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Mayser P, Nenoff P, Reinel D, Abeck D, Brasch J, Daeschlein G, Effendy I, Ginter-Hanselmayer G, Gräser Y, Hipler UC, Höger P, Kolb-Mäurer A, Ott H, Schaller M, Zidane M. S1 guidelines: Tinea capitis. J Dtsch Dermatol Ges 2020; 18:161-179. [PMID: 32026639 DOI: 10.1111/ddg.14026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Tinea capitis describes a dermatophyte infection of scalp and hair that predominately occurs in children. The diagnostic workup includes microscopic examination, culture and/or molecular tests. Treatment is guided by the specific organism involved and should consist of systemic agents as well as adjuvant topical treatment. The aim of the present update of the interdisciplinary German S1 guidelines is to provide dermatologists, pediatricians and general practitioners with a decision tool for selecting and implementing appropriate diagnostic and therapeutic measures in patients with tinea capitis. The guidelines were developed based on current international guidelines, in particular the 2010 European Society for Pediatric Dermatology guidelines and the 2014 British Association of Dermatologists guidelines, as well as on a review of the literature conducted by the guideline committee. This multidisciplinary committee consists of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guidelines were approved by the participating medical societies following a comprehensive internal and external review.
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Affiliation(s)
| | - Pietro Nenoff
- Partnership Pietro Nenoff, PhD, MD & Constanze Krüger, MD, Laboratory for Medical Microbiology, Rötha OT Mölbis, Germany
| | | | | | - Jochen Brasch
- Department of Dermatology, University Medical Center of Schleswig Holstein, Kiel, Germany
| | - Georg Daeschlein
- Department of Dermatology, Greifswald University Medical Center, Greifswald, Germany
| | - Isaak Effendy
- Department of Dermatology, Bielefeld Medical Center, Bielefeld, Germany
| | | | - Yvonne Gräser
- National Reference Laboratory for Dermatophytes, Institute for Microbiology and Hygiene, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | - Peter Höger
- Department of Pediatrics and Pediatric Dermatology/Allergology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Annette Kolb-Mäurer
- Department of Dermatology, Venereology and Allergology, Würzburg University Medical Center, Würzburg, Germany
| | - Hagen Ott
- Department of Pediatric Dermatology and Allergology, Auf der Bult, Hanover, Germany
| | - Martin Schaller
- Department of Dermatology, Tübingen University Medical Center, Tübingen, Germany
| | - Miriam Zidane
- Department of Dermatology, Venereology and Allergology, Division of Evidence-based Medicine (dEBM) and Berlin Institute of Health, Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, Berlin, Germany
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Akhoundi M, Marteau A, Lintanf M, Izri A, Brun S. Case Report: Extensive Tinea Corporis and Inflammatory Tinea Capitis Caused by the Anthropophilic Dermatophyte Trichophyton tonsurans. Am J Trop Med Hyg 2020; 103:2127-2128. [PMID: 32901593 DOI: 10.4269/ajtmh.20-0176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Trichophyton tonsurans is an anthropophilic dermatophyte with a worldwide distribution and is responsible for superficial mycosis with a wide range of clinical manifestations. We report two atypical cases of tinea due to T. tonsurans in two children: a case of extensive tinea corporis and a case of inflammatory tinea capitis.
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Affiliation(s)
- Mohammad Akhoundi
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Anthony Marteau
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Maryvonne Lintanf
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Arezki Izri
- Unité des Virus Emergents (UVE), Aix Marseille University, IRD 190, INSERM 1207, IHU Méditerranée Infection, Marseille, France.,Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Sophie Brun
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
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3
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Mayser P, Nenoff P, Reinel D, Abeck D, Brasch J, Daeschlein G, Effendy I, Ginter-Hanselmayer G, Gräser Y, Hipler UC, Höger P, Kolb-Mäurer A, Ott H, Schaller M, Zidane M. S1‐Leitlinie Tinea capitis. J Dtsch Dermatol Ges 2020; 18:161-180. [PMID: 32026649 DOI: 10.1111/ddg.14026_g] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Pietro Nenoff
- Partnerschaft Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Labor für medizinische Mikrobiologie, Rötha OT Mölbis, Deutschland
| | | | | | - Jochen Brasch
- Universitäts-Hautklinik Kiel, Universitätsklinikums Schleswig-Holstein, Kiel, Deutschland
| | - Georg Daeschlein
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Hautkrankheiten, Greifswald, Deutschland
| | - Isaak Effendy
- Hautklinik, Klinikum der Stadt Bielefeld, Bielefeld, Deutschland
| | | | - Yvonne Gräser
- Konsiliarlaboratorium für Dermatophyten, Institut für Mikrobiologie und Hygiene, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - Peter Höger
- Pädiatrie und Pädiatrische Dermatologie/Allergologie, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Deutschland
| | - Annette Kolb-Mäurer
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Hagen Ott
- Pädiatrische Dermatologie und Allergologie, Auf der Bult, Hannover, Deutschland
| | - Martin Schaller
- Universitäts-Hautklinik Tübingen, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Miriam Zidane
- Department of Dermatology, Venerology und Allergology, Division of Evidence-based Medicine (dEBM) and Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Deutschland
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4
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Lin CY, Lo HJ, Tu MG, Ju YM, Fan YC, Lin CC, Chiang YT, Yang YL, Chen KT, Sun PL. The survey of tinea capitis and scalp dermatophyte carriage in nursing home residents. Med Mycol 2018; 56:180-185. [PMID: 28525623 DOI: 10.1093/mmy/myx034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/04/2017] [Indexed: 11/14/2022] Open
Abstract
Tinea capitis is a contagious dermatophyte infection of scalp and associated hairs. On the other hand, asymptomatic carriage is a status of positive dermatophyte scalp culture, but without signs or symptoms of tinea capitis, and no evidence of hair shaft invasion confirmed by direct microscopy. Tinea capitis and asymptomatic carriage mostly occur in children, but adult females are becoming another population in recent decades. In this study, we focused on the prevalence and related fungi of tinea capitis and asymptomatic carriage in elderly by the shampoo brush method, as well as the source of transmission, in 10 nursing home residents. Two hundred and thirteen residents were screened, and 186 isolates were identified, of which only three were dermatophytes (1.4%). The scalp dermatophyte isolates were identified as Trichophyton rubrum by morphological characters and sequences comparisons in all three cases. After revisiting, these cases were proved to be asymptomatic carriers by negative microscopic and culture examination; however, two cases were found to have concurrent tinea pedis and onychomycosis, which were identified as T. rubrum and Trichophyton interdigitale. The source of the T. rubrum scalp carriage may come from tinea elsewhere on the body of the same subject or from other people in the same institute. Finding and treating the source of carriage, as well as treating scalp carriage patients according to the colony counts, may help prevent disease spreading.
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Affiliation(s)
- Chien-Yio Lin
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou and Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Jung Lo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan.,School of Dentistry, China Medical University, Taichung, Taiwan
| | - Ming-Gene Tu
- School of Dentistry, China Medical University, Taichung, Taiwan
| | - Yu-Ming Ju
- Institute of Plant and Microbial Biology, Academia Sinica, Nankang, Taiwan
| | - Yun-Chen Fan
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou and Taipei, Taiwan
| | - Chih-Chao Lin
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Ya-Ting Chiang
- School of Dentistry, China Medical University, Taichung, Taiwan
| | - Yun-Liang Yang
- Institute of Molecular Medicine and Bioengineering, National Chiao Tung University, Hsinchu, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Kai-Ting Chen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Pei-Lun Sun
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou and Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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5
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Durán-Valle MT, Regodón-Domínguez M, Velasco-Rodríguez MJ, Aragón A, Gómez-Garcés JL. [Outbreak of Trichophyton tonsurans ringworm in a health area of the Community of Madrid (Spain)]. Rev Iberoam Micol 2016; 33:126-8. [PMID: 26774595 DOI: 10.1016/j.riam.2015.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/08/2015] [Accepted: 01/23/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Trichophyton tonsurans is a dermatophyte fungus that can cause ringworm outbreaks. In our health area in September 2013, two cases of T. tonsurans ringworm were diagnosed in children who lived in a Children's Centre. AIMS To determine the origin and extent of the outbreak. METHODS Mycological cultures of scalp and skin samples from the contacts of the diagnosed cases were performed, as well as environmental samples from the Children's Centre. The patients started with a treatment for their ringworm, and an environmental disinfection of the centre was performed. RESULTS Twelve cases of ringworm were detected, along with three asymptomatic scalp carriers of T. tonsurans among 20 children in the Centre. The index case was a resident in whose family, that had just returned from their country of origin, Nigeria, three cases of ringworm were diagnosed. From November 2013 to February 2014 another five cases of ringworm were diagnosed among schoolmates of three cases from the Children's Centre. CONCLUSIONS The antifungal treatment of the children resulted in the mycological and clinical resolution, and from February to November 2014 no other cases of ringworm by T. tonsurans in the same health area were diagnosed.
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Affiliation(s)
| | | | | | - Andrés Aragón
- Sección de Epidemiología, Servicio de Salud Pública del Área 8 de la Comunidad de Madrid, Madrid, España
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6
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Zhan P, Li D, Wang C, Sun J, Geng C, Xiong Z, Seyedmousavi S, Liu W, de Hoog GS. Epidemiological changes in tinea capitis over the sixty years of economic growth in China. Med Mycol 2015; 53:691-8. [PMID: 26260745 DOI: 10.1093/mmy/myv057] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 06/11/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tinea capitis is a fungal infection of the scalp occurring commonly in children. Historical data indicate that clinical manifestations and the spectrum of etiologic agents vary greatly with geography, as well as socioeconomic affected populations. OBJECTIVE To study the possible connection between socioeconomic status, the disease patterns and the variability of etiological agents. METHODS We reviewed tinea capitis in China through literature since 1956. The disease pattern was correlated with economic and public health management protocols. Historical data on fungal identification were mostly obtained by morphology. The accuracy of these historical results was further confirmed by use of both morphological and ITS identification on a control set of 90 isolates collected recently from local hospital. RESULTS Full agreement of the two identification methods implies that data from the literature were sufficiently reliable to allow comparison across reported cases. In sum, 88 papers involving 25 administrative provinces and municipalities with 38,962 clinical strains met the inclusion criteria of this review. Zoophilic species Microsporum canis is the most prevalent agent within large, modernized cities in China today accounting for over 80% of infections. In contrast, anthropophilic dermatophytes, particularly Trichophyton violaceum, are geographically endemic only in some southeastern and northwestern regions. CONCLUSION Economic development and urbanization of cities favor a shift of etiological agents from anthroponoses to zoonoses in contemporary China. Pets are becoming the most likely sources of infection in modern lifestyles, replacing the earlier human-to-human transmission mode. However, the latter transmission mode is still prevalent in less developed areas lacking adequate social and public health facilities.
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Affiliation(s)
- Ping Zhan
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing 210042, China Dermatology Hospital of Jiangxi Province, Jiangxi Provincial institute of Dermatology, Nanchang 330001, China CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
| | - Dongmei Li
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing 210042, China Georgetown University Medical Center, Department of Microbiology / Immunology, Washington, DC 20057, United States
| | - Chong Wang
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing 210042, China Dermatology Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009 China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Chengfang Geng
- Dermatology Hospital of Jiangxi Province, Jiangxi Provincial institute of Dermatology, Nanchang 330001, China
| | - Zhiwei Xiong
- Dermatology Hospital of Jiangxi Province, Jiangxi Provincial institute of Dermatology, Nanchang 330001, China
| | - Seyedmojtaba Seyedmousavi
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands Department of Medical Microbiology and Infectious Diseases, Erasmus MC, The Netherlands
| | - Weida Liu
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing 210042, China
| | - G Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
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7
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Nenoff P, Krüger C, Schaller J, Ginter-Hanselmayer G, Schulte-Beerbühl R, Tietz HJ. Mycology - an update part 2: dermatomycoses: clinical picture and diagnostics. J Dtsch Dermatol Ges 2015; 12:749-77. [PMID: 25176455 DOI: 10.1111/ddg.12420] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/19/2014] [Indexed: 11/28/2022]
Abstract
Most fungal infections of the skin are caused by dermatophytes, both in Germany and globally. Tinea pedis is the most frequent fungal infection in Western industrial countries. Tinea pedis frequently leads to tinea unguium, while in the elderly, both may then spread causing tinea corporis. A variety of body sites may be affected, including tinea glutealis, tinea faciei and tinea capitis. The latter rarely occurs in adults, but is the most frequent fungal infection in childhood. Following antifungal treatment of tinea unguium and also tinea capitis a dermatophytid or hyperergic reaction to dermatophyte antigens may occur. Yeast infections affect the mucous membranes both of the gastro-intestinal system and the genital tract as candidiasis mostly due to Candida albicans. Cutaneous candidiasis affects predominantely the intertriginous regions such as groins and the inframammary area, but also the intertriginous space of fingers and toes. In contrast, pityriasis versicolor is a superficial epidermal fungal infection primarily on the the trunk. Mold infections are rare in dermatology; they play a role nearly exclusively in nondermatophyte-mold (NDM) onychomycosis. The diagnosis of dermatomycoses comprises the microscopic detection of fungi using the potassium hydroxide preparation or alternatively the fluorescence optical Blankophor preparation together with culture. The histological fungal detection with PAS staining possesses a high sensitivity, and it should play a more important role in particular for diagnosis of onychomycosis. Molecular biological methods, based on the amplification of fungal DNA with use of specific primers for the distinct causative agents are on the rise. With PCR, such as dermatophyte-PCR-ELISA, fungi can be detected directly in clinical material in a highly specific and sensitive manner without prior culture. Today, molecular methods, such as Matrix Assisted Laser Desorption/Ionization Time-Of-Flight Mass Spectrometry (MALDI TOF MS) as culture confirmation assay, complete the conventional mycological diagnostics.
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Affiliation(s)
- Pietro Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
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8
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A Chronic Disseminated Dermatophytosis Due to Trichophyton violaceum. Mycopathologia 2014; 179:159-61. [DOI: 10.1007/s11046-014-9823-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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9
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Nenoff P, Krüger C, Schaller J, Ginter-Hanselmayer G, Schulte-Beerbühl R, Tietz HJ. Mykologie - ein Update Teil 2: Dermatomykosen: Klinisches Bild und Diagnostik. J Dtsch Dermatol Ges 2014. [DOI: 10.1111/ddg.12420_suppl] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Pietro Nenoff
- Labor für medizinische Mikrobiologie, Mölbis, Deutschland
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10
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Dessinioti C, Papadogeorgaki E, Athanasopoulou V, Antoniou C, Stratigos AJ. Screening for asymptomatic scalp carriage in household contacts of patients with tinea capitis during 1997-2011: a retrospective hospital-based study. Mycoses 2014; 57:366-70. [PMID: 24372570 DOI: 10.1111/myc.12166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/27/2013] [Accepted: 12/02/2013] [Indexed: 11/30/2022]
Abstract
For anthropophilic tinea capitis (TC), household spread and asymptomatic scalp carriage (ASC) is considered an important route of transmission and incomplete clearance. To investigate ASC in household contacts of patients diagnosed with TC in a tertiary hospital in Athens, Greece, we retrospectively reviewed the medical files of household contacts that were screened for ASC from 1997 to 2011. Only 34 household contacts of 15 index cases agreed to come for screening. Thirty-three (97%) household contacts were asymptomatic scalp carriers. The most commonly isolated species was Trichophyton violaceum (59%). There was a statistically significant association of ASC with the isolated dermatophyte species (T. violaceum, P-value: 0.029), and with the age of younger than 16 years old (P-value: 0.005), while there was no association with gender (P-value: 0.672). A small number of household contacts accepted to proceed for screening. ASC was found in nearly all screened household contacts and was associated with T. violaceum and younger age. The low number of household contacts that accepted screening may reflect the ignorance of the general population about the possibility of ASC among household contacts in case of a patient with TC.
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Affiliation(s)
- Clio Dessinioti
- 1st Department of Dermatology, University of Athens, Andreas Syggros Hospital, Athens, Greece
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12
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Trichophyton tonsurans scalp carriage among wrestlers in a national competition in Turkey. Mycopathologia 2011; 172:215-22. [PMID: 21472391 DOI: 10.1007/s11046-011-9421-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
Abstract
Trichophyton tonsurans tinea gladiatorum is an emerging epidemic among combat-sport athletes across the globe. In the present study, we investigated the prevalence of symptomatic and asymptomatic dermatophytic infections among wrestlers in the National Greco-Roman Championship in Turkey. In total, 194 wrestlers from 32 provinces and 72 clubs were examined for scalp, trunk, groin, and toe web dermatophytic infections. We also administered a questionnaire to obtain information on the participants' lifestyles, wrestling characteristics, and risk factors for dermatophytic infections. The hairbrush method was used for scalp and trunk sampling, whereas a cotton swab was used for groin, toe web, and mat sampling. Three wrestling mats in the gymnasium were surveyed for dermatophytes using the touch preparation method. A total of 17 (8.8%) wrestlers harbored dermatophytes, and 22 strains were isolated: 13 (59.1%) T. tonsurans and 9 (40.9%) T. rubrum. These isolates were found on the scalp (8), trunk (2), forearm (1), hand (1), groin (3), and feet (7). In addition, we recovered 8 dermatophyte strains from the 150 mat samples (5.3%): T. rubrum in 6 samples (75%) and T. tonsurans in two samples (25%). T. tonsurans was only recovered from 11 out of 194 (5.7%) wrestlers. Scalp carriage represents the predominant (72.7%) clinical picture of a T. tonsurans infection in these Greco-Roman wrestlers in Turkey.
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