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Charpantidis S, Siopi M, Pappas G, Theodoridou K, Tsiamis C, Samonis G, Chryssou SE, Gregoriou S, Rigopoulos D, Tsakris A, Vrioni G. Changing Epidemiology of Tinea Capitis in Athens, Greece: The Impact of Immigration and Review of Literature. J Fungi (Basel) 2023; 9:703. [PMID: 37504692 PMCID: PMC10381159 DOI: 10.3390/jof9070703] [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: 05/22/2023] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 07/29/2023] Open
Abstract
Mass population movements have altered the epidemiology of tinea capitis (TC) in countries receiving refugees. Periodic monitoring of the local pathogen profiles may serve as a basis for both the selection of appropriate empirical antifungal therapy and the implementation of preventive actions. Therefore, we investigated the impact of an unprecedented immigration wave occurring in Greece since 2015 on the epidemiological trends of TC. All microbiologically confirmed TC cases diagnosed during the period 2012-2019 in a referral academic hospital for dermatological disorders in Athens, Greece, were retrospectively reviewed. A total of 583 patients were recorded, where 348 (60%) were male, 547 (94%) were children and 160 (27%) were immigrants from Balkan, Middle Eastern, Asian as well as African countries. The overall annual incidence of TC was 0.49, with a significant increase over the years (p = 0.007). M. canis was the predominant causative agent (74%), followed by T. violaceum (12%), T. tonsurans (7%) and other rare dermatophyte species (7%). M. canis prevalence decreased from 2014 to 2019 (84% to 67%, p = 0.021) in parallel with a three-fold increase in T. violaceum plus T. tonsurans rates (10% to 32%, p = 0.002). An increasing incidence of TC with a shift towards anthropophilic Trichophyton spp. in Greece could be linked to the immigration flows from different socioeconomic backgrounds.
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Affiliation(s)
- Stefanos Charpantidis
- Department of Microbiology, "Elena Venizelou" Maternity Hospital, 11521 Athens, Greece
| | - Maria Siopi
- Clinical Microbiology Laboratory, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgios Pappas
- Institute of Continuing Medical Education of Ioannina, 45333 Ioannina, Greece
| | - Kalliopi Theodoridou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Microbiology, "Andreas Syggros" Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
| | - Constantinos Tsiamis
- Department of Public and Integrated Health, School of Health Sciences, University of Thessaly, 43100 Karditsa, Greece
| | - George Samonis
- Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion Crete, Greece
| | - Stella-Eugenia Chryssou
- Department of Microbiology, "Andreas Syggros" Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
| | - Stamatios Gregoriou
- 1st Department of Dermatology and Venereology, "Andreas Syggros" Hospital for Skin and Venereal Diseases, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology and Venereology, "Andreas Syggros" Hospital for Skin and Venereal Diseases, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Microbiology, "Andreas Syggros" Hospital for Skin and Venereal Diseases, 16121 Athens, Greece
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Feußner C, Karrer S, Lampl BMJ. An uncommon cause of tinea: Trichophyton violaceum in a German kindergarten - outbreak report and quantitative analysis of epidemiological data from Europe. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc02. [PMID: 35284206 PMCID: PMC8899716 DOI: 10.3205/dgkh000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Global mobility is increasingly associated with the emergence of "unusual" infectious agents. At the beginning of 2019, a putative outbreak of Impetigo contagiosa occurred in a kindergarten in Regensburg, Germany, that was mainly attended by children with a migrant background. After thorough examination, the outbreak was classified as infection with Trichophyton (T.) violaceum. Methods: Based on case investigations, infection control measures, disinfection, and cleaning were implemented. Microscopy of native specimens, fungal cultures, and polymerase chain reaction were used for diagnosis. Additionally, a systematic literature search in Medline, followed by a quantitative analysis of epidemiological data from Europe, were performed. Results: Between January and November 2019, 12 cases of tinea were diagnosed in 7 educators and 2 household members. Children were initially not affected. T. violaceum was only detected in 2 patients. No extensive screening measures were carried out after risk-benefit assessment. Studies on T. violaceum in Europe are heterogeneous, and the number of cases and the prevalence vary considerably. The pathogen is mainly found in children of African descent who clinically present with tinea capitis. Discussion: In the present case, the source of infection and the chain of transmission remained unclear. The pathogen could only be diagnosed in 2 cases. In Europe, the (re)emergence of pathogens such as T. violaceum is likely to be caused by increasing migration and travel. Pathogens should be identified for epidemiological reasons in all cases. In outbreaks, measures must be adapted to the dynamics of the individual outbreak after assessment of the risks, benefits, and proportionality.
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Affiliation(s)
| | - Sigrid Karrer
- Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany
| | - Benedikt M. J. Lampl
- Regensburg Department of Public Health, Regensburg, Germany,Department of Epidemiology and Preventive Medicine, Faculty of Medicine, University of Regensburg, Regensburg, Germany,*To whom correspondence should be addressed: Benedikt M. J. Lampl, Regensburg Department of Public Health, Division of Infection Control and Prevention, Altmühlstr. 3, 93059 Regensburg, Germany, Phone: +49 941 4009 523, E-mail:
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Veraldi S, Schianchi R, Benzecry V, Gorani A. Tinea manuum: A report of 18 cases observed in the metropolitan area of Milan and review of the literature. Mycoses 2019; 62:604-608. [PMID: 30929271 DOI: 10.1111/myc.12914] [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] [Received: 03/05/2019] [Accepted: 03/21/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Tinea manuum is considered in Italy as an uncommon infection, although no recent epidemiological data are available. METHODS In the period 2000-2018, we observed in the metropolitan area of Milan 18 patients with mycologically tinea manuum. RESULTS The infection was monolateral in all patients and characterised by erythema and scaling; in two patients, each vesicles and pustules were present. Two patients had also onychomycosis of one fingernail. No cases of simultaneous tinea pedis were observed. As far as the job of these patients is concerned, seven of them were masseurs, three barbers, two cattlemen, two masons, one car mechanic, one florist, one maid and one veterinarian. Trichophyton rubrum was isolated in 6 patients, Microsporum canis in 4, Trichophyton gypseum in 3, Trichophyton verrucosum in 3 and Trichophyton violaceum in 2 patients. CONCLUSION Masseurs were the most affected. Trichophyton rubrum and Microsporum canis were the most frequent isolated dermatophytes.
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Affiliation(s)
- Stefano Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Valentina Benzecry
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Gorani
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Dermatophyties à Trichophyton violaceum au laboratoire de parasitologie mycologie de l’HMMI de Mekhnès (à propos de douze cas). J Mycol Med 2018; 28:1-7. [DOI: 10.1016/j.mycmed.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/09/2017] [Accepted: 12/15/2017] [Indexed: 11/18/2022]
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Abstract
Dermatophytoses are among the most frequently diagnosed skin infections worldwide. However, the distribution of pathogenic species and the predominating anatomical sites of infection vary with geographical location and change over time. The aim of this study was to determine the epidemiological and aetiological factors of dermatophytoses in Crete, Greece over the last 5-year period (2011-2015) and their incidence in relation to the gender and the age of the patients. We compared our findings with those previously reported from the same area and from other parts of the world. A total of 2,910 clinical specimens (skin scrapings, nail clippings, and hair specimens) obtained from 2,751 patients with signs of dermatomycoses were examined using direct microscopy and culture. Overall, 294 specimens (10.1%) were proved mycologically positive for dermatophytes. The age of the patients ranged from 2 to 86 years (mean age, 37 years). Tinea corporis was the predominant clinical type of infection, followed by tinea unguium, tinea pedis, tinea capitis, tinea faciei, tinea cruris and tinea manuum. Among dermatophytes, eight species were isolated: Microsporum canis (35.8%), Trichophyton rubrum (35.1%), Trichophyton mentagrophytes (23.3%), Epidermophyton floccosum (2.5%), Microsporum gypseum (1.8%), Trichophyton violaceum (0.7%), Trichophyton verrucosum (0.4%), and Trichophyton tonsurans (0.4%). In our area, the most common dermatophyte was M. canis followed by T. rubrum. Increased migration, mass tourism, and climate changes will contribute to further changes in the epidemiology of dermatophytoses in our area. Continuing studies are necessary for determining the new epidemiological trends and to implement the appropriate control measures.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine
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Lova-Navarro M, Gómez-Moyano E, Martínez Pilar L, Fernandez-Ballesteros MD, Godoy-Díaz DJ, Vera-Casaño A, Crespo-Erchiga V. Tinea capitis in adults in southern Spain. A 17-year epidemiological study. Rev Iberoam Micol 2016; 33:110-3. [DOI: 10.1016/j.riam.2015.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 01/20/2015] [Accepted: 02/25/2015] [Indexed: 11/28/2022] Open
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Factors in Etiology and Predisposition of Adult Tinea Capitis and Review of Published Literature. Mycopathologia 2016; 181:371-8. [DOI: 10.1007/s11046-016-0004-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/16/2016] [Indexed: 11/27/2022]
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Sacheli R, Adjetey C, Darfouf R, Harag S, Huynen P, Meex C, Descy J, Melin P, Arrese J, Hayette MP. A one-year survey of Microsporum audouinii infections in Belgium: epidemiological and genotypic characterization. Clin Microbiol Infect 2016; 22:285.e9-17. [DOI: 10.1016/j.cmi.2015.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/20/2015] [Accepted: 11/26/2015] [Indexed: 11/16/2022]
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Romano C, Feci L, Fimiani M. Thirty-six cases of epidemic infections due toTrichophyton violaceumin Siena, Italy. Mycoses 2013; 57:307-11. [DOI: 10.1111/myc.12164] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Clara Romano
- Dermatology Section; Department of Clinical Medicine and Immunogical Sciences; Siena University; Siena Italy
| | - Luca Feci
- Dermatology Section; Department of Clinical Medicine and Immunogical Sciences; Siena University; Siena Italy
| | - Michele Fimiani
- Dermatology Section; Department of Clinical Medicine and Immunogical Sciences; Siena University; Siena Italy
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Valari M, Stathi A, Petropoulou T, Kakourou T, Pangali A, Arabatzis M. Cases of Tinea capitis due to pale isolates of Trichophyton violaceum (Trichophyton glabrum) in South-East Europe. A challenge to the clinical laboratory. Med Mycol Case Rep 2012; 1:66-8. [PMID: 24371741 DOI: 10.1016/j.mmcr.2012.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 08/07/2012] [Accepted: 08/20/2012] [Indexed: 11/29/2022] Open
Abstract
Two recent indigenous cases of tinea capitis in children due to pale isolates of Trichophyton violaceum are reported herein for the first time from South-East Europe (Greece). Pale isolates of Trichophyton violaceum, reported in the past as Trichophyton glabrum, are thus far sporadically reported only from African or Asian countries. The cases reported herein raise the awareness of its existence in the community, assigning special importance to its accurate identification in the clinical laboratory.
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Affiliation(s)
- Manthoula Valari
- Pediatric Dermatology Department, Aghia Sophia Children's Hospital, Athens, Greece
| | - Ageliki Stathi
- Microbiology Laboratory, Aghia Sophia Children's Hospital, Athens, Greece
| | - Theoni Petropoulou
- First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Talia Kakourou
- First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Anastasia Pangali
- Microbiology Laboratory, Aghia Sophia Children's Hospital, Athens, Greece
| | - Michael Arabatzis
- First Department of Dermatology-Venereology, Medical School, Aristotle University, Thessaloniki, Greece (Lecturer Elect), Athens, Greece ; Mycology Laboratory (K.A.70/3/6915), Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Calabrò G, Nino M, La Bella S, Gallo L. Trichophyton violaceum infection in an adult black patient in Europe. Int J Dermatol 2011; 50:761-3. [DOI: 10.1111/j.1365-4632.2009.04487.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Binder B, Lackner HK, Poessl BD, Propst E, Weger W, Smolle J, Ginter-Hanselmayer G. Prevalence of tinea capitis in Southeastern Austria between 1985 and 2008: up-to-date picture of the current situation. Mycoses 2011; 54:243-7. [DOI: 10.1111/j.1439-0507.2009.01804.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Changes of Dermatophytoses in Southwestern Greece: An 18-Year Survey. Mycopathologia 2011; 172:63-7. [DOI: 10.1007/s11046-011-9397-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 02/01/2011] [Indexed: 11/30/2022]
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Abstract
Significant changes in epidemiology, etiology, and the clinical pattern of mycotic infections caused by Microsporum spp have been observed in recent years. Fungal infections caused by M canis, followed by M gypseum and M hominis, involving skin and its appendages, represent one of the most common diseases worldwide and a recalcitrant problem in dermatology that demands appropriate diagnostic and treatment strategies. The most striking clinical phenomena of superficial and kerion and other forms of tinea, such as tinea capitis, fungal infections of the glabrous skin (tinea pedis, manus, cruris et corporis), and even onychomycosis due to Microsporum spp are described, with emphasis on the changes that have occurred in the last decade. The data on significant differences in the prevalence and clinical pattern of the fungal skin infections caused by Microsporum spp today compared with the data at the beginning of the epidemic breakout might still be rather controversial, depending also on the patients' lifestyle and geography. In general, physicians should be aware of the clinical spectrum of mycotic infections due to Microsporum spp to avoid mistakes in identifying the fungal etiology and to provide patients with the proper therapy.
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Affiliation(s)
- Mihael Skerlev
- University Department of Dermatology and Venereology, Zagreb University Hospital Centre and Zagreb University School of Medicine, Salata 4, 10000 Zagreb, Croatia.
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Porta N, San Juan J, Simal E, Baldellou R, Ara M, Zubiri M. Análisis de la demanda asistencial de Dermatología en la población inmigrante del área de salud del Hospital Miguel Servet de Zaragoza. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74634-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Porta N, San Juan J, Simal E, Baldellou R, Ara M, Zubiri M. Analysis of the Demand for Dermatological Care in the Immigrant Population Served by Hospital Miguel Servet in Saragossa, Spain. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Monteagudo B, León-Muiños E, Ordóñez P, de las Heras C, Rodríguez-Mayo M, Cacharrón JM. Tinea capitis causada por Trichophyton violaceum. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:553-4. [PMID: 17067541 DOI: 10.1016/s0001-7310(06)73465-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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