Trypanosoma cruzi DTU II coinfection with bacteria producing prolonged cutaneous lesion in a healthy young male

ABSTRACT Chagas disease (CD) is a neglected tropical disease caused by Trypanosoma cruzi and is genetically classified in six discrete typing units (DTUs). The isolates reported in Mexico are generally associated with DTU I. We presented a case of a prolonged cutaneous lesion in a Mexican man, caused by DTU II in coinfection with Bacillus velezensis and Corynebacterium sp. The patient assessment included a complete clinical history, physical exam, laboratory tests, and a skin biopsy. In the facial tissues, intracellular parasites were revealed. The PCR tests were positive for T. cruzi in tissue and blood samples. DNA satellite sequencing was correlated with the DTU II. The initial serological tests reported negative results. However, four months later, two serological tests reported positive results. These exams were performed in different health centers. Mexico is considered an endemic area for CD; nevertheless, this is just the second cutaneous case associated with a DTU different from DTU-I noted in this country. From an ecological point of view, this fact suggests a geographical expansion of DTU II and an association with atypical skin manifestations. Further studies should be conducted to understand this exciting association between DTU-II and prolonged cutaneous expression in humans.

Un caso infantil de tinea faciei por Trichophyton tonsurans en Guatemala / A child case of Trichophyton tonsurans tinea for faciei in Guatemala

El Trichophyton tonsurans es un dermatofito antropofílico de distribución mundial, asociado a brotes epidémicos de tinea capitis, pero que también se puede aislar en tinea ungueum y faciei. Se presenta un paciente de sexo masculino, de 3 años de edad, procedente de Guatemala, que tiene una lesión eritematosa de bordes bien definidos, con descamación gruesa en la mejilla derecha, de dos semanas de evolución, de la cual se aisló Trichophyton tonsurans. Curó luego del tratamiento con crema de ketoconazol al 2% durante 15 días.

Trichophyton tonsurans is an anthropophilic dermatophyte with a worldwide distribution that is associated with epidemic outbreaks of tinea capitis and sometimes it is also isolated from tinea ungueum and faciei. We report a 3 year-old male from Guatemala, with a two weeks history of a scaly erythematous lesion on the right cheek. Trichophyton tonsurans was isolated and the lesion resolved after a 15 days-course of 2% ketoconazole cream.