Aspergillus niger – a possible new etiopathogenic agent in Tinea capitis? Presentation of two cases

Abstract Tinea capitis is generally considered as the most frequent fungal infection in childhood, as it accounts for approximately 92% of all mycosis in children. The epidemiology of this disease varies widely ranging from antropophillic, zoophilic, and geophillic dermatophytes, as the main causative agent in different geographic areas, depending on several additional factors. Nowadays, the etiology is considered to vary with age, as well with gender, and general health condition. The former reported extraordinary Tinea capitis case reports have been replaced by original articles and researches dealing with progressively changing patterns in etiology and clinical manifestation of the disease. This fact is indicative that under the umbrella of the well-known disease there are facts still hidden for future revelations. Herein, we present two rare cases of Tinea capitis in children, which totally differ from the recently established pattern, in their clinical presentation, as well as in the etiological aspect, as we discuss this potential new etiological pattern of the disease, focusing on our retrospective and clinical observation. Collected data suggest that pathogenic molds should be considered as a potential source of infection in some geographic regions, which require total rationalization of the former therapeutic conception, regarding the molds’ higher antimitotic resistance compared to dermatophytes. Molds-induced Tinea capitis should be also considered in clinically resistant and atypical cases, with further investigations of the antifungal susceptibility of the newest pathogens in the frame of the old disease. Further investigations are still needed to confirm or reject this proposal.

The First Korean Case of Disseminated Mycetoma Caused by Nocardia pseudobrasiliensis in a Patient on Long-Term Corticosteroid Therapy for the Treatment of Microscopic Polyangiitis

Nocardia pseudobrasiliensis is predominantly associated with invasive infections in immunocompromised patients. We report a case of disseminated mycetoma caused by N. pseudobrasiliensis in a 57-yr-old woman with microscopic polyangiitis, who was treated for 3 months with corticosteroids. The same organism was isolated from mycetoma cultures on the patient's scalp, right arm, and right leg. The phenotypic characteristics of the isolate were consistent with both Nocardia brasiliensis and N. pseudobrasiliensis, i.e., catalase and urease positivity, hydrolysis of esculin, gelatin, casein, hypoxanthine, and tyrosine, but no hydrolysis of xanthine. The isolate was identified as N. pseudobrasiliensis based on 16S rRNA and hsp65 gene sequencing. The patient was treated for 5 days with intravenous ampicillin/sulbactam, at which time both the mycetomas and fever had subsided and discharged on amoxicillin/clavulanate. This case highlights a very rare presentation of mainly cutaneous mycetoma caused by N. pseudobrasiliensis. This is the first reported case of N. pseudobrasiliensis infection in Korea.

The First Korean Case of Disseminated Mycetoma Caused by Nocardia pseudobrasiliensis in a Patient on Long-Term Corticosteroid Therapy for the Treatment of Microscopic Polyangiitis

Nocardia pseudobrasiliensis is predominantly associated with invasive infections in immunocompromised patients. We report a case of disseminated mycetoma caused by N. pseudobrasiliensis in a 57-yr-old woman with microscopic polyangiitis, who was treated for 3 months with corticosteroids. The same organism was isolated from mycetoma cultures on the patient's scalp, right arm, and right leg. The phenotypic characteristics of the isolate were consistent with both Nocardia brasiliensis and N. pseudobrasiliensis, i.e., catalase and urease positivity, hydrolysis of esculin, gelatin, casein, hypoxanthine, and tyrosine, but no hydrolysis of xanthine. The isolate was identified as N. pseudobrasiliensis based on 16S rRNA and hsp65 gene sequencing. The patient was treated for 5 days with intravenous ampicillin/sulbactam, at which time both the mycetomas and fever had subsided and discharged on amoxicillin/clavulanate. This case highlights a very rare presentation of mainly cutaneous mycetoma caused by N. pseudobrasiliensis. This is the first reported case of N. pseudobrasiliensis infection in Korea.

Piedra blanca y efluvio telógeno: una rara asociación / White piedra and telogen effluvium: an unusual association

Antecedentes: La piedra blanca es una infección fúngica, superficial del tallo piloso que se describe como nódulos asintomáticos, en ocasiones numerosos, blandos adheridos a la superficie del pelo. Caso clínico: Se presenta paciente femenino de 30 años de edad, con caída de cabello de casi 1 año de evolución, asociado a puntos blancos adheridos al pelo. En el cultivo se aisló Trichosporon sp. Se realizó biopsia de piel cabelluda, en la cual se observó una infiltración de linfocitos e histiocitos alrededor de paredes foliculares altas y algunos folículos en fase telógena. Con estos hallazgos se estableció el diagnóstico de piedra blanca asociada a efluvio telógeno. El tratamiento fue con champú anti caída y de ketoconazol al 2% con mejoría del cuadro. Conclusión: Existe un subdianóstico de casos de piedra blanca, que podría deberse a la falta de conocimiento de esta entidad y más excepcional su asociación con efluvio telogénico.

Pityrosporum ovale en cuero cabelludo: estudio piloto en población sana de Santiago / Pityrosporum ovale in scalp: pilot study in healthy population in Santiago

Nuestro propósito fue investigar la prevalencia aproximada del Pityrosporum ovale (PO) en el cuero cabelludo de población sana en diferentes grupos etarios. Se estudiaron 6 grupos desde RN hasta adultos de más o menos 20 personas cada uno, a los que se les tomó muestra de escamas de cuero cabelludo y se hizo cultivo especial para PO. En total se estudiaron 133 casos, encontrando diferentes positividades a distintas edades. En el grupo de RN no se cultivó PO, el cual se empieza a aislar desde la edad lactante. En los escolares y adolescentes se encontró positividad más alta (86% y 60% respectivamente). Estos resultados nos dan información para futuros estudios de prevalencia en nuestra población

Piedra branca: revisäo de literatura a respeito de três casos / White piedra: review of the literatura report of three cases

Os autores apresentam três casos de piedra branca comprometendo o couro cabeludo de crianças em idade pré-escolar. O Trichosporon beigelii foi caracterizado por exames micológicos. Revisa-se a literatura abordando aspectos clínicos, micológicos e terapêuticos