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CASE REPORT
TINEA CORPORIS CAUSED BY MICROSPORUM AUDOUINII
Mungky Sukarnadi, Safruddin Amin, Wiwiek Dewiyanti
Department of Dermatovenereology Medical Faculty of Hasanuddin University / WahidinSudirohusodo Hospital Makassar
ABSTRACT
Tinea corporis is a superficial dermatophyte fungal infection of the
trunk, leg and arm region. These infections are by the caused by species ofTrichophyton, Epidermophyton and Microsporum.
One case of tinea corporis et causa Microsporum audouinii in a 61 years old
woman was reported. Diagnosis was established based on history, physical
examination, direct microscopic examination with potassium hydroxide (KOH
10%) and culture. The patient was treated with oral ketoconazole and topical
treatment contains a combination of Salicyl acid 3%, 6% benzoic acid and
vaseline 30gr (AAV1). Eight days after therapy, the patient showed clinical and
mycological improvement.
Key words: Microsporum audouini, ketoconazole, tinea corporis
Address for correspondence : Mungky Sukarnadi, dr., Department of Dermatovenereology Medical Faculty of Hasanuddin University / WahidinSudirohusodo Hospital Makassar, 11 Komp. TNI AL Dewakang Jl. Koptu Harun Makassar, South Sulawesi, Indonesia 90245,[email protected]
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Mungky Sukarnadi tinea corporis caused by microsporum audouin i i
INTRODUCTION
Dermatophytosis is a superficial infection
caused by dermatophyte fungi on keratin-containing tissues such as nails, hair and
stratum corneum of the skin. Tinea
corporis is a superficial fungal infection
caused by dermatophytes on regional
bodies, legs, and arms. ( 1-3 )
Dermatophyte fungi are classified
based on habitat or source of infection, ie
geophilic, zoophilic, and anthropophilic.
Three fungi most commonly found in
cases of tinea corporis is Trichophytonrubrum, Trichophyton mentagrophytes and
Epidermophyton floccosum. Trichophyton
rubrum, Microsporum canis and
Trichophyton mentographytes a common
cause in the United States. Some species
have a predilection for certain body parts,
such as Microsporum audouinii typical
cause of tinea capitis and Trichopyton
rubrum which generally causes tinea
pedis, but they also can cause tineacorporis. ( 1 , 4-6 )
The incidence of dermatophyte
infection according to a survey World
Health Organization (WHO) that
approximately 20% of people worldwide
are infected, especially tinea corporis
(70%), followed by tinea cruris, tinea pedis
and onychomycosis. ( 7 ) Incident
dermatomycosis in Indonesia shows the
highest incidence of dermatophytosisfollowed by pityriasis versicolor and
candidiasis skin. ( 8 )
Clinical picture of tinea corporis
varied, can be demarcated erythematous
plaques with more rising edge and the
center of the lesion tends to heal (central
healing). Adjacent lesions can coalesce to
form polycyclic pattern. Lesions of tinea
corporis can also serpiginous and annular
(ringworm-like). ( 1 )
Diagnosis of tinea corporis can be
established based on history, physical
examination and investigation by direct
microscopic examination and culture. ( 1 , 9 ,
10 ) Patient with tinea corporis usually
responds well to topical antifungal
treatment within 2-4 weeks. Various
preparations allilamin, imidazole, and
available in several forms. Patient with
extensive lesions or fail with topical
treatments, anti-fungal preparations can
be administered orally, such as
griseofulvin, ketoconazole, itraconazole
and terbinafin. ( 1 , 11 , 12 )
Microsporum audounii is a
dermatophyte fungus anthropophilic group
most likely to cause tinea capitis, although
rarely reported to cause tinea corporis. ( 4 ,
5 , 13 ) In this paper, we reported a case of
tinea corporis in a woman 61 years old
caused by Microsporum audouinii
CASE REPORT
A woman aged 61 years old, occupation a
housewife came to dermatovenereology
clinic Wahidin Sudirohusodo hospital with
chief complaint red spots on the upper left
arm since 1 year ago. Patient also
complained of itchy, and while sweating
itchy getting worse . Initially lesion showed
reddish patches scaly and became
larger. Previous history of similar
complaints (+). History of its own
lubrication purchased at pharmacies (notknown the title), but not improved. Family
history of similar disease undeniable.
Denied a history of diabetes mellitus.
Denied a history of allergy.
Physical examination on the region of the
left brachial showed erythema plaques
with elevated edges and fine scales .
(Figure 1.AB)
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IJDV Vol.2 No.2 2013
Figure 1. Erythematous plaques with elevated
edges and fine scales on the the left brachial region
Direct microscopic examination ofskin scrapings of the lesion with KOH 10%
solution showed insulated length and
branching hyphae. (Figure 2)
Figure 2. Long, septate and branching hyphae on
KOH 10% examination
Culture examination conducted by
the specimen scrapings of skin lesions on
media Saboroud's Dextrose Agar (SDA).
Macroscopic picture looks a brownish red
colonies with elevated surfaces and edges
are white gray, bottom looks brownish
yellow colonies. (Figure 3.AB)
Figure 3A. SDA culture day 21 showed a brownish red
colonies with elevated surfaces and edges are white gray.3B. Bottom side showed brownish yellow colonies.
On microscopic examination using
staining Lactophenol Cotton Blue (LCB) of
culture looks macroaleurospora andbizarre branching. (Figure 4.AB)
Figure 4A. Macroaleurospora 4B. Branching
Bizarre
Final diagnosis is established tineacorporis caused by Microsporum
audouinii. Management of this case oral
ketoconazole 200 mg per day, and topical
therapy contains 3% salicylic acid ,
benzoic acid 6% and vaseline 30gr (AAV1)
applied two times a day.
On day 8 therapy, clinical
improvement appeared in the form of
macular hypopigmentation with complaint
of itching diminished. (Figure 5). Direct
microscopic examination with 10% KOH
showed negative result and continued
therapy.
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Mungky Sukarnadi tinea corporis caused by microsporum audouin i i
Figure 5. On the day 8 therapy showed macular
hypopigmentation.
DISCUSSION
In this case report, patient
diagnosed tinea corporis caused by
Microsporum audouinii based on history,
physical examination and investigations
using direct microscopic examination
followed by culture examination to
determine the cause of the species.
Tinea corporis is a disease that
causes itching and complaints intensifiedwhen the patient sweats. Clinical picture of
tinea corporis vary, and may be macular
erythematous plaque with an active edge
and accompanied squama, with the center
of the cure (central healing). ( 1 ) In this
case, patient complaints of itching
erythematous plaques with elevated edges
and fine scales on the left brachial region.
Microscopic examination of skin scrapings
specimens using 10% KOH solution is asimple diagnostic method to see length
hyphae, branched hyphae, and arthospora
Scales collected by scrape edge of an
active lesion, then dropped 10-20% KOH
solution. ( 1 , 4 , 5 , 14 ) In this case KOH 10%
examination showed length and branching
hyphae. Fungal culture is used to confirm
the diagnosis and identify pathogenic
species. Culture media is a selective
medium for the isolation of dermatophytes,and then stored at a temperature of 26 0 C
( 1 , 2 ) In our case, on day 21
macroscopically showed maroon colonies
with elevated surface and gray white edge,
the bottom side showed brownish yellow
colonies. Microscopic picture looks
macroaleurospora and bizarre branching.
Culture results according to Microsporum
audouinii. ( 15 )
Microsporum audouinii an anthro-
pophilic dermatophyte fungi spesises
which is one of the most frequent causes
of dermatophytes (61.5%) in tinea capitis,
especially in children who are in Latin
America and South Africa, but this species
can also infect the skin and nails. ( 13 )
Reported a young woman from Germany
with tinea corporis due to Microsporum
audouinii accompanied by tinea capitis.( 16)
Systemic antifungal therapy is
indicated if the lesions are extensive or
fails to topical treatment, recurrent or
chronic, or if the skin condition gets worse.( 11 , 12 )
Ketoconazole is an antifungalsystemic broad spectrum imidazole group
and is fungistatic. Mechanism of action of
ketoconazole that inhibit the biosynthesis
of ergosterol, the main sterol which serves
to maintain the integrity of the fungal cell
membrane, by inhibiting the enzyme
cytochrome P-450 lanosterol 14α
demetilase an enzyme essential for fungal
cell membrane ergosterol synthesis. ( 4 , 7 ,
12 ) In a study to compare strength between
itraconazole and fluconazole and the
ketoconazole and fluconazole obtained
similar results with a cure rate of
approximately 90% for all three drugs. ( 17 )
In this case , patient was treated
ketoconazole 200 mg per day. On day 8
therapy, lesions looks macular
hypopigmentation, itching diminished and
negative KOH examination. Other oral
anti-fungal medication that can be given to
tinea corporis is fluconazole, itraconazole,
griseofulvin, and terbinafin. On a compa-
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IJDV Vol.2 No.2 2013
rative study of adults showed fluconazole
150 mg per week for 4 to 6 weeks,
itraconazole 100 mg per day for 15 daysand terbinafin 250 mg per day for 2 weeks
is as effective by administering griseofulvin
200 mg per day for 2 to 6 weeks. ( 1 )
Research conducted comparing Clayton
and Connor clotrimazole cream and
Whitfield's ointment was not found
significant differences and showed
negative mycological results after 4 weeks
of treatment. Whitfield's ointment is
fungistatic and keratolytic.
( 18 , 19 )
In thiscase, topical treatment with
AAV1/Whitfield 's ointment was applied
two times a day.
Non-medicamentous management by
reducing the predisposing factors, suggest
to wear loose clothing and absorb sweat,
dry off after shower and sweating. ( 2 )
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