Fungus invasion into human hair tissue in black dot ringworm: light and electron microscopic study

Scanning and transmission electron microscopic observation of the parasitic form of Trichophyton violaceum in the infected hair from tinea capitis

Trichophyton violaceum is a pathogen of tinea capitis and usually cause infection of scalp and hair in children. To investigate the parasitic form of T. violaceum in the human hair tissue, the infected hair strands were collected from a 9-year-old boy with tinea capitis due to T. violaceum and observed under both the scanning electron microscope (SEM) and transmission electron microscope (TEM). The SEM and TEM findings revealed that T. violaceum parasitically lives in the hair shaft in various forms and the morphological transformation of the fungus from hyphae into arthrospores was noted. The involved hair shaft was damaged to the great extent and its ultrastructural changes were evident. Those morphological characteristics of T. violaceum and the three-dimensional ultastructure changes of infected hairs give a better knowledge about the host-fungus relationship in tinea capitis.

Hyphal growth in human fungal pathogens and its role in virulence

Most of the fungal species that infect humans can grow in more than one morphological form but only a subset of pathogens produce filamentous hyphae during the infection process. This subset is phylogenetically unrelated and includes the commonly carried yeasts, Candida albicans, C. dubliniensis, and Malassezia spp., and the acquired pathogens, Aspergillus fumigatus and dermatophytes such as Trichophyton rubrum and T. mentagrophytes. The primary function of hypha formation in these opportunistic pathogens is to invade the substrate they are adhered to, whether biotic or abiotic, but other functions include the directional translocation between host environments, consolidation of the colony, nutrient acquisition and the formation of 3-dimensional matrices. To support these functions, polarised hyphal growth is co-regulated with other factors that are essential for normal hypha function in vivo.

Ultrastructural aspects of hair digestion in black piedra infection

The ultrastructural pattern of human hair infection by Piedraia hortae in vivo has been studied. The fungus destroyed the cuticular layers of the hair and was able to penetrate deeply into the cortex. The course of destruction of human hair is described and compared with that produced by other fungi. Two well-defined types of cortex digestion were characterized. The slow rate of keratin degradation at the cortex together with the compacted stromatic organization of the nodules are argued as the main reasons that guarantee the long survival of the fungus, and therefore the chronic course of the disease. The data provided in this paper may help to understand the mechanisms that regulate the pathogenicity of this fungus.

Tinea capitis: new perspectives on an old disease

Tinea capitis caused by Trichophyton tonsurans is a common infection in children, and has become a significant public health problem in the United States. Epidemics of tinea capitis occur both in families and in institutions such as schools and day care centers. Infection is often difficult to eradicate. Fomites and asymptomatic carriers likely contribute to the spread of the disease and to re-infection of treated patients. The morphology of tinea capitis is diverse, from seborrhea-like scaling to tender, inflammed nodules on the scalp. Because a lengthy course of systemic griseofulvin is required to treat this infection, management of tinea capitis can be challenging. As newer antifungal agents are developed, more effective and convenient therapy for tinea capitis may become available.

Oral itraconazole versus topical bifonazole treatment in experimental dermatophytosis

Guinea pigs, infected with either Trichophyton mentagrophytes or Microsporum canis, were treated orally or topically with azole antifungals daily for two weeks. Fungi located in the stratum corneum were affected similarly by both treatment schedules, showing typical cell wall changes after azole exposure and necrosis of internal organelles. Fungi located in the hair sheaths were affected only by the oral treatment, which not only prevented invasion of the inner hair structures and inflammatory responses but also led to a complete clearance of the infection within 7 days. Topically applied azole treatment was not able to injure fungi in the hair sheaths and did not suppress invasion into the hair shafts. These observations are in favour of oral antifungal medication with azoles for the treatment of dermatophyte infections involving hairy skin.

Pathogenesis of hair infection and black dots in tinea capitis caused by Trichophyton violaceum: a histopathological study

The majority of tinea capitis in southern Taiwan occur in adult women and are caused by Trichophyton violaceum. We report the histopathological findings of a series of 10 cases of tinea capitis caused by T. violaceum, the largest such study to date. Our study provides new information regarding the process of hair infection, mechanism of black dot formation, and chronicity of infection caused by this fungus. The cuticle remains intact. The fungi enter the proximal cortex where the cuticle is immature. They then colonize the proximal keratinized cortex and generate septate hyphae which transform gradually into arthrospores as they are carried upwards by the growing hair. At the infundibular level, the hair cortex is almost completely replaced by spores and swells, impeding further exit of the growing hair and causing the already weakened hair to coil up inside the infundibulum, forming a black dot. In one patient who had infection for more than 20 years, there were changes suggestive of cyclic reinfection of the same follicles which might contribute to the chronicity of the infection.

Trichophyton rubrum invasion of human hair apparatus in tinea capitis and tinea barbae: light- and electron microscopic study

We have previously reported morphological changes of Trichophyton violaceum and Microsporum canis in hair apparatuses in tinea capitis. To investigate the morphology of Trichophyton rubrum in the human hair apparatus, two cases of tinea capitis and one case of tinea barbae were examined by light- and electron microscopy. The fungal elements, which were located in the lower keratogenous zone, showed non-septate hyphae in the outer part of the hair cortex. With the upward development of the hair layers, some hyphae invaded the keratinized hair cuticle and keratinized inner root sheath and were transformed into arthrospores. Some hyphae remaining in the hair cortex were also transformed into arthrospores, while other hyphae in the hair cortex did not survive, but degenerated. In T. rubrum hair infection, there is a distinct relationship between the morphological changes of the fungi and the hair cell differentiation as seen in T. violaceum and M. canis infections. However, T. rubrum displays unique morphological changes, which are different from those of T. violaceum and M. canis, in hair apparatuses.

Fungus invasion of human hair tissue in tinea capitis caused by Microsporum canis: light and electron microscopic study

Previously, we reported a morphological change of Trichophyton violaceum in hair tissue in black dot ringworm. To investigate the morphology of Microsporum canis in human hais tissue, three cases of tinea capitis by M. canis were examined by both light and electron microscopy. The fungal elements, which were located deeplyin the keratogenous zone, showed nonseptate hyphae in the outer part of the hair cortex. With the upward development of hair tissues, some hyphae invaded the keratinized inner root sheath and were there transformed into arthrospores, which then occupied the large volume of the inner root sheath; each spore was surrounded by an electron-lucent halo. In some affected hair follicles, at the follicular isthmus level, a microabscess composed of polymorphonuclear leukocytes was often formed in the outer root sheath adjacent to the arthrospores in the keratinized inner root sheath. On the other hand, the remaining hyphae in the cortex became degenerated. Fungi did not invade the hair-germinative cells. There is a distinct relationship between the morphological change of fungi and the differentiation of hair cells in tinea capitis by M. canis as well as in that by T. violaceum, although the direction of invasion and pathological roles of fungal elements within hair tissue are significantly different between the two species of fungi.