Letter - Tropical/Infectious and parasitic dermatology
Tinea corporis caused by Trichophyton benhamiae: report of the first case transmitted by guinea pig in Brazil
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(A) An infiltrative plaque of small ulcers and crusts in the right cheek, and a satellite lesion in the nasal border (black arrow). (B) The patient presented great improvement with 1.5 g of liposomal amphotericin. A lasted lesion (white arrow) was treated with cryosurgery using an open probe. (C) Histopathology showing pseudoepitheliomatous hyperplasia and a granulomatous infiltrate in the dermis (Hematoxylin & eosin, 4×). (D) Rare round structures inside macrophages suggesting amastigotes forms can be seen (red arrowhead) (Hematoxylin & eosin, 100×). 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KOH 40% (×100).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Trichophyton benhamiae (T. benhamiae)</span> is an emerging zoophilic dermatophyte, an important causative agent of dermatophytosis in several parts of the world. It is transmitted mainly by guinea pigs (<span class="elsevierStyleItalic">Cavia porcellus</span>), and its identification is carried out by molecular and proteomic methods, in addition to morphological ones.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the first case of <span class="elsevierStyleItalic">tinea corporis</span> in a child living in Rio de Janeiro, Brazil, transmitted by a guinea pig.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A ten-year-old, healthy white female patient seeked medical care because two weeks before, she had presented with multiple, mildly pruritic lesions on the neck, submandibular region, left forearm, and right scapular region, ranging from 2‒6 cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). She had been in contact with a guinea pig for one month which was initially healthy, but which developed a skin lesion after ten days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Direct mycological examination of the skin desquamation showed septate hyaline hyphae and arthroconidia (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). <span class="elsevierStyleItalic">Trichophyton benhamiae</span> was isolated and identified by its macro- and micromorphological aspects (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> A‒D) and by proteomic analysis (MALDI ToF-MS, Biomerieux, confidence level 99.9%).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">She started treatment with oral terbinafine, 250 mg/day, for four weeks, with complete resolution of the lesions (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The animal was treated by the veterinarian with clotrimazole cream, applied twice a day for two weeks, with improvement of the condition.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Trichophyton benhamiae</span>, first described by Ajello and Cheng in 1967,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> is a zoophilic dermatophyte fungus that has gained global prominence in the last 20 years.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The first case of infection in humans was published in 2002, in Japan.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Since then, cases have been reported in Germany and other European countries, as well as in China and the Americas, and their prevalence has been increasing, especially in Germany, Switzerland, and Japan.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Fratti et al., in a recent Swiss study that analyzed the prevalence of dermatophytes in different animals, showed that <span class="elsevierStyleItalic">T. benhamiae</span> was the most prevalent dermatophyte in guinea pigs, found in 48 of 50 animals,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> data confirmed in another prevalence study carried out in Germany.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In addition to the guinea pig, transmission can occur through other animals, such as small rodents, rabbits, cats, dogs, and porcupines.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6,7</span></a> The first and only case of <span class="elsevierStyleItalic">tinea corporis</span> caused by <span class="elsevierStyleItalic">T. benhamiae</span>, reported in Brazil, was transmitted by a cat.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Berlin et al. concluded, in a study on the prevalence and dissemination factors of <span class="elsevierStyleItalic">T. benhamiae</span>, that guinea pigs can be asymptomatic carriers: 92.7% of the colonized animals did not have any apparent lesions.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Clinically, the lesions have an inflammatory nature, due to the fact that they are not adapted to human parasitism, manifesting themselves as <span class="elsevierStyleItalic">tinea faciei</span>, <span class="elsevierStyleItalic">tinea corporis</span>, <span class="elsevierStyleItalic">tinea barbae</span>, <span class="elsevierStyleItalic">tinea capitis</span>, Kerion celsi and <span class="elsevierStyleItalic">tinea unguium</span>.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,8</span></a> It mainly affects children and adolescents through direct contact with domestic animals, but it can also appear in young adults and immunosuppressed patients.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The identification of the fungus is made by morphological characteristics, associated with proteomic and molecular techniques.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4,9</span></a> The yellowish color observed in the macromorphological examination of the colony suggests <span class="elsevierStyleItalic">Microsporum canis</span>; however, the micromorphology is more suggestive of <span class="elsevierStyleItalic">T. mentagrophytes</span>, showing rounded or oval microconidia, grouped or implanted laterally in the hyphae. The laboratory technician suspicion is important for the correct identification of the colony, confirming it through molecular or proteomic characteristics, as in the reported case.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The treatment of choice for extensive cases is oral terbinafine. In isolated lesions, topical therapy with azoles, terbinafine, or cyclopiroxolamine is indicated, with excellent response.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The clinician must be aware of new species of fungi as etiological agents of cutaneous mycoses, especially in children, due to the current diversification of domestic animals in contact with humans. The laboratory technician needs to be prepared to suspect and identify new species of fungi as etiological agents of cutaneous mycoses, especially infections caused by <span class="elsevierStyleItalic">T. benhamiae</span>, in which the usual morphological identification is not so characteristic. It is up to the veterinarian to advise animal owners about the possibility of the transmission of cutaneous mycoses to those who live with them.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The integration of different specialties and laboratory support is invaluable for a favorable patient outcome.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0080" class="elsevierStylePara elsevierViewall">Cristiana Ludwig Schneider Longo: Design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied case; critical review of the literature; approval of the final version of the manuscript.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Flávio Marcondes Hercules: Collection, analysis and interpretation of data; effective participation in research orientation; critical review of the literature; approval of the final version of the manuscript.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Fábio Silva de Azevedo: Collection, analysis and interpretation of data; effective participation in research orientation; critical review of the literature.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Adriana Lúcia Pires Ferreira: Collection, analysis and interpretation of data; effective participation in research orientation, critical review of the literature.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Rosane Orofino-Costa: Design and planning of the study; drafting and editing of the manuscript; collection, analysis and interpretation of data, effective participation in research orientation; critical review of the literature; approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-05-21" "fechaAceptado" => "2023-06-30" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Private Practice, Barra da Tijuca, Rio de Janeiro, RJ, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2111 "Ancho" => 2341 "Tamanyo" => 272120 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous-desquamative, circinated, vesico-crusted plaques with well-defined edges. They show centrifugal growth and central clearing.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1091 "Ancho" => 1675 "Tamanyo" => 328208 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Direct mycological examination: skin desquamation containing septate, branched hyaline hyphae and arthroconidia. KOH 40% (×100).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2691 "Ancho" => 2341 "Tamanyo" => 336870 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Trichophyton benhamiae</span>. (A) Macromorphology of the colony showing a yellowish-beige, velvety surface with radial growth. (B) Back of the colony, bright yellow; (C and D) micromorphology, with septate, branched hyaline hyphae and rounded, pyriform microconidia, grouped in clusters or arranged laterally and at the ends of the hyphae. Lactophenol-cotton blue (×100 and ×400).</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1784 "Ancho" => 2341 "Tamanyo" => 273294 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Complete resolution after 30 days of oral treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The perfect state of Trichophyton mentagrophytes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. 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