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Trichophyton erinacei: an emergent pathogen of pediatric dermatophytosis
Trichophyton erinacei: un patógeno emergente en las dermatofitosis en niños
Belén Rivayaa, Gema Fernández-Rivasa,
, Francisco Javier Cabañesb, Isabel Bielsac, Gemma Castelláb, Jun Hao Wanga, Lurdes Matasa,d
Corresponding author
a Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Germans Trias i Pujol, Department of Genetics and Microbiology, Autonomous University of Barcelona, Badalona, Spain
b Veterinary Mycology Group, Department of Animal Health and Anatomy, Autonomous University of Barcelona, Spain
c Dermatology Department, Hospital Germans Trias i Pujol, Badalona, Spain
d CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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We present two cases of tinea in children that own a guinea pig and a hedgehog, respectively.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Case 1: A five-year-old girl with a history of atopic dermatitis was attended due to a 3 month-itching lesion in the left malar area. Initially, topical corticosteroids were prescribed, without any improvement. Afterwards, itraconazole and a topical betamethasone-clotrimazole combined therapy were prescribed based on the fact that the family had a guinea pig at home. When itraconazole was stopped, skin lesions worsened and the patient needed again medical attention. The direct examination showed erythematous and scaly plaques with an active edge on the left cheek and periocular area. A <span class="elsevierStyleItalic">tinea corporis</span> was suspected and lesions healed after 8 weeks with terbinafine and topical clotrimazole treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Case 2: A nine-year-old boy presented with a two-week history of itching lesions on the temple and upper left eyelid. In physical examination a well-defined erythematous plaque with active edges and marked fine desquamation, with some 1-2 millimeters pustules, was observed (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Due to the clinical suspicion of <span class="elsevierStyleItalic">tinea faciei</span> the mother was asked about pets, saying that they had a hedgehog that the kid regularly touched and got close to his face. Topical terbinafine was prescribed for 4 months and lesions improved.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In both cases samples were inoculated on Sabouraud-glucose agar plates supplemented with chloramphenicol with and without gentamicin, and on Sabouraud glucose agar tubes with and without cycloheximide. Cultures yielded numerous white powdery colonies with yellow to brown reverse. Complementary microscopical findings were compatible with <span class="elsevierStyleItalic">Trichophyton erinacei</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). In the second case, morphological identification was further confirmed by ITS1-5.8S-ITS2 rRNA gene sequencing. A search on the GenBank database revealed a 100% match with <span class="elsevierStyleItalic">T. erinacei</span> type strain ATCC 28443. This sequence was deposited at NCBI with the accession number MN807946.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Dermatophytosis is prevalent worldwide, being <span class="elsevierStyleItalic">Trichophyton rubrum</span> the most frequent agent involved. Due to social, cultural and globalization changes, there are less prevalent etiological agents that should be considered in clinical practice. <span class="elsevierStyleItalic">T. erinacei</span> is a zoophilic dermatophyte that is currently emerging as a human pathogen, causing a severe inflammatory and pruritic infection. Hedgehogs are relatively often infected or colonized by this species in our country.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> In recent years, some <span class="elsevierStyleItalic">tinea corporis</span> cases have been reported related to hedgehogs, mainly in Asia,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,4,7</span></a> other European countries <a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5,6</span></a> and only one case linked to a guinea pig in Spain.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> As far as we know, the carriage of <span class="elsevierStyleItalic">T. erinacei</span> is uncommon, and due to the similarity with <span class="elsevierStyleItalic">Trichophyton benhamiae</span> sequencing is mandatory to confirm the identification. Unfortunately, as in Duran-Valle <span class="elsevierStyleItalic">et al.</span> case,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> our first isolate was not sequenced. The morphological resemblance between <span class="elsevierStyleItalic">T. benhamiae</span> and <span class="elsevierStyleItalic">T. erinacei</span> makes <span class="elsevierStyleItalic">T. erinacei</span> a suspected etiology, but the possibility of a <span class="elsevierStyleItalic">T. benhamiae</span> related to guinea pigs is also plausible. A guided interview revealed that the pet cage was previously used for housing a hedgehog, explaining the guinea pig infection and patient's lesions.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A long-term combination of topical and systemic antifungal therapy is usually required to treat this infection. Both patients received oral and topical terbinafine, respectively, and lesions resolved entirely. Success rates for this therapy have reached 75 to 90% in <span class="elsevierStyleItalic">tinea corporis</span>.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> An accurate medical record, with a guided anamnesis about possible risk factors and an ongoing and open dialogue between microbiologists and clinicians are essential to improve both patients’ care and the management of these exotic and zoophilic dermatophytoses.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding information</span><p id="par0035" class="elsevierStylePara elsevierViewall">No funding was received for this study</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1442127" "titulo" => "Abstract" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Case report" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1316164" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1442128" "titulo" => "Resumen" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1316165" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding information" ] 5 => array:2 [ "identificador" => "xack503366" "titulo" => "Acknowledgements" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-27" "fechaAceptado" => "2020-06-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1316164" "palabras" => array:5 [ 0 => "Dermatophytosis" 1 => "Hedgehog" 2 => "<span class="elsevierStyleItalic">Tinea</span>" 3 => "<span class="elsevierStyleItalic">Trichophyton erinacei</span>" 4 => "Spain" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1316165" "palabras" => array:5 [ 0 => "Dermatofitosis" 1 => "Erizo" 2 => "Tiña" 3 => "<span class="elsevierStyleItalic">Trichophyton erinacei</span>" 4 => "España" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dermatophytoses in children are common pathologies worldwide caused mainly by <span class="elsevierStyleItalic">Trichophyton rubrum</span>. However, due to the globalization and the atypical pets that people nowadays own, some zoonotic species are also involved in these lesions.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present two cases of <span class="elsevierStyleItalic">tinea faciei</span> caused by the zoonotic mould <span class="elsevierStyleItalic">Trichophyton erinacei</span> in two children that owned a guinea pig and a hedgehog, respectively<span class="elsevierStyleItalic">.</span> Mycological diagnosis was performed inoculating skin scales on Sabouraud-glucose agar plates supplemented with chloramphenicol, with and without gentamicin, and on Sabouraud-glucose agar tubes, with and without cycloheximide. Microscopical examination in both cases and ITS region sequencing to confirm the identification (performed in one of them) were compatible with <span class="elsevierStyleItalic">T. erinacei.</span> Multiple treatments like corticosteroids and antibiotics were prescribed prior to the accurate diagnosis. Finally, both patients received topical and oral terbinafine, respectively, the lesions being resolved entirely.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Zoonotic fungi must be considered in the diagnosis of skin lesions. An accurate medical record, with a guided anamnesis about possible risk factors and an ongoing and open dialogue between health professionals, are essential to improve both the management of these exotic and zoophilic dermatophytoses.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Case report" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Antecedentes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las dermatofitosis son patologías comunes en niños y son causadas principalmente por <span class="elsevierStyleItalic">Trichophyton rubrum</span>. Sin embargo, debido a la globalización y a la presencia cada vez más frecuente de animales exóticos como mascotas, algunas especies zoonóticas menos habituales pueden convertirse en agentes causales.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Caso clínico</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nuestro objetivo es describir dos casos de <span class="elsevierStyleItalic">Tinea faciei</span> causados por <span class="elsevierStyleItalic">Trichophyton erinacei</span> en dos niños que poseían, respectivamente, una cobaya y un erizo como mascotas. Se tomó muestra de escamas cutáneas que fueron inoculadas en placas de agar Sabouraud-glucosa suplementado con cloranfenicol, con y sin gentamicina, y en tubos de agar Sabouraud-glucosa con y sin cicloheximida. El examen microscópico fue compatible con <span class="elsevierStyleItalic">Trichophyton erinacei</span>, cuya identificación pudo ser confirmada por secuenciación de la región ITS en uno de los casos. Antes del correcto diagnóstico los pacientes habían recibido múltiples tratamientos (corticosteroides, antibióticos). Finalmente, los dos pacientes recibieron terbinafina tópica y oral, respectivamente, lo que llevó a la resolución completa de las lesiones.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los hongos zoonóticos deben ser considerados en el diagnóstico diferencial de las lesiones cutáneas. Una historia clínica con anamnesis guiada sobre posibles factores de riesgo, junto con una comunicación multidisciplinar fluida, es indispensable para mejorar el manejo de estas dermatofitosis.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1188 "Ancho" => 1583 "Tamanyo" => 232638 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Annular plaque on left eyebrow with pustules on the active edge.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1222 "Ancho" => 1625 "Tamanyo" => 105530 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Microscopic observation of <span class="elsevierStyleItalic">Trichophyton erinacei</span> stained with Lactofenol blue solution.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Trichophyton erinacei</span> in pet hedgehogs in Spain: Occurrence and revision of its taxonomic status" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.L. 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Barragán for their collaboration in sample processing.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/11301406/0000003700000034/v2_202012290734/S1130140620300309/v2_202012290734/en/main.assets" "Apartado" => array:4 [ "identificador" => "8082" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Nota" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/11301406/0000003700000034/v2_202012290734/S1130140620300309/v2_202012290734/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130140620300309?idApp=UINPBA00004N" ]
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