Querión Celso, dermatofitosis del cuero cabelludo infantil / Kerion Celsi, dermatophytosis of the scalp in young boy

Resumen Querión Celso es una micosis ocasionada por hongos dermatofitos que daña el cuero cabelludo principalmente a niños y en raras ocasiones a adultos. La forma de infección para los humanos proviene de los animales y del suelo y se relaciona con mala higiene personal, hacinamiento en las viviendas, condiciones de subdesarrollo y pobreza. Se presenta un caso de un niño de 9 años con una úlcera de 7 cm de diámetro en el cuero cabelludo y en forma de placa circular que presentaba material purulento, pelo quebradizo y un área alopécica. Al inicio, se abordó de manera terapéutica como una infección bacteriana; posteriormente, se solicitó estudio micológico que evidenció una coinfección por el microorganismo Microsporum gypseum. Se le confirmó el diagnóstico de tiña capitis con afección inflamatoria y se le prescribió griseofulvina, lo que resultó en una curación completa.

Abstract Kerion Celsi is a mycosis caused by dermatophyte fungi that mostly affects children and rarely adults, causing damage to the scalp. The form of infection for humans comes from animals and the soil. The infection is related to poor personal hygiene, overcrowded homes, underdeveloped conditions, and poverty. A case of a 9-year-old boy with a 7cm diameter ulcer on the scalp and in the form of a circular plaque that presented purulent material, brittle hair and an alopecic area is presented. Initially it was therapeutically addressed as a bacterial infection, a mycological study was requested, which showed coinfection by the microorganism Microsporum gypseum, the diagnosis of tinea capitis with inflammatory condition was confirmed, and Griseofulvin was prescribed, resulting in complete cure.

Tiña capitis por Trichophyton tonsurans en un paciente pediátrico / Tinea capitis by Trichophyton tonsurans in a pediatric patient

La tiña capitis (TC) es una micosis superficial del cuero cabelludo, considerada una de las infecciones más frecuentes por dermatofitos en niños. Hasta la actualidad, las especies descritas con mayor frecuencia en nuestro medio son el Microsporum y, en segundo término, Trichophyton, los cuales se contraen principalmente por contacto directo con animales o seres humanos infectados, respectivamente. Se presenta el caso de una paciente de 8 años con alopecia y lesiones inflamatorias de 2 años de evolución, en la que finalmente se llegó al diagnóstico de TC inflamatoria causada por T. tonsurans, un hongo antropofílico considerado poco frecuente en Argentina y emergente en la provincia de Buenos Aires. Este patógeno presenta alta transmisibilidad; son varios los países que han reportado brotes escolares y comunitarios. Se debe resaltar la importancia de su sospecha clínica temprana para un tratamiento adecuado.

Tinea capitis (TC) is a superficial mycosis of the scalp, considered one of the most common dermatophyte infections in children. Until now, the species mainly described in our environment are Microsporum and secondly Trichophyton, which are contracted mainly by direct contact with infected animals or humans, respectively. We present the case of an 8-year-old patient with alopecia and inflammatory lesions of 2 years of evolution, finally reaching the diagnosis of inflammatory tinea capitis caused by T. tonsurans, an anthropophilic fungus considered rare in Argentina and emerging in the province of Buenos Aires. This pathogen has high transmissibility; several countries have reported school and community outbreaks. The importance of its early clinical suspicion for adequate treatment should be emphasized.

Tiña Capitis en niños / Tinea capitis in children

La tiña capitis (TC) es una infección por dermatofitos con una alta prevalencia en la población pediátrica. Su epidemiología ha cambiado en las últimas décadas debido a la creciente migración poblacional alrededor del mundo. Se han identificado factores de riesgo ambientales y propios del huésped, relacionados al desarrollo de esta infección. Las manifestaciones clínicas son variables y dependen del agente causal. La dermatoscopia y la luz de Wood son herramientas útiles para la aproximación diagnóstica, sin embargo, la confirmación de la infección se basa en las pruebas micológicas. El aislamiento del agente causal permite orientar el tratamiento antifúngico adecuado, siendo estos eficaces y seguros en población pediátrica. El tratamiento se centra en la terapia antimicótica sistémica en combinación con medidas locales. El objetivo del manuscrito es hacer una revisión actualizada sobre el enfoque clínico y terapéutico de la TC en población pediátrica.

Tinea capitis (TC) is a dermatophyte infection with a high prevalence in the pediatric population. Its epidemiology has changed in recent decades due to increasing population migration worldwide. Environmental and host-specific risk factors have been identified which are with the development of this infection. The clinical manifestations are variable and depend on the causal agent. Dermatosco- py and Wood's lamp are useful tools for the diagnostic approach; however, the confirmation of in fection is based on mycological tests. The identification of the causal agent allows guiding the appro priate antifungal treatment, which is specific and safe in the pediatric population. Treatment focuses on systemic antifungal therapy combined with local measures. The objective of this paper is to carry out an updated review of the clinical and therapeutic approach to TC in the pediatric population.

Dr. Julio V. Uriburu. Su destacada participación en la micología nacional / Dr. Julio V. Uriburu. His outstanding participation in the national mycology

Destacado dermatólogo, el doctor Julio V. Uriburu propició el estudio de las afecciones micóticas en nuestro medio. Realizamos una breve actualización del diagnóstico y tratamiento de tiñas de cuero cabelludo.

Dr. Julio V. Uriburu was a very important specialist in skin disorders. He worked in the investigation of micotics infections of hair and scalp disorders. We did a review of diagnostic and treatment of tinea capitis.

TeleCondutas: dermatofitoses / TeleGuides: dermatophytosis

Dermatofitoses são infecções cutâneas superficiais causadas por fungos denominados genericamente de dermatófitos (gêneros: Microsporum, Trichophyton e Epidermatophyton) que afetam tecidos queratinizados como pele, cabelos e unhas. Uma vez que estes fungos são encontrados em humanos, animais e no ambiente, o principal fator de risco para o desenvolvimento da doença é o contato direto com animais ou humanos doentes ou portadores. A transmissão também pode ocorrer através do contato com objetos ou ambientes contaminados tais como: escovas de cabelo, roupa de cama, vestiários, carpetes ou outras superfícies contaminadas. O diagnóstico das dermatofitoses costuma ser com base no quadro clínico. Porém, na dúvida diagnóstica ou falha ao tratamento, pode-se solicitar o exame micológico direto para confirmar a infecção. A seguir, são apresentadas as formas mais comuns das dermatofitoses e seus respectivos tratamentos. Esta guia apresenta informação que orienta a conduta para casos de dermatofitoses no contexto da Atenção Primária à Saúde, incluindo: tinea corporis, tinea capitis, tinea cruris, tinea pedis e mannum, encaminhamento para serviço especializado.

Dermatoscopic fi ndings as a complementary tool in the differential diagnosis of the etiological agent of tinea capitis

Tinea capitis is a scalp infection caused by fungi. In Brazil, the main causative agents are Microsporum canis and the Trichophyton tonsurans. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. We reveal the dermoscopic findings that enable distinction between the main causative agents of Tinea capitis, M. canis and T. tonsurans. The association of clinical and dermatoscopic findings in suspected Tinea capitis cases may help with the differential diagnosis of the etiological agent, making feasible the precocious, specific treatment.

Tinea capitis inflamatoria por Trichophyton tonsurans var. sulfureum / Inflammatory tinea capitis by Trichophyton tonsurans var. sulfureum

Los dermatofitos constituyen un grupo de hongos queratinofílicos y queratinolíticos que pueden producir lesiones en piel y sus anexos en animales y el hombre. Las lesiones pueden variar de intensidad desde leves a severas, algunas de las cuales son altamente inflamatorias. Trichophyton tonsurans es un dermatofito antropofílico agente de tiñas no inflamatorias, de piel y raramente de uñas. Es altamente contagioso, que se adquiere por contacto interhumano y de escasa presentación en nuestro medio. Raramente y asociado a estados de inmunocompromiso ocasiona tiña inflamatoria de cuero cabelludo (Kerion Celsi o Querión de Celso). Kerion Celsi es una lesión altamente inflamatoria y supurativa, generalmente causada por dermatofitos zoofílicos que se transmiten de animales al hombre, la cual representa una respuesta inmune exagerada del huésped a la presencia del hongo. Se documenta un caso de Kerion Celsi a T. tonsurans presentado por un niño de 4 años de edad, sin inmunocompromiso, residente en el interior de la provincia. Se trata del primer caso local de tinea capitis altamente inflamatoria a T. tonsurans. El propósito es demostrar que el hongo, a pesar de ser antropofílico, puede ocasionar esta forma clínica en paciente sin inmunocompromiso. Su existencia en el medio requiere de diagnóstico rápido, de extremar medidas higiénicas y posterior control para evitar su propagación.

The dermatophytes are keratinophilic and keratinolytic fungi that cause skin and its annexes lesions in animals and man. T. tonsurans is an anthropophilic fungi, highly contagious, of rare presentation in our environment. Infection is acquired by interpersonal. Noninflammatory ringworm occurs in children and adults. Very rarely it causes highly inflammatory and suppurative ringworm of the scalp (Celsi kerion) associated with immunocompromised states. The kerion is caused by zoophilic dermatophytes. It represents an exaggerated host immune response to the presence of the fungus. This paper presents a case of T. tonsurans Kerion in a 4-year-old non-immunocompromised patient, who lives in rural area in the province. This is the first local case of severe inflammatory tinea capitis to T. tonsurans. The purpose of the study is to demonstrate that T. tonsurans can cause Kerion not associated to immunocompromised. Furthermore, it shows its existence in the medium, which requires immediate diagnosis of the diseases and increase hygiene and disease control to prevent the spread of the fungus.

Dermoscopy findings in tinea capitis: case report and literature review / Achados dermatoscópicos na tinea capitis: relato de caso e revisão da literatura

Dermoscopy is a method of increasing importance in the diagnoses of cutaneous diseases. On the scalp, dermoscopic aspects have been described in psoriasis, lichen planus, seborrheic dermatitis and discoid lupus. We describe the "comma" and "corkscrew hair" dermoscopic aspects found in a child of skin type 4, with tinea capitis.

A dermatoscopia é um método que ganha cada vez mais importância na diagnose de diversas dermatoses. No couro cabeludo, já foram descritos os aspectos dermatoscópicos presentes na psoríase, no líquen plano, na dermatite seborréica e no lúpus discóide. Nós descrevemos padrão dermatoscópico de "cabelos em vírgula e em saca rolhas" encontrado em uma criança com fototipo 4, com tinha do couro cabeludo.

Onicomicosis: epidemiología, agentes causales y evaluación de los métodos diagnósticos de laboratorio / Onychomycoses: epidemiology, causative agents and assessment of diagnostic laboratory methods

Desde marzo de 2007 hasta marzo de 2011 se estudiaron prospectivamente 414 pacientes con onicodistrofias en un laboratorio privado de Esquel. La prevalencia de onicomicosis de pie fue del 78 %; la de mano, del 58 %. Los principales agentes etiológicos fueron Trichophyton rubrum, Candida spp. y Trichophyton mentagrophytes. El desarrollo de dermatofitos prevaleció en las onicopatías de pie y el de Candida spp. en las de uñas de mano (ambos, p < 0,05). En las onicomicosis candidiásicas predominaron especies diferentes a Candida albicans. Las onicomicosis fueron más frecuentes en los hombres que en las mujeres. A su vez, en los hombres hubo más aislamientos de T. rubrum en pies (p < 0,05) y mayor proporción de exámenes directos (ED) y cultivos positivos (ambos, p < 0,05). La correlación entre los resultados del ED y del cultivo fue del 68 %. El rédito de ambos métodos se asoció a un mayor tamaño de la lesión ungueal. El ED fue más efectivo en onicodistrofias que superaban los 5 años de evolución. La positividad del cultivo fue independiente de la cronicidad de la onicodistrofia.

Since March 2007 to March 2011, 414 patients with onychopathies were prospectively analyzed. Prevalence of the toenail and fingernail mycoses was 78 % and 58 %, respectively. The major etiological agents were Trichophyton rubrum, Candida spp. and Trichophyton mentagrophytes. Dermatophytes were more frequently cultured from toenails, whereas Candida spp. from fingernails (both, p < 0.05). In candidal onychomycosis, species different from C. albicans were prevalent. A higher prevalence of toenail and fingernail mycoses, a predominance of T. rubrum in toenails (p < 0.05), and greater positivity in the direct examination (DE) and in culture (both, p < 0.05) were more frequently observed in men than in women. The correlation between DE and culture was 68 %. DE and culture yields were associated with a greater size lesion. DE was more effective in onycodystrophies with duration of more than 5 years. Culture positivity was independent of nail affection chronicity.

Black dot tinea affecting the eyebrows in an adult female

Tinea capitis is the invasion of the hair by dermatophytic species. It is predominantly an infection of children, although adult cases have been reported particularly with Trichophyton tonsurans. We report an adult female patient with black dot variety of tinea capitis involving the eyebrows along with scalp, body and nails

Micoses superficiais na infância / Superficial mycoses in childhood

Os autores descrevem as principais micoses superficiais na infância. Seus fatores predisponentes, agentes etiológicos, mecanismos de transmissão e o tratamento são discutidos.

Valor predictivo de signos y síntomas en el diagnóstico de tiña capitis en niños / Predictive value of signs and symptoms in the diagnosis of tinea capitis in children

Objetivo: Determinar el valor predictivo positivo de la adenopatía, alopecia, prurito y/o descamación del cuero cabelludo, en el diagnóstico de tiña capitis en niños. Material y Métodos: Estudio restrospectivo, descriptivo de asociación, observacional y de corte transversal, seleccionando 147 pacientes con sospecha de tiña capitis, entre 8 meses y 15 años. La prueba de oro fue el cultivo de las lesiones. Resultados y Conclusiones: Alopecia tuvo el mayor valor predictivo positivo de 92,1 por ciento (p menor 0,05), seguido de prurito con valor predictivo positivo = 90,4 por ciento (p menor 0,05), escamas con valor predictivo positivo = 89,9 por ciento (p mayor 0,05) y, adenopatía con valor predictivo positivo=80,0 por ciento (p menor 0,05). La asociación de alopecia y escamas tuvo un valor predictivo positivo de 94,3 por ciento (p menor 0,05); alopecia y prurito un valor predictivo positivo de 93,8 por ciento (p menor 0,05). Alopecia, escamas y prurito tuvo un valor predictivo positivo de 95,2 por ciento (p menor 0,05), siendo el mayor con respecto a los signos o síntomas o sus combinaciones. Las demás combinaciones ni superaron un valor predictivo positivo de 93 por ciento. Los valores predictivos negativos no fueron superiores a 35 por ciento.

Treatment of tinea capitis caused by Microsporum ferrugineum with itraconazole.

A prospective, non-randomized, open clinical trial was conducted to determine the efficacy of itraconazole for treatment of Microsporum ferrugineum tinea capitis. Itraconazole capsules were given every day in continuous group and every day for 1 week on and 3-week off in pulse therapy group. Concomitant topical therapy with 2% ketoconazole shampoo was used daily. Clinical evaluation consisted of assessing the degree of hair loss, scaling, erythema, pustule, and crust. In both groups, the treatment was stopped when the clinical signs of inflammation had resolved and the mycological examination had become negative or at week 12. There were 81 patients consisted of 49 boys and 32 girls enrolled and average dose of itraconazole was 4.5 mg/kg/day. During the 16-week study period (with 4-week follow-up visit) the overall clinical severity score decreased every visit (p < 0.001). The improvement of the scores showed no statistical difference between both groups. The cumulative cure rate using combined clinical and mycological cure at week 16 in patients treated with continuous and pulse regimen was 54.3% (19/35) and 37.0% (17/46), respectively. The cumulative percentage of all cure rates including clinical cure, mycological cure and combined clinical and mycological cure of the continuous group was significantly higher than in the pulse therapy group (p < 0.001). The superior efficacy of the continuous therapy group was observed after week 8. The cumulative cure rate increased with the longer treatment duration but decreased with the larger infected area involvement (p = 0.001). All patients who were not cured showed improvement. There was no significant adverse effect. The higher dosage or the longer treatment duration of itraconazole may be required for treatment of tinea capitis from M. ferrugineum to achieve more cure rate.

Comparison of the efficacy of fluconazole and griseofulvin in tinea capitis

Tinea capitis is a relatively common fungal infection in children. Although several oral antifungal agents have been used in the treatment of tinea capitis, griseofulvin has been considered as the treatment of choice for a long time. To compare the therapeutic effects of fluconazole with griseofulvin on tinea capitis. Through a randomized, single-blinded, clinical trial on 40 clinically suspected and mycologically confirmed tinea capitis cases, 19 cases received oral fluconazole for 4 weeks and 21 patients were treated with griseofulvin for 6 weeks. All patients were evaluated clinically and mycologically before receiving their treatment and 8 weeks after the begining of treatment. The age range of the patients was from 1 to 16 years. Thirty-two cases were males. Mycology studies indicated that the causative agents were Trichophyton verrucosum in 16 cases, Trichophyton violaceum in 16 cases and Microsporum canis in 8 cases. At the end of the eighth week of the begining of treatment, 15 cases were cured in the fluconazole group compared with 16 cases in the griseofulvin group [P>0.05]. It seems that griseofulvin could be still considered as the first choice drug in the treatment of tinea capitis and fluconazole could be used as an alternative drug

Tinea Capilatis causada por Trichophyton rubrum en un adulto portador de artritis reumatoidea / Tinea capilatis caused by T. rubrum in adult patient with rheumatoid arthritis

Presentamos un caso de tinea capilatis causada por Trichophyton rubrum en una mujer de 47 años de edad con artritis reumatoidea. Creemos que esta enfermedad crónica la volvió susceptible a esta dermatofitosis poco común

Importance of mycological confirmation of clinically suspected cases of Tinea corporis, Tinea pedis and Tinea cruris

Tinea corporis, tinea cruris, and tinea pedis are of the most prevalent dermatophytoses. Several conditions that mimic dermatophytoses and atypical and steroid modified forms of the disease usually present difficulties in diagnosis. Hence, the present investigation aimed at studying these conditions on mycological basis. The study included 163 cases clinically diagnosed as having tinea corporis, tinea pedis or tinea cruris. Specimens were taken by skin scraping. Samples were cultured on Sabouraud's dextrose agar and examined microscopically. The results revealed that, only 90.8% of cases were mycologically proven [positive by one or both methods]. Most of tinea corporis, tinea pedis and tinea cruris cases [68.9%, 79.1% and 83.9% respectively] were diagnosed by both methods [P>0.05]. For cases of tinea corporis and tinea cruris, males were more than females [51.4%, 48.6% and 58.1%, 41.9% respectively] while females exceeded-males [72.1%, 27.9% respectively] in cases with tinea pedis [P<0.05]. Trichophyton rubrum [T.rubrum] was the most common isolate in all the studied conditions, represented 64.9% in tinea corporis, 53.4%, for tinea pedis and 64.6% for tinea cruris. T.mentagrophytes var interdigitale was mostly isolated from cases of tinea pedis [23.3%].The majority of T.violaceum was isolated from cases of tinea corporis [12.2%].The main isolation of E.floccosum was from cases of tinea cruris [16.1%] Microsporum canis [M. canis] was only isolated from one case [1.4%] of tinea corporis while Candida albicans [C.albicans] alone [9.3%] or with T.rubrum [7.0%] was isolated only from cases of interdigital tinea pedis. [P<0.05].The majority of cases of tinea corporis, tinea pedis and tinea cruris had chronic lesions [78.4%, 76.7% and 54.8% respectively] [P<0.05] and received prior therapy for the condition 79.7%, 76.7% and 58.1% respectively, [P>0.05]. In conclusion, early accurate diagnosis [on mycological basis] is an important tool to control and reduce the incidence of dermatophytosis. Periodic epidemiological analysis of these conditions is required to ensure their efficacious control