1
|
Deng R, Chen X, Zheng D, Xiao Y, Dong B, Cao C, Ma L, Tong Z, Zhu M, Liu Z, Lu S, Fu M, Jin Y, Yin B, Li F, Li X, Abliz P, Liu H, Zhang Y, Yu N, Wu W, Xiong X, Zeng J, Huang H, Jiang Y, Chen G, Pan W, Sang H, Wang Y, Guo Y, Shi D, Yang J, Ran Y, Hu J, Yang L, Bai S, Yu J, Wang X, Li R. Epidemiologic features and therapeutic strategies of kerion: A nationwide multicentre study. Mycoses 2024; 67:e13751. [PMID: 38825584 DOI: 10.1111/myc.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/13/2024] [Accepted: 05/26/2024] [Indexed: 06/04/2024]
Abstract
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.
Collapse
Affiliation(s)
- Ruixin Deng
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Xiaoqing Chen
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Dongyan Zheng
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuanyuan Xiao
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Bilin Dong
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
| | - Cunwei Cao
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhongsheng Tong
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
| | - Min Zhu
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zehu Liu
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meng Fu
- Department of Dermatology, Xijing Hospital, Xi'an, China
| | - Yun Jin
- Department of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, China
| | - Bin Yin
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, China
| | - Fuqiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China
| | - Xiaofang Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Palida Abliz
- Department of Dermatology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hongfang Liu
- Department of Dermatology, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Yu Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Nan Yu
- Department of Dermatology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Weiwei Wu
- Department of Dermatology, The Fifth People's Hospital of Hainan Province, Haikou, China
| | - Xincai Xiong
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jingsi Zeng
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huaiqiu Huang
- Department of Dermatology and Venereology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanping Jiang
- Department of Dermatology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Guanzhi Chen
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weihua Pan
- Department of Dermatology, Shanghai Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Hong Sang
- Department of Dermatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ying Wang
- Department of Dermatology, Changhai Hospital of Shanghai, Shanghai, China
| | - Yun Guo
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dongmei Shi
- Department of Dermatology, Jining First People's Hospital, Jining, China
| | - Jianxun Yang
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuping Ran
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Hu
- Department of Dermatology, The Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | | | - Shuang Bai
- The Affiliated Hospital of Inner Mongolia Medical University, Huhhot, China
| | - Jin Yu
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Xiaowen Wang
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| |
Collapse
|
2
|
Hill RC, Gold JAW, Lipner SR. Comprehensive Review of Tinea Capitis in Adults: Epidemiology, Risk Factors, Clinical Presentations, and Management. J Fungi (Basel) 2024; 10:357. [PMID: 38786712 PMCID: PMC11122068 DOI: 10.3390/jof10050357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Jeremy A. W. Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10021, USA
| |
Collapse
|
3
|
Hill RC, Caplan AS, Elewski B, Gold JAW, Lockhart SR, Smith DJ, Lipner SR. Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance. Am J Clin Dermatol 2024; 25:359-389. [PMID: 38494575 PMCID: PMC11201321 DOI: 10.1007/s40257-024-00848-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/19/2024]
Abstract
Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes.
Collapse
Affiliation(s)
| | - Avrom S Caplan
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Boni Elewski
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeremy A W Gold
- Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA, USA
| | - Shawn R Lockhart
- Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA, USA
| | - Dallas J Smith
- Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA.
| |
Collapse
|
4
|
Chen X, Liang Y, Guo Z, Huang R, Zheng W, Wu W, Li W. Photodynamic therapy combined with antifungal drugs against kerion: A report of six cases and literature review. Photodiagnosis Photodyn Ther 2024; 46:104039. [PMID: 38452908 DOI: 10.1016/j.pdpdt.2024.104039] [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: 01/14/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
Kerion, a severe manifestation of tinea capitis caused by dermatophytes, is a fungal skin disease primarily affecting children. This report discusses six cases of pediatric kerion that were successfully treated with a combination of photodynamic therapy (PDT) and antifungal agents. Additionally, we conducted a literature review, identifying and analyzing six published reports on kerion and tinea capitis. The characteristics and efficacies of these cases are summarized. In summary, early combination therapy and proactive pre-treatment interventions proved effective in maximizing therapeutic outcomes, reducing disease duration and minimizing adverse reactions such as cicatricial alopecia. This approach has emerged as a favorable choice for the treatment of kerion.
Collapse
Affiliation(s)
- Xiaoli Chen
- Department of Plastic and Dermatologic Surgery, The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China; Department of Plastic and Dermatological Surgery, Affiliated Dermatology Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yujia Liang
- Department of Plastic and Dermatologic Surgery, The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China; Department of Plastic and Dermatological Surgery, Affiliated Dermatology Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Ziyu Guo
- Department of Plastic and Dermatologic Surgery, The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China; Department of Plastic and Dermatological Surgery, Affiliated Dermatology Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Ruiye Huang
- Department of Plastic and Dermatologic Surgery, The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China; Department of Plastic and Dermatological Surgery, Affiliated Dermatology Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Wenai Zheng
- Department of Laboratory Medicine, The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China
| | - Weiwei Wu
- Department of Plastic and Dermatologic Surgery, The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China; Department of Plastic and Dermatological Surgery, Affiliated Dermatology Hospital of Hainan Medical University, Haikou, Hainan, China.
| | - Wen Li
- Department of Plastic and Dermatologic Surgery, The Fifth People's Hospital of Hainan Province, Haikou, Hainan, China; Department of Plastic and Dermatological Surgery, Affiliated Dermatology Hospital of Hainan Medical University, Haikou, Hainan, China.
| |
Collapse
|
5
|
Herzum A, Garibeh E, Gariazzo L, Occella C, Viglizzo G. Erythema nodosum triggered by kerion celsi in pediatrics: literature review and case report. An Bras Dermatol 2024; 99:312-315. [PMID: 38007316 PMCID: PMC10943322 DOI: 10.1016/j.abd.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 11/27/2023] Open
Affiliation(s)
- Astrid Herzum
- Dermatology Unit, IRCCS Giannina Gaslini, Genova, Italy.
| | - Ehab Garibeh
- Dermatology Unit, IRCCS Giannina Gaslini, Genova, Italy
| | | | | | | |
Collapse
|
6
|
Lefranc M, Fourmond S, Jabet A, Normand AC, Girard D, Accoceberry I, Gabriel F, Delhaes L, Imbert S. Severe kerion Celsi caused by Trichophyton quinckeanum: Severe kerion Celsi due to Trichophyton quinckeanum. J Mycol Med 2024; 34:101453. [PMID: 38042016 DOI: 10.1016/j.mycmed.2023.101453] [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: 08/23/2023] [Revised: 10/14/2023] [Accepted: 11/15/2023] [Indexed: 12/04/2023]
Abstract
We report a severe case of kerion Celsi of the scalp in a previously healthy 13-year-old girl due to Trichophyton quinckeanum, an emerging dermatophyte species in Europe. The species was definitely identified by DNA sequencing and the patient was successfully treated by oral terbinafine for 6 weeks. Kerion Celsi is a severe inflammatory form of tinea capitis, which is characterised by a purulent discharge and alopecia [1]. It typically occurs in children infected with zoophilic dermatophytes, such as Trichophyton mentagrophytes, and an increasing number of cases caused by other Trichophyton species has recently been reported [2]. Herein we report a severe case of kerion Celsi of the scalp caused by the emerging species Trichophyton quinckeanum, which was successfully treated by oral antifungal.
Collapse
Affiliation(s)
- M Lefranc
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - S Fourmond
- Service de Dermatologie, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - A Jabet
- Laboratoire de Parasitologie-Mycologie, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - A-C Normand
- Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier La Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - D Girard
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Sud Gironde, 33210 Langon, France
| | - I Accoceberry
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - F Gabriel
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - L Delhaes
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - S Imbert
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France.
| |
Collapse
|
7
|
Li F, He J, Yang T, Li S, Liu L, Huang Q, Duan X. 5-aminolevulinic acid-photodynamic therapy for a refractory severe kerion: A case report. Photodiagnosis Photodyn Ther 2023; 44:103888. [PMID: 37949388 DOI: 10.1016/j.pdpdt.2023.103888] [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: 08/30/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
Kerion is a subtype of tinea capitis with a severe inflammatory response, requiring early diagnosis to prevent secondary bacterial infection, folliculitis and permanent alopecia. Oral antifungal drugs are considered the first-line treatment for tinea capitis; however, drugs therapy is challenged by the long treatment duration, side effects, and drug resistance. Photodynamic therapy (PDT) has been widely used to treat dermatomycosis and has shown significant efficacy in recent years. We report the case of a girl who presented with refractory severe kerion following unregulated treatment and insensitivity to itraconazole; however,she was cured with 5-aminolevulinic acid-PDT. The case showed that PDT is a potentially promising alternative treatment for cutaneous fungal infections.
Collapse
Affiliation(s)
- Feng Li
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Jia He
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Ting Yang
- Department of Dermatology,Nanchong Central Hospital, Nanchong 637000, China
| | - Si Li
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Li Liu
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Qing Huang
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Xi Duan
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
| |
Collapse
|
8
|
Deng R, Wang X, Li R. Dermatophyte infection: from fungal pathogenicity to host immune responses. Front Immunol 2023; 14:1285887. [PMID: 38022599 PMCID: PMC10652793 DOI: 10.3389/fimmu.2023.1285887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Dermatophytosis is a common superficial infection caused by dermatophytes, a group of pathogenic keratinophilic fungi. Apart from invasion against skin barrier, host immune responses to dermatophytes could also lead to pathologic inflammation and tissue damage to some extent. Therefore, it is of great help to understand the pathogenesis of dermatophytes, including fungal virulence factors and anti-pathogen immune responses. This review aims to summarize the recent advances in host-fungal interactions, focusing on the mechanisms of anti-fungal immunity and the relationship between immune deficiency and chronic dermatophytosis, in order to facilitate novel diagnostic and therapeutic approaches to improve the outcomes of these patients.
Collapse
Affiliation(s)
- Ruixin Deng
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Xiaowen Wang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Ruoyu Li
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| |
Collapse
|
9
|
Dong B, Chen Y, Yu H, Chen Z, Yang J, Qu Z, Li M, Tong Z. Epidemiology and Aetiology of Tinea Capitis in Wuhan and Its Surrounding Areas from 2011 Till the Present: A Single-Center Retrospective Study. Mycopathologia 2023; 188:479-488. [PMID: 37185790 DOI: 10.1007/s11046-023-00732-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/26/2023] [Indexed: 05/17/2023]
Abstract
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.
Collapse
Affiliation(s)
- Bilin Dong
- Department of Dermatology, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Key Laboratory of Skin Infection and Immunity, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Research Center for Infectious Skin Diseases, No.1 Hospital of Wuhan, Wuhan, China
| | - Yao Chen
- Department of Dermatology, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Key Laboratory of Skin Infection and Immunity, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Research Center for Infectious Skin Diseases, No.1 Hospital of Wuhan, Wuhan, China
| | - Huiyuan Yu
- Department of Dermatology, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Key Laboratory of Skin Infection and Immunity, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Research Center for Infectious Skin Diseases, No.1 Hospital of Wuhan, Wuhan, China
| | - Zunyi Chen
- Department of Dermatology, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Key Laboratory of Skin Infection and Immunity, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Research Center for Infectious Skin Diseases, No.1 Hospital of Wuhan, Wuhan, China
| | - Jing Yang
- Department of Dermatology, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Key Laboratory of Skin Infection and Immunity, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Research Center for Infectious Skin Diseases, No.1 Hospital of Wuhan, Wuhan, China
| | - Zilu Qu
- Department of Dermatology, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Key Laboratory of Skin Infection and Immunity, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Research Center for Infectious Skin Diseases, No.1 Hospital of Wuhan, Wuhan, China
| | - Meihua Li
- Department of Dermatology, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Key Laboratory of Skin Infection and Immunity, No.1 Hospital of Wuhan, Wuhan, China
- Hubei Research Center for Infectious Skin Diseases, No.1 Hospital of Wuhan, Wuhan, China
| | - Zhongsheng Tong
- Department of Dermatology, No.1 Hospital of Wuhan, Wuhan, China.
- Hubei Key Laboratory of Skin Infection and Immunity, No.1 Hospital of Wuhan, Wuhan, China.
- Hubei Research Center for Infectious Skin Diseases, No.1 Hospital of Wuhan, Wuhan, China.
| |
Collapse
|
10
|
González FE, Rodríguez JA, Muñoz LM, Apráez G, Vásquez LR. An outbreak of trichophytic tinea capitis in a group of schoolchildren in a rural area of the department of Cauca, Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:57-68. [PMID: 37721918 PMCID: PMC10593267 DOI: 10.7705/biomedica.6793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/13/2023] [Indexed: 09/20/2023]
Abstract
Introduction. Tinea capitis is a mycosis of keratinized tissue, which affects the scalp and may cause alopecia, pruritus, and desquamation. This type of mycosis is more frequent in school-age children, and it may represent a public health problem; the main etiological agents reported for Colombia are zoophilic dermatophytes. Objective. To characterize an outbreak of Tinea capitis in 32 children from a rural school in the department of Cauca. Materials and methods. We conducted an epidemiological field study using a structured survey to characterize sociodemographic aspects and predisposing factors for this mycosis. We collected samples of affected scalp scales and hair for mycological studies. The children and the general population received recommendations, about these mycoses’ prevention, from Cauca’s health authorities and the local hospital. The parents verbally approved the informed consent. Results. The etiological agent isolated in 63% of the collected samples was Trichophyton tonsurans, an anthropophilic dermatophyte, and the main predisposing factor was sharing razors (87.5%). Conclusions. Ideally, mycological studies define the etiological agent to propose therapeutics and recommendations in agreement with management guidelines. Implementation of multidisciplinary measures to control the outbreak and educate the population is required.
Collapse
Affiliation(s)
| | | | - Lina María Muñoz
- Facultad Ciencias de la Salud, Universidad del Cauca, Popayán, Colombia.
| | - Giovanny Apráez
- Secretaría Departamental de Salud, Gobernación del Cauca, Popayán, Colombia; Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | | |
Collapse
|
11
|
Fratti M, Bontems O, Salamin K, Guenova E, Monod M. Survey on Dermatophytes Isolated from Animals in Switzerland in the Context of the Prevention of Zoonotic Dermatophytosis. J Fungi (Basel) 2023; 9:jof9020253. [PMID: 36836366 PMCID: PMC9967568 DOI: 10.3390/jof9020253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
Most inflammatory dermatophytoses in humans are caused by zoophilic and geophilic dermatophytes. Knowledge of the epidemiology of these fungi in animals facilitates the prevention of dermatophytosis of animal origin in humans. We studied the prevalence of dermatophyte species in domestic animals in Switzerland and examined the effectiveness of direct mycological examination (DME) for their detection compared to mycological cultures. In total, 3515 hair and skin samples, collected between 2008 and 2022 by practicing veterinarians, were subjected to direct fluorescence microscopy and fungal culture. Overall, 611 dermatophytes were isolated, of which 547 (89.5%) were from DME-positive samples. Cats and dogs were the main reservoirs of Trichophyton mentagrophytes and Microsporum canis, whereas Trichophyton benhamiae was predominantly found in guinea pigs. Cultures with M. canis significantly (p < 0.001) outnumbered those with T. mentagrophytes in DME-negative samples (19.3% versus 6.8%), possibly because M. canis can be asymptomatic in cats and dogs, unlike T. mentagrophytes, which is always infectious. Our data confirm DME as a reliable, quick, and easy method to identify the presence of dermatophytes in animals. A positive DME in an animal hair or skin sample should alert people in contact with the animal to the risk of contracting dermatophytosis.
Collapse
Affiliation(s)
- Marina Fratti
- Service de Dermatologie, Laboratoire de Mycologie, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Olympia Bontems
- Service de Dermatologie, Laboratoire de Mycologie, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Karine Salamin
- Service de Dermatologie, Laboratoire de Mycologie, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Emmanuella Guenova
- Service de Dermatologie, Laboratoire de Mycologie, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Michel Monod
- Service de Dermatologie, Laboratoire de Mycologie, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-21-314-0376; Fax: +41-21-314-0378
| |
Collapse
|
12
|
Shemer A, Lyakhovitsky A, Kaplan B, Kassem R, Daniel R, Caspi T, Galili E. Diagnostic approach to tinea capitis with kerion: A retrospective study. Pediatr Dermatol 2022; 39:708-712. [PMID: 35510777 DOI: 10.1111/pde.15021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kerion is an inflammatory type of tinea capitis manifesting as boggy crusted nodules. Diagnosis of kerion is often challenging due to high rates of false-negative mycological samples. METHODS A retrospective study among children with kerion, prior to antifungal treatment, was conducted to assess rates of false-negative mycological samples. Specimens for direct microscopy and fungal culture were collected at baseline and after administration of an oral antibiotic course, with or without an oral steroid course. Kerion was categorized as highly inflammatory when a painful, moist scalp nodule with spontaneous purulent discharge or exuberant crust was present, or mildly inflammatory when an erythematous, dry scalp nodule was seen. RESULTS Twenty-three children (mean age 7.9 ± 3.0 years) were included in the study. Trichophyton tonsurans was the most common species isolated (69.6%). Highly inflammatory kerions were significantly more likely to be culture negative before treatment than mildly inflammatory kerions (80% vs. 16.7%, p < .01). Non-inflammatory tinea capitis lesions (n = 13) were culture positive in all cases. Following a combined oral antibiotic and steroid course given to most highly inflammatory kerions (n = 11/13), higher rates of positive fungal cultures were found compared to baseline (90.9% vs. 18.2%, p < .01). CONCLUSION High rates of negative fungal cultures were found only in highly inflammatory kerion. Sampling a highly inflammatory kerion after a combined oral antibiotic and steroid course improved rates of positive fungal cultures. In addition, sampling of non-inflammatory tinea capitis lesions (when present in addition to the kerion) had the highest culture sensitivity.
Collapse
Affiliation(s)
- Avner Shemer
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Kaplan
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Riad Kassem
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ralph Daniel
- University of Mississippi Medical Center, Jackson, Mississippi, USA.,University of Alabama, Birmingham, Alabama, USA
| | - Tomm Caspi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
13
|
Bitew A, Yilma B, Taye T. 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. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:1313-1324. [PMID: 35847420 PMCID: PMC9285527 DOI: 10.2147/ccid.s367763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022]
Abstract
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.
Collapse
Affiliation(s)
- Adane Bitew
- Department of Medical Laboratory Science, College Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Betelhem Yilma
- Saint Peter's Specialized Tuberculosis Referral Hospital, Addis Ababa, Ethiopia
| | - Tomas Taye
- Rank Specialized Dermatology Clinic, Addis Ababa, Ethiopia
| |
Collapse
|
14
|
Salazar L, Gomes R, Fernandes A, Oliveira MJ. A rare complication of a common infection. J Paediatr Child Health 2022. [PMID: 35775443 DOI: 10.1111/jpc.16102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Luís Salazar
- Pediatrics Department, Centro Materno-Infantil do Norte (CMIN) - Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Rita Gomes
- Pediatrics Department, Centro Materno-Infantil do Norte (CMIN) - Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Alexandre Fernandes
- Pediatrics Department, Centro Materno-Infantil do Norte (CMIN) - Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Maria João Oliveira
- Pediatrics Department, Centro Materno-Infantil do Norte (CMIN) - Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| |
Collapse
|
15
|
Rajkumar A, Britton PN. Kerion: a great mimicker. Med J Aust 2022; 216:563-567. [DOI: 10.5694/mja2.51588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/27/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Philip N Britton
- Children’s Hospital at Westmead Sydney NSW
- University of Sydney Sydney NSW
| |
Collapse
|
16
|
5-aminolevulinic acid-photodynamic therapy is a potential approach for kerion. Photodiagnosis Photodyn Ther 2022; 38:102855. [PMID: 35395413 DOI: 10.1016/j.pdpdt.2022.102855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/22/2022] [Accepted: 04/03/2022] [Indexed: 11/20/2022]
Abstract
Kerion is an inflammatory variant of tinea capitis that is caused by ringworm fungi (zoophilic dermatophytes). It often affects prepubertal children. Classical antifungals are primarily used as therapeutic agents to treat kerion. However, many patients do not respond well to these agents and severe hepatotoxic side reactions may occur with the long-term use of such drugs. New therapeutic approaches are urgently needed. Here, we report a juvenile case of kerion successfully treated by ALA-PDT (5-aminolevulinic acid-photodynamic therapy) after the failure of a 4-week course of itraconazole and terbinafine. We find three published cases of kerion in the literature, all of which were successfully cured by application of ALA-PDT, highlighting a potentially superior therapeutic choice for kerion treatment.
Collapse
|
17
|
Wei S, Wang H, Li A, Yuan C. Kerion Celsi caused by Microsporum gypseum in a Chinese child, a case report. Medicine (Baltimore) 2022; 101:e28936. [PMID: 35421059 PMCID: PMC9276258 DOI: 10.1097/md.0000000000028936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/09/2022] [Indexed: 01/04/2023] Open
Abstract
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.
Collapse
|
18
|
Assessment of the properties of terbinafine hydrochloride and the search route for antifungal agents. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2021.132225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Friedland R, Sabbah F, Reiss-Huss S, Ben Amitai D. Epidemiologic features and risk of scarring in pediatric patients with kerion celsi. Pediatr Dermatol 2022; 39:215-219. [PMID: 35028962 DOI: 10.1111/pde.14916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Kerion celsi represents the inflammatory extreme of tinea capitis, as a delayed hypersensitivity reaction to the causative dermatophyte. Data regarding prevalence, trends in pathogens, and risk factors for scarring are limited. OBJECTIVE The main objective of the study is to assess clinical and epidemiologic features of children with kerion celsi and risk factors for scarring. METHODS We reviewed medical records of pediatric patients with kerion celsi treated between January 2006 and July 2020. RESULTS Among 80 patients, the prevalence of permanent alopecia was 27.5%. Patients with remaining alopecia presented to our clinic at a mean 1.3 months earlier than those with complete response to treatment (2.2 ± 2.1 and 3.4 ± 4.8, respectively; p < .05). Patients of Ethiopian ethnicity were more represented than in the general population; however, scarring was observed in only 11% (p = 0.08). Outcomes did not differ by pathogen, antifungal treatment prescribed, duration of treatment, or the use of prednisone or antibiotics. CONCLUSIONS Scarring alopecia is a common complication of kerion celsi. Host innate immune response, pathogen virulence, and treatment timeline should be considered as possible variables affecting risk of scarring in the future studies.
Collapse
Affiliation(s)
- Rivka Friedland
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fareed Sabbah
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiran Reiss-Huss
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Ben Amitai
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
20
|
Yasuda-Sekiguchi F, Kamata A, Hosokawa R, Kouno M, Takahashi S, Yaguchi T, Aoyama K, Sato T. A Case of Kerion Celsi Caused by <i>Trichophyton tonsurans</i>, a Plate Culture of Which Showed Yellow-Green Fluorescence Under UVA Light. Med Mycol J 2022; 63:37-41. [DOI: 10.3314/mmj.21-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Aki Kamata
- Department of Dermatology, Keio University School of Medicine
| | - Ryoko Hosokawa
- Department of Dermatology, Keio University School of Medicine
| | - Michiyoshi Kouno
- Department of Dermatology, Tokyo Dental College Ichikawa General Hospital
| | - Shinichi Takahashi
- Department of Dermatology, Tokyo Dental College Ichikawa General Hospital
| | | | - Kazuhiro Aoyama
- Department of Dermatology, Teikyo University Chiba Medical Center
| | - Tomotaka Sato
- Department of Dermatology, Teikyo University Chiba Medical Center
| |
Collapse
|
21
|
Discovery of New Trichophyton Members, T. persicum and T. spiraliforme spp. nov., as a Cause of Highly Inflammatory Tinea Cases in Iran and Czechia. Microbiol Spectr 2021; 9:e0028421. [PMID: 34468188 PMCID: PMC8557871 DOI: 10.1128/spectrum.00284-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Pathogens from the Trichophyton benhamiae complex are one of the most important causes of animal mycoses with significant zoonotic potential. In light of the recently revised taxonomy of this complex, we retrospectively identified 38 Trichophyton isolates that could not be resolved into any of the existing species. These strains were isolated from Iranian and Czech patients during molecular epidemiological surveys on dermatophytosis and were predominantly associated with highly inflammatory tinea corporis cases, suggesting possible zoonotic etiology. Subsequent phylogenetic (4 markers), population genetic (10 markers), and phenotypic analyses supported recognition of two novel species. The first species, Trichophyton persicum sp. nov., was identified in 36 cases of human dermatophytosis and one case of feline dermatophytosis, mainly in Southern and Western Iran. The second species, Trichophyton spiraliforme sp. nov., is only known from a single case of tinea corporis in a Czech patient who probably contracted the infection from a dog. Although the zoonotic sources of infections summarized in this study are very likely, little is known about the host spectrum of these pathogens. Awareness of these new pathogens among clinicians should refine our knowledge about their poorly explored geographic distribution. IMPORTANCE In this study, we describe two novel agents of dermatophytosis and summarize the clinical manifestation of infections. These new pathogens were discovered thanks to long-term molecular epidemiological studies conducted in Czechia and Iran. Zoonotic origins of the human infections are highly probable, but the animal hosts of these pathogens are poorly known. Further research is needed to refine our knowledge about these new dermatophytes.
Collapse
|
22
|
Kassem R, Shemesh Y, Nitzan O, Azrad M, Peretz A. Tinea capitis in an immigrant pediatric community; a clinical signs-based treatment approach. BMC Pediatr 2021; 21:363. [PMID: 34445992 PMCID: PMC8390185 DOI: 10.1186/s12887-021-02813-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/16/2021] [Indexed: 12/23/2022] Open
Abstract
Background Tinea capitis is a common cutaneous infection of the scalp and hair follicles, typically diagnosed by direct examination and culture. Treatment with oral antifungals is usually withheld until mycology results are available. In Israel, African refugee children demonstrate higher susceptibility to Tinea capitis and generally fail to undergo follow-up evaluations. Methods This study aimed to identify the clinical characteristics and treatment responses of refugee children in Israel with Tinea capitis, in order to formulate a treatment plan for primary care physicians. To this end, demographic, clinical and laboratory data were extracted from the electronic medical records of 76 refugee children presenting with Tinea capitis during 2016–2017. All measured variables and derived parameters are presented using descriptive statistics. The correlation between background clinical and demographic data and Tinea capitis diagnosis was assessed using the chi-squared and Wilcoxon tests. Correlations between demographic/clinical/laboratory characteristics and other types of fungi or other important findings were assessed using a T-test. Results Scaling was the most common clinical finding. Cultures were positive in 64 (84%) and direct examination in 65 (85%) cases, with a positive correlation between the methods in 75% of cases. The most common fungal strain was T. violaceum. Fluconazole treatment failed in 27% of cases. Griseofulvin 50 mg/kg/day was administered to 74 (97%) children, and induced clinical responses. No side effects were reported. Conclusions The key aim of this study was to emphasize the importance of diagnosis and treatment of these immigrant children by their primary pediatric doctor since it takes, an average of 4.3 months until they visit a dermatologist. During this critical time period, the scalp can become severely and permanently damaged, and the infection can become systemic or cause an outbreak within the entire community. In conclusion, we recommend to relate to scaly scalp in high-risk populations as Tinea capitis, and to treat with griseofulvin at a dosage of up to 50 mg/kg/day, starting from the first presentation to the pediatrician.
Collapse
Affiliation(s)
- Riad Kassem
- Dermatology Department, Sheba Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yahel Shemesh
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orna Nitzan
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel
| | - Maya Azrad
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Israel
| | - Avi Peretz
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel. .,Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Israel.
| |
Collapse
|
23
|
Lousada MB, Lachnit T, Edelkamp J, Rouillé T, Ajdic D, Uchida Y, Di Nardo A, Bosch TCG, Paus R. Exploring the human hair follicle microbiome. Br J Dermatol 2021; 184:802-815. [PMID: 32762039 DOI: 10.1111/bjd.19461] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 12/31/2022]
Abstract
Human hair follicles (HFs) carry complex microbial communities that differ from the skin surface microbiota. This likely reflects that the HF epithelium differs from the epidermal barrier in that it provides a moist, less acidic, and relatively ultraviolet light-protected environment, part of which is immune-privileged, thus facilitating microbial survival. Here we review the current understanding of the human HF microbiome and its potential physiological and pathological functions, including in folliculitis, acne vulgaris, hidradenitis suppurativa, alopecia areata and cicatricial alopecias. While reviewing the main human HF bacteria (such as Propionibacteria, Corynebacteria, Staphylococci and Streptococci), viruses, fungi and parasites as human HF microbiome constituents, we advocate a broad view of the HF as an integral part of the human holobiont. Specifically, we explore how the human HF may manage its microbiome via the regulated production of antimicrobial peptides (such as cathelicidin, psoriasin, RNAse7 and dermcidin) by HF keratinocytes, how the microbiome may impact on cytokine and chemokine release from the HF, and examine hair growth-modulatory effects of antibiotics, and ask whether the microbiome affects hair growth in turn. We highlight major open questions and potential novel approaches to the management of hair diseases by targeting the HF microbiome.
Collapse
Affiliation(s)
- M B Lousada
- Monasterium Laboratory, Münster, Germany
- Zoological Institute, Christian-Albrechts University Kiel, Kiel, Germany
| | - T Lachnit
- Zoological Institute, Christian-Albrechts University Kiel, Kiel, Germany
| | - J Edelkamp
- Monasterium Laboratory, Münster, Germany
| | - T Rouillé
- Monasterium Laboratory, Münster, Germany
| | - D Ajdic
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Y Uchida
- Monasterium Laboratory, Münster, Germany
| | - A Di Nardo
- Department of Dermatology, University of California, San Diego, CA, USA
| | - T C G Bosch
- Zoological Institute, Christian-Albrechts University Kiel, Kiel, Germany
| | - R Paus
- Monasterium Laboratory, Münster, Germany
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK
| |
Collapse
|
24
|
Zhou YB, Chao JJ, Ma L, Xiao YY. Kerion caused by Trichophyton tonsurans in an infant. Int J Infect Dis 2020; 102:242-243. [PMID: 33197583 DOI: 10.1016/j.ijid.2020.11.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ya Bin Zhou
- National Center for Children's Health, Department of Dermatology, Beijing Children's Hospital, Capital Medical University, No. 56 Nan Lishi Rd, Xicheng District Beijing, 100045 China
| | - Jin Jing Chao
- National Center for Children's Health, Department of Dermatology, Beijing Children's Hospital, Capital Medical University, No. 56 Nan Lishi Rd, Xicheng District Beijing, 100045 China
| | - Lin Ma
- National Center for Children's Health, Department of Dermatology, Beijing Children's Hospital, Capital Medical University, No. 56 Nan Lishi Rd, Xicheng District Beijing, 100045 China
| | - Yuan Yuan Xiao
- National Center for Children's Health, Department of Dermatology, Beijing Children's Hospital, Capital Medical University, No. 56 Nan Lishi Rd, Xicheng District Beijing, 100045 China.
| |
Collapse
|
25
|
Nguyen T, Ewe KY, Wood F, Rea S, Bowen AC. Case report: Scald burn to the scalp complicated by fungal kerion. BURNS OPEN 2020. [DOI: 10.1016/j.burnso.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
26
|
Tonin B, Geat D, Girolomoni G. A case of kerion celsi caused by Trichophyton tonsurans. Pediatr Int 2020; 62:1007-1008. [PMID: 32851760 DOI: 10.1111/ped.14279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/31/2020] [Accepted: 04/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Beatrice Tonin
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Geat
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
27
|
Yang X, Shi X, Chen W, Zhou Y, Lionakis MS, Kontoyiannis DP, Liu W. First report of kerion (tinea capitis) caused by combined Trichophyton mentagrophytes and Microsporum canis. Med Mycol Case Rep 2020; 29:5-7. [PMID: 32477858 PMCID: PMC7251309 DOI: 10.1016/j.mmcr.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Xinyu Yang
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Peking University, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, 100034, China
| | - Xiuyan Shi
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Peking University, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, 100034, China
| | - Wei Chen
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Peking University, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, 100034, China
| | - Yabin Zhou
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Peking University, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, 100034, China
| | - Michail S Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Wei Liu
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Center for Skin and Immune Diseases, Research Center for Medical Mycology, Peking University, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, 100034, China
| |
Collapse
|
28
|
Gnat S, Łagowski D, Nowakiewicz A, Dyląg M. Unusual dermatomycoses caused by Nannizzia nana: the geophilic origin of human infections. Infection 2020; 48:429-434. [PMID: 32232786 PMCID: PMC7256082 DOI: 10.1007/s15010-020-01416-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fungal infections of the skin, hair, and nails are the largest and most widespread group of all mycoses. Nannizzia nana is a relatively rare etiological factor of dermatomycosis in humans, as it usually affects animals, e.g. pigs and boars. In addition to the zoophilic nature, there are also reports of the geophilic reservoir of this dermatophyte species. OBJECTIVE In this study, we present symptomatic infections with N. nana aetiology in humans reported recently in Poland. Interestingly, these cases had a non-specific clinical picture and occurred as skin lesions on the neck and foot as well as onychomycosis of the toenails. From the medical history, the patients had no contact with pigs. METHODS Diagnostics of these infections was performed with a combination of classical phenotypic and molecular genomic methods. The genomic diversity of the isolates was determined using the MP-PCR method. In vitro antifungal susceptibility tests against itraconazole, ketoconazole, terbinafine and naftifine hydrochloride were also performed. RESULTS Nannizzia nana has been identified as an etiological factor of dermatomycosis. Moreover, heterogeneity of the genomes was revealed for the obtained strains. In vitro activities of antifungal agents showed that isolates were susceptible to all tested drugs. The patients were treated with oral terbinafine and topical ketoconazole cream, which led to a complete recovery. CONCLUSIONS In conclusion, the cases studied by us may indicate that the infrequency of N. nana infections may not necessarily be related to the low infectivity of this fungal agent, but they are rather associated with misdiagnosis. Furthermore, N. nana reservoirs should also be sought in soil.
Collapse
Affiliation(s)
- Sebastian Gnat
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, University of Life Sciences in Lublin, Akademicka 12, 20-033, Lublin, Poland.
| | - Dominik Łagowski
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, University of Life Sciences in Lublin, Akademicka 12, 20-033, Lublin, Poland
| | - Aneta Nowakiewicz
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, University of Life Sciences in Lublin, Akademicka 12, 20-033, Lublin, Poland
| | - Mariusz Dyląg
- Department of Mycology and Genetics, Faculty of Biological Sciences, Institute of Genetics and Microbiology, University of Wroclaw, Przybyszewskiego 63/77, 51-148, Wroclaw, Poland
| |
Collapse
|
29
|
Romita P, Liguori G, Giuffrida R, Conforti C, Lovero G, Marzullo A, Caggiano G, Foti C. Crusty scabbing plaques and nodules on the head: A diagnostic and therapeutic challenge in an elderly immunocompetent patient. A case of Majocchi's granuloma. Dermatol Ther 2020; 33:e13295. [PMID: 32141639 DOI: 10.1111/dth.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/29/2020] [Accepted: 03/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Romita
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Giovanni Liguori
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Grazia Lovero
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari, Bari, Italy
| | - Andrea Marzullo
- Pathology Section, Department of Emergency and Organ Transplants (DETO), University of Bari Aldo Moro, Bari, Italy
| | - Giuseppina Caggiano
- Department of Biomedical Sciences and Human Oncology, Section of Hygiene, University of Bari, Bari, Italy
| | - Caterina Foti
- Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| |
Collapse
|
30
|
Gallo L, Fabbrocini G, Festa B, Tranchini P, Patrì A. An enigma for the head. Ital J Dermatol Venerol 2020; 156:109-110. [PMID: 32163044 DOI: 10.23736/s2784-8671.20.06511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lucia Gallo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Bianca Festa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paolo Tranchini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angela Patrì
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| |
Collapse
|
31
|
Walkty A, Elgheriani A, Silver S, Pieroni P, Embil J. Tinea barbae presenting as a kerion. Postgrad Med J 2020; 96:441. [PMID: 32165548 DOI: 10.1136/postgradmedj-2020-137609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Andrew Walkty
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada .,Department of Microbiology, Shared Health, Winnipeg, Manitoba, Canada
| | | | - Shane Silver
- Section of Dermatology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter Pieroni
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Microbiology, Shared Health, Winnipeg, Manitoba, Canada
| | - John Embil
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
32
|
Successful treatment of kerion with itraconazole and ALA-PDT: A case report. Photodiagnosis Photodyn Ther 2019; 27:385-387. [DOI: 10.1016/j.pdpdt.2019.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/24/2019] [Accepted: 07/08/2019] [Indexed: 02/02/2023]
|
33
|
Saadia A, Reckhow J, Rozenblat M, Last O. Kerion of the pubis and vulva with bacterial superinfection: a rare occurrence. BMJ Case Rep 2019; 12:12/8/e230320. [PMID: 31466986 DOI: 10.1136/bcr-2019-230320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kerion is a severe hypersensitivity reaction to fungal infection that is rarely seen in the groin. Frequent shaving of pubic hair and religious conservatism surrounding genital hygiene are common among Bedouin women in the Negev Desert, and may predispose to kerion. This case highlights the clinical course of a 20-year-old Bedouin woman who presented with severe kerion celsi of the pubis and vulva with secondary bacterial infection. The patient was successfully treated with intravenous antibiotics, oral antifungal medication and wet topical dressings. The case outlines the risk factors and treatment for severe kerion celsi of the groin, as well as possible preventive measures that may reduce its incidence.
Collapse
Affiliation(s)
- Adi Saadia
- Dermatology and Venereology, Soroka University Medical Center, Beer Sheva, Israel
| | - Jensen Reckhow
- Medical School for International Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Mati Rozenblat
- Dermatology and Venereology, Soroka University Medical Center, Beer Sheva, Israel
| | - Omer Last
- Dermatology and Venereology, Soroka University Medical Center, Beer Sheva, Israel
| |
Collapse
|
34
|
Species Distinction in the Trichophyton rubrum Complex. J Clin Microbiol 2019; 57:JCM.00352-19. [PMID: 31189587 PMCID: PMC6711931 DOI: 10.1128/jcm.00352-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/11/2019] [Indexed: 02/06/2023] Open
Abstract
The Trichophyton rubrum species complex comprises commonly encountered dermatophytic fungi with a worldwide distribution. The members of the complex usually have distinct phenotypes in culture and cause different clinical symptoms, despite high genome similarity. In order to better delimit the species within the complex, molecular, phenotypic, and physiological characteristics were combined to reestablish a natural species concept. The Trichophyton rubrum species complex comprises commonly encountered dermatophytic fungi with a worldwide distribution. The members of the complex usually have distinct phenotypes in culture and cause different clinical symptoms, despite high genome similarity. In order to better delimit the species within the complex, molecular, phenotypic, and physiological characteristics were combined to reestablish a natural species concept. Three groups, T. rubrum, T. soudanense, and T. violaceum, could be distinguished based on the sequence of the internal transcribed spacer (ITS) ribosomal DNA barcode gene. On average, strains within each group were similar by colony appearance, microscopy, and physiology, but strains between groups showed significant differences. Trichophyton rubrum strains had higher keratinase activity, whereas T. violaceum strains tended to be more lipophilic; however, none of the phenotypic features were diagnostic. The results of matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and amplified fragment length polymorphism (AFLP) were partially consistent with the ITS data but failed to distinguish the species unambiguously. Despite their close similarity, T. violaceum, T. soudanense, and T. rubrum can be regarded as independent species with distinct geographical distributions and clinical predilections. Trichophyton soudanense is pheno- and genotypically intermediate between T. rubrum and T. violaceum. For routine diagnostics, ITS sequencing is recommended.
Collapse
|
35
|
Changing Concepts and Current Definition of Majocchi's Granuloma. Mycopathologia 2019; 185:187-192. [PMID: 31297666 DOI: 10.1007/s11046-019-00358-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/01/2019] [Indexed: 01/13/2023]
Abstract
Dermatophytic granuloma characterized by perifollicular granulomatous inflammation was first described by Domenico Majocchi and was later named after him, Majocchi's granuloma (MG). Although the initial description was related to a dermatophyte Trichophyton tonsurans, later reports linked MG to non-dermatophytes (Phoma, Aspergillus, Malbranchea), which led to a confusion of disease patterns caused by cutaneous pathogens and general opportunistic microorganisms. Furthermore, several causative agents of MG described in the literature were not confirmed as such. Our review addressed the following aspects: (1) significance of histopathological finding for MG diagnosis, (2) dermatophytes as exclusive agents of MG, (3) spectrum of etiological agents causing different types of invasive dermatophytic infections, and (4) treatment options.
Collapse
|
36
|
Goto Y, Suzuki T, Suzuki Y, Anzawa K, Mochizuki T, Tamura T, Makimura K, Aoshima M, Ito T, Tokura Y. Trichophyton tonsurans-induced kerion celsi with decreased defensin expression and paradoxically increased interleukin-17A production. J Dermatol 2019; 46:794-797. [PMID: 31294481 DOI: 10.1111/1346-8138.15008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/07/2019] [Indexed: 12/24/2022]
Abstract
We report a case of kerion celsi due to Trichophyton tonsurans. An 18-year-old male student judo practitioner had alopecic patches, black dots and subcutaneous abscesses on the right temporal region. The damaged hair represented endothrix infection with T. tonsurans, as assessed by mycological examinations. He was treated with oral itraconazole without any therapeutic effect, followed by terbinafine with good effect. A skin biopsy showed neutrophil, lymphocyte and histiocyte infiltration into the dermis and subcutaneous tissue with abscesses around a number of dilated hair follicles. Immunostaining showed that the expression level of human β-defensin 2 (HBD-2) was decreased in the epidermis of the alopecic and adjacent skin. Because interleukin (IL)-17A generally induces HBD-2 production by epidermal keratinocytes, we also immunohistochemically investigated IL-17A expression. Unexpectedly, many IL-17A-bearing cells were found around destructed hair follicles, indicating that IL-17A expression was not attenuated, but rather increased in the skin lesion. Our case suggests that IL-17A-upregulated antimicrobial peptide expression is disordered in kerion celsi, and severe inflammation with IL-17A may cause tissue damage and resultant scar.
Collapse
Affiliation(s)
- Yoshihiro Goto
- Division of Dermatology, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Takahiro Suzuki
- Division of Dermatology, Fujinomiya City General Hospital, Fujinomiya, Japan
| | - Yoko Suzuki
- Division of Dermatology, Shizuoka Municipal Hospital, Shizuoka, Japan
| | - Kazushi Anzawa
- Department of Dermatology, Kanazawa Medical University, Kanazawa, Japan
| | - Takashi Mochizuki
- Department of Dermatology, Kanazawa Medical University, Kanazawa, Japan
| | - Takashi Tamura
- General Medical Education and Research Center, Teikyo University, Tokyo, Japan
| | - Koichi Makimura
- Medical Mycology, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Masahiro Aoshima
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Taisuke Ito
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
37
|
Mikaeili A, Kavoussi H, Hashemian AH, Shabandoost Gheshtemi M, Kavoussi R. Clinico-mycological profile of tinea capitis and its comparative response to griseofulvin versus terbinafine. Curr Med Mycol 2019; 5:15-20. [PMID: 31049453 PMCID: PMC6488289 DOI: 10.18502/cmm.5.1.532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: Tinea capitis is the most common superficial mycosis in children. This disease is a contagious infection with worldwide distribution and is occasionally associated with permanent alopecia. The treatment of this infection usually requires the administration of appropriate oral antifungal agents. The current study was conducted to evaluate the clinico-mycological profile of tinea capitis and compare the efficiency of oral griseofulvin and terbinafine in the treatment of this disease. Materials and Methods: This study was conducted on 69 patients, including 23 females (33.3%) and 46 males (66.7%), clinically suspected of tinea capitis. After the confirmation of tinea capitis diagnosis through direct examination, the subjects were randomly assigned into two groups of griseofulvin and terbinafine. Demographic data, clinical and mycological characteristics, and therapeutic outcome were recorded for both groups. Results: According to the results, tinea capitis was more common in children younger than 15 years (73.9%), athletes (37.7%), and males (66.7%), and those with frontal involvement (34.8%), non-inflammatory type (68.1%), endothrix (69.6%), and Trichophyton tonsurans species (41.7%). The griseofulvin and terbinafine groups had the treatment success rates of 90.9% and 80.6%, respectively (P=0.311). The griseofulvin group had a shorter therapeutic course than the terbinafine group (P=0.129). Conclusion: Although our findings demonstrated that both griseofulvin and terbinafine were effective in the treatment of tinea capitis, griseofulvin showed a little higher efficacy in this regard. Consideration of some variables, such as age, associated risk factors, clinical type, hair involvement pattern, and dominant pathogenic species, is important in the determination of the drugs.
Collapse
Affiliation(s)
- Ali Mikaeili
- Department of Mycology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Kavoussi
- Department of Dermatology, Hajdaie Dermatology Clinic, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | - Reza Kavoussi
- Student Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
38
|
Nakagawa H, Nishihara M, Nakamura T. Kerion and tinea capitis. IDCases 2018; 14:e00418. [PMID: 29988774 PMCID: PMC6031098 DOI: 10.1016/j.idcr.2018.e00418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hidenori Nakagawa
- Department of Pediatrics, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka-shi, Osaka, 533-0024, Japan
| | - Masato Nishihara
- Department of Pediatrics, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka-shi, Osaka, 533-0024, Japan
| | - Takashi Nakamura
- Department of Pediatrics, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka-shi, Osaka, 533-0024, Japan
| |
Collapse
|