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Müller VL, Kreuter A, Uhrlaß S, Nenoff P. [Trichophyton mentagrophytes genotype VII increasingly causes anogenital infections]. Dermatologie (Heidelb) 2024; 75:48-54. [PMID: 38189829 DOI: 10.1007/s00105-023-05275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/09/2024]
Abstract
In the course of globalization, migration and global warming, we are increasingly confronted with pathogens that do not occur naturally in our latitudes or appear in a different form. We know keratinophilic dermatophytes as the cause of tinea pedis, onychomycosis and also tinea corporis and capitis. Transmission usually occurs via domestic or farm animals and via autoinoculation. In recent years dermatophytes have gained additional importance as a possible sexually transmitted disease between immunocompetent persons. For the first time, dermatophytosis was described as a sexually transmitted infection in travelers who developed pronounced pubogenital or anogenital tinea after travelling in Southeast Asia, including Thailand, mostly after intensive sexual contact. Molecular and cultural analyses have identified Trichophyton (T.) mentagrophytes ITS (internal transcribed spacer) genotype VII as the main pathogen. Although this dermatophyte genotypically belongs to the zoophilic complex, direct (sexual) and occasionally indirect human-to-human contact with infected persons is suspected to be the current route of transmission. The infection can lead to inflammatory and purulent dermatophytosis, causing a high level of suffering. In this respect, a rapid and reliable diagnosis is essential in order to be able to initiate targeted treatment. The discovery of infection pathways and the awareness of the need to take rare diseases into account in our everyday lives will increasingly accompany us over the next few years and present us with new challenges, particularly in terms of prevention and treatment.
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Affiliation(s)
- Valentina Laura Müller
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Johannes Klinikum Duisburg, Dieselstr. 185, 47166, Duisburg, Deutschland.
| | - Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Johannes Klinikum Duisburg, Dieselstr. 185, 47166, Duisburg, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen/Universität Witten-Herdecke, Oberhausen, Deutschland
| | - Silke Uhrlaß
- labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis, Rötha OT Mölbis, Deutschland
| | - Pietro Nenoff
- labopart - Medizinische Laboratorien, Labor Leipzig-Mölbis, Rötha OT Mölbis, Deutschland
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Abstract
Kerion is a severe hypersensitivity reaction to fungal infection that is rarely seen in the groin. Frequent shaving of pubic hair and religious conservatism surrounding genital hygiene are common among Bedouin women in the Negev Desert, and may predispose to kerion. This case highlights the clinical course of a 20-year-old Bedouin woman who presented with severe kerion celsi of the pubis and vulva with secondary bacterial infection. The patient was successfully treated with intravenous antibiotics, oral antifungal medication and wet topical dressings. The case outlines the risk factors and treatment for severe kerion celsi of the groin, as well as possible preventive measures that may reduce its incidence.
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Affiliation(s)
- Adi Saadia
- Dermatology and Venereology, Soroka University Medical Center, Beer Sheva, Israel
| | - Jensen Reckhow
- Medical School for International Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Mati Rozenblat
- Dermatology and Venereology, Soroka University Medical Center, Beer Sheva, Israel
| | - Omer Last
- Dermatology and Venereology, Soroka University Medical Center, Beer Sheva, Israel
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Affiliation(s)
- Vidya Kuntoji
- Department of Dermatology, Venereology and Leprosy, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Chandramohan Kudligi
- Department of Dermatology, Venereology and Leprosy, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Pradeep Vittal Bhagwat
- Department of Dermatology, Venereology and Leprosy, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Dinesh Prasad Asati
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Arika Bansal
- Consultant Dermatologist and Trichologist, Eugenix Skin and Hair Sciences, Gurgaon, Haryana, India
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Affiliation(s)
- Philippa Dickison
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Emily Forward
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Gayle Fischer
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Abstract
Vulvovaginal conditions are common in mature women. This reflects age-related changes in immunity and skin barrier function of vulvovaginal tissues. Vaginal atrophy is commonly complicated by dryness and inflammation, which makes postmenopausal atrophic vaginitis a virtually ubiquitous condition. The differential of vaginitis includes inflammatory, infectious, and malignant diseases, plus drug hypersensitivity. Atrophic vaginitis is treated with estrogen replacement therapy. Vulvovaginal malignant melanoma occurs predominantly in postmenopausal women and carries a poor prognosis. Similarly, the incidence of vulvovaginal malignancies, such as squamous cell carcinoma and extramammary Paget disease, rises exponentially after 65 years of age. Early diagnosis of these malignancies is of utmost importance. Lichen sclerosus et atrophicus and vulvovaginal candidosis are among the most common postmenopausal vulvovaginal conditions. Lichen sclerosus et atrophicus is associated with significant morbidity, and its management can be challenging. The incidence of vulvovaginal candidosis increases in patients on estrogen replacement therapy.
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Affiliation(s)
- Natalie Matthews
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI
| | - Vivian Wong
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.
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Abstract
A multitude of infectious diseases of viral (genital herpes, herpes zoster, genital warts and molluscum contagiosum), bacterial (syphilis, chancroid, lymphogranuloma venereum, donovanosis, erysipelas, cellulitis and necrotising fasciitis, folliculitis, impetigo, bartholin gland abscess, trichomycosis and erythrasma), fungal (candidiasis and dermatophytosis) and parasitic (pediculosis pubis) origin may affect the vulvar area. Herein, we review the infections and their skin manifestations in the vulvar area.
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Affiliation(s)
- Freja Lærke Sand
- a Department of Dermatology , Bispebjerg Hospital , Copenhagen , Denmark
| | - Simon Francis Thomsen
- a Department of Dermatology , Bispebjerg Hospital , Copenhagen , Denmark.,b Department of Biomedical Sciences , University of Copenhagen , Copenhagen , Denmark
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Gracia-Cazaña T, Milagro A, Rezusta A, Gilaberte Y. Querion de Celso de la vulva: una enfermedad común en una localización infrecuente. Rev Iberoam Micol 2017; 34:123-125. [DOI: 10.1016/j.riam.2016.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/16/2016] [Accepted: 11/04/2016] [Indexed: 12/01/2022] Open
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Ginter-hanselmayer G, Nenoff P, Kurrat W, Propst E, Durrant-finn U, Uhrlaß S, Weger W. Tinea im Genitalbereich: Eine diagnostische und therapeutische Herausforderung. Hautarzt 2016; 67:689-99. [DOI: 10.1007/s00105-016-3848-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tirado-sánchez A, Ponce-olivera RM, Bonifaz A. Majocchi’s Granuloma (Dermatophytic Granuloma): Updated Therapeutic Options. Curr Fungal Infect Rep 2015; 9:204-212. [DOI: 10.1007/s12281-015-0234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bakardzhiev I, Chokoeva A, Tchernev G, Wollina U, Lotti T. Tinea profunda of the genital area. Successful treatment of a rare skin disease. Dermatol Ther 2015; 29:181-3. [PMID: 26555874 DOI: 10.1111/dth.12311] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a rare case of 36-year-old female patient, who developed a severe Majocchi granuloma in the pubis after waxing, with isolated causative agent Trichophyton mentagrophytes. The condition was initially misdiagnosed as a bacterial folliculitis and treated unsuccessfully with topical corticosteroids and antibiotics. After the adequate diagnose was confirmed by mycological examination, followed by histopathological verification, complete remission of the symptoms was achieved at the 4th week after initiating 6 weeks course of antifungal therapy with Terbinafine 250 mg/daily dose, while good therapeutic response was observed even in the 10th day. The etiopathogenesis of the disease, as well as its current treatment options are considered, in respect to the rare occurrence of this condition in the pubic area and its frequent misdiagnosis.
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Affiliation(s)
- Ilko Bakardzhiev
- Medical College, Medical University of Varna, 84 Tzar Osvoboditel str., Varna, 9000, Bulgaria
| | - Anastasiya Chokoeva
- "Onkoderma"-Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 blvd., Sofia, Bulgaria
| | - Georgi Tchernev
- Medical Faculty, Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, University Hospital Lozenetz, Koziak street 1, Sofia, 1407, Bulgaria
| | - Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Torello Lotti
- University of Rome "G. Marconi", Rome, Italy.,Department of Biotechnology, Delft University of Technology, 2628, BC, Delft, The Netherlands
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Luchsinger I, Bosshard PP, Kasper RS, Reinhardt D, Lautenschlager S. Tinea genitalis: a new entity of sexually transmitted infection? Case series and review of the literature. Sex Transm Infect 2015; 91:493-6. [PMID: 26071391 PMCID: PMC4680168 DOI: 10.1136/sextrans-2015-052036] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/31/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Investigation on recent cases of tinea genitalis after travelling to South East Asia. METHODS Patients with tinea in the genital region, which emerged after sex in South East Asia, underwent further assessment including microscopy, cultures and DNA analyses. RESULTS The case series includes seven patients. In six patients, Trichophyton interdigitale (former Trichophyton mentagrophytes) was detected. Three patients suffered from a severe inflammatory reaction of the soft tissue and two of them needed hospitalisation due to severe pain. In four patients, cicatrising healing was noticed. Five patients were declared incapacitated for work. CONCLUSIONS Sexual activity should be considered as a potentially important and previously underappreciated means of transmission of T. interdigitale. To avoid irreversible scarring alopecia, prompt initiation of antifungal treatment is essential and adequate isolation and identification of the pathogen is mandatory.
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Affiliation(s)
| | | | | | - Dominic Reinhardt
- Outpatient Clinic of Dermatology, Triemli Hospital, Zurich, Switzerland
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Liu HB, Liu F, Kong QT, Shen YN, Lv GX, Liu WD, Sang H. Successful Treatment of Refractory Majocchi's Granuloma with Voriconazole and Review of Published Literature. Mycopathologia 2015; 180:237-43. [PMID: 26045285 DOI: 10.1007/s11046-015-9902-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
Majocchi's granuloma (MG) is a rare deep skin dermatophyte infection that can occur either in immunocompetent or in immunocompromised individuals. Oral itraconazole or terbinafine is considered to be the first choice of treatment. We report an immunocompetent man with deep nodular form of MG, the form which is generally found in immunosuppressed individuals. Previous treatment with either oral itraconazole or terbinafine yielded no apparent improvement. After a series of examination, the man was diagnosed as having Trichophyton rubrum-induced MG mixed with bacterial infection as evidenced by growth of Klebsiella pneumoniae in tissue bacterial culture. The patient was treated with a combination of cefoselis and levofloxacin for bacterial clearance followed by voriconazole treatment. After approximately 4 months of voriconazole treatment, the lesions completely resolved. Alternative medicine (voriconazole) can be considered in case of refractory infections during MG treatment.
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Abstract
Background: Deep dermatophytosis of genital skin is a rare clinical manifestation of infection by a common group of pathogens. Objective: We emphasize the importance of clinical suspicion and the use of accurate diagnostic methods in the evaluation of deep dermatophytosis. Methods: We report a single case of tinea pubis, kerion type, caused by Trichophyton mentagrophytes in an immunocompetent host. Results: A 54-year-old female presented with a suppurative infection of the vulva and pubis that was unresponsive to empirical antibiotic therapy. T. mentagrophytes was isolated. Oral itraconazole was initiated on the basis of clinical suspicion and continued for a total of 6 weeks. Conclusion: Accurate diagnosis and treatment of deep dermatophytosis of genital skin rests upon proper identification of the pathogen. Prompt initiation of treatment with an oral antifungal agent, such as itraconazole, should be undertaken in order to avoid irreversible scarring alopecia.
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Affiliation(s)
- Amina Bougrine
- Departments of Dermatology, Pathology, and Microbiology, Centre Hospitalier de l’Université de Montréal, Montreal, QC
| | - Catherine Villeneuve-Tang
- Departments of Dermatology, Pathology, and Microbiology, Centre Hospitalier de l’Université de Montréal, Montreal, QC
| | - Danielle Bouffard
- Departments of Dermatology, Pathology, and Microbiology, Centre Hospitalier de l’Université de Montréal, Montreal, QC
| | - Danielle Rouleau
- Departments of Dermatology, Pathology, and Microbiology, Centre Hospitalier de l’Université de Montréal, Montreal, QC
| | - Suzanne Chartier
- Departments of Dermatology, Pathology, and Microbiology, Centre Hospitalier de l’Université de Montréal, Montreal, QC
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