Microsporum canis-Induced Tinea Capitis: A Rapid Screening Algorithm

Tinea capitis is a common fungal infection of the scalp, primarily affecting children, and caused by fungi like Trichophyton and Microsporum. Its pathogenesis is influenced by both host-specific and environmental factors, resulting in various clinical presentations including hair loss and scaling of the scalp. We present the case of an eight-year-old male with tinea capitis, characterized by itching and hair loss in the occipital area. Examination revealed characteristic findings on trichoscopy, and direct examination of hair confirmed parasitization. Treatment with terbinafine was initiated, leading to the resolution of symptoms. Epidemiological variations in the etiology of tinea capitis exist globally, with Trichophyton predominating in some regions and Microsporum in others. Trichoscopy is a valuable diagnostic tool for differentiating fungal infections, guiding treatment decisions. Despite the efficiency of direct skin and hair examination, the common occurrence of tinea and the lack of mycological centers in many clinics pose challenges. To address this, we propose integrating trichoscopy and epidemiological and clinical data for a quick in-office decision tool.

Kerion Celsi in infants and children-A narrative review 2010-2023

Kerion Celsi is an inflammatory, deep fungal infection of the scalp. It is rare in neonates but gets more common in children about 3 years and older. It represents with swelling, boggy lesions, pain, alopecia and purulent secretions. Secondary bacterial infection is not unusual after maceration. Extracutaneous manifestations include regional lymphadenopathy, fever and very rare fungemia. Id-reactions can occur. Diagnosis is based on clinical suspicion, clinical examination and medical history. Diagnosis should be confirmed by microscopy, fungal culture and molecular procedures. The most common isolated fungal species are anthropophilic Trichophyton (T.) tonsurans and zoophilic Microsporum (M.) canis, while geophilic species and moulds rarely cause Kerion Celsi. Treatment is medical with systemic and topical antifungals supplemented by systemic antibiotics when necessary, while surgery needs to be avoided. Early and sufficient treatment prevents scarring alopecia. The most important differential diagnosis is bacterial skin and soft tissue infections.

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.

Antifungal activity of citronellal against Trichophyton rubrum and its predictive mechanism of action by CYP51 inhibition through molecular docking

The present study aimed to investigate the antifungal activity of citronellal (CIT) against clinical isolates of T. rubrum and to show the possible mechanism of action involved. The antifungal potential of CIT was evaluated from the Minimum Inhibitory Concentration (MIC), Minimum Fungicide Concentration (MFC) and assays with ergosterol and sorbitol, to elucidate the possible mechanisms of action, and molecular docking. MIC and MFC values ranged from 4 to 512 µg/mL. Regarding the mechanism of action, the monoterpene demonstrated interaction with fungal ergosterol. In addition, it is possible to observe that CIT acts on crucial enzymes for the biosynthesis and maintenance of the fungal cell membrane, due to the ability of the monoterpene to bind to CYP51. The results obtained in this research demonstrate that CIT has the potential to become, in the future, a product for the treatment of dermatophytosis.

Tinea capitis caused by Trichophyton violaceum in an immunocompetent elderly patient: A case report and review of literature

Tinea capitis is a common dermatophyte infection of the scalp in children. It is an uncommon infection in adults and usually affects postmenopausal women and immunocompromised patients. We report an immunocompetent elderly female with inflammatory tinea capitis caused by Trichophyton violaceum and review the literature for the past 5 years to describe the disease, its epidemiologic characteristics, dermatophyte species involved and treatment options used. The total number of cases was 11, including 8 women and 3 men, with an average age of 48.36. The most commonly isolated dermatophyte was Trichophyton tonsurans, and most cases were treated successfully with oral terbinafine with no side effects. In our case, the diagnosis was established by direct examination, culture and histological examination. Remedy with itraconazole and prednisolone was very successful. Early diagnosis of tinea capitis in adults is necessary to provide early treatment and minimize sequelae of the disease.

Cutaneous Fungal Infections Caused by Dermatophytes and Non-Dermatophytes: An Updated Comprehensive Review of Epidemiology, Clinical Presentations, and Diagnostic Testing

Cutaneous fungal infection of the skin and nails poses a significant global public health challenge. Dermatophyte infection, mainly caused by Trichophyton spp., is the primary pathogenic agent responsible for skin, hair, and nail infections worldwide. The epidemiology of these infections varies depending on the geographic location and specific population. However, epidemiological pattern changes have occurred over the past decade. The widespread availability of antimicrobials has led to an increased risk of promoting resistant strains through inappropriate treatment. The escalating prevalence of resistant Trichophyton spp. infections in the past decade has raised serious healthcare concerns on a global scale. Non-dermatophyte infections, on the other hand, present even greater challenges in terms of treatment due to the high failure rate of antifungal therapy. These organisms primarily target the nails, feet, and hands. The diagnosis of cutaneous fungal infections relies on clinical presentation, laboratory investigations, and other ancillary tools available in an outpatient care setting. This review aims to present an updated and comprehensive analysis of the epidemiology, clinical manifestations, and diagnostic testing methods for cutaneous fungal infections caused by dermatophytes and non-dermatophytes. An accurate diagnosis is crucial for effective management and minimizing the risk of antifungal resistance.

Facial tinea incognito: a clinical, dermoscopic and mycological study of 38 cases

BACKGROUND

Tinea incognito (TI) is a dermatophytic infection of the skin that is modified by steroid use. As a result, it shows atypical clinical presentations that can lead to misdiagnosis. TI occurring on the face is most frequently misdiagnosed as cutaneous fungal infection, however, very limited information is available on facial TI.

OBJECTIVES

This study aimed to characterize the clinical, dermoscopic and mycological features of facial TI.

MATERIALS & METHODS

We retrospectively evaluated 38 patients with mycologically proven facial TI at a single institution in Korea between July, 2014 and July, 2021.

RESULTS

The patients had a mean age of 59.6 ± 20.4 years and showed a slight female predominance (male-to-female ratio of 1:1.38). The most common clinical presentation was an eczema-like pattern (47.4%), followed by rosacea-like (15.8%), psoriasis-like (10.5%), lupus erythematosus-like (10.5%), cellulitis-like (7.9%), and folliculitis-like (7.9%) patterns. The mean duration from disease onset to diagnostic confirmation was 3.4 months. Overall, 78.9% of the patients had accompanying chronic systemic diseases, and 57.9% had concurrent tinea infections at other skin sites, mainly the feet and toenails. On dermoscopy, scales and dilated vascular patterns (arborizing vessels and telangiectasia) were commonly observed on glabrous skin, with follicular patterns, such as black dots, broken hairs, and empty follicles. The characteristic trichoscopic features were comma, corkscrew, Morse code-like, and translucent hairs.

CONCLUSION

The clinical characteristics and distinct dermoscopic features described in this article may aid in the differential diagnosis of facial TI while reducing diagnostic delays and unnecessary treatments.

Clinicomycological Profile and Risk Factors for Dermatophytosis at a Teaching Tertiary Care Centre in North India: A Cross-sectional Study

BACKGROUND

Dermatophytosis has gained significant importance in recent years owing to increased incidence, more atypical lesions, changing mycological profile and growing antifungal resistance. Therefore, this study was planned to know the clinicomycological profile of dermatophytic infections in patients attending our tertiary care centre.

MATERIALS AND METHODS

A total of 700 patients with superficial fungal infections belonging to all age groups and both sexes were taken up for this cross-sectional study. Sociodemographic and clinical details were noted on a prestructured proforma. Superficial lesions were clinically examined and the sample was collected by appropriate collection methods. Direct microscopy by potassium hydroxide wet mount was done to see hyphae. For culture Sabouraud's dextrose agar (SDA) with chloramphenicol and cyclohexamide was used.

RESULTS

Dermatophytic infections were detected in 75.8% (531/700) patients. Young people belonging to age group of 21-30 years were commonly affected. Tinea corporis was the commonest clinical picture seen in 20% of the cases. Oral antifungals were taken by 33.1% and topical creams were used by 74.2% of the patients. Direct microscopy was positive in 91.3% and culture was positive for dermatophytes in 61% of the study subjects. T. mentagrophytes was the commonest dermatophyte isolated.

CONCLUSION

Irrational use of topical steroids needs to be controlled. KOH microscopy can be useful as a point of care test for rapid screening of dermatophytic infections. Culture is necessary to differentiate various dermatophytes and to guide the antifungal treatment.

A Cross-Sectional Clinicomycological Study on Dermatophytosis: A Report From a Single Tertiary Healthcare Center in Eastern India

Background Dermatophytosis is a public health concern in tropical countries. In India, a scalable number of dermatophytosis cases from multiple states are reported. In the eastern part of India, very few studies were published assessing the clinicomycological profiles of patients. Hence, we conducted this study to ascertain the clinicomycological profile of patients suffering from dermatophytosis with special reference to associated socio-environmental factors. Materials and methods This cross-sectional observational study was conducted in a tertiary care hospital situated in Bihar state of India from January 2021 to December 2021. We included a total of 330 patients of all age groups who were clinically diagnosed with superficial mycosis from the Department of Dermatology and sent for investigations to the Department of Microbiology. The collected specimens from the lesions were prepared with wet potassium hydroxide and examined under the microscope. Then, the specimens were inoculated and incubated at 25°C for up to four weeks. Fungal isolates were identified by gross appearance and microscopy if growth was observed. Results Among the 330 patients, 186 (56.4%) were males and 144 (43.6%) were females. The majority of the patients (54.5%) were from the low socioeconomic group and living in overcrowded places. Direct microscopy was positive in 198 (60%) patients, and culture was positive in 68 (20.61%) patients. The majority of the patients who were found positive in direct microscopy were from the age group of 21-30 years (39.9%), followed by 1-10 years (25.25%). A total of 92 (46.4%) cases were of tinea capitis, followed by 68 (34.3%) patients of tinea corporis. Trichophyton was the predominant fungus isolated, and Trichophyton mentagrophytes was the most common species (52.6%). Conclusion Tinea capitis was the most common provisionally diagnosed dermatophytosis in our tertiary care hospital in Bihar, an Indian state in its eastern zone. Low socioeconomic status and poor personal hygiene were the factors associated with the high prevalence of dermatophyte infections in this region of India. A detailed analysis of all these epidemiological factors is needed to limit the prevalence of dermatophytosis in tropical regions.

Epidemiology of scalp ringworms and superficial fungal infections in schools in Mauritania

INTRODUCTION

Scalp Tinea is the most common mycosis in children and adolescents. The objective of this work was to determine the epidemiological and etiological profile of Scalp Tinea in schoolchildren in Mauritania, during the year 2019.

METHODS

This is a descriptive cross-sectional study lasting four months, from May to September 2019, in a sample of schoolchildren from Nouakchott, included following a random survey at three levels, having benefited from a clinical examination, mycological and culture samples.

RESULTS

A total of 228 children out of the 434 included (52,5%) were detected as carriers of Scalp Tinea, after fungal culture, i.e. rates of 54% in boys and 46% in girls. The most affected age group was 9-12 years (49%). Public schools were the most affected (37,7%), followed by private schools (32%) and traditional schools (30,3%), (p<0,05). Trichophyton sudanense represented 23,5% (n=102) followed by Trichophyton rubrum (15,4%, n=67) and Microsporum langeronii 8,1% (n=35). The type of habitat, the humidity of the environment and walking with bare feet did not significantly influence the presence of ringworms, unlike overcrowding (sleeping with more than two people). The prevalence of scalp ringworms increased from 1,3% for children sleeping on single beds to 22,8% in children sharing their beds and to 75,9% in students sleeping together on the same bed (p˂0,05).

CONCLUSION

The results of this survey, conducted in 2019, confirmed the changes in the epidemiological and ecological trend of the mycological profile of Scalp Tinea, in Mauritania. It is necessary to strengthen these results with the molecular characterization of fungal strains circulating in our country.

Tinea pedis in a child: How reflectance confocal microscopy can help in diagnosis of dermatophytosis

A 7-year-old girl presented with a hyperkeratotic scale on the plantar surface of her left foot. A microscopic potassium hydroxide examination was performed and negative. Reflectance confocal microscopy was performed showing fungal hyphae and an inflammatory infiltrate confirming a diagnosis of tinea pedis.

Beyond the Superficial: Disseminated Trichophyton rubrum Infection in a Kidney Transplant Recipient

Superficial dermatophyte infections are common in the general population and are readily treated with topical antifungals. Deeper invasion is rare, and dissemination to visceral organs is extremely uncommon. We describe a 66-year-old renal transplant recipient who developed disseminated Trichophyton rubrum infection while undergoing treatment for acute humoral rejection. The infection presented as a facial rash with subsequent dissemination to the lungs and chest wall. All sites of infection improved with combination administration of oral posaconazole and terbinafine. In this work, we review the available literature regarding management of disseminated Trichophyton infection and discuss therapeutic interventions for disseminated dermatophytosis in immunosuppressed hosts.

Tinea Corporis-associated Erythroderma: Case Report and Review of Erythrodermic Patients with Chronic Dermatophyte Infection

Erythroderma presents as generalized skin redness. The features of a 39-year-old man who presented with erythroderma are described. His skin biopsy revealed hyphae in the stratum corneum, which established the diagnosis of tinea corporis. His erythroderma resolved following treatment with an oral antifungal agent. Several conditions can be associated with erythroderma. Common etiologies for erythroderma include medications, neoplasms, and papulosquamous disorders. Superficial dermatophyte-associated erythroderma is rare. However, although erythroderma caused by generalized superficial mycosis is infrequently encountered, tinea corporis should be included in the new-onset or chronic erythroderma. The detection of fungal hyphae in the stratum corneum of a biopsy of the erythrodermic skin can not only establish dermatophyte infection as the underlying cause of the individual’s erythroderma but also an alternative cause of erythroderma. 

Occurrence of dermatophytoses in patients from the Sistema Único de Saúde

BACKGROUND

Dermatophytosis is a cutaneous disease caused by filamentous keratinophilic fungi belonging to the genera Trichophyton, Microsporum and Epidermophyton, which present a high prevalence in the general population, being among the most common mycoses affecting about 20% of the world's population.

OBJECTIVE

To carry out the epidemiological survey of cases of dermatophytosis in patients from the Sistema Único de Saúde in a regional Laboratory in the period of 5 years (2009 to 2013).

METHODS

A retrospective study (January 2009 to December 2013) was carried out with a qualitative and quantitative design, through the registry book of the laboratory, Mycology Sector, where cases of patients with suspected dermatomycosis were analyzed.

RESULTS

In a 5-year period, a total of 4467 cases were suspected of having a fungal infection. Of these, 68.74% (3071) cases were of dermatomycosis. In relation to cultures with fungal growth, 12.54% (385 cases) were dermatophyte fungi and 7.97% (245 cases) non-dermatophyte fungi were isolated. Among the species identified, there was a higher prevalence of T. rubrum complex (75%), T. mentagrophytes complex (11.68%) and M. canis (7.01%). Regarding the sites analyzed, nail involvement was the most frequent in 75% of the cases.

STUDY LIMITATIONS

This work is representative in the studied region.

CONCLUSIONS

Dermatomycosis samples are the most frequent among all samples of fungal infections from these patients, with the nail being the most affected area and the fungi T. rubrum complex and T. mentagrophytes complex the most frequent.

Antidermatophytic and Protease-inhibiting Activities of Zerumbone: A Natural Sesquiterpene from the Rhizome of Zingiber zerumbet (L.) Roscoe ex J.E; Smith

CONTEXT

Due to increase in the number of patients with impaired immunity, incidence of dermatophytoses has increased considerably. Antidermatophytic agents with anti-inflammatory and protease-inhibiting activities will help in restricting inflammatory response associated with dermatophytoses.

AIMS

The present study aims to evaluate antidermatophytic and protease-inhibiting activities of zerumbone. Cytotoxicity was tested using Chang liver cell line as a preliminary step in toxicity study.

METHODS AND MATERIALS

Minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of zerumbone purified from the rhizome of Zingiber zerumbet were determined against Epidermophyton floccosum var. nigricans, Microsporum canis, Microsporum gypseum, and Trichophyton rubrum. MIC was determined according to Clinical and Laboratory Standards Institute (CLSI) method M38-A2. Protease-inhibiting property was tested using trypsin as the enzyme. In vitro cytotoxic effect was studied using the MTT assay.

RESULTS

MIC of zerumbone was 8 mg/L against E. floccosum and M. canis and 16 mg/L for M. gypseum and T. rubrum. MFC of zerumbone was 64 mg/L against E. floccosum and M. canis and 128 mg/L for M. gypseum and T. rubrum. Zerumbone exhibited remarkable protease-inhibiting activity. In the MTT assay, IC50 values were 150 and 0.31 µg, respectively, for zerumbone and reference drug.

STATISTICAL ANALYSIS USED

For protease inhibition, assay and cytotoxicity assay control and tests were done in triplicate and the results are expressed as mean ± SD, where n = 3.

CONCLUSIONS

Zerumbone is a novel candidate for use in dermatophytoses therapy because of the combined antifungal, anti-inflammatory (unpublished results), and protease-inhibiting properties. Cytotoxicity of zerumbone was found to be very low compared with the reference drug.

KEY MESSAGES

Zerumbone possesses antidermatophytic, anti-inflammatory, and protease-inhibiting activities. Hence, it is a novel candidate for the development of new antidermatophytic drug.Cytotoxicity of zerumbone against Chang liver cell line was found to be very low compared with the reference drug doxorubicin.

SUMMARY

Zerumbone isolated from the rhizome of Zingiber zerumbet exhibited antidermatophytic activity against E. floccosum and M. canis (MIC 8 mg/L) and M. gypseum and T. Rubrum (MIC 16 mg/L).Zerumbone exhibited remarkable protease-inhibiting activity.Zerumbone is a novel candidate for the development of new antidermatophytic drug.Cytotoxicity of zerumbone against Chang liver cell line was found to be very low compared with the reference drug doxorubicin. Abbreviations used: CFU: colony forming unit, CLSI: Clinical and Laboratory Standards Institute, COX: cyclooxygenase, DMSO: dimethyl sulphoxide, EDTA: ethylene diamine tetra acetic acid, FT-IR: Fourier transform-infra red spectroscopy, HPLC: high-performance liquid chromatography, LOX: lipoxygenase, IMTECH: Institute of Microbial Technology, LCMS: liquid chromatography mass spectrometry, MTT: 3-(4,5 dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide, MTCC: microbial type culture collection, MFC: minimum fungicidal concentration, MIC: minimum inhibitory concentration, MPO: myeloperoxidase, NMR: nuclear magnetic resonance spectroscopy, PAR: proteinase-activated receptor, PBS: phosphate-buffered saline, TCA: trichloro acetic acid.

Production of an anti-dermatophyte monoclonal antibody and its application: immunochromatographic detection of dermatophytes

Tinea refers to superficial infection with one of three fungal genera-Microsporum, Epidermophyton, or Trichophyton-that are collectively known as dermatophytes. These infections are among the most common diseases worldwide and cause chronic morbidity. They are usually diagnosed by direct microscopy and fungal culture, which are burdensome to perform in the clinical setting. To supplement conventional methods, we developed a new method that employs an immunochromatography test for detection of dermatophyte infections. First, anti-Trichophyton monoclonal antibodies (mAb) were produced in mice using a Trichophyton allergen solution as an immunogen. The mAb specificity was assessed by immunostaining alcohol fixed slide cultures and formalin fixed paraffin-embedded microbial samples. Both alcohol- and formalin-fixed samples of all seven species of Trichophyton tested displayed positive immunostaining. Immunochromatography test strips were created using the anti-Trichophyton mAb. The efficiency of the test strip was assessed in patients diagnosed with tinea unguium and in healthy volunteers. Of the 20 patient nails tested, 19 tested positive and one tested negative, whereas of the 17 volunteer nails, only one tested positive. However, KOH microscopic examination of the volunteer nail that tested positive revealed the existence of Trichophyton hyphae. Although the number of nails assayed was small, since the assay had a sensitivity of 95.0% (19/20) and a specificity of 94.1% (16/17), the obtained results were considered to be promising. Thus, while further investigation with a greater number of samples is necessary, this method could potentially be employed as a new diagnostic tool for Trichophyton in the future.

Effective Single Photodynamic Treatment of ex Vivo Onychomycosis Using a Multifunctional Porphyrin Photosensitizer and Green Light

Onychomycosis is predominantly caused by the dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton tonsurans. The main treatment obstacle concerns low nail-plate drug permeability. In vitro antifungal photodynamic treatment (PDT) and nail penetration enhancing effectiveness have been proven for multifunctional photosensitizer 5,10,15-tris(4-N-methylpyridinium)-20-(4-(butyramido-methylcysteinyl)-hydroxyphenyl)-[21H,23H]-porphine trichloride (PORTHE). This study investigates single PORTHE green laser/LED PDT of varying degrees of ex vivo onychomycoses in a human nail model. T. mentagrophytes, T. rubrum, T. tonsurans onychomycoses were ex vivo induced on nail pieces at 28 °C (normal air) and 37 °C (6.4% CO₂) during 3 to 35 days and PDTs applied to the 37 °C infections. All dermatophytes showed increasingly nail plate invasion at 37 °C between 7 and 35 days; arthroconidia were observed after 35 days for T. mentagrophytes and T. tonsurans. Using 81 J/cm² (532 nm) 7-day T. mentagrophytes onychomycoses were cured (92%) with 80 µM PORTHE (pH 8) after 24 h propylene glycol (PG, 40%) pre-treatment and 35-day onychomycoses (52%–67%) with 24 h PORTHE (40–80 µM)/40% PG treatment (pH 5). 28 J/cm² LED light (525 ± 37 nm) improved cure rates to 72%, 83% and 73% for, respectively, T. mentagrophytus, T. rubrum and T. tonsurans 35-day onychomycoses and to 100% after double PDT. Data indicate PDT relevance for onychomycosis.

A clinical and mycological study of dermatophytic infections

BACKGROUND

Dermatophytoses refer to superficial fungal infection of keratinized tissues caused by keratinophilic dermatophytes. According to observations worldwide, dermatophytoses are the most common of the superficial fungal infections. It is common in tropics and may present in epidemic proportions in areas with high rates of humidity. Although common, the precise size of the problem defies measurement.

AIMS

The present study was undertaken to assess the clinical profile of dermatophytic infection and to identify the species of fungi that are prevalent in this region.

MATERIALS AND METHODS

A total of 100 patients clinically suspected for dermatophytoses were selected for the study. Direct microscopy in 10% potassium hydroxide (KOH) and culture was done in each case.

RESULTS

Out of 100 patients, the maximum were seen in the age groups of 16-30 years. Tinea corporis was the most common clinical type (44.3%) followed by tinea cruris (38.2%). Overall positivity by culture was 39% and by direct microscopy 96%.

CONCLUSION

Trichophyton rubrum was the predominant species isolated (67.5%) in all clinical types followed by Trichophyton mentagrophytes. Culturing the fungus may identify the species, but it is not essential for the diagnosis as it is not a sensitive test.

Clinical study of Tinea capitis in Northern Karnataka: A three-year experience at a single institute

BACKGROUND

Tinea capitis is a superficial fungal infection of the hair follicle of scalp. Most of the dermatophytosis do not have such age propensity as tinea capitis which almost invariably involves the paediatric age group. The exact incidence of tinea capitis is not known. This study is done in order to isolate the species variation in an area, to know the changing patterns of occurrence of different species and their association with clinical pattern

MATERIALS AND METHODS

All clinically diagnosed cases of tinea capitis which presented to our out patient department over a period of one year were included in the study.

RESULTS

70 cases of Tinea capitis were studied.

DISCUSSION

Tinea capitis is a disease of prepubertal children with common in age group of 5- 15 years. The incidence varies from 0.5% to 10%. Most common presenting feature was alopecia.