Tinea manuum caused by Trichophyton erinacei: first report in Switzerland

Abstract

Conflicts of interest: None declared.Dermatophytic infections can occur as very inflammatory lesions, particularly if they are caused by non-anthropophilic species. New trends in pet ownership (of rodents, birds, reptiles, fishes) have lead to the development of unusual infections in humans. Case reportWe report a case of hand infection by Trichophyton erinacei in a 23-year-man who kept an African hedgehog as a pet. The patient presented with a 7-day history of annular erythematous lesions at the base of the right hand and the second and third fingers. The periphery was raised, slightly scaly, and became vesiculous and purulent. The patient had applied no topical therapy before seeking medical assistance. A painful lymphangitis was present on the medial aspect of the ipsilateral arm (Fig. 1). The bacterial swab was negative. Direct examination of purulent material and scales 1 showed high numbers of septate filaments and spores. Culture assay for seven days at 32°C on Sabouraud's agar medium produced a growing fungus that looked like a white powder (Fig. 2), demonstrated the production of numerous pyriform microconidia, and was identified as a species belonging to the Trichophyton mentagrophytes complex. Fungal genomic DNA was isolated using the DNeasy Plant Mini Kit (Qiagen AG, Hombrechtikon, Switzerland) according to the manufacturer's protocol, and the internal transcribed spacer (ITS) region of the ribosomal DNA was subsequently amplified by polymerase chain reaction (PCR). A standard DNA amplification protocol with the universal primers LR1 (5 0 -GGTTGGTT TCTTTTCCT-3 0 ) and SR6R (5 0 -AAGTAAAAGTCGTA ACAAGG-3 0 ) was used as previously described. 2,3 The sequence of the PCR product was found to be 100% identical to the sequences EU622882 and EU622883 deposited in the GenBank database for isolates described under T. mentagrophytes var. erinacei 4 and the ITS sequence of strain CBS 511.73, 5 the original strain of T. erinacei. A dermatophyte was also isolated from scales and hair of the hedgehog. Both the phenotypic characteristics and the ITS sequence were identical to those of the fungus isolated from the patient's samples, confirming that T. erinacei originated from the pet. Isolates from both the patient and the animal were deposited in the Belgian Co-ordinated Collections of Micro-organisms (BCCM)/IHEM strain collection (IHEM 25493 and IHEM 24648, respectively). A 1-month treatment with topical and oral terbinafine (250 mg/d) resulted in complete recovery. A significant clinical improvement was observed after a couple of days, but the treatment was carried on to prevent recurrence of the infection. No glucocorticoid ointment was applied. DiscussionThe differential diagnosis of vesiculous or purulent lesions on the hands, in particular on the palmar side and lateral aspect of the fingers, includes dyshidrosis, contact dermatitis, and pustular eruptions like palmoplantar psoriasis ª

Tinea manuum: A report of 18 cases observed in the metropolitan area of Milan and review of the literature

“…Trichophyton mentagrophytes var. erinacei is usually transmitted by the hedgehog Atelerix albiventris . Very rare cases of tinea manuum caused by Trichophyton eriotrephon , Trichophyton rubrum var.…”

“…Tinea mannum is characterised by more or less important erythema and scaling . Vesicles, blisters, pustules, erosions, papules and hyperkeratosis may be observed. Pruritus is usually mild.…”

“…erinacei is usually transmitted by the hedgehog Atelerix albiventris. 19,29,37,41,43,54 Very rare cases of tinea manuum caused by Trichophyton eriotrephon, 37 Trichophyton rubrum var. raubitschekii 18,25,31 and Arthroderma benhamiae 37,45,49 have also been described.…”

Tinea manuum caused by Trichophyton erinacei

“…Recently, the worldwide appearance of this fungus as an emerging pathogen has been reported. 1 We report the case of an erosive tinea manuum from a T. erinacei infection.…”

“…Dear Editor, Circulating cell-free DNA (cfDNA) originates from apoptotic or necrotic cells and reflects the extent of cellular damage. 1 Although cfDNA has recently attracted attention as a marker for the diagnosis and prognosis of various disorders, there have been few reports in dermatology. For example, cfDNA levels in patients with melanoma are increased compared with those in healthy controls, 2 and BRAF V600E copies in cfDNA are useful as a marker for staging and predicting prognosis.…”