Tinea capitis in the Florence area between 1985 and 1993

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.

Cortisol levels in cats' hair in presence or absence of Microsporum canis infection

The purpose of this work was to perform a preliminary screening in the domestic cat to assess the concentration of cortisol in hairs by radioimmunoassay technique (RIA) in presence or absence of Microsporum canis infections. A total of 245 cats (7 with cutaneous lesions referable to dermatophytosis and 238 apparently healthy) coming from 14 shelters were examined. M. canis was isolated in 126 (51.4%) cats. The cortisol levels were significantly higher in cats with lesions or without lesions but with a high number of colonies in the plates (≥ 10 CFU) than in cats negative or with a lower number of colonies. The results obtained seem to highlight that chronic high levels of cortisol in cats could possibly promote the dermatophytes infections. Furthermore, in High-CFU asymptomatic cats, it could be present a state of infectious, and they, therefore, represents not a simple mechanical carrier.

Tinea capitis among children in the Columbus area, Ohio, USA

Tinea capitis is a fungal infection of the hair follicles of the scalp. In the US, the most common organisms have traditionally been Trichophyton tonsurans, and occasionally Microsporum canis. This study was designed to examine patterns of organisms causing tinea capitis and determine factors associated with infection. A retrospective database analysis was conducted to locate records of patients with tinea capitis from May 2001 to May 2006 at Nationwide Children's Hospital in Columbus, OH. Descriptive statistics, frequency analysis, chi-squared test, and Student's t-test were performed to evaluate types of causative organisms and associated patient characteristics. One hundred and eighty-nine charts of patients with a positive scalp culture for tinea capitis were located. Trichophyton tonsurans (88.9%) was the foremost causative agent followed by Trichophyton violaceum (4.2%). Tinea capitis was more prevalent among African Americans and was more common in urban areas (P < 0.05). Children of African descent inhabiting urban settings were most vulnerable to tinea capitis. The most common organism isolated in this retrospective study was T. tonsurans. Trichophyton violaceum and Trichophyton soudanense were also isolated, which are not commonly reported causes of tinea capitis in the US.

Dermatophytoses in cats and humans in central Italy: epidemiological aspects

Two hundred hair/skin samples were collected from 2002 to 2004 from two groups of cats (privately owned and stray cats from a shelter) and 165 samples were obtained during the same period from persons in whom dermatophyte infection was highly suspected. The epidemiological data were statistically evaluated. Thirteen of the 100 privately owned cats (13%) and 100% of the stray cats were positive; of the 165 human samples examined 109 (66%) were positive for dermatophytes. Microsporum canis was the most common dermatophyte isolated in both cat groups while Trichophyton mentagrophytes was the most common in humans. Interestingly, a geophylic dermatophyte species (Microsporum gypseum) was found to be present and associated with clinical signs. Living in the countryside proved to be a risk factor for dermatophytoses in privately owned cats while in humans the main risk factor for M. canis was contact with animals followed by young age. None of the variables considered was associated with positivity for T. mentagrophytes while positivity for other fungi was correlated with life in the countryside.

Epidemiology of tinea capitis in Europe: current state and changing patterns

Tinea capitis (scalp ringworm) is the most common dermatophyte infection of the scalp affecting mainly children and rarely adults. The epidemiology of tinea capitis varies within different geographical areas throughout the world. It may occur sporadically or epidemically and an increase in its incidence has been noted over the last few decades. The aim of the study is to obtain a general overview of the current state and changing pattern of tinea capitis in Europe. According to the literature, there has been a significant increase in the incidence of tinea capitis and a change in the pattern of infectious agents in particular. Microsporum canis, a zoophilic dermatophyte, is still the most common reported causative agent of tinea capitis in Europe. The countries reporting the highest incidence of M. canis infections are mainly in the Mediterranean but also bordering countries like Austria, Hungary, Germany and Poland. Besides the increase in Microsporum-induced tinea capitis, there is a shift towards anthrophilic tinea capitis mainly in urban areas in Europe. The largest overall increase with anthropophilic dermatophytes has been noted with Trichophyton tonsurans mainly in the UK and with Trichophyton soudanense and Microsporum audouinii in France. The occurrence of anthropophilic infections seems to be geographically restricted and is possibly linked to the immigration from African countries. Children (aged 3-7 years with no predilection of gender) remain the most commonly affected, but recently an increase of tinea capitis has been observed in adults and in the elderly. The results of the study clearly demonstrate the importance of diagnosing and proper treatment of mycotic scalp infection in the Europe. If not diagnosed and treated properly, its prevalence might reach epidemic proportions in the near future. Therefore, an increased level of surveillance (screening in schools), and a highly effective interdisciplinary cooperation among general practitioners, mycologists, veterinarians and dermatologists are strongly recommended.

Epidemiology of dermatophytoses in a rural community in Eastern Nigeria and review of literature from Africa

A total of 4,287 primary school children, comprising 1,740 males and 2,547 females in Arochukwu local government area of Abia state Nigeria were examined for clinical signs of dermatophytoses. About 873 (20.4%), consisting of 505 males and 368 females had lesions consistent with dermatophytoses. The disease was more prevalent in males (29%) than females (14.4%) in a ratio of approximately 2:1 (P < 0.05). The infection rate increased from 16.8% in the 4-6 year age group to a peak of 28.1% in the 10-12 year age bracket and dropped sharply to 5.6% in the 16-18 year group. The highest prevalence (39%) was observed among males aged 10-12 years while females 16-18 years had the lowest prevalence (2.5%). Tinea capitis was the predominant clinical type of dermatophytoses, and occurred in 13.7% of the total population studied and 67% of lesion positive cases. Trichophyton soudanense and Trichophyton tonsurans the predominant aetiological agents of dermatophytoses with a prevalence of 26.2% and 21.6%, respectively. Others include Trichophyton mentagrophytes (18.8%), Epidermophyton floccosum (8.3%), Microsporum audouinii (6.4%), Microsporum gypseum (6.0%), Trichophyton rubrum (5.5%) and Microsporum ferrugineum (7.3%), which was isolated for the first time in Nigeria.

Analysis of the dermatophyte species isolated in the British Isles between 1980 and 2005 and review of worldwide dermatophyte trends over the last three decades

Infections of the skin, hair and nails by dermatophyte fungi are common in developed and developing countries alike. However, the species involved and the resulting clinical entities vary both geographically and with time. We have surveyed 15,333 dermatophytes obtained from primary isolations at the Mycology Reference Laboratory, Bristol, UK from 1980 through 2005. Several striking trends in dermatophyte prevalence were apparent over this period. The relative frequencies of isolations of Microsporum canis (cat and dog ringworm), Trichophyton verrucosum (cattle ringworm), T. mentagrophytes var. mentagrophytes (rodent ringworm) and Epidermophyton floccosum (a cause of human groin and foot infections) all decreased by 90%. Conversely, the contributions of T. tonsurans and T. violaceum (two anthropophilic scalp-infecting species) to total dermatophyte isolations increased by 1000% over the same period. Finally, T. rubrum and T. mentagrophytes var. interdigitale, the two common causes of foot infection comprised 80% of all dermatophytes isolated in 1980 and 90% of isolations in 2005. Similar trends in dermatophyte prevalence were evidenced throughout the British Isles, based on the voluntary reporting of isolations from a large number of British laboratories at 5-yearly intervals over the same period. The implications of these changing patterns of dermatophyte species, and the clinical entities they produce are discussed in the context of a review of worldwide dermatophyte isolations over the last three decades, with emphasis on the causal agents of tinea capitis.

A case of bullous tinea pedis with dermatophytid reaction caused by Trichophyton violaceum

Summary The authors report a case of bullous tinea pedis caused by Trichophyton violaceum with dermatophytid reaction in a 26-year-old woman who had been in Africa. Diagnosis was based on mycological examination (direct microscope observation and culture). Recovery was achieved after systemic antimycotic therapy with itraconazole and topical imidazole for a month.

Tinea capitis in a dermatology center in the city of Fortaleza, Brazil: the role of Trichophyton tonsurans

BACKGROUND

Over a 3-year period (March 1999 to March 2002), 944 patients with scalp lesions attended a dermatology reference center in the city of Fortaleza, Ceará, Brazil. Clinical specimens were examined at the Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza-CE, Brazil, to detect patients with tinea capitis.

METHODS

Specimens were obtained from pus, scales, and hairs from suspected lesions of tinea capitis. Mycologic analyses were conducted by direct microscopy and by fungal culture on Sabouraud dextrose agar, with or without chloramphenicol and Mycosel agar. The culture tubes were incubated at 28 degrees C and examined daily for 1 month.

RESULTS

Fungi were seen in 438 (46.4%) of the 944 clinical specimens. The percentage of positive direct microscopic examinations of the clinical specimens was 83.7%. Of those patients with tinea capitis, 157 (35.8%) were males and 281 (64.2%; P < 0.001) were females. The distribution of dermatophyte species in males, from 136 positive cultures, was Trichophyton tonsurans (54.41%), Microsporum canis (38.97%), T. rubrum (4.41%), T. mentagrophytes var. mentagrophytes (1.47%), and M. gypseum (0.74%). On the other hand, only three species, from 251 positive cultures, were present in females: T. tonsurans (80.08%), M. canis (17.53%), and T. rubrum (2.39%). There was a high proportion of positive results in children under 10 years of age (n = 309). No significant difference was detected in the seasonal distribution of tinea capitis.

CONCLUSIONS

Our data show that T. tonsurans is the main etiologic agent of tinea capitis, and is more likely to be found in females and in the prepubertal population.

Etiology of tinea capitis in Athens, Greece - a 6-year (1996-2001) retrospective study. Atiologie der Tinea capitis in Athen, Griechenland. Retrospektive Analyse der Jahre 1996-2001

A total of 577 patients with tinea capitis have been diagnosed at the Mycology laboratory of 'A. Sygros' Hospital of Skin and Venereal Diseases, Athens, Greece between 1996 and 2001. From these patients, 100 were immigrants from Balkan, Near East and African countries. The vast majority of the patients (95%) were children, mainly at preschool and school age and only 5% were adults. Zoophilic dermatophytes accounted for 86.5% followed by anthropophilic (12.4%) and geophilic (1.2%) dermatophytes. The majority of anthropophilic infections (59.5%) were recorded in the sub-population of immigrants. Microsporum canis (84.5%) was the main etiologic agent.

Tinea capitis in infants less than 1 year of age

Tinea capitis is the most frequent manifestation of dermatophyte infection in children, but because it is rare in the first months of life it is often misdiagnosed. Here we report 15 cases of tinea capitis observed in Italy in infants less than 1 year of age. There were 10 boys and 5 girls (mean age 6 months). Diagnosis was confirmed by mycologic examination. Microsporum canis was isolated in nine cases and Trichophyton mentagrophytes in three. These 12 infants were Italian and animals were the source of infection. Trichophyton erinacei was isolated in one Italian infant, and the source was soil. In the other two cases, Trichophyton tonsurans and Trichophyton violaceum were isolated; these infants were from Central America and India, respectively, and had contracted the infection from humans. All achieved clinical and mycologic recovery after systemic and topical antimycotic therapy.

Tinea capitis in Europe: new perspective on an old problem

A survey of tinea capitis conducted under the auspices of the European Confederation of Medical Mycology showed that laboratories contributing to a voluntary scheme for reporting have recently been seeing a different pattern of scalp ringworm. The survey was conducted among 92 medical mycology laboratories across 19 European countries by postal questionnaire comparing the years 1987 with 1997. The survey shows an overall increase in the numbers of cases caused by anthropophilic infections, which, in 1997, were the dominant causes of scalp infection; the greatest increase was seen in laboratories covering urban populations and in African Caribbean children living in Europe. While the commonest infection remains Microsporum canis, the largest overall increase has been in Trichophyton tonsurans, which in 1997 was the second commonest cause of infection overall and the commonest in urban populations. The pattern of change is not uniform in Europe and while some cities have reported large increases in T. tonsurans others, e.g. in France, have seen more cases of infection due to T. soudanense and M. audouinii. While these figures do not necessarily reflect changes in the underlying prevalence of infection, the trends are important to recognize as the control measures for anthropophilic tinea capitis differ from those used in zoophilic infections. In particular there is a need for an increased level of surveillance and more advice on control given to primary care physicians, dermatologists and school health authorities.

Dermatophytosis due to Trichophyton violaceum in Tuscany from 1985 to 1997

We describe 45 cases of dermatophytosis due to Trichophyton violaceum diagnosed in Tuscany from 1985 to 1997. Diagnosis was based on direct microscope mycological examination and culture. Nine of the 45 patients were Italian, eight of whom were born and resident in Tuscany; the others were Africans who contracted the infection in their country of origin. The first case in a non-European was observed in 1985, but since 1991 isolation from foreigners has become more frequent. The increase in cases of infection by T. violaceum in our region is certainly linked to immigration. The cases of epidermomycosis in Tuscans suggests that the fungus has already become autochthonous.

Trichophyton rubrum tinea capitis in an 85-year-old woman

BACKGROUND

Tinea capitis is a worldwide problem and occurs most commonly in young children. Certain common fungal types are most often recognized as the responsible infecting organism.

OBJECTIVE

This article presents the case of an elderly woman with tinea capitis caused by a fungal organism that rarely infects hair. A review of the world literature provides evidence of only a few other similar cases.

CONCLUSIONS

Trichophyton rubrum causing tinea capitis in adults is a rare but now increasingly recognized entity. This possibility should be kept in mind when caring for adults with nonhealing scalp conditions.

Tinea capitis in Siena, Italy. An 18-year survey

In the period 1980-1998, 181 cases of tinea capitis out of a total of 1480 cases of dermatophytosis were observed in Siena, Italy; 176 cases were children (mean age 6 years, range 45 days to 14 years; 91 boys, 85 girls) and the other five cases were postmenopausal women. Diagnosis was made on the basis of culture which was positive in 179 cases, and direct microscopic observation which was positive in 155 of 179 cases. In two cases, positive direct microscopic results were not confirmed by the culture. The most frequently isolated mycete was Microsporum canis (162 cases, 90.5%) and the main source of infection was the cat, which was often a healthy carrier. The second most frequent mycete was Trychophyton mentagrophytes. Trichophyton violaceum, a dermatophyte practically absent from our province since the 1960s, was isolated in five patients. All patients were successfully treated. One adult was treated with oral ketoconazole and the other four with oral itraconazole. The children were all treated with griseofulvin and topical antimycotics. Two children, observed in 1997-1998, who did not respond to griseofulvin, achieved clinical and mycological recovery with oral itraconazole.

Tinea capitis in children in northern Greece during the period 1981-1995

In our 15 years of investigation in northern Greece, the predominant organism producing tinea capitis in children was found to be the zoophilic Microsporum canis (494 strains) which is a common saprophyte of the hair of pets, especially cats. The high percentage of cases with M. canis (97%), in contrast to zoophilic fungi (3%), is probably due to the increased contact of children with pets. The small number of infections with anthropophilic fungi (41 strains) is attributed to good hygienic conditions. The fluorescence of infected hair under Wood's light seems to be a major diagnostic criterion in the hands of dermatologists who are not served by a mycological laboratory.

Efficacy of oral terbinafine in feline dermatophytosis due to Microsporum canis

Microsporum canis is the dermatophyte most commonly responsible for ringworm in cats. The purpose of this paper was to evaluate the in vivo efficacy of oral terbinafine (Lamisil; Sandoz) in the treatment of feline ringworm caused by M canis, and to consider this drug as an alternative to griseofulvin or imidazoles. Fifteen cats infected with M canis were treated orally once daily with 30 mg/kg of terbinafine over a 2-week period. All treated animals were checked for dermatophytes on the last day of treatment, a month later and 3 months after the last administration of the drug. Only 12 cats could be used in the whole trial and 11 of these (92%) showed a complete cure. Terbinafine could be an effective alternative to griseofulvin when fungal resistance or idiosyncrasic intolerance are shown and, compared with griseofulvin, could give a faster rate of cure and less relapses.

Kerion Celsi: a clinical epidemiological study

We present a case record of patients with kerion Celsi observed in the Clinic of Dermatology, University of Cagliari (Italy) from 1981 to 1995. Altogether, 31 children (18 male and 13 female) with an age range of 40 days to 12 years were studied. In all cases the lesions were confined to the scalp. In 10 cases the disease developed as such, while in 21 patients it represented the inflammatory evolution of tinea capitis secondary to incongruous topical treatment. Microsporum canis was isolated in 22 cases and Trichophyton mentagrophytes in nine cases. Systemic treatment was carried out in 20 patients with griseofulvin, in six with ketoconazole and in five with terbinafine. Complete recovery was obtained in 25-30 days. No cases of relapse were observed. The authors stress the importance of an early diagnosis followed by timely and effective treatment to prevent scarring and permanent hair loss.

Tinea due to Trichophyton violaceum in Victoria, Australia

From 1963 to 1995, twenty isolates of Trichophyton violaceum from cases of tinea capitis and tinea corporis were referred to the Mycology Reference Laboratory of the Microbiological Diagnostic Unit at the University of Melbourne (Parkville, Victoria, Australia). The patients had presented at clinics in metropolitan Melbourne and country towns in the state of Victoria, Australia. Most patients were immigrants from the Mediterranean region or were Australian Aborigines. The most recent isolates of T. violaceum came from Ethiopian immigrants. Details of these twenty case histories are presented. The changing global distribution of infections due to T. violaceum is noted. The literature recording infections due to T. violaceum in Australia is reviewed.