Piedra in lower animals; a case report of white piedra in a monkey and a review of the literature.
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[Clinical and mycological study of 11 cases of genitopubic trichosporosis nodosa (white piedra)].
Piedra (stone in Spanish) is the name given to a trichomycosis characterized by the formation of nodules resembling small stones. There are two varieties of the disease, depending on the colour of the nodules: white piedra and black piedra. Black piedra sharply differs from white piedra on three main scores: a) the causative agent is a black filamentous and sexed dematicious fungus, Piedraia hortai; b) the disease exclusively affects the scalp, and c) the geographical distribution of human black piedra is limited to tropical and subtropical areas (South America, South-East Asia). White piedra has a different aetiology, being caused by an asexual fungus, Trichosporon beigeli. The genus Trichosporon (Behrend, 1890) and the species T. beigeli (Vuillemin, 1902) were created from a case of piedra of the moustache. White piedra may involve hairy regions other than the scalp, such as the beard and moustache, less frequently the armpits, eyebrows, eyelashes and pubic hair. The disease has been observed in all continents, except Africa, and under all climates, although it is exceptionally found in cold areas (two indigenous cases in Finland). The observatio princeps of white piedra (on a false chignon) was published in 1865 by Beigel, in London. In France, only three cases, all concerning the moustache, were reported at the very beginning of this century No other case has been published in that country in the east 80 years. T. beigeli is a common saprophyte in nature. It has been found in soil, water, fruit, rotten vegetables, sawdust, as well as in man (skin, skin appendages, mucosae) and in animals (mammals, insects, mussels).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Clinical and mycological study of scalp white piedra in the State of Paraíba, Brazil.
White piedra is a superficial mycoses characterized by nodules on the hair shaft, caused by the basidiomycetous yeasts. In the present study, clinical and mycological findings of scalp white piedra caused by Trichosporon spp. are related. Twenty three cases of scalp white piedra were observed with a high incidence in women (87%) and preschool children from 2 to 6 (74%) years old. These groups presented a relationship of dependence with this infection. Despite the low socio-economic status, poor standards of hygiene, (48% of the patients) as well as the fact that 30.4% of the children shared the same nursery, these factors were not significant for the transmission of the mycosis. These were the first reports of scalp white piedra in João Pessoa city, Paraíba, Brazil.
Adolescent↗
Co-isolation of Trichosporon inkin and Candida parapsilosis from a scalp white piedra case.
White piedra is a rare fungal infection of the hair shaft characterized by small, firm, irregular white-brown nodules. The infection is caused by basidiomycetous yeasts in the genus Trichosporon. We report a case of a 28-year-old female patient who acquired the infection in Qatar. In this case, the scalp was the only site affected, but infection at that site was extensive. The hair had a Saccharomyces-like yeast odor and appeared to be beaded, with light-brown nodules of varying sizes up to 2 mm long. Trichosporon sp. accompanied by Candida parapsilosis grew out along hair shafts planted in primary isolation media. Molecular identification of the Trichosporon carried out by analyzing the 26S ribosomal gene gave a 100% match with Trichosporon inkin, a major cause of pubic white piedra. The patient was treated with daily applications of ketoconazole shampoo followed by econazole shampoo and cream, and was considered clinically and mycologically cured after 2 months. Novel findings in the present case are the first identification of T. inkin as an agent of scalp white piedra, and the heavy outgrowth of C. parapsilosis from the concretions, although in the latter case it is not clear if the co-occurring yeast was etiologically contributory to the pathogenesis of the white piedra.
Adult↗
White piedra: further evidence of a synergistic infection.
White piedra is a fungal infection of the hair shaft caused by Trichosporon beigelii. A synergistic coryneform bacterial infection is often present with T beigelii. White piedra, although not commonly reported to infect scalp hair in North America, is an important consideration in the differential diagnosis of scalp hair concretions. We report a case of white piedra of scalp hair with synergistic coryneform bacterial infection in two sisters, both US natives. Culture and light and electronmicroscopic evidence of the synergistic infection are presented.
Actinomycetales Infections↗
Itraconazole therapy for white piedra affecting scalp hair.
BACKGROUND: Treatment of white piedra remains an area of therapeutic frustration. Several topical and systemic antifungal agents have failed to eradicate the fungus and prevent disease recurrence. Itraconazole is a safe and effective systemic antifungal agent for various superficial and deep mycotic infections of the skin and hair. In vitro studies have shown significant antifungal activity against Trichosporon beigelii. OBJECTIVE: Our study was intended to assess the efficacy of itraconazole in the treatment of uncomplicated white piedra affecting the scalp hair. METHODS: The study was designed as an open trial involving 12 female patients with white piedra of the scalp hair. They were administered oral itraconazole 100 mg once daily until culture negativity was achieved; they were then followed up for 3 months. RESULTS: Eleven patients (91.67%) showed disease remission after 8 weeks of treatment. One patient (8.33%) showed no improvement, and the disease recurred in 2 patients (16.67%) after completion of therapy. No significant side effects were noted.
Adolescent↗
White piedra in children.
BACKGROUND: White piedra is a fungal infection of the hair shaft caused by species of Trichosporon. Rarely has this infection been reported in the United States. Historically, infected individuals required shaving of their hair to achieve clearance of the infection. OBJECTIVE: We sought to describe 8 cases of Trichosporon scalp infections seen in the northeastern United States. METHODS: We conducted chart review and prospective evaluation of 7 girls and 1 boy seen in two dermatology practices in New Haven, Conn, and New York, NY. RESULTS: Seven girls, ages 4 to 16 years old, and one 4-year-old boy were determined to have Trichosporon scalp infection, all through culture. Of the 8 children who were available for follow-up, 7 had clearance of their infection with a combination of oral azole antifungal medication and azole antifungal shampoo, without shaving the scalp hair. LIMITATIONS: This was a sample of patients from a localized region of the United States. CONCLUSIONS: White piedra is emerging as a commonly seen hair and scalp infection in the northeastern United States. Contrary to prior publications, scalp and hair infection may be successfully treated with a combination of oral azole antifungals and shampoos without shaving the scalp.
Administration, Oral↗
Genital white piedra: epidemiology, microbiology, and therapy.
The epidemiology of genital white piedra was investigated in 166 young men with a variety of genital complaints. Trichosporon beigelii was isolated from sixty-six (40%) of the cultured scrotal hairs. Infection was more common among black patients--54% of those examined, compared to 16% of white patients and 30% of "others" (p less than 0.001). There was no relationship between infection and foreign travel. White piedra was also found in young women, but less frequently than in young men (14% vs 40%, respectively). Transmission rarely occurred from person to person. Occasionally multiple body sites were simultaneously infected. A relationship may exist between T. beigelii and Corynebacterium concurrently infecting genital hair shafts. Eradication of infection was extremely difficult, despite in vitro sensitivity to antifungal agents. Spontaneous remissions occurred, however, in some patients.
Adult↗
White piedra: evidence for a synergistic infection.
To determine the relative roles of coryneform bacteria and Trichosporon beigelii in the pathogenesis of genital white piedra, scrotal hair from 10 subjects was studied. Hairs were examined by light microscopy to determine the relative proportions of each organism, and were also cultured for coryneforms and yeast. Histologically, hair nodules from five out of nine cases showed a mixture of yeasts and bacteria, four had bacteria alone, and none showed yeast alone. Five strains of T. beigelii were cultured, two strains of Saccharomyces cerevisiae and 22 strains of coryneforms. The isolates were tested for synergism by a plate-overlay method. Growth of coryneforms occurred over and around sections of the plate inoculated with T. beigelii but not around the control yeast, S. cerevisiae. There were strain differences in the stimulatory response of both T. beigelii and coryneform strains. In reverse experiments coryneforms did not enhance growth of T. beigelii. It was concluded that white piedra is a mixed infection caused by the synergistic action between T. beigelii and a specific coryneform bacteria resulting in invasion of the hair cuticle and cortex.
Actinomycetales↗
Black piedra: the first case treated with terbinafine (Lamisil).
A 23-year-old Swedish Caucasian man presented with typical clinical signs of black piedra of his scalp after his return from 4-months' stay in India. There were black nodules around the hair shafts, and the crushed nodules revealed numerous asci and ascospores on microscopy. Piedraia hortae was isolated from the concretions. He was treated with oral terbinafine 250 mg daily for 6 weeks. At the end of treatment no nodules were visible, but 16 days later a few 'new' black concretions appeared. Microscopy of these nodules revealed markedly degenerated fungal elements, and cultures were negative. No further signs of the disease were seen 2 months after cessation of therapy. In vitro susceptibility tests showed that Piedraia hortae was sensitive to terbinafine. This case demonstrates that terbinafine is effective in the treatment of black piedra.
Administration, Oral↗
White piedra and Trichosporon species in equatorial Africa. I. History and clinical aspects: an analysis of 449 superficial inguinal specimens.
White piedra is a hair infection characterized by nodules composed of fungal elements which envelop the hair shaft. Classically, this infection was considered to be produced by an asexual yeast-like fungus, Trichosporon beigelii. At present, in accordance with studies carried out previously, this species is subdivided into six newly defined distinct species (T. asahii, T. ovoides, T. inkin, T. mucoides, T. asteroides and T. cutaneum), all belonging to the class Basidiomycetes. Although widespread, white piedra has not previously been described in tropical regions of Africa. The present study, carried out in Libreville (Gabon), an equatorial region of Africa, shows that the incidence of this infection is quite high (18% of 449 inguinal specimens) in the female population aged 15-60 years, with a predominance in young patients (15-44 years). The relationship between the clinical manifestations and the specific hair lesions is also detailed. Three species belonging to the genus Trichosporon were identified: T. mucoides, T. asahii and T. inkin.
Adolescent↗
White piedra.
A 39-year-old Thai man had eczema on the left groin accompanied by asymptomatic white nodules on the public hair for two weeks. Examination with the Wood's lamp, microscopic examination, culture and biochemical testing showed organisms compatible with Trichosporon beigelii. The diagnosis of "White Piedra" was made, and this is the first case of White Piedra to be reported in Thailand.
Adult↗
Surrogate nits impregnated with white piedra--a case report.
White piedral spores packed inside empty pedicular nits were accidentally found on microscopic examination in a 42-year-old Indian woman who presented with hair loss. The diagnosis of piedra was confirmed on culture. She responded to topical 2% miconazole nitrate solution and manual removal of the nits. This is the first case report of pedicular nits found to be impregnated with spores of white piedra.
Adult↗
White piedra and Trichosporon beigelii: the incidence in patients attending a clinic in genitourinary medicine.
To assess the occurrence of white piedra and the asymptomatic carriage rate of T beigelii, 100 heterosexual and 49 homosexual/bisexual men were entered into the study. White piedra of the scrotal hair was discovered in a total of four (2.7%) patients (two heterosexual, one homosexual and one bisexual), while in addition a positive scrotal culture for T beigelii was noted in a further seven (4.8%) patients (four heterosexual and three homosexual). Rectal carriage rates were 1% in the heterosexual and 4% in the homosexual/bisexual groups, while there was no pharyngeal carriage in either group.
Hair↗
Morphology of Piedra hortal.
Piedra hortai, an ascomycete causing black piedra, was studied with light and electron microscopy. The nodule on the hair contains septate hyphae, asci and free ascospores, all of which were smaller than those previously reported. A mode of spread of infection is suggested.
Ascomycota↗
Trichosporosis (white piedra). A case report from Finald.
A 25-year-old Finnish male had had brownish-black nodules along the shafts of his scrotal hair for a period of 1 1/2 years. From the clinical appearance, piedra was suspected. Fungal culture demonstrated Trichosporum cutanum (T. Beigelii) and a diagnosis of white piedra was made. The patient has never been outside the boundaries of Finland.
Adult↗
White piedra.
White piedra, a fungal infection caused by Trichosporon cutaneum, has been reported in Europe, South America, and the Orient. A few cases have also been reported in the United States, all of them acquired as well in this country. A patient whose condition was diagnosed in California apparently contracted white piedra while visiting Panama, demonstrating that tropical diseases may occasionally be found at great distances from their point of origin. Therapy with topical clotrimazole and removal of infected hairs by shaving failed to produce a clinical or culturally confirmed cure in this patient.
Adult↗
[White genital piedra].
White piedra is a rare hair infection of man and certain animals, caused by the widespread Trichosporon fungi. The infection is characterized clinically by whitish, soft and easily removable coating of the hair shafts; however, the shafts may be destroyed by the pathogens invading at localized points. While all body hair may be affected, the pubic hair is most frequently affected. This paper is the first report genital white piedra in a 34-year-old Central European man. In all, 22 cases have been described world-wide in young men ranging in age from 20 to 40 years. Only 2 men, aged 42 and 53 years, do not fall in this range. Recently, a major African study disclosed this disease in women for the first time. In moderate latitudes, however, this infection appears to occur almost exclusively in young men.
Adult↗