Trichophyton tonsurans—Ringworm in an NICU

Abstract

Ringworm is very rarely found in the neonate, especially infants who have been confined from birth to an intensive care unit. We report an infection with the dermatophyte Trichophyton tonsurans, the most common cause of tinea capitis in children but not yet described in a premature baby who has never left the nursery. Our case illustrates the need to consider this diagnosis among the causes of dermatitis in the newborn, especially in at-risk populations such as indigenous Australians. Though our infant's presentation was the classic "ring" shape, a literature review revealed varied presentations. In contrast to the usual need for long-term antifungal medication, our case responded rapidly to a topical azole preparation. Although we did not screen visiting family members, screening would have been appropriate, and those found positive might have benefited from at least antifungal shampoo.

A systematic review of worldwide data on tinea capitis: analysis of the last 20 years

“…In Oceania, the main causal agents of TC started to change in 2000. Between 1996 and 1998, M. canis was the most frequent dermatophyte followed by T. tonsurans and T. violaceum, but, currently, high prevalence of TC caused by T. soudanense , T. violaceum, M. audouinii, T. verrucosum , T. tonsurans, T. rubrum, T. mentagrophytes and N. gypsea has been reported 3,196–199 . These findings demonstrate that, at a global level, M. canis is the most frequent zoophilic agent, while within the anthropophilic agents T. violaceum and T. tonsurans stand out.…”

“…It is worth mentioning that there are recent reports in which T. tonsurans was isolated in a neonate intensive care unit from an Australian aboriginal new born. This seems to indicate changes in endemic dermatophytes in this population, but more studies are needed 198 . In Oceania, the main causal agents of TC started to change in 2000.…”

“…A comprehensive summary of all included cases of TC 179,190–198 from European continent is presented in Table 4.…”

“…Children, mainly African refugees, were the most frequently affected by dermatophytes causing TC. The most common pathogenic agents reported, in order of incidence, were T. soudanense , M. audouinii , T. violaceum , T. verrucosum , T. tonsurans and M. canis 3,196–199 …”

Tinea faciei in a newborn due to Trichophyton tonsurans

“…However, there are few cases of tinea capitis in neonates caused by T. tonsurans . Up to now, only one case of neonatal ringworm due to this species was reported in the Neonate Intensive Care Unit in Australia and one case of tinea capitis was reported in Korea[5],[6]. No data are available in China.…”