Features of clinical and laboratory diagnostics of scalp mycosis

Introduction. Mycosis of the scalp (Tinea capitis) is one of the most common infections localized on the scalp and occurs mainly in children. The frequency of purulent inflammatory type (Kerion celsii) is about 15% of all cases of of scalp mycosis. The causative agents are zoophilic dermatophyte fungi that cause skin mycoses in cattle, donkeys, dogs, goats, sheep and horses. Zoonotic infection Trichophyton verrucosum is reported ubiquitously, more frequently in Asia and the Middle East. Human infection occurs in rural areas where close contact with animals is more likely. The urgency of the problem is associated with the increasing number of cases of severe scalp mycosis caused by T. verrucosum.

Aim. Analyse clinical and laboratory features of T. verrucosum infection.

Results. The article describes two cases of mycosis of the scalp caused by T. verrucosum. Both patients received complex treatment in the inpatient department of the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology. Effective treatment was delayed due to incorrect clinical and laboratory diagnosis of the disease. After hospitalization in the pediatric dermatovenereology department, both patients quickly responded to treatment with oral antifungals. No growth of T. verrucosum culture was obtained during laboratory diagnostics of pathological material. Direct microscopy revealed an ectothrix-like arrangement of spores.

Conclusions. Due to active migration and the popularity of tourism, dermatovenerologists in their daily practice must be prepared for an increase in infectious diseases. A properly collected anamnesis allowed specialists to establish the correct diagnosis of scalp mycosis caused by a zoophilic dermatophyte. In the given clinical examples, when the bacteriological method did not give a result, direct microscopy allowed to confirm the clinical diagnosis, identify the etiologic agent (T. verrucosum) and optimize the tactics of systemic and topical therapy.

1. Gheisari M, Zahedi K, Al-Zubaidi N. Tinea capitis caused by Trichophyton violaceum in an immunocompetent elderly patient: A case report and review of literature. Clin Case Rep. 2023;11(11):e8205. https://doi.org/10.1002/ccr3.8205.

2. Hay RJ. Tinea Capitis: Current Status. Mycopathologia. 2017;182(1-2):87–93. https://doi.org/10.1007/s11046-016-0058-8.

3. Pires CA, Cruz NF, Lobato AM, Sousa PO, Carneiro FR, Mendes AM. Clinical, epidemiological, and therapeutic profile of dermatophytosis. An Bras Dermatol. 2014;89(2):259–264. https://doi.org/10.1590/abd1806-4841.20142569.

4. Hill RC, Gold JAW, Lipner SR. Comprehensive Review of Tinea Capitis in Adults: Epidemiology, Risk Factors, Clinical Presentations, and Management. J Fungi. 2024;10(5):357. https://doi.org/10.3390/jof10050357.

5. Baumgardner DJ. Fungal Infections From Human and Animal Contact. J Patient Cent Res Rev. 2017;4(2):78–89. https://doi.org/10.17294/2330-0698.1418.

6. Veasey JV, Muzy GSC. Tinea capitis: correlation of clinical presentations to agents identified in mycological culture. An Bras Dermatol. 2018;93(3):465–466. https://doi.org/10.1590/abd1806-4841.20187435

7. Kallel A, Hdider A, Fakhfakh N, Belhadj S, Belhadj-Salah N, Bada N et al. Tinea capitis: Main mycosis child. Epidemiological study on 10 years. J Mycol Med. 2017;27:345–350. https://doi.org/10.1016/j.mycmed.2017.02.009.

8. Kaufman G, Horwitz BA, Duek L, Ullman Y, Berdicevsky I. Infection stages of the dermatophyte pathogen Trichophyton: microscopic characterization and proteolytic enzymes. Med Mycol. 2007;45(2):149–155. https://doi.org/10.1080/13693780601113618.

9. Veasey JV, Miguel BAF, Mayor SAS, Zaitz C, Muramatu LH, Serrano JA. Epidemiological profile of tinea capitis in São Paulo City. An Bras Dermatol. 2017;92(2):283–284. https://doi.org/10.1590/abd1806-4841.20175463.

10. Peixoto RRGB, Meneses OMS, da Silva FO, Donati A, Veasey JV. Tinea Capitis: Correlation of Clinical Aspects, Findings on Direct Mycological Examination, and Agents Isolated from Fungal Culture. Int J Trichology. 2019;11(6):232–235. https://doi.org/10.4103/ijt.ijt_88_19.

11. Рetrucelli MF, Abreu MH, Cantelli BAM, Segura GG, Nishimura FG, Bitencourt TA et al. Epidemiology and Diagnostic Perspectives of Dermatophytoses. J Fungi. 2020;6(4):310. https://doi.org/10.3390/jof6040310.

12. Zhan P, Liu W. The Changing Face of Dermatophytic Infections Worldwide. Mycopathologia. 2017;182(1-2):77–86. https://doi.org/10.1007/s11046-016-0082-8.

13. Guschin AE, Nosyreva KK, Negasheva ES, Polevshchikova SA, Sapozhnikova NA, Potekaev NN. First experience of Real-Time PCR method application for dermatophytosis diagnosis and its comparison with KOHmicroscopy and mycological culture. Klinicheskaya Dermatologiya i Venerologiya. 2023;22(4):382391. (In Russ.) https://doi.org/10.17116/klinderma202322041382.

14. Anton A, Plinet M, Peyret T, Cazaudarré T, Pesant S, Rouquet Y et al. Rapid and Accurate Diagnosis of Dermatophyte Infections Using the DendrisCHIP® Technology. Diagnostics. 2023;13(22):3430. https://doi.org/10.3390/diagnostics13223430.

15. O’Gorman SM, Britton D, Collins P. An uncommon dermatophyte infection: two cases of cutaneous infection with Trichophyton verrucosum. Clin Exp Dermatol. 2015;40(4):395–398. https://doi.org/10.1111/ced.12559.