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2</a>A and B&#41;&#46; A powdery white superficial mycelium developed with light radial folds at the center of the colonies &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; The fungus hydrolyzed urea &#40;Christensen and Maslen urea broth&#41; after 7 days and sporulation did not present on the dextrose potato agar plate after 21 days of incubation&#46; With a VITEK MS &#40;matrix-assisted laser desorption&#47;ionization time-of-flight mass spectrometry &#91;MALDI-TOF MS&#93;&#44; BioM&#233;rieux&#41;&#44; <span class="elsevierStyleItalic">Arthroderma benhamiae</span> &#40;99&#46;9&#37;&#41; was identified after 7 days of incubation on the potato dextrose agar&#46; Molecular identification of the microorganism was performed in the Mycology Unit of the Spanish Microbiology Center in Majadahonda&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The lesion was treated for 1 month with terbinafine cream&#44; but follicular involvement still persisted&#46; Finally&#44; the infection resolved with oral terbinafine 125&#8239;mg&#47;d for 4 weeks&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The microbiology department of our hospital has recorded 15 cases of ringworm caused by <span class="elsevierStyleItalic">A&#46; benhamiae</span> between 2005 and 2017&#44; mainly in children with transmission by guinea pigs&#59; the first case was in 2010 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; As in cases reported in the literature&#44; all were cases of inflammatory ringworm&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Dermatophytic fungi are usually identified using conventional techniques based on macroscopic and microscopic morphology&#44; although in some cases&#44; absence of sporulation and morphological similarities between species requires identification using molecular techniques or the use of MALDI-TOF MS&#46; In the present case&#44; MALDI-TOF MS was used for identification due to the absence of fungal sporulation in the culture media&#46; MALDI-TOF MS is a widely used technique in the field of bacteriology&#46; The technique is based on obtaining a protein profile of the isolate and comparing this with a database&#46; The use of this technique has expanded to mycology&#44; with results equivalent to DNA sequence analyses&#44; provided that the reference spectra for the species to be identified are included in the library used&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">A&#46; benhamiae</span> is represented in the commercial library &#40;V3&#41; of the VITEK MS&#44; which enabled its identification with a concordance of 99&#46;9&#37;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A&#46; benhamiae</span>&#44; basionym &#40;or previously denominated&#41; <span class="elsevierStyleItalic">Trichophyton benhamiae</span>&#44; is an emerging dermatophytic fungus that causes zoonotic epidemics from infected pets&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5</span></a> Since 2002&#44; there have been reports of inflammatory ringworm such as tinea corporis and faciei &#40;more frequently&#41;&#44; and tinea capitis and Kerion celsi&#46; Onychomycoses are rare&#46; In Japan&#44; where the first cases were reported&#44; contagion occurs through rabbits&#44; rodents&#44; and white-bellied hedgehogs&#44; all of which are popular pets in that country&#46; In Germany&#44; guinea pigs are the main source of contagion&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The fungus has also been isolated from dogs and cats&#46; Children and adolescents are the individuals most often affected&#44; and cases in immunosuppressed individuals may also occur&#46; The fungus can be confused macroscopically with <span class="elsevierStyleItalic">Microsporum canis</span> &#40;yellow colonies&#41; and microscopically with <span class="elsevierStyleItalic">Trichophyton mentagrophytes</span>&#47;<span class="elsevierStyleItalic">Trichophyton interdigitale</span> &#40;rounded conidia and urea hydrolysis&#41;&#44; and so its incidence may be underestimated if not correctly identified&#46; Even so&#44; in some regions of Germany&#44; it may already be the most widespread zoophilic dermatophyte&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In tinea capitis caused by <span class="elsevierStyleItalic">A&#46; benhamiae</span> or extensive infections&#44; oral terbinafin is the treatment of choice&#44; followed by fluconazole or itraconazole&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> although few studies are available&#46; Griseofulvin has also been used&#46; The minimum duration of treatment is usually 4&#8211;6 weeks&#46; For other types of lesions&#44; topical antimycotic agents used in other dermatophytoses can be used&#44; such as terbinafine&#44; imidazoles&#44; and ciclopirox&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">It is likely that the incidence of this dermatophytic fungus will increase&#44; and so dermatologists should bring themselves up to date regarding relevant clinical and epidemiological aspects&#44; methods of identification&#44; and potential diagnostic errors&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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                          "etal" => false
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                            0 => "C&#46; L&#8217;Ollivier"
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                            1 => "R&#46; Kano"
                            2 => "E&#46; Nakamura"
                            3 => "K&#46; Saito"
                            4 => "S&#46; Watanabe"
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                    0 => array:2 [
                      "doi" => "10.1046/j.1439-0507.2002.00732.x"
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                      "doi" => "10.1111/j.1365-3164.2008.00691.x"
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Case and Research Letters
Arthroderma benhamiae, an emerging dermatophyte cause of tinea
Arthroderma benhamiae, un dermatofito causante de una tiña emergente
B. Lozano-Masdemonta,
Autor para correspondencia
belenmasdemont@gmail.com

Corresponding author.
, B. Carrasco-Fernándezb, I. Polimón-Olabarrietaa, M.T. Durán-Valleb
a Servicio de Dermatología, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
b Servicio de Microbiología, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
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2</a>A and B&#41;&#46; A powdery white superficial mycelium developed with light radial folds at the center of the colonies &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; The fungus hydrolyzed urea &#40;Christensen and Maslen urea broth&#41; after 7 days and sporulation did not present on the dextrose potato agar plate after 21 days of incubation&#46; With a VITEK MS &#40;matrix-assisted laser desorption&#47;ionization time-of-flight mass spectrometry &#91;MALDI-TOF MS&#93;&#44; BioM&#233;rieux&#41;&#44; <span class="elsevierStyleItalic">Arthroderma benhamiae</span> &#40;99&#46;9&#37;&#41; was identified after 7 days of incubation on the potato dextrose agar&#46; Molecular identification of the microorganism was performed in the Mycology Unit of the Spanish Microbiology Center in Majadahonda&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The lesion was treated for 1 month with terbinafine cream&#44; but follicular involvement still persisted&#46; Finally&#44; the infection resolved with oral terbinafine 125&#8239;mg&#47;d for 4 weeks&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The microbiology department of our hospital has recorded 15 cases of ringworm caused by <span class="elsevierStyleItalic">A&#46; benhamiae</span> between 2005 and 2017&#44; mainly in children with transmission by guinea pigs&#59; the first case was in 2010 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; As in cases reported in the literature&#44; all were cases of inflammatory ringworm&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Dermatophytic fungi are usually identified using conventional techniques based on macroscopic and microscopic morphology&#44; although in some cases&#44; absence of sporulation and morphological similarities between species requires identification using molecular techniques or the use of MALDI-TOF MS&#46; In the present case&#44; MALDI-TOF MS was used for identification due to the absence of fungal sporulation in the culture media&#46; MALDI-TOF MS is a widely used technique in the field of bacteriology&#46; The technique is based on obtaining a protein profile of the isolate and comparing this with a database&#46; The use of this technique has expanded to mycology&#44; with results equivalent to DNA sequence analyses&#44; provided that the reference spectra for the species to be identified are included in the library used&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">A&#46; benhamiae</span> is represented in the commercial library &#40;V3&#41; of the VITEK MS&#44; which enabled its identification with a concordance of 99&#46;9&#37;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A&#46; benhamiae</span>&#44; basionym &#40;or previously denominated&#41; 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                  \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">&nbsp;\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"><span class="elsevierStyleItalic">A</span>&#46; <span class="elsevierStyleItalic">benhamiae</span>&nbsp;\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">Total number of cases &#40;2005&#8211;2017&#41;&nbsp;\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">15&nbsp;\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 " rowspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of cases per year</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">2 &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">1 &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">1 &#40;2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">2 &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">1 &#40;2014&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">1 &#40;2015&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">5 &#40;2016&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">2 &#40;2017&#41;&nbsp;\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 " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age range and number of cases</span></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"><span class="elsevierStyleHsp" style=""></span>Children&nbsp;\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">5&#8211;12 years 13&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Adults&nbsp;\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">19&#8211;35 years 2&nbsp;\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 " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical form</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 corporis 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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 faciei 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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 with tinea faciei 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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 manuum 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                      "titulo" => "MALDI-TOF-based dermatophyte identification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; L&#8217;Ollivier"
                            1 => "S&#46; Ranque"
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                    0 => array:2 [
                      "doi" => "10.1007/s11046-016-0080-x"
                      "Revista" => array:6 [
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                        "fecha" => "2017"
                        "volumen" => "182"
                        "paginaInicial" => "183"
                        "paginaFinal" => "192"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27734185"
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              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular epidemiology of <span class="elsevierStyleItalic">Arthroderma benhamiae</span>&#44; an emerging pathogen of dermatophytoses in Japan&#44; by polymorphisms of the non-transcribed spacer region of the ribosomal DNA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "T&#46; Mochizuki"
                            1 => "M&#46; Kawasaki"
                            2 => "H&#46; Ishizaki"
                            3 => "R&#46; Kano"
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                            5 => "H&#46; Tosaki"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/s0923-1811(01)00101-3"
                      "Revista" => array:6 [
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                            "web" => "Medline"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Case report&#46; First report on human ringworm caused by <span class="elsevierStyleItalic">Arthroderma benhamiae</span> in Japan transmitted from a rabbit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46; Nakamura"
                            1 => "R&#46; Kano"
                            2 => "E&#46; Nakamura"
                            3 => "K&#46; Saito"
                            4 => "S&#46; Watanabe"
                            5 => "A&#46; Hasegawa"
                          ]
                        ]
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1439-0507.2002.00732.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mycoses"
                        "fecha" => "2002"
                        "volumen" => "45"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pets as the main source of two zoonotic species of the Trichophyton mentagrophytes complex in Switzerland&#44; <span class="elsevierStyleItalic">Arthroderma vanbreuseghemii</span> and <span class="elsevierStyleItalic">Arthroderma benhamiae</span>"
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                            2 => "M&#46; Fratti"
                            3 => "P&#46; Roosje"
                            4 => "M&#46; Monod"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1111/j.1365-3164.2008.00691.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Vet Dermatol"
                        "fecha" => "2009"
                        "volumen" => "20"
                        "paginaInicial" => "13"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
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                      "titulo" => "Trichophyton species of <span class="elsevierStyleItalic">Arthroderma benhamiae</span> &#8211; a new infectious agent in dermatology"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Nenoff"
                            1 => "S&#46; Uhrla&#223;"
                            2 => "C&#46; Kr&#252;ger"
                            3 => "M&#46; Erhard"
                            4 => "U&#46;C&#46; Hipler"
                            5 => "F&#46; Seyfarth"
                          ]
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                      "doi" => "10.1111/ddg.12390"
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                        "fecha" => "2014"
                        "volumen" => "12"
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Información del artículo
ISSN: 15782190
Idioma original: Inglés
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