TineaCapitis:AreEpidemiologicShiftsAssociatedWithDistinctClinicalPresentations?SigridCollier,MD;CuongVNguyen,MD;AshleyMerten,MD;SheilaghMMaguiness,MD;KristenPHook,MD

DepartmentofDermatology,UniversityofMinnesota,Minneapolis,MN

!  Tineacapitisisaninfectionofthehaironthescalpcausedbydermatophyticfungi.!  Thegeographicdistributionofindividualorganismshaschangedsignificantlyovertime.1,2!  Inthelate19thandearly20thcenturyEurope,M.audouiniiandT.schoenleinii

predominated,bothofwhichareanthropophilicorganisms,beingpassedfromhumantohuman.3

!  Thiswasfollowedbyariseofzoophilicorganisms,thosepassedfromanimalstohumans,suchasM.canisandT.mentagrophytes.3

!  IntheUnitedStates,T.tonsurans,ananthropophilicorganism,isnowthemostcommoncauseoftineacapitis.3

!  SeveralstudieshavenotedthatwhileM.caniscontinuestobethepredominantorganisminWesternEuropetherehasbeenincreasedprevalenceofT.violaceumandT.tonsuransinthelast20-30years.4,5

!  Theepidemiologicalandbiologicalunderpinningsforthesechangesovertimearecomplexandtheimportanceofenvironmentalfactors,geneticpredisposition,andmovementofpopulationshasbeenbroadlydebated.1

Methods Results

Discussion

Introduction

62patientsidentifiedwithtineacapitis

16patientswithnegativecultures

6patientswithonlyfungalcontaminants

46patientswithculturepositivetineacapitis

T.Tonsurans26patients

T.Violaceum15patients

T.Soudanese3patients

Microsporumsp.2patients

Fungalspeciesidentified

Excluded

!  RetrospectiveelectronicchartreviewattheUniversityofMinnesota,DepartmentofDermatologyanddivisionofPediatricDermatology.

!  Childrenunder18yearsofagewithdiagnosisoftineacapitisidentifiedbetweentheyears2010-2015.

!  Patientswhohadnegativeculturesoronlygrewspeciesthatareconsiderednon-pathogenicwereexcludedfromtheanalysis.

!  SignificancewasdeterminedbytheFisher’sexacttest.!  Inflammatorytineacapitiswasdefinedasthepresenceofpustules,bogginess,or

lymphadenopathy.

References

p-value<.0001

p-value<0.0265

GlobalDistributionofTineaCapitisDermatophytes

Methods

Results Figure1.TrichophytonViolaceum:Non-inflammatoryPattern

Figure2.TrichophytonTonsurans:InflammatoryPattern

!  ThisstudycorroboratestheclinicalexperienceatourinstitutionthattineacapitiscausedbyT.violaceumislessinflammatorythantineacapitiscausedbyT.tonsurans.

!  BothT.tonsuransandT.violaceumareanthropophilicspecies,whichhistoricallyareassociatedwithlessinflammatorytineacapitisthanzoophilicspecies.

!  Wefoundsignificantvariationinthedegreeofinflammatoryresponseevenbetweenthesetwoanthropophilicspecies.

!  CliniciansintheUnitedStatesaremorefamiliarwiththemoreinflammatoryclinicalpresentationoftineacapitisassociatedwithT.tonsurans,asthisisthepredominantspeciesintheUnitedStates(Figure2).

!  TineacapitisassociatedwithT.violaceumcanbeextremelysubtleandtheclinicalpresentationcanevenmimicseborrheicdermatitis(Figure1).

!  Inourstudy,T.violaceuminfectionsweremorecommonlyseenamongpeopleofAfricanethnicity,andlackofawarenessofthedistinctclinicalpresentationassociatedwithT.violaceumlikelyleadstoincorrectdiagnosisandinadequatetreatmentoftineacapitisinthispatientpopulation.

!  Accordingtocensusdatabetween2000and2015,morethan20,000EastAfricanswithrefugeestatusresettledinMinnesota.6,7

!  Asnewpopulationssuccessfullyintegrateintocommunitiesthepredominantanthropophilicspeciesoftineacapitisandassociatedclinicalpresentationsmaychange.

!  Studyingepidemiologicchangesintineacapitiscanhelpusunderstandhowgeographicchangesinteractwithclinicaldiseasepresentationsasourpopulationmake-upevolves,allowingustoprovidecrucialqualityhealthcaretoall.

1.  HayRJ.TineaCapitis:CurrentStatus.Mycopathologia,2017:182(1–2),87–93.2.  CoulibalyO,L’OllivierC,PiarrouxR,EphaneRanqueS.EpidemiologyofhumandermatophytosesinAfrica.

MedicalMycology,2017:1–17.3.  ZhanP,LiuW.TheChangingFaceofDermatophyticInfectionsWorldwide.Mycopathologia,2017:182(1–

2),77–86.4.  GrigoryanK,OlsonM,TollefsonM,NewmanC.FeaturesoftineacapitiscausedbyTrichophytonviolaceum

andTrichophytonsoudanense.JournaloftheAmericanAcademyofDermatology,2017:76(6),AB140.5.  HällgrenJ,PetriniB,WahlgrenCF.IncreasingtineacapitisprevalenceinStockholmreflectsimmigration.

MedicalMycology,2004:42(6),505–509.6.  http://www.mncompass.org/immigration/groups-at-a-glance-somali.AccessedMay1,20187.  http://www.mncompass.org/immigration/groups-at-a-glance-Ethiopian.AccessedMay1,2018

!  T.tonsuranswassignificantlymorelikelythanT.violaceumtoexhibitaninflammatorypattern(68%vs22%,p-value<0.0265).

!  Whenwetestedforanassociationbetweenthetineaspeciesandeachfeatureindividually,i.e.presenceofpustules,bogginess,orlymphadenopathy,therewasnoclinicalsignificance

!  Inthe18(42.9%)patientsthatwereinfectedwitheitherT.violaceumorT.soudenese,allwereofAfricanethnicity.

!  Incontrast,T.tonsuranswasidentifiedinaminorityofAfricanpatients(3.8%),revealingastatisticallysignificantdifferencebetweenethnicityandinfectivespecies(p-value<0.0001).

!  TherewasnosignificantdifferenceinsuccessfultreatmentregimenforT.tonsuransvsT.violaceum.

Results

0

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100

M.canis/cookei M.gypseum T.soudanese T.tonsurans T.violaceum

Percen

t

DistributionofTineaSpeciesbyEthnicity

Africanethnicity

Otherethnicity

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M.canis/cookei M.gypseum T.soudanese T.tonsurans T.violaceum

Percen

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DistributionofTineaSpeciesbyFeaturePresence(PustulesorBogginessorLymphadneopathy)

No

Yes

Reference:ZhanP,LiuW.TheChangingFaceofDermatophyticInfectionsWorldwide.Mycopathologia,2017:182(1–2),77–86.