Tinea capitis caused by Trichophyton tonsurans: An emerging disease in Argentina. / Tinea capitis por Trichophyton tonsurans: una enfermedad emergente en Argentina.

Tinea capitis is a dermatophytosis, which is more common in children. It is caused by dermatophytes that vary according to the region; the most frequently isolated dermatophyte in our setting is Microsporum canis. Given its anthropophilic nature, its dissemination via interpersonal transmission and through the use of hair care tools is very common. In the course of the past year, an increase has been reported in the incidence of a pathogen that was very rare in our setting: Trichophyton tonsurans. Here we describe a retrospective study of cases of tinea capitis caused by Trichophyton tonsurans identified between September 2021 and March 2023 in the Department of Pediatric Dermatology at a general hospital of the City of Buenos Aires.

La tinea capitis es una dermatofitosis, más frecuente en niños. Está causada por hongos dermatofitos que varían según la región; el más frecuentemente aislado en nuestro medio es el Microsporum canis. Dado su carácter antropofílico, la transmisión por vía interpersonal y mediante el uso de instrumentos de cuidado capilar es muy habitual. En el transcurso del último año, se ha reportado un incremento en la incidencia de un patógeno que era muy poco habitual en nuestro medio: el Trichophyton tonsurans. Presentamos un estudio retrospectivo de los casos de tinea capitis por Trichophyton tonsurans identificados en el período comprendido entre septiembre de 2021 y marzo de 2023 en la Sección de Dermatología Infantil de un hospital general de la Ciudad Autónoma de Buenos Aires.

Molecular typing of a collection of Iranian clinical Trichophyton tonsurans isolates based on the non-transcribed spacer region of rDNA and antifungal susceptibility testing of the species.

INTRODUCTION: Wrestling, considered the national sport of Iran, has gained immense popularity among Iranians. Wrestlers frequently encounter skin conditions, with dermatophyte fungal infections, particularly tinea gladiatorum (TG), being a common issue. TG, caused by the Trichophyton genus, has emerged as a major health concern for wrestlers and other contact sport athletes worldwide. This study aimed to assess the genotypic diversity and antifungal susceptibility of Trichophyton tonsurans isolates responsible for TG in Iranian wrestlers from Mazandaran province, northern Iran. MATERIALS AND METHODS: A total of 60 clinical T. tonsurans isolates collected from various cities in Mazandaran, were included in the study. The isolates were identified through PCR-restriction fragment length polymorphism and sequencing methods. Genomic DNA was extracted from these isolates, and the non-transcribed spacer (NTS) region of ribosomal RNA (rRNA) was targeted for genotyping using newly designed primers. Haplotype analysis was performed to explore genetic diversity, and antifungal susceptibility to terbinafine (TRB) and itraconazole (ITC) was assessed. RESULTS: The results revealed five distinct NTS types: NTS-I, NTS-II, NTS-III, NTS-IV and NTS-V, with NTS-IV being the most prevalent. The distribution of NTS types varied across different cities, suggesting potential transmission patterns among wrestlers. Antifungal susceptibility testing showed that all isolates were susceptible to TRB, while one isolate demonstrated resistance to ITC. Genotypic diversity was not correlated with antifungal susceptibility, emphasising the importance of monitoring susceptibility to ensure effective treatment. Haplotype analysis highlighted significant genetic diversity among the T. tonsurans isolates. This diversity may be attributed to factors such as human-to-human transmission, geographic location and lifestyle changes. The study's findings underscore the need for comprehensive genotypic analysis to understand the epidemiology and evolution of T. tonsurans infections in athletes. CONCLUSION: In conclusion, this study provides valuable insights into the genotypic diversity and antifungal susceptibility of T. tonsurans isolates causing TG in Iranian wrestlers. The presence of multiple NTS types and varying susceptibility patterns highlights the complexity of T. tonsurans infections in this population. Further research is warranted to track the transmission routes and genetic evolution of T. tonsurans strains among wrestlers and develop effective control measures.

Predominance of Trichophyton tonsurans causing tinea capitis: A 12-year retrospective study in the north of Iran.

Background and Purpose: Among different clinical entities of dermatophytosis, tinea capitis (TC) is considered a major public health challenge in the world, especially in regions with poor health and low income. Therefore, this study aimed to provide a retrospective analysis of the patients suspected of TC who were referred to the medical mycology laboratory of Mazandaran, a northern province of Iran. Materials and Methods: A retrospective analysis was performed on the patients suspected of TC who were referred to the medical mycology laboratory from July 2009 to April 2022. Hair roots and skin scrapings were collected from the participants. The laboratory diagnosis was confirmed by direct microscopic examination and culture. Finally, 921 out of 11095 (8.3%) patients were suspected of TC. Results: Based on the findings, TC was confirmed in 209 out of 921 patients (22.7%). In terms of gender, 209 TC patients (75.1%) were male. Moreover, the male to female ratio of TC patients was 1:3.0. Trichophyton tonsurans (146/174, 83.91%) was the most etiological agent, followed by T. mentagrophytes (13/174, 7.47%), T. violaceum (9/174, 5.17%), Microsporum canis (3/174, 1.71%), T. verrucosum (2/174, 1.15%) and T. rubrum (1/174, 0.57%). Besides, endothrix (77.0%) was the most prevalent type of hair invasion. Conclusion: The results revealed the predominance of T. tonsurans, as a causative agent of TC. Despite the prevalence of TC, the absence of appropriate consideration highlights that it is a neglected complication among children.

[Trichophyton tonsurans Infection].

Trichophyton tonsurans infection has been prevalent among individuals involved in contact sports in Japan since about 2000. The present review focuses on its diagnosis, molecular epidemiology, drug susceptibility, and infection control. The most commonly observed lesions of T. tonsurans, an anthropogenic dermatophyte, are tinea corporis and tinea capitis. However, the presence of asymptomatic carriers must be considered for infection control. Genotypic epidemiology using restriction fragment length polymorphisms (RFLP) in the non-transcribed spacer (NTS) region of the ribosomal RNA gene showed a lack of diversity of genotypes, and only the NTS I genotype is detected at present. In regard to drug susceptibility, terbinafine drug resistance has not been found to be associated with the RFLP genotypes, and it is assumed that there are no terbinafine-resistant strains in Japan. T. tonsurans coexisted with other fungi and bacteria in the scalp of asymptomatic carriers without affecting species diversity. T. tonsurans is an anthropogenic dermatophyte and may be difficult for the human immune system to eliminate. During an infection outbreak, screening of infection and treatment including asymptomatic carriers are essential to eradicate the infection.

A Case of Kerion Celsi due to Trichophyton tonsurans.

The patient was a 13-year-old boy who was a member of the judo club at his junior high school. Approximately 1 week prior to his presentation, he developed multiple erythematous pilaris papules on his occipital area and was treated by a local doctor. The erythematous lesions expanded to 10 × 10 cm, showing granulation with drainage and strong spontaneous pain. At this point, he visited our hospital. He was diagnosed with kerion celsi due to Trichophyton tonsurans by fungal examination. The patient was treated with terbinafine (125 mg/day) for 6 weeks, and a brush test at 6 weeks was negative. All 18 members of the judo club, including this patient, were investigated; brush tests were positive in 4 cases, and one was positive for tinea corporis alone. The patient's family members parents were both negative. When an athlete is diagnosed with ringworm, T. tonsurans infection should be considered, and testing and treatment of family members and fellow athletes should be carried out to prevent the spread of infection.

Antifungal activity of probiotic strain Lactiplantibacillus plantarum MYSN7 against Trichophyton tonsurans.

The primary objective of this study was to assess the probiotic attributes and antifungal activity of lactic acid bacteria (LAB) against the fungus, Trichophyton tonsurans. Among the 20 isolates screened for their antifungal attributes, isolate MYSN7 showed strong antifungal activity and was selected for further analysis. The isolate MYSN7 exhibited potential probiotic characteristics, having 75 and 70% survival percentages in pH3 and pH2, respectively, 68.73% tolerance to bile, a moderate cell surface hydrophobicity of 48.87%, and an auto-aggregation percentage of 80.62%. The cell-free supernatant (CFS) of MYSN7 also showed effective antibacterial activity against common pathogens. Furthermore, the isolate MYSN7 was identified as Lactiplantibacillus plantarum by 16S rRNA sequencing. Both L. plantarum MYSN7 and its CFS exhibited significant anti-Trichophyton activity in which the biomass of the fungal pathogen was negligible after 14 days of incubation with the active cells of probiotic culture (106 CFU/ml) and at 6% concentration of the CFS. In addition, the CFS inhibited the germination of conidia even after 72 h of incubation. The minimum inhibitory concentration of the lyophilized crude extract of the CFS was observed to be 8 mg/ml. Preliminary characterization of the CFS showed that the active component would be organic acids in nature responsible for antifungal activity. Organic acid profiling of the CFS using LC-MS revealed that it was a mixture of 11 different acids, and among these, succinic acid (9,793.60 µg/ml) and lactic acid (2,077.86 µg/ml) were predominant. Additionally, a scanning electron microscopic study revealed that CFS disrupted fungal hyphal structure significantly, which showed scanty branching and bulged terminus. The study indicates the potential of L. plantarum MYSN7 and its CFS to control the growth of T. tonsurans. Furthermore, in vivo studies need to be conducted to explore its possible applications on skin infections.

Brote de dermatofitosis en región de cabeza y cuello asociadas al rasurado en peluquerías: estudio descriptivo multicéntrico de una serie de casos / Outbreak of Dermatophyte Infections on the Head and Neck Related to Shave Haircuts: Description of a Multicenter Case Series

Introducción Desde 2021 se ha detectado un aumento de casos de tiñas del cuero cabelludo en adolescentes que se cortan el pelo mediante rasurado o degradado. Pacientes y métodos Estudio observacional retrospectivo multicéntrico de casos de dermatofitosis del polo cefálico con el antecedente de haber sido contraídas tras el rasurado frecuente en peluquería. Se realizó una llamada a dermatólogos de la Academia Española de Dermatología y Venereología (AEDV) para que aportaran casos observados entre enero de 2021 y diciembre de 2022. Se incluyeron pacientes con confirmación microbiológica mediante cultivo o examen directo con KOH. Resultados Se recogieron 107 casos, siendo 106 pacientes varones. Se observaron 78 formas no inflamatorias frente a 29 inflamatorias. El hongo aislado con mayor frecuencia fue Trichophyton tonsurans (75,7% de los casos). Las lesiones aparecieron predominantemente en la nuca y en el área temporal. Conclusiones La distribución por sexo, edad y localización lesional parece apuntar a que una nueva tendencia social, en la que adolescentes varones acuden asiduamente a peluquerías para el afeitado de las zonas occipital y temporal, sería la causante de esta agrupación de casos de tiña del cuero cabelludo. El microorganismo más frecuente en nuestro estudio (T.tonsurans) coincide con el más prevalente en nuestro medio. Con el presente estudio se evidencia un acúmulo de casos susceptible de ser tenido en cuenta por organismos competentes de salud pública, a los cuales corresponde velar por el cumplimiento de las normas de desinfección del material empleado para el rasurado (AU)

Introduction Since 2021, an increase in cases of tinea capitis has been detected in adolescents who shave their hair with fade haircut. Patients and methods Multicenter retrospective observational study of cases of cephalic pole dermatophytosis with a history of having been acquired after frequent shaving in hairdressing. A call was made to dermatologists from the Spanish Academy of Dermatology and Venereology (AEDV) to provide cases observed between January 2021 and December 2022. Patients with microbiological confirmation by culture or direct examination with KOH were included. Results 107 cases were collected, 106 of which were male. 78 non-inflammatory forms were observed, compared to 29 inflammatory. The most frequently isolated fungus was Trichophyton tonsurans (75.7% of cases). The lesions appeared predominantly on the nape of the neck and temporal area. Conclusions The distribution by sex, age and lesional location seems to indicate that a new social trend, in which male adolescents regularly go to hairdressers to shave the occipital and temporal areas, would be the cause of this grouping of cases of ringworm of the scalp. The most frequent microorganism in our study (T.tonsurans) coincides with the most prevalent in our environment. This study shows an accumulation of cases that can be taken into account by competent Public Health agencies, which are responsible for ensuring compliance with the rules of disinfection of the material used for shaving (AU)

[Translated article] Outbreak of Dermatophyte Infections on the Head and Neck Related to Shave Haircuts: Description of a Multicenter Case Series / Brote de dermatofitosis en región de cabeza y cuello asociadas al rasurado en peluquerías: estudio descriptivo multicéntrico de una serie de casos

Introduction Since 2021, an increase in cases of tinea capitis has been detected in adolescents who shave their hair with fade haircut. Patients and methods Multicenter retrospective observational study of cases of cephalic pole dermatophytosis with a history of having been acquired after frequent shaving in hairdressing. A call was made to dermatologists from the Spanish Academy of Dermatology and Venereology (AEDV) to provide cases observed between January 2021 and December 2022. Patients with microbiological confirmation by culture or direct examination with KOH were included. Results 107 cases were collected, 106 of which were male. 78 non-inflammatory forms were observed, compared to 29 inflammatory. The most frequently isolated fungus was Trichophyton tonsurans (75.7% of cases). The lesions appeared predominantly on the nape of the neck and temporal area. Conclusions The distribution by sex, age and lesional location seems to indicate that a new social trend, in which male adolescents regularly go to hairdressers to shave the occipital and temporal areas, would be the cause of this grouping of cases of ringworm of the scalp. The most frequent microorganism in our study (T.tonsurans) coincides with the most prevalent in our environment. This study shows an accumulation of cases that can be taken into account by competent Public Health agencies, which are responsible for ensuring compliance with the rules of disinfection of the material used for shaving (AU)

Introducción Desde 2021 se ha detectado un aumento de casos de tiñas del cuero cabelludo en adolescentes que se cortan el pelo mediante rasurado o degradado. Pacientes y métodos Estudio observacional retrospectivo multicéntrico de casos de dermatofitosis del polo cefálico con el antecedente de haber sido contraídas tras el rasurado frecuente en peluquería. Se realizó una llamada a dermatólogos de la Academia Española de Dermatología y Venereología (AEDV) para que aportaran casos observados entre enero de 2021 y diciembre de 2022. Se incluyeron pacientes con confirmación microbiológica mediante cultivo o examen directo con KOH. Resultados Se recogieron 107 casos, siendo 106 pacientes varones. Se observaron 78 formas no inflamatorias frente a 29 inflamatorias. El hongo aislado con mayor frecuencia fue Trichophyton tonsurans (75,7% de los casos). Las lesiones aparecieron predominantemente en la nuca y en el área temporal. Conclusiones La distribución por sexo, edad y localización lesional parece apuntar a que una nueva tendencia social, en la que adolescentes varones acuden asiduamente a peluquerías para el afeitado de las zonas occipital y temporal, sería la causante de esta agrupación de casos de tiña del cuero cabelludo. El microorganismo más frecuente en nuestro estudio (T.tonsurans) coincide con el más prevalente en nuestro medio. Con el presente estudio se evidencia un acúmulo de casos susceptible de ser tenido en cuenta por organismos competentes de salud pública, a los cuales corresponde velar por el cumplimiento de las normas de desinfección del material empleado para el rasurado (AU)

Pediatric Tinea Capitis: A Retrospective Cohort Study from 2010 to 2021.

Pediatric tinea capitis displays a wide range of prevalence, with significant variability among populations. We retrospectively extracted the medical records of 456 pediatric patients diagnosed with tinea capitis during the years 2010-2021, from the dermatology outpatient clinics in two tertiary medical centers. Three species were isolated in 90% of patients: T. tonsurans, M. canis, and T. violaceum. While T. tonsurans presented a six-fold increase in incidence during the years 2019-2021, M. canis maintained stable incidence rates. Furthermore, terbinafine was the most efficient antifungal agent against T. tonsurans, achieving complete clinical clearance in 95% of patients, as compared to fluconazole (68%) and griseofulvin (38%) (p < 0.001). The mycological cure was recorded in 61/90 (68%) of patients with available data, at an average of 10 weeks. For patients with M. canis, griseofulvin and fluconazole were equally efficient (73% and 66%, respectively) (p = 0.44). Kerion was described in 36% and 14% of patients with T. tonsurans and M. canis, respectively, (p < 0.001). In conclusion, since 2019, there has been a significant increase in the prevalence of T. tonsurans, establishing this pathogen as the most common cause for tinea capitis in our population. Our data suggest that terbinafine is effective and presents high cure rates for tinea capitis in the pediatric population.

Outbreak of Dermatophyte Infections on the Head and Neck Related to Shave Haircuts: Description of a Multicenter Case Series. / Brote de dermatofitosis en región de cabeza y cuello asociadas al rasurado en peluquerías: estudio descriptivo multicéntrico de una serie de casos.

INTRODUCTION: Since 2021, an increase in cases of tinea capitis has been detected in adolescents who shave their hair with fade haircut. PATIENTS AND METHODS: Multicenter retrospective observational study of cases of cephalic pole dermatophytosis with a history of having been acquired after frequent shaving in hairdressing. A call was made to dermatologists from the Spanish Academy of Dermatology and Venereology (AEDV) to provide cases observed between January 2021 and December 2022. Patients with microbiological confirmation by culture or direct examination with KOH were included. RESULTS: 107 cases were collected, 106 of which were male. 78 non-inflammatory forms were observed, compared to 29 inflammatory. The most frequently isolated fungus was Trichophyton tonsurans (75.7% of cases). The lesions appeared predominantly on the nape of the neck and temporal area. CONCLUSIONS: The distribution by sex, age and lesional location seems to indicate that a new social trend, in which male adolescents regularly go to hairdressers to shave the occipital and temporal areas, would be the cause of this grouping of cases of ringworm of the scalp. The most frequent microorganism in our study (T.tonsurans) coincides with the most prevalent in our environment. This study shows an accumulation of cases that can be taken into account by competent Public Health agencies, which are responsible for ensuring compliance with the rules of disinfection of the material used for shaving.

Adult Kerion Celsi Caused by Trichophyton tonsurans Secondary to Black Dot Tinea Capitis.

A 34-year-old female patient presented with hair loss due to black dot tinea capitis caused by Trichophyton tonsurans for 6 months. Hair loss progressed to painful swelling for 2 months due to kerion Celsi which may be associated with treatment like topical minoxidil, antibiotic and corticosteroid previously. The patient was treated with oral Itraconazole initially without success but cured by Terbinafine eventually. It's very interesting that the patient caught kerion celsi secondary to a four-month history of hair loss due to black dot tinea capitis.

Clonal Outbreak of Trichophyton tonsurans Causing Tinea Capitis Among a Wrestling Team in Beijing, China.

Trichophyton tonsurans mostly causes tinea capitis and tinea corporis and often associates with outbreaks among combat sports athletes. Here, we report an outbreak of tinea capitis caused by T. tonsurans among five juvenile athletes in a wrestling team in Beijing, China. Scrapings from the lesions of the five patients were performed by direct microscopic examination and fungal culture. The fungal pathogens were all identified as T. tonsurans by morphology and sequencing of the internal transcribed spacer (ITS) regions. Multilocus genotyping analysis was performed by sequencing of 13 gene loci. The sequences of these markers were identical among the five isolates, revealing a single genotype. Antifungal susceptibilities of terbinafine, itraconazole, fluconazole, ketoconazole, and amphotericin B against T. tonsurans was determined by broth microdilution method according to the Clinical and Laboratory Standards Institute M38-A3 document and these isolates were all susceptible to the common antifungal drugs treating tinea capitis.

Increasing incidence of Trichophyton tonsurans in Munich-A single-centre observation.

BACKGROUND: Tinea capitis and tinea corporis are highly prevalent fungal skin infections, which globally are mainly caused by Microsporum canis and Trichophyton rubrum, respectively. While in the United States and Great Britain Trichophyton tonsurans is widely prevalent as a causative pathogen, it so far only plays a minor role in Germany. OBJECTIVES: Since the frequency of pathogenic species varies regionally and temporally, this study assesses the proportion of Trichophyton tonsurans infections in the dermatology department of a large university hospital in Germany from 2019 to 2022 and thoroughly characterises the affected patient population. PATIENTS/METHODS: This retrospective study at the Technical University of Munich analyses mycological culture results regarding the identified dermatophyte and infection site. Detailed patient and disease-related information on Trichophyton tonsurans positive patients was obtained. RESULTS: In 2022, 23 patients of 111 dermatophyte culture-positive patients tested positive for Trichophyton tonsurans. This accounted for 20.7% and represented a tenfold increase from 2.1% in 2019. Contact sports were only practiced by 21.7% of patients, and no common hotspot or other linkage could be identified between the cases. Additionally, 47.8% of the patients received a systemic treatment, with 30.4% visiting the clinic more than three times. In 2022, 21.7% were diagnosed with a simultaneous infection of the capillitium and body, whereas this was only observed in 7.1% of cases in 2019 to 2021. CONCLUSIONS: This study suggests an increase of Trichophyton tonsurans infections via several routes of transmission.

Tinea capitis caused by Trichophyton tonsurans among adults: Clinical characteristics and treatment response.

BACKGROUND: Trichophyton tonsurans tinea capitis has become a growing epidemiological concern. Yet, its clinical manifestations and treatment response, specifically among adults, have only been described among small sample size studies. OBJECTIVE: To assess clinical manifestations and treatment outcome of T. tonsurans tinea capitis among adults. PATIENTS AND METHODS: A retrospective cohort study was carried out among 111 adults with T. tonsurans tinea capitis. Diagnosis was confirmed by fungal culture or polymerase chain reaction. Examinees' demographics, disease characteristics and treatment response were measured. The risk factors for the treatment failure were evaluated. RESULTS: The mean age was 20.1 years (±3.1), with men (98.2%) outnumbering women. The follow-up lasted 12.2 months (±5.6). The majority of T. tonsurans tinea capitis was seen in the occipital area (87.6%). In 78.9% of the cases, the scalp manifestation was non-inflammatory (scaly plaques and papules:76.1% and seborrhoea-like: 2.8%). 21.1% of cases presented with inflammatory tinea capitis (21.1%; Kerion: 10.1% and pustular: 11%). Concomitant involvement of other than scalp areas was common: tinea corporis was seen in 38.7% of the cases; tinea faciei and barbae in 24.3%; nape and anterior neck in 76.6% and 2.7% of the cases, respectively. An adequate treatment course with oral terbinafine resulted in 83.2% clinical cure rate. Treatment failure was significantly associated with concomitant tinea corporis (odds ratio 3.9; 95% confidence interval 1.3-12.1, p-Value< .02). CONCLUSION: The most common clinical presentation of T. tonsurans tinea capitis included occipital scaly plaques and papules with concomitant non-scalp lesions. Oral terbinafine was found to be highly effective. Concomitant tinea corporis increased the risk for treatment failure.

Case report: Severe deep ulcer on the left abdomen mimicking mycosis fungoides caused by Trichophyton tonsurans in a patient with novel CARD9 mutation.

Dermatophytosis is the most common type of superficial fungal infection caused by dermatophytes. Occasionally, the fungus invades deep into the dermis or other tissues, causing deep dermatophytosis. Deep dermatophytosis is often associated with Caspase Recruitment Domain-containing protein 9 (CARD9) deficiency in patients. Here, we report the first case of deep dermatophytosis with a rare mycosis fungoides manifestation caused by T. tonsurans in a patient with a novel mutation in exon 4 of CARD9. The condition presented with heterozygous K196E mutation, which leads to deficiency of innate and adaptive immune responses in the patient, and caused intractable severe lesions. The patient received treatment with multiple antifungal drugs and was ultimately alleviated by posaconazole. These findings extend the pathogen spectrum of deep dermatophytosis linked with CARD9 deficiency and enriched their phenotypic spectrum.

Tiña capitis por Trichophyton tonsurans en un paciente pediátrico / Tinea capitis by Trichophyton tonsurans in a pediatric patient

La tiña capitis (TC) es una micosis superficial del cuero cabelludo, considerada una de las infecciones más frecuentes por dermatofitos en niños. Hasta la actualidad, las especies descritas con mayor frecuencia en nuestro medio son el Microsporum y, en segundo término, Trichophyton, los cuales se contraen principalmente por contacto directo con animales o seres humanos infectados, respectivamente. Se presenta el caso de una paciente de 8 años con alopecia y lesiones inflamatorias de 2 años de evolución, en la que finalmente se llegó al diagnóstico de TC inflamatoria causada por T. tonsurans, un hongo antropofílico considerado poco frecuente en Argentina y emergente en la provincia de Buenos Aires. Este patógeno presenta alta transmisibilidad; son varios los países que han reportado brotes escolares y comunitarios. Se debe resaltar la importancia de su sospecha clínica temprana para un tratamiento adecuado.

Tinea capitis (TC) is a superficial mycosis of the scalp, considered one of the most common dermatophyte infections in children. Until now, the species mainly described in our environment are Microsporum and secondly Trichophyton, which are contracted mainly by direct contact with infected animals or humans, respectively. We present the case of an 8-year-old patient with alopecia and inflammatory lesions of 2 years of evolution, finally reaching the diagnosis of inflammatory tinea capitis caused by T. tonsurans, an anthropophilic fungus considered rare in Argentina and emerging in the province of Buenos Aires. This pathogen has high transmissibility; several countries have reported school and community outbreaks. The importance of its early clinical suspicion for adequate treatment should be emphasized.

Tinea Gladiatorum: Epidemiology, Clinical Aspects, and Management.

Tinea gladiatorum (TG) is a fungal skin infection that occurs among wrestlers and other contact sport athletes with a varied prevalence rate. The most common causative factor responsible as well for local outbreaks of the infection is an anthropophilic dermatophyte species-Trichophyton tonsurans (T. tonsurans). The purpose of this study was to gather current data about TG, including epidemiology, possible diagnosing methods, clinical features, treatment approaches, and potential prevention techniques. We also performed a systematic review of studies describing TG incidence. The prevalence of the disease varied from 2.4% up to 100%. That wide range of variability forces medical practitioners to update knowledge about TG and points to the fact that it still may be a diagnostic and therapeutic challenge. Spreading awareness among athletes and trainers is one of the most important preventive steps.

[Tinea capitis by Trichophyton tonsurans in a pediatric patient]. / Tiña capitis por Trichophyton tonsurans en un paciente pediátrico.

Tinea capitis (TC) is a superficial mycosis of the scalp, considered one of the most common dermatophyte infections in children. Until now, the species mainly described in our environment are Microsporum and secondly Trichophyton, which are contracted mainly by direct contact with infected animals or humans, respectively. We present the case of an 8-year-old patient with alopecia and inflammatory lesions of 2 years of evolution, finally reaching the diagnosis of inflammatory tinea capitis caused by T. tonsurans, an anthropophilic fungus considered rare in Argentina and emerging in the province of Buenos Aires. This pathogen has high transmissibility; several countries have reported school and community outbreaks. The importance of its early clinical suspicion for adequate treatment should be emphasized.

La tiña capitis (TC) es una micosis superficial del cuero cabelludo, considerada una de las infecciones más frecuentes por dermatofitos en niños. Hasta la actualidad, las especies descritas con mayor frecuencia en nuestro medio son el Microsporum y, en segundo término, Trichophyton, los cuales se contraen principalmente por contacto directo con animales o seres humanos infectados, respectivamente. Se presenta el caso de una paciente de 8 años con alopecia y lesiones inflamatorias de 2 años de evolución, en la que finalmente se llegó al diagnóstico de TC inflamatoria causada por T. tonsurans, un hongo antropofílico considerado poco frecuente en Argentina y emergente en la provincia de Buenos Aires. Este patógeno presenta alta transmisibilidad; son varios los países que han reportado brotes escolares y comunitarios. Se debe resaltar la importancia de su sospecha clínica temprana para un tratamiento adecuado.

A Case of Kerion Celsi Caused by Trichophyton tonsurans, a Plate Culture of Which Showed Yellow-Green Fluorescence Under UVA Light.

We herein report a case of kerion celsi of the scalp and tinea corporis due to Trichophyton tonsurans. A 17-year-old Japanese male high school student who practiced judo had alopecic patches with severe inflammation on the scalp. We performed a fungal culture and identified the causative fungus as T. tonsurans. A plate culture of T. tonsurans showed lemon-yellow colonies with yellow-green fluorescence under UVA light, which are typical findings for Microsporum canis. However, genetic analysis of the ribosomal RNA gene of the isolate facilitated differential diagnosis of T. tonsurans.In contrast to dermatophytosis due to other dermatophytes, the clinical features of infection caused by T. tonsurans, an anthropophilic dermatophyte, are initially not very apparent and, thus, are frequently overlooked. We herein present a case of a severe type of kerion celsi caused by T. tonsurans with a fluorescence pattern mimicking M. canis colonies under UVA light. We suspect that yellow pigment metabolites, such as riboflavin, which are fluorescent under UV when secreted into the culture medium, are the virulence factors for not only M. canis, but also T. tonsurans, as shown in the present case.