Down Syndrome Patient with Tinea Capitis due to Aspergillus ochraceus, The First Rare Case Report

Abstract

Tinea capitis is a fungal infection of the scalp skin and hair and often caused by dermatophytes .it is the most common type of superficial dermatophytosis in children despite the fact that this infection is not familiar in children with Down syndrome. The infection occurs mainly due to keratinophilic fungi which are anthropophilic and zoophilic species of the genera Trichophyton , Microsporum and Epidermophyton, but not by Aspergilla species because cutaneous aspergillosis in general is a rare disease since all types of aspergillosis infection are more likely to occur in underlying conditions and immunocompromised patients. Limited numbers of published reports referred to scalp mycosis by aspergilla which were caused by Aspergillus protuberus and aspergilla niger. To our knowledge, until so far there is no published report case indicated to the diagnosis of tinea capitis caused by Aspergilla ochraceus and no published report correlated a tinea capitis caused by A.ochraceus in Down syndrome child. So we report a first rare case of a typical tinea capitis infection with its picture and with a rare causative agent which is Aspergilla ochraceus and all these findings were found in 6-year old girl with a Down syndrome.

Keywords

• Aspergillus ochraceus
• Down syndrome
• Tinea capitis

References

1. 1. Kechia FA, Kouoto EA, Nkoa T, Nweze EI, Fokoua DC, Fosso S, Somo MR.Epidemiology of tineacapitis among school-age children in Meiganga,Cameroon. J Mycol Med. 2014;24:129–34.
2. 2. Venugopal PV, Venugopal TV. Superficial mycoses in Saudi Arabia. Aust J Dermatol 1992;33:45-8.
3. 3. Khaled JM, Golah HA, Khalel AS, Alharbi NS, Mothana RA. Dermatophyte and non dermatophyte fungi in Riyadh City, Saudi Arabia. Saudi J Biol Sci. 2015;22:604–9, http://dx.doi.org/10.1016/j.sjbs.2014.12.006.
4. 4. Gupta AK, Summerbell RC. Tinea capitis. Med Mycol. 2000; 38:255–287.
5. 5. Elewski B. Tinea capitis: a current perspective. J Am Acad Dermatol. 2000;42:1–20.
6. 6.Bonifaz A, Isa-Isa R, Araiza J, Cruz C, Hernández MA, Ponce RM. Cytobrush-culture method to diagnose tinea capitis. Mycopathologia. Jun 2007; 163(6):309-13. 7 .Bassiri -Jahromi S, Khaksari AA. Epidemiological survey of dermatophytosis in Tehran, Iran, from 2000 to 2005. Indian J Dermatol Venereol Leprol 2009;75:142-7.
7. 8. Foster KW, Ghannoum MA, Elewski BE. Epidemiologic surveillance of cutaneous fungal infection in the United States from 1999 to 2002. J Am Acad Dermatol 2004;50:748-52.
8. 9. Mohapatra S, Xess I, Swetha JV, et al. Primary cutaneous aspergillosis due to Aspergillus niger in an immunocompetent patient. Indian J Med Microbiol 2009;27:367–70.

9. 10. Van Burik JA, Colven R, Spach DH. Cutaneous aspergillosis. Journal of Clinical Microbiology 1998;36:3115–21.
10. 11.Arikan S, Uzun O, Cetinkaya Y, Kocagoz S, Akova M, Unal S. Primary cutaneous aspergillosis in human immunodeficiency virus-infected patients: two cases and review. Clinical Infectious Diseases 1998;27:641–3.
11. 12. Chakrabarti A, Gupta V, Biswas G, Kumar B, Sakhuja VK. Primary cutaneous aspergillosis: Our experience in 10 years. J Infect 1998;37:24-7.
12. 13. Ozer B, Kalaci A, Duran N, et al. Cutaneous infection caused by aspergillus terreus: case report. J Med Microbiol 2009;58:968–70.
13. 14. Andresen J, Nygaard EA, Størdal K. Primary cutaneous aspergillosis—a case report. Acta Paediatr 2005;94:761–2.
14. 15. Chokoeva AA, Zisova L, Chorleva K, Tchernev G. Aspergillus niger - a possible new etiopathogenic agent in Tinea capitis? Presentation of two cases. Braz J Infect Dis. 2016 May-Jun;20(3):303-7. doi: 10.1016/j.bjid.2016.01.002. Epub 2016 Mar 7.
15. 16. Jia et al .The first case report of kerion-type scalp mycosis caused by Aspergillus protuberus . BMC Infectious Diseases (2019) 19:506 https://doi.org/10.1186/s12879-019-4144-7
16. 17. Clayton YM, Midgley G. The increasing variety of ringworm fungi currently affecting London school children. [Abstract] CR des Communications. 5th Congress ISHAM Paris, 1971; 98-9.
17. 18.Carter DM, Jegasothy BV. Alopecia areata and Down syndrome. Arch Dermatol 1976;112:1397–1399.
18. 19. Schepis C, Barone C, SiragusaMet al. An updated survey on skin conditions in Down syndrome. Dermatology 2002;205:234–238
19. 20. Visagie, C. M., Varga, J., Houbraken, J., Meijer, M., KocsubÚ, S., Yilmaz, N., ... & Samson, R. A. (2014). Ochratoxin production and taxonomy of the yellow aspergilli (Aspergillus section Circumdati). Studies in mycology, 78, 1-61.
20. 21.Muñoz, K., Vega, M., Rios, G., Geisen, R., & Degen, G. H. (2011). Mycotoxin production by different ochratoxigenic Aspergillus and Penicillium species on coffee-and wheat-based media. Mycotoxin research, 27(4), 239-247.
21. 22. John PU, Shadomy HJ. Deep fungal infections. In: Fitzpatrick TB, Eisen AZ, Wolff K, et al. editors. Dermatology in general medicine. 3rd ed. New York: McGraw . Hill; 1987. p. 2266-8
22. 23. Ajith C, Dogra S, Radotra BD, Chakrabarti A, Kumar B. Primary Cutaneous Aspergillosis in an immunocompetent individual. J Eur Acad Dermatol Ven. 2006;20:738–9. [PubMed] [Google Scholar]
23. 24. Granstein RD, First LR, Sober AJ. Primary cutaneous aspergillosis in premature neonates. Br J Dermatol. 1980;103:681–4. [PubMed] [Google Scholar]
24. 25. Scherbenske JM, Benson PM, Rotchford JP, et al. Cutaneous andocular manifestations of Down syndrome. J Am Acad Dermatol1990; 22:933–938.
25. 26. Moschella SL, Hurley HJ, eds. Dermatology, vol 2. Philadelphia:W.B. Saunders, 1985
26. 27. Daneshpazhooh M, Nazemi TM, Bigdeloo L, Yoosefi M. Mucocutaneous findings in 100 children with Down syndrome. Pediatr Dermatol. 2007 May-Jun;24(3):317-20.
27. 28. Ram G, Chinen J. Infections and immunodeficiency in Down syndrome. Clin Exp Immunol. 2011 Apr;164(1):9-16. doi: 10.1111/j.1365-2249.2011.04335.x. Epub 2011 Feb 24.
28. 29. Zizka Z, Calda P, Fait T. Prenatally diagnosable differences in the cellular immunity of fetuses with Down’s and Edwards’ syndrome. Fetal Diagn Ther 2006; 21:510–14.
29. 30. Kusters MA, Verstegen RH, Gemen EF, de Vries E. Intrinsic defect of the immune system in children with Down syndrome: a review. Clin Exp Immunol. 2009 May;156(2):189-93. doi: 10.1111/j.1365-2249.2009.03890.x. Epub 2009 Jan 22.
30. 31. G. Ghibaudo and A. Peano, “Chronic monolateral otomycosis in a dog caused by Aspergillus ochraceus,” Veterinary Dermatology, vol. 21, no. 5, pp. 522–526, 2010.
31. 32.Reponen T, Lockey J, Bernstein DI, et al (2012). Infant origins of childhood asthma associated with specific molds. J Allergy Clin Immunol. 130(3):639-644.e5.
32. 33.Howard DH (2003). Pathogenic Fungi in Humans and Animals. Marcel Dekker, New York. pp 294-295.
33. 34.Bui-Klimke TR, Wu F (2015). Ochratoxin A and human health risk: a review of the evidence. Crit Rev Food Sci Nutr. 55(13):1860-9.
34. 35. Farhang Babamahmoodi et al. Rare Case of Aspergillus ochraceus Osteomyelitis of Calcaneus Bone in a Patient with Diabetic Foot Ulcers. Hindawi Publishing Corporation.Case Reports in Medicine.Volume 2015, Article ID 509827, 5 pages http://dx.doi.org/10.1155/2015/509827
35. 36. Bernardeschi C, Foulet F, Ingen-Housz-Oro S, et al. Cutaneous invasive aspergillosis: retrospective multicenter study of the French invasiveaspergillosis registry and literature review. Medicine (Baltimore) 2015;94:e1018.
36. 37.Walsh TJ. Primary cutaneous aspergillosis—an emerging infection among immunocompromised patients. Vol. 27, Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. United States 1998;453–7.
37. 38. Alberti C, Bouakline A, Ribaud P, et al. Relationship between environmental fungal contamination and the incidence of invasive aspergillosis in haematology patients. J Hosp Infect 2001;48:198–206.
38. 39. Cramer RA, Rivera A, Hohl TM. Immune responses against Aspergillus fumigatus: what have we learned? Curr Opin Infect Dis 2011;24:315–22.
39. 40.Chimelli PA, Sofiatti AD, Nunes RS, Martins JE. Dermatophyte agents in the cit y of São Paulo, from 1992 to 2002. Revista do Instituto de Medicina Tropical de São Paulo., 2003; 45(5): 259 -63.
40. 41. Cruz NV, Mahmoud SA, Chen H, Lowery-Nordberg M, Berlin K, Bahna SL. Follow up study of immune defects in patients with dysmorphic disorders. Ann Allergy Asthma Immunol 2009;102:426–31.