Epidemiological changes in tinea capitis over the sixty years of economic growth in China

Molecular epidemiology and antifungal susceptibility of dermatophytes and Candida isolates in superficial fungal infections at a grade A tertiary hospital in Northern China

This study analyzed the prevalence and antifungal susceptibility of superficial fungal infections in 295 cases from 2019 to 2020 at a dermatology clinic. Dermatophytes were the predominant pathogens (69.5%), including Trichophytonrubrum, T. interdigitale, Microsporum canis, et al., followed by Candida spp. (29.5%), including Candidaalbicans, Ca. parapsilosis, and Ca. glabrata. The most common infections were onychomycosis (36.3%), tinea cruris (30.5%), and tinea corporis (18.6%). The distribution of SFI types showed variations based on gender, age, and season. Common antifungal agents, including terbinafine, voriconazole, ciclopiroxamine, amphotericin B, itraconazole, and ketoconazole have exhibited low minimum inhibitory concentrations against dermatophytes, especially terbinafine, which has been potent against superficial fungal infections caused by dermatophytes in the local area. Candida spp. strains were generally susceptible or classified as wild-type to 5-flucytosine and amphotericin B, with 92.0% being wild-type for itraconazole. However, resistance to fluconazole and voriconazole was observed in a small percentage of Ca. albicans and Ca. parapsilosis strains. The emergence of drug-resistant Candida underscores the importance of prudent antifungal use and continuous surveillance.

Epidemiologic features and therapeutic strategies of kerion: A nationwide multicentre study

BACKGROUND

Kerion is a severe type of tinea capitis that is difficult to treat and remains a public health problem.

OBJECTIVES

To evaluate the epidemiologic features and efficacy of different treatment schemes from real-world experience.

METHODS

From 2019 to 2021, 316 patients diagnosed with kerion at 32 tertiary Chinese hospitals were enrolled. We analysed the data of each patient, including clinical characteristics, causative pathogens, treatments and outcomes.

RESULTS

Preschool children were predominantly affected and were more likely to have zoophilic infection. The most common pathogen in China was Microsporum canis. Atopic dermatitis (AD), animal contact, endothrix infection and geophilic pathogens were linked with kerion occurrence. In terms of treatment, itraconazole was the most applied antifungal agent and reduced the time to mycological cure. A total of 22.5% of patients received systemic glucocorticoids simultaneously, which reduced the time to complete symptom relief. Furthermore, glucocorticoids combined with itraconazole had better treatment efficacy, with a higher rate and shorter time to achieving mycological cure.

CONCLUSIONS

Kerion often affects preschoolers and leads to serious sequelae, with AD, animal contact, and endothrix infection as potential risk factors. Glucocorticoids, especially those combined with itraconazole, had better treatment efficacy.

Comprehensive Review of Tinea Capitis in Adults: Epidemiology, Risk Factors, Clinical Presentations, and Management

Tinea capitis is a fungal infection of the scalp and hair caused by dermatophyte molds, that most often affects children and may also affect adults. Previous estimates suggest that between 3% and 11% of all tinea capitis cases worldwide occur in adults, although updated epidemiological studies are needed to reassess the prevalence of tinea capitis in adult populations specifically. Postmenopausal adult women are most often affected by tinea capitis, with African American or Black women particularly at risk. Adults who experience crowded living conditions, who live in close proximity to animals, who are immunosuppressed, and/or who live in households with affected children are at greatest risk of infection. Tinea capitis can be non-inflammatory or inflammatory in nature, and the subtype affects the extent and severity of clinical symptoms. Fungal culture and potassium hydroxide preparations are the most commonly used diagnostic tools. Trichoscopy, defined as dermoscopic imaging of the scalp and hair, is a useful adjunct to the physical examination. The mainstay of therapy is oral antifungal therapy, and topical therapy alone is not recommended. Since tinea capitis infection is uncommon in adults, there are no widely accepted treatment guidelines. Rather, the same medications used for tinea capitis infection among children are recommended for adults at varying doses, including griseofulvin, and terbinafine, and, less commonly, itraconazole and fluconazole. The prognosis for tinea capitis in adults is typically excellent when prompt and adequate treatment is administered; however, delayed diagnosis or inadequate treatment can result in scarring alopecia. Over the past decade, dermatophyte infections resistant to treatment with topical and oral antifungal agents have emerged. While tinea capitis infections resistant to antifungal therapy have been rarely reported to date, antifungal resistance is rising among superficial fungal infections in general, and antifungal stewardship is necessary to ensure that resistance to treatment does not develop among dermatophytes that cause tinea capitis.

Tinea Capitis at Ibn Sina Hospital in Rabat, Morocco: Epidemiological and Etiological Study Over 25 Years (From 1997 to 2021)

Introduction/Objective In Morocco, tinea capitis is a common reason for consultation, especially in children. Our study aimed to determine the epidemiology of tinea capitis in the Central Laboratory of Parasitology and Mycology at the Ibn Sina University Hospital Center (UHC) in Rabat. Materials and methods This is a retrospective study conducted over 25 years (from 1997 to 2021). It included 247 patients with lesions suggestive of tinea capitis, who underwent a mycological examination. Results Among 594 requests for the diagnosis of tinea capitis, 247 cases were positive. A clear predominance of children (86.23%; n=213) as compared to adults (13.77%; n=34) was observed. The sex ratio (M/F) was 1.77. Hair parasitism was mainly dominated by the pure endothrix type 54.47% (n=122). The two most frequently isolated species were Trichophyton violaceum (51.24%; n=125) and Microsporum canis (36.06%; n=88). In children, these two species represented 47.42% (n=101) and 41.31% (n=88), respectively. In adults, Trichophyton violaceum was the predominant species, accounting for 77.42% (n=24); in females, it was 76.41% (n=68); and Microsporum canis was predominant in males (50.32%; n=78). Conclusion The epidemiology of this condition is in a constant state of flux, influenced by various lifestyle factors. Our research unveiled a notable upward trend in zoophilic species over the 25-year study period, while conversely, anthropophilic species demonstrated a discernible decline.

Tinea Capitis in Children Younger than Two Years Old: A Retrospective Study and Treatment Recommendations

BACKGROUND

Tinea capitis (TC) is a dermatophytosis of the scalp and hair, which occurs less common in children younger than two years of age, and the data of TC in this age group are still unknown.

OBJECTIVES

We aimed to reveal the epidemiological, clinical and mycological characteristics of TC in children under two years old.

METHODS

We retrospectively analyzed all reported cases of TC in children in their first two years of life from 1991 to 2022, by searching PubMed, Embase, Web of Science, CNKI, Wanfang and Weipu databases.

RESULTS

A total of 47 articles involving 126 cases of pediatric TC were enrolled in this study. The sex ratio (M/F) was 1.28:1. The age of the children ranged from ten days old to two years old with a median age of three months. The main clinical manifestations were alopecic patches (40 cases, 31.7%) and scaling (39 cases, 31.0%) on the scalp, and 29 infants (23.0%) appeared kerion. The most common sources of contagion were animals (35 cases, 27.78%) and humans (31 cases, 24.60%). The leading pathogens were Microsporidium canis (64 cases, 50.79%), followed by Trichophyton violaceum (13 cases, 10.32%), T. mentagrophytes complex (12 cases, 9.52%) and T. tonsurans (10 cases, 7.94%). Ninety-five children (75.40%) were treated with systemic antifungal drugs and 22 patients (17.46%) were only treated with topical therapy. Except for 10 patients with unknown final prognosis, all the other cases were cured after treatment. There was one child (0.79%) relapsed after treatment with griseofulvin and one case (0.79%) presented with gastrointestinal symptoms from griseofulvin.

CONCLUSION

The principal clinical symptoms of TC in children less than two years old were alopecic patches and scaling. The top four pathogens were M. canis, T. violaceum, T. mentagrophytes complex and T. tonsurans. Oral treatment for pediatric TC had achieved good therapeutic effects, and topical therapy can be an alternative choice.

Epidemiology and Clinical Findings of Tinea Capitis: A 23-Year Retrospective, Single-Center Study in Guangzhou, China

BACKGROUND

Tinea capitis (TC) is one of the most common public health concerns due to its high incidence in preadolescent children. The epidemiological and clinical characteristics of TC vary depending on geographical regions and have changed over the past decades.

OBJECTIVES

This study aimed to identify epidemiological changes in recent decades, including the prevalence and clinical and mycological characteristics of TC in southern China.

METHODS

We conducted a retrospective study at the Department of Dermatology of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from June 1997 to August 2020.

RESULTS

We retrospectively evaluated 401 TC patients. Of these, 157 patients (39.2%) were preschool children aged 3-7 years and the majority were males. However, the prevalence in children under 3 years old is on the rise (from 19.67% during 1997-2010 to 32.49% during 2011-2020). Grey patches were the most common clinical pattern and mostly occurred in children (71.3%), while the proportion of grey patches and black dots was almost the same in adults. Although Microsporum canis (76%) was the most common causative organism, the number of the T. mentagrophytes complex, as a zoophilic fungus, has increased more than that of the anthropophilic fungi T. violaceum in the recent decade. There was a significant difference in the portion of sex among different age groups, and the gender difference was more notable in the adult group, which showed that the TC prevalence in females was 9 times that in males. In males, M. canis and the T. mentagrophytes complex were the two most common causative fungi, while M. canis and T. violaceum were the two most common causative fungi in females. Additionally, approximately 61.7% of black dot TCs occurred in females. For treatment, oral antifungal therapeutics were widely used in most patients with different treatment durations, although without a significant difference in efficacy (P = 0.106).

CONCLUSIONS

In the last decade, the prevalence of TC in children under 3 years old increased, and boys dramatically outnumbered girls. In adults, the TC prevalence in females is nine times that in males, and most TCs occurring in females are presented as black dots. Moreover, the zoophilic T. mentagrophytes complex has replaced T. violaceum and is now the second most prevalent organism, followed by M. canis of TC.

Epidemiology of Tinea Capitis in Children in Beijing and Adjacent Regions, China: A 15-Year Retrospective Study

BACKGROUND

Tinea capitis is the most common dermatophytosis in children. Due to many factors, the types of pathogenic fungi of tinea capitis vary all over the world, and the pathogenic fungi of tinea capitis may change over time even in the same region.

OBJECTIVES

To investigated the epidemiological characteristics and pathogenic strains distribution of tinea capitis in children in Beijing and adjacent regions. Patients/Methods Through retrospective study and epidemiological analysis, we investigated the epidemiological characteristics of tinea capitis in children in Beijing and adjacent regions over 15 years.

RESULTS

A total of 1739 children with tinea capitis were retrospectively investigated from January 2006 to December 2020, including 1100 boys and 639 girls. A total of 67.4% of tinea capitis patients were between 1 and 5 years of age. A decreasing trend in tinea capitis was observed before 2009, while for the following 12 years, the incidence rate of tinea capitis fluctuated little. Zoophilic isolates (primarily Microsporum canis) were responsible for 88.4% of tinea capitis. Males are at greater risk for M. canis infection (p = 0.02).

CONCLUSION

Zoophilic species were responsible for approximately nine-tenth of the tinea capitis cases. The incidence of tinea capitis decreased before 2009.

The Epidemiology of Tinea Capitis in Guangxi Province, China

The aim of this study was to analyze the epidemiological characteristics and pathogen spectrum of tinea capitis in Guangxi, southern China. A multicenter prospective descriptive study was conducted in 8 hospitals across Guangxi. From January 2019 to July 2022, one hundred seventy-one (171) patients diagnosed with tinea capitis were included. Demographic data, risk factors, and fungal data were collected. If necessary, species were further identified by morphological or molecular sequencing in the central laboratory. Of the 171 cases of tinea capitis, 74.3% occurred in patients aged 2-8 years. Children with tinea capitis were mainly boys (59.6%) and were more likely than adults to have a history of animal contact (44.2% vs. 33.3%) and zoophilic dermatophyte infection (76.9% vs. 46.7%, P = 0.008). The adults were mainly female (53%) and were more likely than children to have a history of infection with anthropophilic organisms (53.3% vs. 18.9%). The causative agents of tinea capitis in Guangxi were diverse, and the most common pathogen was Microsporum canis (M. cani, n = 98, 62%), followed by Trichophyton mentagrophytes (T. mentagrophytes n = 18, 11.4%) and Trichophyton tonsurans (T. tonsurans n = 12, 7.6%). In addition, tinea capitis caused by Nannizzia incurvata (N. incurvata) and Trichophyton verrucosum (T. verrucosum) was detected in the study. Notably, the proportion of patients with kerion in the study was 41.5% (n = 71), and most of those patients were children (n = 68), especially neglected children living in the rural mountainous areas of Guangxi, where they were unable to receive timely diagnosis and appropriate treatment. In conclusion, the causative agents of tinea capitis in Guangxi, South China, are diverse, and the incidence of kerion is high, indicating that diagnosis and treatment modalities in the region remain grossly inadequate. Clinicians and policy-makers should collaborate to adopt public health strategies to control the disease.

Global Demographic Characteristics and Pathogen Spectrum of Tinea Capitis

Tinea capitis is an important superficial fungal infection with a global distribution. It mainly affects prepubertal children and is more common in males. Anthropophilic and zoophilic dermatophytes are responsible for most infections. The pathogen spectrum of tinea capitis varies across different regions and changes over time, and is influenced by multiple factors, such as economic development, changes in lifestyle, immigration and animal distribution. This review aimed to clarify the demographic and etiological characteristics of tinea capitis worldwide and determine the common trends of causative pathogens. By mainly analyzing the literature published from 2015 to 2022, we found that the incidence and demographic characteristics of tinea capitis remained generally stable. Zoophilic Microsporum canis, anthropophilic Trichophyton violaceum and Trichophyton tonsurans were the predominant pathogens. The pathogen spectra in different countries changed in different directions. In some countries, the main pathogen shifted to an anthropophilic dermatophyte, such as T. tonsurans, Microsporum audouinii or T. violaceum; in contrast, it shifted to a zoophilic agent, such as M. canis, in some other countries. Dermatologists are advised to continue monitoring the pathogen spectrum and implement preventive measures according to the reported changes.

Epidemiology and Aetiology of Tinea Capitis in Wuhan and Its Surrounding Areas from 2011 Till the Present: A Single-Center Retrospective Study

Tinea capitis is still common in Wuhan, and there exists significant difference in its pathogen spectrum between this area and other parts of China. In the present study, we aimed to clarify the epidemiological characteristics of tinea capitis and changes of pathogen spectrum in Wuhan and its surrounding areas from 2011 to 2022, and further to present potential risk factors focusing on some major etiological agents. Briefly, a retrospective single-center survey was performed on 778 patients with tinea capitis from 2011 to 2022 in Wuhan, China. The isolated pathogens were identified to species level by morphological examination or by ITS sequencing. The data were collected and statistically analyzed by Fisher's exact test and Bonferroni method. Among all enrolled patients, the most common pathogen was Trichophyton violaceum in both child (310, 46.34%) and adult tinea capitis (71, 65.14%). There existed significant difference in pathogen spectrum between child and adult tinea capitis. Furthermore, black-dot type represented the most common type of tinea capitis for both children (303, 45.29%) and adults (71, 65.14%). Notably, the number of cases caused by Microsporum canis consecutively exceeded that caused by Trichophyton violaceum in children from Jan, 2020 to Jun, 2022. Additionally, we suggested a series of potential factors that might increase the risks of acquiring tinea capitis by focusing on several major agents. Considering the different risk factors related to specific pathogen, it was meaningful to adjust the measures against the spreading of tinea capitis according to the changes of pathogen distribution within recent years.

Superficial Dermatophytosis across the World's Populations: Potential Benefits from Nanocarrier-Based Therapies and Rising Challenges

The most prevalent infection in the world is dermatophytosis, which is a major issue with high recurrence and can affect the entire body including the skin, hair, and nails. The major goal of this Review is to acquire knowledge about cutting-edge approaches for treating dermatophytosis efficiently by adding antifungals to formulations based on nanocarriers in order to overcome the shortcomings of standard treatment methods. Updates on nanosystems and research developments on animal and clinical investigations are also presented. Along with the currently licensed formulations, the investigation also emphasizes novel therapies and existing therapeutic alternatives that can be used to control dermatophytosis. The Review also summarizes recent developments on the prevalence, management approaches, and disadvantages of standard dosage types. There are a number of therapeutic strategies for the treatment of dermatophytosis that have good clinical cure rates but also drawbacks such as antifungal drug resistance and unfavorable side effects. To improve therapeutic activity and get around the drawbacks of the traditional therapy approaches for dermatophytosis, efforts have been described in recent years to combine several antifungal drugs into new carriers. These formulations have been successful in providing improved antifungal activity, longer drug retention, improved effectiveness, higher skin penetration, and sustained drug release.

Human adaptation and diversification in the Microsporum canis complex

The Microsporum canis complex consists of one zoophilic species, M. canis, and two anthropophilic species, M. audouinii and M. ferrugineum. These species are the most widespread zoonotic pathogens causing dermatophytosis in cats and humans worldwide. To clarify the evolutionary relationship between the three species and explore the potential host shift process, this study used phylogenetic analysis, population structure analysis, multispecies coalescent analyses, determination of MAT idiomorph distribution, sexual crosses, and macromorphology and physicochemical features to address the above questions. The complex of Microsporum canis, M. audouinii and M. ferrugineum comprises 12 genotypes. MAT1-1 was present only in M. canis, while the anthropophilic entities contained MAT1-2. The pseudocleistothecia were yielded by the mating behaviour of M. canis and M. audouinii. Growth rates and lipase, keratinolysis and urea hydrolytic capacities of zoophilic M. canis isolates were all higher than those of anthropophilic strains; DNase activity of M. ferrugineum exceeded that of M. canis. The optimum growth temperature was 28 °C, but 22 °C favoured the development of macroconidia. Molecular data, physicochemical properties and phenotypes suggest the adaptation of zoophilic M. canis to anthropophilic M. ferrugineum, with M. audouinii in an intermediate position.

Insights into Changing Dermatophyte Spectrum in India Through Analysis of Cumulative 161,245 Cases Between 1939 and 2021

Dermatophytosis is one of the most common superficial infections of the skin affecting nearly one-fifth of the world population at any given time. With nearly 30% of worldwide terbinafine-resistance cases in Trichophyton mentagrophytes/Trichophyton interdigitale and Trichophyton rubrum reported from India in recent years, there is a significant burden of the emerging drug resistance epidemic on India. Here, we carry out a comprehensive retrospective analysis of dermatophytosis in India using 1038 research articles pertaining to 161,245 cases reported from 1939 to 2021. We find that dermatophytosis is prevalent in all parts of the country despite variable climatic conditions in different regions. Our results show T. rubrum as the most prevalent until 2015, with a sudden change in dermatophyte spectrum towards T. mentagrophytes/T. interdigitale complex since then. We also carried out an 18S rRNA-based phylogenetics and an average nucleotide identity-and single nucleotide polymorphism-based analysis of available whole genomes and find very high relatedness among the prevalent dermatophytes, suggesting geographic specificity. The comprehensive epidemiological and phylogenomics analysis of dermatophytosis in India over the last 80 years, presented here, would help in region-specific prevention, control and treatment of dermatophyte infections, especially considering the large number of emerging resistance cases.

High Trichophyton violaceum-Induced Tinea Capitis with Isolation of Many Non-Dermatophyte Molds in Scalp Scrapings in Patients Referred to a Dermatology Clinic in Addis Ababa, Ethiopia

Objective

This work aimed to determine the magnitude of tinea capitis, the diversity and species composition of fungi, and the predominant dermatophytes implicated in causing tinea capitis.

Methods

A prospective, cross-sectional study was conducted at a dermatology clinic. Scalp scrapings were collected and cultured, and dermatophyte and non-dermatophyte molds were identified.

Results

Of 364 scalp scrapings, fungi were recovered from 301 (82.7%) clinical samples. About 60.7% of the samples were collected from women, while 39.3% were collected from male study subjects. The association between the magnitude of scalp ringworm and gender was not statistically significant (P = 0.105). Two hundred eighty study subjects were less than 15 years of age, of which 254 were culture positive. The association of tinea capitis and the age of patients was statistically significant (P = 0). Three hundred forty-nine fungal isolates were isolated, of which 54.2% were dermatophytes, while 45.8% were non-dermatophyte molds. The occurrence of dermatophytes in their decreasing order was T. violaceum (138; 73%), Trichophyton mentagrophytes (18; 9.5%), Trichophyton tonsurans (16; 8.5%), Trichophyton verrucosum (8; 4.5%), Microsporum audouinii (7; 3.7%), Trichophyton schoenleinii (1; 0.5%), and Trichophyton soudanense (1; 0.5%).

Conclusion

A high prevalence rate of T. violaceum-induced tinea capitis was reported. The magnitude of scalp ringworm in adults was remarkably high. Therefore, conducting a nationwide epidemiological survey on tinea capitis regardless of age is suggested. The isolation of many non-dermatophyte molds in the current study may shade questions about the perception that tinea capitis is caused by dermatophytes only. Therefore, studies on their potential pathogenic role on skin and skin-related (nail and the scalp) infections appear to be an active field of research.

Kerion Celsi caused by Microsporum gypseum in a Chinese child, a case report

RATIONALE

Kerion Celsi, a severe form of tinea capitis, is generally caused by zoophilic and geophilic fungi. This is the first report of an unusual case of kerion Celsi caused by Microsporum gypseum in a 6-year-old boy.

PATIENT CONCERNS

A 6-year-old boy presented to the dermatology clinic with the complaint of multiple pustules, edematous plaques over the scalp with hair loss for 1 month.

DIAGNOSIS

Clinical and laboratory investigations, including reverse transcriptase-quantitative polymerase chain reaction, confirmed M gypseum causing kerion Celsi.

INTERVENTIONS

Upon combination therapy using oral itraconazole and oral prednisolone along with the topical terbinafine, kerion Celsi remitted in the patient.

OUTCOME

New hair growth was noted during the 4-month follow-up.

LESSON

We presented the first case of kerion Celsi infection secondary to M gypseum that was probably transmitted from a guinea pig.

The Changing Face of Epidemiology of Dermatophytoses in Chinese Mainland: A 30 years Nationwide Retrospective Study from 1991 to 2020

BACKGROUND

Dermatophytoses are the most common infectious skin disease. Its epidemiology varies in different countries and regions, and its prevalence in China is still unknown.

OBJECTIVES

We aimed to reveal the epidemiological features of dermatophytoses in Chinese mainland in the past thirty years.

METHODS

From 1991 to 2020, a 30-year retrospective epidemiological study was carried out. All published literatures containing dermatophytoses and dermatophytes were collected and analyzed.

RESULTS

A total of more than 180,000 cases in 124 articles from more than 100 hospitals were included and analyzed. Among dermatophytoses, tinea cruris (24.92%) was the predominant clinical type, followed by tinea pedis (22.97%) and tinea corporis (18.12%). In recent 10 years, tinea pedis (25.40%) was more common than tinea cruris (22.39%) and became the most common infection. Among dermatophytes, T. rubrum (69.48%) has always been the most common isolates, followed by T. mentagrophytes (16.45%) and M. canis (8.09%). Other species were found below 3%. In superficial mycoses, dermatophytes accounted for 75.52%, higher than that of yeasts/yeast-like (21.83%) and molds (2.65%). The prevalence of tinea capitis was lower in economically developed eastern region than that in central and western regions. Tinea cruris was more common in warm zones than cold zones.

CONCLUSIONS

The top three dermatophytoses are tinea cruris, tinea pedis and tinea corporis, while the top three dermatophytes are T. rubrum, T. mentagrophytes and M. canis. The distribution of dermatophytoses may be influenced by socioeconomic status and geographical-meteorological conditions.

In vitro Activity of Allicin Alone and in Combination With Antifungal Drugs Against Microsporum canis Isolated From Patients With Tinea Capitis

The checkerboard broth method based on the Clinical and Laboratory Standards Institute M38-A3 document was used in this study to evaluate the in vitro activity of allicin alone and in combination with the antifungal drugs (griseofulvin, fluconazole, itraconazole and terbinafine) against Microsporum canis isolated from patients with tinea capitis. When allicin was used alone, only weak anti-M. canis effects were found. The MIC₅₀, MIC₉₀ and geometric mean (GM) of terbinafine were the lowest among the compounds tested. Synergism was observed for the combinations of allicin with itraconazole and terbinafine. Only indifference was observed for the combinations of allicin with griseofulvin and fluconazole. Our study illustrated the synergism of allicin in combination with itraconazole and terbinafine, which could be a reference for the treatment of tinea capitis due to M. canis.

Aetiology of tinea capitis in China: A multicentre prospective study

BACKGROUND

Tinea capitis is still common in developing countries, such as China. Its pathogen spectrum varies across regions and changes over time.

OBJECTIVES

This study aimed to clarify the current epidemiological characteristics and pathogen spectrum of tinea capitis in China.

METHODS

A multicentre, prospective descriptive study involving 29 tertiary hospitals in China was conducted. From August 2019 to July 2020, 611 patients with tinea capitis were enrolled. Data concerning demography, risk factors and fungal tests were collected. The pathogens were further identified by morphology or molecular sequencing when necessary in the central laboratory.

RESULTS

Among all enrolled patients, 74.1% of the cases were 2- to 8-year-olds. The children with tinea capitis were mainly boys (56.2%) and more likely to have an animal contact history (57.4% vs. 35.3%, P = 0.012) and zoophilic dermatophyte infection (73.5%). The adults were mainly females (83.3%) and more likely to have anthropophilic agent infection (53.5%). The most common pathogen was zoophilic Microsporum canis (354, 65.2%), followed by anthropophilic Trichophyton violaceum (74, 13.6%). In contrast to the eastern, western and northeastern regions where zoophilic M. canis predominated, anthropophilic T. violaceum predominated in central China (69.2%, P < 0.0001), where the patients had the most tinea at other sites (20.3%) and dermatophytosis contact (25.9%) with the least animal contact (38.8%). Microsporum ferrugineum was the most common anthropophilic agent in the western area, especially in Xinjiang Province.

CONCLUSIONS

Boys aged approximately 5 years were mainly affected. Dermatologists are advised to pay more attention to the different transmission routes and pathogen spectra in different age groups from different regions.

Review article: Emerging issues in pediatric skin of color, part 1

Dermatology for the pediatric skin of color population is the application of dermatology to the genetically diverse and distinctive segment of the pediatric population that includes children of non-White racial and ethnic groups with increased pigmentation including individuals of Asian, LatinX, African, Native American, Pacific Island descent, Indigenous Peoples, among others, with overlap in particular individuals, and mixtures thereof. Treating children of color is a unique skill set within the field of pediatric dermatology, requiring knowledge and sensitivity. The discipline of pediatric skin of color can be challenging. Difficulty in diagnosis of common conditions stems from underlying pigmentation, variations in common hairstyling practices, and differences in demographics of cutaneous disease, whereas some conditions are more common in children of color, other conditions have nuances in clinical appearance and/or therapeutics with regard to skin color. This article is the first in a series of two articles looking at recently published skin-related issues of high concern in children of color. Conditions reviewed in Part 1 include (1) hairstyling hair-related concerns (traction alopecia, central centrifugal cicatricial alopecia, endocrine disruption), (2) autoimmune concerns (cutaneous lupus, vitiligo), and (3) infections (tinea capitis, progressive macular hypomelanosis).

Aetiological changes of tinea capitis in the Hubei area in 60 years: Focus on adult tinea capitis

BACKGROUND

Tinea capitis is a common dermatophyte infection of the scalp primarily affecting children, with less frequent, though not rare, observation in adults.

OBJECTIVE

This study aimed to assess changes in the causative agents of adult tinea capitis over a 60-year period in the Hubei area.

METHODS

A retrospective, single-centre study was performed on 164 adults with tinea capitis between 1960 and 2020.

RESULTS

Out of 1113 cases of tinea capitis, 164 patients were adults, representing 14.7% of all patients. Adult tinea capitis was slightly more prevalent in males (91, 55.5%) than in females (73, 44.5%), but gender difference was not statistically significant between adults and children. Adult tinea capitis was most prevalent between the ages of 18 and 29 years, with a mean age of 22 years. Trichophyton schoenleinii was the most common dermatophyte in adult tinea capitis (78, 47.6%), followed by Trichophyton violaceum (58, 35.4%). Most adult tinea capitis cases before the 1980s were caused by T. schoenleinii, but T. violaceum has become the leading pathogen for recent adult tinea capitis cases.

CONCLUSION

Tinea capitis is not a disease exclusive to children. On the contrary, an upward trend of tinea capitis in adults has been observed in recent years. T. violaceum has become the dominant causative agent of adult tinea capitis in the Hubei area, replacing T. schoenleinii. These results provide a better understanding of the treatment and prevention of tinea capitis in adults.

Comprehensive genome and transcriptome analysis of the dermatophyte Trichophyton schoenleinii reveals the candidate pathogenic genes

BACKGROUND

Trichophyton schoenleinii is an anthropophilic dermatophyte that causes tinea favosa. Nowadays, it remains an important pathogen in some regions of the world, mainly epidemic in Africa and West Asia. Despite the medical importance of T. schoenleinii infections, a high-quality reference genome for T. schoenleinii is still unavailable, neither its transcriptomic profile.

OBJECTIVES

The aim of the current study was to improve understanding of the underlying pathogenic mechanism of T. schoenleinii, and to define the candidate pathogenic genes of T. schoenleinii.

METHODS

Comprehensive genomic analysis of T. schoenleinii was carried out by Illumina and PacBio sequencing platforms. Transcriptome profiles of T. schoenleinii cultured in vitro in two media containing either keratin or soy protein were determined using RNA sequencing (RNA-seq) technology.

RESULTS

Here, we present the first draft genome sequence of T. schoenleinii strain T2s, which consists of 11 scaffolds containing 7474 predicted genes. Transcriptome analysis showed that genes involved in keratin hydrolysis have higher expression in T. schoenleinii grown in keratin medium, including genes encoding proteases, cysteine dioxygenase and acetamidase. Other genes with higher expression include genes encoding the components of the pH-responsive signal transduction pathways and transcription factors, many of which may play a role in pathogenicity.

CONCLUSION

In summary, this study provides new insights into the pathogenic mechanism of T. schoenleinii and highlights candidate genes for further development of novel targets in disease diagnosis and treatment of tinea favosa.

Tinea capitis in children: A single-institution retrospective review from 2011 to 2019

Tinea capitis remains a common public health problem worldwide, especially in developing countries.

OBJECTIVES

To investigate the changes of the predominant dermatophytes of tinea capitis in children in Hangzhou in recent 9 years.

METHODS

The age, gender and pathogen spectrum of 650 children with tinea capitis at the Department of Dermatology, Affiliated Third People's Hospital of Hangzhou, Anhui Medical University from 2011 to 2019 were analysed, and the distribution of pathogens from 1998 to 2000 was compared.

RESULTS

Among the 650 cases, 340 cases (48.2%) were males and 310 cases (51.8%) were females. The main population infected with tinea capitis was children aged 0-10 years (620 cases, 95.4%). From 2011 to 2019, the predominant dermatophyte was changed from Trichophyton violaceum (2011) to Trichophyton mentagrophytes complex (2012-2015) and later to Microsporum canis (2016-2019). In the past 9 years, M. canis (250 cases, 38.5%) was the most common dermatophyte and followed by T mentagrophytes complex (209 cases, 32.2%). The dermatophyte spectrum was statistically different between the years 2011 and 2019 (Chi square: χ²  = 69.75, P < .05), and the differences in anthropophilic and zoophilic pathogens between 1989-2000 and 2011-2019 were statistically significant (χ²  = 24.4, P < .05).

CONCLUSIONS

Research showed that children diagnosed with tinea capitis were mainly 0-10 years old. With age, the percentage of anthropophilic dermatophytes gradually increased, while the percentage of zoophilic dermatophytes decreased. M. canis was the predominant dermatophyte of tinea capitis in children, followed by T. mentagrophytes complex. The dermatophytes have shifted from anthropophilic to zoophilic dermatophytes in the past two decades.

Clinical and epidemiological characteristics of tinea capitis in northern Taiwan during 2014-2019: An unusual bimodal distribution of patients and comparison of paediatric and adult cases

Tinea capitis (TC) mainly occurs in children, and related studies in adults are rare. We aimed to investigate the current epidemiological, clinical and mycological characteristics of TC and to compare adult and paediatric patients in northern Taiwan. We conducted a retrospective study at Chang Gung Memorial Hospital, Linkou Branch, from 2014 to 2019. The dataset included age, sex, records of underlying diseases, animal contact history, frequent hair salon visits, clinical patterns, treatment and outcome via chart or phone call reviews. The average ages of 72 children and 104 adults recruited were 6.0 and 74.0 years, respectively. A female predominance was noted in both groups, and the ratio of females was significantly higher in adults (94.2% vs 59.7%, P < .0001). Microsporum canis (76.4%) and Trichophyton mentagrophytes (11.1%) in children, and M. canis (49.0%) and T. violaceum (31.7%) in adults were the most common pathogens. Adults were more likely to be infected with T. violaceum (OR = 10.14, 95% CI = 2.04-50.26) than children. In contrast, adults were less likely to be infected with M. canis than children (OR = 0.31, 95% CI = 0.11-0.90). Furthermore, adults visited hair salons more, had less animal contact and were more immunosuppressed than children. TC is not unusual in the adult population. Dermatologists are advised to realise risk factors such as immunosuppression and regular hair salon visit in adult TC.

Analysis on the pathogenic fungi in patients with superficial mycosis in the Northeastern China during 10 years

This study analyzed the infection of superficial mycosis and the relationship between the distribution characteristics of pathogenic fungi and age, time and sex in Northeast China in the past 10 years. We would like to provide a theoretical basis for the diagnosis and treatment of related diseases. From December 2008 to December 2018, 5,374 superficial mycoses from Northeast China were selected. The fungal species were identified by fungal microscopy, fungal culture, and species identification. Besides, the relationship between sex, age, time and the distribution of superficial mycosis and pathogenic fungi was analyzed. Among the 5,374 patients, the top three infections were tinea pedis (n=1,538, 28.62%), tinea cruris (n=1,018, 18.94%) and tinea corporis (n=938, 17.45%). The top three pathogens were Trichophyton rubrum (n=2,849, 48.65%), Trichophyton mentagrophytes (n=947, 16.14%) and Candida spp. (n=804, 13.70%). The main pathogenic fungi were dermatophytes. The age group with the highest incidence of tinea capitis was children (n=372, 6.92%). The highest incidence rate of tinea pedis was in 31-69-year adults (n=905, 16.84%); Malassezia mainly affects young people aged 15-30. Yeast and mold mostly invade the elderly patients >60 years old. The incidence of tinea cruris, tinea pedis and tinea corporis in male patients was higher than that in female patients. The incidence of onychomycosis in female patients was higher than that in male patients (P<0.05). The isolation rate of Candida, Mold, Microsporum canis, Malassezia and Sporothrix increased year by year, while that of Trichophyton rubrum, Trichophyton mentagrophyte, Trichophyton schoenleinii and Epidermophyton floccosum decreased. From December 2008 to December 2018, dermatophytes were the main pathogens of superficial mycosis in Northeast China. The distribution of disease species and pathogenic fungi varied in different gender, age and time.

Updates on Genital Dermatophytosis

Dermatophytes are a group of keratinophilic fungi, which normally cause superficial infection of skin, hair and nails. Based on ecology, they are classified into three groups: anthropophilic, zoophilic and geophilic. Superficial dermatophytic infection of the genital region is called genital dermatophytosis, tinea genitalis or pubo-genital dermatophytosis. In this review, we would like to discuss briefly, the various clinical presentations of genital dermatophytosis, current changes in the taxonomy and nomenclature, introduction of new diagnostic techniques and briefly describe some common dermatophytes and their sources. Also, there are serious concerns associated with the recent development of antifungal resistance among the dermatophytes. We are also facing the scenario of hard-to-treat dermatophytosis.

Burden of tinea capitis among children in Africa: protocol for a systematic review and meta-analysis of observational studies, 1990-2020

INTRODUCTION

Tinea capitis is the most common form of dermatophytosis among children, contributing significantly to the global burden of skin and hair infections. However, an accurate account of its burden in Africa, where most cases are thought to occur, is lacking. We aim to systematically evaluate the burden, aetiology and epidemiological trend of tinea capitis among children over a 30-year period in Africa.

METHODS AND ANALYSIS

A systematic review will be conducted using Embase, PubMed, African Journals Online, Web of Science and the Cochrane Library of Systematic Review. These resources will be used to identify studies published between 1990 and December 2020, which report the prevalence, aetiology and trend of tinea capitis among children younger than 18 years in Africa. Articles in English and French will be considered. Two independent reviewers will screen the articles for eligibility, and any discrepancies will be resolved by discussion and consensus between the authors. Methodological quality of all studies will be assessed and critically appraised. We will perform a metaregression to assess the impact of study characteristics on heterogeneity and also to correct the meta-analytical estimates for biases. A qualitative synthesis will be performed, and STATA V.16.0 software will be used to estimate the pooled prevalence and aetiology of tinea capitis. The Mann-Kendall trend test will be use to evaluate the trend in the prevalence of tinea capitis over the study period.

ETHICS AND DISSEMINATION

Ethical approval from an institutional review board or research ethics committee is not required for this systematic review and meta-analysis. The results will be published in a peer-reviewed journal and presented in conferences.

Isolation of dermatophytes from dogs and cats in the South of England between 1991 and 2017

BACKGROUND

Since the epidemiology of canine and feline dermatophytosis might evolve in response to chronological, sociological and ecological factors, the authors studied the occurrence of dermatophyte pathogens over 27 years subsequent to the last major UK survey.

METHODS

Dermatophyte culture submission records from dogs and cats to the Royal Veterinary College Diagnostic Laboratory in England between 1991 and 2017 were reviewed. Samples were routinely cultured aerobically at 26°C for up to four weeks on Sabouraud's dextrose agar containing cycloheximide and chloramphenicol; dermatophytes were identified using conventional phenotypic methods.

RESULTS

Proportional isolation from cats (15.9 per cent of 1389) exceeded that of dogs (8.1 per cent of 2193) (P<0.001). Together, Microsporum canis and Trichophyton mentagrophytes accounted for 91.9 per cent (n=203) and 80.2 per cent (n=142) of isolations from cats and dogs, respectively. M canis was more frequently (P<0.001) isolated from cats and dogs under two years of age. Dermatophytes were more frequent (P≤0.001) in samples from first-opinion rather than referral practice, and from Jack Russell and Yorkshire terriers and from Persian and chinchilla cats (P≤0.002).

CONCLUSIONS

M canis and T mentagrophytes remain the most common agents of canine and feline dermatophytosis in the South of England; continued clinical vigilance is required.

First report of kerion (tinea capitis) caused by combined Trichophyton mentagrophytes and Microsporum canis

A 5-year-old boy was presented with large ulcer accompanied by surrounding follicular pustules on the left parietal scalp. Dermoscopy showed "comma" and dystrophic broken hairs. Fungal culture showed mixed growth of two types of colonies. Trichophyton mentagrophytes and Microsporum canis were identified by using mycological examinations. To our knowledge, this is the first case of kerion caused by the combined Trichophyton mentagrophytes and Microsporum canis. Treatment with oral terbinafine for 2 months was effective.

Outbreak of Trichophyton soudanense causing tinea capitis in an orphanage in Myanmar

We report an outbreak of Trichophyton soudanense causing tinea capitis and corporis in an orphanage in Myanmar. The thirty orphan children were suspected to have anthropophilic tinea but zoonotic tinea could not be excluded as all children were playing with stray dogs. Direct mycological examinations of hair and scalp samples showed filaments but culture assays remained sterile. We revealed T. soudanense as the infectious agent by PCR amplification of extracted fungal DNA and further sequencing of the PCR products. Children were successfully treated by terbinafine and reinfection was prevented by hygiene measures. This case report shed the light on T. soudanense infection on another continent than Africa and on the significant help of PCR identification.

Molecular epidemiology and in vitro antifungal susceptibility of Trichophyton schoenleinii, agent of tinea capitis favosa

Trichophyton schoenleinii is an anthropophilic dermatophyte usually causing tinea favosa. Only few studies have provided data on molecular epidemiology and antifungal profiles of this fungus due to its limited prevalence after 1950s. Forty-nine strains from Asia (n = 27), Africa (n = 10), Europe (n = 10) and from unknown regions (n = 2) were analysed with amplified fragment length polymorphism fingerprinting (AFLP) to reveal intraspecific genetic diversity in this dataset. Amplified fragment length polymorphism fingerprinting genotyping revealed five clusters which did not correspond to geographic origins or clinical characteristics. Additionally, in vitro antifungal susceptibility to seven antifungals was provided for all strains. Terbinafine, ketoconazole, miconazole and itraconazole proved to be the most effective drugs, followed by griseofulvin. No correlation between genotypes and differences in antifungal susceptibility was observed. It is concluded that the AFLP groups are lineages within a single species.

Phylogeny of dermatophytes with genomic character evaluation of clinically distinct Trichophyton rubrum and T. violaceum

Trichophyton rubrum and T. violaceum are prevalent agents of human dermatophyte infections, the former being found on glabrous skin and nail, while the latter is confined to the scalp. The two species are phenotypically different but are highly similar phylogenetically. The taxonomy of dermatophytes is currently being reconsidered on the basis of molecular phylogeny. Molecular species definitions do not always coincide with existing concepts which are guided by ecological and clinical principles. In this article, we aim to bring phylogenetic and ecological data together in an attempt to develop new species concepts for anthropophilic dermatophytes. Focus is on the T. rubrum complex with analysis of rDNA ITS supplemented with LSU, TUB2, TEF3 and ribosomal protein L10 gene sequences. In order to explore genomic differences between T. rubrum and T. violaceum, one representative for both species was whole genome sequenced. Draft sequences were compared with currently available dermatophyte genomes. Potential virulence factors of adhesins and secreted proteases were predicted and compared phylogenetically. General phylogeny showed clear gaps between geophilic species of Arthroderma, but multilocus distances between species were often very small in the derived anthropophilic and zoophilic genus Trichophyton. Significant genome conservation between T. rubrum and T. violaceum was observed, with a high similarity at the nucleic acid level of 99.38 % identity. Trichophyton violaceum contains more paralogs than T. rubrum. About 30 adhesion genes were predicted among dermatophytes. Seventeen adhesins were common between T. rubrum and T. violaceum, while four were specific for the former and eight for the latter. Phylogenetic analysis of secreted proteases reveals considerable expansion and conservation among the analyzed species. Multilocus phylogeny and genome comparison of T. rubrum and T. violaceum underlined their close affinity. The possibility that they represent a single species exhibiting different phenotypes due to different localizations on the human body is discussed.

In Vitro Antifungal Susceptibility Profiles of 12 Antifungal Drugs against 55 Trichophyton schoenleinii Isolates from Tinea Capitis Favosa Patients in Iran, Turkey, and China

Trichophyton schoenleinii is an anthropophilic dermatophyte mainly causing tinea favosa of the scalp in certain regions of the world, especially Africa and Asia. We investigated the in vitro susceptibilities of 55 T. schoenleinii isolates collected over the last 30 years from Iran, Turkey, and China to 12 antifungals using the CLSI broth microdilution method. Our results revealed that terbinafine and ketoconazole were the most potent antifungal agents among those tested, independently of the geographic regions where strains were isolated.

The Changing Face of Dermatophytic Infections Worldwide

Dermatophytes evolve along with the geography and socioeconomic conditions. Epidermophyton floccosum, Microsporum audouinii and Trichophyton schoenleinii acted as the major pathogens of superficial fungal diseases 100 years ago, but their frequency decreased dramatically since the middle of the twentieth century and they are limited to some less-developed countries nowadays; meanwhile, frequency of Trichophyton rubrum, Trichophyton interdigitale, Trichophyton tonsurans and Microsporum canis increased gradually, and these fungi have become the major species globally. Some other dermatophytes, i.e., Trichophyton violaceum, Trichophyton verrucosum and Microsporum ferrugineum, are mainly endemic in some parts of Africa, Asia and Europe. At present, T. rubrum is the leading pathogen for skin and nail fungal infections, whereas M. canis, T. tonsurans and T. violaceum present as the predominant dermatophytes involved in tinea capitis. Population mobility, changes in human lifestyle and advents of antifungal drugs will continually drive the dermatophyte evolution in the skin microenvironment. Comprehensive observation is needed to better understand this kind of organisms and prospect the trends of their changes in future.

Tinea capitis: a retrospective epidemiological comparative study

BACKGROUND

Currently, a wide spectrum of retrospective studies regarding the incidence of TC among children and adults are available in the world literature, but none of them are comparative, aiming to distinguish etiological diversity depending on the different geographic areas.

OBJECTIVE

This study aimed to investigate the epidemiology of TC in Plovdiv, Bulgaria and Thessaloniki, and Greece, and to compare the results and predominant etiological agents using retrospective comparative analysis for an 11-year time period.

MATERIALS AND METHODS

The subjects included were selected from archives of the Mycological Laboratory of the University Dermatologic Clinic, University Hospital "St. George" Plovdiv, Bulgaria, and the Mycological Laboratory of the First Dermatology Department of Aristotle University Thessaloniki, Greece, by retrospective analysis of data from an 11-year time period (2004-2014). A total count of 374 children aged 0-18, with confirmed diagnosis of TC via direct mycological examination and culture were included (128 children from Plovdiv, Bulgaria, and 246 children from Thessaloniki, Greece). Samples were plated on Sabouraud agar, followed by species identification of the isolated colonies.

RESULTS

Our results demonstrate that the incidence of TC in the region of Bulgaria and Thessaloniki for the investigated period was lower than for the previously reported period. In Plovdiv, Bulgaria, it was 1.20 ± 0.09 % (n = 172 from a total count of 14,278 cases of mycoses), as the disease accounts for 23.10 ± 1.79 % of all mycological infections among the pediatric population and 0.36 ± 0.05 % (n = 49 from a total count of 13,724) among the adults patients in Plovdiv, Bulgaria. The incidence of the disease during the period 2004-2014 in Thessaloniki was 2.49 ± 0.15 % (n = 253 cases of TC from a total count of 10,168 mycoses), as it accounts for approximately 27.06 ± 1.47 % of mycological infections among the pediatric population in Thessaloniki, Greece, and 0.08 ± 0.03 % (n = 7 from a total count of 9259) of the population of adult patients with mycoses. Our study confirmed the presumption that M. canis is the leader among the causative agents in TC in children in both of the included countries, but its presence in the etiology of disease in adult patients was very low and nonsignificant. We categorically identified dominance of the female gender among the children with TC in Plovdiv, Bulgaria; while in Thessaloniki, Greece, the gender distribution had an almost equal ratio of males to females.

CONCLUSION

Our results suggest that the gender predisposition depends also on the investigated geographic region and the time of the study, rather than only on the causative pathogen and age.

Epidemiological trends of dermatophytosis in Tehran, Iran: A five-year retrospective study

OBJECTIVE

Dermatophytosis is the most frequent fungal infection all over the world and its frequency is constantly increasing. The aim of this study was to evaluate clinical features and epidemiological trends of dermatophytosis over the years 2010 to 2014 in Tehran, Iran.

PATIENTS AND METHODS

A total of 13,312 patients clinically suspected of cutaneous fungal infections were examined. Skin scales, plucked hairs, nail clippings and sub-ungual debris were examined by direct microscopy and culture. Dermatophyte species were identified at the species level by a combination of morphological and physiological criteria.

RESULTS

Direct microscopy confirmed a contamination rate of 19.7% (2622/13,312 cases) of which 1535 cases (58.5%) were culture positive distributed in male (1022 cases) and female (513 cases). The most commonly infected age group was the 30-39 years old. Tinea pedis (30.4%) was the most prevalent type of dermatophytosis followed by tinea cruris (29.8%) and tinea corporis (15.8%). Epidermophyton floccosum (31%) was the most prevalent causative agent, followed by Trichophyton rubrum (26.2%) and Trichophyton mentagrophytes (20.3%).

CONCLUSION

Our results showed considerable distribution of dermatophytosis from zoophilic, anthropophilic and geophilic species among population with diverse age groups. Although anthropophilic fungi such as T. mentagrophytes, E. floccosum, and T. rubrum were the main etiologic agents of dermatophytosis, the prevalence of T. verrucosum showed a meaningful increase over the years, which highlights the importance of rural dermatophytosis mainly transmitted from large animals. This noticeable information improves our current knowledge about dermatophytosis and assists to establish effective prevention and therapeutic strategies to overcome the disease.

Aspergillus niger – a possible new etiopathogenic agent in Tinea capitis? Presentation of two cases

Tinea capitis is generally considered as the most frequent fungal infection in childhood, as it accounts for approximately 92% of all mycosis in children. The epidemiology of this disease varies widely ranging from antropophillic, zoophilic, and geophillic dermatophytes, as the main causative agent in different geographic areas, depending on several additional factors. Nowadays, the etiology is considered to vary with age, as well with gender, and general health condition. The former reported extraordinary Tinea capitis case reports have been replaced by original articles and researches dealing with progressively changing patterns in etiology and clinical manifestation of the disease. This fact is indicative that under the umbrella of the well-known disease there are facts still hidden for future revelations. Herein, we present two rare cases of Tinea capitis in children, which totally differ from the recently established pattern, in their clinical presentation, as well as in the etiological aspect, as we discuss this potential new etiological pattern of the disease, focusing on our retrospective and clinical observation. Collected data suggest that pathogenic molds should be considered as a potential source of infection in some geographic regions, which require total rationalization of the former therapeutic conception, regarding the molds’ higher antimitotic resistance compared to dermatophytes. Molds-induced Tinea capitis should be also considered in clinically resistant and atypical cases, with further investigations of the antifungal susceptibility of the newest pathogens in the frame of the old disease. Further investigations are still needed to confirm or reject this proposal.

Epidemiological Aspects of Dermatophytosis in Khuzestan, southwestern Iran, an Update

Dermatophytosis is among the most common superficial mycoses in Iran. The purpose of this report was to update the clinical and mycological features of human dermatophytosis in the Khuzestan, southwestern Iran. In the framework of a one-year survey, a total of 4120 skin, hair and nail samples obtained from the outpatients with symptoms suggestive of tinea were analyzed by using direct microscopy, culture and molecular identification methods. Strains isolated from cultures were subjected to amplification of the nuclear rDNA ITS regions in a PCR assay followed by an early established RFLP analysis. For confirmation of species identification, 100 isolates as representatives of all presumable species were subjected to ITS sequencing. Infection was confirmed in 1123 individuals (27.25 %) in the age range of 1-89 years by direct microscopy and/or culture including 603 males versus 520 females. Frequencies of infections were the highest and the lowest in age groups of 21-30 and 11-20 years, respectively. Tinea corporis was the most prevalent clinical manifestation followed by tinea cruris, tinea capitis, tinea manuum, tinea pedis, tinea unguium, tinea faciei and tinea barbae. Trichophyton interdigitale (58.7 %) was the most dominant isolate followed by Epidermophyton floccosum (35.4 %), Microsporum canis (3 %), T. rubrum (1.5 %), T. species of Arthroderma benhamiae (0.5 %), T. tonsurans (0.3 %) and T. violaceum (0.3 %). Other species included M. gypseum, M. fulvum and T. verrucosum (each one 0.1 %). Such a high occurrence of infection with T. interdigitale, which has not been reported from Iran, is due to the use of accurate molecular methods based on new species concept in dermatophytes. The prevalence of dermatophytoses caused by zoophilic species remarkably increased and Trichophyton species of A. benhamiae has emerged as a new agent of dermatophytosis in southwestern Iran, while infections due to anthropophilic species, except E. floccosum, took a decreasing trend.