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.

Tinea capitis: temporal shift in pathogens and epidemiology.

BACKGROUND: Tinea capitis is the most common type of dermatomycosis in children. Its pathogen profile shows geographic variations as well as temporal shifts. PATIENTS AND METHODS: Data from 150 patients with mycologically confirmed tinea capitis treated at the Department of Dermatology, University Hospital Würzburg, between 1990 and 2014 were analyzed with respect to gender, age, and pathogen spectrum. Two time periods, each 12.5 years long, were compared. RESULTS: Although tinea capitis was most frequently diagnosed in children between the ages of 0 and 5, the percentage of adults (16 %) was higher than previously reported. The zoophilic dermatophyte Microsporum canis was most frequently identified as the causative agent of tinea capitis. However, there was a rise in infections caused by the anthropophilic fungi Trichophyton tonsurans and Trichophyton rubrum, and also a trend towards a lower percentage of zoophilic versus anthropophilic pathogens. Over the course of time, we observed an increase in the diversity of the pathogen spectrum. Dermatophytes such as Trichophyton soudanense, the Trichophyton anamorph of Arthroderma benhamiae, Trichophyton schoenleinii, and Microsporum audouinii were isolated either for the first time or for the first time after a long hiatus. CONCLUSIONS: Although Microsporum canis infections still predominate, there has been an increase in anthropophilic pathogens. Given the unexpectedly high percentage of adults, tinea capitis should be included in the differential diagnostic considerations in all age groups.

A different kind of hedgehog pathway: tinea manus due to Trichophyton erinacei transmitted by an African pygmy hedgehog (Atelerix albiventris).

The unusual case of a 29-year-old woman with tinea manus caused by infection due to Trichophyton erinacei is described. The patient presented with marked erosive inflammation of the entire fifth finger of her right hand. Mycological and genomic diagnostics resulted in identification of T. erinacei as the responsible pathogen, which had been transmitted by a domestic African pygmy hedgehog, Atelerix albiventris. Upon prolonged treatment with topical and systemic antifungal agents skin lesions slowly resolved. This case illustrates that the increasingly popular keeping of extraordinary pets such as hedgehogs may bear the risk of infections with uncommon dermatophytes.

[Chronic favus caused by infection with Trichophyton schönleinii]. / Langjährig bestehender Favus nach Infektion mit Trichophyton schönleinii.

A 25-year-old female patient from Kosovo presented with a slowly progressive cicatricial alopecia which had started when she was 6 years old. Her brother in Kosovo had similar lesions. At the erythematous border of the hairless area, crusts, erosions and pustules were apparent. Mycological examination identified Trichophyton schönleinii, the causative pathogen of favus. Histological examination revealed hyphae and showed no features suggestive of other causes of cicatricial alopecia. Systemic terbinafine combined with topical ciclopiroxolamine resulted in rapid improvement of this disease which is seldom seen in Central Europe.