Aetiology of tinea capitis in China: a multicentre prospective study

Abstract

Summary Background Tinea capitis is still common in developing countries, such as China. Its pathogen spectrum varies across regions and changes over time. Objectives This study aimed to clarify the current epidemiological characteristics and pathogen spectrum of tinea capitis in China. Methods A multicentre, prospective descriptive study involving 29 tertiary hospitals in China was conducted. From August 2019 to July 2020, 611 patients with tinea capitis were enrolled. Data concerning demography, risk factors and fungal tests were collected. When necessary, the pathogens were further identified by morphology or molecular sequencing in the central laboratory. Results Among all enrolled patients, 74·1% of the cases were in patients aged 2–8 years. The children with tinea capitis were mainly boys (56·2%) and were more likely than adults to have a history of animal contact (57·4% vs. 35·3%, P = 0·012) and zoophilic dermatophyte infection (73·5% vs. 47%). The adults were mainly female (83%) and were more likely than children to have anthropophilic agent infection (53% vs. 23·9%). The most common pathogen was zoophilic Microsporum canis (354, 65·2%), followed by anthropophilic Trichophyton violaceum (74, 13·6%). In contrast to the eastern, western and northeastern regions, where zoophilic M. canis predominated, anthropophilic T. violaceum predominated in central China (69%, P < 0·001), where the patients had the most tinea at other sites (20%) and dermatophytosis contact (26%) but the least animal contact (39%). Microsporum ferrugineum was the most common anthropophilic agent in the western area, especially in Xinjiang province. Conclusions Boys aged approximately 5 years were the most commonly affected group. Dermatologists are advised to pay more attention to the different transmission routes and pathogen spectra in different age groups from different regions.

Changing face of epidemiology of dermatophytoses in Chinese Mainland: A 30 years nationwide retrospective study from 1991 to 2020

“…21,[26][27][28][29] Also, in some region of the world, main form of transmission by anthropophilic species (T tonsurans and T violaceum) is increasing, however, such tendency has not been seen in China. 20,[30][31][32] Besides, in the years nearby, an increasing trend of tinea capitis was found in some Europe cities, mostly caused by zoophilic dermatophytes such as M canis, T mentagrophytes or T verrucosum, which should be attributed to the increasing exposure to animals, especially domestic animals or pets. 33 In our study, tinea cruris accounted for a much higher proportion among all infection types, which was different from that of other countries.…”

Altered skin fungal and bacterial community compositions in tinea capitis

“…and Trichophyton ( T .) are responsible for most infections 1 . It can present as broken‐off hairs, scales, alopecia and follicular papules, and in severe cases, it manifests as a painful, inflammatory mass, also known as kerion 2 .…”

“…It can present as broken‐off hairs, scales, alopecia and follicular papules, and in severe cases, it manifests as a painful, inflammatory mass, also known as kerion 2 . Tinea capitis is still widespread in developing countries, and its outbreak can cause a burden for local healthcare systems 1 . In China, its incidence has increased in recent years due to an increase in domestic pets 1 …”

“…1 In China, its incidence has increased in recent years due to an increase in domestic pets. 1 Successful treatment of tinea capitis requires accurate identification of the pathogen. Fungal culture is a common method for pathogen identification.…”

“…Tinea capitis occurs most frequently in children aged between 2 and 8 years but rarely in adults. 1 The increasing resistance of hair to dermatophyte colonisation of adults is considered to be due to the production of fungistatic long-chain fatty acids by sebaceous glands. 5 Previous studies have shown that the increase in sebaceous gland activity during puberty is associated with alterations in the skin microbiome and that the skin bacterial and fungal communities are different between adults and children.…”