RESUMO
Antifungal-resistant dermatophyte infections have recently emerged as a global public health concern. A survey of US infectious diseases specialists found that only 65% had heard of this issue and just 39% knew how to obtain testing to determine resistance. Increased clinician awareness and access to testing for antifungal-resistant dermatophytosis are needed.
Assuntos
Antifúngicos , Farmacorresistência Fúngica , Tinha , Humanos , Antifúngicos/uso terapêutico , Antifúngicos/farmacologia , Estados Unidos/epidemiologia , Tinha/microbiologia , Tinha/epidemiologia , Tinha/tratamento farmacológico , Inquéritos e Questionários , Arthrodermataceae/efeitos dos fármacos , Testes de Sensibilidade MicrobianaRESUMO
Tinea capitis presents a significant public health care challenge due to its contagious nature, and potential long-term consequences if unrecognized and untreated. This review explores the prevalence, risk factors, diagnostic methods, prevention strategies, impact on quality of life, and treatment options for pediatric tinea capitis. Epidemiological analysis spanning from 1990 to 1993 and 2020 to 2023 reveals prevalence patterns of pediatric tinea capitis influenced by geographic, demographic, and environmental factors. Notably, Trichophyton species is most prevalent in North America; however, Microsporum species remain the primary causative agent globally, with regional variations. Risk factors include close contact and environmental conditions, emphasizing the importance of preventive measures. Accurate diagnosis relies on clinical evaluation, microscopic examination, and fungal culture. Various treatment modalities including systemic antifungals show efficacy, with terbinafine demonstrating superior mycological cure rates particularly for Trichophyton species. Recurrent infections and the potential development of resistance can pose challenges. Therefore, confirming the diagnosis, appropriately educating the patient/caregiver, accurate drug and dose utilization, and compliance are important components of clinical cure. Untreated or poorly treated tinea capitis can lead to chronic infection, social stigma, and psychological distress in affected children. Prevention strategies focus on early detection and healthy lifestyle habits. Collaborative efforts between healthcare providers and public health agencies are important in treating pediatric tinea capitis and improving patient outcomes. Education and awareness initiatives play a vital role in prevention and community-level intervention to minimize spread of infection. Future research should explore diagnostic advances, novel treatments, and resistance mechanisms in order to mitigate the disease burden effectively.
RESUMO
The classical dermatophytes diagnosis is based on mycological culture and microscopy observation both human and animal hair, skin, and nail samples. The aim of this work was to develop the new in-house real-time PCR with pan-dematophyte reaction for detection and identification of the main dermatophytes directly from hair samples, providing a simple and rapid diagnosis of dermatophytosis in dogs and cats. An in-house SYBR-Green real-time PCR was designed and used for detecting a DNA fragment encoding chitin synthase 1 (CHS1). A total of 287 samples were processed by culture, microscopic examination with KOH 10%, and real-time PCR (qPCR) analysis. Melting curve analysis of the CHS1 fragment revealed to be reproducible, showing a single distinct peak for each species of dermatophyte, namely Trichophyton mentagrophytes, T. verrucosum, Microsporum canis, and Nannizzia gypsea (formerly M. gypseum). Then, out of the 287 clinically suspected cases of dermatophytosis, 50% were positive for dermatophytes by qPCR, 44% by mycological culture, and 25% by microscopic examination. Microsporum canis was identified in 117 samples tested by culture and 134 samples tested by qPCR, followed by N. gypsea in 5 samples (either tested by culture or qPCR) and T. mentagrophytes detected in 4 and 5 samples when tested by culture or qPCR, respectively. Overall, qPCR allowed the diagnosis of dermatophytosis in clinical samples. The results suggest this newly proposed in-house real-time PCR assay can be used as alternative diagnosis and rapid identification of dermatophytes frequently associated to clinical hair samples of dogs and cats.
The aim of this work was to develop a molecular detection strategy for dermatophytes by SYBR-Green real-time PCR of hair samples from animals. The melting curve analysis of the CHS1 fragment revealed to be reproducible, showing a single distinct peak for distinct dermatophyte species and allowed the diagnosis of dermatophytosis in dogs and cats caused mainly by Trichophyton mentagrophytes, Microsporum sp., and Nannizzia gypsea).
Assuntos
Arthrodermataceae , Doenças do Gato , Dermatomicoses , Doenças do Cão , Tinha , Gatos , Animais , Cães , Humanos , Arthrodermataceae/genética , Dermatomicoses/diagnóstico , Dermatomicoses/veterinária , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Doenças do Gato/diagnóstico , Doenças do Cão/diagnóstico , Microsporum/genética , Cabelo , Quitina Sintase/genética , Tinha/veterinária , Trichophyton/genéticaRESUMO
BACKGROUND: There are limited clinical studies evaluating the Trichophyton mentagrophytes complex, with most reports confined to small case studies. Additionally, the studies are dated and provide limited information on response to newer or currently available therapies. HYPOTHESIS/OBJECTIVES: The aim of the study was to determine if there is a breed prevalence, lesion distribution and seasonality associated with the T. mentagrophytes complex for dogs evaluated in the central United States. An additional aim of the study was to evaluate response to therapies because there are minimal data available on clinical response with newer systemic antifungal drugs. ANIMALS: A total of 64 canine medical records were evaluated that had a previous diagnosis of T. mentagrophytes complex infection. MATERIALS AND METHODS: A retrospective study of medical records to evaluate signalment, time of onset of clinical signs, clinical presentation and therapeutic management. RESULTS: A higher incidence of T. mentagrophytes complex infection was observed in the American Kennel Club (AKC) Sporting group (43%) and Terrier group (20%). A seasonal influence was noted, with the onset of clinical signs being highest in October. Lesions most often affected the muzzle (48%), followed by the head excluding the pinnae (21%). Ketoconazole, itraconazole and terbinafine appeared equivalent as systemic therapeutic options to treat T. mentagrophytes complex infections. CONCLUSIONS AND CLINICAL RELEVANCE: This study identified patterns in breeds, seasonality and lesion distribution for the T. mentagrophytes complex in dogs from the central United States. Additionally, the study found several reasonable and reliable treatment options for systemic therapy.
Assuntos
Doenças do Cão , Tinha , Cães , Animais , Estudos Retrospectivos , Tinha/tratamento farmacológico , Tinha/epidemiologia , Tinha/veterinária , Trichophyton , Melhoramento Vegetal , Antifúngicos/uso terapêutico , Doenças do Cão/tratamento farmacológico , Doenças do Cão/epidemiologiaRESUMO
Background and Objectives: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of tumors have been found to be associated with childhood irradiation due to tinea capitis, most commonly cancers of the head and neck, as well as brain tumors. The often unusually aggressive and recurrent nature of these tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. Materials and Methods: This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation therapy due to tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients' characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. Results: Local flaps were used for reconstruction in 34 patients, direct sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities (p = 0.001), aseptic bone necrosis (p = 0.001), as well as skin atrophy in frontal, occipital, and parietal region (p = 0.001, p = 0.042 and p = 0.001, respectively). A significant correlation between major complications and moderate skin atrophy was found only in the parietal region (p = 0.026). Conclusions: Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin atrophy associated with high tumor recurrence rate and radiation-induced vascular impairment, such as in tinea capitis patients in Serbia. An algorithm has been developed based on the authors' experience in managing these patients.
Assuntos
Couro Cabeludo , Tinha do Couro Cabeludo , Humanos , Feminino , Masculino , Idoso , Couro Cabeludo/cirurgia , Estudos Retrospectivos , Recidiva Local de Neoplasia , Tinha do Couro Cabeludo/radioterapia , Tinha do Couro Cabeludo/cirurgia , Atrofia/cirurgia , AlgoritmosRESUMO
Extensive dermatophytosis caused by terbinafine-resistant Trichophyton indotineae harboring Phe397Leu and Leu393Ser substitutions in the squalene epoxidase enzyme was diagnosed in France. Analysis of internal transcribed spacer sequences revealed the wide spread of this species in Asia and Europe. Detection of T. indotineae in animals suggests their possible role as reservoirs.
Assuntos
Arthrodermataceae , Tinha , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Farmacorresistência Fúngica , França/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Terbinafina , Tinha/diagnóstico , Tinha/tratamento farmacológico , Trichophyton/genéticaRESUMO
Tinea capitis is an important superficial infection and affects children globally. A literature review was conducted to identify recent findings and the current understanding of this fungal infection. Here, we highlight updates on important aspects of tinea capitis including advances in dermatophyte detection and diagnosis and comparing these new methods to more traditional techniques. Additionally, aspects of treating tinea capitis are discussed, including the importance of mycological confirmation and current means of treatment, and the treatment of asymptomatic carriers are reviewed. This review also examines the subject of laboratory monitoring of patients undergoing treatment with systemic antifungals; we discuss the opinions of prominent researchers and currently accepted guidelines. Lastly, we provide answers to several common questions that practitioners may encounter when treating a child with tinea capitis.
Assuntos
Tinha do Couro Cabeludo , Antifúngicos/uso terapêutico , Criança , Família , Heterozigoto , Humanos , Imunoterapia , Tinha do Couro Cabeludo/diagnóstico , Tinha do Couro Cabeludo/tratamento farmacológico , Tinha do Couro Cabeludo/microbiologiaRESUMO
Trichophyton (T.) verrucosum is a highly pathogenic dermatophyte causing zoonotic bovine ringworm that is transmissible to humans. The virulence factors subtilisin (Sub)3 and Sub6 are discussed to contribute to disease manifestation but no protein expression study is available for T. verrucosum. We used customized antibodies (against Trichophyton-species, Sub3 and Sub6) to examine skin biopsies of infected cattle via immunofluorescence stainings. Both virulence factors Sub3 and 6 were solely expressed by conidia and not only found in epidermal but also in dermal and hair structures. The anti-T-antibody reliably detected the fungus and proved more sensitive compared to histological stains. LAY SUMMARY: We examined the zoonotic dermatophyte Trichophyton (T.) verrucosum in bovine skin and studied two important virulence factors called subtilisin (Sub)3 and Sub6 that T. verrucosum produces and secretes using immunolabeling.
Assuntos
Doenças dos Bovinos/microbiologia , Pele/microbiologia , Subtilisina/genética , Tinha/veterinária , Trichophyton/genética , Trichophyton/patogenicidade , Animais , Biópsia/veterinária , Bovinos , Doenças dos Bovinos/diagnóstico , Imunofluorescência , Pele/patologia , Esporos Fúngicos/genética , Esporos Fúngicos/patogenicidade , Subtilisina/classificação , Tinha/microbiologia , Fatores de Virulência/genética , Zoonoses/microbiologiaRESUMO
The Caatinga is an exclusively Brazilian biome where semiarid climatic conditions promote singularities in adaptive biodiversity. Many aromatic species are found in this region possessing antifungal properties, which are attributed to their essential oils. Thus, we questioned whether essential plant oils found in the Caatinga present anti-dermatophytic potential. Dermatophytes are keratinophilic fungi that cause one of the most prevalent mycoses globally, skin infections known as dermatophytoses (tineas). Here, we provide a comprehensive report of the available published information, analyzing the methods used to evaluate the antifungal activity, verifying the quality of the evidence and possible clinical applications, and discussing research trends in this area. The plants studied concentrated in the genera Croton (Euphorbiaceae), Lippia (Verbenaceae), Piper (Piperaceae), and Mentha (Lamiaceae). All of the studies used in vitro tests to analyze antifungal potential, and little evidence was ascertained concerning the mechanism of antifungal action. In addition, the essential oils also evidenced drug modifying activity of conventional antifungal drugs (Ketoconazole and Terbinafine). We believe that the anti-dermatophyte potential of plant essential oils occurring within the Caatinga is underestimated and that this review will encourage future chemical-pharmacological investigations into the plants within this biome.Key points⢠The essential oils from plants occurring in the Caatinga Biome present unknown anti-dermatophyte potential.⢠The studies against dermatophyte fungi concentrate on the families Lamiaceae and Verbenaceae.⢠In vitro assays were used to assess the anti-dermatophyte potential of the essential oils.
Assuntos
Óleos Voláteis , Tinha , Antifúngicos/farmacologia , Ecossistema , Humanos , Testes de Sensibilidade Microbiana , Óleos Voláteis/farmacologia , Óleos de PlantasRESUMO
Ringworm in cattle may cause an occupational skin disease in humans. Trichophyton verrucosum lead to a highly inflammatory fungal skin infection that is often misdiagnosed as bacterial disease and consequently mistreated with antibiotics. To establish the correct diagnosis, it is necessary to collect skin scales; in addition, a skin biopsy can be helpful. Deep dermatophyte infections by Trichophyton verrucosum can be treated effectively with oral terbinafine. In addition, it is necessary to pay careful attention to use suitable hygiene measures in the stables to protect against reinfection.
Assuntos
Tinha , Trichophyton , Animais , Bovinos , Fazendeiros , Humanos , Pele , Terbinafina , Tinha/diagnóstico , Tinha/tratamento farmacológicoRESUMO
Hedgehogs have increased in popularity as pets in Spain but there are no data of infection rates of this exotic animal with dermatophytes in our country. During the period of 2008-2011 a total of 20 pet hedgehogs (19 African pygmy hedgehogs and 1 Egyptian long-eared hedgehog) suspected of having dermatophytoses were studied. This is the first survey of the occurrence of T. erinacei in household hedgehogs in Spain. The T. erinacei infection rate was 50% (9 out of 19 African pygmy hedgehogs, and the one Egyptian long-eared hedgehog surveyed). Morphological identification of the isolates was confirmed by molecular analysis. All the strains had the same ITS sequence and showed 100% sequence similarity to T. erinacei type strain CBS 511.73 (AB 105793). The Spanish isolates were confirmed as T. erinacei urease positive. On the basis of ITS sequences, T. erinacei is a species close to but separate from the taxa included in the A. benhamiae complex. Review of the current literature on DNA-based methods for identification of species included in this complex has highlighted the urgent need to reach a consensus in species circumscription and classification system accepted by all mycologists.
Assuntos
Ouriços/microbiologia , Animais de Estimação/microbiologia , Tinha/veterinária , Trichophyton/classificação , Trichophyton/isolamento & purificação , Animais , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Feminino , Genótipo , Masculino , Técnicas Microbiológicas , Microscopia , Filogenia , Prevalência , Análise de Sequência de DNA , Espanha/epidemiologia , Tinha/epidemiologia , Tinha/microbiologia , Trichophyton/enzimologia , Trichophyton/genética , Urease/análiseRESUMO
Trichophyton verrucosum is a zoophilic dermatophyte, known as a causative agent of inflammatory mycoses of the skin and the scalp in humans. In this study, we reviewed all cases of T. verrucosum infection diagnosed in our laboratory over a 12-year period, to determine epidemiological and clinical characteristics. Among 18,340 samples analyzed, 5,186 cultured positive with dermatophytes (2674 patients), of which 64 samples (41 patients) were positive for T. verrucosum. Our data show that there was a strong influence of age on the type of lesion, with children and adults presenting more frequently with tinea capitis and skin infections, respectively (P < .0001). Infection of children and adults resulted more frequently from indirect and direct exposure to cattle, respectively (P < .01). We observed a marked increase of cases over the last 4 years, with a correlation of the number of cases and the mean annual rainfall (P < .05), suggesting that increasing humidity favors cattle infection, and thereby, human infection. Whether this increase is the consequence of climate changes remains to be determined but should be considered.
Assuntos
Tinha/epidemiologia , Tinha/patologia , Trichophyton/isolamento & purificação , Adolescente , Adulto , Fatores Etários , Idoso , Animais , Bovinos , Criança , Pré-Escolar , Exposição Ambiental , Feminino , França/epidemiologia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Zoonoses/epidemiologia , Zoonoses/patologiaRESUMO
Tinea barbae represents a very rare dermatophytosis. We report on a tinea barbae profunda following a journey to Southeast Asia. After travel to Thailand, a businessman was affected by a foudroyant proceeding abscessing infection of the upper lip and beard area. The initial therapy with oral acyclovir and oral ciprofloxacin, which later was changed to ampicillin plus sulbactam, intravenously, was unsuccessful. In a biopsy sample, histologically, with Grocott-Gomori's methenamine silver stain, fungal mycelium was apparent in the tissue. Thereupon, terbinafine 250 mg was given for 4 weeks, topically, a 1% ciclopiroxolamine-containing cream. In fungal culture, T. mentagrophytes were found to grow. Meanwhile, the patient's German wife suffered from a tinea faciei. From skin scrapings from the cheek, T. mentagrophytes was also cultivated. This zoophilic dermatophyte was identical with other zoophilic strains of T. mentagrophytes currently found in Germany, which were also acquired in Thailand. The patient had contact with Thai female sex workers who must be considered as a source of infection of the dermatophytosis. There was no animal contact, neither in Thailand, nor in Germany. The infection chain of the dermatophytosis from Thailand probably reached from a female sex worker via the here described patient to his wife in Germany. This pathway of infection has been known for 1 or 2 years, but until now, in Germany, Switzerland, and Austria exclusively via pubogenital infections (tinea genitalis profunda) due to T. mentagrophytes after journeys to Southeast Asia. For treatment, oral antifungal agents should be used, first of all terbinafine, alternatively fluconazole or itraconazole.
Assuntos
Abscesso/diagnóstico , Países em Desenvolvimento , Dermatoses Faciais/diagnóstico , Doenças Labiais/diagnóstico , Tinha/diagnóstico , Doença Relacionada a Viagens , Abscesso/tratamento farmacológico , Adulto , Ciclopirox/uso terapêutico , Quimioterapia Combinada , Dermatoses Faciais/tratamento farmacológico , Feminino , Alemanha/etnologia , Humanos , Doenças Labiais/tratamento farmacológico , Masculino , Profissionais do Sexo , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Terbinafina/uso terapêutico , Tailândia , Tinha/tratamento farmacológico , Tinha/transmissão , Resultado do TratamentoRESUMO
Trichophyton verrucosum is the most common ringworm agent in cattle. Epidemiology of cattle dermatophytoses in Central Italy is not clear. Its diffusion among cattle and herdsmen was investigated in 20 Umbrian farms, Central Italy. Hairs and scales were taken from 395 animals and 31 workers. Typical ringworm was present in 71.7% of cattle under 6 months and in 11% of animals over 6 months. T. verrucosum was isolated from 98.9% of symptomatic heads and was the most prevalent dermatophyte in all herds investigated (isolated in 18 of the 20 farms). T. mentagrophytes var. mentagrophytes was found in 16 symptomatic and in eight asymptomatic young animals. Prevalence of asymptomatic carriers of both species was significantly higher in young heads (21.1% vs. 8.1%) and the age below 6 months was the only statistically significant risk factor associated with dermatophytosis. About the workers, all the 14 men with lesions were positive for T. verrucosum; copresence of T. verrucosum and Microsporum gypseum was noticed in one case. Results indicate a high diffusion of T. verrucosum among both animals and humans in Umbrian farms and confirm the dermatophyte infection as a public health problem. Periodic epidemiological surveys, treatment of sick livestock and workers, cleaning/sanitisation of herds and vaccination programmes may be useful in controlling the infection.
Assuntos
Doenças dos Bovinos/transmissão , Tinha/veterinária , Trichophyton/isolamento & purificação , Zoonoses/transmissão , Adulto , Animais , Arthrodermataceae , Bovinos , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/microbiologia , Dermatomicoses/microbiologia , Dermatomicoses/transmissão , Dermatomicoses/veterinária , Cabelo/microbiologia , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Tinha/epidemiologia , Tinha/microbiologia , Tinha/transmissão , Adulto Jovem , Zoonoses/microbiologiaRESUMO
A 6-year-old Hispanic patient presented with a 1-month history of pruritic patches on her scalp, characterized by hair loss, black dots, and dandruff-like scales. The patient was seen by her primary care physician, who prescribed ketoconazole 2% shampoo. This provided little relief for her symptoms, which prompted her admission to nearby hospital, where fluconazole was administered intravenously and mometasone lotion applied. The patient was discharged and instructed to use the ketoconazole shampoo and mometasone lotion. The previously prescribed medications failed to improve her now enlarged, inflamed, scaly, pustule-speckled lesions. Given her condition, she was admitted to the University Pediatric Hospital in San Juan, where the Dermatology Department was consulted. Cultures were taken from the lesions, revealing the presence of Trichophyton tonsurans, which led to the diagnosis of tinea capitis (ringworm of the scalp) with kerion formation. In addition, multiple nits and adult lice characteristic of Pediculus humanus capitis were observed. A 6-week course of griseofulvin, a 1-week course of permethrin solution, and a 5-day course of oral prednisolone were started, effectively cleared the patient's inflammation and fungal infection. This case highlights how there exist areas of improvement in terms of interprofessional communication between physicians, as well a need to increase awareness of the proper treatment for this common pediatric skin condition. We postulate that in doing so, similar cases could be spared the unfortunate results of untreated tinea capitis, that is, kerion formation and the possible scarring this lesion can produce.
Assuntos
Antifúngicos , Tinha do Couro Cabeludo , Humanos , Tinha do Couro Cabeludo/tratamento farmacológico , Tinha do Couro Cabeludo/microbiologia , Feminino , Criança , Antifúngicos/administração & dosagem , Fatores de Tempo , Griseofulvina/administração & dosagem , Atraso no TratamentoRESUMO
Introduction Dermatophytosis is a common infection of the skin, hair, and nails caused by dermatophytes, a group of filamentous fungi capable of digesting and obtaining nutrients from keratin. Dermatophytes comprise three important genera: Epidermophyton, Microsporum,and Trichophyton. This study aimed to analyze the antifungal susceptibility patterns of Trichophyton mentagrophytes isolates using the epsilometer test (E-test) method. Material and methods This prospective observational study was conducted on clinically suspected cases of dermatophytosis. All samples, including skin scrapings, hair, and nails, were subjected to potassium hydroxide (KOH) examination followed by fungal culture. The Trichophyton mentagrophytes isolates were then subjected to antifungal susceptibility testing using the E-test method for the two most prescribed antifungals: itraconazole and fluconazole. Results In this study, one-third of the patients who tested positive for dermatophytosis belonged to the same family, with spouses being the most commonly affected. Tinea corporis was the most common clinical presentation, with Trichophyton mentagrophytes identified as the most common etiological agent. Itraconazole was more effective than fluconazole. Conclusion The current study demonstrated that antifungal susceptibility testing of dermatophytes using the E-test is easier and can be applied in routine laboratories as a screening method, serving as an alternative to broth microdilution.
RESUMO
INTRODUCTION: There is an increasing number of reports of Trichophyton indotineae infections. This species is usually poorly responsive to terbinafine. AREAS COVERED: A literature search was conducted in May 2024. T.indotineae infections detected outside the Indian subcontinent are generally associated with international travel. Reports of local spread are mounting.As a newly identified dermatophyte species closely related to the T. mentagrophytes complex with limited genetic and phenotypic differences, there is an unmet need to develop molecular diagnosis for T. indotineae. Terbinafine has become less effective as a first-line agent attributed to mutations in the squalene epoxidase gene (Leu393Phe, Phe397Leu). Alternative therapies include itraconazole for a longer time-period or a higher dose (200 mg/day or higher). Generally, fluconazole and griseofulvin are not effective. In some cases, especially when the area of involvement is relatively small, topical non-allylamine antifungals may be an option either as monotherapy or in combination with oral therapy. In instances when the patient relapses after apparent clinical cure then itraconazole may be considered. Good antifungal stewardship should be considered at all times. EXPERT OPINION: When both terbinafine and itraconazole are ineffective, options include off-label triazoles (voriconazole and posaconazole). We present four patients responding to these newer triazoles.
Ringworm (dermatophytosis, tinea) is a fungal infection of the skin, hair and nails that is commonly seen by primary and secondary healthcare providers. An estimated 2025% of the global population is affected by this condition. In Europe and the United States, tineas are often treated empirically using over-the-counter medications, which can increase the risk of resistance development.While antifungal resistance is not a new problem, this topic has garnered the attention of physicians and researchers in recent years due to an outbreak from South Asia caused by a new pathogen known as Trichophyton indotineae. In this review, we summarize the global prevalence, diagnosis methods, antifungal resistance profile and treatment options for T. indotineae. Currently, most cases outside of South Asia are linked to international travel, there is evidence suggesting local person-to-person transmission and transmission via animal contact. One hurdle to surveilling the spread of this pathogen is the requirement of complex molecular diagnosis, tackling this challenge will require the development of newer assays.Terbinafine, a widely available antifungal drug, is becoming less effective owing to resistance mutations of the squalene epoxidase gene. Itraconazole has shown effectiveness, especially with a higher dose and a longer treatment duration. There is a significant risk of T. indotineae infections becoming chronic with episodes of relapse. When both terbinafine and itraconazole fail, newer agents such as posaconazole and voriconazole can be considered. Combination therapy using oral and topical medications should also be considered.
RESUMO
Context: Risk factors for the persistence of superficial skin infestations are prevalent in humid tropical environments, which are favorable for breeding of the causative vector mite Sarcoptes scabiei (ectoparasite) and dermatophyte fungi. Aim: This study aimed at assessing the awareness and knowledge of childhood scabies and ringworm infestations among parents in Calabar, a highly humid rainforest tropical environment. Settings and Design: Cross-sectional study design and systematic random sampling were used to recruit school-age children in selected primary schools in Calabar. Materials and Methods: Researcher-driven administration of a structured questionnaire was conducted to obtain quantitative data from parents of recruited children. Statistical Analysis Used: : Chi-square was used to assess factors associated with ever hearing or seeing scabies and ringworm infestations. Statistical significance was set at P < 0.05. Results: One hundred and eighty-two (56.7%) and 218 (67.9%) of the respondents had heard of or seen scabies and ringworm infestation. Among respondents that were aware of scabies, 53.3% knew of the cause, 50.5% were aware of the risk factors while 68.1% and 78.0% knew their treatment and prevention, respectively; 98.6%, 60.6%, 76.6%, and 80.7% of respondents knew the cause, risk factors, treatment, and prevention of ringworm infestation, respectively. Fathers with at least secondary school literacy level and sharing beds were significantly associated with awareness of scabies. Conclusion: There is a suboptimal level of awareness and knowledge of two of the most common superficial skin infestations among parents of primary school children in the study setting. There is a need to redouble our effort at sensitization of parents toward improved awareness of these common infestations.
Résumé Contexte: Les facteurs de risque de persistance des infestations cutanées superficielles sont prévalents dans les environnements tropicaux humides, favorables à la reproduction du vecteur responsable, la gale Sarcoptes scabiei (ectoparasite), et des champignons dermatophytes. Objectif : Cette étude visait à évaluer la sensibilisation et les connaissances des parents de Calabar, un environnement tropical de forêt équatoriale très humide, concernant la gale et les infestations à la teigne chez les enfants. Cadre et conception : Une étude transversale et un échantillonnage systématique ont été utilisés pour recruter des enfants d'âge scolaire dans des écoles primaires sélectionnées à Calabar. Méthodes et matériel: Une administration dirigée par le chercheur d'un questionnaire structuré a été réalisée pour obtenir des données quantitatives auprès des parents des enfants recrutés. Analyse statistique utilisée: Le test du chi carré a été utilisé pour évaluer les facteurs associés à la connaissance de la gale et des infestations à la teigne. La signification statistique a été fixée à P < 0,05. Résultats: Cent quatre-vingt-deux (56,7 %) et 218 (67,9 %) des répondants avaient entendu parler ou vu une infestation de gale et de teigne. Parmi les répondants qui étaient au courant de la gale, 53,3 % connaissaient la cause, 50,5 % étaient conscients des facteurs de risque, tandis que 68,1 % et 78,0 % connaissaient respectivement leur traitement et leur prévention. De même, 98,6 %, 60,6 %, 76,6 % et 80,7 % des répondants connaissaient respectivement la cause, les facteurs de risque, le traitement et la prévention de l'infestation à la teigne. Les pères ayant au moins un niveau d'alphabétisation au niveau secondaire et partageant des lits étaient significativement associés à la connaissance de la gale. Conclusion: Il existe un niveau sous-optimal de sensibilisation et de connaissance de deux des infestations cutanées superficielles les plus courantes parmi les parents d'enfants d'école primaire dans le cadre de l'étude. Il est nécessaire de redoubler d'efforts pour sensibiliser les parents afin d'améliorer la connaissance de ces infestations courantes. Mots-clés: Infestations cutanées, gale, teigne, connaissance, parents, enfants d'âge scolaire, Nigeria.
Assuntos
Escabiose , Tinha , Criança , Humanos , Escabiose/epidemiologia , Escabiose/prevenção & controle , Estudos Transversais , Nigéria/epidemiologia , Tinha/complicações , PaisRESUMO
To limit the spread of bovine ringworm, control measures such as movement restrictions are highly recommended. In this context, calves at auction markets in Styria, Austria, displaying skin lesions characteristic for bovine ringworm, are excluded from the auctions. To investigate whether these clinical assessments correspond to laboratory diagnosis, a total of 166 samples taken from skin lesions assigned to the three clinical categories 'ringworm very likely (v), likely (l) or unlikely (u)' were mycologically examined using microscopy, culture, and nested PCR followed by amplicon sequencing. Further, the relationships of isolated dermatophytes were determined through multi-locus sequence typing (MLST). Overall, a high agreement between clinical assessment and laboratory results were observed with microscopy and nested PCR, providing more consistent results and molecular detection possessing an analytical sensitivity superior to that of cultural isolation (culture 21.7% vs. nested PCR 48.2%). Phylogenetic analyses revealed that most of the isolated dermatophytes belong to a unique Trichophyton verrucosum MLST genotype. In conclusion, clinical assessments were largely confirmed through laboratory diagnosis with nested PCR and sequencing, providing rapid, sensitive, and species-specific detection of dermatophytes in calves at auction markets displaying skin lesions typical for ringworm; this seems to be predominantly caused by a single Trichophyton verrucosum strain.