Why is ringworm called ringworm?
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From 1972 to 1977 the authors examined 1,311 patients in Rome affected by ringworm of the scalp, beard and body, comparing their findings with a study made in Milan between 1969 to 1973 and with earlier Italian studies from 1900 to date. It appears that at the beginning of the century scalp ringworm was usually caused by Trichophyton violaceum and T. tonsurans, whereas Microsporum canis was rarely found. Today the Trichophyton species are rarely isolated, whereas Microsporum species, particularly M. canis (88.9% of the cases in Rome, 74.6% in Milan), predominate in the etiology of scalp ringworm. Ringworm of the beard in Rome is mainly caused by T. mentagrophytes (50% of the cases) and T. verrucosum (25%). In Milan the frequency of T. verrucosum is 51.2% and of T. mentagrophytes 38.5%. Ringworm of the body today is mainly due to M. canis (47.8% of the cases in Rome and 65.7% of those in Milan). These ringworms in Rome and Milan are caused mostly by the zoophilic dermatophytes that have supplanted the anthropophilic dermatophytes, which were the main cause of dermatomycoses in the early years of this century. This change, particularly evident after World War II, appears to result from improved socio-economic and hygienic conditions, with resulting decrease of infections through interhuman contacts, and from increased numbers of pet animals and consequent increase of stray cats and dogs, which result in increase of infections of animal origin.
A survey was carried out on the distribution of ringworm infections among school children in four primary schools in Jos, Plateau State of Nigeria. Out of a total population of 6 987,237 (3.4%) were found to be infected by this disease. There was a high incidence of both scalp and foot ringworms among the infected children. Fourteen species of dermatophytes were isolated from the ringworm cases. The scalp ringworm had the highest number of fungal isolates. Trichophyton mentagrophyte and T. rubrum had the highest frequencies of occurrence. Some of the infected children were found to have nomadic parents who moved about with cattle.
BACKGROUND: Scalp ringworm or tinea capitis has become an increasingly important public health issue in the past decade in Great Britain. Recently, certain dermatology departments in London have seen a large increase in tinea capitis in all its forms. OBJECTIVES: The aim of this paper is to present the detailed analysis of a cohort of 277 patients with tinea capitis seen during a 2-year period together with the latest local figures of tinea capitis cases from an inner city paediatric dermatology service. Methods Demographic, clinical and laboratory data were collected prospectively over 2 years from all cases of ringworm in patients seen in a paediatric clinic specially set up for scalp problems. RESULTS: Sixty-two per cent of 277 cases of scalp ringworm were caused by Trichophyton tonsurans, occurring mainly (91%) in patients with Afro-Caribbean hair type, more often in boys (68%), and in the 3-8 year olds (70%). Only 7% of the patients had received appropriate treatment with oral griseofulvin. An additional 156 cases from the general paediatric dermatology clinic showed 91%T. tonsurans infections. CONCLUSIONS: The prevalence of scalp ringworm appears to be reaching epidemic proportions in certain areas that include south-east London. The clinical problem is not yet well recognized by local general practitioners.
Protective properties of a live, freeze-dried vaccine against ringworm, produced by Bioveta, Ivanovice na Hané, Czechoslovakia, were tested in a group of 422 calves. Vaccinated and control calves were challenged by epicutaneous inoculation of a virulent culture of Trichophyton verrucosum. Between 4.4 and 9.5% of calves challenged between days 14 and 25 after revaccination showed only mild clinical signs of ringworm and 99-100% were fully protected from day 28, the immunity persisting for at least one year. All control calves showed signs of ringworm after challenge. In most cases, extensive mycotic lesions, also penetrating into deep skin layers, were observed. Protective properties of the Czechoslovak vaccine and a USSR vaccine were high and comparable.
Ringworm of cattle is nearly exclusively caused by Trichophyton verrucosum. This skin disease is worldwide present in cattle and is responsible for high economic losses in cattle farming. T. verrucosum may also be responsible for severe skin diseases in man. For economic and epidemiological causes a control of ringworm in cattle is still necessary. Preventive measures consist in hygiene and vaccination of cattle with live vaccines against ringworm in cattle.
A survey was conducted to study camel ringworm in Eastern Sudan. Ringworm was diagnosed in 217 out of 498 young camel calves under two years old examined during a whole year (43.5%). The peak incidence of the disease was found to be in Autumn and Winter. The disease was observed more frequently among young growing calves (1-2 years) than older animals but the prevalence among male and female animals was found to be similar. Lesions were observed mainly on the head, neck and shoulder with frequent extension to the flanks and limbs. Trichophyton verrucosum was isolated in pure culture for the first time from camel ringworm in the Sudan. Histopathological findings of the natural disease are described. Epidemiology in Eastern Sudan is discussed.
There are very few medical reports on the nomadic peoples of the world. In Nigeria such reports are non-existent. The present work has looked at the distribution of ringworm infections among the Nigerian nomadic Fulani herdsmen. An examination of their infected herds of cattle revealed similarities in the species of dermatophytes isolated from the herdsmen and those isolated from their cattle. Some of the leaves of the plants that lined the cattle tracks normally used by both the herdsmen and their cattle yielded some of the species of dermatophytes isolated from the herdsmen and their cattle. The possible origins of the dermatophytes that caused the ringworm infections amongst the nomads are discussed.
Of a group of seven calves, four were vaccinated against bovine ringworm with the vaccine Ringvac bovis LTF-130 (Alpharma, Oslo, Norway), while three calves were left unvaccinated. All calves were inoculated epicutaneously with a virulent strain of Trichophyton verrucosum. Clinical signs were recorded. In response to stimulation with trichophytin, in vitro interferon-gamma (IFN-gamma) production in whole blood cell cultures was assessed in samples obtained pre- and post-vaccination and pre- and post-inoculation. A commercial enzyme immunoas say kit was used to measure IFN-gamma levels (Bovigam, CSL, Victoria, Australia). Control calves developed typical ringworm lesions, whereas vaccinated calves did not. Following vaccination, release of IFN-gamma in whole blood cell cultures indicated the presence of circulating trichophytin-specific lymphocytes. After inoculation with T. verrucosum, IFN-gamma production was demonstrated in samples from both vaccinated and control calves. This study showed that vaccination with Ringvac bovis LTF-130 elicits a protective immune response suggesting involvement of the cellular branch of the immune system. Experimental infection of naïve nonvaccinated calves with T. verrucosum, also indicated stimulation of a cell-mediated immune response essential for resolution of lesions.
Resolution of lesions and subsequent protection against ringworm is primarily associated with the development of a cell-mediated immune (CMI) response, in which stimulation of Type-1 lymphocytes and cytokines such as interleukin-2 (IL-2), IL-12 and interferon gamma are significant. Type-2 lymphocyte activation and antibody formation seem a feature of chronic disease states, rather than protection, and are antagonistic to a Type-1 cell response. Initial studies on ringworm vaccines should be directed at identifying and characterizing dermatophyte antigens elaborated during spore germination and early hyphal growth, and the method of their presentation which best potentiates Type-1 cell-associated events, and primes the recipient for a subsequent CMI response.
In order to investigate the morphology of fungi invading into the human hair tissue, three cases of black dot ringworm caused by Trichophyton violaceum and Trichophyton glabrum were studied by light and electron microscopy. Fungal elements were mainly present in the hair cortex and showed a constant morphologic change during the differentiation of hair layers. The fungal elements, located deep in the keratogenous zone of the cortex, showed less electron dense non-septate hyphae. Distally, the hyphae showed septation and contained several scattered dense bodies in the cytoplasm. At the level where the Huxley's layer was keratinized, the fungal elements were transformed into arthrospores, which occupied the large volume of the cortex; each spore was surrounded by a fiber- and melanosome-free, electron lucent halo. Fungal elements occasionally invaded the keratinized hair cuticle and keratinized inner root sheath in a few hair follicles. Fungi do not invade the hair germinative cells. There seems to be a distinct relationship between the morphology of the invading fungi and the cortical cell differentiation in black dot ringworm; a balance between the fungus proliferation and the cortical cell development may be present.
Two related cases of ringworm caused by contact with an infected hedgehog are reported. The causal fungus, Trichophyton erinacei, was isolated from human and animal cases. The epidemiology of hedgehog ringworm is discussed.
A suspension based on the antibiotic, natamycin, was applied by sponging to 83 horses of various breeds and ages with signs of clinical ringworm. A number of different causative agents were involved of which Trichophyton equinum was the most common. Treatment successfully eliminated the disease within 4 weeks. After treatment the recovered animals did not show any evidence of re-infection for up to 6 months. The mycological clearance rate was 97 per cent and apart from the efficacy against ringworm, the preparation had the advantage of being non-irritant and odourless. It was also useful for treating the surroundings of the animals.
In an outbreak of ringworm, 30 out of 32 bull calves being reared intensively for beef showed infection. Weekly observations were made from their arrival at the farm at about one week old until slaughter at approximately 10 1/2 to 12 months of age. The outbreak lasted for 33 weeks and appeared to originate from two animals brought into the unit. Lesions occurred first, and most commonly, in the head region. The disease in individual animals lasted eight weeks and each lesion had a mean duration of 3.6 weeks. New lesions occurred after those elsewhere on the same animal had healed. The mean incubation period was estimated at 4.6 weeks. Spread of ringworm was probably mainly due to the licking and grooming activities of the calves' tongues.
Ringworm infection of a farm manager is described. Treatment of 10 ringworm-infected calves (group A) on the farm was undertaken with the daily administration of griseofulvin powder for seven days at a rate of 7.5 mg per kg body-weight and compared with nine infected control calves (group B). Group A showed fewer new lesions (22) than group B (80) and fewer new lesions per infected animal (3.7 and 11.4 respectively). The appearance of the last new lesions was earlier in group A (21 days) than in group B (56 days) and the duration of infection in the former group was less (49 days and 98 days respectively). Two control calves were not infected until after infection in group A had resolved.
Persistent dermatomycosis (ringworm) caused by Trichophyton verrucosum affected 20 dairy calves aged between 3 months and 1 year and housed together. The infection also spread to 2 animal attendants working among the calves. The major clinical lesions observed on the affected calves were extensive alopecia and/or circumscribed thick hairless skin patches affecting the head, neck, flanks and limbs. The observed lesions persisted for more than 17 weeks and most of the calves did not respond to topical treatment with various anti-fungal drugs within the anticipated period of 9 weeks. Two animal attendants developed skin lesions that were circumscribed and itchy and there was good response to treatment following the application of anti-fungal skin ointment. Although ringworm in dairy animals in Kenya has not previously been associated with spread to humans, the potential is evident from this report.
Immunogenicity of six strains of Trichophyton mentagrophytes var. granulosum isolated from arctic foxes with ringworm was evaluated in guinea pigs and foxes. Two strains of T. mentagrophytes (Tm-3 and Tm-4) out of six examined (Tm-1, Tm-2, Tm-3, Tm-4, Tm-5 and Tm-6) induced in the experimental foxes a strong cellular immune response measured by the leukocyte migration inhibition test (LMIT), lymphocyte transformation test (LTT), and by skin delayed-type hypersensitivity (DTH). The guinea pigs immunised with Tm-3 and Tm-4 were well protected against the artificial infection with the virulent strain of T. mentagrophytes (Tm-9). These two strains of T. mentagrophytes with high immunogenic properties were used for production of a vaccine against ringworm in foxes.