Microsporum audouinii: Re-Emergence of Ringworm Due to the Dermatophyte
Microsporum audouinii: un dermatofito causante de una tiña reemergente
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Cultivo de pelos y escamas en placas de agar Sabouraud cloranfenicol actidiona a los 15 días (28<span class="elsevierStyleHsp" style=""></span>°C). Se observan colonias planas de borde estrellado, con micelio superficial blanco-lanoso en el anverso (A) y de color amarillo-anaranjado pálido en el envés (B). C-F. Morfología microscópica, tras 7 días en agar patata dextrosa.C: hifa pectinada (peine). D: clamidosporas intercalares (20X). E: macroconidio (20X). F: clamidospora terminal de <span class="elsevierStyleItalic">M. audouinii</span> (20X).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Lozano-Masdemont, B. Carrasco-Fernández, I. Polimón-Olabarrieta, M.T. Durán-Valle" "autores" => array:4 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Lozano-Masdemont" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Carrasco-Fernández" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Polimón-Olabarrieta" ] 3 => array:2 [ "nombre" => "M.T." "apellidos" => "Durán-Valle" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219019302707" "doi" => "10.1016/j.adengl.2018.11.024" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019302707?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101930119X?idApp=UINPBA000044" "url" => "/00017310/0000011000000009/v1_201911020642/S000173101930119X/v1_201911020642/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S1578219019302689" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.04.023" "estado" => "S300" "fechaPublicacion" => "2019-11-01" "aid" => "2182" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:783-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Green Nail Caused by Onychomycosis Coinfected With <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "783" "paginaFinal" => "785" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uña verde causada por onicomicosis coinfectada por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 815 "Ancho" => 1255 "Tamanyo" => 149208 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nail of the fifth toe of the right foot. A, Yellow-green discoloration of the nail plate. B, Subungual hyperkeratosis and areas of yellow, green, and black discoloration. C, Dermoscopic image showing subungual hyperkeratosis (&), an irregular distal border, brown areas with a hemorrhagic appearance (⏶), and discoloration of the nail plate with homogeneous areas of green ($) and blackish-blue (*) and longitudinally distributed areas of yellowish discoloration (→).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Monteagudo, O. Figueroa, O. Suárez-Magdalena, S. Méndez-Lage" "autores" => array:4 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Monteagudo" ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Figueroa" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Suárez-Magdalena" ] 3 => array:2 [ "nombre" => "S." 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Lozano-Masdemont, B. Carrasco-Fernández, I. Polimón-Olabarrieta, M.T. Durán-Valle" "autores" => array:4 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Lozano-Masdemont" "email" => array:1 [ 0 => "belenmasdemont@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "Carrasco-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Polimón-Olabarrieta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M.T." "apellidos" => "Durán-Valle" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Microsporum audouinii</span>: un dermatofito causante de una tiña reemergente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2275 "Ancho" => 1750 "Tamanyo" => 459900 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Culture of hairs and scales in Sabouraud chloramphenicol actidione agar for 15 days at 28<span class="elsevierStyleHsp" style=""></span>°C. Flat colonies with a stellate fringe, a woolly-white superficial mycelium (A), and a pale yellow-orange underside (B) are observed. C–F, Microscopic morphology after incubation for 7 days in potato dextrose agar: C, pectinate hyphae (comb-like structure); D, intercalary chlamydospores (original magnification ×20); E, macroconidium (original magnification ×20); F, terminal chlamydospores of <span class="elsevierStyleItalic">M audouinii</span> (original magnification ×20).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Microsporum audouinii,</span> an anthropophilic dermatophyte fungus that has been rarely reported since the middle of the last century, is re-emerging in several European countries<span class="elsevierStyleItalic">.</span> Unlike other species that cause ringworm, it can cause epidemics of tinea capitis in schools. We present a typical clinical case and summarize the clinical and epidemiological data from cases recorded in our microbiology department between 2005 and 2017.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 5-year-old black boy was seen for multiple areas of alopecia and gray scaling on the scalp (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) that had appeared 1 month earlier. Hair and scales were collected from the scalp with a scalpel, carpet square, and a sterile brush. Microscopic examination with 20% KOH + 40% DMSO revealed a mycelium and ectothrix spores compatible with a dermatophyte fungus. Hairs and scales were cultured in Sabouraud chloramphenicol actidione agar, in which flat colonies with a stellate fringe, a woolly-white superficial mycelium, and a pale yellow-orange underside grew after 5 days (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B). Examination of microscopic morphology after 7 days in potato dextrose agar revealed pectinate hyphae, abortive macroconidia, and intercalary and terminal chlamydospores, enabling identification of the species as <span class="elsevierStyleItalic">M audouinii</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C–F). <span class="elsevierStyleItalic">M audouinii</span> was also identified by examination of the culture by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS; VITEK MS, bioMérieux, Marcy l’Etoile, France) after incubation for 7 days in potato dextrose agar. The patient had never left Spain, but did have contact with his black African father who had travelled outside the country. Clinical examination and mycological culture of scalp samples from members of the patient's family (except for the father, who was unavailable) confirmed that none presented any lesions or were asymptomatic carriers. No new cases were reported in the patient's school. The patient was treated with micronized griseofulvin in oral suspension (10 mg/kg/d). He responded well during the first month, but fungal regrowth was observed in the second month and the dose was increased to 20 mg/kg/day. Four weeks later, with no further improvement observed, the dose was increased to 25 mg/kg/day. Cure was achieved 8 weeks later, after a total of 5 months of griseofulvin treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Between 2005 and 2017, 16 cases of ringworm due to <span class="elsevierStyleItalic">M audouinii</span> were recorded in our hospital (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The first was recorded in 2010. Eleven of the 16 cases had tinea capitis and 7 were originally from Africa or had been in contact with other Africans.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M audouinii</span> is a globally distributed anthropophilic dermatophyte fungus, and together with <span class="elsevierStyleItalic">Trichophyton soudanense</span> is the most common cause of tinea capitis in Africa, where it is endemic. Identification by MALDI-TOF MS involves characterization of the isolate's protein profile and comparison with those recorded in a protein library. The results are comparable to those obtained by DNA sequence analysis, provided that the reference spectra of the species to be identified are present in the library used. A review of the incidence of dermatophytes in Spain from 1926 to 1994 found that <span class="elsevierStyleItalic">M audouinii</span> was very common in patients with tinea capitis in Madrid, Zaragoza, Valencia, and Andalusia between 1930 and 1950,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> but practically disappeared in the 1960s after the introduction of griseofulvin.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The most recent Spanish series indicate that <span class="elsevierStyleItalic">M audouinii</span> continues to be sporadically isolated from patients with tinea corporis, tinea capitis, tinea faciei, and tinea pedis.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> However, numerous cases have been recorded in France, again in the form of tinea capitis, and there have been outbreaks in Switzerland, Germany, Belgium, and Australia.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> An outbreak among refugee children in Israel was likely due to transmission from other African refugee children.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Gilaberte and coworkers have described transmission from immunocompetent African mothers to their babies, who become infected in childhood and in whom the fungus persists without causing evident clinical signs.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> A 2016 Cochrane review<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> of the treatment of tinea capitis due to <span class="elsevierStyleItalic">Microsporum</span> species reported that griseofulvin treatment for 6 to 12 weeks was more effective than terbinafine treatment for 6 weeks in achieving complete cure (50.9% and 34.7% of patients, respectively), and found no differences in adherence and a reasonable safety profile for both drugs. The recommended dose for griseofulvin is 20<span class="elsevierStyleHsp" style=""></span>mg/kg/day to 25 mg/kg/day for the micronized form available in Spain,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> and 10<span class="elsevierStyleHsp" style=""></span>mg/kg/day to 15 mg/kg/day for the ultramicronised form.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> In the Summary of Product Characteristics provided with the medication supplied to our patient the indicated dose was 10 mg/kg/day, even though the formulation was the micronized form. The patient's mother administered the recommended dose up until the first examination, at which point we noticed the error. Forms of tinea other than tinea capitis can be successfully treated using topical antifungals or, in case of follicular involvement, systemic antifungals such as itraconazole (100 mg/d for 3 months).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Because the incidence of this dermatophyte fungus is likely to continue to increase in Spain, it is important to be aware of its clinical and demographic features and the risk of possible outbreaks.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lozano-Masdemont B. <span class="elsevierStyleItalic">Microsporum audouinii</span>: un dermatofito causante de una tiña reemergente Eczema y urticaria en Portugal. 2019;110:785–787.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 872 "Ancho" => 750 "Tamanyo" => 254625 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tinea capitis in a 5-year-old black boy born in Spain. Multiple areas of alopecia with gray scales are evident on the scalp.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2275 "Ancho" => 1750 "Tamanyo" => 459900 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Culture of hairs and scales in Sabouraud chloramphenicol actidione agar for 15 days at 28<span class="elsevierStyleHsp" style=""></span>°C. Flat colonies with a stellate fringe, a woolly-white superficial mycelium (A), and a pale yellow-orange underside (B) are observed. C–F, Microscopic morphology after incubation for 7 days in potato dextrose agar: C, pectinate hyphae (comb-like structure); D, intercalary chlamydospores (original magnification ×20); E, macroconidium (original magnification ×20); F, terminal chlamydospores of <span class="elsevierStyleItalic">M audouinii</span> (original magnification ×20).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total No. of Cases \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">16 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of cases per year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2010)0 (2011)0 (2012)2 (2013)1 (2014)1 (2015)8 (2016)1 (2017) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of cases per age groupChildren, 3–7 yAdults, 20–57 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">133 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of cases per clinical form \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tinea capitis<span class="elsevierStyleItalic">:</span> 11Tinea corporis<span class="elsevierStyleItalic">:</span> 4Tinea corporis with tinea capitis<span class="elsevierStyleItalic">:</span> 1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2169911.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Summary of Epidemiological and Clinical Data of Cases of <span class="elsevierStyleItalic">M audouinii</span> Ringworm Recorded in our Microbiology Department From 2005 to 2017.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidencia de los dermatofitos en España desde 1926 a 1994" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. 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| año/Mes | Html | Total | |
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| 2024 Noviembre | 28 | 14 | 42 |
| 2024 Octubre | 198 | 49 | 247 |
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| 2024 Febrero | 157 | 49 | 206 |
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| 2023 Noviembre | 240 | 51 | 291 |
| 2023 Octubre | 278 | 44 | 322 |
| 2023 Septiembre | 209 | 42 | 251 |
| 2023 Agosto | 208 | 35 | 243 |
| 2023 Julio | 224 | 46 | 270 |
| 2023 Junio | 170 | 34 | 204 |
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| 2023 Marzo | 143 | 24 | 167 |
| 2023 Febrero | 148 | 32 | 180 |
| 2023 Enero | 163 | 42 | 205 |
| 2022 Diciembre | 182 | 48 | 230 |
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| 2022 Octubre | 85 | 29 | 114 |
| 2022 Septiembre | 140 | 51 | 191 |
| 2022 Agosto | 74 | 28 | 102 |
| 2022 Julio | 45 | 50 | 95 |
| 2022 Junio | 38 | 32 | 70 |
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| 2022 Abril | 156 | 41 | 197 |
| 2022 Marzo | 198 | 56 | 254 |
| 2022 Febrero | 210 | 39 | 249 |
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| 2021 Diciembre | 174 | 36 | 210 |
| 2021 Noviembre | 180 | 66 | 246 |
| 2021 Octubre | 127 | 60 | 187 |
| 2021 Septiembre | 97 | 53 | 150 |
| 2021 Agosto | 130 | 44 | 174 |
| 2021 Julio | 90 | 34 | 124 |
| 2021 Junio | 143 | 42 | 185 |
| 2021 Mayo | 155 | 50 | 205 |
| 2021 Abril | 366 | 69 | 435 |
| 2021 Marzo | 233 | 32 | 265 |
| 2021 Febrero | 142 | 25 | 167 |
| 2021 Enero | 106 | 35 | 141 |
| 2020 Diciembre | 103 | 42 | 145 |
| 2020 Noviembre | 105 | 28 | 133 |
| 2020 Octubre | 78 | 19 | 97 |
| 2020 Septiembre | 68 | 12 | 80 |
| 2020 Agosto | 56 | 22 | 78 |
| 2020 Julio | 37 | 17 | 54 |
| 2020 Junio | 31 | 18 | 49 |
| 2020 Mayo | 38 | 15 | 53 |
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