Case report
Kerion Celsi in a newborn due to Microsporum canis Fallbericht. Durch Microsporum canis verursachtes Kerion Celsi bei einem Neugeborenen Nicola Aste, Anna Luisa Pinna, Monica Pau and P. Biggio Department of Dermatology, University of Cagliari, Cagliari, Italy
Summary
The present study deals with a case of a 40-day-old girl with kerion Celsi caused by Microsporum canis. The source of the infection were the parents who presented tinea corporis caused by M. canis. Systemic treatment was carried out with terbinafine and complete recovery was achieved. Tinea capitis is unusual in children during their first year of life and its evolution towards kerion is very rare in newborns.
Zusammenfassung
Vorgestellt wird der Fall eines 40-ta¨gigen Neugeborenen weiblichen Geschlechts mit einem durch Microsporum canis hervorgerufenen Kerion Celsi. Infektionsquelle waren die mit Tinea corporis befallenen Eltern, die von M. canis ausgelo¨st worden war. Das Neugeborene wurde systemisch mit Terbinafin behandelt und konnte vollsta¨ndig geheilt werden. Tinea capitis ist im ersten Lebensjahr ungewo¨hnlich, und nur sehr selten kommt es bei Neugeborenen zur Ausbildung einer Kerion-Erkrankung.
Key words: Microsporum canis, kerion Celsi, tinea capitis, newborn. Schlu¨sslwo¨rter: Microsporum canis, Kerion Celsi, Tinea capitis, Neugeborene.
Introduction
Case report
Kerion Celsi occurs almost exclusively in children, nevertheless it is rare in newborns and infants. The clinical features may develop as such but are more often the result of an inflammatory reaction to tinea capitis.1 Microsporum canis is the worldwide, zoophilic infective agent of tinea capitis in children, who normally contract the infection by direct contact with animals.2,3 We describe a case of kerion Celsi in a newborn caused by M. canis, which responded well to treatment with oral terbinafine.
A 40-day-old girl (5 kg body weight) seemingly healthy, presented with a 2 week history of erythematous, pustular, crusting lesions on the scalp with some hair loss. She had been treated unsuccessfully with oral and topical antibiotics, for a suspected bacterial infection by her general practitioner. Physical examination revealed one raised, intensely erythematous and well-demarcated, round-shaped hairless area, 1.5 cm in diameter, in the vertex, very painful when palpated. It was covered with yellowish crusts and pus was seen oozing from the hair follicles (Fig. 1). Individual broken hairs could be pulled out easily. Routine blood test, urinalysis and serum protein were normal and culture of skin swabs showed no bacterial growth. Microscopic examination of material obtained by scraping the scalp after treatment with 20% potassium hydroxide (KOH) demonstrate rare branching hyphae and abundant spores on the hair with ectotrix distribution. Mycological culture produced a profuse growth of M. canis. Oral treatment
Correspondence: Dr Nicola Aste, Clinica Dermatologica – Universita` di Cagliari, Via Ospedale 54, 9124 Cagliari, Italy. Tel.: 0039 070 668738. Fax: 0039 070 609 2580. E-mail:
[email protected] Accepted for publication 16 January 2003
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Kerion Celsi in a newborn
Figure 1 Pustular and crusting lesions on the scalp.
was started with terbinafina 62.5 mg daily for 1 month. No local therapy was given. During the first 2 weeks of treatment there was a significant improvement in the scalp lesions; at the end of therapy the affected area was still inflamed, but the patient’s hairs had started to grow. One month after discontinuation of treatment, her scalp was clinically and mycologically cured. No relapse was observed. Investigation of environmental conditions showed no pets present in the home. Both parents were diagnosed as having tinea corporis caused by M. canis and were treated with oral terbinafine 250 mg daily for 4 weeks.
Discussion The present study dealt with a case of kerion Celsi in a newborn caused by inter-family contamination by a zoophilic dermatophyte, M. canis, responsible for tinea corporis in both child’s parents. Tinea capitis is unusual in children during their first year of life.4 In the series of Venugopal and Venugopal,5 among 240 cases of tinea capitis only two (0.8%) occurred in babies under 1 year of age. In a previous 15 year observation at our Department over 31 cases of kerion only one child had less than 2 years of age.1 From the published cases of tinea capitis in newborns and infants the source of infection has rarely been identified.6,7 Unrecognized carriers are important for the diffusion of the disease and their existence has largely been documented for Trichophyton tonsurans and M. canis.8,9 Asymptomatic subjects, carrying the fungus for months as demonstrated by repeated cultural examinations, represent a very natural reservoir of the infection.10 In our case, the source of
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infection has been easily identified as the parents, both affected by dermatomycoses caused by M. canis. Interhuman contagion is the main way of diffusion for tinea capitis by anthropophilic dermatophytes, but it is very important even for zoophilic species, especially in M. canis infections. In the District of Cagliari (Italy), M. canis is the preponderant aetiological agent of tinea capitis in children and in adults.1,4 Terbinafine is a very effective drug in dermatomycoses and its use in infection with hair involvement and in scalp kerion has been previously reported.11–13 This case adds the evidence that systemic terbinafine is useful in the treatment of the M. canis infection without other local treatment.
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