Dermatofitosis por Microsporum gypseum en un niño con inmunodeficiencia primaria / Microsporum gypseum dermatophytosis in a child with primary immunodeficiency

El Microsporum gypseum es un hongo geofílico que puede producir lesiones cutáneas inflamatorias en personas sanas. Se han descripto lesiones más extensas en pacientes inmunocomprometidos. Se presenta el caso de un paciente con dermatofitosis, con exámenes micológicos positivos para Candida sp, Epidermophytom floccosum y Trichophyton tonsurans, al que, ante la mala respuesta al tratamiento con griseofulvina e itraconazol a dosis habituales, se le realizó biopsia cutánea para cultivo que evidenció la presencia de M. gypseum. Debido a la extensión y a la mala respuesta al tratamiento, se realizó evaluación inmunológica y se diagnosticó un defecto en STAT1 con ganancia de función (STAT1-GOF). Los pacientes que tienen esta inmunodeficiencia primaria son susceptibles a las infecciones micóticas, especialmente por Candida, pero también, aunque en menor medida, a virus y bacterias. El paciente aquí presentado recibió tratamiento prolongado con antimicóticos imidazólicos sistémicos, con resolución de las lesiones.

Microsporum gypseum is a geophilic fungus that can cause inflammatory skin lesions in heathy people. More extensive lesions have been described in immunocompromised patients. We present a patient with extensive dermatophytosis, which mycological examination led the identification of Candida sp, Epidermophyton Floccosum and Trichophyton tonsurans and showed poor response to treatment with griseofulvina and itraconazol at usual doses. When skin biopsy was performed, it had positive culture for M. gypseum. Due to the extension and poor response to treatment, immunological assessment was performed and it showed a defect of STAT1 with gain of function (STAT 1-GOF). Patients with primary immunodeficiency are susceptible to fungal infections, especially Candida but also virus and bacteria, although to a lesser extent. The patient received long-term treatment with systemic imidazole antifungal recovering for the lesions.

Tinea corporis by Nannizia gypsea: delayed diagnosis due to unusual presentation

Abstract Fungal infections by dermatophytes can present with unusual clinical manifestations, which can cause diagnostic difficulties. The authors present the case of a patient with cutaneous infection by Nanizzia gypsea, initially treated erroneously with topical corticosteroids due to a wrong diagnosis. It was cured after antifungal treatment.

Primer reporte de caso autóctono de tinea nigra en Chile / First autochthonous case report of tinea nigra in Chile

Resumen La tinea nigra es una infrecuente micosis superficial causada por el hongo dematiáceo Hortaea werneckii. Se presenta habitualmente en zonas costeras tropicales, siendo muy escasos los reportes en países sudamericanos con climas más templados. Habitualmente corresponde a infecciones importadas por viajeros. Se presenta el caso de una paciente adulta chilena, sin historia previa de viajes recientes, cursando con cuadro clínico y microbiológico compatible con tinea nigra palmar, tratado con itraconazol oral y sertaconazol tópico con respuesta favorable. Esta paciente corresponde al primer caso reportado en Chile de origen autóctono.

Abstract Tinea nigra is an infrequent superficial mycosis caused by the dematiaceous fungus Hortaea werneckii. It usually occurs in tropical coastal areas, with very few reports in South American countries with temperate climates, generally corresponding to infections imported by travelers. We present the case of a Chilean adult patient, with no previous history of recent trips, with clinical and microbiological background consistent with palmar tinea nigra, treated with oral itraconazole and topical sertaconazole with a favorable response. This article is the first case reported in Chile, of autochthonous origin.

Profil mycologique de teignes du cuir chevelu vues à l'UPFR Parasitologie - Mycologie du HU-JRA Antananarivo, Madagascar de 2005-2018

Introduction : Les teignes sont des affections fongiques contagieuses causées par plusieurs espèces de dermatophytes. Cette mycose touche essentiellement l'enfant et rarement l'adulte. Les teignes anthropophiles sont fréquentes dans la plupart des pays en voie de développement. Cette affection reste sous-documentée à Madagascar. Notre étude a pour objectif de rapporter les cas de teignes diagnostiqués dans le laboratoire de parasitologie-mycologie au CHU Ravoahangy Andrianavalona Antanananarivo de 2005 à 2018. Méthode : Il s'agit d'une étude rétrospective descriptive incluant tous les dossiers des patients ayant effectué un examen mycologique. Ont été inclus les dossiers comportant comme diagnostic la teigne. Chacun de ces patients a bénéficié d'un examen direct et d'une culture mycologique Résultats : Nous avons colligé en 13 ans 1014 patients confirmés porteurs de mycose. La fréquence des teignes sur l'ensemble des mycoses a été de 5,81% (59/1014). La prévalence brute des teignes a été de 37,57% (59/157). L'âge des patients variait de 2 à 67 ans dont 52,54% sont des enfants moins de 10 ans. La moyenne d'âge est de 13,5 ans. Les teignes étaient plus retrouvées chez les hommes (71,19 %) que chez les femmes (28,81 %) avec un sex ratio H/F de 2,47.Parmi ces patients, 77, 96% ont eu une notion de traitement avant l'examen mycologique. Dix souches de dermatophytes ont été isolées. Parmi les espèces retrouvées, Microsporium langeronii est l'espèce la plus isolée (33,89 %), suivie de Trichophyton mentagrophytes à 20,33 %. Conclusion : La fréquence des teignes n'est pas négligeable à Madagascar atteignant préférentiellement les enfants. Le diagnostic biologique des teignes est indispensable avant de débuter le traitement. L'identification de l'agent causal est importante pour prévenir et contrôler l'infection dermatophytique

Tiña negra: reporte de tres casos pediátricos / Tinea nigra: report of three pediatrics cases

Resumen: Introducción: La tiña negra es una micosis superficial causada por Hortaea werneckii. Su caracte rística clínica es la aparición de una mácula café negruzca de rápido crecimiento, producto del pig mento sintetizado por el mismo hongo. Sus características pigmentarias y de rápido crecimiento, de localización preferentemente acral, genera preocupación en los pacientes y en sus médicos tratantes por la sospecha de una lesion névica en evolución. Objetivos: Presentar 3 casos clínicos de pacientes pediátricos con esta patología y dar a conocer las herramientas para su diagnóstico diferencial. Casos clínicos: Tres pacientes, edades 3 y 5 años, con lesión macular pigmentada en palmas o plantas, cuyos padres referían habían crecido en forma rápida en poco tiempo. Dos de los casos tenían antecedentes de viajes previos al Caribe. Ante la sospecha clínica y dermatoscópica de una tiña negra, se realizó exámen micológico que confirmó el diagnóstico. En todos los casos, el tratamiento con antimicóticos tópicos llevó a la resolución completa de las lesiones. Conclusión: Aunque la tiña negra es rara en un clima seco, los viajes cada vez más frecuentes de los pacientes a países tropicales, probablemente aumentarán el número de casos. La dermatoscopía y el examen micológico son las herramientas que permiten realizar un correcto diagnóstico, evitando biopsias y/o cirugías innecesarias.

Abstract: Introduction: Tinea nigra is a superficial mycosis caused by Hortaea werneckii. Its clinical characte ristic is the appearance of a blackish brown macula of rapid growth, caused by the pigment produced by the fungus itself. The presence of a dark, fast growing, acral pigmentary lesion causes concern among patients and their treating physician about the possibility of a malignant pigmentary lesion. Objective: To present a series of three clinical cases in pediatric patients with this pathology and to show the tools that help to make a differential diagnosis. Clinical cases: Three patients between three and five years of age, which present a macular pigmented lesion on palms or soles, whose parents reported a rapid growth over a short period of time. Two of the patients reported previous trips to the Caribbean. Clinical and dermatoscopy suspicion of tinea nigra lead to a direct mycological exa mination, which confirmed the diagnosis. In all three cases, treatment with topical antifungals led to complete healing of the lesions. Conclusions: Although tinea nigra is rare in a dry climate, increasing travel of patients to tropical countries will increase the number of cases. Dermatoscopy and direct mycological examination are the tools that allow performing a correct diagnosis and avoiding unne cessary biopsies and/or surgeries.

White piedra, black piedra, tinea versicolor, and tinea nigra: contribution to the diagnosis of superficial mycosis

Abstract Superficial mycoses are fungal infections restricted to the stratum corneum and to the hair shafts, with no penetration in the epidermis; they are: white piedra, black piedra, tinea versicolor, and tinea nigra. This study presents images of mycological tests performed in the laboratory, as well as exams performed at the authors office, in order to improve the dermatologist's knowledge about the diagnosis of these dermatoses, which are common in many countries.

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.

Dermatofitoses: agentes etiológicos, formas clínicas, terapêutica e novas perspectivas de tratamento / Dermatophytoses: etiologic agents, clinical forms, therapy and new perspectives of treatment

As dermatofitoses têm ocorrência mundial, sendo mais prevalentes em países de clima tropical e subtropical. Dados epidemiológicos indicam que essas micoses estão entre as infecções fúngicas de maior ocorrência. O quadro clínico mais comum de dermatofitose inclui despigmentação, placas anulares, prurido e perda de cabelo, com lesões tipicamente conhecidas como tineas, ocasionadas por fungos filamentosos dermatofíticos de três gêneros anamórficos: Microsporum, Trichophyton e Epidermophyton. O tratamento das dermatofitoses, em geral, está relacionado ao uso de antifúngicos tópicos e/ou sistêmicos, apresentando como problemática o surgimento de espécies multirresistentes. Esta revisão aborda as dermatofitoses e seus agentes etiológicos de forma aprofundada em aspectos epidemiológicos, apresentando a importância clínica do tema, com ênfase na causa, prevenção, tratamento e prognóstico dessa micose cutânea (AU)

Dermatophytoses have worldwide occurrence with higher prevalence in tropical and subtropical countries. Epidemiological data show that these mycoses are among the most frequent fungal infections. The most common symptoms of dermatophytoses include depigmentation, annular plaques, itching and hair loss, with lesions such as tinea, caused by dermatophytic filamentous fungi of three anamorphic genera: Microsporum, Trichophyton and Epidermophyton. Topical and/or systemic antifungalmedications are used in the treatment of dermatophytoses in general, resulting in problems such as the emergence of multidrug-resistant species. This review discusses dermatophytoses and their etiological agents with a focus on epidemiological aspects, presenting the clinical importance of the issue, with emphasis on cause, prevention, treatment and prognosis of this skin mycosis (AU)

Skin Infection due to Trichophyton tonsurans Still Occurs in People in Korea but not as Outbreaks

Since 1995, Trichophyton tonsurans has been one of the causative agents of dermatophytosis in Korea. Herein we evaluate 77 patients infected with T. tonsurans who visited an outpatient clinic between 2004 and 2014. Infections due to T. tonsurans were diagnosed by mycological examination, which included direct microscopic examination using 15% KOH and culture in potato dextrose agar complemented with 0.5% chloramphenicol. The annual prevalence of infection due to T. tonsurans was the highest in 2014 (15 cases) but remained constant in non-gladiators between 2004 and 2014. The ratio of male to female patients was 1:0.3. The spring season presented the highest incidence compared with other seasons, with 27 cases. The incidence of infections due to T. tonsurans among gladiators was highest in spring compared with the other seasons whereas the incidence in non-gladiators was the highest in the winter. The body site most commonly affected was the face. Tinea corporis was the most common subtype of dermatophytosis caused by T. tonsurans. Herein, we demonstrate that the prevalence of infection with T. tonsurans remain constant throughout the study period in Korea.

Um início duvidoso, um fim incógnito ­ um caso de tinha incógnita / A doubtful beginning, an incognito ending­A case of tinea incognito / Un comienzo dudoso, un final incógnito ­ un caso de tiña incognita

A tinha incógnita é causada pela modificação de uma dermatofitose após tratamento com imunossupressores, geralmente corticoides tópicos, mascarando as suas características típicas, resultando na progressão da infecção fúngica original. Relata-se um caso clínico de um homem de 71 anos que desenvolveu um quadro de "picadelas" (sic), dor e desconforto no antebraço direito associado a lesões pápulo-vesiculares de cor rósea, não pruriginosas. O doente foi avaliado e medicado, com antiviral, antibiótico, anti-inflamatório não esteroide e corticoide sem sucesso, tendo desenvolvido lesões pápulo-pustulosas violáceas com descamação em cerca de 1 mês. Após prova terapêutica com um agente antifúngico e depois de descoberto que o paciente usava cronicamente corticoides tópicos, foi diagnosticada uma tinha incógnita. O diagnóstico da tinha incógnita representa um desafio para o Médico de Família, uma vez que esta mimetiza várias condições dermatológicas.

Tinea incognito is caused by the modification of ringworm after treatment with immunosuppressants, normally topical steroids, which mask its typical characteristics, and result in the progression of the original fungal infection. This is a case of a 71-year-old man who developed a clinical picture involving "bites" [sic], pain, and discomfort in the right forearm, associated with papular vesicular lesions that were pinkish in color and non-pruritic. The patient was evaluated and medicated with antivirals, antibiotics, and nonsteroidal anti-inflammatory drugs with no success. He developed violaceous papular-pustular lesions with scaling in about 1 month. After a therapeutic trial with an antifungal agent and the discovery of the patient's chronic use of topical corticosteroids, a diagnosis of tinea incognito was established. This diagnosis presents a challenge to the general practitioner due to its similarity to various dermatological conditions.

La Tiña incógnita es causada por la modificación de una dermatofitosis después del tratamiento con inmunosupresores, generalmente esteroides tópicos, enmascarando sus características típicas, conllevando a la progresión de la infección fúngica inicial. Se presenta un caso de un hombre de 71 años que desarrolló un cuadro de "picaduras", dolor y malestar en el antebrazo derecho, asociado a lesiones vesiculares papulosas de color rosado, no pruriginosas. El paciente fue evaluado y medicado con antibióticos, antivirales, corticoides y antiinflamatorio no esteroideo, sin éxito. Se desarrollaron lesiones escamosas violáceas, pápula-pustulosas con evolución de un mes. Después que se descubrió que el paciente estaba usando corticoides tópicos crónicamente, y luego de la prueba terapéutica con un anti-fúngico, le fue diagnosticada una tiña incógnita. El diagnóstico de tiña incógnita representa un desafío para el médico de familia, ya que ésta imita varias condiciones dermatológicas.

Presentación de siete casos de tiña negra en niños / Reports of seven cases of tinea nigra in children

Introducción: la tiña negra es una micosis superficial causada por el hongo Hortaea werneckii. Se considera una micosis benigna que por lo general es observada en países tropicales. Objetivo: reportar siete casos de tiña negra en niños de dos hospitales de La Habana, Cuba. Métodos: se realizó estudio micológico (examen directo y cultivo) a partir de escamas tomadas mediante raspado de las lesiones a siete niños con diagnóstico clínico presuntivo de tiña negra palmar. Se registraron las características de las lesiones, edad, sexo y factores predisponentes de los pacientes, así como la evolución del cuadro con el tratamiento antifúngico. Resultados: se confirmó la sospecha clínica de tiña negra a través del aislamiento e identificación de Hortae werneckii. Las edades de los pacientes oscilaron entre 3 y 6 años y el 57 por ciento era del sexo femenino. La hiperhidrosis se encontró en el 43 por ciento de los casos. El tratamiento específico con antifúngicos azólicos y terbinafina tópicos fue satisfactorio en 21 días como promedio. Conclusiones: todos los casos con sospecha de tiña negra fueron confirmados de manera oportuna en el laboratorio, lo que permitió descartar enfermedades malignas y aplicar tratamiento específico(AU)

IL-17 assay in adult T-cell leukemia/lymphoma patients with dermatophytosis

Assess IL-17 level as proinflamtory cytokine and predictor for the outcome of inflammatory process in ATLL patients with dermatophytosis. Isolation and identification of different types of dermatophytes infecting patients with ATLL. 58 subjects were included in this study [16 adult patients with adult T-cell leukemia / lymphomaclinically diagnosed to have dermatophytosis, 14 adult patients with adult T-cell leukemia / lymphoma clinically diagnosed to have no dermatophytosis, 12 age and sex matched patients clinically diagnosed to have dermatophytosis and 16 Age and sex matched apparently healthy Controls]. Sampleswere examined microscopically using 20% KOH and cultured on into SDA containing chloramphenicol [0.5%] with/without cycloheximide [0.5%] and Dermatophyte test medium [DTM]. in the non-ATLL patients with dermatophytosis, the serum IL-17 level was significantly increased compared with the healthy controls. In ATLL patients either with or without dermatophytosis, the IL-17 levels were significantly lower than those in the healthy controls. There was no significant difference in the IL-17 level between ATLL patients with dermatophytosis and those without dermatophytosis. Again, it is suggested that ATLL patients have low levels of IL-17, which cannot be enhanced by the presence of dermatophytosis. Among patients with ATLL with dermatophytosis [Group I] T. rubrum was the commonest dermatophyte causing infection; 64% of samples [tineacorporis 46%, tineaunguium 18%], whereas T. mentagrophytes was the 2[nd] commonest dermatophyte; 27% [tineaunguium 27%], lastly T. tonsurans; 9% [tineacorporis 9%]. In patients with Non-ATLL with dermatophytosis [Group III] T. rubrum was also the commonest dermatophyte causing infection; 64% of samples [tineacorporis 7%, tineaunguium 14%, tineapedis 43%], whereas T. mentagrophytes was the 2nd commonest dermatophyte; 29% [tineaunguium 7%, tineapedis 22%], lastly T. tonsurans; 7% [tineacorporis 7%]. Our data provides clinical evidence linking Th17 cells to immune deficiency in ATLL and opens a new avenue in the study of tumor immunotherapy based on promoting Th17 cell population

Current mycological profile of dermatophytosis in a tertiary care set up in North Bengal

To determine the occurrence, distribution and mycological profile of dermatophytosis in North Bengal Medical College and Hospital, in Darjeeling, West Bengal, India. A total of 200 specimens were collected from clinically suspected dermatophytoses from February to April 2013. Samples of skin scrapings, hair shafts and nails were sent to laboratory from dermatology OPD for direct examination, fungal culture and identification. Adult males outnumbered females in all cases of dermatophytosis except tinea corporis. Most cases showed high culture sensitivity except tinea unguium. Trichophyton rubrum was the most commonly isolated fungal organism. This study identifies the clinical distribution and predominant organisms causing dermatophytosis in North Bengal, which may be useful to ascertain the past and present trends in dermatophytosis and provide insight into future diagnosis and treatment

A case of Tinea nigra associated to a bite from a European rabbit (Oryctolagus cuniculus, Leporidae): the role of dermoscopy in diagnosis

We report a case of Tinea nigra in an adolescent living in Itapema, Santa Catarina, Brazil, who presented a hyperchromic macule on the palm of the left hand, close to another erythematous macule caused by a rabbit bite. The patient received guidance on accidents and animal bites and evolved well treated with topical butenafine for the dermatomycosis. The authors also highlight the efficacy of the dermoscopic exam in diagnosing Tinea nigra with animal bite lesions and other traumas.