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

Dermoscopic findings in Tinea Capitis among under 18 children in dermatology polyclinic patients: a hospital-based cross-sectional study

Background

Tinea capitis is a fungal infection that affects the scalp. It is caused by a group of fungi known as dermatophytes, which thrive in warm and moist environments. In Somalia, there is a data shortage regarding dermatological conditions, especially in Mogadishu, the most populous city in the country. Tinea capitis has gone unreported despite its high prevalence in Somali dermatology clinics and the Somali diaspora in Western countries. The absence of up-to-date information hampers the capability to diagnose, treat, and prevent Tinea capitis. Therefore, the study aims to evaluate dermoscopic signs about isolated organisms and potassium hydroxide (KOH) examination.

Method

A hospital-based cross-sectional study was implemented between January and April 2023 in Mogadishu, Somalia. All eligible Tinea capitis-infected children were included in the study. Microscopically, analysis was conducted by adding 10% of KOH in fungal elements. Data were analyzed using descriptive statistics and the χ2 test at P value less than 0.05.

Results

A total of 76 tinea capitis-infected children participated in the study; 56% were age group between 5-9 years old, 68.4% were male, and 92.1% showed KOH positivity. Trichophyton violaceum (65.8%) and Trichophyton sudanense (14.5%) were the most common fungal organisms detected in the culture. comma hairs (93.10%), scales (40.80%), and corkscrews (32.90%) were the most common dermoscopic signs of tinea capitis. The demographical characteristics and dermoscopic signs of tinea capitis significantly associated with the positivity of KOH examination were age, sex, comma hairs, corkscrew hairs, broken hair, Scales, and Zigzag hair.

Conclusion

Children in Mogadishu, Somalia, bear a significant burden of Tinea Capitis infections. Trichophyton violaceum and Trichophyton sudanense were the predominant causative agents identified in the cultures. The most common dermoscopic signs of tinea capitis observed in this study were comma hairs, scales, and corkscrew patterns. Hence, early diagnosis of Tinea Capitis infections and timely, effective treatments with contact tracing are highly needed.

Dermatophyte Infections Worldwide: Increase in Incidence and Associated Antifungal Resistance

The increase in incidence of superficial fungal infections combined with the emergence of antifungal resistance represents both a global health challenge and a considerable economic burden. Recently, dermatophytes, the main culprit causing superficial fungal infections, have started to exhibit antifungal resistance. This can be observed in some of the most common species such as Trichophyton rubrum and Trichophyton mentagrophytes. Importantly, the new subspecies, known as Trichophyton indotineae, has been reported to show high resistance to terbinafine, a first-line treatment for dermatophyte infections. Compounding these issues is the realization that diagnosing the causative infectious agents requires using molecular analysis that goes beyond the conventional macroscopic and microscopic methods. These findings emphasize the importance of conducting antifungal susceptibility testing to select the appropriate antifungal necessary for successful treatment. Implementing these changes may improve clinical practices that combat resistant dermatophyte infections.

The Epidemiology of Tinea Capitis in Guangxi Province, China

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

Tinea capitis among schoolchildren in Ethiopia: A systematic review and meta analysis

BACKGROUND

Tinea capitis accounts for25 to 30% of all fungal infections, but it is often ignored because it is not life threatening in nature. It is more common among schoolchildren particularly in developing countries. Due to the presence of significant variability among the previous studies, this study was conducted to provide a pooled prevalence and associated factors of tinea capitis in Ethiopian schoolchildren.

METHOD

We conducted a systematic search in five major databases for articles similar to our topic. This review included school-based cross-sectional studies that were reported in English and conducted from 2006 through 2022. The data were extracted using Microsoft Excel and further analysis was done using StataTM Version 17.0 statistical software. Forest plots were used to assess the presence of heterogeneity with 95% confidence intervals. A random effects meta- analysis model was used to pool primary estimates. To declare the presence or absence of association, 95% confidence interval with odds ratio was used.

RESULTS

Fourteen studies with a total of 9465 schoolchildren were included. The pooled prevalence was 29.03% (95%CI: 15.37-42.71). There was observed heterogeneity, which could be explained by publication bias (P = 0.04). Family history of tinea capitis (OR: 9.18, 95%CI: 3.5-24.02), under the age of 10 years (OR: 1.65, 95%CI: 1.17-2.33) were factors increasing the development of tinea capitis among schoolchildren and schoolchildren who had hair wash at least once a week (OR: 0.31, 95%CI: 0.24-0.42) was significantly associated with reduced risk for tinea capitis.

CONCLUSION

One of the most prevalent childhood health condition in Ethiopia is tinea capitis, which affects over one in every four schoolchildren. Schoolchildren who had family history of tinea capitis and under the age of 10 years were the identified risk factors but they had hair wash at least once a week was the protective factor of tinea capitis among schoolchildren. Clinical and public engagement activities are needed to overcome the burden of the disease.

Clinical clues and trends in epidemiology and pathogens in paediatric tinea capitis: a retrospective cohort study

BACKGROUND

Tinea capitis is the most common dermatophyte infection in children. Pathogens differ between populations. During the past few decades pathogen shifts have been reported in many countries around the world. This study aimed to characterize the pathogens involved in tinea capitis in a large tertiary paediatric medical centre in Israel.

METHODS

The electronic medical records of the dermatology unit were searched for patients diagnosed with tinea capitis from 2010 to 2019, and demographic, clinical and mycological data were retrieved. A stepwise logistic regression was performed to determine the variables most significantly associated with positive cultures.

RESULTS

The prevalence of Trichophyton tonsurans isolates was found to be significantly increased during 2019. In the logistic regression analysis, alopecia was most significantly associated with a positive culture (OR = 8.72, 95% CI 4.29-17.7, P < 0.001) while positive culture was also associated with age (OR = 1.11 per year of age, 95% CI 1.02-1.22, P = 0.01) and Ethiopian ethnicity (OR = 3.67, 95% CI 1.42-9.45, P = 0.01). The presentation of alopecia was significantly related to having a positive culture. This symptom was more prevalent in boys than in girls, and the diagnosis of tinea capitis was delayed by an average of 2 months in girls.

CONCLUSION

The results of this study may herald a pathogen shift in Israel. Physicians should be aware that rates of alopecia are lower in girls and this can result in delayed diagnosis and the development of complications, including chronicity, scarring alopecia and kerion formation.

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Trichoscopic signs of tinea capitis: a guide for selection of appropriate antifungal

BACKGROUND

Tinea capitis is the most common pediatric dermatophyte infection. Optimal treatment regimen differs according to the type of the dermatophyte involved.

OBJECTIVES

The aim of this work was to study the trichoscopic signs in relation to isolated organism in a sample of Egyptian patients with tinea capitis and the possibility of using them as a guide for selection of appropriate antifungal.

METHODS

This study was carried out on 60 subjects with tinea capitis. Patients were mycologically examined, both direct microscopy with KOH preparation and culture of the scraped hair materials on Sabouraud dextrose agar. Culture mounts were used for identification of the organism. Trichoscopic examination of all patients was performed using the Dermlite DLIII dermoscope.

RESULTS

There was significant higher prevalence of both comma and corkscrew hair in endothrix infection and T. violaceum-infected cases. On the other hand, there was significant higher prevalence of zigzag, barcode hairs, and white sheaths in ectothrix infection and M. canis-infected cases.

CONCLUSION

While some trichoscopic findings are nonspecific, others were found to be more specific. Finding zigzag hairs and barcode hairs points to ectothrix infection (M. canis), and it is recommended to start treatment with griseofulvin. On the other hand, finding comma hairs and corkscrew hairs without zigzag hairs and barcode hairs points to endothrix infection (T. violaceum), and it is recommended to start treatment with terbinafine in the usual dose.

Prevalence of skin infections, infestations, and papular urticaria among adolescents in secondary schools in Calabar, Nigeria

Background

Acne is an inflammatory disorder of the pilosebaceous gland, and the most common dermatosis in adolescents globally. Infectious dermatoses are common in the tropics, but due to the paucity of epidemiologic surveys, not much is known about the prevalence and common types found in different sub-populations including adolescents. It is however presumed that the prevalence will be high and the pattern diverse. We therefore conducted a school-based survey to ascertain the prevalence and pattern of infectious dermatoses, infestations, and papular urticaria (insect bite reactions) in teenage adolescents in Calabar, Nigeria.

Methods

A cross sectional observational survey of adolescents aged 13–19 years attending randomly selected secondary schools in Calabar, Nigeria. It involved the use of questionnaires and subsequent whole body examination.

Results

A total of 1447 senior secondary school students were examined. Infectious dermatoses, infestations, and papular urticaria (IDIP) were observed in 505 (34.9%) persons, among whom were 269 (53.3%) males, and 236 (46.7%) females (X²=34.87, p=<0.001). Fungal dermatoses constituted more than 90% of the diseases, the bulk of which was contributed by pityriasis versicolor [430 (79.6%)]. The six most common dermatoses in descending order of frequencies were Pityriasis versicolor, tinea, papular urticaria, candidiasis, furuncles, and viral warts.

Conclusion

A high prevalence of cutaneous infections exists among teenage adolescents in Calabar, Nigeria. Males have a higher predisposition to fungal dermatoses. Control of the predominant cause of cutaneous infections — pityriasis versicolor, will significantly affect the prevalence of infectious dermatoses, and invariably, the burden of skin disorders in adolescents in Calabar, Nigeria.

Funding

Self sponsored

Tinea capitis: A single-institution retrospective review from 2010 to 2015

BACKGROUND/OBJECTIVE

Tinea capitis is a common infection of scalp hair in children. The prevalent etiologic organism has changed significantly over time, which may reflect the complex interaction of environmental factors, genetic predisposition, and movement of populations. We evaluate the prevalence of different infectious organisms causing tinea capitis and describe the clinical characteristics.

METHODS

A retrospective chart review of patients diagnosed with tinea capitis with tissue culture confirmation, who were seen in pediatric dermatology at a tertiary care center from 2010 to 2015. Patient demographics, culture data, and clinical characteristics were evaluated. Inflammatory pattern, characterized by presence of pustules, bogginess, or lymphadenopathy, was noted.

RESULTS

Forty-six patients with culture-positive tinea capitis were identified. In the 18 (42.9%) patients who were infected with either Trichophyton violaceum or Trichophyton soudanenese, all were of African ethnicity. In contrast, Trichophyton tonsurans was identified in a minority of African patients (3.8%), revealing a statistically significant difference between ethnicity and infective species (P-value < 0.001). T tonsurans was significantly more likely than T violaceum to exhibit an inflammatory pattern (68% vs 22%, P value < 0.027).

CONCLUSIONS

While T tonsurans remained the most common cause of tinea capitis, T violaceum and T soudanense have increased in prevalence. As these latter agents are less inflammatory, clinical diagnosis may be delayed. Studying changes in the infectious cause of tinea capitis can help us create a snapshot to better understand the evolution of our population make-up, allowing us to provide crucial quality health care to all.

[Evolution of tinea capitis observed in mycology laboratory of institute Pasteur of Algeria from1995 to 2015]

Tinea capitis are common in Algeria and are a frequent reason for consultation. This mycosis affects children and rarely adults. This is a retrospective study over a period of 20 years from 1995 to 2015 at the mycology laboratory of the Pasteur institute of Algeria.

OBJECTIVE OF THE STUDY

Observe the evolution of these tinea over the years, to study the epidemiological aspects and identify the responsible agents.

PATIENTS

This study concerned patients of all ages and sexes living in the region of Algiers and the environs, consultant for various scalp lesions.

MATERIALS AND METHODS

For each patient, a completed information sheet is developed in insisting on the presence of animals and people with similar lesions. For each sampling, direct examination and culture on Sabouraud medium and antibiotics are utilized. The cultures are put at T° 27 to 28°C and controlled regularly during 3 to 4 weeks.

RESULTS

A total of 2664 samples were collected, 892 examinations were positive corresponding to a frequency of 33.48%. The age group 0-10 years is the most affected 710 cases (79.60%), with a slight predominance for male sex 502 cases (56.27%) and 390 cases (43.72%) for female sex. Eight hundred and fifty-five dermatophytes strains were isolated. Among the species found, Trichophyton violaceum is the most species isolated (59.41%), followed by Microsporum canis to 35.08%. In our series, the number of cases of tinea has increased slightly over the years, the rate of 26% in 2001 has progressed to 41.02% in 2015. From 1995 to 2011, T. violaceum was the predominant species, but from the year 2011 we see an increase of M. canis and decreased of T. violaceum.

CONCLUSION

Tinea capitis remains frequent in Algeria and affects preferentially the children. T. violaceum and M. canis dominate the dermatophytic flora. Tinea trichophytic anthropophiles have progressively decreased in favor of tinea microsporic zoophiles who saw their number increased.

Estimated Burden of Serious Fungal Infections in Jamaica by Literature Review and Modelling

OBJECTIVE

Jamaica is one of the largest countries in the Caribbean with a population of 2 706 500. Prevalence of human immunodificency virus (HIV) in Jamaica is high, while that of tuberculosis (TB) is recorded to be low. In this study, we have estimated the burden of serious fungal infections and some other mycoses in Jamaica.

METHODS

All published papers reporting on rates of fungal infections in Jamaica and the Caribbean were identified through extensive search of the literature. We also extracted data from published papers on epidemiology and from the World Health Organization (WHO) TB Programme and UNAIDS. Chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) rates were derived from asthma and TB rates. Where there were no available data on some mycoses, we used specific populations at risk and frequencies of fungal infection of each to estimate national prevalence.

RESULTS

Over 57 600 people in Jamaica probably suffer from serious fungal infections each year, most related to 'fungal asthma' (ABPA and SAFS), recurrent vulvovaginal candidiasis and AIDS-related opportunistic infections. Histoplasmosis is endemic in Jamaica, though only a few clinical cases are known. Pneumocystis pneumonia is frequent while cryptococcosis and aspergillosis are rarely recorded. Tinea capitis is common in children. Recurrent vulvovaginal candidiasis is very common (3154/100 000) and candidaemia occurs. Subcutaneous mycoses such as chromoblastomycosis and mycetoma also seem to be relatively common.

CONCLUSION

Local epidemiological studies are urgently required to validate or modify these estimates of serious fungal infections in Jamaica.

Cutaneous Mycoses among Rice Farmers in Anambra State, Nigeria

Rice grain is one of the world's most important food crops, and its cultivation is a major occupation in Anambra State, Nigeria. These rice farmers are exposed to various agents that predispose them to cutaneous mycoses. The aim of this work was to screen rice farmers for lesions suggestive of cutaneous mycoses and to isolate and identify fungal agents associated with the infection. This survey was carried out between November 2009 and June 2011 in Anambra State, Nigeria. Clinical samples collected from 201 farmers with lesions suggestive of cutaneous mycoses were processed and the organisms identified. Questionnaires were used to obtain other necessary data and were statistically analyzed. Of the 2,580 rice farmers screened, 201 (7.79%) showed positive lesions. Organisms recovered included Microsporum audouinii, Microsporum ferrugineum, Trichophyton megnini, Trichophyton tonsurans, Trichophyton rubrum, Aspergillus terrus, Aspergillus candidus, Aspergillus scleriotorum, Aspergillus niger, Aspergillus flavus, Scopulariopsis sp., Chrysosporium sp., Eupenicillium javanicum, Fusarium sp., Penicillium aculeatum, and Penicillium pinophilum. At the end of this work, onychomycosis was observed to be the most prevalent with nondermatophyte molds now becoming very important agents of cutaneous mycoses among rice farmer.

Tinea faciei in a newborn due to Trichophyton tonsurans

We report here the first case of neonatal tinea faciei caused by Trichophyton tonsurans in mainland China. The mother of the infant had tinea corpris and tinea capitis while the father had tinea incongnito. The infections in the parents were mycologically confirmed to be due to Trichophyton tonsurans. Ttinea faciei in the infant was cured after two-week topical use of amorolfine cream. The mother ceased breastfeeding and took oral terbinafine for 4 weeks. No recurrence was observed in the infant during 12 months of follow-up.

Trichophyton tonsurans in a family microepidemic

Trichophyton tonsurans is a highly transmissible anthropophilic dermatophyte fungus, which invades keratinized tissues. This study reports a case of family microepidemic caused by this dermatophyte. Despite their excellent hygiene conditions, it remained active for several years, spreading to all family members. The hypothesis that the fungus was being kept alive in the family home was confirmed after samples collected from it were analyzed. Pure cultures of the fungus were isolated and identified. After diagnosis, the house was disinfected with concomitant oral treatment for all family members.