Annals of Tropical Medicine and Public Health

CASE REPORT
Year
: 2016  |  Volume : 9  |  Issue : 5  |  Page : 351--353

A First case of Microsporum ferrugineum causing tinea corporis in Uttarakhand


Dimple Raina1, Pratima Gupta2, Ankit Khanduri1,  
1 Department of Microbiology, SGRRIM and HS, Dehradun, Uttarakhand, India
2 Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Correspondence Address:
Pratima Gupta
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh - 249 201, Uttarakhand
India

Abstract

This is the first case of Microsporum ferrugineum isolated from a patient in Uttarakhand. A 56-year-old man came to the skin outpatient department with the chief complaints of tinea corporis associated with the symptoms of tinea cruris. Examination of the patient disclosed diffuse erythematic and perifollicular papules and pustules in the chest, abdominal, and the back. Typical vesiculopustular lesions involved the skin of groin area also. Isolate was identified as M. ferrugineum on the basis of macroscopic and microscopic colony characteristics. The patient was treated successfully with griseofulvin which was administered for 4 weeks.



How to cite this article:
Raina D, Gupta P, Khanduri A. A First case of Microsporum ferrugineum causing tinea corporis in Uttarakhand.Ann Trop Med Public Health 2016;9:351-353


How to cite this URL:
Raina D, Gupta P, Khanduri A. A First case of Microsporum ferrugineum causing tinea corporis in Uttarakhand. Ann Trop Med Public Health [serial online] 2016 [cited 2019 Oct 19 ];9:351-353
Available from: http://www.atmph.org/text.asp?2016/9/5/351/190195


Full Text

 Introduction



Dermatophytes are assuming greater significance both in developed and developing countries particularly due to the advent of immunosuppressive drugs and diseases like AIDS. [1] The prevalence of these infections also tends to increase with age, change in geographic location and climate. These infections are especially common in tropical countries like India due to environmental factors such as heat and humidity. In addition, the risk factors include socioeconomic conditions such as overcrowding, poverty, and neglect of personal hygiene. [2] Although dermatophytes have a worldwide distribution, some species are found in specific areas. Microsporum ferrugineum is most common in the far East, Northern China, Korea, Thailand, Japan, the Middle East and Nigeria. [3],[4]

We report here the first case of M. ferrugineum isolated from a patient of tinea corporis in our region.

 Case Report



A 56-year-old man came to the outpatient Department for Dermatology with the chief complaints of inflammatory skin lesions in the chest, abdominal, and the back areas. He also complained of similar lesions in his groin area. This patient was a farmer living in close contacts with animals like poultry, dogs, and cattle; furthermore, he was also a diabetic. Physical examination disclosed erythematic and perifollicular papules and pustules in the affected areas. Typical vesiculopustular lesions involved the skin of the groin area.

Skin scrapings were collected from the borderline areas of the ringworm lesions in all the affected areas after a thorough cleaning with 70% of alcohol. These were preserved in small black paper envelopes for easy visualization and absorption of moisture and to reduce/eliminate bacterial load. After proper collection procedures, the skin specimens were subject to direct microscopic examination with 20% KOH which revealed the presence of hyaline septate branching hyphae, the culture was performed in three media; Sabouraud Dextrose Agar (SDA) with chloramphenicol 50 mg/L, SDA with chloramphenicol 50 mg/L and cycloheximide 500 mg/L, and dermatophyte test medium (DTM). These were incubated at room temperature for 4 weeks and 10 days, respectively. Pure isolates were generated by sub-culturing on SDA and Potato Dextrose Agar (PDA) media respectively for both visual and microscopic examinations of cultural (color and growth pattern) and morphological characteristics respectively for further differentiation. M. ferrugineum was identified based on colony morphology on SDA, DTM, and PDA media. Characteristic microscopic findings in lactophenol cotton blue preparations showed the presence of bamboo hyphae with chlamydoconidia, and lack of macro and microconidia [Figure 1]. Negative in vitro hair perforation test and positive urease test further clinched the diagnosis.{Figure 1}

The patient was treated successfully with griseofulvin which was administered for 4 weeks.

 Discussion



Tinea corporis is the ringworm of glabrous skin. The ringworm of the upper parts of the body usually involves the shoulders, axilla, chest, and back. It may also involve the face, legs, or the dorsa of hands or feet. The lesions are well-marginated with raised erythematous, vesicular borders. The annular, scaly patches may coalesce to form large areas of chronic infection when Trichophyton rubrum is the etiologic agent. All species of dermatophytes belonging to the genera, Trichophyton, Microsporum, and Epidermophyton are capable of producing tinea corporis. The most common species involved are T. rubrum, Trichophyton mentagrophytes, Trichophyton tonsurans, and Microsporum canis.[3]

Tinea corporis is by, and large the most common infection caused by dermatophytes in India as reported by most workers and T. rubrum is the single largest etiological agent as reported from many parts of the country. [5] The source of infection is usually an active lesion on any animal or other human, fomites like clothing, furniture, etc., soil or spread from an existing localized infection. A tropical or subtropical climate is associated with more frequent and severe tinea corporis, and the infection is more common in adult males. Children appear to have an increased incidence of tinea corporis caused by zoophilic organisms. [6]

M. ferrugineum as the etiological agent of tinea corporis has been reported for the first time from this hilly state of Uttarakhand. M. ferrugineum is an anthropophilic dermatophyte causing tinea in humans. It is endemic in the far East (where it is the most frequent cause of tinea capitis), Central Africa, Northern China, Korea, Thailand, and Japan. [3],[4] The clinical features of the disease caused by M. ferrugineum are similar to those of infections caused by other dermatophytes. An outbreak of tinea capitis due to M. ferrugineum in Thailand has been reported with a frequency of 66.7% by Wisuthsarewong and Chaiprasert. [4] Mahmoudabadi in their research article isolated M. ferrugineum for the first time from a case of tinea faciei in Iran. [7] Similar to our findings, M. ferrugineum was also isolated from a case of tinea corporis from Cuba. [8] In India, very few published reports about the isolation of M. ferrugineum are available. Sporadic cases have been reported in India from the North East and Lucknow. [9],[10] The study done by Grover and Roy in North East have isolated 5 cases of M. ferrugineum; two being isolated from tinea pedis patients whereas as one each isolated from tinea faciei, tinea corporis, and tinea cruris patients. [9] Sahai and Mishra in their study from Lucknow have reported M. ferrugineum to constitute 9.5% of the total number of isolates. Tinea corporis being the most common presentation. [10]

As observed in the studies above and in our study M. ferrugineum has been isolated from tinea corporis and even from other tinea conditions. Therefore, the diversity of dermatophyte isolates causing a particular condition has widened with many isolates like M. ferrugineum which till recent times were linked to the causation of tinea capitis and were endemic in Africa and Oriental Asia have now started to change their patterns of causation and places of endemicity. Hence, we can conclude that changes in lifestyle, behavioral patterns, hygiene levels, contact with animals and in particular modes of occupation and migrations from one place to another could significantly contribute to the alteration in spectrum of dermatophytes and the finding of uncommon fungal isolates in clinical practice. Therefore, a high level of diagnostic acumen could help to diagnose more such cases in future and help to study changing pattern of dermatophytosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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