Tinea Capitis: An Updated Review

Background: Tinea capitis is a common and, at times, difficult to treat, fungal infection of the scalp. Objective: This article aimed to provide an update on the evaluation, diagnosis, and treatment of tinea capitis. Methods: A PubMed search was performed in Clinical Queries using the key term “tinea capitis”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. The information retrieved from the above search was used in the compilation of the present article. : Patents were searched using the key term “tinea capitis” at www.freepatentsonline.com. Results: Tinea capitis is most often caused by Trichophyton tonsurans and Microsporum canis. The peak incidence is between 3 and 7 years of age. Non-inflammatory tinea capitis typically presents as fine scaling with single or multiple scaly patches of circular alopecia (grey patches); diffuse or patchy, fine, white, adherent scaling of the scalp resembling generalized dandruff with subtle hair loss; or single or multiple patches of well-demarcated area (s) of alopecia with fine-scale, studded with broken-off hairs at the scalp surface, resulting in the appearance of “black dots”. Inflammatory variants of tinea capitis include kerion and favus. Dermoscopy is a highly sensitive tool for the diagnosis of tinea capitis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wetmount preparation and fungal culture. It is desirable to have mycologic confirmation of tinea capitis before beginning a treatment regimen. Oral antifungal therapy (terbinafine, griseofulvin, itraconazole, and fluconazole) is considered the gold standard for tinea capitis. Recent patents related to the management of tinea capitis are also discussed. Conclusion: Tinea capitis requires systemic antifungal treatment. Although topical antifungal therapies have minimal adverse events, topical antifungal agents alone are not recommended for the treatment of tinea capitis because these agents do not penetrate the root of the hair follicles deep within the dermis. Topical antifungal therapy, however, can be used to reduce transmission of spores and can be used as adjuvant therapy to systemic antifungals. Combined therapy with topical and oral antifungals may increase the cure rate.

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Safety of Metformin in Hospitalized Patients with COVID-19

10.36502/2020/droa.6171 ◽

2020 ◽

Vol 2 (3) ◽

pp. 68-71

Author(s):

Mikhail N ◽

Wali S

Keyword(s):

Lactic Acidosis ◽

Hospital Admission ◽

Retrospective Studies ◽

English Literature ◽

Hospitalized Patients ◽

Increased Risk ◽

Increase Risk ◽

Patients With Diabetes ◽

Pubmed Search ◽

Meta Analyses

Background: It is unclear whether metformin should be continued or discontinued in patients with coronavirus disease 2019 (COVID-19) admitted to the hospital. Objective: To review metformin safety, particularly its impact on mortality among hospitalized patients with COVID-19. Methods: Review of English literature by PUBMED search until September 11, 2020. Search terms included diabetes, COVID-19, metformin, Retrospective studies, meta-analyses, pertinent reviews, pre-print articles, and consensus guidelines are reviewed. Results: Retrospective studies suggest that metformin use prior to hospital admission may be associated with decreased mortality in patients with diabetes admitted to the hospital with COVID-19. Continuing metformin use after hospital admission did not have a significant impact on 28-day all-cause mortality. Metformin use after hospitalization of patients with COVID-19 was associated with approximately 4.6 times increase risk of lactic acidosis in patients with severe symptoms of COVID-19, patients taking 2 gm/d of metformin or higher, and patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 kg/m2. Metformin use in the hospital was associated with a significant decrease in the risk of heart failure and acute respiratory distress syndrome (ARDS). Conclusions: In patients with diabetes and COVID-19 admitted to the hospital, metformin should not be used in presence of severe symptoms of COVID-19, kidney dysfunction (eGFR < 60 ml/min/1.73 m2), and with daily doses of 2 gm or more due to increased risk of lactic acidosis.

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Prevalence of Tinea Capitis among School Children in Nok Community of Kaduna State, Nigeria

Journal of Pathogens ◽

10.1155/2016/9601717 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Josephine Dogo ◽

Seniyat Larai Afegbua ◽

Edward Christopher Dung

Keyword(s):

School Children ◽

Tinea Capitis ◽

Cross Sectional Study ◽

Single Infection ◽

Microsporum Canis ◽

Fungal Culture ◽

Cross Sectional ◽

Number Of Children ◽

Mode Of Transmission ◽

Group 5

In recent years, the prevalence of tinea capitis, an infection of the scalp by dermatophytes, has increased in children worldwide. This cross-sectional study was carried out to determine the prevalence and risk factor of tinea capitis among school children in Nok community of Kaduna State, Nigeria. A total of 100 children were screened and 45% were diagnosed to have tinea capitis after fungal culture and microscopy. The prevalence of tinea capitis among girls was higher (51.4%) than that among boys (41.5%) but not significantly different (p=0.402). The prevalence with respect to age was lower for the age group 5–10 years (42.6%) than that of 11–15 years (50%) but was not significantly different (p=0.524).Trichophyton rubrum(28.8%) andMicrosporum canis(22.7%) were the most prevalent dermatophytes isolated and the least wereTrichophyton verrucosum(4.5%) andTrichophyton tonsurans(4.5%). There were 73.3% single infection while 26.7% had 2–4 dermatophytes of the generaMicrosporumandTrichophyton. The predisposing factors with statistically significant association with tinea capitis were number of children in the family (p=0.02) and sharing of the same bed (p=0.002). This indicates the high tendencies of spread of tinea capitis through human-to-human mode of transmission and possible animal contact. Community health education on the cause, mode of transmission, prevention, and prompt treatment of tinea capitis is recommended.

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Travelers’ Diarrhea: A Clinical Review

Recent Patents on Inflammation & Allergy Drug Discovery ◽

10.2174/1872213x13666190514105054 ◽

2019 ◽

Vol 13 (1) ◽

pp. 38-48 ◽

Cited By ~ 6

Author(s):

Alexander K.C. Leung ◽

Amy A.M. Leung ◽

Alex H.C. Wong ◽

Kam L. Hon

Keyword(s):

English Literature ◽

Bacterial Pathogen ◽

Developed Country ◽

Traveler’S Diarrhea ◽

Treatment And Prevention ◽

Pubmed Search ◽

Meta Analyses ◽

Clinical Queries ◽

Traveler's Diarrhea ◽

Selection Of

Background: Travelers’ diarrhea is the most common travel-related malady. It affects millions of international travelers to developing countries annually and can significantly disrupt travel plans. Objective: To provide an update on the evaluation, diagnosis, treatment, and prevention of traveler’s diarrhea. Methods: A PubMed search was completed in Clinical Queries using the key term “traveler’s diarrhea”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. Patents were searched using the key term “traveler’s diarrhea” from www.freepatentsonline.com. Results: Between 10% and 40% of travelers develop diarrhea. The attack rate is highest for travelers from a developed country who visit a developing country. Children are at particular risk. Travelers’ diarrhea is usually acquired through ingestion of food and water contaminated by feces. Most cases are due to a bacterial pathogen, commonly, Escherichia coli, and occur within the first few days after arrival in a foreign country. Dehydration is the most common complication. Pretravel education on hygiene and on the safe selection of food items is important in minimizing episodes. For mild travelers’ diarrhea, the use of antibiotic is not recommended. The use of bismuth subsalicylate or loperamide may be considered. For moderate travelers’ diarrhea, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used. Loperamide may be considered as monotherapy or adjunctive therapy. For severe travelers’ diarrhea, antibiotics such as azithromycin, fluoroquinolones, and rifaximin should be used. Azithromycin can be used even for the treatment of dysentery whereas fluoroquinolones and rifaximin cannot be used for such purpose. Recent patents related to the management of travelers’ diarrhea are discussed. Conclusion: Although travelers’ diarrhea is usually self-limited, many travelers prefer expedient relief of diarrhea, especially when they are traveling for extended periods by air or ground. Judicious use of an antimotility agent and antimicrobial therapy reduces the duration and severity of diarrhea.

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Kerion Type of Tinea Capitis Treated with Double Pulse Dose Terbinafine

Indonesian Journal of Tropical and Infectious Disease ◽

10.20473/ijtid.v6i2.1655 ◽

2016 ◽

Vol 6 (2) ◽

pp. 34

Author(s):

Franky Chandra

Keyword(s):

Tinea Capitis ◽

Clinical Manifestations ◽

Double Pulse ◽

Microsporum Canis ◽

Fungal Culture ◽

Pulse Dose ◽

Mycologic Cure ◽

Higher Doses ◽

Dermatophyte Infection

Objective: Tinea capitis is a common dermatophyte infection affecting hair and skin which always requires systemic treatment to get a clinical and mycologic cure, preventing relapse, and infection spread. Griseofulvin has been the antifungal therapy of choice for tinea capitis, but it often requires higher doses and a longer duration than recommended. Thus, effective alternative antifungal with good oral tolerability and shorter course of treatment are therefore required. The objective of this report is to evaluate the effectiveness of double pulse dose terbinaﬁne for tinea capitis alternative therapy.Method: A case of kerion type of tinea capitis in a two-year-old girl was reported. Diagnosis was established based on clinical manifestations of alopecia, presented as erythematous macule with pustules, hemorrhagic crusts, and scales on the scalp, accompanied with occipital lymphadenopathy. Fungal culture showed growth of Microsporum canis (M. canis) colonies. Patient was treated with doubled pulse dose terbinafine 125 mg/day and 2% ketoconazole shampoo for two months.Result: Clinical improvements were found on 35th day of follow up, while mycologic cure was achieved on 60th day of follow up. Tolerability was excellent and no side effects observed.Conclusion: Double pulse dose terbinafine is effective for kerion type of tinea capitis. Key words: double pulse dose, kerion, M. canis, terbinafine, tinea capitis

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Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence

Current Pediatric Reviews ◽

10.2174/1573396314666181113094047 ◽

2019 ◽

Vol 15 (1) ◽

pp. 22-29 ◽

Cited By ~ 5

Author(s):

Alexander K.C. Leung ◽

Amy A.M. Leung ◽

Alex H.C. Wong ◽

Kam Lun Hon

Keyword(s):

English Literature ◽

Clinical Manifestations ◽

Deficiency Anemia ◽

Current Evidence ◽

Breath Holding ◽

Loss Of Consciousness ◽

Strong Impact ◽

Forced Expiration ◽

Pubmed Search ◽

Meta Analyses

Background:Breath-holding spells are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made.Objective:To familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of children with breath-holding spells.Methods:A PubMed search was completed in Clinical Queries using the key term "breath-holding spells". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.Results:Breath-holding spells affect 0.1 to 4.6% of otherwise healthy young children. The onset is usually between 6 and 18 months of age. The etiopathogenesis is likely multifactorial and includes autonomic nervous system dysregulation, vagally-mediated cardiac inhibition, delayed myelination of the brain stem, and iron deficiency anemia. Breath-holding spells may be cyanotic or pallid. The former are usually precipitated by anger or frustration while the latter are more often precipitated by pain or fear. In the cyanotic type, the child usually emits a short, loud cry, which leads to a sudden involuntary holding of the breath in forced expiration. The child becomes cyanosed, rigid or limp, followed by a transient loss of consciousness, and a long-awaited inspiration and resolution of the spell. In the pallid type, crying may be minimal or “silent”. The apneic period in the pallid type is briefer than that in the cyanotic type prior to the loss of consciousness and posture. The episode in the pallid type then proceeds in the same manner as a cyanotic spell except that the child in the pallid type develops pallor rather than cyanosis. In both types, the entire episode lasts approximately 10 to 60 seconds. The spells usually disappear spontaneously by 5 years of age.Conclusion:Although breath-holding spells are benign, they can be quite distressing to the parents. Confident reassurance and frank explanation are the cornerstones of treatment. Underlying cause, if present, should be treated. Interventions beyond iron supplementation may be considered for children with severe and frequent breath-holding spells which have a strong impact on the lifestyle of both the child and family.

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Tinea Capitis by Microsporum canis in an Elderly Female with Extensive Dermatophyte Infection

Mycopathologia ◽

10.1007/s11046-020-00519-9 ◽

2021 ◽

Vol 186 (2) ◽

pp. 299-305

Author(s):

Zhihui Yang ◽

Wei Chen ◽

Zhe Wan ◽

Yinggai Song ◽

Ruoyu Li

Keyword(s):

Tinea Capitis ◽

Disease Onset ◽

The Body ◽

Microsporum Canis ◽

Fungal Culture ◽

History Of ◽

Stray Cat ◽

Immunocompetent Adults ◽

Effective Drugs ◽

Dermatophyte Infection

AbstractTinea capitis is a type of dermatophyte infection primarily affecting children. We report a case of an elderly woman with well-controlled diabetes mellitus presenting with a six-month history of erythema with yellow crusts on her scalp and extensive erythematous patches with scales on the body skin. She adopted a stray cat before the disease onset. Dermoscopic findings and manifestation under the Wood’s lamp favoured the diagnosis of tinea capitis. Further microscopic examinations of her scalp, including direct KOH and fluorescence stain examination, fungal culture and polymerase chain reaction sequencing identification confirmed the diagnosis of tinea capitis caused by Microsporum canis. Treatment with oral terbinafine was effective. Adult tinea capitis is often misdiagnosed due to its rarity and atypical presentation. However, in some regions, the incidence of tinea capitis in immunocompetent adults is rising which requires the awareness of clinicians. A thorough history (including the animal contacting history), physical examination and further mycological examinations are required for diagnosis. Trichophyton violaceum is the most common dermatophyte species in most regions while adult tinea capitis caused by Microsporum canis is less common. Terbinafine, griseofulvin and itroconazole have been reported to be effective drugs for the treatment of tinea capitis, and terbinafine can be considered as systemic treatment in elderly patients with comorbidities to reduce the drug–drug interaction.

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Surgical Repair of Bulbar Urethral Strictures: Advantages of Ventral, Dorsal, and Lateral Approaches and When to Choose Them

Advances in Urology ◽

10.1155/2015/397936 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Krishnan Venkatesan ◽

Stephen Blakely ◽

Dmitriy Nikolavsky

Keyword(s):

English Literature ◽

Urethral Reconstruction ◽

Urethral Strictures ◽

Buccal Mucosa Graft ◽

Buccal Mucosal Graft ◽

Pubmed Search ◽

Augmentation Techniques ◽

Retrospective Nature ◽

Meta Analyses

Objectives. To review the available literature describing the three most common approaches for buccal mucosal graft (BMG) augmentation during reconstruction of bulbar urethral strictures. Due to its excellent histological properties, buccal mucosa graft is now routinely used in urethral reconstruction. The best approach for the placement of such a graft remains controversial.Methods. PubMed search was conducted for available English literature describing outcomes of bulbar urethroplasty augmentation techniques using dorsal, ventral, and lateral approaches. Prospective and retrospective studies as well as meta-analyses and latest systematic reviews were included.Results. Most of the studies reviewed are of retrospective nature and majority described dorsal or ventral approaches. Medium- and long-term outcomes of all three approaches were comparable ranging between 80 and 88%.Conclusion. Various techniques of BMG augmentation urethroplasty have been described for repairs of bulbar urethral strictures. In this review, we describe and compare the three most common “competing” approaches for bulbar urethroplasty with utilization of BMG.

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Update on Inclisiran for Treatment of Hypercholesterolemia

10.47363/jdrr/2020(2)106 ◽

2020 ◽

pp. 1-3

Author(s):

Nasser Mikhail ◽

Keyword(s):

Severe Renal Impairment ◽

English Literature ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Apo B ◽

Pubmed Search ◽

Cv Disease ◽

Long Acting ◽

Meta Analyses

Background: Inclisiran is a drug under development that inhibits the hepatic synthesis of proprotein convertase subtilistin/Kexin type 9 (PCSK9) leading to reduction in plasma levels of low-density lipoprotein-cholesterol (LDL-C). Methods: Review of pertinent English literature by Pubmed search until June 12, 2020. Search terms are lipids, PCSK9, LDL-C, inclisiran, safety, efficacy. Studies included are randomized trials, meta-analyses, and review articles. Results: Inclisiran is administered by subcutaneous (SC) injection at day 1, day 90, then every 6 months. In patients with atherosclerotic cardiovascular (CV) disease and those with heterozygous familial hypercholesterolemia receiving maximally tolerated statins, the placebo-adjusted percent reduction in LDL-C levels was 48% to 52% after 6 months. Inclisiran also lowers other atherogenic lipoproteins such non-high-density lipoprotein-cholesterol (nonHDL-C) by 43 to 47%, apoprotein B (apo B) 39% to 43%, lipoprotein(a) by 18-25% compared with placebo. Efficacy of inclisiran in lowering LDL-C levels was similar in patients with and without diabetes, and patients with normal renal function compared with those with severe renal impairment. Inclisiran is overall well-tolerated. Most common adverse effects are injection site reactions. Conclusions: Inclisiran is an effective and long-acting drug for lowering LDL-C levels. Studies are underway to evaluate effects of inclisiran on CV events and mortality

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