Tinea favosa: psoriasiform favus in bindi area of an adult.

Favus is an uncommon chronic inflammatory dermatophyte infection of the scalp. Predominantly, a disease of childhood, uncommon reports of adult cases are described. For the most part, this infection is characterised by invasion of hair shaft clinically presenting as yellowish scaly plaques, alopecia and/or inflammatory lesions. We hereby present an immunocompetent adult presenting with a psoriasiform plaque over glabella, culturally referred to as 'bindi' area. No involvement of the scalp or other hair-borne areas was seen. As she did not agree to undergo a skin biopsy, a last resort of simple stains like potassium hydroxide was done confirming favus. Systemic itraconazole was initiated and complete clinical and mycological resolution was seen with no relapse. Such atypical presentations in adults can cause a diagnostic dilemma and simple stains still hold their ground in making a diagnosis in resource-poor settings.

Comprehensive genome and transcriptome analysis of the dermatophyte Trichophyton schoenleinii reveals the candidate pathogenic genes.

BACKGROUND: Trichophyton schoenleinii is an anthropophilic dermatophyte that causes tinea favosa. Nowadays, it remains an important pathogen in some regions of the world, mainly epidemic in Africa and West Asia. Despite the medical importance of T. schoenleinii infections, a high-quality reference genome for T. schoenleinii is still unavailable, neither its transcriptomic profile. OBJECTIVES: The aim of the current study was to improve understanding of the underlying pathogenic mechanism of T. schoenleinii, and to define the candidate pathogenic genes of T. schoenleinii. METHODS: Comprehensive genomic analysis of T. schoenleinii was carried out by Illumina and PacBio sequencing platforms. Transcriptome profiles of T. schoenleinii cultured in vitro in two media containing either keratin or soy protein were determined using RNA sequencing (RNA-seq) technology. RESULTS: Here, we present the first draft genome sequence of T. schoenleinii strain T2s, which consists of 11 scaffolds containing 7474 predicted genes. Transcriptome analysis showed that genes involved in keratin hydrolysis have higher expression in T. schoenleinii grown in keratin medium, including genes encoding proteases, cysteine dioxygenase and acetamidase. Other genes with higher expression include genes encoding the components of the pH-responsive signal transduction pathways and transcription factors, many of which may play a role in pathogenicity. CONCLUSION: In summary, this study provides new insights into the pathogenic mechanism of T. schoenleinii and highlights candidate genes for further development of novel targets in disease diagnosis and treatment of tinea favosa.

Nannizzia incurvata as a rare cause of favus and tinea corporis in Cambodia and Vietnam.

Nannizzia (N.) incurvata (formerly Microsporum incurvatum) represents a geophilic dermatophyte which has been previously classified as belonging to the species complex of N. gypsea (formerly Microsporum gypseum). A 42-year-old Vietnamese female from Saxony, Germany, suffered from tinea corporis of the right buttock after she returned from a 2-week-visit to her homeland Vietnam. From skin scrapings of lesions, N. incurvata grew on Sabouraud's dextrose agar. Treatment by ciclopirox olamine cream twice daily for 4 weeks was successful. A 6-year-old Cambodian boy living near river Mekong with contact history to chicken, dogs and cattle suffered from tinea faciei and capitis. Symptoms of the favus-like tinea capitis and tinea faciei were erythema and scaly patches with areas of alopecia. N. incurvata grew on Sabouraud's dextrose agar. The boy was treated with oral terbinafine 125 mg daily, topical miconazole cream and ketoconazole shampoo. The symptoms healed within 4 weeks of treatment. Cultivation of the samples revealed growth of N. incurvata. For confirmation of species identification, the isolates were subject to sequencing of ITS (internal transcribed spacer) region of the rDNA, and addition of the "translation elongation factor 1 α" (TEF 1 α) gene. Sequencing of the ITS region showed 100% accordance with the sequence of N. incurvata deposited at the NCBI database under the accession number MF415405. N. incurvata is a rare, or might be underdiagnosed geophilic dermatophyte described in Sri Lanka and Vietnam until now. This is the first isolation of N. incurvata in Cambodia, and the first description of favus in a child due to this dermatophyte.

Favus of Scrotum Due to Trichophyton rubrum in Immunocompetent Patients: A Clinical, Mycological and Ultrastructural Study.

PURPOSE: To characterize the clinical and mycological features of favus of scrotum due to Trichophyton rubrum. METHODS: A single-site prospective study was carried out in an outpatient dermatology clinic. Microscopic examination and fungal culture were done using skin scrapings. Scales on the scrotum were stained with PAS and visualized by microscopy, including in vivo reflectance confocal microscopy (RCM). Two strains were analyzed by RAPD typing. Scutular lesions were fixed for scanning electron microscopy (SEM) and transmission electron microscopy (TEM). RESULTS: Cultures of the scale from the scrotum and/or groin in all patients showed a growth of T. rubrum. T. rubrum strains from scrotum and groins in one patient were demonstrated as the same strain by RAPD typing. The average age of patients was 34.1 ± 12.78 years. The mean course was 8.2 ± 5.07 days. All the patients received only topical treatment for 2 weeks without recurrence. Direct smear, calcofluor-white staining and in vivo RCM study of the scrotal favus in patients showed a massive number of septate branching hyphae, while fewer septate hyphae in scales in the groin. Abundant hyphae were found only in the outer layer of the stratum corneum of the scrotum under SEM and TEM with intact bilateral cell walls, and normal nucleus, liposomes and reticulum. Few distorted hyphae structures, cell wall degeneration, degenerated cytoplasm and the autophagy phenomenon could be seen in scales from groin under TEM. CONCLUSIONS: Scrotal favus due to T. rubrum is still a true infection, which most often occurred in immunocompetent patients.

Revival of favus in Japan caused by Trichophyton schoenleinii.

Favus is a type of dermatophytosis known to produce yellow scutula around hair follicles. Most cases of this disease worldwide are infections of Trichophyton schoenleinii. Favus has rarely been reported in Japan throughout the last four decades, and T. schoenleinii has not been clinically isolated in any case during the period. Here, we report a case of favus of vellus hair observed in a 63-year-old Japanese woman. Fungal culture showed negative; however, we detected fungal elements in the crust and hair bulbs by Grocott staining. Pathogenic fungi were identified as T. schoenleinii by polymerase chain reaction-based DNA sequencing, targeting the internal transcribed spacer regions of the rRNA gene using the formalin-fixed, paraffin-embedded tissue sample. She was successfully treated with p.o. administration of terbinafine and topical application of luliconazole cream.

In Vitro Antifungal Susceptibility Profiles of 12 Antifungal Drugs against 55 Trichophyton schoenleinii Isolates from Tinea Capitis Favosa Patients in Iran, Turkey, and China.

Trichophyton schoenleinii is an anthropophilic dermatophyte mainly causing tinea favosa of the scalp in certain regions of the world, especially Africa and Asia. We investigated the in vitro susceptibilities of 55 T. schoenleinii isolates collected over the last 30 years from Iran, Turkey, and China to 12 antifungals using the CLSI broth microdilution method. Our results revealed that terbinafine and ketoconazole were the most potent antifungal agents among those tested, independently of the geographic regions where strains were isolated.

Evolution of tinea capitis in the Nanchang area, Southern China: a 50-year survey (1965-2014).

Tinea capitis remains a common public health problem worldwide especially in developing areas. Aetiologic agents and clinical pattern vary with geography and history of socioeconomic conditions. Three community surveys and a prospective study were carried out over the past 50 years (1965-2014) in the Qingyunpu District of Nanchang, Southern China. Clinical presentation and spectrum of aetiological agents were monitored to understand the evolution of tinea capitis. In 1965 favus was highly epidemic and Trichophyton schoenleinii presented as the overwhelming aetiological agents of scalp infection in the study area, with a prevalence of 3.41% of the population. During a governmental campaign to eliminate tinea capitis initiated in mid of 1960s, favus was successfully controlled and the prevalence decreased to less than 0.01% in 1977. After that period, clinical presentation and spectrum of fungi changed with social development. Trichophyton schoenleinii was replaced by Trichophyton violaceum and Trichophyton mentagrophytes. Nowadays, the species corresponds with a dominant black dot type of tinea capitis in the Nanchang area. The prevalence of causative agents of tinea capitis is not only related to geography but also to socioeconomic factors. Multiple factors have to be considered for the management for control of this disease.

Cat favus caused by Microsporum incurvatum comb. nov.: the clinical and histopathological features and molecular phylogeny.

Favus is a distinctive form of infection that is caused by exclusively dermatophytes. Its clinical presentation is characterized by scutula, which are concave, thick fungal crusts. The best-known examples of human scalp favus are caused by Trichophyton schoenleinii and those of mouse favus are caused by T. quinckeanum. However, other dermatophytes, such as T. violaceum, T. verrucosum, Microsporum audouinii, M. gallinae, M. gypseum, and M. canis, have been reported sporadically to cause favic lesions. Favus on cats has rarely been mentioned in the literature, and the pathogens with which it has been associated are, for the most part, unknown. Here, we examine four cat favus cases, focusing on clinical presentations and histopathological features. In all cases the etiologic agent was identified as M. incurvatum based on its morphological characteristics and sequences of internal transcribed spacers (ITS) of nuclear ribosomal DNA. Phylogenetic analysis using the neighbor-joining method, which is based on ITS, showed that these four isolates belonged to two strains of M. incurvatum; one strain was a new combination from the basionym Nannizzia incurvata.

Pitfall scarring alopecia: favus closely mimicking lichen planus.

We describe a woman presenting primarily with slowly progressing scarring alopecia. Course, symptoms, and clinical picture were highly suggestive for lichen planus. But mycological investigations revealed that cicatricial alopecia was caused by a specific infection with Trichophyton schoenleinii running a chronic course with minimal skin inflammation.

[Tinea capitis in the University Hospital of Constantine (Algeria)]. / Les teignes du cuir chevelu au CHU de Constantine (Algérie).

Although benign, tinea capitis are a public health problem and a frequent complaint in children. In Algeria, these disorders have long been known; their high frequency was related to unfavorable social conditions of people both in cities than in rural areas. Our aim is the study of tinea capitis diagnosed in the laboratory of Parasitology and Mycology of the University Hospital of Constantine through a retrospective review of 15 consecutive years from 1997 to 2011. Currently the clinical and biological differ from those described by ancient authors; dermatophytic flora has evolved significantly and favus, once quite common in our country, is hardly ever found. In addition, we are witnessing a resurgence of zoophilic tinea particularly those caused by Microsporum canis.

Favus of the scalp: an overview and update.

Tinea capitis favosa, a chronic inflammatory dermatophyte infection of the scalp, affects over 90% of patients with anthropophilic Trichophyton schoenleinii. T. violaceum, T. verrucosum, zoophilic T. mentagrophytes (referred to as 'var. quinckeanum'), Microsporum canis, and geophilic M. gypseum have also been recovered from favic lesions. Favus is typically a childhood disease, yet adult cases are not uncommon. Interestingly, favus is less contagious than other dermatophytoses, although intrafamilial infections are reported and have been widely discussed in the literature. Clinical presentation of T. schoenleinii infections is variable: this fungus can be isolated from tinea capitis lesions that appear as gray patches, but symptom-free colonization of the scalp also occurs. Although in the past T. schoenleinii was the dominant fungus recovered from dermatophytic scalp lesions, worldwide the incidence has decreased except in China, Nigeria, and Iran. Favus of the glabrous skin and nails are reported less frequently than favus of the scalp. This review discusses the clinical features of favus, as well as the etiological agents, global epidemiology, laboratory diagnosis, and a short history of medical mycology.

Tinea capitis favosa due to Trichophyton schoenleinii.

A case of a tinea capitis caused by Trichophyton schoenleinii is presented. It involves a 6-year old Tunisian boy that had presented with diffuse scaling of the scalp misdiagnosed as psoriasis and was treated unsuccessfully with keratolytic shampoos for two years. Tinea favosa due to Trichophyton schoenleinii was confirmed by mycological examination. He was successfully treated with griseofulvin for 6 weeks and topical application of imidazole. Trichophyton schoenleinii is an important anthropophilic dermatophyte that causes tinea favosa. It is transmitted by contagion between humans and is currently endemic in Africa. Ringworm is still frequent in Tunisia, but favus is becoming exceptional due to improvements in living conditions and hygiene.

Atypical favic invasion of the scalp by Microsporum canis: report of a case and review of reported cases caused by Microsporum species.

Favus is an uncommon pattern of dermatophytic infection of the scalp, glabrous skin and nails. We report the first documented case of favus of the scalp caused by Microsporum canis in an immunocompetent 8-year-old girl. The classic and various atypical clinical presentations of favus are discussed, as well as a brief review of the literature given.

Trichophyton tonsurans associated tinea corporis infection with the development of Majocchi's granuloma in a renal transplant patient.

Trichophyton tonsurans is an uncommon cause of tinea corporis, and an even more uncommon cause of Majocchi's granuloma. We report a patient who developed tinea corporis with Majocchi's granuloma from T. tonsurans infection. Immunocompromised hosts are predisposed to develop cutaneous fungal infections, as was the case with this patient. Majocchi's granuloma is a rare complication with immunosuppression, but is significant to consider when a fungal infection is suspected because it may require more aggressive therapy.

[Chronic favus caused by infection with Trichophyton schönleinii]. / Langjährig bestehender Favus nach Infektion mit Trichophyton schönleinii.

A 25-year-old female patient from Kosovo presented with a slowly progressive cicatricial alopecia which had started when she was 6 years old. Her brother in Kosovo had similar lesions. At the erythematous border of the hairless area, crusts, erosions and pustules were apparent. Mycological examination identified Trichophyton schönleinii, the causative pathogen of favus. Histological examination revealed hyphae and showed no features suggestive of other causes of cicatricial alopecia. Systemic terbinafine combined with topical ciclopiroxolamine resulted in rapid improvement of this disease which is seldom seen in Central Europe.

Favus due to Trichophyton mentagrophytes var. quinckeanum.

A case of inflammatory tinea capitis caused by Trichophyton mentagrophytes var. quinckeanum in a 3-year-old Tunisian girl is presented. The disease healed after treatment with griseofulvin for 6 weeks and topical application of econazole.

Favus due to Trichophyton mentagrophytes var. quinckeanum.

We report a case of favus affecting the temporal region of the scalp in a 22-month-old boy. Mycological study of hairs and crusts identified Trichophyton mentagrophytes var. quinckeanum (T. quinckeanum), the causative agent of mouse favus. Treatment with oral griseofulvin led to healing.