Asymptomatic dermatophyte scalp carriage: laboratory diagnosis, epidemiology and management

Comprehensive Review of Tinea Capitis in Adults: Epidemiology, Risk Factors, Clinical Presentations, and Management

Tinea capitis is a fungal infection of the scalp and hair caused by dermatophyte molds, that most often affects children and may also affect adults. Previous estimates suggest that between 3% and 11% of all tinea capitis cases worldwide occur in adults, although updated epidemiological studies are needed to reassess the prevalence of tinea capitis in adult populations specifically. Postmenopausal adult women are most often affected by tinea capitis, with African American or Black women particularly at risk. Adults who experience crowded living conditions, who live in close proximity to animals, who are immunosuppressed, and/or who live in households with affected children are at greatest risk of infection. Tinea capitis can be non-inflammatory or inflammatory in nature, and the subtype affects the extent and severity of clinical symptoms. Fungal culture and potassium hydroxide preparations are the most commonly used diagnostic tools. Trichoscopy, defined as dermoscopic imaging of the scalp and hair, is a useful adjunct to the physical examination. The mainstay of therapy is oral antifungal therapy, and topical therapy alone is not recommended. Since tinea capitis infection is uncommon in adults, there are no widely accepted treatment guidelines. Rather, the same medications used for tinea capitis infection among children are recommended for adults at varying doses, including griseofulvin, and terbinafine, and, less commonly, itraconazole and fluconazole. The prognosis for tinea capitis in adults is typically excellent when prompt and adequate treatment is administered; however, delayed diagnosis or inadequate treatment can result in scarring alopecia. Over the past decade, dermatophyte infections resistant to treatment with topical and oral antifungal agents have emerged. While tinea capitis infections resistant to antifungal therapy have been rarely reported to date, antifungal resistance is rising among superficial fungal infections in general, and antifungal stewardship is necessary to ensure that resistance to treatment does not develop among dermatophytes that cause tinea capitis.

Analysis of optimal control strategies on the fungal Tinea capitis infection fractional order model with cost-effective analysis

In this study, we have formulated and analyzed the Tinea capitis infection Caputo fractional order model by implementing three time-dependent control measures. In the qualitative analysis part, we investigated the following: by using the well-known Picard-Lindelöf criteria we have proved the model solutions' existence and uniqueness, using the next generation matrix approach we calculated the model basic reproduction number, we computed the model equilibrium points and investigated their stabilities, using the three time-dependent control variables (prevention measure, non-inflammatory infection treatment measure, and inflammatory infection treatment measure) and from the formulated fractional order model we re-formulated the fractional order optimal control problem. The necessary optimality conditions for the Tinea capitis fractional order optimal control problem and the existence of optimal control strategies are derived and presented by using Pontryagin's Maximum Principle. Also, the study carried out the sensitivity and numerical analysis to investigate the most sensitive parameters and to verify the qualitative analysis results. Finally, we performed the cost-effective analysis to investigate the most cost-effective measures from the possible proposed control measures, and from the findings we can suggest that implementing prevention measures only is the most cost-effective control measure that stakeholders should consider.

Neglected Adult Tinea Capitis in South China: A Retrospective Study in Nanchang, Jiangxi Province, from 2007 to 2021

Tinea capitis (TC) in adults is much less frequently diagnosed in comparison to TC in children. In this study, we explored retrospectively adult TC in a specialized dermatology hospital, located in South China, during the years 2007-2021. Among 1037 TC cases, 168 (16.2%) patients were older than 18 years. The majority of adults with TC, 77.38% (130/168), were older than 40, with a peak in the age of 51-60 years (40/168, 23.81%). Before presenting at our hospital, many of patients did not got proper treatment due to misdiagnosis or simply did not consulted an appropriate clinic. 60.71% (102/168) of the patients reported symptoms lasting for more than 1 year and 29.76% (50/168) reported chronic scalp problems of at least 10 years. And 27.38% (46/168) of the patients had an immunocompromised status, including long-term use of corticosteroids shampoo, type 2 diabetes mellitus (DM), psoriasis vulgaris, rheumatoid arthritis, systemic lupus erythematosus or bullous pemphigoid. As for clinical presentation, 87.5% (147/168) of the cases presented as black dot type of TC and anthropophilic dermatophytes were the predominant etiology, with Trichophyton violaceum (126), T. tonsurans (15), T. rubrum (8) and T. shoenleinii (6). Grey patch type of TC (3.57%, 6/168) was seldom in Jiangxi Province and zoophilic/geophilic dermatophytes were rare. Our study indicates that anthropophilic Trichophyton species can cause long-lasting TC in adults. Not in all cases, the manifestation had symptom clearly indicating a dermatophyte-related TC. Thus, patients with long-lasting scalp inflammation, also older ones, should be examined for the presence of dermatophyte-related TC.

Trichophyton species isolated from asymptomatic patients of the pet-owner pair in Mexico

Background and Purpose:

Superficial mycoses are the fourth most common cause of disease worldwide. It is not surprising that zoonotic transmission occurs to humans due to close contact with different animals, be it companion or farm animals. Therefore, the objective of this study was to determine the presence of asymptomatic dermatophyte carriers in the owner-pet pairs, identify the most common etiologic agents, and find the likely connection between the carrier status of an owner and the presence of dermatophytes in their pets.

Materials and Methods:

From May 2019 to January 2020, 21 cats and 115 dogs with their respective owners were selected for dermatophyte culture. All the dogs and cats included in the study were from the communities of southeastern Mexico. The samples were taken with a cotton swab, which was vigorously rubbed and twisted on the scalp or body of the pet four times and grown on Mycosel Agar. The isolates were identified based on macroscopic and microscopic characteristics. The prevalence of the binomial ranged from 0.73% in pet skin and human hands to 2.2% in human scalp. In humans, the agents were Trichophyton tonsurans and Trichophyton verrucosum, while in pets, a strain of Trichophyton sp was found.

Conclusion:

Different species of dermatophytes were found in the owner/pet pairs, which denotes that coexistence is not related in asymptomatic cases.

Asymptomatic Scalp Carriage among Household Contacts of Children Affected by Tinea Capitis: A Prospective Study in the Metropolitan Area of Brussels, Belgium

<b><i>Introduction:</i></b> Tinea capitis (TC) is a superficial fungal infection affecting the scalp. The existence of asymptomatic carriers (ACs) could represent a potential reservoir responsible of (re)contamination and failure of treatment. No prospective studies on ACs in household contacts of TC patients in Europe have been published to date. <b><i>Objectives:</i></b> The aim of this study was to assess the prevalence of ACs in a cohort of household contacts of children who were diagnosed with TC in the metropolitan area of Bruxelles, Belgium. <b><i>Methods:</i></b> This prospective observational study was conducted from October 2015 to April 2016 at the Dermatology Department of the University Hospitals Brugmann, Saint-Pierre, Queen Fabiola Children Hospital. <b><i>Results:</i></b> Ninety-nine cases of TC from 95 different family circles were included. The main infectious agent identified was <i>Microsporum audouinii</i> in 53 cases. The mean age of TC patients was 5.8 years. Male/female ratio was 2.8. Eighty-one household contacts of TC patients were enrolled in the study. Two cases of ACs (5%) were identified. <b><i>Conclusions:</i></b> <i>M. audouinii</i> was the most common pathogen identified. The prevalence of ACs we report is on average higher compared to other European large cities. Larger prospective studies including all close contacts of affected patients are required in order to establish guidelines regarding identification and management of ACs.

Epidemiology of Dermatophytes Isolated from Clinical Samples in a Hospital in Eastern Saudi Arabia: A 20-Year Survey

BACKGROUND

Dermatophytes are group of fungi that cause superficial infections via enzymes that degrade keratin in human skin. Several factors, including climate, gender, age, lifestyle, human migration, cultural habits, and socioeconomic status influence the prevalence of dermatophyte infections. We analyzed the prevalence of dermatophyte isolates in a hospital in Eastern Saudi Arabia from 2000 to 2019.

METHODS

The data on fungal cultures were obtained from the Laboratory Information System of the Mycology Laboratories at Johns Hopkins Aramco Healthcare, and were used for the analysis. Fungal isolates were examined microscopically for the presence of specialized hyphal structures and conidia. The Vitek^® MS microbial identification system (biomerieux) was used if the culture type was not identified microscopically.

RESULTS

Among the 10,021 samples analyzed, 3040 (30.33%) were positive for fungi and only 398 (3.97%) were dermatophytes. Microsporum species was the most common dermatophyte accounting for 50.5% (n = 201) followed by trichophyton with 36.9% (n = 147). The most common positive samples were scrapping (251, 63%) and hair (68, 17%). Culture positivity relative to the age groups revealed a cluster of positive dermatophyte species in children < 10 years of age with 215 (54%) of all cases and among 10-19 years of age with 60 (15) of the cases (p < 0.001). Microsporum species were the prevalent dermatophytes in patients  < 10 years of age, while Epidermophyton species were the most frequent dermatophyte species in age groups 10-19, 20-29, and 30-39 years. However, Trichophyton species were the most frequent dermatophyte species in individuals 70-79 years. The percentage of Microsporum and Trichophyton species decreased significantly over time (p < 0.001). In addition, there was a significant seasonal variation in relation to Trichophyton species. A comparison between the most frequent species showed that there was no difference in relation to gender, but there was a difference in relation to the specimen type and age group.

CONCLUSION

Dermatophytosis was common among children and adolescent with the most common samples were scrapping and hair. There was a significant reduction in Microsporum and Trichophyton species over time.

Tinea capitis asymptomatic carriers: what is the evidence behind treatment?

Tinea capitis is a fungal infection mostly affecting children. Epidemiology is changing over time due to migration, and it has been estimated that up to 40% of children from certain developing countries are affected. The mechanism of transmission is still unclear although asymptomatic carriage seems to have an influence in establishing persistent reservoirs that can cause or fuel epidemics. Screening and prophylactic treatment of close contacts of tinea capitis patients are therefore recommended by several international guidelines, but vaguely and not consistent. The treatments involved can be expensive, hard to integrate in everyday life, have well-known side effects and some are not approved for the treatment of children. The aim of this review was to clarify the evidence behind treatment of human asymptomatic carriers of tinea capitis. Databases were searched for the 'tinea capitis', 'carriers' and 'treatment'. Inclusion criteria were clinical trials, observational and interventional studies including case series (10+ cases) and case reports in English, Danish, Swedish, Norwegian and French. Reviews, guidelines, unclear reports and in vitro trials were excluded. A systematic review identified 10 studies with low to moderate evidence levels. The topical treatments ketoconazole, povidone-iodine, miconazole and the systemic antifungals terbinafine and itraconazole have all shown significant effects in the mycological eradication of fungal conidia. General prophylactic hygienic measures may have a benefit. The scientific evidence behind the treatment of asymptomatic carriage of scalp dermatophytes is sparse and not of high quality. Yet, both topical and systemic antifungal agents show treatment efficacy. Considering the possible adverse effects, topical agents are preferable, but with necessary attention to the compliance of asymptomatic contacts with treatment.

Tinea capitis et barbae caused by Trichophyton tonsurans: A retrospective cohort study of an infection chain after shavings in barber shops

BACKGROUND

Tinea capitis is a highly contagious infectious disease caused by dermatophytes. In Central Europe, it is mainly caused by zoophilic dermatophytes, as, for example Microsporum (M) canis or Trichophyton (T) mentagrophytes and increasingly by anthropophilic fungi. T tonsurans was commonly related to the Tinea gladiatorum, where transmission occurred between infected persons or via contaminated floors.

OBJECTIVE

Reporting the transmission of this highly contagious dermatophyte for the first time via beard shaving and hairdressing in barber shops in Germany.

PATIENTS AND METHODS

18 young male patients developed tinea capitis and/or barbae shortly after shavings of the beard and/or hair in a barber shop. Native, cultural and molecular diagnostics as well as tissue biopsies and resistance tests were performed of skin and hair samples.

RESULTS

In all samples, T tonsurans could be identified. The medical history and the clinical picture suggest a transmission through contaminated hairdressing tools. The patients were treated with terbinafine or itraconazole in combination with or exclusively with topical antimycotics.

CONCLUSION

The transmission and a resulting increase in the incidence of infections with T tonsurans may be due to shavings with direct skin contact of insufficiently disinfected hairdressing tools. This path of infection has already been observed in Africa and is now being described for the first time in Germany. Knowledge of the pathogen and its transmission ways are essential to interrupt the chain of infection.

Molecular epidemiology of Tinea gladiatorum in contact sports in northern Iran

BACKGROUND

Tinea gladiatorum as the major health concern among combat athletes and the most common cause of a decrease in the quality of their sports activities.

OBJECTIVES

This study aimed to determine the molecular epidemiology of tinea gladiatorum in contact sports in Mazandaran Province, Northern Iran.

MATERIALS/METHODS

In total, 631 suspected athletes out of 4240 ones were screened for tinea gladiatorum in this cross-sectional study from May 2018 to February 2019. The infection was confirmed by direct microscopy and culture tests. The causative agents were identified by polymerase chain reaction-restriction fragment length polymorphism method on ITS rDNA region. The indoor environmental factors were evaluated in 81 sports halls in terms of temperature (°C), humidity (%), density (m² /athletes) and the number of ventilators.

RESULTS

Tinea gladiatorum was confirmed in 6.5% (278/4240) of the athletes. Tinea corporis was the most common type of tinea (192/278; 69.0%), and 175 cases (27.7%) had more than one type of tinea. Moreover, Trichophyton tonsurans (192/203; 94.5%) was the most aetiological agent in all athletes followed by Microsporum canis (6/203; 2.9%), Trichophyton rubrum (2/203; 0.9%) and Trichophyton interdigitale (1/203; 0.4%). There was no significant association between the prevalence of tinea gladiatorum and the indoor environmental factors.

CONCLUSION

T. tonsurans is the most common agent of tinea gladiatorum in Northern Iran. Since no positive culture of dermatophyte was obtained from mats, it seems that skin-to-skin contact would be the most probable mode of transmission among wrestlers. Accordingly, periodical checkups should be considered by health care providers.

Species Distinction in the Trichophyton rubrum Complex

The Trichophyton rubrum species complex comprises commonly encountered dermatophytic fungi with a worldwide distribution. The members of the complex usually have distinct phenotypes in culture and cause different clinical symptoms, despite high genome similarity. In order to better delimit the species within the complex, molecular, phenotypic, and physiological characteristics were combined to reestablish a natural species concept.

The Trichophyton rubrum species complex comprises commonly encountered dermatophytic fungi with a worldwide distribution. The members of the complex usually have distinct phenotypes in culture and cause different clinical symptoms, despite high genome similarity. In order to better delimit the species within the complex, molecular, phenotypic, and physiological characteristics were combined to reestablish a natural species concept. Three groups, T. rubrum, T. soudanense, and T. violaceum, could be distinguished based on the sequence of the internal transcribed spacer (ITS) ribosomal DNA barcode gene. On average, strains within each group were similar by colony appearance, microscopy, and physiology, but strains between groups showed significant differences. Trichophyton rubrum strains had higher keratinase activity, whereas T. violaceum strains tended to be more lipophilic; however, none of the phenotypic features were diagnostic. The results of matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and amplified fragment length polymorphism (AFLP) were partially consistent with the ITS data but failed to distinguish the species unambiguously. Despite their close similarity, T. violaceum, T. soudanense, and T. rubrum can be regarded as independent species with distinct geographical distributions and clinical predilections. Trichophyton soudanense is pheno- and genotypically intermediate between T. rubrum and T. violaceum. For routine diagnostics, ITS sequencing is recommended.

Molecular characterization and antifungal susceptibility profile of dermatophytes isolated from scalp dermatophyte carriage in primary school children in Arak city, Center of Iran

OBJECTIVE

Asymptomatic carriage is a condition of positive dermatophyte scalp culture without signs and symptoms of tinea capitis. Carriers are the source of dermatophytes that are able to transfer fungal agents to other people. The aim of this study was evaluating asymptomatic dermatophyte scalp carriage among students of primary schools in Arak city.

MATERIALS AND METHODS

Sampling by a sterilized hairbrush from scalp was performed among 3174 students. Hairbrush was inoculated onto Mycosel agar plates. Dermatophyte isolates were identified by PCR-RFLP using MvaI enzyme. In vitro antifungal susceptibility test was done according to the Clinical and Laboratory Standards Institute (CLSI) M38-A2 protocol. The antifungal drugs used included griseofulvin (GRZ), terbinafine (TER), itraconazole (ITC) and fluconazole (FLU).

RESULTS

A total of 3174 schoolchildren were screened, 15 cases (0.48%) had a positive culture for dermatophytes. Asymptomatic carriers including 11 (73.3%) boys and 4 (26.7%) girls and their age range were between 7-12 years. Trichophyton tonsurans (80%), T. interdigitale (13.3%) and T. rubrum (6.7%) were the most common isolated dermatophyte. Based on the obtained antifungal susceptibility results, terbinafine had the lowest and fluconazole had the highest MIC values for all of the tested dermatophyte isolates.

CONCLUSION

In the study, T. tonsurans was the most common species isolated from asymptomatic carriers and of the four antifungals tested, terbinafine had the most active antifungal in vitro against all isolates. Identifying and treating scalp dermatophyte carriers can prevent the spread of tinea capitis in the community.

The survey of tinea capitis and scalp dermatophyte carriage in nursing home residents

Tinea capitis is a contagious dermatophyte infection of scalp and associated hairs. On the other hand, asymptomatic carriage is a status of positive dermatophyte scalp culture, but without signs or symptoms of tinea capitis, and no evidence of hair shaft invasion confirmed by direct microscopy. Tinea capitis and asymptomatic carriage mostly occur in children, but adult females are becoming another population in recent decades. In this study, we focused on the prevalence and related fungi of tinea capitis and asymptomatic carriage in elderly by the shampoo brush method, as well as the source of transmission, in 10 nursing home residents. Two hundred and thirteen residents were screened, and 186 isolates were identified, of which only three were dermatophytes (1.4%). The scalp dermatophyte isolates were identified as Trichophyton rubrum by morphological characters and sequences comparisons in all three cases. After revisiting, these cases were proved to be asymptomatic carriers by negative microscopic and culture examination; however, two cases were found to have concurrent tinea pedis and onychomycosis, which were identified as T. rubrum and Trichophyton interdigitale. The source of the T. rubrum scalp carriage may come from tinea elsewhere on the body of the same subject or from other people in the same institute. Finding and treating the source of carriage, as well as treating scalp carriage patients according to the colony counts, may help prevent disease spreading.

Spectrum and burden of dermatophytes in children

Tinea capitis is the most important superficial fungal condition in children. It is often unrecognised but the presence of alopecia, scale and lymphadenopathy, especially in inner-city children should prompt investigation. An understanding of changing epidemiology and prevalence of causative organisms is important in deciding appropriate therapy. The use of diagnostic aids including dermoscopy is increasing and is reported to be helpful in identifying subtle signs. Trichophyton tonsurans accounts for the majority of cases in the UK and terbinafine is increasingly advocated as a safe and effective therapy. Exclusion from school is unnecessary provided the child is receiving appropriate systemic and topical therapy, but family members should be screened and carriers should receive treatment. Steroids and surgical treatments should be avoided. Treatment failure is common and may be multifactorial. Mycological cure after completing treatment should be sought and therefore follow up is necessary for Tinea capitis cases. Development of molecular diagnostic methods may improve our ability to diagnose Tinea capitis accurately and quickly in the future. Emerging new dermatophytoses affecting other anatomical sites are discussed which, although not common in the UK, may be seen due to increasing travel worldwide.

Fungal Infections From Human and Animal Contact

Fungal infections in humans resulting from human or animal contact are relatively uncommon, but they include a significant proportion of dermatophyte infections. Some of the most commonly encountered diseases of the integument are dermatomycoses. Human or animal contact may be the source of all types of tinea infections, occasional candidal infections, and some other types of superficial or deep fungal infections. This narrative review focuses on the epidemiology, clinical features, diagnosis and treatment of anthropophilic dermatophyte infections primarily found in North America. Other human-acquired and zoonotic fungal infections also are discussed in brief.

The kerion: an angry tinea capitis

Tinea capitis has a high incidence with a global changing pathogen distribution, making this condition a public health concern around the world. As the infection is initially asymptomatic, it is easily spread. Moreover, it is present in many fomites, including hairbrushes, pillows, and bedding. Prompt recognition and treatment is necessary for kerion, an inflammatory subtype characterized by tender boggy plaques with purulent drainage. Kerion is usually associated with infection by zoophilic dermatophytes, although other sources have been described. Treatment for this severe form of dermatophytic infection can be challenging. In addition to the use of topical treatments, oral administration of griseofulvin, terbinafine, itraconazole, or fluconazole is often required. Griseofulvin, the first-line treatment, may not completely eradicate pathogen colonization of the host and may contribute to reinfection and prevalence of infective but asymptomatic carriers. This review highlights new agents that are being evaluated for the treatment of kerion and typical tinea capitis, enhanced diagnostic criteria, and a grading system for kerion evaluation.

[Outbreak of Trichophyton tonsurans ringworm in a health area of the Community of Madrid (Spain)]

BACKGROUND

Trichophyton tonsurans is a dermatophyte fungus that can cause ringworm outbreaks. In our health area in September 2013, two cases of T. tonsurans ringworm were diagnosed in children who lived in a Children's Centre.

AIMS

To determine the origin and extent of the outbreak.

METHODS

Mycological cultures of scalp and skin samples from the contacts of the diagnosed cases were performed, as well as environmental samples from the Children's Centre. The patients started with a treatment for their ringworm, and an environmental disinfection of the centre was performed.

RESULTS

Twelve cases of ringworm were detected, along with three asymptomatic scalp carriers of T. tonsurans among 20 children in the Centre. The index case was a resident in whose family, that had just returned from their country of origin, Nigeria, three cases of ringworm were diagnosed. From November 2013 to February 2014 another five cases of ringworm were diagnosed among schoolmates of three cases from the Children's Centre.

CONCLUSIONS

The antifungal treatment of the children resulted in the mycological and clinical resolution, and from February to November 2014 no other cases of ringworm by T. tonsurans in the same health area were diagnosed.

Dermatophytes and transmission risks to family: a retrospective study of a cohort of 256 adopted children from 1998 to 2012

In this 14-year retrospective study we analyzed samples collected from 101 adopted children originating from developing countries in search of dermatophytosis; a dermatophyte was isolated in 44 children. We demonstrated that dermatophytoses often have a silent clinical presentation (16%) and in approximately 20% of cases cause family member contamination. This study highlights the importance of the clinical examination of children and families as well as systematic sampling of children to avoid dermatophyte transmission to other family members.

Tinea capitis and tinea faciei in the Zurich area - an 8-year survey of trends in the epidemiology and treatment patterns

BACKGROUND

Tinea capitis and tinea faciei are dermatophyte infections of the scalp and glabrous skin of the face affecting mainly prepubertal children. During the past 30 years, a significant increase and a change in the pattern of infectious agents has been noted for tinea capitis.

OBJECTIVES

The aim of this study was to determine trends in the current epidemiological situation of tinea capitis and tinea faciei in the Zurich area, Switzerland and adjacent Central and Eastern Switzerland.

METHODS

Consecutive cases diagnosed between 2006 and 2013 were studied retrospectively.

RESULTS

A total of 90 tinea capitis and 40 tinea faciei cases were observed. Anthropophilic isolates (primarily Trichophyton violaceum and Microsporum audouinii) accounted for 76% of tinea capitis cases. In contrast, zoophilic isolates (primarily T. interdigitale) were responsible for 73% of tinea faciei cases. The peak incidence in both conditions was in 4-8 year-old children. While the annual number of tinea faciei cases remained stable over the past 8 years, a trend for an increase in T. violaceum-positive tinea capitis has been observed. This was mainly due to patients of African ethnicity.

CONCLUSIONS

Anthropophilic isolates accounted for three quarters of tinea capitis and one quarter of tinea faciei cases. T. violaceum-positive tinea capitis was primarily linked to patients of African ethnicity. Tinea capitis caused by Microsporum spp. was more refractory to therapy and needed longer treatment than Trichophyton spp.-induced infection.

Screening for asymptomatic scalp carriage in household contacts of patients with tinea capitis during 1997-2011: a retrospective hospital-based study

For anthropophilic tinea capitis (TC), household spread and asymptomatic scalp carriage (ASC) is considered an important route of transmission and incomplete clearance. To investigate ASC in household contacts of patients diagnosed with TC in a tertiary hospital in Athens, Greece, we retrospectively reviewed the medical files of household contacts that were screened for ASC from 1997 to 2011. Only 34 household contacts of 15 index cases agreed to come for screening. Thirty-three (97%) household contacts were asymptomatic scalp carriers. The most commonly isolated species was Trichophyton violaceum (59%). There was a statistically significant association of ASC with the isolated dermatophyte species (T. violaceum, P-value: 0.029), and with the age of younger than 16 years old (P-value: 0.005), while there was no association with gender (P-value: 0.672). A small number of household contacts accepted to proceed for screening. ASC was found in nearly all screened household contacts and was associated with T. violaceum and younger age. The low number of household contacts that accepted screening may reflect the ignorance of the general population about the possibility of ASC among household contacts in case of a patient with TC.

Tinea capitis in Botswana

Background

Tinea capitis (TC) is a common dermatophyte infection of the scalp that can also involve the eyebrows and eyelashes.

Aim

This study aimed to find the causative fungus responsible for TC in Botswana and determine its association with the clinical types of TC.

Methods

Samples for potassium hydroxide 10% mounts and fungal cultures were collected in a microbiology laboratory at the National Health Laboratory, Gaborone, Botswana. Dermasel agar and Sabouraud dextrose agar were inoculated with the samples. Lactophenol cotton blue mounts were prepared from the culture-positive samples to study the morphological characteristics.

Results

Trichophyton violaceum was found to be the predominant causative organism of TC. Trichophyton tonsurans was isolated from one patient. Both are anthropophilic species.

Conclusion

TC was found to be most common in those aged 1–15 years (81%). Of 17 patients in this age group, 16 were younger than 10 years old and one was 14 years old. T. violaceum was the most common dermatophyte species isolated.

Trichophyton tonsurans scalp carriage among wrestlers in a national competition in Turkey

Trichophyton tonsurans tinea gladiatorum is an emerging epidemic among combat-sport athletes across the globe. In the present study, we investigated the prevalence of symptomatic and asymptomatic dermatophytic infections among wrestlers in the National Greco-Roman Championship in Turkey. In total, 194 wrestlers from 32 provinces and 72 clubs were examined for scalp, trunk, groin, and toe web dermatophytic infections. We also administered a questionnaire to obtain information on the participants' lifestyles, wrestling characteristics, and risk factors for dermatophytic infections. The hairbrush method was used for scalp and trunk sampling, whereas a cotton swab was used for groin, toe web, and mat sampling. Three wrestling mats in the gymnasium were surveyed for dermatophytes using the touch preparation method. A total of 17 (8.8%) wrestlers harbored dermatophytes, and 22 strains were isolated: 13 (59.1%) T. tonsurans and 9 (40.9%) T. rubrum. These isolates were found on the scalp (8), trunk (2), forearm (1), hand (1), groin (3), and feet (7). In addition, we recovered 8 dermatophyte strains from the 150 mat samples (5.3%): T. rubrum in 6 samples (75%) and T. tonsurans in two samples (25%). T. tonsurans was only recovered from 11 out of 194 (5.7%) wrestlers. Scalp carriage represents the predominant (72.7%) clinical picture of a T. tonsurans infection in these Greco-Roman wrestlers in Turkey.

Epidemiology of dermatophyte infections in Stockholm, Sweden: a retrospective study from 2005-2009

Dermatophytic infections are common worldwide but the distribution of dermatophyte species varies among geographical areas and changes over time. The aim of this study was to determine the epidemiologic profile of dermatophytosis in Stockholm, Sweden. Laboratory records comprising direct microscopy and culture results of 37,503 specimens from skin, hair and nail scrapings collected from January 2005 through December 2009 were retrospectively analyzed in the mycology laboratory at Karolinska University Hospital. Onychomycosis had, over time, the highest overall prevalence of 14.1%, followed by tinea pedis (4.4%). Trichophyton rubrum was the predominant pathogen isolated from these cases (83.2%), followed by T. mentagrophytes (7.4 %). In contrast, T. violaceum and T. soudanense accounted for 81.6% of the isolates from patients with tinea capitis.

Microsporum audouinii tinea capitis in a Swiss school: assessment and management of patients and asymptomatic carriers

We report three cases involving 7- to 8-year-old children from a Swiss school who had refractory tinea capitis due to an unusual strain of Microsporum audouinii which perforates hair in vitro. The patients showed no response to modern oral antifungal drugs like terbinafine and fluconazole. After switching to oral griseofulvin, two of the patients had a complete recovery, while the third was cured after the introduction of oral itraconazole. Given the high potential for contagion of this anthropophilic dermatophyte, all family members and three entire school classes were screened using the 'toothbrush technique'. Three family members and five class-mates were found to be asymptomatic carriers of M. audouinii and were consequently treated to avoid further transmission or reinfection of the treated patients. This is the first report of an outbreak of M. audouinii in Switzerland and underlines the importance of screening all contacts of patients with M. audouinii tinea capitis. Further, the effectiveness of griseofulvin in Microsporum tinea capitis has been corroborated, while newer antimycotic drugs like fluconazole or terbinafine failed.

Prevalence and causative fungal species of tinea capitis among schoolchildren in Gabon

Tinea capitis is endemic among schoolchildren in tropical Africa. The objective was to determine the prevalence of symptomatic tinea capitis in schoolchildren in Gabon. A cross-sectional study was conducted with 454 children aged 4-17 years, attending a rural school and an urban school. The diagnosis of tinea capitis was based on clinically manifest infection, direct microscopic examination using 20% potassium hydroxide (KOH) solution and fungal culture. Based on clinical examination, 105 (23.1%) of 454 children had tinea capitis. Seventy-four (16.3%) children were positive by direct examination (KOH) and/or fungal culture. The prevalence of tinea capitis depended on the school studied and ranged from 20.4% in the urban school with a higher socioeconomic status to 26.3% in the rural school with a lower socioeconomic status. Similarly, the spectrum of causative species varied between the different schools. Taken the schools together, Trichophyton soudanense (29.4%) was the most prominent species, followed by Trichophyton tonsurans (27.9%) and Microsporum audouinii (25.0%). Clinically manifest tinea capitis is endemic among schoolchildren in the Lambaréné region in Gabon. The prevalence of tinea capitis and the causative species depended on the type of school that was investigated.

Management of tinea capitis in childhood

Tinea capitis (TC) is a common dermatophyte infection affecting primarily prepubertal children. The causative pathogens belong to only two genera: Trichophyton and Microsporum. Although there is a great local variation in the epidemiology of TC worldwide, T. tonsurans is currently the most common cause of TC with M. canis second. Even though there is an emerging number of anthropophilic scalp infections, M. canis remains the predominant causative organism in many countries of the Mediterranean basin, the most important dermatophyte carriers being stray cats and dogs as well as pet puppies, kittens and rabbits. TC always requires systemic treatment because topical antifungal agents do not penetrate down to the deepest part of the hair follicle. Since the late 1950s, griseofulvin has been the gold standard for systemic therapy of TC. It is active against dermatophytes and has a long-term safety profile. The main disadvantage of griseofulvin is the long duration of treatment required which may lead to reduced compliance. The newer oral antifungal agents including terbinafine, itraconazole, ketokonazole, and fluconazole appear to have efficacy rates and potential adverse effects similar to those of griseofulvin in children with TC caused by Trichophyton species, while requiring a much shorter duration of treatment. They may, however, be more expensive.