusual after maceration. Extracutaneous manifestations include regional lymphadenopathy, fever and very rare fungemia. Id-reactions can occur. Diagnosis is based on clinical suspicion, clinical examination and medical history. Diagnosis should be confirmed by microscopy, fungal culture and molecular procedures. The most common isolated fungal species are anthropophilic Trichophyton (T.) tonsurans and zoophilic Microsporum (M.) canis, while geophilic species and moulds rarely cause Kerion Celsi. Treatment is medical with systemic and topical antifungals supplemented by systemic antibiotics when necessary, while surgery needs to be avoided. Early and sufficient treatment prevents scarring alopecia. The most important differential diagnosis is bacterial skin and soft tissue infections.
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Affiliation(s)
- Anca Chiriac
- Department of Dermatology, Nicolina Medical Center, Iasi, Romania
- Apollonia University, Iasi, Romania
- Romanian Academy, P. Poni Institute of Macromolecular Chemistry, Iasi, Romania
| | - Adriana Diaconeasa
- Dermatology Ambulatory Care Center, "Grigore Alexandrescu" Clinical Emergency Hospital for Children, Bucharest, Romania
| | - Cristiana Voicu
- Department of Dermatology, MedLife Medical System, Bucharest, Romania
| | | | | | - Anca E Chiriac
- Department of Dermatology, Nicolina Medical Center, Iasi, Romania
| | - Pietro Nenoff
- Labor Leipzig-Mölbis, labopart - Medizinische Laboratorien, Rötha/OT Mölbis, Germany
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum, Dresden Academic Teaching Hospital, Dresden, Germany
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Schumny U, Wiegand C, Hipler UC, Darr-Foit S, Peckruhn M, Uhrlaß S, Nenoff P, Elsner P. Berufliche Infektion mit Trichophyton verrucosum bei einem Rinderzüchter. Hautarzt 2020; 71:899-902. [PMID: 32720167 PMCID: PMC7653785 DOI: 10.1007/s00105-020-04655-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Die Kälberflechte ist eine durch Tiere übertragene Pilzinfektion, die berufsbedingt auftreten und nach Nr. 3102 BKV (Berufskrankheiten-Verordnung) als Berufskrankheit anerkannt werden kann. Die durch Trichophyton verrucosum ausgelöste Zoonose zeichnet sich häufig durch einen schweren klinischen Verlauf aus, der nicht selten als bakterielle Infektion fehlgedeutet und primär antibiotisch behandelt wird. Die Gewinnung und mykologische Untersuchung von Schuppenmaterial ist diagnostisch entscheidend; auch eine Biopsie kann wegweisend sein. Die orale Therapie erfolgt leitliniengemäß mit Terbinafin. Zudem ist zum Schutz vor Reinfektionen auf besondere Hygienemaßnahmen in Ställen zu achten.
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Affiliation(s)
- Uta Schumny
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland.
| | - Cornelia Wiegand
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland
| | - Uta-Christina Hipler
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland
| | - Susanne Darr-Foit
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland
| | - Melanie Peckruhn
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland
| | - Silke Uhrlaß
- Labor für medizinische Mikrobiologie, Mölbiser Hauptstr. 8, 04571, Rötha, OT Mölbis, Deutschland
| | - Pietro Nenoff
- Labor für medizinische Mikrobiologie, Mölbiser Hauptstr. 8, 04571, Rötha, OT Mölbis, Deutschland
| | - Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland
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[7-year-old male with suppurative, abscess-forming, pressure painful lesions of the scalp : Preparation for the medical specialist examination: Part 14]. DER HAUTARZT 2019; 69:136-144. [PMID: 30374535 DOI: 10.1007/s00105-018-4272-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Wiegand C, Mugisha P, Mulyowa GK, Elsner P, Hipler UC, Gräser Y, Uhrlaß S, Nenoff P. Identification of the causative dermatophyte of tinea capitis in children attending Mbarara Regional Referral Hospital in Uganda by PCR-ELISA and comparison with conventional mycological diagnostic methods. Med Mycol 2018; 55:660-668. [PMID: 27760831 DOI: 10.1093/mmy/myw112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022] Open
Abstract
Tinea capitis is a dermatophyte infection common among prepubertal children in sub-Saharan Africa and mainly caused by Trichophyton and Microsporum species. Accurate identification is challenging as conventional methods like culture and microscopy are slow and mostly based on morphological characteristics, which make them less sensitive and specific. Modern molecular methods, like polymerase chain reaction (PCR) assays, are gaining acceptance and are quick as well as accurate. The aim of this study was to investigate the clinical patterns of tinea capitis and to accurately identify the most common causative dermatophytes affecting the scalps of children aged 1 to 16 years attending the Skin Clinic at Mbarara University of Science and Technology (MUST), Mbarara, Uganda, East Africa, using both conventional mycological methods and PCR-ELISA for detection of dermatophyte DNA. One hundred fifteen clinical samples from children from Western Uganda attending the MUST Skin Clinic with a clinical diagnosis of tinea capitis were analyzed. T. violaceum was identified as the most common causative agent, followed by M. audouinii, T. soudanense, and T. rubrum. The early identification of the causative agent of tinea capitis is a prerequisite for the effective management of the disease, the identification of probable source and the prevention of spreading. Children with tinea capitis in Western Uganda should be treated by systemic therapy rather than topical preparations to ensure high cure rates as the most common causative dermatophytes T. violaceum exhibits an endothrix rather than ectothrix invasion of the hair follicle.
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Affiliation(s)
| | - Peter Mugisha
- Dept. of Dermatology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Grace K Mulyowa
- Dept. of Dermatology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Germany
| | | | - Yvonne Gräser
- Konsiliarlabor für Dermatophyten, Institut für Mikrobiologie und Hygiene, Universitätsmedizin Berlin-Charité, Deutschland
| | - Silke Uhrlaß
- Labor für medizinische Mikrobiologie Mölbis, Germany
| | - Pietro Nenoff
- Labor für medizinische Mikrobiologie Mölbis, Germany
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Wollina U, Hansel G, Uhrlaß S, Krüger C, Schönlebe J, Hipler UC, Nenoff P. Deep facial mycosis due to Trichophyton verrucosum-molecular genetic identification of the dermatophyte in paraffin-embedded tissue-case report and review of the literature. Mycoses 2017; 61:152-158. [PMID: 29082569 DOI: 10.1111/myc.12719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/19/2017] [Indexed: 11/30/2022]
Abstract
Deep trichophytosis is relatively uncommon. The infection of the bearded area is also known as sycosis barbae or tinea barbae and can be caused by various fungal species, most often zoophilic fungi. We report on an 80-year-old male patient with severe sycosis barbae who had no animal contact and was treated with systemic antibiosis without improvement. Microbial and mycological investigations using swabs from oozing lesions revealed Staphylococcus haemolyticus and Candida parapsilosis. Histology demonstrated fungal elements in hair follicles. Paraffin-embedded material was subjected to further mycological analysis. For molecular diagnostics DNA was prepared from paraffin sections for real-time polymerase chain reaction (RT-PCR). For sequencing, DNA was isolated from paraffin-embedded skin tissue and the ITS region of the rDNA was selected. Sequencing of the ITS2 region of rRNA revealed a 100% accordance with Trichophyton (T.) verrucosum. Treatment with oral terbinafine achieved a complete remission. Sycosis barbae is an important differential diagnosis for infections of the bearded area. Nucleic acid amplification techniques (NAAT) are more and more used for direct examination of dermatophytes in clinical samples, eg T. verrucosum. NAAT are also used as culture confirmation tests for identification of rare dermatophytes like T. verrucosum. Today, singleplex and multiplex quantitative real-time PCR (qRT-PCR) assays for the detection of the most common dermatophytes including T. verrucosum in clinical specimens are available. Recently, an ITS2 PCR assay has been successfully used for direct detection of T. verrucosum in paraffin-embedded formalin-fixed skin tissue. The PCR is fast and highly specific. The sensitivity of direct molecular detection of the dermatophytes both in native clinical material, and in paraffin-embedded skin tissue can been increased.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Municipal Hospital Dresden, Academic Teaching Hospital Friedrichstadt, Dresden, Germany
| | - Gesine Hansel
- Department of Dermatology and Allergology, Municipal Hospital Dresden, Academic Teaching Hospital Friedrichstadt, Dresden, Germany
| | - Silke Uhrlaß
- Laboratory for Medial Microbiology, Mölbis, Germany
| | | | - Jacqueline Schönlebe
- Institute of Pathology "Georg Schmorl", Municipal Hospital Dresden, Academic Teaching Hospital Friedrichstadt, Dresden, Germany
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Nenoff P, Krüger C, Schaller J, Ginter-Hanselmayer G, Schulte-Beerbühl R, Tietz HJ. Mycology - an update part 2: dermatomycoses: clinical picture and diagnostics. J Dtsch Dermatol Ges 2015; 12:749-77. [PMID: 25176455 DOI: 10.1111/ddg.12420] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/19/2014] [Indexed: 11/28/2022]
Abstract
Most fungal infections of the skin are caused by dermatophytes, both in Germany and globally. Tinea pedis is the most frequent fungal infection in Western industrial countries. Tinea pedis frequently leads to tinea unguium, while in the elderly, both may then spread causing tinea corporis. A variety of body sites may be affected, including tinea glutealis, tinea faciei and tinea capitis. The latter rarely occurs in adults, but is the most frequent fungal infection in childhood. Following antifungal treatment of tinea unguium and also tinea capitis a dermatophytid or hyperergic reaction to dermatophyte antigens may occur. Yeast infections affect the mucous membranes both of the gastro-intestinal system and the genital tract as candidiasis mostly due to Candida albicans. Cutaneous candidiasis affects predominantely the intertriginous regions such as groins and the inframammary area, but also the intertriginous space of fingers and toes. In contrast, pityriasis versicolor is a superficial epidermal fungal infection primarily on the the trunk. Mold infections are rare in dermatology; they play a role nearly exclusively in nondermatophyte-mold (NDM) onychomycosis. The diagnosis of dermatomycoses comprises the microscopic detection of fungi using the potassium hydroxide preparation or alternatively the fluorescence optical Blankophor preparation together with culture. The histological fungal detection with PAS staining possesses a high sensitivity, and it should play a more important role in particular for diagnosis of onychomycosis. Molecular biological methods, based on the amplification of fungal DNA with use of specific primers for the distinct causative agents are on the rise. With PCR, such as dermatophyte-PCR-ELISA, fungi can be detected directly in clinical material in a highly specific and sensitive manner without prior culture. Today, molecular methods, such as Matrix Assisted Laser Desorption/Ionization Time-Of-Flight Mass Spectrometry (MALDI TOF MS) as culture confirmation assay, complete the conventional mycological diagnostics.
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Affiliation(s)
- Pietro Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
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Nenoff P, Krüger C, Schaller J, Ginter-Hanselmayer G, Schulte-Beerbühl R, Tietz HJ. Mykologie - ein Update Teil 2: Dermatomykosen: Klinisches Bild und Diagnostik. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12420_suppl] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Pietro Nenoff
- Labor für medizinische Mikrobiologie, Mölbis, Deutschland
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[Kerion caused by the zoophilic dermatophyte Trichophyton species of Arthroderma benhamiae in a child. A new emerging pathogen of dermatomycoses in Germany]. Hautarzt 2014; 64:846-9. [PMID: 24008933 DOI: 10.1007/s00105-013-2665-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Trichophyton (T.) species of Arthroderma (A.) benhamiae is a new emerging pathogen of dermatomycoses in children and adolescents. This zoophilic fungus seems to be more common than other zoophilic dermatophytes, e. g. Microsporum canis transmitted from cats to humans, zoophilic strains of T. interdigitale, and T. verrucosum as cause of ringworm of cattle. Trichophyton species of A. benhamiae is transmitted from guinea pigs (Cavia porcellus form. domestica) to human beings and causes highly inflammatory dermatomycoses both of the face and the scalp. When this dermatophyte produces purulent abscess-forming deep cutaneous infections of the scalp known as kerions, they are both a diagnostic and in particular a therapeutic challenge.
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