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.

Epidemiology of human dermatophytoses in Africa.

In this critical literature review, we summarize the epidemiological trends of dermatophytoses reported in Africa. Our findings clearly emphasize the heavy burden of dermatophytosis in Africa. Tinea capitis is the primary clinical presentation of dermatophytosis in African children throughout the entire African continent. The disease affects more than 20% of school-age children in West Africa, while the prevalence ranges from 10% to more than 70% in other regions of Africa. In African adults, the presence of tinea corporis is the most frequent indicator of dermatophytosis. However, epidemiological studies have been primarily conducted on particular patient groups that are not representative of the general population. We examined dermatophyte species distribution patterns. We observed a predominance of anthropophilic dermatophytes, mainly T. violaceum, in the North and East of Africa and both T. soudanense and M. audouinii in the Western and Central regions of the continent. Interestingly, the zoophilic species, M. canis, has recently emerged in North and East Africa. Optimization of both mycology diagnosis capacities and epidemiological methodology would provide insight into the role that climate and other global aspects of the human environment play in dermatophyte epidemiology. We advocate that using a multisectoral and collaborative strategy would strengthen such future studies.

Griseofulvin and Fluconazole Reduce Transmission of Tinea Capitis in Schoolchildren.

OBJECTIVE: We evaluated the efficacy of griseofulvin and fluconazole in reducing the potential for person-to-person transmission of tinea capitis (TC) in children. METHODS: Children with TC with positive fungal cultures were treated with griseofulvin 25 mg/kg/day (group A) or fluconazole 6 mg/kg/day (group B) for at least 21 days and up to 12 weeks until cure was achieved. Clinical and mycologic examinations occurred before treatment and on days 3, 7, 10, 14, and 21 of treatment. During each visit, mycologic examination was performed from scalp lesions of children and fingertips of medical staff and parents after a brief touch of the patient's scalp lesions. RESULTS: Ninety patients were enrolled: 48 treated with griseofulvin and 42 with fluconazole. The predominant species were Trichophyton violaceum (n = 44) and Microsporum canis (n = 41), followed by Trichophyton mentagrophytes (n = 3) and Trichophyton rubrum (n = 2). Ten days after treatment more than 75% of patients from both treatment groups were noncontagious. At day 21, all patients from group A were noncontagious and two (7%) with positive culture of M. canis from group B were still contagious. CONCLUSIONS: No statistically significant differences were found between treatment groups. Griseofulvin and fluconazole reduced the potential for disease transmission in children with TC, with griseofulvin being more effective for M. canis infections, although children with TC may be potentially contagious even after up to 3 weeks of treatment. These data should be considered regarding school attendance of children with TC.

Tinea corporis due to Trichophyton rubrum in a woman and Tinea capitis in her 15-day-old baby: molecular evidence of vertical transmission.

We report a case of a 40-year-old Caucasian woman who came under our observation with a 7-year history of a chronic erythematous scaly dermatitis, diagnosed as psoriasis, involving gluteal area and thighs, and treated with topical steroids without benefit. During pregnancy, a progressive worsening of her condition and an extension of cutaneous lesions were observed. Her newborn, a 15-day-old girl, presented a similar scaly and squamous lesion on her scalp. Mycological examination was positive for Trichophyton rubrum in both cases, and random amplified polymorphic DNA analysis confirmed the isogenicity of the two isolates. We performed a diagnosis of T. rubrum tinea corporis and tinea capitis. The case we describe illustrates an unusual clinical presentation of tinea corporis with remarkable extension of cutaneous lesions due to the diagnostic delay and the continuous use of local steroids, together with a rare tinea capitis in the newborn. Our experience highlights the possibility of mother-child transmission and the importance of an early diagnosis.

Tinea capitis: still an unsolved problem?

Tinea capitis is a fungal infection specifically involving the scalp and hair. It is the most common dermatophyte infection in children under 12 years of age, with a predominance in those of sub-Saharan African descent. Common signs include hair loss, scaling, erythema and impetigo-like plaques. Adults may also be affected, but to a lesser degree. The causative species are from the Microsporum and Trichophyton genera. Limited treatment options and diverse modes of transmission complicate the clinician's ability to address this disease adequately. Although dermatophytes are ubiquitous in our environment and tinea capitis is common, therapeutic options can be utilised to reduce morbidity.

[Dermatomycosis with epidemic proportions: Tinea capitis and onychomycosis]. / Dermatomykosen mit epidemiologischem Potenzial: Tinea capitis und Onychomykose.

Superficial fungal infections caused by dermatophytes (dermatophytoses) are the most common skin infections with about 10-15% of the population throughout the world being affected. Up to now the occurrence of fungal infections of the skin has been connected, like ectoparasitic infections with poor hygiene and poor living conditions. During the last decades, however, there has been a dramatic change with a significant increase in mycotic scalp infections as well as fungal nail disease mainly in highly developed countries like the US and those on the European continent.

Screening for asymptomatic carriage of Trichophyton tonsurans in household contacts of patients with tinea capitis: results of 209 patients from South London.

BACKGROUND: There is currently an epidemic of tinea capitis in urban areas of developed countries caused by Trichophyton tonsurans. Recurrence or re-infection with dermatophyte is not uncommon after adequate oral treatment. Asymptomatic carriers who are household contacts may partly explain this observation by forming a reservoir for infection. PATIENTS/METHODS: Two-hundred and nine household contacts of patients with tinea capitis were examined and screened for asymptomatic carriage of dermatophyte. RESULTS: Only 7.2% had clinically evident disease yet 44.5% had silent fungal carriage on the scalp. Children under 16 years were much more likely to be carriers than adults (P < 0.001) and males were less likely than females to be affected (P < 0.01). CONCLUSION: This evidence poses questions about factors relevant in transmission of dermatophytes. The authors propose that all household contacts of patients with tinea capitis should be offered screening to eradicate a potential reservoir of infection.

Epidemiology of tinea capitis in Europe: current state and changing patterns.

Tinea capitis (scalp ringworm) is the most common dermatophyte infection of the scalp affecting mainly children and rarely adults. The epidemiology of tinea capitis varies within different geographical areas throughout the world. It may occur sporadically or epidemically and an increase in its incidence has been noted over the last few decades. The aim of the study is to obtain a general overview of the current state and changing pattern of tinea capitis in Europe. According to the literature, there has been a significant increase in the incidence of tinea capitis and a change in the pattern of infectious agents in particular. Microsporum canis, a zoophilic dermatophyte, is still the most common reported causative agent of tinea capitis in Europe. The countries reporting the highest incidence of M. canis infections are mainly in the Mediterranean but also bordering countries like Austria, Hungary, Germany and Poland. Besides the increase in Microsporum-induced tinea capitis, there is a shift towards anthrophilic tinea capitis mainly in urban areas in Europe. The largest overall increase with anthropophilic dermatophytes has been noted with Trichophyton tonsurans mainly in the UK and with Trichophyton soudanense and Microsporum audouinii in France. The occurrence of anthropophilic infections seems to be geographically restricted and is possibly linked to the immigration from African countries. Children (aged 3-7 years with no predilection of gender) remain the most commonly affected, but recently an increase of tinea capitis has been observed in adults and in the elderly. The results of the study clearly demonstrate the importance of diagnosing and proper treatment of mycotic scalp infection in the Europe. If not diagnosed and treated properly, its prevalence might reach epidemic proportions in the near future. Therefore, an increased level of surveillance (screening in schools), and a highly effective interdisciplinary cooperation among general practitioners, mycologists, veterinarians and dermatologists are strongly recommended.

Microsporum canis: report of a primary school outbreak.

Microsporum canis is the causative organism in less than 10% of all tinea capitis infections in the UK. Transmission is generally via contact with an infected family pet and there are only rare reports of case clustering. This article describes an outbreak of M. canis in a primary school classroom demonstrating human-to-human spread from an index case who was presumed to have acquired the infection prior to arriving in the UK. There was no suggestion of clinical improvement following 4 weeks of oral terbinafine 125 mg daily and treatment was changed to griseofulvin. The Health Protection team screened class members and confirmed cases (either clinically or mycologically) were also treated with griseofulvin 10-20 mg/kg/day for 10 weeks. Classmates and siblings of classmates were recommended to use selenium sulphide or ketoconazole-containing shampoo twice weekly.

[Clinical study of 57 cases of infection with Trichophyton tonsurans examined at a dermatology clinic in Saga Prefecture, Japan].

This paper is a clinical study of 57 cases of infection with Trichophyton tonsurans (T. tonsurans) examined in our clinic between January 2004 and July 2006. The patients were 31 high school students, 19 junior high school students, 2 primary school students, 1 kindergartener, and 4 sports instructors. The male:female ratio was 51:6. Most patients were male Judo practitioners. Patients were clinically categorized as follows: 13 cases of tinea capitis {10 containing black dot ringworms (BDR), 2 scaled, and 1 with inflammation}, 41 cases of tinea corporis, 1 case of tinea manum, and 7 carriers. Five patients displayed both tinea capitis and tinea corporis. Among tinea corporis patients, 21 displayed annular erythemas, whereas 19 displayed small circular eythemas characterized by a lightly inflamed non-typical rush. In 3 tinea corporis cases, we sampled T. tonsurans from hair grown inside the skin rash. Eleven of the tinea corporis patients displayed multiple lesions. Compared to patients with singular lesions, these 11 cases had a larger degree of comorbidity with BDR or HB positivity. A 6-8 week treatment with griseofulvin was efficient in 90% of the tinea capitis cases. Tinea corporis patients were healed following a 4-9 week treatment with topical antifungals and griseofulvin. When examining T. tonsurans infections, patients with BDR or lightly inflamed tinea corporis as well as asymptomatic carriers can be easily overlooked or misdiagnosed. Therefore, we suggest that mycological examination, including careful observation of the rash and KOH mount, is essential in these cases.

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.

[Trichophyton violaceum infection occurring in a nursing home].

Six cases of Trichophyton (T.) violaceum infection seen in a nursing home are reported. A 66-year-old female (case 1) was found with tinea corporis on her face, chest and shoulder, associated with black dot ringworm. A KOH examination of hair showed endothrix parasitism. Reddish purple colonies were isolated from the patient on Sabouraud's dextrose agar, and intercalary and terminal chlamydospores were observed on slide culture. PCR-RFLP analysis of the microorganism showed a pattern of T. violaceum type. Therefore, the isolated fungus was identified as T. violaceum, a typical anthropophilic dermatophyte which had spread among residents and staffs easily. Using a mycological method, we examined 59 persons (21 residents and 38 staff members) who had had contact with case 1. The results were as follows. An 85-year-old female (case 2) and an 83-year-old female (case 3) were carriers of T. violaceum. A 23-year-old male (case 4) had tinea corporis on his right forearm due to T. violaceum. A 24-year-old male (case 5) probably had tinea corporis on his right forearm due to T. violaceum. One year after case 1's first visit to our clinic, we observed an 88-year-old female (case 6) of tinea capitis by T. violaceum. It seems that the organism was preserved in surroundings and members of the nursing home. The contagion in our cases could either have been caused by directly touching the person or by sharing their comb. PCR-RFLP analysis was performed within a short time, so that we managed effectively to select a way of treatment and to prevent the infection from spreading.

Current topics of tinea capitis in China.

Tinea capitis is one type of superficial fungal infection which is found all over the world. The major etiologic agent of tinea capitis varies in different areas. Tinea capitis in China has unique characteristics. The epidemiology, transmission and therapy of child and adult tinea capitis in China are reviewed in this paper.

[Identification of geophilic and zoophilic dermatophytes in siblings with tinea capitis. A pathogenic factor or contamination?]. / Nachweis geophiler und zoophiler Dermatophyten bei Geschwistern mit Tinea capitis. Pathogenetischer Zusammenhang oder Kontamination?

Two siblings of African origin presented with multiple scaling patches and alopecia on the scalp four weeks after returning from a vacation in Eritrea. Direct KOH examination revealed fungal elements; Trichophyton mentagrophytes and Trichophyton terrestre were identified in the fungal culture. We discuss the putative pathogenic role of both microorganisms in causing disease. Although infection with Microsporum canis currently accounts for almost fifty percent of all cases of tinea capitis in Germany, other fungi have gained importance due to tourism and increasing migration.