Chronically Recurrent and Widespread Tinea Corporis Due to Trichophyton rubrum in an Immunocompetent Patient

Kong, Qingtao; Du, Xue; Yang, Rui; Huang, Siming; Sang, Hong; Liu, W. D.

doi:10.1007/s11046-014-9834-5

Cited by 9 publications

(8 citation statements)

References 4 publications

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“…Some published cases were compatible with deep or extensive dermatophytosis but lacked mycological confirmation [ 31 , 93 , 94 ]. In other published cases, there was no identified predisposing condition [ 28 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ]. However underlying immunodeficiency cannot be excluded in these patients without thorough immunological investigations.…”

Section: Underlying Conditions Responsible For Severe Dermatophytsmentioning

confidence: 97%

Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review

Rouzaud

Hay

Chosidow

et al. 2015

JoF

106

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Dermatophytes are keratinophilic fungi responsible for benign and common forms of infection worldwide. However, they can lead to rare and severe diseases in immunocompromised patients. Severe forms include extensive and/or invasive dermatophytosis, i.e., deep dermatophytosis and Majocchi’s granuloma. They are reported in immunocompromised hosts with primary (autosomal recessive CARD9 deficiency) or acquired (solid organ transplantation, autoimmune diseases requiring immunosuppressive treatments, HIV infection) immunodeficiencies. The clinical manifestations of the infection are not specific. Lymph node and organ involvement may also occur. Diagnosis requires both mycological and histological findings. There is no consensus on treatment. Systemic antifungal agents such as terbinafine and azoles (itraconazole or posaconazole) are effective. However, long-term outcome and treatment management depend on the site and extent of the infection and the nature of the underlying immunodeficiency.

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Section: Underlying Conditions Responsible For Severe Dermatophytsmentioning

confidence: 97%

Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review

Rouzaud

Hay

Chosidow

et al. 2015

JoF

106

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“…Reinfection may occur if a reservoir (tinea pedis, tinea capitis, onychomycosis) of infection is present. 5 , 50 , 125 …”

Section: Prognosismentioning

confidence: 99%

Tinea corporis: an updated review

Leung¹,

Lam²,

Leong³

et al. 2020

DIC

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Background Tinea corporis is a common fungal infection that mimics many other annular lesions. Physicians must familiarize themselves with this condition and its treatment. Objective This article aimed to provide a narrative updated review on the evaluation, diagnosis, and treatment of tinea corporis. Methods A PubMed search was performed with Clinical Queries using the key term ‘tinea corporis.’ The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies, and reviews. The search was restricted to the English language. The information retrieved from the mentioned search was used in the compilation of the present article. Results Tinea corporis typically presents as a well-demarcated, sharply circumscribed, oval or circular, mildly erythematous, scaly patch or plaque with a raised leading edge. Mild pruritus is common. The diagnosis is often clinical but can be difficult with prior use of medications, such as calcineurin inhibitors or corticosteroids. Dermoscopy is a useful and non-invasive diagnostic tool. If necessary, the diagnosis can be confirmed by microscopic examination of potassium hydroxide wet-mount preparations of skin scrapings from the active border of the lesion. Fungal culture is the gold standard to diagnose dermatophytosis especially if the diagnosis is in doubt and results of other tests are inconclusive or the infection is widespread, severe, or resistant to treatment. The standard treatment of tinea corporis is with topical antifungals. Systemic antifungal treatment is indicated if the lesion is multiple, extensive, deep, recurrent, chronic, or unresponsive to topical antifungal treatment, or if the patient is immunodeficient. Conclusion The diagnosis of tinea corporis is usually clinical and should pose no problem to the physician provided the lesion is typical. However, many clinical variants of tinea corporis exist, rendering the diagnosis difficult especially with prior use of medications, such as calcineurin inhibitors or corticosteroids. As such, physicians must be familiar with this condition so that an accurate diagnosis can be made and appropriate treatment initiated.

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“…Importantly, there are few and conflicting data regarding predisposing genetic traits in chronic Tp ( Svejgaard et al, 1983 ; Ahmed et al, 1985 ). Although patients with CWD are frequently described in the literature ( Sentamilselvi et al, 1997–1998 ; Vittorio, 1997 ; Gorani et al, 2002 ; Cordeiro et al, 2006 ; Seyfarth et al, 2007 ; Balci and Cetin, 2008 ; Kong et al, 2015 ), it is not yet known why they are unable to mount CMI responses and resolve the infection. Our present findings may provide some clues to this issue.…”

Section: Discussionmentioning

confidence: 99%

“…CARD9 is an adaptor protein downstream to several immune receptors such as dectin-1, dectin-2, and mincle, which recognize fungal structures and are critical for antifungal Th-17 responses ( Lionakis and Holland, 2013 ). On the other hand, there are also frequent reports of patients presenting with recurrent or chronic widespread dermatophytosis (CWD) of the skin which, although not invasive, is difficult to manage ( Sentamilselvi et al, 1997–1998 ; Vittorio, 1997 ; Gorani et al, 2002 ; Cordeiro et al, 2006 ; Seyfarth et al, 2007 ; Balci and Cetin, 2008 ; Kong et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Chronic widespread dermatophytosis due to Trichophyton rubrum: a syndrome associated with a Trichophyton-specific functional defect of phagocytes

et al. 2015

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Dermatophytes are agents of typically benign superficial infections. However, an increasing number of severe infections in immunocompromised hosts has been reported. We aimed to understand the factors underlying the existence of a cohort of patients presenting with chronic widespread dermatophytosis (CWD) due to Trichophyton rubrum, but with no signs of immunodeficiency. Their disease is usually recurrent and difficult to manage. Fourteen patients meeting the following criteria for CWD were studied: T. rubrum culture-proven skin lesions of ≥10 cm in at least one dimension; the involvement of at least three non-contiguous localizations of >1 year’s duration; and no predisposing conditions. For comparison, we also studied 13 acute Tinea pedis patients. Macrophages and neutrophils were isolated and tested for T. rubrum conidia phagocytic and killing activity. H2O2, NO, and pro- and anti-inflammatory cytokine release were measured. All experiments were run with age- and sex-matched healthy donors’ cells in parallel. CWD patients’ macrophages and neutrophils presented with reduced T. rubrum–phagocytic and killing abilities, and reduced H2O2 and NO release when compared with those of healthy donors. CWD patients’ macrophages secreted lower levels of the proinflammatory cytokines interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor (TNF)-α, but enhanced levels of the anti-inflammatory cytokine IL-10. Neutrophil secretion closely followed this unbalanced pattern. In contrast, responses to the positive controls zymosan, lipopolysaccharide, and phorbol myristate acetate were comparable with those of healthy donors. The same experiments were performed with macrophages and neutrophils from the acute Tinea pedis patients and showed no differences when compared with the matched healthy donors. Patients with CWD have a T. rubrum-related functional deficiency of phagocytes and may represent a distinct clinical entity in the complex spectrum of the Trichophyton–host interaction.

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Chronically Recurrent and Widespread Tinea Corporis Due to Trichophyton rubrum in an Immunocompetent Patient

Cited by 9 publications

References 4 publications

Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review

Severe Dermatophytosis and Acquired or Innate Immunodeficiency: A Review

Tinea corporis: an updated review

Chronic widespread dermatophytosis due to Trichophyton rubrum: a syndrome associated with a Trichophyton-specific functional defect of phagocytes

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