Deep facial mycosis due to Trichophyton verrucosum—molecular genetic identification of the dermatophyte in paraffin‐embedded tissue—case report and review of the literature

Deep trichophytosis is relatively uncommon. The infection of the bearded area is also known as sycosis barbae or tinea barbae and can be caused by various fungal species, most often zoophilic fungi. We report on an 80‐year‐old male patient with severe sycosis barbae who had no animal contact and was treated with systemic antibiosis without improvement. Microbial and mycological investigations using swabs from oozing lesions revealed Staphylococcus haemolyticus and Candida parapsilosis. Histology demonstrated fungal elements in hair follicles. Paraffin‐embedded material was subjected to further mycological analysis. For molecular diagnostics DNA was prepared from paraffin sections for real‐time polymerase chain reaction (RT‐PCR). For sequencing, DNA was isolated from paraffin‐embedded skin tissue and the ITS region of the rDNA was selected. Sequencing of the ITS2 region of rRNA revealed a 100% accordance with Trichophyton (T.) verrucosum. Treatment with oral terbinafine achieved a complete remission. Sycosis barbae is an important differential diagnosis for infections of the bearded area. Nucleic acid amplification techniques (NAAT) are more and more used for direct examination of dermatophytes in clinical samples, eg T. verrucosum. NAAT are also used as culture confirmation tests for identification of rare dermatophytes like T. verrucosum. Today, singleplex and multiplex quantitative real‐time PCR (qRT‐PCR) assays for the detection of the most common dermatophytes including T. verrucosum in clinical specimens are available. Recently, an ITS2 PCR assay has been successfully used for direct detection of T. verrucosum in paraffin‐embedded formalin‐fixed skin tissue. The PCR is fast and highly specific. The sensitivity of direct molecular detection of the dermatophytes both in native clinical material, and in paraffin‐embedded skin tissue can been increased.

[1]  P. Elsner,et al.  Dermatophytosen, verursacht durch seltene anthropophile und zoophile Erreger , 2019, Der Hautarzt.

[2]  J. Haiduk,et al.  [Tinea barbae profunda due to Trichophyton mentagrophytes : Case report and review]. , 2019, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete.

[3]  T. Meyer,et al.  Molekulare Diagnostik von Hautinfektionen am Paraffinmaterial – Übersicht und interdisziplinärer Konsensus , 2018, Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG.

[4]  J. Gangneux,et al.  Epidemiology of Trichophyton verrucosum infection in Rennes University Hospital, France: A 12‐year retrospective study , 2017, Medical mycology.

[5]  P. Nenoff,et al.  [Tinea barbae profunda due to Trichophyton mentagrophytes after journey to Thailand : Case report and review]. , 2017, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete.

[6]  P. Nenoff,et al.  Tinea barbae profunda durch Trichophyton mentagrophytes nach Thailand-Reise , 2017, Der Hautarzt.

[7]  U. Wollina,et al.  Severe atypical herpes zoster as an initial symptom of fatal myelodysplastic syndrome with refractory anemia and blast excess (RAEB II) , 2017, Clinical, cosmetic and investigational dermatology.

[8]  S. Gnat,et al.  Evaluation of growth conditions and DNA extraction techniques used in the molecular analysis of dermatophytes , 2017, Journal of applied microbiology.

[9]  L. Rossi,et al.  Trichophyton verrucosum infection in livestock in the Chitral district of Pakistan. , 2017, Journal of infection in developing countries.

[10]  P. Olafson,et al.  Fungi Isolated From House Flies (Diptera: Muscidae) on Penned Cattle in South Texas , 2016, Journal of Medical Entomology.

[11]  A. Ayadi,et al.  Molecular characterization of strains of the Trichophyton verrucosum complex from Tunisia. , 2016, Medical mycology.

[12]  M. Göker,et al.  Toward a Novel Multilocus Phylogenetic Taxonomy for the Dermatophytes , 2016, Mycopathologia.

[13]  Y. Mahmmod,et al.  Diagnostic performance of molecular and conventional methods for identification of dermatophyte species from clinically infected Arabian horses in Egypt. , 2016, Veterinary dermatology.

[14]  S. Nardoni,et al.  Dermatophytosis in donkeys (Equus asinus) due to Microsporum racemosum, an unusual geophilic agent , 2016, Medical mycology case reports.

[15]  D. Metze,et al.  Species identification of dermatophytes in paraffin‐embedded biopsies with a new polymerase chain reaction assay targeting the internal transcribed spacer 2 region and comparison with histopathological features , 2016, The British journal of dermatology.

[16]  C. Kupsch,et al.  Detection of common dermatophytes in clinical specimens using a simple quantitative real‐time TaqMan polymerase chain reaction assay , 2016, The British journal of dermatology.

[17]  K. Makimura,et al.  Epidemiological Aspects of Dermatophytosis in Khuzestan, southwestern Iran, an Update , 2016, Mycopathologia.

[18]  A. Al-Janabi,et al.  Suitability of hair type for dermatophytes perforation and differential diagnosis of T. mentagrophytes from T. verrucosum , 2016, Mycoses.

[19]  S. Maraki,et al.  Epidemiology of Dermatophytoses in Crete, Greece. , 2016, Medical mycology journal.

[20]  P. Collins,et al.  An uncommon dermatophyte infection: two cases of cutaneous infection with Trichophyton verrucosum , 2015, Clinical and experimental dermatology.

[21]  U. Paasch,et al.  Mycology – an update Part 3: Dermatomycoses: topical and systemic therapy , 2015, Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG.

[22]  H. Badali,et al.  In vitro susceptibility patterns of clinically important Trichophyton and Epidermophyton species against nine antifungal drugs , 2015, Mycoses.

[23]  H. Mirhendi,et al.  A comparative study on morphological versus molecular identification of dermatophyte isolates. , 2015, Journal de mycologie medicale.

[24]  M. Jinnin,et al.  Clinical features of 80 cases of tinea faciei treated at a rural clinic in Japan. , 2014, Drug discoveries & therapeutics.

[25]  P. Nenoff,et al.  Mycology – an update Part 2: Dermatomycoses: Clinical picture and diagnostics , 2014, Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG.

[26]  K. Makimura,et al.  Restriction Analysis of β‐Tubulin Gene for Differentiation of the Common Pathogenic Dermatophytes , 2014, Journal of clinical laboratory analysis.

[27]  H. Kamata,et al.  Mating Type Gene (MAT1-2) of Trichophyton verrucosum , 2014, Mycopathologia.

[28]  P. Nenoff,et al.  [Kerion caused by the zoophilic dermatophyte Trichophyton species of Arthroderma benhamiae in a child. A new emerging pathogen of dermatomycoses in Germany]. , 2013, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete.

[29]  P. Nenoff,et al.  Kerion Celsi durch den zoophilen Dermatophyten Trichophyton species von Arthroderma benhamiae bei einem Kind , 2013, Der Hautarzt.

[30]  P. Kordbacheh,et al.  A Molecular Epidemiological Survey of Clinically Important Dermatophytes in Iran Based on Specific RFLP Profiles of Beta-tubulin Gene , 2013, Iranian journal of public health.

[31]  U. Wollina,et al.  Tinea atypica: report of nine cases , 2013, Wiener Medizinische Wochenschrift.

[32]  M. Flaig,et al.  Molecular diagnostics in infectious skin diseases , 2013, Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG.

[33]  W. Handrick,et al.  [Dermatomycoses due to pets and farm animals : neglected infections?]. , 2012, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete.

[34]  W. Handrick,et al.  Dermatomykosen durch Haus- und Nutztiere , 2012, Der Hautarzt.

[35]  M. Ilkit,et al.  Identification of rare macroconidia-producing dermatophytic fungi by real-time PCR. , 2012, Medical mycology.

[36]  P. Nenoff,et al.  Tinea capitis profunda durch Trichophyton verrucosum mit abszedierender Superinfektion durch cMRSA bei einem Kleinkind , 2012, Der Hautarzt.

[37]  P. Nenoff,et al.  [Tinea capitis profunda due to Trichophyton verrucosum with cMRSA superinfection in an infant]. , 2012, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete.

[38]  R. Wintermans,et al.  Evaluation of a single-tube real-time PCR for detection and identification of 11 dermatophyte species in clinical material. , 2010, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[39]  M. H. Xavier,et al.  Sycosiform tinea barbae caused by Trichophyton rubrum. , 2008, Dermatology online journal.

[40]  A. Bonifaz,et al.  Tinea Barbae (Tinea Sycosis): Experience with Nine Cases , 2003, The Journal of dermatology.

[41]  U. Wollina,et al.  Deep mycosis caused by Trichophyton mentagrophytes in a diabetic patient , 2003, Mycoses.

[42]  R. Thomson,,et al.  From animal to man: Tinea barbae , 2000, Current infectious disease reports.

[43]  P. Kielstein,et al.  Zur Variabilität von Trichophyton verrucosum‐Isolaten aus Impfbeständen mit Rindertrichophytie , 1998 .

[44]  P. Blanz,et al.  [Variability of Trichophyton cerrucosum isolates from vaccinated herds with cattle ringworm]. , 1998, Mycoses.

[45]  M. Kaatz,et al.  Fluconazole-resistant life-threatening deep trichophytia : successful treatment with itraconazole , 1997 .

[46]  F. Nunes,et al.  [Sycosis of the beard (tinea barbae). Analysis of 42 cases]. , 1981, Medicina cutanea ibero-latino-americana.