Dermatophytosis and the associated risk factors among primary school children in southern and central Côte d'Ivoire.

BACKGROUND: Dermatophytosis, particularly the subtype tinea capitis, is common among African children; however, the risk factors associated with this condition are poorly understood. OBJECTIVES: This study aimed to determine the factors associated with tinea capitis and the prevalence rate of other dermatophytoses among primary school students in the rural and urban areas of the southern and central Côte d'Ivoire. PATIENTS AND METHODS: The study was carried out in seven towns of Côte d'Ivoire from October 2008 to July 2009, among 17,745 children aged 4-17 years and attending urban and rural primary schools; a complete physical examination of the skin and appendages, including nails and hair, was performed by the physicians. Direct microscopic examination using 30% potassium hydroxide solution and culture on Sabouraud's dextrose agar supplemented with 0.5 g/L chloramphenicol and 0.4 g/L actidione was performed during sampling. RESULTS: For the 17,745 children clinically examined, 2645 exhibited symptoms suggestive of tinea capitis. Positive cultures for dermatophytes were found in 2635 patients, and the overall prevalence rate of tinea capitis was 14.8%. The following factors, age, sex, pets at home, number of bathing daily, sharing of sponges, combs and towels and hair length, were statistically associated with tinea capitis (p < .001). In addition to tinea capitis, other superficial fungal infections were identified among these children. These included tinea corporis (0.9%), tinea unguium (0.6%) and pityriasis versicolor (0.4%). CONCLUSION: Tinea capitis is common among pupils in rural southern and central Côte d'Ivoire, especially in young boys.

[Tinea capitis: clinical features and therapeutic alternatives]. / Tinea capitis: aspectos clínicos y alternativas terapéuticas.

A descriptive observational and cross-sectional study was carried out. The clinical characteristics, etiologic agents, treatments and outcome of 33 cases of tinea capitis in the Mycology Unit at Francisco J. Muñiz Hospital of Buenos Aires City between January 2015 and December 2019 were analyzed. The median age of the patients was 7 years, 21 of whom were male, 3 were HIV-positive and 22 had pets. The isolated etiologic agents were the following: Microsporum canis in 22 cases, Trichophyton tonsurans in 8, Nannizzia gypsea in 2 and Trichophyton mentagrophytes in one patient. Suppurative tinea capitis (krion Celsi) was detected in 10 cases and the same number of patients presented other skin locations of their dermatophytosis in addition to those in the scalp. Twenty-one cases were orally treated with griseofulvin and 12 with terbinafine. Those patients with suppurative tinea capitis received drops of betamethasone by mouth besides the antifungal drugs. All patients had good clinical and mycological response to the treatments, all lesions disappeared, and mycological studies turned negative by the end of the treatments. We conclude that both drugs were effective for the treatment of tinea capitis; however, lesions in those cases receiving terbinafine involuted more slowly.

Tinea Capitis: An Updated Review.

BACKGROUND: Tinea capitis is a common and, at times, difficult to treat, fungal infection of the scalp. OBJECTIVE: This article aimed to provide an update on the evaluation, diagnosis, and treatment of tinea capitis. METHODS: A PubMed search was performed in Clinical Queries using the key term "tinea capitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. The information retrieved from the above search was used in the compilation of the present article. Patents were searched using the key term "tinea capitis" at www.freepatentsonline.com. RESULTS: Tinea capitis is most often caused by Trichophyton tonsurans and Microsporum canis. The peak incidence is between 3 and 7 years of age. Non-inflammatory tinea capitis typically presents as fine scaling with single or multiple scaly patches of circular alopecia (grey patches); diffuse or patchy, fine, white, adherent scaling of the scalp resembling generalized dandruff with subtle hair loss; or single or multiple patches of well-demarcated area (s) of alopecia with fine-scale, studded with broken-off hairs at the scalp surface, resulting in the appearance of "black dots". Inflammatory variants of tinea capitis include kerion and favus. Dermoscopy is a highly sensitive tool for the diagnosis of tinea capitis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wetmount preparation and fungal culture. It is desirable to have mycologic confirmation of tinea capitis before beginning a treatment regimen. Oral antifungal therapy (terbinafine, griseofulvin, itraconazole, and fluconazole) is considered the gold standard for tinea capitis. Recent patents related to the management of tinea capitis are also discussed. CONCLUSION: Tinea capitis requires systemic antifungal treatment. Although topical antifungal therapies have minimal adverse events, topical antifungal agents alone are not recommended for the treatment of tinea capitis because these agents do not penetrate the root of the hair follicles deep within the dermis. Topical antifungal therapy, however, can be used to reduce transmission of spores and can be used as adjuvant therapy to systemic antifungals. Combined therapy with topical and oral antifungals may increase the cure rate.

[Epidemiological, clinical and etiological profile of tinea capitis in adult patients in Dakar, Senegal]. / Profil épidémio-clinique et étiologique des teignes du cuir chevelu chez l'adulte à Dakar (Sénégal).

OBJECTIVE: To determine the epidemiological and etiological profile of tinea capitis in adults in Dakar (Senegal). PATIENTS AND METHODS: A 9-month prospective, multicenter, descriptive and analytic study. Patients included were aged over 18 years. Mycological tests were used to confirm the diagnosis. RESULTS: 121 patients were included with a mean age of 36.1 years and a hospitalisation frequency of 0.8%. The age range of 64.4% of patients was between19 and 38 years. 51% of patients were housewives. A low socioeconomic level was found in 72.8% of cases. In 3.3% of patients, the disease began in childhood. 31.4% of patients had already consulted a traditional healer. Similar familial cases were noted in 60.3% of patients. Contact with a sheep was noted in 32.2% of cases, deliberate skin lightening in 64% of women, hair salon attendance in 46.7% of women, and immunosuppression in 17.3% of patients, while itching was present in 95.5%. Dermatologic examination showed scaled plaques and a diffuse form, with 92.6% and 64% (n=75) respectively. Wood's light examination was positive in 40.2% of patients. A positive culture test was found in 71%. The most frequently encountered species were: T. soudanense (65%), M. audouinii (21%), T. rubrum (4.7%), M. gypseum (3.5%), T. violaceum (2.3%), T. verrucosum (2.3%) and M. canis (1 case). The clinical course was favorable under treatment with griseofulvin or terbinafine. CONCLUSION: Tinea capitis in adults mainly affects young women. The diffuse form is the most common. The most frequently encountered species was T. soudanense.

Tinea Capitis by Microsporum audouinii: Case Reports and Review of Published Global Literature 2000-2016.

Tinea capitis caused by Microsporum audouinii is reported herein from two Brazilian schoolchildren, which are brothers. Arthroconidia were evidenced on direct examination of scalp hair, and a fungus of the genus Microsporum was isolated from cultures of each patient. The isolated fungi were classified as M. audouinii by visualization of species-specific structures, including: pectinate hyphae, chlamydospores, and fusiform macroconidia, sterile growth with characteristic brown pigment in rice grains, and through DNA sequencing of the internal transcriber spacer region. Patients were refractory to ketoconazole, but the two cases had a satisfactory response to oral terbinafine. All M. audouinii infections described in this century were reviewed, and to our knowledge, this is the first literature description of this species from South America. Misidentification of M. audouinii with Microsporum canis can occur in this area, leading to erroneous data about the occurrence of this species.

Tinea capitis: Erregerspektrum und Epidemiologie im zeitlichen Wandel.

HINTERGRUND: Die Tinea capitis ist die häufigste Dermatomykose des Kindesalters. Das Erregerprofil zeigt unterschiedliche geographische Verteilungsmuster und variiert im Laufe der Zeit. PATIENTEN UND METHODIK: Zwischen 1990-2014 an der Würzburger Universitätsklinik für Dermatologie erhobene Daten von 150 Patienten mit mykologisch gesicherter Tinea capitis wurden hinsichtlich Alter, Geschlecht und Erregerspektrum analysiert und über zwei Zeiträume von jeweils 12,5 Jahren miteinander verglichen. ERGEBNISSE: Obwohl eine Tinea capitis am häufigsten bei Kindern der Altersgruppe zwischen 0 und 5 Jahren diagnostiziert wurde, lag der Anteil betroffener Erwachsener mit 16 % höher als bislang berichtet. Der zoophile Dermatophyt Microsporum canis konnte am häufigsten als Erreger der Tinea capitis identifiziert werden, jedoch war ein Anstieg von Infektionen mit den anthropophilen Pilzen Trichophyton tonsurans und Trichophyton rubrum zu verzeichnen. Tendenziell sank der Anteil zoophiler im Verhältnis zu den anthropophilen Erregern. Im zeitlichen Verlauf zeigte sich eine zunehmende Heterogenität des Erregerspektrums: Dermatophyten wie Trichophyton soudanense und Trichophyton violaceum, Trichophyton anamorph von Arthroderma benhamiae sowie Trichophyton schoenleinii und Microsporum audouinii konnten erstmalig bzw. nach langer Zeit wieder erneut isoliert werden. SCHLUSSFOLGERUNGEN: Wenngleich Microsporum-canis-Infektionen noch dominieren, sind zunehmend anthropophile Erreger nachzuweisen. Angesichts des unerwartet hohen Anteils von Erwachsenen sollte eine Tinea capitis in allen Altersgruppen differenzialdiagnostisch in Betracht gezogen werden.

Antifungal activity of Cleome gynandra L. aerial parts for topical treatment of Tinea capitis: an in vitro evaluation.

BACKGROUND: Cleome gynandra L. (Capparaceae) is an edible weed used in Uganda topically for its presumed antifungal activity against Tinea capitis. The goal of this study was to determine if this plant possesses antifungal activity in vitro, since T. capitis is a pervasive infection among especially rural children. METHODS: Antifungal activity assay was performed by Broth dilution method, and testing done on clinical isolates of three common Tinea capitis-causing fungal strains. Evaluation of in vitro antifungal activity of the ethanol and water extracts of C. gynandra was done to determine the minimum inhibitory concentrations (MICs) and the minimum fungicidal concentrations (MFCs) of the extracts. RESULTS: The MIC of C. gynandra ethanol extract ranged from 0.0313 to 0.0625 mg/ml for Trichophyton rubrum, and from 0.25 to 0.5 mg/ml for both Microsporum canis and Trichophyton mentagrophytes. The MICs of C. gynandra aqueous extract ranged between 0.125 to 0.25 mg/ml for T. rubrum, and 0.25 to 0.5 mg/ml for both M. canis and T. mentagrophytes. T. rubrum was more sensitive than M. canis (p < 0.002) and more sensitive than T. mentagrophytes (p < 0.035) to the antifungal activity of C. gynandra. T. rubrum was 6.9 times (95 % CL: 1.15 - 41.6) more likely to have a better outcome (more sensitive) than T. mentagrophytes. Cleome gynandra aqueous extract had MFC of ≥0.0313 mg/ml for M. canis, ≥0.0156 mg/ml for T. mentagropyhtes, and ≥0.0625 mg/ml for T. rubrum. Cleome gynandra ethanol extract showed MFCs of ≥0.5 mg/ml for M. canis and T. mentagrophytes, and ≥0.125 mg/ml for T. rubrum. CONCLUSION: Both plant extracts demonstrated antifungal activity, shown by the MIC and MFC for the different extracts, which varied with the type of organism of the clinical fungal isolates. The ethanol extract exhibited comparable antifungal activity to the aqueous extract indicated by the MIC values seen. Conversely, after subculturing the fungal isolates, MFCs were lower for the aqueous than for the ethanol extract.

A Case of Multiple Tinea Infections in an Infant Child After Contact with a Dog / 대한의진균학회지

Dermatophytosis in children is relatively infrequent than adults. Dermatophytosis in children can be different clinically and mycologically from those in adults in that children experience rapid physical changes and they have different skin features and environments from those of adults. Microsoprum (M.) canis is one of the zoophilic dermatophytes responsible for 3~30% of tinea corporis and tinea capitis in children. It is most likely transmitted by contact with infected animals such as cats and dogs. Clinical manifestations were single or multiple annular shaped, erythematous scaly patches and sometimes hard to differentiate with other skin diseases. A 6-year-old girl presented with multiple, pruritic, erythematous scaly patches on cheek and buttock. The lesion started 3 weeks before visiting our skin clinic. There was no personal or family history of any skin disease but she had a history of contacting with a dog. A fungal culture from tissue of the lesions grown on potato dextrose agar-corn meal-tween 80 showed typical Microsporum canis. The skin lesions were clinically improved after topical treatment for 4 weeks.

Simultaneous Occurrence of Tinea corporis Caused by Microsporum canis in a Grandmother and a Granddaughter / 대한의진균학회지

Microsporum (M.) canis is one of the zoophilic dermatophytes which can cause ringworm in cats and dogs and is responsible for 3~30% of tinea corporis and tinea capitis in human. It is most likely transmitted by contact with infected animals, but rare cases of person-to-person transmission and an outbreak among school girls have also been reported. Herein we report on interesting cases of tinea corporis caused by M. canis in a grandmother and a granddaughter. A 63-year-old woman presented with pruritic, scaly, erythematous plaques on the post. neck and trunk which had started 2 months ago. Also her 9-year-old granddaughter presented with pruritic, annular, erythematous plaques on chest and back for 7 days. They denied contact with animals. KOH smear showed several hyphaes on microscope. Fungus culture on potato dextrose agar showed growth of colonies with whitish fluffy surface and radial folds, the dorsal surface of the colonies showed golden-brown color which were identified as M. canis in both patients. As for the grandmother the lesions improved with oral itraconazole 200 mg/day for 7 days and topical antifungal cream for 5 weeks which resulted in marked improvement of the lesions.

Extra-scalp black dot ringworm caused by Trichophyton tonsurans among contact sports players.

We describe here two patients with tinea corporis exhibiting black dot ringworm (BDR). A cluster of black dots was observed on the extensor surfaces of the extremities of two rather hairy male patients, a 15-year-old judo practitioner and a 26-year-old combined martial arts fighter, during treatment of tinea corporis with topical antimycotics. Direct KOH examination showed that the black dots were composed of degenerated hair with numerous arthroconidia and were indistinguishable from BDR of tinea capitis. Trichophyton tonsurans was isolated from the dots of both patients. Although they were diagnosed with tinea corporis, they required 2-3 months of treatment with oral terbinafine. Dermatologists should be aware that BDR can appear on areas of the skin other than the scalp.

Tinea Capitis Caused by Trichophyton rubrum in an Adult Woman Judoist / 대한의진균학회지

Tinea capitis occurs mostly in the children and rarely affects adults. The most common cause of tinea capitis is known as Microsporum canis. Trichophyton rubrum is an anthropophilic, commonest dermatophyte affecting man but rarely involves the scalp and hair. A 19-year-old woman, current judo player, presented with 1-month history of hair loss and erythematous scaly macules with brownish crusts on her scalp. The patient was diagnosed as tinea capitis caused by T. rubrum based on macroscopic and microscopic characteristics of the fungus culture. As T. rubrum rarely causes tinea capitis, we assumed this patient might have had contact with T. rubrum on the ground or other players while playing judo, which could be described as tinea gladiatorum.

A random comparative study of terbinafine versus griseofulvin in patients with tinea capitis in Western China.

OBJECTIVE: To compare the efficacy and safety of terbinafine with griseofulvin in the treatment of tinea capitis in Western China. METHODS: Children (2-14 years of age) with clinically diagnosed and potassium hydroxide microscopy-confirmed tinea capitis were randomized into three groups: group GRI4 received 4 weeks of griseofulvin; group TBF2 received 2 weeks of terbinafine; and Group TBF4 received 4 weeks of terbinafine. Clinical and mycological evaluations were done in 0, 2, 4, and 8 weeks and 1 year after therapy started. The isolated pathogenic fungi were evaluated for in vitro susceptibility by detecting the minimal inhibitory concentration (MIC) against terbinafine, griseofulvin, itraconazole, and ketoconazole. RESULTS: The clinical effectiveness rate of GRI4, TBF2, and TBF4 were 100% (95% CI-confidence interval: 82-100%), 96.3% (95% CI: 81-100%), and 100%(95% CI: 85-100%), respectively, at week 8 and 100% after 1 year for the 3 groups; clinical cure rates were 84.2%(95% CI: 77-99%), 85.2%(95% CI: 71-98%), and 78.3%(95% CI: 61-95%), respectively, at week 8 and 100% after 1 year for all agents; mycological cure rates were 100%(95% CI: 74-100%), 95.0%(95% CI: 74-100%), and 94.1%(95% CI: 50-93%) at week 8 and 100% after 1 year for the 3 groups. In vitro, all patient-derived cultures were sensitive to the four antifungal agents. CONCLUSION: Data from the clinical trial and in vitro antifungal activity indicated that terbinafine is efficacious and well tolerated in the treatment for Trichophyton infections (T. violaceum; Arthroderma vanbreuseghemii; and T. tonsurans) of the scalp, i.e., a 2- to 4-week course of terbinafine is as effective as a 4-week course of griseofulvin; in fact, a 2-week course of terbinafine is sufficient. Terbinafine is an effective alternative to griseofulvin against tinea capitis of Trichophyton infections.

Trichophyton rubrum como agente etiológico de un caso de Querion de Celso / Trycophyton rubrum as a causal agent in a case of Celso´s Kerion

Introducción. El querion de Celso, típico de la infancia, es una forma de presentación inflamatoria de la tiña del cuero cabelludo. Se trata de una lesión inflamatoria en placa, habitualmente única, sobreelevada, bien delimitada y de tamaño variable. Se manifiesta como eritema, edema y formación de costras. Contiene pústulas en su interior y está cubierta de pelos fracturados que se desprenden con facilidad. Suele cursar sin afectación del estado general ni fiebre. Normalmente se acompaña de adenopatías retroauriculares i laterocervicales dolorosas. Tricophyton rubrum com a agent etiològic d’un cas de quèrion de Cels Cinta Rosa Gas-Colomé, Sara Hernàndez-Luque, Antoni Soriano-Arandes, Frederic Gómez-Bertomeu Servei de Pediatria. Hospital Universitari Joan XXIII. Tarragona Caso clínico. Paciente de 8 años que presenta lesión en placa, exudativa, en región parietal izquierda, de 5 días de evolución. No refiere fiebre ni otra sintomatología sistémica acompañante. Se orienta el caso como querion de Celso, confirmado por estudios micológicos. Se inicia tratamiento antifúngico con griseofulvina, con buena respuesta. Comentario. Los dermatofitos más frecuentes causantes de querion de Celso en nuestro medio son Tricophyton mentagrophytes y Microsporum canis. Menos frecuentemente, entre el género Tricophyton podemos encontrar T. tonsurans, T. rubrum, T. verrucosum y T. violaceum, y entre el género Microsporum podemos encontrar M. gipseum, entre otros. El diagnóstico se obtiene fundamentalmente a través de la tinción KOH y el cultivo en medio Sabouraud; éste último identificará la especie. Las primeras líneas terapéuticas son la griseofulvina micronizada a dosis entre 10 y 20 mg/kg/día, la terbinafina a dosis de 2,5 mg/kg/día i el itraconazol a dosis de 5 mg/kg/día. El tratamiento se deberá instaurar cuanto antes, para así minimizar las secuelas(AU)

Introduction. Celso’s kerion, typical in childhood, is a form of inflammatory presentation of ringworm of the scalp. This is an inflammatory lesion in the form of a plaque, normally a single one (although it can be multiple), raised, well outlined, and of variable size. It manifests as erythema, oedema, and the formation of scabs. It has pustules inside, and is covered by fractured hairs that detach easily. It tends to run its course without affecting the general condition or causing fever. It is normally accompanied by swollen lymph nodes behind the ears and pain on the sides of the cervical vertebrae. Clinical case. 8-year-old patient who presented with a painful plaque lesion, exudative, in the left parietal region, with 5 days of evolution. There was no fever or other accompanying systemic symptoms. The case was oriented as Celso’s kerion, and the presence of Trichophyton rubrum was determined in the fungal culture. Fungicidal treatment was given with oral griseofulvin, with a good response. Comment. Celso’s kerion is mainly caused by Trichophyton mentagrophytes, Trichophyton tonsurans and Microsporumn canis. Trichophyton rubrum as a causal agent responsible for these clinical symptoms is exceptional. The diagnosis is fundamentally obtained by way of direct microscopic observation with KOH and a culture in Sabouraud agar, DTM (dermatophyte test medium) or others. The first therapeutic lines are micronized Griseofulvin at a dosage of 10 to 20 mg/kg/day, terbinafine at a dosage of 2.5 mg/kg/day, and itraconazole at a dosage of 5 mg/kg/day. The treatment must be started as soon as possible to minimise the sequelas(AU)

Tinea capitis: predictive value of symptoms and time to cure with griseofulvin treatment.

OBJECTIVES: To describe (a) the predictive value of symptoms for diagnosis of tinea capitis and (b) the rate and timing of cure with high-dose griseofulvin treatment. METHODS: This prospective open-label study enrolled children aged 1 to 12 years with clinical tinea capitis. Participants with a positive dermatophyte culture received oral griseofulvin (20-25 mg/kg/day) and topical selenium sulfide shampoo for 6 weeks. Main outcome measures. The rate of symptoms of tinea capitis, and rates of mycologic and clinical cure. RESULTS: The positive predictive values of any 1, 2, 3, or 4 symptoms for a positive culture were 88%, 82%, 78%, and 77%, respectively. The observed rates of mycologic, clinical, and complete cure were 89%, 66%, and 49%, respectively. conclusion: In a high-risk population it is reasonable to diagnose tinea capitis using one or more cardinal symptoms. Oral griseofulvin at 20 to 25 mg/ kg/day with adjunctive shampooing for 6 weeks is moderately successful as treatment.

Changing face of tinea capitis in Europe.

PURPOSE OF REVIEW: The aim of this review is to update the latest epidemiological situation in Europe, explore recent issues in recognition and emerging opportunities in diagnosis and look at progressions in treatment. Papers reviewed have, in the main, been published within the last 2 years. RECENT FINDINGS: The predominantly responsible organism varies with country. Trichophyton tonsurans accounts for 50-90% of cases in the UK, Microsporum canis is commonest in Central and Southern Europe and T. violaceum in Greece and Belgium. Confirming the diagnosis of tinea capitis is best undertaken with more than one sampling method to include scraping of scalp, and either scalp massage brush, toothbrush, moistened cotton gauze swab or cytobrush to increase sensitivity. Advances in the speed of species identification is offered by the novel PCR-based detection/identification scheme, and although not yet commercially available, with potential turnaround times of <24 h this will offer a significant advance in the speed of diagnosis, allowing treatment to be organism tailored. Although griseofulvin remains the only licensed treatment in the UK and a meta-analysis confirms it is effective against the major tinea capitis pathogens, a new granule formulation of terbinafine has been shown to be more effective against T. tonsurans. SUMMARY: With the evolving organism profile across Europe, obtaining an accurate diagnosis and species identification is crucial. Using more than one sampling method followed by rapid species identification techniques will facilitate this. Although there are no changes in specific product license to include children, the production of a child-friendly formulation of terbinafine will contribute to improved compliance.

[Screening examination of Trichophyton tonsurans among Judo practitioners at the All Japan Inter High School Championships, Saga 2007].

This paper presents the results of an examination for Trichophyton tonsurans(T. tonsurans)performed by the hairbrush (HB; 90 bristles)method at the All Japan Inter High School Championships, Saga 2007. Samples were taken from 487 Judo practitioners (265 males and 222 females) out of a total of 951. The areas with the highest positive rates were: Kyushu 21%(15 participants out of 73 sampled), Tohoku 17% (13 out of 77), Kinki 16% (14 out of 89), and Chubu 13% (12 out of 89). Four participants from Kyushu, four from Tohoku, two from Kinki, and two from Chubu were strongly positive carriers, their samples developing more than 30 colonies per dish. This finding is in concordance with the high HB-positive rates in these areas. The results of a questionnaire distributed during sampling showed that 90% of the examinees had heard of T. tonsurans infection, 11% had been sampled by the HB method previously, and 37% declined to receive the results of the medical examination. The low percentage of participants who had experienced a HB sampling before could be explained by the insufficient penetration of this test among dermatologists, as well as by the fact that team trainers are reluctant to expose their athletes to sampling. Although trainers' education concerning T. tonsurans is also an important factor, we strongly recommend that dermatologists take the initiative to perform medical examinations such as HB sampling in schools or at other public organizations. As for the reason why so many practitioners refused to be informed about the diagnosis, many of them mentioned being afraid that it might be overheard by trainers or fellow practitioners. It can be easily inferred that this type of concern leads Judo practitioners to avoid participation in sampling. Therefore, we concluded that substantial care to protect personal information is essential when communicating the results of the examination.

Susceptibility of dermatophyte isolates obtained from a large worldwide terbinafine tinea capitis clinical trial.

BACKGROUND: Our group, in collaboration with seven other laboratories, has recently developed a method to determine the susceptibility of dermatophytes. OBJECTIVES: The objective of this study was to determine the terbinafine susceptibility profile of dermatophyte isolates obtained from patients with tinea capitis enrolled in two large worldwide clinical trials and to investigate whether these susceptibilities differ by geographical location. Methods Susceptibilities were determined according to the Clinical and Laboratory Standards Institute M38-A2 standard. RESULTS: From a total of 978 baseline dermatophyte isolates, we selected 301 isolates at random. These included: Trichophyton tonsurans (n = 125), Microsporum canis (n = 94), T. violaceum (n = 63) and M. audouinii (n = 19). The terbinafine minimum inhibitory concentration (MIC) range was 0.001-0.25 microg mL(-1), while MIC(50) and MIC(90) ranged between 0.002 and 0.125 microg mL(-1) and 0.03 and 0.25 microg mL(-1), respectively, for all species tested. MIC(50) and MIC(90) varied by individual species; however, there was no difference in terbinafine MIC among the different species isolated from U.S. and non-U.S. sites. CONCLUSION: Terbinafine demonstrates potent antifungal activity against dermatophyte isolates obtained from patients with tinea capitis worldwide.

Terbinafine hydrochloride oral granules versus oral griseofulvin suspension in children with tinea capitis: results of two randomized, investigator-blinded, multicenter, international, controlled trials.

BACKGROUND: Although griseofulvin is currently considered the primary antifungal agent used to treat tinea capitis in many countries, increasingly higher doses and longer durations of treatment are becoming necessary to achieve effective treatment. Alternative antifungal therapies with shorter/simpler treatment regimens may be important to develop for this indication. OBJECTIVE: To compare the efficacy and safety of a new pediatric formulation of terbinafine hydrochloride oral granules with griseofulvin oral suspension in the treatment of tinea capitis. METHOD: Children (4-12 years of age) with clinically diagnosed and potassium hydroxide microscopy-confirmed tinea capitis were randomized in two identical studies (trial 1, trial 2) to once-daily treatment with terbinafine (5-8 mg/kg; n = 1040) or griseofulvin administered per label (10-20 mg/kg; n = 509) for a period of 6 weeks followed by 4 weeks of follow-up. End-of-study complete cure (negative fungal culture and microscopy with Total Signs and Symptoms Score [TSSS] = 0), and mycologic (negative culture and microscopy) and clinical cure (TSSS = 0) were primary and secondary efficacy variables, respectively. Efficacy analysis was based on pooled data using modified intent-to-treat population (those who received at least one dose of study drug and had positive baseline fungal culture, N = 1286). Safety assessments included monitoring of the frequency and severity of adverse events (AEs). RESULTS: Rates of complete cure and mycologic cure were significantly higher for terbinafine than for griseofulvin (45.1% vs 39.2% and 61.5% vs 55.5%, respectively; P < .05). A majority (86.7%) of patients received griseofulvin, 10 to 19.9 mg/kg per day; complete cure rate was not found to be higher among patients who received griseofulvin more than 20 mg/kg per day compared with those who received less than 20 mg/kg per day. Complete cure rate was statistically significantly greater for terbinafine compared to griseofulvin in trial 1 (46.23% vs 34.01%) but not in trial 2 (43.99% vs 43.46%). On the basis of pooled data, clinical cure was higher for terbinafine than for griseofulvin, but the difference was not found to be statistically significant (P = .10). Subgroup analyses revealed that terbinafine was significantly better than griseofulvin for all cure rates--mycologic, clinical, and complete--among patients with Trichophyton tonsurans but not Microsporum canis (P < .001). For M. canis, mycologic and clinical cure rates were significantly better with griseofulvin than with terbinafine (P < .05). Approximately 50% of patients in each group reported an AE; almost all were mild or moderate in severity. Nasopharyngitis, headache, and pyrexia were most common in both groups. There were no drug-related serious AEs, no deaths, and no significant effects on weight or laboratory parameters, including liver transaminases. LIMITATIONS: In retrospect, a difference in the distribution of infecting microorganisms between the two trials was a limitation. Stringent adherence to griseofulvin doses recommended by prescribing information but smaller than those used in current clinical practice, and exclusion of adjuvant therapies such as shampoos or topical agents, which are routinely used in practice, are other limitations. CONCLUSIONS: Data from this largest pediatric trial of terbinafine to date indicate that terbinafine is efficacious and well tolerated in the treatment of tinea capitis. Terbinafine is an effective alternative to griseofulvin against T. tonsurans tinea capitis.

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.