Cellular immunodeficiency related to chronic dermatophytosis in a patient with Schistosoma mansoni infection: can schistosomiasis induce immunodeficiency?

Abstract: Here, we describe a case of hepatosplenic schistosomiasis that progressed to widespread persistent dermatophytosis. Significant T and B lymphocytopenia was confirmed. T-cell deficit is associated with increased susceptibility to fungal infections of skin and mucous membranes. The accumulation of a large amount of blood cells in the spleen could have played a crucial role in the development of lymphocytopenia in the present case. Alternatively, the schistosomiasis-induced increase in prostaglandin E2 levels could have inhibited the production of interferon-γ, a cytokine fundamental to fungal resistance. This case shows the potential of hepatosplenic schistosomiasis to impair the immune response.

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

Case for diagnosis

Majocchi's granuloma is a persistent supurative folliculitis, associated with a deep granulomatous reaction induced by dermatophytes. There are two clinical forms of Majocchi's granuloma: the superficial form that appears in healthy individuals after localized trauma; and the nodular form, which occurs in inmunocompromised patients. We present a case of nodular Majocchi's granuloma on the forearm of an immunocompetent patient. Microbiological culture and examination of a deep aspiration sample identified Trichophyton rubrum. Collecting a deep sample of tissue is essential in achieving a good diagnostic performance.

Dermatophytosis: association between ABO blood groups and reactivity to the trichophytin

The authors investigated the relationship between dermatophytosis and ABO blood groups through blood typing, identification of isolated dermatophytes and specific cellular immune response of 40 individuals carriers of this mycosis. They verified that the fungus Trichophyton rubrum, isolated from 54.5 percent of the patients, was more frequent in individuals belonging to blood group A. The cellular immune response, evaluated through the trichophytin antigen, was positive in 25 percent of the studied patients; the presence of immediate reactions (30 minutes) was verified in 35 percent. The blood group distribution among patients with dermatophytosis and control groups was, respectively: 47.5 percent X 36 percent in group A, 40 percent X 50 percent in group O, 12.5 percent X 11 percent in group B. Even though the authors have found a higher number of patients belonging to blood group A infected by T. rubrum, these results suggest that there is no statistical evidence that these individuals are more susceptible to dermatophytosis

Dermatophytosis: association between ABO blood groups and reactivity to the trichophytin / Dermatofitose: associação entre grupos sanguíneos ABO e reatividade à tricofitina

The authors investigated the relationship between dermatophytosis and ABO blood groups through blood typing, identification of isolated dermatophytes and specific cellular immune response of 40 individuals carriers of this mycosis. They verified that the fungus Trichophyton rubrum, isolated from 54.5 percent of the patients, was more frequent in individuals belonging to blood group A. The cellular immune response, evaluated through the trichophytin antigen, was positive in 25 percent of the studied patients; the presence of immediate reactions (30 minutes) was verified in 35 percent. The blood group distribution among patients with dermatophytosis and control groups was, respectively: 47.5 percent X 36 percent in group A, 40 percent X 50 percent in group O, 12.5 percent X 11 percent in group B. Even though the authors have found a higher number of patients belonging to blood group A infected by T. rubrum, these results suggest that there is no statistical evidence that these individuals are more susceptible to dermatophytosis

Os autores investigaram a relação entre dermatofitose e grupos sanguíneos ABO por meio da tipagem sanguínea, identificação de dermatófitos isolados e resposta imune celular específica de 40 indivíduos portadores dessa micose. Verificaram que o fungo Trichophyton rubrum, isolado de 54,5 por cento dos pacientes, era mais frequente em indivíduos pertencentes ao grupo sanguíneo A. A resposta imune celular, avaliada pelo antígeno tricofitina, foi positiva em 25 por cento dos pacientes estudados; a presença de reações imediatas (30 minutos) foi verificada em 35 por cento. A distribuição do grupo sanguíneo entre os pacientes com dermatofitose e grupos controle foi, respectivamente: 47,5 por cento X 36 por cento no grupo A, 40 por cento X 50 por cento no grupo O, 12,5 por cento X 11 por cento no grupo B. Mesmo que os autores encontraram um maior número de pacientes pertencentes ao grupo sanguíneo A infectado por T. rubrum, estes resultados sugerem que não há evidências estatísticas de que esses indivíduos sejam mais suscetíveis à dermatofitose

Neurocysticercosis.

Sixty-two cases of neurocysticercosis (NCC) were examined over a period of five years. Convulsive seizure was the commonest presentation (57%). The other modes of presentation included features of raised intracranial pressure (19%) meningoencephalitis (9%), "Stroke" like onset (4%) and progressive dementia (6%). Clinical signs were scanty. Six patients had papilloedema, five had hemiparesis while three had isolated cranial nerve palsies. Soft tissue calcification and mucocutaneous nodules were infrequent and was found in 13 (21%) and 5 cases (8%) respectively. Clinical suspicion supported by CT scan and Immunobiologic tests using ELISA were the mainstay in diagnosis. Praziquantel and Albendazole were found effective in the treatment of neurocysticercosis, but because of serious side effects encountered in some cases, the drugs should be used cautiously in selected cases only.

Contribuição ao estudo da reação à tricofitina nas dermatofitoses / Contribution to the study of the reaction to trichophyline in dermatophytoses

Os autores investigaram a competência imunológica específica de 31 indivíduos portadores de dermatofitose, utilizando o antígeno tricofitina. Destes, 54,8% mostraram-se reatores à fase tardia dessa prova (48 h) nas seguintes proporções: tinea inguinale, 75%; tinea pedis, 61,5%; tinea unguium, 50% e tinea corporis, 20%. 62,5% dos casos apresentaram positividade à fase imediata (30 m) da reação. A associação entre essas reações revelou que, embora a maioria dos pacientes com reação imediata positiva apresentasse negatividade à reação tardia, 20,8% apresentaram positividade para as duas fases da reação. Dos pacientes não reatores à fase tardia, oito foram submetidos a outros testes cutâneos: PPD, estreptoquinase, candidina, vacínia e DNCB, verificando-se imunidade celular conservada em 75% dos casos. Estes resultados sugerem que, quando da utilização dessa prova na avaliação imunológica de pacientes com dermatofitose, deve-se considerar o estado imune geral do paciente, a presença de hipersensibilidade imediata e a localização da infecção

The authors investigated the specific immunological competence of 31 patients with dermatophytosis using tricophytin antigen. Among them, 54.8% showed reaction to the delay phase (48 h) in the following proportions: tinea inguinale, 75%; tinea pedis, 61.5%; tinea unguium, 50% and tinea corporis, 20%. Other 62.5% showed positive result to the early phase (30 m). The association between these reactions revealed that, although the majority of cases with early positive reaction showed negativity to the delayed reaction, 20.8% presented positivity to both phases of the reaction. Out of the non-reactive patients to the delayed phase, 8 were submitted to the other cutaneous tests such as PPD, streptokinase, candidin, vaccinia and DNCB and showed preserved cellular immunity in 75%. These results suggest that, while using this reaction for immunological evaluation of patients with dermatophytosis, one should consider the overall immune status of the patient, the presence of early hypersensibility and the localization of the infection

Tinea capitis em adulto / Tinea capitis in adults

Os autores relatam um caso de Tinea capitis de evoluçäo crônica em adulto, e discutem os aspectos epidemiológicos e imunopatogênicos desta entidade clínica