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.

Tiña capitis por Microsporum gypseum, una especie infrecuente / Tinea capitis by Microsporum gypseum, an infrequent species

La tiña capitis es considerada la infección por dermatofitos más frecuente en los niños. Los agentes etiológicos varían con el tiempo y según la zona geográfica, aunque, normalmente, son dermatofitos de origen zoofílico y, en los últimos años, también dermatofitos antropofílicos. Se presenta un caso de tiña capitis inflamatoria en un niño de 6 años de edad causada por Microsporum gypseum, un hongo geofílico patógeno para humanos y animales. Las fuentes de infección humana son el suelo, los gatos, los perros y pequeños mamíferos. Esta especie es poco frecuente como causa de dermatofitosis en el hombre, descrita, sobre todo, en tiña corporis y, raramente, en tiña capitis. En el diagnóstico de tiña capitis, identificar la especie causal es un factor determinante para el tratamiento.

Tinea capitis is considered the most frequent dermatophyte infection in children. The etiological agents vary from time to time and by geographical area, although they normally are zoophilic dermatophytes and in the last years also anthropophilic species. We report a clinical case of inflammatory tinea capitis in a 6-year-old child caused by Microsporum gypseum, a geophilic fungus pathogenic to humans and animals. The sources of human infection are soil, cats, dogs and small mammals. This species is less frequent as a cause of dermatophytosis in humans, described mainly in tinea corporis and rarely in tinea capitis. In the diagnosis of tinea capitis identifying the causative species is a determinant of the treatment.

Epidemiological profile of tinea capitis in São Paulo City

Abstract: Tinea capitis is the most common fungal infection in children. The identification of the etiologic agent helps clinicians make their therapeutic choice. Studies conducted in different countries show a changing pattern of the main etiological agents according to their regions. We performed a retrospective study in the tertiary public service in São Paulo, analyzing the isolated etiological agents in patients with tinea capitis from March 2013 to May 2015. Microsporum canis was the main agent (56.6%), followed by Trichophyton tonsurans (36.6%). Despite recent migratory movements in the city, we observed no change in the causative agent of tinea capitis.

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.

Dermatophytes and other associated fungi in patients attending to some hospitals in Egypt

Dermatophytes are keratinophilic fungi that infect keratinized tissues causing diseases known as dermatophytoses. Dermatophytes are classified in three genera, Epidermophyton, Microsporum, and Trichophyton. This investigation was performed to study the prevalence of dermatomycosis among 640 patients being evaluated at the dermatology clinics at Kasr elainy, El-Husein and Said Galal hospitals in Cairo and Giza between January 2005 and December 2006. The patients were checked for various diseases. Tinea capitis was the most common clinical disease followed by tinea pedis and tinea corporis. Tinea cruris and tinea unguium were the least in occurrence. Tinea versicolor also was detected. The most susceptible persons were children below 10 years followed by those aged 31–40 years. Unicellular yeast was the most common etiological agent and T. tonsuranswas the second most frequent causative agent followed by M. canis.

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.

Tinea capitis among children at one suburban primary school in the City of Maputo, Mozambique

This study evaluated the prevalence of Tinea capitis among schoolchildren at one primary school and also identified the causative agents. Scalp flakes were collected from children presenting clinical signs suggestive of Tinea capitis. Dermatophytes were identified by following standard mycological procedures. This study found a clinical prevalence of Tinea capitis of 9.6 percent (110/1149). The dermatophytes isolated were Microsporum audouinii, Trichophyton violaceum, and Trichophyton mentagrophytes. The most prevalent causative agent in this study was Microsporum audouinii, thus confirming the findings from previous cross-sectional studies carried out in the city of Maputo.

O estudo avaliou a prevalência da Tinea capitis na população estudantil duma Escola Primária e também identificou os agentes causais responsáveis. Escamas do couro cabeludo foram recolhidas das crianças apresentando sinais clínicos sugestivos de Tinea capitis. Dermatófitos foram identificados seguindo procedimentos micológicos padronizados. Este estudo encontrou uma prevalência clínica de Tinea capitis de 9,6 por cento (110/1149). Os dermatófitos isolados foram Microsporum audouinii, Trichophyton violaceum e Trichophyton mentagrophytes. O agente causal mais prevalente neste estudo foi Microsporum audouinii confirmando os achados dos estudos transversais anteriores levados a cabo na Cidade de Maputo.

The changing pattern of Tinea capitis in Jamaica / El patrón cambiante de la tinea capitis en Jamaica

The species of dermatophyte fungi causing tinea capitis vary from country to country and may also change with time. This study was done to identify the predominant organisms causing tinea capitis in the Jamaican population. It was a retrospective study looking at all fungal culture requests to the Microbiology Department at the University Hospital of the West Indies during the period January 1, 1998 to December 31, 2002. The results showed a gradual switch from the dominance of Microsporum audouinii (61.5) in 1998 to the dominance of Trichophyton tonsurans (85) in 2002. The mean age was 8.6. Females constituted 55.7of positive cases and males, 44.3.

Las especies de hongos dermatofitos que causan la tinea capitis varían de país en país, y también pueden cambiar con el tiempo. Este estudio se realizó con el propósito de identificar los organismos predominantes que causan la tinea capitis en la población jamaicana. Se trata de un estudio retrospectivo que revisó todas las solicitudes de cultivos fúngicos hechas al Departamento de Microbiología del Hospital Universitario de West Indies durante el periodo del 1ero. de enero de 1998 al 31 de diciembre de 2002. Los resultados mostraron un cambio gradual del predominio de Microsporum audoinii (61.5%) en 1998 al predominio de Trichophyton tonsurans (85%) en 2002. La edad promedio fue 8.6. Las hembras constituyeron el 55.7%, y los varones el 44.3% de los casos positivos, respectivamente.

Tinha do couro cabeludo / Tinea capitis

Os autores apresentam um caso de Tinea capitis em paciente de cor branca do sexo feminino. A pesquisa micológica revelou Trichophyton mentagrophytes como agente etiológico. Revisa-se a literatura, demonstrando a importância do caso.

Agentes etiológicos de micosis superficiales en un area de Santiago - Chile: 1977-1987 / Etiologicals agents of superficial mycosis in an area of Santiago - Chile: 1977-1987

Con el propósito de determinar la prevalencia de los diferentes agentes etiológicos fúngicos durante un período de diez años (1977-1987) se examinaron muestras de piel, pelo y uñas de 1539 pacientes (932 se sexo masculino y 607 de sexo femenino), con sospecha clínica de micosis superficiales procedentes del consultorio N§ 1 de Especialidades, Hospital Paula Jaraquemada. El examen directo en KOH al 20% mostró un rendimiento global del 48,5%, mientras que el del cultivo en Sabouraud glucosado y Lactritmel fue de un 50,2%. De las 892 muestras de piel glabra analizadas, el agente aislado con mayor frecuencia fue Trichosporum rubrum (57,3%) seguido por Microsporum canis (23,4%). En 497 muestras de uñas, Candida spp se aisló en el 54% y T. rubrum en el 46,5%. En 150 muestras de cuero cabelludo se observó un predominio de M. canis (93,2%). Se destaca el hallazgo de hongos poco frecuentes en nuestro medio como es T. Schoenleinii (3), M. gypseum (4) y agentes oportunistas productores de micosis ungueal como Scopulariopsis brevicaulis (2) y Aspergillus spp (4)