1	Overview of Tinea Capitis The Epidemic
2	Tinea Capitis-Historical Perspective “tinea-”insect whose larvae feed on clothes, books Galen-parasitic infestation of skin; then annular rashes of any sort=ringworm 16^th century-ringworm=diseases of the scalp 1830’s-fungi described as causative agents Gruby and later Saboraud described all forms of hair invasion (late 19^th early 20^th centuries) No effective Rx until griseofulvin introduced in 1950’s
3	Epidemiology 40 species of dermatophytes 22 Trichophyton 16 Microsporum 2 Epidermophyton Species and natural host-determine clinical Sx Predominant species vary geographically Most human infection from 16 species, 5 in US
4	Principle N Am Dermatophytes Dermatophyte T. rubrum (55%) T. tonsurans (31%) T.mentag. (6%) M. canis (4%) E. flocosum (2%) Main Clinical Sx Tinea corporis Tinea capitis Tinea pedis/corporis Tinea capitis Tinea cruris/pedis
5	Distribution of Endothrix Tinea Capitis
6	Changes in Geographic Distribution Late 19^th-early 20^th C-M. canis, audouinii M. audouinii epidemic in 1940’s, then replaced by T. tonsurans 1890’s T. tonsurans in Puerto Rico, Mexico 1920’s T. tonsurans reported in Texas T. tonsurans predominant by 1970’s
7	Tinea Capitis-Age, Sex Predilection M. Audouinii more common in boys T. Tonsurans-equal in boys, girls More common in AA Peak incidence-first decade (3-7 yrs), but can occur in young and old (more common in adult women) Inflammatory sp often resolve spontaneously T. tonsurans can persist indefinitely T. tonsuran anthropophilic-spreads readily
8	Our youngest tinea capitis 2 week old in Harriet Lane Clinic with 5 scalp lesions
9	Insert image of BMJ citation-adults
10	Sources of Infection Predisposing factors-large family size, low SES, crowding Transmission-infected individuals, fallen infected hairs/scale, fomites, animal vectors Barber shops, movie theaters, schools, day care Zoophilic species from family pets In our neighborhood kittens are main source of M. canis In rural setting M. gypseum from soil
11	Epidemic-Pittsburgh School for the Blind Called by director to evaluate infected staff 5 children identified with T. tonsurans tinea capitis Most but not all AA children Multiple staff with tinea corporis all T. tonsurans Positive cultures from hats, combs, brushes, physical therapy floor mats, lockers
12	Source of Infection-Home? Three successive generations + cultures Mullins (1954) Herbert (1985) High prevalence in family members Raubitshcek (1958) Reid, Shimkin (1968) Prompted our study in Pittsburgh
13	Tinea Capitis Study-Pittsburgh Physical exam Tooth brush scrapings on Mycosel medium Incubated at 31 degrees C for 4 weeks Study families identified from pedsderm patients with clinical dx and positive culture Control families identified from medical clinic for health maintenance check
14	Pittsburgh Study-Tooth Brush Cultures
15	Pittsburgh Study Index cases-31 culture + patients Study patients-atleast 1 adult and 1 other child in index family Control patients-20 families with atleast 1 available adult, 2 children
16	Pittsburgh Study-Results 50% of study families with atleast 1 other + culture 20% of control families with atleast 1 + culture Statistically significant difference
17	Pittsburgh Study-Conclusions High prevalence of undetected tinea capitis in index families High prevalence of positive cultures in pediatric population ( primarily AA children) Most undetected tinea in children, some in adults Carrier state common, but prevalence decreases as examiner gets experience Family reservoir for infection
18	Sources of Infection-School Philadelphia school study -17% of private school students screened -New cases did not correlate with seating in school British school survey -2%à5% over last 10 years Probably not issue in older children, but problem in settings with close physical contact
19	Sources of Infection-Tinea Gladiatorum Epidemic among wrestlers All white suburban children Tinea capitis, corporis 17/25 members of the team T. tonsurans (Schmidt, Cohen. NEngJMed, 1992)
20	Summary Organisms are everywhere Epidemiology varies with geography and time Epidemiology varies with therapeutic and public health intervention Sources Carrier state Treatment Public health measures
21	References Aly R, Hay J, Del Palacio A, Galimberti R. Epidemiology of tinea capitis. Med Mycol 2000;38, suppl 1:183-88. Buckley DA, Fuller LC, Higins EM, du Vivier AWP. Tinea capitis in adults. BMJ 2000;320:1389-90. Elewski BE. Tinea capitis: a current perspective. J Am Acad Dermatol 2000;42:1-20. Gupta AK, Summerbell RC. Tinea capitis. Med Mycol 2000;38:255-87. Rebell G, Taplin D. Dermatophytes Their Recognition and Identification. University of Miami Press, 1979.