Trichophyton violaceum: An Emerging Pathogen in Southern Switzerland.

BACKGROUND: Trichophyton violaceumis an anthropophilic dermatophyte, endemic in Africa and recently an emerging pathogen in Europe. OBJECTIVE: To perform a retrospective analysis of dermatophytoses due to T. violaceum between 2007 and 2018, in order to evaluate epidemiological trends in Southern Switzerland (Ticino). METHODS: We reviewed all medical records of patients affected by dermatophytosis due to T. violaceum between January 2007 and December 2018 in Bellinzona (Ticino, Switzerland). RESULTS: Dermatophytoses due to T. violaceumwas diagnosed in 44 patients, 33 of which were in the last 4 years. The most affected sex was female (25/44) and the most frequent diagnosis was tinea capitis (30/44). The majority of tinea capitis patients were children younger than 13 years of age (27/30). The main source of contagion were people from endemic areas, especially from Eritrea. CONCLUSION: In Southern Switzerland T. violaceumhas been rarely diagnosed before 2014. Its increased occurrence seems linked to increased migratory flows from Eritrea. Since it is responsible mainly for tinea capitis, with most of the time no clearly defined alopecia patches, it is important to consider it as a possible diagnosis when facing scalp scaling. Tinea capitis due to T. violaceum is a benign affection, but if left untreated it can spread epidemically, especially among children in schools and kindergartens. Mycological examination is then required, not only for a correct diagnosis and epidemiological data, but also for planning the appropriate treatment.

Common Child and Adolescent Cutaneous Infestations and Fungal Infections.

Cutaneous infections and infestations are common among children and adolescents. Ectoparasitic infestations affect individuals across the globe. Head lice, body lice, scabies, and infestations with bed bugs are seen in individuals who reside in both resource poor areas and in developed countries. Superficial cutaneous and mucosal candida infections occur throughout the life cycle. Dermatophyte infections of keratin-containing skin and skin structures result in tinea capitis (scalp), tinea corporis (body), tinea pedis (foot), and tinea unguium (nails). Less frequent endemic fungal infections such as blastomycosis, coccidiodomycosis, and histoplasmosis may present with skin findings. This article will describe the epidemiology and transmission of these conditions as well as their clinical manifestations. The approach to diagnosis will be addressed as well as primary prevention and current therapies.

Dr. Julio V. Uriburu. Su destacada participación en la micología nacional / Dr. Julio V. Uriburu. His outstanding participation in the national mycology

Destacado dermatólogo, el doctor Julio V. Uriburu propició el estudio de las afecciones micóticas en nuestro medio. Realizamos una breve actualización del diagnóstico y tratamiento de tiñas de cuero cabelludo.

Dr. Julio V. Uriburu was a very important specialist in skin disorders. He worked in the investigation of micotics infections of hair and scalp disorders. We did a review of diagnostic and treatment of tinea capitis.

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.

Lesión inflamatoria 'en espumadera' en región parietal / Inflammatory injury 'in skimmer' in the parietal area

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Successful treatment of severe kerion Celsi in an immunocompromised girl with evacuation of pus, terbinafine and short course glucocorticosteroids.

A 6-year-old girl with a 2-year history of idiopathic thrombocytopenic purpura complained of a 4-week history of scalp desquamation together with small pustules. During the recent 10 days, she complained of high fever with multiple abscesses formation with no response to intravenous antibiotics. She received varied doses of oral prednisone therapy for 2 years. Microscopy showed endothrix infection. We prescribed terbinafine 125 mg/d and prednisone 10 mg/d. After 1 week, she returned to our office with severe ache and persistent high fever. She refused any topical drugs because of pain. Manual pressure to remove pus from sinuses and infected scale under general anesthesia was done and about 100 ml pus was discharged from kerion lesions. Prednisone (1 mg/kg/d) was started and fever disappeared on the same day. Prednisone was tapered to withdraw in 10 days. A total of a 3-month course of oral terbinafine (125 mg/d) resulted in mycological clearance. Hair regrowth was satisfactory 8 months later.

Successful use of silver impregnated hydrofiber dressing in the treatment of kerion celsi caused by Microsporum gypseum.

A method of treatment of tinea capitis is presented in a case of a 10-year-old boy who was referred to the pediatric surgical unit for the treatment of a skin lesion on the scalp, which had persisted for more than two months. The initial dermatologic examination led to the clinical diagnosis of inflammation of the scalp, while mycological analysis revealed an uncommon dermatophyte agent, Microsporum gypseum, in the culture. The lesion was subsequently treated with local and oral antifungal agents, but antifungal therapy was discontinued due to the resulting liver dysfunction and was replaced by treatment with a silver impregnated hydrofiber dressing. During one-month treatment, the patient's scalp lesion cleared completely. The treatment of tinea capitis is discussed.

Tinea capitis inflamatoria por Trichophyton tonsurans var. sulfureum / Inflammatory tinea capitis by Trichophyton tonsurans var. sulfureum

Los dermatofitos constituyen un grupo de hongos queratinofílicos y queratinolíticos que pueden producir lesiones en piel y sus anexos en animales y el hombre. Las lesiones pueden variar de intensidad desde leves a severas, algunas de las cuales son altamente inflamatorias. Trichophyton tonsurans es un dermatofito antropofílico agente de tiñas no inflamatorias, de piel y raramente de uñas. Es altamente contagioso, que se adquiere por contacto interhumano y de escasa presentación en nuestro medio. Raramente y asociado a estados de inmunocompromiso ocasiona tiña inflamatoria de cuero cabelludo (Kerion Celsi o Querión de Celso). Kerion Celsi es una lesión altamente inflamatoria y supurativa, generalmente causada por dermatofitos zoofílicos que se transmiten de animales al hombre, la cual representa una respuesta inmune exagerada del huésped a la presencia del hongo. Se documenta un caso de Kerion Celsi a T. tonsurans presentado por un niño de 4 años de edad, sin inmunocompromiso, residente en el interior de la provincia. Se trata del primer caso local de tinea capitis altamente inflamatoria a T. tonsurans. El propósito es demostrar que el hongo, a pesar de ser antropofílico, puede ocasionar esta forma clínica en paciente sin inmunocompromiso. Su existencia en el medio requiere de diagnóstico rápido, de extremar medidas higiénicas y posterior control para evitar su propagación.

The dermatophytes are keratinophilic and keratinolytic fungi that cause skin and its annexes lesions in animals and man. T. tonsurans is an anthropophilic fungi, highly contagious, of rare presentation in our environment. Infection is acquired by interpersonal. Noninflammatory ringworm occurs in children and adults. Very rarely it causes highly inflammatory and suppurative ringworm of the scalp (Celsi kerion) associated with immunocompromised states. The kerion is caused by zoophilic dermatophytes. It represents an exaggerated host immune response to the presence of the fungus. This paper presents a case of T. tonsurans Kerion in a 4-year-old non-immunocompromised patient, who lives in rural area in the province. This is the first local case of severe inflammatory tinea capitis to T. tonsurans. The purpose of the study is to demonstrate that T. tonsurans can cause Kerion not associated to immunocompromised. Furthermore, it shows its existence in the medium, which requires immediate diagnosis of the diseases and increase hygiene and disease control to prevent the spread of the fungus.

Cutaneous infestations and infections.

Cutaneous infections and infestations are common problems in childhood and adolescence. This article provides an update focusing on the diagnosis and management of several frequently encountered infections and infestations: scabies, bedbugs, head lice, tinea capitis, and tinea versicolor.

Diagnosing and treating hair loss.

Physicians should be careful not to underestimate the emotional impact of hair loss for some patients. Patients may present with focal patches of hair loss or more diffuse hair loss, which may include predominant hair thinning or increased hair shedding. Focal hair loss can be further broken down into scarring and nonscarring. Scarring alopecia is best evaluated by a dermatologist. The cause of focal hair loss may be diagnosed by the appearance of the patch and examination for fungal agents. A scalp biopsy may be necessary if the cause of hair loss is unclear. Alopecia areata presents with smooth hairless patches, which have a high spontaneous rate of resolution. Tinea capitis causes patches of alopecia that may be erythematous and scaly. Male and female pattern hair losses have recognizable patterns and can be treated with topical minoxidil, and also with finasteride in men. Sudden loss of hair is usually telogen effluvium, but can also be diffuse alopecia areata. In telogen effluvium, once the precipitating cause is removed, the hair will regrow.

[Tinea capitis - a recurring problem]. / Tinea capitis - starronový problém.

In the first quarter of the 20th century, tinea capitis represented the most important dermatomycological diagnosis in Europe. For its significant social impacts (affecting children, potential permanent disfiguration), developed countries introduced strict anti-epidemic measures which, together with the discovery of griseofulvin in 1960, contributed to nearly complete eradication of the disease in Central Europe. Since 1980s, however, the incidence of tinea capitis has increased to become a serious medical problem both in America and in some parts of Europe. In the Czech Republic, as well as in the neighbouring countries, the main causative agent remains the zoophilic Microsporum canis. The main agent in the USA, the anthropophilic Trichophyton tonsurans, slowly migrates to the British Isles and Western Europe. Moreover, Trichophyton rubrum is a newly emerging pathogen. Because of different biological behaviour of the individual pathogens, both therapeutic approaches and preventive hygiene measures vary.

Tinea capitis: current concepts in clinical practice.

Tinea capitis is a common infection, particularly among young children in urban regions. The infection often is seen in a form with mild scaling and little hair loss, a result of the prominence of Trichophyton tonsurans (the most frequent cause of tinea capitis in the United States). T. tonsurans does not fluoresce under Wood light, unlike the common tinea capitis-causing fungal organisms seen in Europe and many other countries, which emit a green fluorescence. However, T. tonsurans, like other fungi, also may less often produce an intense inflammatory reaction, which is suggestive of an acute bacterial infection.

Tinea capitis: a treatment update.

Currently, many experts consider griseofulvin to be the drug of choice for tinea capitis. It is FDA approved for this indication, highly efficacious, and has an excellent long-term safety record. Nonetheless, there is now ample evidence documenting the efficacy and safety of other antifungal agents. Terbinafine, itraconazole, and fluconazole have been used off-label in the United States and United Kingdom for tinea capitis. Several studies have shown that short-term terbinafine, itraconazole, or fluconazole each are comparable in efficacy and safety to griseofulvin. High-dose griseofulvin is still the first-line therapy for tinea capitis in our practice, but a large-scale, multicenter trial of higher dose terbinafine is now ongoing, and positive efficacy and safety results from that study may lead to a change in our standard of care. Terbinafine, itraconazole, or fluconazole currently are used in patients who have either failed griseofulvin or developed adverse reactions to this medication. Families must be informed that these other antifungal agents are not FDA-approved for this indication when they are used. Guidelines for therapy with each of these agents are summarized in Table 5. In addition, the adjuvant use of antifungal shampoos is recommended for all patients in order to decrease the viability of fungal spores present on the hair, as well as for all household contacts to prevent infection or eliminate the carrier state.