Title: A young child ofAfrican origin with tinea capitis and multiple kerions

Biography:

Avneet Singh Kalsi graduated from Chaudhary Charan Singh University, Meerut. Presently, he is working as a research scholar. His research fields mainly focus on dermatophytic infections, its epidemiology and diagnostic challenges associated with them. He has published several research papers in peer-reviewed international journals such as tinea genitalis in males and females, clinical manifestations and diagnostic challenges of tinea faciei, extensive tinea corporis and tinea cruris et corporis due to Trichophyton interdigitale.

Abstract

Tinea capitis (TC) is a common dermatophyte infection of the scalp that can also involve the eyebrows and eyelashes. Tinea capitis especially due to Trichophyton violaceum (TV) is common in children of African descent in sub-Saharan Africa. TC is the most common dermatophyte infection in children, with the highest incidence in children aged 3–7 years old. This age predilection may partly result from the fungi static properties of fatty acids in post pubertal sebum. We present a 12-year old child from southern Africa, who was borne HIV positive. Antiretroviral Therapy (ART) was started at the age of one month. He presented to the dermatology clinic with history of itching, scaling, patches of baldness and multiple boggy swellings over the scalp. He was investigated for tinea capitis by taking scalp scrapings using sterile toothbrush and the scalp was rubbed with a gauze piece to collect infected hairs. All these samples were collected after instructing the child to come after head wash with an ordinary shampoo. Potassium hydroxide (KOH) mounts were prepared for the scalp scales and scalp hairs. KOH mount showed endothrix invasion of the hair shaft with long chains of arthrospores. The culture was set up on Derm agar, which grew multiple waxy violet colonies after two weeks of incubation at 37⁰C. Lactophenol cotton blue mounts were prepared from the culture plate. Isolates were identified based on macroscopic and microscopic features (Figure). Patient was prescribed higher doses of oral griseofulvin, which adequately penetrate the shaft of the hair to eliminate the infection. Adjunct therapy was also given by advising the patient to use Selenium Sulfide shampoo 2.5% twice weekly. After two weeks of treatment with griseofulvin, patient developed vesiculo-papular rashes on forehead and right pinna. After 8 weeks of treatment, few colonies grew in the culture. The treatment was extended for four weeks, after which the mycological cure was achieved.