Combs and hair-trimming tools as reservoirs for dermatophytes in juvenile tinea capitis

Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance

Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes.

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

BACKGROUND

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

OBJECTIVE

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

PATIENTS AND METHODS

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

RESULTS

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

CONCLUSION

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

Diagnosis and treatment of dermatophytosis in dogs and cats.: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology

BACKGROUND

Dermatophytosis is a superficial fungal skin disease of cats and dogs. The most common pathogens of small animals belong to the genera Microsporum and Trichophyton. It is an important skin disease because it is contagious, infectious and can be transmitted to people.

OBJECTIVES

The objective of this document is to review the existing literature and provide consensus recommendations for veterinary clinicians and lay people on the diagnosis and treatment of dermatophytosis in cats and dogs.

METHODS

The authors served as a Guideline Panel (GP) and reviewed the literature available prior to September 2016. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) provided guidance and oversight for this process. A draft of the document was presented at the 8th World Congress of Veterinary Dermatology (May 2016) and was then made available via the World Wide Web to the member organizations of the WAVD for a period of three months. Comments were solicited and posted to the GP electronically. Responses were incorporated by the GP into the final document.

CONCLUSIONS

No one diagnostic test was identified as the gold standard. Successful treatment requires concurrent use of systemic oral antifungals and topical disinfection of the hair coat. Wood's lamp and direct examinations have good positive and negative predictability, systemic antifungal drugs have a wide margin of safety and physical cleaning is most important for decontamination of the exposed environments. Finally, serious complications of animal-human transmission are exceedingly rare.

Prevalence of Tinea Capitis Infection Among Primary School Children in a Rural Setting in South-West Nigeria

Dermatophyte infection is a common skin disorder. Tinea capitis, infection of the scalp and hair shaft, is the most common dermatophytosis in children aged between six months and pre-pubertal age. The aim of the study was to determine the prevalence, causative agents and to identify predisposing factors among primary school children in a rural community in Sagamu, Ogun state, Nigeria. This was a descriptive cross sectional study. Interviewer administered questionnaire was used. Following a physical examination, children with a clinical diagnosis of tinea capitis had scalp and hair scrapings for microscopy and culture. Tinea capitis was confirmed in 15.4%. Trichophyton mentagrophyte (51.7%) and Microsporum aoudouinii (20.7%) were the most prevalent organisms in this study. The most common predisposing factors were carrying of objects on the scalp; sharing of hair clippers, scissors, combs, towels and fomites. Low socioeconomic status coupled with overcrowding and poor hygiene was the major determinant of tinea capitis among the children. Tinea capitis remains a common infection among Nigerian school children. Health promotion and health education interventions are recommended to promote good hygiene, better living conditions, early identification and treatment.

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

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