Commonly affected body sites in 92 Japanese combat sports participants with Trichophyton tonsurans infection.

Outbreaks of Trichophyton tonsurans infection constitute one of the serious problems among combat sports practitioners in Japan. To facilitate the diagnosis of individuals at risk, we undertook a study to determine which body sites are most commonly infected. We reviewed medical data, hairbrush culture results and questionnaire information from patients with T. tonsurans infection who were admitted to the dermatology clinic of Juntendo University hospital from 2000 to 2004. The study included 92 patients (87 males), aged 6-38 years (mean age: 18.4 years old). Eighty-nine patients were judo practitioners and three were wrestlers. Twenty-eight patients (30.4%) were asymptomatic carriers. In 64 patients, 51 patients (55.4%) with tinea corporis, 27 patients (29.3%) with tinea capitis, and/or one patient (1.1%) with tinea manuum were seen. Tinea corporis was observed on the forehead, auricles, nape of the neck, bilateral shoulders, left side of the upper chest, both elbows, back of the left hand to the wrist and both knees. Tinea capitis was most common in the occipitonuchal region at the hairline and in the temporal and frontal regions, at both auricles. Initial screening of these sites might facilitate the identification of the infection especially in judo practitioners.

[Results of questionnaire survey of Trichophyton tonsurans infection in judo clubs registered under the All Japan Judo Federation].

UNLABELLED: It has been seven years since an outbreak of Trichophyton tonsurans infection occurred in Japan. We have examined the state of T. tonsurans infection by a hairbrush test of athletes and a questionnaire survey of doctors' experience in its treatment, but have not completely grasped the actual state of infection at the sites of judo matches and its treatment or application of preventive measures. SUBJECTS AND METHODS: The questionnaire was distributed to the leaders of all judo clubs (10,077 clubs) registered under the All Japan Judo Federation, and responses recovered from 1,199 clubs (11.9%) were analyzed. These leaders were asked about (1) members of the club, (2) recognition of the infection, (3) experience of the breakout of infection at present and in the past, (4) present state of preventive measures, and (5) their opinions and requests. RESULTS: A higher percentage of the leaders of junior high school physical education judo clubs and primary school judo clubs responded they "did not know" about the infection, as compared with leaders of the other age groups. The answer regarding the "experience of the outbreak of infection" was "yes" in responses from 371 clubs (30.9%) , with a significantly higher percentage of leaders of senior high school judo clubs replying in the affirmative. Concerning preventive measures such as providing shower rooms, 540 clubs (45.1%) answered "no measures taken", which was more frequent in junior high school and primary school judo clubs. Since T. tonsurans infection is expected to spread to younger age groups in the future, a nationwide campaign by the All Japan Judo Federation for the education of risk of infection is urgently needed.

Management and follow-up survey of Trichophyton tonsurans infection in a university judo club.

The prevalence of Trichophyton tonsurans infection of the scalp in members of a university judo club (combat sport) was investigated over a 3.5-year period using a questionnaire survey and an assay based on fungal culture by the hairbrush method. In November 2002, 11 (35%) of 31 athletes were found to be positive for T. tonsurans infection by the hairbrush method and provided treatment with oral and topical antifungal agents according to a prescribed protocol. All the infected subjects became culture-negative following this treatment. We continued to conduct screening examinations every year in the month of April, when new university enrolment occurs. During three-and-a-half years of follow-up, there have been no outbreaks of the infection among the members of the university judo club. There were some positive culture results among the newly enrolled students, but these cases also became culture-negative with treatment. No re-infection has been noted after graduation among the club members who had been educated about and treated for the infection. Our findings indicate that the spread of T. tonsurans infection in sports clubs can be controlled by regular mass screening examination, therapy and measures at regular intervals to prevent the infection.

[Trichophyton tonsurans infection among judo practitioners who attended the National Junior High School Judo Tournament in Japan (2005): incidence and therapeutic response].

The spread of Trichophyton tonsurans infection among high school students and university undergraduates who practice Judo is an emerging problem in Japan and other countries. However, the extent of infection among Judo practitioners in junior high school in Japan is unknown. We conducted an epidemiological study of T. tonsurans infection among students who participated in the national junior high school Judo tournament in 2005. Of the 1,039 tournament participants invited to undergo screening, 496 (218 boys and 278 girls) consented, and 45 participants (9.1%) were found to be positive by hairbrush culture. We found the following to be relative risk factors for T. tonsurans infection: 1) male gender, 2) frequent judo practice in groups at either a high school or a dojo, 3) presence of tinea corporis in practice partners, 4) history of tinea corporis, 5) classification in lower-weight categories. 45 culture positive subjects were offered treatment and re-examined by hairbrush culture 3 months later. All twelve of them had negative cultures after miconazole shampoo treatment. A half of 12 subjects who had systemic antifungal therapy with itraconazole had positive culture. These observations suggest that T. tonsurans infection is rapidly spreading among junior high school Judo players in Japan. We speculate that the outbreak is caused, at least in part, by ignorance of the disease among Judo students, coaches and officials due to the high incidence of carriers and the mild or asymptomatic form of disease seen in infected individuals. Appropriate measures should be taken immediately to prevent more severe outbreak of this disease.

A case of lymphangitic sporotrichosis occurring on both forearms with a published work review of cases of bilateral sporotrichosis in Japan.

The patient, 56-year-old man who was working as a clerk and a farmer, presented with nodules that had appeared on the dorsa of both his hands 3 months earlier. At the first examination, there were multiple dark-red nodules scattered on the fingers, dorsa and wrists of both hands. The nodules were up to 3 cm in diameter and had crusts in the incenters. The patient was suspected to suffer from prurigo and was subsequently treated with topical steroid, but the nodules did not respond. Therefore, a skin biopsy and fungal culture were performed, and the patient was finally diagnosed as having bilateral multiple sporotrichosis. He was then successfully treated with local thermotherapy and oral potassium iodide. Bilaterally-distributed lymphangitic sporotrichosis is very rare and often difficult to diagnose. Careful attention is required to avoid misdiagnosis.

A nationwide survey of Trichophyton tonsurans infection among combat sport club members in Japan using a questionnaire form and the hairbrush method.

BACKGROUND: The emerging outbreak of Trichophyton tonsurans infection among members of combat sports clubs in Japan during the last 4 years has become a serious public health problem. To overcome this outbreak, a survey for T. tonsurans infection in Japan may be essential. OBJECTIVES: We sought to clarify the prevalence of T. tonsurans infection among members of combat sports clubs in Japan. METHODS: We conducted a survey of members of participating combat sports clubs using a standardized questionnaire to assess background factors and using the hairbrush method to identify T. tonsurans infection. Statistical significance of the correlation between data from the questionnaire and the hairbrush culture results was determined. RESULTS: We surveyed 1000 people (826 male) from 49 institutions and found 115 (11.5%) were positive for T. tonsurans infection revealed by the hairbrush method. Demographic factors associated with high positive rates (> or =20%) of the infection were familial T. tonsurans infection (20.0%), history of tinea corporis (24.2%), increased dandruff (32.1%), and concomitant tinea corporis (31.6%). Those with positive hairbrush culture results without current or previous tinea were considered asymptomatic carriers. LIMITATIONS: The study population was limited to members of judo clubs all over Japan; they were asked to participate in this survey via the All Japan Judo Federation. CONCLUSION: Infection of T. tonsurans appears to have spread widely among members of combat sports club in Japan. The questionnaire used in this study is a simple and useful tool to estimate epidemiology of this infection.

Genotype analysis of the variable internal repeat region in the rRNA gene of Trichophyton tonsurans isolated from Japanese Judo practitioners.

Tinea capitis due to Trichophyton tonsurans is currently epidemic among Japanese Judo practitioners. T. tonsurans has seven genotypes in a variable internal repeat (VIR) region of the rRNA gene. All 101 isolates obtained from Japanese Judo practitioners had the identical genotype. This suggests that a specific genotype strain occurs throughout Japan.

[Screening Examination and Management of Dermatophytosis by Trichophyton tonsurans in the Judo Club of a University].

Thirty-one members of the Judo Club of a certain university (age: 18~23) underwent a screening examination for dermatophytosis by Trichophyton tonsurans. Test items were: age, sex, height, weight, living mode, exercise duration, number of judo contestants, presence of foreign contestants, occurrence, if any, of dermatophytosis past or present according to a subject's answers to a questionnaire, medical examinations and mycological examinations (KOH, cellophane tape culture, and hairbrush culture). Twenty-four subjects (77%) replied that they had suffered from dermatophytosis in the past, and 8 subjects (26%) had had head eruption in the past. Eleven subjects (35%) had suspicious dermatophytosis at the time of screening; 3 of them were found positive by direct microscopy, 2 of them were positive by cellophane tape culture. Eleven subjects (35%) were found positive by the hairbrush culture, but only 2 had eruption-like folliculitis. The remaining 9 subjects were free from clinical symptoms and were judged to be asymptomatic carriers. As countermeasures, we recommended cleaning and the use of shampoo containing miconazole nitrate. Subjects with suspicious tinea corporis were treated with antimycotic ointment. The 7 subjects who showed more than 5 colonies by the hairbrush culture were treated with 1-week pulse therapy of 400 mg itraconazole, and 3 of these who took a total dose of a pulse became negative through one pulse therapy.