Aspergillus niger - a possible new etiopathogenic agent in Tinea capitis? Presentation of two cases

Abstract

Tinea capitis is generally considered as the most frequent fungal infection in childhood, as it accounts for approximately 92% of all mycosis in children. The epidemiology of this disease varies widely ranging from antropophillic, zoophilic, and geophillic dermatophytes, as the main causative agent in different geographic areas, depending on several additional factors. Nowadays, the etiology is considered to vary with age, as well with gender, and general health condition. The former reported extraordinary Tinea capitis case reports have been replaced by original articles and researches dealing with progressively changing patterns in etiology and clinical manifestation of the disease. This fact is indicative that under the umbrella of the well-known disease there are facts still hidden for future revelations. Herein, we present two rare cases of Tinea capitis in children, which totally differ from the recently established pattern, in their clinical presentation, as well as in the etiological aspect, as we discuss this potential new etiological pattern of the disease, focusing on our retrospective and clinical observation. Collected data suggest that pathogenic molds should be considered as a potential source of infection in some geographic regions, which require total rationalization of the former therapeutic conception, regarding the molds' higher antimitotic resistance compared to dermatophytes. Molds-induced Tinea capitis should be also considered in clinically resistant and atypical cases, with further investigations of the antifungal susceptibility of the newest pathogens in the frame of the old disease. Further investigations are still needed to confirm or reject this proposal.

Keywords: Children; Etiology; Molds; Tinea capitis.

Fig. 1

(A, B) Clinical presentation of TC, caused by Aspergillus niger in a 9-year-old female patient – diffuse white desquamation with multiple yellowish crusts with areas with yellow exudation, single follicular papules, and disseminated exudative vesicles, without hair loss. (C, D) Growth of Aspergillus niger established on mycological examination on Sabouraud agar and direct microscopic evaluation. (E, F) Clinical presentation within the regimen with Terbinafine, dosage 125 mg per day, after antibiotic and keratolytic therapy.

Fig. 2

(A, B) Clinical presentation of TC, caused by Aspergillus niger in a 4-year-old male patient – hair loss and diffuse desquamation with multiple yellowish and brownish crusts at the area of the vertex, with severe erythema of the underlying skin and hemorrhagic crusts. (C, D) Growth of Aspergillus niger established on mycological examination on Sabouraud agar and direct microscopic evaluation. (E, F) Clinical presentation on the 90th day within the regimen with oral administration of Terbinafine – dosage 75 mg per day. Good therapeutic response was observed on 30th day, as hair growth and single areas of effluvium was still observed on the 90th day.