1/22. Photolocalized tinea facialis.The case of a 34-year-old white woman with tinea facialis that persisted for nine months prior to diagnosis is presented. The confluent plaquelike erythematous eruption of the face with eyelid lichenification that flared outdoors was thought to represent polymorphic light eruption and was refractory to antibiotics, corticosteroids (topical and systemic), and antimalarials. A KOH preparation was positive when the dermatosis spilled onto the mandibular region, and restaining of the initial skin biopsy revealed fungal hyphae. Complete resolution was accomplished with griseofulvin and MicTin. tinea cab be added to the list of infectious agents that have a photosensitivity component. The fungus possibly "photolocalizes" to sun-damaged areas, ie, areas of increased capillary permeability. This case illustrates the importance of including tinea in considering diagnoses of sun-exposed lesions of the face.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
2/22. Microbiological and molecular diagnosis of deep localized cutaneous infection with trichophyton mentagrophytes.We describe a healthy young woman with a localized deep dermal infection on the right side of the chest wall. It was caused by the dermatophyte trichophyton mentagrophytes, and resolved after two pulses of oral itraconazole 200 mg twice daily for 1 week. As cultural and microscopic features did not enable a precise identification of the fungus, molecular investigation was undertaken. Patterns of HaeIII restriction digests of genomic dna from the culture matched those from Arthroderma incurvata and A. benhamiae, which is the teleomorph of T. mentagrophytes var. mentagrophytes.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
3/22. Dermatophytosis caused by trichophyton raubitschekii. Report of the first case in Sao Paulo, brazil.The authors report the first case of dermatophytosis caused by trichophyton raubitschekii in a patient from the State of Sao Paulo with tinea corporis lesions localized on the buttocks. culture on Sabouraud-agar with cycloheximide permitted the isolation and identification of the fungus, and the diagnosis was confirmed by Dr. Lynne Sigler, University of alberta, canada. Systemic treatment with fluconazole, 150 mg/week for 4 weeks, in combination with topical treatment with isoconazole initially yielded favorable results, with recurrence of the lesions after the medication was discontinued. This is the fifth case of this dermatophytosis published in the Brazilian medical literature.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
4/22. A case of black dot ringworm with a review of Japanese cases.Black dot ringworm (BDR), caused by trichophyton violaceum var. glabrum (T. glabrum), was observed in a 28-year-old Japanese female who had been treated with prednisolone (22.5 mg/day) for systemic lupus erythematosus. It was successfully treated with oral terbinafine (125 mg/day) for 12 weeks. The causative fungus was identified by molecular analysis as well as morphological and biochemical examination. The chitin synthase 1 (CHS1) gene cleavage pattern of the clinical isolate with restricted enzyme HinfI was identical to that of T. violaceum. We reviewed previous reports of BDR to determine the historical trend of this infection in japan. Since 1974, 93 Japanese cases have been reported. The age distribution was bi-modal: the higher peak consisted of children (aged 0-15 years), and the lower peak was composed of the elderly (aged 60-75 years). In the elderly group, females were predominant (M:F=1:22, p<0.001). T. violaceum, including T. glabrum, was identified as the most common causative fungus of BDR (75.3%). Sixty percent of cases showed slight erythema. In 8 families, 16 cases were found to be intrafamilial infections. A history of previous steroid treatment was described in about 40%.- - - - - - - - - - ranking = 2keywords = fungus (Clic here for more details about this article) |
5/22. Recalcitrant trichophytic granuloma associated with NK-cell deficiency in a SLE patient treated with corticosteroid.Although deep trichophytic infection often occurs in immunocompromised patients, the immune deficiency in such patients has not been clarified. A 28-year-old man who suffered from recalcitrant trichophytic granuloma and tinea universalis during treatment for SLE with corticosteroid is described here to define the immunological abnormalities. In addition to routine immunological tests, we evaluated the patient's innate and specific immune functions to dermatophytes, including T cell, natural killer (NK) cell and neutrophil functions and activation of the complement cascade. We measured the minimum inhibitory concentration (MIC) of itraconazole for the isolated fungus and its concentrations in the patient's serum and pus. trichophyton (T.) rubrum was constantly isolated from the exudates of the patient's skin lesions, although the concentrations of itraconazole in his serum (198 ng/ml) and lesions (210 ng/ml) were sufficient to inhibit the growth of the isolated fungus in vitro. Specific cell-mediated immune responses, determined by T cell stimulation and IFN-gamma production, were evoked following stimulation with trichophytic antigens. The patient's innate immunity, assessed by activation of the complement cascade and neutrophil-mediated phagocytosis, was not impaired. The number of circulating NK cells was markedly decreased (0.2% of the peripheral blood mononuclear cells), and was associated with low NK cell activity against K-562 cells even though lymphopenia had improved. The deficiency of innate immunity mediated by NK cells might be responsible for a part of the persistence of trichophytic granuloma in our case. Dermatophytes usually affect the horny layer of the skin and do not invade the living layers because the host immune system uses various mechanisms to eliminate the fungi. Both specific T cell-mediated immunity and nonspecific immunological mechanisms provide host defense against fungal infections. An adaptive immune response is usually preceded by innate immune responses mediated by neutrophils, NK cells, and circulating proteins such as complement components and anti-microbial peptides. However, in patients with localized or systemic immunological defects, granulomatous cutaneous infection of dermatophytes mostly caused by trichophytic fungi may occur [1]. Trichophytic granuloma includes Majocchi's granuloma [2] and disseminated trichophytic granuloma [3]. Recently, we experienced a patient with trichophytic granuloma and tinea universalis caused by trichophyton (T.) rubrum infection during treatment with corticosteroid for systemic lupus erythematosus (SLE). We describe the clinical details of this patient, focusing on his immunological defects which led to the persistence of the fungal infection.- - - - - - - - - - ranking = 2keywords = fungus (Clic here for more details about this article) |
6/22. tinea barbae associated with erythema nodosum in an immunocompetent man.We describe the case of a 45-year-old man with atopy who developed marked inflammatory lesions on the bearded area of the face caused by Tricophyton rubrum, an anthropophilic fungus not frequently correlated with kerion of the face. After starting therapy with griseofulvin, he developed typical lesions of erythema nodosum on both legs. We discuss how these lesions could be correlated with the kerion of the face.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
7/22. Preseptal cellulitis caused by trichophyton (ringworm).A 10-year-old boy with a past medical history significant for chicken pox at 7 years of age was referred to our eye center by an outside ophthalmologist for a 15-day history of worsening right-sided preseptal cellulitis. The patient reported photophobia, pruritus, and pain in the eyelid region. There appeared to be vesicular lesions on the eyelids. Empiric therapy with oral antibacterial and antiviral medications failed to resolve the preseptal cellulitis. Lid cultures revealed coagulase negative staphylococcus, Streptococcal viridans, and a trichophyton species of fungus. The infection was successfully treated with two courses of oral itraconazole. This is the first case of preseptal cellulitis caused by this dermatophyte that we could find in the literature.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
8/22. tinea barbae caused by a zoophilic strain of trichophyton interdigitale.A deep absceding infection is reported of the inframandibular part of the face of a 22-year-old male student due to a zoophilic strain of trichophyton interdigitale. The fungus was probably acquired from the cat of the patient. Initial therapy by a general practitioner was with topical glucocorticoids and oral antihistaminica. The patient developed a severe phlegmoneous inflammation of the bearded part of the face. Later, the patient was successfully treated by a combination of itraconazole and fluconazole. Identification of the species was confirmed by light and scanning microscopy as well as sequence analysis of the internal transcribed spacer region of the ribosomal dna.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
9/22. trichophyton raubitschekii: a new agent of dermatophytosis in brazil?A microbiological and ultrastructural study of trichophyton raubitschekii recovered from a patient with tinea faciei is presented. This is the second case of isolation of this fungus in Sao Paulo and the sixth case in brazil. Upon culture, the morphological pattern and the physiological tests performed confirmed the identification of T. raubitschekii. The ultrastructural study of T. raubitschekii showed the presence of a membrane-like structure located in the outer portion of the hyphal walls. This structure was bi-stratified and very like the one observed in T. rubrum. Is T. raubitschekii a new fungus emerging in brazil or is it a T. rubrum variant?- - - - - - - - - - ranking = 2keywords = fungus (Clic here for more details about this article) |
10/22. Hazards from hedgehogs: two case reports with a survey of the epidemiology of hedgehog ringworm.Two related cases of ringworm caused by contact with an infected hedgehog are reported. The causal fungus, trichophyton erinacei, was isolated from human and animal cases. The epidemiology of hedgehog ringworm is discussed.- - - - - - - - - - ranking = 1keywords = fungus (Clic here for more details about this article) |
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