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18 girls from an orphanage (Orfanato Santo Antônio) in Niterói presented tinea capitis due to Trichophyton tonsurans (15 cases-83.3%) and Microsporum canis (3 cases-26.7%). Comments are made about clinical, mycological and therapeutic aspects of this microepidemic.
Analysis of 325 patients (182 males, 143 females) of mycologically proven tinea capitis (TC) seen over a period of two years from January 2001--December 2002 in the Farwaniya region of Kuwait is presented in this study. The age range was 8 months to 17 years. Peak incidence was observed in the 3-14 year age group (79.6%). Positive family history and contact with pets were noted in 22% and 36.7% of the cases, respectively. The non-inflammatory 'gray patch' variety was the most common clinical type, seen in 163 (50.2%) children, followed by the black-dot variant in 100 (30.2%) patients. A significant proportion of the cases (16.6%) had the uncommonly reported seborrheic dermatitis or dandruff like pattern. Highly inflammatory kerion was encountered infrequently (2.5%). Seven species of dermatophytes were isolated; Trichophyton violaceum in 135 (41.5%), followed by Microsporum canis in 89 (27.4%), Microsporum audouinii in 48 (14.8%), Trichophyton mentagrophytes var. mentagrophytes in 31 (9.5%), Trichophyton verrucosum in 15 (4.6%), Trichophyton tonsurans in 6 (1.9%) and Microsporum gypseum in 1 (0.3%) patient. T. violaceum was the most common fungus responsible for the black-dot variety (89/100) and kerion (4/8) patients. Three cases of kerion (33.3%) grew T. verrucosum. M. canis was the most common species isolated from the 'gray patch' cases (79/163; 48.5%) followed by almost equal prevalences of T. violaceum (16.6%), M. audouinii (15.3%), and T. mentagrophytes var. mentagrophytes (12.3%). Among the seborrheic type of cases, M. audouinii was the most common fungus isolated in 20/54 (37%) followed by T. violaceum in 15 (27.8%), T. mentagrophytes var. mentagrophytes in 9 (16.7%), M. canis in 8 (14.8%) and T. verrucosum and T. tonsurans in one (0.3%) patient each. The results are significantly different from those in earlier studies in Kuwait.
Selenium sulfide lotion used as a shampoo has been shown to be an effective adjunctive agent to griseofulvin in the treatment of tinea capitis. Of 16 children with Trichophyton tonsurans infections 15 had negative fungal cultures at two weeks following a regimen of daily oral griseofulvin and selenium sulfide shampooing twice weekly. All patients treated with griseofulvin alone or in combination with either a bland shampoo or topical clotrimazole had positive cultures not only at the two-week interval but also as long as eight weeks later. In vitro analysis shows selenium sulfide to be sporicidal, correlating well with the in vivo observations. It is postulated that selenium sulfide usage may lessen the chances for spreading of infectious spores to other individuals.
Acne keloidalis is characterized by firm skin-colored papules on the surface of the neck and scalp. We report a case of tinea capitis in 60-year-old female which mimicked acne keloidalis. The lesions resolved following oral antifungal medication.
In our 15 years of investigation in northern Greece, the predominant organism producing tinea capitis in children was found to be the zoophilic Microsporum canis (494 strains) which is a common saprophyte of the hair of pets, especially cats. The high percentage of cases with M. canis (97%), in contrast to zoophilic fungi (3%), is probably due to the increased contact of children with pets. The small number of infections with anthropophilic fungi (41 strains) is attributed to good hygienic conditions. The fluorescence of infected hair under Wood's light seems to be a major diagnostic criterion in the hands of dermatologists who are not served by a mycological laboratory.
We report an observed change in the causative organisms in 45 consecutive cases of tinea capitis seen in the Cardiff area over the last 9 years. Direct microscopy using potassium hydroxide was positive in all but one case, but this was subsequently positive on culture. This retrospective analysis shows that more cases are being seen in our department, and that a higher proportion of cases are due to Trichophyton violaceum whereas previously we would have expected the majority of cases to be due to Microsporum canis. We believe that the change in causative organism that we have identified has important practical and diagnostic implications. Endothrix fungi such as T. violaceum do not fluoresce under Wood's lamp unlike ectothrix fungi such as M. canis, and therefore failure to perform adequate mycological examination of specimens could result in missed diagnoses. We are not aware of this change having been reported from other UK centres. The finding indicates a need for further prospective epidemiological studies to confirm this apparent trend.
An 89-year-old black woman was examined for generalized folliculitis of the scalp that proved to be tinea capitis caused by Trichophyton tonsurans. To our knowledge, she is the oldest known patient with this condition to be reported to date. Although it is uncommon in adults, this condition must be considered when clinicians are evaluating patients with hair loss and nonspecific scalp dermatitis.
OBJECTIVE: To determine the influences of hair-grooming practices and environmental factors as risk factors for the acquisition of tinea capitis (TC) in children. DESIGN: Case-control study comparing children with culture-proved TC with age-, sex-, and race-matched control subjects without scalp disease. SETTING: A multicenter study involving 3 urban referral centers in the United States. PARTICIPANTS: A convenience sample of 66 patients aged 12 years and younger presenting to pediatric dermatology clinics with clinical evidence of TC were enrolled as cases. Matched control subjects (n = 68), without known scalp disease, were enrolled from the outpatient pediatric clinics at the same institutions. RESULTS: Significant associations with TC in the conditional logistic regression model were a prior history of TC (odds ratio, 3.11; 95% confidence interval, 1.02-9.43; P =.04) and exposure to TC (odds ratio, 16.32; 95% confidence interval, 3.55-75.16; P =.001). The use of a hair conditioner was statistically significant in the univariable model but not in the multivariable model (odds ratio, 0.46; 95% confidence interval, 0.20-1.08; P =.07). Hairstyling, frequency of washing, use of oils or grease, and other hair care practices were not shown to be associated with the presence of TC. CONCLUSIONS: Hair-grooming practices do not appear to play a major role in the acquisition of TC. Hair conditioners may be protective in children at risk for TC, but further studies are needed to confirm this finding.
Clinical data on 1068 cases of dermatophytosis as well as mycological data on 382 of these cases seen from March 1983 to September 1984 are reported. Tinea cruris was present in 34.1%, with Trichophyton rubrum and Epidermophyton floccosum isolated from 31% and 25% respectively. Tinea corporis was found in 17.9% of all patients of dermatophytosis with T. tonsurans responsible in 30.8%. Tinea pedis and Tinea unguium were present in 7.2% and 2% respectively, T. rubrum being the main causative agent; nail involvement was present in 27.3% of these cases. Tinea capitis was observed in 38.7% of 1068 dermatophytosis cases with T. violaceum and M. canis causing 48% and 32% of all T.C. cases respectively. The dermatophytic flora of the West Bank of Jordan apparently comprises about 14 dermatophytes, T. violaceum being the predominant agent of infection (in more than 34%). Other most common agents found in this survey were M. canis, T. rubrum, E. floccosum, T. schoenleini, T. tonsurans, and T. mentagrophytes.
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In this randomized, double-blind study, the efficacy and safety of oral itraconazole (n = 28) and terbinafine (n = 27), each given for 2 weeks, was compared in patients with tinea capitis. Trichophyton violaceum was the major pathogen in both groups (82.1% and 88.9%, respectively). The final evaluation at week 12 showed a cure rate of 85.7% and 77.8%, respectively (P > 0.05). Adverse events noted were mild and did not warrant discontinuation of therapy.
Two sisters, ages 5 and 6 years, who were adopted from Liberia, presented in Cincinnati, Ohio, with tinea capitis. Fungal cultures grew Trichophyton soudanense, a dermatophyte rarely seen in North America. Both girls had multiple other infections. They responded well to therapy with oral griseofulvin and topical selenium sulfide. With the current increase in international travel and adoption, nonendemic dermatophyte infections such as this need to be recognized.
OBJECTIVE: Report of clinical and microbiological periodontal findings before and 6 months after treatment of two siblings with Papillon-Lefèvre syndrome (PLS) and tinea capitis. METHODS: Two brothers, RG 3 years and NG 5 years of age, were referred for treatment due to premature mobility of their deciduous teeth. Probing depths (PPD), attachment levels (PAL-V), and furcation involvements were examined clinically. Panoramic radiographs were taken. Subgingival plaque samples within the deepest pocket of each tooth were taken and analysed by real-time polymerase chain reaction (PCR) for Actinobacillus actinomycetemcomitans (AA), Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Fusobacterium nucleatum, and Prevotella intermedia. One-stage full-mouth scaling and extraction of hopeless teeth were performed under general anaesthesia, followed by systemic amoxicillin and metronidazole for 7 days. Clinical and microbiological analyses were performed 6 months after treatment. RESULTS: Before treatment, both siblings had exhibited PPD of up to 13 mm, Class III furcation defects at four teeth, and marginal suppuration. AA was detected in both patients and at all teeth at levels ranging from 3.0 x 10(2) to 5.1 x 10(6). Both patients exhibited palmar and plantar hyperkeratosis. Seven teeth were extracted from RG, and nine from NG. Six months after treatment, PPD had been reduced to <or=5 mm. AA was not detected in any of the remaining teeth. CONCLUSION: Even periodontally affected deciduous teeth of PLS patients can be treated successfully. Suppression of AA to below detection level seems to be of high significance.
In an open multicentre study we have demonstrated that itraconazole pulse therapy, 5 mg/kg per day, is effective and safe in the management of tinea capitis in 10 children (seven boys, three girls, mean age: 6.6 years, age range 4-11 years). The causative organisms were Trichophyton tonsurans (six cases), T. violaceum (two cases), T. soudanense (one case) and Microsporum gypseum (one case). Each pulse of drug therapy lasted 1 week with 2 weeks off between consecutive pulses. One, two and three pulses produced complete, clinical and mycological, cure in one, six and three patients, respectively. The children tolerated the treatment well and there were no clinical or laboratory adverse effects. This 1-week pulse therapy regimen resulted in a high degree of compliance. The preliminary results of this study are promising and need to be evaluated in a larger sample of patients.
INTRODUCTION: One epidemiologic survey was carried out in two children communities, following detection of several cases of Microsporum langeronii tinea capitis. PATIENTS AND METHODS: In one case, 3 year-old children from a day-nursery were contaminated by a child originating from France, who had been previously infected by contact with a friend originating from Ivory Coast. In the second case, lesions were diagnosed in a nursery-school in African children born in France. These were treated before epidemic progression into the school. RESULTS: Our study confirms data from the literature concerning the risk of contamination by Microsporum langeronii, with a familial contamination being more frequent than scholar one. DISCUSSION: The interest of our study was the rapid starting of the epidemiologic survey after first case diagnosis (one to two months) and the treatment of all the patients without scholar eviction. Treatment of all affected patients as well as "asymptomatic carriers" leaded to the arrest to the epidemy. No case of relapse was noted during the following year.
The mycological laboratory of our Hospital examined 31,073 patients between 1981 and 1995. Sex, age, the residence of patients, the clinical type of tinea and contacts with other persons and animals were investigated. All the patients were also examined under Wood's light. Tinea capitis was diagnosed in 35 adults. Trichophyton violaceum was the commonest aetiological agent (54.5%), especially in elderly women. The other anthropophilic fungi were T. rubrum (8.5%), T. schoenleinii (5.7%) and T. tonsurans (2.8%). The zoophilic fungi Microsporum canis (14.3%), T. terrucosum (8.5%) and T. mentagrophytes (5.7%) were also isolated.