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Kassem R, Barzilai A, Baum S, Kempfner A, Pavlotsky F. Improved effectiveness of an increased dose of griseofulvin for treating Tinea capitis among refugee children in Israel: A retrospective cohort study. Mycoses 2023; 66:1064-1070. [PMID: 37620517 DOI: 10.1111/myc.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Tinea capitis (TC), a fungal infection that occurs in children, is primarily caused by dermatophytes such as Trichophyton and Microsporum species. For Trichophyton species, treatment with terbinafine is considered more effective than griseofulvin treatment. Specific populations, such as refugee children, are more susceptible to TC. OBJECTIVE This study aimed to describe and compare the response to treatment among Israeli and refugee children with TC. PATIENTS/METHODS We retrospectively reviewed data collected on refugee and Israeli children with TC between January 2004 and January 2020. RESULTS Overall, 3358 children with TC (refugees: 1497; Israelis: 1861) were identified. Among these, 86% of the refugee children had TC caused by Trichophyton violaceum, 65% of the Israeli children had TC caused by Microsporum canis and 83% of all children were treated with griseofulvin. Overall, 14% of the refugees showed a partial response to a griseofulvin dose of ≤25 mg/kg/day; however, they showed a complete response upon increasing the dose to ≥30 mg/kg/day. No significant adverse effects were observed. CONCLUSION The over-crowded day care centres and dense living make refugee children more susceptible to TC than the general population, and griseofulvin dosage adjustment is necessary. TC, due to Trichophyton species, could benefit from receiving an increased dose of griseofulvin in a suspension form, which is cheaper than terbinafine.
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Affiliation(s)
- R Kassem
- Dermatology Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Barzilai
- Dermatology Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Baum
- Dermatology Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Kempfner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - F Pavlotsky
- Dermatology Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Evaluation of the Multiplex Real-Time PCR DermaGenius ® Assay for the Detection of Dermatophytes in Hair Samples from Senegal. J Fungi (Basel) 2021; 8:jof8010011. [PMID: 35049951 PMCID: PMC8781194 DOI: 10.3390/jof8010011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022] Open
Abstract
For the successful treatment of dermatophytoses, especially tinea capitis, there is a need for accurate and rapid diagnostic methods. A lot of recent literature has focused on the detection of dermatophytes directly on sample material such as nails, hair and skin scrapings. Molecular tools offer the ability to rapidly diagnose dermatophytosis within 48 h. This study aimed to compare the results of a commercial real-time PCR (real-time PCR) assay DermaGenius®(DG) 2.0 complete multiplex kit with those of conventional diagnostic methods (direct microscopy and culture). A total of 129 hair samples were collected in Dakar (Senegal) from patients suspected of dermatophytosis. DG was applied for the molecular detection of Candida albicans, Trichophyton rubrum/soudanense, T. interdigitale, T. tonsurans, T. mentagrophytes, T. violaceum, Microsporum canis, M. audouinii, Epidermophyton floccosum, T. benhamiae and T. verrucosum. Dermatophytes species and C. albicans were differentiated by melting curve analysis. The sensitivity and specificity of the PCR assay were 89.3% and 75.3%, respectively. DG PCR was significantly more sensitive than culture (p < 0.001). DG PCR is fast and robust to contamination. In this paper, the main questions discussed were the replacement of culture by a broad-spectrum fungal real-time PCR and the implementation of DG PCR into a routine laboratory in Senegal.
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Kassem R, Shemesh Y, Nitzan O, Azrad M, Peretz A. Tinea capitis in an immigrant pediatric community; a clinical signs-based treatment approach. BMC Pediatr 2021; 21:363. [PMID: 34445992 PMCID: PMC8390185 DOI: 10.1186/s12887-021-02813-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/16/2021] [Indexed: 12/23/2022] Open
Abstract
Background Tinea capitis is a common cutaneous infection of the scalp and hair follicles, typically diagnosed by direct examination and culture. Treatment with oral antifungals is usually withheld until mycology results are available. In Israel, African refugee children demonstrate higher susceptibility to Tinea capitis and generally fail to undergo follow-up evaluations. Methods This study aimed to identify the clinical characteristics and treatment responses of refugee children in Israel with Tinea capitis, in order to formulate a treatment plan for primary care physicians. To this end, demographic, clinical and laboratory data were extracted from the electronic medical records of 76 refugee children presenting with Tinea capitis during 2016–2017. All measured variables and derived parameters are presented using descriptive statistics. The correlation between background clinical and demographic data and Tinea capitis diagnosis was assessed using the chi-squared and Wilcoxon tests. Correlations between demographic/clinical/laboratory characteristics and other types of fungi or other important findings were assessed using a T-test. Results Scaling was the most common clinical finding. Cultures were positive in 64 (84%) and direct examination in 65 (85%) cases, with a positive correlation between the methods in 75% of cases. The most common fungal strain was T. violaceum. Fluconazole treatment failed in 27% of cases. Griseofulvin 50 mg/kg/day was administered to 74 (97%) children, and induced clinical responses. No side effects were reported. Conclusions The key aim of this study was to emphasize the importance of diagnosis and treatment of these immigrant children by their primary pediatric doctor since it takes, an average of 4.3 months until they visit a dermatologist. During this critical time period, the scalp can become severely and permanently damaged, and the infection can become systemic or cause an outbreak within the entire community. In conclusion, we recommend to relate to scaly scalp in high-risk populations as Tinea capitis, and to treat with griseofulvin at a dosage of up to 50 mg/kg/day, starting from the first presentation to the pediatrician.
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Affiliation(s)
- Riad Kassem
- Dermatology Department, Sheba Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yahel Shemesh
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orna Nitzan
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Infectious Disease Unit, Baruch Padeh Medical Center, Poriya, Israel
| | - Maya Azrad
- Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Israel
| | - Avi Peretz
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel. .,Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poriya, Israel.
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A Retrospective Study of Tinea Capitis Management in General Pediatric Clinics and Pediatric Emergency Departments at 2 US Centers. J Pediatr 2021; 234:269-272. [PMID: 33794219 DOI: 10.1016/j.jpeds.2021.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/19/2021] [Accepted: 03/25/2021] [Indexed: 12/16/2022]
Abstract
We examine management practices of tinea capitis at 2 US academic centers. The majority of providers treated tinea capitis with the oral antifungal agent griseofulvin and did not obtain a fungal culture. We recommend newer antifungal treatments such as terbinafine and fluconazole and obtaining a fungal culture for effective treatment.
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Deh A, Diongue K, Diadie S, Diatta BA, Diop K, Ndour N, Ndiaye M, Diallo M, Niang SO. Kerion celsi due to Microsporum audouinii: a severe form in an immunocompetent girl. Ther Adv Infect Dis 2021; 8:20499361211020879. [PMID: 34123381 PMCID: PMC8175834 DOI: 10.1177/20499361211020879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
A 9-year-old girl presented a large inflammatory cup-shaped scalp lesion with alopecia surrounded by pustules, dander, and suppuration associated with an occipital inflammatory lymphadenopathy for 1 month. Wood's light exam was positive as well as KOH mount showing ectothrix type hair involvement. Hair and pus culture on Sabouraud dextrose agar (SDA) added with chloramphenicol and supplemented with cycloheximide isolated a dermatophyte species identified as Microsporum audouinii according to the colonies features. Species identification was confirmed by matrix-assisted laser desorption-ionization-time of flight mass spectrometry (MALDI-TOF MS) and the patient was treated for kerion celsi with terbinafine tablets 125 mg per day associated with a ketoconazole-based shampoo. The evolution was favorable, with hair regrowth after 2 months.
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Affiliation(s)
- Aminata Deh
- Clinic of Dermatology, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Khadim Diongue
- Service of Parasitology and Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Avenue Cheikh Anta Diop, Dakar BO 3005, Senegal
| | - Saer Diadie
- Clinic of Dermatology, Aristide Le Dantec Hospital, Dakar, Senegal
| | | | - Khadim Diop
- Clinic of Dermatology, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Niar Ndour
- Clinic of Dermatology, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Maodo Ndiaye
- Clinic of Dermatology, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Moussa Diallo
- Clinic of Dermatology, Aristide Le Dantec Hospital, Dakar, Senegal
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Skin Fungal Infections in Children: Diagnostic Challenges. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Jerasutus S, Vejjabhinanta V, Prapapan O. Treatment of tinea capitis with topical 1% encapsulated terbinafine hydrochloride gel: A pilot study. Pediatr Dermatol 2020; 37:1090-1093. [PMID: 32951299 DOI: 10.1111/pde.14377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 08/14/2020] [Accepted: 08/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVE Oral antifungal agents are the mainstay of the therapy of pediatric tinea capitis. No approved topical medications for tinea capitis are found. We evaluated the therapeutic efficacy, safety, and tolerability of topical 1% encapsulated terbinafine hydrochloride gel for the treatment of pediatric tinea capitis. METHODS An open-label clinical trial was performed on 10 children with clinical and mycologically confirmed diagnosis of tinea capitis. Each child was prescribed topical 1% encapsulated terbinafine hydrochloride gel to be applied twice daily to the full scalp for 4 weeks. Clinical and mycological examinations were assessed 2 weeks after completion of treatment. Monitoring was performed for associated side effects during the treatment and follow-up periods. RESULTS Ten male patients were enrolled with a mean age of 10.3 years. A cure rate of 80% (n = 8) was noted 2 weeks after treatment completion. An additional 20% (n = 2) had mycological cure with incomplete, but significant clinical improvement. No significant side effects were reported. CONCLUSIONS This preliminary study demonstrated that topical 1% encapsulated terbinafine hydrochloride gel was an effective treatment for tinea capitis in children.
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Le M, Ghazawi FM, Gabrielli S, Alkhodair R, Sheppard DC, Jafarian F. Reply to: “Comment on ‘Efficacies and merits of the cotton swab technique for diagnosing tinea capitis in the pediatric population’”. J Am Acad Dermatol 2020; 83:e195-e196. [DOI: 10.1016/j.jaad.2020.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 11/16/2022]
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Le M, Gabrielli S, Ghazawi FM, Alkhodair R, Sheppard DC, Jafarian F. Efficacies and merits of the cotton swab technique for diagnosing tinea capitis in the pediatric population. J Am Acad Dermatol 2020; 83:920-922. [PMID: 31940462 DOI: 10.1016/j.jaad.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/24/2019] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michelle Le
- Division of Allergy, Immunology and Dermatology, McGill University, Montreal, Quebec, Canada
| | - Sofianne Gabrielli
- Division of Allergy, Immunology and Dermatology, McGill University, Montreal, Quebec, Canada
| | - Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rayan Alkhodair
- Division of Allergy, Immunology and Dermatology, McGill University, Montreal, Quebec, Canada
| | - Donald C Sheppard
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Fatemeh Jafarian
- Division of Allergy, Immunology and Dermatology, McGill University, Montreal, Quebec, Canada.
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Trichophyton as a Rare Cause of Postoperative Wound Infection Resistant to Standard Empiric Antimicrobial Therapy. Case Rep Pediatr 2019; 2018:3483685. [PMID: 30671272 PMCID: PMC6317086 DOI: 10.1155/2018/3483685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022] Open
Abstract
Fungal infections are rare causes of acute surgical wound infections, but Candida is not an infrequent etiology in chronic wound infections. Trichophyton species is a common cause of tinea capitis but has not been reported as a cause of neurosurgical wound infection. We report a case of Trichophyton tonsurans causing a nonhealing surgical wound infection in a 14-year-old male after hemicraniectomy. His wound infection was notable for production of purulent exudate from the wound and lack of clinical improvement despite empiric treatment with multiple broad-spectrum antibiotics targeting typical bacterial causes of wound infection. Multiple wound cultures consistently grew Trichophyton fungus, and his wound infection clinically improved rapidly after starting terbinafine and discontinuing antibiotics.
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11
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Abstract
The primary care provider will commonly see skin and soft tissue infections in the outpatient setting. Skin and soft tissue infections range from the uncomplicated impetigo to the potentially lethal necrotizing fasciitis. This article reviews these infections based on their underlying etiology: bacterial, fungal, and viral causes. This article discusses the etiology, presentation, evaluation, and management of impetigo, bullous impetigo, erysipelas, cellulitis, periorbital cellulitis, orbital cellulitis, folliculitis, furuncles, carbuncles, abscess, necrotizing fasciitis, sporotrichosis, tinea corporis, tinea pedis, tinea capitis, Herpes Simplex Virus, zoster, molluscum contagiosum, and warts.
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Affiliation(s)
- Karl T Clebak
- Department of Family and Community Medicine, Penn State College of Medicine, 121 North Nyes Road, Harrisburg, PA 17112, USA.
| | - Michael A Malone
- Department of Family Medicine, Tidelands Health MUSC Family Medicine Residency Program, 4320 Holmestown Road, Myrtle Beach, SC 29588, USA
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Gits-Muselli M, Benderdouche M, Hamane S, Mingui A, Feuilhade de Chauvin M, Guigue N, Picat MQ, Bourrat E, Petit A, Bagot M, Alanio A, Bretagne S. Continuous increase of Trichophyton tonsurans as a cause of tinea capitis in the urban area of Paris, France: a 5-year-long study. Med Mycol 2018; 55:476-484. [PMID: 27744309 DOI: 10.1093/mmy/myw107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/22/2016] [Indexed: 12/14/2022] Open
Abstract
Tinea capitis (TC) is a highly contagious fungal infection of the scalp due to dermatophytes in children. To obtain information on the epidemiology of TC in the urban area of Paris, we analysed the microbiological results of 3090 patients seen with suspected TC from October 2010 to September 2015 at Saint Louis hospital, Paris, France. A peak of TC was observed in 3-6 year-old children, followed by a progressive decrease until 16 years of age. Of the 1311 positive cultures, 95% (1246) yielded one of the three anthropophilic species [Trichophyton tonsurans (33.5%), Trichophyton soudanense (38.3%), or Microsporum audouinii (28.2%)]. When considering one TC case per family, we observed a significant increase of T. tonsurans (P = .018) during these 5 years. The increase was more pronounced (P = .0047) in patients of West-African descent (n = 666), and was at the expense of M. audouinii and T. soudanense. On the other hand, the Caribbean patients (n = 85) remained predominantly (72.9%) infected by T. tonsurans. Our results show a better virulence of T. tonsurans over other species as already reported. Since T. tonsurans has not been reported in Africa, the infection of patients of West-African descent probably took place in the Paris area by exchanges with Caribbean patients. This increase of TC due to T. tonsurans was observed in the context of griseofulvin being the only licensed paediatric treatment for TC in France, which should deserve reappraisal because terbinafine may be more efficacious.
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Affiliation(s)
- Maud Gits-Muselli
- Laboratoire de Parasitologie-Mycologie; AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal.,Université Paris-Diderot, Sorbonne Paris Cité
| | - Mazouz Benderdouche
- Laboratoire de Parasitologie-Mycologie; AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Samia Hamane
- Laboratoire de Parasitologie-Mycologie; AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Anselme Mingui
- Laboratoire de Parasitologie-Mycologie; AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Martine Feuilhade de Chauvin
- Laboratoire de Parasitologie-Mycologie; AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal.,Université Paris-Diderot, Sorbonne Paris Cité
| | - Nicolas Guigue
- Laboratoire de Parasitologie-Mycologie; AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Marie-Quitterie Picat
- Service de Biostatistique et Information Médicale, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Emmanuelle Bourrat
- Service de dermatologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, AP-HP
| | - Antoine Petit
- Service de dermatologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, AP-HP
| | - Martine Bagot
- Université Paris-Diderot, Sorbonne Paris Cité.,Service de dermatologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, AP-HP
| | - Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie; AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal.,Université Paris-Diderot, Sorbonne Paris Cité.,Inserm U976.,Institut Pasteur, Molecular Mycology Unit, National Reference Center of Invasive Mycoses and Antifungals, Paris, France
| | - Stéphane Bretagne
- Laboratoire de Parasitologie-Mycologie; AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal.,Université Paris-Diderot, Sorbonne Paris Cité.,Inserm U976.,Institut Pasteur, Molecular Mycology Unit, National Reference Center of Invasive Mycoses and Antifungals, Paris, France
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ŞAHAN YAPICIER Ö, ŞABABOĞLU EŞABABOĞLU, ÖZTÜRK D, PEHLİVANOĞLU F, KAYA M, TÜRÜTOĞLU H. KEDİ ve KÖPEKLERDEN DERMATOFİTLERİN İZOLASYONU. MEHMET AKIF ERSOY ÜNIVERSITESI VETERINER FAKÜLTESI DERGISI 2017. [DOI: 10.24880/maeuvfd.359535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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14
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Möhrenschlager M, Seidl HP, Holtmann C, Ring J, Abeck D. Microsporum-canis-bedingte Tinea capitis et corporis bei einer immunsupprimierten erwachsenen Patientin. Mycoses 2017. [DOI: 10.1111/j.1439-0507.2003.tb00032.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Möhrenschlager
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein; Technische Universität München; München Deutschland
| | - H. P. Seidl
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein; Technische Universität München; München Deutschland
| | - Christiane Holtmann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein; Technische Universität München; München Deutschland
| | - J. Ring
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein; Technische Universität München; München Deutschland
| | - D. Abeck
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein; Technische Universität München; München Deutschland
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Bhat YJ, Zeerak S, Kanth F, Yaseen A, Hassan I, Hakak R. Clinicoepidemiological and Mycological Study of Tinea Capitis in the Pediatric Population of Kashmir Valley: A Study from a Tertiary Care Centre. Indian Dermatol Online J 2017; 8:100-103. [PMID: 28405548 PMCID: PMC5372428 DOI: 10.4103/2229-5178.202279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Tinea capitis is a superficial fungal infection that predominantly affects the pediatric population. The etiological factors vary from region to region, and the exact incidence remains obscure. The clinicoepidemiological and mycological aspects of this dermatophytosis were studied in a tertiary care centre in Kashmir valley. AIM To determine the clinicoepidemiological aspects and mycological findings of dermatophytes involved in tinea capitis cases in Kashmir valley. MATERIALS AND METHODS Wood's lamp examination, KOH examination, and fungal culture were performed in one hundred fifty clinically diagnosed cases of tinea capitis with patients' age upto 14 years over a period of 6 months. The epidemiological factors associated with the disease were also evaluated. RESULTS Tinea capitis was predominant in the 3-6 and 6-9 years age groups with a male preponderance. Grey patch tinea capitis was the most common variant. KOH positivity was 76%, and Trichophyton tonsurans was the most common fungal isolate. CONCLUSION Tinea capitis is a very common fungal infection in our setting. Early detection and diagnosis is mandatory to prevent its spread in the community as well as the development of scarring alopecia in the affected individual.
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Affiliation(s)
- Yasmeen J Bhat
- Department of Dermatology, STD and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Sumaya Zeerak
- Department of Dermatology, STD and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Farhat Kanth
- Department of Microbiology, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Atiya Yaseen
- Department of Dermatology, STD and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Iffat Hassan
- Department of Dermatology, STD and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Rubina Hakak
- Department of Microbiology, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
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Epidemiología de la tinea capitis: 19 años de experiencia en un laboratorio clínico especializado en Colombia. INFECTIO 2016. [DOI: 10.1016/j.infect.2015.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
PURPOSE OF REVIEW Hair loss is common in infants and children and the ability to distinguish why a child is losing hair enables providers to distinguish hair loss that is related to infection, autoimmune conditions, nutrition, medications, trauma/traction, or underlying genetic disorders such as ectodermal dysplasias. Making these distinctions leads to best management and guidance for patients and their families. RECENT FINDINGS Careful physical examination of the hair, scalp, skin, and nails coupled with dermoscopy or trichoscopy, or both, can yield more accurate and faster diagnosis. Biopsy is rarely needed in children for hair loss conditions. SUMMARY Hair loss, particularly on the scalp, can affect all ages and can impact patients socially and emotionally. The majority of hair loss in children is nonscarring. Diagnosis begins with a good history, including personal and family history, medication use, a thorough physical examination, and use of dermoscopy or trichoscopy, or both. With these, providers can begin to divide hair loss into congenital vs. acquired, and then further subdivide into focal vs. diffuse and scarring vs. nonscarring. Secondary change, including scale and erythema, can further help with diagnosis.
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Prevalence of Tinea Capitis among School Children in Nok Community of Kaduna State, Nigeria. J Pathog 2016; 2016:9601717. [PMID: 27471603 PMCID: PMC4947659 DOI: 10.1155/2016/9601717] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/28/2016] [Accepted: 04/17/2016] [Indexed: 11/18/2022] Open
Abstract
In recent years, the prevalence of tinea capitis, an infection of the scalp by dermatophytes, has increased in children worldwide. This cross-sectional study was carried out to determine the prevalence and risk factor of tinea capitis among school children in Nok community of Kaduna State, Nigeria. A total of 100 children were screened and 45% were diagnosed to have tinea capitis after fungal culture and microscopy. The prevalence of tinea capitis among girls was higher (51.4%) than that among boys (41.5%) but not significantly different (p = 0.402). The prevalence with respect to age was lower for the age group 5-10 years (42.6%) than that of 11-15 years (50%) but was not significantly different (p = 0.524). Trichophyton rubrum (28.8%) and Microsporum canis (22.7%) were the most prevalent dermatophytes isolated and the least were Trichophyton verrucosum (4.5%) and Trichophyton tonsurans (4.5%). There were 73.3% single infection while 26.7% had 2-4 dermatophytes of the genera Microsporum and Trichophyton. The predisposing factors with statistically significant association with tinea capitis were number of children in the family (p = 0.02) and sharing of the same bed (p = 0.002). This indicates the high tendencies of spread of tinea capitis through human-to-human mode of transmission and possible animal contact. Community health education on the cause, mode of transmission, prevention, and prompt treatment of tinea capitis is recommended.
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Chen X, Jiang X, Yang M, González U, Lin X, Hua X, Xue S, Zhang M, Bennett C. Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev 2016; 2016:CD004685. [PMID: 27169520 PMCID: PMC8691867 DOI: 10.1002/14651858.cd004685.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tinea capitis is a common contagious fungal infection of the scalp in children. Systemic therapy is required for treatment and to prevent spread. This is an update of the original Cochrane review. OBJECTIVES To assess the effects of systemic antifungal drugs for tinea capitis in children. SEARCH METHODS We updated our searches of the following databases to November 2015: the Cochrane Skin Group Specialised Register, CENTRAL (2015, Issue 10), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), and CINAHL (from 1981). We searched five trial registers and checked the reference lists of studies for references to relevant randomised controlled trials (RCTs). We obtained unpublished, ongoing trials and grey literature via correspondence with experts in the field and from pharmaceutical companies. SELECTION CRITERIA RCTs of systemic antifungal therapy in children with normal immunity under the age of 18 with tinea capitis confirmed by microscopy, growth of fungi (dermatophytes) in culture or both. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 25 studies (N = 4449); 4 studies (N = 2637) were new to this update.Terbinafine for four weeks and griseofulvin for eight weeks showed similar efficacy for the primary outcome of complete (i.e. clinical and mycological) cure in three studies involving 328 participants with Trichophyton species infections (84.2% versus 79.0%; risk ratio (RR) 1.06, 95% confidence interval (CI) 0.98 to 1.15; low quality evidence).Complete cure with itraconazole (two to six weeks) and griseofulvin (six weeks) was similar in two studies (83.6% versus 91.0%; RR 0.92, 95% CI 0.81 to 1.05; N = 134; very low quality evidence). In two studies, there was no difference between itraconazole and terbinafine for two to three weeks treatment (73.8% versus 78.8%; RR 0.93, 95% CI 0.72 to 1.19; N = 160; low quality evidence). In three studies, there was a similar proportion achieving complete cured with two to four weeks of fluconazole or six weeks of griseofulvin (41.4% versus 52.7%; RR 0.92, 95% CI 0.81 to 1.05; N = 615; moderate quality evidence). Current evidence for ketoconazole versus griseofulvin was limited. One study favoured griseofulvin (12 weeks) because ketoconazole (12 weeks) appeared less effective for complete cure (RR 0.76, 95% CI 0.62 to 0.94; low quality evidence). However, their effects appeared to be similar when the treatment lasted 26 weeks (RR 0.95, 95% CI 0.83 to 1.07; low quality evidence). Another study indicated that complete cure was similar for ketoconazole (12 weeks) and griseofulvin (12 weeks) (RR 0.89, 95% CI 0.57 to 1.39; low quality evidence). For one trial, there was no significant difference for complete cure between fluconazole (for two to three weeks) and terbinafine (for two to three weeks) (82.0% versus 94.0%; RR 0.87, 95% CI 0.75 to 1.01; N = 100; low quality evidence). For complete cure, we did not find a significant difference between fluconazole (for two to three weeks) and itraconazole (for two to three weeks) (82.0% versus 82.0%; RR 1.00, 95% CI 0.83 to 1.20; low quality evidence).This update provides new data: in children with Microsporum infections, a meta-analysis of two studies found that the complete cure was lower for terbinafine (6 weeks) than for griseofulvin (6-12 weeks) (34.7% versus 50.9%; RR 0.68, 95% CI 0.53 to 0.86; N = 334; moderate quality evidence). In the original review, there was no significant difference in complete cure between terbinafine (four weeks) and griseofulvin (eight weeks) in children with Microsporum infections in one small study (27.2% versus 60.0%; RR 0.45, 95% CI 0.15 to 1.35; N = 21; low quality evidence).One study provides new evidence that terbinafine and griseofulvin for six weeks show similar efficacy (49.5% versus 37.8%; RR 1.18, 95% CI 0.74 to 1.88; N = 1006; low quality evidence). However, in children infected with T. tonsurans, terbinafine was better than griseofulvin (52.1% versus 35.4%; RR 1.47, 95% CI 1.22 to 1.77; moderate quality evidence). For children infected with T. violaceum, these two regimens have similar effects (41.3% versus 45.1%; RR 0.91, 95% CI 0.68 to 1.24; low quality evidence). Additionally, three weeks of fluconazole was similar to six weeks of fluconazole in one study in 491 participants infected with T. tonsurans and M. canis (30.2% versus 34.1%; RR 0.88, 95% CI 0.68 to 1.14; low quality evidence).The frequency of adverse events attributed to the study drugs was similar for terbinafine and griseofulvin (9.2% versus 8.3%; RR 1.11, 95% CI 0.79 to 1.57; moderate quality evidence), and severe adverse events were rare (0.6% versus 0.6%; RR 0.97, 95% CI 0.24 to 3.88; moderate quality evidence). Adverse events for terbinafine, griseofulvin, itraconazole, ketoconazole, and fluconazole were all mild and reversible.All of the included studies were at either high or unclear risk of bias in at least one domain. Using GRADE to rate the overall quality of the evidence, lower quality evidence resulted in lower confidence in the estimate of effect. AUTHORS' CONCLUSIONS Newer treatments including terbinafine, itraconazole and fluconazole are at least similar to griseofulvin in children with tinea capitis caused by Trichophyton species. Limited evidence suggests that terbinafine, itraconazole and fluconazole have similar effects, whereas ketoconazole may be less effective than griseofulvin in children infected with Trichophyton. With some interventions the proportion achieving complete clinical cure was in excess of 90% (e.g. one study of terbinafine or griseofulvin for Trichophyton infections), but in many of the comparisons tested, the proportion cured was much lower.New evidence from this update suggests that terbinafine is more effective than griseofulvin in children with T. tonsurans infection.However, in children with Microsporum infections, new evidence suggests that the effect of griseofulvin is better than terbinafine. We did not find any evidence to support a difference in terms of adherence between four weeks of terbinafine versus eight weeks of griseofulvin. Not all treatments for tinea capitis are available in paediatric formulations but all have reasonable safety profiles.
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Affiliation(s)
- Xiaomei Chen
- West China Hospital, Sichuan UniversityDepartment of Dermatology & VenereologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Xia Jiang
- West China Hospital, Sichuan UniversityDepartment of Dermatology & VenereologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Ming Yang
- West China Hospital, Sichuan UniversityCenter of Geriatrics and GerontologyNo. 37, Guo Xue LaneChengduSichuanChina610041
| | - Urbà González
- CLĺNICA GO&FERUnit of DermatologyRiera Blanca 6‐8, L´HospitaletBarcelonaSpain08903
| | - Xiufang Lin
- West China Hospital, Sichuan UniversityCenter of Geriatrics and GerontologyNo. 37, Guo Xue LaneChengduSichuanChina610041
| | - Xia Hua
- West China Hospital, Sichuan UniversityDepartment of Dermatology & VenereologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Siliang Xue
- West China Hospital, Sichuan UniversityDepartment of Dermatology & VenereologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Min Zhang
- West China Hospital, Sichuan UniversityDepartment of Dermatology & VenereologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Cathy Bennett
- Coventry UniversityCentre for Technology Enabled Health Research (CTEHR)Priory StreetCoventryUKCV1 5FB
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Gray RM, Champagne C, Waghorn D, Ong E, Grabczynska SA, Morris J. Management of a Trichophyton tonsurans outbreak in a day-care center. Pediatr Dermatol 2015; 32:91-6. [PMID: 25257708 DOI: 10.1111/pde.12421] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Trichophyton tonsurans is the leading cause of tinea capitis in the United Kingdom (UK) as well as causing tinea corporis. This organism has been linked to several outbreaks in the UK and abroad, and such outbreaks may be prolonged since T. tonsurans can be difficult to control. There remains an incomplete consensus in the literature on the optimal management of such outbreaks of this infection. Following notification that a child with T. tonsurans was identified at a day-care center in the UK, initial investigations identified nine cases of fungal infection involving children and staff over the previous 7 months. We report on the management of an outbreak of T. tonsurans tinea capitis and tinea corporis among children and staff in a day-care center. An outbreak control team with representatives from dermatology, microbiology, day-care center management, and the Health Protection Agency initiated case ascertainment by scalp inspection and brushing of all children and staff at the nursery. Two complete rounds of screening were required before the outbreak was declared over. Infection control measures included antifungal shampoo use, exclusion of identified cases for a short period, removal of shared items from the center, and enhanced decontamination of fomites. The outbreak, which lasted longer than 12 months, involved 12 children and 7 staff members. Of these, 12 cases were confirmed by positive fungal culture. T. tonsurans is difficult to manage, especially in childcare settings, but case ascertainment, appropriate treatment with oral agents, and sustained infection control measures can be effective in controlling such outbreaks.
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Affiliation(s)
- Robert M Gray
- Thames Valley Public Health England Centre, Oxfordshire, UK
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Abstract
A case of a tinea favosa involving the scalp of a child represented in the painting
"Boys climbing a tree" (Muchachos trepando a un árbol), by Francisco Goya y
Lucientes, with pictorial representation of favic scutula and consequent
alopecia.
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Zink A, Papanagiotou V, Todorova A, Seidl HP, Niedermeier A, Ring J, Traidl-Hoffmann C. Outbreak of Microsporum audouinii in Munich--the return of infectious fungi in Germany. Mycoses 2014; 57:765-70. [PMID: 25175409 DOI: 10.1111/myc.12242] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/16/2014] [Accepted: 08/04/2014] [Indexed: 12/28/2022]
Abstract
After experiencing an unusually high number of Microsporum (M.) audouinii infections at our hospital within only a few weeks, we began to investigate and control an outbreak in Munich, Germany. Main goals of our health management were to treat infected persons, identify extent and form of transmission and to prevent new infections. We analysed data from structured interviews with patients and mycological cultures of swabs taken of patients and investigated involved public facilities. Outbreak management included antifungal treatment of patients, decontamination of affected facilities, the introduction of a temporary kindergarten ban for M. audouinii positive children and the organisation of educational meetings. Between March and August 2011, 16 children and 4 adults were identified with M. audouinii infections. The fungus was brought to Munich by the index patients from a family vacation in Africa and then spread to fellow children in kindergarten and subsequently to their families. All patients were treated successfully and the epidemic was declared ceased after 40 weeks but causing considerable financial damage. Due to travelling and migration, M. audouinii infections will rise in Germany and Europe. Sufficient and sustainable strategies are needed for the management of future outbreaks of highly contagious fungi.
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Affiliation(s)
- Alexander Zink
- Department of Dermatology and Allergy, Biederstein, Technische Universität München, Munich, Germany; Institute of Environmental Medicine, Technische Universität München, Munich, Germany
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Abstract
Alopecia in childhood is a source of high concern, frustration, and anxiety. Delineating types of alopecia and those that are chronic or potentially related to underlying medical problems is important. There are 5 common types of hair loss in children: alopecia related to tinea capitis, alopecia areata spectrum/autoimmune alopecia, traction alopecia, telogen effluvium, and trichotillomania/trichotillosis. Hair-cycle anomalies including loose anagen syndrome can lead to sparse-appearing hair. Rarer reasons for alopecia in children include pressure-induced alopecia, alopecia related to nutritional deficiency or toxic ingestion, and androgenetic alopecia. Congenital lesions should be considered for areas of localized alopecia occurring at birth.
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Affiliation(s)
- Leslie Castelo-Soccio
- Section of Dermatology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 2nd Floor Dermatology, Philadelphia, PA 19104, USA.
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Dessinioti C, Papadogeorgaki E, Athanasopoulou V, Antoniou C, Stratigos AJ. Screening for asymptomatic scalp carriage in household contacts of patients with tinea capitis during 1997-2011: a retrospective hospital-based study. Mycoses 2014; 57:366-70. [PMID: 24372570 DOI: 10.1111/myc.12166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/27/2013] [Accepted: 12/02/2013] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Clio Dessinioti
- 1st Department of Dermatology, University of Athens, Andreas Syggros Hospital, Athens, Greece
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Lachapelle JM, Castel O, Casado AF, Leroy B, Micali G, Tennstedt D, Lambert J. Antiseptics in the era of bacterial resistance: a focus on povidone iodine. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/cpr.13.50] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fernandes S, Amaro C, da Luz Martins M, Inácio J, Araújo T, Vieira R, Silvestre MJ, Cardoso J. Kerion caused by Microsporum audouinii in a child. Med Mycol Case Rep 2013; 2:52-4. [PMID: 24432216 DOI: 10.1016/j.mmcr.2013.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/04/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022] Open
Abstract
Kerion celsi is rarely associated with Microsporum audouinii infection. We report the case of a 3-year-old girl with a kerion celsi caused by M. audouinii and successfully treated with oral terbinafine. Fungi identification was made by macro and microscopical colony morphology analyses and molecular (genotypic) studies.
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Affiliation(s)
- Sónia Fernandes
- Hospital Curry Cabral, Department of Dermatology and Venereology, Rua da Beneficência no. 8, Lisbon 1069-166, Portugal
| | - Cristina Amaro
- Hospital Curry Cabral, Department of Dermatology and Venereology, Rua da Beneficência no. 8, Lisbon 1069-166, Portugal
| | - Maria da Luz Martins
- Laboratório de Micologia, Medical Microbiology Unit, Instituto de Higiene e Medicina Tropical/CREM-Universidade Nova de Lisboa, Rua da Junqueira, Lisbon 1149-008, Portugal
| | - João Inácio
- Laboratório de Micologia, Medical Microbiology Unit, Instituto de Higiene e Medicina Tropical/CREM-Universidade Nova de Lisboa, Rua da Junqueira, Lisbon 1149-008, Portugal
| | - Teresa Araújo
- Hospital Curry Cabral, Clinical Pathology Department, Rua da Beneficência no. 8, Lisbon 1069-166, Portugal
| | - Raquel Vieira
- Hospital Curry Cabral, Department of Dermatology and Venereology, Rua da Beneficência no. 8, Lisbon 1069-166, Portugal
| | - Maria José Silvestre
- Hospital Curry Cabral, Clinical Pathology Department, Rua da Beneficência no. 8, Lisbon 1069-166, Portugal
| | - Jorge Cardoso
- Hospital Curry Cabral, Department of Dermatology and Venereology, Rua da Beneficência no. 8, Lisbon 1069-166, Portugal
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Abstract
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.
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Affiliation(s)
- Rameshwari Thakur
- Department of Microbiology, Muzaffarnagar Medical College, Muzaffarnagar, India
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Gupta AK, Drummond-Main C. Meta-analysis of randomized, controlled trials comparing particular doses of griseofulvin and terbinafine for the treatment of tinea capitis. Pediatr Dermatol 2013; 30:1-6. [PMID: 22994156 DOI: 10.1111/j.1525-1470.2012.01866.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two oral antifungal agents, griseofulvin and terbinafine, have regulatory approval in the United States, but it is unknown whether one has superior overall efficacy. Genus-specific differences in efficacy are believed to exist for the two agents. It is not clear at what doses and durations of treatment these differences apply. The goals of this meta-analysis were to determine whether a statistically significant difference in efficacy exists between these agents at a given dose and duration of each in tinea capitis infections overall and to determine whether a genus-specific difference in efficacy exists for these two treatments at a given dose and duration of each. We performed a literature search for clinically and methodologically similar randomized controlled trials comparing 8 weeks of griseofulvin (6.25-12.5 mg/kg/day) to 4 weeks of terbinafine (3.125-6.25 mg/kg/day) in the treatment of tinea capitis. A meta-analysis was performed using the Mantel-Haenszel method and random effects model; results were expressed as odds ratios with 95% confidence intervals. Meta-analysis of randomized controlled trials did not show a significant difference in the overall efficacy of the two drugs at the doses specified, but specific efficacy differences were observed based on the infectious species. For tinea capitis caused by Microsporum spp., griseofulvin is superior (p = 0.04), whereas terbinafine is superior for Trichophyton spp. infection (p = 0.04). Our results support species-specific differences in treatment efficacy between griseofulvin and terbinafine and provide a clinical context in which this knowledge may be applied.
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Abdel-Rahman SM, Wright KJ, Navarre HC. Griseofulvin Only Modestly Diminishes Persistence of Trichophyton tonsurans on the Scalp of Carriers. J Pediatr Pharmacol Ther 2012; 14:94-9. [PMID: 23055896 DOI: 10.5863/1551-6776-14.2.94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Using genetic strain typing, we previously identified a high rate of T. tonsurans carriage among preschool-aged children attending an urban daycare center. No treatment was provided as part of the observational study; however, children when symptomatic were treated in accordance with daycare policies. This retrospective investigation examines antifungal drug therapy received during the previous investigation and characterizes the impact of treatment on persistence of the fungus on the scalp. METHODS Children in whom serial typeable isolates of T. tonsurans were recovered were eligible for evaluation. Clinic charts were reviewed and dispensing records obtained from the primary pharmacies serving the daycare. Infection patterns were examined before and after treatment. RESULTS We identified 72 dispensing records for 53 children, all of whom received griseofulvin. Nine children could not be evaluated because treatment was coincident with their last study visit. Thus, 63 treatment events in 44 children with 331 discrete infection events remained. After a single course of griseofulvin, 22.7% of children became culture negative, 6.8% acquired another strain of T. tonsurans and, 70.5% remained persistently positive with the same strain carried prior to treatment. Among those receiving a second course of therapy, 54% remained positive and the cumulative percent of children that became culture negative increased to 36.4%. If children subsequently acquiring a different strain are considered together with those that became culture negative, cumulative strain clearance was observed in 43% of children. Neither the griseofulvin dose nor the duration of time over which children were infected prior to treatment differed between those that remained positive and those that became negative. CONCLUSIONS Griseofulvin eradicates dermatophyte scalp carriage in less than one-half of preschool-aged children receiving between one and four 4-week courses of the drug.
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Affiliation(s)
- Susan M Abdel-Rahman
- Division of Pediatric Clinical Pharmacology and Medical Toxicology, The Children's Mercy Hospital ; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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Abstract
Tinea capitis, tinea corporis, and pityriasis versicolor are common superficial fungal infections in the pediatric population. • Tinea capitis is the most common dermatophyte infection worldwide. In North America, the cause is almost exclusively T tonsurans. Diagnosis of tinea capitis usually can be made by clinical features alone, especially when occipital or postauricular lymphadenopathy is present. Skin scrapings prepared with potassium hydroxide for microscopic examination, or a cotton swab for fungal culture, usually are diagnostic. • Treatment of tinea capitis requires systemic antifungal therapy. Terbinafine and griseofulvin are both effective against T tonsurans and are FDA-approved for this indication in children. • Adjunctive topical therapy for the patient and household contacts decreases transmission of this infection. • Topical antifungal therapy usually is effective for tinea corporis and pityriasis versicolor. However, recurrences of pityriasis versicolor are common.
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Affiliation(s)
- Brendan P Kelly
- Tufts University School of Medicine, Bayside Children's Hospital, Springfield, MA, USA
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Tinea capitis en mujeres de edad avanzada: descripción de 4 casos. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:144-8. [DOI: 10.1016/j.ad.2011.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 01/03/2011] [Accepted: 01/19/2011] [Indexed: 11/22/2022] Open
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Morell L, Fuente M, Boada A, Carrascosa J, Ferrándiz C. Tinea Capitis in Elderly Women: A Report of 4 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Ginter-Hanselmayer G, Seebacher C. Treatment of tinea capitis - a critical appraisal. J Dtsch Dermatol Ges 2010; 9:109-14. [DOI: 10.1111/j.1610-0387.2010.07554.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bennassar A, Grimalt R. Management of tinea capitis in childhood. Clin Cosmet Investig Dermatol 2010; 3:89-98. [PMID: 21437064 PMCID: PMC3047946 DOI: 10.2147/ccid.s7992] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Antoni Bennassar
- Dept of Dermatology, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Ang CC, Tay YK. Inflammatory Tinea Capitis: Non-healing Plaque on the Occiput of a 4-year-old Child. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n5p412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: Inflammatory tinea capitis is an uncommon condition in Singapore. In this case report we present a patient whom we managed for this condition. Clinical Picture: A 4-year-old girl presented to us with multiple pustules over the occipital scalp for 6 weeks, associated with painful cervical lymphadenopathy. Her condition did not respond to topical and oral antibiotics. Treatment: The patient was diagnosed with kerion (inflammatory tinea capitis) and fungal culture of plucked hairs from the kerion grew Microsporum species of dermatophyte. She was treated with a course of oral griseofulvin and topical selenium sulfide shampoo. She was advised to bring her pet cats to the veterinarian for screening, as well as not to share combs with her other siblings. Outcome: Her condition improved with the antifungal therapy, and there was no residual alopecia. Conclusion: Physicians should consider tinea capitis when they encounter a patient with scalp folliculitis or scarring alopecia in the appropriate clinical context.
Key words: Kerion, Microsporum species, Scalp folliculitis
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Dastghaib L, Azizzadeh M, Jafari P. Therapeutic options for the treatment of tinea capitis: Griseofulvin versus fluconazole. J DERMATOL TREAT 2009; 16:43-6. [PMID: 15897167 DOI: 10.1080/09546630510025932] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Tinea capitis is a relatively common fungal infection of childhood. Griseofulvin has been the mainstay of treatment for many years. However, newer oral antifungal agents are being used more frequently. OBJECTIVE Our purpose was to evaluate the therapeutic efficacy of fluconazole in comparison with griseofulvin in the treatment of tinea capitis. METHODS We performed a single-blind, randomized, prospective evaluation of 40 patients with a clinical and mycologic diagnosis of tinea capitis. One group received fluconazole for 4 weeks. The other group received griseofulvin for 6 weeks. Five clinical parameters were evaluated. Mycologic examinations were performed at baseline and at the end of 8 weeks. RESULTS Patients ranged in age from 1 to 16 years; 80% were boys and 20% were girls. Mycologic examinations disclosed Trichophyton verrucosum in 40% of patients, T. violaceum in 40% and Microsporum canis in 20%. At week 8, the griseofulvin-treated group showed a cure rate of 76%, and the fluconazole-treated group 78%. The cure rates were not statistically significant. CONCLUSION Fluconazole constitutes an alternative but, because of greater availability and lower cost, griseofulvin remains the treatment of choice for tinea capitis.
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Affiliation(s)
- L Dastghaib
- Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
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Binder B, Richtig E, Weger W, Ginter-Hanselmayer G. Tinea capitis in early infancy treated with itraconazole: a pilot study. J Eur Acad Dermatol Venereol 2009; 23:1161-3. [PMID: 19453785 DOI: 10.1111/j.1468-3083.2009.03271.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tinea capitis is the most common fungal infection of the scalp in childhood, but a very rare disorder in the first year of life. OBJECTIVE To evaluate the efficacy, tolerability and safety of itraconazole in 7 children aged between 3 and 46 weeks (median: 36 weeks) suffering from tinea capitis caused by Microsporum canis. METHODS Prospective case note study. In all patients KOH testing and fungal cultivation on Sabouraud dextrose agar were performed. RESULTS 7 patients (5 girls and 2 boys) were included in the period between 2001 and 2008. The causative etiologic agent was Microsporum canis in all children. The patients received itraconazole 5mg/kg bodyweight daily for 3 to 6 weeks with no clinically side effects being noted. In all patients clinical and mycological cure could be achieved. CONCLUSION Itraconazole proved to be a safe and effective treatment option for Microsporum canis induced tinea capitis in children in their first year of life.
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Affiliation(s)
- B Binder
- Department of Dermatology, Medical University of Graz, Graz, Austria.
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Elewski BE, Cáceres HW, DeLeon L, El Shimy S, Hunter JA, Korotkiy N, Rachesky IJ, Sanchez-Bal V, Todd G, Wraith L, Cai B, Tavakkol A, Bakshi R, Nyirady J, Friedlander SF. Terbinafine hydrochloride oral granules versus oral griseofulvin suspension in children with tinea capitis: Results of two randomized, investigator-blinded, multicenter, international, controlled trials∗. J Am Acad Dermatol 2008; 59:41-54. [DOI: 10.1016/j.jaad.2008.02.019] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Revised: 02/11/2008] [Accepted: 02/13/2007] [Indexed: 11/25/2022]
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Sidat MM, Correia D, Buene TP. Tinea capitis among children at one suburban primary school in the City of Maputo, Mozambique. Rev Soc Bras Med Trop 2008; 40:473-5. [PMID: 17876474 DOI: 10.1590/s0037-86822007000400020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 06/20/2007] [Indexed: 11/21/2022] Open
Abstract
This study evaluated the prevalence of Tinea capitis among schoolchildren at one primary school and also identified the causative agents. Scalp flakes were collected from children presenting clinical signs suggestive of Tinea capitis. Dermatophytes were identified by following standard mycological procedures. This study found a clinical prevalence of Tinea capitis of 9.6% (110/1149). The dermatophytes isolated were Microsporum audouinii, Trichophyton violaceum, and Trichophyton mentagrophytes. The most prevalent causative agent in this study was Microsporum audouinii, thus confirming the findings from previous cross-sectional studies carried out in the city of Maputo.
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Affiliation(s)
- Mohsin M Sidat
- Department of Community Health, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.
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Abstract
The scalp is unique among skin areas in humans, with high follicular density and a high rate of sebum production. The relatively dark and warm environment on the scalp surface provides a welcoming environment for the superficial mycotic infections associated with many scalp conditions and for parasitic infestation. Infections and infestations can occur when items such as fingers, combs, hats, or styling implements come into contact with the hair and scalp and introduce microorganisms. Inflammatory conditions may also produce changes in the scalp. Many common scalp conditions have similar symptoms and clinical features, complicating diagnosis, but a correct diagnosis is critical to determining proper treatment. This paper describes the symptoms, etiology, and treatment strategies for a number of common scalp conditions, including dandruff, seborrheic dermatitis, tinea capitis, pediculosis capitis, and psoriasis.
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Affiliation(s)
- Ramon Grimalt
- Department of Dermatology, University of Barcelona, Barcelona, Spain.
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González U, Seaton T, Bergus G, Jacobson J, Martínez-Monzón C. Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev 2007:CD004685. [PMID: 17943825 DOI: 10.1002/14651858.cd004685.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Tinea capitis is a common contagious fungal infection of the scalp in children. Systemic therapy is required for treatment and to prevent spread. OBJECTIVES To assess the effects of systemic anti-fungal drugs for tinea capitis in children. SEARCH STRATEGY We searched the Cochrane Skin Group Specialised Register (June 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (2003 to June 2005), EMBASE ( 2003 to June 2005), LILACS (1982 to July 2005), CINAHL (1982 to July 2005), the ACP journal club (1991 to July 2005) and Healthstar (1975 to July 2005). SELECTION CRITERIA Randomised controlled trials (RCTs) that evaluated systemic antifungal therapy in people with normal immunity under the age of 18 who had tinea capitis confirmed by microscopy or growth of dermatophytes in culture or both. DATA COLLECTION AND ANALYSIS At least two authors independently examined each retrieved trial for eligibility and quality. MAIN RESULTS We included 21 studies (1812 participants). Infections involving Trichophyton species: Terbinafine for four weeks and griseofulvin for eight weeks showed similar efficacy in 3 studies involving 382 participants (RR 1.09; 95% CI 0.95 to 1.26). Cure rates following treatment with itraconazole and griseofulvin for 6 weeks were similar in 1 study of 35 children (RR 1.06; 95% CI 0.81 to 1.39). Another study of 100 children did not show any significant difference in cure between itraconazole for 2 weeks compared with griseofulvin for 6 weeks (RR 0.89; 95% CI 0.76 to 1.04). There was no difference between itraconazole and terbinafine for treatment periods lasting 2 to 3 weeks in 2 studies involving 160 children (RR 0.93; 95% CI 0.72 to 1.19). Two studies that included 140 children found similar cure rates between 2 to 4 weeks of fluconazole with 6 weeks of griseofulvin (RR 0.92; 95% CI 0.80 to 1.05). Microsporum infections: There was no significant difference in cure between terbinafine and griseofulvin in children with Microsporum infections in 1 small study of 29 children (RR 0.64; 95% CI 0.19 to 2.20). AUTHORS' CONCLUSIONS The best evidence suggests that newer treatments including terbinafine, itraconazole and fluconazole may be similar to griseofulvin in children with tinea capitis caused by Trichophyton species. Newer treatments may be preferred because shorter treatment durations may improve treatment adherence, although they may be more expensive. There is not enough evidence on the use of systemic treatments in children with Microsporum infections. Not all treatments for tinea capitis are available in paediatric formulations but all have reasonable safety profiles.
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Affiliation(s)
- U González
- Clinica Plato, Department of Dermatology, c/ Plato 21, Barcelona, Catalunya, Spain, 08006.
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Mohammedamin RSA, van der Wouden JC, Koning S, Schellevis FG, van Suijlekom-Smit LWA, Koes BW. Reported incidence and treatment of dermatophytosis in children in general practice: a comparison between 1987 and 2001. Mycopathologia 2007; 164:271-8. [PMID: 17891509 PMCID: PMC2780650 DOI: 10.1007/s11046-007-9062-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 09/03/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Dermatophytosis is a common skin infection in children. Although the epidemiology is relatively unknown it is becoming a major health problem in some countries. We determine the incidence and management of dermatophytosis in Dutch general practice in 1987 and 2001. METHODS We used data of all children aged 0-17 years derived from two national surveys performed in Dutch general practice in 1987 and 2001 respectively. All diagnoses, prescriptions and referrals were registered over a 12 months period by the participating general practitioners (GPs), 161 and 195 respectively. Data were stratified for socio-demographic characteristics. RESULTS Compared to 1987, in 2001 the total reported incidence rate of dermatophytosis in children in general practice increased from 20.8 [95%CI 18.9-22.8] to 24.6 [95%CI 23.5-25.7] per 1,000 person years. Infants (<1 year), girls, children in rural areas and children of non-western immigrants more often consulted the GP for dermatophytosis in 2001. In both surveys GPs treated the majority of children with dermatophytosis with topical drugs, especially with azoles. CONCLUSIONS The reported incidence rate of dermatophytosis in children in general practice increased; however it is unclear whether this is a consequence of an increasing prevalence in the population or a changing help seeking behaviour. GPs generally follow the national guideline for the treatment of dermatophytosis in children.
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Affiliation(s)
- R. S. A. Mohammedamin
- Department of General Practice, Room Ff304, Erasmus MC-University Medical Center, P. O. Box 2040, 3000 DR Rotterdam, The Netherlands
| | - J. C. van der Wouden
- Department of General Practice, Room Ff304, Erasmus MC-University Medical Center, P. O. Box 2040, 3000 DR Rotterdam, The Netherlands
| | - S. Koning
- Department of General Practice, Room Ff304, Erasmus MC-University Medical Center, P. O. Box 2040, 3000 DR Rotterdam, The Netherlands
| | - F. G. Schellevis
- Department of General Practice, Netherlands Institute
for Health Services Research (NIVEL), Free University, Utrecht, Amsterdam The Netherlands
| | - L. W. A. van Suijlekom-Smit
- Department of Paediatrics, Sophia Children’s Hospital, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - B. W. Koes
- Department of General Practice, Room Ff304, Erasmus MC-University Medical Center, P. O. Box 2040, 3000 DR Rotterdam, The Netherlands
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Abstract
Tinea capitis is an infection of the scalp and hair shaft caused by dermatophyte fungi. It is seen in all age groups, and the incidence seems to be on the rise in North America. Clinical diagnosis of tinea capitis can be challenging, as symptoms can vary from minimal pruritus with no hair loss, to severe tenderness, purulence, and permanent scarring in inflammatory kerion lesions. The diagnosis of tinea capitis must be confirmed in the laboratory by using fungal stains or obtaining cultures, since treatment may be prolonged with potential side effects. Systemic therapy is needed because topical antifungals cannot effectively penetrate the hair shaft to eradicate the infection. Oral griseofulvin remains the standard treatment agent, but terbinafine and itraconazole are also effective alternatives (although currently without Food and Drug Administration approval).
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Affiliation(s)
- Samina Ali
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.
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White JML, Higgins EM, Fuller LC. Screening for asymptomatic carriage of Trichophyton tonsurans in household contacts of patients with tinea capitis: results of 209 patients from South London. J Eur Acad Dermatol Venereol 2007; 21:1061-4. [PMID: 17714125 DOI: 10.1111/j.1468-3083.2007.02173.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- J M L White
- Department of Cutaneous Allergy, St. John's Institute of Dermatology, London, UK.
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Seebacher C, Abeck D, Brasch J, Cornely O, Daeschlein G, Effendy I, Ginter-Hanselmayer G, Haake N, Hamm G, Hipler C, Hof H, Korting HC, Kramer A, Mayser P, Ruhnke M, Schlacke KH, Tietz HJ. Tinea capitis: ringworm of the scalp. Mycoses 2007; 50:218-26. [PMID: 17472621 DOI: 10.1111/j.1439-0507.2006.01350.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The guideline tinea capitis, as passed by three German medical societies, is presented in the present study.
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