[Favus of the scalp with favus crusts on the lower limbs].
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Three cases of tinea favus of pityriasic aspect and without a "scutulum" sign are diagnosed in a small town of "Poitou" region. They correspond to an autochtonal focus. The various enquiries show that favus has become rare in France but the local focus as are still active, since 43 p. 100 of recorded favus are of local origin.
We report a case of favus affecting the temporal region of the scalp in a 22-month-old boy. Mycological study of hairs and crusts identified Trichophyton mentagrophytes var. quinckeanum (T. quinckeanum), the causative agent of mouse favus. Treatment with oral griseofulvin led to healing.
Miconazole nitrate 2% was tested for its efficacy against Microsporum gallinae (the causative agent in favus) in a flock of various Oriental breed (Shamo and Aseel) and crossbreed chickens. Six adult males showing clinical signs of favus were randomized into control and experimental groups. The males were maintained on individual tiecords on the range, with no physical contact between birds. The experimental birds had the affected areas washed with soap and water and dried, and an ointment of miconazole nitrate 2% was applied. The experimental birds received the treatment twice a day for 34 days. Scrapings from the affected areas of all birds were cultured at the beginning and end of the test. At the end of the treatment period, the control birds were still positive for M. gallinae, but the organism could not be cultured from the treated birds.
Twenty indigenous cases of favus in two families residing in the province of Quebec were studied. Importantly, the disease, although active, remained undiagnosed for many years in most of the cases. The finding of active cases suggests that the disease is still endemic in regions previously described as harboring cases, namely the province of Quebec and possibly Kentucky.
The ultrastructure of 5 griseofulvin-resistant fungi of favus was studied by image processing with microcomputer. It was found that the cell walls of the fungi consisted of 8 layers, and the inner layer containing cytoplasm was loose. It was also found that all structures within the cytoplasm possessed a 1-3 layers integral envelope with chromatins in the nucleus. These might be contributing factors in the development of resistance to griseofulvin. This multiple-layered, thick cell wall might act as a barrier responsible for the impermeability of the cell to griseofulvin.
Favus has become a rarly found chronic fungal infection mainly caused by Trichophyton schoenleini and occasionally by Trichophyton violaceum or Microsporum gypseum. It can still be found in areas where the population suffers from poor hygiene and malnutrition. Cases are seen in the Mediterranean basin, the Middle East, Asia, Poland, Russia, France, and the Balkans. Isolated cases have also been reported from South Africa, Mexico, Central America, and Canada. Cases are encountered occasionally in the United States, almost exclusively in immigrants.
A 25-year-old female patient from Kosovo presented with a slowly progressive cicatricial alopecia which had started when she was 6 years old. Her brother in Kosovo had similar lesions. At the erythematous border of the hairless area, crusts, erosions and pustules were apparent. Mycological examination identified Trichophyton schönleinii, the causative pathogen of favus. Histological examination revealed hyphae and showed no features suggestive of other causes of cicatricial alopecia. Systemic terbinafine combined with topical ciclopiroxolamine resulted in rapid improvement of this disease which is seldom seen in Central Europe.
Favus, or avian ringworm, was diagnosed in a backyard flock of game chickens from which Microsporum gallinae was isolated. Infected birds had white crusts on the comb and on the skin of the head and neck. Histopathological lesions included hyperkeratosis of the skin epithelium with invasion of the stratum corneum by fungal mycelia, acanthosis, acantholysis, and hydropic degeneration of cells in the stratum spinosum. The underlying dermis was infiltrated by mononuclear cells and contained lymphoid foci. Daily topical treatment with miconazole was applied in the field and in the laboratory, with apparent success.
Mycoses of the hairy part of the head have been effectively treated in the two last decades in Armenia. The number of trichophytosis patients has reduced from 32.7 per 100,000 in 1965 to 5.4 per 100,000 in 1987. The share of anthroponotic trichophytosis among all trichophytosis forms has reduced from 24.9 to 6.7 percent. Chronic trichophytosis became quite rare among adult patients. Favus has not been recorded in Armenia since 1976. Epidemic outbreaks of imported anthroponotic microsporosis were recorded in the 60s and 70s. The incidence of zooanthroponotic microsporosis was low and the cases were imported. In recent years cases of human infection from mongrel cats were recorded in Armenia.
Experimental investigations have been carried out in 32 children on the therapeutic effect of griseofulvin in favus caused by Trichophyton schoenleinii and to determine the optimal treatment schedule.It was found that, while daily doses of 3.12 mg, 6.25 mg or 12.50 mg griseofulvin per kg of body-weight did bring about a measurable degree of inhibition of the fungal hyphae in infected hairs, a dose of 25 mg/kg daily for some 28 days was required to effect complete cure. The advantages of greater daily doses (50 mg/kg) were not sufficiently pronounced to justify the extra cost involved. Administration of doses under 50 mg/kg on alternate days is unsatisfactory, as it allows for the re-establishment of the hyphae in newly formed keratin.Another favourable schedule is the administration of 50 mg/kg daily for five days, thus setting up a stable and impenetrable griseofulvin barrier, followed for about 28 days by daily doses of 6.25 mg/kg that would otherwise be subtherapeutic but in this case prevent the reintroduction of infection from extrapilar fungi.
The first diagnosis of favus in chickens in Costa Rica was made in a 1-year-old fighting cock that had lesions surrounding the comb. The etiologic agent was isolated and identified as Microsporum gallinae. The rooster recovered during topical treatment with tolnaftate and oral treatment with griseofulvin.
Chickens of various Oriental breeds (Shamo and Aseel) and crossbreeds in California's Central Valley were observed to have an unusual skin condition and feather loss. The appearance of white plaques on the comb, face, and/or ear lobes was followed by feather loss starting at the caudal base of the comb and progressing down the neck. Although the cocks were affected first, the condition spread to the hens paired with those cocks. The birds showed no other signs of illness. The affected areas were scraped and biopsied. The samples were examined histologically and by culturing on Sabouraud's dextrose agar and dermatophyte test medium. Microsporum gallinae, the causative agent of favus (avian dermatophytosis), was identified by the histological and mycological tests.
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