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A zoonotic ringworm outbreak caused by a dysgonic strain of Microsporum canis from stray cats
Brote zoonótico de tiña causado por una cepa disgónica de Microsporum canis de gatos callejeros
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Lanes 3–4 <span class="elsevierStyleItalic">Hind</span>III restricted IGS (alleles 0 and 1). Lane 5 <span class="elsevierStyleItalic">Mva</span>I restricted IGS (allele 0). Lane 6 <span class="elsevierStyleItalic">Rsa</span>I restricted IGS (allele 2). Lanes 7–8 <span class="elsevierStyleItalic">Rsa</span>I restricted Nitrate reductase (alleles 0 and 1). Lane 9 100<span class="elsevierStyleHsp" style=""></span>bp molecular weigth marker. <span class="elsevierStyleBold">(B)</span> Lanes 1–4 <span class="elsevierStyleItalic">Hae</span>III restricted IGS (alleles 0, 6, 5 and 4).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Claudio Muñoz, Sebastián Gómez Talquenca, Enrique Oriolani, Mariana Combina" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Claudio" "apellidos" => "Muñoz" ] 1 => array:3 [ "Iniciales" => "S." "nombre" => "Sebastián" "apellidos" => "Gómez Talquenca" ] 2 => array:2 [ "nombre" => "Enrique" "apellidos" => "Oriolani" ] 3 => array:2 [ "nombre" => "Mariana" "apellidos" => "Combina" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140610000215?idApp=UINPBA00004N" "url" => "/11301406/0000002700000002/v2_201308271753/S1130140610000215/v2_201308271753/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1130140610000173" "issn" => "11301406" "doi" => "10.1016/j.riam.2009.09.003" "estado" => "S300" "fechaPublicacion" => "2010-04-01" "aid" => "40" "copyright" => "Revista Iberoamericana de Micología" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Iberoam Micol. 2010;27:57-61" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 10337 "formatos" => array:3 [ "EPUB" => 61 "HTML" => 9220 "PDF" => 1056 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Queratomicosis en un centro de atención oftalmológica en la Ciudad de México" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "57" "paginaFinal" => "61" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Mycotic keratitis in an eye care hospital in Mexico city" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig2" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 725 "Ancho" => 980 "Tamanyo" => 163517 ] ] "descripcion" => array:1 [ "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Tinción con ácido periódico de Schiff de una muestra de lesión corneal. Se observan hifas teñidas rodeadas de exudado inflamatorio (40×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Virginia Vanzzini Zago, Patricia Manzano-Gayosso, Francisca Hernández-Hernández, Luis Javier Méndez-Tovar, Alfredo Gómez-Leal, Rubén López Martínez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Virginia" "apellidos" => "Vanzzini Zago" ] 1 => array:2 [ "nombre" => "Patricia" "apellidos" => "Manzano-Gayosso" ] 2 => array:2 [ "nombre" => "Francisca" "apellidos" => "Hernández-Hernández" ] 3 => array:2 [ "nombre" => "Luis Javier" "apellidos" => "Méndez-Tovar" ] 4 => array:2 [ "nombre" => "Alfredo" "apellidos" => "Gómez-Leal" ] 5 => array:3 [ "Iniciales" => "R." "nombre" => "Rubén" "apellidos" => "López Martínez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140610000173?idApp=UINPBA00004N" "url" => "/11301406/0000002700000002/v2_201308271753/S1130140610000173/v2_201308271753/es/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "A zoonotic ringworm outbreak caused by a dysgonic strain of <span class="elsevierStyleItalic">Microsporum canis</span> from stray cats" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "62" "paginaFinal" => "65" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Miguel Hermoso de Mendoza, Javier Hermoso de Mendoza, Juan M. Alonso, Joaquin M. Rey, Sergio Sanchez, Remigio Martin, Felix Bermejo, Maria Cortes, Jose M. Benitez, Waldo L. Garcia, Alfredo Garcia-Sanchez" "autores" => array:11 [ 0 => array:4 [ "nombre" => "Miguel" "apellidos" => "Hermoso de Mendoza" "email" => array:1 [ 0 => "mhermoso@unex.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Javier" "apellidos" => "Hermoso de Mendoza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Juan M." "apellidos" => "Alonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Joaquin M." "apellidos" => "Rey" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 4 => array:3 [ "nombre" => "Sergio" "apellidos" => "Sanchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 5 => array:3 [ "nombre" => "Remigio" "apellidos" => "Martin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 6 => array:3 [ "nombre" => "Felix" "apellidos" => "Bermejo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 7 => array:3 [ "nombre" => "Maria" "apellidos" => "Cortes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 8 => array:3 [ "nombre" => "Jose M." "apellidos" => "Benitez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 9 => array:3 [ "nombre" => "Waldo L." "apellidos" => "Garcia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 10 => array:3 [ "nombre" => "Alfredo" "apellidos" => "Garcia-Sanchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Cátedra de Patología Infecciosa, Facultad de Veterinaria, Universidad de Extremadura, Cáceres, España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Cinegetic Resources Research Institute IREC, Ciudad Real, España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Research Center Finca La Orden-Valdesequera, INIA-JEX, Badajoz, España" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Brote zoonótico de tiña causado por una cepa disgónica de <span class="elsevierStyleItalic">Microsporum canis</span> de gatos callejeros" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig8" "etiqueta" => "Fig. 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 737 "Ancho" => 980 "Tamanyo" => 238288 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Thick walled multicellular structures. Four months old culture in SDA. Lactophenol–Cotton Blue mount, 400×.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">Many veterinary students are quite prone to adopt pets. Kittens are a favourite because they can be easily kept in student flats, and litters are offered for adoption all year around.</p><p class="elsevierStylePara elsevierViewall">Cats are known carriers of <span class="elsevierStyleItalic">Microsporum canis</span>, and since the authors have witnessed some previous episodes of zoonotic infection in students related to stray kittens, the students are advised every year during the lectures about ringworm about the potential risks.</p><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M. canis</span> produces a wide range of clinical manifestations, from asymptomatic carriage to acute inflammatory kerion lesions; however microscopic examination of KOH mounts frequently shows sinuous, well branched, septate, slender hyphae and chains of arthrospores, as well as the ectothrix invasion of hairs.</p><p class="elsevierStylePara elsevierViewall">Isolates are also easily recognized by their young radiate colonies, the dense cottony aerial mycelium, the early production of a bright yellow pigment, and the heavy formation of large, thick walled, echinulate, spindle shaped macroconidia.</p><p class="elsevierStylePara elsevierViewall">Nevertheless, these characteristic culture features are not always observed. Dysgonic strains have been described in Spain<a class="elsevierStyleCrossRefs" href="#bib4"><span class="elsevierStyleSup">4,5,7</span></a> and elsewhere,<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1–3,6,9</span></a> and produce the same in vivo manifestations but lack most of these growth characters in culture. Moreover, these strains seem to have an increased infectivity for animal and human hosts.<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1,6,8</span></a></p><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Diagnostic procedures</span>: Human and animal patients were all diagnosed in the Infectious Pathology Diagnostic Service of the Clinical Veterinary Hospital (CVH) at the University of Extremadura (Cáceres, Spain). Samples were taken of skin lesions by direct scraping and scotch taping, processed for microscopic examination in 20% KOH and Lactophenol–Cotton Blue mounts, and inoculated onto Sabouraud dextrose agar (SDA) as well as SDA with chloramphenicol and actidione. Cultures were incubated at 30<span class="elsevierStyleHsp" style=""></span>°C and observed each week up to 3 months. Cultures demonstrating growth were subcultured every 2 weeks.</p><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case reports</span>: In September 2007 an orphaned litter of 5 stray kittens was rescued by an animal protection association. The animals were undernourished with dirty fur on arrival (<a class="elsevierStyleCrossRef" href="#fig1">Fig. 1</a>). They were nursed for 3 weeks under the care of the CVH, and then offered for adoption. The kittens were subsequently adopted by students from two flats (A and B).</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case</span> 1: The dog of one CVH interns developed alopecic annular pruriginous lesions on the medial tarsus of right hind leg while the kittens were still being nursed in the Hospital. The dog did not visit the CVH, and did not have any direct contact with the kittens. The owner herself had frequent contact with the cats, taking routine precautions when nursing them, but did not demonstrate any lesion herself. Hairs and skin scrapings of dog's lesions were treated with 20% KOH and examined at 400×, showing abundant well ramified hyphae with arthrospore chains (<a class="elsevierStyleCrossRef" href="#fig2">Fig. 2</a>). The samples were inoculated on SDA plates and incubated at 30<span class="elsevierStyleHsp" style=""></span>°C. The dog's dermatitis was diagnosed as ringworm and treated accordingly with 6 enilconazole baths (0.2% in tap water, one every 4 days), with complete recovery in 1 month. Restriction of movement, hygienic measures, and hypochlorite disinfection were implemented in the dog's environment. No recurrences were observed and the dog's owner did not develop infection.</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case</span> 2: Two weeks after their arrival, the flat A-kittens showed alopecic patches in face and limbs (<a class="elsevierStyleCrossRef" href="#fig3">Fig. 3</a>) and were carried to our Diagnostic Service. Hairs and skin scrapings were taken and processed. Huge amounts of slender ramified hyphae, small arthrospores in chains, and hair sheath ectothrix colonization (<a class="elsevierStyleCrossRef" href="#fig4">Fig. 4</a>) were observed at 400×. The dermatitis was diagnosed as ringworm. Samples were also inoculated on SDA plates. Two days later, three of the four flat A-student mates, one adult cat, and one dog showed annular pruriginous lesions on the face, thorax, forearms, and legs. Lesions in all cases showed abundant hyphae, arthrospore chains, and a hair sheath morphology identical to that observed in the kittens (<a class="elsevierStyleCrossRef" href="#fig5">Fig. 5</a>). Scrapings and hair were inoculated on SDA plates. Our findings and a diagnosis of ringworm were reported and the students were immediately referred to a dermatologist for treatment. The affected cats were treated with oral griseofulvin (40<span class="elsevierStyleHsp" style=""></span>mg/kg) and local povidone iodine. Lesions cleared in 1 month. The dog received enilconazole baths twice a week and lesions healed in about 3 weeks. Hygienic measures and hypochlorite disinfection were implemented, but movement of animals was not restricted. Treatment of human cases with oral (250<span class="elsevierStyleHsp" style=""></span>mg/day) and topic (1% cream) terbinafine was effective in about a month, but the adult cat's owner had two recurrences, one in February and another in May.</p><elsevierMultimedia ident="fig3"></elsevierMultimedia><elsevierMultimedia ident="fig4"></elsevierMultimedia><elsevierMultimedia ident="fig5"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case</span> 3: One of the affected kittens was adopted by another student, who lived alone (flat B). The kitten showed small ventral and inguinal alopecic patches, and when the owner noticed that the litter was infected with ringworm she began to treat the kitten with griseofulvin 25<span class="elsevierStyleHsp" style=""></span>mg/kg. No other measures were adopted. Twenty days later she observed annular non-pruriginous lesions on her own legs (<a class="elsevierStyleCrossRef" href="#fig6">Fig. 6</a>) and came to our Diagnostic Service. The samples obtained by scotch taping were treated with Lactophenol–Cotton Blue, and looked at 400× under a microscope—several small sized, well ramified hyphae, and arthrospore chains were observed. Scrapings were inoculated on SDA plates. A diagnosis of ringworm was established and the owner of the kitten was referred to the dermatologist. Restriction, hygienic, and disinfection measures were then implemented. Oral terbinafine 250<span class="elsevierStyleHsp" style=""></span>mg/day treatment for the owner and griseofulvin 40<span class="elsevierStyleHsp" style=""></span>mg/kg oral treatment for the kitten were effective within 1 month with no recurrences.</p><elsevierMultimedia ident="fig6"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case</span> 4: One student from the other flat (C) visited flat A on one occasion with her dog. The dog developed one single annular thoracic lesion, which was fairly inflammatory and pruriginous (<a class="elsevierStyleCrossRef" href="#fig7">Fig. 7</a>). Specimens were obtained and analysed as usual, and showed the same display of hyphae and ectothrix arthrospores as the other animal cases. Once diagnosed as ringworm, a treatment with enilconazole 0.2% baths twice a week was implemented, being effective in 3 weeks. Scraping samples were cultivated on SDA plates. Restriction of movements and hygienic and disinfection measures were taken. Neither the dog's owner nor her mates or their dogs were affected.</p><elsevierMultimedia ident="fig7"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case</span> 5: Another student's dog (Flat D) that interacted at the Faculty with the flat A-dogs prior to their confinement developed small alopecic annular lesions on the thorax and the left foreleg. Scrapings and hair samples were processed as usual, showing the same morphology and distribution of hyphae and arthrospores as in all the other cases. Diagnosed as ringworm, the samples were inoculated on SDA and enilconazole 0.2% baths were implemented once weekly, and the dog was cured in 1 month. Restriction, hygienic, and disinfection measures were adopted. The owner was not affected.</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Culture results</span><p class="elsevierStylePara elsevierViewall">Colonial growth was visible after 2 weeks of incubation. <span class="elsevierStyleItalic">M. canis</span> was not recognized in plain SDA or in the actidione- or chloramphenic-supplemented plates. The young colonies (about 18 days) appeared grayish, were fully submerged with a raised darker center, and displayed thick distorted hyphae radially arranged. When mature (40 days of incubation) they acquired a dull khaki colour with a very short aerial mycelium. No trace of bright yellow pigment was visible on the reverse, and neither typical macroconidia nor microconidia were observed. Only some scarce, multicellular, thick walled structures (<a class="elsevierStyleCrossRef" href="#fig8">Fig. 8</a>) roughly similar to chlamydospore chains or misshapen macroconidia were observed in 100-day cultures. Colonial features of the cultures were fairly unstable and pleomorphic, reverting to <span class="elsevierStyleItalic">mycelia sterilia</span> after about the second or third subculture on SDA.</p><elsevierMultimedia ident="fig8"></elsevierMultimedia></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara elsevierViewall">The disappointing lack of a recognizable dermatophyte in obvious cases of ringworm lead us to change the batch of culture medium three times, and made us suspect a dysgonic strain of <span class="elsevierStyleItalic">M. canis</span> strain, as these strains often present with features similar to those seen in our isolates. The colonial morphology with submerged radial growth, velvety aerial mycelium, and a raised center agreed with the descriptions of Sánchez et al.<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a> and Pereiro Jr et al.,<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a> who also found wide, inverse branching hyphae, also described by English<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a>; only the radial disposition of mycelium suggested the regular <span class="elsevierStyleItalic">M. canis</span> morphology. In contrast with other author reports,<a class="elsevierStyleCrossRefs" href="#bib3"><span class="elsevierStyleSup">3–5</span></a> our strain never produced yellow pigment, and only greyish and dim khaki colours were visible on both sides of the plates. All the authors describe poor conidiation with scarce, anomalous, and irregularly shaped macroconidia. Our thick walled structures were especially similar to those described in Refs. <a class="elsevierStyleCrossRefs" href="#bib1">1, 4, 5</a>. The morphology of our cultures was far less stable than that described in Ref. <a class="elsevierStyleCrossRef" href="#bib7">7</a>, and never reverted to typical <span class="elsevierStyleItalic">M. canis</span> morphology as documented in Refs. <a class="elsevierStyleCrossRefs" href="#bib2">2, 6, 9</a>, nor did they show features compatible with <span class="elsevierStyleItalic">Microsporum distortum</span> as seen in the Brasch strains.<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> A striking feature of this outbreak was the highly contagious nature of the strain, a feature also noted in Refs. <a class="elsevierStyleCrossRefs" href="#bib1">1, 6</a> for their strains. In our case, six cats, four dogs, and at least four individuals were infected or reinfected in five separate locations. Direct contact was proven in most cases, but in some the carriages of arthrospores by the owners’ clothes or footwear seem the most probable way of infection, and in two cases only one actual contact is known between infected and healthy animals. Environmental persistence of fungus is also an important consideration. The only case of reinfection was in flat A, the focus of the infection. Despite aggressive and repeated hygienic and disinfection measures, reinfection occurred on two occasions, 5 and 8 months after the initial infection. Summerbell<a class="elsevierStyleCrossRef" href="#bib8"><span class="elsevierStyleSup">8</span></a> points out that the lack of some growth characters favouring the saprophytic survival of dermatophytes on soil keratin, as macro and microconidia and pigment production, may be an adaptation to the parasitism on the living animal hair keratin, and be accompanied by greater infectivity, by means of enhanced resistance of artrhrospores in the environment as well as by an increase of infective ability of the mycelium fragments. The dsygonic mutation of <span class="elsevierStyleItalic">M. canis</span> could be an example of a trend in this direction.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres263444" "titulo" => array:6 [ 0 => "Abstract" 1 => "Background" 2 => "Objectives" 3 => "Methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec246990" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres263443" "titulo" => array:6 [ 0 => "Resumen" 1 => "Antecedentes" 2 => "Objetivos" 3 => "Métodos" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec246991" "titulo" => "Palabras clave" ] 4 => array:1 [ "titulo" => "Patients and methods" ] 5 => array:1 [ "titulo" => "Culture results" ] 6 => array:1 [ "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "xack58488" "titulo" => "Acknowledgments" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-07-10" "fechaAceptado" => "2009-12-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec246990" "palabras" => array:3 [ 0 => "Stray cats" 1 => "Zoonotic ringworm" 2 => "Dysgonic <span class="elsevierStyleItalic">Microsporum canis</span>" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec246991" "palabras" => array:3 [ 0 => "Gatos callejeros" 1 => "Tiña zoonótica" 2 => "<span class="elsevierStyleItalic">Microsporum canis</span> disgónico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p class="elsevierStyleSimplePara elsevierViewall">Cats are frequent carriers of <span class="elsevierStyleItalic">Microsporum canis</span> and veterinary students are at high risk of exposure and acquisition of the organism a la infección.</p> <span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">An outbreak of zoonotic ringworm carried by a litter of stray cats is described. Four veterinary students, four dogs, and six cats living in five separate locations were affected. All had direct or indirect contact with the infected kitten litter. We tried to identify the causal dermatophyte.</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">Conventional and mycological culture methods were used.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Microscopic features of scrapings and hairs treated with 20% KOH strongly suggested a <span class="elsevierStyleItalic">M. canis</span> etiology, and a diagnosis of ringworm was empirically supported by successful treatment of humans and animals. Nevertheless, cultures failed to show the expected morphology.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Culture features of our strain are compared with those described by other authors for dysgonic <span class="elsevierStyleItalic">M. canis</span> strains. Epidemiological features are also discussed.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Antecedentes</span><p class="elsevierStyleSimplePara elsevierViewall">Los gatos son frecuentemente portadores de <span class="elsevierStyleItalic">Microsporum canis.</span> Los estudiantes de veterinaria están especialmente expuestos a la infección.</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Se describe un brote de tiña zoonótica difundido por una camada de gatos callejeros. Cuatro estudiantes de veterinaria, cuatro perros y seis gatos de cinco localizaciones diferentes se vieron afectados. Todos tuvieron contacto directo o indirecto con la camada de gatitos infectados. Se intenta identificar el dermatofito causal.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se utilizan los procedimientos micológicos morfológicos y de cultivo convencionales.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Los hallazgos microscópicos en pelo y raspados cutáneos aclarados en KOH al 20% sugirieron fuertemente una etiología por <span class="elsevierStyleItalic">M. canis</span>, y el diagnóstico de tiña fue apoyado empíricamente por el éxito en el tratamiento de humanos y animales. Sin embargo, los cultivos no mostraron la morfología esperada.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los caracteres del cultivo de nuestra cepa son comparados con los descritos por otros autores en cepas disgónicas de <span class="elsevierStyleItalic">M. canis</span>. Las características epidemiológicas son discutidas también.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 735 "Ancho" => 980 "Tamanyo" => 141971 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Dirty poor fur. Infected litter kitten.</p>" ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 488 "Ancho" => 750 "Tamanyo" => 157786 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Hyphae and arthrospore chains. HCV dog scraping, 20% KOH mount, 400×.</p>" ] ] 2 => array:7 [ "identificador" => "fig3" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 735 "Ancho" => 980 "Tamanyo" => 205370 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Kitten facial lesions. Infected litter, Flat A.</p>" ] ] 3 => array:7 [ "identificador" => "fig4" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 733 "Ancho" => 975 "Tamanyo" => 225368 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Ectothrix hyphae and arthrospore chains. Flat A-kitten hair and scrapings, 20% KOH mount, 400×.</p>" ] ] 4 => array:7 [ "identificador" => "fig5" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 739 "Ancho" => 980 "Tamanyo" => 201598 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Ectothrix hyphae and arthrospore chains on human hair. Flat A-mate scraping, 20% KOH mount, 400×.</p>" ] ] 5 => array:7 [ "identificador" => "fig6" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 737 "Ancho" => 980 "Tamanyo" => 190481 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Annular lesion on human leg. Flat B-girl.</p>" ] ] 6 => array:7 [ "identificador" => "fig7" "etiqueta" => "Fig. 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 737 "Ancho" => 980 "Tamanyo" => 176317 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Annular lesion on dog chest. Flat C-dog.</p>" ] ] 7 => array:7 [ "identificador" => "fig8" "etiqueta" => "Fig. 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 737 "Ancho" => 980 "Tamanyo" => 238288 ] ] "descripcion" => array:1 [ "en" => "<p class="elsevierStyleSimplePara elsevierViewall">Thick walled multicellular structures. Four months old culture in SDA. Lactophenol–Cotton Blue mount, 400×.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Microsporum canis</span> with polymorphous macroconidia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. 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Toribio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Mycol Med" "fecha" => "1997" "volumen" => "7" "paginaInicial" => "162" "paginaFinal" => "165" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preliminary report on the isolation of a dysgonic variety of <span class="elsevierStyleItalic">Microsporum canis</span> together with the normal variety from a cattery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.M. Philpot" 1 => "M.J. Newman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Mycopathologia" "fecha" => "1992" "volumen" => "120" "paginaInicial" => "73" "paginaFinal" => "77" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1480210" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolation of dysgonic strains of <span class="elsevierStyleItalic">Microsporum canis</span> in Bilbao (Spain)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Sanchez" 1 => "P. Velasco" 2 => "G. Quindos" 3 => "C.K. Campbell" 4 => "R. Cisterna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Med Vet Mycol" "fecha" => "1989" "volumen" => "27" "paginaInicial" => "391" "paginaFinal" => "395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2628559" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Summerbell RC. Form and function in the evolution of dermatophytes. In: Kushwaha RKS, Guarro J, editors. Biology of dermatophytes and other keratinophilic fungi. Revista Iberoamericana de Micología, Bilbao, 2000. p. 30–43." ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The dysgonic form of <span class="elsevierStyleItalic">Microsporum canis</span> in N.W. London" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.D.L. Tucker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1980" "volumen" => "102" "paginaInicial" => "429" "paginaFinal" => "435" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7387885" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack58488" "titulo" => "Acknowledgments" "texto" => "<p class="elsevierStylePara elsevierViewall">To all affected and unaffected veterinary students, who kindly answered our epidemiological enquiries.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/11301406/0000002700000002/v2_201308271753/S1130140610000227/v2_201308271753/en/main.assets" "Apartado" => array:4 [ "identificador" => "8046" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/11301406/0000002700000002/v2_201308271753/S1130140610000227/v2_201308271753/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140610000227?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
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| 2024 November | 23 | 0 | 23 |
| 2024 October | 207 | 8 | 215 |
| 2024 September | 170 | 6 | 176 |
| 2024 August | 95 | 3 | 98 |
| 2024 July | 72 | 7 | 79 |
| 2024 June | 46 | 6 | 52 |
| 2024 May | 58 | 2 | 60 |
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| 2024 March | 57 | 11 | 68 |
| 2024 February | 98 | 2 | 100 |
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| 2023 November | 191 | 7 | 198 |
| 2023 October | 249 | 1 | 250 |
| 2023 September | 150 | 5 | 155 |
| 2023 August | 144 | 1 | 145 |
| 2023 July | 189 | 2 | 191 |
| 2023 June | 181 | 2 | 183 |
| 2023 May | 290 | 4 | 294 |
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| 2022 September | 156 | 13 | 169 |
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| 2020 May | 159 | 10 | 169 |
| 2020 April | 137 | 11 | 148 |
| 2020 March | 111 | 8 | 119 |
| 2020 February | 146 | 9 | 155 |
| 2020 January | 138 | 6 | 144 |
| 2019 December | 122 | 11 | 133 |
| 2019 November | 98 | 12 | 110 |
| 2019 October | 114 | 7 | 121 |
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| 2019 May | 142 | 45 | 187 |
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| 2019 March | 57 | 10 | 67 |
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| 2019 January | 86 | 6 | 92 |
| 2018 December | 47 | 4 | 51 |
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| 2018 September | 322 | 3 | 325 |
| 2018 August | 294 | 4 | 298 |
| 2018 July | 239 | 5 | 244 |
| 2018 June | 252 | 0 | 252 |
| 2018 May | 250 | 9 | 259 |
| 2018 April | 210 | 3 | 213 |
| 2018 March | 176 | 0 | 176 |
| 2018 February | 129 | 3 | 132 |
| 2018 January | 149 | 0 | 149 |
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| 2017 November | 175 | 4 | 179 |
| 2017 October | 147 | 2 | 149 |
| 2017 September | 139 | 2 | 141 |
| 2017 August | 71 | 4 | 75 |
| 2017 July | 117 | 3 | 120 |
| 2017 June | 124 | 5 | 129 |
| 2017 May | 124 | 2 | 126 |
| 2017 April | 71 | 9 | 80 |
| 2017 March | 114 | 26 | 140 |
| 2017 February | 174 | 3 | 177 |
| 2017 January | 66 | 2 | 68 |
| 2016 December | 72 | 10 | 82 |
| 2016 November | 93 | 8 | 101 |
| 2016 October | 134 | 11 | 145 |
| 2016 September | 250 | 6 | 256 |
| 2016 August | 184 | 4 | 188 |
| 2016 July | 162 | 2 | 164 |
| 2016 June | 198 | 15 | 213 |
| 2016 May | 196 | 18 | 214 |
| 2016 April | 155 | 14 | 169 |
| 2016 March | 174 | 17 | 191 |
| 2016 February | 123 | 21 | 144 |
| 2016 January | 170 | 18 | 188 |
| 2015 December | 188 | 15 | 203 |
| 2015 November | 166 | 16 | 182 |
| 2015 October | 194 | 21 | 215 |
| 2015 September | 182 | 9 | 191 |
| 2015 August | 197 | 12 | 209 |
| 2015 July | 347 | 13 | 360 |
| 2015 June | 218 | 6 | 224 |
| 2015 May | 286 | 9 | 295 |
| 2015 April | 211 | 9 | 220 |
| 2015 March | 222 | 7 | 229 |
| 2015 February | 196 | 1 | 197 |
| 2015 January | 115 | 1 | 116 |
| 2014 December | 192 | 5 | 197 |
| 2014 November | 162 | 4 | 166 |
| 2014 October | 195 | 4 | 199 |
| 2014 September | 212 | 2 | 214 |
| 2014 August | 140 | 2 | 142 |
| 2014 July | 168 | 3 | 171 |
| 2014 June | 208 | 0 | 208 |
| 2014 May | 175 | 2 | 177 |
| 2014 April | 92 | 3 | 95 |
| 2014 March | 183 | 11 | 194 |
| 2014 February | 196 | 11 | 207 |
| 2014 January | 188 | 11 | 199 |
| 2013 December | 172 | 6 | 178 |
| 2013 November | 151 | 9 | 160 |
| 2013 October | 147 | 9 | 156 |
| 2013 September | 130 | 13 | 143 |
| 2013 August | 130 | 7 | 137 |
| 2013 July | 125 | 5 | 130 |
| 2013 June | 82 | 4 | 86 |
| 2013 May | 72 | 6 | 78 |
| 2013 April | 60 | 9 | 69 |
| 2013 March | 44 | 7 | 51 |
| 2013 February | 54 | 11 | 65 |
| 2013 January | 83 | 5 | 88 |
| 2012 December | 21 | 6 | 27 |
| 2012 November | 3 | 2 | 5 |
| 2012 October | 3 | 1 | 4 |
| 2010 March | 829 | 0 | 829 |
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