Clinical and Biochemical Characteristics of Hemophagocytic Lymphohistiocytosis in People Living With HIV and Disseminated Histoplasmosis at a Tertiary Hospital in Mexico.

Background: Hemophagocytic lymphohistiocytosis (HLH) is considered a rare disease with high morbidity and mortality risks. Most research on this disease is conducted in pediatric settings. Therefore, this study aimed to describe the clinical characteristics, laboratory findings, and outcomes related to HLH in people living with human immunodeficiency virus (HIV)/AIDS) and disseminated histoplasmosis. Methods: A retrospective and descriptive study was conducted in a tertiary hospital in México City from January 2018 to December 2022, including people living with HIV who had disseminated histoplasmosis confirmed through direct microbiological or immunological methods with an HScore ≥169 or who met 5 of the 8 HLH-2004 criteria. Results: HLH occurred in 36.1% (n = 26) of patients with HIV and disseminated histoplasmosis; the majority were men (84.9%), and their mean age (standard deviation) was 30.19 (5.6) years. The most frequent clinical manifestations were hepatomegaly (100%), fever (96.2%), and dyspnea (84.6%). The most common biochemical changes were hyperferritinemia (100%), elevated lactate dehydrogenase (100%), and bicytopenia (61.5%). Partial thromboplastin time (P = .012) and prothrombin time (P = .004) were associated with the 30-day mortality rate, and the 30-day survival rate was 65.4%. Conclusions: We detected a high frequency of HLH; therefore, we encourage physicians to use diagnostic prediction tools (HLH-2004 and HScore criteria) in each reassessment for timely detection.

Review Article White Piedra: Review of 131 cases.

This study analyzes the clinical characteristics of patients diagnosed with White Piedra through a systematic review of cases in the literature. A sample of 131 subjects was considered, of which 91.6% were female and most were 18 years of age or younger. Most studies were conducted in Brazil, followed by India, and Mexico. The most common etiologic agent found was Trichosporon spp (34.3%). Most affected patients were asymptomatic (94.6%) and predisposing factors included long hair, use of a hair band or hair accessories, and wet hair. The most common clinical feature was the presence of nodules. The evaluation of treatment effectiveness was hindered by the scarcity of follow-up information in the majority of the studies. It is concluded that White Piedra infection is more common in young women and is associated with hair-related factors.

Mixed oral candidiasis in type 2 diabetic patients: Identification and spectrum of sensitivity / Candidiasis oral mixta en pacientes con diabetes de tipo 2: identificación y espectro de sensibilidad

Introduction: Patients with type 2 diabetes mellitus are susceptible to acquire Candida spp. infections, sometimes involving more than one species. The resistance of some species to antimycotic agents can cause treatment failure. Objectives: To determine the frequency and clinical varieties of mixed oral candidiasis in patients with type 2 diabetes mellitus, the involved species, and its sensitivity spectra when exposed to antifungals used as candidiasis treatment. Material and methods: We developed an analytical cross-sectional study with 72 patients with type 2 diabetes mellitus with hyperglycemia (HbA1C ≥ 7%) and an oral candidiasis diagnosis. The causal species of oral candidiasis were identified through microbiological techniques, and sensitivity tests were carried out using the diffusion method in a plate with strips (E-test ®). Results: We included 72 patients in the study, 32 (44%) males and 40 (56%) females. Patients were divided into three age groups: young adults (17%), adults (74%), and older adults (9%). The mean age of the patients was 51 years. No significant differences were found between mixed oral candidiasis and groups (sex and age), or between mixed oral candidiasis and gender, glycosylated hemoglobin level (HbA1C), antihyperglycemic treatment, or type 2 diabetes mellitus time of diagnosis. We found a correlation between the adult group and development of mixed or simple oral candidiasis. The results showed eight (13%) cases of mixed oral candidiasis: seven with a coinfection of two species and one with a coinfection of three species. The identified species were Candida albicans, C. glabrata, C. dubliniensis, C. kefyr, C. tropicalis, and C. krusei. Most of these species presented sensitivity against ketoconazole and fluconazole, and higher resistance to itraconazole. Conclusions: Mixed oral candidiasis occurs in approximately 10% of the patients with type 2 diabetes mellitus and its treatment can be ineffective when the etiological agent is not identified.

Introducción: Los pacientes con diabetes mellitus de tipo 2 son propensos a adquirir infecciones por Candida spp., en ocasiones, causadas por más de una especie. La resistencia de algunas de ellas puede resultar en complicaciones médicas por falla del tratamiento. Objetivos: Determinar la frecuencia y las variedades clínicas de la candidiasis oral mixta en pacientes con diabetes mellitus de tipo 2, las especies de Candida involucradas y sus espectros de sensibilidad a los antifúngicos utilizados como tratamiento. Material y métodos. Se hizo un estudio transversal analítico en pacientes con diabetes mellitus de tipo 2, hiperglucemia (superior o igual al 7 % de la hemoglobina glucosilada, HbA1C) y con diagnóstico clínico de candidiasis oral. Mediante técnicas microbiológicas, se identificaron las especies causales de la candidiasis oral. Las pruebas de sensibilidad se llevaron a cabo con el método de difusión en placa con tiras (E-test®). Resultados: Se incluyeron 72 pacientes: 32 (44 %) hombres y 40 (56 %) mujeres, clasificados en tres grupos de edad: jóvenes adultos (17 %), adultos (74 %) y ancianos (9 %), con una media de 51 años. No se encontraron diferencias significativas en la candidiasis oral según los grupos de sexo y edad, ni entre las candidiasis orales mixtas y el sexo, el porcentaje de HbA1C, el tratamiento antihiperglucemiante o el tiempo de diagnóstico de la diabetes mellitus de tipo 2. En el grupo etario de adultos, se encontró una correlación con las candidiasis mixtas o simples. Se encontraron 8 (13 %) casos de candidiasis mixtas: siete con coinfección por dos especies de Candida y uno con coinfección por tres especies. Las especies identificadas en ellos, fueron: Candida albicans, C. glabrata, C. dubliniensis, C. kefyr, C. tropicalis y C. krusei. La mayoría de estas especies presentó sensibilidad a ketoconazol y fluconazol, y mayor resistencia a itraconazol. Conclusiones: Las candidiasis orales mixtas se presentan, aproximadamente, en el 10 % de los pacientes con diabetes mellitus de tipo 2 y el tratamiento puede ser ineficaz cuando no se identifica el agente etiológico.

Candidiasis oral mixta en pacientes con diabetes de tipo 2: identificación y espectro de sensibilidad / Mixed oral candidiasis in type 2 diabetic patients: Identification and spectrum of sensitivity

Introducción. Los pacientes con diabetes mellitus de tipo 2 son propensos a adquirir infecciones por Candida spp., en ocasiones, causadas por más de una especie. La resistencia de algunas de ellas puede resultar en complicaciones médicas por falla del tratamiento. Objetivos. Determinar la frecuencia y las variedades clínicas de la candidiasis oral mixta en pacientes con diabetes mellitus de tipo 2, las especies de Candida involucradas y sus espectros de sensibilidad a los antifúngicos utilizados como tratamiento. Materiales y métodos. Se hizo un estudio transversal analítico en pacientes con diabetes mellitus de tipo 2, hiperglucemia (superior o igual al 7 % de la hemoglobina glucosilada, HbA1C) y con diagnóstico clínico de candidiasis oral. Mediante técnicas microbiológicas, se identificaron las especies causales de la candidiasis oral. Las pruebas de sensibilidad se llevaron a cabo con el método de difusión en placa con tiras (E-test®). Resultados. Se incluyeron 72 pacientes: 32 (44 %) hombres y 40 (56 %) mujeres, clasificados en tres grupos de edad: jóvenes adultos (17 %), adultos (74 %) y ancianos (9 %), con una media de 51 años. No se encontraron diferencias significativas en la candidiasis oral según los grupos de sexo y edad, ni entre las candidiasis orales mixtas y el sexo, el porcentaje de HbA1C, el tratamiento antihiperglucemiante o el tiempo de diagnóstico de la diabetes mellitus de tipo 2. En el grupo etario de adultos, se encontró una correlación con las candidiasis mixtas o simples. Se encontraron 8 (13 %) casos de candidiasis mixtas: siete con coinfección por dos especies de Candida y uno con coinfección por tres especies. Las especies identificadas en ellos, fueron: Candida albicans, C. glabrata, C. dubliniensis, C. kefyr, C. tropicalis y C. krusei. La mayoría de estas especies presentó sensibilidad a ketoconazol y fluconazol, y mayor resistencia a itraconazol. Conclusiones. Las candidiasis orales mixtas se presentan, aproximadamente, en el 10 % de los pacientes con diabetes mellitus de tipo 2 y el tratamiento puede ser ineficaz cuando no se identifica el agente etiológico.

Introduction. Patients with type 2 diabetes mellitus are susceptible to acquire Candida spp. infections, sometimes involving more than one species. The resistance of some species to antimycotic agents can cause treatment failure. Objectives. To determine the frequency and clinical varieties of mixed oral candidiasis in patients with type 2 diabetes mellitus, the involved species, and its sensitivity spectra when exposed to antifungals used as candidiasis treatment. Materials and methods. We developed an analytical cross-sectional study with 72 patients with type 2 diabetes mellitus with hyperglycemia (HbAIC s 7%) and an oral candidiasis diagnosis. The causal species of oral candidiasis were identified through microbiological techniques, and sensitivity tests were carried out using the diffusion method in a plate with strips (E-test ®). Results. We included 72 patients in the study, 32 (44%) males and 40 (56%) females. Patients were divided into three age groups: young adults (17%), adults (74%), and older adults (9%). The mean age of the patients was 51 years. No significant differences were found between mixed oral candidiasis and groups (sex and age), or between mixed oral candidiasis and gender, glycosylated hemoglobin level (HbA1C), antihyperglycemic treatment, or type 2 diabetes mellitus time of diagnosis. We found a correlation between the adult group and development of mixed or simple oral candidiasis. The results showed eight (13%) cases of mixed oral candidiasis: seven with a coinfection of two species and one with a coinfection of three species. The identified species were Candida albicans, C. glabrata, C. dubliniensis, C. kefyr, C. tropicalis, and C. krusei. Most of these species presented sensitivity against ketoconazole and fluconazole, and higher resistance to itraconazole. Conclusions. Mixed oral candidiasis occurs in approximately 10% of the patients with type 2 diabetes mellitus and its treatment can be ineffective when the etiological agent is not identified.

The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries.

Reports of COVID-19-associated mucormycosis have been increasing in frequency since early 2021, particularly among patients with uncontrolled diabetes. Patients with diabetes and hyperglycaemia often have an inflammatory state that could be potentiated by the activation of antiviral immunity to SARS-CoV2, which might favour secondary infections. In this Review, we analysed 80 published and unpublished cases of COVID-19-associated mucormycosis. Uncontrolled diabetes, as well as systemic corticosteroid treatment, were present in most patients with COVID-19-associated mucormycosis, and rhino-orbital cerebral mucormycosis was the most frequent disease. Mortality was high at 49%, which was particularly due to patients with pulmonary or disseminated mucormycosis or cerebral involvement. Furthermore, a substantial proportion of patients who survived had life-changing morbidities (eg, loss of vision in 46% of survivors). Our Review indicates that COVID-19-associated mucormycosis is associated with high morbidity and mortality. Diagnosis of pulmonary mucormycosis is particularly challenging, and might be frequently missed in India.

Actinomycetoma by Actinomadura madurae. Clinical and therapeutic characteristics of 18 cases with two treatment modalities.

BACKGROUND: Actinomycetoma due to Actinomadura madurae is susceptible to numerous chemotherapeutic agents, however, the response to those treatments is variable and closely related to several factors. OBJECTIVE: We aimed to evaluate the clinical-therapeutic characteristics of patients with actinomycetoma due to Actinomadura madurae with two treatment modalities. METHODS: This was a retrospective study of eighteen patients with a diagnosis of actinomycetoma. The most widely used therapeutic scheme was streptomycin 1 g every third day plus TMP/SMX 800 mg/160 mg/12h, followed by TMP/SMX with DDS 100 mg/day. In six patients (33%), ciprofloxacin 500 mg every 12 h was used instead of DDS. RESULTS: Conventional scheme achieved clinical and mycological cure in 58% of the cases, improvement in 16%, and 25% of the patients failed to treatment; in the cases treated with ciprofloxacin, clinical and microbiological cure was achieved in 83% of patients and clinical improvement in 16%. The treatment time to achieve clinical and mycological did not have a statistically significant difference (median 10 ± 1.38 vs. 12 ± 4.6). CONCLUSION: Treatment based on streptomycin + TMP/SMX with ciprofloxacin was found to be effective in treating patients with actinomycetoma, and comparable to the conventional treatment with DDS in actinomycetoma due to A. madurae with minimal bone involvement.

Oral involvement in mucormycosis. A retrospective study of 55 cases.

INTRODUCTION: Mucormycosis with oral involvement (OIM) is a rare opportunistic and lethal mycosis, which has increased in the last decade and is generally associated with uncontrolled diabetes and neutropenia. METHODS: A retrospective study of cases with OIM was carried out in a tertiary-care center. Mycological and histological examinations were performed, and the isolated organisms were identified by morphology and molecular biology. RESULTS: Fifty-five OIM patients were included, with a median age of 38 years (61.8% males). The most frequent associated disease was type-2 diabetes mellitus (61%), followed by neutropenia due to acute lymphocytic leukemia (27%). The main presentation was palatal and mandibular ulcers (92.7%) and, to a lesser extent, gingival and lingual necrosis. The diagnosis was established by mycological and histopathological studies. The most frequent fungi isolated was Rhizopus arrhizus (67.2%). CONCLUSION: OIM is a rapidly progressing disease, therefore, an early diagnosis and the proper control of predisposing factors is necessary, and consequently, contributing to improve the outcome of mucormycosis.

Oral involvement in mucormycosis. A retrospective study of 55 cases / Mucormicosis con compromiso oral. Estudio retrospectivo de 55 casos

Introduction: Mucormycosis with oral involvement (OIM) is a rare opportunistic and lethal mycosis, which has increased in the last decade and is generally associated with uncontrolled diabetes and neutropenia. Methods: A retrospective study of cases with OIM was carried out in a tertiary-care center. Mycological and histological examinations were performed, and the isolated organisms were identified by morphology and molecular biology. Results: Fifty-five OIM patients were included, with a median age of 38 years (61.8% males). The most frequent associated disease was type-2 diabetes mellitus (61%), followed by neutropenia due to acute lymphocytic leukemia (27%). The main presentation was palatal and mandibular ulcers (92.7%) and, to a lesser extent, gingival and lingual necrosis. The diagnosis was established by mycological and histopathological studies. The most frequent fungi isolated was Rhizopus arrhizus (67.2%). Conclusion: OIM is a rapidly progressing disease, therefore, an early diagnosis and the proper control of predisposing factors is necessary, and consequently, contributing to improve the outcome of mucormycosis.(AU)

Introducción: La mucormicosis con afectación oral (MAO) es una micosis oportunista, letal y poco frecuente, pero que ha aumentado en la última década y que generalmente se asocia a diabetes descontrolada y neutropenia. Métodos: Se realizó un estudio retrospectivo de casos con MAO en un centro de tercer nivel. Se realizaron examen micológico e histológico, y los organismos aislados se identificaron por morfología y biología molecular. Resultados: Se incluyeron 55 pacientes con MAO, con una mediana de edad de 38 años (61,8% varones). La enfermedad asociada más frecuente fue la diabetes mellitus tipo 2 (61%), seguida de la neutropenia por leucemia linfocítica aguda (27%). La presentación principal fueron úlceras palatinas y mandibulares (92,7%) y, en menor medida, necrosis gingival y lingual. El diagnóstico se estableció con estudios micológicos e histopatológicos. El hongo más frecuentemente aislado fue Rhizopus arrhizus (67,2%). Conclusión: La MAO es una enfermedad de rápida evolución, por lo que es necesario un diagnóstico precoz y un adecuado control de los factores predisponentes y, en consecuencia, contribuir a mejorar la evolución de la mucormicosis.(AU)

Actinomycetoma by Actinomadura madurae: Clinical Characteristics and Treatment of 47 Cases.

CONTEXT: Mycetoma is a chronic, granulomatous disease caused by fungi (eumycetoma) or aerobic filamentous actinomycetes (actinomycetoma). Actinomadura madurae is one of the most frequent actinomycetes. AIM: The study aims to provide an update on clinical, diagnostic, therapeutic, and outcome data for patients with actinomycetoma in a single center in Mexico. SETTINGS AND DESIGN: This was a retrospective study of 47 cases diagnosed with actinomycetoma. SUBJECTS AND METHODS: The cases were selected from a total of 536 mycetoma obtained during 35 years (from 1985 to 2019). Clinical data were retrieved from the clinical records of our department. Microbiological data were obtained from our Mycology laboratory. STATISTICAL ANALYSIS: Frequencies and percentages were used for categorical variables. Normality was determined with the Kolmogorov-Smirnov test. We used means and medians to describe the variables. RESULTS: Forty-seven patients with actinomycetoma were included; female:male ratio 1.9:1; median age 38 years. The foot was the most affected region in 76.5% of cases. The bone invasion was observed in 89%. The time between symptoms onset and diagnosis was 5.5 years. Grain detection by direct examination was positive in 95% of cases. The most commonly used, as well as the most effective treatment scheme was streptomycin + sulfamethoxazole-trimethoprim with dapsone. Sixty-three percent (30 patients) achieved clinical and mycological cure, and 10.6% (5 patients) had treatment failure. CONCLUSIONS: We highlight the importance of designing therapeutic strategies to standardize treatments and gain more experience to improve the care of these patients.

Thoracic actinomycetoma: a retrospective clinical-epidemiological study of 64 cases.

BACKGROUND: Actinomycetoma is a chronic granulomatous infection that follows traumatic implantation. Thoracic actinomycetoma (TA) is rare and may lead to severe complications. METHODS: A retrospective study of cases of TA diagnosed from 1985 to 2019 was carried out. Each case underwent direct examination, culture and biopsy. RESULTS: Sixty-four cases (12.8%) were included, with a male predominance (84.3%); the main occupation was peasant farmer (71.8%) and the main site was the back (76.5%). Vertebral involvement was observed in 21.8% and pulmonary involvement in 7.8%. Nocardia brasiliensis was the main aetiological agent (53 cases, 74.5%). CONCLUSIONS: TA is a poorly studied disease that can cause neurological and lung complications.

Deep mycoses and pseudomycoses of the foot: a single-center retrospective study of 160 cases, in a tertiary-care center in Mexico.

BACKGROUND: Deep mycoses and pseudomycoses (DMP) may cause significant disability and even death; however, the reports regarding these diseases, mainly affecting the foot, are scarce. OBJECTIVE: To describe the epidemiological, clinical, and diagnostic characteristics of DMP of the foot in 160 patients. METHODS: A retrospective and observational study of DMP affecting the foot was carried out in a tertiary-care center in Mexico for 20 years (from January 2000 to December 2019). Cases with confirmatory microbiological studies were included; the identification of the isolated fungi was based on the forms of reproduction. For actinomycetes, morphological analysis in an automated system ATB Vitek® 1574 (Biomèrieux) was used. The fungi were identified by PCR, using several primers from the ITS regions and for actinomycetes in the 16S rRNA region. Data from histopathological studies were also collected. RESULTS: One hundred and sixty proven cases of DMP of the foot were included. The cases were categorized into nine types of infections including mycetoma (actinomycetoma and eumycetoma) in 102 cases (63.7%); sporotrichosis in 21 cases (13.1%); chromoblastomycosis, 18 cases (11.2%); phaeohyphomycosis, 3 cases (1.8%); histoplasmosis, 12 cases (7.5%); coccidioidomycosis 2 cases (1.2%) and botryomycosis and nocardiosis with one case respectively (0.6%). Most cases developed after traumatic implantation (147 cases, 91.8%). One hundred fifteen cases (71.8%) were men. The evolution was chronic in 125 cases (78.2%); bone involvement was observed in 64 cases (40%). Parasitic forms were observed In 139 cases (86.8%). The isolation and identification of the etiological agents were confirmed in all cases. CONCLUSION: The main DMP affecting the foot were infections due to traumatic implantation; most were endemic mycoses. The clinical characteristics and the evolution of the diseases are easily misdiagnosed, and thus, diagnostic tests are usually required.

Mucormycosis with cutaneous involvement. A retrospective study of 115 cases at a tertiary care hospital in Mexico.

BACKGROUND/OBJECTIVES: Cutaneous mucormycosis is an emerging opportunistic mycosis caused by Mucorales. It can be divided into primary caused by trauma and secondary by extension of rhino-cerebral and disseminated cases. The objective is to present a retrospective study of cases of mucormycosis with cutaneous involvement. METHODS: A retrospective and descriptive study was carried out. Mucormycosis patients were included and divided into two groups: a) Primary Cutaneous and b) Secondary Cutaneous. Mycological tests were performed; the agents were identified by morphology and molecular studies (PCR and sequencing); some cases underwent histopathology. Clinical data and response to treatment were collected. RESULTS: 115 cases were included, 18 of primary, and 97 of secondary cutaneous mucormycosis. Primary cutaneous mucormycosis was most associated with adhesive bands (44.4%) and trauma from traffic accidents (33.3%). The principal clinical form was extensive and deep necrotic ulcers. Secondary cutaneous mucormycosis cases were rhino-cerebral with uncontrolled diabetes (81.4%) The most frequent clinical presentation was necrosis of the eyelid and the nose (65.9%). In both groups, the principal agent was Rhizopus arrhizus, 38.8% and 74.2% respectively. The most effective treatment was the combination of amphotericin B with surgical debridement. The clinical and mycological cure was achieved in 31.0% of primary cases, and 44.4% for secondary cases. CONCLUSION: Primary cutaneous mucormycosis is caused by implantation of the Mucorales due to trauma or rupture of the cutaneous barrier-breach, and secondary cutaneous mucormycosis develops as part of the rhino-cerebral process. The response to treatment depends on the extension and depth, as well as the predisposing factors.

Mucormycosis at a tertiary-care center in Mexico. A 35-year retrospective study of 214 cases.

BACKGROUND: Mucormycosis is a rare, invasive disease associated with high mortality rates, produced by opportunistic pathogens related to the Mucorales order and characterised by a diverse range of clinical forms; acute rhino-orbital-cerebral and pulmonary symptoms are the most reported ones. OBJECTIVES: To report the experience of mucormycosis observed in a tertiary-care hospital in Mexico for 35 years. METHODS: This was a retrospective, descriptive and observational study on mucormycosis at a tertiary-care hospital in Mexico from January 1985 to December 2019. Demographic and clinical data and mycological and histopathological records were selected. RESULTS: Two hundred fourteen proven cases of mucormycosis for 35 years at a tertiary-care hospital in Mexico were included. Most of the cases were male patients with a median age of 45 years. The two most associated underlying diseases were diabetes mellitus (76.6%) and haematologic malignancy (15.4%). The three primary clinical forms were as follows: rhino-orbito-cerebral (75.9%), cutaneous (8.41%) and pulmonary (7.47%) mucormycosis. The most isolated agents were Rhizopus arrhizus (58.4%) and Lichtheimia corymbifera (12.3%). The overall therapeutic response was 58.5%, and the best response was observed with amphotericin B deoxycholate and surgical debridement. CONCLUSION: Mucormycosis is an emerging disease, and its incidence has increased at our hospital over the years. In this study, the rhino-cerebral clinical type was the most frequent in patients with uncontrolled diabetes; the main aetiological agent was R. arrhizus. Early diagnosis, control of the underlying disease and prompt management may increase the survival rate.

Oral involvement in mucormycosis. A retrospective study of 55 cases.

INTRODUCTION: Mucormycosis with oral involvement (OIM) is a rare opportunistic and lethal mycosis, which has increased in the last decade and is generally associated with uncontrolled diabetes and neutropenia. METHODS: A retrospective study of cases with OIM was carried out in a tertiary-care center. Mycological and histological examinations were performed, and the isolated organisms were identified by morphology and molecular biology. RESULTS: Fifty-five OIM patients were included, with a median age of 38 years (61.8% males). The most frequent associated disease was type-2 diabetes mellitus (61%), followed by neutropenia due to acute lymphocytic leukemia (27%). The main presentation was palatal and mandibular ulcers (92.7%) and, to a lesser extent, gingival and lingual necrosis. The diagnosis was established by mycological and histopathological studies. The most frequent fungi isolated was Rhizopus arrhizus (67.2%). CONCLUSION: OIM is a rapidly progressing disease, therefore, an early diagnosis and the proper control of predisposing factors is necessary, and consequently, contributing to improve the outcome of mucormycosis.

Tinea gladiatorum due to Trichophyton tonsurans in a school wrestling team in Mexico: A case series.

BACKGROUND AND PURPOSE: Tinea gladiatorum is a type of dermatophytosis that occurs in combat athletes, such as wrestlers and judo fighters, as a result of Trichophyton species. Herein, we aimed to present a small outbreak of tinea gladiatorum in a high school in Mexico. MATERIALS AND METHODS: Seven individuals belonging to the school fighting team were mycologically studied with direct examinations and cultures. In four cases, T. tonsurans was isolated and identified by morphological and proteomic methods (Matrix-assisted laser desorption/ionization- time-of-flight mass spectrometry). Out of the four subjects, two cases had clinical lesions presented as tinea corporis, and two cases were healthy carriers. Trichophyton tonsurans was also isolated from one of the four training mats (25%). All positive patients were treated with systemic or topical antifungals and achieved clinical and mycological cure. CONCLUSION: We report the first outbreak of tinea gladiatorum caused by T. tonsurans among a group of high school wrestlers in Mexico.